ILO/WHO/D.1/1997
ILO/WHO Consultation on Guidelines for Conducting
Pre-sea and Periodic Medical Fitness Examinations for Seafarers
(Geneva, 25-27 November 1997)
Report
1. The ILO/WHO Consultation on Guidelines for Conducting Pre-Sea and Periodic Medical Fitness Examinations for Seafarers was held at the International Labour Office in Geneva from 25 to 27 November 1997 in accordance with the decisions of the Governing Body taken at its 268th Session (Geneva, March 1997) and of the 49th Session of the World Health Assembly in May 1996 (resolution WHA49.12). A list of participants is given in Annex I to this report.
2. The Consultation was opened by Mr. Bjorn Klerck Nilssen, Chief of the Maritime Industries Branch of the Sectoral Activities Department of the International Labour Office. He underlined the importance of close collaboration between the WHO and ILO on matters related to the health of seafarers. A seafarer not fit for sea service would be a danger not only to himself/herself but also to fellow shipmates, passengers, and the safety of the ship. The ILO had addressed health issues, inter alia, through the adoption of standards such as the Medical Examination of Young Persons (Sea) Convention, 1921 (No. 16), and the Medical Examination (Seafarers) Convention, 1946 (No. 73). These instruments required seafarers to hold valid medical certificates as conditions of sea service. However, they did not specify, in detail, the criteria for the issuing of such certificates. This had led to a recognition of the need for harmonization of medical examinations of seafarers, including specific requests by not only the Joint ILO/WHO Committee on the Health of Seafarers but also the IMO Conference to the Parties of the International Convention on Standards of Training, Certification and Watchkeeping in 1995. The ILO and the WHO had therefore conducted a survey on how medical examinations of seafarers were undertaken in more than 25 countries. The draft Guidelines prepared for the Consultation were to a large extent based on the results of the survey. It was hoped that the Consultation would agree a set of Guidelines that could serve the maritime industry for many years to come.
3. Dr. M.I. Mikheev, Chief Medical Officer of the Office of Occupational Health of the World Health Organization, noted that studies had shown that human error was the cause of many accidents at sea. Such error was often connected to the health of the seafarer. Seafarers were subject to occupational stress and isolation from family and friends, and this may lead to health problems. He noted the special attention therefore given by the World Health Assembly and the WHO collaborating centres to occupational health problems, including those experienced by seafarers. The standards for fitness for sea service varied considerably from country to country, and this had resulted in a need for harmonization, the first step of which would be the Guidelines. An initial draft of the Guidelines, which had been prepared by Dr. Tomaszunas, had been discussed by the Third International Symposium on Maritime Health held in Baltimore, Maryland, United States, in 1995. He in particular welcomed the participation by Dr. Saeme of the International Maritime Health Association, which had been formed earlier this year. Finally, he stressed the importance of reaching agreement by the end of the Consultation, and thanked the ILO for its support and for hosting the meeting.
4. Professor H. Ebert (Germany) -- WHO member -- was unanimously elected Chairperson and Reporter of the Consultation. Mr. D. Lindemann (Germany) -- ILO Shipowner member -- and Mr. P. Funch (Denmark) -- ILO Seafarer member -- were elected Vice-Chairpersons.
Presentation of the draft Guidelines
5. In introducing the draft Guidelines, Mr. Brandt Wagner of the Maritime Industries Branch of the ILO noted that the results of the survey undertaken, as well as preliminary comments from the IMO, some WHO collaborating centres and the Shipowner and Seafarer groups of the ILO Joint Maritime Commission, had been used in preparing the draft. An attempt had been made to also address quality of examinations and examiners, appeals procedures, privacy of examination results and other important issues. Annex I of the draft Guidelines prepared by the Office contained a list of medical conditions which should be taken into account when deciding fitness for sea service. It was essential that careful consideration be given to how this list would be used in determining fitness. Finally, he drew the participants attention to the report of the Meeting of Experts on Workers' Health Surveillance (Geneva, 2-9 September 1997), which are relevant to the finalization of the draft Guidelines.
