Merchant Shipping (Medical Stores) Regulations, 2008

Regulations, 2008.

Interpretation.

445

"Category A ship" means a seagoing ship with no limitation on length of trips;

"Category B ship" means a seagoing ship making trips of less than 150

nautical miles from the nearest port with adequate medical equipment or a seagoing ship making trips of less than 175 nautical miles from the nearest port with adequate medical equipment and which remain continuously within range of helicopter rescue services;

"Category C ship" means a ship staying not more than 30 nautical miles from shore or a ship with no cabin accommodation other than a wheelhouse;

"crew" means all persons, including the master, employed in any capacity on board a ship;

!!dangerous substances 11 means any chemical substance listed in the following IMO publications -

{a)

ships employed solely for service within a river;

{b)

pleasure crafts, used for non-commercial purposes and not manned by professional crews;

{c)

tugs operating in harbour areas.

2446

Carriage of medical stores.

Every Category A and Category B ships shall carry on board medical stores in accordance with the First Schedule.

Every Category A and Category B ships carrying more than 12

passengers but without a qualified doctor as a member of the crew shall, in addition to the medical stores specified in the First and Second Schedules, carry additional requirements in accordance with Part A of the Third Schedule.

All medical stores kept on board a ship in accordance with these Regulations shall conform to the standards and requirements of the British Pharmacopoeia, the European Pharmacopoeia or the United States Pharmacopoeia, and with the requirements and specifications set out in the First and Second Schedules.

Packaging and labelling of containers.

Without prejudice to any other written law, any container of medical stores required by these Regulations to be kept on board a ship -

{a)

shall have in English on a label the particulars specified in sub-regulation (3);

Any medicine shall be stored in accordance with the instructions on its container.

A ship to which these Regulations apply shall carry the publications specified in the Fifth Schedule.

Inspection of medical stores.

The medical stores shall be inspected at least once in every 12 months by a competent person or authority who, on being satisfied that the ship is provided with medical stores in accordance with the appropriate scale, shall issue a certificate to that effect.

Ships carrying dangerous substances.

The master of any ship carrying a dangerous substance as whole or part of the cargo, or any residue of a dangerous substance from earlier voyages, shall ensure that the correct antidote to the dangerous substance is carried. The master shall comply with the requirements set out in the Fourth Schedule.

There shall be kept on board every ship on a voyage on which a qualified doctor is carried as a member of the crew any additional supplies which the doctor may reasonably require, having regard to the size of the crew, the number of passengers on board and the intended voyage.

Ships operating in malarial areas.

Ships operating in the malarial areas shall take preventive measures as specified in the Seventh Schedule.

Offences.

The Director may exempt any person or ship or class of persons or ships from all or any of the provisions of these Regulations on such conditions as he may specify and may, subject to giving reasonable notice, alter or cancel any such exemption granted.

2451

FIRST SCHEDULE

(regulations 4(1L 5(1), 6,

7(3), 9(1) and 10(1))

MEDICAL STORES FOR CATEGORY A AND CATEGORY B SHIPS

MEDICAL SUPPLIES

NOTES:

1.

In the following table, the columns are as follows-Column 1 is the treatment which must be available to comply with these

Regulations;

Column 2 is the medicine and dosage strength which the Director considers best complies with the required treatment. Owners and operators may substitute exact equivalents on the advice of a qualified medical practitioner or pharmacist, provided they are satisfied that an equivalent level of treatment is assured;

Column 3 is the quantity of medicine/equipment considered sufficient to provide treatment for a crew of 10 persons.

2.

Owners and operators may, on the advice of a qualified medical practitioner or pharmacist, determine whether any additional or different quantities, products or equipment are required, taking into account the factors identified below and any other relevant considerations -

(a}

the nature of the voyage and in particular-

(i)

the ports of call;

[ii)

the destination; and

(iii)

the duration;

(d)

the number of crew.

2452

For example, anti-malarial drugs may be appropriated if a ship is operating in malarial areas.

1 2 3

Recommended Medicine and Dosage

Recommended quantity

Treatments Requirements for 10 workers

Strength representing best practice

Category A Category B

1 Cardio vascular

1*

Sympathomimetics

BP 0.5ml-adrenaline acid tartrate injection l.Omg in 1 ml (1 in 1000)

Glyceryl Trinitrate Spray 1 unit 1 unit 400 micrograms/metered 200 dose aerosol or transdermal patches 5mgx2

Frusemide/Furosemide i)

40mg tablets 20*

5*

ii)

10mg in 1ml injection.

2

-

2ml ampoule

1*

1*

(including uterotonics if paediatric injection 0.2ml there are women with

(1 ampoule)

potential for child bearing working on board)

1*

inj. Oxytocine 5 units in 1ml ampoule

Atenolol 500mg tablets x 28 1 pack

-

2.

Gastro-intestinal system

Histamine H2 receptor

Cimetidine 400mg tablets 1 pack

-

anti-ulcer antagonist 60 tablet pack

- Anti-acid mucous

Proprietary Antacid of choice

As

As dressings required required

30*

buccal tablets ii) Promethazine hydrochloride 10*

.

25mg per ml ( 1ml ampoules)

2453

1 2 3

Recommended Medicine and Dosage

Recommended quantity

Treatments Requirements for 10 workers

Strength representing best practice

Category A Category B

Glycerol Suppository 4mg mould 12

Codeine Phosphate 30mg tablets 30 30

Trimethoprim 200mg tablets 20 20

Proprietary preparation of choice

As

As required required 3 Analgesics and anti-spasmodics

and anti-flammatory agents ii) Diclofenac sodium 100mg 10

-

suppository

Use 2(d)

Use 2(d)

2(d))

-

1ml injection

Hyoscine hydrobromide 0.3mg 60 60

tabs.

