Subdivision Part A Seafaring and medical fitness - Marine Orders - Part 9: Health-Medical Fitness, Issue 5 (Order No. 22 of 1999) - Part A Seafaring and medical fitness | Zoe
- Hearing standard
- Table 2: Minimum standards of Hearing for Deck and Engine Departments
- The conduct of the conversation test
- Other ear, nose and throat conditions
- Prescribed drugs
- Table 3: Classes of drugs with potential to affect an individual’s skills to operate ships, boats, plant and equipment, including cranes
- Illegal drugs
- Alcohol
Marine Orders, Part 9 (Medical Fitness of Seafarers) is administered by the Australian Maritime Safety Authority. Part 9 makes provision for the issue of Certificates of Medical Fitness for duty at sea of seafarers (masters, mates, engineers and integrated ratings) and gives effect to Article 3 of ILO convention 73.
These guidelines have been compiled for the use of Medical Inspectors who are assessing an individual’s fitness to work at sea. The medical fitness standards have been developed in relation to the basic job task analyses in Annex 1 to these Guidelines. An employing company may have more stringent guidelines developed by its own occupational physician. Such guidelines will depend on the nature of the jobs and any specific equipment operated. Where such guidelines exist, they should be followed.
While the final judgement on whether or not an applicant is fit to work in a
particular job at sea rests with the Medical Inspector, these guidelines draw attention to those conditions that have the potential to present a high level of risk in some circumstances.
1.1 Why is fitness important?
1.1.1 Employers have a duty of care to provide a safe work environment and protect the health, safety and welfare of employees. Employees similarly have a duty of care for their own safety and that of the people they work with and the community. Medical assessment of fitness is one aspect of meeting this duty of care.
1.1.2 The primary objectives of a medical assessment of fitness for duty at sea are:
to ensure that individuals are fit to perform the essential tasks of their job at sea effectively
and
to anticipate and, where possible, prevent the avoidable occurrence of ill-health offshore which could place individuals, their colleagues and emergency personnel at risk.
1.1.3 Medical conditions may impinge on work in the following areas:
(a) the condition may limit, reduce or prevent an individual from performing the job effectively eg loss of mobility and dexterity making engine room work and other maintenance tasks difficult;
(b) the condition may be made worse by the job eg an asthmatic exposed to allergens on a grain ship;
(c) the condition may make it unsafe for the person to do the job eg liability to sudden loss of consciousness whilst transferring from a smaller vessel to a larger vessel by climbing a rope ladder;
(d) the condition is likely to make it unsafe both for the individual and other crew eg a ships crane operator liable to sudden loss of consciousness; catering crew with infectious hepatitis or gastro-enteritis;
(e) the condition is likely to make it unsafe for other shipping eg a master or mate who is at risk of sudden loss of consciousness due to a cardiac arrhythmia;
(f) the condition, if it worsens, is one which will require emergency evacuation for medical treatment eg gastric ulcer haemorrhage.
1.2 The work environment of seafarers
1.2.1 Medical Inspectors should bear in mind the aspects of seafaring life, listed below, when assessing fitness for duty at sea.
1.2.2 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.
1.2.3 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 qualified 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 inadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or to return to seagoing employment.
1.2.4 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.
1.2.5 Seafarers should be medically fit to perform their normal duties correctly and to be able to respond to emergency situations (eg fighting fires, lowering lifeboats, assisting passengers).
1.2.6 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, to lift heavy weights and to be able to withstand exposure to harsh weather conditions on deck or excessive heat in the machinery spaces. They should not suffer from conditions which are exacerbated by air travel.
1.2.7 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.
1.2.8 Shipping operations and shipboard duties vary substantially. For a fuller understanding of physical demands of particular categories of work on board ship, the Medical Inspector should consult the employer.
2 Procedures
2.1 Frequency of health assessments
2.1.1 All seafarers and coastal pilots should be assessed as to medical fitness for duties at sea:
less than 18 years of age: annually
18 - 54 years of age: two-yearly
55 years of age and over: annually with resting ECG (stress ECG, if in safety critical job and clinically indicated)
if there is a change in the medical condition of the employee
after prolonged sickness absence of 3 months or more due to injury or illness.
