Medical emergency — onboard response

The Master has ultimate responsibility for the medical care of all persons on board. Ships are required under MLC Regulation 4.1 and STCW Regulation VI/4 to carry designated medical first-aiders and, on larger vessels, a person trained in medical care. This decision tree follows the IMO Medical First Aid Guide (MFAG, 3rd ed. 2022) and MLC Standard A4.1.

Initial assessment

1. Ensure scene safety before approaching the casualty. In the engine room: risk of hot surfaces, rotating machinery, oil. In a confined space: check atmosphere (O2, CO, H2S) before entry with a calibrated multi-gas detector.
2. Primary survey: Airway — is it clear? Breathing — rate and quality? Circulation — pulse present? Disability — conscious? Responds to voice? Pain? Unresponsive? Exposure — any injuries, bleeding, burns?
3. Record baseline vital signs: pulse rate and rhythm, respiratory rate, blood pressure (systolic/diastolic), oxygen saturation (SpO2) by pulse oximeter, temperature, Glasgow Coma Score (GCS: eye/verbal/motor, max 15).
4. Notify the Master immediately. The Master assesses whether the ship's medical capability is adequate or whether external assistance is required — this is a non-delegable command decision.
5. Open the IMO MFAG (3rd ed. 2022) to the relevant chapter based on presenting symptoms. The MFAG is the primary onboard reference; it includes triage criteria, treatment protocols, and indications for evacuation.

TMAS telemedicine call

1. Call TMAS as early as possible — not as a last resort. Most providers are available 24/7. Contact via Inmarsat voice, GMDSS DSC Ch 16 / 2182 kHz, or satellite telephone. CIRM (Italy): +39 081 551 1010. Radio Medical Norway: +47 51 51 91 20. MedLink (US): available via Inmarsat or ship's satellite phone; standard contact via MRCC.
2. Have ready when you call: patient's full name, age, nationality and rank; vital signs (pulse, BP, SpO2, temperature, GCS); mechanism of injury or onset of illness; current medications and known allergies; ship name, MMSI, flag, current position (Lat/Long), heading and speed, ETA next port; weather and sea state; medical chest category (A/B/C) and specific medicines available onboard.
3. Follow TMAS physician instructions exactly. Document all instructions, the physician's name, and the time of each call in the Medical Log. MLC Standard A4.1 para 4(a) requires a record of all medical care provided.
4. Repeat vital signs every 15–30 minutes and call TMAS again if the patient's condition changes significantly.

CPR and AED protocol

1. If the casualty is unresponsive and not breathing normally: start CPR immediately. Call for the AED at the same time — do not delay CPR to retrieve the AED.
2. 30 chest compressions to 2 rescue breaths (ratio 30:2). Compression depth: 5–6 cm. Rate: 100–120 per minute. Allow full chest recoil between compressions. Rotate compressors every 2 minutes to maintain quality.
3. When the AED arrives: switch it on and follow voice prompts. Apply pads to bare chest (upper right below clavicle; lower left at apex). Stand clear for analysis. Deliver shock if advised. Resume CPR immediately after each shock — do not pause to check pulse.
4. Continue CPR until: TMAS physician advises cessation (core temperature confirmed above 32°C in normothermic patient with no return of spontaneous circulation after 30 minutes), AED advises "no shock advised" repeatedly with no signs of life, or rescue helicopter crew takes over.

Medevac request and helicopter winching

1. Contact the nearest MRCC on VHF Ch 16 or DSC 2187.5 kHz. Provide: ship name, MMSI, position, patient condition, number of persons on board, weather and sea state, wind direction and speed, ship's course and speed, deck clear for helicopter operations.
2. Prepare the ship: select a clear landing area or winching deck (forecastle or poop preferred). Remove all loose equipment from the deck. Post guards at access points. Ensure deck lighting is on for night operations.
3. When helicopter approaches: maintain steady course and speed into the wind unless instructed otherwise. Do not use radar in X-band above 9 GHz on the helicopter approach bearing — inform bridge.
4. Static discharge: allow the winch wire and hook to touch the deck (or a grounded metal point) before anyone touches it — helicopter builds static charge in flight. Do not grasp the wire before it grounds.
5. Package the patient: secure in a Neil Robertson stretcher or similar. Attach patient medical notes, passport, medication list. Hand-off to paramedic verbally: vitals, mechanism, treatment given, TMAS instructions.
6. If helicopter is not available: divert to the nearest port with adequate medical facilities. Notify the port agent and port health authority of ETA and patient condition. SOLAS Reg V/4.1 obliges the Master to proceed to assist if required by the MRCC.

Post-incident requirements

1. Complete the Medical Log: all assessments, vital signs, treatments, TMAS consultations, and outcome. The log is required by MLC Standard A4.1 and must be available for inspection by port state health authorities.
2. Notify the flag-state administration and DPA of any serious medical incident, injury at work, or death on board. Most flags require notification within 24 hours.
3. Notify the P&I Club if the seafarer suffered a work-related injury — the club covers medical costs and potential compensation claims under MLC Reg 4.2.
4. Reconcile the controlled drug register: any controlled substance administered must be entered with quantity, patient name, date, time, and witness signature. Report any discrepancy to the flag state and port health authority at the next port call.
5. Review the ship's medical chest inventory. Restock used or expired items before the next sea passage. Flag state approval may be required for controlled drug restocking.

Sources: MLC 2006, Regulation 4.1 + Standard A4.1 (medical care on board ship and ashore); STCW 1978 as amended, Regulation VI/4 (proficiency in medical first aid and medical care); SOLAS Reg V/4.1 (master's obligation to render assistance); IMO Medical First Aid Guide (MFAG) 3rd edition 2022 (IMO publication IA261E); WHO International Medical Guide for Ships 3rd edition. See also TMAS telemedicine, MFAG, and medical care rights under MLC.