Clarification concerning Annex 5
Changes to the content of tables 1 and 2
Some columns have been deleted or combined. The basis for this
remains the categorization A, B, C, as described in Annex 1 of
EC Directive 92/29/EG. The columns in the Regulation Medical
Supplies on board seagoing vessels's annex were, however, even
more specific, a measure that has now been revoked in Annex 2.
Columns A, A-G and A-Z have been combined, and this applies also
to columns B, B-G and B-Z and to columns C and C-Z. Column CG is
deleted, because it was in fact superfluous. Columns D and E are
included in national and short international voyages. Column R
contains requirements for rescue vessels, as before. A new
column, 'Max', has been added, giving maximum quantities. The
basic premise is that the quantities in any given column are
stipulated for all ships unless an alternative quantity is
stipulated for ships carrying hazardous materials. In this
latter case, the quantity appears in parentheses.
The content of the tables has been adapted as described below.
The basis has in each case been the international regulation, in
accordance with the order of the tables. Italics indicate that
the medicine was previously included in the tables. The
following abbreviations are employed: amp. (ampules), caps.
(capsules), bot. (bottles), im. (intramuscular), iv.
(intravenous), sc. (subcutaneous), tabl. (tablets).
It has become apparent that quantities of medicines that must be
kept on board vessels with and without the presence of dangerous
goods were too high for this last category of vessel. These have
therefore been reduced, but are not specified further here. As
far as content is concerned, the tables have been further
adapted as described below. Only the most significant changes
0.25 mg has been removed, as this is meaningless
without an ECG to hand. Furthermore, the most common side
effects cannot be distinguished from under dosage, meaning that
the medicine may not be administered by a layperson.
Furosemide tabl. 40 mg is removed. Blood pressure can be
subtly regulated with this diuretic, but this must not be done
on board. A beta-blocker is in fact sufficient. In the case of
pulmonary oedema, a strong medicine must be used. Injectable
furosemide is available for this, as detailed in 1.3.03.
amp 0,2 ml/1 ml (im and sc injectable) has been
replaced by oxytocine amp 5 U/1 ml. This is due to
methylergometrine's being a so-called 'controlled drug' and
because oxytocine is more effective. A supply is necessary only
when there are women on board.
1.5.01: Nifedipine caps. 10 mg has been replaced by
1.5.02 metoprolol tabl. 50 mg.
now the standard treatment for (threatened) myocardial
infarction, high blood pressure and increased heart rate
(tachycardia). Due to this latter indication, it can replace
digoxine in the treatment of atrial fibrillation.
2.1.03: Cimetidine tabl. 400 mg. has been
withdrawn. It has been replaced by 2.1.05, whereby omeprazole
tabl./caps. 20 mg is prescribed. Omeprazole has for some years
been the first-choice drug and has fewer side effects than
cimetidine. The stock that was previously only recommended in
column B is now mandatory, due to the frequency of stomach
2.2.02R: Metoclopramide supp 20 mg. Technical
developments make it possible to extend the certification period
in the case of some life rafts from a maximum of 12 months to a
maximum of 30 months. The 2.2.02 domperidone supp 60 mg in
column R of the medical provisions was found to have too short a
shelf life. To allow for the extended certification period for
lifeboats, life rafts and rescue vessels, domperidone is
replaced by metoclopramide.
2.2.03: Metoclopramide amp. 10 mg/2 ml (im injectable)
has been removed from columns B and E because domperidone
suppositories are in general effective for treatment of serious
nausea. The previously recommended stock of 5 in column A is now
the mandatory stock, since the treatment of nausea can be of
vital importance in the case of serious stomach complaints in
global navigational areas.
2.3.01: Lactulose syrup, bottle 300 ml. The quantity of
1 bottle in column B and in the former column B-G is now no
longer simply recommended, but, also in the case of transport of
dangerous goods, is now mandatory in column B. The reason for
this is information from the Marine Radio Medical Assistance
concerning frequent complaints of constipation in seafarers.
Diazepam microclyster 10 mg/2,5 ml. Instead of the
recommended stock of 5, 2 are now stipulated (so, mandatory) in
column B. Although there is no alternative for treatment of an
epileptic event, in view of the restricted navigational area, 2
4.2.02: Haloperidol amp 5 mg/1 ml (im and iv
injectable). The recommended stock of 5 ampoules in the
case of column B or the former column B-G is now replaced by a
mandatory stock of 2 for column B, also in the case of transport
of dangerous goods. This drug is necessary for the treatment of
serious mental confusion, for example due to alcohol, but again,
due to the restricted navigational area, 2 suffice.
