title: Medical assistance at the sea: legal and medico-legal problems.
abstract: BACKGROUND
  In case of pathologies or accidents on board which require medical intervention but lacking on-board medical or paramedical personnel, the ship's captain, or his delegate can contact a Telemedical Maritime Assistance Service (TMAS). International Maritime Organisation considers telemedicine at sea as an integral part of rescue procedures. Five key elements contribute to the delivery of good medical assistance at sea: one or more coordination and rescue centres; the TMAS; the possibility of intervention at sea; an organisation of appropriate institutions on ground and common operating procedures. This paper analyses the responsibility of the ship's captain and of the TMAS doctor in case of diseases or injuries on board in the frame of the main important international regulations.
  In case of a disease or injury on board a ship, the captain must contact the TMAS as soon as possible. A captain not acting promptly and not doing whatever it is possible for the ill/injured person by consulting the TMAS or a physician and/or not following prescriptions received, could be charged for omission of responsibility. A captain underestimating a medical problem and knowing that the patient's condition could worsen, but still not consulting a medical centre for assistance, should be ready to accept the consequences of his choices.
  The doctor of TMAS has full responsibility for the diagnosis, prescription and treatment, while the ship's captain is responsible for the final decision. Regarding the medical treatment and assistance on board a ship, the TMAS doctor should pay attention not only for the diagnosis, but also for the prognosis. Telemedicine implies that the doctor should make decisions without a clinical examination, often without some additional medical examinations and by maintaining a contact with other people who are in direct contact with the patient. The physician usually has to rely on the account of colleagues of the sick seafarer as far as medical history is concerned. This may make harder to take a decision.
  
  
  CONCLUSIONS
  The ship's captain is guilty if he fails to contact a TMAS in case of diseases or accidents on board. Similar to a traditional relationship between a patient and a physician, the doctor consulted via telecommunication systems is also responsible for his diagnosis and treatment. However, in telemedicine the contrasts with the most basic principles of the traditional medicine are obvious. This makes the delivery of medical care of seafarers on board ships quite complicated.
authors.affiliation: School of Law, Legal Medicine Section, University of Camerino, Camerino, Italy. francesco.amenta@unicam.it.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Ricci
authors.forename: Isabel
authors.initials: I
authors.lastname: Pirillo
authors.forename: Cristian
authors.initials: C
authors.lastname: Rinuncini
authors.forename: Francesco
authors.initials: F
authors.lastname: Amenta
mesh_terms: D005060:Europe; D006801:Humans; D007391:International Cooperation; D016365:Liability, Legal; D009326:Naval Medicine / Q000331:legislation & jurisprudence* / Q000379:methods / Q000458:organization & administration; D009786:Occupational Health Services / Q000331:legislation & jurisprudence* / Q000379:methods / Q000458:organization & administration; D010819:Physician's Role; D024382:Professional Role; D017216:Telemedicine / Q000331:legislation & jurisprudence* / Q000379:methods / Q000458:organization & administration