Requirements for Organisation of Medical Care on Ships and List of Medical Equipment Required on Ships Registered in Estonia1

 

Regulation of the Minister of Social Affairs of 23 October 2002

entered into force 1 January 2003.

 

The Regulation is established pursuant to subsection 28 (1) of the Seafarers Act

 

§ 1. Scope of application

(1) This Regulation applies to all vessels registered in Estonia, except warships and border guard ships, small craft, tugs operating in harbour areas and pleasure boats used for non-commercial purposes.

(2) For the purposes of this Regulation, medical care for a crew member includes:

1) general medical care provided by a doctor;

2) medical care provided by the master, if the master has undergone appropriate training, or by a crew member with appropriate training designated by the master;

3) first aid provided by the master or by a crew member who has undergone appropriate training for first aid providers;

4) the provision of emergency care on ships or the organisation of emergency medical care.

(3) For the purposes of this Regulation, medical equipment includes medicines and medical devices.

 

§ 2. Categories of vessels

For the purposes of this Regulation, vessels shall be classed in the following categories:

1) category A vessels, with no limitation on length of trips or navigation area;

2) category B vessels, making trips of less than 150 nautical miles from the nearest port where health care services are provided;

3) category C vessels, meaning vessels navigating in internal water bodies and vessels operating on domestic voyages.

 

§ 3. Organisation of medical care on ships

(1) Every vessel with a crew of 100 or more workers and engaged on a voyage of more than three days shall have a doctor on board.

(2) Persons specified in clauses 1 (2) 2) and 3) (hereinafter providers of medical care) shall provide medical care or first aid on vessels where a doctor is not mandatory.

(3) If the state of health of a crew member prevents the crew member from being treated on the ship or if the illness of a crew member is putting the life or health of other crew members or passengers in danger and it is not possible to take measures to prevent the disease from spreading, the master shall send the crew member who has fallen ill to a health care institution at the nearest port within the shortest possible time.

(4) If necessary due to the state of health of a crew member, the master shall call an ambulance crew through the Tallinn Maritime Rescue Co-ordination Centre or the Maritime Rescue Co-ordination Centre (MRCC) of a foreign state.

(5) If a crew member is sent to a health care institution, an internationally recognised report, the format of which is provided in Annex 1, shall be issued to the crew member.

(6) A report shall be prepared in three original copies, of which Part I shall be prepared by the master or a person authorised thereby and Part II shall be prepared by the doctor of the health care institution. The master shall prepare Part III if the crew member is signed off.

(7) One copy of the report shall be retained by the health care institution, the second copy shall, if possible, be returned by the doctor of the health care institution to the master or, in the absence of the master, to the agent or shipowner, and the third copy shall be given to the crew member concerned.

(8) If a member of an ambulance crew or a doctor who is not a crew member provides medical care to a crew member on board a ship, the person who provides medical care shall prepare Part II of the report specified in subsection (5).

(9) It shall be ensured that free medical advice can be offered to providers of medical care twenty-four hours a day from radio consultation centres located in Estonia.

(10) In the event of providing medical care to a crew member, sending him or her to a health care institution or receiving advice from a radio consultation centre, the doctor or provider of medical care shall make an entry in the medical journal specified in § 5.

 

§ 4. Sick-bay

Every vessel of more than 500 gross registered tonnes, with a crew of 15 or more workers and engaged on a voyage of more than three days shall have a sick-bay for the storage of medical equipment and the provision of medical care.

 

§ 5. Medical journal

(1) A medical journal maintained by a doctor or a provider of medical care is mandatory on vessels specified in clauses 2 1) and 2).

(2) An entry on each procurement of medical equipment shall be made in the medical journal. The entry shall contain detailed information on the date of the procurement and the quantities of the procured medical equipment or a reference to the delivery note.

(3) An entry shall be made in the medical journal on each medicine dispensed. The entry shall contain at least the following information: the date, the given name and surname of the person to whom the medicine, including antidotes, is dispensed, the name and quantity of the medicine or antidote, the reason for dispensation, and the name of the person who dispenses the medicine.

(4) The medical journal shall be preserved for at last two years after the last entry.

