Bulletin 040 – Medical Care and Medical Oxygen Cylinders 1.1

Notice to: Shipowners, Operators, Officers, Flag State Inspectors and Recognised Organisations.

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1.             References

a)              Barbados Merchant Shipping Act, 2024

b)              Barbados S.I. 2025 No. 32: Merchant Shipping (Ships’ Medical Stores) Regulations, 2025

c)              Maritime Labour Convention, 2006 (MLC, 2006)

d)              SOLAS, International Convention for the Safety of Life at Sea.

e)              WHO International Medical Guide for Ships, 3rd edition

f)               PPO01-F14 Ship Masters Medical Report Form

g)              PPO01-F17 Controlled Drugs Requisition

h)              Bulletin 021 – BMSR Certificates of Endorsements

i)                International Maritime Dangerous Goods Code (IMDG Code)

j)                Medical First Aid Guide for Use in Accidents Involving Dangerous Goods (MFAG)

k)              Seafarers’ Training, Certification and Watchkeeping Code (STCW Code)

l)                Code of Signals, Edition 2005

2.             Purpose

2.1           This Bulletin provides guidance on implementing the MLC, 2006 Reg. 4.1 requirements for medical care on board, the Barbados Merchant Shipping Act, 2024 and the S.I. 2025 No. 32., and adopts the WHO International Medical Guide for Ships, 3rd edition as guidance for Barbadian vessels.

3.             Application

3.1           This Bulletin applies to all Barbados vessels engaged in international voyages other than pleasure yachts.

4.             Vessel Medical Stores

4.1           All vessels shall carry medical stores, medical equipment and a medical guide, which shall be maintained and inspected at intervals not exceeding twelve (12) months.

4.2           The medical stores shall conform to the standards and requirements of the British National Formulary, the British Pharmacopoeia, the European Pharmacopoeia or the United States Pharmacopoeia, and to the requirements of Chapter 33 of WHO International Medical Guide for Ships, 3rd edition.

4.3           The exact inventory of medicines, medical equipment and supplies should be determined by the shipowner or operator in consultation with a qualified medical practitioner, such as the vessel’s doctor or pharmacist.

4.4           The medical stores, packing, and labelling shall be as per Sec. 20 of S.I. 2025 No. 32 and stored as per Sec. 21 of S.I. 2025 No. 32.

4.5           Drawers or medicine cabinets should be large enough to store medicines and equipment in an orderly manner so that they are easily identified and available for immediate use. This is particularly important for medicines and equipment used in emergencies: these should be kept separately in the most accessible place. Generally, items of the same type or category should be stored in a box, shelf or drawer, properly labelled.

4.6           All medicines shall be kept in good condition and protected against humidity and temperature extremes. They should be stored at room temperature (15–25 °C) when not otherwise specified. A refrigerator should be available nearby for items that must be kept at 2–8 °C. This refrigerator should not be used for any other purpose and should be equipped with a lock.

5.             First Aid Kits

5.1           In addition to the medical stores under Sec. 4 above, vessels with a crew of more than 10 shall carry first aid kits distributed in appropriate locations on the vessel, such as in the galley and engine, as per Sec. 3 of the Third Schedule of S.I. 2025 No. 32.

6.             Medical Doctor and Person designated to provide Medical Care

6.1           Vessels, including Passenger Ships, carrying 100 or more persons and ordinarily engaged on international voyages of more than three days’ duration, are required to have a qualified medical doctor responsible for providing medical care.

6.2           For mobile offshore drilling units and mobile offshore units, the requirement for a doctor on board may be met with a qualified medic or nurse where the unit is within helicopter range of shore medical services and facilities.

6.3           Vessels, which do not carry a medical doctor shall be required to have either at least one designated seafarer on board who is in charge of medical care and administering medicine as part of their regular duties or if the vessel is ordinarily capable of reaching qualified medical care and medical facilities within eight (8) hours, the vessel shall have at least one (1) seafarer on board competent to provide medical first aid.

6.4           The person in charge of medical care on board who is not a qualified medical doctor shall have satisfactorily completed training in medical care that meets the requirements of STCW Code. Seafarers designated to provide medical first aid shall have satisfactorily completed training in medical first aid that meets the requirements of the  STCW Code, with  the latest edition of MFAG, and the medical section of the International of Code of Signals.

