1. Francesco Amenta Fondazione Centro Internazionale Radio Medico (CIRM), Roma Centro di Telemedicina e Telefarmacia Università di Camerino, Camerino, Italy Medical care to a special population of travelers: The seafarers

3. Medical Travel Medical travel indicates traveling for medical care. In general it is referred to patients travelling in search of specialised treatments, surgeries or rehabilitation programs in high-level hospitals with qualified personnel and innovative technologies. The term is also used when healthy patients decide to travel to improve their health. There are also other travellers for medical care. It is the case of workers on board merchant ships or airlines. In case of diseases or accidents that cannot be treated satisfactorily on board they go to a physician/hospital in the first port/airport.

4. Injuries and illness at sea: who cares? The largest majority of merchant ships do not have on board a doctor or adequately trained paramedic personnel Merchant ships can be at sea for days or weeks before they can reach a port For centuries medical assistance to people on board ships was left to the responsibility of the ship’s captain. He helped himself with notions learned in courses of hygiene in nautical institutes or with medical books The level of medical assistance in these conditions was extremely poor.

5. Medical Assistance at Sea Since the first Radio Medical service started in New York City (1920), between 1922 and 1939 12 countries have developed Radio Medico All countries ratifying ILO 106 (1958) are required to have a Radio Medical Service free of charge No distinction made between nationality of patients using Radio Medical services

6. Telemedicine at Sea More advanced telemedical systems are slowly being taken on board the ships Circular IMO MSC/circ 960 (2000) emphasizes the relevance of telemedical services for providing high quality medical assistance to sealing seafarers The circular introduces the Telemedical Maritime Assistance Service (TMAS) and defines standards and roles for TMAS

7. Landbased network Satellite Land Earth Station Medical service Ship with patient Maritime telemedicine Speach Communication from ship via satellite Expensive use

8. Advantages offered by telemedicine 1938: Transmission of breathing and pulse rate by radiotelegraphy 2002: Store-and-forward picture of an ankle injury used for guiding medication 2000: Dermatological lesion

9. A medical officer is in charge of the patient On land, several doctors (TMAS) are available to give advise The doctor will need the best possible information about the state of the patient The doctor will need the best collaboration from the ship side Knowledge of the patient’s medical history is extremely useful Injuries and illness at sea: who cares?

10. TELEMEDICAL EQUIPMENT AND SOFTWARE ELECTRONIC HEALTH RECORD SOFTWARE

11. http://217.59.1.178/_medicirm

13. Knowledge of the patient’s medical history is extremely useful SEAFARERS HEALTH PASSPORT

14. New Health Requirements for European Flag Ships THE NEAR FUTURE