 

§ 6. Medical equipment

(1) Every vessel shall carry on board medical equipment which corresponds to the specifications for the category to which the vessel belongs. The list of medical equipment which corresponds to the specifications for the category to which the vessel belongs is set out in Annex 2 (Medicines) and Annex 3 (Medical Devices). The quantities of medicines and the number of medical devices set out in the Annexes are prescribed for a crew of up to 25 members. If the number of crew members is greater, the amount of medical equipment shall be increased proportionally and any quantities shall be rounded to the nearest whole number.

(2) The medical equipment of a vessel carrying substances deemed on the basis of the Dangerous Goods Code of the International Maritime Organisation (IMO) to be hazardous to health shall include antidotes which are to be used to prevent or treat the harmful effects of the substances in the event of an accident.

(3) The medical equipment specified in subsections (1) and (2) shall be accompanied by an exhaustive list thereof and instructions for the use of the medical devices. The therapeutic indication of a medicine and the instructions for its use shall be set out on the package leaflet.

(4) Medical equipment of category C vessels, which bears the labelling “Meditsiinivarustus / Medical equipment”, and instructions for the provision of first aid are mandatory on life-rafts or life-boats assembled in the Republic of Estonia. If the medical equipment of a life-raft or life-boat is procured in a foreign port, the equipment shall meet the requirements of the International Convention on the Safety of Life at Sea (SOLAS).

 

§ 7. Storage of medical equipment

(1) Medical equipment shall be stored in a locked room where it is protected against humidity, freezing and excessive heat. In the case of vessels specified in § 4, medical equipment shall be stored in the sick-bay.

(2) Medicines shall be stored in their original packaging. Each package shall be legibly marked. The expiry date of the medicine shall be indicated on the packaging.

(3) Unless the package leaflet of a medicine contains comments regarding special conditions, the medicine shall be stored at room temperature.

(4) Light-sensitive medicines shall be stored in tightly closed, lightproof packaging or in a closed box or dark room. If necessary, additional lightproof packaging shall be used.

(5) Volatile and humidity-sensitive medicines shall be stored in a cool place and be tightly closed. Hygroscopic medicines shall be stored in hermetically sealed glass or plastic containers and, if necessary, the closure shall be covered with paraffin wax. Disinfectants shall be stored in hermetically sealed packaging, in a cool and dark place and separately from medicines.

(6) Category A and B vessels shall have a refrigerator which ensures the necessary temperature for the storage of thermolabile medicines. In the case of vessels specified in § 4, the refrigerator shall be located in the sick-bay.

(7) The medical equipment of life-rafts and life-boats shall be stored in watertight packages.

 

§ 8. Procurement, renewal and replenishment of medical equipment

(1) Before the start of a voyage, the doctor or a provider of medical care shall check that the medical equipment meets the requirements and, if necessary, submit an application to the master for the renewal or replenishment of medical equipment.

(2) This Regulation provides the legal basis for pharmacies to release prescription medicinal products to a master or a person authorised thereby on the basis of an application.

 

§ 9. Inspection of medical equipment

(1) Checks that the medical equipment of a vessel meets the requirements of this Regulation shall be carried out once a year by the Maritime Administration while the vessel is in its home port. In exceptional circumstances, this annual inspection may be postponed for up to five months. Inspections of the medical equipment on life-rafts and life-boats shall be carried out in the course of their annual maintenance.

(2) In the course of inspection, the following shall be ascertained:

1) whether there is necessary amount of medical equipment which corresponds to the specifications for the category to which the vessel belongs;

2) whether the expiry dates of the medical equipment have been respected;

3) whether the medical equipment has been labelled according to the requirements;

4) whether the medical equipment is stored and maintained according to the requirements.

(3) A report shall be prepared concerning the results of inspection. The person carrying out the inspection shall also make an entry concerning the inspection in the medical journal.

 

§ 10. Entry into force of Regulation

This Regulation enters into force on 1 January 2003.

 

1 The requirements of Directive 92/29/EEC (OJ L 113, 30.04.1992, pp. 19–36) of the Council of the European Communities have been taken into account in this Regulation.

