Annex B

Minimum in-service hearing standards

Hearing capacity for experienced seafarers should be at least 30 dB (unaided) in the better ear and 40 dB (unaided) in the other ear within the frequencies 500, 1,000, 2,000 and 3,000 Hz (speech hearing distance 3 metres and 2 metres respectively). It is recommended that all hearing examinations should be made by a pure tone audio meter. For safety sensitive positions the competent authority may require higher standards.

Annex C

Medical conditions which should be considered when deciding whether to issue medical certificates to seafarers

The medical examiner should bear in mind that it is not possible to develop a comprehensive list of contraindications but that this list may provide some guidance. It cannot replace sound medical judgement.

When determining fitness for sea service in the case of persons with medical problems, he/she should consider and evaluate the following points:

(a)the critical time needed for treatment/access to appropriate land-based care;

(b)the extent of the threat and danger caused by the medical problem to the patient, other persons on board and to the safety of the vessel or the environment;

(c)the current risk of occurrence of the medical problem.

The medical conditions cited below are examples which might justify restrictions on time, position, trade area, type of ships, or medical surveillance, or render the examinee temporarily or permanently unfit.

1. Infectious and parasitic diseases

• Tuberculosis.⁸
• Hepatitis.
• Malaria.
• Acquired Immunodeficiency Syndrome (AIDS).
• Enteritis.
• Sexually transmitted diseases.
• Any other infectious or parasitic disease in its communicable or carrier state which would present a health hazard to other crew members or passengers through casual contact.

2. Neoplasms

• Neoplasms of any type which could be considered to disqualify a seafarer from duty until evaluated. Exceptions may be appropriate for serving seafarers after treatment and without signs of recurrence.

3. Endocrine, nutritional and metabolic conditions and immunity disorders

• Adrenal insufficiency, uncontrolled.
• Diabetes mellitus, all cases requiring insulin.⁹
• Immunosuppressive therapy.
• Obesity, incapacitating function.
• Thyroid disease.

4. Diseases of the blood and blood-forming organs

• There should be no diseases or abnormalities of the haemopoetic system or the circulating blood.

5. Mental disorders

• Consumption of alcohol and use of psychotropic drugs which adversely affect the health of the seafarer or the safety of the ship.
• Psychosis.
• Psychoneurosis.
• Dementia.
• Personality disorder.
• State after mental disorder with tendency for recurrence.

6. Conditions of the nervous system

• Organic diseases of the nervous system or disorders due to metabolic disease causing disturbance of muscular function, balance, coordination or alertness.
• Epilepsy.
• Migraine, frequent attacks causing incapacity.
• Syncope and other disturbances of consciousness.
• Meniere's disease.
• Post-concussion syndrome.

7. Conditions of the cardiovascular system

The cardiovascular system should be free from diseases causing disability:

• Heart diseases:
  • vascular disease;
  • ischaemic heart disease, angina pectoral history of coronary thrombosis or bypass grafting;
  • symptomatic abnormality of the rate of rhythm;
  • dependence on pacemaker.

• Hypertension:
  • Hypertension necessitating the use of antihypertensive drugs with side-effects which adversely affect seafarers' fitness.

• Arterial disease:
  • history of intermittent claudication;
  • aortic aneurysm.

• Cerebrovascular disease:
  • history of cerebrovascular accident including transient ischaemic attack;
  • general cerebral arteriosclerosis including senility.

• Diseases of veins:
  • varicose veins, moderate to severe;
  • varicose ulcerations;
  • deep vein thrombosis or thrombophlebitis;
  • haemorrhoids, symptomatic;
  • varicocele, symptomatic.

8. Conditions of the respiratory system

Any condition of the respiratory system -- obstructive, restrictive or infectious -- causing significant disability, for example:

• Bronchial asthma.¹⁰
• Pulmonary fibrosis.
• Gross deformity of the chest wall.
• Pneumothorax.
• Tumours.

9. Oral health

• Infections of the mouth cavity or gums.
• Severe dental defects that interfere with proper mastication.
  Seafarers must be dentally fit.

10. Conditions of the digestive system

• Peptic ulcer.¹¹
• History of gastro-intestinal bleeding/perforation.
• Recurrent appendicitis.
• Cholelithiasis, cholecystitis, cholangitis.
• Liver cirrhosis.
• Pancreatitis, recurrent.
• Intestinal stoma.
• Hepatitis.
• Perianal pathology.

11. Conditions of the genito-urinary system

• Genito-urinary tract infections, specific and non-specific.
• Renal failure.
• Urinary tract obstruction.
• Prostatism.
• Removal of one kidney.
• Renal transplantation.
• Urinary incontinence.
• Hydrocoele, large, symptomatic.
• Gynaecological condition likely to cause complications.
• Menstrual dysfunction.

12. Pregnancy

13. Conditions of the skin

• Infections of the skin, until satisfactorily treated.
• Eczema.
• Dermatoses.
• Manifestations of systemic disease (e.g. lupus, allergy).

14. Conditions of the musculoskeletal system

• Seafarers should have no defect of the musculoskeletal system that could interfere with their ability to discharge their duties (muscular power, balance, mobility and coordination should be unimpaired):
  
  • Osteoarthritis.
  • Recurrent dislocation of a major joint.
  • Symptomatic flat foot or halux valgus.
  • A limb prosthesis would not be acceptable.

15. Ears

• Infectious or inflammatory ear conditions.
• For hearing capacity, see Annex B.

16. Eyes

• Both eyes must be free from progressive pathological conditions.
• Recommended minimum in-service eyesight standards taken from the STCW Code, Annex II, Section B, Guidance regarding medical standards -- Issues and registration of certificates, paragraphs 7-11 and table B-I/9, are included in Annex A.

17. Other

• Hernia.
• Severe speech impediment.

⁸ The examining physician should take into account the advice of a chest physician, whether the lesion is fully healed and whether the patient has completed a full course of chemotherapy. Cases where either one or both lungs have been seriously affected are rarely suitable for re-employment.

⁹ All other cases should disqualify new candidates. For serving seafarers, cases controlled by food restrictions and/or oral hypoglycaemic agents should be evaluated and assessed individually. Exceptions may be made for serving seafarers if they do not require insulin.

¹⁰ Asthmatics who require systematic oral corticosteroids, or have been taking such medication during the past year, should be re-evaluated for the likelihood of a recurrence of acute asthmatic attack. This disease disqualifies new candidates, but serving seafarers may be employed on board ships carrying a medical doctor.

¹¹ In the case of serving seafarers, those with proven ulceration should not return to seafaring until they are free of symptoms. There should be gastroscope evidence of healing and the seafarer should have been on an ordinary diet, without treatment, for at least six months. Persons who have had gastro-intestinal bleeding, perforation, recurrent peptic ulceration (despite treatment) or complications after surgery should be classified as unfit for work on ships.

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