11 Insert new Appendix N

  1.1.1 The International Convention on Maritime Search and Rescue 1979 gives the ability for parties to the Convention to provide on request from Masters of ships, medical advice, initial medical assistance or arrange medical evacuations for patients.

  1.1.2 The RCC is responsible for search and rescue services which include the organization of medical advice and assistance. The RCC has designated one or more providers of this service (Organization) at (Location) is one of the designated (Country) Telemedical Assistance Service (TMAS).

  1.1.3 The procedures and practices defined in this document establish Procedures and Practices, including lines of responsibility for both the TMAS Provider and the Rescue Coordination Centre in the coordination and provision of medical advice and assistance to ships at sea and the provision of medical advice to the RCC in support of search and rescue.

  1.1.4 Further guidance on Medical Assistance at Sea, Importance of the Role of Telemedical Assistance Services; and Medical Assistance at Sea and maritime radio communications can be found in IMO MSC/Circ.960.

  1.2.1 Masters of ships

  1.2.1.1 The Masters of ships are ultimately responsible for the health and safety of crew and passengers on board their ships.

  1.2.2 Maritime Communications Station

  1.2.2.1 The maritime communications station is responsible for:

• a. responding to any request for medical advice or assistance;

• b. providing an effective communications interface between Masters of ships at sea and the TMAS; and

• c. in the event of a MEDEVAC being required, requesting and passing all necessary information to the RCC.

  1.2.3 Telemedical Assistance Service (TMAS)

  1.2.3.1 The TMAS is responsible for the following functions:

• a. Be available 24 hours per day, 7 days a week to receive requests from vessels at sea and/or the RCC for the provision of medical advice;

• b. Making prompt medical assessments of remote patients and providing prompt advice to ships’ Masters in relation to medical treatment to be administered to those patients, generally by non-medical personnel;

• c. Providing prompt medical specialist advice when required;

• d. Where it is essential for the safety of the patient, taking into account all circumstances, making recommendations to ship Masters and to the RCC for evacuation of patients to shore-based facilities or to another vessel;

• e. Advising the RCC of any special medical requirements or constraints that may affect the type and equipment fit of the proposed recovery platform for evacuation of patients to shore-based facilities or to another vessel;

• f. Providing briefing to the paramedic or doctor who may accompany the MEDEVAC vehicle, to provide continuity of medical attention and also consult on evacuation procedures and constraints;

• g. When a patient is to be evacuated to a shore-based medical facility or the Master of a ship has decided to divert to a port, consulting with the RCC and the evacuating craft and recommending a medical facility to which the patient should be evacuated. Make appropriate arrangements with the medical facility to receive the patient;

• h. Ensuring, through liaison as required, that the receiving hospital is briefed about the patient’s condition and treatment;

• i. As necessary for the purpose of communicating with a ship’s Master or crew, arranging access to interpreter services where possible. – Note that this interpreter service may be arranged by the RCC;

• j. Providing medical advice to the RCC with respect to the prospects for survival/injury of persons subject to search and rescue in both land and sea environments; and

• k. Providing statistical information, to the RCC, on an annual basis in relation to the services performed.

  1.2.4 Rescue Coordination Centre

  1.2.4.1 The RCC is responsible for the following functions:

• a. Ensuring that ships’ Masters have the necessary information available to be able to contact the TMAS;

• b. Coordinating any MEDEVAC when requested, assisted by medical advice provided from the TMAS;

• c. Arranging of surface (water and land) or air assets necessary to conduct a MEDEVAC to achieve delivery to the medical facility recommended by the TMAS. As an integral part of the evacuation, the RCC will, where possible, organize to have paramedics on board the recovery platform;

• d. Where evacuation is required and requested, coordinating with the ships’ Masters for meeting or receiving the rescue platform and patient transfer arrangements;

• e. Where the TMAS recommends the patient is landed urgently, and the Master requests assistance, the RCC will advise the ship’s Master and the TMAS of suitable port(s) based on operational assessment only; and

• f. As necessary for the purpose of communicating with a ship’s Master or crew, arranging access to interpreter services where possible.

  2.1.1 The TMAS can expect to receive requests for assistance from:

• a any ships in surrounding waters; and

• b Country-flag and foreign ships outside that country’s designated Search and Rescue Region.

  2.1.2 This section addresses procedures to be adopted in response to three main conditions:

• a medical advice to ships;

• b diversion of a ship to another port; and

• c MEDEVAC.

