Table Of Content

SEE-BERUFSGENOSSENSCHAFT German Medical Guide for Ships Manual for Captains and Ship's Officers Dingwort Verlag German Medical Guide for Ships Manual for Captains and Ship's Officers 5th Updated and Extended Edition Edited by See-Berufsgenossenschaft Revised by H. Ebert and B.-F. Schepers Using excerpts from the book "Medizin auf See", 2nd edition 2003, edited by Meinhard Kohfahl and DSV Publishers. Dingwort Publishers © Copyright 2008 by Verlag Carl W. Dingwort, Hamburg Production by Dingwort in Hamburg ISBN 978-3-87166-062-7 Preface For sailors, over lengthy periods, the ship is simultaneously home and workplace. They are thus not in a position to access the resources of medical care available in their homeland. This instruction book provides captains and ship's officers with a manual with which, after the appropriate medical training, they will be placed in the position of being able to implement health protection on board, prevent health hazards, recognise and treat illnesses, help with urgent emergencies, with doctor's advice via the radio when required, according to the specific shipping conditions. Since 1855, when the first instruction book appeared in Germany under the title: Gemeinfassliche Heilkunde und Gesundheitslehre für Schiffsoffiziere (General Medicine and Hygienics for Ship's Officers), experienced experts in maritime medicine have continued to author up-to-date medical instruction books for shipping which take both medical progress and changing shipping conditions into account. Since 1957, the See-Berufsgenossenschaft has been publishing an "German Medical Guide for Ships", which has been updated through 4 editions. It is herewith supplanted by a completely rewritten book of instructions. This new edition was written using the book Medizin auf See (Medicine at Sea), 2nd edition, 2003, written by a team of 28 authors from different fields, edited by Dr. med. Meinhard Kohfahl and published by DSV, whose content is principally geared towards non-commercial seafaring and the German Society for Rescue of Castaways, but the publishing rights of whose text, graphics and images manuscript have been acquired by the See- Berufsgenossenschaft, for which particular thanks are due to the editor and publisher. The adaptation of the book for use in commercial shipping was taken on by Prof. Dr. med. Heinz Ebert, former Director of Hamburg Port Health Centre, and Dr. med. Bernd-Fred Schepers, Medical Director of the See- Berufsgenossenschaft. The entire general section of the book Medizin auf Seeand a number of text components have been rewritten and adapted to the conditions of commercial shipping and the standard of training of the ship's officers. The sections of Medizin auf See where experienced authors deal with pathology and emergency care have for technical reasons been taken over largely unchanged, merely adapted to the conditions of commercial shipping. 3 In the new book, as well as the chapters on health protection on board, pathology and emergency care, the medical training standards for ship's officers according to the STCW Convention, the functional tasks of the officer on board responsible for medical care and cooperation with the radio medical advisory service and port health services are incorporated. The updated "Ordinance for the Medical Care on Seagoing Vessels", together with their appendices, including the list of medicines, medical products and adjuvants, newly compiled by a team of specialists, is to be found in the appendix. This book presents in comprehensible form for all those involved the process of medical care on ships without a ship's doctor, based on practice-related medical training of ship's officers, modern medical facilities, a medical guide for training and use on board, and a radio medical advisory service available at all times during the voyage. Introduction to the English edition In the course of worldwide globalisation, structures in shipping and ship operating have changed as well. On a large proportion of German ships, ship's officers who have received their basic medical training predominantly in English are functionally charged with the implementation of medical care. As a result, English has internationally acquired a high importance in ships' operation and communication on board. This has led to the urgent need to translate the already published German edition of Anleitung zur Krankenfürsorge auf Kauffahrteischiffeninto English. This English edition is completely identical in content with the German edition, as it is imperative to avoid different medical care actions on board. The content of the book follows the recommendations of the International Labour Organisation, the International Maritime Organisation and the World Health Organisation. The See-Berufsgenossenschaft, as editor thanks the translator team of EUROSPEAK e. V., Rostock, under the leadership of Frau Prof. Dr. Edith Buchholz, Rostock, and with the major contribution of Mr. Rowley Newton, London, for their professional translation in close cooperation with the revisers. The Editor 4 List of Authors Andres, Friedrich, Ear, Nose, Throat Diseases Bellmer, Helmut, Radio Communications Bennefeld, Harald, Dr. med., Neurosurgery, Neurology, Sports Medicine Brüning, Harald, Dr. med., Skin and Venereal Diseases Diesch, Jörg, Dr. med., Orthopaedics, Competitive Sport Dressler, Horst, Dr. med., Urologist Ebert, Heinz, Prof. Dr. med., Maritime Medicine, Occupational Medicine Faesecke, Karl-Peter, Dr. med., Diving Medicine, Occupational Medicine Flesche, Christian, Dr. med., Rescue Medicine, Telemedicine Gottwald, Helmut, Dr. med., Eye Diseases Heinrich, Kurt, Prof. Dr. med., Psychiatry Hunger, Wolfgang, Dr. med., Orthopaedics, Sports Medicine Jensen, Hans-Joachim, Prof. Dr. rer. pol., Maritime Psychology Koch, Peter, Dr. med., Intensive Medicine, Anaesthesia, Rescue Medicine Kohfahl, Jens, Dr. med., General and Occupational Medicine, Rescue and Sports Medicine Kohfahl, Meinhard, Dr. med., General, Occupational and Sports Medicine, Kupferschmidt,Hans-Gert, Dr. med. Dr. phil. DTMH, Internal, Tropical, Travel Medicine Laprell, Heinz, Dr. med., Surgery, Orthopaedics Laucht, Reinhard, Dr. med., Internal Medicine Möller, Inge, Photographer Petzold, Thomas, Dr. med., Thorax, Heart und Vascular Surgery Rieckert, Hans, Prof. Dr. med., Sports Medicine Ross, Hans-Georg, Dr. med., Gynaecology and Obstetrics Schaper, Marlies, Graphic Designer Schepers,Bernd-Fred, Dr. med., Maritime Medicine, Occupational Medicine Scheuermann, Egbert, Fleet Chief Petty Officer, Helicopter Pilot Schönle, Christoph, Dr. med., Orthopaedics Stegmann, Thomas, Prof. Dr. med., Thorax, Heart and Vascular Surgery Timmermann, Dirk, Dr. med. dent., Dentistry Volbehr, Klaus-Peter, Dispensing Chemist 5 CONTENTS A. BASICS OF HEALTH PROTECTION ON BOARD.............. 