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[LEGAL NOTICE NO. 92] MARITIME TRANSPORT DECREE 2013 (DECREE NO. 20 OF 2013) Maritime (Ships Medical Requirements)
IN exercise of the powers conferred upon me by section 240(1)(o) of the Maritime Transport Decree 2013, I hereby make these Regulations— PART 1—PRELIMINARY Short title and commencement 1. These Regulations may be cited as the Maritime (Ships Medical Requirements) Regulations 2014 and shall come into force on a date appointed by the Minister by notice in the Gazette.
2. In these Regulations, unless the context otherwise requires— "competent person" means a person referred to in paragraphs 9.8 and 9.10 of "Decree" means the Maritime Transport Decree 2013; "domestic voyages" means voyage, trade or operation of a ship within Fiji waters; "Fiji waters" means all the waters in Fiji comprising of— the territorial seas; the archipelagic waters; the inland waters; and the exclusive economic zone; "operator" means the owner or any organisation or person who has assumed responsibility for the operation of the ship; "specified drug" means diazepam, morphine, nitrazepam or pentazocine; "surveyor" means a person from the Authority who, or an organisation that, offers the services of surveying or inspecting ships and who are recognised as such by the Chief Executive Officer in accordance with the provisions of the Decree; and "unlimited voyages" means a voyage, trade or operation of a ship beyond the Fiji waters.
3. These Regulations— (a) stipulate the responsibilities of ship operators or owners, masters and crew with respect to medical stores required on board ships; (b) specify the requirements for first aid, medical stores supplies and associated equipment on board ships and includes requirements relating to inventories, labelling, packaging and expiry date control of medicines and medical equipment; and (c) specify the construction, location and marking of medical cabinets and first 4. These Regulations shall apply to all Fiji registered ships engaged in domestic voyage and unlimited voyage.
PART 2—REQUIREMENTS 5.—(1) To the extent that is reasonable, adequate medical supplies and appropriately competent persons must be available to treat injuries and diseases aboard ship, until a patient can be transferred to the care of a medical practitioner.
(2) The guidelines and the list in Schedules 1 and 2 on medical stores on board ships shall assist a ship operator in determining the medical supplies appropriate for any particular situation.
(3) A Ship Captain's Medical Guide shall contain information to assist ships' crew in diagnosing and treating sick or injured seafarers and such must be carried on board Fiji ships.
Duties of the operator 6.—(1) It is the responsibility of the operator of a ship to arrange for the provision of such medical supplies as are reasonably necessary to ensure that persons on board the ship have access to adequate first-aid. (2) Pursuant to sub-regulation (1), "reasonably necessary" shall depend on the circumstances where the operator shall be required to take into consideration, amongst other factors, the following— (a) the number and sex of persons who will be on board ship at any particular (b) the type of ship and the particular health hazards of the cargoes being (c) the length of the proposed voyage; (d) the facilities available for communication with shore-based advice; and (e) the distance the ship will be from medical facilities on shore and the capacity for evacuation of sick or injured persons in an emergency.
(3) The operator of a ship must also ensure that medical supplies are capable of being stored on board the ship in such a way that they are adequately protected from premature deterioration. (4) Storage must be secure enough to prevent misuse, while ensuring that prompt access is available when required.
(5) The operator of a ship must ensure that the master and crew of the ship are provided (a) a list of medical supplies on the ship; (b) written instructions covering the obtaining of advice from qualified medical (c) adequate training on the proper use of medical supplies.
(6) The operator of a ship must not send a ship to sea, or allow a ship to be taken to sea, unless the operator has met the requirements set out in sub-regulations (1) to (3).
(7) Any person who contravenes this regulation commits an offence and shall be liable upon conviction to a fine not exceeding $5,000 or to a term of imprisonment not exceeding 2 years or, to both.
Duties of the master 7.—(1) It shall be the responsibility of the master of a ship to ensure that the medicines are not expired and that medical supplies are in working order and readily available for use. (2) The master must also ensure that all members of the crew are aware of the operator's instructions on the proper use of medical supplies.
(3) The master of a ship must ensure that non-reusable medical supplies used, or otherwise becoming unserviceable, during a voyage are replaced at the earliest opportunity and if, for whatever reason, the master of a ship considers that the medical supplies provided on the ship are inadequate, he or she must take necessary steps to rectify the deficiency.
(4) The master of a ship must not take the ship to sea unless the master has met the requirements set out in sub-regulations (1) to (3).
(5) Any person who contravenes this regulation commits an offence and shall be liable upon conviction to a fine not exceeding $2,000 or to a term of imprisonment not exceeding 3 months, or to both.
Duties of crew members 8.—(1) A person who is a member of the crew of a ship must comply with the operator's directions on the use of medical supplies.
(2) Any person who contravenes sub-regulation (1) commits an infringement offence and shall be liable to a fine not exceeding $500. (3) A person who is a member of the crew of a ship must report to a responsible officer any deficiency in medical supplies noticed by that person. (4) Any person who contravenes sub-regulation (2) commits an infringement offence and shall be liable to a fine not exceeding $200. Control of certain drugs 9.—(1) The use of certain drugs on board ship must conform as far as practicable with (2) The operator of a ship shall be responsible for ensuring that a Controlled Drug Register is provided on the ship.
(3) A person who dispenses a specified drug must record the particulars set out in sub-regulation (5) in the Controlled Drug Register.
(4) Any operator of a ship who contravenes sub-regulation (2) commits an infringement offence and shall be liable to a fine not exceeding $500. (5) A Controlled Drug Register must contain the following particulars— (a) full name of the person to whom the specified drug is administered; (b) reason for administering the specified drug; (c) date and time at which the specified drug was administered; (d) name and quantity of the specified drug administered; and (e) name and designation of the person who administered the specified drug.
(6) The master of a ship must ensure that any loss or theft of a specified drug is recorded in the Controlled Drug Register.
(7) Any master of a ship who contravenes sub-regulation (6) commits an infringement offence and shall be liable to a fine not exceeding $500. (8) If any loss or theft of a specified drug occurs or is detected while a ship is in port, the master of the ship must report the loss or theft of the specified drug immediately to the appropriate law enforcement agencies.
