Training Circular No. 8 of 2004

Sub: Guidelines -Medical First Aid (MFA) Course

Maritime safety and efficiency is of utmost concern to the Directorate General of Shipping(DGS), the constituted authority of the Government of India for all maritime affairs.

It was noticed that some training institutes barely met the minimum standards set by the Directorate, while other provided training facilities that were world class. In order to bring about uniformity of training, amenities and equipment provided by all, old guidelines were revised and new ones formulated. This was done by the DGS in consultation with the training institutes and employers (shipowners and manning agencies). Draft guidelines were displayed on the website of the DGS and comments invited from interested parties, regardless of the position or office held.

Meetings of interested parties were held and modification made to the draft guidelines. In keeping with Government policy, the guidelines have been made in as transparent manner as practicable. The final guidelines for Medical First Aid (MFA) course is attached herewith.

It is expected that training institutes would follow these guidelines in letter and spirit. The above guidelines shall come into force w.e.f. 01.05.2004.

This issues with the approval of the Director General of Shipping and ex-officio Addl. Secretary to the Government of India.

Sd/-

(Naresh Salecha)

Sr.Dy. Director General of Shipping

GUIDELINES FOR THE CONDUCT OF

ISSUED BY

THE DIRECTORATE GENERAL OF SHIPPING

To avoid unnecessary repetition, reference has been made herein to DGS Order no: 1 of 2003 (Guidelines for the conduct of Pre-Sea Training courses for Merchant Navy) wherever appropriate.

TABLE OF CONTENTS

1. BASIC DETAILS OF THE COURSE
   1. Aims:
   2. Objectives:
   3. Application:
2. QUALIFICATION & ELIGIBILITY OF STUDENTS
   1. Entry standards:
   2. Required attendance:
   3. Course intake limitations:
3. INFRASTRUCTURE REQUIREMENT
4. COURSE DETAILS
   1. Course duration
   2. Course outline
   3. Detailed Teaching Syllabus
5. HOLIDAYS
6. FACULTY REQUIREMENT
   1. Qualifications and experience of course in charge:
   2. Qualifications and experience of faculty members:
   3. Training of Trainers & Assessors Course:
   4. Visiting faculty members:
   5. Age limit for regular faculty members:
7. FACULTY STRENGTH
8. COURSE DURATION
9. ASSESSMENT
10. QUALITY STANDARDS
11. INSPECTIONS
12. FEES TO GOVT.

Annexure 1 - Additional equipment, etc

Annexure 2 ' Course outline

Annexure 3 ' Detailed teaching syllabus

MEDICAL FIRST AID COURSE

1. BASIC DETAILS OF THE COURSE

   1. Aims

   This course aims at preparing seafarers to provide medical first aid in accordance with Section A-VI/4 Paras 1 to 3 and Table A-VI/4-1 of the STCW Code

   2. Objectives:

   The objectives of this course are to provide the student with the knowledge and skill in First Aid to be able to take immediate action in the case of accident or illness likely to occur on board ship.

   3. Application:

   Compliance with these guidelines shall be mandatory for all institutes from 1st May 2004.

2. QUALIFICATION & ELIGIBILITY OF STUDENTS

   1. Entry standards:

   Completed a course in Elementary First Aid, or attained a similar standard in elementary first aid, and thereafter have served on board ship for a minimum period of 6 months.

   2. Required attendance:

   100% attendance is required for successful completion of the course. However, in exceptional circumstances, a student is allowed absence of up to one day subject to his attending the lectures missed out during the next course at the same institute. The institute shall keep proper records of such cases and intimate Chairman of respective Academic Council.

   3. Course intake limitations:

   The number of students shall not exceed 24 per class.

   The number of students attending each session will depend on the availability of faculty members, the equipment and facilities available for conducting the course of training. However, the upper limit is 24 students per course

3. INFRASTRUCTURE REQUIREMENT

   1. Physical requirement for classroom, black/white boards, overhead projector, screen, notice board, faculty room, study environment, teaching equipment are to be provided as per DGS order 1 of 2003.
   2. The institute shall have a library-cum-reading room of not less than 36m2 in area.
   3. Additional equipment, Training Aids, Video Cassettes/CDs/DVDs and publications, etc., required for this course are as per Annexure 1.

