Ship safety

Ship safety may cover many different aspects with the ship itself, like hull construction, machinery, equipment, manning, navigation, operations, maintenance, load lines, and a lot of other aspects like maritime search and rescue, emergency communication, maps, traffic control systems, salvage etc.

In this chapter I will limit discussion to a more restricted definition of ship safety, addressing only ship and crew, dealing only with aspects regarding maritime medicine and maritime health.


Ship safety and the IMO approach

The IMO conventions for ship safety are listed in table 5.6. We will deal with the most important one, one of the four pillars, the International Convention for the Safety of Life at Sea (SOLAS) from 1960.

Some of the other conventions will be mentioned, and others discussed under different subheadings.


 The SOLAS convention is generally regarded the most important international convention addressing maritime safety, although the first international treaties date back to the 1860s.

The Titanic disaster of 1912 was the direct incentive that led to the development the SOLAS convention.


This convention was also the prelude to the Convention establishing the International Maritime Organization, adopted in 1948 in Geneva, and leading to IMO having its first meeting in 1959.

The first major task for IMO was to establish and maintain the 1960 convention, with clear intentions to keep it up to date with successive amendments. It soon became apparent that this was a slow and complex way of maintaining the convention, and in 1974 a complete new convention was adopted, based on the 1960 conventions and its amendments, including a new amendment procedure, making maintenance easier




Although regarded the most important convention for maritime safety, it is not the most important convention regarding maritime medicine (see table 5.7 for the content of the SOLAS Convention). The most important topic for maritime physicians is the regulations for life saving appliances in chapter three.

There is, however, a long list of conventions addressing ship safety, as listed in Table 5.6. Not all of them apply directly to maritime health.

The International Convention of Load Lines (Load Lines 1966), addresses freeboards, draught to which a ship may be loaded, weathertight and watertight integrity.

The Convention on the International Regulations for Preventing Collisions at Sea, 1972 (COLREGs), addresses traffic separation schemes, determining safe speed and making the regulations mandatory, not only as guidance.

The other ship safety conventions of the IMO, namely the CSC, the INMARSAT, the COS-SAR, the SAR, the STCW, the STCW-F will be dealt with under separate subheadings.


The International Management Code for the Safe Operation of Ships and for Pollution Prevention (the ISM Code) 

The human factor is generally regarded as one of the most important causes of accidents at sea, as exemplified by the capsize of “Herald of Free Enterprise” on the 6th of March 1987, the Scandinavian Star disaster on the 7th of April 1990 and the capsize of “Estonia” on the 28th September 1994.

In 1989 the IMO adopted “Guidelines on management for the safe operation of ships and for pollution prevention”. In the following years the International Management Code for the Safe Operation of Ships and for Pollution Prevention (the ISM Code) was developed. It was adopted in 1993 by the IMO, and became mandatory from 1998 for all member nations.

The purpose of these guidelines is to provide those responsible for the operation of ships with a framework for the proper development, implementation and assessment of the safety and pollution prevention management in accordance with good practice, to ensure safety, prevent human injury or loss of life, and avoid damage to the environment and property.

A safety management system (SMS) must be established by "the Company", which is defined as the shipowner or any person, such as the manager or bareboat charterer, who has assumed responsibility for operating the ship.

The Company must establish a policy for the purpose of achieving the objectives, including the necessary resources and shore-based support. One or more designated persons ashore shall have direct access to the highest level of the management. Procedures shall be documented and compiled in a Safety Management Manual, a copy of which should be kept on board.

Effective implementation of the ISM Code should lead to a move away from a culture of "unthinking" compliance with external rules towards a culture of "thinking" self-regulation of safety - the development of a 'safety culture'. The safety culture involves moving to a culture of self regulation, with every individual - from the top to the bottom - feeling responsible for actions taken to improve safety and performance.

A possible conflict of interests, though, or a paradoxical result of the ISM code has been discussed in recent years addressing the fact that the requirements under the ISM Code lead to production of a wide range of documents and reports as a part of the ship’s safety management system (SMS) – documents which also have the potential to incriminate those who produced it.


Ship Safety – the ILO approach

 None of the ILO conventions specifically addresses ship safety. There are a number of conventions that concern different factors which may affect ship safety, including minimum manning standards, work and rest hours, certification of certain professionals, living and working conditions, access to medical care, service in ports etc.