4. Nervous system

ml, 2ml ampoules ii) Diazepam 10mg tablets 20*

-

-

25mg injection ii) Chlorpromazine hydrochloride 40*

10*

25mg tablets

I Hyoscine hydrobromide

Use 3(c)

Use 3(c)

Diazepam rectal dispenser 1 Omg 4 4

in 2.5ml

5. Anti-allergies and anti-anaphylactics

Loratadine 1 Omg tablets 30*

30*

2454

23rd. AUGUST, 2008 1 2 3

Recommended Medicine and Dosage

Recommended quantity

Treatments Requirements for 10 workers

Strength representing best practice

Category A Category B

powder for reconstitution 100mgm vial with 2ml water for injection 10 5

micrograms per metered hose.

200 dose inhaler with volumatic ii) Beclomethasone /Beclometa-

1 1

sone 50 micrograms per metered hose. 200 dose inhaler

Codeine phosphate tablet (cough

Use 2(d)

Use 2(d)

suppressant)

Paracetamol

Use 3(a)

Use 3(a)

and sinusitis

7. Anti-infection

families)

benzylpenicillin sodium 600mg injection (powder for reconstitution in a rubber capped and metal topped vial)

and water for injection 2ml ii) Ciprofloxacin as hydrochloride 10 10 500mgm tablet

( • to be carried in Category A

• iii) Cefuroxime injection 20

-

ships which may be more than 750mgm vial and water for 48 hours from medical injection assistance)

-

Trimethroprim 200mg tab 20

-

Trimethroprin

Use 7(b)

Mebendazole 100mg tablets 1*

1*

6 tablet pack 2455

1 2 3

Recommended Medicine and Dosage

Recommended quantity

Treatments Requirements for 10 workers

Strength representing best practice

Category A Category B

Metronidazole suppositories 1gm 10

-

Metronidazole tablets 400mg 14 14

tablets

Tetanus Vaccine 0.5ml ampoule 5*

1*

immunoglobulins

Tetanus Immunoblobulin 1*

1*

ampoule for injection 8 Compunds promoting rehydration, caloric intake and plasma expansion

Sodium chloride and dextrose 12 12

rehydration salts 8g sachets of

Oral Rehydration Salts, Formula

A. BP Oral powder in sachet to provide Na = 35mmol,

K = 20mmol, Cl-37mmol, HC03 18mmol and glucose 200mmol when reconstituted in a litre of

. water

!

9 Medicines for external use

1*

1*

- Antiseptic solutions impregnated wipes containing bottle bottle 0.015% w/v chlorhexidine and or 1

or 1 0.15% w/v cetrimide pack pack wipes wipes

- Antibiotic ointments

Cicatrin cream 15mg tube 1 1

- Anti-inflammatory and

-

analgesic ointments 15g tube ii) Benzoic Acid Ointment BP

3 1 50mg (benzoic acid 6o/o;

salicylic acid 3o/o, in emulsifying ointment 15g)

- Anti-mycotic skin cream

Miconazole nitrate 2o/o topical 2 1

cream 30g

- Burn preparations

Silver Sulphadiazine 1 o/o cream 2 1

l 50g tube 2456

23rd. AUGUST, 2008 1 2 3

Recommended Medicine and Dosage

Recommended quantity

Treatments Requirements for 10 workers

Strength representing best practice

Category A Category B

Miscellaneous skin preparations i)

Permethrin 1 o/o in a basis 2*

-

containing isopropylalcohol 20o/o Cream Rinse ii) Zinc ointment, BP

1*

-

(containing zinc oxide 15o/o)

25g iii) Potassium permanganate 1*

-

crystals lOg container

Antibiotic ointment

Framycetin sulphate 0.5o/o 4 1

ointment 5g tube

- Antibiotic and anti-Betamethasone sodium phosphate 2 1*

inflammatory drops 0.1 o/o neomycin sulphate 0.5o/o eyedrops 5ml

- Anaesthetic drops

Amethocaine hydrochloride 0.5o/o 5*

5*

5ml

- Hypotonic myotic drops

Pilocarpine hydrochloride 1*

1*

eyedrops 0.5o/o lOml

Detection of foreign bodies

Fluorescein Sodium 1 o/o eyedrops 1*

-

- Antibiotic solutions

Antibiotic eardrops containing in 1*

1*

each ml; neomycin 3,400 units, polymixin B sulphate 10,000

units, hydrocortisone lOmg 5ml dropper bottle

- Anaesthetic and anti-Ephedrine nasal drops BR 0.5o/o 1*

1*

inflammatory solutions ephedrine hydrochloride lOml

- Antibiotic or antiseptic

Chlorhexidine gluconate 0.2o/o 1 1

mouthwashes mouthwash 300ml 2457

1 2 3

Recommended Medicine and Dosage

Recommended quantity

Treatments Requirements for 10 workers

Strength representing best practice

Category A Category B

- Local anaesthetics using

Ethyl chloride liquid spray 50mg 1*

1*

freezing

- Local anaesthetics given

Lignocaine/Lidocaine 5 5

by subcutaneous hydrochloride 1% 25mg in 5ml injections for injection

- Dental anaesthetics and

-

antiseptic mixtures

(lignocaine hydrochloride 2%

in a water miscible (base) gel)

1*

*The specified quantity is considered sufficient regardless of crew size.

2458

1.

Required Equipment

Resuscitation equipment

Manual resuscitation appliance

MEDICAL EQUIPMENT

Recommended Specification

Oxygen Giving Set comprising the following-

1) Oxygen reservoir 2} 1 flow meter unit giving a minimum setting of 4 litres per minute

3) 1 pressure regulating unit

4) 1 set of tubing

5) 5 x 24% oxygen disposable face masks

6) 5 x 35% oxygen disposable face masks each part constructed so that it can only be assembled in the correct manner

Aspirator to clear airways (manual, hand operated) plus 2 catheters

Laerdal Pocket Mask

Guedal Airway Sizes 3 and 4

Category

1 1 1

Category

1 1 1

2. Dressing and suturing equipment

Suture and needle pack or suture kit with needles

Sterile non absorbable, sutures BP, of monofilament nylon or silk, swaged to a 26mm, and 40mm half circle needle with a cutting edge

Each needle and suture to be in a sealed pack

.

