Textbook of Maritime Medicine

The level of onboard medical care on a ship varies widely. Many factors influence the level of medical care administered to seafarers and passengers. Obviously, there is a different level of care given on large passenger cruisers as compared to old reefers, especially when these are sailing under a flag of convenience.  Factors influencing the level of care can be mainly divided in human-, ship-linked-, and external-factors.

Each of these factors have their own set of sub-factors that impact either positively or negatively on the overall level of onboard medical care.

9.1.1   Human factors

Human factors are a large group of conditions and matters that are related to the persons on board.  It deals for instance with their physical condition of seafarers (Ref. Pre-employment physical), but also with their skills and level of training on how to deal with sick or injured persons on board, for instance legislation.

9.1.2    Ship-linked factors

Ship linked factors comprise a wide variety of factors that are somehow related to the ship. It deals with the type of the ship, its sailing area, the medical equipment but also factors like flag state, company policy in relation to safety and welfare on board  and type of  cargo. Main item is that these factors can be influenced or even be controlled.

 9. 1.3   External factors

External factors influence the quality of medical care provided on board that are not directly linked to Ship-linked nor to Human factors and are not or nearly not controlled. Clear factors that cannot be controlled are sea state and weather. This is for example the care provided by a Tele-medical Maritime Advice Service (TMAS) and another is the availability of professional medical follow-on care.  This is mainly but not only about medical evacuation. In the following paragraphs the sub factors under these factors will be discussed in greater detail.

The main objective of all systems that are involved in handling medical conditions on board is that all should strive to ensure the best level of care that can be provided given the circumstances. Some of the systems are grounded in (international) regulations, but although sailing is probably one of the most internationally oriented industries, many of these regulations are still organised on a national level. This is also the case for systems that regulate medical care on board.

Medical care on board of non-passenger ships is in essence provided by the first officer. Apart from his drive, the care to be provided is dependent on his knowledge, his skills and experience in handling medical matters and by his skills in managing sickness and injuries. He might be assisted in dealing with medical matters by a TMAS. Although one should realize that external assistance will only be available once the ship has called for it.  Provided that the TMAS is of good quality, one should always realize that information on the medical condition is transferred from the ship through the responsible officer and occasionally through the patient himself. Therefore the information is passed on with the possibility of being distorted. Language barriers, misinterpretation, miscommunication and the lack of socio-cultural understanding between the ship and the external advisor may cause such problems. Even with modern techniques, like for instance pictures sent by e-mail, one can question whether  the consultation will ever be of the same quality as if it was face-to-face.

 Seafarers are entitled to the best medical care that can be provided in their circumstances. To reach this goal there is need for a connecting set of interdependent systems that enable development of the best medical care for any seafarer when and where needed.  However, one should also realize that it is unrealistic to expect that this objective will ever be met. Nevertheless there ought to be a constant drive from all competent authorities, ship-owners and last but not least seafarers themselves to improve the chain of systems that will  provide the persons on board with the best medical care where and when needed.