Approaches to Medical Emergencies on Commercial Flights.

In-flight medical incidents are becoming increasingly critical as passengers with diverse health profiles increase in the skies. In this paper, we reviewed how airlines, aviation authorities, and healthcare professionals respond to such emergencies. The analysis was focused on the strategies developed by the top ten airlines in the world by examining training in basic first aid, collaboration with ground-based medical support, and use of onboard medical equipment. Appropriate training of crew members, availability of adequate medical resources on board airplanes, and improved capabilities of dialogue between a flying plane and medical doctors on the ground will contribute to a positive outcome of the majority of medical issues on board airlines. In this respect, the adoption of advanced telemedicine solutions and the improvement of real-time teleconsultations between aircraft and ground-based professionals can represent the future of aviation medicine, offering more safety and peace of mind to passengers in case of medical problems during a flight.

Design and evolution of the Seafarer's Health Passport for supporting (tele)-medical assistance to seafarers.

BACKGROUND: Seafarers undergo periodic medical examination for their employment. This information inmost cases is not effectively used when requesting for medical assistance during service on board ships.The medical history of an individual is important for provision of medical care and can be critical to theoutcome. There is growing adoption of digital applications and electronic health records that are addinggreat value to the care provided. The Seafarer's Health Passport (SHP) is an application specifically designedfor improving the quality of medical assistance provided to seafarers both through telemedicineor classic medical check-ups in ports/hospitals worldwide. The SHP provides a secure and unique way toarchive and retrieve the seafarer's medical history in an electronic support. MATERIALS AND METHODS: The SHP that we have developed is a product with specific hardware and softwarespecifications. The basic features of this software are Linux operating system Debian/Ubuntu, ApacheWeb server 2.x, Server database MySQL/Maria DB PHP programming language 5.6.xx, and secure connectionin https. RESULTS: The SHP represents a helpful hint to physicians providing medical advices to seafarers enablingthem to make more decisions that are informed and curtailing possible complications due to misdiagnosis. CONCLUSIONS: Provision of high quality medical assistance requires knowledge of patient's medical history.The availability of an easy access and friendly use system of own medical history is useful for a populationof travellers, such as seafarers to guarantee a reasonable level of medical care at any time.

Food safety on board tankers. Results of analysis from 'Healthy Ship' project.

BACKGROUND: Microbiological monitoring of surfaces used for food preparation, as required by the Hazard Analysis and Critical Control Points (HACCP) plan, is important in risky conditions as those observed in the kitchens of ships. Limits to introduce a classification of risk levels and methods to adopt in conditions as those occurring in tankers have not been investigated. This paper presents the results of the "Healthy Ship" project on HACCP monitoring of surfaces used in food preparation on Italian flag tankers. MATERIALS AND METHODS: Microbiological monitoring was carried out on 19 tankers between 2013 and 2017. Food handlers were also trained on board ship according to HACCP standards. Contact plates (ISO 18593:2004 compliant) were used to determine the colonies and bacterial charge according to the Wirtanen and Salo's method. RESULTS: A total of 1074 samples, 108 before the first course, 168 after the first course, 390 during the period of refresher (2015-2016), and 408 after the refresher training, were obtained from the three main kitchen surfaces: the worktop, cutting board, and kitchen sink. A good level of hygiene was observed in 56.9% of all samples, 0.1% were classified as adequate, and the remaining 43% as poor. The highest contamination was observed on the cutting board and kitchen sink and involved the total aerobic count. The only surface with inadequate levels of hygiene was the worktop. A reduction of contaminated samples was noted after training. CONCLUSIONS: Our results suggest that continuous training should be provided for personnel responsible for handling foodstuffs on board ships.

Survey on smoking habits among seafarers.

BACKGROUND: Populations living in stressful environments experience higher mortality from lung cancer and chronic diseases. Work-related stress was identified as important determinant of smoking together to health problems caused by a incorrect lifestyles. Aim of the work was to analyze tobacco smoking addiction in seafarers working on merchant ships. Only a few studies are available on this topic. METHODS: The survey was conducted using an anonymous questionnaire. The total number of questionnaires filled-in was 1478, out of 2000 distributed (response rate 73.9 %). RESULTS: About half of the sample (55.07%) has never smoked, the 28.96% is currently a smoker, while 15.97% of responders belong to the category of ex-smokers. Analysis of the number of cigarettes smoked every day based on the rank shows that captains and officers smoke more cigarettes than the crew members who smoke 10 cigarettes maximum per day. Analysis of the level of dependence among the smokers group by the Fagerström Test for Nicotine Dependence (FTND) revealed that a 89.0% of sample has a low/very low dependence level, and only the 10.98% of the sample show a high/very high dependence. A further analysis of the results of FTND in the different age groups has shown that the 41-50 and 51-60 age groups have high dependence levels. CONCLUSIONS: Working on board is associated to a high risk for chronic, lifestyle-related diseases, due also to lifestyle behaviours. This study suggests to further investigate the presence of other risk factors such as diet, physical exercise, combined with tobacco smoking, obesity. (www.actabiomedica.it).

