VI.03 CM · Cap. 5 — Medical Section and Appendices

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1. Overview and General Instructions

Source: International Maritime Organization. International Code of Signals. London: IMO, 2005 — Medical section (Instructions; I Request for medical assistance, capítulos 1 a 7) e Apêndices 1 (Distress signals), 2 (Table of signalling flags) e 4 (Radiotelephone procedures).

Syllabus: Anexo 2-B recorta os Capítulos I a V, VII, VIII, X, XI, XII, a Seção Geral, a Seção Médica (Request for medical assistance) e os Apêndices 1, 2 e 4 · Anexo 2-A, item VI Comunicações — VI.3.1 Bandeiras e flâmulas internacionais; VI.3 Seção Médica (Instructions) – Request for medical assistance.

A ship without a doctor aboard, or without a language in common with the ship or coast station that has one, still has to describe a patient precisely enough for someone else to prescribe. The Medical section turns that description into fixed three-letter groups the size of MFE, alone or followed by a numeral complement as in MTQ 8 — a coded request loses nothing a plain-language message would carry, and gains a channel that survives poor radio conditions and no shared vocabulary.

"Medical advice should be sought and given in plain language whenever it is possible but, if language difficulties are encountered, this Code should be used." "Even when plain language is used, the text of the Code and the instructions should be followed as far as possible."

Three procedure signals sit outside the Medical section itself but govern how every group in it can be bent to a yes, a no or a question: C, N (or NO) and RQ, appended after the main group.

Suffix	Effect on the main group	Worked example
C	turns the group affirmative	—
N or NO	turns the group negative	MFE N = "Bleeding is not severe."
RQ	turns the group interrogative	MFE RQ = "Is bleeding severe?"

The complements this cut keeps referring to — Table M1 (regions of the body), Table M2 (diseases) and Table M3 (medicaments) — are printed later in the same Code section (pp. 152-162) but fall outside this chapter's syllabus cut. Every group below that calls for one keeps the parenthetical exactly as the source prints it (". . . (Table M1)", etc.) without inventing what the table would say.

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2. Instructions to Masters — Standard Method of Case Description

Before coding anything, the master should make a careful examination of the patient and should try to collect, as far as possible, information covering six subjects, in the order the Instructions print them — the same order chapters 2 through 6 (and, on the advice side, chapter 9) follow inside the Medical section.

2.1 Standard method of case description

#	Subject	Where it is coded
.1	Description of the patient	Chapter 2, page 132
.2	Previous health	Chapter 3, page 132
.3	Localization of symptoms, diseases or injuries	Chapter 4, page 132
.4	General symptoms	Chapter 5, page 133
.5	Particular symptoms	Chapter 6, page 136
.6	Diagnosis	Chapter 9, page 146

This information should be coded by choosing the appropriate groups from the corresponding chapters, and it would help the recipients of the signal if it is transmitted in the order stated above.

Chapter 1 (page 131) contains signals that can be used independently — with or without the rest of the case description.

Once a reply from the doctor has been received and its instructions followed, the master can give a progress report using signals from chapter 7 (page 145, section 8 below).

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3. Instructions to Doctors — Worked Examples

The Instructions close with the doctor's side of the exchange and, immediately after, two full worked cases. The doctor's-side chapters named here (8 through 12, all under "II Medical advice") sit outside this chapter's cut; only the worked examples the Instructions print are reproduced.

3.1 Steps and worked examples

Step	What it is for	Worked example
1	Ask for more information (chapter 8)	MQB = "I cannot understand your signal; please use standard method of case description".
2	Diagnosis (chapter 9)	MQE 26 = "My probable diagnosis is cystitis".
3	Prescribing, which should be limited to the List of medicaments	—
4	Special treatment (chapter 10)	MRP 4 = "Apply ice-cold compress and renew every 4 hours".
5.1	Prescribing a medicament — the medicament itself (chapter 11.1 + Table M3)	MTD 32 = "You should give aspirin tablets".
5.2	Prescribing a medicament — method of administration and dose (chapter 11.2)	MTI 2 = "You should give by mouth 2 tablets/capsules".
5.3	Prescribing a medicament — frequency of the dose (chapter 11.3)	MTQ 8 = "You should repeat every 8 hours".
6	Frequency of external applications (chapter 11.4)	MTU 4 = "You should apply every 4 hours".
7	Diet advice (chapter 12)	MUC = "Give water only in small quantities".

Two full cases close the Instructions, request and reply set side by side exactly as printed.

