Both for reasons of cost and acquisition of experience by doctors, it is preferable for the TMAS to be provided by as few bodies as possible.
There may be an advantage in the service being provided through a specialized centre, which could even cover several countries (e.g. those sharing a common language).
3.3 It does not matter much whether the designated medical institution is in the public or private sector. The important thing is that it is permanently manned by doctors qualified in conducting remote consultations and well versed in the particular nature of treatment on board ship.
3.4 The annex to this circular contains further details of the benefits and effectiveness of a TMAS.
4 Means of intervention at sea
The means used for evacuation are generally the same maritime or aeronautical means used for rescue operations. It may be useful in certain circumstances to use a more specialized means of search (e.g. aircraft) to guide the rescue craft responsible for the evacuation.
The responsible authorities should regard it as desirable to have on board the rescue craft a team that includes either a doctor, or one or two people with appropriate training, when recommended by the TMAS doctor.
5 Shore-based arrangements
Unless the evacuation craft transports the evacuated person directly to a hospital (evacuation by helicopter), it is essential to provide for reception of the sick or injured person and transport from the point of disembarkation to the hospital, including specialized equipment (ambulance) and trained personnel and, if necessary, a doctor. There is nothing specifically maritime about this aspect, but being well prepared to admit the patient to the most suitable medical establishment is essential if the system is to be fully effective.
6 Operational procedures
It is desirable to have a national reference text that defines the procedures for joint operations by the various partners in medical assistance at sea, and their respective responsibilities:
- TMAS: medical advice1, medical advice on evacuation (MEDEVAC) or diversion, liaison with shore-based medical partners in the case of evacuation or diversion;
- RCC: initiation of nautical or aeronautical means of evacuation, nautical advice to the captain when advised to divert on medical grounds, overall coordination of the operation, alerting and liaison with the shore-based reception facility;
- means of intervention at sea: evacuation from the ship to the shore by nautical or aeronautical means with a medical or paramedical team where necessary;
- shore-based arrangements: provision of medical personnel, reception and transport of the patient to hospital by land or aeronautical means with a medical or paramedical team.
1 Medical advice (acronym MEDICO) consists of diagnosis and prescription of treatment on board. It may in some cases be given by bodies other than those providing the TMAS, where such advice does not involve evacuation or diversion.
