Medical Fitness Examination and Certification of Seafarers and - PowerPoint PPT Presentation

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

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

International Guidelines “Guidelines on the Medical Examination of Seafarers” (2013) were established by n International Labour Organization (ILO) and International Maritime Organization (IMO) to provide advice on the application of: Maritime Labour Convention (2006); and n the International Convention for Standards of Training, Certification and Watchkeeping n 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 n guidelines for Portworkers. 2

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

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

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

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

Medical Certification Medical certificates should genuinely reflect the examinee’s state of health n A medical certificate is neither a certificate of general health nor a certification of the n absence of illness. It is a confirmation that the the examinee is expected to be able to meet the minimum n 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 n Unrestricted Medical Certificate - Able to perform all duties worldwide within n designated department Restricted Medical Certificate - Able to perform some but not all routine and n 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 n routine and emergency duties safely or effectively 7

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

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

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

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

Thank You