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SHIPS’ MEDICAL STORES
Application of the Merchant Shipping and FishingVessels (Medical Stores) Regulations 1995 (SI 1995/1802) and the Merchant Shipping and FishingVessels (Medical Stores) (Amendment) Regulations1996 (SI 1996/2821)
Notice to Shipowners, Agents, Masters, Skippers of Fishing Vessels and all Seafarers.
This Notice supersedes Merchant Shipping Notice MSN 1726 (M+F) and should be read in conjunctionwith the above mentioned Regulations, and MSN 1776 (M) and MGN 257 (M).
MERCHANT SHIPPING NOTICE
Summary
This Notice sets out the minimum requirements for medical stores for UK ships under the aboveRegulations. Basic statutory requirements (deriving from EC directive 92/29/EEC) remain as in theprevious Notice (MSN 1726) but where appropriate the recommended treatments and specificmedicines have been updated. It covers:
• The definitions of categories of vessel for the purposes of the Regulations
• Medical stores required and recommended additional equipment………………………….. Annex 1
• Additional requirements for passenger vessels - Doctor’s Bag ………………………….. Annex 2
• First aid kits ………………………….. Annex 3
• Advice on medicines to be carried on ships (including ferries) transporting dangerous substances …………………………. Annex 4
• Medical guides to be carried and Radio Medical Advice …………………………. Annex 5
• Precautions against malaria …………………………. Annex 6
• Guide to use of medicines ………………………….. Annex 7
• Specimen requisition form for obtaining controlled drugs …………………………. Annex 8
• Completion of the controlled drugs register …………………………. Annex 9
MSN 1768 (M+F)
1
MSN-1768 28/8/03 2:13 am Page 1
1.0 REGULATIONS
1.1 The United Kingdom implemented therequirements of Council Directive 92/29/EEC,which sets out the minimum standards forships’ medical stores, by introducing theMerchant Shipping and Fishing Vessel(Medical Stores) Regulations 1995, as amendedby the Merchant Shipping and Fishing Vessel(Medical Stores) (Amendment) Regulations1996 (referred to as the Regulations). ThisNotice provides details of the required medical stores.
2.0 VESSEL CATEGORIES
2.1 The categories of vessels and the consequentrequirements for medical stores andequipment areas are set out in the Directive.The vessel categories are :
Category A Seagoing or sea-fishing vessels withno limitation on length of trips.
Category B Seagoing or sea-fishing vesselsmaking trips of less than 150 nauticalmiles from the nearest port withadequate medical equipment. Thiscategory is extended to seagoing orsea-fishing vessels which make tripsof less than 175 nautical miles fromthe nearest port that has adequatemedical equipment and which remaincontinuously within range ofhelicopter rescue services.
Category C Harbour vessels, boats and craftstaying very close to shore or with nocabin accommodation other than awheelhouse. Lifeboats and life-raftsare also required to carry Category C stores.
The UK interprets the phrase "very close to shore"as meaning that a vessel operating more than 60nautical miles out to sea would not be operatingvery close to shore. Notwithstanding thisinterpretation, it is for owners and skippers, for thepurpose of complying with the Regulations, toassess whether, in respect of voyages in which thevessel goes less than 60 nautical miles out to sea, thevessel is "very close to shore".
2.2 The following vessels are excluded from therequirements of this Notice:
• inland navigational vessels, defined in theRegulations as those vessels plying on watersof Categories A to C as defined in MerchantShipping Notice MSN 1776 (M).
• warships
• pleasure boats used for non-commercialpurposes and not manned by professionalcrews, defined in the Regulations as follows:
any vessel which at the time it is being used is:
(a) (i) in the case of a vessel wholly owned by anindividual or individuals, used only for thesport or pleasure of the owner or theimmediate family or friends of the owner;or
(ii) in the case of a vessel owned by a bodycorporate, the persons on the vessel areemployees or officers of the body corporate,or their immediate family or friends; and
(b) (i) on a voyage or excursion which is one forwhich the owner does not receive anymoney for or in connection with operatingthe vessel or carrying any person, otherthan as a contribution to the direct expensesof the operation of the vessel incurredduring the voyage or excursion; or
(ii) wholly or partly owned by or on behalf of amembers’ club formed for the purpose ofsport or pleasure of members of that club ortheir immediate family; and for the use ofwhich any charges levied are paid into clubfunds and applied for the general use of theclub; and
(iii)in the case of any vessels referred to inparagraph (i) or (ii) above, no otherpayments are made by or on behalf of usersof the vessel, other than by the owner.
• tugs operating in harbour areas, - as definedin the Regulations "tug" means a vesselconstructed solely for the purpose of, andnormally used for providing external motivepower to, floating objects or vessels.
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MSN-1768 28/8/03 2:13 am Page 2
3.0 MEDICAL STORES REQUIREMENTS
3.1 The requirements and recommended stores areset out in the attached schedules.
Annex 1 Requirements for Categories A, B & C vessels and recommendedadditional equipment
Annex 2 Additional requirements forpassenger ships – Doctor’s Bag
Annex 3 First Aid Kits
Annex 4 Requirements for ships carryingdangerous cargoes
3.2 A checklist of all the medicines and equipmentrequired by this MSN should be kept on boardand reviewed annually.
4.0 MEDICINES FOR SHIPS CARRYINGDANGEROUS CARGOES
4.1 Ships, including ferries, carrying dangerouscargoes or their residues, should comply withthe International Maritime Dangerous Cargoes(IMDG) Code and the guidance in theIMO/WHO/ILO Medical First Aid Guide for use in accidents involving DangerousGoods (MFAG) 1994 and any subsequentamendments, and the guidance in Annex 4.
5.0 CARRIAGE OF DEFIBRILLATORS
5.1 There is no statutory requirement underinternational or national legislation for ships tocarry defibrillators. It is accordingly a matterfor individual operators to decide whether ornot to include a defibrillator with the medicalstores or doctor’s bag. If a defibrillator iscarried, MCA recommends that systems are in place to ensure regular maintenance of the equipment (in accordance with themanufacturer’s instructions), and adequatetraining for the first aiders, including regularrefresher training (at least every 6 months).Training should also particularly cover care of the patient after defibrillation, bearing inmind that immediate hospitalisation may notbe possible.
6.0 MEDICAL GUIDES AND RADIO MEDICALADVICE
6.1 The Ship Captain’s Medical Guide should bereferred to for help with diagnosis. This Noticeshould be kept with the current edition of theGuide. Radio medical advice should be soughtas appropriate (See Annex 5).
7.0 SHIPS’ DOCTORS
7.1 Under the Merchant Shipping (Ships’ Doctors)Regulations 1995 all UK registered ships whichcarry more than 100 persons on board, andwhich are engaged on an international voyageof more than three days, or on a voyage whichis more than one and a half days from port withadequate medical equipment, are required tocarry a qualified medical practitioner.
8.0 RESPONSIBILITIES OF THE OWNER,EMPLOYER AND THE MASTER
8.1 Responsibility of the owner
The owner of the vessel is responsible for thecost of any medicine and medical equipment,including the periodic replacements in order tokeep stocks of any required medicines in dateand immediately useable.
8.2 Responsibility of the seafarer’s employer
Section 45 of the Merchant Shipping Act 1995specifies, among other things, that if a person,while employed in a UK ship receives anysurgical or medical treatment or such dental or optical treatment (including repair orreplacement of any appliance) outside the UK,that cannot be postponed without impairingthe seafarer’s efficiency, the reasonableexpenses of this treatment shall be paid by the employer(s).
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MSN-1768 28/8/03 2:13 am Page 3
8.3 Responsibility of the Master
Where a United Kingdom ship does not carry adoctor among the seafarers employed in it,Section 53 of the Merchant Shipping Act 1995holds the Master responsible for ensuring thatany necessary medical attention given onboard ship is given either by him, or under hissupervision, by a person appointed by him forthat purpose. The Master is also responsible for the management of the medical suppliesand ensuring that they are maintained in good condition.
8.4 IMMUNISATION ARRANGEMENTS
8.4 Ship operators, employers and the Master allhave a duty of care to protect the health andsafety of workers, so far as reasonablypracticable. This responsibility includes takingsteps to minimise the risk of infection andensuring appropriate preventative measuressuch as immunisation are taken. Generalguidance on precautions against malaria can befound in Annex 6 and specific guidance onimmunisation and anti-malaria medication(prophylaxis) is given in Marine GuidanceNote MGN 257 (M)
9.0 FURTHER INFORMATION
9.1 Further information on the contents of thisNotice may be obtained from any MCA MarineOffice or the Seafarer Health and Safety Branchat the address below :
Seafarer Health and Safety BranchMaritime & Coastguard Agency2/09 Spring Place105 Commercial RoadSouthamptonSO15 1EG
www.mcga.gov.uk
Tel: 023 80329249Fax: 023 80329251Email : seafarer_h&[email protected]
MS 016/022/0140
August 2003
© Crown Copyright 2003
4
The MCA is an executive agencyof the Department for TransportSafer Lives, Safer Ships, Cleaner Seas
MSN-1768 28/8/03 2:13 am Page 4
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
1. C
ard
io V
ascu
lar
(a)
Car
dio
vas
cula
r an
alep
tics
Sym
path
omim
etic
sA
dre
nalin
e /
Epi
neph
rine
inje
ctio
n B
P0.
5ml
10*
5*-
– ad
rena
line
acid
tart
rate
inje
ctio
n 1.
0mg
in
1ml (
1 in
100
0)
and
/ o
r E
pipe
n (
Ad
rena
line
0.3m
g)5
5-
5
AN
NE
X 1
ME
DIC
AL
ST
OR
ES
FO
R V
ES
SE
LC
AT
EG
OR
IES
A, B
& C
(see
def
init
ions
on
Page
2 o
f th
e N
otic
e)
For
any
item
s m
arke
d* t
he s
peci
fied
quan
tity
is c
onsi
dere
d su
ffici
ent
rega
rdle
ss o
f cre
w s
ize.
Ow
ners
and
ope
rato
rs m
ay, o
n th
e ad
vice
of a
qua
lifie
d m
edic
al p
ract
itio
ner
or p
harm
acis
t, d
eter
min
e w
heth
er a
ny a
dd
itio
nal o
r d
iffe
rent
qua
ntit
ies,
pro
duc
tsor
equ
ipm
ent
are
requ
ired
, tak
ing
into
acc
ount
the
fac
tors
iden
tifi
ed b
elow
and
any
oth
er r
elev
ant
cons
ider
atio
n: t
he n
atur
e of
the
voy
age
and
in p
arti
cula
rpo
rts
of c
all,
natu
re o
f th
e ca
rgo,
des
tina
tion
, num
ber
of c
rew
, dur
atio
n of
voy
age
and
ty
pe o
f w
ork
to b
e ca
rrie
d o
ut d
urin
g th
e vo
yage
. For
exa
mpl
e, a
nti-
mal
aria
l d
rugs
may
be
appr
opri
ate
if a
shi
p is
ope
rati
ng i
n tr
opic
al a
reas
. (se
e M
GN
257
(M
) fo
r gu
idan
ce o
n im
mun
isat
ions
and
ant
i-m
alar
ia m
edic
atio
n).