Identification of World Health Organisation ship's medicine chest contents by Anatomical Therapeutic Chemical (ATC) classification codes.

BACKGROUND: Ships should carry mandatory given amounts of medicinal products and basic first aid items, collectively known as the ship's medicine chest. Type and quantities of these products/items are suggested by the World Health Organisation (WHO) and regulated by individual flag states. In countries that lack national legislation, it is assumed that ships should follow WHO indications. An objective difficulty mainly involving vessels of international long-haul routes could be to recognise medicinal compounds obtained in other countries for replacing products used or expired. Language barrier may complicate, if not make it impossible to interpret the name of the medicinal product and/or of the active principle as indicated in a box printed in a completely different language. Handling of the ship's pharmacy may be difficult in case of purchasing of drugs abroad due to language barriers. Medicinal products are identified by the international non-proprietary name of the active principle and/or by their chemical or invented (branded) names. This may make the identification of a medicinal product difficult, primarily if it is purchased abroad and the box and instructions are written in the language of the country where it is marketed. Therefore, there is a simpler classification system of the medicinal compounds the ATC (ATC: Anatomy, Therapeutic properties, Chemical, pharmacological properties). This paper has reviewed the list of medicinal products recommended by WHO and assigned to each one the ATC code as a solution to the problem of medicinal compounds organisation. MATERIALS AND METHODS: Two researchers independently examined the list of medicinal compounds indicated in the third edition of the International Medical Guide for Ships and attributed to each compound the ATC code according to the 2013 Guidelines for ATC classification and Defined Daily Dose (DDD) assignment. RESULTS: The ATC code was attributed to the medicinal compounds indicated in the third edition of the International Medical Guide for Ships. CONCLUSIONS: The availability of an objective system to identify medicinal products is required for ships, which will contribute in making the identification of items purchased simpler, making it easier to understand which drug seafarers need to be administer, and consequently reduce possible therapeutic mistakes.

Development of software for handling ship's pharmacy.

BACKGROUND: Ships are required to carry a given amount of medicinal products and medications depending on the flag and the type of vessel. These medicines are stored in the so called ship's "medicine chest" or more properly - a ship pharmacy. Owing to the progress of medical sciences and to the increase in the mean age of seafarers employed on board ships, the number of pharmaceutical products and medical devices required by regulations to be carried on board ships is increasing. This may make handling of the ship's medicine chest a problem primarily on large ships sailing on intercontinental routes due to the difficulty in identifying the correspondence between medicines obtained abroad with those available at the national market. To minimise these problems a tool named Pharmacy Ship (acronym: PARSI) has been developed. MATERIALS AND METHODS: The application PARSI is based on a database containing the information about medicines and medical devices required by different countries regulations. In the first application the system was standardised to comply with the Italian regulations issued on the 1st October, 2015 which entered into force on the 18 January 2016. RESULTS: Thanks to PARSI it was possible to standardize the inventory procedures, facilitate the work of maritime health authorities and make it easier for the crew, not professional in the field, to handle the 'medicine chest' correctly by automating the procedures for medicines management. As far as we know there are no other similar tools available at the moment. The application of the software, as well as the automation of different activities, currently carried out manually, will help manage (qualitatively and quantitatively) the ship's pharmacy. CONCLUSIONS: The system developed in this study has proved to be an effective tool which serves to guarantee the compliance of the ship pharmacy with regulations of the flag state in terms of medicinal products and medications. Sharing the system with the Telemedical Maritime Assistance Service may result in avoiding mistakes in drug administration. Last but not least the availability of PARSI could help reduce/ avoid problems with maritime health authorities in case any of the required medicinal products are missing.

Dental hygiene habits and oral health status of seafarers.

