Introduction:
A guideline for specificities/needs of medical operations in expedition vessels is being developed in the European project Healthy Sailing¹, a research/innovation action aiming to prevent, mitigate and manage infections in large passenger ships.

Methods:
The new guideline is based on the: ILO/IMO Regulations Maritime Labor Convention 2006, WHO Handbook for inspection of ships and issuance of ship sanitation certificate², EU SHIPSAN Manual³, previous guidelines^4,5 and international reference documents for ashore hospitals⁶. The development proceeded in light of our experience gained in the authorization of medical facilities of new Italian cruise ships/ferries ⁷.

Results:
The guideline layout includes 1) medical services 2) health services plan; 3) health staff (consistency, qualifications, training and skills); 4) layout/physical design; 5) equipment and laboratory testing capability; 6) telemedical assistance; 7) medicines 8) preparedness and readiness (contingency plan and reserve emergency facility); 9) public health; 10) quality system, clinical risk management; 11) customer satisfaction and complaints management; 12) prevention and occupational medicine for crew; 13) medico legal practice; 14) medical SPA and dialysis); 15) use of environmental resources; 16) authorization process, periodic audits, grade. The guideline will be pilot tested on board over six months in collaboration with ship companies.

Conclusion:
Innovative points of this guideline include: A) global view of the medical facilities (three pillars model): which must provide quality medical care, effective actions to prevent the spread of communicable diseases and occupational/preventive medicine for crew. B) transition from a static planning of requirements to a flexible model according to “what if scenarios” C) complementary services; D) authorization process proceeding in a collaborative way from the design phase through shipyard until sea operations; E) quality and clinical risk management system. This draft will be continually reviewed, updated, and expanded with the contribution of all stakeholders. Readers are encouraged to provide feedback and contribute material for further updates.