4. COURSE DETAILS

   1. Course duration: 4 days
   2. Course outline: As per Annexure 2
   3. Detailed Teaching Syllabus: As per Annexure 3

5. HOLIDAYS

   1. Sundays shall be holidays.
   2. Independence Day and Republic Day shall be compulsory holidays.
6. FACULTY REQUIREMENT
   1. Qualifications and experience of course in charge:

   MBBS Medical Practitioner OR

   Certificate of Competency as Master (FG) issued or recognised by Govt. of India

   2. Qualifications and experience of Faculty members

   MBBS Medical Practitioner

   3. Qualifications and experience of Instructors

   Duly qualified paramedic or

   Duly qualified nurse.

   4. Training of Trainers & Assessors Course:

   As per DGS Order no: 1 of 2003.

   5. Visiting faculty members:

   Qualifications and experience of visiting faculty members should be the same as that of regular faculty.

   6. Age limit for regular faculty members:

   As per DGS Order no: 1 of 2003.

7. FACULTY STRENGTH

Not less than one MBBS medical practitioner.

For demonstrations and practicals, there shall be one instructor for every eight students.

8. COURSE DURATION

Education & practical training shall be of 4 days duration.

9. ASSESSMENT

At the end of the course, there shall be assessment by written, practical & oral examination.

10. QUALITY STANDARDS

As per DGS Order no: 1 of 2003.

11. INSPECTIONS

As per DGS Order no: 1 of 2003.

12. FEES TO GOVT.

As per DGS Order no: 1 of 2003.

TEACHING AIDS

Equipment

The following equipment shall be made available for conducting the course:

Video Films/CDs/DVDs

These shall include following:

Publications

For implementation of this course, Institutes should for reference and guidance use appropriate books and publications, which may include

IMO Model Course 1.14 "Medical First Aid"

The International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1995 (STCW 1995).

Medical Section of International Code of signals.

ILO/IMO/WHO International Medical Guide for ships (IMGS).

Medical first Aid guide, for use in Accidents Involving Dangerous Goods (MFAG)

Guidance on the implementation of IMO Model Course ' IMO

First Aid at sea-St. John's Ambulance

COURSE OUTLINE

Tables that follow list the competences and areas of knowledge, understanding and proficiency together with total hours required for lectures and practical exercises. Timings given in the Course Outline may be adapted to suit individual groups of students depending on their ability, experience, equipment and staff available for training.

DETAILED TEACHING SYLLABUS

Detailed teaching syllabus given below is based on theoretical and practical knowledge specified in the STCW Code. It is written as a series of learning objectives in other words, what a student is expected to be able to do as a result of teaching and training. Each of the objectives is expanded to define a required performance of knowledge, understanding and proficiency.

Knowledge, Understanding and Proficiency

1. Immediate action                            (2.0 hours)

Required performance:

Revises, as necessary, important aspects of the Elementary First aid training course

2. First Aid Kit                                         (1.5 hours)

Describes and lists the contents of the first aid kit required by national regulations

Lists location of first aid kits

Describes contents of lifeboat kit

Demonstrates use of the first aid box in appropriate medical situations

3. Body structure and functions                 (2.5 hours)

uses a chart, dummy, human body or other suitable medium, such as audio- visual aids, to describe and explain the structure of the human body and functions of the important parts and systems; in particular:

For the skeletal system:

Lists the major parts of the skeleton

Describes the different kinds of bones

Explains the function of the skeleton

For the muscular system:

Lists the major muscles of the human body

Explains their operation and function

For the cardiovascular system:

States the location of the heart

Describes the distribution of arteries and veins

Describes the physiological function of blood

Describes the heart as a pump

Explains how the blood circulatory system operates

States the location of the arterial pressure points and explains how they can be effectively used in an emergency involving bleeding

For respiratory system:

States the location of the lungs

Explains the function of the lungs in terms of gas exchange

States the importance of respiratory rate

Explains the importance of the composition of inspired/expired air

For the digestive system and abdomen:

Describes in simple terms the digestive system and its operation

List the abdominal organs and describes their function

4. Toxicological hazards aboard ship (1.5 hours)

States that there are important regulations to be observed for the transport of dangerous cargo aboard ship as required by the IMO/IMDG Code

