Guidance to persons authorized by competent authorities to conduct medical examinations and to issue medical certificates

VIII. Aspects of the seafaring life which are relevant to the medical examination of seafarers

The medical examiner should bear in mind the following aspects of shipboard life:

* Ships' officers generally receive basic first-aid and other medical training, and ships are usually equipped with basic medical supplies. Nevertheless, it is often quite difficult to transport sick or injured seafarers ashore where they can be treated by certified physicians. In some geographical areas, the closest medical care ashore may be well below the standard of the seafarer's home country. It is therefore unadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or to return to seagoing employment.

* Seafarers live close to each other at sea, often for long periods. Contagious diseases therefore may be a serious threat, endangering not only the health of other seafarers but also the safety of the ship and, where carried, passengers. It is particularly important that seafarers concerned with the preparation of food do not suffer from conditions which may be transmitted to others through their work.

* Seafarers should be medically fit to perform their normal duties correctly and to be able to respond to emergency situations (e.g., fighting fires, lowering lifeboats, assisting passengers, etc.).

* Although efforts are, and should be, continuously made to improve the living and working conditions on board ships, seafarers should be able to adjust to the often violent motions of the ship, to be able to live and work in sometimes cramped spaces, to be able to climb ladders and to lift heavy weights and to be able to withstand exposure to harsh weather conditions on deck or excessive heat in the machinery spaces. As they often travel by air to reach and return from their ships, they should not suffer from conditions which are exacerbated by air travel.

* In view of the physical demands of work at sea and the relative isolation from shore-based medical facilities, the medical standards should specify the conditions under which seafarers suffering from potentially life-threatening conditions controlled by medication may be allowed to continue to serve at sea.

* Special attention should be given in the medical standards to practical definitions of obesity.

* Seafarers should be able to live and work closely with the same people for weeks and perhaps months on end and under occasionally stressful conditions. They should be capable of dealing effectively with isolation from family and friends and, in some cases, from persons of their own cultural background.

* Shipping operations and shipboard duties vary substantially. For a fuller understanding of the physical demands of particular categories of work on board ship, the medical examiner should acquire knowledge of the STCW Convention or equivalent national requirements and consult the relevant national authority, the shipping company and trade union representatives concerned and otherwise endeavour to learn as much as possible about seafaring life.

IX. Type and frequency of medical examinations

For the purpose of these Guidelines there are two major types of medical examinations: pre-sea medical examinations, those conducted before a person embarks upon a seafaring career, and periodic medical examinations, those conducted either before a seafarer reports to a ship or at periodic intervals during the seafarer's career. Both these types of examinations may be required by the competent authority, the training institution, the shipping company or the trade union. A medical certificate, signed by the medical examiner, is issued to seafarers who pass the examination (see section IV).

A pre-sea medical examination provides an opportunity to prevent a person from embarking on a seafaring career for health reasons apparent at that time. It is therefore more stringent in nature than a periodic examination, bearing in mind that that objective is to head off an unhealthy or unwise career choice. By its very nature, this examination may occur only once, and it is very important that the medical examiner conducts it thoroughly. Appropriate equipment should be used. The medical findings (such as the results of sight, hearing and blood tests, etc.) and medical history should be recorded and maintained for the lifetime of the seafarer.³

A periodic medical examination provides an opportunity to ensure that a seafarer remains fit for sea service by identifying medical conditions which may have developed since the seafarer entered the profession. It should be more flexible than the pre-sea examination, yet not so flexible as to permit unfit seafarers from working on ships. Seafarers should be examined at least once every two years. However, the medical examiner may decide that more frequent medical examinations may be necessary. Seafarers below the age of 18 years employed at sea should be examined at least every year. If a seafarer has been incapacitated by sickness or injury for 30 or more days, or has been evacuated/discharged from ships for health reasons, the medical certificate should be reviewed by a medical examiner.

Such medical examinations should also provide the opportunity to take measures to correct or mitigate medical conditions which could adversely affect the health of seafarers and should include measures of a preventive character. Laboratory and other tests necessary to evaluate the occupational exposure at work on board ship should be a part of these examinations.

X. The conduct of medical examinations

1. The medical examiner should determine if the purpose of the examination is to evaluate whether a person is fit for a seafaring career (pre-sea examination) or fit to return to sea (periodic examination) and conduct the examination accordingly.

2. The identity of the person to be examined should be verified. The number of his or her discharge book, passport or other relevant identity document should be entered on the examination form.