4.5.01: Temazepam tabl/caps 10 mg. The recommended stock
of 10 tablets or capsules for column B or the former column B-G
is now mandatory for column B, also in the case of transport of
dangerous goods. This is an inexpensive sleeping pill that
easily interrupts the vicious circle of insomnia.
Volumatic device to be used with 6.1.02 and 6.1.03.
The mandatory quantity in the former column E-G has now been
corrected from 1 to 2 for column E for the transport of
dangerous goods, arising from a typing error in the previous
500 mg. Erythromycin is stipulated in the MFAG (column
A), but can be deleted since there are sufficient alternative
antibiotics available. Erythromycin is used for, amongst other
indications, treatment of (suspected) legionella infection, but
Ciproxin is available for this. It is furthermore the second
choice for persons allergic to penicillin. There are, however,
sufficient alternatives available in this case.
7.2.02: Cotrimoxazole tabl
800+160 mg. The quantity of 20 tablets previously
stipulated in column A and the former column A-G has now been
increased to 30 tablets in column A, also for transport of
dangerous goods. The Radio Medical Assistance has reported
shortage of medicines in the case of regularly occurring
inflammation of the prostate.
7.7.02 + 7.7.03: Proguanil tabl 100 g +
choloroquine sulphate tabl 100 mg. The quantities of
both medicines have now been drastically reduced due to the fact
that the combination of proguanil and chloroquine can no longer
be recommended because of increased resistance, especially along
the coast of West Africa. Proguanil must, however, still be kept
on board for the prophylaxis of milder forms of malaria.
Chloroquine is still needed for the treatment of less
complicated, mild malaria.
7.7.05: Malarone® tabl. 250/100 mg.
This is, in view of the above, now the first-choice medicine.
Usage is limited to 4 consecutive weeks. More extended usage is
possible only after the seafarer has signed a declaration of
informed consent in the presence of a physician.
Compounds promoting rehydration, caloric intake and
NaCl tabl 400 mg + coating glucose 100. This
medicine is superfluous as long as the cook has been instructed
to include more salt in food in the tropics. Salt shortage can
be remedied with a bouillon and tomato juice with salt.
8.1.01: Oral Rehydration
Salts. WHO-formula, sachet to give 1 liter rehydration
solution. The quantities are reduced in all columns due
to advances in medical insight.
8.3.01: Polygeline (Haemaccel) infusion, flac 500 ml.
This medicine is no longer included, but is replaced by a plasma
substitute of choice. This is because Haemaccel is no longer
available in the Netherlands. Also, improvements in AIDS
prevention mean that infusion bottles need no longer be taken
ashore. The quantities have therefore been reduced in columns A,
B, D en E from 10, 5, 10max20 and 10 to 5, 3, 5max10 en 3,
Chlorhexidine 0,5%, bottle 30 ml. The recommended
quantity of 2 in column B and the former column B-G is now
mandatory in column B, also for the transport of dangerous
goods, due to the discontinuation of Povidone-Iodine.
9.1.05: Ethanol 70% based hand sanitizer. Introduction
of this substance is unavoidable in view of prevention of
infection by SARS, etc.
9.1.08: Betadine ointment, tube 50 g. Tubes of 30 g are
now stipulated, since the shelf life of such tubes is twice as
long as those of 50 g.
9.1.10: Miconazol nitrate cream 2%, tube 30 g. The
quantities recommended in column B and the former column B-G are
now mandatory. The Radio Medical Assistance has indicated that
this medicine is frequently needed for fungal infections of the
9.1.13R: Long-shelflife antiseptic cream suitable for
treatment of burns.
advances have made possible the extension of the certification
period for rescue vessels from a maximum of 12 months to a
maximum of 30 months. It has become apparent that 9.1.13 silver
sulphadiazine cream 1% in medical provisions column R has too
short a shelf life. To permit the longer certification period,
silver sulphadiazine cream is replaced for lifeboats, life rafts
and rescue vehicles by a long-shelflife antiseptic cream
suitable for treatment of burns.
9.1.15: Alumnis compositum powder, can 100 g. According
to the Radio Medical Assistance, this talc is in frequent use
for the prevention of skin complaints due to perspiration, and
instead of being simply recommended, it is now mandatory. In
view of the limited navigational area associated with column B
and the former column B-G, one bottle will suffice.
9.1.18: Lanette/menthol cream 2%, tube 10 g. 1 tube was
recommended for column B and the former column B-G. The Radio
Medical Assistance has, however, indicated that this preparation
is very seldom used, and for the new column B nothing is
dictated or recommended.