(9) Any master of a ship who contravenes sub-regulation (8) commits an infringement offence and shall be liable to a fine not exceeding $500. (10) If any loss or theft of a specified drug occurs or is detected while a ship is underway, the master of the ship must report the loss or theft of the specified drug to the appropriate law enforcement agency immediately after arrival of the ship in port.
(11) Any master of a ship who contravenes this regulation commits an infringement offence and shall be liable to a fine not exceeding $500. Made this 14th day of December 2014.
Minister for Infrastructure and Transport MEDICAL REQUIREMENTS FOR FIJI SHIPS ON DOMESTIC VOYAGE This Schedule provides requirements for the first aid, medical stores and associated equipment on board Fiji Ships on domestic voyage and includes requirements relating to inventories, labelling, packaging and expiry date control of medicines and medical equipment, and the construction, location and marking of medical cabinets and first aid kits. The objective of this Schedule is to specify the medical stores supplies necessary to treat minor medical conditions or injuries, or to temporarily stabilise a patient until transfer to medical assistance can be arranged.
Owners and operators must obtain medical advice from their consultant medical practitioners or pharmacists in specifying medical supplies for their ships, especially should they wish to add to the mandatory listings. The medical practitioners or pharmacists shall then issue a Certificate of Inspection of Medical Stores which must be valid for 12 months.
Medical Stores listed in Tables 3, 4 and 5 shall be inspected by a surveyor as part of any periodical survey.
Equipment and Supplies to be carried
All ships shall carry the medical equipment and stores supplies specified in Table 3, Table 4 and Table 5, as applicable to the ship, dependent on the use of ship and its operating area. Table 2 identifies the scales applicable to ship use and operational area.
The scales of medical equipment and stores supplies specified in Table 3 to Table 5 are those required for single incident events involving 1 or 2 persons, and are based on the assumption that medical assistance will be achieved within the time periods specified in Table 1.
Table 1—Medical Assistance Time period in which medical assistance can be obtained Carriage of Dangerous Goods
All ships carrying as cargo, or in shipboard use, any quantity of a hazardous or dangerous chemical or goods, as defined under the International Maritime Dangerous Goods (IMDG) Code, shall have available on board the appropriate additional first aid, medicinal antidotes and other additional treatments as specified by the manufacturer, supplier or other authorised body or publication, including the material safety data sheets relating to the hazardous chemical or goods.
Expiry Dates
Medical supplies carried in accordance with this standard shall not exceed the expiry date specified by the manufacturer or supplier of the product.
All medicines have an expiry date. Expired or surplus medications must be returned to a registered pharmacist for appropriate disposal.
Unused controlled drugs shall not be disposed of other than by transferring them to the control of a registered pharmacist.
Replacement of Stock
Antibiotics shall always be supplied in original packages or patient courses; however, other products such as analgesics and creams shall be considered adequate if an opened package contains at least 50% of the original quantity, and the remaining product is uncontaminated and unaffected by any expiry date as a result of any seal being broken.
Labelling and Packaging
Medication must be provided in original, sealed blister or foil packs where possible.
All products shall carry instructions and directions for use in English and clearly state the adult dose where applicable to enable safe and effective use of the medication for the intended purpose.
Children's doses, with weight or age criteria, can be shown if space permits on the label. It must be understood, however, that the medical inventories for ships are designed for adult passengers and crew. If a child requires treatment, then radio medical advice must be sought.
All medicines and, where necessary, first aid stock must carry cautionary and advisory labelling, as provided for in the Australia Pharmaceutical Formulary (APF – 22nd edition or the latest edition) to alert ships masters or patients as to issues of sedation or interaction with food or alcohol, etc. This ancillary labelling may be printed by the manufacturer on the packaging, included on a dispensing label, or by cautionary and advisory stickers.
The following details must be supplied on the label— (a) the expiry date and batch number; (b) the generic or drug name (the brand name is optional unless repackaged); (c) the strength or quantity as applicable; (d) the instruction for use and adult dose or directions for safe and effective administration; and (e) the supplying pharmacist's name, address and telephone number on Schedule 4 and higher medicines and substances.
All ships shall carry and record the use of all medicines, first aid and medical incidents in a Medical Logbook (to include the time, patient, condition and treatment) and record the stock movements for Controlled Drugs in a Controlled Drugs Register. This includes the supply, use, disposal, loss or theft of such controlled drugs.
First Aid Kit
All ships covered by Scales D, E and F shall carry at least one remote First Aid Kit as specified in Scale F. For ships covered by Scale G, either the Scale G or Scale F First Aid Kit shall be carried.
The first aid kit shall be located adjacent to the master's accommodation, or in the wheelhouse. In small partly open ships, the first aid kit shall be stored so as to protect it from incoming spray and the weather.
The first aid kit shall be stored in a weather-tight, portable case of a non-corrosive material of suitable strength and size to accommodate the first aid stores. The case must be fastened securely with quick-release closures.
The first aid kit case shall be labelled "FIRST AID" on the lid and at least 2 sides for quick identification. The storage location of the first aid kit shall be clearly identified with an appropriate sign or sticker.
The contents shall be listed with a brief instruction for use for each item listed, along with expiry dates and the last check date. The list shall be stowed within or adjacent to the first aid kit.
First aid kits shall be cleaned and checked every 3 months and shall be checked by surveyors during the semi-annual surveys. All ships covered by Scales D and E shall be provided with a medical cabinet of suitable size, design and construction for storing medical supplies.
The medical cabinet shall be located either— (a) in a separate compartment adjacent to the hospital accommodation; (b) where hospital accommodation is not provided, adjacent to the vessel officers' accommodation; or (c) in a dry and cool space accessible to the master and a designated ship The medical cabinet shall be provided with— (a) an outer door, fitted with an efficient lock; (b) an inner cupboard, independently locked, for storing special drugs (noted in Scales by the symbols "*" or "#"); (c) a dispensing counter or table, with an impervious surface, which may be a shelf in the medical cabinet; (d) suitable storage space for medicines and measuring devices, which facilitate identification of various items; and (e) illumination by electric light from inside or immediately outside the The medical cabinet shall be clearly identified on the outer door with an appropriate sign or sticker.
The contents of the medical cabinet shall be listed with a brief instruction for use for each item listed, along with expiry dates and the last check date. The list shall be stowed within or adjacent to the medical cabinet.
Each inner cupboard key carried on board must be kept in the custody of the master or the designated ship officer.
