When Maliga Aplila, a 19-year-old Filipino seaman, fell 30 feet onto the deck of his ship in rough Atlantic seas on December 20, his injuries required emergency medical attention.

Officers aboard the Sirius Delmas decided to put into the nearest port of call -- Bermuda.

The next day a similar decision was made when Captain Stanley Duncan, the 54-year-old skipper of the cargo ship Excel , felt sharp stabbing pains in his chest.

In both instances, the decision to head for Bermuda triggered a remarkable chain of events that brought together an array of skilled people to help those in peril on the sea.

Mr. Aplila and Capt. Duncan became what is known locally as "medicos'' or medical emergencies.

In 1993, Harbour Radio responded to 38 medicos. That number -- an average of about one every nine days -- owes much to the Island's position off the US east coast and inside major north-south and east-west shipping lanes.

Each medico is a test of Bermuda's medical, communications and seafaring skills, as well as a test of the courage and compassion of its professionals.

They include Harbour Radio operators, King Edward VII Memorial Hospital staff, Marine & Ports pilots, local shipping agents, volunteer interpreters and US Navy pilots and para-jumpers.

Medicos can be highly stressful operations, not only because people have to mesh their different skills to work as a team but also because, more often than not, events take place in harsh conditions.

And as many participants interviewed by The Royal Gazette indicated, their teamwork can mean the difference between life or death, smooth sailing or commercial catastrophe.

In almost every instance, medical emergencies first come to the attention of Bermuda through Harbour Radio.

Mr. Scott Simmons, a Harbour Radio officer in charge of coordinating rescues, said most ships had medical expertise on board.

"There is usually someone with medical type expertise, but sometimes things do get out of control due to lack of facilities.

"The ship then looks to get the person off because it's important for commercial reasons that the ship gets to its destination on time.

"Normally they call us over the radio depending on how close they are and give us the information. They will also call the US Coast Guard because they have medics who can also make a medical assessment. If it is a serious case, the ship will be diverted.'' There are two pilot launches, the St. David and the St. George that go out to meet the ship along with the ship's agent, and an official from Customs and Immigration to ensure all documents are in order.

And, usually, there is Dr. Henry Subair.

Dr. Subair, a St. George's-based physician who has been handling medicos since 1980, said the evacuation of Capt. Duncan during the early morning hours last Tuesday, presented unique difficulties.

St. David's pilot Mario Thompson, who accompanied Dr. Subair to Five Fathom Hole off the east end, agreed.

"They did not have the navigational charts for Bermuda, but that's to be expected because they did not expect to be coming here,'' he said.

"It was a 600-foot cargo ship with no cargo. The first thing we had to do was to get some of the lights on board their deck turned off because they obscured our vision.

"They had put the ladder over the side. It was a 45-foot climb from the pilot boat to the ship. The wind is a great factor but swells are also important.

"Ideally the ship should be at minimal speed moving through the water. If the ship is stopped it tends to roll side ways. We approach from the leeward side (protected from the wind), and wait until the swell is at the highest point before starting to climb.'' The pilot boarded first followed by Dr. Subair.

"The captain was complaining of chest pains,'' Dr. Subair said. "He was adamant that he wanted to go down the rope ladder, but I told him that he had to be put into the metal basket and lowered off the ship's side.'' Once the captain was secured, he was then lowered 45 feet to the pilot boat in the stretcher -- not the easiest of tasks at the best of times and under the cover of early morning darkness, the difficulties were intensified.

"The launch was surging and rising as high as eight to ten feet,'' the pilot continued.

"While he was being lowered we couldn't really see so we depended on voice commands as we tried to lower the stretcher as level as possible and flush with the ship's side.'' The captain was successfully lowered onto the launch. Once back on land, he was taken to hospital. Fortunately, a cardiogram and blood tests revealed no abnormalities.

Mr. Harold Millet, a 30-year veteran pilot with many medical emergencies under his belt, said the most hazardous weather came out of the east.

Rough conditions cause ships to roll in the water. Supertankers can roll as much as 20 feet -- a situation that makes coming alongside incredibly difficult.

Boarders climb the ships' ladder as she rolls away, said Mr. Millet. Sometimes the climb to the deck can be as high as 50 feet.

"I remember one incident some years ago when I was working for Meyer Agencies... We had just spent a lot of time coaching the doctor about how to get on and off the rope ladder. We told her to get on when the launch was on top of the swell.

"But she got on at the bottom of the ladder at the bottom of the swell. She was lucky the boat rolled away or it would have crushed her leg.'' When a crewman is taken off a ship, local agents assume full responsibility.

They take care of hospital visits and inform family members in the crewman's home country. Often they need to find translators as many seaman do not speak English.

Not all medical emergencies are handled by the St. David or the St. George .

Sometimes US Navy helicopters are used, depending on the type and severity of the case.

"We often use helicopters and land them on Police field in Prospect,'' Mr.

Simmons said.

"But they cannot fly at night and are limited to 100 miles. If the person has a heart condition, we will use the paramilitary jumpers from the Air National Guard or the US Air Force Reserves.

"The jumpers are the ultimate paramedics. They are highly trained medics who are trained to operate behind enemy lines and to help to stabilise downed air crew.

"They will parachute into the water and board the ship and work to stabilise the patient until they get to the nearest port of call.'' Dr. Subair's diagnostic skills are always tested in medicos. When he boarded the Sirius Delmas , the captain asked him to look at a second crewman suffering high fever. The crewman was suffering from malaria.

On Christmas Eve, Maliga Aplila was released from hospital and accommodated at the Palmetto Bay Hotel where he recuperated from a fractured back and leg.

Malaria sufferer, 18-year-old Tui Evi, remained in a hospital ward until last Wednesday.

The following day, shipping agents John S. Darrell arranged for the two men to fly back to their south Pacific island of Tavula, near Fiji.

On Thursday, a Meyer Agency representative discharged Capt. Duncan from hospital and put him up at the Grotto Bay Hotel.

Doctors finally attributed his chest pains to acute stress, a consequence he said later of bad weather and inter-port work along the east coast.

Doctors will observe the captain's recovery over the next few days before deciding if he should be sent back to his UK home or to his ship, now bound for New York City. "Everything was first class,'' Capt. Duncan said of his treatment in Bermuda.

"I have no grumbles whatsoever. Everyone treated me very well.'' SEA SEARCH -- The Marine and Ports search and rescue boat St. David heads from the east end on its way to help in the hunt for the missing crew of a fishing boat early last year.

EMERGENCY -- A 79-year-old passenger on board the cruise ship Regent Sun , arrives at Police Field by helicopter. From there he's rushed to King Edward VII Memorial Hospital.