 

Annex 1 to Regulation of the Minister of Social Affairs of 23 October 2002 “Requirements for Organisation of Medical Care on Ships and List of Medical Equipment Required on Ships Registered in Estonia”

 

Teatis – Report

 

Part I

I Osa

To be completed by Master or his Deputy

Täidab kapten või tema pool volitatud isik

1. Ship's name

Laeva nimi

2. Port of call

Sihtsadam

3. Date

Kuupäev

4. Surname of crewmember

Laevapere liikme perekonnanimi

Other name(s)

Eesnimi

5. Date of birth

Sünniaeg

6. Nationality & Language(s)

Kodakondsus ja keel(ed)

7. Job Description

Töö kirjeldus

8. Seamen's book number

Meremehe teenistusraamatu number

9. Date illness / injury occurred

Haigestumise / vigastuse kuupäev

10. Date work ceased on board

Töö lõpetamise kuupäev

11. Date work resumed on board

Töö jätkamise kuupäev

12. Details about the illness / injury and treatment on board

Haigestumise / vigastuse ja laeval osutatud meditsiiniabi kirjeldus

14. Ship Master's signature

Kapteni allkiri

13. Ship's agent

Agent / reeder

Address / Aadress

Tel No / Telefoni nr

P art II

II Osa

To be completed by Examining Doctor

Täidab arst

15. To the doctor: please see this patient and then fill in the report.

Retain back copy and return first copy to the master (or agent), second copy accompanies the crewmember.

Arstile: palun kontrollida patsienti ja täita teatis.

Säilitada kolmas koopia, tagastada esimene koopia kaptenile (või agendile / reederile), teine koopia anda laevapere liikmele

16. Diagnosis

Diagnoos

17. Treatment: Please specify exactly all medicines to be taken, the generic name of the medicine, the dose, the frequency of the dose, the way it is to be taken, and any other treatments required.

Ravi: Palun märkida täpselt kõik ravimid, nende toimeained, doos, manustamise viis, sagedus ning teised ravimise viisid.

 

No / Ei

Yes / Jah

 

18. Should he / she see another doctor later?

Kas patsient peaks edaspidi pöörduma teise arsti poole?

 

 

When?

Millal?

Contagious or infectious disease

Nakkushaigus

 

 

Are any precautions necessary for other crew members?

Kas on vaja rakendada ettevaatusabinõusid teiste laevapere liikmete suhtes?

 

Estimated duration of illness (days)

Haiguse eeldatav kestus (päevades)

19. Fit for normal work now

Kõlblik tööle

 

 

Fit for normal work from

Kõlblik tööle alates

 

Date

Kuupäev

Fit for restricted work

Kõlblik piirangutega tööle

 

What restrictions?

Millised piiranguid peab rakendama?

 

20. Unfit for work

Töövõimetu

 

For how many days?

Päevae arv

 

Bed rest necessary

Vajalik voodire˛iim

 

For how many days?

Päevade arv

 

Recommended to be signed off

Soovitus maha munsterdada

 

 

 

- and be repatriated

ja saata koju

 

Is air transport recommended?

Kas on vaja õhutransporti?

Yes

Jah

No

Ei

- and go to hospital after repatriation

ja saata kodumaal tervishoiuasutusse

 

 

Yes

Jah

No

Ei

 

21. The examination took place - date

Tervisekontroll toimus - kuupäev

- in the doctor's office

tervishoiuasutuses

 

 

- on board

laeval

 

 

- elsewhere

mujal

 

Specify

Täpsusta, kus

22. Name of health institution, doctor's name, address and Tel No

Tervishoiuasutuse nimetus, arsti nimi, aadress ja telefoni nr

Doctor's signature

Arsti allkiri

.....

Part III

III Osa

Master to complete (only to be filled in if signed off)

Täidab kapten laevapere liikme mahamunsterdamisel

23. Port of discharge

Sadam, kuhu laevapere liige jäetakse

24. Date

Kuupäev

25. Domicile

Alaline elukoht

26. Name and address of next of kin (relationship) or friend

Laevapere liikme poolt osutatud isiku või lähisugulase nimi ja aadress

27. Name and address of health institution where crew member is staying

Tervishoiuasutuse nimi ja aadress, kuhu laevapere liige jääb

28. Disposition of effects

Korraldused laevale jäänud vara hoidmiseks

 

Annex 2 to Regulation No. 128 of the Minister of Social Affairs of 23 October 2002 “Requirements for Organisation of Medical Care on Ships and List of Medical Equipment Required on Ships Registered in Estonia”

 

Medicines

 

 

Minimum quantity

Quantity on vessel

Category of vessel

A

B

C

1. Cardiovascular

 

 

 

 

Adrenaline/Epinephrine (1mg/ml 1ml injections)

5 ampoules

1

1

 

Glyceryl nitrate (0.5 mg tablets)