.

BP of catgut swaged to a 40mm half circle cutting edge 2459

Required Equipment

Recommended Specification

Category

Category

Adhesive Elastic Bandage 7. Scm x 4 1 4m

Crepe bandage 7.Scm x 4.Sm when 4 1

stretched

20m length with applicator 1 1

seamless, of a size suitable for finger dressings

Packet containing S sterile gauze 6 3

pads BP size 7. Scm x 7. Scm

Absorbent cotton and viscose wadding db, in a roll, in damp proof packaging

victims

Calico, with 2 sides@ 90cm and a 4 4

base@ 127cm

Large size 2S

2S gloves

Assorted, sterile 40 40

m Sterile compression

bandages and unmedicated (2)large 13cm x 9cm s 3

dressings

oxide bandages

Use Equipment items 2(a)(1) and

Use

Use with needles 2(a)(2)

items items 2(a)(1)

2(a)l1)

2(a)!2)

2(a)(2)

Paraffin gauze dressings, size lOcm 40 40

x 10cm i 2460

Required Equipment

Recommended Specification

Category

Category

3. Instruments

-

(bJ Stainless-steel instrument 1 1

box

other round-ended

pointed

-

-

4. Examination and monitoring equipment

-

analysis

depressor

sphygmomanometer

thermometer

-

(disposable)

-

plastic with airtight lid 50ml with blank labels)

2461

Required Equipment

Recommended Specification

Category 1:I:_

5. Equipment for injection, perfusion, puncture and catheterisation

Bladder drainage set (including bag,

1

~

instruments spigots and tube)

~

Integral in equipment. Some

If

If produced items may require a required required separate filter

Use bladder drainage set

Use 5(a)

Use 5(a)

needles size

1

-

5ml balloon (short/medium term use in adults)

-

(with no balloon)

16. General medical equipment

Stainless steel or sterilisable plastic 1

~

With fabric cover

!

1

-

-

7. Immobilisation and setting equipment

hand splint

Set of 4 (half-leg, full leg, half arm 1 1

and full arm)

Adult size set of 3, small, medium 1 1

immobilisation and large

~

mattress 2462

Required Equipment 8.

Recommended Specification

Disinfection, disinsectisation and prophylaxis

In liquid form - litres

In liquid form litres 9 First aid kits (to be carried by ships of a crew of more than 1 0)

5 5

First aid kits to be distributed in appropriate locations on the ship 3 max e.g. in the galley and engine room and to contain the following items in a portable waterproof container.

10. Recommended additional equipment

(i)

Safety pins, rustless medium

UJ Magnifying glass 7.5cm diameter on handle

(1)

Stretcher equipment (A system for trauma management, that is immobilisation and stretcher equipment most suited for treat-ment on the vessel concerned)

-

-

6 1 1 1 1 5

-

-

-

-

Required Equipment

Recommended Specification

Category

Category

11. Kit for protection against blood transmitted diseases (to be carried in all ships trading in known malarial areas and in areas where medical facilities are limited and emergency shore based treatment is necessary)

Kit for protection against blood transmitted diseases to be kept in a heavy gauge polythene bag and labelled "to be used only for the treatment of ........... "(insert the name of the seafarer going ashore for emergency treatment)

Each kit to contain the following-

( 1) 10 x 2ml syringes

1 2464

SECOND SCHEDULE

(regulations 4(2), 5(1), 6,

7{3), 9(1) and 10(1))

MEDICAL STORES FOR CATEGORY C SHIPS

MEDICAL SUPPLIES

Recommended

Treatment Requirements

Recommended Medicine and Dosage quantity for 10 1.

Strength representing best practice workers or for a lifeboat/liferaft

Cardio vascular

Glyceryl Trinitrate Spray 1 unit 400 micrograms/metered 200

dose aerosol or transdermal patches 5mg x 2

1*

(including uterotonics if paediatric injection 0.2ml there are women with

(1 ampoule)

potential for child bearing working on board)

inj. Oxytocine 5 units in 1 ml ampoule

I 2. Gastro-intestinal system

Hyoscine hydrobromide 0.3mg 60

tablets

Codeine Phosphate 30mg tablets 20

Analgesics and anti-spasmodics

Analgesics

Use 2(b)

(see 2(b))

4. Nervous system

Seasickness remedies

Hyoscine hydrobromide (see 2(a))

Use 2(a)

2465

Recommended

Treatment Requirements

Recommended Medicine and Dosage quantity for 10 5.

Strength representing best practice workers or for a lifeboat/liferaft

Medicines for external use

Skin medicines

- Antiseptic solutions 100ml solution or pre-impregnated 1 bottle or 1 pack wipes containing 0.015% w/v wipes chlorhexidine and 0.15% w/v cetrimide

- Burn preparations

Cetrimide Cream 50g tube 1

•

MEDICAL EQUIPMENT

Required Equipment

Recommended Specification 1.

Quantity

Resuscitation equipment

Mask for mouth-to-mouth

Laerdal Pocket Mask 1

resuscitation

2. Dressing and suturing equipment

Adhesive Elastic Bandage 1

bandage 7.5cmx4m

Large size 5 pairs gloves

I c) Adhesive dressings

Assorted, sterile 20

bandages and

unmedicated dressings

zinc oxide bandages

Packet containing 5 sterile gauze 1

Compress pads size 7.5cm x 7.5cm 2466

Required Equipment

Recommended Specification 3.

