Nautical officers at sea: emergency experience and need for medical training

Abstract

BackgroundOn merchant ships, the medical treatment including emergency interventions on the high seas are carried out by nautical officers who have to pass a forty hours medical refresher course every five years in order to meet international requirements. This study aims to show the most frequent kinds of medical emergencies on the high seas and to assess the seafarers’ knowledge about their treatment.Methods465 nautical officers who participated in the medical refresher course at the Institute for Occupational and Maritime Medicine in Hamburg, within the period from 2006 to 2013, were interviewed about their experience of serious diseases and accidents on board, which had led to an emergency port call, a course deviation or an evacuation. Furthermore, prior to the course the officers were asked to answer 18 basic medical questions about common medical issues on board.Results133 seafarers (28.6%) reported that they had been confronted with at least one serious medical emergency at sea. These emergencies encompassed trauma (37.9%), cardiovascular diseases (18.2%), severe gastrointestinal diseases (15.9%), serious skin or pulmonary infections (9.8%), neurological (9.1%) and urological diseases (4.5%) as well as burns (4.5%). With regards to the basic medical questions, an average of 70.7% of the total score had been achieved (from 26.8% to 100%). On average, 65.5% of internal and 65.6% of surgical questions had been answered correctly. Proper answers to toxicological and infectious questions had been given by 93.3% and 94.1% respectively and to topics of hypothermia and medical treatment by 59.4% and 61.0%. In total, a significant number of younger seafarers answered the questions correctly (p = 0.001).ConclusionsAccording to this study, serious emergencies on board are most frequently related to trauma or cardiovascular diseases. Taking into account the acquired medical knowledge, there seems to be a need to train deck officers within these fields more intensively. Considering the knowledge of seafarers about medical issues directly before attending their medical refresher course, the 5 years interval without any form of refresher course appears to be too long to guarantee adequate medical treatment by the lay persons on board.

Risk of cardiovascular diseases in seafarers

“…In a recent German survey, 465 nautical officers who participated in the medical refresher course at the Institute for Occupational and Maritime Medicine in Hamburg were interviewed about their experience of serious diseases and accidents on board, which had led to an emergency port call, a course deviation or an evacuation [9]. 133 (28.6%) seafarers reported on an experience of at least one serious medical emergency at sea during their seafaring time.…”

“…With regard to the vessel type, a high number of CVD occurred particularly on passenger liners (29.4%) with many and frequently older people on board. Besides passenger liners, the occurrence of serious CVD required a course deviation in 10 out of 69 reported cases on container ships [9].…”

Maritime doctors’ skills and competencies: A review for policy analysis

“…It encompasses the occupational health of the employees onboard, infectious diseases, the personal hygiene of seafarers, vaccinations, and other preventive interventions, as well as crew health counselling (Peltz & Warger, 2002). This stream of medicine also includes the training of seafarers in providing first aid and basic medical services onboard during voyages, health standards for work at sea, medical examinations of seafarers, and radio medical advice for ships (Carter, 2011;Oldenburg et al, 2014).…”

Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships

“…Cardiovascular diseases (CvD) have traditionally been a major concern in commercial maritime operations, mainly due to the potential risk of serious complications such as sudden death. Although cardiovascular cases are not a frequent cause of telemedical advice (11 th cause telemedical advice [1]) they remain the principal cause of medical emergencies, medical evacuations and natural deaths on board [2,3]. It might be assumed that seafarers constitute a healthier population compared to employees ashore (healthy worker effect) since their medical fitness is certified at least biennially.…”

“…Studies have shown that recording and transmitting electrocardiogram (ECG) is technically feasible and enables timely initiation of antithrombotic therapy [12]. More intensive training of deck officers remains a fundamental measure against potential cardiovascular emergencies [3], while the applicability of automated external defibrillators remains controversial [1]. The prompt implementation of the pre-employment medical examinations (PEMEs) is the cornerstone of CvD prevention.…”