Guidelines forControlling Hypothermia
at SeaThe Maritime Human Resource Institute, Japan
http://mhrij.org/

The Maritime Human Resource Institute, Japan

Forward

All seafarers face various risks during operations of a seagoingvessel. For example, you may get caught up in a mooring line(net) and sustain an injury. You may also fall into the ocean while
performing your duties on deck and suﬀer from hypothermia as aresult of the ensuing decrease in your body temperature.
Among these risks, hypothermia can be especially perilous.
Even without falling into the ocean, you may begin to develop
symptoms simply during your normal duties, and not evenrealize it. By that time, it may be too late. You may consider thesymptoms of hypothermia to be exhaustion or generally justfeeling unwell, and you may overlook them.
This may be your ﬁrst time hearing the word "hypothermia", but it isactually a very serious condition with a mortality rate of 20% - 90%.
The SOLAS Convention, the International Convention for the
Safety of Life at Sea, also stipulates that seafarers must be
suﬃciently educated regarding hypothermia.
I t is , t h e refo re, e x t re m e ly i m p o r t a n t to fo s te r a w i d eunderstanding among seafarers and everyone else involved inmaritime matters concerning exactly what hypothermia is andwhat can be done in order to prevent it.
That is why these guidelines have been created. We hope thatthey will prove useful.

Guidelines for Controlling Hypothermia at Sea
Chapter 1

Contents

Hypothermia

1-1What is Hypothermia? ……………………………………………………… 3

1-2

Causes of Hypothermia …………………………………………………… 5

1-3

Types of Hypothermia ……………………………………………………… 7

1-4 Internal Changes due to Hypothermia (Symptoms)………………… 8
Chapter 2

Conditions that Cause Hypothermia

2-1 Conditions that Cause Hypothermia ………………………………… 13
Chapter 3

Saving and Treating Hypothermia Victims

3-1

Hypothermia from Falling into the Ocean …………………………… 15

3-2

Hypothermia from Other Causes ……………………………………… 17

3-3 Emergency Treatment for Hypothermia (Heat Retention / Warming)… 19
3-4 After Emergency Treatment ……………………………………………… 21
Chapter 4

Prevention of Hypothermia

4-1 Prevention of Hypothermia ……………………………………………… 23

Reference: Hypothermia Related Materials ……………………………… 27
Closing Remarks ………………………………………………………………………… 29

1

2

Chapter 1

Hypothermia

Chapter 1

Hypothermia

Q
A

What is Hypothermia?

Hypothermia occurs when your bodytemperature falls below 35℃ . It is anextremely dangerous condition with amortality rate of 20% - 90%!

Hypothermia
means a bodytemperature
below 35℃ !

Further Details"Body temperature" as used above refers to what is known as "core

There are two types of hypothermia.

temperature". Core temperature refers to such things as rectal temperature,
bladder temperature, esophageal temperature and pulmonary artery
temperature, but it is generally taken as rectal temperature (to be precise, a

Accidental Hypothermia

Caused by accidents or unforeseen
circumstances

Secondary Hypothermia

Caused as a secondary result of illness,drugs, poor health or other factors

measurement taken at a depth of about 7cm from the anus).
It is not possible to measure body temperature correctly in regard tohypothermia by using the same methods as when taking your temperaturenormally, such as under the armpit or under the tongue. A true measurementof core body temperature can be taken, be it rectal, bladder or esophageal.
The easiest and so most commonly used method to gain such a reading is a

These guidelines focus on "accidental hypothermia," which all seafarers
must be aware of in the course of performing their duties.

rectal measurement.

1-1 What is Hypothermia?

1-1 What is Hypothermia?

34Chapter 1

Hypothermia

Q
A

Chapter 1

What causes hypothermia?

Hypothermia

When physical conditions
exceed regulation limits
and body temperature falls

Hypothermia is caused by exposure to acold environment!

lower than regular levels,

EatingExercising

the body's thermoregulatory
mechanism fails.

Exposure to a cold climate

Further Details
The surface of the human body, in particular the skin, is layered with nerves
that detect temperature, which maintains the normal body temperature

Heat Retention

within a ﬁxed range of approximately 36 - 37 ℃. If this range is deviated from,that information is transmitted to the body temperature center of the
hypothalamus in the center of the brain and measures such as contraction

Things That Increase
Body Temperature

Falling into the sea

or expansion of blood vessels are used in order to adjust body temperatureaccordingly.
However, exposure to an excessively cold environment means that theseadjustments can no longer be performed.

