Background: Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. Materials and methods: The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. Results: The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. Conclusions: According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems often complicate medical management on board. Effective communication and knowledge of patient's medical history and risk profile is very important to reviewing physician. Effective diagnosis depends on accurate and objective description of symptoms and clinical condition.

Objective: The access of seafarers to health care services ashore and proper medical care by specialist doctors has been established through an extensive legal framework, which dictates that seafarers are entitled to the same quality of medical care as other employees working onshore. However, during the COVID-19 pandemic, international travel and trade were significantly disrupted, and port restrictions and border closures imposed unprecedented barriers to medical referrals of seafarers ashore, resulting in serious consequences for their health and well-being. Objective: The objective of this study was to present the serious difficulties and complications faced by telemedical assistance services in managing medical cases on board during 2020-2021. Methods: The study analyzed all cases reported to Med Solutions International, an international telemedical assistance company, during the two years of the pandemic. It specifically focused on delays and denials of medical referrals ashore, which led to most cases being exclusively handled through telemedicine. Results: The study demonstrated that only a minority of cases had the opportunity to be referred ashore for medical examination, while many cases were repatriated for further investigation and treatment when ashore referrals were denied. The absence of diagnostic testing and treatment ashore posed significant challenges and frequently endangered the lives of seafarers. Conclusions: The overall medical care of seafarers and their access to healthcare facilities ashore were severely affected by the COVID-19 pandemic. Telemedical assistance services were tasked with the challenging responsibility of replacing shoreside medical care. The detrimental impact on seafarers' health and human rights calls for corrective measures from international institutions.