EMSA activities on ship safety

 A number of EC council regulations and directives concerns ship safety, as listed in table 5.8.

EMSAs regulations addresses the implementation, surveillance and inspection of international conventions, at the same time as it also includes addendums and supplements to international treaties, specific for the European Unions ships, ports and waters.


Environment and pollution

 IMO Conventions in the field of pollution

 Pollution caused by ships not only covers oil pollution, although this alone counted for approximately 600.000 tons of oil being discarded in the European waters during the last two decades. In addition a number of noxious liquid substances, sewage, garbage and air pollution may be discharged by ships either in the course of normal operations or accidentally. Air pollution from ship exhausts may be a health risk for those working in port areas and more generally have adverse effects on population health by contribution to ambient pollution.

Ships themselves are potential pollutants throughout their lifetime, from the building process, operation and maintenance, until the dismantling process has ended the ship’s life.

Ships may also carry marine organisms from one part of the world to another, particularly in ballast water and these alien organisms can endanger marine ecosystems and fisheries.

A considerable number of conventions and amending protocols from the IMO address the question of pollution of marine environment, as shown in Table 5.7, starting with OILPOL 1954, via INTERVENTION 1969 and LC 1972 to MARPOL 1973. The preparedness, response and cooperation is further developed in the OPRC 1990 as amended in the HNS-OPRC Protocol of 2000, harmful anti-fouling systems are covered in the AFS 2001 convention, and management of ships’ ballast water and sediments in the BWM 2004, not yet entered into force (September 2012). (The BWM 2004 will enter into force 12 months after ratification by 30 states, representing 35% of the world merchant shipping tonnage. By September 2012 35 states have ratified, representing 27,95 % of the world merchant shipping tonnage.)


 The MARPOL Convention was considerably revised and strengthened in 2008, setting new standards for SOx and NOx emissions which will give results in a long-term perspective. Regarding the CO2 emissions, however, there still are no rules.

 Nevertheless, lack of treaties and their possible defects are not the biggest obstacles to the protection of the environment from pollution. Failing to apply standards, guidelines and legislation is a far more important issue, often due to lack of port facilities for the reception of wastes or the costs of disposal in port or merely as a matter of operational convenience.

Hence, efforts to implement the treaties in national legislation, the strengthening of inspections and effective sanctions when breaches are discovered are vital.


UNEP Conventions in the field of pollution

 The IMO is not alone addressing maritime pollution and the environment.

The UNEP Conventions from Basel, Rotterdam and Stockholm are the most important international treaties addressing the carriage of hazardous chemicals, pesticides, persistant organic pollutants, and how to move and dispose of wastes.

Basel Convention[1] on the Control of Transboundary Movement of Hazardous Wastes and their Disposal (BC) adopted in 1989, entered into force in 1992.

Rotterdam Convention[2] on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade (PIC) was adopted in 1998 and entered into force 2004.

Both the Basel and the Rotterdam Conventions aim to control the illegal trafficking of persistant organic pollutants (POPs) and POPs contaminated wastes and concern about the environmental release by the final disposal of such wastes.

Stockholm Convention[3] on Persistent Organic Pollutants (SC), adopted 2001 and entered into force 2004 shall protect human health and the environment from chemicals that remain intact in the environment for long periods, become widely distributed geographically and accumulate in the fatty tissue of humans and wildlife. 

Exposure to Persistent Organic Pollutants (POPs) can lead serious health effects including certain cancers, birth defects, dysfunctional immune and reproductive systems, greater susceptibility to disease and even diminished intelligence.  Given their long range transport, no government acting alone can protect is citizens or its environment from POPs. 

ILO Conventions in the field of pollution

 ILO has no instruments specifically addressing pollution, but risks from pollution to the health or safety of crew members, dock workers etc., will be a part of the risks in their working environment, and hence are indirectly and generally covered in several ILO conventions, like ILO C163, C164 and MLC 2006.

 EMSA regulation in the field of pollution

 The EMSA activities on the area of pollution and environmental protection, includes regulations in the fields of air pollution, anti-fouling coats, ballast water, port waste reception facilities, liability and compensation and on ship recycling[4]. Ship recycling will be mentioned separately, the rest of the areas are discussed here.


Human factors and safety

The human factor is probably the most important factor in ship accidents. This is why several organizations have focused on this aspect in different ways, and the reason why several conventions deal with this topic


STCW Convention

 The STCW Convention from 1978 is a very important convention from the maritime health professional’s point of view.