Examination of the draft Guidelines
6. The Shipowners' members underlined that the health of seafarers was a prime concern to them. Seafarers' health was a shipowner's responsibility as well as a matter of self-interest. Sickness benefits represented a growing proportion of the shipping industry's third-party liability insurance claims, most of which were covered by Protection and Indemnity Clubs (P&I Clubs) that are mutually owned by shipping companies. The shipping industry was paying for the costs of thousands of medical examinations which, in keeping with the requirements of Convention No. 73, were required at least every two years. Certificates were checked not only by flag States but also through port State control. Unfortunately, the scope and quality of the examinations varied widely. The international maritime community, most recently at the IMO, had therefore called for international medical standards for such examinations. Harmonization of examination requirements would be useful but a more serious issue was to improve control by governments of doctors authorized to issue medical certificates. Finally, the Shipowners noted that the ILO and WHO had prepared a very good draft Guidelines for discussion. An effective implementation would be of great importance in the future.
7. The Seafarers' members associated themselves with the views of the Shipowners on the quality of the draft Guidelines adding that they reflected the needs and requirements of the industry to guide both maritime authorities and physicians. The Guidelines were based on existing international instruments as well as the results of the ILO/WHO questionnaire of 1994. There was no question that the need for internationally agreed minimum standards on medical examination requirements for seafarers, as was expressed by the Seventh Session of the ILO/WHO Committee on the Health of Seafarers in 1993, was even more urgent today than four years ago. The Seafarers were convinced that the deliberations would be successful and they were committed to the Consultation's successful outcome. The Seafarers therefore would not seek major changes to the draft but only to clarify certain points. Specific amendments would therefore be introduced throughout the course of the discussions.
8. A WHO member noted the timeliness of the Consultation and supported the draft. He stressed the importance of discussing the issues of privacy and human rights protection.
9. Another WHO member cited the need to improve the parts of the Guidelines concerning the principles of prevention of health problems. The WHO had formulated general principles on medical screening, and these should be reflected. Medical examinations also provided an opportunity to obtain information useful for research and prevention purposes. This should be considered. Furthermore, he expressed a need to bear in mind that consideration be given to requirements for seafarers on, for example, coastal voyages, as opposed to deep-sea voyages.
10. An observer from the International Transport Workers' Federation raised the issue of the future of the Guidelines. After adoption, they should be disseminated widely. After a few years the ILO and WHO should survey members on the usefulness of the Guidelines. If the replies were positive, consideration might be given to developing an instrument.
11. The observer from the International Medical Health Association (IMHA) introduced his organization which worked for the benefit of the whole of the maritime community. The IMHA members were experts who dealt daily with maritime medical problems. Their main concern was to promote the quality of health of seafarers and therefore the safety of shipping. He noted vast changes in shipping in recent times, including more frequent use of multinational crews. The Guidelines would be valuable to physicians concerned with maritime medicine, but of course could not take the place of an understanding by physicians of life and work at sea. The IMHA had prepared some proposals for amendments to improve the draft and, if accepted, he would raise these in any working groups which might be formed.
12. A WHO member cited the importance of providing assistance to developing countries in the field of maritime medicine. He suggested that consideration be given to the development of an international course on maritime health. Such training would serve as a focal point for the enhancement of maritime health worldwide.
13. An ILO Seafarer member underlined that it would not be possible to implement new medical examination standards overnight. Standards would necessarily vary depending on the nature of the voyage. The Consultation must also be careful not to develop unreasonable fitness requirements. Finally, careful consideration should be given to guidance concerning appeals procedures. For example, in his country it would only make sense that the physician handling an appeal had a higher medical qualification than the initial examiner.
14. An ILO Shipowner member pointed out that the Consultation was not setting standards but was developing guidance which would be flexible enough to take into account the diversity of conditions in different countries. The Guidelines should achieve maximum flexibility without endangering the health of the seafarer or the safety of the ship.
