Medevac at Sea
Maritime Medevac Checklist
A structured evacuation decision framework for ship doctors, cruise nurses, and offshore medics. From clinical assessment to helicopter handoff, every step documented.
Decision Framework
When to Activate a Medevac at Sea
A maritime medevac checklist is not a bureaucratic exercise. It is the difference between a structured evacuation and a chaotic one. At sea, there is no rapid response team down the corridor, no CT scanner on standby, and no surgeon arriving in minutes. Every medevac decision must balance clinical urgency against operational reality: weather, distance, helicopter range, oxygen supply, and what the vessel can actually provide.
The checklist below is designed for clinicians working aboard cruise ships, expedition vessels, cargo ships, and offshore installations. It follows a sequential logic: assess the patient, define the capability gap, communicate with the bridge, coordinate the evacuation, and document everything. Skip a step, and you risk delays, miscommunication, or a failed transfer.
Four Questions Before Every Medevac Decision
- Can I manage this patient safely with my current resources? Consider medications, monitoring equipment, oxygen supply, staffing, and procedural capability aboard.
- Will the patient's trajectory outlast my resources? If the rate of deterioration exceeds your supply runway, the answer is already clear.
- What is the realistic time to definitive care? Helicopter range, nearest port with appropriate facilities, weather windows, and daylight all factor in.
- What happens if I do not evacuate? If the answer is predictable harm or death, initiate the medevac now rather than waiting for certainty.
These questions form the foundation of any ship evacuation medical decision. For a deeper exploration of medevac reasoning, see the full medevac decision-making framework.
Step-by-Step
The Maritime Medevac Checklist
Seven phases from initial assessment to post-evacuation documentation. Each step is designed to be actionable under pressure.
1 Clinical Assessment and Stabilisation
Complete primary survey (ABCDE). Record vital signs with timestamps. Establish IV access. Begin treatment within your capability. Calculate NEWS2 score if applicable. Identify the clinical trajectory: improving, stable, or deteriorating.
Key output: A clear working diagnosis and an honest assessment of what you can and cannot manage onboard. Use the NEWS2 calculator to quantify acuity.
2 Capability Gap Analysis
Define exactly what the vessel cannot provide that the patient needs. This may be imaging, surgical intervention, blood products, ventilation, specialist consultation, or simply enough oxygen to last until the next port. The capability gap is what justifies the evacuation to the bridge, the company, and the medical record.
Key output: A documented capability gap statement. Example: "Patient requires CT head and potential neurosurgical intervention. Neither is available aboard. Estimated time to clinical deterioration: 4-6 hours."
3 Oxygen and Resource Audit
Calculate remaining oxygen at current flow rate. Inventory critical medications (adrenaline, analgesics, antiemetics, sedation). Check defibrillator battery and monitor function. Confirm stretcher and transfer equipment readiness. If oxygen endurance is shorter than time to evacuation, this becomes the primary driver.
Key output: Oxygen endurance time, critical medication counts, equipment status. Use the oxygen burn rate calculator for precise figures.
4 SBAR-M Communication
Structure your communication using SBAR-M: Situation (who, what, how urgent), Background (relevant history and treatments given), Assessment (diagnosis, trajectory, capability gap), Recommendation (specific action needed), Maritime context (position, sea state, oxygen endurance, helicopter availability, distance to port).
Deliver to the bridge first, then to telemedical advisory services. The bridge needs operational language. TMAS needs clinical detail plus the maritime context. See the full SBAR-M template for structure and examples.
5 Bridge Coordination
Confirm the bridge has contacted the relevant coast guard or MRCC (Maritime Rescue Coordination Centre). Provide vessel position, heading, and speed. Agree on the evacuation method: helicopter, pilot boat, or port diversion. If helicopter evacuation, confirm the vessel can create a suitable winching area and that the deck is cleared. Confirm patient can tolerate transfer (movement, noise, altitude change).
Key output: Confirmed evacuation method, ETA of rescue asset or ETA to port, winching area or disembarkation point identified.
6 Patient Preparation for Transfer
Secure all IV lines and monitoring leads. Package the patient for movement (vacuum mattress or scoop stretcher for spinal precautions). Prepare a written clinical handover summary including vitals, treatments given with times, allergies, and current medications. Ensure a copy stays aboard and a copy goes with the patient. Remove patient-identifiable information from any non-secure communications.