3.2 Case One

Request for medical assistance — "I have a male age (44) years. Patient has been ill for (2) days. Patient has suffered from (bronchitis (acute)). Onset was sudden. Patient is delirious. Patient has fits of shivering. Temperature taken in mouth is (40). Pulse rate per minute is (110). The rate of breathing per minute is (30). Patient is in pain (chest). Part of the body affected is right (chest). Pain is increased on breathing. Patient has severe cough. Patient has bloodstained sputum. Patient has been given (penicillin injection) without effect. Patient has received treatment by medicaments in last (18) hours. My probable diagnosis is (pneumonia)."

Medical advice — "Your diagnosis is probably right. You should continue giving (penicillin injection). You should repeat every (12) hours. Put patient to bed lying down at absolute rest. Keep patient warm. Give fluid diet, milk, fruit juice, tea, mineral water. Give water very freely. Refer back to me in (24) hours or before if patient worsens."

3.3 Case Two

Request for medical assistance — "I have a male aged (31) years. Patient has been ill for (3) hours. Patient has had no serious previous illness. Pulse rate per minute is (95). Pulse is weak. Patient is sweating. Patient is in pain in lumbar (kidney) region. The part affected is left lumbar (kidney) region. Pain is severe. Pain is increased by hand pressure. Bowels are regular."

Request for additional information — "I cannot make a diagnosis. Please answer the following question(s). Temperature taken in mouth is (number). Pain radiates to groin and testicle. Patient has pain on passing water. Urinary functions normal. Vomiting is present."

Additional information — "Temperature taken in mouth is (37). Pain radiates to groin and testicle. Patient has pain on passing water. Patient is passing small quantities of urine frequently. Vomiting is absent. Patient has nausea."

Medical advice — "My probable diagnosis is (kidney stone (renal colic)). You should give morphine injection. You should give by subcutaneous injection (15) milligrams. Give water freely. Apply hot water bottle to lumbar (kidney) region. Patient should be seen by doctor when next in port."

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4. Chapter 1 — Request: General Information

Chapter 1 opens "I Request for medical assistance" proper. Its first six groups (MAA-MAF) are the request's own vocabulary — urgency, rendez-vous, hospital admission, distance from port. The rest of the table borrows groups from elsewhere in the Code (single and double letters, some with numeral complements) because they answer the same question: is a doctor needed, and how does help get there.

Signal	Meaning
MAA	I request urgent medical advice.
MAB	I request you to make rendez-vous in position indicated.
MAC	I request you to arrange hospital admission.
MAD	I am . . . (indicate number) hours from nearest port.
MAE	I am converging on nearest port.
MAF	I am moving away from nearest port.
W	I require medical assistance.
AL	I have a doctor on board.
AM	Have you a doctor?
AN	I need a doctor.
AN 1	I need a doctor; I have severe burns.
AN 2	I need a doctor; I have radiation casualties.
BR 2	I require a helicopter urgently with a doctor.
BR 3	I require a helicopter urgently to pick up injured/sick person.
BT 2	Helicopter is coming to you now (or at time indicated) with a doctor.
BT 3	Helicopter is coming to you now (or at time indicated) to pick up injured/sick person.
AQ	I have injured/sick person (or number of persons indicated) to be taken off urgently.
BS	You should send a helicopter/boat with a stretcher.
BU	A helicopter/boat is coming to take injured/sick.
AT	You should send injured/sick persons to me.

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5. Chapters 2–4 — Description, Previous Health, Localization

These three short chapters fix the patient before any symptom is coded: who they are (chapter 2), what came before (chapter 3), and where on the body the complaint sits (chapter 4).

5.1 Chapter 2 — Description of patient

Signal	Meaning
MAJ	I have a male aged . . . (number) years.
MAK	I have a female aged . . . (number) years.
MAL	I have a female . . . (number) months pregnant.
MAM	Patient has been ill for . . . (number) days.
MAN	Patient has been ill for . . . (number) hours.
MAO	General condition of the patient is good.
MAP	General condition of the patient is serious.
MAQ	General condition of the patient is unchanged.
MAR	General condition of the patient has worsened.
MAS	Patient has been given . . . (Table M3) with effect.
MAT	Patient has been given . . . (Table M3) without effect.
MAU	Patient has received treatment by medicaments in last . . . (indicate number) hours.

5.2 Chapter 3 — Previous health

Signal	Meaning
MBA	Patient has suffered from . . . (Table M2).
MBB	Patient has had previous operation . . . (Table M2).
MBC	Patient has had no serious previous illness.
MBD	Patient has had no relevant previous injury.

5.3 Chapter 4 — Localization of symptoms, diseases or injuries

Signal	Meaning
MBE	The whole body is affected.
MBF	The part of the body affected is . . . (Table M1).
*MBG	The part of the body affected is right . . . (Table M1).
*MBH	The part of the body affected is left . . . (Table M1).

* MBG and MBH are the exception to plain MBF: they exist only for the cases where the right/left side of the body or limb needs to be told apart.