15. The Consultation felt that the establishment of maritime health centres would further the aims of these Guidelines. Therefore, member States should be encouraged to and assist in establishing centres dealing with seafarers' medical examinations, maintenance of records and research on maritime health and safety.
16. In light of its discussion the Consultation decided to set up two working groups: one to consider the main body of the Guidelines up to and including section VIII and the other the remaining sections and the annexes.
Adoption of the report and the Guidelines
17. With some amendments the Consultation unanimously agreed on the proposals of the two working groups. The text of the Guidelines with annexes are reproduced in Annex II.
18. Having considered the draft report on the proceedings at its final sitting and making certain amendments, the Consultation adopted the text thereof including Annex II.
Geneva, 27 November 1997.
(Signed) H. Ebert,
Chairperson and Reporter.
Annex I
ILO/WHO Consultation on Guidelines for Conducting
Pre-Sea and Periodic Medical Examinations for Seafarers
(Geneva, 25-27 November 1997)
List of participants and secretariat
ILO
Shipowners' members
Mr. D. Lindemann (Germany), German Shipowners' Association
Dr. W.W. Daoud (Kuwait), Kuwait Oil Tanker Company
Seafarers' members
Mr. P. Funch (Denmark), Vice-President, Dansk Navigatørforening
Dr. L. Barnes (India), General Secretary, National Union of Seafarers of India (NUSI)
WHO members
Professor S. Tomaszunas (Poland), Deputy Director, Institute of Maritime and Tropical Medicine, and Director, WHO Inter-regional Collaborating Centre on Maritime Occupational Health
Professor H. Ebert (Germany), Hamburg Port Health Centre
Dr. O. Jensen (Denmark), Head, Institute of Maritime Medicine
Dr. K. Logunov (Russian Federation), Department of Maritime Health Medical Academy for Postgraduate Studies
Observers
Belgium
Dr. R. Verbist, Port Physician, MEDIPORT
Spain
Dr. M.L. Canals, Instituto Social de la Marina
International Maritime Health Association (IMHA)
Dr. M. Saeme, President, IMHA
Dr. B. Schepers (Germany), Medical Director, See-Berufsgenossenschaft
International Transport Workers' Federation
Mr. W. Steinvorth
Dr. H. Wickramatillake
International Shipping Federation
Ms. K. Chan
Ms. B. Johansen
Dr. A. Smith
Mr. S. Bennett
Finnish Institute of Occupational Health Centre of Maritime Medicine
Dr. H. Saarni, Chief Medical Officer
International Confederation of Free Trade Unions (ICFTU)
Mr. G. Ryder, Director
Mr. D. Cunniah, Assistant Director
Joint secretariat
WHO
Dr. M.I. Mikheev, Chief Medical Officer, Office of Occupational Health
ILO
Mr. B. Klerck Nilssen, Chief, Maritime Industries Branch
Mr. B. Wagner, Maritime Industries Branch
Mr. B.H. Yoon, Maritime Industries Branch
Ms. I. Gregersen, Maritime Industries Branch
Annex II
Guidelines for conducting pre-sea and periodic
medical fitness examinations of seafarers
International Labour Office
Geneva, Switzerland
World Health Organization
Geneva, Switzerland
Background
Requests for the development of international, harmonized standards concerning the medical examination of seafarers have arisen during meetings at the International Labour Organization (ILO), International Maritime Organization (IMO) and World Health Organization (WHO).
In May 1993 the Joint ILO/WHO Committee on the Health of Seafarers met in Geneva at its Seventh Session and, inter alia, concluded that, as regards the issue of the harmonization of medical examination requirements for seafarers:
Fitness standards for seafarers vary widely. It is, therefore, desirable that an international standard be developed for pre-sea and periodic examinations. Doctors performing such examinations should have a clear understanding of the special requirements of seafaring life. In June-July 1995, the Conference of Parties to the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW Conference), which met in London at IMO headquarters, adopted resolution No. 9, Development of international standards of medical fitness for seafarers, which, inter alia, invited the IMO, in cooperation with the International Labour Organization and the World Health Organization, to develop international standards of medical fitness for seafarers.