In th
is A
nnex
col
umns
are
as
follo
ws:
Col
um
n 1
Is th
e re
fere
nce
num
ber
in E
C D
irec
tive
92/
29. T
his
is in
clud
ed f
or id
enti
fica
tion
of
trea
tmen
ts w
hen
seek
ing
or r
ecei
ving
rad
io m
edic
al a
dvi
cefr
om a
ny E
urop
ean
Com
mun
ity
Mem
ber
Stat
e.C
olu
mn
2Is
the
stat
utor
ily r
equi
red
trea
tmen
t w
hich
mus
t be
avai
labl
e to
com
ply
wit
h th
e R
egul
atio
ns.
Col
um
n 3
Is th
e re
com
men
ded
med
icin
e an
d d
osag
e st
reng
th w
hich
MC
Aco
nsid
ers
best
com
plie
s w
ith
the
stat
utor
ily r
equi
red
trea
tmen
t. O
wne
rs a
ndop
erat
ors
may
sub
stit
ute
exac
t equ
ival
ents
on
the
advi
ce o
f a
qual
ifie
d m
edic
al p
ract
itio
ner
or p
harm
acis
t, pr
ovid
ed th
ey a
re s
atis
fied
that
an
equi
vale
nt le
vel o
f tr
eatm
ent i
s as
sure
d.
Col
um
n 4
Is th
e re
com
men
ded
qua
ntit
y of
med
icin
e /
equ
ipm
ent w
hich
MC
Aco
nsid
ers
suff
icie
nt to
pro
vid
e tr
eatm
ent f
or 1
0 w
orke
rs o
r fo
r th
e cr
ew o
fa
life
boat
or
life-
raft
.R
ecom
men
ded
qua
ntit
ies
(Col
umn
4) w
ill n
ot a
lway
s re
flec
t sta
ndar
d p
acks
. In
this
cas
e th
e re
com
men
dat
ion
is f
or th
e ne
ares
t ava
ilabl
ed
ispe
nsin
g sa
les
pack
abo
ve th
e m
inim
um r
ecom
men
ded
qua
ntit
y. T
his
will
ens
ure
the
pati
ent i
nfor
mat
ion
leaf
let i
s en
clos
ed.
MSN-1768 28/8/03 2:13 am Page 5
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Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
(b)
Ant
i-an
gina
pre
para
tion
sG
lyce
ryl T
rini
trat
e Sp
ray
400
mic
rogr
ams
/
1 un
it1
unit
1 un
itm
eter
ed 2
00 d
ose
aero
sol
and
tr
ansd
erm
al p
atch
es 5
mg
x 2
22
-
(c)
Diu
reti
cs
Frus
emid
e /
Fur
osem
ide
i) 4
0mg
tabl
ets
28*
28*
-ii)
10m
g in
1m
l inj
. (2m
l am
poul
e)2
--
(d)
Ant
i-ha
emor
rhag
ics
if th
ere
are
wom
en w
ith
i)Ph
ytom
enad
ione
(V
itam
in K
1)1*
1*-
pote
ntia
l for
chi
ld b
eari
ng w
orki
ng o
n bo
ard
pa
edia
tric
inje
ctio
n (0
.2m
l am
poul
e)(i
nclu
din
g ut
erto
nics
).ii)
Erg
omet
rine
500
mcg
, O
xyto
cin
5 un
its
2*1*
-(1
ml a
mpo
ule)
(Sy
ntom
etri
ne)
(e)
Ant
i-hy
pert
ensi
veA
teno
lol 5
0mg
tabl
ets
28-
-
2. G
astr
o in
test
inal
sys
tem
(a)
Med
icin
es f
or g
astr
ic a
nd d
uod
enal
dis
ord
ers
• H
ista
min
e H
2 re
cept
or a
nti-
ulce
r an
tago
nist
sC
imet
idin
e 40
0mg
tabl
ets
60-
-
• A
ntac
id m
ucou
s m
ixtu
rePr
opri
etar
y A
ntac
id o
f ch
oice
As
reqd
As
reqd
-
6
MSN-1768 28/8/03 2:13 am Page 6
7
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
(b)
Ant
i-em
etic
si)
Proc
hlor
pera
zine
mal
eate
3m
g bu
ccal
tabl
ets
50*
50*
-
ii)Pr
omet
hazi
ne h
ydro
chlo
rid
e 25
mg
10*
--
per
ml (
1ml a
mpo
ules
)
iii)H
yosc
ine
hyd
robr
omid
e 0.
3mg
tabl
ets
6060
60
or C
inna
rizi
ne 1
5mg
6060
60
(c)
Lub
rica
nt la
xati
ves
Gly
cero
l Sup
posi
tory
mou
ld 4
mg
12-
-
(d)
Ant
i-d
iarr
hoea
lsL
oper
amid
e 2m
g ca
psul
es30
3030
(e)
Inte
stin
al a
ntis
epti
csi)
Trim
etho
prim
200
mg
tabl
ets
Use
7(b
) U
se 7
(b)
- ii)
Cip
rofl
oxac
in 5
00m
g ta
blet
s7(
a)ii
7(a)
ii-
iii)M
etro
nid
azol
e 40
0mg
tabl
ets
7(e)
7(e)
-
(f)
Hae
mor
rhoi
d p
repa
rati
ons
Prop
riet
ary
prep
arat
ion
of c
hoic
eA
s re
qdA
s re
qd-
3. A
nal
gesi
cs A
nti
– S
pas
mod
ics
(a)
Ana
lges
ics,
ant
i-py
reti
cs a
nd
i)Pa
race
tam
ol 5
00m
g ta
blet
s10
050
50an
ti-i
nfla
mm
ator
y ag
ents
and
ii)Ib
upro
fen
400m
g ta
blet
s10
050
50
iii)D
iclo
fena
c so
diu
m 5
0mg
sup
posi
tory
10-
-
MSN-1768 28/8/03 2:13 am Page 7
8
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
(b)
Pow
erfu
l ana
lges
ics
i)C
odei
ne P
hosp
hate
30m
g ta
blet
s28
28-
ii)M
orph
ine
Sulp
hate
10m
g in
1m
l10
10-
inje
ctio
n (1
ml a
mpo
ule)
or Nal
buph
ine
10m
g in
1m
l inj
ecti
on10
10-
(c)
Spas
mol
ytic
sH
yosc
ine
buty
lbro
mid
e 10
mg
tabl
ets.
5656
-
4. N
ervo
us
syst
em
(a)
Anx
iolit
ics
i)D
iaze
mul
s in
ject
ion
5mg
per
ml,
5*-
-(2
ml a
mpo
ules
)ii)
Dia
zepa
m 5
mg
tabl
ets
28*
--
(b)
Neu
role
ptic
si)
Chl
orpr
omaz
ine
hyd
roch
lori
de
25m
g in
ject
ion
5*-
-
ii)C
hlor
prom
azin
e hy
dro
chlo
rid
e 25
mg
tabl
ets
28*
28*
-
(c)
Seas
ickn
ess
rem
edie
sH
yosc
ine
hyd
robr
omid
e 0.
3mg
tabl
ets
Use
2b(
iii)
Use
2b(
iii)
Use
2b(
iii)
or Cin
nari
zine
15m
g
(d)
Ant
i-ep
ilept
ics
Dia
zepa
m r
ecta
l dis
pens
er 1
0mg
in 2
.5m
l5
5-
5. A
nti
-all
ergi
cs a
nd
An
ti-a
nap
hyl
acti
cs
(a)
H1
Ant
i-hi
stam
ines
Cet
rirz
ine
10m
g ta
blet
s30
*30
*-
MSN-1768 28/8/03 2:13 am Page 8
9
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
(b)
Inje
ctab
le /
oral
glu
coco
rtic
oid
si)
Hyd
roco
rtis
one
inje
ctio
n po
wd
er f
or
31
-re
cons
titu
tion
100
mg
vial
wit
h 2m
l wat
er
for
inje
ctio
n /
rea
dy
dilu
ted
100
mg
in
1ml i
njec
tion
ii)Pr
edni
solo
ne 5
mg
tabl
ets
2828
-
6. R
esp
irat
ory
Sys
tem
(a)
Bro
ncho
spas
m p
repa
rati
ons
i)Sa
lbut
amol
inha
ler
100
mic
rogr
ams
per
11
-m
eter
ed d
ose.
200
dos
e in
hale
r w
ith
volu
mat
ic
ii)B
eclo
met
haso
ne 1
00 m
icro
gram
s pe
r 1
1-
met
ered
dos
e in
hale
r
(b)
Ant
i-tu
ssiv
esPr
opri
etar
y co
ugh
mix
ture
As
reqd
As
reqd
-
(c)
Med
icin
es u
sed
for
col
ds
and
sin
usit
isPa
race
tam
ol 5
00m
g ta
blet
sU
se 3
a(i)
Use
3a(
i)-
or Prop
riet
ary
cold
rem
edy
As
reqd
As
reqd
-
MSN-1768 28/8/03 2:13 am Page 9
10
12
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Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
7. A
nti
-in
fect
ion
(a)
Ant
ibio
tics
i)B
enzy
lpen
icill
in –
ben
zylp
enic
illin
sod
ium
10
2-
600m
g in
ject
ion
(pow
der
for
rec
onst
itut
ion
in
a ru
bber
cap
ped
and
met
al to
pped
via
l) a
nd
wat
er f
or in
ject
ion
2ml
ii)C
ipro
flox
acin
(as
hyd
roch
lori
de)
500
mg
tabl
ets
2010
-
iii)C
efur
oxim
e in
ject
ion
750m
g vi
al a
nd w
ater
20-
-fo
r in
ject
ion
iv)E
ryth
rom
ycin
250
mg
tabl
ets
2828
-
v)D
oxyc
yclin
e 10
0mg
caps
ules
8-
-
(b)
Ant
i-ba
cter
ial
/
Trim
etho
prim
200
mg
tabl
ets
1414
-(c
)U
rina
ry a
ntis
epti
cs
(d)
Ant
i-pa
rasi
tics
Meb
end
azol
e 10
0mg
tabl
ets
6*6*
-
(e)
Inte
stin
al a
nti-
infe
ctiv
esM
etro
nid
azol
e su
ppos
itor
ies
1g10
--
Met
roni
daz
ole
500m
g or
400
mg
tabl
ets
2121
-
(f)
Ant
i-te
tanu
s va
ccin
es a
nd im
mun
oglo
bulin
i)Te
tanu
s V
acci
ne (
0.5m
l am
poul
e) o
r 5*
1*-
Teta
nus
& D
ipht
heri
a V
acci
ne
ii)Te
tanu
s Im
mun
oglo
bulin
am
poul
e fo
r in
ject
ion
1*-
-
MSN-1768 28/8/03 2:13 am Page 10
11
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
8. C
omp
oun
ds
pro
mot
ing
reh
ydra
tion
, cal
oric
in
tak
e an
d p
lasm
a ex
pan
sion
WH
O G
ener
ic
Sod
ium
chl
orid
e &
dex
tros
e re
hyd
rati
on s
alts
1
Box
1 B
ox-
Form
ula
sach
ets
of O
ral R
ehyd
rati
on S
alts
, For
mul
a A
. (1
6-20
)(1
6-20
)B
PO
ral p
owd
er in
sac
het t
o pr
ovid
e N
a=35
mm
ol,
K=
20m
mol
, Cl-
37m
mol
, HC
O3 =
18
mm
ol a
nd g
luco
se 2
00m
mol
whe
n re
cons
titu
ted
in a
litr
e of
wat
eror Pr
opri
etar
y eq
uiva
lent
e.g
. Dio
raly
te
9. M
edic
ines
for
ext
ern
al u
se
(a)
Skin
Med
icin
es
Ant
isep
tic
solu
tion
s10
0ml s
olut
ion
or p
re-i
mpr
egna
ted
wip
es
1* b
ottl
e 1*
bot
tle
1* b
ottl
e co
ntai
ning
0.0
15%
w/
v ch
lorh
exid
ine
and
or
1 p
ack
or 1
pac
k or
1 p
ack
0.15
% w
/v
cetr
imid
ew
ipes
wip
esw
ipes
Ant
ibio
tic
oint
men
tsN
eom
ycin
/ B
acit
raci
n cr
eam
15g
tube
11
-
Ant
i-in
flam
mat
ory
and
ana
lges
ic o
intm
ents
i)H
ydro
cort
ison
e 1%
cre
am 1
5g tu
be2
--
ii)Pr
opri
etar
y N
SAID
gel
/oi
ntm
ent
As
reqd
As
reqd
As
reqd
Ant
i-m
ycot
ic s
kin
crea
ms
i)B
enzo
ic o
intm
ent B
P50
mg(
benz
oic
acid
6%
;3
1-
salic
ylic
aci
d 3
%, i
n em
ulsi
fyin
g oi
ntm
ent 1
5g
ii)M
icon
azol
e ni
trat
e 2%
topi
cal c
ream
30g
21
-iii
)Clo
trim
azol
e 50
0mg
pres
sary
(if
wom
en
21
-on
boar
d).
