The short version
- The decision is split: the physician advises on clinical urgency, the master decides on operational feasibility and holds overriding authority on safety.
- MLC A4.1(4)(d) makes radio and satellite medical advice free in ratifying states. The US has ratified neither MLC nor 92/29/EEC.
- The 2024 MLC amendments added prompt disembarkation and access to medical facilities ashore for serious injury or disease.
- A physician cannot judge urgency without position, next ports, transit time and weather. Those are handover items, not navigation trivia.
- The decision starts non-medical clocks: 46 CFR 28.80 and 28.90 reporting, and in Alaska a 120-day treatment deadline for the Fishermen’s Fund.
The hardest call at sea is not clinical. It is deciding, with incomplete information and a weather window closing, whether a person can wait. Search for guidance on it and you get five methods of medevac, two advocacy pieces and a P&I circular on repatriation. Nobody gives you the decision itself.
The decision does not belong to any one person, and that is the first thing to fix. It is split, and writing down the split is most of the work.
Four parties, four different questions
Every delayed evacuation this framework is meant to prevent comes from the same failure: one party trying to answer someone else’s question.
| Party | The question they own | The question that is not theirs |
|---|---|---|
| The shore-side physician | How urgent is this clinically, and what can be managed on board | Not whether a helicopter can fly, and not what it costs |
| The master | What is operationally possible and safe, and holds overriding authority on safety | Not the clinical severity. A master forced to guess at that is being failed by the system around them |
| The company ashore | Resourcing, port selection, and standing by the decision | Not second-guessing urgency after the fact |
| The coastal state or SAR authority | Whether and how an extraction happens | Not your medical judgment, and not your record-keeping |
Write those four rows into the procedure with names against them. The value is not the table, it is that a master at 0300 does not have to work out who to call or who decides. Accountability for holding that document is covered in owner or DPA.
Two failure patterns come out of blurring the rows. The first is a master carrying clinical weight they were never trained for, deciding alone whether chest pain can wait until the next scheduled port. The second is quieter and more common: a shore office treating an evacuation as a cost decision and asking the physician to soften a recommendation. Neither happens when the split is written down, because a documented split makes both attempts visible the moment they occur.
Radio medical advice is free, and is the first call
Under MLC Standard A4.1(4)(d), ratifying states must ensure medical advice by radio or satellite is available free of charge to vessels at sea, and 92/29/EEC requires Member States to designate centres providing free advice by radio[1][5].
The gap for a US-flagged vesselThe United States has ratified neither instrument[1]. A US-flagged hull gets no treaty guarantee of a free advice service, which means the escalation route is something the operator establishes and documents rather than something the flag provides. That is a one-page job that nobody does until the night they need it.
What the physician needs before they can advise
Advice quality is bounded by handover quality. Six items, and the last two are the ones crews forget because they feel like navigation rather than medicine.
| What to have ready | Why it changes the advice |
|---|---|
| Mechanism and time of onset | Time is often more diagnostic than the symptom |
| Vital signs, and the trend | A single set of numbers says far less than three sets an hour apart |
| What has been given, dose and time | Prevents duplication and tells the physician what has already been tried |
| What the chest actually holds | There is no point advising a treatment the vessel cannot deliver[7] |
| Position, next ports, and time to each | Turns “urgent” into a decision. Urgency only means something against a clock |
| Weather and realistic extraction window | Determines whether waiting is even an option |
Row four is a chest problem disguised as a communication problem. If nobody ashore knows what is in the chest, advice defaults to conservative. Keeping an accurate, current contents list reachable from shore is one of the quieter arguments for managed chest service, and the build method is in how to stock a ship medicine chest.
The decision starts clocks, and some of them are not medical
The 2024 MLC amendments added an expectation that seafarers are promptly disembarked when in need of immediate medical care, with access to medical facilities ashore in cases including serious injury or disease[2]. That moves “prompt” from a judgment to something a port state may ask you to evidence.
