Master's responsibility in medical emergency

Professional Mariner Forum
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Anybody got an resources for what the master’s legal responsibility is, in the event of a medical emergency on board?

I have the highest level of medical training on my passenger ship (not big enough to have an actual medical officer), because I took Medical First Aid Provider to get my STCW license. However, I’m currently sailing domestic, which means I’m also subject to state laws that say if I get involved/take charge of a medical emergency, I have to remain in charge until I hand off the patient to someone with equivalent or higher level training, or I can be charged with abandoning my patient. In 99% of cases, it’ll be faster to either put the patient in a tender/fast rescue boat and run them to shore to waiting EMS, or medevac someone off, than steam to port with the mother ship. Owing to the nature of the ship and lack of any safe place to land a rescue swimmer on board, a Coast Guard helicopter evac would have to occur from our tender. Putting the patient in a tender, whether to go out for helicopter evac or direct run to shore, requires turning their care over to a member of my crew who only has basic first aid training. So basically, unless there’s a law enforcement or other go-fast boat with trained personnel on board that can swing by and transfer directly off the mother ship, I have to pick between not getting involved at all, or abandoning my patient to have a crew member take them out in the tender, or abandoning my passengers to take the patient out in the tender myself. I’m not required to carry a second licensed master on board. Wondering if there might be federal/maritime law that would supersede state law (since we’re operating on federally navigable waterways) that would cover my butt if I had to send a patient out in our tender for a medevac.

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License insurance first

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I would be asking for clarification from the office on their expectations. I would print out those emails and keep them in my fire proof safe at home.

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I’ve asked this of our lawyers in the past. The answer boils down to Good Samaritan Laws, which each state has.

Good Samaritan law - Wikipedia

Basically, the law requires that you provide medical aid up to the limit of your training, and shields you from litigation if something goes wrong. In your email the crucial point is placing the patient in the tender. If that, in your determination as master, is the best way to get the patient to care, then you would be shielded by the law. Same deal with the tender coxswain.

In decades of dealing with similar cases I have never had a master sued over a medical case. The company is sued, not the master.

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Taken to the extreme, this would make it illegal for an orderly in a hospital to wheel patients from place to place without a doctor following them.

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That 24 hour STCW Medicare Provider course is NOT a significant amount of training. It provides very minimal skills. If not used or refreshed, as a practical matter those skills are lost after a couple years.

Like most things as Master, you should do what a reasonable Master would probably do under the circumstances.

In the situation you describe, I think the most reasonable thing to do is to get the injured person ashore and on the way to a hospital as quickly as possible in a safe manner.

Many Masters would be very reluctant to launch a small boat underway, but you apparently have the crew and ability to do that. Again, a lot to be said for small boat training

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I would think that your legal responsibility as master supercedes any possible legal responsibility as first aid provider. You can’t abandon the vessel to take the patient ashore in the skiff. Furthermore, I see no reason you need to be the responsible party at all simply because you have slightly higher first aid training. As master I would expect that you would delegate treatment to others while you did master duties.

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It was called the Shipmasters Medical course when I did it for STCW and it was a 2 week course and I remember it being quite expensive.

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I think you’re over thinking it. Your company should have an SMS that details what to do for a passenger medical emergency. If you don’t have that, the basics are have a deckhand treat the passenger, your primary responsibility and duty is to safely navigate the vessel and communicate the situation to shoreside responders. Your deckhands should have basic first aid(likely not required to in your situation, but they shoulddd) companies I’ve worked for that ran 100T pax boats required all crew to have basic first aid and provided refreshers on it annually. Even if they don’t have it, they can still treat the patient as directed by you, most states will have a good Samaritans law that will generally hold you harmless. Just focus on doing what you can and getting them to the professional EMS crew asap. The person or their family may still sue the company if they were injured(rather than just general illness) on the boat, that’s why insurance exists.

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Not applicable to Domestic Voyages in NA. Mine expired decades ago.
They keep changing the title.
We are required to have Occupational First Aid, Then it was Industrial or it was the other way around buggered if I can remember what its called now.
Crew size dictates the level of certification. Domestic reg’s don’t give two shits about pax.
I prefer larger crews where my certificate level is way to low.
On small crews my license requirement Basic + Maine or roughly equivalent to what I learned as a Cub Scout 60 years ago. Sylvester, CPR or whatever the F it is now. Give compressions don’t give compressions. Or was Don’t give breaths. Whatever.

I’m the Captain, If you are relying on me for actual first aid you are pretty much buggered.

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It’s pretty much the same as everything else. Your the Master you are responsible.
Use some common dog.
I personally don’t like the sight of blood or any bodily fluids or solids ect and pass out or come close to about medical Stuff on TV. I don’t like First Aid. You do what you have to do, if you have to do it.

Some years ago? One of my Focsle Lawyers, When informed by Dispatch he would be or designated OFA. Said he couldn’t be designated because he wasn’t Qualified.
Having found It was a transportation endorsement was a requirement to be designated as OFA if you are more than 20 minutes from a hospital.
This of course is not a federal coast guard requirement but a local OSHA requirement. The Vessel being on a short HT voyage only we could comply with Local OSHA.
The company decided it was way cheaper to send all the Masters to do a Transport Endorsment than sending all the deck hands.
I have the minimum required basic marine first aid and a full transportation endorsment. Which I did with all kinds of gung ho youngsters who work way the hell and gone out in the bush. With OFA and or Paramedic. Most of who wondered why we were doing this. Cause I’m Master on a small RoRo pax approximately and the dock 23 minutes from the nearest hospital.

