Introduction

I. Purpose of the Guidelines

Nothing in these Guidelines should prevent a competent authority, after consulting with the most representative organizations of shipowners and seafarers, from applying different requirements which are at least equivalent to the content of these Guidelines for the medical examination of seafarers.

II. Contents and use of the Guidelines

-- an overview of relevant international laws and regulations;

-- a description of the purpose and contents of the seafarer's medical certificate;

-- guidance on the right of privacy;

-- recommended qualifications for those conducting medical fitness examinations of seafarers;

-- a discussion of appeals procedures for seafarers denied a medical certificate;

-- a brief description of seafaring life which may be relevant to the medical examination of seafarers;

-- a brief description of the types and frequencies of seafarers' medical examinations;

-- recommended procedures for the conduct of medical examinations;

-- recommended vaccinations for seafarers;

-- an annex providing minimum in-service eyesight standards for seafarers;

-- an annex providing minimum in-service hearing standards;

-- an annex providing information on medical conditions which should be considered by medical examiners when deciding whether to issue medical certificates to seafarers;

-- an annex providing minimum requirements for the medical examination of seafarers;

-- an annex providing a medical certificate for service at sea; and

-- an annex concerning collection, processing and communication of health-related data.

Some parts of the Guidelines are more appropriate for competent authorities than for individual medical examiners, and vice-versa. Nevertheless, it is suggested that the whole of the Guidelines be reviewed to ensure that all topics and information are taken into account. The Guidelines are designed as a tool to enhance medical examinations; they cannot and are not intended to replace the professional skill and judgement of physicians.

Guidance relevant to competent authorities

III. Relevant standards of and guidance from the International Labour Organization, International Maritime Organization and the World Health Organization .

ILO instruments concerning seafarers medical examination and health

The Health Protection and Medical Care (Seafarers) Convention, 1987 (No. 164), includes, among other things, requirements for medical report forms for ill or injured seafarers.

The Ships' Medicine Chests Recommendation, 1958 (No. 105), and the Medical Advice at Sea Recommendation, 1958 (No. 106), while not focusing on medical examination itself, concern the provision of medical care at sea and may be of professional interest to the medical community.

The ILO Occupational Health Services Convention, 1985 (No. 161), its accompanying Recommendation (No. 171) and the Technical and Ethical Guidelines for Workers' Health Surveillance (1997) are also relevant.

IMO instruments concerning medical requirements for seafarers

WHO mechanism concerning seafarers' health and medical service

IV. Purpose and contents of the medical certificate

(a) that the hearing, sight and colour vision of the person to be employed in the deck department (except for certain specialist personnel whose fitness for the work which they are to perform is not liable to be affected by defective colour vision) are satisfactory;

(b) that he/she is not suffering from any disease likely to be aggravated by, or render him/her unfit for, service at sea or likely to endanger the health of other persons on board ships.

The Convention provides that the medical certificate shall remain in force for a period not exceeding two years from the date on which it is granted. In so far as a medical certificate relates to colour vision it shall remain in force for a period not exceeding six years from the date it is granted. Certificates which expire during the course of a voyage shall continue in force until the end of the voyage. The competent authority may grant certain exemptions for single voyages.

As indicated in section VII, the Convention also calls for arrangements to be made for persons who have been refused a medical certificate to apply for a further examination by a medical referee or referees who shall be independent of any shipowner or of any organization of shipowners or seafarers.

The competent authority may, after consultation with organizations of shipowners and seafarers, delegate the work, or part of it, to an organization or authority exercising similar functions in respect of seafarers generally.

V. The right of privacy

VI. Qualifications of medical examiners

A medical examiner so authorized by the competent authority:

-- should be a licensed physician;

-- should be experienced in general and occupational medicine or maritime occupational medicine;

-- should have knowledge of the living and working conditions on board ships, gained either through special instruction or through personal experience of seafaring;

-- 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;

-- should enjoy absolute professional independence from employers, workers and their representatives in exercising their medical judgement in terms of the medical examination procedures.

It is further recommended that such examiners:

-- should be provided with information on the standard of competence for seafarers designated to take charge of medical care on board ship (e.g., as provided in section A-VI/4, Mandatory minimum requirements related to medical first aid and medical care, of the STCW Code), or in relevant national laws and regulations; and

-- should be familiar with the publication The International Medical Guide for Ships, or an equivalent national medical guide for use on ships.

In the case of a certificate solely concerned with a seafarer's sight and/or hearing, the competent authority may authorize a person other than a certified physician to test the seafarer and issue such a certificate. In such cases the qualifications for such authorized persons should be clearly established by the competent authority, and such persons should receive information on the appeals procedure described in section VII.

The competent authority should have in place a procedure for the investigation of complaints from shipowners and seafarers, and their representatives, concerning the medical examination procedures and the authorized medical examiners.

Medical examiners who are found as a result of an appeals or complaints procedure to be incompetent, unethical or guilty of professional misconduct should have their authorization to conduct seafarers' medical examinations for the purpose of issuing medical certificates withdrawn by the competent authority.

VII. Appeals procedures

In addition to the provisions of Convention No. 73, and to ensure that such a system of appeals may function successfully, it should include the following elements:

-- the referee or referees should have higher or at least the same qualifications as the medical examiner;

-- the referee or referees should be mutually acceptable to the most representative organizations of shipowners and seafarers;

-- the referee or referees should have two advisers acceptable to the most representative organizations of shipowners and seafarers, to provide practical guidance;

-- the appeals procedure should be provided in writing to the medical examiner. This information should also:

-- set out the contents of the rejection notification;

-- include a written explanation of the appeals procedure which should be given to the seafarer (if rejected);

-- the appeals procedure should function efficiently and not result in unnecessary delays for the seafarer or shipowner; and

-- the same principles of confidentiality called for in handling of medical records should apply to the appeals procedure.

The competent authority should enable an employer to require a seafarer on articles to be examined again by another medical examiner if there are valid grounds to believe that he/she is clearly unfit for sea service.

¹ Convention No. 73 is included in the Appendix of the ILO Merchant Shipping (Minimum Standards) Convention, 1976 (No. 147). Commercial ships operating in international trade may be subject to inspections by port States for compliance with Convention No. 147, thus the requirement in Convention No. 73 for seafarers to hold medical certificates (see section IV) is essentially universal.

² Competent authorities should always consult the text of the Convention itself. This explanation is necessarily abbreviated.