LETTER TO THE EDITOR
French maritime procedures concerning the Ebola infection, experience of the French Tele-Medical Assistance Service (TMAS)
Emilie Dehours, Patrick Roux, Julien Tabarly, Alexandre Saccavini, Pierre Roucolle, Michel Pujos
Centre de Consultation Médicale Maritime (CCMM — French maritime Tele-Medical Assistance Service — TMAS), Emergency Department, University Hospital, Toulouse, France
Emilie Dehours, Centre de Consultation Médicale Maritime, Place du Dr Baylac, 31059 Toulouse, France, tel: +33(0)5 67 69 16 76, fax: +33(0)5 61 77 24 11, e-mail: firstname.lastname@example.org
Since Ebola worldwide infection, the Centre de Consultation Médicale Maritime (CCMM), French maritime Tele-Medical Assistance Service (TMAS), has been widely involved; this on request of the French Directorate for Maritime Affairs (Ministry for Ecology and Transport), to implement recommendations. Several procedures have been developed jointly with the Directorate for Maritime Affairs (DAM), the Maritime Health Service (SSGM), the Directorate of Health (DGS) and the French maritime TMAS. In this letter, we present and discuss those procedures.
GENERAL PRACTICE RECOMMENDATIONS 
This note concerns all shipping companies whose ships call at ports located in areas affected by Ebola, or embarking crewmembers or passengers having stayed in this area.
It exposes the preventive measures to be implemented for a suspected case of Ebola fever on board. A specific medical chest has been proposed to cope with a possible case. It recommends that any person with a temperature above 38°C and having stayed in one of the countries within the contagion area has to be considered as a suspected case and has to be isolated. A telemedical advice is required from the French TMAS (+33 534 393 333). Goal of this medical teleconsultation, based on an assessment questionnaire, is to eliminate all suspicion of contamination.
PRACTICAL GUIDANCE IN CASE OF AN EBOLA FEVER ON BOARD A SHIP 
The practical guidance drafted by French TMAS defines a ‘suspected case’ and provides the procedure to be followed in such a case. This procedures indicates which type of action should be taken for patient isolation and staff individual protection; it also requires the master to ask for telemedical advice as soon as possible. When facing a ‘suspected case’, telemedical consultation should enable the doctor, in relation with the National Health Institute, to tell a ‘possible case’ from an ‘excluded case’. In the event of a ‘possible case’ French TMAS will give all the information to take care of the patient (Fig. 1).
Figure 1. Practical Guidance in case of an Ebola fever on board a ship
FRENCH OFFICIAL PROCEDURE IN CASE OF A SUSPECTED CASE OR A POSSIBLE CASE OF EBOLA FEVER ON BOARD A SHIP
This document, drafted by the Directorate of Health, describes the disease and the preventive measures. It provides the definition of a ‘suspected’ or ‘contact’ case, as well as the procedure to be followed.
- 1. For a French flag ship which is not coming to France and which is sailing anywhere else at sea, the recommendations and the action to be taken are those of the “Practical Guidance in case of an Ebola fever on board a ship” . French Maritime Rescue Coordination Centre (MRCC) and French TMAS in contact with local maritime and health authorities organise the arrival and the patient’s support in port of destination.
- 2. For a French flag ship or any foreign flag ship arriving to a French port or being near French coasts:
- — If the ship is inside the port, recommendations will be the ones drafted by the Directorate of Health for any people living or arriving on the French territory. Maritime recommendations do not apply.
- — If the ship is at sea (outside the port), maritime recommendations apply as described in paragraph 1.
Since this Ebola outbreak appeared, the French Maritime Medical Advice Centre has been contacted six times: only one case has been identified as a ‘possible case’ and this one has not been confirmed as a real one.
As a conclusion: official common Maritime/Health procedures are available for the French TMAS enabling to provide a fast and appropriate answer to any call referring to a suspected or possible case of Ebola fever on board a ship.
Such procedures, drafted in relation with the national maritime and health authorities could be transposed to any other similar situation related to International Health Regulations.
- 1. Ministry for Ecology and Transport [Internet]. General Practice Recommendations [updated 2014 Oct 06; cited 2015 July 09]. Available from: http://www.developpement-durable.gouv.fr/IMG/pdf/Recommandations_Ebola_06-10-2014.pdf.
- 2. Ministry for Ecology and Transport [Internet]. Practical Guidance in case of an Ebola fever on board a ship [updated 2014 Aug 13; cited 2015 July 09]. Available from http://www.developpement-durable.gouv.fr/IMG/pdf/Conduite_a_tenir_devant_un_CAS_SUSPECT_Ebola_13-8-2014.pdf.