2.2 What information goes to the employer, AMSA and the seafarer?
Confidentiality
2.2.1 The employer, AMSA and the applicant/seafarer will receive a copy of the Certificate of Medical Fitness.
2.2.2 The Medical Inspector (or successor) should keep all the medical examination forms, including results of investigations in a confidential file, for a period of at least 30 years. This information is not to be released to any person, agency or employer without a signed consent form or as required by law.
2.3 Health assessment outcomes
2.3.1 An applicant or seafarer is either fit for the intended duties at sea or unfit.
2.3.2 Those declared unfit may be temporarily or permanently unfit or may be fit for duties other than the intended duties.
2.3.3 If temporarily unfit, the Medical Inspector should specify a minimum period after which the assessment can be reviewed.
3 Forms
The form of the Certificate of Medical Fitness is prescribed in Appendix 3 to Marine Orders, Part 9. Other forms that may be found useful are available from AMSA, freecall 1800 021 098 or from the AMSA web site at www.amsa.gov.au.
Part B Medical Standards
1 Overview
1.1 This section provides information and guidance on medical conditions which may affect individuals in the safe performance of their duties at sea.
1.2 The medical standards attempt to be specific and give examples of tasks/jobs which may be affected. The standards cannot cover every clinical situation and the Medical Inspector should exercise judgement in relation to the key objective - maintaining safety. For example, could the condition cause sudden loss of control of a ship, or sudden loss of consciousness when working at heights, or interfere with the performance of emergency duties?
1.3 Medical Inspectors should make a comprehensive medical assessment of overall health in the knowledge that errors or omissions of a critical task in some jobs can lead to serious consequences in terms of human health and life, environmental impact and/or major property loss.
1.4 The critical time needed for treatment/access to appropriate land-based care is also a consideration when determining fitness.
1.5 Medical Inspectors of Seafarers should consider what medical conditions could increase the probability of poor performance of critical tasks, and the probability and severity of the consequences when determining “Is this applicant medically fit for duty at sea?”.
Obesity
Body morphology
2.1 As obesity can hamper evacuation procedures, persons with a body mass index of more than 30 kg/m2 should be able to demonstrate that they can climb ladders and fit through hatches. An Occupational Physician or an Occupational Therapist may need to conduct a functional assessment on board ship.
2.2 A body mass index of more than 35 kg/m2 presents a high risk. Applicants in this category may need to undertake weight reduction and be reassessed. It should be noted that sleep apnoea is more common in those with morbid obesity, as are diabetes and hypertension.
Eyes / vision
Visual acuity
3.1 Far vision is required for:
(a) watchkeeping duties; and
(b) control of ships, ships’ small craft and cranes.
3.2 Near vision is required to read charts, weather maps, computer screens, monitors and instructions.
3.3 Night and depth vision are required for watchkeeping and control of the ship (depth vision is especially important for operating cranes at close distances).
Colour vision
3.4 Good colour vision is required for bridge watchkeeping duties to distinguish red and green port and starboard channel markers, navigation beacons and ships’ navigation lights. The ability to identify red, green and white navigation lights is an essential part of the job for masters, deck officers and seamen required to carry out lookout duties.
3.5 Impaired colour vision presents a risk to engineers who may be required to distinguish the colours of electrical wiring in order to make proper electrical connections. As such, it presents a risk depending on the degree of impairment that may affect a person’s ability to perform his duties. However, engineers and ratings may provide evidence from a relevant employer that, within the last two years, impaired colour vision, if present, has not been found to affect their work.
3.6 When testing colour vision, coloured lenses should not be worn by the seafarer.
Note: The wearing of contact lenses or spectacles with chromagen lenses with red filters will increase the contrast of greens, yellows & browns, thus enabling a colour deficient seafarer to pass the Ishihara test. Unfortunately, these lenses are not sufficient to enable safe watchkeeping duties at sea.
3.7 Information regarding colour vision impairment must be provided on the medical certificate to assist the employer to make an appropriate decision regarding engagement or continued employment.
Note: Guidance on appropriate screening for colour vision is contained in Annex 2 of these Guidelines.