It is the convention regulating the pre-sea medical and periodic examinations of seafarers, although being very general in its approach. It also set up the standards for emergency medical training requirements for different groups of personnel on board. We will deal with this in more detail.

The STCW Convention includes the STCW Codes, where practical aspects of compliance with the convention are addressed.



 Medical training for personnel on board

Training in medical emergency procedures and medical care is another very important issue for the STCW-convention.


The training requirements differ according to position on board. The requirements are set in tables in the STCW Code Section A.

The lowest level is that of “personal survival techniques” (Table A-VI/1-1). This is obligatory for anyone signing on to a ship, as is the next step “elementary first aid” (Table A-VI/1-3). Together with the fire prevention and fire fighting course set out in table A-VI/1-2 and the personal safety and social responsibilities course set out in A-VI/1-3 these courses form the basic safety training for everyone on board.

The next level is that of “medical first aid”, which is obligatory for persons with a safety function in certain positions on board, usually working in the deck and engine departments.

The highest level is “medical care”. This course aims at training dedicated personnel how to carry out medical care on board, and is obligatory for deck officers. While the responsibility for medical care always lies with the ship’s master, it is usually given to the 1st officer’s duty to ensure health risks are minimised and that those with illnesses and injuries are appropriately treated.

IMO has developed a series of model courses to be used for guidance purposes for maritime safety training centres which want to develop their own courses. The IMO model courses are a description of the minimum requirements according to the STCW Convention. However, the courses need revision, as the last revisions were in 2000.


 IMO model courses 

 The IMO model courses, corresponding to the STCW requirements set out in the Code are shown in Table 5.12.

There are aspects of maritime health topics in most of the courses, although the pure medical courses are the 1.13, 1.14 and 1.15.

Pre-sea medical examinations


Guidelines on the medical examination of seafarers

 The need for medical examinations of seafarers has been one of the most important areas for the International Labour Organization since its establishment. One of the first conventions to be adopted by the ILO was the “Medical Examination of Young Persons (Sea) Convention i(ILO C 16) in 1921. The process continued with the ILO Convention No. 73 in 1946 (Medical Examination (Seafarers) Convention). Both of them are now included in the Maritime Labour Convention 2006 (MLC 2006).

The International Maritime Organization also has a focus on seafarers’ medical fitness. The STCW 1978 Convention required that seafarers should hold a valid medical certificate issued in accordance with the provisions of Regulation I/9 and of Section A-I/9 in the STCW Code.

In 1997 International Guidelines for Conducting Pre-Sea and Periodic Medical Fitness Examinations for Seafarers were published by the ILO and the WHO. This was the first attempt to harmonize medical examinations of seafarers. They described minimum requirements as a guideline to be used by flag-states in the development of national requirements.

The internationalization of the shipping industry together has made such international guidelines even more important, the experience with the guidelines and different national regulations has made it clear that the guidelines should be more detailed, and the changes in medical knowledge and therapeutic possibilities together with increased awareness of the needs, increased the need for a revision process of the 1997 guidelines. The revision of the STCW Convention (Manila amendments) and the adoption of the MLC 2006 prompted the revision.

In 2011 the ILO and IMO agreed on revised guidelines. This time, the WHO only observed the process, and did not involve directly in it, due to a change in WHO internal policy regarding the development of guidelines in general.

The new guidelines have been endorsed by the ILO Governing Body and the IMO Maritime Safety Committee to provide complementary advice to competent authorities, medical practitioners and all stakeholders.

The Guidelines on medical examinations of seafarers (ILO/IMO/JMS/2011/12) supersedes the Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers (ILO/WHO 1997).

  • ILO Instruments concerning the medical examination and health of seafarers

Several earlier conventions on seafarers’ working conditions have been consolidated in the MLC 2006, including requirements for medical certificates.

  • IMO Instruments concerning medical examination requirements for seafarers

The STCW Convention (1978) as amended (latest Manila amendments 2010) requires medical examination and the issue of medical certificates. The Regulation I/9 and the Section A-I/9 of the STCW Code describes the requirements that seafarers should meet according to this convention. Standards in the STCW Code A is mandatory for ratifying states to implement, and standards of the STCW Code B is regarded as guidance to competent authorities in their process of implementation and establishment of national regulations.

