Textbook of Maritime Medicine

Since 1920 the International Labour Organization (ILO) has adopted more than 65 legal instruments which addresse to all aspects of working and living conditions onboard ships. These instruments are called Recommendations & Conventions. Some of them are addressed to medical care, occupational safety and health protection and repatriation. These different instruments led to the foundation of the tele-medical assistance for seafarers (TMAS).

9.3.1        Recommendation 106: Medical Advice at Sea

In 1958 the International Labour Organization (ILO) decided upon the adoption of certain proposals with regard to medical advice by radio to ships at sea. It was named as ILO. This recommendation includes that every member should ensure that the medical advice given by radio is available free of charge 24h/7 days a week. This available medical advice should also include, where necessary and practicable, a specialist advice. It was also recommended that there should be an up-to-date and a complete list of all radio stations from which medical advice can be received.

9.3.2    ILO Convention 164

In 1987 another ILO Convention was ratified and it still includes the former Recommendation 106. The article 7 of this convention included “Medical Advice by Radio”. It was stated that a satellite communication for medical advice at sea can be used.

It was also recommended that there should be included an up-to-date and a complete list of all coast earth stations through which medical advice can be obtained. It was furthermore stated that “seafarers on board requesting medical advice by radio or satellite communication shall be instructed in the use of the ship`s medical guide and the medical section of the most recent edition of the International Code of Signals published by the ILO so as to enable them to understand the type of information needed by the advising doctor as well as the advice received.” It was expressed that “the competent Authority shall ensure that doctor providing medical advice in accordance with this article receive appropriate training and are aware of shipboard conditions”.

9.3.3   Council Directive 92/29/EEC (1992)

15 years later a new convention was published by the Council of the European Communities. This Directive was dealing with the issue of “Minimum Safety and Health Requirements for Improved Medical Treatment on Board Vessels” and Article 6 concerned Medical Consultation by Radio. This directive included now that radio consultation centres may keep confidential personal medical records with the agreement of the workers concerned. The physicians also in charge with TMAS should have been trained in the special conditions prevailing on board ships.

In June 2000 the Maritime Safety Committee of IMO stated that the general tendency to regard medical assistance at sea as an integral part of rescue. The IMO published at this time the, which was acting on medical assistance at sea.

The Committee approved a guide on Medical Assistance at Sea and Importance of the Role of Telemedical Assistance Services. It was stated furthermore that the rescue co-ordination centres (RCC) should always be able to provide the captain onboard with information to allow him to contact TMAS without problems and to organize e.g. a necessary evacuation.  Often the captain calls the TMAS in an medical emergency directly, but in a well organised inter-sectoral global working system of medical assistance at sea, RCC`s and TMAS co-operate effectively across institutional borders. TMAS as a national institution should also be officially designated by a competent national authority. This designation should also indicate effective links with one or more RCC`s so that it is clear to which RCC they have agreed to refer.

9.3.4   MLC (2006)

2006 the governing of ILO decided to compile all the old conventions into one consolidated convention called Maritime Labour Convention 2006 (MLC). This convention should include a modernized management strategy in order to provide a more universal acceptance to its standards. As formats articles, regulations and code systems (mandatory standards & non-mandatory guidelines) had been used and health protection, medical care, welfare and social protection was mentioned under title 4. For the medical issue like occupational health and safety it was addressed that a modernized management strategy in order to provide a more universal acceptance to its standards.