Maritime health in Spain: integrated services are the key.

The maritime occupational health services in Spain are overviewed, and their coordination for seafarers and fishermen within the integrated governmental "Maritime Health Programme", which as from 1984 has been supervised by the Labour and Social Affairs Ministry. The institution in charge is the "Instituto Social de la Marina" (ISM) in Madrid (Mariners' Social Institute) established in 1919, which has organised a network of specialised health institutions in ports. They provide medical assistance on board ships and coastal preventive services for maritime workers. There is the Radio Medical Advice Centre in Madrid, local centres in ports, centres abroad, hospital ships and a repatriation centre. All of them are connected in a centralised database net of shared medical records in a confidential computerised system. Another institution is "Sanidad Exterior" which is related to vaccinations and hygienic problems in harbours. There is also a non profit national scientific medical organisation, the Spanish Society of Maritime Medicine (SEMM) established in 1989, and another society of Naval Medicine founded in 1995. There are also groups of specialists in underwater medicine and health problems of divers. A separate article is published on the SEMM and its activities.