Current situation and challenge of maritime patient transfer system in archipelagic province

The demand for maritime patient transfer (MPT) has recently increased in Samui District, Thailand; however, no formal documentation maritime patient transfer system (MPTS) currently exists. This study aimed to assess the existing MPT operations and provide recommendations for system development. A cross-sectional study was conducted from January to November 2025 across all 15 organizations involved in MPT. Researchers collected data, observed the transfer procedure, and surveyed the ports and vessels. Of 140 personnel from district hospitals, 121 participated (86.43 %), alongside all 42 representatives from other organizations. MPT is currently conducted independently by hospitals, with Samui Hospital serving as the primary transfer facility. None of the participating organizations reported having formal MPT protocols or standardized ambulance boats. Awareness of core MPTS components was limited. At Samui Hospital, respondents showed general awareness, but limited understanding, of the MPTS. Prior transfer experience was associated with higher knowledge of procedures, guidelines, systems, and safety equipment (all p ≤ 0.008), yet lower confidence in on-board emergency patient evacuation (p < 0.001). Among involved organizations, experienced representatives were more likely to recognize their organizational role in the district MPT system (p < 0.001) and to understand the organizational MPT concept than those without experience (p ≤ 0.031). Key challenges included the absence of an integrated system, unclear organizational responsibilities, and workforce and training limitations. The study recommends establishing a district-wide MPTS with a dedicated Operation Center to provide consultation, operational support, transfer monitoring, and rescue coordination. A preliminary MPTS model was collaboratively developed with key organizational representatives and presented during stakeholder consultations in Samui District. Subsequent engagement with Koh Phangan Hospital expanded the model’s application to both Samui and Phangan Districts. Feedback from both districts was consolidated, refined, and endorsed by stakeholders. Sustainable MPT in island settings requires standardized ambulance boats, regulatory frameworks for operator training and certification, and structured educational programs. The proposed system is feasible and scalable due to reliance on existing budgets and personnel. It may be applicable to other archipelagic provinces, given their comparable healthcare infrastructure and maritime patient transferring. Highlights This pioneering study provides the first comprehensive assessment of maritime patient transfer system (MPTS) in Samui District of archipelagic province where current practices remain fragmented, hospital-dependent, and constrained by the absence of formal protocols, standardized ambulance boats, and adequately trained personnel. Through extensive data collection and full stakeholder participation, it generated critical insights into key challenges, gaps and opportunities. The findings establish an evidence-based for a prototype MPTS and contribute valuable information for the development of a standardized, nationally endorsed framework for MPT across Thailand.