Nobody in thier right mind is ever going to expect me to stop the dam ship, go down and personally C Spine, Intubate, Package a passenger or crewmember. And then go back up to bridge to dock it.

But I get an extra 150 dollars a month as the designated OFA.

All my deckhands used to get the extra 150 cause you only have to be designated one day per monto get the bonus.
So my focsle Lawyer was real popular after that.

If anyone ever needs first aid I just send a deckhand to give em a band aid hold their hand or whatever and call 911.
When its over He or She gets the OFA bonus for the rest of the month.

Common dog, On longer runs where, I have a proper OFA on board. Or in cases their is a Doctor on board.
When their is a First Aid Call.
I want to know how bad is it.
Do I need to Turn Back.
I will not over rule an OFA or Doctor who advises me o turn around.

I have on a number of occasions. Gone and personally talked and explained to the Doctor or OFA. If I divert or turn around now I can be back within X amount of time. I am currently getting further way from help, It will be at least Y amount of time until I am this close to help. Is the casualty going to be OK if we are X + Y until we get to assistance. Don’t tell an hour form now we need to turn back tell me now or don’t
If he or she is not confident in their answer, I turn around. So As a Master yes I have over ruled an OFA and or a Doctor.
My Boss has never complained. If it sounds bad and justified I have no problem turning around. And having an ambulance or even a Helicopter waiting for us.
I also talk to RCC explain what the emergency is what the Doctor or OFA says get their advice and take it.
You work on a RoRo Pax vessel it happens quite often. Mostly Passengers.
You do what you have to do. My expertise is driving a boat, not first aid.
I ain’t stupid.
My crew who do the OFA job have saved quite a few lives. On our major runs there are few days with 1000 plus people on board they do not get a call. Most are very routine. Every now and again there is a bad one. I don’t envy them. I really appreciate them. I wouldn’t have their job for all the tea in china.

I have entered in the Log and filled out one form to register a birth. It was stress full but a good day.
Filling out the form to register a death on board is not.
More than one of our OFA’s have Quit being after.

My worst day it was a crew member.

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Different course. That’s the one for persons in charge of medical care (STCW Code Table A-VI/4-2). “Medical care Provider” is also called “Medical First Aid” and is a 3-day course required for all officers in charge of a navigation or engineering watch certificate (STCW Code Table A-VI/4-1) .

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Thanks all, for your thoughts.

It’s bizarre to me that the highest level of medical training (whether Medical PIC or Medical First Aid Provider) is required of the master (and chief mates, for the larger STCW licenses), who, as you all point out, should be busy focusing on the safe navigation of the ship, not stabilizing a patient. If it were me, I’d require it for the OICNWs and the ratings.

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That’s why an unstable patient doesn’t go anywhere with just an orderly.

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Medical Care and Medical PIC are very different courses, for different persons.

Medical Care PIC is not required for Master, or any particular person. It’s required for ever is in charge of medical care, which often is not the Master. Whoever is designated as being in charge of medical care needs it, not necessarily the Master.

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I really do hate to argue with the expert, but that’s not what the checklists say.

Chief Mate and Master <500-3000 GT and Chief Mate and Master 3000+ GT all require Medical PIC, according to the checklists.
https://www.dco.uscg.mil/Portals/9/NMC/pdfs/checklists/mcp_fm_nmc5_203_web.pdf?
https://www.dco.uscg.mil/Portals/9/NMC/pdfs/checklists/mcp_fm_nmc5_202_web.pdf?
https://www.dco.uscg.mil/Portals/9/NMC/pdfs/checklists/mcp_fm_nmc5_205_web.pdf?
https://www.dco.uscg.mil/Portals/9/NMC/pdfs/checklists/mcp_fm_nmc5_206_web.pdf?

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Those checklists don’t say what you think they say…

“Management of Medical Care” is not the same as “Medical Care PIC.” They are different courses.

STCW endorsements for Master and Chief Mate require MANAGEMENT of Medical Care. It’s not the same as Medical Care PIC. The checklists do not say Medical PIC is required for Chief Mates and Masters. .

The check lists note Medical PIC OR Management of Medical Care because Management of Medical Care is a required single module in the much longer, much more comprehensive Medical Care PIC course, so taking the PIC course will also meet the requirement for management of medical care, i.e., if you already took a PIC course, you don’t need the lesser management course

Also, the controlling authority is the CFR, not an NMC checklists. See e.g. 46 CFR 11.305. and note that Medical PIC is NOT a requirement. But as noted, there’s no conflict between the CFR and the checklists.

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Gotcha gotcha! That makes way more sense! Thanks for clarifying.

Good to know for somewhere down the road if I’m ever going for a bigger STCW license.

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Back in the day when promotion was “ dead man’s shoes” I did my masters unlimited plus all the required STCW courses as second mate like most of my peers and the medical duties were part of the second matés responsibilities . By the time I got to master the dam job had followed me.

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The NMC checklist would be more clear if it listed Management of Medical Care as the requirement, and added in parentheses “Medical Care PIC will meet this requirement.”

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