During an MLC inspection, the officer from the flag state asks the master to show the medical chest and confirm it meets the required standard. What legislation governs the medical chest contents, who is responsible for its maintenance, and what is checked?

A. MEDICAL CHEST — GOVERNANCE, RESPONSIBILITY AND INSPECTION: LEGISLATION: (a) SOLAS Chapter III Reg 18 — first aid equipment; (b) MLC 2006 Standard A4.1 — medical care requirements including medicines; (c) UK Merchant Shipping (Medical Stores) Regulations 1995 (as amended) — specifies exact minimum contents by voyage type and vessel size; (d) MSN 1768 (MCA) — list of required medical stores by category. CATEGORIES OF MEDICAL STORES: MS Regulations 1995 specify three categories of vessels (A: ocean, B: coastal, C: near-coastal) with different minimum medical chest requirements. Category A (ocean-going) has the most comprehensive requirement including prescription medications requiring radio medical advice to administer. RESPONSIBILITY: (a) PRIMARY: the master has overall responsibility for the medical stores being present, maintained, and within expiry dates; (b) OPERATIONAL: on many vessels the chief mate is responsible for day-to-day maintenance; (c) Medical stores that are prescription-only (Class A) must be kept locked and accessed under radio medical authority; (d) Log all medications used with the details listed in the medical log. WHAT IS INSPECTED: (1) Inventory against MS Regulations minimum list; (2) Expiry dates — any expired medication is a deficiency; (3) Controlled drugs register (if applicable); (4) Medical equipment (stethoscope, BP cuff, thermometer, AED, suture kit) in working order; (5) Cold storage for medications requiring refrigeration.

B. The medical chest is the company doctor's responsibility ashore. The master only needs to confirm the chest is locked and sealed — contents management is a medical professional's function.

C. There are no specific regulations on medical chest contents for cargo vessels. The company decides what medications to carry based on commercial judgement.

D. The medical chest is only inspected at annual dry dock. PSC and MLC inspectors do not have authority to inspect medical chest contents during port state inspections.

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. 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.