Other clocks run in parallel and they are easy to miss while an evacuation is in progress. On a US commercial fishing vessel, 28.80 requires a casualty report for death or serious injury, and 28.90 requires the individual to notify the master, individual in charge or other agent of the employer within seven days[4][3]. In Alaska a benefit clock also starts, because the Fishermen’s Fund requires initial treatment within 120 days of onset[6].
None of those is the master’s problem in the moment, which is exactly why the company ashore should own them. The full picture sits in the six federal obligations and Alaska compliance.
What has to exist afterwards
An evacuation ends when the person is ashore. The file does not. Three records decide whether the decision looks considered or improvised when someone reviews it months later, and all three are easier to produce on the day.
| Record | Who writes it | What it has to show |
|---|---|---|
| The clinical handover | Whoever treated on board | Times, observations, what was given. It travels with the patient and is the receiving clinician’s starting point[7] |
| The decision log | Master, countersigned ashore | When advice was sought, what was advised, what was decided and why. This is what evidences “prompt”[2] |
| The statutory reports | Company ashore | Casualty report where required, and the injury notification chain[4][3] |
The decision log is the one nobody keeps and the only one that defends the judgment. A record showing that advice was sought within an hour, that a physician was reached, and that a port was selected on stated grounds converts a contested call into a documented one. Where that sits in the wider program is set out in what an audit checks, and the chest side that feeds the handover in the 28.210 rules.
Write it before you need it
- Name the four parties and the question each owns. One page, with real names and numbers, on the bridge[1].
- Establish the advice route and test it once. A number nobody has ever dialled is not a route[5].
- Put the handover set on the same page. Six items, in order, so a stressed officer reads rather than recalls.
- Compute the self-sufficiency window in advance so urgency has a clock to be measured against. Method in planning by time to definitive care.
- Assign the reporting clocks ashore, not to the master[3][4].
Step one is free and takes an afternoon. It is also the step that decides whether the next call is a decision or an argument. If you want a physician on the other end of that call and the procedure written around it, that is maritime medical consulting, and the sequence it fits into is the six decisions. Everything else is in the guidance library and the physician page.
Common questions
Who decides whether to evacuate a seafarer?
The clinical judgment belongs to a physician, and the operational decision belongs to the master, who holds overriding authority on safety. The useful framing is that the physician advises on urgency and the master decides on feasibility. Confusing the two is how decisions get delayed. Our consulting service provides the shore-side physician side of that.
Is medical advice by radio free?
Under MLC Standard A4.1(4)(d) ratifying states must ensure medical advice by radio or satellite is available free of charge, and 92/29/EEC requires Member States to designate centres giving free advice by radio[1][5]. The United States has ratified neither, so a US-flagged vessel writes its own route. See decision four.
What did the 2024 MLC amendments change about this?
They added an expectation that seafarers are promptly disembarked when in need of immediate medical care, with access to medical facilities ashore in cases including serious injury or disease[2]. That converts a judgment call into something a port state may ask you to evidence. See what the amendments changed.
What information should be ready before calling for advice?
A short structured set: what happened and when, vital signs and trend, what has been given and at what time, what the chest actually holds, the vessel position and next ports, and realistic transit and weather. A physician cannot advise on urgency without the last two. Build the chest so the list is answerable, which is what MedChest does.
Does a decision to evacuate create reporting duties?
On a US commercial fishing vessel, yes. Section 28.80 requires a casualty report for death or serious injury, and 28.90 requires the individual to notify the master or employer within seven days[4][3]. See the six federal obligations.
How does distance change the decision?
It changes the deadline, not the criteria. A vessel six hours from an equipped port and one four days out face the same clinical question with completely different margins. Compute the window in advance rather than in the moment. That method is in planning by time to definitive care.
Does an evacuation affect a crew member’s benefit claim?
It can, on the timing. In Alaska the Fishermen’s Fund requires initial treatment within 120 days of onset and the application within one year of that treatment[6]. A delayed decision can quietly close a route the crew member did not know existed. See Alaska compliance.