3. The examinee's intended position on board ship, and, as far as practicable, the physical and psychological requirements of this work, should be established. This may lead to restrictions based on the nature of the voyage (for example, fit for coastal or harbour service only) and the job to be held. Information on occupational history is essential as it may lead to closer attention on potential occupational health hazards (for example, risk of cancer from certain chemical cargoes or risk of hearing loss from work in the engine-room).

4. The examinee's previous medical records, where appropriate, should be reviewed.

5. Information should be collected directly from the examinee on his or her previous medical history. Point-by-point questions on the details of previous diseases and injuries should be asked and the results recorded. Details on other diseases or injuries not covered should also be recorded. After the information is collected the examinee should sign the form to certify it is a true statement.⁴

6. The physical examination and the necessary additional examinations⁵ should be checked and recorded according to set procedures.

7. Hearing, eyesight and colour vision should be checked and recorded. Eyesight should be in compliance with the international eyesight standards for seafarers set out in the section B-I/9 of the STCW Code, Guidance regarding medical standards -- Issues and registration of certificates (see Annex A for minimum in-service eyesight standards). In examinations, appropriate equipment (such as audio meters, etc.) should be used in the assessment of hearing capacity and visual acuity, colour vision, night blindness, particularly regarding those examinees who will be engaged in watch-keeping duties.

8. The examinee's vaccination record should be examined. Advice should be given on immunizations. If new vaccinations are given they should be recorded on the International Certificate of Vaccination (see also section XI).

9. The results of the examination should be recorded and assessed to determine if the seafarer is fit for the work which will be undertaken. Annex C contains guidance on medical conditions which should be taken into account when considering whether a person is fit or currently unfit for work at sea. The age and experience of the person to be examined, the nature of the duties to be performed and the type of shipping operation and cargo should be considered.

10. If the examinee is found fit for the work to be performed the medical certificate should be issued. Any restrictions concerning work (i.e., the job the seafarer will perform, the trade area, time-limit and other considerations) should be reflected in the description of the work he or she is fit to undertake. Further information on the medical certificate is provided in Annex E.

11. If the examinee is found temporarily or permanently unfit for service, he or she should be given an explanation of the reasons and should be advised on the right to appeal and how to make an appeal. Additional guidance on appeals procedures is provided in section VII. If "temporarily unfit", advice should be given on the need to make additional tests, to obtain opinions from specialists, to complete dental or other treatment, rehabilitation and/or appropriate medical care. The examinee should be informed when to return for another examination.

12. As appropriate, the seafarer should be counselled on lifestyle (to limit alcohol intake,⁶ stop smoking, modify diet, lose weight, etc.), on the dangers and methods of prevention of malaria, hepatitis, HIV/AIDS⁷ and other communicable diseases. Printed health educational materials on drug and alcohol abuse prevention, smoking cessation, diet, communicable diseases prevention, etc. should also be provided, if available).

13. The medical examination records should be clearly marked "CONFIDENTIAL" and be retained according to national regulations in the custody of the health establishment where the medical certificate was issued. The file should be kept confidential and shall be used for no other purpose than to facilitate the treatment of seafarers and should be made available only to persons duly authorized in accordance with data protection laws.

14. Relevant information on his/her health should be given to the seafarer on request and the seafarer should be advised to take it to the next medical examination or when he or she is treated for an illness or injury. If possible, a card indicating blood type and other vital information should also be given to the seafarer to facilitate emergency treatment.

15. A copy of the medical certificate should be kept in the files of the health institution in which it was issued.

XI. Vaccination requirements for seafarers

³ See Chapter 4 on "Collection, processing and communication of health-related data" included in the Technical and Ethical Guidelines for Workers' Health Surveillance (see Annex F).

⁴ An individual should not, however, bear the burden of proof concerning the consequences of physical or mental illness, past or present, on his or her fitness for work.

⁵ If drug and alcohol testing is required, reference should be given to the Guiding Principles on drug and alcohol testing procedures for worldwide application in the maritime industry adopted by the Joint ILO/WHO Committee on the Health of Seafarers (Geneva, 10-14 May 1993).

⁶ The medical examiner may wish to consult the ILO publication Drug and alcohol prevention programmes in the maritime industry (A manual for planners) or a similar publication aimed at prevention of drug and alcohol abuse.

⁷ If the tests for HIV which may have been carried out in connection with the examination reveal a positive result, the seafarer should always be informed. An HIV positive test result should not render the seafarer unfit for duty.