9.1.20: Permethrin lotion 1%, bottle. 59 ml. The
recommended quantity of 1 is now mandatory following the advice
of the Radio Medical Assistance, which employs this preparation
for the treatment of regularly occurring contagion by lice or
9.2.04: Pilocarpine eye drops 1%, dropper bottle. 10 ml.
De 1% eye drops are no longer available, and for this reason 2%
9.2.06: Tetracycline ointment 1%, 4g. The polymyxine
stipulated previously is also no longer available and has
therefore been replaced by tetracycline in the table.
The memoranda concerning the oxygen supply and the stretcher have
been changed. In accordance with general government policy to
reduce the number of rules and regulations, a certificate of
approval from the Netherlands Shipping Inspectorate is no longer
required for oxygen equipment and stretchers. The memoranda
concerning the conditions to be met for such a certificate have
therefore been repealed. Also due to the reduction of rules and
regulations, the regulations concerning installation and use of
the 40 litre oxygen cylinders on board ships transporting
dangerous goods are no longer described in detail. The Notices
for Shipping 35/1965 (Acetylene welding and cutting
installations) applies for the time being.
does not alter the fact that seafarers' safety always takes
priority. The same degree of safety must obviously be
maintained. The way in which this is done is, however, more than
in the past the responsibility of the ship owner and the
Dressing and suturing equipment
Tubular gauze bandage for finger dressings
with applicator. This is deleted from column R. It does
not belong in the real first-aid equipment and its use is too
complex in an actual survival situation.
are alternative solutions to hand.
Waterjel burn dressing 20x46 cm. This is no longer
stipulated. Cooling with water is standard treatment.
Scalpel sterile disposable. A quantity of 3 was a
recommendation for column B and the former column B-G. The
scalpel must be included in the mandatory suture kit in
II.3.07: Razor disposable. Two razors were also only a
recommendation for column B and the former column B-G. A razor
is now mandatory in column B, also for the transport of
dangerous goods, in view of the mandatory provision of a suture
kit in II.2.01.
Eyecup for irrigation (plastic)). This equipment is
deleted. Although splashes or specks of dirt are probably quite
common at sea, flushing under a lukewarm shower or with lukewarm
water from a PET bottle is more effective than using an eye
Gastric tube Ch 21. This equipment is deleted because
its wrong positioning (in the lung) can cause extensive injury.
Examination and monitoring equipment
II.4.03: Temperature/pulse charts. Five sheets
were recommended in column B. However, in case of sickness,
temperature and pulse must always be recorded. This equipment is
therefore now mandatory.
II.4.09: Penlight type flashlight + blue cover. One
(column A) or two (column B) of these was the recommendation for
diagnosis of specks in the eye. The Radio Medical Assistance has
reported that this is a frequently occurring complaint, which is
reason enough to make this apparatus, in the same quantities,
Equipment for injection, perfusion, puncture and
infuser. This apparatus is deleted in view of the
improved situation regarding prevention of AIDS.
Citrate-containing blood collecting bags. This equipment
is deleted in view of the improved situation regarding
prevention of AIDS. The equipment is furthermore expensive and
has a relatively short shelf life.
II.5.06: Catheter sterile
Thieman no. 16 is replaced by catheter sterile Thieman,
without balloon, Nos. 12 and 16. Furthermore, the prescribed
quantities have been adjusted. The change is due to the fact
that injudicious use of a catheter with balloon can cause
injury. No. 16 is for use only in men; No. 12 is an average
dimension for women.
Immobilization and setting equipment
II.7.03: Inflatable splints
assorted. Inflatable splits are these days not
recommended due to observed circulatory system complications.
Instead of these, vacuum splits are to be used (half/whole arm,
half/whole leg), with a hand pump.
Disinfection, disinsectization and prophylaxis
T (Halamid) 25% free chlorine, sachet 25 g. This
substance is replaced by "a disinfectant for drinking water
suitable for human consumption" in sufficient quantity to
disinfect the complete on-board water supply in one
II.8.03: Insecticide Cyflutrin 9%, packet cont. 5 sachets 20
mg. The Cyflutrin packaging warns that only suitably
trained persons must use the insecticide. Since seafarers do not
satisfy this condition, this substance is replaced by "a
sprayable pesticide of choice, effective against flying and
creeping insects, bottle".
bag for preservation of amputated parts of the body.
This equipment is deleted, since an ordinary plastic bag
II.9.03: Condoms. The
recommended quantity of 20 condoms in column B and the former
column B-G is now given as mandatory in column B. There is a
general increase in sexually transmitted diseases (STDs) and HIV
through reduced condom usage.