Before departure a crew member presents a valid ENG1 but discloses he is taking medication for controlled hypertension. As master, how do you assess fitness for duty and what are your obligations?

A. FITNESS FOR DUTY — MANAGED MEDICAL CONDITIONS: POSITION OF THE ENG1: A valid ENG1 (or equivalent national medical fitness certificate) means the seafarer has been medically examined and declared fit for sea service by an MCA-approved doctor, who was aware of the hypertension when issuing the certificate. The ENG1 is the primary evidence of fitness — the master is not a medical professional and does not override an approved medical officer's fitness decision. MASTER's ROLE: (1) Accept the ENG1 at face value — the seafarer is deemed fit; (2) Discuss with the crew member: is the condition currently well-controlled? Any recent changes to medication? Any symptoms (headache, dizziness)? (3) Ensure the medical chest has appropriate BP monitoring equipment; (4) Ensure the crew member knows to report any symptoms affecting their duty performance; (5) Consider the duty roster — if the medication causes potential side effects (e.g. diuretics causing fatigue) consider whether this affects watch-keeping schedules; (6) Notify the company DPA so that the P&I Club medical team are aware. WHEN TO ACT: if the crew member becomes symptomatic (severe headache, chest pain, breathlessness, visual disturbance — signs of hypertensive crisis) — treat as a medical emergency: IMGS Chapter on Headache/Chest Pain, seek radio medical advice, consider MEDEVAC. MLC 2006 Standard A1.2: seafarers must hold a medical fitness certificate — the master should retain a copy.

B. Refuse the crew member permission to sail. Any medication use is disqualifying — a crew member on medication cannot stand watch and must be replaced before departure.

C. Ignore the disclosure. The ENG1 is valid and the crew member's medications are a private matter. The master has no role in managing individual medical conditions at sea.

D. Confiscate the medication and monitor the crew member drug-free for the voyage. Medications that affect alertness cannot be taken by watchkeeping officers without the master's supervision.

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.