Things That Reduce
Body Temperature

Body
Temperature*Cold environment: cold outdoor climate, cold storage, wet clothing, cold water, etc.

Hypothermia occurs

1-2 Causes of Hypothermia

1-2 Causes of Hypothermia

56Chapter 1

Hypothermia

Q
A

Chapter 1

How is hypothermia classiﬁed?

Hypothermia can be divided into three
types: mild, moderate, and severe.

Further Details

Q
A

Hypothermia

What kind of symptoms appear withhypothermia?

The representative symptom of mild
hypothermia is "shivering". As hypothermia
progresses the symptoms change andbecome severer.

Further Details

Hypothermia is generally classified as follows in accordance with body

The following is an explanation of the changes that occur within thetemperature.

body depending on the type of hypothermia.

Mild hypothermia

35 - 32℃

Moderate hypothermia

32 - 28℃

Severe hypothermia

Lower than 28℃

Onset of
Hypothermia• When body temperature starts to fall, ﬁrst the bodytemperature center and peripheral mechanisms
come into operation, attempting to return bodytemperature to above 36℃ through the actionof sympathetic nerves, causing vasoconstriction,tachycardia, shivering, cold extremities,
hyperventilation and excessive urination.

The mortality rate increases as the body temperature falls.

1-3 Types of Hypothermia

1-4 Internal Changes due to Hypothermia (Symptoms)

78Chapter 1

Hypothermia

35 - 32℃ :Mild hypothermia

Chapter 1• Mainly suppresses function of the central
nervous system, reducing cogitative capabilities
and impairing judgment.

Lower than 28℃ :Severe hypothermia• Shivering becomes apparent.

• Extreme suppression of the central nervous
system impairs consciousness and can lead tocoma.

• Coma, respiratory failure, heart failure and low
blood pressure can all occur in a short period oftime.
• Although each case is diﬀerent, there is stilla chance of recovery. Resuscitation should be
performed immediately.

• Also makes feelings slow and sluggish.

32 - 28℃ :Moderate hypothermia

Hypothermia

Lower than 22℃• Breathing stops.

Lower than 20℃• Immediate heart failure.

• Heartbeat goes into arrhythmia and cardiac
output slows.
• Suppression of breathing means that oxygenand carbon dioxide cannot be exchanged, andoxygen levels in the blood fall.
• Functions of organs other than the nervous
system, heart and lungs are also aﬀected.
• Functioning of the digestive system is also
reduced, causing intestinal obstruction, andmuscles become rigid and unable to move.

As seen above, hypothermia mainly appears with symptoms relating to the• Impediments to the blood and metabolic
systems suppress the action of organs such as
the liver, kidneys and pancreas.

systems are harder to notice.

nervous system, respiratory system and skeletal muscle, all of which should
be relatively easy to observe. Symptoms relating to the blood and metabolic
Taking all of these points into account, observe those around you from theperspective of their potentially suﬀering from hypothermia.
You should also use your own body as a basis for making judgements.

1-4 Internal Changes due to Hypothermia (Symptoms)

1-4 Internal Changes due to Hypothermia (Symptoms)

910Chapter 1

Hypothermia

Chapter 1

Changes in Symptoms in Accordance with
Body Temperature

Hypothermia

Notice changes in hypothermia symptoms and use that
information to facilitate early prevention.

Normal conditions

Mild hypothermia

Moderate hypothermia

Severe hypothermia（less than 37℃→ 36℃）

（less than 35℃→ 32℃）

（less than 32℃→ 28℃）

（less than 28℃）

The body works tomaintain this bodytemperature range.

Below 35℃

Below 32℃

Lower than 28℃

When body temperature falls
below the normal level:

・Incessant shivering

・Impaired consciousness

・Deep coma

・Impaired cognition and judgment

・Inability to get up or move・Loss of consciousness

・Shivering*・Inability to stand・Muscle rigidity

・Overpowering exhaustion

・Vacant expression

・Weakened breathing and pulse* There is still potential for revival
at this stage

・Inability to move as desired・Hyperventilation
22℃

・Excessive urination

・Respiratory failure
20℃*Shivering: When the body starts shaking in order to generate heat,or when muscles react involuntarily due to inability to create heat.

