Chapter 5 – Marine Medical Care

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5.1 Course Duration, Pre-requisites and Goal

  1. The Marine Medical Care course has a duration of 50 hours and is provided to those seafarers who are designated to provide medical care on board vessels at sea. In order to register for this course, trainees must have completed the 31-hour training course in Marine Advanced First Aid during the previous three years.

  2. This course may be combined with the Marine Advanced First Aid course to facilitate the training of any individual who wishes to take the Marine Medical Care course but does not have the necessary prerequisite. A combined program will include the content of both courses for a total of 75.5 hours.

  3. Every seafarer who is designated to provide medical care in the event of an accident or illness on board a vessel at sea is required to demonstrate competence to undertake the tasks, duties and responsibilities described in items 1 to 15.

  4. Teaching staff should note that this outline is offered for guidance purposes only as regards the different learning objectives and the length of time to be allocated to each objective. These factors may be adapted by instructors to suit individual groups of trainees depending on their experience and abilities as well as the equipment and staff available for training.

5.2 Number of Trainees per Instructor

The number of trainees in a course must not exceed eight when under the supervision of one accredited instructor.

5.3 Course Criteria

Marine Medical Care is required by:

The person designated to take charge of medical care on board a vessel carrying less than 100 crew members and is engaged on a voyage of a duration of more than three days that is an unlimited voyage or a near coastal voyage, class 1.

5.4 Instructor Qualification – Physician

This course must be delivered by a physician and a team whose knowledge and qualifications are recognized by a professional body.

5.5 Training Certificate

After successfully completing this training, candidates will receive a training certificate titled: Marine Medical Care in Accordance with STCW Convention, Regulation VI/4-2.

5.6 Course Outline and Duration

Section Subject Time (in hours)
1. First aid – review 6.0
2. Care of casualties 7.0
3. Aspects of nursing 3.5
4. Treatment of diseases 4.5
5. Alcohol and drug abuse 3.0
6. Dental care 1.0
7. Gynecology and pregnancy 2.0
8. Medical care of rescued persons, including trauma, hypothermia and cold exposure 3.0
9. Death at sea 1.0
10. Environment control on board ship 2.0
11. Disease prevention 1.0
12. Record keeping and regulations 0.5
13. Medicines and medical equipment 4.0
14. Surgical equipment, instruments and supplies 4.0
15. External assistance 3.0
  TOTAL 45.5
16. Assessment 4.5

5.7 Knowledge and Competencies

Methods of demonstrating competency are by assessment of the candidate on instruction received and demonstration of the acquired skills. When available, approved practical experience at a hospital or similar establishment should be encouraged.

Table 1 - First Aid - Review

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
1. 1.1 First Aid – Review

1.1.1 Review the knowledge and associated practical skills contained in the Marine Basic First Aid and Marine Advanced First Aid training courses as specified in document TP 13008, emphasizing:

  • anatomy and physiology
  • toxicological hazards on board ships with special reference to oil tankers, chemical tankers and liquefied natural gas tankers
  • the examination of patients

1.1.2 Describe and carry out simple laboratory tests for:

  • the use and evaluation of urine testing sticks
  • the collection of blood for malaria smears

Explain the concepts of clinical examination and medical history tracking under seagoing conditions.

Trainees must be able to review the basic and intermediate knowledge, as contained in the Marine Basic First Aid and the Marine Medical courses.

Table 2 - Care of Casualties

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
2.

2.1 Head and spinal injuries

2.1.1 Recognize the mechanisms and symptoms of head and spinal injuries:

  • assess the casualty’s level of responsiveness
  • describe the significance of the casualty’s level of consciousness in assessing the seriousness of the casualty’s condition
  • assess the seriousness of head and spinal injuries based on the mechanism of injury and signs and symptoms

2.1.2 Describe how to care for an unconscious casualty and emphasize that no anesthetic or sedative should be used unless prescribed.