Medical cabinets shall be cleaned and checked every 3 months and shall be checked by surveyors during the semi-annual surveys.
Persons administering first aid must possess as a minimum, a current first aid qualification.
Persons administering first aid using Scale D and E must have the competency of an Advanced First Aid Certificate including, First Aid Oxygen therapy, Asthma management, splinting with vacuum and air splints, and manual resuscitation.
Persons administering the supplies in Scale E First Aid Kits and medical supplies must possess a current First Aid At Sea Certificate or, more preferably the Occupational level of First Aid Certificate, First Aid Oxygen therapy, Asthma management and the use of Air Splints.
Where a Defibrillator unit is carried, SAE Defibrillation training must be undertaken.
Table 2—Scales applicable to type of ship (ships use) and operational area Ships Use Operational Area Extra Specification Scale and Table 1. Passenger Ships Berthed passengers Scale D – Table H.4 & Table H.5 Scale D –Table H.4 & Table H.5 Territorial Seas & Berthed passengers Scale E – Archipelagic waters Table H.4 & Table H.5 Scale F – Table H.3 Berthed passengers Scale F – Table H.3 Scale G – Table H.3 Ships Use Operational Area Extra Specification Scale and Table Sheltered waters Berthed passengers Scale F – Table H.3 Scale G – Table H.3 2. Non Passenger Scale E –Table H.4 & Table H.5 Territorial Seas & Scale F – Table H.3 Archipelagic waters Scale G – Table H.3 Sheltered waters Scale G – Table H.3 3. Fishing Ships Scale E –Table H.4 & Table H.5 Territorial Seas & Scale F – Table H.3 Archipelagic waters Scale G – Table H.3 Sheltered waters Scale G – Table H.3 Table 3—Scale G and F First Aid Kits Description Scale G Scale F Bandage, conforming 5 cm secure dressing and support injured parts Bandage, conforming 10 cm secure dressing and support injured parts Bandage, heavy crepe 7.5 cm Bandage, heavy crepe 10 cm support bandage, wide Bandage, triangular Dressing, combine 10 x 10 cm, bleeding control Dressing, combine 10 x 20 cm, bleeding control, large Description Scale G Scale F Dressing, non-adherent (10 x 10 cm or similar) Dressing, hydroactive blisters, burns and (10 x 10 cm or similar) minor exudate wounds Wound dressing, combination, Wound dressing, combination, Adhesive roll non-woven fabric securing dressings Dressings, elastic fabric strips minor wound cover Gauze swabs, sterile cleansing/dressing (single use pkt of 3) Wound closure strips, wide, securing wound sides Tape surgical waterproof Tape surgical waterproof Towels, disposable, pkt of 2 Plastic bag set (3 asst L, M and S) disposal of soiled dressings Gloves, disposable, large Safety pins, stainless, assorted pkt Description Scale G Scale F Blanket, emergency thermal Hypothermia and shock Ice pack, instant Resuscitation mask, disposable Resuscitation mask, pocket Splinter probes, sterile, disposable Splinter forceps, 12.5 cm Shears, stainless, 19 cm minimum Scalpel, disposable Splint malleable, universal Normal saline, sterile 30 ml eye irrigation / wound Povidone iodine swabs (single Anaesthetic + antiseptic cream Hydrocortisone 1% cream 30 g Paracetamol 500 mg tabs or caps Paracetamol 500 mg / moderate pain relief Ibuprofen 200 mg tablet Hyoscine hydrobromide 0.3 mg Loperimide 2 mg tablets Description Scale G Scale F Loratadine HCl 10 mg or antihistamine (non- Fexofenadine HCl 120 mg tablets CPR instruction chart or card Australian First Aid Book SAE Defibrillator (Laerdal First Aid unit or similar) Stretcher for helicopter evacuation First Aid Oxygen Unit (Oxyport Table 4—Scale E and D Medication Scale E Scale D Adrenaline 1-1000 1 ml ampoules sudden allergic reaction Antibiotic ointment 15 g or 20 g Amoxycillin 500 mg caps Doxycycline 100 mg caps or tabs Benzyl penicillin 600 mg with antibiotic injection Chloramphenicol Eye Ointment Glyceryl trinitrate 400 mcg spray angina/ heart pain Scale E Scale D Morphine 10 mg/ ml ampoules severe pain only with Naloxone 0.4 mg/ml minijet morphine antagonist Paracetamol 500 mg/Codeine 30 moderate-severe pain also cough suppression Prochlorperazine 5 mg tablet nausea, giddiness Prochlorperazine 25 mg vomiting, giddiness Prochlorperazine 25 mg severe seasickness Prednisolone 5 mg tablet Salbutamol inhaler Sodium chloride and glucose or dextrose compound, powder sachets, 4.9 g approx.
* = Requires prescription# = Requires separate locked storage and recording in Controlled Drug Register Table 5—Scale E and D Medical Equipment Scale E Scale D Scalpel, sterile, disposable Scissors, stainless, blunt/sharp Splint set, vacuum or air inflation Neck collar, multi-size, rigid, fully Syringe with needle, sterile Syringe with needle, sterile, disposable 2 ml or 3 ml, 23 G or 25 G Isopropyl alcohol swabs BVM air resuscitator SAE Defibrillator (Laerdal First Aid unit or similar) Stretcher for helicopter evacuation Optional First Aid Oxygen Unit (Oxyport Ship Captain's Medical Guide, Controlled Drug Register MEDICAL STORES CARRIED ON-BOARD FIJI SHIPS ENGAGED IN UNLIMITED VOYAGE This Schedule provides guidance on the appropriate medical stores to be carried on ships engaged in unlimited voyages. The supplies and quantities are based on experience of the range of medical and surgical emergencies that can arise on board. However, they must be adjusted in accordance with the particular risks inherent on the voyage, the length of voyage, ports of call, the cargoes carried, and the persons on board.
Operators must obtain medical advice from their consultant medical practitioners or pharmacists in specifying medical stores for their ships, especially if they wish to differ from the suggested listings. They must provide the master of each ship with a written list of the medicines to be provided on board. In appropriate cases, other, or additional, medicines may be desirable.
Medicines in the attached tables are grouped according to purpose. Group 1 covers medicines for dealing with cardiovascular problems. In the rows below the shading, ‘A', ‘B', etc. refer to sub-groups; thus ‘1C' relates to medicines with a diuretic effect.
