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The Ship Doctor
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Maritime medicine insights, field notes, career guidance and clinical updates for clinicians at sea.
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Practical articles, career resources, operational frameworks and clinical tools — organised by the area of maritime medicine that matters most to you.
Case of the Month
Clinical Decision Under Constraint
Real-world maritime scenarios designed to sharpen your clinical decision-making at sea. Calm, operational, realistic.
Crushing Chest Pain, 14 Hours From Port
0230h. You are the sole physician on a 2,800-passenger cruise ship in the mid-Atlantic. A 52-year-old male crew member presents with crushing retrosternal chest pain radiating to the left arm, onset 45 minutes ago. Diaphoretic. GCS 15. 12-lead ECG shows ST elevation in V2–V4.
HR 104 • BP 148/92 • SpO2 96% on RA • RR 22 • Temp 36.9°C • NEWS2: 4
PMH: Hypertension (amlodipine 5mg), smoker 20 pack-years. No previous cardiac history. No allergies documented.
Nearest port with PCI capability: 14 hours at full speed. Helicopter range exceeded — nearest SAR base 680nm. Sea state 5 (rough). Satellite connection intermittent. Ship pharmacy: aspirin, clopidogrel, enoxaparin, morphine, GTN, tenecteplase available. No cardiologist onboard. TMAS line operational but 20-minute hold times reported this week.
You are facing a confirmed STEMI with no access to percutaneous coronary intervention for at least 14 hours. Fibrinolysis window is narrowing. The bridge is requesting your medevac recommendation. You have tenecteplase but have never administered it without a cardiologist present. TMAS is on hold.
What do you do? Consider: fibrinolysis risk-benefit, contraindication screening, bridge communication for potential diversion, and your documentation obligations.
Helicopter transfer not feasible. Ship-to-ship transfer considered but sea state prohibitive. Diversion would cost the company an estimated $800K+ and disrupt 2,800 passengers. Your clinical documentation will be reviewed by the company, flag state, and potentially port state authorities.
- Pre-hospital fibrinolysis protocols exist for exactly these resource-limited scenarios
- Document your decision-making process in real time, not retrospectively
- SBAR-M to bridge should include: clinical urgency level, time-sensitivity, and your specific operational request
- A well-documented clinical decision to treat is more defensible than a delayed transfer request
- Tenecteplase is weight-based, single bolus — review dosing before the emergency
All Articles
Emergency & Remote Medicine Library
Evidence-led clinical articles, simulation practice and career guidance for doctors, nurses, paramedics and students working where help is far away.
12-Lead ECG Interpretation Practice
A fixed eight-step reading order, four practice traces that punish pattern-matching, and how to act when the ECG and the patient point in different directions.
Read the article → SimulationMedical Simulation vs Question Banks
What question banks genuinely train, what they cannot train, and a weekly split that uses both formats for the thing each is actually good at.
Read the article → SimulationABCDE Assessment Practice Cases for Students
Three evolving primary-survey prompts, when to interrupt the sequence to treat, and a debrief structure that examines decisions rather than recall.
Read the article → POCUSLung POCUS Image Interpretation
Why lung ultrasound is a study of artefacts, the four patterns worth recognising, the zones to scan, and the acquisition errors that manufacture false findings.
Read the article → NursesEmergency Drug Calculations for Nurses
The four calculation patterns behind almost every emergency infusion, a unit-cancelling method that survives fatigue, and the six error types that recur in incident reports.
Read the article → ParamedicsParamedic Clinical Decision Simulation
The four prehospital decisions worth rehearsing, a structure for scenarios that trains judgement instead of protocol recall, and how to debrief a decision that turned out well for the wrong reason.
Read the article → ECGSTEMI Mimics: ECG Practice
Why ST elevation is a finding rather than a diagnosis, the categories of trace that imitate occlusion, the presentations that hide it, and the five questions that separate them.
Read the article → SimulationACLS Scenario Practice
The five decisions the algorithm leaves to the team leader, a fifteen-minute rehearsal structure that needs no manikin, and how to drill compression quality and role clarity.
Read the article → NursesRecognising Deterioration in Remote Nursing
Why trends outperform thresholds, what an early warning score is for when nobody is coming, and an escalation structure built around lead time rather than response time.
Read the article → SimulationHow to Debrief a Medical Simulation
A five-question framework that works without a trained facilitator, how to debrief alone, and the four habits that turn a debrief into a critique nobody learns from.
Read the article → POCUSeFAST Ultrasound Practice in Trauma
The windows, the question each one answers, why a negative study excludes very little, and a practice routine that builds views you can obtain in a moving vehicle.
Read the article → SimulationPALS Paediatric Scenario Practice
What genuinely changes in a paediatric emergency, six scenarios worth rehearsing, the adult habits that cause errors, and how to prepare the equipment problem in advance.
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Resources
Start With the Essentials
Download the free Red-Zone Card, explore the clinical tools, or get the Maritime Medicine Playbook for practising medicine at sea.