Quantity

Recommended Additional Items

THIRD SCHEDULE

(regulations 5(1), (2),

ADDITIONAL REQUIREMENTS FOR PASSENGER SHIPS

CONTENTS OF THE DOCTOR'S CASE

Name of Medicine

Ordering Size

Quantity

Adrenaline/Epinephrine 1ml ampoule 5

Adrenaline tartrate injection (1 in 1,000) 1.0mg in 1ml

Aminophylline 1 Oml ampoule 4

Aminophylline injection 25mg in 1 ml

Aspirin 300mg tablets 50

Dispersible aspirin 300mg 1 Beclomethasone Diproponate 50 micrograms 200 metered

Beclomethasone Diproponate + SPACER inhalations

Chlropromazine 25mg in 1ml 1ml ampoule

Chlropromazine hydrochloride injection ampoule

. Cyclizine

Injection 50mg 5

I Cyclizine lactate in 1 ml ampoule

Dextrose 20ml ampoule 2

Dextrose intravenous infusion 50%

Diazepam 2ml ampoule 5

. Diazepam injection Smg in 1ml

I Frusemide/Furosemide 2ml ampoule 5

Frusemide injection 1 Omg in 1 ml

Glucagon 1ml ampoule 1

Glucagon injection 1mg with diluent

Glucose 1 litre 1

Glucose intravenous infusion 5%

Glucose in blood

Ill Blood test sticks - glucose 10

Guedel Airway

Size 1

!Adult size 1

already in ship's medical stores)

Hydrocortisone

Hydrocortisone sodium succinate powder for reconstitution 100mg vial 1

with diluent

Insulin 10ml vial 1

Insulin injection, soluble, 100 units per ml 2468

Name of Medicine

Ordering Size

Quantity

Intravenous Infusion Giving Sets with Cannulae

Intravenous placement device consisting of over needle

cannula attached to disposable syringe of 2.5ml capacity size 16g (1.3mm in a sterile pack 0Dx45mm)

size 18g (1.7mm 0Dx45mm)

Intravenous infusion cannula with luer-lok injection port

in a sterile pack 16g (1.7mm x 45mm)

Disposable filter infuser - if not inbuilt in the equipment 1

Laerdal Pocket Mask 1

Modified Gelatin 500ml container 4

Infusion Solution (for plasma substitution)

Morphine 1 ampoule 5

Morphine sulphate 10mg in 1ml

Oxygen Resuscitator

Hand-operated manual adult bag resuscitator {bag to be of 1

silicone rubber} complete with oxygen reservoir of 2600ml capacity and facemasks sizes 5, 3 and 1

Manual suction pump with 2 yankauer suction catheters and 2 flexible catheters 1

FG 14 size

Pediatric Paracetamol (soluble)

120mg tablet 24

Prednisole 5mg tablet 25 1 Prednisole

Salbutamol

Salbutamol aerosol inhaler unit giving 100 micrograms 200 inhalations 1

per metered inhalation + SPACER

Swabs 50

Alcohol impregnated swabs, sterile

Syringe and Needle, Hypodermic, Pack

Sterile disposable conforming to BSI Standard BS 691

published on 21.12.19

Name of Medicine

Ordering Size

Quantity

Stethoscope*

1

Aneroid Sphygmomanometer*

1

Note:

Category A and Category B ships need only carry one of each of the items marked *.

2470

FIRST AID KITS

The first aid kits consist of the following items which should be kept in a separate portable waterproof container -

(1)

4 x triangular bandages (90cm x 127cm base)

(2)

6 x medium sterile bandages with unmedicated dressings, lOcm x Scm

(3)

2 x large sterile bandages with unmedicated dressings, 13cm x 9cm

(4)

2 x extra large unmedicated dressings, 28cm x 17.5cm

(5)

6 medium safety pins, rustless

(6)

20 assorted elastic adhesive dressings medicated BPC

(7)

2 x sterile eye pads with attachment

(8)

2 x packages containing 15 grammes sterile cotton wool

(9}

5 pairs large size disposable polythene gloves.

2471

FOURTH SCHEDULE

(regulation 13( 1))

General.

MEDICINES TO BE CARRIED ON SHIPS TRANSPORTING

DANGEROUS SUBSTANCES

1.

When a Brunei Darussalam registered ship is carrying a dangerous substance as whole or part of the cargo, or any residue of a dangerous substance from earlier voyages, the master must ensure that the correct antidote to the dangerous substance (plus any necessary ancillary equipment eg. syringes) is carried. The correct antidote and the equipment can be found in Appendix 14

of the IMO Medical First Aid Guide for Use in Accidents involving

Dangerous Goods (MFAG) of the IMDG Code Supplement of the 2000

edition. Any updating of the IMDG Code should be taken into account when preparing the list of medicines to be carried and any associated risk assessment.

2. The substances listed below are to be taken into account, in whatever form they are carried on board, including the form of waste or cargo residues -

Explosive substances and objects;

-

Gases: compressed, liquefied or dissolved under pressure;

-

Inflammable liquids;

-

Inflammable solids;

Substances liable to spontaneous combustion;

Substances which on contact with water give off inflammable gases;

-

Combustible substances;

-

Organic peroxides;

Toxic substances;

-

Infectious substances;

-

Radioactive substances;

-

Corrosive substances;

Various dangerous substances, i.e. any other substances which experience has shown, or may show, to be dangerous, so that the antidotes need to be carried.

3.

The medicines and equipment already available in the ship's medical stores may be counted towards the recommended minimum quantity specified in

Appendix 14 of the MFAG.

2472

FIFTH SCHEDULE

(regulation 11)

PUBLICATIONS

Category A ships

{a)

Controlled drugs register; and

(b)

Ship Captain's Medical Guide (latest edition).

Category B ships

Ship Captain's Medical Guide (latest edition).

Category C ships

{a)

First Aid Manual (StJohn's, Red Cross or St Andrew's); or

{b)

First Aid Instructions, in English on waterproof paper (lifeboats and liferafts only).

2473

SIXTH SCHEDULE

(regulation 7(3))

SPECIFICATIONS OF DISINFECTANTS AND INSECTICIDES

PART 1

Specification of Disinfectants 1.

The disinfectant should be a white fluid and should be a finely dispersed, stabilised emulsion containing coal-tar acids or other phenolic bodies, with or without hydrocarbons.

2.

Germicidal value and the method of its determination-The germicidal value shall not be less than 1.7 when determined by the modified Chick-Martin method as laid down by the British Standards Specification No. 808, confirmed by PD 2627, 1960.

3.