Some medicines fall into two groups. For instance, ‘hyoscine hydrobromide' is both in group 4C, as a seasickness remedy, and group 3C, as an anti-spasmolytic. Where this occurs, the latter group usually refers to the earlier group. The main exception to this is Group 15, where a large number of medicines are also listed in earlier groups. Quantities are specifically listed for all items in Group 15 (Poison Treatments and Antidotes), being the quantity required to be carried by the latest edition of the IMO Medical First Aid Guide which must be carried on board ships. Where quantities are listed in Group 15 and another Group, e.g., ‘100' in Group 15 and ‘12' in Group 4, the amount that must be carried is the higher of the two, not the sum of both (e.g., 100, not 112).
Except for Group 15 (see below), the quantity specified in the column headed "Category A" is a suggested quantity for a ship on unlimited voyages, and assumes that supplies can be restocked if necessary from acceptable sources at way-ports without problems. The quantity must be sufficient for a crew of about 20 people. If the voyage is to be lengthy, without a satisfactory opportunity of replenishing supplies from reputable sources, some quantities may need to be increased. For larger crews, an increase in quantity may be desirable (an extra quarter or half quantity is suggested for each extra 5 or 10 crew).
For Group 15 (Poison Treatments and Antidotes), the Category A quantity is for ships where casualties cannot, or may not, be able to be hospitalised on shore within 24 hours.
Provision of Medical Stores
All ships engaged on unlimited voyages shall carry the medical equipment and stores specified in Table 6, and it is the responsibility of the operator of a ship to ensure that the provision of such medical stores are provided on board the ship as is necessary.
Expiry Dates
Medicines carried in accordance with this standard shall not exceed the expiry date specified by the manufacturer or supplier of the product.
Surgical stores and appliances must be in working order and readily available for use.
Non-reusable medical stores used or otherwise becoming unserviceable, during a voyage must be replaced at the earliest opportunity.
Expired or surplus medications must be returned to a registered pharmacist for appropriate disposal. Unused controlled drugs shall not be disposed of other than by transferring them to the control of a registered pharmacist.
Storage of medical supplies
Drugs and other medicines must be stored in a cool place, below 25°C if possible, but no such item must be frozen.
Storage must be secure enough to prevent misuse, while ensuring that prompt access to them is available when they are required. The nature of some medicines requires special care to be taken in their storage and security. The medical supplies provided in a ship must be kept in a medical cabinet of a suitable size, design and construction. It must be provided with the following— (a) an outer door, fitted with an efficient lock; (b) an inner cupboard, independently locked, for storing medical stores; (c) a dispensing counter or table, with an impervious surface, which may be a shelf in the medical cabinet; (d) suitable storage space for medicines and measuring devices, which facilitate identification of various items; and (e) illumination by electric light from inside or immediately outside the The medical cabinet shall be located— (a) in a separate compartment adjacent to the hospital accommodation; (b) where hospital accommodation is not provided, adjacent to the vessel officers' accommodation; or (c) in a dry and cool space accessible to the master and a nominated crew Medical supplies marked with the symbol "*" in the Schedule 2 must be stored in a locked inner cupboard of the medical cabinet. Each inner cupboard key carried on board must be kept in the custody of the master or designated ships officer.
Medical supplies marked with the symbol "§" in Schedule 2 must be kept in refrigerated storage between 2°C and 8°C.
Packaging and Labelling of medical supplies
Drugs, other medicines and disinfectants must be packed in containers conforming to the requirements of the laws of the State or country of manufacture.
Medication must be provided in original, sealed blister or foil packs where possible.
All products shall carry instructions and directions for use in English and clearly state the dose where applicable, to enable safe and effective use of the medication for the intended purpose. A drug or medicine supplied in a country other than Fiji must comply with the equivalent labelling requirements of that country.
If a pharmacist supplies a drug or medicine, the use of which is not described in the Ship Captain's Medical Guide, the pharmacist must, unless already provided by the manufacturer, provide advisory and cautionary labels describing the substitute's safe and efficient use and warnings regarding side effects and adverse indications.
The following details must be supplied on the label— (a) the expiry date and batch number; (b) the generic or drug name (the brand name is optional unless repackaged); (c) the strength or quantity as applicable; (d) the instruction for use and adult dose or directions for safe and effective administration; and (e) the supplying pharmacist's name, address and telephone number on Schedule 4 and higher medicines and substances.
The following publications may assist operators in demonstrating compliance with paragraph 4.3; (a) Ship Captain's Medical Guide (published by HMSO, London) provides information to assist in diagnosing and treating the sick and injured, as well as general information regarding the obtaining of radio medical advice, and is strongly recommended; and (b) Medical First Aid Guide, for use in accidents involving dangerous goods (published by IMO) is required to be carried on ships carrying dangerous goods, and is contained in the Supplement to the IMDG Code, 2000 Edition.
Medicines for ships of Category A – Ships on unlimited voyage
Explanation of symbols— * – must be stored in a locked inner cupboard of the medical cabinet. § – must be kept in refrigerated storage between 2°C and 8°C. # – must be stored in a locked inner cupboard of the medical cabinet. Special recording requirements apply.
† – for items so marked in column 4, the specified quantity is considered sufficient regardless of the number of persons on board.
Names in brackets refer to the same medicine. Medicine and dosage are given in the following format: Name of medicine, dosage/strength, type of supply (e.g., tablet, bottle & pack, unless included in name of medicine), or size. In the case of injections supplied in ampoules, the word ampoule is omitted and strengths are given as "total quantity per ampoule/size of ampoule". If the quantity suggested of a particular drug is less than the manufacturer's smallest pack, the smallest available pack must be used.
Table 6—Medical stores to be carried on ships engaged in unlimited voyages Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Cardio vascular restoratives Sympathomimetics
Adrenaline (Epinephrine) 1.0 mg/1
ml, injection
Glyceryl trinitrate 400 micrograms, spray, 200 metre dose aerosol Frusemide 40 mg, tablet Frusemide 20 mg/2 ml, injection Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Anti-haemorrhagics(including uterotonics if there are women with potential for child bearing, working on board) Phytomenadione Paediatric 1 mg/0.5 ml, injection (Vitamin K1).