The following Guidelines have been prepared to respond to these requests.
Introduction
I. Purpose of the Guidelines
1. These Guidelines are intended for use by competent authorities, medical examiners, shipowners, seafarers' representatives and others concerned with the conduct of medical fitness examinations of seafarer candidates and serving seafarers. They have been developed to reduce wide differences in medical requirements and examination procedures and to ensure that medical certificates which are issued to seafarers are a valid indicator of their medical fitness for the work they will perform. Ultimately, the aim of the Guidelines is to contribute to improved health and safety at sea.
2. 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
3. The Guidelines are organized as follows:
- 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.
4. 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
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III. |
Relevant standards of and guidance from the International Labour Organization,
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5. Where appropriate, the Guidelines have taken into account the Conventions, Recommendations and other instruments of the International Labour Organization (ILO), the International Maritime Organization (IMO) and the World Health Organization (WHO). Competent authorities should ensure that medical examiners are provided information on other relevant standards which may have been formulated after the date of adoption of these Guidelines.
ILO instruments concerning seafarers medical examination and health
6. The Medical Examination of Young Persons (Sea) Convention, 1921 (No. 16), and the Medical Examination (Seafarers) Convention, 1946 (No. 73),1 set out international standards concerning medical examination of seafarers, including requirements for medical certificates, frequency of medical examinations, scope of the medical examination, period of validity of the certificates, exemptions, appeal procedures and delegation by competent authorities of work related to medical examinations.
7. 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.
8. 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.
9. 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
10. The International Convention on Standards of Training, Certification and Watchkeeping (STCW Convention), 1978, as amended in 1995, Regulation I/9, Medical standards -- Issue and registration of certificates provides provisions concerning medical standards for seafarers. Further guidance is contained in the STCW Code, Guidance regarding medical standards -- Issues and registration of certificates.
WHO mechanism concerning seafarers' health and medical service
11. The WHO Executive Board and World Health Assembly have adopted resolutions on the health of seafarers (WHA14.51, EB29.R10, WHA15.21, EB37.R25, EB43.R23), requesting to assist nations to improve the health of seafarers, to ameliorate the medical records of seafarers, to make available to seafarers in each port services where the necessary specialized medical care can be provided. Furthermore, in May 1996, a resolution of the Forty-Ninth World Health Assembly (WHA49.12) on WHO's Global Strategy for Occupational Health for All urges countries to give special attention to full occupational health services for the working population including groups at high risk, such as seafarers.
IV. Purpose and contents of the medical certificate2
12. The Medical Examination (Seafarers) Convention, 1946 (No. 73), establishes international standards concerning medical examinations and certificates. It calls for the competent authorities, after consultation with the shipowners' and seafarers' organizations concerned, to prescribe the nature of the medical examination to be made and the particulars to be included in a medical certificate. The certificate is to attest:
- 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;
- 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.
13. 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.
14. 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.
15. 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
16. All persons concerned with the conduct of medical examinations, including those who come in contact with medical examination forms, laboratory results and other medical information, should ensure the right of privacy of the examinee. Medical examination reports should be marked as confidential and so treated, and all medical data collected from a seafarer should be protected. Medical records should only be used for determining the fitness of the seafarer for work and enhancing health care. The seafarer should have the right of access to and receipt of a copy of his/her personal medical data.
VI. Qualifications of medical examiners
17. The competent authority should maintain a list of medical examiners authorized to conduct medical examinations of seafarers and issue medical certificates. The competent authority should consider, in consultation with relevant shipowners' and seafarers' organizations, the need for medical examiners to be personally interviewed and for clinic facilities to be inspected before authorization to conduct medical examinations of seafarers is given. A list of medical examiners recognized by the competent authority should be made available to other competent authorities in other countries, companies and seafarers' organizations on request. The names of any medical examiners whose authorization has been withdrawn during the previous 12 months should continue to be included with a note to the effect that they are no longer authorized by the competent authority to conduct seafarers' medical examinations.
