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 Recommendations and Factors to be Taken into Account in a Medical Examination

Medical examinations are required before a certificate is issued under the Marine Certification Regulations and also at specified intervals to maintain the validity of certificates for use at sea under the Crewing Regulations. The intervals are set out in Division 8 of the Crewing Regulations as follows: every 2 years for a seafarer who holds a certificate and is at least 40 years of age; every 2 years for a seafarer who does not hold a certificate and is at least 60 years of age; and in all other cases, every 3 years. The interval may be shorter if specified by the physician or if the Minister requires a re-examination under Division 8 of the Crewing Regulations. It is recommended that a medical examination consists, at a minimum, of the following elements:

* Not to be used for drug testing.

Factors to be Taken into Account  ^

The intention of this section is to provide information that assists physicians in reaching appropriate decisions in respect of medical examinations of seafarers. The nature of the requirement for a medical examination requires the application of the physician's knowledge of the individual, the job, and the specific circumstances under which the job will be carried out. The paragraphs which follow deal with a variety of occupational groups and general environments. Within occupational groups, there may be found a variety of jobs, and within general environment descriptions a variety of specific environments. The following factors are relevant to assessing the fitness of a seafarer.

Remoteness from Medical Assistance ^

Seagoing occupations may require a seafarer to be away from major medical facilities for several months at a time. Few ships carry medical officers; even in those ships that do, treatment resources are minimal. While at sea, ships are frequently more than several hours or days away from medical facilities, which provide more than minimal treatment resources.

Shift Work ^

On average, 40% of the positions on ships involve watchkeeping. Officers and crew work on either the lay-day watch system or the conventional watch system. The lay-day watch system requires the employee to be on duty for six hours and off duty for six hours ("six and six"), for 28 days of 12 hours work per day, followed by 28 days leave. The conventional watch system requires the individual to be on duty for four hours and off duty for eight hours ("four and eight"), for an eight-hour work day, 40-hour work week, plus weekends which are considered overtime. For the conventional watch system, seafarers could spend eight weeks or more at sea without a day off.

Minimal Privacy Conditions ^

While at sea, seafarers frequently work long hours under uncomfortable weather conditions, rough seas and in comparatively close quarters isolation. Living conditions and meals aboard are generally good. There is, however, little privacy on board as the ship's crew members must share cabins and washrooms (two to four to a cabin averaging 3 m by 2.5 m in size). Crew cabins are usually on the lower decks and often have no portholes; therefore, have no natural light or fresh air. The ship's officers generally have private cabins on the upper decks but share washrooms, however, they sometimes are required to share two to a cabin.

Limited Outside Communications ^

Further negative influences include working in isolated areas, reduced space and limited mobility due to the fact that one cannot leave the work site (the ship). Crew must be able to relate easily with fewer people, where interaction and team work is essential to the safe and successful operation of the vessel. There is frequent separation from family and friends and lack of contact with the outside world. Telephones are generally not available for personal use, except in emergencies.

Limited Recreational Activity ^

Boredom between work periods is a major factor while at sea. There are reduced options for spending one's leisure time in the confines of a vessel. Crew must be self-reliant in making their own entertainment. Leisure activities consist of cards, games, reading, video films, hobbies, some radio, and, occasionally, television. Some of the larger ships are equipped with gymnasium equipment.

Mental and Physical Stressors ^

Mental stress results from isolation, boredom, lack of privacy, the constant background noise and vibration, the demands of the work and, in the case of search and rescue incidents or emergency situations, possibly witnessing severe human injury or death. Physical stress frequently results from maintaining balance in an environment where the platform is constantly rolling, frequently violently (in excess of 12 degrees port and starboard), pitching and pounding in high seas and bad weather; and from the actual physical demands required of working at sea including remaining standing while on watch for six hours at a time and frequently longer, depending upon the circumstances. Engine room personnel are frequently exposed to very uncomfortable heat, cold, high humidity levels, obnoxious odours and airborne contaminants, occasionally requiring the use of breathing apparatus. Cooks and stewards experience split shift work where the 8 or 12-hour days are spread over 12 to 15 hours, and peak periods of high energy activity while provisioning a vessel which may extend beyond normal hours of work.

Presence of Hazards ^

Seagoing personnel are exposed to a variety of hazards, including wet, slippery and moving platforms; contact with chemicals, vapour fumes, harsh environmental conditions, noise, machinery and electricity; being struck by objects suspended overhead (for example, cargo pallets, swinging hooks); falling or being washed overboard; combating emergency situations such as retrieving objects which have broken loose from their lashings, fire on board, damage control, and abandoning ship. High noise levels (up to 160 dB) are normal in engine room and machinery spaces requiring the use of hearing protection, and these spaces are often cramped and confined and have no natural lighting.

Emergency Drills and Emergency Response ^

Emergency duty exercises for a ship’s complement are held during the training courses leading to qualification and during the drills which are held periodically on board ship. Persons requiring aids are at increased risk of breaking or losing them during an emergency situation. Some emergency escape routes involve climbing up vertical ladders through comparatively small exits. It could also mean abandoning ship in a lifeboat or life-raft or by jumping into freezing waters from a moving platform 12 metres in height, then swimming to a lifeboat or life-raft and climbing into it, lifting injured people from the water, all while wearing lifesaving equipment. Although emergency situations rarely occur, when one does occur, the crew has only one chance of successfully overcoming it.

All members of the complement are responsible for marine emergency duties. Emergency situations almost always occur during adverse weather conditions, at which time the forced ventilation is switched off and the lighting is reduced to emergency levels.

A ship is a unique work site. The complement is its own fire department, first aid attendants and lifeboat party. There is nowhere to escape in the event of a fire or other emergency. Quick and decisive emergency countermeasure procedures are the best way to avert a marine disaster. The entire ship's complement is a team which must rely on one another for survival. The size of ships' complements are steadily decreasing; therefore, each member of the complement may be required to compensate for the reduced numbers during emergencies. It occasionally happens that members of the complement are injured, thereby reducing the number of persons available to participate in emergency duties. This results in other individuals having to increase their physical responses to accomplish the outstanding tasks.

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