MEDICAL ASSISTANCE AT SEA

ISMI Training - SAR Level 2 - June 2021

Definition of rescue:

AN OPERATION TO RECOVER PERSONS IN

DISTRESS, PROVIDE THEM WITH ANY MEDICAL
OR OTHER FIRST AID THEY MAY REQUIRE, AND
RETURN THEM TO SAFETY.

(SAR Convention - Hamburg - 1979)

Medical aid at sea :

- Is based on medical teleconsultation,

- consists in the care by a doctor of any health problem occurring at sea,

- among crew members and passengers,

- on board a commercial, fishing or pleasure vessel.

Departments involved and their roles:

MRCC:
- reception and transfer of the call from the ship to TMAS via a 3-way conference
between TMAS/MRCC/Navire,
- implementation of adapted nautical or air means if necessary,
- nautical advice to the captain (relations with the port)

TMAS (TeleMedical Assistance Service):

- medical diagnosis,
- emergency measures to be taken on board and recommendations,
- medicines available on board or to be obtained

The local "SAMU" :

- medical team supply if needed to board the means,
- care on land: ambulance... if necessary,
- preparation of the reception of the hospital
IMO: MSC / Circular 960 of 20/06/00 on medical assistance at sea
Several possible outcomes following the diagnosis of TMAS:
 Onboard care (prescription, care, monitoring) + follow-up
 Care and diversion
 EVASAN
 EVAMED

Decision made BY the Commander ON ADVICE or

RECOMMENDED by the TMAS Physician (Discussion)

SHARED RESPONSIBILITY :
 The Captain: Responsible for the care on board
 The TMAS Physician: Medical Liability
 Importance of TMAS implementation:

• 24H/24 - 7D/7
• Assistance to lone victims at sea and to the captain
• 1 single reference structure (performance in response because
of experience acquisition and cost reduction)
• Trained physician must be available during the call
- 15 to 30 minutes per call

Staff trained to take calls

•Reinsurance
STRESS •Adapted vocabulary
•Empathetic behavior
•Knowing the on-board equipment
•To know the different actors of the medical aid at sea
•Make sure that the prescriptions are well understood
 Importance of TMAS implementation:

Depending on the diagnosis, evacuation only if necessary

Remember that an evacuation :

• can be dangerous for the intervention team or for the victim
• has a cost
• causes secondary problems:
+ isolation of the patient
+ repatriation of the victim to the country of origin

Decision support for the MRCC, which is often the captain's first point of contact

A TMAS can be common to several countries (common language preferred)

TMAS international = CIRM (Centro Internazionale Radio-Medico in Rome (Italy)

TMAS coordinates in the IMO database: GISIS

International cooperation :

A ship's master can access the TMAS of his choice according to his nationality, the flag of the ship or
the language spoken.

At the end of the regulation, the captain informs the MRCC competent in the area of the doctor's
decision.

The MRCC contacts its TMAS so that the latter can retrieve the medical check-up carried out by the
TMAS that has regulated via a Medical Information Exchange Form (IMO: MSC.1/Circ 1218 of 15/12/06 and
IAMSAR flight 2 appendix R):

 avoids a 2nd teleconsultation by 2nd TMAS

 allows the medical organization of the operation

This allows the area TMAS to forward recommendations to the MRCC CMS.
NOTE:

Medical assistance at sea is free to its beneficiaries if:

- Medical teleconsultation between ship and TMAS
- AND emergency confirmed by TMAS

However, a ship's master may request a medical evacuation of a person even if TMAS has
deemed it unnecessary.

The evacuation is carried out on the initiative and at the expense and risk of the
shipowner or the master without the mandatory intervention of the MRCC.

Vocabulary:
MEDICO = Medical Advice (UK)
MEDEVAC = medical evacuation (UK = evacuation of a person for medical reasons)
Example of an
alert
Example of an
alert
 Special case of diving accident

Diving accidents occur most often in coastal areas.

It is rare, atypical and often not well known by first aiders and doctors.

Considered as an absolute emergency, it requires a rapid transfer to a

specialized facility.
 Special case of diving accident

A short regulation loop should be favored in order to concentrate skills (limited number of specially trained
physicians) and reduce the number of interlocutors:
- MRCC
- EMS / Hyperbaric doctor

The roles of the services :

- MRCC:
Receive the alert and collect the elements (alert form)
3-way communication: diving support / EMS (or TMAS) / MRCC
Implementation of adapted means if necessary (medical contraindications: winching, strap or stretcher)

- The EMS (or TMAS):

* medical regulation
* recommendations on the 1st care to bring on board
* decision of medicalization of the means after advice of a hyperbaric doctor
supply of a medical team if necessary
assistance on land (ambulances, emergency services) if necessary
preparation of the reception of the hospital/hyperbaric chamber (= keeping the list of available chambers up to
date)
EXAMP
LE
OBJECTIVES:
The delay between the reception of the alarm and the admission to the chamber
must not exceed 2 hours, the objective being to reduce this delay to 1 hour.

REMARKS:
The apnea accident should follow the same procedure as hyperbaric advice is required.

If a helicopter is used, the flight should be made at the lowest possible altitude (ideally < 300m
to be confirmed with the regulating physician).