18. 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.
19. 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
20. 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.
21. 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.
22. 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
23. Convention No. 73 provides for arrangements to be made to enable a person who, after examination, has been refused a certificate to apply for a further examination by a medical referee or referees who shall be independent of the shipowner or any organization of shipowners and seafarers.
24. 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.
25. 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.
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
26. The medical examiner should bear in mind the following aspects of shipboard life:
- As ships often operate far offshore or in inaccessible areas, it is often difficult to replace seafarers who become injured or ill. Many ships have only the minimal number of persons on board necessary to operate the ship, thus the incapacitation of even one seafarer may place a substantial additional burden on his or her shipmates.
- 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
27. The medical standards may differentiate between those persons seeking to start a career at sea and those seafarers already serving at sea. In the former case, for example, it might be appropriate to designate higher standards in certain areas, while in the latter case some reduction may be made for age (see STCW Code, section B-1/9).
28. 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).
29. 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
30. 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.
31. 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
32. The following suggested procedures do not aim to replace in any way the judgement or experience of the medical examiner. They will, however, serve as a tool to assist in the conduct of examinations of seafarers. A model medical examination form has been provided in Annex D.
- 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.
- 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.
- 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).
- The examinee's previous medical records, where appropriate, should be reviewed.
- 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
- The physical examination and the necessary additional examinations5 should be checked and recorded according to set procedures.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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/AIDS(7) 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).
- 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.
- 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.
- 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
Seafarers should be vaccinated according to the requirements indicated in the WHO publication International travel and health: Vaccination requirements and health advice updated periodically.
Annex A
Minimum in-service eyesight standards
(partly taken from section B of the STCW Code,
Guidance regarding medical standards --
Issues and registration of certificates,
paragraphs 7-11 and table B-I/9)
In the absence of mandatory international eyesight standards for seafarers, the following standards and table 1 should be considered the minimum for the safe operation of ships.
Each competent authority has the discretionary authority to grant a variance or waiver of any of the standards set out in table 1, based on an assessment of a medical evaluation and any other relevant information concerning an individual's adjustment to the condition and proven ability to satisfactorily perform assigned shipboard functions. However, if the aided distant visual acuity of either eye is less than the standard, the aided distant visual acuity in the better eye should be at least 0.2 higher than the standard indicated in the table. The unaided distant visual acuity in the better eye should be at least 0.1.
Persons required to use spectacles or contact lenses to perform duties should have a spare pair conveniently available on board the ship. Any need to wear visual aids to meet the required standards should be recorded on each certificate and endorsement issued.
Eyes of seafarers should be free of disease. Any permanent or progressing debilitating pathology without recovery should be cause for determination of unfitness.
All tests needed to determine the visual fitness of a seafarer must be reliable and performed by a competent person recognized by the relevant national authority.
Notwithstanding these provisions, the competent authority may require higher standards than those given in the table.
Table B-I/9. Minimum in-service eyesight standards
|
| ||||||||||
|
STCW
|
Category of
|
Distance vision*
|
Near/immediate vision and colour vision
|
Visual
|
Night blindness |
Diplopia
| ||||
|
One eye |
Other eye |
Both eyes together, aided or unaided | ||||||||
|
| ||||||||||
|
I/11
|
Masters, deck
|
|
|
Vision required for ships' navigation (e.g. chart and nautical publication reference, use of bridge instrumentation and equipment, and identification of aids to navigation) |
Normal visual fields |
Vision required to perform all necessary functions in darkness without compromise |
No significant condition evident | |||
|
I/11
|
All engineer
|
|
|
Vision required to read instruments in close proximity, to operate equipment, and to identify systems/components as necessary |
Sufficient visual fields |
Vision required to perform all necessary functions in darkness without compromise |
No significant condition evident | |||
|
I/11
|
Radio officers
|
|
|
Vision required to read instruments in close proximity, to operate equipment, and to identify systems/components as necessary |
Sufficient visual fields |
Vision required to perform all necessary functions in darkness without compromise |
No significant condition evident | |||
|
* Valuables given in Snellen decimal notation. ** A value of at least 0.7 in one eye is recommended to reduce the risk of undetected underlying eye disease. | ||||||||||
|
| ||||||||||
Additional minimum in-service eyesight standards
The minimum in-service eyesight standards for other seafarers than mentioned in the STCW Code should be 0.1 unaided in each eye.