・ Heart failure

1-4 Internal Changes due to Hypothermia (Symptoms)

1-4 Internal Changes due to Hypothermia (Symptoms)

1112

Chapter 2

Conditions that Cause Hypothermia

Chapter 2

Conditions that Cause
Hypothermia

Q
A

Under what kind of circumstances canseafarers suﬀer from hypothermia?

Q
A

Can the individual physical conditions ofeach seafarers also make a diﬀerence?

Yes, the individual physical conditionsof each seafarers can make a diﬀerence.
Please take all due care.

Further Details

Potential causes of hypothermia for thecrew of a seagoing vessel include falling
into the ocean, being adrift in the ocean,working in a cold environment on deck,and working inside onboard cold storage.

When fatigue from work and lifestyle accumulates, seafarers may feelexhausted, suffer from pneumonia, influenza or other illness, or go forlong periods with insufficient sleep, they are more prone to developing
hypothermia; hence, extra caution is required.
Failure to eat after drinking alcohol also reduces the body's capacity togenerate heat and makes a person more likely to develop hypothermia.
Suﬀerers of diabetes, chronic cardiopulmonary disease or endocrine disease
are also more likely to develop hypothermia, so caution should be paid

Further Details

accordingly.

The primary cause of hypothermia symptoms is a decrease in external
temperature. In an environment with an external temperature below 10 15℃ , it can become diﬃcult for the human body to maintain the regular bodytemperature of 36 - 37℃ .
However, even within the permissible range of external temperature, the riskof hypothermia can still increase as a result of extended exposure, clothing
conditions, nutritional conditions, the presence of chronic disease and otherfactors .

2-1 Conditions that Cause Hypothermia

2-1 Conditions that Cause Hypothermia

13

14Chapter 3

Saving and Treating Hypothermia Victims

Chapter 3

Saving and Treating
Hypothermia Victims

QA

use an AED only once).
Once cardiopulmonary recovery has been achieved, next it is vital to warm
the body.

Rescue from Falling into The Ocean
1 Someone has fallen from the deck
into the ocean while navigating
through a cold region!

2 Immediately pull the person intoa rescue boat.

What is the ﬁrst thing to do if a seafarers
falls into the ocean?

The most important thing is to get them outof the water as quickly as possible!
If they have stopped breathing, perform
artiﬁcial respiration.

3 If the person
has stopped
breathing begin
cardiopulmonary
resuscitation with
artiﬁcial respiration
using ﬁve breaths.

Further Details
The longer a person is left exposed in the sea, the lower their chances ofsurvival. The mortality rate climbs very high if they are not pulled quickly outof the cold seawater.

4 Remove the wet
clothing, change
him/her into dry
clothes, and warm
up the body.

If the victim has drowned, securing respiratory function must be the ﬁrst
step. Start by administering cardiopulmonary resuscitation while blowing ﬁvetimes into the mouth of the victim, (while two times is the generally accepted
practice, in the case of respiratory failure due to drowning, ﬁve times is moresuitable in order to clear the airway obstruction).
If the drowning victim's heart has stopped, perform heart massage at a rateof 100 - 120 times per minute. If you have an AED, then you may use that.
(However, if body temperature is low, in the 32 - 35℃ degree range, you may

3-1 Hypothermia Caused by Falling into the Ocean

3-1 Hypothermia Caused by Falling into the Ocean

15

16Chapter 3

Saving and Treating Hypothermia Victims

Q
A

What can be done in order to quickly
identify seafarers who have developed
hypothermia for reasons other than falling
into the ocean?
The early identiﬁcation of hypothermia
requires noticing for yourself and"identiﬁcation through observation by athird party".

Chapter 3

Saving and Treating Hypothermia Victims

Key Points for Noticing Yourself and Observing by Others
Key points for noticing in yourself and by others are such things as an"exhausted expression," "sluggish movements," "dulled emotions," "impaired
judgement," "slow response to questions" and "cold body".
In particular, you should maintain a firm understanding of the changes insymptoms due to body temperature as outlined earlier in these guidelines.

Check 1Is there shivering?

Check 2
Does the expression
look exhausted?

Check 3
Have movements
become sluggish?

