G U I D E L I N E N o. 3

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1 SHIP SANITATION COMMITTEE OF GERMAN FEDERAL STATES G U I D E L I N E N o. updated version as of 1 July 010 in Agreement with the Ship Safety Division, Maritime Medical Service, of the BG Verkehr (BG Transport and Traffic) to the Third Ordinance to amend the Ordinance on the Medical Care on Seagoing Vessels dated September 007 (Krankenfürsorge auf Kauffahrteischiffen vom. September 007 (BGBl. I S. 1)) - Second Section - Rooms and Equipment on Merchant Ships with up to 7 Persons With this guideline, the Ship Sanitation Committee of German Federal States of the federal states of Bremen, Hamburg, Mecklenburg-West Pomerania, Lower Saxony, North Rhine-Westphalia and Schleswig-Holstein pursues the objective of adopting uniform principles and equal standards in the coastal federal states, adapted to the development process in shipping. Enquiries and comments must be addressed to the Directorate of the Ship Sanitation Committee of German Federal States.

2 With reference to the Third Ordinance to amend the Ordinance on the Medical Care on Seagoing Vessels (SchKrFürsV) dated September 007 (BGBl. I S. 1), supplementary information is provided on the Second Section Rooms and Equipment for merchant ships with up to 7 persons. This Guideline is developed further and brought up to date with Chapter A.6.1. Equipping of the Treatment Room and Sickroom in the German Medical Guide for Ships *, pages General Information 1.1 The maritime medical service of the home port gives advice in individual cases regarding the equipping of treatment rooms and sickrooms. 1. The treatment room and the sickroom (if existent), in the following called medically used rooms, should be located together on the same deck. 1. The medically used rooms are to be used solely for the treatment of sick persons and for the isolation of potentially infectious patients. 1. They should be located in a quiet area with low vibration. 1. The admittance of daylight should be ensured in the treatment room and must be ensured in the sickroom through windows in the exterior walls. 1.6 The medically used rooms must have a seperate, active ventilation system. The opening for the exhaust air in the medically used rooms must not be in the immediate vicinity of the air intake of the general ventilation system. 1.7 The medically used rooms and their furnishings and equipment must have smooth, light-coloured surfaces, be disinfectable through wiping as well as being washable. They must not have textile floor coverings or upholstery covers. 1.8 Entrances to treatment rooms and sickrooms should have dimensions which allow for the transport of an injured person lying on a rescue-basket stretcher with a vacuum mattress through the entrance. A minimum width of 1000 mm is necessary. If the treatment room or the sickrooms have an exterior wall, it is recommended to provide an additional entrance with a width of at least 800 mm and a lockable door leading directly to the outside area of the deck to facilitate the transport of patients in lying position. 1.9 It must be ensured that in emergencies the necessary medication, instruments and aids in the treatment and sickroom are accessible at all times. A spare key must be kept in a labelled glass-front box beside the entrance door A hygiene schedule must be drawn up and kept available. In the hygiene schedule, all cleansing and disinfecting measures to be carried out regularly regarding surfaces, appliances and other equipment must be defined. Further, a schedule must be drawn up for flushing all drinking water taps in the

3 treatment and sickrooms (washbasin, shower and bath). The hygiene, disinfecting and washing schedules must be hung up in such a way that they are clearly visible. A specimen hygiene schedule is found in Attachment The automated external defibrillator (AED) according to.0 should be mounted in a clearly visible location and be freely accessible so that all members of the crew can easily recognise where it is kept and are able to reach and use it in cases of emergency. Depending on the type of ship, various rooms can be suitable as a location for mounting the AED. However, it must always be taken into consideration that the appliance must at all times be accessible and quick to reach for all members of the crew. For this reason, the ship s office or the mess lend themselves to the purpose. The treatment room or the bridge can also be sensible places. In the following rooms, it must be clearly indicated where the device is kept: Ship s office, engine control room, bridge, messes, treatment room, at the muster stations as well as at the point where the muster roll is posted. For indicating the location of the AED, the glow-in-the-dark safety sign D- E017 automated external defibrillator in accordance with DIN 8- must be used. A medical devices book must be maintained and kept in the treatment room, and presented to the port health officials on request. A specimen of a suitable medical devices book is available as Attachment. 1.1 The rescue basket stretcher with its vacuum mattress must be ready for use, stored secured in an easily accessible location. The storage location must at least be indicated with a sign at the door of the treatment room and the location itself must bear a sign. The working order of the vacuum mattress must be checked regularly (for example within the scope of emergency drills). 1.1 The emergency kit according to.0 must be stowable when open in drawer No. 11 and should contain, in addition to the items.0.08, equipment for initial treatment (according to Attachment ).. Treatment room ( 7 of the Krankenfürsorgeverordnung (Ordinance on the Medical Care on Seagoing Vessels).1 The treatment room should have an area of at least 10 m².. The examination couch must be freely accessible on three sides with a space of at least one metre freedom of movement. This means that opened doors, drawers, etc. must not protrude into this free space. The lying height of the examination couch must be at least 60 mm. A safety measure must be provided to prevent the patient from falling off the couch, e.g. adjustable side rails. It must be possible to lay patients in the shock position; the back section must enable a sitting position, and the foot end should be heightadjustable (in accordance with chapter C of the Guide*.. At least one double socket must be mounted in the vicinity of the examination couch to enable the connection of additional devices.