25 1. Ship and cargo ..................................................................... 25 1.1. Crew accommodation / Crew's quarter regulations .......... 25 1.2. Treatment rooms and patients' rooms ................................ 25 1.3. Sanitary areas ......................................................................... 26 1.4. Holds, cargo, ventilation, hazardous cargo, hold gas treatments ............................................................... 26 2. Food and drinking water hygiene ................................... 28 2.1. Food storage rooms, galleys, pantries, messes ................. 28 2.2. Drinking water ........................................................................ 29 2.2.1. Drinking water disinfection (continuous chlorination) .............. 30 2.2.2. Drinking water system disinfection (high chlorination) ............ 31 2.2.3. Implementing disinfection measures ....................................... 32 2.3. Food on board ........................................................................ 33 2.4. Simple methods for inspecting perishable foods ............... 36 3. Pest control .......................................................................... 38 6 Contents 4. Port Health Authorities ...................................................... 39 4.1. General ship clearance .......................................................... 39 4.2. Maritime declaration of health .............................................. 39 4.3. Putting in at foreign ports ..................................................... 40 4.4. Port medical treatments and decisions on ships ............... 40 4.4.1. Protection against infection ..................................................... 40 4.4.2. Infection prophylaxis ................................................................ 40 4.4.3. Health protection ..................................................................... 41 4.5. Conduct at ports where there is a risk of infection ........... 41 4.6. Vaccination and infection prophylaxis ................................. 42 4.6.1. Specific vaccinations ............................................................... 43 4.6.2. Malaria prophylaxis ................................................................. 45 4.6.3. Summary of vaccinations and infection prophylaxis ............... 46 5. Health and nursing care on board .................................. 47 5.1. Health requirements / fitness for sea duty .......................... 47 5.2. Medical training of sailors and ship's officers .................... 47 5.2.1. Training and further training of all sailors ................................. 47 5.2.2. Training and further training of ship's officers ......................... 48 5.3. Brief summary of medical training and refresher training of ship's officers ...................................... 49 5.3.1. Minimum standards for qualification in elementary "first aid" ............................................................... 50 5.3.2. Minimum requirements for suitability for "medical care" .................................................................... 51 5.4. Functional tasks of the responsible officer (short designation "health officer") ...................................... 53 5.4.1. Prerequisites for the employment of a ship's officer as health officer ...................................................................... 53 5.4.2. Tasks before sailing .................................................................. 53 5.4.3. Tasks during the trip ................................................................ 54 5.4.4. Tasks before arriving at home port ......................................... 54 5.4.5. Obligations to port health service .......................................... 54 5.5. Principles of treatment .......................................................... 55 5.6. Giving medication .................................................................. 56 5.6.1. Specific forms of drug application ........................................... 57 5.6.2. Rules the health officer must observe when applying medication................................................................................. 59 7 5.7. Nursing under on-board conditions ..................................... 59 5.7.1. General nursing ........................................................................ 59 5.7.2. Nursing of patients with infectious diseases ........................... 60 5.7.3. Disinfection and disinfectants .................................................. 61 5.7.3.1. Solutions for the disinfection of skin and instruments............. 62 5.7.3.2. Disinfectants for areas, things and excretions ........................ 62 5.7.3.3. Insecticide sprays .................................................................... 62 5.7.3.4. Body vermin emulsion ............................................................. 63 5.7.3.5. Disinfectant for drinking water ................................................. 63 5.7.4. Hot and cold applications ........................................................ 63 5.7.5. Evacuation of the bowels and bladder .................................... 64 5.7.5.1. Evacuation of the bowels ......................................................... 