Stability before dilution

On standing for 3 months at ordinary temperatures

(5°C to 30°C) the disinfectant fluid should not precipitate nor show separation of more than traces of oil. A creamed fluid which can be rendered homogeneous by gentle mixing may be carried.

4.

Stability after dilution - The disinfectant fluid should be mixed with distilled water and artificial seawater (27 grammes of sodium chloride and 5 grammes of crystalline magnesium sulphate (MgS047H20) dissolved in and made up to l,OOOml with distilled water and filtered before use) in proportion of 1, 2, 3, 4

and 5 per cent to give a stable emulsion which will not break nor show more than traces of separation of either top or bottom oil, when maintained at l8°C

- 22°C for 6 hours, the sample and diluent having each been brought to a temperature within that range before mixing by pouring the sample into the diluent from a cylinder.

5.

Odour and corrosive

The fluid should be free from objectionable smell, and when used as directed, should have no more corrosive action on metals than that occasioned by the water employed as a diluent.

PART2

Specification of Insecticides

Insecticide formulations should conform to the following specifications -

{a) the insecticide should not be harmful to humans;

(b)

instructions for use should be specified on the packaging;

{c)

the insecticide should be effective for the purpose specified in the instructions and suitable for use in crew and passenger accommodation and in spaces used for the preparation of food; and

{d)

it should be free from offensive odour and, so far as possible, should be non-staining.

2474

23rd. AUGUST 1 2008

SEVENTH SCHEDULE

(regulation 15)

PRECAUTIONS AGAINST MALARIA

Preventive Measures

Avoid mosquito bites.

1.

Mosquitoes are most active after dusk. Cabin and working accommodation doors 1 windows and ventilators must be kept shut. Any mosquito found in compartments should be killed using "knockdown" insecticide spray. If you go on deck or ashore after dusk keep your armsl legs and feet covered and use insect repellents on any remaining exposed areas. If you have to stay ashore in non-air conditioned accommodation make sure that the beds have netsl preferably impregnated with pyrethroid insecticides~

e.g.

diethyltoluamide known as DEET 1 that they have no tears or holes and are well tucked in.

Medication.

2.

Anti-malarial tablets treatment varies depending on the nature and resistance of local malarial parasites. You should take the treatment strictly in accordance with the specific instructions for the medication prescribed. Most deaths occur in those who do not take the tablets for the required period or in the recommended dosages.

Warning signs.

3.

Anyone who develops a fever in a malarial area should obtain medical advice as soon as possible. It is important to consult a doctor immediately if any feverish illness develops within 3 months of return from a malarial area. Be sure to let the doctor know that you have been to a country or territory where malaria is a health risk.

4.

ANYONE

WHO

HAS

BEEN

TREATED

FOR

MALARIA

OR

SUSPECTED MALARIA MUST HAVE A MEDICAL EXAMINATION AT

THE NEXT PORT OF CALL, ACCOMPANIED BY THEIR BLOOD

SLIDE. SERIOUS CASES NEED URGENT HOSPITALISATION. (See Ship

Captain 1 s Medical Guide for more details).

2475

EIGHTH SCHEDULE

GUIDE TO THE USE OF MEDICINES

General

General advice about medicines.

(regulations 5(5), 8(2)

and 9(1))

1.

Many "over the counter" medications are now available with patient information leaflets and the advice on dose precautions and side effects should be consulted and retained for reference. Valuable guidance is also available from pharmacists or by seeking radio medical advice.

2.

When obtaining medicines from a pharmacist, ensure that they are clearly labelled with their strength (e.g. 125mg per tablet or 125mg per 5ml) and they are packaged in accordance with any written law relating to medicines.

Medicines obtained abroad.

3.

Drug supplies should be replenished whenever possible at the same strengths as specified in the British Pharmacopoeia. If drugs are obtained elsewhere, e.g. in the United States of America, they may be of different strength, and this must be taken into account when administering them.

4.

The local pharmaceutical name for some medicines bought abroad may differ from that used in the list of medical stores. The chemist should have a

"translation" of pharmaceutical names, but, if in doubt about a medicine, get radio medical advice.

Medicines obtained by seafarer from a doctor ashore.

5.

A seafarer who goes to a doctor ashore should be asked to obtain from the doctor a written note of the pharmaceutical name of any prescribed medicine, details of how it is to be taken and any cautionary or advisory guidance, e.g. may cause drowsiness. The details on the note from the doctor should be checked against the information on the medicine container to ensure that they match. In case of any problem or doubt it may be necessary to check the prescription with the radio medical doctor.

Controlled drugs.

6.

The following paragraphs describe Brunei Darussalam regulations for controlled drugs. Most countries or territories have similar regulations. When 2476

outside Brunei Darussalam territorial waters, as much as possible, the same procedures must be followed.

Controlled drugs are preparations subject to the prescription requirements of the Misuse of Drugs Act (Chapter 27). The different drugs are graded according to the harmfulness attributed to the drug when it is misused and for this purpose there are 3 categories of drugs -

Class A drugs;

Class B drugs;

Class C drugs, as specified in Parts I, II or III of the First Schedule to the Misuse of Drugs

Act (Chapter 27).

Each of these categories contains many more drugs than those quoted. The drugs subject to the strictest controls are those specified in the Second 1 Third and Fourth Schedules of the Misuse of Drugs Regulations (Rg 1 of Chapter 27). Detailed information may be obtained from the Narcotics Control Bureau or the Ministry of Health.

A ship must not carry quantities of controlled drugs specified in the Second and Third Schedules of the Misuse of Drugs Regulations (Rg 1 of Chapter 27)

greater than those recommended in these Regulations unless required to do so by a doctor on the ship's complement or under licence under the Misuse of

Drugs Regulations (Rg 1 of Chapter 27). The only controlled Class A drug listed is morphine sulphate in Category A ships and in the doctor's case.

Obtaining controlled drugs.

7.