2.1.3 Describe and demonstrate the technique to use for a case of suspected spinal fracture:

  • the safe approach to patient treatment
  • the treatment to be applied; selection, sizing and positioning of a commercial cervical collar
  • decide whether the patient should be transported and how
  • how to stabilize and prepare a casualty for transport according to established protocols

2.2 Injuries to the ears, nose, throat and eyes

2.2.1 Recognize the mechanisms and symptoms of injuries to the ears, nose, throat and eyes:

  • assess injuries to ears, nose, throat and eyes and determine their seriousness, according to signs and symptoms;
  • assess the nature of injuries to the eyes and related hazards

2.2.2 Describe the appropriate treatment for such injuries:

  • determine care appropriate for common injuries to ears, nose and throat

2.2.3  For injuries to the ears, nose and throat:

  • establish a diagnosis
  • identify possible cause(s)

2.2.4 For injuries to the eye region and external eye:

  • assess situations where removal of foreign bodies from the eye or area around the eye should not be attempted
  • provide appropriate care for removal of foreign bodies from the eye
  • provide appropriate care for injuries to the eyes or around the eyes
  • provide appropriate care for burns to the eyes
  • describe and demonstrate the use of a moistened cotton pad or swab for the removal of foreign bodies
  • use of fluorescent stain for corneal ulcers
  • describe the correct aftercare to be applied

2.3 External and internal bleeding

2.3.1 For external and internal bleeding:

  • recognize the symptoms
  • identify the causes
  • explain the risks
  • describe and demonstrate the appropriate treatment
  • use of tourniquets and pressure points

2.4 Burns and frostbite

2.4.1 Recognize the signs of burns and frostbite.

2.4.2 State the possible complications that can arise from such injuries:

  • assess burned area

2.4.3 Define a burn and recognize burns according to type: heat, hot liquid, electrical, chemical, radiation.

2.4.4 Explain the difference between first-degree, second-degree and third-degree burns:- determine seriousness of injury based on degree and area involved

  • recognize special considerations and types of burns

2.4.5 For the further treatment of a burn:

  • state the need for and importance of sterile dressings- prevent shock
  • explain the importance of fluid balance
  • calculate fluid requirements
  • evaluate the need for prophylactic treatment or antibiotics in cases involving radio communication- describe antibiotic prophylaxis
  • explains the procedures for pain relief

2.4.6 Explain the difference between burns and frostbite.

2.4.7 Describe how tissues can be damaged by frostbite:

  • recognize frostbite and determine seriousness of the casualty’s condition based on signs and symptoms
  • provide care appropriate to the nature of the frostbite

2.4.8 Describe and demonstrate appropriate procedures for:

  • immediate first aid
  • further treatment

2.5 Fractures, dislocations and muscular injuries

2.5.1 Describe, explain and demonstrate for fractures, dislocations and muscle injuries:

  • procedures for diagnosis
  • recognition of muscle strains
  • appropriate practical treatment

2.5.2 List and describe the types of fractures:

  • open or compound
  • closed or simple
  • complicated or mixed
  • controlling bleeding from an open fracture

2.5.3 Describe and demonstrate the methods used for:

  • immobilization of an injury, including the application of tape
  • treatment of suspected sprains, fractures and dislocations by immobilizing the injured area and providing support during transportation
  • the prevention of infection

2.5.4 Describe the special requirements for the treatment of pelvic, femoral and spinal injuries.

2.5.5 Describe the mechanisms and symptoms for the treatment of:

  • sprains
  • strains
  • dislocations

2.6 Wounds, wound healing and infection

2.6.1 Recognize and list the different kinds and types of wounds:

  • abrasions
  • contusions
  • excoriations
  • incisions
  • lacerations
  • perforations.

2.6.2 Describe and demonstrate the different techniques for wound treatment:

  • provide care for wounds and bleeding, including wounds to the eyes, ears, nose, mouth, knocked out or damaged teeth and crush injuries

2.6.3 Describe the general process of wound healing.

2.6.4 List the measures to prevent infection:

  • correct aseptic procedures
  • wound cleaning- stopping bleeding
  • correct procedure for wound dressing, using both commercial materials and improvised dressings
  • immobilization
  • tetanus prevention

2.6.5 Describe the treatment of infected wounds:

  • sources of infection
  • procedures for treatment

2.6.6 Demonstrate treatment procedures to be used for infected wounds.

2.6.7 Describe the physiological state of shock and its importance in the care of persons suffering from an illness or injury:

  • identify the signs and symptoms of shock
  • provide appropriate care for shock, taking into consideration the nature of the illness or injury involved.