  • WHO measures concerning seafarers’ health, medical services and medical examinations

WHO is no longer directly involved in the publication of Guidelines for Medical Examination of Seafarers. Nevertheless, they have an interest in the field, and support in principle the publication. A series of resolutions regarding seafarers’ health have been adopted (WHA14.51, EB29.R.10, WHA15.21, EB37.R25, EB43.R23). The Global strategy for occupational health for all came in 2007. Of special interest to the approved doctor are the “Guidelines for treatment of tuberculosis”, the “WHO Policy on TB infection control in health-care facilities, congregate settings and housholds” as well as the “Guidelines for using HIV testing technologies in surveillance: selection, evaluation and implementation”.

Differences between the 1997 and 2011 Guidelines

The 2011 Guidelines are elaborated in much more detail than the 1997 guidelines. They introduce a different way of thinking by using an algorithmic approach to medical decision-taking. ICD-10 classification is introduced for all medical conditions, and it is recommended that the decisions should be differentiated in temporarily and permanent unfitness, restricted or limited medical certificates, or certificates for world-wide traffic without limitations.

Other important aspects for the medical certificate requirements are the introduction of a mandatory algorithm for the examination of colour vision according to the STCW Code A. The algorithm is to be found in the “International Recommendations for Colour Vision Requirements for Transport” (CIE 143-2001, from the International Commission on Illumination)[5].

Another important aspect of the new guidelines is the requirement for quality assurance of medical examiners. The competent authority must have a system in place for assuring the quality of the doctor, not only upon entry into the system, but as a continuing or periodic process.

As a result of this, negotiations have already taken place (September 2012) between Germany, Netherlands, Norway and UK regarding a possible harmonization regarding medical requirements and quality assurance of approved medical examiners abroad.


The role of the International Maritime Health Association

The International Maritime Health Association has been active advocating the need for new guidelines. A working group in IMHA was active during several years looking at the list of medical conditions based on the UK approach. This work was carried further after the ILO established its own special adviser for this purpose, professor Tim Carter, who also had been the chair of the IMHA WG.

Parallel to this activities, IMHA also worked on a quality assurance project, which by September 2012 has led to the establishment of a charity under UK law, an organization with the name “IMHA Quality” and its subsidiary “IMHA Quality Services”. This organisation focuses on the needs for quality assurance of the different areas where maritime health professionals work, starting with the quality assurance of medical examiners.

Working and living conditions and environment

The working and living environment has been of utmost importance to the International Labour Organisation from the beginning. Many different aspects has been focused through a series of conventions.

The IMO has also been very interested in this part. The responsibility of the IMO is different from the ILO, and the main interest of IMO has been that of safety at sea, which of course include the human factor, stable working force, lowest possible risk of unwanted incidents due to unhealthy seafarers to avoid other crew members and the safe operation of ships to be endangered.

The MLC consolidates a series of earlier conventions, but the ratifications of the earlier conventions are not cancelled. For instance, a state which has ratified the ILO C 164 and implemented regulations stronger than the requirements of the MLC, still are obliged to carry those arrangements further.


Maritime Labour Convention 2006 (MLC 2006)

 Maritime Labour Conventions 2006 will in the future be the most important tool to improve and maintain best possible working and living conditions for seafarers. The MLC 2006 has not yet entered into force, but by the ratification by the Russian Federation on the 20th of August 2012, the sufficient number of ratifying states has been reached. The necessary representation of world merchant shipping tonnage has been reached several years ago. This means that the MLC 2006 will enter into force on the 20th of August 2013.

This is actually the ILO Convention No. 186, but is never mentioned like that. The numbering continues after the MLC 2006 with C187 and C188.

The “Maritime Labour Certificate” (MLC) and the “Declaration of Maritime Labour Compliance” (DMLC) are new instruments introduced by this convention. They apply to all ships above 500 tons in international trade, probably increasing the awareness of and compliance with the requirements of the MLC 2006 Convention.

The content of the convention is much alike the content of the conventions it is based upon. Several ILO Conventions will be replaced when MLC 2006 has entered into force. revious page

The MLC includes sixteen articles as well as the code. The code consists of five “Titles” which describe specific provisions for different areas. The important Titles in the Code are the following.


  • Minimum requirements for seafarers to work on a ship (Title 1)
  • Employment conditions (Title 2)
  • Accommodation, Recreational facilities, Food and Catering (Title 3)
  • Health Protection, Medical Care, Welfare and Social Security Protection (Title 4)
  • Compliance and enforcement (Title 5).