Bur
n pr
epar
atio
nsi)
Si
lver
Sul
phad
iazi
ne 1
% c
ream
50g
tube
21
-
ii)Pr
opri
etar
y an
tise
ptic
cre
am-
-1
{}
MSN-1768 28/8/03 2:13 am Page 11
12
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
Mis
cell
aneo
us
skin
pre
par
atio
ns
i)Pe
rmet
hrin
1%
in a
bas
e co
ntai
ning
2*
--
isop
ropy
lalc
ohol
20%
Cre
am R
inse
ii)Z
inc
oint
men
t, B
P(c
onta
inin
g zi
nc
1*-
-ox
ide
15%
) 25
g
iii)P
otas
sium
per
man
gana
te c
ryst
als
1*
--
10g
cont
aine
r /
Per
mit
abs
pack
(b)
Eye
Med
icin
es
- A
ntib
ioti
c oi
ntm
ent
Chl
oram
phen
icol
1%
4g
tube
41
-
All
eye
drop
s ar
e re
com
men
ded
inM
inim
(si
ngle
dos
e) fo
rm:
- A
ntib
ioti
c d
rops
Neo
myc
in s
ulph
ate
0.5%
0.5
ml
2020
-
- A
nti-
infl
amm
ator
y d
rops
Dex
amet
haso
ne s
odiu
m p
hosp
hate
0.1
% 0
.5m
l20
20-
- A
naes
thet
ic d
rops
Am
etho
cain
e hy
dro
chlo
rid
e 0.
5% 0
.5m
l20
20-
- H
ypot
onic
dro
psPi
loca
rpin
e ni
trat
e 2%
0.5
ml
2020
-
- D
iagn
osti
c d
rops
Fluo
resc
ein
sod
ium
1%
0.5
ml
2020
-(f
or d
etec
tion
of
fore
ign
bod
ies
/
scra
tche
s /
ulc
ers)
(c)
Ear
/ Nas
al M
edic
ines
Ant
ibio
tic
/ a
nti i
nfla
mm
ator
y so
luti
onA
ntib
ioti
c ea
rdro
ps c
onta
inin
g in
eac
h m
l; ne
omyc
in
1*1*
-3,
400
unit
s, p
olym
ixin
B s
ulph
ate
10,0
00 u
nits
, hy
dro
cort
ison
e 50
mg
(5m
l dro
pper
bot
tle)
MSN-1768 28/8/03 2:13 am Page 12
13
12
34
Ref
. No.
Stat
utor
y Tr
eatm
ent
Req
uire
men
tsR
ecom
men
ded
Med
icin
e an
d D
osag
eR
ecom
men
ded
quan
tity
for
10
Stre
ngth
Rep
rese
ntin
g be
st p
ract
ice.
wor
kers
AB
C
Dec
onge
stan
t sol
utio
n : E
phed
rine
nas
al
1*1*
-d
rops
BP
0.5%
eph
edri
ne h
ydro
chlo
rid
e (1
0ml b
ottl
e)
(d)
Med
icin
es f
or o
ral
and
th
roat
in
fect
ion
s
Ant
ibio
tic
or a
ntis
epti
c m
outh
was
hes
Chl
orhe
xid
ine
gluc
onat
e 0.
2% m
outh
was
h 30
0 m
l1
1-
(e)
Loc
al a
nae
sth
etic
s
Loc
al a
naes
thet
ics
give
n by
sub
cuta
neou
s in
ject
ion
Lig
noca
ine
/ L
idoc
aine
5
5-
hyd
roch
lori
de
1% 5
0mg
in 5
ml f
or in
ject
ion
Loc
al a
naes
thet
ic g
elL
igno
cain
e /
Lid
scai
ne g
el 2
%, c
hlor
lexi
din
e 1
--
0.25
% in
lubr
ican
t (sy
ring
e)
Den
tal a
naes
thet
ics
and
ant
isep
tic
mix
ture
si)
Prop
riet
ary
gel e
.g. B
onje
la1
1-
ii)O
il of
Clo
ves
10m
l1*
1*-
MSN-1768 28/8/03 2:13 am Page 13
14
ME
DIC
AL
EQ
UIP
ME
NT
Stat
utor
y R
equi
rem
ents
Rec
omm
ende
d Sp
ecif
icat
ion
Qua
ntit
yA
BC
1. R
esu
scit
atio
n E
qu
ipm
ent
App
lianc
e fo
r th
e ad
min
istr
atio
n of
oxy
gen
Oxy
gen
givi
ng s
et c
ompr
isin
g of
the
follo
win
g:-
11
-
1)O
xyge
n re
serv
oir
(e.g
. D S
ize
300l
tr c
ylin
der
)2)
1 fl
ow m
eter
uni
t giv
ing
a m
inim
um s
etti
ng o
f no
t les
s th
an 4
ltrs
per
min
ute
3)1
pres
sure
reg
ulat
ing
unit
4)1
set o
f tu
bing
5)5
x 24
% o
xyge
n d
ispo
sabl
e fa
ce m
asks
6)5
x hi
gh c
once
ntra
tion
oxy
gen
dis
posa
ble
face
mas
ks w
ith
a re
serv
oir.
Eac
h pa
rt c
onst
ruct
ed s
o th
at it
can
onl
y be
ass
embl
ed in
the
corr
ect m
anne
rM
echa
nica
l asp
irat
or to
cle
ar u
pper
res
pira
tory
pas
sage
sA
spir
ator
to c
lear
air
way
s (m
anua
l, ha
nd
11
-op
erat
ed)
+ 2
cat
hete
rsE
quip
men
t for
mou
th to
mou
th r
esus
cita
tion
Pock
et f
ace
mas
k w
ith
val
ve a
nd O
21
11
inle
t Gue
dal
Air
way
Siz
es 3
& 4
11
-
2. D
ress
ing
and
su
turi
ng
equ
ipm
ent
Dis
posa
ble
skin
sta
pler
/or
sut
ure
kit
1)St
erile
non
-abs
orba
ble
sutu
res
swag
ed to
a
6-
-(i
nclu
din
g st
aple
rem
over
)ha
lf c
ircl
e ne
edle
wit
h a
cutt
ing
edge
2 si
zes
e.g.
16m
m &
26m
m
2)St
erile
abs
orba
ble
sutu
res
swag
ed to
a
3-
-ha
lf c
ircl
e ne
edle
1 s
ize
e.g.
26m
m
MSN-1768 28/8/03 2:13 am Page 14
Stat
utor
y R
equi
rem
ents
Rec
omm
ende
d Sp
ecif
icat
ion
Qua
ntit
yA
BC
Ad
hesi
ve e
last
ic b
and
age
Ad
hesi
ve e
last
ic b
and
age
7.5c
m x
4m
41
1C
repe
ban
dag
e 7.
5cm
x 4
m4
4-
Tubu
lar
gauz
e ba
ndag
e, f
or f
inge
r d
ress
ings
20m
leng
th w
ith
appl
icat
or1
1-
Dis
posa
ble
glov
esL
atex
fre
e, v
inyl
25pr
s25
prs
5prs
Ad
hesi
ve d
ress
ings
Ass
orte
d s
teri
le40
4020
Ster
ile b
and
ages
wit
h un
med
icat
ed d
ress
ings
(1)
med
ium
, No.
1 (1
2x10
) cm
53
2(A
mbu
lanc
e d
ress
ings
)(2
) la
rge,
No.
2 (2
0x15
) cm
53
2(3
) ex
tra
larg
e, N
o.3
(28x
20)
cm4
21
Ad
hesi
ve s
utur
es75
mm
ad
hesi
ve s
utur
e st
rips
66
6St
erile
gau
ze s
wab
sPa
cket
con
tain
ing
5 st
erile
gau
ze p
ads
size
10
51
7.5c
m x
7.5
cmSt
erile
she
et f
or b
urns
vic
tim
s1
1-
Tria
ngul
ar s
ling
/ b
and
age
44
-Pa
raff
in g
auze
dre
ssin
gs, s
ize
10cm
x 1
0cm
4010
-
3. I
nst
rum
ents
Dis
posa
ble
scal
pels
e.g.
10
blad
es2
--
Stai
nles
s st
eel i
nstr
umen
t box
11
-Sc
isso
rsSt
ainl
ess
stee
l dre
ssin
g sc
isso
rs
11
-Sh
arp
poin
ted
sci
ssor
s1
1-
Dis
sect
ing
forc
eps
toot
hed
11
-H
aem
osta
tic
clam
ps1
1-
Nee
dle
for
ceps
1-
-D
ispo
sabl
e ra
zors
5-
-
4. E
xam
inat
ion
an
d m
onit
orin
g eq
uip
men
t
Dis
posa
ble
tong
ue d
epre
ssor
s 10
10-
Rea
ctiv
e st
rips
for
uri
ne a
naly
sis
e.g.
