The I.S.M. (Mariners’ Social Institute) permanently maintains the health care and logistics support ship "Esperanza del Mar" in the fishing ground between the Canary Islands and the Sahara area.

During the tuna fishing season in the months of June, July and August, the I.S.M. locates a hospital ship in the North Atlantic to back up the large Spanish fishing fleet. In recent years the boat chartered for this has been the "Remolcagure Bat" although, since it is subject to rent, this may change, so it has been decided to use the generic name "Sanimar".

For information on RADIO-MEDICAL CONSULTATION CENTRES: go to Unit 2

Sometimes the rescue of survivors from the water or a lifeboat must be carried out with a helicopter which, if possible, should be equipped with dual controls, gas biturbine, a crane for maneuvers, basic life support facilities and specialized health care personnel.

In Spain the "Helimer"helicopters of the "Sociedad Estatal de Salvamento Marítimo" (State Marine Rescue Organization) have specialized personnel, even for immersions, and can give aid from the water to survivors who are in such a physical state that they cannot attach themselves to suspension devices from the helicopter. The use of helicopters in an emergency will be determined by the distance to the coast from the scene of the accident, since their range without refueling is only 180 miles in the best of cases.

Evacuating people with a helicopter requires suitable coordination between both parties involved. At great distance, communications between ship and helicopter will take place by radio, and when they are within sight of each other they will additionally use the signals prescribed for these cases in the International Signal Code since helicopter rotors cause a high level of noise and an air turbulence below which prevent the oral transmission of orders.

Whatever equipment is used to hoist survivors (sling, basket, net, seat):

- these must wear life jackets throughout the operation, even during the flight and until they leave the helicopter, with the only exception of those victims whose state could deteriorate by using them.

- they must not wear loose clothing or personal belongings that can be sucked in by or dragged towards the helicopter's rotors or engines.

- they must not touch the hook on hoisting equipment unless its potential electrostatic charge has previously been earthed.

- in case of dysbaric diving accidents, transfer must include medical attention, maintaining health care measures initiated at the scene of the accident as well as normobaric conditions: thus the helicopter must not exceed a maximum altitude of 100-150 metres in flight.

HYPERBARIC (COMPRESSION) CHAMBERS

Diving accidents involve a specific pathology which usually requires recompression treatment with oxygen given in so-called hyperbaric chambers.

A list of existing hyperbaric chambers in Spanish territory together with further information can be found on the Web page of the Comité Coordinador de Centros de Medicina Hiperbárica (Coordinating Committee of Hyperbaric Medicine Centres).

The following Centres, despite not being health care institutions, coordinate any type of maritime emergency and put the captains in contact with health care personnel suitable for each situation:

In Spain:

"CENTRO NACIONAL DE COORDINACIÓN DE SALVAMENTO DE LA MARINA MERCANTE" (CNCSMM) (National Center for Coordination of Merchant Navy Rescue Operations)

Telephone numbers: (+34) 900 202202; 91 5964988; 91 5964989

World-wide:

CROSS ETEL (FRANCE)

Telephone: 00 (or international access code) 33 297 553535

Ask to speak to the "Chef de quart" (area manager). Explain the case, and give boat's position and telephone number. They will call back to check data and coordinate the whole evacuation process.

MEDICAL GUIDES FOR SHIPS

In 1948 the International Labour Organization (ILO) and the World Health Organization (WHO) decided to set up a joint Committee, the Committee for Sailors' Hygiene, to study the health problems of maritime workers. At a meeting of this Committee in Geneva in 1965, the decision was taken to publish an "International Medical Guide for Ships" to facilitate guidelines for health care at sea, and also containing instructions on the optimum use of on-board medical supplies and the International Signal Code (reforming the part related to medical attention), and also on the transmission of the messages in radio consultations.

This joint Committee pointed out the twofold utility of the International Guide; on the one hand, that it should be distributed to vessels belonging to countries which did not have their own medical guide, and on the other hand, it was suggested that those countries which had a national guide should take the international proposal into consideration when writing up their respective guides.