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6. Chapter 5 — General Symptoms

Chapter 5 is the vital-signs chapter: onset, then temperature, pulse, breathing, sweating, mental state, pain, and a run of single-organ symptoms (cough, bowels, vomiting, urine, bleeding, rash, swelling), each grouped under its own heading exactly as the Code prints them.

Signal	Meaning
MBP	Onset was sudden.
MBQ	Onset was gradual.

6.1 Temperature

Signal	Meaning
MBR	Temperature taken in mouth is . . . (number).
MBS	Temperature taken in rectum is . . . (number).
MBT	Temperature in the morning is . . . (number).
MBU	Temperature in the evening is . . . (number).
MBV	Temperature is rising.
MBW	Temperature is falling.

6.2 Pulse

Signal	Meaning
MBX	The pulse rate per minute is . . . (number).
MBY	The pulse rate is irregular.
MBZ	The pulse rate is rising.
MCA	The pulse rate is falling.
MCB	The pulse is weak.
MCC	The pulse is too weak to count.
MCD	The pulse is too rapid to count.

6.3 Breathing

Signal	Meaning
MCE	The rate of breathing per minute is . . . (number) (in and out being counted as one breath).
MCF	The breathing is weak.
MCG	The breathing is wheezing.
MCH	The breathing is regular.
MCI	The breathing is irregular.
MCJ	The breathing is strenuous (noisy).

6.4 Sweating

Signal	Meaning
MCL	Patient is sweating.
MCM	Patient has fits of shivering (chills).
MCN	Patient has night sweats.
MCO	Patient's skin is hot and dry.
MCP	Patient is cold and clammy.

6.5 Mental state and consciousness

Signal	Meaning
MCR	Patient is conscious.
MCT	Patient is semi-conscious but can be roused.
MCU	Patient is unconscious.
MCV	Patient found unconscious.
MCW	Patient appears to be in a state of shock.
MCX	Patient is delirious.
MCY	Patient has mental symptoms.
MCZ	Patient is paralysed . . . (Table M1).
MDC	Patient is restless.
MDD	Patient is unable to sleep.

6.6 Pain

Signal	Meaning
MDF	Patient is in pain . . . (Table M1).
MDG	Pain is a dull ache.
MDJ	Pain is slight.
MDL	Pain is severe.
MDM	Pain is intermittent.
MDN	Pain is continuous.
MDO	Pain is increased by hand pressure.
MDP	Pain radiates to . . . (Table M1).
MDQ	Pain is increased on breathing.
MDR	Pain is increased by action of bowels.
MDT	Pain is increased on passing water.
MDU	Pain occurs after taking food.
MDV	Pain is relieved by taking food.
MDW	Pain has no relation to taking food.
MDX	Pain is relieved by heat.
MDY	Pain has ceased.

6.7 Cough

Signal	Meaning
MED	Cough is present.
MEF	Cough is absent.

6.8 Bowels

Signal	Meaning
MEG	Bowels are regular.
MEJ	Patient is constipated and bowels last opened . . . (indicate number of days).
MEL	Patient has diarrhoea . . . (indicate number of times daily).

6.9 Vomiting

Signal	Meaning
MEM	Vomiting is present.
MEN	Vomiting is absent.
MEO	Patient has nausea.

6.10 Urine

Signal	Meaning
MEP	Urinary functions normal.
MEQ	Urinary functions abnormal.

6.11 Bleeding

Signal	Meaning
MER	Bleeding is present . . . (Table M1).
MET	Bleeding is absent.

6.12 Rash

Signal	Meaning
MEU	A rash is present . . . (Table M1).
MEV	A rash is absent.

6.13 Swelling

Signal	Meaning
MEW	Patient has a swelling . . . (Table M1).
MEX	Swelling is hard.
MEY	Swelling is soft.
MEZ	Swelling is hot and red.
MFA	Swelling is painful on hand pressure.
MFB	Swelling is discharging.
MFC	Patient has an abscess . . . (Table M1).
MFD	Patient has a carbuncle . . . (Table M1).

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7. Chapter 6 — Particular Symptoms

Chapter 6 is the longest of the Medical section: fifteen numbered groups of "particular symptoms," organised by body system, each carrying its own run of M-groups plus, wherever a symptom already coded earlier in the section applies again, a cross-reference back to that same group rather than a new one.