Mul
isti
x1
pack
--
15
MSN-1768 28/8/03 2:13 am Page 15
Stat
utor
y R
equi
rem
ents
Rec
omm
ende
d Sp
ecif
icat
ion
Qua
ntit
yA
BC
Tem
pera
ture
cha
rts
1 pa
d1
pad
-M
edic
al e
valu
atio
n re
port
s1
pad
--
Preg
nanc
y te
st k
itW
hen
wom
en o
n bo
ard
1-
-St
etho
scop
e1
1-
Ane
roid
sph
ygm
oman
omet
er1
1-
Stan
dar
d c
linic
al th
erm
omet
er3
1-
Hyp
othe
rmic
ther
mom
eter
low
rea
din
g re
ctal
ther
mom
eter
11
-Sp
utum
cup
wit
h co
ver
Dis
posa
ble
2-
-Sp
ecim
en ja
rsSt
rong
gla
ss o
r pl
asti
c w
ith
airt
ight
lid
2
--
50 m
l wit
h bl
ank
labe
ls
5. E
qu
ipm
ent
for
inje
ctio
n, p
erfu
sion
, pu
nct
ure
an
d c
ath
eter
izat
ion
Bla
dd
er d
rain
age
Bla
dd
er d
rain
age
set (
incl
udin
g ba
g,
1-
-sp
igot
s an
d tu
be)
Rec
tal d
rip
set
1-
-U
rine
dra
inag
e ba
gU
se b
lad
der
dra
inag
e se
tU
se 5
(1)
--
Dis
posa
ble
syri
nges
2ml,
5ml,
10m
l10
of
each
5 of
eac
h-
Dis
posa
ble
hypo
der
mic
nee
dle
s(2
1G)
0.8m
m a
nd (
25G
) 0.
5mm
3015
-"S
harp
s" d
ispo
sal b
ox1
litre
siz
e1
1-
Cat
hete
r1)
Fol
ey ty
pe 1
6 C
harr
iere
gua
ge, 5
ml b
allo
on
1-
-(s
hort
/ m
ediu
m te
rm u
se in
ad
ults
)2)
Nel
aton
siz
e 16
Cha
rrie
re g
uage
(w
ith
no b
allo
on)
1-
-3)
Pen
ile s
heat
h se
t1
--
6. G
ener
al M
edic
al E
qu
ipm
ent
Bed
pan
(sta
inle
ss s
teel
or
ster
ilisa
ble
plas
tic)
1-
-H
ot w
ater
bot
tle
Wit
h fa
bric
cov
er1
--
Uri
ne b
ottl
e (u
rina
l)1
--
Iceb
ag1
--
16
MSN-1768 28/8/03 2:13 am Page 16
17
Stat
utor
y R
equi
rem
ents
Rec
omm
ende
d Sp
ecif
icat
ion
Qua
ntit
yA
BC
7. I
mm
obil
izat
ion
an
d s
etti
ng
equ
ipm
ent
Mal
leab
le f
inge
r sp
lint
11
-M
alle
able
for
earm
and
han
d s
plin
t1
1-
Splin
ts –
sim
ple,
vac
uum
(in
flat
able
onl
y if
oth
ers
unav
aila
ble)
Set o
f fo
ur (
half
leg,
ful
l leg
, hal
f ar
m a
nd f
ull a
rm)
11
-T
high
spl
int
- (T
ract
ion)
e.g.
Tho
mas
spl
int,
Don
way
etc
.1
1-
Col
lar
for
neck
imm
obili
sati
on –
(se
mi-
rigi
d)
Ad
ult s
ize
pack
of
3, s
mal
l, m
ediu
m a
nd
11
-la
rge
or a
dju
stab
le c
olla
r
8. D
isin
fect
ion
, Dis
inse
ctiz
atio
n a
nd
Pro
ph
ylax
is
Wat
er –
dis
infe
ctio
n co
mpo
und
In li
quid
for
m -
litr
es5
--
Liq
uid
inse
ctic
ide
In li
quid
for
m -
lit
res
5-
-Po
wd
er in
sect
icid
e
AB
C
Face
mas
ks d
ispo
sabl
e6
6-
Plas
tic
mea
suri
ng ju
g 1/
2 lit
re s
ize
11
-D
ispo
sabl
e pa
per
tow
els
100
100
-L
atex
fre
e st
erile
sur
gica
l dis
posa
ble
glov
es (
larg
e)5p
rs5p
rs-
Wat
erpr
oof
plas
tic
shee
ting
, siz
e 1m
x 2
m2
1-
Lot
ion
bow
l (si
ze a
t lea
st 2
00m
m x
90m
m, s
tain
less
ste
el o
r st
erili
sabl
e pl
asti
c, to
be
mar
ked
"m
edic
al")
1-
-K
idne
y d
ish
(siz
e 25
0mm
sta
inle
ss s
teel
or
ster
ilisa
ble
plas
tic)
1-
-Sa
fety
pin
s, r
ustl
ess
med
ium
66
6
RE
CO
MM
EN
DE
DA
DD
ITIO
NA
LM
ED
ICA
LE
QU
IPM
EN
T
Rec
omm
ende
d A
ddit
iona
l E
quip
men
tQ
uant
ity
MSN-1768 28/8/03 2:13 am Page 17
18
Kit
for
pro
tect
ion
agai
nst
bloo
d tr
ansm
itte
d di
seas
es (
to b
e ca
rrie
d in
all
ves
sels
tra
ding
in
mal
aria
l ar
eas
1-
-w
here
med
ical
fac
ilit
ies
are
lim
ited
and
em
erge
ncy
shor
e ba
sed
trea
tmen
t is
nec
essa
ry)
(To
be k
ept
in h
eavy
gau
ge p
olyt
hene
bag
, and
labe
lled
"to
be u
sed
only
for
the
trea
tmen
t of
…."
Ins
ert
the
nam
e of
the
sea
fare
r go
ing
asho
re fo
r em
erge
ncy
trea
tmen
t).
Eac
h ki
t to
con
tain
the
follo
win
g :
(1)
10 x
2 m
l syr
inge
s(2
) 10
x 1
0 m
l syr
inge
s(3
) 20
x 2
1G 0
.8m
m n
eed
les
(4)
1 bl
ood
giv
ing
set
(5)
1 bl
ood
taki
ng s
et(6
) pa
ck o
f pr
e in
ject
ion
site
sw
abs
(7)
Dis
posa
ble
late
x fr
ee g
love
s 2
pair
s (l
arge
siz
e)
AB
C
Mag
nify
ing
glas
s 7.
5cm
dia
met
er w
ith
hand
le1
1N
ail b
rush
11
Stre
tche
r eq
uipm
ent (
Asy
stem
for
trau
ma
man
agem
ent,
i.e. i
mm
obili
sati
on a
nd s
tret
cher
equ
ipm
ent m
ost s
uite
d
-1
-fo
r tr
eatm
ent o
n th
e ve
ssel
con
cern
ed)
Bod
y ba
g –
larg
e si
ze1
1V
esse
ls in
mal
aria
l are
as o
nly
– m
icro
scop
e sl
ides
in in
div
idua
l tra
nsit
con
tain
ers
55
1)
Exc
avat
or d
oubl
e en
ded
Guy
s’ p
atte
rn G
21
Set o
f -
-al
l ite
ms
2)
Filli
ng p
aste
inse
rter
(fo
r in
sert
ing
filli
ng p
aste
into
the
toot
h)
3)
Den
tal m
irro
r si
ze 4
on
hand
le
4)
Cav
it (
tem
pora
ry d
enta
l fill
ing)
tube
Scis
sors
sta
inle
ss s
teel
or
dis
posa
ble
1pr
Tria
ngul
ar b
and
ages
abo
ut 9
0cm
x 1
27cm
4St
erile
par
affi
n ga
uze
dre
ssin
gs10
Plas
tic
burn
bag
s1
Qua
ntit
yR
ecom
men
ded
Add
itio
nal
Equ
ipm
ent
MSN-1768 28/8/03 2:13 am Page 18
ANNEX 2
ADDITIONAL REQUIREMENTS FOR PASSENGER VESSELS
Doctor’s Bag
1. A Doctor’s Bag is required for seagoing ships where there is no qualified medical practitioneramong the crew, and the vessel carries more than 12 passengers. (Class VI and VI(A) vessels areexcluded from this requirement).
2. All the medicines and equipment in this list should be kept in a Doctor’s Bag or case. The caseshould be locked and kept in a locked cabinet and the keys held by the Master or someonenominated by him. The Doctor’s Bag should be clearly labelled as follows :
" The medicines in this case are only to be used by a qualified medical practitioner, registered general nurse,qualified paramedic, or someone under the direct supervision of a medical practitioner on board the ship"
3. Except where indicated the items listed in this Annex are additional to those which the vessel maybe required to carry as set out in Annex 1 of this Notice. Where an injection is specified, a prefilledsyringe is acceptable.
4. The obtaining, use and disposal of morphine from this case should be recorded in the ship’sControlled Drugs Register. (See Annex 9)
5. A doctor or other authorised person using the Doctor’s Bag should be made aware that radiomedical advice may be obtained and if necessary medical evacuation arranged, by contacting HM Coastguard.