6.5           Persons referred to in Sec. 6.3 and 6.4 above, and other seafarers with medical assigned tasks should undergo refresher courses at intervals not exceeding five (5) years to enable them to maintain and increase their knowledge and skills and to keep up-to-date with new developments, as per MLC, 2006 Guideline B4.1.1.3. Documentary evidence of this refresher training should be maintained.

7.             Vessels carrying Dangerous Cargoes

7.1           In addition to the medical stores under Sec. 4 above, when a Barbados-registered vessel is carrying a dangerous substance in quantities in excess of those defined in Vol 1, Section 18 of IMDG Code shall comply with the IMDG Code and the guidance in the latest edition of MFAG.

7.2           Medicines and equipment already available in the IMGS list may be counted toward the MFAG numerical requirement, if appropriate and should be stored and registered together with the regular medicines and medical supplies carried on board.  

7.3           Where a cargo, classified as dangerous, has not been included in the most recent edition of MFAG, the necessary information on the nature of the substances, the risks involved, the necessary personal protective devices, the relevant medical procedures, and specific antidotes should be made available to the seafarers via the vessel’s occupational safety and health policies.

8.             Medicines for Passenger Ships

8.1           In addition to the medical stores under Sec. 4 above, Passenger Ships that do not normally carry a medical doctor, particularly Ro-Ro Passenger Ships, are required to carry a Doctor’s Bag as per the Second Schedule of S.I. 2025 No. 32.

8.2           The Doctor’s Bag should be clearly labelled as follows:

.1                        “The medicines in this case are only to be used by a qualified medical practitioner, qualified nurse with maritime-situational healthcare competence, qualified paramedic, or someone under the direct supervision of a medical practitioner on board the vessel”.

8.3           Passenger Ships shall carry one first aid kit as per Sec. 5 above, for every 100 passengers or a fraction of that number, subject to a maximum requirement for 3 kits, e.g. 250 persons require three kits. A first aid kit is to be included in the Doctor’s Bag.

9.             Medical Guides and Maritime TeleMedical Assistance Services

9.1           The Master of every vessel shall carry on board the guides to the use of medical stores listed in the Fourth Schedule of S.I. 2025 No. 32, including instructions for the use of antidotes, and The Admiralty List of Radio Signals, Volume 1 (NP281)—Maritime Radio Stations (Parts 1 & 2) lists and all Maritime TeleMedical Assistance Services (TMAS) worldwide.

10.         Precautions against Malaria

10.1       The Master of every vessel voyaging in an area susceptible to malaria shall provide a copy of the advice set out in the Fifth Schedule of S.I. 2025 No. 32 to all passengers and crew.

11.         Controlled Drugs

11.1       Controlled drugs are graded according to the harmfulness attributed to them when misused. There are three drug categories:

.1                        Class A includes heroin, morphine, and opium;

.2                        Class B includes barbiturates and codeine; and

.3                        Class C includes, among other drugs, anabolic steroids.

11.2       A vessel shall not carry excess quantities of Class B and C drugs unless required by a doctor or authorised by the BMSR.

11.3       Morphine Sulphate is the only controlled Class A drug authorised to be carried aboard Barbados vessels and in the doctor’s bag.

11.4       Controlled drugs shall be obtained only from a retail pharmacist or other person licensed to supply drugs, through the use of an order, signed by the vessel’s owner or its Master, or by a person authorised by him, in the form PPO01-F17 Controlled Drugs Requisition or an equivalent with the same wording.

11.5       Every vessel shall have a lockable medical cabinet for the storage of medicines and drugs. The cabinet shall have an inner cupboard solely for the storage of controlled drugs, fitted with a door and a separate lock that cannot be opened with the key to the medical cabinet. Only the Master or a person authorised by him may open the inner cupboard.

11.6       A Controlled Drugs Register as per Sec. 13.5 below shall be maintained by the Master and shall be kept onboard for 2 years after the date of the last entry.

12.         Inspection and Certification Requirements

12.1       MLC, 2006 Standard A4.1.4(a) requires a competent authority to inspect the vessel’s medical stores at regular intervals not exceeding 12 months.

