Ship Medicine Chest
By ALF MAGNE HORNELAND
There is at present some confusion regarding international standards for the content of the “Ship Medicine Chest”.
The “Ship Medicine Chest” is not really a chest any more, but the name is still there, although it would have been more appropriate today to talk about ship medical facilities and ship medicine, as it comprises both medicines and equipment.
The existence of many different national lists and some supranational ones (EU) is a major concern among professionals and opinion leaders in maritime medicine.
On an international level we today have the following lists:
1) An “old” recommendation from WHO/ILO/IMO in the second edition of the International Medical Guide for Ships - IMGS 2 – with recommended quantities of each medicine. Up to this day this list has been in use, in spite of a new on in the 3rd edition of IMGS, because of its recommendations of quantities, although some medicines in use nowadays are lacking.
2) In the last edition of the IMGS – the IMGS3 – there is another one this time without recommended quantities. The lack of quantification has caused a lot of trouble both to shipowners, seafarers, suppliers and inspectors – what should be on board? Nobody knows for real.
3) An Interime List from a workgroup composed of International Maritime Health Association members and members of the WHO network of collaboration centres for seafarers health was published in the International Maritime Health in 2010 as the direct result of the Athens meeting of IMHA, mentioned below.
4) The so-called “Quantification Addendum: International Medical Guide for Ships 3rd edition” from WHO was published in September 2010 rather surprisingly to the other parties behind the IMGS who didn’t even know that the work was going on. The surprise was even bigger, as WHO had declared rather explicitly that there was no need of quantification to the Ship Medicine Chest.
Now – how could this happen?
Athens meeting in 2008
The revision of the old IMGS2 was long overdue when the work started. For several reasons the publishing of a 3rd edition was somewhat mixed-up, and there was a change in the approach to how the guide should be written. This led to a lot of concerns, and was the direct reason why the International Maritime Health Association (IMHA) in November 2008 held a workshop in Athens that resulted in the following statement:
“Flag states that do not have national requirements for the contents of the medical chest have in the past relied on a list that has been provided by WHO in the International Medical Guide for Ships (2ndEdition, 1988). This list provided information on the quantities to be carried on board… when WHO recently published a new edition of the Guide it included updated lists of recommended medications that were derived from the WHO Essential Medications List and of medical equipment taken from The Inter-agency Emergency Health Kit 2006. While this was a rational approach for the WHO to ensure that well validated treatments were available it did not take into account the need for remedies for minor ailments at sea – the sort that can impair ability to work without being dangerous, nor did it cover all the medical equipment that was needed in maritime situations. More significantly WHO did not consider that they could specify quantities of medications to be carried as there was a lack of information on use and effectiveness of medications at sea. In the absence of such data WHO considered that quantities should be related to voyage pattern and to political / managerial decisions rather than being stated by WHO. This lack of specification is not causing immediate problems where the flag state of the ship has its own national regulations or guidelines but it has led to great difficulties for maritime pharmacists called on to check and restock medical chests on ships from countries, including many of those with major open ship registries, that have no national lists…”.
The IMGS and the Ship medicine chest
The role of “International Medical Guide for Ships” (IMGS3) as being a guide for medical treatment on board, as well as for the content of the medical chest, makes in inevitable to discuss the two aspects in context.
The IMGS is organised like a textbook with diagnostic entities, making it suitable for teaching purposes at a course. However, it is not very useful in a practical situation on board, leading seafarers from symptoms or situation to practical handling of the problems, as you really need to know which diagnosis is concerned, to find the right part to read in the book. There are some other challenges regarding consistency, the format, accordance between advice given and the list of medicines available.
Based on feedback received from users of this quantification addendumWHO plans to incorporate a quantification list in the fourth edition of the International Medical Guide for Ships, scheduled for publication in 2012.
Regarding the ship medicine chest, there is yet no agreed international standard, rather a host of national standards. The WHO list is based on WHO Essential List of Medicines, without consideration of the special needs in maritime medicine. The list does not always correspond to the advice given in the guide, which sometimes is confusing.
Improvement approaches – the IMHA initiatives
The problems stated above prompted the IMHA at the Athens meeting to establish a working group with Clara Schlaich as a leader to initiate the production of “Guidance to the International Medical Guide for Ships 3rdedition" which may serve as an interim advice regarding the best use of the medical chest for ocean-going merchant vessels without a doctor on board. The product was published in the “International Maritime Health” (IMH) with Clara Schlaich as the main author. These guidelines were developed by IMHA and WHO CC on Seafarers’ Health and adopted by ILO, IMO and WHO
To ensure further influence on the development of IMGS and the Ships’ Medicine Chest, IMHA established in 2009 a IMHA Working Group on the International Guidelines on Ship Medicine Chest with the aim of reaching agreement between all international parts and stakeholders, firstly on principles and secondly on a list of medicines and equipment that can be used internationally on board seagoing vessels.
The leadership of the group consist of Alf Magne Horneland, Clara Schlaich and Bernd-Fred Schepers with Horneland as chair.
The mandate for the IMHA WG
The International Maritime Health Association (IMHA) establishes a Workgroup on International Guidelines on Medical Chest on Board (WGMC).
The WGMC shall work in close cooperation with
- World Health Organization (WHO) - including the WHO Collaborating Centres on Maritime Health network
- International Maritime Organization (IMO)
- International Labour Organization (ILO)
- International Transport Workers Federation (ITF)
- International Shipping Federation (ISF)
The paramount objective of the WGMC is to:
- reach agreement and consensus on recommendations and guidelines given by different international bodies regarding a list of ship medicines
- develop and propose a framework and principles for future revision of the Medical Chest on Board
- create an expert advisory panel on maritime health for close cooperation with the different international UN bodies concerned with maritime health, intergovernmental and governmental bodies, international and national organizations which are stakeholders in the shipping industry.
As the paramount objective of this group will inevitably overlap and interact with different aspects of maritime health on board it is foreseeable that the group will also need to reach agreement and consensus on other relating aspects of maritime health such as:
- requirements for medical care on board ships
- emergency communications procedures
- radio medical advice
- medical guides and manuals for seafarers including International Medical Guide for Ships
- requirements for ship hospitals
If needed and if unavoidable, the mandate of WGMC may be expanded to the areas stated above, or the cooperation with newly formed workgroups covering those areas could be established, but the group will aim to stay focused on its primary objective as much as possible.
The WGMC is established in 2009, and shall be working as long as necessary. The IMHA board appoints the leader and the members of the WGMC. Appointments are valid for periods of 4 years and may be continued.