We examined the emergencies arising on fishing vessels in Scottish Coastal Waters which required ship-to-shore radio medical advice. All calls to the service were identified for the 12-month period from August 2005. A total of 186 calls were received; 38% of calls were from fishing vessels. During the study period 53% of the calls were trauma-related, while 47% were medical emergencies. Our data suggest that there are many fishermen working offshore with chronic medical conditions. Overall, 85% of calls from fishing vessels resulted in evacuation as the outcome. Improved occupational health screening, compliance with health and safety legislation, and an evidence-based approach to remote medical care may improve seafarer self-care and reduce emergency evacuations.