(Note: intended for use with new-born infants) Ergometrine Maleate 500 micrograms & Oxytocin 5 units, injection.
(additional quantity recommended if there are women with potential for child bearing working on board) Atenolol 50 mg, tablet, pack of 28.
Gastro intestinal system
Medicines for gastric
and duodenal disorders
Histamine H2 receptor
anti-ulcer antagonists
Cimetidine 400 mg, tablet, pack Proprietary antacid of choice, tablet, or corresponding quantity of
powder or liquid.
Prochlorperazine 3 mg, buccal Prochlorperazine 5 mg, tablet Promethazine 25 mg/1 ml, Prochlorperazine 12.5 mg/1 ml, Glycerol Suppository, 4 g.
Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Codeine Phosphate 30 mg, tablet, Loperamide 2 mg, capsules trimethoprim 200 or 300 mg, tablet Proprietary preparation of choice, pack.
(Increase quantity if needed). Analgesics and Anti-
spasmodics
Analgesics, anti-pyretics
& anti-inflammatory
Paracetamol 500 mg, tablet, pack Diclofenac 100 mg, suppository.
Ibuprofen 200 mg or 400 mg, tablet, pack of 24, or Mefenamic acid 250 mg, capsules, Naproxen 275 mg, tablet, pack of Codeine Phosphate 30 mg, tablet.
Morphine Sulfate 10 mg/1 ml, Emergency antidote to Naloxone 0.4 mg/1 ml, injection.
Note: Naloxone is a Morphine
antidote or antagonist, NOT an
analgesic.
Hyoscine hydrobromide 0.3 mg, Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Tranquilizers, muscle
Diazepam 10 mg/2 ml, injection (See also Group 15). Diazepam 5 mg, tablet.
Chlorpromazine 25 mg/1 ml, Chlorpromazine 25 mg, tablet.
Benztropine 2 mg, tablet.
(for concurrent therapy with chlorpromazine, to control
side effects, on doctor's Hyoscine hydrobromide 0.3 mg, Diazepam 10 mg, rectal.
Amitriptyline 50 mg, tablet.
Nitrazepam 5 mg, tablet.
Anti-allergics and Anti-anaphylactics
Loratadine 10 mg, tablet.
(Note: This anti-histamine can be used where patient sedation MUST be avoided or some alcohol has been consumed.) Hydrocortisone powder for injection 100 mg vial, each with 2 ml water
for reconstitution.
(use on medical advice only)
Prednisolone, tablet, 5 mg.
(use on medical advice only)
Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Salbutamol, 100 micrograms per metered dose, 200 dose inhaler.
Beclomethasone, 50 micrograms per metered dose,200 dose inhaler.
Codeine Phosphate 30 mg, tablet.
Codeine Phosphate, linctus, 100 ml Medicines for colds and sinusitis
Paracetamol 500 mg, tablet.
Menthol & benzoin, inhalation, "Cold & Flu" tablets Benzyl Penicillin 600 mg, injection, Water for injection, to suit Benzyl Ciprofloxacin 500 mg, tablet.
Ceftriaxone 1 g, injection, vial.
(To be diluted with Lignocaine injection, see 13B2.) (Note: for Category A ships which may be more than 48 hours from medical assistance) Erythromycin 250 mg, tablet Doxycycline 100 mg, tablet (General requirement for treatment of STDs. Additional product, if required, may be available from Group 14 (anti- malarial regime)) Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Trimethoprim 200 mg or 300 mg, Trimethoprim 200 mg or 300 mg, Mebendazole 100 mg, tablet Metronidazole 0.5 g, suppository Metronidazole 400 mg, tablet.
Tinidazole 500 mg, tablet.
Anti-tetanus vaccines
Tetanus Adsorbed Vaccine, injection, Tetanus Immunoglobulin 250 units, Compounds promoting rehydration, caloric intake and plasma
Sodium chloride and glucose or dextrose compound, powder sachets, 4.9 g.
Equivalent other formulations may be used. Skin medicines
Pre-diluted aqueous solution containing cetrimide and chlorhexidine, bottle, 100 ml, for individual use Bacitracin Co., tube, 15 g or proprietary brand of antibiotic ointment or cream Anti-inflammatory and
Hydrocortisone 1% cream or ointment, tube, 30 g Calamine 15%, Lotion, non-oily, bottle, 200 ml.
Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Anti-fungal skin creams
Benzoic acid compound ointment (synonym: Whitfields ointment).
Miconazole nitrate 2% vaginal (Only if one or more persons on board is female. Increasequantity if four or more females are on board.) Miconazole nitrate 100mg vaginal pessary, pack of 7 (Only if one or more persons on board is female.) Miconazole nitrate 2 % topical (Double quantity must be supplied if one or more persons on board is female.) Silver sulfadiazine 1% and chlorhexidine digluconate 2% cream, sterile tube, 50 g.
Miscellaneous skin preparations
Gamma benzene 1% or Pemethrin,
Gamma benzene or Pemethrin (hair
application bottle, 100 ml.
Petroleum jelly 50 g.
Potassium permanganate, crystals, Zinc oxide, ointment, 100 g.
Antibiotic eye ointment
Framycetin 0.5 % eye ointment, Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Antibiotic and anti-inflammatory eyedrops
Betamethasone sodium phosphate 0.1 % neomycin sulfate 0.5%,
eyedrops, 5 ml
Use on radiomedical advice only,
and preferably after diagnosis by
an eye specialist
Amethocaine 0.5%, eye drops, (individual doses).
Pilocarpine 0.5%, eyedrops, 15 ml Detection of foreign bodies
Fluorescein 2% eye drops, disposable Ear medicines
Antibiotic eardrops containing in neomycin 3 400 units, polymixin B sulfate 10 000 units, hydrocortisone 10 mg, in a 5 ml
dropper bottle, or
Cortisone ear drops (containing Framycetin 5 mg, Dexamethasone 0.5 mg, Gramicidin 0.05 mg/ml) 8 ml Aluminium acetate ear drops, with Wax softener, lubricating
Arachis Oil, ear drops, with dropper, Ephedrine 0.5%, nasal drops, 15 ml Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Medicines for mouth and throat infections
Chlorhexidine gluconate 0.2%, mouthwash, 300 ml Local anaesthetics using freezing
Ethyl chloride, liquid spray, 100 ml.
