Port-State Handover Checklist
Getting the patient off the ship is only half the job. The handover determines what happens next.
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 port-state handover is the process of transferring a patient from the care of the ship's medical officer to a shore-based medical facility when the vessel reaches port. It is one of the most complex clinical-operational intersections in maritime medicine, involving coordination between the ship doctor, the Master, the port agent, ambulance services, the receiving hospital, immigration authorities, and sometimes the patient's insurance provider or P&I club, all within a narrow window while the vessel is alongside.
Unlike a hospital-to-hospital transfer where both facilities share the same electronic health record, language, and protocols, a port-state handover crosses jurisdictional, linguistic, and systemic boundaries. The ship doctor must ensure that the clinical picture is communicated clearly, that all relevant documentation accompanies the patient, and that logistical hurdles such as customs clearance and immigration formalities do not delay the transfer of a critically ill patient.
Key Checklist Items
Clinical Documentation Package
Prepare a complete clinical summary in English and, if possible, in the local language of the receiving port. This should include: the patient's full name, date of birth, nationality, and passport number; a chronological summary of the illness or injury from onset to present; all vital signs recorded during the voyage with timestamps; a complete medication list including what was administered aboard with doses and times; allergies; the working diagnosis and differential diagnoses; any procedures performed (wound closures, splinting, catheterisation); and your clinical recommendation for the receiving facility. Print two copies: one for the ambulance crew and one for the receiving hospital.
Medications and Supplies
Prepare a list of all medications currently being administered and their remaining supply. If the patient is on intravenous fluids or medications, ensure there is sufficient supply to cover the transfer time from gangway to hospital bed. Include the time of the last dose of each medication. If you have been using medications that may not be standard in the receiving country, provide the generic name and class. Send any remaining medication that belongs to the patient (personal prescriptions) with them.
Imaging and Laboratory Results
If you have performed any diagnostic tests aboard, ensure the results accompany the patient. ECG strips should be labelled with the patient's name, date, and time. If you have a portable ultrasound and captured images, transfer them to a USB drive. Blood glucose logs, urine dipstick results, and any other point-of-care testing results should be documented in the clinical summary. If you have communicated with telemedical services and received advice, include a summary of that advice and the advising physician's name and contact details.
Customs, Immigration, and Insurance
This is where many port-state handovers stall. The patient's passport must accompany them ashore. If the patient is a crew member, coordinate with the Master and the ship's agent to arrange shore leave or sign-off documentation. In some ports, immigration officials must clear the patient before they can be removed from the vessel. In others, a medical emergency exemption allows immediate disembarkation with paperwork completed retrospectively. Know the local procedure before arrival by briefing the port agent in advance.
Insurance documentation is equally critical. Have the P&I club or the patient's personal insurance details ready. Many hospitals in unfamiliar ports will delay treatment until payment or insurance guarantee is confirmed. The port agent can often facilitate this, but only if they receive the information early enough to coordinate with the insurer before the vessel arrives.
Coordination with Port Agent, Ambulance, and Receiving Hospital
The port agent is your primary logistics partner for a port-state handover. Contact them as early as possible, ideally 12 to 24 hours before arrival, with a brief clinical summary and a clear statement of what the patient needs. Specify: "This patient requires ambulance transfer to a hospital with [specific capability]. The patient is [ambulatory / stretcher-bound / on supplemental oxygen]. We will need [stretcher access to the gangway / crane lift from the vessel]." The more specific your brief, the better the agent can coordinate.
If possible, establish direct communication with the receiving hospital's emergency department before arrival. A ship-to-shore call or email via the agent can provide the receiving team with a clinical summary so they are prepared when the patient arrives. This is particularly important for time-critical conditions such as stroke, myocardial infarction, or surgical emergencies where pre-notification reduces door-to-treatment time.
Coordinate the ambulance timing with the vessel's estimated time of berthing and the time required for the gangway to be rigged. There is little value in having an ambulance waiting on the quayside for two hours while the vessel completes mooring operations. Equally, a 45-minute delay waiting for an ambulance after berthing is unacceptable for a critically ill patient. Communicate realistic timelines to all parties.
Documentation Requirements
Beyond the clinical summary, several additional documents should be prepared for the handover. A signed medical report for the company, documenting the case and the reason for disembarkation. A copy of the ship's medical log entries relating to the patient. If the disembarkation was triggered by a capability gap note, include a copy. A transfer-of-care form, signed by you and ideally countersigned by the receiving clinician, documenting the time and date of transfer and confirming that the clinical summary and all relevant information were handed over.
Retain copies of everything aboard. The ship's medical records should contain a complete duplicate set of all documentation that accompanied the patient ashore. This protects both the patient's continuity of care (if the shore-side copies are lost) and the ship doctor's medicolegal position.
Common Challenges
Language Barriers
In many ports, the receiving medical team may not speak English fluently, and the ship doctor is unlikely to speak the local language. Prepare your clinical summary with simple, clear language, avoiding abbreviations that may not be universally understood. Use the patient's vital signs, medication names (generic, not brand), and numerical data as the universal language of the handover. If the port agent can provide a translator, request one. If not, consider using a translation app to prepare a basic summary in the local language, but always provide the English original as the authoritative document.
Different Healthcare Systems
Healthcare capability varies enormously between ports. A port-state handover in Rotterdam or Singapore is a fundamentally different operation from one in a small West African port or a remote Pacific island. Research the receiving port's medical facilities before arrival. The port agent can advise on hospital capabilities. If the nearest hospital lacks the required capability, consider whether it is better to divert to a different port entirely rather than disembark a patient into a facility that cannot provide definitive care.
Customs Clearance for Medications and Equipment
If controlled substances were administered aboard (opioids, benzodiazepines), the remaining quantities must be reconciled with the ship's controlled drug register. Some ports require declaration of controlled substances administered to a patient being disembarked. If the patient is being transferred with any ship's medical equipment (e.g., a splint, cervical collar, or oxygen cylinder), document what was sent ashore and arrange for replacement at the next opportunity. Oxygen cylinders in particular may trigger port security protocols and should be coordinated with the agent in advance.
The Handover Moment
When the ambulance crew arrives, perform a structured verbal handover using the SBAR-M format. Hand over the printed clinical summary. Confirm that the receiving crew has understood the key clinical points: the diagnosis, current treatment, allergies, and any ongoing concerns. If the patient is conscious, introduce them to the receiving team and reassure them about the transfer. Document the time of handover, the names of the receiving personnel, and the ambulance identification in your medical log.
Your responsibility does not end at the gangway. Follow up with the port agent within 24 hours to confirm the patient was admitted and to obtain the name and contact details of the treating physician at the receiving hospital. This information will be needed by the company, the P&I club, and potentially by flag state authorities. A clean handover with documented follow-up closes the loop on your clinical responsibility and demonstrates the standard of care expected of a maritime medical professional.
Never Improvise a Handover Again
The Complete Ship Doctor Toolkit includes printable handover checklists, clinical summary templates, and the full library of maritime documentation frameworks. Prepare before you need them, not while the ambulance is waiting at the gangway.
Get the Complete Toolkit