Textbook of Maritime Medicine

The sea is a place of freedom and pleasure but it is also a potentially hostile place.  Risks are many at sea and addressing health problems is not as rapid as it is on the ground.  Yet, when health problems occur, the seafarer can benefit from a special assistance.  Special procedures and measures are available to him that he should be aware of.

Prevention is essential.  It is based on periodic assessment of sailors’ medical fitness to board (at sea).  These medical examinations are carried out under the responsibility of qualified physicians who are knowledgeable about the specific risks faced by seafarers.

Like any physician, the maritime physician must have a strong knowledge base acquired during his medical studies.  He must also, through additional training, acquire a good understanding of the maritime environment and the skills essential to practicing medicine in isolation.

Several countries have developed and implemented training courses dedicated to maritime physicians.  These range from simple degree diplomas to full medical specialties.  All training courses should provide physician trainees with the same knowledge base and skills regardless of the country and be validated through adequate assessment methods.   The knowledge base and skills that are necessary to maritime physicians are defined based on common references globally accepted by maritime professionals in collaboration with experienced teachers in the domain.  These basic competencies (knowledge and skills) should therefore be established at the international level first and be adapted to fit countries’ specific legislations and modes of operation for medical assistance at sea.

In Europe, the first attempts to harmonize teaching courses were made at the workshops in Barcelona and Brest under the guidance of the International Maritime Health Association.  It became obvious (at these workshops) that maritime medical training ought to be developed at three levels: the international level, the European level, and, of course the national level.  The first objective of maritime professionals training is for physicians to become familiar with the maritime environment (oceanography, climatology), ships, living and working conditions on board, as well as international rules and regulations.  It is especially important for physicians to know about seafarers’ international rights, international sanitary regulations, and the action of a State at sea.  Maritime physicians must also be knowledgeable about the specifics of ships’ environment: noise, vibrations, electromagnetic fields, radars, and toxics.  They also must understand ergonomic constraints and be able to assess occupational safety on board.

Aside from these fundamentals, the training must address specific health problems that a maritime physician is likely to encounter during his practice: acute intoxications, sickness associated with travel (hypothermia, heat stroke, drowning, tropical infections and seafarers psychopathologies), in-port medicine (such as preparing sailors for going in-port and health problems encountered in ports), and finally, health problems that may affect sailors upon returning home.

In our teaching curriculum in France, we also include a special course on maritime emergencies:  emergency plans, water sporting casualties, on-shore accidents, and diving accidents….  Our goal is to address all situations that a maritime physician is likely to encounter in his practice and for trainees to acquire the very skills that are expected from them by their employers as well as the skills needed to assist professionals or non professionals seafarers.