STATUTORY TREATMENTS REQUIRED FOR DOCTOR’S BAG
19
Item Ordering Size Quantity Required
Adrenaline / Epinephrine 1ml ampoule 5Adrenaline tartrate injection (1 in 1,000)1.0mg in 1mlAminophylline 10ml ampoule 5Aminophylline injection 25mg in 1mlAspirin 300mg tablets 50Dispersible aspirin 300 mgAtropine 600micrograms / 5Atropine sulphate ml 1ml ampouleBeclomethasone Diproponate 100 micrograms/ 1Beclomethasone diproponate + SPACER 200 metered doses3rd Generation Cephalosporin 1g injection vial 4Cefotaxime for reconstitutionChlorpromazine 25mg in 1ml 1Chlorpromazine hydrochloride injection ampouleCyclizine Injection 50mg inCyclizine lactate 1ml ampoule 2
MSN-1768 28/8/03 2:13 am Page 19
20
Item Ordering Size Quantity Required
Diazepam 2ml ampoule 5Diazemuls injection 5mg in 1mlFrusemide / Furosemide 2ml ampoule 5Frusemide injection 10mg in 1mlGlucagon 1ml pre-filled 1Glucagon injection 1mg with diluent syringeGlucose 1 ltr 1Glucose intravenous infusion 5%Glucose 50% 50ml ampoule 2Intravenous injectionHydrocortisone 100mg vial 1Hydrocortisone sodium succinate powder for constitution with diluent.Insulin 10ml vial 1Insulin injection, soluble, 100 units per mlModified Gelatine 500ml container 2Infusion solution (for plasma substitution)Morphine 10mg/ml 5Morphine sulphate 1ml ampouleNormal Saline 0.9% 1 ltr 2Paediatric Paracetamol elixir 250mg / 5ml 1 bottlePrednisolone 5mg tablet 28PrednisoloneSalbutomal 200 inhalations 1Salbutamol aerosol inhaler unit, giving 100 micrograms per metered inhalation + SPACER
MSN-1768 28/8/03 2:13 am Page 20
21
Item Ordering Size Quantity Required
EQUIPMENT
Aneroid sphygmomanometer 1First aid kit 1Glucose in blood1) Blood test sticks – glucose colomimetric 102) Blood lancets – sterile 10Guedel Airway Size 1 (Adult sizes 1
already in shipsmedical stores)
Intravenous Infusion Giving Sets with Cannulae
Intravenous infusion cannula with luer-lok injection 1) cannula size 2port in a sterile pack 16G (1.7mm
x 45mm)
IV giving set with filter 2) cannula size 218G (1.2 mm
x 45 mm)Manual suction pump with two yankauer suction 1catheters and two flexible catheters FG 14 sizeOxygen Resuscitator (disposable) 1Hand operated manual adult bag resuscitator (bag to be of silicone rubber complete with oxygen reservoir of 2600 ml capacity and facemasks sizes 5,3 and 1)Pocket mask With valve 1
and O2 inletStethoscope 1SwabsAlcohol impregnated swabs, sterile 50Syringe and Needle, Hypodermic, Pack1) 2ml syringe with 0.8mm (21G) x 4cm needle 22) 20ml syringe with 0.8mm (21G) x 4cm needle 23) 1 ml insulin syringe 100 units with 0.4mm (27G) 2
x 12mm needle
Note:
In addition to the statutory requirements for inclusion in the Doctor’s Bag as detailed above, theattention of operators is also drawn to the International Maritime Organization’s Circular MSC/Circ 1042.
This Circular provides advice on medical provisions for ro-ro passenger ships not normally carryinga medical doctor, and also provides a list of recommended contents for the Doctor’s Bag. Copies of Circular MSC/Circ 1042 are available from the International Maritime Organization -www.imo.org.
MSN-1768 28/8/03 2:13 am Page 21
22
ANNEX 3
FIRST AID KITS
Seagoing ships with a crew of more than 10 should carry first aid kits, distributed in appropriatelocations on the ship e.g. in the galley and engine room.
Passenger vessels must carry one first aid kit for every 100 passengers or fraction of that number subjectto a maximum requirement for 3 kits e.g. 250 persons require three kits. A first aid kit is to be includedin the Doctor’s Bag. (Annex 2).
The first aid kit should include the following items, kept in a portable waterproof container.
(1) 4 x triangular bandages (2) 6 x medium sterile bandages with unmedicated dressings(3) 2 x large sterile bandages with unmedicated dressings(4) 2 x extra large unmedicated dressings(5) 6 medium safety pins, rustless(6) 20 assorted elastic adhesive dressings medicated (7) 2 x sterile eye pads with attachment(8) 2 x packages containing sterile gauze swabs(9) 5 pairs large size disposable latex-free examination gloves(10) sterile eye wash in eye wash bottle
The Merchant Shipping and Fishing Vessel (Medical Stores) Regulations 1995 do not apply to vesselsoperating on inland waters, as defined in MSN 1758(M). However, the HSE Health and Safety (FirstAid) Regulations 1981 do apply and the HSE Approved Code of Practice for First Aid at Work should be followed.
MSN-1768 28/8/03 2:13 am Page 22
23
ANNEX 4
MEDICINES TO BE CARRIED ON SHIPS CARRYING DANGEROUS CARGOES
General
1. When a UK registered vessel is carrying a dangerous substance or substances in quantities, inexcess of those defined in Vol 1, Section 18 of the IMDG Code, as whole or part of the cargo, theMaster must ensure that the correct antidote can be found in the IMO Medical First Aid Guide forShips MFAG 1994 edition. Any updating of the IMO International Maritime Dangerous Goods Codeshould be taken into account when preparing the list of medicines to be carried.
2. The substances listed below are to be taken into account, in whatever form they are carried onboard, including the form of waste or cargo residues.
- Explosive substances and objects- Gases : compressed, liquified or dissolved under pressure - Inflammable liquids- Inflammable solids- Substances liable to spontaneous combustion- Substances which on contact with water give off inflammable gases- Combustible substances- Organic peroxides- Toxic substances- Infectious substances- Radioactive substances- Corrosive substances- Various dangerous substances, i.e. any other substances which experience has shown, or may
show, to be dangerous, so that antidotes need to be carried.
3. The quantities of any medicines need to be carried aboard should be based on an estimate of risks, taking into account such factors as number of crew, length of voyage and risk of accidental exposure.
Ferries
4. Whether or not the vessel is required to carry Category A or B stores, ferries or similar vesselswhose operating arrangements do not allow sufficient forewarning of the nature of any dangeroussubstances which might be transported on them, must carry at least the antidotes and equipmentlisted below :
Antidotes :- General- Cardio vascular- Gastro – intestinal system- Nervous system- Anti-infective- For external use
Equipment : for the administration of oxygen.
Where these substances are already included in the ship’s medical store, separate stocks are notnecessarily required. EC Directive 92/29/EEC provides that on a regular route where the crossing is dueto last less than two hours, the antidotes may be limited to those which have to be administered in casesof extreme emergency within the period of time not exceeding the normal duration of crossing.
MSN-1768 28/8/03 2:13 am Page 23
ANNEX 5
MEDICAL GUIDES TO BE CARRIED AND RADIO MEDICAL ADVICE
In addition, vessels in all Categories (other than lifeboats and liferafts) should carry a copy of this Noticeor subsequent replacements.
Radio Medical Advice
Radio Medical Advice is available to all ships at sea by contacting HM Coastguard (See MGN 225 (M+F)for details). Advice is provided by 2 UK designated centres at Aberdeen Royal Infirmary and QueenAlexandra Hospital, Portsmouth, but initially contact should be made with the Coastguard.
24
Vessel Category Publication
Category A Controlled Drugs RegisterShip Captain’s Medical Guide
Category B Ship Captain’s Medical GuideCategory C First Aid Manual (St John’s,
Red Cross or St Andrew’s)orFirst Aid Instructions, in Englishon waterproof paper (Lifeboatsand Life-rafts only)
MSN-1768 28/8/03 2:13 am Page 24
ANNEX 6
PRECAUTIONS AGAINST MALARIA
PREVENTIVE MEASURES
Avoid mosquito bites
1. Mosquitoes are most active after dusk. Cabin and working accommodation doors, windows andventilators should be kept shut. Any mosquitoes found in compartments should be killed using"knockdown" insecticide spray. If you go on deck or ashore after dusk keep your arms, legs andfeet covered and use insect repellents e.g. containing diethyltoluamide known as DEET, on anyremaining exposed areas. If you have to stay ashore in non-air conditioned accommodation makesure that the beds have nets, preferably impregnated with permethrin, that they have no tears orholes and are well tucked in.
Medication
2. Anti-malarial tablet treatment varies depending on the nature and resistance of local malarialparasites. You should take the treatment strictly in accordance with the specific instructions for themedication prescribed. Most deaths occur in those who do not take the tablets for the requiredperiod or in the recommended dosages.
Warning signs
3. Anyone who develops a fever in a malarial area should obtain medical advice as soon as possible. Itis important to consult a doctor immediately if any feverish illness develops within twelve monthsof return from a malarial area. Be sure to let the doctor know that you have been to a country wheremalaria is a health risk.
4. ANYONE WHO HAS BEEN TREATED FOR MALARIA OR SUSPECTED MALARIA MUSTHAVE A MEDICAL EXAMINATION AT THE NEXT PORT OF CALL, ACCOMPANIED BY ABLOOD SLIDE. SERIOUS CASES NEED URGENT HOSPITALISATON (See Ship Captain’sMedical Guide for more details).
KEY POINTS
• Travellers to malarial areas must avoid mosquito bites, take anti-malarial medicines and urgentlyseek early diagnosis and treatment for any feverish illness.
• The key to preventing malaria is avoiding infective mosquito bites by using repellents, covering upat night and sleeping with bednets if mosquitoes cannot be excluded from the room.
• Appropriate anti-malarial medicine is essential when travelling to known malarial areas. Drugresistance is increasing in many areas so recommended regimens have changed.
• Doses and choice of medicine may have to be altered when someone has another illness or is takingtreatment for another medical condition.
• Standby treatment may be given to those who will be unable to reach medical services for extended periods.
• No preventive treatment is infallible so all fever and flu like illnesses occurring within a year ofreturning from malarial regions need to be urgently investigated with malaria in mind.
• Diseases other than malaria can be transmitted by biting insects. Take local advice and observerecommended precautions.
25
Full guidance on immunisations and anti-malaria medication (prophylaxis) is given in MarineGuidance Note MGN 257 (M). This annex gives advice on preventive measures on board ship,whilst in malarial areas.
MSN-1768 28/8/03 2:13 am Page 25
ANNEX 7
GUIDE TO THE USE OF MEDICINES
General advice about medicines
Many over-the-counter medicines are now available with patient information leaflets and the adviceon dose precautions and side effects should be consulted and retained for reference. Valuableguidance is also available from pharmacists or by seeking Radio Medical Advice.
When obtaining medicinal products, prepared or dispensed by a pharmacist in a pharmacy, ensurethat they are clearly labelled with their strength (e.g. 125mg per tablet or 125mg per 5ml) and expirydate, and that they are packaged in accordance with UK medicines legislation.
Medicines obtained abroad
Medicine supplies should be replenished wherever possible at the same strengths as specified in theBritish Pharmacopoeia. If medicines are obtained elsewhere, e.g in the USA, they may be ofdifferent strength, and this must be taken into account when administering them.
The non-proprietary name (local pharmaceutical name) for some medicines bought abroad maydiffer from that used in the list of medical stores. The pharmacist should have a "translation" of thenon-proprietary name, but if in doubt about a medicine, get RADIO MEDICAL ADVICE.
Medicines obtained by seafarer from a doctor ashore
A seafarer who goes to a doctor ashore should be asked to obtain from the doctor a written note ofthe non-proprietary name of any prescribed medicine, details of how it is to be taken and anycautionary or advisory guidance e.g. may cause drowsiness. The details on the note from the doctorshould be checked against the information on the medicine container to ensure that they match. In case of any problem or doubt it may be necessary to check the prescription with the radiomedical doctor.
Controlled drugs
The following paragraphs describe UK regulations for controlled drugs. Most countries have similar regulations. When outside UK territorial waters you should, as far as possible, follow thesame procedures.
Controlled drugs are preparations subject to the prescription requirements of the Misuse of DrugsAct 1971. The different drugs are graded according to the harmfulness attributed to the drug whenit is misused and for this purpose there are three categories of drugs;
Class A includes heroin, morphine and opiumClass B includes barbiturates, and codeine Class C includes, among other drugs, anabolic steroids
Each of these categories contains many more drugs than those quoted. The drugs subject to thestrictest controls are those in Schedule 1 of the Misuse of Drugs Regulations 1985. Detailedinformation may be obtained from the Drugs Branch, Queen Anne’s Gate, London SW1H 9AT.