  2.1.3 When the TMAS receives a request for medical assistance it must:

• a promptly undertake a remote medical assessment of the patient; and

• b promptly provide appropriate medical advice to the ship’s Master on the treatment to be administered (generally by non-medical personnel).

  2.1.4 Where the condition of the patient is such as to warrant more urgent and specialized care, the TMAS may also decide to make a recommendation to a ship’s Master that:

• a the patient should be landed urgently/as soon as possible to enable more expert treatment of the patient; or

• b the patient should be evacuated immediately/as soon as possible to a land-based medical facility.

  2.2.1 On receipt of a request for medical advice from a ship’s Master, the TMAS will consult with the ship’s Master as necessary and provide the appropriate medical advice.

  2.2.2 Requests for medical advice received directly by or on-passed to, the TMAS from ships do not require referring or reporting to the RCC unless evacuation is recommended.

  2.2.3 In the event that the TMAS suspects that the medical problem may have border control implications:

• a TMAS. The TMAS must inform the RCC of the:

  • .1 Name of the ship;

  • .2 Name(s) of the affected person;

  • .3 the medical condition; and

  • .4 probable port of arrival.

• b The RCC. The RCC must inform the appropriate border control agencies.

  2.3.1 In those cases where it is determined by the ship’s Master, after medical consultation with the TMAS that diversion to a port other than the next port of call is or may be necessary:

  2.3.2 The TMAS must inform the RCC that diversion is or may be undertaken.

  2.3.3 The RCC must, on request from the Master of the ship, render necessary assistance to the Master of the ship. This may include advice as to available ports and advising the ship’s agent, port, medical and border control authorities at the port of diversion.

  2.4.1 The decision to MEDEVAC a patient is a matter for the ship’s Master to decide on the basis of medical advice that is provided by the TMAS. Consideration must be given to other factors, including the environmental conditions (weather, sea state, etc.) that may prevail at the time of possible extraction and the ship’s geographical location. The availability and type of recovery platform(s) may also affect the strategy or decision to MEDEVAC. Accordingly, close and ongoing consultation may be required between the ship’s Master, the ship’s agent, the TMAS, the RCC, the operating agency/crew of the rescue platform and the receiving medical facility.

  2.4.2 Medical evacuations are generally undertaken by helicopter, possibly supported by a fixed wing aircraft. The TMAS must take into account that such evacuations can be carried out only when the ship is within helicopter’s flying range from land and only when a suitably equipped helicopter is available. It may be possible under conditions of extreme medical urgency for surface and air assets to be used (ship as a staging landing platform plus helicopter), however the availability of such assets cannot be assumed or guaranteed.

  2.4.3 Where the ship’s Master requires a MEDEVAC, and need of it is supported by the TMAS, the ship’s Master may communicate with the RCC directly or through a Maritime Communications Station without further reference to the TMAS. In this event the Maritime Communications Station or the RCC will ascertain information which may include:

• .1 patient’s name and nationality;

• .2 patient’s condition;

• .3 Master’s name and nationality;

• .4 vessel name, flag and IMO number;

• .5 call sign;

• .6 ship’s position;

• .7 shipowner/operator and his country; and

• .8 nearest port and ETA.

  2.4.4 The RCC must:

• a Consult with the TMAS for medical advice that may affect:

  • (a) the type of rescue platform provided,

  • (b) any medical constraints or requirements that may affect the point and method of extraction,

  • (c) the recommended medical facility for delivery, and

  • (d) any other considerations that could affect the conduct of the MEDEVAC;

• b Source and task the surface and/or air asset(s) to be used as a recovery platform;

• c Advise the TMAS of the details of the recovery platform and the operating agency;

• d Advise the ship’s Master of arrangements for the MEDEVAC, including rendezvous and any pre-arrangements for the extraction;

• e Advise the TMAS and the medical facility of the actual time of extraction and estimated time of delivery of the patient to the shore based medical facility;

• f Facilitate the MEDEVAC as necessary and maintain a watch over the progress of the MEDEVAC until the patient is delivered to the medical facility; and

• g Notify the TMAS and the maritime communications station of the outcome of the MEDEVAC on completion of the event.