4 . The treatment room must have a general room illumination of at least 00 lux. In addition, a mobile examination lamp in accordance with DIN EN must be available.. There should be a refrigerator in the treatment room. On seagoing vessels with no treatment room, a storage location must be defined for the storage of medicines which must be stored in a cool place. The refrigerator must be equipped with a thermometer for determining the inner temperature..6 In the treatment room, brackets must be provided for a 10-litre oxygen cylinder (consecutive no. 7.1 MFAG Ausrüstung (medical first aid guide equipment)). This oxygen cylinder should be mountable at the head end on one side of the examination couch (compare image 1). If the other 10-litre oxygen cylinders are stored in the treatment room, secure brackets must be provided for them. When cylinders are stored, the cylinder valves must be secured with the aid of caps. At all times, both one stationary and one portable oxygen treatment unit must be available and ready for use (oxygen cylinder containing sufficient oxygen with a suitable pressure regulator connected, a flowmeter, and a connected oxygen mask)..7 Within the direct vicinity of the washbasin, a disinfectant dispenser, a liquidsoap dispenser, a dispenser for paper towels, a dispenser for disposable gloves, and a waste bin with a lid must be available. All of the just mentioned hygiene utensils must be maintained in a usable state..8 For the safe disposal of cannulas and disposable surgical instruments such as scalpels and needles, a stationary pierce-resistant and unbreakable disposal container (in accordance with TRBA 0 (technical regulation regarding biological materials)) must be installed in place, preferably in the direct vicinity of the examination couch. This container must be marked clearly..9 A possibility for hanging infusion bottles must be provided in alignment with the upper part of the body. At all times, a functioning telecommunication facility (telephone) for direct medical advice by radio must be available on or at the desk.. Sickroom ( 8 Krankenfürsorgeverordnung (Ordinance on the Medical Care on Seagoing Vessels)).1 The area of a sickroom with only one bed should be at least 6 m² with regard to the enclosed space. The area required increases by m² for every further bed.. The sickbeds in the sickrooms should have minimum dimensions of 000 x 900 mm and be firmly lockable in place. They must be arranged according to the ship s longitudinal direction. They should fulfil the functions of a hospital bed, and must at least have side guards to prevent patients from falling out as well as height-adjustable back and foot sections.

5 They must be adjustable to enable laying patients with their backs raised, in the shock position or with their knees raised. To enable cardiopulmonary reanimation on the soft mattress of the sickbed, a flat, hard board should be kept ready for use, which can be slid under the patient s torso if needed (reanimation board or spineboard). The space between the sickbeds should be at least 1000 mm in width.. In place of a bedside cabinet, a foldable tray can be mounted at the head end of the bed.. The call system in the sickroom should be connected with visual and acoustic signals to the bridge, the passage outside the sickroom and the cabin of the officer responsible for health protection. The call system should be within easy reach even for patients with limited mobility.. In the area of the sickbed accommodating the upper part of the patient s body, a possibility must be provided for hanging infusion bottles.. Sanitary facilities ( 10 Krankenfürsorgeverordnung (Ordinance on the Medical Care on Seagoing Vessels).1 The sanitary rooms should be fitted with a call system and must be directly accessible from the sickroom. The doors must have no locks or latches.. Above the washbasin, a mirror, a shelf and a protected electrical socket should be provided; here the technical rules regarding operational safety must be observed. Within the direct vicinity of the washbasin, a disinfectant dispenser, a liquid-soap dispenser, a dispenser for paper towels and a waste bin with a lid must be available. All mentioned hygiene utensils must be maintained in a usable state at all times. Attachment 1: Hygiene Framework Attachment : Specimen Medical Devices Book Attachment : Equipment for Emergency Kit (to follow)

6 Image 1 Treatment room for seagoing vessels (principle drawing) min mm 1. Rescue basket stretcher with vacuum mattress, ready for use, (alternative storage in another suitable location, see 1.1. The storage location must at least be indicated at the door of the treatment room).. Desk ( min. 800 x 00 mm). chairs. Waste bin. Examination couch (Lying height at least 60 mm) 6. Refrigerator 7. Ship s medicine cabinet 8. Washbasin with soap dispenser, disinfectant dispenser, dispenser for paper towels, dispenser for disposable gloves 9. Communication system for direct medical advice by radio (telephone) 10. Examination lamp (mobile) 11. Glass-front box for spare key(s) 1. Double electrical socket litre oxygen cylinder 1. Indication of the storage location for the defibrillator (AED), MFAG equipment and rescue basket stretcher 1. Pierce-resistant and unbreakable disposal container (in accordance with TRBA 0) 16. Hook for infusion bottle 6

7 Image Sickroom for seagoing vessels with 1 to 7 persons (principle drawing) min mm Bedside cabinet (or foldable tray). Lamp. Call system. Sickbed (000 x 900 mm each). Chair 6. Table 7. Wall or table-top lamp Double locker 9. WC Mirror with shelf and electrical socket 11. Shower 1. Washbasin with soap dispenser, disinfectant dispenser, dispenser for paper towels, and waste bin 1. Hook for infusion bottle 7