12.2       The inspection can be carried out by a competent person or the authorities of a country where Barbados has an STCW Recognition Agreement, as listed in Sec. 5 of Bulletin 021 and shall ensure that the vessel is carrying the required medical stores, that these stores are correctly stored, and that any perishable medicines have been replaced. The labelling, expiry dates, and conditions of storage of all medication, along with directions for their use, are to be checked, and all equipment shall function as required.

12.3       Annual Flag State inspections will verify that the medical stores are adequate and have been certified within the last 12 months.

12.4       Inspection and certification of the medical stores can be carried out on board or remotely. Where physical attendance on board is not feasible, the Master shall:

.1                        Ensure that the medicines have not been expired and their packaging and supplies are not damaged;

.2                        Ensure that the medical equipment is usable and free from any damage;

.3                        Provide the inspecting authority with the updated medicine list;

.4                        Provide information to the authority conducting the inspection of whether the ship falls into WHO Category A, B, or C based on ship type and distance from shore and whether the medical stores are stocked in accordance with Sec. 4 above;

.5                        Confirm with the inspecting authority the number of persons allowed on board by the Cargo Ship Safety Equipment Certificate;

.6                        Inform the inspecting authority whether the vessel carries dangerous goods or chemicals.

12.5       If the review shows that the medicine chest is stocked appropriately for the particular vessel’s route, operation, and number of persons on board, then documentation certifying this shall be obtained from the inspecting authority.

12.6       This documentation shall include a statement that all required contents of the medical store are present and will not expire during the period covered by the issued documentation. The documentation (which could be in a certificate form) shall also include, to the extent possible:

.1                        IMO Number;

.2                        Name of Vessel;

.3                        Registry of Vessel;

.4                        Unique serial number or ID code on the document; and

.5                        Issuing and expiry dates.

12.7        The document or certificate shall be signed and stamped by the authority carrying out the inspection, and it should display their full name and title.

12.8       If the review results indicate that the medical stores are not suitable for the specific vessel’s route, operation, and number of persons on board, the Master shall take corrective action. The Master shall secure signed and stamped documentation from the authority conducting the inspection once the medical stores are considered appropriate. The authority conducting the inspection shall include its full name on the document.

13.         Recordkeeping and Reporting Requirements

13.1       Electronic Records

.1                        All records required under this section may be kept and managed electronically.

13.2       Inventory of Medicines

.1                        A list of medicines and medical supplies shall be maintained on board all Barbados vessels.

.2                        The list shall be regularly updated and contain the expiration date, storage conditions, quantities remaining after purchase or use, and disposal information for each item.

.3                        The medical stores shall be inventoried no less than once a year. All items in the medical stores should have an expiration date and be resupplied as necessary by the expiry date.

13.3       Ship Master Medical Report Form

.1                        The Master or designated and certified onboard medical care provider shall complete the PPO01-F14 Ship Masters Medical Report Form when a seafarer’s treatment aboard a vessel needs to be rendered on shore, send it to the BMSR at Ops@barbadosmaritime.com, and it shall be kept by the Shipowner for a period of two years.

.2                        The purpose of the PPO01-F14 Ship Masters Medical Report Form is to facilitate the exchange between the vessel and shore regarding a seafarer’s medical condition and related information in cases of illness or injury.

.3                        The information shall be kept confidential and only used to facilitate the treatment of seafarers.

13.4       Medical Log

.1                        Each vessel shall keep a medical logbook wherein every case of illness or injury happening to any member of the crew, passenger or other persons engaged in the business of the vessel, the nature thereof, and the medical treatment shall be entered.

13.5       The Controlled Drugs Register shall: 

.1                        Detail why, when, and in what quantity the Master purchased controlled drugs, as well as the history of their dispensing or disposal; 

.2                        Be retained for two years after the date of the last entry. 

14.         Disposal of Medicines and Medical Supplies

14.1       Medicines and medical supplies shall be disposed of properly as per all applicable local and national laws and regulations of the State where disposal occurs and any appropriate international requirements.