Local anaesthetics given by subcutaneous injection
Lignocaine 1%, injection, 2 ml.
Note: In addition to its use as an anaesthetic, Lignocaine is used as a diluent for Ceftriaxone, q.v. (see 7A3). Dental anaesthetic and antiseptic mixtures
(see 22 for other dental Lignocaine 2%, gel, water miscible *Regime 1
Chloroquine 150 mg base (approx.),
tablet and
Proguanil 100 mg, tablet.
*Regime 2
Doxycycline 100 mg, tablet.
For prolonged visits to malarial areas, sufficient Doxycycline must be carried to allow administration of one tablet per adult per day for the period 2 days before to 14 days after potential exposure. Mefloquine 250 mg, tablet (Note: for prolonged visits to malarial areas, sufficient Mefloquine must be carried to allow administration of one tablet per adult per week for the period 7 days before to 14 days after potential exposure.) Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A For prevention, alternate between regimes 1 and 2 on an alternate voyage basis (provided a full course of treatment of each regime is completed).
Use Regime 3 if malaria is known to be resistant to Regimes 1 or 2.
Treatment Pyrimethamine (25 mg) & Sulfadoxine (500 mg), tablet (Note: Use only on medical advice)
Quinine 300 mg, tablet.
Use Regime 3 above also for treatment
Poison treatments and Antidotes
Note: Quantities specified against items in the following table
are those listed in the IMDG Code, as amended. Where quantities
are listed in Group 15 and in another group or groups, the amount
that must be carried is the higher or highest of the individual
quantities, not the sum of all quantities listed.
With the revision of the Medical First Aid Guide (MFAG), contained in the Supplement to the IMDG Code, as amended, except for a few specific treatments there is no longer a set link between poison and antidote. The Group 15 medicines in italics are no longer contained in the Medical First Aid Guide, but are recommended as specific antidotes for the substances listed with the entry.
Should the master consider that the nature or quantity of specific hazardous materials carried warrants the carriage of specific antidotes or treatments, not listed in Group 15, advice must be obtained from the Company's medical or pharmaceutical consultant, or a registered pharmacist.
* Amoxycillin 500 mg, capsule.
Amyl Nitrite Vitrella 0.3 ml. Antidote for poisoning by cyanides, nitriles or hydrogen sulphide Anaesthetic eye drops, e.g. Amethocaine 0.5%, eye drops, (individual use).
Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Antibiotic eye ointment - Framycetin eye ointment.
Ascorbic Acid 500 mg/5 ml, Atropine 1.2 mg/1 ml, injection.
Beclomethasone, 50 micrograms per metered dose, 200 dose inhaler.
Calcium Gluconate 2%, gel.
Calcium Gluconate 1 g, tablet, Ceftriaxone 1 g, injection, plus 5 Lignocaine 1%, as diluent Charcoal, activated 300 mg, tablet. Diazepam 10 mg, rectal. Dimercaprol 100 mg /2 ml injection, Antidote for poisoning by arsenic and mercury compounds Erythromycin 250 mg, tablet Ethyl Alcohol 90%, solution, 500 Vitamin K1 (Phytomenadione) See Groups 1 & 15.
Disinfectants and Antiseptics
Solutions of alkylphenols in a saponaceous solvent or a quaternary ammonium compound, litres.
Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Solution of Chlorhexidine 0.05% & Cetrimide 0.5% in an aqueous vehicle.
Hydrogen peroxide 6% (20 vol), solution, 100 ml.
Calcium hypochlorite, high test, Note 1: Do not store near metal objects, instruments, sinks, etc. Keep in sealed container until used.
Note 2: Replace annually if not used.
Note 3: Calcium hypochlorite is an oxidising agent and has been implicated in fires. It is recommended that if stored on board it must be kept at temperatures less than 35°C and, so far as possible, only purchased for immediate use. Insecticides and Repellents
Repellent, personal (Recommended 1 pack per crew member) Insecticide, liquid The insecticide must not be harmful to humans, must be free from offensive odour and so far as possible non-staining, must be effective for killing insects or keeping spaces clear of insects, and must be suitable for use in crew and passenger a c c o m m o d a t i o n a n d f o o d preparation areas. Instructions m u s t b e s p e c i f i e d o n t h e packaging.
Treatment and storage Recommended Medicine and Suggested Dosage Strength Category A Tetanus Vaccine Adsorbed, injection, 0.5 ml Oil of Cloves, 15 ml.
Zinc oxide dental paste, tube, 7 g.
(This is the recommended quantity irrespective of the number of persons on board.) Equipment marked ‘MF' is additional equipment recommended in the Medical First Aid Guide, published by IMO, for ships carrying dangerous goods. It is not required for other ships.
Category A Manual resuscitation Valve and bag type. One must be supplied for ordinary ships. Two are required for ships carrying dangerous cargoes.
Appliance for the Oxygen Giving Set comprising the following: administration of oxygen (1) Oxygen reservoir, 2 cylinders with 60—90 minutes total supply; (2) 1 flow metre unit giving a minimum setting of 4 litres per minute; (3) 1 pressure regulating unit; (4) 1 set of tubing; (5) 5 x 24% oxygen disposable face masks; Category A (6) 5 x 35% oxygen disposable face masks.
Each part must be constructed so that it can only be assembled in the correct manner.
Note 1: Items (2) and (3) may be combined in one unit.
Note 2: A carry case for the set need only contain one oxygen cylinder if a second is stored nearby and is interchangeable with the first with negligible interruption to the flow of oxygen. Appliance for the In addition to the above, ships carrying dangerous administration of cargoes must carry 10 x 60% disposable For ships carrying There must be a minimum of 44 litres of oxygen dangerous cargoes, at 200 bar. This supply (including the above) other than tankers must be composed as follows: 1 portable set with at least 1 x 2 litre 200 bar cylinder ready for use, with a spare 2 litre 200 bar cylinder, and 1 x 40 litre 200 bar cylinder ready for direct use at the ship's hospital, with one flowmeter unit (two ports) for supplying of oxygen to two persons at the same time. (Small cylinders may be used to give the equivalent amount.) If more than one non-portable oxygen cylinder is used, there must be two flowmeter units for supply of oxygen to two persons at the same time.
Mechanical aspirator Aspirator to clear airways (manual, hand operated) + 2 catheters respiratory passages Pocket Mask or
Disposable mouth-to-mouth plastic shield.