7.1 6.1 Accidents, injuries, fractures, suicide and poisons

Signal	Meaning
MER	Bleeding is present . . . (Table M1).
MFE	Bleeding is severe.
MFF	Bleeding is slight.
MFG	Bleeding has been stopped by pad(s) and bandaging.
MFH	Bleeding has been stopped by tourniquet.
MFI	Bleeding has stopped.
MFJ	Bleeding cannot be stopped.
MFK	Patient has a superficial wound . . . (Table M1).
MFL	Patient has a deep wound . . . (Table M1).
MFM	Patient has penetrating wound . . . (Table M1).
MFN	Patient has a clean-cut wound . . . (Table M1).
MFO	Patient has a wound with ragged edges . . . (Table M1).
MFP	Patient has a wound discharging . . . (Table M1).
MFQ	Patient has contusion (bruising) . . . (Table M1).
MFR	Wound is due to blow.
MFS	Wound is due to crushing.
MFT	Wound is due to explosion.
MFU	Wound is due to fall.
MFV	Wound is due to gun-shot.
MFW	Patient has a foreign body in wound.
MFX	Patient is suffering from concussion.
MFY	Patient cannot move the arm . . . (Table M1).
MFZ	Patient cannot move the leg . . . (Table M1).
MGA	Patient has dislocation . . . (Table M1).
MGB	Patient has simple fracture . . . (Table M1).
MGC	Patient has compound fracture . . . (Table M1).
MGD	Patient has comminuted fracture . . . (Table M1).
MGE	Patient has attempted suicide.
MGF	Patient has cut throat.
MGG	Patient has superficial burn . . . (Table M1).
MGH	Patient has severe burn . . . (Table M1).
MGI	Patient is suffering from non-corrosive poisoning (no staining and burning of mouth and lips).
MGJ	Patient has swallowed corrosive (staining and burning of mouth and lips).
MGK	Patient has swallowed unknown poison.
MGL	Patient has swallowed a foreign body.
MGM	Emetic has been given with good results.
MGN	Emetic has been given without good results.
MGO	No emetic has been given.
MGP	Patient has had corrosive thrown on him . . . (Table M1).
MGQ	Patient has inhaled poisonous gases, vapours, dust.
MGR	Patient is suffering from animal bite . . . (Table M1).
MGS	Patient is suffering from snake bite . . . (Table M1).
MGT	Patient is suffering from gangrene . . . (Table M1).

7.2 6.2 Diseases of nose and throat

Signal	Meaning
MGU	Patient has nasal discharge.
MGV	Patient has foreign body in nose.
MHA	Lips are swollen.
MHB	Tongue is dry.
MHC	Tongue is coated.
MHD	Tongue is glazed and red.
MHF	Tongue is swollen.
MHG	Patient has ulcer on tongue.
MHJ	Patient has ulcer in mouth.
MHK	Gums are sore and bleeding.
MHL	Throat is sore and red.
MHM	Throat has pinpoint white spots on tonsils.
MHN	Throat has grey white patches on tonsils.
MHO	Throat hurts and is swollen on one side.
MHP	Throat hurts and is swollen on both sides.
MHQ	Swallowing is painful.
MHR	Patient cannot swallow.
MHT	Patient has hoarseness of voice.
MGL	Patient has swallowed a foreign body.
MHV	Patient has severe toothache.

7.3 6.3 Diseases of respiratory system

Signal	Meaning
MHY	Patient has pain in chest on breathing . . . (Table M1).
MCG	Breathing is wheezing.
MHZ	Breathing is deep.
MIA	Patient has severe shortness of breath.
MIB	Patient has asthmatical attack.
MEF	Cough is absent.
MIC	Patient has severe cough.
MID	Cough is long-standing.
MIF	Patient is coughing up blood.
MIG	Patient has no sputum.
MIJ	Patient has abundant sputum.
MIK	Sputum is offensive.
MIL	Patient has blood-stained sputum.
MIM	Patient has blueness of face.

7.4 6.4 Diseases of the digestive system

Signal	Meaning
MIN	Patient has tarry stool.
MIO	Patient has clay-coloured stool.
MEL	Patient has diarrhoea . . . (indicate number of times daily).
MIP	Patient has diarrhoea with frequent stools like rice water.
MIQ	Patient is passing blood with stools.
MIR	Patient is passing mucus with stools.
MEO	Patient has nausea.
MIT	Patient has persistent hiccough.
MIU	Patient has cramp pains and vomiting.
MEM	Vomiting is present.
MEN	Vomiting is absent.
MIV	Vomiting has stopped.
MIW	Vomiting is persistent.
MIX	Vomit is streaked with blood.
MIY	Patient is vomiting much blood.
MIZ	Vomit is dark (like coffee grounds).
MJA	Patient vomits any food and liquid given.
MJB	Amount of vomit is . . . (indicate in decilitres: 1 decilitre equals one-sixth of a pint).
MJC	Frequency of vomiting is . . . (indicate number) daily.
MJD	Patient has flatulence.
MJE	Wind has not been passed per anus for . . . (indicate number of hours).
MJF	Wind is being passed per anus.
MJG	Abdomen is distended.
MJH	Abdominal wall is soft (normal).
MJI	Abdominal wall is hard and rigid.
MJJ	Abdominal wall is tender . . . (Table M1).
MDF	Patient is in pain . . . (Table M1).
MEW	Patient has a swelling . . . (Table M1).
MJK	Hernia is present.
MJM	Hernia cannot be replaced.
MJN	Hernia is painful and tender.
MJO	Patient has bleeding haemorrhoids.
MJP	Haemorrhoids cannot be reduced (put back in place).