64 5.7.5.2. Evacuation of the bladder ........................................................ 65 5.7.6. Patient diet ............................................................................... 65 6. The workplace of the health officer ............................... 66 6.1. Treatment room and sickbay facilities ................................. 66 6.1.1. The treatment room ................................................................. 67 6.1.2. Patients' room .......................................................................... 68 6.1.3. Sanitary rooms ......................................................................... 70 6.2. Ship's medical gear / ship's dispensary .............................. 70 6.2.1. Storage of ship's medical gear ................................................ 70 6.2.1.1. Ship's dispensary cabinet ........................................................ 70 6.2.1.2. Cold storage of drugs .............................................................. 71 6.2.1.3. Storage of narcotics ................................................................. 71 6.2.1.4. Labelling (signing) of drugs ...................................................... 71 6.2.1.5. Lifeboat and life raft medical equipment ................................. 71 6.2.1.6. Care and storage of instruments, nursing appliances and dressing material ............................................................... 72 6.3. Checking, provision and completion of ship's medical gear ........................................................................... 72 6.4. Keeping records of and reporting medical actions ........... 73 6.4.1. Patients' register ...................................................................... 73 6.4.2. Controlled drugs register ......................................................... 73 6.4.3. Progress report ........................................................................ 73 6.4.4. Temperature chart / course of disease and treatment ............ 74 7. Structure and functions of the human body ............... 75 7.1. General .................................................................................... 75 7.2. Nervous system ...................................................................... 75 7.3. Bones ...................................................................................... 76 7.4. Heart / blood vessels / blood circulation ............................ 77 8 Contents 7.5. Lungs / air passages / respiration ....................................... 78 7.6. Digestive organs / other abdominal organs / digestion..... 78 7.7. Urinary and sexual organs..................................................... 79 B. PATHOLOGY .......................................................................... 88 1. Diagnosis .............................................................................. 88 1.1. Examination ............................................................................ 88 1.2. Case history ............................................................................ 89 1.3. Guiding symptoms ................................................................. 90 1.3.1. Heart-lung symptoms .............................................................. 92 1.3.1.1. Collapse ................................................................................... 92 1.3.1.2. Heart rhythm disorders ............................................................ 93 1.3.1.3. Cessation of breathing ............................................................. 94 1.3.1.4. Shortness of breath ................................................................. 95 1.3.1.5. Coughing .................................................................................. 96 1.3.1.6. Pains in the chest .................................................................... 97 1.3.2. Abdominal symptoms .............................................................. 98 1.3.2.1. Pains in the upper abdomen .................................................... 98 1.3.2.2. Pains in the lower abdomen .................................................... 99 1.3.2.3. Pains in the lower abdomen of women ................................. 100 1.3.2.4. Vomiting ................................................................................. 101 1.3.2.5. Bloody vomiting ..................................................................... 102 1.3.2.6. Diarrhoea ................................................................................ 103 1.3.2.7. Constipation ........................................................................... 104 1.3.2.8. Bowels bleeding ..................................................................... 105 1.3.3. Neurological symptoms ........................................................ 106 1.3.3.1. Headache ............................................................................... 106 1.3.3.2. Cramps ................................................................................... 107 1.3.3.3. Paralysis ................................................................................. 108 1.3.3.4. Mental confusion .................................................................... 109 1.3.3.5. Dizziness ................................................................................ 110 1.3.3.6. Loss of sight .......................................................................... 111 1.3.4. Urological symptoms ............................................................ 112 1.3.4.1. Urge to urinate ....................................................................... 112 1.3.4.2. Urine suppression .................................................................. 113 1.3.4.3. Bleeding from the bladder ......................................................114 1.3.4.4. Pains in the kidney area ......................................................... 115 1.3.4.5. Swelling in the testicle area ................................................... 116 9