|
| |||||||||
|
Category of seafarer |
Distance vision
|
Near/immediate vision and colour vision
|
Visual fields |
Night blindness |
Diplopia (double vision) | ||||
|
One eye |
Other eye |
Both eyes together, aided or unaided | |||||||
|
| |||||||||
|
Others |
|
Sufficient for duties |
Sufficient for duties |
-- |
-- | ||||
|
Aided: |
|
0.1 |
|
|
|
|
|
|
|
|
Unaided: |
|
0.1 |
|
|
|
|
|
|
|
|
| |||||||||
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:
- the critical time needed for treatment/access to appropriate land-based care;
- 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;
- 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.
Annex D
Minimum requirements for the medical examination of seafarers
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| ||||
|
Name (last, first, middle): | ||||
|
Date of birth (day/month/year): |
/ / |
Sex: |
male |
female |
|
| ||||
|
Home address: | ||||
|
| ||||
|
| ||||
|
Passport No./Discharge Book No.: | ||||
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| ||||
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Type of ship (container, tanker, passenger, fishing): | ||||
|
| ||||
|
Trade area (e.g., coastal, tropical, worldwide): | ||||
|
| ||||
Examinee's personal declaration
(Assistance should be offered by medical staff)
Have you ever had any of the following conditions?
|
Condition |
Yes |
No |
Condition |
Yes |
No | |||
|
1. |
Eye/vision problem |
18. |
Sleep problems |
|||||
|
2. |
High blood pressure |
19. |
Do you smoke? |
|||||
|
3. |
Heart/vascular disease |
20. |
Operation/surgery |
|||||
|
4. |
Heart surgery |
21. |
Epilepsy/seizures |
|||||
|
5. |
Varicose veins |
22. |
Dizziness/fainting |
|||||
|
6. |
Asthma/bronchitis |
23. |
Loss of consciousness |
|||||
|
7. |
Blood disorder |
24. |
Psychiatric problems |
|||||
|
8. |
Diabetes |
25. |
Depression |
|||||
|
9. |
Thyroid problem |
26. |
Attempted suicide |
|||||
|
10. |
Digestive disorder |
27. |
Loss of memory |
|||||
|
11. |
Kidney problem |
28. |
Balance problem |
|||||
|
12. |
Skin problem |
29. |
Severe headaches |
|||||
|
13. |
Allergies |
30. |
Ear/nose/throat problems |
|||||
|
14. |
Infectious/contagious diseases |
31. |
Restricted mobility |
|||||
|
15. |
Hernia |
32. |
Back problems |
|||||
|
16. |
Genital disorders |
33. |
Amputation |
|||||
|
17. |
Pregnancy |
34. |
Fractures/dislocations |
|
If any of the above questions were answered "yes", please give details.
|
Additional questions
|
|
|
Yes |
No |
|
35. |
Have you ever been signed off as sick or repatriated from a ship? |
||
|
36. |
Have you ever been hospitalized? |
||
|
37. |
Have you ever been declared unfit for sea duty? |
||
|
38. |
Has your medical certificate ever been restricted or revoked? |
||
|
39. |
Are you aware that you have any medical problems, diseases or illnesses? |
||
|
40. |
Do you feel healthy and fit to perform the duties of your designated position/occupation? |
||
|
41. |
Are you allergic to any medications? |
|
Comments:
|
42. Are you taking any non-prescription or prescription medications?
|
If yes, please list the medications taken and the purpose(s) and dosage(s).
|
I hereby certify that the personal declaration above is a true statement to the best of my knowledge.
