Comparative analysis of the medicinal compounds of the ship’s “medicine chests” in European Union maritime countries. Need for improvement and harmonization
Abstract
Background: The contents of the ship pharmacy, namely “medicine chest” and its compliance with the respective regulations concerning the type of drugs to be provided for merchant vessels involved in long distance voyages and without a doctor on board were analysed. The current existing disparity between regulations can make medical assistance more complicated, and more often of low quality, due to frequent off-label use of supplied drugs. This study may represent a starting point leading to a model high-quality medicine chest on board ships. Materials and methods: A comparative analysis between the medicine chest requirements of 12 European countries and the CEE Directive 31 March 1992 n.92/29 was made. Prescriptions of the aforementioned Directive were compared with the WHO Model List of Essential Medicines (third Edition). Results: The investigation showed a lack of homogeneity of contents. It emerged that some medicine chests lack of several pharmaceutical categories required by the reference standards. The subsequent comparison of the European Directive with the WHO Model List of Essential Medicines has highlighted the absence of some therapeutic categories that in the ship environment can be of important to ensure adequate therapy in many situations. Conclusions: There are disparities regarding regulations concerning the ship medicine chests. It is crucial to harmonize these and create a single medicine chest for all the ships without a doctor on board, undergoing periodic updates and revisions, based on epidemiological analysis that will ensure high-quality healthcare to seafarers around the world.
Keywords: healthcare qualityseafarermedicine cheststandardizationhealthcare quality in ship
References
- Goethe WHG, Watson EN W, Jones DT J. Handbook of Nautical Medicine. Heidelberg: Springer-Verlag; 1984.
- US Department of Health and Human Services Public Health Service. The Ship's Medicine Chest and Medical Aid at Sea. Rockville: Office of the Surgeon General; 2003.
- Healthcare International Conference. Paris: Background of Augustine Hat Printing of Fine Arts; 1851.
- International Medical Guide for Ships. Geneva: World Health Organization; 1988.
- International Medical Guide for Ships. 3rd ed. Geneva: World Health Organization; 2007.
- European Union. Directive 92/29 On Minimum Safety and Health Requirements for Improved Medical Treatment On Board Vessels. European Economic Community; 1992.
- Agenzia Europea per la sicurezza e la salute sul lavoro. Directive 92/29/EEC - medical treatment on board vessels; 31 March 1992 on the minimum safety and health requirements for improved medical treatment on board vessels. https://osha.europa.eu/it/legislation/directives/17.
- Word Health Organization: WHO Model List of Essential Medicines. Department of Essential Medicines and Health Products; published on 6 June 2017. http://www who int/selection_medicines/list/en.
- Republic of Cyprus, Ministry of Communications and Works, Lemesos. Department of Merchant shipping, Lemesos. The Merchant Shipping (Minimum Requirements of Medical Treatment on Board Ships) Order of 2010 (P.I .233/2010). Circular No. 15 /2010 9 June 2010.
- Fortegnelse, kontroldokument og brugervejledning over lægemiddelstoffer og medicinsk udstyr kategori A. Jf. Meddelelser fra Søfartsstyrelsen A, Kapitel IX B.
- Ministry of Social Affairs and Health, Finland. Decree of the Ministry of Social Affairs and Health on Ships' Medical Stores. No. 589/2015.
- Direction générale des Infrastructures, des Transports et de la Mer - Affaires Maritimes - Dispositions Sanitaires et Medicales. Paris, 1996.
- Bundesministerium für Verkehr Infrastruktur digital. German Medical Guide for Ships Manual for Captains And Ship's Officers. Berlin: Berufsgenossenschaft; 2016.
- Greece. Presidential Decree No 376/95 of 11/09/1995, Number 206. Published on 05/10/1995.
- Interministerial Decree 20, 1 October 2015 - Amendments to the Schedule to the Decree of 25 May 1988 n. 279, which indicates medicines, the dressing objects and tools of which must be provided to national ships for merchant shipping, fishing and recreational boating. Official Gazette of the Italian Republic 18 November 2015.
- Malta. Legal Notice 145 of 2013. Subsidiary Legislation 234.51. Maritime Labour Convention; 2013.
- Inspectie Verkeer en Waterstaat. Medical supplies on board Dutch sea-going vessels and fishing vessels, 16 July 2006.
- Diario da Republica — I Serie-B. N.o 1 — 2-1-1997. Portaria n.o 6/97 de 2 de Janeiro.
- Ministerio de Empleo y Seguridad Social - Guia Sanitaria on Board, 1995.
- United Kingdom Maritime and Coastguard Agency. MSN 1768 Ship's Medical Stores, London 2003.
- Oldenburg M, Herzog J, Harth V. Seafarer deaths at sea: a German mortality study. Occup Med (Lond). 2016; 66(2): 135–137.
- Grappasonni I, Petrelli F, Amenta F. Deaths on board ships assisted by the Centro Internazionale Radio Medico in the last 25 years. Travel Med Infect Dis. 2012; 10(4): 186–191.
- Sąlyga J, Kušleikaitė M. Factors influencing psychoemotional strain and fatigue, and relationship of these factors with health complaints at sea among Lithuanian seafarers. Medicina (Kaunas). 2011; 47(12): 675–681.
- Nittari G, Pallotta G, Canio MDi, et al. Benzodiazepine prescriptions on merchant ships without a doctor on board: analysis from medical records of Centro Internazionale Radio Medico (CIRM). Int Marit Health. 2018; 69(1): 28–34.
- G. Nittari, G. Pallotta, I. Pirillo, G. Ricci, F. Amenta. Evaluation of medical prescriptions and off-label use on board ships to improve healthcare quality. Eur Rev Med Pharmacol Sci. Year: 2018 Vol. 22 - N. 13 Pages: 4392-4400 DOI: 10. 26355/eurrev. ; 201807: 15439.
- Tayebati SK, Nittari G, Mahdi SS, et al. Identification of World Health Organisation ship's medicine chest contents by Anatomical Therapeutic Chemical (ATC) classification codes. Int Marit Health. 2017; 68(1): 39–45.
- Nittari G, Tomassoni D, Di Canio M, et al. Overweight among seafarers working on board merchant ships. BMC Public Health. 2019; 19(1): 45.
![](https://journals.viamedica.pl/plugins/generic/popups/images/icons/close.png)