Operational Guide · Registers & Logbooks

# The Onboard Medical Centre: Between MLC and Voluntary Standards

A licensed doctor and at least two nurses: not a commercial choice by cruise companies, but the minimum medical staffing required on board, available around the clock even just to stabilise an emergency until disembarkation.

medical centre MLC Regulation 4.1 CVSSA ACEP

## Operational Explanation

The onboard medical centre of passenger ships operates within a regulatory framework structured across several levels. Regulation 4.1 of the MLC 2006 (Maritime Labour Convention) sets out the general obligation of medical care on board and ashore for all seafarers, including the ship's own personnel. For ships operating to/from US ports, the US Coast Guard has verified since 2010 the compliance of medical centres with the Cruise Vessel Security and Safety Act (CVSSA).

On the clinical operating standards side, the cruise industry largely follows, on a voluntary but effectively well-established basis, the guidelines published by the American College of Emergency Physicians (ACEP): a framework not legally binding but widely adopted as a practical reference. The commonly expected minimum staffing is a licensed doctor and at least two licensed nurses, with the medical centre operating around the clock to treat routine medical conditions and begin stabilising more serious conditions pending disembarkation.

## Regulatory Reference

MLC 2006, Regulation 4.1: general obligation of medical care on board and ashore for seafarers. CVSSA (United States, since 2010): USCG verification of medical centre compliance for ships operating to/from US ports. ACEP guidelines (American College of Emergency Physicians): reference clinical operating standards followed on a voluntary basis by the cruise industry, not legally binding but widely adopted.

## Scope of Application

Every passenger ship with an onboard medical centre; specific USCG verification for ships operating to/from US ports per the CVSSA.

## Procedure / How to Complete It

1. Verify that the onboard medical centre has the expected minimum staff (a licensed doctor, at least two licensed nurses) and operates around the clock.
2. Maintain documentation of compliance with the ACEP guidelines as a reference for the medical centre's clinical operating standards.
3. For ships subject to CVSSA, prepare medical centre compliance documentation for USCG verification before calls at US ports.
4. Ensure the medical centre has the equipment needed to treat routine conditions and begin stabilising more serious conditions pending disembarkation.
5. Coordinate medical centre procedures with the gastrointestinal outbreak management plan and other onboard health procedures.

## Practical Example

Example: the Company of a cruise ship also intended for US port calls verifies, before entry into service, that the medical centre has the required minimum staff, documents compliance with the ACEP guidelines for clinical operating standards, and prepares the documentation needed for USCG verification relating to the CVSSA.

## Real Cases

The voluntary-but-effectively-binding framework of the ACEP guidelines reflects a distinctive feature of the industry: in the absence of a specific, detailed international IMO standard on onboard medical centres for passenger ships, the industry has converged on a shared clinical reference published by a scientific society, filling a regulatory gap with an industry consensus.

## Common Mistakes Mistake Library

Mistake | Consequence | How to avoid it
--- | --- | ---
Medical centre clinical operating standards not aligned with the industry-reference ACEP guidelines | Medical centre below the de facto industry-expected standard, even in the absence of a specific legal obligation | Align the medical centre's clinical operating standards with the ACEP guidelines as the industry reference
Medical centre CVSSA compliance documentation not updated before a call at a US port | Non-compliance detectable in a USCG inspection | Always keep the medical centre's CVSSA compliance documentation up to date for ships with scheduled US calls

## PSC Observations

The US Coast Guard verifies medical centre compliance with the CVSSA for ships calling at US ports; outside this context, the medical centre is not typically subject to direct PSC verification under the Paris/Tokyo MOU, but remains subject to MLC verification.

## Operational Tips

- Do not treat the ACEP guidelines as optional just because they are not legally binding: they are effectively the standard expected by the industry.
- Coordinate medical centre procedures with gastrointestinal outbreak management procedures: they are distinct but operationally linked functions.
- If the ship has even a single scheduled US call, still maintain the medical centre's CVSSA compliance documentation.

## Checklist

- Minimum medical centre staff (one doctor, at least two licensed nurses) present and operating around the clock
- Clinical operating standards aligned with the reference ACEP guidelines
- CVSSA compliance documentation up to date for ships with US calls
- Equipment for treating routine conditions and stabilising serious conditions available
- Coordination between the medical centre and gastrointestinal outbreak management procedures defined

## FAQ

What is the minimum staffing typically expected in a cruise ship medical centre?
A licensed doctor and at least two licensed nurses, with the medical centre operating around the clock.
Are the ACEP guidelines legally mandatory?
No, they are voluntary clinical operating standards published by the American College of Emergency Physicians, but widely adopted as a de facto reference by the cruise industry.
Who verifies the medical centre's compliance with the CVSSA?
The US Coast Guard (USCG), for ships operating to/from United States ports.
🎬 Additional photos, videos and interactive diagrams for this topic will be available in a future version of the platform.

## Related Topics

Managing a Gastrointestinal Outbreak on Board Cabin Safety: Stateroom Security Requirements under the CVSSA

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