14.2       Disposal of Non-Controlled Medications and Medical Supplies:

.1                        Expired medicines and medical supplies should be returned to the supplier, where possible, or sent to an approved shoreside contractor for disposal.

.2                        If disposal is not possible, expired medicines and medical supplies may be incinerated at sea where a vessel has in place a written waste disposal policy and a program that includes incineration at appropriate temperatures by exclusively authorised personnel. Records of these incinerated medicines and medical supplies shall be kept as part of the medical inventory.

.3                        There are licensed pharmaceutical distribution centres that supply and dispose of prescription and non-prescription medications for marine vessels globally.

14.3       Disposal of Controlled Drugs:

.1                        There are various methods to dispose of controlled drugs lawfully. They include:

i)            Giving them to a person who may lawfully supply them, such as a qualified doctor or pharmacist;

ii)          Incineration;

iii)         waste encapsulation;

iv)         inertisation.

.2                        Whatever disposal method for a controlled drug is used, the following conditions shall be met:

i)            The method used shall be properly implemented; and

ii)           The entire process from unpacking through to the controlled drug’s final destruction shall be witnessed by at least two persons and documented in the Controlled Drugs Register of Sec. 13.5 above.

15.         Carriage of Defibrillators

15.1       There is no statutory requirement under international or national legislation for vessels to carry defibrillators. It is a matter for individual operators to decide whether to include a defibrillator with the medical stores or the Doctor’s Bag.

16.         Hospital

16.1       Vessels carrying 15 or more persons engaged in a voyage of more than three days shall provide separate hospital accommodation which is to be used exclusively for medical purposes.

17.         Medical Oxygen

17.1       Under MLC Regulation 4.1, vessels shall maintain adequate medical oxygen to address crew health needs.

17.2       The medical oxygen cylinders or systems shall be sufficient for the vessel’s size, crew complement, and voyage duration and shall meet the International Pharmacopoeia or WHO International Medical Guide for Ships, 3rd edition standards.

17.3       Oxygen cylinders shall be stored in ventilated, fire-resistant lockers away from heat sources, flammable materials, and direct sunlight and as a Class 5.1 oxidising gas, oxygen requires segregation from incompatible substances (e.g., fuels) and clear hazard labelling (IMDG Code).

17.4       Systems shall be regularly inspected for integrity, with valves and regulators maintained to prevent accidental release

17.5       For certain cargoes, the IMDG Code requires the carriage of oxygen resuscitation equipment as specified in the MFAG.

17.6       Vessels subject to MFAG Column A or B are required to carry a minimum of 44 litres/200 bar oxygen as follows:

.1                        one 40 litre/200 bar medical oxygen cylinder located in the vessel’s hospital, assembled for direct use, equipped with one flowmeter unit (with two ports) for supplying oxygen for two persons simultaneously; and

.2                        one complete portable set, ready for use, with a 2 litre/200 bar medical oxygen cylinder and a 2 litre/200 bar spare cylinder.

17.7       The single 40 litre/200 bar medical oxygen cylinder of Sec. 17.6.1 above may be substituted with either two 20 litre/200 bar cylinders or four 10 litre/200 bar cylinders, provided the equipment/flowmeter units are arranged to supply oxygen to two persons simultaneously.

17.8       Medical oxygen cylinders with less than a 200 bar filling pressure may be used, provided that the total volume of oxygen delivered by multiple cylinders is at least equal to that contained in a 40 litre/200 bar cylinder or  2 litre/200 bar cylinders, as required by 17.6.1 and 17.6.2 above.

17.9       Medical oxygen cylinders shall be hydrostatically tested every five years or at an interval specified by the manufacturer, whichever occurs sooner.

17.10    The contents of the medical oxygen cylinders shall be checked and changed as required by the manufacturer’s instructions, and the entire system shall be inspected annually by a competent person in accordance with the manufacturer’s instructions.

17.11    Vessels issued with a valid Document of Compliance for Dangerous Goods do not need to carry the additional medical oxygen cylinders as requested by MFAG and as listed in Sec. 17.6 above when not loading, carrying, or discharging dangerous goods.

17.12    The shipboard Safety Management System shall include provisions to ensure that the cylinders and system will be provided onboard before the vessel begins any of these operations with dangerous goods.