30 tablets

1

1

1

Furosemide (40 mg tablets)

30 tablets

1

1

 

Phytomenadione/Vitamin K (2 mg 0.5 ml injections)

1 ampoule

1

1

 

Oxytocin (5 U/ml 1ml injections) if there are women on board

5 ampoules

1

1

 

Metoprolole (25 mg tablets)

30 tablets

1

1

 

2. Gastro-intestinal system

Omeprazolum (20 mg capsules)

14 tablets

3

1

 

Anti-acid mucous dressing chewing tablets or suspension

30 tablets or 250 ml

4

2

1

Metoclopramide (10 mg tablets)

30 tablets

3

2

 

Metoclopramide (5 mg/ml injections)

10 ampoules

1

1

 

Bisacodyl (5 mg tablets)

50 tablets

1

1

 

Natrii picosulfas (7.5 mg/ml drops)

10 ml

2

1

 

Loperamide (2 mg capsules)

10 capsules

6

3

2

Prednisolone in the form of ointment in combination with other haemorrhoid preparations

20 g

2

1

 

Insulin (100 U/ml injections)

5 ml

1

1

 

Carbo medicinalis (250 mg tablets)

10 tablets

20

10

5

3. Analgesics and anti-spasmodics

Paracetamol (500 mg tablets)

20 tablets

5

3

1

Diclofenac (50 mg tablets)

20 tablets

5

3

1

Diclofenac (100 mg suppository)

10 suppositories

2

 

 

Diclofenac (25 mg/ml 3 ml injections)

5 ampoules

2

1

 

Morfine (10 mg/ml 1ml injections)

10 ampoules

1

1

 

4. Nervous system

Diazepam (5 mg tablets)

20 tablets

2

1

 

Diazepam (5 mg/ml 2 ml injections)

5 ampoules

2

1

 

Diazepam (5 mg rectal tube)

5 tubes

1

 

 

Haloperidol (2 mg/ml drops)

10 ml

1

1

 

Seasickness remedies

10 tablets

6

6

3

5. Anti-allergics and anti-anaphylactics

Loratadine (10 mg tablets)

10 tablets

3

1

 

Hydrocortisone (100 mg injection and 2 ml solution)

1 ampoule

4

3

 

Prednisolone (5 mg tablets)

20 tablets

1

1

 

6. Respiratory system

Salbutamol (inh aer 100 mcg/dose)

200 doses

2

1

 

Codeine phosphate (30 mg tablets)

30 tablets

3

2

 

Bromhexine (8 mg tablets)

20 tablets

3

2

 

Xylometazoline (1 mg/ml nose drops)

10 ml

2

1

 

7. Anti-infection

Phenoxymethylpenicillin (1 000 000 U tablets)

20 tablets

4

2

 

Doxycycline (100 mg tablets)

10 tablets

5

3

 

Ciprofloxacine (250 mg tablets)

10 tablets

6

2

 

Cefuroxime (750 mg injection)

1 ampoule

20

 

 

Cefadroxil (500 mg tablets)

30 tablets

3

2

 

Chloroquine (250 mg tablets) – in the event of navigation in an area at risk of malaria

100 tablets

1

 

 

Mefloquine (250 mg tablets) – in the event of navigation in an area at risk of cloroquine resistant malaria

6 tablets

2

 

 

Mebendazole (100 mg tablets)

6 tablets

2

 

 

8. Compounds promoting rehydration, caloric intake and plasma expansion

Perfusion solution 0.9% NaCl

500 ml

6

3

 

9. Medicines for external use

Skin medicines

Hydrogenii peroxydi 3%

40 ml

5

2

1

Chlorhexidine (desinfectant solution)

1000 ml

1

1

 

Desinfectant solution 2-propanolum, benzalkonium chloride (Cutasept)

250 ml

2

1

 

Tetracycline (ointment 3%)

20 g

2

2

 

Hydrocortisone (ointment 1%)

30 g

1

1

 

Miconazole (cream 2%)

30 g

3

2

 

Silver Sulphadiazine (cream 1%)

50 g

3

2

1

Dexpanthenolum

1 original

3

1

 

Permethrin (cream 5%)

30 g

2

 

 

Permethrin (shampoo 5%)

50 ml

1

 

 

Eye medicines

Chloramphenicol (eye drops 0.5%)

10 ml

2

1

 

Tetracycline (eye ointment 1%)