  2.4.5 The TMAS must:

• a Provide the RCC with:

  • (a) medical advice on issues that may affect the type of rescue platform provided,

  • (b) advice as to any medical constraints or requirements that may affect the point and method of extraction, and

  • (c) any other considerations that could affect the conduct of the MEDEVAC;

• b If necessary advise on the most appropriate medical facility to which the MEDEVAC should deliver the patient and coordinate with the receiving medical facility for receipt of the patient;

• c Consult with the operating agency/recovery platform to advise on the patient’s medical condition, any recommended constraints or requirements related to immediate treatment or processes of MEDEVAC and the proposed medical facility to receive the patient;

• d Continue to consult with the ship’s Master regarding the patient’s condition as necessary in the circumstances;

• e Advise the medical facility of the medical status of the patient at the commencement of the MEDEVAC; and

• f Inform the RCC of any circumstances that may cause a need for change in the recovery platform type or timing including where the MEDEVAC is no longer deemed necessary.

  3.1.1 The TMAS must maintain in operation at all times facilities for voice and data communications to enable communication with the RCC, ships at sea and rescue personnel. Those communications capabilities should include:

• a. Voice communication;

• b. Text messages;

• c. Facsimile; and

• d. Digital data transmission (photograph or electrocardiogram).

  3.1.2 To support this communications capability, the TMAS must provide separate and dedicated phone and facsimile lines.

  3.2.1 Ships seeking medical advice will normally be put in contact with one of the maritime communications stations. Calls will then either be transferred or relayed to the TMAS. Requests for advice may therefore come to the TMAS:

• a. directly from a ship via a transferred telephone call;

• b. via a maritime communications station which has received a request for assistance from a ship by:

  • .1 Radiotelephony (RTF);

  • .2 Radio telex;

  • .3 Fax/phone;

  • .4 Inmarsat;

  • .5 E-mail; or

  • .6 Via the RCC.

  3.2.2 Requests for medical assistance passed to a maritime communications station will normally be relayed to the TMAS over the telephone and replies should be sent through the appropriate maritime communications station.

  3.2.3 In some instances communications directly with a ship, for the provision of medical advice, may not be possible. In such circumstances, communications may need to be conducted through maritime communications stations.

  3.3.1 Communications between the TMAS and the RCC must be conducted by telephone or facsimile or the most appropriate and reliable telecommunication system.

  3.4.1 Given the international dimension of maritime navigation, a medical problem may occur on board a ship very far from its country of origin. In such a case the master, who is responsible for the care of those on board, normally calls his designated national TMAS, which can perform remote consultation in his language. Should there be need, following the remote consultation, for an evacuation to the nearest shore, the master will contact the RCC responsible for SAR operations in the search and rescue region (SRR) concerned. In order to facilitate and enhance the planning of the medical aspects of the SAR operation involving medical assistance at sea, all available medical information collected by the TMAS that has carried out a remote consultation will be transferred to the TMAS attached to the responsible RCC. Everything must be done to avoid a second remote consultation by the second TMAS.

  3.4.2 A common form for the exchange of medical information is available to facilitate the transfer of all available and relevant medical information between the two TMAS authorities. See attached MSC/Circ.1218.

  3.4.3 On the basis of trans-national partnership agreements, the “medical information exchange form” is used for SAR operations involving medical assistance at sea, in the following manner:

• a when, following a remote consultation, a TMAS has indicated its recommendation to carry out a medical evacuation, the physician will complete the “medical information exchange form”;

• b once the RCC responsible for the SAR operation has been identified, the remote TMAS will transmit the form to the corresponding partner TMAS of the RCC concerned;

• c the RCC will be advised appropriately by its designated national TMAS of the medical constraints affecting the SAR operation; and

• d at the completion of the SAR operation, the operational TMAS will send any necessary information on medical follow-up to the TMAS that had performed the remote consultation.

  3.5.1 Telemedical advice and assistance is subject to the confidentiality provision of the relevant Acts for the manner in which they are handled, stored and communicated.

  3.5.2 In particular, telemedical advice must not be provided to third parties except for the delivery of the advice to:

• a. the target ship;

• b. the RCC; and

• c. paramedic organizations and medical institutions involved in the provision of the particular medical services to which the advice and assistance relates.

  3.5.3 All TMAS communications must be identified by date and time and must be stored securely and so as to enable the records to be accessed promptly should they be required.

  3.5.4 TMAS must fully document all communications including but not limited to:

• a case notes;

• b time and date of contact and the name of the vessel;

• c the names of those with whom they deal (so far as a name can be ascertained); and

• d the means of communication (telephone, radio, fax, e-mail, etc., plus contact numbers).

  3.5.5 The TMAS must make the records, with the exception of case notes, available to the RCC on request.”