A ship must not carry quantities of Category C Medical Store drugs greater than thoserecommended in this Notice, unless required to do so by a doctor on the ship’s complement orunder licence from the Home Office. The only controlled Class A drug listed is morphine sulphatein Category A vessels and in the doctor’s bag.
26
MSN-1768 28/8/03 2:13 am Page 26
Obtaining controlled drugs
Controlled drugs should be obtained only from a retail pharmacist or other person licensed tosupply drugs, who will require a written requisition. An example of the wording to be used is givenin Annex 8.
Other drugs / medicines
UK medicines legislation, in conjunction with Merchant Shipping and Fishing Vessel (MedicalStores Regulations) 1995 as amended, permits a retail pharmacist to supply medicines andequipment to the Master or owner of a commercial vessel without a prescription from a registeredmedical practitioner. However a similar requisition to that for controlled drugs may be required.
Storage and Security of Medicines
Storage of medicines
Drugs must be stored to ensure that they will meet the standards at the time of use. Where nospecific storage temperature is given drugs should be stored at room temperature between 15 - 25ºcentigrade. Some of the drugs should be kept under refrigeration, 2 - 5º centigrade, but care mustbe taken not to freeze them, otherwise they will lose their potency, or the ampoules will be broken.
Security of controlled drugs
The Merchant Shipping (crew accommodation) (Fishing vessels) Regulations require ships to have alockable medical cabinet for the storage of medicines and drugs. The regulations also require thecabinet to have an ‘inner cupboard’ solely for the storage of ‘dangerous drugs’ (i.e. the controlleddrugs). The cupboard should be fitted with a door and a lock which cannot be opened by the keyto the medical cabinet. Under the Misuse of Drugs (Safe Custody) Regulations only the master or aperson authorised by him may open the inner cupboard.
It is illegal to destroy unwanted Category A and B drugs. They can be disposed of only by givingthem to a person who may lawfully supply them, such as qualified pharmacist or qualified doctor.It is also possible to dispose of drugs via the police. A receipt should be obtained from the recipient,and kept with, or affixed to, the controlled drugs register.
Record keeping
Under the Official Log Book Regulations the record of any treatment given to anybody on boardincluding the type and quantity of any medicines, and drugs supplied, must be entered in the logbook. For controlled drugs, the Master is required to maintain, in bound book, a two section register.The two sections of the register should detail, why, when and in what quantity the Master purchaseda controlled drug and similarly the history of the dispensing or disposal of those controlled drugs.This register must be kept for two years after the date of the last entry. Annex 9 gives an example ofthe entries required in each section of the Controlled Drugs Register. (Under proposed amendmentsto the Misuse of Drugs Regulations 2001,computer records will in future be acceptable).
27
MSN-1768 28/8/03 2:13 am Page 27
28
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
1.C
ard
io-V
ascu
lar
(a)
Ad
rena
line
(Epi
neph
rine
) In
ject
ion
Hea
rt s
tim
ulan
t Ana
phal
apti
c sh
ock
0.5
to 1
.0m
l 0.
5ml (
1 in
100
0)(S
ever
e al
lerg
y w
ith
colla
pse)
by I
M in
j.Si
de e
ffect
s : A
nxie
ty, t
rem
or, h
igh
bloo
d pr
essu
re, r
apid
irre
gula
r he
art
beat
. Onl
y us
e in
sev
erel
y ill
, col
laps
ed p
atie
nts
wit
h lo
ss o
f blo
od p
ress
ure
/ se
vere
bre
athi
ng p
robl
ems.
(b)
Gly
cery
l Tri
nitr
ate
(GT
N)
Spra
y A
nti-
angi
na (
hear
t pai
n) s
uspe
cted
hea
rt a
ttac
k or
hea
rt p
ain
1-2
spra
ys
400
mic
rogm
met
ered
dos
eun
der
tong
ueSi
de e
ffect
s: T
hrob
bing
hea
dach
e, fl
ushi
ng, d
izzi
ness
, fai
ntne
ss, l
ow b
lood
pre
ssur
e
(c)
Frus
emid
e 40
mg
tabl
ets
Diu
reti
c (w
ater
tabl
et)
swel
ling
/ f
luid
ret
enti
on b
reat
hles
snes
s 40
mg
(1 ta
b) o
nce
Frus
emid
e 20
mg
in 2
ml
due
to h
eart
fai
lure
dai
ly, 2
ml b
y IM
inj.
Side
effe
cts:
Few
in s
hort
ter
m, l
ow d
ose
use.
(d)
Phyt
omen
adio
ne (
Vit
K)
Ant
i-ha
emor
rhag
e d
rug
for
new
bor
n ba
bies
0.2m
l (1a
mp)
by
IM
paed
iact
ric
inj
inj s
ingl
e d
ose
Erg
omet
rine
wit
h O
xyto
cin
Ant
i-ha
emor
rhag
e d
rug
used
imm
edia
tely
aft
er d
eliv
ery
of b
aby
or f
or
1ml (
1am
p) b
y IM
50
0 m
icro
gram
s /
5 u
nits
blee
din
g af
ter
mis
carr
iage
inj s
ingl
e d
ose
Side
effe
cts:
Nau
sea,
vom
itin
g, h
eada
che,
diz
zine
ss, a
bdom
inal
pai
n.
(e)
Ate
nolo
l 50m
g ta
blet
sA
nti-
hype
rten
sion
(hi
gh B
P) d
rug,
may
be
usef
ul f
or a
ngin
a al
so50
mg
(1 ta
b)
once
dai
lySi
de e
ffect
s: T
ired
ness
, slo
w p
ulse
, low
blo
od p
ress
ure,
hea
rt fa
ilure
2.G
astr
o-in
test
inal
(a)
Cim
etid
ine
400m
g ta
blet
sA
nti-
acid
dru
g fo
r he
artb
urn,
dys
peps
ia, s
tom
ach
and
duo
den
al u
lcer
s40
0mg
(1 ta
b)
twic
e d
aily
Side
effe
cts
: Few
at
norm
al d
oses
for
shor
t pe
riod
s
US
E O
F M
ED
ICIN
ES
Thi
s ta
ble
is a
bri
ef g
uid
e to
the
dru
gs d
etai
led
in th
is M
Not
ice
and
is d
esig
ned
to b
e us
ed i
n co
njun
ctio
n w
ith
the
Ship
Cap
tain
’s M
edic
al G
uid
e.
The
sid
e ef
fect
s lis
ted
are
a g
uid
e on
ly. T
his
list i
s no
t com
preh
ensi
ve. T
he c
omm
on o
r im
port
ant s
ide
effe
cts
only
are
list
ed. I
f a
dru
g m
ight
be
caus
ing
apr
oble
m, w
hich
is n
ot li
sted
see
k R
adio
Med
ical
Ad
vice
.
MSN-1768 28/8/03 2:13 am Page 28
29
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
Ant
acid
Dru
gs –
e.g
. Mis
tPr
opri
etar
y an
ti-i
ndig
esti
on p
repa
rati
ons
for
hear
t bur
n, D
yspe
psia
etc
.A
s in
stru
ctio
ns
Mag
nesi
um T
risi
licat
ew
ith
pack
age.
(b)
Proc
hlor
pera
zine
3m
g bu
ccal
tabl
ets
Ant
i-si
ckne
ss d
rug
used
for
sic
knes
s d
ue to
ear
pro
blem
s (v
erti
go),
3mg
(1 ta
b) u
nder
d
rugs
e.g
. mor
phin
eto
ngue
twic
e d
aily
Side
effe
cts
: Dry
mou
th, b
lurr
ed v
isio
n, r
apid
pul
se
Prom
etha
zine
25
mg
inje
ctio
nA
nti-
sick
ness
dru
g an
d a
nti-
hist
amin
e us
eful
for
sev
ere
mot
ion
sick
ness
and
25
mg
(1 a
mp)
fo
r se
vere
alle
rgic
rea
ctio
nsby
IM
inj
Side
effe
cts
: Dro
wsi
ness
, dry
mou
th, b
lurr
ed v
isio
n
Hyo
scin
e H
ydro
brom
ide
Ant
i-si
ckne
ss ta
blet
0.3m
g (1
tab)
60.
3mg
tabl
ets
hour
ly m
ax 3
in 2
4hrs
Side
effe
cts:
Dro
wsi
ness
, dry
mou
th, d
izzi
ness
blu
rred
vis
ion
Cin
nari
zine
15m
gA
nti s
ickn
ess
dru
g us
ed f
or m
otio
n si
ckne
ss15
mg
(1 ta
b)
8 ho
urly
Side
effe
cts:
Fat
igue
, dry
mou
th, b
lurr
ed v
isio
n
(c)
Gly
cero
l Sup
posi
tory
L
ubri
cant
laxa
tive
use
d to
enc
oura
ge p
assa
ge o
f st
ools
1 su
ppos
. ins
erte
d
in th
e re
ctum
(d)
Lop
eram
ide
2mg
tabl
ets
Con
trol
of
dia
rrho
ea4m
g in
itia
lly th
en2m
g af
ter
each
lo
ose
stoo
lSi
de e
ffect
s : D
row
sine
ss, d
izzi
ness
, abd
omin
al c
ram
ps
3.A
nal
gesi
cs a
nd
an
tisp
asm
odic
s
(a)
Para
ceta
mol
500
mg
tabl
ets
"Sim
ple"
pai
nkill
er s
uita
ble
for
mos
t mild
to m
oder
ate
pain
.1g
m (
2 ta
bs)
4 ho
urly
Side
effe
cts
: Few
at
corr
ect
dose
, ver
y da
nger
ous
in o
verd
ose
& p
oiso
nous
to
liver
Ibup
rofe
n 40
0mg
Ant
i-in
flam
mat
ory
pain
kille
r, su
itab
le f
or h
ead
ache
, lim
b pa
in40
0mg
(1 ta
b)
8 ho
urly
Side
effe
cts:
Sto
mac
h pa
ins,
nau
sea,
whe
ezin
ess.
Do
not
give
if p
atie
nt h
as s
tom
ach
/ duo
dena
l ulc
er o
r as
thm
a
MSN-1768 28/8/03 2:13 am Page 29
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
Dic
lofe
nac
50m
g su
ppos
itor
yA
nti-
infl
amm
ator
y pa
inki
ller
suit
able
for
mos
t pai
n, e
spec
ially
bon
e,
50m
g (u
p to
3 v
ia
join
t and
mus
cle
pain
the
rect
um d
aily
)Si
de e
ffect
s : S
tom
ach
pain
s, n
ause
a, w
heez
ines
s. D
o no
t gi
ve if
pat
ient
has
sto
mac
h / d
uode
nal u
lcer
or
asth
ma.