7.5 6.5 Diseases of the genito-urinary system

Signal	Meaning
MDF	Patient is in pain . . . (Table M1).
MJS	Patient has pain on passing water.
MJT	Patient has pain in penis at end of passing water.
MJU	Patient has pain spreading from abdomen to penis, testicles or thigh.
MJV	Patient is unable to hold urine (incontinent).
MJW	Patient is unable to pass urine.
MJX	Patient is passing small quantities of urine frequently.
MJY	Amount of urine passed in 24 hours . . . (indicate number in decilitres: 1 decilitre equals one-sixth of a pint).
MEP	Urinary functions normal.
MKA	Urine contains albumen.
MKB	Urine contains sugar.
MKC	Urine contains blood.
MKD	Urine is very dark brown.
MKE	Urine is offensive and may contain pus.
MKF	Penis is swollen.
MKH	Foreskin will not go back to normal position.
MKI	Patient has swelling of testicles.
MKJ	Shall I pass a catheter?
MKK	I have passed a catheter.
MKL	I am unable to pass a catheter.

7.6 6.6 Diseases of the nervous system and mental diseases

Signal	Meaning
MKP	Patient has headache . . . (Table M1).
MKQ	Headache is throbbing.
MKR	Headache is very severe.
MKS	Head cannot be moved forwards to touch chest.
MKT	Patient cannot feel pinprick . . . (Table M1).
MKU	Patient is unable to speak properly.
MKV	Giddiness (vertigo) is present.
MCZ	Patient is paralysed . . . (Table M1).
MCR	Patient is conscious.
MCT	Patient is semi-conscious but can be roused.
MCU	Patient is unconscious.
MKW	Pupils are equal in size.
MKX	Pupils are unequal in size.
MKY	Pupils do not contract in a bright light.
MKZ	Patient has no control over his bowels.
MLA	Patient has fits associated with rigidity of muscles and jerking of limbs - indicate number of fits per 24 hours.
MCY	Patient has mental symptoms.
MLB	Patient has delusions.
MLC	Patient is depressed.
MCX	Patient is delirious.
MLD	Patient is uncontrollable.
MGE	Patient has attempted suicide.
MLE	Patient has had much alcohol.
MLF	Patient has delirium tremens.
MLG	Patient has bedsores . . . (Table M1).

7.7 6.7 Diseases of the heart and circulatory system

Signal	Meaning
MDF	Patient is in pain . . . (Table M1).
MLH	Pain has been present for . . . (indicate number of minutes).
MLI	Pain in chest is constricting in character.
MLJ	Pain is behind the breastbone.
MDP	Pain radiates to . . . (Table M1).
MIM	Patient has blueness of face.
MLK	Patient has pallor.
MCE	The rate of breathing per minute is . . . (number) (in and out being counted as one breath).
MCB	The pulse is weak.
MBY	The pulse rate is irregular.
MCC	The pulse is too weak to count.
MCD	The pulse is too rapid to count.
MLL	Breathing is difficult when lying down.
MLM	Swelling of legs that pits on pressure.
MLN	Patient has varicose ulcer.

7.8 6.8 Infectious and parasitic diseases

Signal	Meaning
MLR	Rash has been present for . . . (indicate number of hours).
MLS	Rash first appeared on . . . (Table M1).
MLT	Rash is spreading to . . . (Table M1).
MLU	Rash is fading.
MLV	Rash is itchy.
MLW	Rash is not itchy.
MLX	Rash looks like general redness.
MLY	Rash looks like blotches.
MLZ	Rash looks like small blisters containing clear fluid.
MMA	Rash looks like larger blisters containing pus.
MMB	Rash is weeping (oozing).
MMC	Rash looks like weals.
MMD	Rash consists of rose-coloured spots that do not blench on pressure.
MME	Skin is yellow.
MFC	Patient has an abscess . . . (Table M1). [cross-reference to the group printed with this same wording in chapter 5, "Swelling"]
MMF	Patient has buboes . . . (Table M1).
MMJ	Patient has been isolated.
MMK	Should patient be isolated?
MML	I have had (indicate number) similar cases.
MIP	Patient has diarrhoea with frequent stools like rice water.

