Medical emergencies at sea: an analysis of ambulance-supported and autonomously performed operations by lifeboat crews.

"Declarations Ethics approval and consent to participateThis study was initiated as a formal student research project of the University of Groningen, Faculty of Medical Sciences and the Universal Medical Centre Groningen (UMCG). The study protocol was approved by both institutions on 11 May 2020, recognizing that this study is a secondary analysis involving no identifiable patient data. For this reason, it was advised by these institutions that there was no need to request the advice from the Medical Ethical Commission of the UMCG nor consent for participation. Before the start of the study, the Medical research Ethics Committees United (MEC-U) of Ziekenhuisgroep Twente Hospital has also reviewed the study protocol and confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to this study (W21.224). All methods of this study were carried out in accordance with relevant guidelines and regulations. Consent for publicationNot applicable. The publication had been approved by the KNRM where the data collection has been carried out. Competing interestsJoost J.L.M. Bierens and Theo van der Linden are involved in the content and organization of the first aid and resuscitation training programs of the KNRM lifeboat crews. Other authors do not have any conflicts of interest to disclose. Competing interests Joost J.L.M. Bierens and Theo van der Linden are involved in the content and organization of the first aid and resuscitation training programs of the KNRM lifeboat crews. Other authors do not have any conflicts of interest to disclose."

"Funding The KNRM has funded the registration fee for the Medical Research Ethics Committees United (Ethical Committee of Ziekenhuisgroep Twente Hospital)."

"Crew departure time has been defined as the time between the moment the JRCC sends an alarm message to the individual crew members (standardized time on the pager) and their departure from the lifeboat station. All lifeboats are equipped with standardized clocks. It should be noted that there is always a delay between the moment the JRCC is alarmed and the moment the alarm message is send to the individual crewmembers. The amount of this delay was not part of this study and was therefore not registered. In operations where a first boat takes off without ambulance crew and the second boat takes off later for the same operation with ambulance crew on board, only the crew departure time of the first boat has been available because the registration system only registers crew departure time of the first lifeboat."