Signature of examinee: ________________________________ Date (day/month/year): _____/_____ /________
Witnessed by: (Signature) _______________________ Name: (Typed or printed________________________
I hereby authorize the release of all my previous medical records from any health professionals, health institutions and public authorities to Dr. ______________________(the approved medical examiner).
Signature of examinee: ________________________________ Date (day/month/year): _____/_____ /________
Witnessed by: (Signature) _______________________ Name: (Typed or printed________________________
Medical examination
|
Pre-sea |
Periodic |
Other |
Sight
|
|
Visual acuity |
|
Visual fields | |||||||
|
|
Unaided |
Aided |
|
Normal |
Defective | |||||
|
|
Right eye |
Left eye |
Binocular |
Right eye |
Left eye |
Binocular |
Right eye |
|
| |
|
Distant |
|
|
|
|
|
|
Left eye |
|
| |
|
Near |
|
|
|
|
|
|
|
|
| |
Colour vision: Not tested Normal Doubtful Defective
Hearing
|
|
Pure tone and audio metry (threshold values in dB) |
Speech and whisper test (metres) |
|
|
500 Hz |
4,000 Hz |
2,000 Hz |
3,000 Hz |
4,000 Hz |
6,000 Hz |
|
Normal |
Whisper | |
|
Right ear |
|
|
|
|
|
|
Right ear |
|
| |
|
Left ear |
|
|
|
|
|
|
Left ear |
|
|
Height: _______________(cm) Weight: ______________________(kg)
Pulse rate: _________(/(minute) Rhythm: ___________________________________
Blood pressure: Systolic: ______________(mm Hg) Diastolic: ____________________(mm Hg)
Urinalysis: Glucose: ________________ Protein: ________________________
|
Normal |
Abnormal |
Normal |
Abnormal | |||
|
Head |
Varicose veins |
|||||
|
Sinuses, nose, throat |
Vascular (inc. pedal pulses) |
|||||
|
Mouth/teeth |
Abdomen and viscera |
|||||
|
Ears (general) |
Hernia |
|||||
|
Tympanic membrane |
Anus (not rectal exam.) |
|||||
|
Eyes |
G-U system |
|||||
|
Opthalmoscopy |
Upper and lower extremities |
|||||
|
Pupils |
Spine (C/S, T/S and L/S) |
|||||
|
Eye movement |
Neurologic (full brief) |
|||||
|
Lungs and chest |
Psychiatric |
|||||
|
Breast examination |
General appearance |
|||||
|
Heart |
||||||
|
Skin |
Chest X-ray: Not performed Performed on (day/month/year): ______/_____/______
Results: ______________________________________________________________________________
Other diagnostic test(s) and result(s):
|
Test |
Result |
|
Medical examiner's comments:
|
|
Vaccination status recorded: |
Yes |
No |
Assessment of fitness for service at sea
On the basis of the examinee's personal declaration, my clinical examination and the diagnostic test results recorded above, I declare the examinee medically:
Fit for look-out duty Not fit for look-out duty
|
|
Deck service |
Engine service |
Catering service |
Other services |
|
Fit |
||||
|
Unfit |
Without restrictions With restrictions
|
Describe restrictions (e.g., specific position, type of ship, trade area)
|
Action taken by medical examiner (e.g., referral):
Place of examination: __________________ Date of examination (day/month/year):________ /_______ /______
Medical certificate's date of expiration (day/month/year):________ /________ /_______
Official stamp (also print name of medical examiner if not legible):
Signature of medical examiner: ___________________________
Authorized by: _______________________________________ (competent authority)
Annex E
Medical certificate for service at sea (sample)
|
| ||||
|
Name (last, first, middle): | ||||
|
Date of birth (day/month/year): |
/ / |
Sex: |
male |
female |
|
| ||||
|
Home address: | ||||
|
| ||||
|
| ||||
|
Passport No./Discharge Book No.: | ||||
|
| ||||
I have evaluated the above-named examinee according to __________________________________________(national law, regulation or other requirement).