Controlled drugs should be obtained only from a retail pharmacist or other person licensed to supply drugs, which will require a written requisition. The requisition when furnished by the master or by a ship 1S doctor not being a medical practitioner must contain a statement signed by the Port Health

Officer that the quantity of the drug to be supplied is the quantity necessary for the equipment of the ship. An example of the wording to be used is given in Annex 1.

Storage of drugs.

8.

Drugs must be stored to ensure that they will meet the standards at time of use. Where no specific storage temperature is givenl drugs should be stored at room temperature of 15°-25°C. Some of the drugs should be kept under refrigeration, 2°-8°C 1 but care must be taken not to freeze them 1 otherwise they will lose their potency~ or the ampoules will be broken.

2477

Security of controlled drugs.

9.

The Merchant Shipping (Crew Accommodation) Regulations, 2007 (S 20/07)

require ships to have an approved lockable cabinet for the storage of medicines and drugs. The approved cabinet is to have 'an inner cupboard'

solely for the storage of dangerous (controlled) drugs. The cupboard should be fitted with a door and a lock which cannot be opened by the key to the medical cabinet. Only the master or a person authorised by him may open the inner cupboard.

10. Unwanted drugs can be disposed by giving them to a person who may lawfully supply them, such as a qualified pharmacist or qualified doctor. It is also possible to dispose of drugs via the police. A receipt should be obtained from the recipient, and kept with, or affixed to, the controlled drugs register.

Record-keeping.

11.

Under the Merchant Shipping (Official Log-Books) Regulations, 2007, the record of any treatment given to any person on board including the type and quantity of any medicines, and drugs supplied, must be entered in the log-book. For controlled drugs, the master is required to maintain a

"two-sections" register. The two-sections register should detail why, when and in what quantity the master purchased a controlled drug and similarly the history of the dispensing or disposal of those controlled drugs. This register must be kept for 3 years after the date of the last entry. An example of the entries required in each section of the controlled drugs register is shown in Annex 2.

Use of Medicines

This table is a brief guide to the drugs detailed in these Regulations and is designed to be used in conjunction with the Ship Captain 1s Medical Guide.

The side effects are a guide only. This list is not comprehensive. The common or important side effects only are listed. If a drug might be causing a problem which is not listed, seek radio medical advice.

1. Cardio-vascular

I Heart stimulant Anaphylactic

0.5 to l.Oml

(Epinephrine) Injection shock by IM injection 2478

0.5ml 11 in 1000)

(Severe allergy with collapse)

Side effects: Anxiety, tremor, high blood pressure, rapid irregular heart beat. Only use in severely ill collapsed patients with loss of blood pressure/severe breathing problems.

Anti-angina (Heart pain)

1-2 sprays

(GTN) Spray 400

Suspected heart attack or heart under tongue microgram metered pain dose

Side effects: Throbbing headache, flushing, dizziness, faintness, low blood pressure.

Diuretic (Water tablet)

40mg (1 tab) once tablets swelling/fluid retention daily

Furosemide 20mg in breathlessness due to heart failure 2ml by IM

2ml injection

Side effects: Few in short-term, low dose use.

Anti-haemorrage drug for new 0.2ml (1 amp) by

(Vit. K) paediatric born babies

IM injection single injection dose

Ergometrine with Oxytocin 500 1ml (1 amp) by IM

Micrograms/5 units injection single dose

Side effects: Nausea, vomiting, headache, dizziness, abdominal pain.

Anti-hypertension (high BP) drug,

50mg (1 tab) once may be useful for angina also daily

Side effects: Tiredness, slow pulse, low blood pressure, heart failure.

2. Gastro-intestinal

Anti-acid drug for heartburn,

400mg ( 1 tab) twice tablets dyspepsia stomach and duodenal daily ulcers

Side effects: Few at normal doses for short periods.

Antacids Drugs-e.g. Mist

Proprietary anti-indigestion

As instructions

Magnesium Trisilicate preparations for heartburn, with package

Dyspepsia etc.

Anti-sickness drug used for 3mg (1 amp) under buccal tablets sickness due to ear problems tongue twice daily

(vertigo), drugs e.g. Morphine

Side effects: Dry mouth, blurred vision, rapid pulse.

Promethazine 25mg

Anti-sickness drug and anti-

25mg (1 amp) by injection histamine for severe motion

IM injection sickness and for severe allergic reactions 2479

Side effects: Drowsiness, dry mouth, blurred vision.

Lubricant laxative used to

1 suppository encourage passage of stools inserted in the rectum

Strong painkiller but also helps 30mg (1 tablet)

i 30mg tablets control diarrhoea 6 hourly

Side effects: Nausea, vomiting, drowsiness and respiratory depression in overdose.

(see antibiotics)

!

tablets

3. Analgesics and anti-spasmodics

"Simple" painkiller suitable for most 1gm (2 tablets)

tablets mild to moderate pain 4 hourly

. Side effects: Few at correct dose, very dangerous in overdose poisonous to liver.

Diclofenac lOOmg

Anti-inflammatory painkiller 100mg (1 via the suppository suitable for most pain, especially rectum)

bone, joint and muscle pain once daily

Side effects: Stomach pains, nausea, wheeziness. Do not give if patient has Peptic ulcer or

Asthma.

Strong painkiller suitable for moderate 30mg ( 1 tablet)

30mg tablets to severe pain 6 hourly

Side effects: Nausea, vomiting, drowsiness and respiratory depression in overdose.

Morphine sulphate

I Very strong painkiller suitable for

I !Omg 11 amp)

10mg injection

/ all severe pain 4-6 ~o~rl~ by IM

!

InJection

Side effects: Nausea, vomiting, drowsiness, respiratory depression in overdose or if used inappropriately. Avoid in head injury and chest injury if possible.

Anti-sickness and dizziness 0.3mg 6 hourly, no bromide 0.3mg tablets medication, especially suitable for more than 3 doses motion (sea) sickness in 24 hourly

! · Side effects: Drowsiness, blurred vision, dry mouth, retention of urine.

