Capability Gap Documentation Template
When you cannot do what the patient needs, document it. The note protects them and you.
Do not enter names, cabin numbers, booking numbers, dates of birth, or other patient-identifiable information. Use anonymized clinical details only. This tool is for education, structure and operational readiness only.
A capability gap exists when the clinical needs of a patient exceed the diagnostic, therapeutic, or monitoring resources available aboard the vessel. This is not a failure of the clinician. It is a structural reality of practising medicine at sea. Every ship's medical facility operates within defined limits: limited imaging, limited laboratory capability, limited pharmacology, limited specialist support, and limited surgical capacity. A capability gap note is the formal acknowledgement that these limits have been reached for a specific patient.
In shore-based medicine, escalation is a phone call and a corridor. At sea, escalation requires coordination between the ship's medical officer, the Master, the company's designated person ashore, telemedical services, rescue coordination centres, and potentially military or coast guard assets. The capability gap note is the document that initiates this chain. Without it, the urgency of evacuation may be lost in translation between clinical and operational stakeholders.
Why Documenting Capability Gaps Matters
The capability gap note serves three critical functions: clinical, operational, and medicolegal.
Clinically, it forces the ship doctor to systematically assess what the patient needs against what is available. This structured thinking often reveals resources that have been overlooked or alternative management strategies that can bridge the gap temporarily. It also ensures that telemedical advisers understand exactly what you can and cannot do, preventing them from recommending treatments that are impossible to deliver.
Operationally, the capability gap note gives the Master and the company a clear, documented basis for diversion or evacuation decisions. Masters are reluctant to divert a vessel, and companies are reluctant to authorise the associated costs, without clear justification. A well-written capability gap note that states "this patient requires CT imaging and neurosurgical consultation that cannot be provided aboard; continued passage without evacuation risks permanent neurological deficit or death" provides the operational justification that triggers action.
Medicolegally, the capability gap note is your defence. If a patient outcome is poor and the case is reviewed, the question will be asked: "Did the doctor recognise that the patient needed more than the ship could provide, and did they communicate that clearly and in a timely manner?" The capability gap note answers that question definitively. Its absence creates a presumption that the clinician either failed to recognise the limitation or failed to communicate it.
Template Structure for a Capability Gap Note
Section 1: Patient Identification and Clinical Summary
Include the patient's name, age, gender, role aboard, and a concise summary of the presenting complaint and current clinical status. State the working diagnosis and relevant differential diagnoses. Include current vital signs with the time of assessment.
Section 2: Current Management
Document all treatments, interventions, and monitoring currently in place. This demonstrates that you have acted within your capability and are not simply requesting evacuation as a first resort. Include medications administered with doses and times, procedures performed, and monitoring frequency.
Section 3: Identified Capability Gaps
This is the core of the document. List each specific capability gap using clear, objective language. For each gap, state: what the patient requires (e.g., "CT angiography of the chest"), why it is required (e.g., "to confirm or exclude pulmonary embolism"), and why it cannot be provided aboard (e.g., "vessel does not carry CT imaging equipment"). Avoid vague statements like "patient needs more advanced care." Be specific about what is missing and why it matters for this patient.
Section 4: Risk Assessment
State the clinical risk of continuing without the identified capabilities. Use clear language: what is the likely trajectory if the gaps are not addressed? What is the timeframe within which definitive care is needed? This section should convey urgency without being alarmist. "Without surgical intervention within 6 to 12 hours, this patient faces a significant risk of bowel perforation and peritonitis" is specific, defensible, and actionable.
Section 5: Recommendation
State your clinical recommendation clearly. This will typically be one of: medical evacuation by helicopter, port diversion for disembarkation to a medical facility, rendezvous with another vessel that has greater medical capability, or continued management aboard with specified telemedical support and a defined reassessment timeline. Include the type of receiving facility required (e.g., "hospital with interventional cardiology capability").
Section 6: Communication Record
Document who has been informed: the Master, the company DPA, telemedical services (with the name of the advising physician and their recommendations), and any rescue coordination centres contacted. Include times for all communications. This creates an auditable trail that demonstrates timely escalation.
When to Issue a Capability Gap Note
Issue a capability gap note whenever a patient's clinical needs exceed your vessel's documented medical capability. This includes situations where you lack the diagnostic equipment to confirm a suspected diagnosis, where the required treatment is not available aboard, where the patient requires a level of monitoring that cannot be sustained (for example, one-to-one nursing care on a vessel with a single medical officer), or where the clinical trajectory suggests deterioration that will exceed your capability within a foreseeable timeframe.
Crucially, do not wait until the gap becomes critical. If you suspect a patient may need capabilities you do not have, issue the note early. An early capability gap note that triggers timely evacuation is infinitely preferable to a late note issued after the patient has deteriorated beyond the point of safe transfer. The note can always be withdrawn if the patient improves. It cannot be issued retrospectively if the patient dies.
Connecting to Bridge Communication and Evacuation
The capability gap note does not exist in isolation. It feeds directly into your SBAR-M communication to telemedical services and your bridge communication with the Master. When you brief the Master, reference the capability gap note by its time and date: "Captain, I have documented a capability gap note at 1430 hours today. This patient requires imaging and surgical capability that we do not have aboard. My clinical recommendation is port diversion to the nearest facility with an operating theatre."
The Master needs to understand that this is not a request. It is a formal clinical document that places the responsibility for the evacuation decision into the operational chain. The ship doctor identifies the gap and recommends. The Master decides the operational response. The company authorises the cost. Each party acts within their authority, and the capability gap note is the document that initiates the chain. This separation of clinical recommendation from operational decision-making protects everyone involved.
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