Medical Fitness Examination and Certification of Seafarers and Portworkers Presentation by Stamford Medical

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1 World Maritime Day in Timor-Leste, 3 Dec 2015 Medical Fitness Examination and Certification of Seafarers and Portworkers Presentation by Stamford Medical

2 International Guidelines Laws of most maritime countries requires that all seafarers (and portworkers) carry a valid medical certificate. Harmonization between different national standards is desirable because of: Increasing internationalization of shipping Widely varying national standards Achieve consistency International Guidelines Provide maritime administrations with internationally recognized set of criteria for use: Either directly; or, As the basis for framing national medical examination standards Establish criteria for equitable decisions about who can safely and effectively perform their routine and emergency duties 1

3 International Guidelines Guidelines on the Medical Examination of Seafarers (2013) were established by International Labour Organization (ILO) and International Maritime Organization (IMO) to provide advice on the application of: Maritime Labour Convention (2006); and the International Convention for Standards of Training, Certification and Watchkeeping for Seafarers (1978, as amended) with regard to safe-guarding the health of seafarers and promoting safety at sea. ILO s Occupational Safety and Health (Dock Work) Convention (1979) established similar guidelines for Portworkers. 2

4 Medical Examinations Establish Fitness to Work Medical examinations are not predictive, and the intent is not to exclude individuals Medical examinations aim to establish if examinees are qualified and fit for their duties, so as to: Safeguard personal health and safety Reduce risk to other crew members Early detection and preventive health Protect property Protect marine environment 3

5 Medical Examination Considerations Relevant examinations/certification should be prescribed in light of examinee s duties Routine and emergency duties must be known to the medical examiner Differentiate between different functions Health is a dynamic process Considerations related to the validity period of the medical certification: Current degree of fitness Likelihood of aggravating any existing medical condition Likelihood of developing an impairing condition Need for surveillance (chronic diseases) Distance from shore-based medical facility (if applicable) Minimise conditions that require medevac (eg. dental abscess) Differentiate between persons seeking to start a career and those already serving 4

6 Structure of Medical Examination Examinee s Declarations Personal particulars (Name, DOB, Sex, Address) Confirmation of identity (Passport) Department (deck, engine, radio, food handling, other) Routine & emergency duties Type of ship; Trade area (if applicable) Examinee s personal declaration Historical medical condition Additional questions (eg. Have you ever been declared unfit for ship duty or repatriated from ship?) Authorization to release medical information 5

7 Structure of Medical Examination Medical Examiner s Assessment Vision Distance vision, near vision, colour vision, visual fields, night vision Hearing Audiometry, or validated/standardized tests Physical capabilities Strength, stamina, flexibility, balance and coordination, size (eg. entry into confined areas), exercise capacity, fitness for specific tasks (eg. wearing breathing apparatus) Investigations as indicated (eg. reflex test) Assessment of risk for back injuries Impairment from the use of medication Assess the known adverse effects of each medication used Presence or recent history of an illness or condition Discussion of conditions which deserve extra attention (eg. If the employee is offshore) Xray Laboratory investigations (as indicated) ECG (as indicated) 6

8 Medical Certification Medical certificates should genuinely reflect the examinee s state of health A medical certificate is neither a certificate of general health nor a certification of the absence of illness. It is a confirmation that the the examinee is expected to be able to meet the minimum requirements for performing the routine and emergency duties specific to their post safely and effectively during the period of validity of the medical certificate. Categories of Certification Unrestricted Medical Certificate - Able to perform all duties worldwide within designated department Restricted Medical Certificate - Able to perform some but not all routine and emergency duties; able to work in some but not all locations; and/or need for increased surveillance Medical Certificate not issued Incompatible with the reliable performance of routine and emergency duties safely or effectively 7

9 If Medical Certificate is Refused, or Restricted Certificate is Issued Appeals Procedure Examinees may choose to have a further examination by another independent medical practitioner or by an independent medical referee The medical practitioner or referee undertaking the review should have at least the same qualifications as the medical practitioner who conducted the initial examination The medical practitioner or referee undertaking the review process should be provided access to other medical experts The appeals procedure should not result in unnecessary delays for the examinee or the employer Quality assurance and review procedures should be in place to confirm the consistency and appropriateness of decisions taken at appeal If necessary, advice on treatment options available should be provided to the examinee (regardless of whether or not medical certificates was issued). Referral to specialists, national/public heath programs for treatment 8

10 Importance of Preventive Care Treatment is more effective in early stages Early detection can reduce the risk of more serious outcomes, like hospitalization due to complications Early detection/treatment reduces social/financial costs Financial cost minimized for early detection compared to cost of treatment of an already established disease, or complications Communicability Minimize lost work days 9

11 Implementation Respect fundamental rights, protections, principles, and employment and social rights. Right to Privacy Persons conducting medical examinations should ensure examinee s right to privacy Medical records should only be used for determining fitness of the examinee, and for enhancing healthcare Medical records should not be disclosed to others without examinee s prior written consent Examinee should have right of access to and receipt of his/her medical data The competent authority should: Maintain list of approved medical practitioners to conduct medical examinations and certification Establish procedures to familiarize medical examiners with examinee s working and living conditions Provide written guidance on the procedures for the conduct of medical examination and appeals process Establish quality assurance procedures to ensure required standards are met (eg. investigation of complaints, audits) 10

12 Implementation Approved medical examiners should: Be qualified medical practitioner with experience in general medicine, occupational medicine, and/or maritime occupational medicine Have adequate knowledge of living and working conditions of candidates Have adequate facilities for the conduct of examinations Refer any medical problems found, when appropriate, for further investigation and treatment Enjoy professional independence from examinees, employers, stakeholders and their representatives 11

13 Thank You

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