Key output: Transfer-ready patient, two copies of clinical handover documentation, portable oxygen calculated to last through transfer.
7 Post-Evacuation Documentation
Record the exact time of patient departure. Document the receiving facility or helicopter callsign. Complete the medical log entry including full clinical timeline, all communications (bridge, TMAS, coast guard), the medevac decision rationale, and the capability gap statement. File copies per company policy. Debrief the medical team.
Key output: Complete medical record, communication log, capability gap documentation, and team debrief notes. Practise structured scenarios with the case simulations.
Communication
SBAR-M: The Maritime Medevac Communication Standard
Standard hospital SBAR assumes shared infrastructure. At sea, the bridge and shore-side teams need operational context that clinical handover alone does not provide.
Who and what, right now
Your name, role, vessel name. Patient identity (age, sex, role). Chief complaint and immediate status. The receiving party should understand the urgency within 15 seconds.
Relevant history and treatment
Medical history, current medications, allergies. Timeline of current presentation. Vital signs with timestamps. Treatments initiated and their effect.
Diagnosis and trajectory
Working diagnosis and differentials. Trajectory: improving, stable, or deteriorating. The capability gap: what you cannot provide that the patient needs.
What you need to happen
Specific request: helicopter medevac, port diversion, coast guard contact. Do not say "please advise." State your recommendation clearly.
Operational constraints at sea
Vessel position, heading, speed. Sea state and weather. Oxygen endurance. Distance to nearest suitable port. Helicopter availability and range. Daylight hours remaining.
Use the SBAR-M Template
The interactive SBAR-M generator produces a structured, copy-ready handover you can read to TMAS or transmit to the bridge.
Open SBAR-M TemplateEvacuation Method
Helicopter Medevac vs. Port Diversion
The choice between helicopter evacuation and diverting to port depends on clinical urgency, distance, patient stability, and weather. Neither is universally better.
Fastest for time-critical conditions
Best for: STEMI, stroke, uncontrolled haemorrhage, or any condition where hours matter. Helicopter range typically 150-300 nautical miles from shore base.
Limitations: Weather-dependent (wind, visibility, sea state). Requires cleared winching area on deck. Patient must tolerate noise, vibration, and altitude. Limited medical equipment in transit. Typically daylight operations only, though some SAR services operate at night.
Checklist items: Confirm helicopter availability with MRCC. Verify patient can tolerate transfer. Clear and secure winching area. Package patient for vertical lift. Prepare written handover for flight paramedic.
Full hospital access, longer timeline
Best for: Surgical conditions, complex medical cases, or situations where helicopter is unavailable. Provides access to imaging, blood bank, specialist teams, and operating theatres.
Limitations: Takes hours. The vessel must change course, affecting schedule and all passengers or crew. Requires a port with appropriate medical facilities, not just any port. Ambulance coordination needed at berth.
Checklist items: Identify nearest port with required capability (surgical, cardiac, stroke). Calculate steaming time. Communicate with port agent for ambulance standby. Prepare patient for stretcher disembarkation. Ensure oxygen supply lasts the transit.
Environmental Factors
Weather and Sea State Considerations
Weather does not pause for medical emergencies. A maritime medevac checklist must account for the environmental conditions that can delay or cancel an evacuation entirely. Include these assessments in every medevac decision.
- Sea state (Beaufort scale): Helicopter winching operations become increasingly difficult above sea state 5 and may be impossible above sea state 7. Pilot boat transfers require calmer conditions.
- Wind speed and direction: Crosswinds above 40 knots can prevent helicopter operations. The vessel may need to alter course to create a lee side for winching.
- Visibility: Fog, heavy rain, and darkness reduce helicopter operational capability. Many SAR services will not fly in visibility below 1 nautical mile.
- Daylight hours: Some helicopter services operate daylight-only. Calculate whether the evacuation window falls within available light. If not, the decision may shift to port diversion.
- Forecast trajectory: Current conditions may be acceptable, but a deteriorating forecast can close the window. Request a marine weather forecast for the next 12-24 hours before committing to a plan.