The first three titles is of direct concern to the working and living conditions and environment. The fourth title is also important to working and living conditions for seafarers who are confined to the ship 24 hours a day for prolonged time. Title four will also be mentioned elsewhere in this chapter.

 Radio medical adviceRadio medical advice is covered partly by several conventions, recommendations and circulars. This topic has different aspects, which are covered in different conventions.

This R 106 Medical Advice at Sea Recommendation, 1958 from ILO was the first ILO document discussing radio medical advice for seafarers. It is a rather short document, but very important. At this time several shipping nations had already recognised the need and established radio medical services based on a risk assessment and a professional evaluation and several providers of radio medical advice were in service, like Centro Internazionale RadioMedico in Rome (from 1935)[6] and Radio Medico Norway (from 1949).

The spirit of the 1958 recommendations were carried onwards with the inclusion of Radio Medical Advice in the ILO Convention 164.

This was a great step forward for the health protection and medical care for seafarers. It deals with ship medicine, ship medical facilities, working and living environment, in on a broad basis, and also mentioned the radio medical advice.

The description of the radio medical advice is, however, much like the description from R 106. The convention is the most important international convention regulating Radio Medical Advice.

The MLC 2006 covers Radio Medical advice with almost the same phrasing as ILO C 164.

The communication systems and equipment are covered in the Convention on the International Maritime Satellite Organization, 1976 (INMARSAT convention). Under this umbrella, the series of IAMSAR manuals have been developed; see 5.12.

Two circulars are of utmost importance when establishing a telemedical maritime assistance service. These are the MSC/Circ. 960 Medical Assistance at Sea of 20th June 2000 from the IMO and the Resolution MSC.70(69) Adoption of Amendments to the International convention on Maritime Search and Rescue 1979, adopted on 18th May 1998. The first of these, the MSC Circ 960 in particular describes the organisation, the interaction and integration between the three corner-stones of a successful provision of medical service to seafarers, namely:

  • The Coast Earth Station (CES)
  • The Telemedical Maritime Assistance Service (TMAS) (or radio medical service)
  • The Maritime (or Joint) Rescue Coordination Centres

On a regional level, the EU Directive 92/29 covers the Telemedical assistance service as a prearranged system for all member states of the EU.

The requirements are also included in national legislation.


Seafarers rights to access medical care

The seafarers’ rights to access medical advice in port are covered in ILO Convention 164 Health Protection and Medical Care (Seafarers) Convention and – from 2013 – the Maritime Labour Convention 2006.

The MLC 2006 covers this in Title 4, Regulation 4..1 and standard A4.1 which requires all ships to provide prompt access to necessary medicines for medical care on board ships (paragraph 1(b)) and to “carry a medicine chest” (paragraph 4(a)). The fulfilment in good faith of this latter obligation clearly means something more than simply having a medicine chest on board each ship. A more precise indication of what is involved is provided in the corresponding Guideline B4.1.1 (paragraph 4) so as to ensure that the contents of the chest are properly stored, used and maintained.

The EU Council Directive 92/29 EEC of 31st March 1992 on the minimum safety and health requirements for improved medical treatment on board vessels, list the detailed requirements for on board medical care on ships flying the flag of an EU member state.

Medical evacuation (Medevac)

The procedures for Medevac are covered in the International Convention on Maritime Search and Rescue, 1979 (SAR Convention), while regulation of repatriation is covered by ILO Convention C 166 Repatriation of Seafarers Convention (1987).

Repatriation of seafarers

The first convention covering this aspect was the Repatriation of Seamen Convention, 1926 (No 23) from the ILO.

The ILO Convention No. 23 was replaced by the Repatriation of Seafarers Convention (Revised), 1987 (No. 166). From the 22 August 2013 the MLC 2006 will enter into force and cover these aspects as it revises the ILO Convention No. 166.

Seafarers who are put ashore in a foreign port for reasons for which they are not responsible, i.e. diseases or injuries have a need for repatriation. The MLC makes it mandatory for the competent authority in the foreign port to ensure that the consular or local representative of the flag State and the seafarer’s State of nationality of State of residence, as appropriate, is informed immediately, and each member state should have regard to proper provisions for the return of seafarers who are put ashore for reasons for which they are not responsible. Special measures should be considered with respect to young seafarers under the age of 18.