In September 1981 the joint Committee (ILO-WHO), at a meeting in Geneva, revised the technical contents of the guide and some necessary changes were discussed. The Committee included representatives of the International Maritime Organization, sailors, shipbuilders, and experts in maritime medicine, as well as ILO and WHO staff. This led to the latest edition of the "International Medical Guide for Ships" in 1988, later reprinted in 1992, 1994, 1996 ... and now WHO has begin to work in the 3rd new edition with a committe of experts and the support of IMHA (International Maritime Health Association). Let's see some of the Guides: International, British and the 3 editions of the Spanish one (Visit the website of ISM, the editor of the last 3rd edition in this link).

1st, 2nd, 3rd Edition Spanish Guide

Following these guidelines, the ISM ("Instituto Social de la Marina", or Mariners' Social Institute) decided to produce a national "Guía Sanitaria a bordo", for Spain, the first edition appearing in 1976: the second edition (1987) was revised and the resulting version published in November, 2001. Its clear language, easily intelligible for professionals not specialized in health care, together with the large number of colour illustrations and diagrams, make it an accessible book. The Health Care Guide is intended to aid medical consultation by radio, and, through easy reference, enable basic health care and anticipate most frequent situations regarding accidents or disease. The second edition in 1987 had 11 chapters. The actual one is composed by several sections: emergencies, urgencies ...

MEDICAL CHEST ON BOARD

In Spain a Presidential Decree (4th of December 1980) established the types of medical supplies which must be carried by national merchant ships and fishing boats, according to their activity, as stipulated in the Organic Regulations of the Department of Overseas Health and in accordance with the norms of the International Agreement for the Safety of Human Life at Sea. Four types of medical supplies were stipulated; numbers 1, 2, 3 and 4, whose contents and characteristics vary depending on the activity, the route of navigation etc.

The above-mentioned norms were updated at the European level and particularly in relation to the contents of the medical supplies applying Directive 92/29/CEE of the Council of the European Communities (31st March 1992), which issued guidelines on "MINIMUM SAFETY AND HEALTH REQUIREMENTS TO PROMOTE IMPROVED MEDICAL CARE ON BOARD SHIPS". Spain has recently published the transposition of the latter in the "BOE" (official state Gazette) in RD 258/99 (BOE, 24th February, 1999) which also includes regulations on health care training clearly related to the STCW - IMO Agreement (1995). Three types of medical chest A, B and C are stipulated, as is the responsibility for regular in-service training in first aid and the use of medical supplies (refresher courses every 5 years). Let's see also the

Let's consult the content of the WHO recommended medical chest class A list of medicines and other medical supplies

The effectivenessof medical care on board will mostly depend on the medical supplies, therefore it must be ensured that these are in perfect condition, that is:

1. Well equipped. - The better the equipment, the better and more comprehensive the medical care will be. The person in charge of the medical supplies should take note of all that has been used in order to know exactly what must be replaced on arrival at port.

2. Suitably arranged. - So that any item can be found as quickly as possible, particularly in case of emergency, where fast and orderly action can be vital.

3. Suitably located. - In a clean dry place, protected from the environmental changes that affect drugs.

4. Suitably stored. - It is advisable to appoint a crew member responsible for medical supplies, who will be in charge of the fulfilment and maintenance of the above-mentioned aspects. Medical supplies must be well protected in order that unwarranted use is not made of medicines.

The equipment established for each type of medical supplies is based on minimum requirements and the shipping or shipbuilding companies can increase the amount of each product and even the number of products, provided that they are not toxic or narcotic, in which case they must not exceed the amount indicated for each type of medical supplies.

The fact that a large number of commercial names are used when listing medicines for medical supplies, due to the impossibility of mentioning the formulae of certain products, does not imply the exclusion of other similar medicines. Therefore, for stock control of medical supplies, any other product with a similar composition and identical applications to those on offical lists will be considered acceptable.