The aim of medical care arrangements on board should be to ensure the best practicable outcome for those seafarers who are injured or become ill while at sea. Current arrangements have a long history and some aspects have yet to take developments in medical diagnosis and treatment and the huge changes in communication fully into account. It is now feasible to provide immediate access to shore based advice and oversight using a wide bandwidth that can include video, audio and telemetry capacity. Training of officers and the published medical guides assume a large measure of autonomy and isolation at sea so they include continuing care information, while at the same time they are weak on the observational techniques needed to reliably relay information on the present state of a casualty to a shore based centre. Similarly the use of the contents of the medicine chest is largely at the discretion of the responsible officer, with little recognition that some medications should probably only be used on medical advice.
Some national authorities have revised their training, medical guides and instructions on use of medications to reflect this. However neglect by some ship operators and national authorities, the international nature of training and crewing in the maritime sector and the variable arrangements for telemedical advice mean that the optimization of medical care aboard thoughout the fleets of the world leaves much to be desired.