(b)
Cod
eine
pho
spha
te 3
0mg
tabl
ets
Stro
ng p
aink
iller
sui
tabl
e fo
r m
oder
ate
to s
ever
e pa
in.
30m
g (1
tab)
6
hour
lySi
de e
ffect
s : N
ause
a, v
omit
ing,
con
stip
atio
n, r
espi
rato
ry d
epre
ssio
n in
ove
rdos
e
(c)
Hyo
scin
e bu
tylb
rom
ide
10m
g ta
blet
sA
nti-
spas
mod
ic f
or tr
eatm
ent o
f ab
dom
inal
cra
mps
and
col
ic10
-20m
g (1
-2 ta
bs)
6 ho
urly
Side
effe
cts
: Dry
mou
th, f
ast
puls
e, b
lurr
ed v
isio
n
Mor
phin
e su
lpha
te 1
0mg
inje
ctio
nV
ery
stro
ng p
aink
iller
sui
tabl
e fo
r al
l sev
ere
pain
10m
g (1
am
p) 4
-6ho
urly
by
IM in
jSi
de e
ffect
s : N
ause
a, v
omit
ing,
dro
wsi
ness
, res
pita
tory
dep
ress
ion
in o
verd
ose
or if
use
d in
appr
opri
atel
y. A
void
in h
ead,
che
st in
jury
if p
ossi
ble
4. N
ervo
us
syst
em
(a)
Dia
zepa
m /
Dia
zem
uls
Ant
i-an
xiet
y, s
edat
ion
med
icat
ion.
Can
hel
p w
ith
mus
cle
spas
m in
inju
ry
5-10
mg
by I
M
10m
g in
ject
ion
(2m
ls)
and
low
bac
k pa
inin
ject
ion
5-10
mg
10m
g ta
blet
sta
blet
, 4 h
ourl
y up
toa
max
imum
of
30m
g pe
r d
aySi
de e
ffect
s : D
row
sine
ss, l
ight
hea
dedn
ess,
con
fusi
on, h
eada
che,
res
pira
tory
dep
ress
ion.
Avo
id w
ith
stro
ng p
aink
iller
s.
(b)
Chl
orpr
omaz
ine
hyd
roch
lori
de
Ant
i-ps
ycho
sis
(acu
te m
adne
ss)
dru
g. S
edat
es a
nd c
ontr
ols
sym
ptom
s in
acu
te
25m
g by
IM
25
mg
inje
ctio
n ps
ycho
sis
espe
cial
ly v
iole
nt o
r d
istu
rbed
pat
ient
sin
ject
ion,
8 h
ourl
y or
25
mg
tabl
ets
25m
g ta
blet
8
hour
lySi
de e
ffect
s : D
row
sine
ss, d
ry m
outh
, ret
enti
on o
f uri
ne. A
cute
spa
sms
or t
wit
ches
. If o
ccur
red
uce
dose
or
stop
tre
atm
ent.
(c)
Hyo
scin
e hy
dro
brom
ide
/ C
inna
rizi
neSe
e 2b
(d)
Dia
zepa
m r
ecta
l dis
pens
er 1
0mg
Ant
i-ep
ilept
ic m
edic
atio
n us
ed to
con
trol
fit
s10
mg
per
rect
umup
to a
max
imum
of
2 d
oses
Side
effe
cts
: See
4 (
a)
30
MSN-1768 28/8/03 2:13 am Page 30
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
5. A
nti
-all
ergi
c an
d a
nti
-an
aph
ylac
tics
(a)
Cet
iriz
ine
10m
g ta
blet
sA
nti-
alle
rgy
med
icat
ion
usef
ul in
con
trol
ling
itch
ing
rash
es a
nd h
ay f
ever
like
10
mg
once
sy
mpt
oms
due
to a
llerg
yd
aily
onl
ySi
de e
ffect
s : D
row
sine
ss a
nd s
low
ed r
eact
ions
(le
ss t
han
olde
r an
ti-h
ista
min
es).
(b)
Hyd
roco
rtis
one
100m
g in
ject
ion
Ant
i-al
lerg
y st
eroi
d f
or s
erio
us a
llerg
ies
caus
ing
seve
re s
ympt
oms
or c
olla
pse
100m
g by
IM
(h
as to
be
mad
e up
in 2
mls
)in
ject
ion,
8 h
ourl
y if
rep
eate
dSi
de e
ffect
s : F
ew fo
r si
ngle
dos
e or
sho
rt c
ours
e
Pred
niso
lone
5m
g ta
blet
sA
nti-
alle
rgy
ster
oid
als
o es
sent
ial t
reat
men
t of
acut
e as
thm
a.5
– 20
mg
once
dai
ly
mor
e in
sev
ere
asth
ma
Side
effe
cts
: Few
for
sing
le d
ose
or s
hort
cou
rse
6. R
esp
irat
ory
syst
em
(a)
Salb
utam
ol in
hale
r 10
0 m
icro
gA
nti-
bron
chos
pasm
(w
heez
e) d
rug
used
to tr
eat a
sthm
a an
d a
llerg
ic w
heez
ing
200
mic
rogm
s (2
ra
m m
eter
ed d
ose
puff
s) 3
-4 ti
mes
dai
lySi
de e
ffect
s : T
rem
or, h
eada
che,
incr
ease
d pu
lse
rate
Bec
lom
etha
sone
/ B
eclo
met
ason
e A
nti-
asth
ma
ster
oid
take
n by
inha
lati
on u
sual
ly w
ith
salb
utam
ol20
0 m
icro
gms
(210
0 m
icro
gm m
eter
ed d
ose
puff
s) 3
-4 ti
mes
dai
lySi
de e
ffect
s : F
ew in
cor
rect
dos
e fo
r sh
ort
peri
ods
(c)
Para
ceta
mol
See
3(c)
7. A
nti
-in
fect
ion
(a)
Ben
zlpe
nici
llin
600m
g (1
meg
a un
it)
Firs
t lin
e an
tibi
otic
for
ser
ious
infe
ctio
ns s
uch
as c
ellu
litis
and
men
ingi
tis
600
to 1
200
mg
by
inje
ctio
n (h
as to
be
mad
e up
in 2
mls
IM
inj,
6 ho
urly
of w
ater
for
inje
ctio
n)Si
de e
ffect
s : F
ew u
nles
s pa
tien
t al
lerg
ic t
o P
enic
illin
s. A
lway
s ch
eck
befo
re g
ivin
g if
poss
ible
31
MSN-1768 28/8/03 2:13 am Page 31
32
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
Cip
rofl
oxac
in h
ydro
chlo
rid
e B
road
spe
ctru
m (
gene
ral p
urpo
se)
anti
biot
ic50
0mg
twic
e d
aily
500m
g ta
blet
sSi
de e
ffect
s : N
ause
a, d
iarr
hoea
, abd
omin
al p
ain,
ras
hes,
alle
rgic
rea
ctio
n
Cef
urox
ime
750m
g in
ject
ion
Bro
ad s
pect
rum
ant
ibio
tic,
use
ful t
o pr
otec
t aga
inst
infe
ctio
n in
maj
or w
ound
s75
0mg
by
IM in
j, 8
hour
lySi
de e
ffect
s : N
ause
a, d
iarr
hoea
, abd
omin
al p
ain,
ras
hes,
alle
rgic
rea
ctio
n. C
are
whe
n us
ed in
pen
icill
in a
llerg
ic p
atie
nts
Ery
thro
myc
in 2
50m
g ta
blet
sG
ener
al p
urpo
se a
ntib
ioti
c, u
sefu
l in
peni
cilli
n al
lerg
ic p
atie
nts
250-
500m
g, 6
hou
rly
Side
effe
cts
: Nau
sea,
dia
rrho
ea, a
bdom
inal
pai
n, r
ashe
s, a
llerg
ic r
eact
ion.
Car
e w
hen
used
in P
enic
illin
alle
rgic
pat
ient
s
Dox
ycyc
line
100m
g ca
psul
esA
ntib
ioti
c us
eful
for
sex
ually
tran
smit
ted
dis
ease
s an
d s
inus
itis
100m
g on
ce d
aily
Side
effe
ct :
Nau
sea,
vom
itin
g, d
iarr
hoea
, ras
hes,
hea
dach
e
(c)
Trim
etho
prim
200
mg
tabl
ets
Ant
ibio
tic
usef
ul f
or tr
eatm
ent o
f ur
inar
y tr
act i
nfec
tion
and
bro
nchi
tis
200m
g tw
ice
dai
lySi
de e
ffect
: N
ause
a, v
omit
ing
and
diar
rhoe
a, r
ashe
s
(d)
Meb
end
azol
e 10
0mg
tabl
ets
Ant
i-pa
rasi
te d
rug
for
trea
tmen
t of
gut i
nfes
tati
on e
.g. t
hrea
dw
orm
s10
0mg
sing
le d
ose
Side
effe
cts
: Rar
e
(e)
Met
roni
daz
ole
1g s
uppo
sito
ries
A
ntib
ioti
c an
d a
nti-
prot
azoa
l e.g
tric
hom
onas
and
am
oebi
c in
fect
ions
. 1m
g pe
r re
ctum
or
400m
g ta
blet
s /
500
mg
tabl
ets
Use
ful t
o gu
t rel
ated
infe
ctio
ns.
400
/ 5
00m
g by
m
outh
, 8 h
ourl
ySi
de e
ffect
: N
ause
a, v
omit
ing,
unp
leas
ant
tast
e, r
ashe
s. A
void
alc
ohol
(f)
Teta
nus
vacc
ine
0.5m
l inj
ecti
on
For
prot
ecti
on a
gain
st te
tanu
s in
fect
ion
eith
er in
unp
rote
cted
or
as a
0.
5ml b
y IM
or
dee
p (+
Dip
hthe
ria
vacc
ine)
boos
ter
afte
r in
jury
subc
utan
eous
inj
Side
effe
cts
: Rar
e if
not
had
vacc
ine
for
mor
e th
an o
ne y
ear.
Not
req
uire
d if
vacc
inat
ed w
ithi
n te
n ye
ars.
Teta
nus
Imm
unog
lobu
lin a
mpo
ule
Use
d to
pro
tect
aga
inst
teta
nus
in h
igh
risk
wou
nds
e.g.
agr
icul
tura
l inj
ury
in
1 am
poul
e by
IM
inj
for
inje
ctio
nun
-vac
cina
ted
pat
ient
s
8. C
omp
oun
d p
rom
otin
g re
hyd
rati
on
Ora
l reh
ydra
tion
sal
ts s
ache
tsU
sed
to tr
eat d
ehyd
rati
on in
vom
itin
g an
d d
iarr
hoea
or
seve
re il
lnes
sFo
llow
inst
ruct
ions
on
sac
het
Side
effe
cts
: Nil.
