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[F1ANNEX IV U.K. General Framework for the Inspection of Vessels’ Medical Supplies (Article 2(1)(c), Article 3(3))

Textual Amendments

SECTION B U.K. CATEGORY B VESSELS

I. Details of the vessel U.K.

Name: …

Flag: …

Home port: …

II. Medical supplies U.K.

a

Under the conditions of use prescribed by national laws and/or practices.

Quantities required Quantities actually carried on board Remarks (in particular, any expiry date)
1. MEDICINE
1.1. Cardiovascular
(a) Cardio-circulatory sympathomimetics 0 0 0
(b) Anti-angina preparations 0 0 0
(c) Diuretics 0 0 0
(d) Anti-haemorrhagics including uterotonics if there are women on board 0 0 0
(e) Anti-hypertensive 0 0 0
1.2. Gastro-intestinal system
(a) Medicines for gastric and duodenal disorders 0 0 0
— Medicine for treatment of stomach ulcer and gastritis 0 0 0
— Anti-acid mucous dressings 0 0 0
(b) Anti-emetics 0 0 0
(c) Anti-diarrhoeals 0 0 0
(d) Haemorrhoid preparations 0 0 0
1.3. Analgesics and anti-spasmodics
(a) Analgesics, anti-pyretics and anti-inflammatory preparations 0 0 0
(b) Powerful analgesics 0 0 0
(c) Spasmolytics 0 0 0
1.4. Nervous system
(a) Anxiolytics 0 0 0
(b) Neuroleptics 0 0 0
(c) Seasickness remedies 0 0 0
(d) Anti-epileptics 0 0 0
1.5. Anti-allergics and anti-anaphylactics
(a) Anti-histaminics 0 0 0
(b) Glucocorticoids 0 0 0
1.6. Respiratory system
(a) Bronchiospasm preparations 0 0 0
(b) Anti-tussives 0 0 0
(c) Medicines used for colds and sinusitis 0 0 0
1.7. Anti-infection
(a) Antibiotics (at least two classes) 0 0 0
(b) Anti-parasitics 0 0 0
(c) Anti-tetanus vaccines and immunoglobulins 0 0 0
(d) Anti-malaria medicines, carriage shall be dependent upon operational area 0 0 0
1.8. Compounds promoting rehydration, caloric intake and plasma expansion 0 0 0
1.9. Medicines for external use
(a) Skin medicines 0 0 0
— Antiseptic solutions 0 0 0
— Antibiotic ointments 0 0 0
— Anti-inflammatory and analgesic ointments 0 0 0
— Burn preparations 0 0 0
(b) Eye medicines 0 0 0
— Antibiotic and anti-inflammatory 0 0 0
— Anaesthetic drops 0 0 0
— Saline solution for eyewash 0 0 0
— Hypotonic myotic drops 0 0 0
(c) Ear medicines 0 0 0
— Anaesthetic and anti-inflammatory solutions 0 0 0
(d) Medicines for oral and throat infections 0 0 0
— Antiseptic mouthwashes 0 0 0
(e) Local anaesthetics 0 0 0
— Local anaesthetics given by subcutaneous injection 0 0 0
2. MEDICAL EQUIPMENT
2.1 Resuscitation equipment
— Ambu bag (or equivalent); supplied with large, medium and small masks 0 0 0
— Appliance for the administration of oxygen with pressure-reducing valve such that ship’s industrial oxygen can be used, or oxygen container a 0 0 0
— Mechanical aspirator to clear upper respiratory passages 0 0 0
2.2. Dressing and suturing equipment
— Tourniquets 0 0 0
— Disposable suture stapler or suture kit with needles 0 0 0
— Adhesive elastic bandage 0 0 0
— Gauze strips 0 0 0
— Sterile gauze compresses 0 0 0
— Sterile sheet for burns victims 0 0 0
— Triangular sling 0 0 0
— Disposable gloves 0 0 0
— Adhesive dressings 0 0 0
— Sterile compression bandages 0 0 0
— Adhesive sutures or zinc oxide bandages 0 0 0
— Vaseline gauze 0 0 0
2.3. Instruments
— Instrument box made of suitable material 0 0 0
— Scissors 0 0 0
— Dissecting forceps 0 0 0
— Haemostatic clamps 0 0 0
2.4. Examination and monitoring equipment 0 0 0
— Disposable tongue depressors 0 0 0
— Medical evacuation sheets 0 0 0
— Stethoscope 0 0 0
— Sphygmomanometer 0 0 0
— Medical thermometer 0 0 0
— Hypothermic thermometer 0 0 0
— Quick malaria test, carriage shall be dependent upon operational area 0 0 0
2.5. Equipment for injection, perfusion, puncture and catheterisation 0 0 0
— Intravenous infusion set 0 0 0
— Disposable syringes and needles 0 0 0
2.6. General medical equipment 0 0 0
— Personal protective medical and nursing equipment 0 0 0
2.7. Immobilisation and setting equipment 0 0 0
— Set of splints of different sizes for the extremities 0 0 0
— Collar for neck immobilisation 0 0 0
3. ANTIDOTES
3.1. General 0 0 0
3.2. Cardio-vascular 0 0 0
3.3. Gastro-intestinal system 0 0 0
3.4. Nervous system 0 0 0
3.5. Respiratory system 0 0 0
3.6. Anti-infective 0 0 0
3.7. For external use 0 0 0
3.8. Other 0 0 0
3.9. Necessary for the administration of oxygen (including maintenance requisites) 0 0 0

Venue and date: …

Captain’s signature: …

Authorisation by competent person or authority: …]