Well then, the CIRM is a little virtual hospital having an action range the utmost wide: all the world seas. In the seat of Rome there's only the physician and the radio operator, while the assisted are far thousands miles and it's impossible the direct contact between physician and patient. Among the diagnostic observations and the therapeutic actions there must be a third person, in general the ship's master that interacts between the two parties. By the means of the satellite communications there's the immediate contact with the ship requiring assistance for an ill or injured person, at any moment, day or night, having no problem concerning distance. The radio contact with ships is carried out by the means of written messages (telex or fax) in 60% cases or by radiotelephony, voice, in 40%. Advantages of the written communication are: a higher precision in listing symptoms, therapeutic prescription and mainly a lower cost of transmission (Immarsat C). The radiotelephony communication is charged instead with higher cost, by the direct talk between the ship's master and the CIRM's physician allows clearing better and quicker the clinic and diagnostics aspects of the disease (or accident). New ship-earth communication techniques have been studied and experimented, as video-conferences, fix and moving images transmissions, electrocardiograms transmission and other instrumental clinic tests as spirometry, oxymetry and others, but it has not been yet reached the real employ of them on ships, even if instruments are already reliable and have got through the experimental phase.
The administrable therapy on board is only of medical kind, never a surgery therapy, but eventual suture and wounds medication, and not always enough right conditions of safety are ensured for the ill or the victim of an accident. In those cases it comes into play the need to collaborate with bodies able to ensure aid in sea, the disembarkation and the admission in hospital of the ill. Since the sizeable part of the assisted by the CIRM are far from Italy, by the operative point of view the activities of international cooperation are indispensable for the emergency cases, to manage an imminent peril of life.

International cooperation within the medical emergencies in sea 

In this paper it has been examined the assistance carried out by the CIRM in the last 16 months, from January 1st 1998 to May 10th 1999, in favour of sailor on navigation, and setting apart the consultations required by airplane passengers, inhabitants of the little Italian islands and the moves between hospitals. In the mentioned period 1.283 sailors have been assisted.

1. The geographic areas of provenance of the applies for aid have been the following ones: 

- Mediterranean Sea:  323 - Atlantic Ocean: 565 - Indian Ocean: 259 - Pacific Ocean: 142

2. The most frequent pathologies have been (according to the international nosological classification, 9th revision)

- Accidents: 331 - Digestive tract diseases: 249 - Symptoms: 178: - Infective diseases: 59 - Circulatory systems diseases: 92 - Respiratory system diseases: 77 - Genitourinary tract diseases: 116 - Other pathologies: 181

3. Class of interventions carried out 
- Sole medical therapy on board: 938 - Change of course and disembarking: 213 - In Italy: 21 - In foreign ports: 192 - Air or ship aid: 132 - In Italy: 9 - In foreign ports: 123

4. Causes of diseases having required the sea aid 

- Accidents: 49 - Digestive tract diseases: 24 - Circulatory systems diseases: 18 - Others: 32

5. Nationality of the assisted ships 

- Italy: 410 - Europe (but Italy): 179 - Asia: 133 - Africa: 154 - Americas: 407

6. Results of the assistances 

- Recovered: 275 - Improved: 467 - Steady State: 360 - Worse: 20 - Dead: 34 - Without Information: 127

So for 75% sailors it's enough the sole radio medical consultation and the therapy administered on board, but it is also remarkable the number of disembarkations for health reasons and the sea aid operations. The sizeable part of operations happens far from Italy and also the disembarkation of the assisted happens often in foreign ports. It must take into account always the possibilities of aid and disembarkation in specific geographic area and the care the ship's mastery takes of the components of the crew.

Bodies cooperating for the sea aid activities. 

Data show how much it is necessary to have on disposal a connection net able to ensure timely interventions of aid in remote areas, when the sole radio medical aid consultation and the therapy administrable on board are not enough. Some requirements are needed and indispensable in order to have on disposal a system all times in activity and ready to intervene in short times. First of all there must be direct connections (phone, fax and telex) preventing waiting times. It's needed the same the direct acknowledgment of the cooperating institutions in order to prevent any bureaucratic obstacle. CIRM's physicians carry out a test to the patients, virtual kind and remote, so the clinic evaluation has evident limits, but the aid body must entrust anyhow the requirement done. The institution the CIRM has steady collaboration with are: 

Medical Bodies: 

Instituto Social de la Marina - Madrid Spain; Spanish Coasts, Canary Islands; Western Sahara Coasts (ship Esperanza del Mar); Centre de Consultation Medical Maritime - Toulouse France; French Coasts, Mediterranean sea and Atlantic; Instituto Nacional de Emergência Médica - Lisbon - Portugal; Portuguese Coasts, Madeira and Azores; Radio Medical Centre Hellenic Red Cross - Athens Greece; Aegean Sea; Gibraltar Medical Centre - Gibraltar UK; Ships way through the Strait

Aid bodies: 

Italian Harbour Offices and Coastguards international coordination; Italian Air Force - SAR Groups; Mediterranean areas, North-East Atlantic, the North Sea; United States Coast Guard (U.S.C.G.); Norfolk (North Atlantic); Alameda (Pacific); Guam (Pacific); Diego Garcia (Indian)

International Cooperation for research and development 

The CIRM is a little body carrying on his own activity in a very wide area by the geographical point of view and technological too, research and development. It's necessary to ensure permanent updating in the field of the maritime medicine, telecommunications and informatics so the CIRM must promote and follow development in telemedicine. We have assisted to a complete change in the communication ship-to-land over past ten years, for the CIRM is permanent contact with the international institutions and works to training or research and develop projects. 

International Organisms:

European Community; World Health Organization (W.H.O.); International Labour Organization (I.L.O.); Maritime International Organization (I.M.O.)

Medical Institutions:

Instituto Social de la Marina - Madrid, Spain; Centre de Consultation Medical Maritime - Toulouse France; Instituto Nacional de Emêrgencia Médica - Lisbon Portugal; Radio Medical Centre Hellenic Red Cross - Athens Greece; Gibraltar Medical Centre - Gibraltar UK; Institute of Maritime and Tropical Medicine - Gdynia Poland; University of Wales, Seafarers International Research Centre - Cardiff UK; University Hospital - Reykjavik Island; University Hospital - Turku Finland; Medical Advice Centre - Esbjerg Denmark

International Projects: 

MAC-NET - Medical Advice Centre Network (training project); GETS - Global Emergency Telemedicine Service (feasibility study); WETS -World Emergency Telemedicine Service (pilot project)

International Cooperation Perspectives. 

The CIRM carries out traditional kind medic care, lying essentially over clinics and semeiotic, in the least part over instrumental tests, but lies its activity over advanced technologies as telecommunications and informatics, that are essential for consulting for radio medical care. For the CIRM is basic to partner international cooperation: integration projects with other medical radio centres; telemedicine research and development projects; collaboration projects with international institutions; 
training projects for physicians, telecommunications operators, Sailors, Fishers, Yachters, Courses and Seminars, radio medical assistance simulation, Teledidactics