Pharmacare on board ships without a doctor. prescriptions analysis and improvement of medical chests.

Seafaring represents a particularly hazardous occupation when compared with shore-based activities and seafarers are exposed to risks rarely encountered by workers in other occupations. People living ashore may have medical services available within a short time. On board ships the situation is different and the majority of vessels is at sea for days or weeks before they can reach a port. On the other hand, ship represents at the same time working place and living quarter and only very few ships carry a doctor or an adequately trained paramedic on board. In this situation, the best possibilities for treating diseases or accidents on board are : (i) to provide medical advice via telecommunications systems; (ii) to guarantee adequate training of personnel with the responsibility of health care on board; (iii) to have an adequate supply of drugs and essential medical equipment. Pharmaceuticals and other medical supplies carried by shipping vessels constitute the so-called ship’s medicine chest. The contents of the medicine chest and the medical equipment carried on board is prescribed by national authorities taking into account international recommendations in this field, such as those of the International Medical Guide for Ships and the List of Essential Drugs published by the World Health Organization (WHO), as well as advances in medical knowledge and approved methods of treatment. The last edition of the Medical Guide for Ships and the List of Essential Drugs were published recently (2008). Contents of the medicine chest and of medical supplied to be carried by ships should consider the type of ship, the number of persons on board and the nature, destination and duration of voyages. Literature available on ship’s medicine chest and more in general on maritime pharmacy is sparse and criteria followed by national authorities or by international organizations in establishing their contents are not known. The Working Group Ships Medicines established by the Community Pharmacy Section (CPS) of the International Pharmaceutical Federation (FIP) has provided an important counseling on the List of Essential Drugs recently recommended by WHO. The Group proposed an international forum to develop international standards of a global quality management system for maritime pharmacy or an internationally accepted guide issued by the WHO. Unfortunately, adeqate (pharmaco)epidemiological data on diseases occurring on board ships, their standard treatment(s) and on the use of medicines on ships serving as a reference for these actions are still missing. Taking into account that telemedical advice is largely used for treating diseases occurring on board ships, we have undertaken an extensive analysis on the type of medications most often used in telemedical assistance to ships. Analysis was based on the review of medical files assisted by Centro Internazionale Radio Medico (CIRM) in 2004-2008. CIRM is the Italian Telemedical Maritime Assistance Service (TMAS) and has one of the largest experience in the world of medical assistance of seafarers with more than 60,000 patients assisted on board ships. The investigation has evaluated the following items: No. of patient’s file, ship’s flag and position, language of teleconsultation, age and sex of patient, rank, days of assistance and number of teleconsultations, diagnosis (ICD-10), drug(s) prescribed (ATC), dosage. Based on pharmacotherapeutic guidelines for a given diagnosis, treatment prescribed on board ship and optimal (according to the guidelines) possible therapy will be defined. The expected results may serve as a reference for future regulations on the contents of the medicine chest.