Guedel Airway Sizes 1, 3 and 4 For ships carrying dangerous cargoes, the quantity must be increased to 2 of each size.
Category A Dressing and suturing equipment
Balls, cotton wool, Pack of 5, in damp proof packaging 7.5 cm x 1.5 m when stretched Bandage, elastic, Seamless, of a size suitable for finger dressings Bandage, suspensory 5 m with applicator, plus 1 refill Bandage, triangular Calico, with two sides about 90 cm and a base Bandage, zinc oxide Zinc Oxide Plaster, waterproof, on a spool: Buds, cotton tipped, Pack of 2, sealed Cl osures, wound, Pack of 8 strips ("Butterfly closures"), 4 x 38 sterile, adhesive Dressing strip, elastic Medicated dressing strip, 6 cm x 1 m, in a pack Dressings, adhesive, 19 mm x 72 mm, or pack of 100, assorted, sterile plastic, waterproof Dressings, paraffin Individually wrapped, 10 x 10 cm Dressings, plain (1) small, BPC 13 wound, unmedicated (2) medium, BPC 14 (3) large, BPC 15 Category A Pack containing one piece, size 1 m x 90 cm Gauze, compresses, Pack containing 5 pads, size 7.5 x 7.5 cm Pack containing ribbon, size 2.5 cm x 2.5 m absorbent, sterile Gloves, disposable Polyethylene or latex, large or extra large Suture kit, disposable, Sutures, sterile, of monofilament nylon or silk with needles (except 3), swaged to a 26 mm, or 40 mm half circle needle with a cutting edge.
(sizes approximate) Each needle and suture to be in a sealed pack suture, non-absorbable, 26 mm half circle needle suture, non-absorbable, 40 mm half circle needle suture, absorbable, catgut, 40 mm half circle Suture strips, sterile, 75 mm adhesive suture strips.
A closable tin containing 100 g of talc dusting powder, BP or similar Tampons/sanitary Small pack. On voyages of more than 48 hours, it is recommended that the quantity carried be 2 packs per female per month.
Category A Towels for treating Towels, assorted, non-adhering, non- linting, in sachets ready for hydrating with normal saline, in a portable kit.
Each kit must contain at least: (1) 2 towels - body dressing size;(2) 2 towels - leg dressing size;(3) 2 towels - arms dressing size;(4) 2 towels - hand dressing size;(5) 1 towel - face mask dressing;(6) 6 x 500 ml bottles/sachets normal saline (7) 3 crepe bandages, light 10 cm width;(8) 2 rolls adhesive tape; and(9) 1 x scissors, s/b stainless steel, 12 cm.
Note: the above can be obtained in a proprietary kit. Bottle, eye wash, for Alternative to eye spud Box, instrument, For forceps, scissors and thermometers.
stainless steel, with Alternative to instrument roll. Forceps, dissecting Stainless steel, 12.5 cm Forceps, epilation (for holding needles for suturing) Stainless steel, 12.5 cm Forceps, Spencer Stainless steel, 12.5 cm Razors, disposable Roll, instrument, For forceps, scissors and thermometers.
Alternative to instrument box. Category A Scalpels, disposable, Straight, size 23 Scissors, surgical, About 18 cm, one blade sharp pointed and the other round-ended Scissors, surgical, 12.5 cm, both blades sharp pointed Spud, eye, rubber Alternative to eyewash bottle Examination & monitoring
Charts, temperature Am/pm, four hourly Container, specimen, Strong, transparent, sterilizable plastic or glass, for blood and urine Cup, sputum with Wax paper or plastic, disposable Strong glass or plastic, with airtight lid, with blank labels, size 50 ml Plain, self-adhesive, about 5 cm x 3 cm Reports, medical Strips, reactive, for Multistix, in manufacturer's container, with Tags, identification For patients who have been given morphine Sub-normal range, low body temperature, stubby bulb pattern Thermometer, rectal Ordinary range, case clearly marked: "For Rectal Use" To Australian Standard – AS 2190 Tongue Depressors, Pencil or other torch suitable for examining Category A Equipment for injection, perfusion puncture and catheterization
Catheter, rectal Size 26 or 28, French gauge Catheter, sterile (1) Foley type, 16 gauge, with 5 ml balloon (Short/medium term use in adults) Catheter, sterile (2) Nelaton or Jacques type, 16 gauge (with no balloon) With teat connexion for incontinence Drainage instrument, Bladder drainage set (including 2 litre capacity bag, spigots and tube) Rectal Infusion Set A drip set for giving into the rectum 200 ml of fluid over a period of 10-15 minutes. Comprises: (1) a 2 m length of transparent plastic tubing attached to a reservoir; (2) a device for attaching the tube to a rectal (3) a device for regulating the flow of liquid from the reservoir; (4) a spigot to close the catheter when the drip set is disconnected; and (5) an appropriate rectal catheter.
(see above for additional rectal catheters if the ship carries dangerous goods.) Infusion equipment, Cannula, (size 1.2 mm) Infusion equipment, Intra-venous administration set, with disposable infuser filters.
2.5 ml syringe/0.8 mm (21 gauge) 4 cm needle needles disposable (additional, for ships 5 ml syringe/0.8 mm (21 gauge) 4 cm needle carrying dangerous cargoes) Category A Syringes and needles, 2.5 ml syringe/0.8 mm (21 gauge) 4 cm needle Syringes and needles, 5 ml syringe/0.8 mm (21 gauge) 4 cm needle Syringes and needles, 10 ml syringe/0.8 mm (21 gauge) 4 cm needle General Medical Equipment
Stainless steel to BS 2588.1, or sterilizable Bottle, hot water rubber, with a non-burn surface or a fabric cover, size about 30 cm x 20 cm Bottle, urine, male Glass or sterilizable plastic, graduated in ml A female bottle must also be carried if there are female crew members Flexible, re-usable Immobilization & setting
Adult size set of 3, small, medium and large, adjustable, rigid, with chin support for fractured neck Splint, inflatable Set of six (half-leg, full leg, half arm, and full arm, ankle and wrist) Splint, malleable, Splint, malleable, Thomas, adjustable With tapes, of robust material throughout, two Disinfection, Disinsectization and Prophylaxis
Category A Electrically heated sterilizer for unwrapped utensils and instruments. Capacity: at least two kidney dishes, one pair of scissors, and three forceps, at one sterilization.