Medical skills – officers in charge of medical care on board

The knowledge and skills of seafarers on board a ship regarding medical competence are covered by the STCW Conventions requirements for training level of nautical personnel as necessary for their certificates.

The STCW requirements are to be found in Chapter VI, which describes the standards regarding emergency, occupational safety, security, medical care and survival functions.

Minimum standards of competence in personal survival techniques are listed in Table A-VI/1-1 where the wanted competence is defined, the requirements for knowledge, understanding and proficiency to comply with the competence requirements are listed, as well as methods for demonstration of competence and criteria for the evaluation of competence.

Specification of minimum standard of competence in elementary first aid are covered by Table A-VI/1-3, personal safety and social responsibilities in Table A-VI/1-4, minimum standard of competence in survival craft and rescue boats other than fast rescue boats in Table A-VI/2-1, fast rescue boats in Table A-VI/2-2, medical first aid in Table A-VI/4-1 and medical care in table A-VI/4-2.

Corresponding model courses are developed by the IMO, of which the most important regarding medical skills are:

  • IMO Model Course 1.13 – Elementary First Aid (Table A-VI/1-3)
  • IMO Model Course 1.14 – Medical First Aid (Table A-VI/4-1)
  • IMO Model Course 1.15 – Medical Care (Table A-VI/4-2)


Ship medical facilities – Ship medical chest

Ship hospitals are not described in detail anywhere in international regulations, but different aspects of the topic are covered in a lot of different conventions, regulations and guidelines – rather complicated and somewhat confusing.

The following ILO Conventions deal with ship medical facilities:

  • C 55 Ship owners' Liability (Sick and Injured Seamen) Convention, 19361
  • C 56 Sickness Insurance (Sea) Convention 19362
  • C 92 Accommodation of Crews Convention (Revised), 1949 Article 14, related to the hospital accommodation.
  • C 126 Accommodation of Crews (Fishermen) Convention, 1966 Article 13, related to the sick bay and medical chest
  • C 133 Accommodation of crew
  • C 134 Prevention of Accidents (Seafarers) Convention, 1970
  • C 164 Health Protection and Medical Care (Seafarers) Convention, 1987,Maritime Labour Convention 2006

In addition several ILO recommendations relate to the field:

  • R105 Ships' Medicine Chests Recommendation, 1958
  • R 106 Medical Advice at Sea Recommendation, 1958
  • R142: Prevention of Accidents (Seafarers) Recommendation, 1970
  • Convention C126 requires that the R105 shall be followed.

The IMO has given directions for the ship medical facilities through:

  • International Convention for the Safety of Life at Sea (SOLAS), 1974, Section III
  • International Life-Saving Appliance (LSA) Code – Resolution MSC.48(66)
  • International Safety Management (ISM) Code 2002
  • International Convention on Maritime Search and Rescue, 1979, SAR
  • The Medical First Aid Guide for use in Accidents Involving Dangerous Goods (MFAG)

It is obvious that there is a need to merge and unify the different recommendations. This has not yet been done at an international level.

The ship medical chest is mentioned in several ways. In a summary, we can say that ships must have adequate medical supplies that are periodically inspected, kept in good condition, are ready for use whenever required. Quantities will depend on duration and destination of the voyage, the number of crew members, and the nature of the cargo.

WHO has developed a recommended list of medicines, based on professional assessment and best practice, linked to the International Medical Guide for Ships (IMGS) and published as an appendix to the IMGS.

The list published in the 3rd edition of IMGS, gave rise to discussions about the content of the list, and several professional criticised it for neither being in accordance with the advice given in the IMGS, nor being organized according to international accepted codification. The list had no advice on quantities and was not being updated according to best practice at present.

There are several national lists as well, differing slightly from each others. The EU has regulated this rather strongly through a directive, the EU Directive 92/29.

The International Maritime Health Association established a Workgroup on International Guidelines on Medical Chests on Board in 2007, to revise existing guidelines and try to establish consensus between the international bodies concerned, like WHO, ILO, IMO, and the social partners.