Further Details
Apart from actually falling into the ocean, seafarers are at risk of hypothermia
due to such factors as "being adrift in the ocean," "working in a cold
environment on deck" and "working inside onboard cold storage." Ashypothermia proceeds gradually under these circumstances, it is more thanpossible for individuals themselves and those around them to not notice it's
advance.

Check 4
Can the person converse
normally?

Check 5
Are hands, feet and bodysurface cold?

For example, even if you experience feelings such as "I'm kind of cold and mybody feels sluggish," "I can't concentrate" and "I just don't have any energy"
you still may not suspect hypothermia, allowing it to proceed into more
serious symptoms.
If the people around you also notice that "something about you is diﬀerent,"
they need to ask if you have been in a situation placing you at risk ofhypothermia, observe you closely, and make a suitable judgment. This can* Is speech slower than normal?
* Is a response slow or delayed?

lead to rescue before it is too late.

3-2 Hypothermia from Other Causes

3-2 Hypothermia from Other Causes

17

18

Chapter 3

Saving and Treating Hypothermia Victims

Q
A

What kind of emergency treatment
should be provided after cardiopulmonary
resuscitation?
The basics of emergency treatment are"change out of wet clothing," "carry to awarm place" and "raise body temperature."

Chapter 3

Saving and Treating Hypothermia Victims

Heat Retention• Immediately change wet clothes into dry clothing.
• Move the victim to a heated room at 21 - 25℃ and warm using blankets andwarm clothing.
• If you don't have items like blankets at hand, use anything and everythingthat can shut out the cold, including newspapers, cardboard, vinyl andsleeping bags.

Raising Body Temperature• Use heating materials such as hot water bottles and thermal patches to heatjust the trunk of the victim's body (stomach, chest, back, around the neck).

Further Details
Whether hypothermia is caused by falling into the ocean or other factors, the• Avoid heating the victim's extremities. Heating the extremities will cause
cold blood from the hands and feet to circulate into the heart, suddenly
lowering core temperature and causing cardiac shock (rewarming shock).

best method for recovery is to "warm the body." In order to achieve this, ﬁrst

• For the same reason, there is no need to massage the victim's hands and feet.

the victim needs to be placed in a warm environment (heat retention).

• When applying heat, be careful of low temperature burns.

After achieving that, you will need to immediately begin increasing the bodytemperature of the victim (warming).
During this step you should increase the temperature at a rate of 0.5 - 2℃

• The victim can also be placed in a bath of warm water (40 - 45℃ ), but
unless you have access to facilities for monitoring body temperature, thisapproach is not recommended.

per hour, rather than all at once. This is because a rapid increase in bodytemperature can also induce shock.
Furthermore, while the order presented here is "heat retention ﬁrst, followed
by warming," these steps should actually be performed almost simultaneously.
If the victim is in a condition that allows eating or drinking, food and drink
are also eﬀective to raise temperature.

Raising Body Temperature Using Food and Drink• It is advisable to oﬀer warm and easy to eat food and drink such as warm
sugar broth or soup. Chocolate and other sweet foods are also eﬀective(glucose and carbohydrates are good because they are absorbed quickly,
while protein and fats are bad because they are absorbed slowly).
• Alcohol, coﬀee and tea promote the production of urine. This can lead todehydration, so they should not be provided in excess.
• Do not allow the victim to smoke.
• Do not oﬀer food and drink if the victim is unconscious.

3-3 Emergency Treatment for Hypothermia After Cardiopulmonary Resuscitation (Heat Retention / Warming)

3-3 Emergency Treatment for Hypothermia After Cardiopulmonary Resuscitation (Heat Retention / Warming)

19

20

Chapter 3

Saving and Treating Hypothermia Victims

Q
A

Once a person has recovered consciousness
from hypothermia, should he/she beallowed to move around?
In the period immediately
after the victim has regained
consciousness, suddenly moving
the person's muscles will cause
cold blood to ﬂow into the heart
and lead to arrhythmia or shock,so massaging them or having
them move around is prohibited.

Do not let the person walkaround or do exercise!
* However, once body temperature has
returned to 32 - 35℃ and stabilizes, it is ﬁne forthe person to move around.