4. Nervous system

Anti-anxiety, sedation medication. Can 5-lOmg by IM lOmg injection (2mls)

help with muscle spasm in injury and injection lOmg tablets low back pain 5-1 Omg tablet 4

I hourly up to i

I maximum of 30 mg per day 2480

Side effects: Drowsiness, light-headedness, confusion, headache, respiratory depression.

Avoid with strong painkillers.

Anti-psychosis (acute madness) drug.

25mg by IM hydrochloride

Sedates and controls symptoms in injection 8 hourly 25 mg injection acute psychosis especially violent or or 25mg tablet 8 25mg tablets disturbed patients hourly

Side effects: Drowsiness, dry mouth, retention of urine. Acute spasms or twitches. If occur reduce dose or stop treatment.

Anti-epileptic medication used to 1 Omg per rectum dispenser 1 Omg control fits up to a maximum of 2 doses

Side effects: See 4(a).

5. Anti-allergic and anti-anaphylactics

· (a) Loratadine 10mg tablets Anti-allergy medication useful in 1 Omg once daily controlling itching rashes and hay-only fever like symptoms due to allergy

Side effects: Drowsiness and slow reactions (less than older anti-histamine).

Anti-allergy steroid for serious 100mg by IM injection (has to be allergies causing severe symptoms or injection, 8 hourly made up in 2mls)

collapse if repeated

Side effects: Few for single dose or short course.

Prednisolone Smg

Anti-allergy steroid also essential 5-20mg once daily, tablets treatment of acute asthma more in severe asthma

Side effects: As hydrocortisone.

6. Respiratory system

Anti-bronchospasm (wheeze) drug 200 micrograms micrograms metered used to treat asthma and allergic

(2 puffs) 3-4 times dose wheezing daily

Side effects: Tremor, headache, increased pulse rate.

Beclomethasone/

Anti-asthma steroid taken by 100 micrograms

Beclometasone 50

inhalation usually with salbutamol

(2 puffs) 3-4 times micrograms metered daily hose

Side effects: Few in correct dose for short periods.

2481

DOS

See 3(b)

See 3(a)

Anti-infection

First line antibiotics for serious 600 to 1200mg by

( 1 mega unit) injection infections such as cellulites and

IM injection

[has to be made up in meningitis 6 hourly 2mls)

Side effects: Few unless patient allergic to Penicillins. Always check before giving if possible.

Ciprofloxacin

Broad spectrum (general purpose)

500mg twice daily hydrochloride 500mg antibiotic tablets

Side effects: Nausea, diarrhoea, abdominal pain, rashes, allergic reaction.

Cefuroime 750mg

Broad spectrum antibiotic useful to 750mg by IM injection protect against infection in major injection 8 hourly wounds

Side effects: Nausea, diarrhoea, abdominal pain, rashes, allergic reaction. Care when used in Penicillin allergic patients.

Erythromycin 250mg

General purpose antibiotic, useful in 250-SOOmg tablets penicillin allergic patients 6 hourly

Side effects: Nausea, diarrhoea, abdominal pain, rashes, allergic reaction.

Doxycycline 1 OOmg

Antibiotic useful for sexually lOOmg capsules transmitted diseases and sinusitis once daily

Side effects: Nausea, vomiting, diarrhoea, rashes, headache.

Antibiotic useful for treatment of 200mg tablets urinary tract infection and bronchitis twice daily

Side effects: Nausea, vomiting, diarrhoea, rashes.

See 7(b)

Anti-parasite drug for treatment of gut lOOmg tablets infestation e.g. threadworms single dose

Side effects: Rare.

Antibiotic and anti-protazoal e.g.

lgm per rectum or lgm suppositories trichomonas and amoebic infections.

400mg by mouth 400mg tablets

Useful in gut related infections 8 hourly

Side effects: Nausea, vomiting, unpleasant taste, rashes. Avoid alcohol.

2482

DOSE/ROUTE

For protection against tetanus infection 0.5ml by IM injection either in unprotected or as a booster or deep after injury subcutaneous injection

Side effects: Rare if not had vaccine for more than one year. Not required if vaccinated within 10 years.

Tetanus Immunoglobulin

Used to protect against tetanus in high 1 ampoule by ampoule for injection risk wounds e.g. agricultural injury in

IM injection unvaccinated patients 1 Side effects: Allergic reaction, fever, pain at injection site.

8. Compound promoting rehydration

Oral rehydration salts

Used to treat dehydration in vomiting

Follow instructions sachets and diarrhoea or severe illness on sachet

Side effects: Nil.

9. Medicines for external use

I (a) A~tiseptic solutions or

For cleaning skin wounds and

Follow instructions wipes disinfection on bottle/packaging

Cicatrin cream 15mg

General purpose anti-bacterial cream

Applied to affected tube for minor wounds, grazes, infections area sparingly etc.

! : Side effects: Nil unless applied to large areas.

Hydrocortisone cream I Anti-inflammatory weak steroid

Applied to affected ·

1% 15mg tube cream. Useful in eczema type rashes, area sparingly no 1 allergic rashes, bites etc.

more than 3 times

I per day

. Side effects: Encourages spread of infection, do not apply to broken skin or rashes due to skin infection e.g. ringworm.

Benzoid Acid

Anti-fungal ointment for treatment of

Applied to

Compound BP athletes foot, ringworm infected area

Ointment 15gm tube twice per day

Side effects: Rare/nil in normal use.

Miconazole nitrate 2%

Anti-fungal cream for treatment of

Applied to cream 30gm tube ringworm etc.

infected area twice per day

Side effects: Rare/nil in normal use.

2483

Silver sulphadiazine

Anti-bacterial cream for protection

Applied to burn 1 o/o cream SOgm tube against infection in burns in burn bag, under dressing or alone. Cleaned off at dressing changes and re-applied

Side effects: Allergic reactions, burning, itching. Unusual.

Permethrine 1 o/o in

Treatment for head lice and scabies.

Follow the isopropylalcohol 20%

Do not use for pubic lice instructions on cream rinse the packaging according to the use required

Side effects: Skin irritation. Do not apply to tender areas or broken skin.