7.9 6.9 Venereal diseases (see also Diseases of genito-urinary system)

Signal	Meaning
MMP	Patient has discharge from penis.
MMQ	Patient has previous history of gonorrhoea.
MMR	Patient has single hard sore on penis.
MMS	Patient has multiple sore on penis.
MMF	Patient has buboes . . . (Table M1).
MMT	Patient has swollen glands in the groin.
MMU	End of penis is inflamed and swollen.

7.10 6.10 Diseases of the ear

Signal	Meaning
MDF	Patient is in pain . . . (Table M1).
MMW	Patient has boil in ear(s).
MMX	Patient has discharge of blood from ear(s).
MMY	Patient has discharge of clear fluid from ear(s).
MMZ	Patient has discharge of pus from ear(s).
MNA	Patient has hearing impaired.
MNB	Patient has foreign body in ear.
MKV	Giddiness (vertigo) is present.
MNC	Patient has constant noises in ear(s).

7.11 6.11 Diseases of the eye

Signal	Meaning
MDF	Patient is in pain . . . (Table M1).
MNG	Patient has inflammation of eye(s).
MNH	Patient has discharge from eye(s).
MNI	Patient has foreign body embedded in the pupil area of the eye.
MNJ	Eyelids are swollen.
MNK	Patient cannot open eyes (raise eyelids).
MNL	Patient has foreign body embedded in the white of the eye.
MNM	Patient has double vision when looking at objects with both eyes open.
MNN	Patient has sudden blindness in one eye.
MNO	Patient has sudden blindness in both eyes.
MKW	Pupils are equal in size.
MKX	Pupils are unequal in size.
MKY	Pupils do not contract in a bright light.
MFM	Patient has a penetrating wound . . . (Table M1).
MNP	Eye-ball is yellow in colour.

7.12 6.12 Diseases of the skin

The Code does not open a separate group for skin diseases here: it cross-refers the whole subject back to 6.8.

"See Infectious and parasitic diseases (chapter 6.8)."

7.13 6.13 Diseases of muscles and joints

Signal	Meaning
MNT	Patient has pain in muscles of . . . (Table M1).
MNU	Patient has pain in joint(s) . . . (Table M1).
MNV	Patient has redness and swelling of joint(s) (Table M1).
MNW	There is a history of recent injury.
MNX	There is no history of injury.

7.14 6.14 Miscellaneous illnesses

Signal	Meaning
MLE	Patient has had much alcohol.
MOA	Patient is suffering from heat exhaustion.
MOB	Patient is suffering from heat stroke.
MOC	Patient is suffering from seasickness.
MOD	Patient is suffering from exposure in lifeboat – indicate length of exposure (number) hours.
MOE	Patient is suffering from frostbite . . . (Table M1).
MOF	Patient has been exposed to radioactive hazard.

7.15 6.15 Childbirth

Signal	Meaning
MOK	I have a patient in childbirth aged . . . (number) years.
MOL	Patient states she has had . . . (number) children.
MOM	Patient states child is due in . . . (number) weeks.
MON	Pains began . . . (number) hours ago.
MOO	Pains are feeble and produce no effect.
MOP	Pains are strong and effective.
MOQ	Pains are occurring every . . . (number) minutes.
MOR	The bag of membranes broke . . . (number) hours ago.
MOS	There is severe bleeding from the womb.
MOT	The head is coming first.
MOU	The buttocks are coming first.
MOV	A foot has appeared first.
MOW	An arm has appeared first.
MOX	The child has been born.
MOY	The child will not breathe.
MOZ	The placenta has been passed.
MPA	The placenta has not been passed.
MPB	I have a non-pregnant woman who is bleeding from the womb.

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8. Chapter 7 — Progress Report

Chapter 7 closes the request side of the Medical section: once advice has been received and acted on, these fourteen groups report how the patient is responding, exactly as the Instructions describe in their fourth paragraph (section 2 above).

Signal	Meaning
MPE	I am carrying out prescribed instructions.
MPF	Patient is improving.
MPG	Patient is not improving.
MPH	Patient is relieved of pain.
MPI	Patient still has pain.
MPJ	Patient is restless.
MPK	Patient is calm.
MPL	Symptoms have cleared.
MPM	Symptoms have not cleared.
MPN	Symptoms have increased.
MPO	Symptoms have decreased.
MPP	Treatment has been effective.
MPQ	Treatment has been ineffective.
MPR	Patient has died.

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9. Appendix 1 — Distress Signals

Appendix 1 is prescribed by the International Regulations for Preventing Collisions at Sea, 1972, not authored by the Code itself: it is the list of signals that, used or exhibited together or separately, indicate distress and need of assistance.

