The short version
- STCW has two medical endorsements. Medical First-aid Provider is for the crew member designated to give first aid. Person in Charge of Medical Care is for the crew member designated to run medical care aboard[1].
- On a US vessel subject to STCW, every person designated to either role must hold that endorsement on their Merchant Mariner Credential[1].
- Each needs an approved course plus the competence standard in STCW Code Table A-VI/4-1 (first aid) or A-VI/4-2 (medical care)[2][3]. A licensed physician, registered nurse or listed medical rating qualifies without the course[2][3].
- Neither endorsement has a professional requirement at renewal[5]. Skills fade faster than credentials, so the refresher is a company decision, not a Coast Guard one.
Two endorsements, two different jobs
The two names sound interchangeable and are not. One is the person who stops the bleeding and starts CPR. The other is the person who owns the sick bay, the medicine chest and the radio call to a doctor, for the whole voyage.
US rules make the split explicit. 46 CFR 15.404 requires every person designated to take charge of medical care on an STCW vessel to hold the Person in Charge of Medical Care endorsement, and every person designated to provide medical first aid to hold the Medical First-aid Provider endorsement or a deck or engineer officer endorsement[1].
| Question | Medical First-aid Provider | Person in Charge of Medical Care |
|---|---|---|
| Role aboard | Designated to provide medical first aid[1] | Designated to take charge of medical care[1] |
| STCW competence standard | Table A-VI/4-1[2] | Table A-VI/4-2[3] |
| US qualifying rule | 46 CFR 12.619[2] | 46 CFR 12.621[3] |
| Route in | Approved medical first aid course + competence[2] | Approved medical care course + competence[3] |
| Who qualifies without a course | Holders of a listed professional licence or rating in 46 CFR 11.807(a)(5) to (a)(8): physician, registered nurse, marine physician assistant, medical technician[2][3][4] | |
| Renewal | No professional requirement for renewal of either endorsement[5] | |
Deck officers already carry one of them
A watchkeeping officer does not need a separate first aid provider on paper. The approved training for an STCW Officer in Charge of a Navigational Watch includes Medical First-aid Provider[6], and 15.404 accepts a deck or engineer officer endorsement in place of the first-aid endorsement[1].
At management level the requirement steps up. The approved training for STCW Master of vessels of 3,000 GT or more includes management of medical care[7]. In practice the master or chief mate on a large US ship is often the Person in Charge of Medical Care, alongside command.
The fleet manager’s question
Not “does anyone have the certificate” but “who is designated”. The rule attaches to the person the company designates for each role[1]. Name them in writing, per vessel, with a relief for crew changes.
Where MLC 2006 fits in
For ships trading to ports that apply the Maritime Labour Convention, the same split appears from the other side. A ship that does not carry a medical doctor must have at least one seafarer in charge of medical care and administering medicine as part of their regular duties, or at least one seafarer competent to provide medical first aid, and those seafarers must have training that meets STCW[8].
The US has not ratified MLC 2006, so it does not bind a US-flag ship directly. It reaches US ships through port state control in countries that have. When a doctor is actually required is covered in ship doctor requirements for US vessels.
Medical care means medicines, and medicines mean paperwork
The Person in Charge of Medical Care is the one who opens the chest, gives the injection and writes it down. That puts three other rule sets in the same person’s hands.
- The chest. Contents are set by flag and voyage, not by STCW. See how to stock a ship medicine chest.
- Controlled substances. Opioid analgesia aboard a US vessel is acquired under 21 CFR 1301.25, through a DEA-registered medical officer or a master’s requisition[10]. The endorsement gives no prescribing authority. See who can prescribe medication on a ship.
- The record. Every treatment and every dose goes in the log. See official logbook medical entries.
Fishing vessels run on a different certificate
Most US commercial fishing vessels are not STCW vessels. Their medical training rule is 46 CFR 28.210, which asks for first aid and CPR certificates from the American Red Cross, the American Heart Association or a Coast Guard approved course: 1 of each above 2 aboard, 2 of each above 16, 4 of each above 49[9].
| Vessel | Medical training rule | What the crew member holds |
|---|---|---|
| STCW vessel, first aid role | 46 CFR 15.404(j)[1] | MMC endorsed Medical First-aid Provider, or a deck or engineer officer endorsement |
| STCW vessel, medical care role | 46 CFR 15.404(i)[1] | MMC endorsed Person in Charge of Medical Care |
| Commercial fishing vessel | 46 CFR 28.210[9] | First aid and CPR course certificates, by crew size |
A fishing skipper who hires from the merchant fleet gains a crew member with the stronger credential. The reverse is not true: a Red Cross card is not an STCW endorsement. For the fishing rules in full see 46 CFR 28.210 first aid rules and commercial fishing vessel medical requirements.
The gap the credential does not close
No refresher is required to renew either endorsement[5]. A mate can hold a valid Person in Charge of Medical Care endorsement several years after last handling a suture kit or a drug calculation.
Three company-level fixes cost little. Put medical scenarios into the drill cycle, not only fire and flooding. Give the designated person a one-page physician escalation card for the radio call. And agree evacuation thresholds before the voyage, using when to medevac a seafarer and remote vessel medical planning.
What to do this week
- List every vessel and its STCW status.
- For each STCW vessel, name the designated first aid provider and the designated person in charge of medical care, with a relief.
- Check each MMC carries the matching endorsement[1].
- Match the chest to the flag and the voyage, and the controlled drugs to a DEA route[10].
- Book a practical refresher even though renewal does not require one.
Discovery Health MD builds the medical side around those designations: the chest through ship medical chest management, scheduled drugs through controlled substances management, and written escalation protocols through maritime medical consulting. Send us your crew list and a physician will map who covers what.
Common questions
What is the difference between STCW medical first aid and medical care?
Medical first aid covers immediate care by the crew member designated to give first aid, against STCW Code Table A-VI/4-1. Medical care covers the crew member designated to take charge of medical care aboard, against Table A-VI/4-2. US rules issue them as two separate MMC endorsements[2][3].
Who must hold the Person in Charge of Medical Care endorsement?
Every person designated to take charge of medical care onboard a vessel subject to the STCW Convention, under 46 CFR 15.404(i)[1].
Does a deck officer need a separate Medical First-aid Provider endorsement?
No. 46 CFR 15.404(j) accepts a deck or engineer officer endorsement for the first aid role, and OICNW training already includes Medical First-aid Provider[1][6].
Can a nurse or doctor get the endorsement without the course?
Yes. Holders of a valid physician or registered nurse licence, or a marine physician assistant or medical technician rating listed in 46 CFR 11.807, qualify for both endorsements[2][3][4].
Do the medical endorsements need a refresher to renew?
No. 46 CFR 10.227 lists Person in Charge of Medical Care and Medical First-aid Provider among endorsements with no professional requirement for renewal[5]. A practical refresher is still good practice.
Does MLC 2006 require a medical care officer?
A ship without a doctor must have a seafarer in charge of medical care or one competent in medical first aid, trained to STCW[8]. The US has not ratified MLC 2006; it reaches US ships through port state control abroad.
Do commercial fishing vessels need STCW medical endorsements?
Most do not. They follow 46 CFR 28.210, which requires first aid and CPR certificates by crew size[9]. See the 28.210 guide.