“Guidance to the International Medical Guide for Ships (3rd edition): interim advice regarding the best use of the medical chest for ocean-going merchant vessels without a doctor on board: joint statement of WHO Collaborating Centres for the health of seafarers and the International” was published in the scientific journal International Maritime Health in 2009[7]

Subsequently the WHO published the “Quantification Addendum: International Medical Guide for Ships 3rd edition in 2010. As this was done unilaterally, without prior discussions with the ILO and IMO, who were partners in the publication “International Medical Guide for Ships”, the publication evoked some discussion at the tripartite meetings between ILO, IMO and WHO in which new guidelines for medical examinations and the content of the ship medicine chest were to be discussed. WHO withdrew from the cooperation on the medical examination guidelines, and the ship medicine chest question and the future of the IMGS still remains to be solved (November 2012).

Ships’ doctors

Ship medical doctors usually are found on board cruise ships, ships for longer lasting expeditions in remote areas of scientific or other nature, and on naval (military) ships.

There is no international convention regarding their duties or tasks, other than requirements regarding when there should be a doctor on board (MLC 2006).

The MLC states in Standard A4.1-4 (b) that ships carrying 100 or more persons and ordinarily engaged on international voyages of more than three days’ duration shall carry a qualified medical doctor who is responsible for providing medical care; national laws or regulations shall also specify which other ships shall be required to carry a medical doctor, taking into account, inter alia, such factors as the duration, nature and conditions of the voyage and the number of seafarers on board;”

 NATO has a handbook for medical doctors on board (STANAG 1269 A Med P-11 (NATO)). The UK has a publication covering this: The Merchant Shipping (Ships' Doctors) Regulations 1995 No[jc1]  1803 (UK).


The risks from transport of dangerous godsUnited Nations “Recommendations on the Transport of Dangerous Goods”

In 1956, the United Nations Committee of Experts on the Transport of Dangerous Goods, established by the UN’s Economic and Social Council (ECOSOC), completed a report with the name United Nations “Recommendations on the Transport of Dangerous Goods”.

After the SOLAS Chapter VII was revised, the revision of these recommendations was prompted.


The International maritime Dangerous goods (IMDG) Code

 The IMDG Code was developed as a uniform international code for the transport of dangerous goods by sea covering such matters as packing, container traffic and stowage, with particular reference to the segregation of incompatible substances.

The work started in 1960 at the Safety of Life at Sea Conference. A working-group commenced preparation of a proposal to the IMO assembly, which adopted the IMDG code in 1965.

Since then the IMDG Code has been amended, either as a result of proposals submitted directly to IMO by Member States, or changes needed to comply with the United Nations Recommendations on the Transport of Dangerous Goods which sets the basic requirements for all the transport modes[8].


The IMO/WHO/ILO Medical first Aid guide for Use in Accidents Involving Dangerous Goods (MFAG)

 Medical First Aid Guide for use in accidents involving dangerous goods (MFAG) is a guide which has been developed to assist in emergency cases on ships carrying dangerous goods. More than 50% of packaged goods and bulk cargoes transported by sea today can be regarded as dangerous, hazardous or harmful to the envronment according to IMO criteria. The cargoes include solid or liquid chemicals and other materials, gases and products for and of the oil refinery industry and wastes.

The IMO/WHO/ILO Medical first Aid guide for Use in Accidents Involving Dangerous Goods (MFAG) gives information on how injuries, which may arise from such accidents should be dealt with.


Maritime search and rescue

The International Convention on Maritime Search and Rescue 1979 – the SAR Convention

 In 1979 the International Convention on Maritime Search and Rescue was adopted at a conference in Hamburg. This convention aims at developing an international SAR plan, so that, no matter where an accident occurs, the rescue of persons in distress at sea will be co-ordinated by a SAR organization and, when necessary, by cooperation between neighbouring SAR organizations.

The SAR Convention is a further development of the earlier obligations of ships to go to the assistance of vessels in distress, grounded in customary international law, tradition and in international treaties, like the SOLAS 1974 Convention and the UN Law of the Sea.

There was, however, no international system covering SAR operations, before the SAR Convention entered into force in 1985.

The technical requirements of the SAR convention include the establishment of SAR regions, pooling of facilities, establishment of common procedures, training and liaison visits, and even expedite entry into each party’s territorial waters of rescue units of other parties. Preparatory measures, including the establishment of rescue coordination centres and sub-centres are described. Reporting systems, under which ships report their position to a coast radio station is described, reducing the interval between loss of contact with a ship and the initiation of a SAR operation and permitting rapid determination of vessels in need of assistance, including medical help.

Under the SAR Convention, the MSC have issued the MSC/Circ. 1042 of 28th May 2002: “List of Contents of the “Emergency Medical Kit/Bag” and medical Consideration for its use on Ro-Ro-Passenger Ships not normally carrying a Medical Doctor.


