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Medical Fitness for Seafarers

  Medical fitness for seafarers
 
 

Working at sea is potentially very hazardous and requires a high standard of health and continuing fitness. Every seafarer must therefore undergo a medical fitness assessment. Its purpose is to ensure he/she is medically fit for the living and working conditions on board ship.

The International Maritime Organization’s (IMO) International Convention on Standards of Training, Certification and Watch-keeping for Seafarers (STCW), 1978, as amended, states that every seafarer holding a certificate issued under the provisions of the Convention, who is serving at sea, shall also hold a valid medical certificate issued in accordance with the provisions of Regulation I/9 and of Section A-I/9 of the STCW Code.

With national fitness standards for seafarers varying widely, the set of international guidelines adopted in 1997 (the Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers) was a first attempt towards harmonization. The increasing internationalization of shipping makes such harmonization even more de­sirable. Medical practitioners performing such examinations should have a clear under­standing of the special requirements of seafaring life, as their professional judgment is often critical to the lives of seafarers. All concerned should be able to trust a seafarer’s medical certificate as having been issued in accordance with the relevant applicable international standards.

The MLC, 2006, (Standard A1.2) and the STCW Convention, 1978, as amended, (sec­tion A-I/9, paragraph 7) specify the information that should be included as a minimum on the medical certificate. The detailed content of these Guidelines aligns with these requirements and the other more detailed provisions of the relevant international Conventions, which should be consulted when developing national procedures. The aim of the Guidelines is, wherever possible, to avoid subjectivity and to give objective criteria for decision-making.

The medical practitioner should indicate on the medical certificate whether the person is fit for all duties worldwide within their department (deck/engine/catering/other), as indicated on their medical certificate; whether they can undertake all routine and emer­gency duties but are only able to work in specified waters, or whether adaptation of some routine and emergency duties is required. Safety-critical visual capabilities such as lookout duties should be specifically indicated.

If the seafarer cannot perform routine and emergency duties safely and effectively and adaptation of duties is not possible, the seafarer should be notified that they are “not fit for duty”. If adaptation is possible then they should be notified that they are “fit for duty with limitations”. The notification must be accompanied by an explanation of the seafarer’s right to appeal.

 

Where illnesses and injuries may impair the ability of a seafarer with a valid medical certificate to perform routine and emergency duties safely, their current fitness may need to be assessed. Such examinations may be considered in various circumstances such as more than 30 days incapacitation, disembarkation for medical reasons, hospital admis­sion or requirement for new medication. Their current medical certificate may be revised accordingly.

Before training commences, it is advantageous for any person who intends to subse­quently work at sea to be medically examined to confirm that they meet the required medical fitness standards.

 

A medical practitioner so recognized by the competent authority:

 

(i)   should be a qualified medical practitioner currently accredited by the medical registration authority for the place where they are working;

(ii)  should be experienced in general and occupational medicine or maritime occu­pational medicine;

(iii)  should have knowledge of the living and working conditions on board ships and the job demands on seafarers in so far as they relate to the effects of health problems on fitness for work, gained wherever possible through special instruc­tion and through knowledge based on personal experience of seafaring;

(iv)   should have facilities for the conduct of examinations that are conveniently sit­uated for access by seafarers and enable all the requirements of the medical fitness examination to be met and conducted with respect for confidentiality, modesty and cleanliness;

(v)   should be provided with written guidance on the procedures for the conduct of medical examinations of seafarers, including information on appeals procedures for persons denied a medical certificate as a result of an examination;

(vi)   should understand their ethical position as examining medical practitioners acting on behalf of the competent authority, ensuring that any conflicts with this are recognized and resolved;

(vii)  should refer any medical problems found, when appropriate, for further investi­gation and treatment, whether or not a seafarer is issued with a medical certifi­cate; and

(viii) should enjoy professional independence from ship-owners, seafarers, and their representatives in exercising their medical judgment in terms of the medical examination procedures. Those employed by, or contracted to, a maritime em­ployer or crewing agency should have terms of engagement which ensure that an assessment is based on statutory standards.

 

It is further recommended that such medical practitioners:

 

 (i)  should be provided with information on the standard of competence for sea­farers designated to take charge of medical care on board ships in relevant na­tional laws and regulations; and

 

 

(ii)   should be familiar with the latest edition of the International Medical Guide for Ships, or an equivalent medical guide for use on ships.

The majority of the information needed to diagnose and manage a patient's problem(s) is obtained during the history of present illness. The information obtained during the latter portions of the interview provides a complete database of the patient's medical, personal and family history needed to provide optimal management of a patient's problems. Frequently, information contained in the past history is asked about and reported in the history of present illness. For example, in interviewing a patient with chest pain that is suspicious for angina, a physician would query the patient about health habits (for example smoking), past history (hypertension, diabetes, hyperlipidemia), and family history (of early coronary artery disease) that would affect the patient's probability of having coronary artery disease.

