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
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
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
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.
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.
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.
further recommended that such medical practitioners:
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.
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
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
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
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.
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
for exercise can be created on board
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”.
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.
for exercise also need to be made during leave periods.
High Blood Pressure
Blood pressure is a measurement of the
force against the walls of arteries as heart pumps blood through body.
readings are given as two numbers in millimeters of mercury (mmHg):
pressure- is the number on top. This is the pressure of the blood when the
heart is pumping
blood pressure- is the number on the bottom. This is the pressure of the blood
when the heart is at rest, between beats.
blood pressure – is lower than 120/80 mmHg
blood pressure- is 140/90 mmHg or above
– 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:
overweight or obese
a relative with high blood pressure
too much salt
or Caribbean descent
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.
of the artery that supplies blood to the kidney (renal artery stenosis)
of the adrenal gland (Cushing Syndrome)
such as brith control pills, diet pills, some cold medicines, painkillers
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:
a healthy, low-fat, balanced diet including potassium and fiber (i.e. fruits
a healthy weight
being sedentary. Increasing physical activity
the amount of sodium (salt) -- aim for less than 1,500 mg per day.