2.7 Pain relief

2.7.1 State the general principles of pain relief and anaesthesia, and apply simple procedures.

2.7.2 Describe the simple procedures for non-medicinal relief:

  • psychotherapy
  • relaxation
  • positioning
  • cooling
  • warmth

2.7.3 Describe the medicinal treatment:

  • methods available
  • application
  • risks of abuse
  • characteristics of medicines
  • procedures for administration by intramuscular injection
  • procedures for administration by injection (maintenance of proficiency)
  • procedures for administration of vaccines

2.7.4 Knowledge of appropriate medications and products available on board:

  • qualifications required for administration of the medications available on board in case of an emergency

2.7.5 Describe non-invasive pain assessment and list the methods used:

  • administration of acetaminophen

2.8 Suturing and clamping techniques

2.8.1 Apply simple measures to stop bleeding and close wounds.

Describe and demonstrate the stoppage of bleeding by:

  • surgical means- the use of a ligature

2.8.2 Describe and demonstrate the surgical treatment of a wound by:

  • the application and removal of sutures
  • the setting and removal of clamps

2.9 Management of acute abdominal conditions

2.9.1 ecognize the signs and symptoms of acute abdominal conditions, including:

  • peritonitis
  • intestinal obstruction and urinary retention
  • abdominal trauma

2.9.2 Describe and apply emergency treatment.

2.9.3 Recognize the need for radio medical advice and describe the procedures used.

2.10 Minor surgical treatment

2.10.1 State that, for surgical instruments:

  • sterile packaging can be used
  • instruments can be sterilized by placing them in boiling water for 20 minutes

2.10.2 Demonstrate the correct preparations for casualty and equipment before proceeding with minor surgical treatment:

  • knowledge of surgical equipment available on board and use of same

2.10.3 Demonstrate how to proceed with minor surgical treatment for localized skin injuries and infections.

2.10.4 Local anesthesia

2.11 Dressings and bandages

2.11.1 Indicate that dressings are sterile gauze or cotton padding with a layer of cotton fabric to cover a wound or injury.

2.11.2 State the main functions of bandages:

  • application of pressure to stop bleeding
  • keeping a dressing in the correct position
  • providing support
  • preventing movement

2.11.3 Demonstrate the use of simple dressings and bandages for injuries to:

  • head
  • limbs
  • torso

2.11.4 Demonstrate the use of elasticized gauze and bandages (RETELAST).

Trainees must be able to ensure that identification of symptoms is based on the concept of clinical examination and medical history and treatment of injury is appropriate and conforms to accepted medical practice and relevant national and international medical guides.

Table 3 - Aspects of Nursing

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
3.

3.1 General principles

3.1.1 Describe the general principles of nursing:

  • observation of patients’ condition
  • observation of patients’ behaviour
  • observation and noting of vital signs: skin, respiration, excretion, pulse, blood pressure, body temperature

3.1.2 Ensure that clinical examination procedures are complete and comply with instructions received:

  • maintain accurate and up-to-date records of vital signs and other clinical information
  • demonstrate the application of nursing principles and the keeping of clinical and medical records

3.2 Nursing care

3.2.1 Describe and apply simple nursing care procedures for:

  • the control of pain
  • giving injections
  • washing and cold sponging patients
  • installing a catheter
  • forms should be available in the infirmary to record patients’ pulse, blood pressure and respiration
Trainees must be able to ensure that personal attitude is calm, confident and reassuring, provide medical care to the sick and injured while they remain on board and the significance of changes in patient’s condition is promptly recognized

Table 4 - Treatment of Diseases

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
4.

4.1 Medical conditions and emergencies

4.1.1 Recognize medical emergencies involving:

  • disorders of the mental and central nervous system
  • disorders of the digestive system and abdominal organs
  • diseases of the heart, cardiovascular system and respiratory systems
  • diseases of the genito-urinary system
  • diseases of the eyes, skin, ears, nose and throat
  • diseases of the musculoskeletal system and joints
  • poisoning and allergic reactions
  • emergency resuscitation procedures

4.1.2 Use of O2 resuscitators:
(a 7200-capacity oxygen bottle should be available in the infirmary)

  • parts of the resuscitator
  • operation of resuscitator
  • changing cylinders
  • CPR with resuscitator
  • after-use care and servicing

4.1.3 Apply measures and treatments to deal with medical emergency conditions:

  • pathological conditions: diabetes, epilepsy, respiratory diseases such as asthma or emphysema, allergic reactions
  • contagious diseases: German measles, chicken pox, scarlet fever, tuberculosis, yellow fever, hepatitis

4.1.4 Demonstrate the use of the WHO’s International Medical Guide for Ships (IMGS) or similar national guides in conjunction with radio medical advice until more expert help is available or the patient recovers.