One of the most common health issues faced by seafarers is weight management, and the onset of obesity which may result in heart problems or diabetes. These conditions may severely limit or bring an end to any future career prospects. The key to avoiding and managing this aspect of health is through a sensible diet and regular exercise.

 

The BMI Calculation acts as a measure as to whether your weight is in proportion to their height. A body mass index (BMI) of 30 is taken as a guide to the upper limit of acceptability for seafarers, but because body mass index does not distinguish between lean and fat weight, there will be some people with a BMI of over 30 because of a well developed musculature. They may be able to be accepted as fit, if this is demonstrated to be the case, and provided there are no other limiting factors, such as the need to enter confined spaces.

 

Obesity is becoming an increasingly frequent finding at statutory seafarer medical examinations. This reflects the increase in the prevalence of obesity in society as a whole. Obesity can mean that you become unfit to work as a seafarer.

 

In the longer term, being overweight is a risk factor for several serious diseases as follows. These may cause sudden illness at sea, with all its risks to you and others or lead you to being declared unfit to continue working at sea a decade or more before normal retirement age.

 

Fatty deposits in and damage to arteries is more likely, causing heart attack or stroke, both often fatal, as well as disabling conditions such as chest or leg pain on exercise.

 

Arterial disease in all its forms is the commonest reason for premature death at sea. It often leads to permanent unfitness for work at sea because of the risk of recurrence or because of

inability to work effectively at sea.

 

 

Diabetes The risk of developing diabetes in mid life is greatly increased by obesity. This can require a restricted diet, medications or injections of insulin. The latter, because of its side

effects, normally leads to permanent unfitness for service at sea. Diabetes also increases the risk of arterial disease and visual loss.

 

High blood pressure Again this increases the likelihood of stroke and heart attack. It is much commoner in those who are overweight and can be lowered by a reduction in weight.

 

Arthritis The increased strain of standing and moving when extra weight is being carried, leads to the development of arthritis, especially in the hips and knees. Pain from this can limit work capability and if joint replacement is needed, this may result in permanent unfitness because of the risks of dislocation and infection of the replacement joint.

Ø  If the diet provided on board your ship does not include healthy options, it is the responsibility of the master and operator to make sure that this is provided.

Ø  Opportunities for exercise can be created on board

Ø  Declaring your need and intention to lose weight to other crew members can mean that they keep you within your dietry and exercise recommendations. They may even join in with you to create a “healthy ship”.

Ø  Partners and relatives who provide meals during leave need to help you. This means that you have to inform them of your need to reduce weight and pass them any advice given by the doctor on healthy eating.

Ø  Opportunities for exercise also need to be made during leave periods.

 

High Blood Pressure (Hypertension)

 

Blood pressure is a measurement of the force against the walls of arteries as heart pumps blood through body.

 

Blood pressure readings are given as two numbers in millimeters of mercury (mmHg):

 

Ø  systolic pressure- is the number on top. This is the pressure of the blood when the heart is pumping

Ø  diastolic blood pressure- is the number on the bottom. This is the pressure of the blood when the heart is at rest, between beats.

Ø  Normal blood pressure – is lower than 120/80 mmHg

Ø  High blood pressure- is 140/90 mmHg or above

Ø  Pre-hypertension – 120/80 or higher but below 140/90

 

Chances of getting hypertension increase as to get older because the blood vessels become stiffer. High blood pressure increases chance of having a heart attack, heart failure, stroke, kidney disease or early death.

 

The following can increase the chance of high blood pressure:

Ø  being overweight or obese

Ø  smoking

Ø  having a relative with high blood pressure

Ø  eating too much salt

Ø  African or Caribbean descent

Ø  diabetes

Ø  drinking too much alcohol

 

In 90% of cases the cause of high blood pressure is unknown. This is called essential hypertension.

In 10% of cases there is an underlying medical condition causing the elevated blood pressure. This is called secondary hypertension.

 

Ø  chronic kidney disease

Ø  narrowing of the artery that supplies blood to the kidney (renal artery stenosis)

Ø  diseases of the adrenal gland (Cushing Syndrome)

Ø  hyperparathryroidism

Ø  pregnancy or presclampsia

Ø  medications such as brith control pills, diet pills, some cold medicines, painkillers (NSAIDs)

Ø  prohibited drugs such as cocaine, amphetamine and metamphetamine.

 

The goal of treating hypertension is to reduce blood pressure to lower the risk of complications. In addition to prescribed medication the following lifestyle changes can help reduce blood pressure:

 

Ø  Eat a healthy, low-fat, balanced diet including potassium and fiber (i.e. fruits and vegetables)

Ø  Maintain a healthy weight

Ø  Avoid being sedentary. Increasing physical activity

Ø  Stop smoking 

     Ø  Limit the amount of sodium (salt) -- aim for less than 1,500 mg per day.
 
 
    News Group   :   Bulletines Date    :   2015/12/16 ساعت    :   16:04:06
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