Zinc ointment BP

Moisturising ointment for dry skin

Applied to 25gm tube conditions affected area

Side effects: Nil in normal use. Contains animal fat.

Potassium permangen-For cleansing and deodorising oozing

Wet dressings or tate crystals 1 Ogm wounds or skin rashes baths 0.01 o/o container solution

Side effects: Stains skin, irritates mucous membranes. Toxic if used for long periods.

General purpose antibiotic eye

Instill into

O.So/o eye ointment ointment for eye infections and affected eye 3-4

Sgm tube protection against infection after times per day removal of foreign bodies etc.

Side effects: Unusual but can cause eye irritation.

Betamethasone/

Treatment of inflamed, irritated eyes.

Instill 1-2 drops

Neomycin eyedrops

Anti-inflammatory with antibiotic into affected eye 4

Sml container times per day

Side effects: Rare in normal use.

Amethocaine hydro-Local anaesthetic drops for eye.

Instill 1-2 drops chloride O.So/o

Useful for numbing eye before into affected eye.

eyedrops Sml removing foreign bodies and for acute

Do not use container pain e.g. in arc eye repeatedly

Side effects: Rare if used one off. Care to avoid eye injury whilst numbed.

Pilocarpine hydro-Drops to constrict the pupil, used to

Instill 2 drops chloride O.So/o treat raised pressure in the eye 3-6 times per day eye drops 1 Oml

(glaucoma)

container 2484

DOSE/ROUTE

Side effects: Blurred vision and headache.

Fluorescein sodium

Stain for detecting scratches on front

Instill 1-2 drops in 1% eyedrops. 0.5ml of eye, and foreign bodies the affected eye minims.

Side effects: Nil in normal use.

!c) Neomycin/polymixin/

General purpose antibiotic/anti-Instill 3 drops into hydrocortisone inflammatory ear drops for infection the affected ear eardrops 5ml dropper of the outer ear canal 3-4 times per day bottle

Side effects: Nil in normal use.

Ephedrine nasal drops

Nasal de-congestant

Instill 1-2 drops

BP 0.5% 10ml dropper into each nostril bottle 3 times per day

Side effects: Nose bleeds. Use for short periods only.

Antiseptic mouthwash for sore

Rinse mouth with gluconate 0.2%

throats, mouth sores etc.

1 Omls twice per mouthwash. 300ml day bottle

Side effects: Nil in normal use.

I Freezing agent used as a local

I Spray from some spray 50mg spray vial anaesthetic. Literally freezes small ems away until areas for very short procedures area required is frozen i

Side effects: Inflammable, and may damage tissue. Use sparingly and with care.

Lignocaine hydro-Local anaesthetic injection for

Inject around chloride 1% 25mg in numbing small wounds for treatment wound edges,

Sml injection 2-Smls usually sufficient, no

!

more than 20mls in an adult

Side effects: Fits, heart problems in over-dosage.

Lignocaine gel 20gm

Local anaesthetic for mouth and gum

Apply to affected tube sores/ulcers area sparingly as required

Side effects: Nil in normal use.

Oil of cloves lOml

Natural oil with local anaesthetic

Apply sparingly bottle properties useful in treating to affected tooth toothache as required by symptoms

Side effects: Nil in normal use.

2485

ANNEX 1

SPECIMEN REQUISITION FORM FOR USE

WHEN OBTAINING CONTROLLED DRUGS

(paragraph 7)

Controlled drugs should be obtained only from a retail pharmacist or other person licensed to supply drugs, and they will require an order worded along the lines below. The order must be signed by either the shipowner or its master.

Requisition

To

(name and address of authorised supplier)

From- (name of ship, and of master or shipowner)

Address- (address of ship or shipowner)

Please supply (name, strength and quantity of drugs in words and figures)

The above drugs are required for the medical stores of (name of ship) in compliance with the Merchant Shipping [Medical Stores) Regulations, 2008.

The ship is required to carry Category .............. [insert appropriate categories)

Medical Stores.

Signature:

Name in capital letters:

Occupation:

Date:

Declaration by the Port Health Officer

I hereby declare that the quantity of the drug to be supplied is the quantity necessary for the medical stores of the ship.

Name:

Signature:

Date:

2486

It is not necessary for the owner or master to receive personally the controlled drugs from the supplier, but if the drugs are received by another person the requisition must be endorsed:

I empower (name of person) to receive the above drugs on my behalf. A specimen of his signature is provided below.

Specimen signature of person empowered

Signature of master/owner 2487

ANNEX 2

(paragraph 11)

COMPLETION OF CONTROLLED DRUGS REGISTER

SECTION 1 - Drugs obtained from authorised supplier or confiscated from seaman

N arne of drug and

Supplier's name and

Date obtained

Amount obtained form in which address obtained

H.M. Kingston Chemists

Morphine sulphate 25.10.2000 24 Elliot Street 10 ampoule 10mg in 1ml in glass

Southampton ampoules

SECTION 2- Drugs dispensed or disposed of

Name and

Right of

Amount

N arne of person

Stock

Date address of person person to supplied administering balance given drug have drug drug 3.1.1999

T.H. Laidlaw

Injured 2amps

Joe Johnson 8amps

Log-book ref.

crewman jMaster)

jfractured humerus)

24.10.2000

H.M. Kingston

Retail 10ml

NA

10 amps

Chemists pharmacist 24 Elliot Street

Southampton

Made this 12th. day of Syaaban, 1429

Hijriah corresponding to the 14th. day of August, 2008.

PEHIN ORANG KAYA SERI KERNA DATO SERI SETIA

HAJI A WANG ABU BAKAR BIN HAJI APONG

Minister of Communications,

Brunei Darussalam.

Dicetak oleh PENGIRAN HAJI ZAINAL ABIDIN BIN PENGIRAN SERI WIJAYA

PENGIRAN HAJI AHMAD, Pemangku Pengarah Percetakan, di Jabatan Percetakan Kerajaan, Bandar Seri Begawan BB3510, Negara Brunei Darussalam.

Harga B$5.00