Chapter 3

Saving and Treating Hypothermia Victims

Further Details
If emergency treatment does not seem to have had a full eﬀect, continue
to perform as many measures as possible while seeking radio medical
consultation or requesting maritime rescue from the closest land-based
medical facility.
• Even if the symptoms appear to have improved, be mindful of the following points.
• The symptoms of hypothermia can recede, and the victim can appear tobe healthy again, but internal changes still happening inside organs cancause sudden change in condition.
• Blood irregularities, arrhythmia, changes in blood pressure and changes in
the respiratory functions of the lungs can all lead to death, meaning thatobservation (overall expression and responses when talked to) is required
until the victim can be taken to a doctor.
• The victim's vital signs (consciousness level, state of breathing andbreathing frequency, pulse and rectal temperature) should be observed,
and state of urination, etc. be recorded for reference.
It is very diﬃcult to tell the diﬀerence between apparent death and actual
death in hypothermia victims. Even if the victim has been in cardiorespiratory
failure for a comparatively long period of time there are still cases in which

Q
A

brain death is yet to occur and resuscitation is possible. It is therefore vitalto keep conducting emergency lifesaving procedures without giving up until

What is the next step after emergency
treatment?

a specialist is consulted. Do not stop cardiopulmonary resuscitation or
observation until the victim's body temperature
is back to 32 - 35℃ .

In principle, you should consult a specialist(doctor).

Keep conducting emergency lifesaving
procedures without giving up until adoctor conﬁrms death.
Also continue observation.

3-4 After Emergency Treatment

3-4 After Emergency Treatment

2122Chapter 4

Prevention of Hypothermia

Chapter 4

Prevention of Hypothermia● Thorough preparation of clothing to prevent the cold
When working in low temperatures, a full range of clothing should be
prepared, including thermal underwear, gloves, hats and cold resistantclothing.
The use of disposable thermal patches is also eﬀective.

Q
A● Not working for many hours in low temperatures

What can we do in order to prevent
hypothermia?

C ha nge a s sig n e d d u ti es f re q u e ntly, ke e p i ng wo rk ti m es i n low
temperatures as short periods as possible.
● Maintenance of temperature inside the vessel
Maintain a suitable temperature inside the vessel, in working areas,

The basics of hypothermia prevention are tohave a thorough knowledge of the causes
and symptoms of hypothermia and tothoroughly protect against the cold.
Paying due attention to the working
environment of seafarers and their physicalhealth can also aid in prevention.

cabins, etc.
● Provision of suﬃcient nutritional intake from meals
While maintaining health by eating suﬃcient meals, avoid damaging healthand lowering stamina due to excessive drinking or eating.
● Relieve exhaustion through suﬃcient rest
Avoid the accumulation of exhaustion due to long working hours or
insuﬃcient sleep.
● Full understanding of hypothermia

Further Details

Having a full understanding of hypothermia allows you to realize and avoid

The following points can help to prevent hypothermia.

the potential risks, or to notice and halt symptoms before they become
too far advanced. This knowledge can also lead to prevention and early
discovery of hypothermia in the people around you.

4-1 Prevention of Hypothermia

4-1 Prevention of Hypothermia

2324Chapter 4

Prevention of Hypothermia

Chapter 4

Clothing is ultimately the best way to prevent hypothermia.

Prevention of Hypothermia

Examples of Heat-retaining Clothing etc.

In principle, you can take reference from the kind of protective clothing usedin mountain climbing in cold seasons.
These kinds of clothing include the following.

Cold
resistantclothing

Protective Clothing

Raincoat

Sweater• Cold resistant clothing (top)• Heat-retaining shirt, sweater, etc. (more eﬀective if worn in multiple layers)• Cold resistant, waterproof trousers• Heat-retaining underwear for both upper and lower body (more eﬀective ifworn in multiple layers)• Heat-retaining socks (more eﬀective if worn in multiple layers)

Waterproof
trousers• Cold resistant hat (including one that can be worn as a hood covering theentire head, mask type, etc.)

Cold resistant hat

Leather
glovesThick socks

Disposable thermal
patches• Cold resistant gloves• Use of heat-retaining scarves is also eﬀective

Examples of items for maintaining body heat

In addition to the above articles of clothing, cold resistant shoes are also
eﬀective.