9.1 The fifteen distress indications

Item	Signal
(a)	a gun or other explosive signal fired at intervals of about a minute
(b)	a continuous sounding with any fog-signalling apparatus
(c)	rockets or shells, throwing red stars fired one at a time at short intervals
(d)	a signal made by radiotelegraphy or by any other signalling method consisting of the group · · · - - - · · · (SOS) in the Morse Code
(e)	a signal sent by radiotelephony consisting of the spoken word "Mayday"
(f)	the International Code Signal of distress indicated by NC
(g)	a signal consisting of a square flag having above or below it a ball or anything resembling a ball
(h)	flames on the vessel (as from a burning tar barrel, oil barrel, etc.)
(i)	a rocket parachute flare or a hand flare showing a red light
(j)	a smoke signal giving off orange-coloured smoke
(k)	slowly and repeatedly raising and lowering arms outstretched to each side
(l)	the radiotelegraph alarm signal *
(m)	the radiotelephone alarm signal †
(n)	signals transmitted by emergency position-indicating radio beacons ‡
(o)	approved signals transmitted by radiocommunications systems

* A series of twelve four-second dashes with intervals of one second. † Two audio tones transmitted alternately at a frequency of 2200 Hz and 1300 Hz for a duration of 30 seconds to one minute. ‡ Either the signal described in † above or a series of single tones at a frequency of 1300 Hz.

9.2 Prohibition on misuse

"The use or exhibition of any of the foregoing signals except for the purpose of indicating distress and need of assistance and the use of other signals which may be confused with any of the above signals is prohibited."

9.3 IAMSAR cross-reference

The Appendix closes by drawing attention to the relevant section of the International Aeronautical and Maritime Search and Rescue Manual (IAMSAR Manual) Volume III – Mobile Facilities, and to two further signals, without folding them into the numbered list above:

Item	Aid
.1	a piece of orange-coloured canvas with either a black square and circle or other appropriate symbol (for identification from the air)
.2	a dye marker

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10. Appendix 2 — Table of Signalling Flags

Appendix 2 is the flag inventory that flag signalling, elsewhere in the Code, assumes as already known: the 26 alphabetical flags, the ten numeral pendants, the three substitutes, and the single code/answering pendant.

10.1 Alphabetical flags


A	H	O	V
B	I	P	W
C	J	Q	X
D	K	R	Y
E	L	S	Z
F	M	T
G	N	U

The plate of the alphabetical flags below fixes the colours and pattern behind each of the 26 letters.

10.2 Numeral pendants

Ten numeral pendants, one per digit 0-9, follow the alphabetical flags in the Appendix 2 plates. What a hoist does with them belongs to the Code's flag-signalling rules (pp. 11-12), outside this chapter's cut.

10.3 Substitutes

Three substitute pendants — First, Second and Third — are printed under that label, between the numeral pendants and the code and answering pendant. How a substitute is used inside a hoist belongs to the Code's flag-signalling rules (pp. 11-12), outside this chapter's cut.

10.4 Code and answering pendant

A single code and answering pendant closes the flag inventory, doing double duty as the mark that a hoist is coded by the Code and as the answering station's acknowledgement.

Mark as read

11. Appendix 4 — Radiotelephone Procedures

Appendix 4 is written as a card to keep by the radiotelephone: the name and call sign of the ship at the top, then how to recognise a safety message, the phonetic and figure-spelling tables needed to spell under pressure, and the distress-transmitting procedure itself.

11.1 Reception of safety messages

Any message heard prefixed by one of three words concerns safety:

Word	Meaning
MAYDAY (Distress)	Indicates that a ship, aircraft or other vehicle is threatened by grave and imminent danger and requests immediate assistance.
PAN PAN (Urgency)	Indicates that the calling station has a very urgent message to transmit concerning the safety of a ship, aircraft or other vehicle, or the safety of a person.
SÉCURITÉ (Safety)	Indicates that the station is about to transmit a message concerning the safety of navigation or giving important meteorological warnings.

"If you hear any of these words, pay particular attention to the message and call the master or the officer on watch."

11.2 Table 1 — Phonetic Alphabet and Figure Spelling

Table 1 (may be used when transmitting plain language or code) fixes one word and one stressed pronunciation per letter and per figure — the syllables to be emphasized are underlined in the source, and each syllable of the figure words should be equally emphasized.