5 g

4

2

 

Dexamethasone+Neomycin+Polymyxin B (eye suspension)

5 ml

2

1

 

Proxymetacaine (eye drops 0.5%)

15 ml

2

1

 

Pilocarpine (eye drops 2%)

10 ml

1

1

 

Ear medicines

Hydrocortisone+Ciprofloxacine (ear drops)

10 ml

2

1

 

Medicines for oral and throat infections

Disinfectant sucking tablets

20 tablets

5

2

 

Local anaesthetics

Lidocaine (injection 1%)

20 ml

1

1

 

Lidocaine (gel 2%)

10 g

2

1

 

 

Annex 3 to Regulation No. 128 of the Minister of Social Affairs of 23 October 2002 “Requirements for Organisation of Medical Care on Ships and List of Medical Equipment Required on Ships Registered in Estonia”

 

Medical Devices

 

 

Quantity on vessel

Category of vessel

A

B

C

1. Resuscitation equipment

 

Manual resuscitation appliance, e.g. bag and mask

1

1

0

 

Appliance for the administration of oxygen with pressure-reducing valve such that ship's industrial oxygen can be used, or oxygen container

1

1

0

 

Mechanical aspirator to clear upper respiratory passages

1

1

0

 

Cannula for mouth-to-mouth resuscitation (Brook airway) or Laerdal face shield

1

1

1

2. Dressing and suturing equipment

 

Disposable suture stapler or suture kit with needles

2

1

0

 

Adhesive elastic bandage (1.25 cm × 1 m)

2

1

1

 

Gauze strips (2.5 cm × 2 m)

1

0

0

 

Tubular gauze for finger bandages (1 m)

1

0

0

 

Sterile gauze compresses (90 cm × 1 m)

2

2

1

 

Cotton wool (15 g package)

2

1

0

 

Sterile sheet for burns victims

1

1

0

 

Triangular sling (90 cm × 90 cm × 127 cm)

1

1

0

 

Disposable polyethylene gloves

100

100

10

 

Adhesive dressings

20

10

5

 

Sterile compression bandages (10 cm × 3 m)

2

1

1

 

Adhesive sutures or zinc oxide bandages

5

4

4

 

Non-absorbable sutures with needles

2

0

0

 

Vaseline gauze (10 cm × 10 cm)

10

5

0

3. Instruments

 

Stainless-steel instrument box

1

1

0

 

Disposable scalpels

2

0

0

 

Scissors

1

1

0

 

Dissecting forceps

1

1

0

 

Haemostatic clamps

2

1

0

 

Needle forceps

1

0

0

 

Disposable razors

2

0

0

4. Examination and monitoring equipment

 

Disposable tongue depressors

4

2

0

 

Reactive strips for urine analysis (glucose, blood, protein, ketones)

4

0

0

 

Temperature charts

2

0

0

 

Stethoscope

1

1

0

 

Aneroid sphygmomanometer

1

1

0

 

Standard medical thermometer

1

1

0

 

Hypothermic thermometer

1

1

0

5. Equipment for injection, perfusion, puncture and catheterisation

 

Bladder drainage instruments (bag, cocks, tube)

1

0

0

 

Rectal drip set

1

0

0

 

Disposable filter infusor (with blood filter)

1

0

0

 

Urine drainage bag

1

0

0

 

Disposable syringes (2 ml; 5 ml; 10 ml) and needles

6

3

0

 

Catheter, e.g. Foley type, 16.5 ml balloon

1

0

0

 

Skin cleansing pads, with isopropyl alcohol, number of packets

20

10

0

6. General medical equipment

 

Stretcher case

1

1

0

 

Bedpan

1

0

0

 

Urine bottle

1

0

0

 

Hot-water bottle

1

0

0

 

Ice bag

1

0

0

7. Immobilisation and setting equipment

 

Malleable finger splint

1

1

0

 

Malleable forearm and hand splint

1

1

0

 

Inflatable splint

1

1

0

 

Thigh splint

1

1

0

 

Collar for neck immobilisation

1

1

0

 

Thomas splint or dimple mattress

1

0

0

8. Disinfection, disinsectisation and prophylaxis

 

Water-disinfection compound (sufficient quantity for the disinfection of 50 litres of water)

1

0

0

 

Liquid insecticide (250 ml)

1

0

0

 

Powder insecticide (15 g)

1

0

0

 

 

 

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