Textbook of Maritime Medicine

It is crucial that a comprehensive approach is devised towards an integrated set of systems that ensures the best possible medical care on board of a ship. In this chain-thinking approach, improvement of a weak part in the chain always creates a new weak part.  Therefore we advise a more stepwise approach when trying to improve the quality of medical care provided on board.  Stages to be assessed in relation to improvement of medical care are: preparation both of personnel and ship (procedures, training and equipment!) for administering adequate medical care when needed.

The outcome of this preparation phase starts by fulfilling the relevant standards and obligations to provide medical care on board in all circumstances. The responsibility of this phase is primarily in the hands of ship-owners and authorities, but seafarers themselves have an important role in signalling problems. There should be a constant awareness of all parties to be prepared in the best possible way to overcome any demand for medical care. It is best to be trained for a case when medical care should be provided. A wide range of achievements is needed to meet the needs!

For medical cases that are beyond onboard competence, there ought to be a system that ensures the best medical care to seafarers.

We should always be aware of the fact that usually there is no doctor on board, nor is there an operating theatre or intensive care unit.  So there ought to be a well functioning consultation system for those responsible on the ship for medical care.. Better collaboration between these persons and between global TMAS systems, better use of technical possibilities to bring the best medical care to the patient or the other way around, medical evacuation. Collaboration, sharing experiences and the will to standardize procedures globally are essential to guarantee best possible care. Hereby implementation of innovations and adequate use of medical facilities including the best way to evacuate injured or ill persons can be put in to practice.. International professional organisations like the International Maritime Health Association (IMHA) should play a steering role in this development

Thirdly it is necessary for the best medical care on board is a well accepted quality assurance system to constantly improve the quality of medical care on board of ships. Therefore a constant and full review of the chain is necessary to ensure the best medical care on board of ships. The responsibility to install these systems lies with ship-owners and competent authorities.    

The question where to start with the improvement of the different elements in the chain is not an easy one But as long as one realises the principle of chain thinking and one is aware of interdependent steps, changing one stage in the system might influence other elements. It therefore gives way to a constant strive of improving care that never will be met entirely, but we hope almost always nearly close to perfection.

To illustrate the latter: with modern broadband satellite communication and adhering devices on board, diagnostic quality can improve dramatically, but if medical education and the equipment to deal with matters is not adjusted to that higher level op diagnostic quality, it will lead to a state of pseudo safety with all related disorders and hazards.