4.2 Sexually transmitted diseases

4.2.1 Name the primary sexually-transmitted and blood-borne infections.

4.2.2 Apply basic medical treatment and counselling after receiving radio medical advice.

4.2.3 Obtain medical advice for:

  • Gonorrhea
  • Human Immunodeficiency Virus (HIV)
  • Herpes

4.3 Tropical and infectious diseases

4.3.1 Recognize and identify infectious diseases.

4.3.2 Define infectious diseases and describe their characteristics, including:

  • diseases caused by viruses: influenza, pneumonia, Acquired Immunodeficiency Syndrome (AIDS), hepatitis, etc.
  • diseases caused by bacteria: salmonella, typhoid fever, cholera, etc.
  • diseases caused by parasites: dysentery, malaria, etc.
  • tropical diseases other than malaria (salmonella, AIDS, hepatitis, cholera, plague, yellow fever, Ebola fever, dengue, typhoid fever)

4.3.3 State that particular emphasis should be placed on the causes, treatment and prevention of gastrointestinal illnesses aboard ship.

4.3.4 For tropical diseases:

  • identify types of poisons based on routes of entry
  • identify the sources of potentially serious infections transmitted via insect and animal bites and stings, and provide appropriate care

4.3.5 Describe prevention techniques and procedures.

Trainees must be able to ensure that identification of symptoms is based on the concepts of clinical examination and medical history and treatment of condition is appropriate and conforms to accepted medical practice and relevant national and international medical guides.

Table 5 - Alcohol and Drug Abuse and Psychiatric Disorders

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
5.

5.1 Recognize alcohol abuse and signs of alcohol dependence.

5.2 Describe potentially addictive drugs and narcotics.

5.3 List the most common substances that can lead to addiction and describe their effects on people.

5.4 Describe and implement treatment measures.

5.5 Describe the risks associated with withdrawal.

5.6 Recognize the importance of alcohol and drug counseling.

5.7 Indicate where such counseling can be obtained.

5.8 Demonstrate the important aspects of counseling.

5.9 Indicate that behavioral and psychiatric problems are sometimes influenced by:

  • factors unique to seafaring
  • the psychological consequences of distance and separation

5.10 Understand the concepts of civil and criminal liability in connection with suspected drug abuse.

Trainees must be able to provide counselling and care with cases of alcohol and drug abuse.

Table 6 - Dental Care

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
6.

6.1 Describe basic dental care:

  • ability to recognize dental emergencies

6.2 Describe the principles of oral hygiene.

6.3 Apply appropriate emergency treatment, including temporary fillings.

Trainees must be able to apply adequate emergency dental care.

Table 7 - Gynecology, Pregnancy and Childbirth

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
7.

7.1 With respect to pregnancy, describe:

  • signs
  • side effects
  • complications

7.2 Describe miscarriage:

  • recognize signs of miscarriage
  • provide first aid for the mother in cases of miscarriage

7.3 Identify and describe diseases specific to women.

7.4 Recognize labour and imminent delivery:

  • assist the mother in delivery
  • provide care for the newborn child
  • provide care for the mother
  • take care of the placenta
Trainees must be able to assist and provide gynecologic care, as indicated.

Table 8 - Medical Care of Rescued Persons, Including Distress, Hypothermia and Cold Exposure

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
8.

8.1 Describe and apply the procedures for dealing with rescued persons.

8.2 Recognize the special problems that can affect rescued persons, and explain the causes and treatment for:

  • hypothermia, including its various stages
  • precautions against heat loss and the effects of wind and humidity
  • exposure to cold, cold injury, immersion foot, etc.
  • seasickness, causes and treatment
  • dehydration and nutrition in rescue situations, frequent errors and hazards
  • sunburn, cause, treatment, prophylaxis and effects
  • hypoxia, gassing on ships, and entry into enclosed spaces

8.3 Recognize the signs and symptoms of heat-related illness:

  • cramps, heat stroke, heat exhaustion
  • provide care in cases of heat-related illness

8.4 Knowledge of casualty care in near drowning incidents, decompression illness:

  • resources available and how to access the for treatment (intravenous hydration)
Trainees must be able to evaluate condition of rescued persons and apply immediately medical care as appropriate.

Table 9 - Death at Sea

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
9.

9.1 Recognize and describe the general principles of care for the dying person.

9.2 Recognize and describe the general principles of care for the deceased:

  • signs of death
  • examination of the corpse
  • recording time of death
  • keeping a corpse on board
  • burial at sea
Trainees must be able to follow prescribed procedures related to death on board or at sea.