Letter	Word	Pronounced as
A	Alfa	AL FAH
B	Bravo	BRAH VOH
C	Charlie	CHAR LEE or SHAR LEE
D	Delta	DELL TAH
E	Echo	ECK OH
F	Foxtrot	FOKS TROT
G	Golf	GOLF
H	Hotel	HOH TELL
I	India	IN DEE AH
J	Juliett	JEW LEE ETT
K	Kilo	KEY LOH
L	Lima	LEE MAH
M	Mike	MIKE
N	November	NO VEM BER
O	Oscar	OSS CAH
P	Papa	PAH PAH
Q	Quebec	KEH BECK
R	Romeo	ROW ME OH
S	Sierra	SEE AIR RAH
T	Tango	TANG GO
U	Uniform	YOU NEE FORM or OO NEE FORM
V	Victor	VIK TAH
W	Whiskey	WISS KEY
X	X-ray	ECKS RAY
Y	Yankee	YANG KEY
Z	Zulu	ZOO LOO

Figure or mark	Word	Pronounced as
0	Nadazero	NAH-DAH-ZAY-ROH
1	Unaone	OO-NAH-WUN
2	Bissotwo	BEES-SOH-TOO
3	Terrathree	TAY-RAH-TREE
4	Kartefour	KAR-TAY-FOWER
5	Pantafive	PAN-TAH-FIVE
6	Soxisix	SOK-SEE-SIX
7	Setteseven	SAY-TAH-SEVEN
8	Oktoeight	OK-TOH-AIT
9	Novenine	NO-VAY-NINER
Decimal point	Decimal	DAY-SEE-MAL
Full stop	Stop	STOP

11.3 Distress Transmitting Procedure

To be used only if immediate assistance is required. Plain language is to be used whenever possible; it is if language difficulties are likely to arise that the message goes in the Code, using Tables 2 and 3.

"USE PLAIN LANGUAGE WHENEVER POSSIBLE. If language difficulties are likely to arise use Tables 2 and 3 below, sending the word INTERCO to indicate that the message will be in the International Code of Signals." Letters and numbers are then spelt out using Table 1 above.

Step	What to send
1	If possible, transmit the ALARM SIGNAL (the two-tone signal) for 30 seconds to one minute — but do not delay the message if there is insufficient time to transmit it.
2	Send the DISTRESS CALL: "Mayday Mayday Mayday. This is . . ." (name or call sign of ship spoken three times).
3	Send the DISTRESS MESSAGE: "Mayday" followed by the name or call sign of the ship; position of ship; nature of distress; and, if necessary, the aid required and any other information that will help the rescue.

11.4 Position in Code

Two ways of stating position in the International Code of Signals, either usable inside the distress message:

Method	How it is built
(1) By bearing and distance from a landmark	Code letter A (Alfa) + a three-figure group for the ship's TRUE bearing from the landmark; name of the landmark; code letter R (Romeo) + one or more figures for distance in nautical miles.
(2) By latitude and longitude — Latitude	Code letter L (Lima) + a four-figure group (2 figures degrees, 2 figures minutes) + N (November) for North or S (Sierra) for South.
(2) By latitude and longitude — Longitude	Code letter G (Golf) + a five-figure group (3 figures degrees, 2 figures minutes) + E (Echo) for East or W (Whiskey) for West.

11.5 Nature of Distress in Code

Code letters	Words to be transmitted	Text of signal
AE	Alfa Echo	I must abandon my vessel.
BF	Bravo Foxtrot	Aircraft is ditched in position indicated and requires immediate assistance.
CB	Charlie Bravo	I require immediate assistance.
CB6	Charlie Bravo Soxisix	I require immediate assistance; I am on fire.
DX	Delta X-ray	I am sinking.
HW	Hotel Whiskey	I have collided with surface craft.

Answer to ship in distress:

Code letters	Words to be transmitted	Text of signal
CP	Charlie Papa	I am proceeding to your assistance.
ED	Echo Delta	Your distress signals are understood.
EL	Echo Lima	Repeat the distress position.

Note: a more comprehensive list of signals may be found in other sections of this book.

11.6 Worked Examples of Distress Procedure

Where possible, transmit ALARM SIGNAL followed by spoken words: "Mayday Mayday Mayday. This is . . . (name of ship spoken three times, or call sign of ship spelt three times using Table 1) Mayday . . . (name or call sign of ship) Position 54 25 North 016 33 West I am on fire and require immediate assistance."

Where possible, transmit ALARM SIGNAL followed by spoken words: "Mayday Mayday Mayday . . . (name of ship spoken three times, or call sign of ship spelt three times using Table 1) Mayday . . . (name or call sign of ship) Interco Alfa Nadazero Unaone Pantafive Ushant Romeo Kartefour Nadazero Delta X-ray." — "(Ship) in distress position 015 degrees Ushant 40 miles I am sinking."

Where possible, transmit ALARM SIGNAL followed by spoken words: "Mayday Mayday Mayday . . . (name of ship spoken three times, or call sign of ship spelt three times using Table 1) Mayday . . . (name or call sign of ship) Interco Lima Pantafive Kartefour Bissotwo Pantafive November Golf Nadazero Unaone Soxisix Terrathree Terrathree Whiskey Charlie Bravo Soxisix." — "(Ship) in distress position latitude 54 25 North longitude 016 33 West. I require immediate assistance; I am on fire."