At 0400, 600 miles from the nearest coast, a crew member develops acute chest pain radiating to the left arm, sweating and pallor. As master, you decide to seek radio medical advice. Describe the exact process and what information you must provide.

A. RADIO MEDICAL ADVICE — PROCESS AND INFORMATION REQUIREMENTS: CONTACT POINT: Telemedical Assistance Service (TMAS) — in UK SAR area, contact MRCC Falmouth (VHF Ch 16 / DSC Ch 70, or MF DSC). MRCC connects to the NHS emergency medical consultation service. Internationally — CIRM (Italy), Euro-TMAS (Germany), Falck (Denmark) also cover international waters. HOW TO CONTACT: transmit "PAN PAN MEDICO" on Ch 16 or via MF DSC. Provide: (1) Vessel name, position, course, speed; (2) Flag state; (3) Distance from nearest coast or port; (4) ETA nearest port; (5) PATIENT MIST REPORT: Mechanism/onset (chest pain started 20 minutes ago at rest), Injury/Illness (crushing chest pain, radiating left arm, sweating, pallor, score 8/10), Signs (BP 160/95, HR 105, RR 18, O2 Sats if monitor available), Treatment (aspirin 300mg given); (6) Available medications on board; (7) Crew medical training level. WHAT THE MEDICAL ADVISER WILL PRESCRIBE: likely: aspirin (if not already given), GTN spray if available, oxygen, ECG if available, rest and monitoring. EVACUATION DECISION: if symptoms are consistent with MI, TMAS will likely recommend MEDEVAC to nearest hospital with cardiac catheterisation capability. DOCUMENT: time contacted, medical adviser name, instructions given, patient observations throughout.

B. Transmit a Mayday on Ch 16 requesting immediate evacuation. A suspected heart attack is a life-threatening emergency requiring Mayday, not PAN PAN.

C. Treat the patient from the IMGS protocol for chest pain and do not contact radio medical advice unless the patient deteriorates. Medical advisers should only be contacted as a last resort.

D. Radio medical advice is only available in coastal waters within 200 miles. On the open ocean, radio medical advice is not available and the master must rely entirely on the IMGS.

A. INTERNATIONAL MEDICAL GUIDE FOR SHIPS (IMGS) — MANAGEMENT USE: THE IMGS (3rd Edition, WHO/IMO publication): the authoritative reference for managing medical cases at sea. It is required under MLC 2006 Standard A4.1 and SOLAS Chapter III. STRUCTURE OF IMGS: (1) SYMPTOM-BASED approach — start from the patient's presenting complaint (chest pain, abdominal pain, breathing difficulty, altered consciousness), not from a diagnosis; (2) Assessment tools — vital signs guidance, AVPU scale, pain scoring; (3) Treatment protocols — appropriate to medications available in the ship's medical chest; (4) Evacuation criteria — specific signs that indicate when MEDEVAC must be requested; (5) Medication information — dosing, contraindications, side effects; (6) Specialist chapters — dental, eye, mental health. PROCESS: (1) Start with the patient's MAIN SYMPTOM — locate the corresponding chapter; (2) Follow the clinical assessment guide to narrow the differential; (3) Apply the treatment protocol; (4) Check the EVACUATION CRITERION — is this patient in the evacuate category? (5) Contact radio medical advice — provide: patient demographics, symptoms duration and onset, vital signs, current treatment. RADIO MEDICAL ADVICE: available 24/7 — in UK SAR area contact MRCC Falmouth, who connect to NHS Pathfinder or the relevant service. Document all medical consultations in the Medical Log.

B. The IMGS is only for use by ships' doctors. Officers without a medical qualification should not attempt diagnosis or treatment — radio for immediate evacuation instead.

C. The IMGS provides fixed protocols with no decision points. Follow the protocol for the suspected condition from beginning to end regardless of patient response.

D. The IMGS is an outdated publication replaced by the Ship Captain's Medical Guide (SCMG). Modern vessels are required to carry the SCMG, not the IMGS.

A. MEDICAL LOG — REQUIRED CONTENT AND LEGAL BASIS: LEGAL BASIS: MLC 2006 Standard A4.1 paragraph 4(d) requires every ship to keep a medical log. SOLAS Chapter III also contains medical requirements. MSN 1841 (MCA) specifies UK requirements. MLC 2006 MEDICAL LOG CONTENT: (1) SICK PARADE RECORDS: date, time, name, rank, complaint, symptoms, assessment, treatment given, outcome; (2) INJURY RECORDS: date, time, location of accident, nature of injury, treatment, time off work, return to duty; (3) MEDICATION DISPENSED: what, dose, to whom, when, for what condition; (4) RADIO MEDICAL CONSULTATIONS: date, time, authority contacted, advice received, actions taken; (5) DEATHS ON BOARD: date, time, circumstances, name, rank; (6) INFECTIOUS DISEASE: any outbreak or suspected communicable disease — must also be reported to port health authority; (7) VACCINATION RECORDS: although typically in individual seafarer files, vaccination given on board should be noted. CONFIDENTIALITY: medical information is confidential to the extent possible — PSC may inspect that the log is maintained but typically cannot read individual case notes in detail unless a specific complaint is being investigated. RETENTION: medical log must be retained on board for 3 years from the last entry. PSC ACTION: if no medical log exists, this is a deficiency — may result in a CIC (Certificate of Inspection Condition) or detention.

B. The medical log is a voluntary record. MLC 2006 requires only that a medical first aid kit be maintained — there is no legal requirement to keep a written medical log for cargo vessels.

C. The medical log only needs to record deaths and serious injuries. Minor illness records are confidential medical records and cannot be held on the vessel.

D. Medical logs are only required for passenger vessels. Cargo vessels must maintain a first aid log only, which records injuries but not illness.