The SOLAS Convention and SAR operations

 The SOLAS convention also contains regulations of importance to SAR operations. The most obvious are

  1. Life saving appliances - in Chapter III
  2. Radio-communications - in Chapter IV


Many other provisions will directly or indirectly affect the SAR systems and their operations. Hence the SOLAS convention is an important cornerstone for the SAR systems, even when there is a convention dealing only with SAR matters.


The development of an International Aeronautical and Maritime Search and Rescue Manual – the IAMSAR Manual

 The implementation of the SAR convention was rather slow the first years, leading to a complete revision process starting in 1995, then to amendments adopted in 1998, harmonizing the provisions from IMO and the International Civil Aviation Organization (ICAO). Since then, the convention was amended in 2004, (into force 2006), to deal with persons in distress at sea.

A common approach for maritime and aviation search and rescue operations has been developed, based on the three conventions:

  1. Convention on International Civil Aviation (Chicago Convention) –Annex 12
  2. International Convention on Maritime Search and Rescue (SAR)
  3. International Convention for the Safety of Life at Sea (SOLAS), Reg. V/33.


The IAMSAR manual consists of three volumes, each of which written as stand-alone documents, containing:

  • VOL I: Organization and Management

-          discussing the global SAR system concept, establishment and improvement of national and regional SAR systems, and co-operation with Neighbouring States to proved effective and economical SAR services.

  • VOL II: Mission Co-ordination

-          intended to assist personnel who plan and coordinate SAR operations and exercises

  • VOL III: Mobile facilities

-          intended to be carried aboard rescue units, aircrafts and vessels to help with performance of a search, rescue, or on-scene co-ordinator function and with aspects of SAR that pertain to their own emergencies.

The IAMSAR manual is a valuable tool for every maritime physician connected to the SAR system, regardless of working on an organizational, administrative or operational level, and every maritime physician should at least be familiar with an overview of the field.


The Global SAR Plan and Global Maritime Distress and Safety System Master plan of Shore Based Facilities (GMDSS Master Plan)

 A global SAR plan is developed, defining detailed responsibilities for each member nation and lists their


  • SAR Authorities:
  • MRCC – Maritime Rescue Coordination Centre
  • MRSC – Maritime Rescue Sub-Centre
  1. ARCC – Aeronautical Rescue Coordiniation Centre
  2. JRCC – Joint Rescue Coordination Centre (joint aeronautical and maritime)
  3. JRSC – Joint Rescue Sub-Centre
  4. RCC – Regional coordination centre
  5. SRR – Search and rescue regions
  6. CES – Coast Earth Stations
  7. CS – Coast Stations
  8. MCC – COSPAS-SARSAT Mission Control


The Global SAR Plan is a necessary and practical tool for SAR operations.

A GMDSS Master plan is also developed. The Conference that adopted the SAR convention in 1979 and passed the resolution calling for the IMO to develop a global search and rescue, also called for the development by IMO of a Global Maritime Distress and Safety System (GMDSS) to provide the communication support needed to implement the SAR plan.


The plan is based on both satellite and terrestrial radio services, and has changed international distress communications from being primarily ship-to-ship to primarily ship-to-shore, the Rescue Coordination Centres (RCCs) playing a major role in the communication and coordination.

The GMDSS Master Plan contains all information necessary for such communication.

[1] Basel Convention homepage:

[2] Rotterdam Convention homepage:

[3] Stockholm Convention homepage:

[5] “International Recommendations for Colour Vision Requirements for Transport” (CIE 143-2001). ISBN 978 3 901906 09 1

[6] accessed 12 November 2012

[7] Schlaich C, Reinke A, Savenich C, Reimer T, Oldenburg M, Baur X, Horneland A, Jaremin BM, Nielsen PS, Wichtmann EM, Brandal L, Puskeppeleit M, Denisenko I, Carter T, Nikolić N: Guidance to the International Medical Guide for Ships 3(rd) edition: interim advice regarding the best use of the medical chest for ocean-going merchant vessels without a doctor onboard: joint statement of WHO Collaborating Centres for the health of seafarers and the International Maritime Health Association - 2009 version. Int Marit Health. 2009;60(1-2):51-66.

 [jc1]Check is this a MSN or MGN? Two separate numbering systems.