Taking care of the sick
Although intended for more day-to-day matters, medical facilities and specialist skills are also likely to be needed when an emergency occurs. Provision of medical facilities on board and the appropriate level will be set by flag states for any above those required under IMO and ILO regulations. Ships are obliged to carry limited stocks of medicines and equipment and some form of medical guide that can be used for advice in emergencies. The exact details of what must be carried are at the discretion of the flag state. Flag states that do not have national requirements for the contents of the medical chest have in the past relied on a list that has been provided by the World Health Organisation (WHO) in the International Medical Guide for Ships (IMGS). It is not a formal international instrument, but the guide is noted as a source of information in the non-statutory part of the relevant ILO convention. Port state control inspectors frequently use the IMGS list as the minimum requirement for medical supplies. A companion publication to IMGS entitled Medical first aid guide for use in accidents involving dangerous goods (MFAG) is published by the IMO and gives specialist advice for substances considered dangerous goods and included in the IMO’s IMDG Code. The guide contains information on symptoms, treatment and care and is considered an essential requirement on most ships. Almost every flag will either make mandatory requirements or recommend a general medical guide that should be carried onboard, but it is most important that the crew member who is appointed to carry out any medical procedures is able to understand the terminology used in the guide and the language it is written in. For this reason, blind adherence to recommendations of a particular guide that is not available in the appropriate language may satisfy PSC but could prove dangerous in a medical emergency. Except on passenger vessels and a very few merchant ships, access to a qualified medical practitioner will be very limited. The first aid and limited medical training that is needed under STCW for various ranks is all that most sick and injured crew can expect unless or until the ship is in port or close enough to land for more expert medical assistance to be given. With the advance in marine communications, it is now possible to subscribe to a small number of specialist telemedicine services that give access at any time to the expertise of trained doctors.