MSN-1768 28/8/03 2:13 am Page 32
33
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
9. M
edic
ines
for
ext
ern
al u
se
(a)
Ant
isep
tic
solu
tion
s or
wip
esFo
r cl
eani
ng s
kin
wou
nds
and
dis
infe
ctio
nFo
llow
inst
ruct
ions
on
bot
tle
/
pack
agin
gSi
de e
ffect
s : N
il un
less
app
lied
to la
rge
area
s
Hyd
roco
rtis
one
crea
m 1
% 1
5mg
tube
Ant
i-in
flam
mat
ory
wea
k st
eroi
d c
ream
. Use
ful i
n ec
zem
a ty
pe r
ashe
s, a
llerg
icA
pplie
d to
aff
ecte
d
rash
es, b
ites
etc
.ar
ea s
pari
ngly
, no
mor
e th
an th
ree
tim
es p
er d
aySi
de e
ffect
s : E
ncou
rage
s sp
read
of i
nfec
tion
do
not
appl
y to
bro
ken
skin
or
rash
es d
ue t
o sk
in in
fect
ion
e.g.
rin
gwor
m
Ben
zoic
aci
d C
ompo
und
BP
Ant
i-fu
ngal
oin
tmen
t for
trea
tmen
t of
athl
etes
foo
t, ri
ngw
orm
etc
.A
pplie
d to
infe
cted
oint
men
t 15m
g tu
bear
ea tw
ice
a d
aySi
de e
ffect
s : R
are
/ nil
in n
orm
al u
se
Mic
onaz
ole
nitr
ate
2% c
ream
A
nti-
fung
al c
ream
for
trea
tmen
t of
ring
wor
m e
tc.
App
lied
to in
fect
ed
30gm
tube
area
twic
e a
day
Side
effe
cts
: Rar
e / n
il in
nor
mal
use
Clo
trim
azol
e 50
0mg
pess
ary
Trea
tmen
t of
vagi
nal o
r vu
lval
thru
shIn
sert
1 p
essa
ry
(sin
gle
dos
e)Si
de e
ffect
s: R
are
/ nil
in n
orm
al u
se
Silv
er s
ulph
adia
zine
1%
cre
am
Ant
i-ba
cter
ial c
ream
for
pro
tect
ion
agai
nst i
nfec
tion
in b
urns
.A
pplie
d to
bur
n in
50
gm tu
bebu
rn b
ag, u
nder
d
ress
ing
or a
lone
. C
lean
ed o
ff a
t d
ress
ing
chan
ges
and
re-
appl
ied
.Si
de e
ffect
s : A
llerg
ic r
eact
ions
, bur
ning
, itc
hing
, Unu
sual
.
Zin
c oi
ntm
ent B
P25
mg
tube
Moi
stur
isin
g oi
ntm
ent f
or d
ry s
kin
cond
itio
nsA
pplie
d to
af
fect
ed a
rea.
Side
effe
cts
: Nil
in n
orm
al u
se. C
onta
ins
anim
al fa
t.
MSN-1768 28/8/03 2:13 am Page 33
34
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
Pota
ssiu
m p
erm
anga
nate
cry
stal
s Fo
r cl
eans
ing
and
deo
dor
isin
g o
ozin
g w
ound
s or
ski
n ra
shes
.W
et d
ress
ings
or
.10
g co
ntai
ner
/ ta
blet
sba
ths
0.01
% s
olut
ion
Side
effe
cts
: Sta
ins
skin
, irr
itat
es m
ucou
s m
embr
anes
. Tox
ic if
use
d fo
r lo
ng p
erio
ds
Chl
oram
phen
ical
eye
G
ener
al p
urpo
se e
ye a
ntib
ioti
c us
e af
ter
fore
ign
bod
y /
min
or in
jury
Inst
ill in
to e
yeoi
ntm
ent 1
%an
d f
or c
onju
ncti
viti
s3-
4 ti
mes
per
day
Side
effe
cts
: Unu
sual
, but
cam
cau
se e
ye ir
rita
tion
(b)
Neo
myc
in s
ulph
ate
0.5%
eye
dro
psG
ener
al p
urpo
se a
ntib
ioti
c ey
e d
rops
for
eye
infe
ctio
ns a
nd p
rote
ctio
n ag
ains
t In
still
into
eye
3-4
in
fect
ion
afte
r re
mov
al o
f fo
reig
n bo
die
s et
c.ti
mes
per
day
Side
effe
cts
: Unu
sual
but
can
cau
se e
ye ir
rita
tion
Dex
amet
haso
ne 0
.1%
eye
dro
psTr
eatm
ent o
f in
flam
ed ir
rita
ted
eye
s. A
nti-
infl
amm
ator
y In
still
1-2
dro
ps in
to
affe
cted
eye
4 ti
mes
a
day
Side
effe
cts
: Rar
e in
nor
mal
use
Am
etho
cain
e hy
dro
chlo
rid
e
Loc
al a
naes
thet
ic d
rops
for
eye
. Use
ful f
or n
umbi
ng e
ye b
efor
e re
mov
ing
Inst
ill 1
-2 d
rops
into
0.
5% e
yed
rops
fore
ign
bod
ies
and
for
acu
te p
ain
e.g.
in a
rc e
yeaf
fect
ed e
ye, d
o no
t us
e re
peat
edly
Side
effe
cts
: Rar
e if
used
one
off.
Car
e to
avo
id e
ye in
jury
whi
lst
num
bed
Pilo
carp
ine
nitr
ate
2% e
ye d
rops
Dro
ps c
onst
rict
the
pupi
l, us
ed to
trea
t rai
sed
pre
ssur
e in
the
eye
(gla
ucom
a)In
still
2 d
rops
3-
6 ti
mes
per
day
Side
effe
cts
: blu
rred
vis
ion
and
head
ache
Flur
esce
in s
odiu
m 1
% e
ye d
rops
U
sed
to d
etec
t scr
atch
es o
r le
sion
s on
the
fron
t of
the
eye
(cor
nea)
In
still
1-2
dro
ps
for
exam
inat
ion
Side
effe
cts
: Nil
in n
orm
al u
se
MSN-1768 28/8/03 2:13 am Page 34
35
Ref
. No.
Dru
gTy
pe o
f D
rug
/ Use
sD
oses
/ R
oute
(c)
Neo
myc
in/
poly
mix
in/
G
ener
al p
urpo
se a
ntib
ioti
c/ a
nti-
infl
amm
ator
y ea
r d
rops
for
infe
ctio
nIn
still
3 d
rops
into
hy
dro
cort
ison
e ea
rdro
ps 5
ml
of th
e ou
ter
ear
cana
lth
e af
fect
ed e
ar 3
-4
dro
pper
bot
tle.
tim
es p
er d
aySi
de e
ffect
s : N
il in
nor
mal
use
Eph
edri
ne n
asal
dro
ps
Nas
al d
e-co
nges
tant
Inst
ill 1
-2 d
rops
into
BP
0.5%
10m
l dro
pper
bot
tle
each
nos
tril
3 ti
mes
a
day
Side
effe
cts:
Nos
e bl
eeds
. Use
for
shor
t pe
riod
s on
ly
(d)
Chl
orhe
xid
ine
gluc
onat
e 0.
2%
Ant
isep
tic
mou
thw
ash
for
sore
thro
ats,
mou
th s
ores
etc
. R
inse
mou
th w
ith
10m
outh
was
h 30
0ml b
ottl
em
ls tw
ice
per
day
Side
effe
cts
: Nil
in n
orm
al u
se
Lig
noca
ine
hyd
roch
lori
de
1%
Loc
al a
naes
thet
ic in
ject
ion
for
num
bing
sm
all w
ound
s fo
r tr
eatm
ent
Inje
ct a
roun
d w
ound
25
mg
in 5
ml i
njec
tion
edge
s, 2
-5m
ls u
sual
lysu
ffic
ient
, no
mor
e th
an 2
0mls
in a
n ad
ult
Side
effe
cts
: Fit
s, h
eart
pro
blem
s in
ove
rdos
e
Oil
of c
love
s 10
ml b
ottl
eN
atur
al o
il w
ith
loca
l ana
esth
etic
pro
pert
ies
usef
ul in
trea
ting
toot
hach
eA
pply
spa
ring
ly to
af
fect
ed to
oth
as
requ
ired
by
sym
ptom
sSi
de e
ffect
s: N
il in
nor
mal
use
Lig
noca
ine
2% /
chl
orhe
xid
ine
Use
d to
num
b ur
ethr
a fo
r in
sert
ion
of u
rina
ry c
athe
ter
Inst
ill f
rom
0.
25%
lubr
ican
t gel
pre-
fille
d s
yrin
ge
Side
effe
cts:
Rar
e bu
t ca
n ca
use
irri
tati
on
MSN-1768 28/8/03 2:13 am Page 35
36
ANNEX 8
SPECIMEN REQUISITION FORM FOR USE WHEN OBTAININGCONTROLLED DRUGS
Controlled drugs should be obtained only from a retail pharmacist or other person licensed to supplydrugs, and they will require an order worded along the lines below. The order must be signed by eitherthe vessel’s owner or its Master.
It is not necessary for the Master or owner to receive personally the controlled drugs from the supplier,but if the drugs are received by another person the requisition must be endorsed as follows :
Requisition
To …………………………………………. (Name and address of authorised supplier)
From …………………………………………. (Name of Master or Ship owner)
Vessel Name …………………………………………. (Name of vessel)
Address …………………………………………. (Address of the Ship or the Ship owner)
Please supply ………………………………………….…………………………………….
………………………………………….…………………………………….(name, strength and quantity of drugs in words and figures)
The above drugs are required for the medical stores of the above vessel in compliance with theMerchant Shipping (Medical Stores) Regulations 1995.
Signature ……………………………………………………………….
Name [capital letters] ……………………………………………………………….
Occupation ……………………………………………………………….
Date ……………………………………………………………….
I empower …………………………………………. to receive the above drugs on my behalf. Aspecimen of their signature is provided below.
Specimen signature of person empowered ……………………………………………………..
Signature of Master / owner ……………………………………………………..
MSN-1768 28/8/03 2:13 am Page 36
ANNEX 9
COMPLETION OF THE CONTROLLED DRUGS REGISTER
SECTION 1 – DRUGS OBTAINED FROM AUTHORISED SUPPLIER OR CONFISCATED FROM SEAFARERS
Example
SECTION 2 – DRUG DISPENSED OR DISPOSED OF
Example
37
Date obtained Suppliers Amount obtained Name of drug and Name & Address form in which obtained
01/01/03 H.M Kingston Chemists 10 ampoules Morphine Sulphate 10mg24 Elliot Street in 1ml in glass ampoulesSouthampton
Date Name & Address of Right of person Amount Supplied Drug and Form in person given drug to have drug which supplied
01/02/03 TH Laidlaw Injured crewman 2 ampoules MorphineLog book ref. 21 (fractured sulphate 10mg
humerus) in 1ml (in glass ampoules)
10/02/03 HM Kingston Chemist Qualified retail 8 ampoules Morphine24 Elliot Street pharmacist sulphate 10 mgSouthampton in 1 ml (in glass
ampoules)
MSN-1768 28/8/03 2:13 am Page 37
