A2 Capacities to be checked by the competent authority in designating a TMAS
A2.1 Permanent manning
The telemedical advice centre must be instantly accessible 24 hours out of 24.
The doctor must be available: telemedical advice, even for relatively simple cases, takes the doctor between 15 and 30 minutes. The doctor must therefore be able to free himself from any other activity during that time.
Some cases involve successive consultations during the course of the same day, sometimes seeking advice from another specialist doctor collaborating in the TMAS and/or calls to different operational partners. It is preferable for the same doctor to remain in charge of the case; continuity of treatment must be assured by communication of information to staff between shifts.
A2.2 Medical staff Rained in telemedical advice
The doctor must be able to direct the examination of the patient and treatment by his correspondent on board taking into account his level of training. He must be aware of the available treatment on board based on the type of medicine chest. He must adapt his vocabulary to allow him to communicate with the captain. He must be trained in the use of multimedia means to be developed.
A2.3 Medical staff trained in treatment in a maritime environment
There are few pathologies specific to the maritime environment. It is mainly the conditions under which treatment is given and the environment that must be familiar to the doctor. Treatment regimes must therefore take account of the medicines available on board.
Decisions to divert or evacuate must take geographical, meteorological and operational constraints into consideration, as well as the strictly medical justification for the intervention.
A2.4 Adequate documentation and means of communication
The non-medical documentation required by a TMAS relates mainly to the specifically maritime aspects of its work and contact addresses.
The means of communication must include at least one telephone line and easy access to a telex and fax.
A2.5 Development of a maritime medical network
Networking of different countries' TMAS would be useful because of the universal nature of maritime navigation. Real time communication between services are often essential at the operational level and permit harmonization of procedures and joint analysis of epidemiological data.
A3 Planning of a TMAS
A TMAS can be provided by various medical organizations subject to their recognition or designation as official partners of RCCs in the framework of a global system of medical assistance at sea. In come cases, the TMAS may be organized as a national centre (or even one shared by several countries).