BACKGROUND: This study has assessed the dental hygiene habits and problems of seafarers and their attitudes/ perceptions regarding oral hygiene using a dental hygiene/habits questionnaire. MATERIALS AND METHODS: A research questionnaire on oral hygiene habits was prepared along with a summary of all the questions and sent to ships via e-mail by Centro Internazionale Radio Medico (CIRM) networks. CIRM, is the Italian Telemedical Maritime Assistance Service (TMAS), and represents the Centre with the largest number of seafarers assisted on board ships worldwide. CIRM proposed the questionnaire to all ships (n = 1,198) asking for medical advice from 1 July 2014 till 31 October 2014. Two dental professionals were involved in the development and analysis of the questionnaire. RESULTS: Seafarers are at risk of several dental health problems due to their oral hygiene and dietary habits, smoking and alcohol consumption, poor oral hygiene knowledge and motivation. Dietary habits during voyages were also questionable and seafarers consume food rich in fermentable carbohydrates, which is a major risk factor for dental caries. CONCLUSIONS: Seafarers need better oral hygiene education and care to enable them to manage their oral health in a better way. Life at the sea, under challenging circumstances is not without stress, that is why it is important that seafarers are given complete information about correct oral hygiene protocols and dental hygiene and the advantages for their health of keeping a healthy mouth.

Recommendations for assessing water quality and safety on board merchant ships.

INTRODUCTION: Health and diseases on board ships may depend on water. Interventions to improve the quality of water may bring to significant benefits to health and water stores/supply and should be controlledto protect health. This paper has reviewed the main regulations for the control of water safety and qualityon board ships and presents some practical recommendations for keeping water healthy and safe in passenger and cargo merchant ships. METHODOLOGY: The main international regulations and guidelines on the topic were analysed. Guidelines forWater Quality on Board Merchant Ships Including Passenger Vessels of Health Protection Agency, World Health Organisation (WHO) Guide to Ship Sanitation, WHO Guidelines for Drinking Water Quality, WHO Water Safety Plan and the United States Center for Disease Control and Prevention Vessel Sanitation Program were examined. Recommendations for passenger and, if available, for cargo ships were collected and compared. Recommended questionnaire: A questionnaire summarising the main information to collect for assessingthe enough quality of water for the purposes it should be used on board is proposed. The need of havinga crew member with water assessment duties on board, trained for performing these activities properlyis discussed. CONCLUSIONS: Water quality on board ships should be monitored routinely. Monitoring should be directedto chemical and microbiological parameters for identifying possible contamination sources, using specifickits by a designed crew member. More detailed periodic assessments should be under the responsibility ofspecialised personnel/laboratories and should be based on sample collection from all tanks and sites of waterdistribution. It is important to select a properly trained crew member on board for monitoring water quality.

The Psychological General Well-Being Index (PGWBI) for assessing stress of seafarers on board merchant ships.

BACKGROUND: In their working activity, seafarers are exposed to high levels of stress that should be accuratelyinvestigated, measured, followed up and, if possible, countered. This is also required by regulations recently entered into force such as the Maritime Labour Convention 2006, recommending to consider special physiological or psychological problems created by the shipboard environment. The choice of the tools for this evaluation is challenging, and a common basic standard usable in a large scale should be identified. AIM: The aim of this study was to evaluate: 1) the suitability of the Psychological General Well-Being Index (PGWBI) questionnaire conducted on board for assessing stress in the sailing seafarers, 2) The presenceof stress in seafarers of different categories (deck officers, engine officers, deck crew, engine crew, chiefstewards/catering staff) monitored by the PGWBI. MATERIALS AND METHODS: 162 male seafarers on board of 7 tankers belonging to the same shipping companywere evaluated through the PGWB questionnaire. Analysis of variance (ANOVA) was used to analyse thedifferences in the scores of the questionnaire. RESULTS: Engine officers exhibited significantly higher anxiety levels than the deck or engine crew, andshowed lower satisfaction than the deck crew. Deck and engine officers revealed higher self-control levelsthan the engine crew. Chief stewards/catering staff showed lower vitality levels than the deck crew. CONCLUSIONS: Deck or engine officers should achieve a greater self-control than the crew and this is documentedby the present study. Our findings support the view that management responsibility is more often associated with higher levels of stress. In our opinion, the PGWB questionnaire is a reasonable compromise forobtaining a global evaluation of psychological conditions, including stress of seafarers. It should be therefore considered as a large scale tool for assessing the well-being and eventual stress levels of sailing seafarers.