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For that Life of Pi moment

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Imagine you’re adrift on a boat with no radio communications and you need to signal to another boat, or to shore, for medical assistance. Unlikely, I know, but as pharmacists we are expected to know what to do in every conceivable situation.

Your answer lies in the International Code of Signals, a flag-based system used by vessels to communicate, generally for navigation purposes to compensate for language issues, but also containing a whole chapter on how to communicate quite complex clinical messages. It even includes its own formulary.

The ICS assigns each letter of the phonetic alphabet and numbers 0-9 their own flag. Combinations of these alphanumeric characters are assigned as codes for various standardised messages. All standardised messaged come in nine languages, and each language has its own book with equivalent messages keyed to the same code. Medical signals all begin with the flag for the letter ‘M’ (a white diagonal cross on a blue background), followed by two more letters and sometimes with additional numerals or letters.

The Medical Signal Code appears to cover most eventualities in just three letters, so that sailors can communicate messages ranging from “Patient has a comminuted fracture” (MGD) to “penis is swollen” (MKF). But prescriptions are what you’re most likely to need to know, and these follow a standard format in this order: name of the medication, method of administration and dose, frequency of dose, frequency of external application, and advice concerning diet. So, if your prescription said MTD 32, MTI 2, MTQ 8, MUC, you should dispense aspirin tablets, labelled ‘Take two tablets orally every eight hours’, and you should advise the patient to take water only in small quantities.

The ICS was drafted in 1855 and published in 1857 as the Commercial Code. The system was severely tested during the First World War and revised as a result in 1930, including its preparation in several languages. As the Medical Signal Code was incorporated in this 1930 revision, much of its formulary seems old-fashioned by today’s standards. It includes, for example, linctus of squill (25) for coughs, tincture of benzoin compound (23) for asthma, and butobarbitone 100mg tablets (34) as a sedative.

Younger pharmacists struggling to understand this Georgian formulary, can always use the standard response, MQB. This means “I cannot understand your signal; please use standard method of case description”.

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