[Directions of interdepartmental interaction in case of delivery of health care for injured in emergency situations in stationing sites of navy].

In points basing of navy will remain probability of emergence of emergency situations which is connected with existence of the enterprises of the industry and objects of navy. As a result of emergency situations in places of basing of navy discrepancy of prospective sanitary losses to possibilities of forces and means of a health service of fleet that demands interaction with health services of other ministries and departments is probable. Criterion of need of interaction is the ratio of quantity struck and possibilities of a health service of navy. Plans of interaction of a health service of fleet with medical institutions of other departments should provide options of use of available forces and means of medical institutions in garrisons for joint assistance struck in an emergency situation. The questions solved during interaction should become: radiation, chemical, biological survey; allocation of forces and means for rendering of medical care; use of sanitary transport; organization of sanitary processing, etc.

[Expert assessment of commands of naval medical service, incorporated in Service for Disaster Medicine].

Expert assessment of possibilities of naval medical service for delivery of assistance in emergency situations in deployment areas is performed. It is noted that the main menaces are radiation, chemical accidents, and explosiveness of objects. Inconsistency between supposed losses and possibilities of naval medical service is probable in case of emergency. This inconsistency requires improvement of interaction with medical services of other ministries, drill of coordinative actions of naval medical commands with other commands of other ministries in organizational frames of united Service for Disaster Medicine.

The need for international seafarer medical fitness standards.

The text of this paper is based on a presentation at the First International Congress of Maritime, Tropical, and Hyperbaric Medicine, 4th July 2009, Gdynia, Poland. The assessment of fitness to work at sea is an important aspect of maritime risk management. The risks in the industry, the approaches used for assessment, and the evidence on which they are based have changed over time. The transition from an industry in which the nationality of seafarers and the ships on which they worked were the same to one in which ownership and crewing have become global means that, as is true for most other aspects of maritime risk management, compatible international criteria for decisions regarding fitness to work are required. Many parties, including flag states, employers and their insurers, and seafarers and their trade unions, are involved in agreeing international medical fitness criteria. While all have a common interest in improved health and safety at sea, each has their own more detailed agenda of sectional interests. The scope for development of agreed standards and the role of the parties involved is reviewed, and the current arrangements for taking this process forward are discussed. Contributions from maritime health professionals and other medical and scientific experts are essential to the development of rational and valid criteria, but the decisions on the level of authority to be given to these and the means adopted for ensuring compliance with them are essentially political issues where the voice of those with subject knowledge is only one among many in the processes for adoption and implementation of any new arrangements.

The nontechnical causes of diving accidents: can U.S. Navy divers learn from other industries?

Although U.S. Navy diving is remarkably safe, because of the high-risk environment in which military divers work, accidents and mishaps do occur. Failures in leadership and situation awareness (particularly in risk and time assessment) were found to be the two most common causes of fatal and nonfatal U.S. Navy diving accidents and near misses. Responses to an attitude survey showed that junior divers want to ask questions, but senior divers do not desire to be questioned. In other high reliability industries (e.g. aviation, medicine) methods have been developed to identify, analyze and mitigate human error. The relevance of these techniques for U.S. Navy diving are discussed.

[Healthcare at water transport].

The timely restructuring of healthcare at water transport is an issue of special importance under the social-and-economic conditions of today. The paper mirrors positive and negative aspects of the present state medical care provided to those occupied at water transport system of the North-West Okrug of the Russian Federation. The virtually identical standard of medical care rendered to the discussed category of employees is observed in other Okrugs of Russia. A model of medical care for seamen for the at-sea and on-shore conditions is put forward. In order to preserve and to promote the discussed sphere of healthcare it is necessary to preserve the positive traditions of the past and, jointly with the interested branches, departments and public and other organizations, to apply the modern methods healthcare organization, i.e. to reorganize some of the sectors, to introduce a strict Register of institutions and organizations preoccupied with medical are at water transport and to develop and to introduce new technologies in all spheres of medical care within the branch.

A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management.