When weather prevents helicopter medevac, the decision defaults to port diversion or continued management aboard. Document the weather-related constraint clearly in the medical record. This is not a failure of clinical judgement; it is an operational reality of medicine at sea.
Medical Record
Documentation for Maritime Medevac
Every medevac generates scrutiny: from the company, the flag state, the port state, insurers, and potentially a coroner or court. Thorough documentation protects the patient, the clinician, and the vessel. A maritime medevac checklist is incomplete without a documentation standard.
What to Document
- Clinical timeline: Presentation time, vital signs at each assessment, treatments given with exact times, clinical trajectory at each review point.
- Capability gap statement: What the patient needs that the vessel cannot provide, written in clear language. This is the medicolegal foundation of the evacuation decision.
- Communications log: Every call to the bridge, TMAS, coast guard, and company medical director. Record the time, who you spoke to, what was discussed, and what was agreed.
- Decision rationale: Why you chose helicopter over port diversion (or vice versa). Why you escalated at this particular time and not earlier or later. Include the clinical reasoning and the operational constraints.
- Handover summary: The clinical document that travels with the patient. Must include diagnosis, treatments, allergies, vital signs trend, and contact details for follow-up.
The Maritime Medicine Playbook includes medevac documentation templates, capability gap note templates, and communication log formats designed for maritime use.
Build Your Medevac Readiness
Prepare Before the Emergency Happens
The clinicians who handle medevacs well are the ones who rehearsed the checklist before the patient deteriorated. Start with the free Red-Zone Emergency Card, then build your full framework with the Maritime Medicine Playbook.
Educational and operational reference only. Always follow local protocols, company medical policy, telemedical advice, and your own clinical judgement.
FAQ
Maritime Medevac Checklist Questions
What should a maritime medevac checklist include?
A comprehensive maritime medevac checklist covers seven phases: clinical assessment and stabilisation, capability gap analysis, oxygen and resource audit, SBAR-M communication to bridge and TMAS, bridge coordination for evacuation method, patient preparation for transfer, and post-evacuation documentation. Each phase has specific outputs that feed into the next.
How do you decide between helicopter medevac and port diversion?
The decision depends on clinical urgency, helicopter availability, distance to shore, patient stability, and weather. Helicopter medevac is faster for time-critical conditions (STEMI, stroke, haemorrhage) but is weather-dependent and range-limited. Port diversion provides full hospital access but takes hours and requires a port with appropriate facilities. Document the reasoning for whichever method you choose.
What is SBAR-M and why is it used for medevac at sea?
SBAR-M stands for Situation, Background, Assessment, Recommendation, and Maritime context. It extends the standard clinical SBAR framework by adding operational maritime variables: vessel position, sea state, oxygen endurance, helicopter range, and distance to port. Without the M, shore-based teams receive a hospital-style handover that omits the constraints unique to medicine at sea.
What weather conditions prevent helicopter medevac?
Helicopter operations are typically limited by sea state above 5-7 (Beaufort scale), winds above 40 knots, visibility below 1 nautical mile, and darkness (for daylight-only services). A deteriorating forecast can also close a viable window. When weather prevents helicopter evacuation, the decision defaults to port diversion or continued management aboard with documented weather constraints.
How should a ship doctor document a medevac decision?
Document the clinical timeline with timestamped vitals and treatments, the capability gap statement (what the patient needs that the vessel cannot provide), a communications log of all calls to bridge, TMAS, and coast guard, the decision rationale for the chosen evacuation method, and a clinical handover summary that accompanies the patient. This documentation protects the clinician, the patient, and the vessel.
Related Resources
Continue Building Your Medevac Framework
- Medevac Decision-Making at Sea — The full framework for evacuation reasoning, escalation triggers, and clinical scenarios.
- SBAR-M Template — Interactive template for structuring medevac communication to bridge and TMAS.
- Case Simulations — Practise medevac decisions, bridge communication, and clinical management under simulated pressure.
- Clinical Tools — NEWS2 calculator, oxygen burn rate calculator, Glasgow Coma Scale, and more.
- Emergency Protocols — Immediate-access protocols for cardiac arrest, stroke, anaphylaxis, and other shipboard emergencies.
- Maritime Medicine Playbook — Medevac templates, decision trees, bridge scripts, and documentation frameworks.