On the basis of the examinee's personal declaration, my clinical examination and diagnostic test results recorded on the medical examination form, I declare the examinee:
Fit for look-out duty Not fit for look-out duty
|
|
Deck service |
Engine service |
Catering service |
Other services |
|
Fit |
||||
|
Unfit |
Without restrictions With restrictions
|
Describe restrictions (e.g., specific position, type of ship, trade area)
|
Place of examination: _________________ Date of examination (day/month/year):_____ /_____ /_____
Medical certificate's date of expiration (day/month/year):_____ /_______ /_______
Official stamp (also print name of medical examiner if not legible):
Signature of medical examiner: ______________________________
Authorized by: __________________________________________ (competent authority)
I acknowledge that I have been advised of the content of the medical examination form.
Examinee's signature: __________________________________________________
(To be signed in the presence of the medial examiner)
Annex F
4. Collection, processing and communication
of health-related data
4.1. The ILO Code of Practice on the Protection of Workers' Personal Data contains general principles which should be applied in workers' health surveillance. Workers' health data should be collected for justified purposes and in conformity with the general principles of occupational health and safety. The ultimate goal of collecting workers' health information should be to enhance the protection of the health and safety of workers and the public in line with the objectives which appear in the definition of occupational health.
4.2. Workers' health surveillance should process only the information which is useful for the assigned purpose. Appropriate attention should be attached to the extension of information technology which, if not properly controlled, may result in a widespread misuse of data. Special instructions concerning health and medical records maintained in electronic form should be issued by the competent authority in addition to general rules and regulations concerning privacy and personal data.
4.3. Good records and documentation are vital to all systems of workers' health surveillance. Health and occupational health professionals should contribute to the workers' personal health files with information relevant to the protection of workers' health and in accordance with their professional judgement and ethics. Personnel providing occupational health services should have access to the information contained in the file to the extent that it is relevant to the performance of their duties.
4.4. Workers' personal medical data should be collected in conformity with medical confidentiality and the general principles of occupational health and safety.
4.5. Workers' personal health data covered by medical confidentiality should be stored only by personnel bound by rules on medical confidentiality. Such data should be maintained separately from all other health data. Access to medical files and data should be restricted to medical professionals.
4.6. Workers have the right of access to their own personal health and medical files. This right should preferably be exercised through a medical professional of their choice. Special attention should be devoted to the need to maintain accurate and up-to-date records. Measures should be taken to facilitate the exercise of the right of each worker to have any erroneous data corrected.
4.7. Confidentiality must be respected in the whole process of workers' health surveillance. Personal health files and medical records must be kept secure under the responsibility of the occupational health physicians or occupational health nurses. The conditions under which, and the length of time during which, workers' health and medical records should be maintained should be prescribed by national laws and regulations or by the competent authority.
4.8. Personal information of a medical nature should only be communicated in accordance with the provisions governing medical confidentiality. Workers should be informed prior to such communications. Personal health data may be communicated to third parties only with the informed consent of the worker concerned.
4.9. General and collective information on the health of workers in the enterprise must be provided to employers and workers and their representatives in an appropriate manner for prevention, protection and promotion purposes. Communication of data may imply an interaction between the originator and the receiver. It may entail an obligation on the receiver's side, for example, the need to take action.
4.10. Special attention should be given to the manner in which forms are conceived. There may be irrelevant questions and some important aspects may be missing. Forms and questionnaires to be filled in by workers or by occupational health professionals may not meet the necessary criteria of respect and confidentiality. Occupational health professionals should examine such forms and questionnaires and endeavour to have them revised if necessary.
4.11. The danger that sophisticated investigations are often coupled with a lack of communication and explanations by the health profession should not be overlooked. Efforts should be made to limit investigations to those which are necessary for occupational health purposes and to ensure transparency, which will build a climate of confidence in the professional judgement and ability of occupational health professionals to provide sound advice which takes judicious account of the need to protect health and to maintain employment.
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.
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.
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.