APPENDIX TO THE CIRCULAR
Objectives, capacities and planning of a TMAS
A1 Objectives of a TMAS in a global system of medical assistance at sea.
A1.1 Aid for sick or injured seafarers; aid to captains.
The overall objective of a system of medical assistance at sea is to try to provide seafarers with medical care as nearly as possible equivalent to the care they would receive ashore, because:
- the seafarers' profession exposes them to a high risk of accident or sickness at sea;
- the position of isolation or remoteness is a potentially exacerbating factor in any on-board medical problem.
In the absence of a doctor on board (which is most often the case), the captain is responsible for medical care. However, any medical training he has received is not such as to allow him to treat a patient unaided. That is why telemedical advice (MEDICO) may enable him to provide a good standard of treatment and make the best use of the compulsory medicine chest.
In terms of responsibility, the TMAS doctor has full responsibility for the diagnosis and prescription of treatment, while the captain is responsible for examining the patient, administering treatment and the final decision.
A1.2 A way of avoiding evacuation
For a long time, while not forgetting the few well-established centres of medical advice by radio, medical assistance at sea has been synonymous with evacuation. Sometimes, however, evacuation is not possible. More often, it is dangerous both for the rescue team (due to the difficulty of the weather or technical conditions), or for the person being assisted (due to his condition). It often presents secondary, but not negligible, problems, linked to the psychological isolation of the patient and the difficulty of repatriating him to his country of origin.
In any case, evacuations are complex and onerous operations for the authorities, albeit essential in some circumstances, and should be reserved for medically justified cases.
A1.3 Aid to decisions by the RCC - need for a link between RCC and the TMAS
Although the ship may call the TMAS directly, RCCs are often the first contact for a captain faced with a medical emergency. They need immediate medical advice and a recommendation for action (which may simply be treatment on board): the TMAS doctor has full authority to recommend evacuation on medical grounds.
The optimal functioning of a global system of medical assistance at sea thus involves cooperation between RCCs and the TMAS, based on confidence in each other. That is why they need to know each other and there are advantages in linking one (or possibly more) RCCs to a single TMAS, and to give official status to the relations between medical and operational partners in the system.