OBJECTIVE: Foodborne disease outbreaks on ships are of concern because of their potentially serious health consequences for passengers and crew and high costs to the industry. The authors conducted a review of outbreaks of foodborne diseases associated with passenger ships in the framework of a World Health Organization project on setting guidelines for ship sanitation. METHODS: The authors reviewed data on 50 outbreaks of foodborne disease associated with passenger ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and food vehicles were collected. RESULTS: The findings of this review show that the majority of reported outbreaks were associated with cruise ships and that almost 10,000 people were affected. Salmonella spp were most frequently associated with outbreaks. Foodborne outbreaks due to enterotoxigenic E. coli spp, Shigella spp, noroviruses (formally called Norwalk-like viruses), Vibrio spp, Staphylococcus aureus, Clostridium perfringens, Cyclospora sp, and Trichinella sp also occurred on ships. Factors associated with the outbreaks reviewed include inadequate temperature control, infected food handlers, contaminated raw ingredients, cross-contamination, inadequate heat treatment, and onshore excursions. Seafood was the most common food vehicle implicated in outbreaks. CONCLUSIONS: Many ship-associated outbreaks could have been prevented if measures had been taken to ensure adequate temperature control, avoidance of cross-contamination, reliable food sources, adequate heat treatment, and exclusion of infected food handlers from work.

A review of outbreaks of waterborne disease associated with ships: evidence for risk management.

OBJECTIVE: The organization of water supply to and on ships differs considerably from that of water supply on land. Risks of contamination can arise from source water at the port or during loading, storage, or distribution on the ship. The purpose of this article is to review documented outbreaks of waterborne diseases associated with passenger, cargo, fishing, and naval ships to identify contributing factors so that similar outbreaks can be prevented in the future. METHODS: The authors reviewed 21 reported outbreaks of waterborne diseases associated with ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and remedial action are presented. RESULTS: The findings of this review show that the majority of reported outbreaks were associated with passenger ships and that more than 6,400 people were affected. Waterborne outbreaks due to Enterotoxigenic Escherichia coli, noroviruses, Salmonella spp, Shigella sp, Cryptosporidium sp, and Giardia lamblia occurred on ships. Enterotoxigenic E. coli was the pathogen most frequently associated with outbreaks. One outbreak of chemical water poisoning also occurred on a ship. Risk factors included contaminated port water, inadequate treatment, improper loading techniques, poor design and maintenance of storage tanks, ingress of contamination during repair and maintenance, cross-connections, back siphonage, and insufficient residual disinfectant. CONCLUSIONS: Waterborne disease outbreaks on ships can be prevented. The factors contributing to outbreaks emphasize the need for hygienic handling of water along the supply chain from source to consumption. A comprehensive approach to water safety on ships is essential. This may be achieved by the adoption of Water Safety Plans that cover design, construction, operation, and routine inspection and maintenance.

Offshore safety case approach and formal safety assessment of ships.

PROBLEM: Tragic marine and offshore accidents have caused serious consequences including loss of lives, loss of property, and damage of the environment. METHOD: A proactive, risk-based "goal setting" regime is introduced to the marine and offshore industries to increase the level of safety. DISCUSSION: To maximize marine and offshore safety, risks need to be modeled and safety-based decisions need to be made in a logical and confident way. Risk modeling and decision-making tools need to be developed and applied in a practical environment. SUMMARY: This paper describes both the offshore safety case approach and formal safety assessment of ships in detail with particular reference to the design aspects. The current practices and the latest development in safety assessment in both the marine and offshore industries are described. The relationship between the offshore safety case approach and formal ship safety assessment is described and discussed. Three examples are used to demonstrate both the offshore safety case approach and formal ship safety assessment. The study of risk criteria in marine and offshore safety assessment is carried out. The recommendations on further work required are given. IMPACT ON INDUSTRY: This paper gives safety engineers in the marine and offshore industries an overview of the offshore safety case approach and formal ship safety assessment. The significance of moving toward a risk-based "goal setting" regime is given.

[The status and trends in the improvement of specialized medical care]. / Sostoianie i puti sovershenstvovaniia spetsializirovannoi meditsinskoi pomoshchi.

The article analyses the changes which have taken place during the last years in the functioning of the system of specialized medical care in the Armed Forces of Russian Federation. A new definition of this kind of medical care is given in this article, as well as its contents, components, and methods of its further improvement. The authors stress the positive results which were achieved by large multipurpose medical establishments with organic specialized medico-diagnostical units. Trends towards the further development of the system of specialized medical care were created taking into account the regional system of medical support of the Army and Navy. This article has a scientific and practical character and is interesting for the physicians and pharmacists of all specialties.