A sterilizer designed for sterilizing baby's bottles must normally be suitable. Water-Disinfection See ‘Chlorine compound' in Group 17 in the Bags, for records Approx. size 30 cm x 50 cm, to hold medivac records, dirty bandages, after- birth Body bag - Large size, heavy duty opaque plastic, with a zip closure on the long side, designed to store a dead person in a refrigerator for up to 14 days or in a cool place for up to 5 days strong, approx. size 15 cm x 30 cm, to hold specimen jars/containers For used needles and scalpels Size at least 200 mm x 90 mm, stainless steel to BS 1823, or sterilizable plastic to BS 5452 Strong, sterilizable plastic throughout Size 250 mm stainless steel to BS 1823, or sterilizable plastic to BS 5452.
plastic, sterilizable Eye Pads, sterile 50 individual Eye shades, either eye Eye wash solution, normal saline or similar, Category A Ships must carry first aid kits to be distributed in appropriate locations on the ship e.g. in the galley, engine room and bridge.
The kit must include the following items to be kept in a portable waterproof container: (1) 8 x triangular bandages (90 cm x 90 cm x (2) 2 x No 13 BPC sterile unmedicated (3) 2 x No 14 BPC sterile unmedicated (4) 1 x No 15 BPC sterile unmedicated (5) 12 medium safety pins, rustless; (6) 30 assorted elastic adhesive waterproof dressings medicated BPC. Those supplied for use in the galley must be blue or other easily detectable colour; (7) 2 x sterile eye pads with attachment; (8) 6 x packs each containing 5 sterile cotton (9) 5 pairs large or extra-large size disposable polythene or latex gloves; (10) 10 paraffin gauze dressings, BP, 10 cm x 10 cm, in individual sterile pack; and (11) one pair of stainless steel scissors, about 18 cm long, one blade sharp pointed, the other round ended.
In addition, it is suggested that in other areas where injuries are possible, such as workrooms, kits for immediate first aid be stored with materials such as hydrogen peroxide solution for disinfection Glass, magnifying 7.5 cm diameter on handle Category A Latex gloves surgical quality - sterile (large and extra-large) Instruments, dental (1) Excavator double ended Guy's pattern G2 (2) Filling paste inserter or cotton tipped applicators (for inserting filling paste into the tooth) (3) Dental mirror size 4 on handle (4) Cavit (temporary dental filling) tube, 7 g (5) Oral splinting tape Note: Items 2 to 5 can be obtained prepacked in a proprietary kit, "Dentist in a Box™ – plus tooth trauma care", which also provides information on emergency dental treatment.
See Group 22 above for other dental requisites. Kit for protection For all ships trading in known malarial areas
and in areas where medical facilities are limited
transmitted diseases and emergency shore based treatment may be
To be kept in a heavy gauge polythene bag, and labelled "to be used only for the treatment of …" (insert the name of the seafarer going ashore for emergency treatment)Each kit to contain the following: (1) 10 x 2.5 ml syringes; (2) 10 x 10 ml syringes; (3) 20 x 21G 0.8 mm needles; (4) 1 blood giving set; (5) 1 blood taking set; (6) pack of pre-injection site swabs; and (7) disposable plastic or latex gloves 2 pairs.
Category A Measuring equipment Transparent plastic measuring jug, strong, sterilizable, 750 ml, graduated Medicine measures, plastic, size 30 ml to 40 ml, Dropper, plastic (for infants) (see disposable Spoon, measuring, plastic, size 5ml, conforming Rustless medium, size 5 cm or assorted Marine Orders Part 10, and the Guidelines Controlled Drug Register Dispensary Book or Medical Log Sheeting, waterproof Smooth, strong, non-adhesive, rubber or plastic sheeting, size 1 m x 2 m, or fitted sheets of similar type and size Slides, microscope Microscope slides in individual transit containers.
Ships in malarial areas only Stretcher equipment An efficient carrying stretcher, suitable for lifting the patient horizontally and vertically Soft paper, in closable container Paper, disposable, individual, hand size Medical Supplies for Category C Ships
(Ships in smooth or partially smooth waters, and those that stay close to the shore.) Treatment, and Recommended Medicine and Storage Symbols Dosage Strength Glyceryl trinitrate 400 micrograms metered 200 doses, spray, aerosol Anti-haemorrhagics (including uterotonics if there are women with potential
for child bearing working on board)
Phytomenadione paediatric 1mg/0.5 ml, (Vitamin K1)injection Ergometrine 500 microgram Oxytocin 5 units, injection, 1ml Gastro intestinal system
Hyoscine hydrobromide 0.3 mg, tablet Codeine Phosphate 30 mg, tablet Analgesics and Anti-spasmodics
Paracetamol 500 mg, tablet Codeine Phosphate (See 2D) Hyoscine hydrobromide (See 2B) Medicines for External Use
Antiseptic solutions Pre-diluted aqueous solution containing Cetrimide and chlorhexidine, bottles, 100 ml, disposable, for individual use Burn preparations Cetrimide Cream, tube, 50 g, with local anaesthetic effect Medical Equipment for Category C Ships
Mask, for mouth to-mouth Pocket Mask Dressing and suturing equipment
Bandage, adhesive elastic 7.5 cm x 4 m Bandages, sterile dressings, unmedicated Bandages, triangular about 90 cm x 90 cm x 127 cm Closures, wound, sterile, Pack of 8 strips ("Butterfly closures"), 4 mm x 38 mm.
Compresses, sterile gauze Pack containing 5 sterile gauze pads. Size Dressings, adhesive Assorted, sterile Instruments, dental (1) Filling paste inserter or cotton tipped 1 set all applicators (for inserting filling paste (2) Dental mirror size 4 on handle (3) Cavit (temporary dental filling) tube, (4) Oral splinting tape Note: These items can be obtained pre-packed in a proprietary kit, "Dentist in a Box™– plus tooth trauma care", which also provides information on emergency dental treatment. Dressings, paraffin gauze Sterile, 10 cm x 10 cm Gloves, disposable Polyethylene or latex, large or extra large Medium, rustless, assorted Scissors, surgical Stainless steel, 12.5 cm Recommended Additional Item
Bag, hazardous waste, For disposal of hazardous waste materials

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