Items Other Than Clothing

Immersion suitHeat insulation device(insulation sheet)• It is also eﬀective to put items that will help to keep you warm, such as
disposable thermal patches, inside your clothing.
• If adrift in a lifeboat, etc. after an accident at sea, wearing an immersion
suit or heat insulation device (insulation sheet) equipped to the lifeboat is
also eﬀective.
• Carrying around a thermos ﬂask containing a hot drink and drinking from it
while at work as required is also eﬀective.
（Provision of materials:
Toyo Bussan Co., Ltd.）

4-1 Prevention of Hypothermia

4-1 Prevention of Hypothermia

25

26Reference: Hypothermia Related Materials

Reference:

Hypothermia Related Materials
1. Relationship Between Water Temperature and Length of Time
Consciousness Can be Maintained in Water (F. Golden R.N.)

3. Using the HELP
(Heat Escape Lessening Posture) Position in the Water

Time eﬀective consciousness can be maintained (hour)

6
5

HELP

4
3
2
1

（Heat Escape Lessening Posture）

When wearing
5mm - thick
Neoprene*
clothing
Wearing regularclothing
No clothing
worn

0

Water
temperature

51015 （℃）*Neoprene: a wetsuit made from rubber（Provision of materials: The Association for Promoting Safety and Sanitation for Seafarers ）• Body temperature can fall 25 times faster in water than in air.
• Factors such as water temperature, body size, volume of fat and movementin the water all inﬂuence survival.

2. Relationship Between Water Temperature,
Loss of Consciousness and Survival Time
Water Temp

Time Until Losing Consciousness

Estimated Survival Time

Below 0℃

Within 15 minutes

15 - 45 minutes

0℃ - 5℃

15 - 30 minutes

30 - 90 minutes

5℃ - 10℃

30 - 60 minutes

1 - 3 hours

10℃ - 15℃

1 - 2 hours

1 - 6 hours

15℃ - 20℃

2 - 7 hours

2 - 40 hours

20℃ - 25℃

2 - 12 hours

More than 3 hours(Provision of materials: Tokyo University of Marine Science and Technology Graduate School, Marine Sport Health Research Lab )• Moving your body in the water greatly accelerates decline of bodytemperature. Unless there is someone nearby trying to save you, do not
move around.
• Heat is lost rapidly from the head, so try to keep it out of the water as
much as possible.
• The more of your body you can keep out of the water, the less volume ofheat will be lost and the higher your chances of survival.
• Using the HELP position (as shown above) to keep your arms and legs close
to you and, if there are other people nearby, wrapping your arms aroundeach other's shoulders, will increase your chances of survival.
（Provision of materials: Takashina Life Preservers Co., Ltd.）

Reference: Hypothermia Related Materials

Reference: Hypothermia Related Materials

27

28

Closing Remarks
We have tried to describe hypothermia in the simplest possible
terms.
Occurrence of hypothermia is not only limited to seafarers
on vessels sailing through arctic waters. It can easily occur inenvironments, both natural and artificial, that are simply a bit
cold.

Reference Materials
1 Yoshihiro Kinoshita, Implementation of Emergency Medical Treatment for
Accidental Hypothermia, The Journal of the Japan Medical Association Issue
135
2 Douglas JA Brown, MD and Jeﬀ Boyd, MB, BS, et al, Accidental Hypothermia
NEJM 2012 ;367:1930 -1938 November 15, 2012.
3 David Szpilman, MD, Joost LM Bierens, MD, et al, Drowning NEJM
2012 ; 366:2102-2110 May 31, 2012.

It is, therefore, important for all seafarers and those affiliatedwith shipping companies to remain aware of how hypothermia
can aﬀect them.

4 St. John Ambulance, St. Andrew's First Aid, British Red Cross (with translation
supervised by Yasuhiro Yamamoto) "First Aid Manual" - "Hypothermia" P194196, Nankodo 2014.

We hope these guidelines will prove useful as a point ofreference.

5 AHA (American Heart Association) "Hypothermia Guidelines".

We wish you all safe voyages and good health in you work.

Guidelines for Controlling Hypothermia at Sea
First Printing February 2017
Edited by:
The Specialist Committee for Research & Development of seafarers Training inCompliance with International Treaties
Cooperating Bodies:Japan Maritime Center
Provision of Materials:
The Association for Promoting Safety and Sanitation for Seafarers,
Tokyo University of Marine Science and Technology Graduate School,
Toyo Bussan Co., Ltd., Takashina Life Preservers Co., Ltd.
Published by:
The Maritime Human Resource Institute, Japan
5 Japan Maritime Center, 4-5 Koji-machi, Chiyoda-ku, Tokyo 102-0083 JAPAN29

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