Applies first aid measures in accordance with Medical First Aid Guide for use in Accidents Involving dangerous goods (MFAG) or its national equivalent:

TWA/TLV levels

Uses, in particular, the appropriate First Aid Guide for:

Identifying the symptoms and clinical aspects of poisoning

Applying first aid in cases of poisoning by ingestion, inhalation, or skin contact/eye injuries

Applying therapy in cases of acid and caustic burns

Use of oxygen resuscitator:

Parts of the resuscitator

Operation of resuscitator

Changing cylinders

CPR with resuscitator

After use care and servicing

5. Examination of patient (1.5 hours)

Makes detailed observations of a casualty, based on medical precepts

Forms a diagnosis from a large variety of individual facts based on::

Information derived from medical history

General appearance

Answers to specific questions

Physical examination

6. Spinal injuries (1.5 hours)

Recognises the symptoms of spinal injury

Bladder control in spinal injuries

Identifies the complications which may be caused by unconsciousness

Applies appropriate first aid measures, including:

Control of sensitivity in the extremities appearance

Appropriate rescue, transport, and treatment for cases of suspected fracture of the spine

Head injuries: Levels of consciousness/unconsciousness

7. Burns, scalds and effects of heat and cold   (2.0 hours)

Recognises the signs of:

Burns

Scalds

Heatstroke

Hypothermia

Frostbite

Applies appropriate first aid measures, including the definition, complications and therapy of the general condition of burns

Distinguishes between burns and scalds

Describes differences between first degree, second degree & third degree burns

Applies the correct first aid procedures for burns and scalds

States the importance of sterile dressings

Describes the effects of heat and states the importance of positioning the patient in the shade, providing the increased fluid requirement and careful cooling of the body.

Distinguishes between hypothermia and frostbite and applies the correct first aid procedures, including rewarming and attention to possible tissue damage

8. Fractures, dislocation and muscular injuries (1.5 hours)

Applies practical first aid procedures for the diagnosis and treatment of fractures, dislocations and muscular injuries

Describes types of fracture as:

Open (or compound)

Closed (or simple)

Complicated

Describes the treatment for injured parts and explains the importance of immobilization of the injured part

States the importance of immobilization of the injured part.

Describes the special requirements for the treatment of pelvic and spinal injuries and demonstrates the correct procedure for transporting the casualty.

Describes the symptoms and therapy of sprains, strains and dislocations

Demonstrates the correct procedures to be used in cases of fractures, dislocations and muscular injuries

States the necessary precautions while issuing pneumatic splints.

9. Medical care of rescued persons, including distress,

hypothermia and cold exposure (1.0 hours)

Applies basic skill in the care of rescued persons

Recognises the special problems in cases of:

Hypothermia, applying the correct treatment and taking precautions against heat loss and taking into account the effects of wind and humidity.

 

Congelation, applying the correct treatment for cold injury, immersion foot etc.

Seasickness, describing the cause and applying the correct therapy.

Sunburn, describing the cause and applying the correct therapy and prophylaxis ' dehydration and nutrition in rescue situations, describing frequent errors and hazards

Rewarming.

10. Radio medical advice (1.0 hours)

states that radio medical advice is available using GMDSS Bmed 1

describes the methods used to obtain radio medical advice

interprets advice obtained from external sources

helicopter evacuation.

11. Pharmacology (1.5 hours)

Drug list on board:

Usage

Dosages

Injections sc/im

Test dose for penicillin

12. Sterilization (1.0hours)

Demonstrates disinfection of surgical instruments:

13. Cardiac arrest, drowning and asphyxia (1.5 hours)

States the cause of and applies the appropriate treatment for:

Cardiac arrest

Asphyxia

Drowning

 

Explains how mouth-to-mouth resuscitation is applied and states under what conditions it cannot be used

Explains how cardiac massage is applied and states the limiting factors related to the use of cardiopulmonary resuscitation (CPR) practice on a dummy

Demonstrates the correct procedures for mouth-to-mouth resuscitation and cardiac massage using a practice dummy

14. Psychological/Psychiatric Problems (2.0 hours)

Explains the situational disturbances may be influenced by:

Psychological characteristics of seafarers

Psychological consequences of separation

States that these may be contributory factors for psychological malfunctioning

15. Review and Assessment (1.0 hours)