Establishing MEDEVAC Procedures for COVID-19 Cruise Ship Passengers Jorge Diena, one of the IMRF Trustees, forwarded this document prepared by Commander Artigas Zorilla and Lieutenant (MD) Ana Mieres about what happened when the Uruguayan Navy received a distress call from a cruise ship, which needed assistance for a passenger with respiratory failure. On 1 March 2020, the MRCC in Montevideo received a distress call from the GREG MORTIMER, a cruise ship anchored 11 nautical miles (approximately one-hour’s sailing) from the port of Montevideo. The ship was requesting the urgent evacuation of a passenger with moderate respiratory failure. The Naval authority declared it an incident and the rescue vessel, ROU 51 Isla de Flores, was ordered to respond. For the Uruguayan Navy, this was their first MEDEVAC of a possible COVID_19 patient registered at sea. They needed to successfully evacuate the sick patient, in coordination with an ambulance and doctor to take the patient to hospital on shore, whilst ensuring that all of the naval personnel involved had the appropriate personal protective equipment. Without much experience of this emerging global virus, the Navy’s SAR Unit was provided with recommended personal protective equipment (PPE) appropriate for hospital intensive care and given a safety briefing, before setting sail for the cruise ship. Thankfully, the prevailing sea conditions helped the team to carry out the MEDEVAC successfully. The patient disembarked from the cruise ship dressed in a waterproof suit, gloves and an oxygen mask and remained seated on board the rescue vessel under the supervision of the doctor, who kept a safe distance, avoiding close contact. On arrival in port, the patient was helped to disembark from ROU Isla de Flores and was taken to hospital in the waiting ambulance. After the evacuation, the rescue team’s doctor was the first to take off his PPE. Then, one by one, under his supervision, the other crew members carefully removed their own PPE, to minimise the risk of infection. Afterwards, the rescue vessel itself, as well as all equipment used in the MEDEVAC, were thoroughly cleaned and disinfected and the cleaning materials disposed of safely. As a result of this experience, the Navy quickly developed its own procedural guidance for any future MEDEVAC patients with COVID-19, detailing the PPE to be used and the recommended products for the subsequent disinfection of the boat. This guidance was tested on 3 and 4 March, with two further urgent MEDEVACs for patients with COVID_19, from the same cruise ship. To date (20/04/20), the Uruguayan Navy has successfully retrieved six patients with COVID 19 using this procedure.