Table 10 - Enviromment Control on Board Ship

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
10.

10.1 Hygiene

10.1.1 Describe the general principles of shipboard hygiene and health education aboard ship.

10.1.2 Apply the main principles to:

  • potable water, chlorination, hardening of water from evaporators, reverse osmosis
  • sewage disposal
  • ventilation and air-conditioning
  • water and food storage
  • food hygiene and galley hygiene
  • food handling
  • defrosting of frozen foods
  • food contamination

10.1.3 Maintain a nursing station.

Trainees must be able to ensure that sanitary and hygiene standards are maintained on board ship.

Table 11 - Disease Prevention

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
11.

11.1 Disinfection, disinfestation, de-ratting

11.1.1 Describe the general principles and apply the procedures for protection against the transmission of disease and the control of epidemics.

11.1.2 State the regulations regarding waste and sewage disposal:

  • waste disposal manual.

11.1.3 Define and apply methods for:

  • disinfection
  • de-ratting

11.2 Vaccination

11.2.1 Describe the general principles regarding the protection of persons by vaccination.

11.2.2 Describe the different kinds of vaccination required for seafarers:

  • vaccination procedures and protocols
Trainees must be able to ensure that protection against infection and spread of diseases is complete and effective.

Table 12 - Record Keeping

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
12.

12.1 Records of signs, symptoms and medicines given

12.1.1 Describe the general principles regarding the keeping of medical records:

  • applicable record keeping procedures
  • responsibilities for completion and retention of medical records

12.1.2 Describe, in particular, the keeping and contents of:

  • medical logs
  • a controlled drugs register
  • reports to port health authorities
  • communications to physicians in port

12.1.3 Verification of medical history.

12.2 Inventory control of medicines (storage standards)

12.2.1 Describe expiry dates on drug packaging and the need for timely supply of replacements.

12.2.2 Knowledge of national and international regulations.

12.2.3 State that international and national health regulations apply to medicine at sea, including recommendations by WHO, IMO, and ILO:

  • location of relevant documents on board
Trainees must be able to maintain inventory control of medicines and keeping of medical records.

Table 13 - Medicines and Medical Equipment

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
13.

13.1 Medicines

13.1.1 List the contents of the ship’s medicine chest.

13.1.2 State for the medicines and drugs contained in the chest:

  • dosage level
  • beneficial action
  • side effects

13.2 Medical equipment

13.2.1 Knowledge of the use of medical equipment kept on board ship.

13.2.2 State procedures for destruction of date-expired medicines:

  • check drug expiry dates

13.2.3 Describe the procedure for the disposal of hospital waste.

Trainees must be able to ensure that the dosage and application of drugs and medication complies with manufacturers’ recommendations and acceptedmedical practice.

Table 14 - Surgical Equiment, Instruments and Supplies

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
14.

14.1 Describe and apply appropriate measures for disinfection and sterilization.

14.2 Demonstrate the use of the surgical equipment and instruments available on board ship.

Trainees must be able to use sterilized surgical equipment.

Table 15 - External Assistance

  Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
15.

15.1 Radio medical advice

15.1.1 Apply and demonstrate the general principles of radio medical advice, including:

  • GMDSS
  • use of the appropriate checklist section of the International Code of Signals.

15.1.2 Establish effective radio communication.

15.1.3 Complete appropriate verbal reports at time of patient hand-over.

15.2 Transportation of the ill and injured, including helicopter evacuation

15.2.1 Identify the problems involved in the transport of the ill and injured:

  • rapidly remove casualties from the accident site, confined space or vehicle
  • perform effective carries involving one, two or multiple rescuers

15.2.2 Ability to use approved stretchers:

  • stretcher carries
  • other equipment available on board, e.g., stokes basket for helicopter evacuation

15.2.3 Describe the procedures for evacuation by helicopter and by boat or lifeboat:

  • knowledge of other resources, e.g. Coast Guard, international assistance, and the requirements and procedures for gaining assistance from same

15.3 Medical care of the ill and injured, involving cooperation with port health authorities or out-patient wards in port

15.3.1 Describe the procedures for cooperating with port health authorities and out-patient wards in port.

15.3.2 Identify possible problems with language and cultural differences.

15.3.3 Describe the detailed medical records that must be kept and demonstrate their use.

Trainees must be able to participate in co-ordinated schemes for medical assistance to ships and ensure that procedures for seeking radio medical advice conform to established practice and recommendations.

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