Approved Doctor's Manual

276 Pages·2010·3.62 MB·English

Approved
Doctor’s Manual
Seafarer Medical Examinations
January 2010
Contents
Foreword Chapter 2: Governance
Instructions for use 2.1 Introduction
2.2 Procedures for appointment of approved Doctors
Chapter 1: Health of seafarers
2.3 Categories of approved Doctors
1.1 Introduction
2.4 Training and competence
1.2 Legal requirements for medical examination
2.5 Facilities
1.3 Purpose of the seafarer health assessment
2.6 Document control, records and returns
1.4 Maritime working conditions
2.7 Quality assurance – general
1.5 Treatment and welfare onboard ship
2.8 Quality assurance and audit – practical arrangements
1.6 Medical stores and the Doctor’s Bag
2.9 areas subject to administrative audit
1.7 Training of seafarers in first aid and medical matters
2.10 areas subject to clinical audit
1.8 radio medical advice
2.11 Overseas approved Doctors
1.9 Occupational health and safety for seafarers
2.12 Outcome: results from audits
1.10 Special hospital care in the uK
2.13 Complaints
1.11 Expenses of medical and other treatment during a voyage
on a uK registered ship 2.14 Customer service
2.15 Management review
2.16 relationships with the MCa and Chief Medical adviser
2.17 Forms – re-ordering arrangements
Annex A Medical administration Team (MaT) contact list
Annex B Seafarer Medical Examinations Feedback report
2 Contents continues
Contents
Chapter 3: The medical examination Chapter 4: Medical standards and aD guidance
3.1 Introduction Merchant Shipping notice (MSn 1822) for current medical standards
including fitness table
3.2 relationship with the seafarer
Standard restrictions
3.3 relationship with employers
ADG 1 Pulmonary Tuberculosis
3.4 relationship with professional colleagues
ADG 2 Infections transmitted in body fluids
3.5 Ethics and confidentiality ADG 3 Cancer
ADG 4 Diabetes
3.6 appointment
ADG 5 Obesity
3.7 registration – EnG 2 completion
ADG 6 Mental disorders
3.8 Conducting the examination
Loss of consciousness, altered awareness, epilepsy
ADG 7
3.9 additional requirements and sleep disorders
ADG 8 Blood pressure and its measurement
3.10 advice on immunisation and prophylaxis
ADG 9 Cardiac events
3.11 Health and vocational advice
ADG 10 asthma
3.12 Issue of EnG 1 certificate
ADG 11 Dental inspection
3.13 Payment of fees
ADG 12 urine testing
3.14 Lost or stolen certificates Hearing, ear disease, disorders of speech
ADG 13
and communication
3.15 return to work medicals
Vision, eye diseases
3.16 Medical reviews (‘appeals’) – role of the Medical referees ADG 14 Annex A Colour vision testing – possible outcomes
Annex B Visual acuity testing – possible outcomes
Annex A Guidance on the use of chaperones
ADG 15 Medication
Annex B Specific advice on fitness pending further results
ADG 16 allergies
ADG 17 assessment of physical capabilities
Contents continues
Chapter 5: Frequently asked questions (FAQs) Chapter 6: Reference material
6.1 Maritime glossary
6.2 Categorisation of waters (non sea)
6.3 Sources of help outside MCA
6.4 Useful publications
6.5 Useful Merchant Shipping Notices (also previously
issued M Notices)
Annex A SI that governs appointment of ADs
Annex B MGN 219
4 Contents
Foreword
This manual details the procedures to be followed to ensure that better information about the prognosis of a condition or because new
medical assessments for seafarers serving on uK ships are carried out treatments have improved the outcome of illness.
to the standards required by the Maritime and Coastguard agency
This manual is produced to assist approved Doctors with examination
in terms of compliance with statutory requirements, good medical
procedures, the issue of medical fitness certificates and record
practice and accountability.
keeping. It is therefore written using terms that will be understood
The manual has been extensively re-written and for the first time by health professionals. although it may also be a useful source of
includes new and more detailed guidance on individual medical information for seafarers and others in the maritime sector this is not
conditions for MCa approved Doctors (aDs). These are linked to the its primary purpose.
medical fitness standards in Merchant Shipping notice 1822. This
Instructions for use
guidance also includes a series of frameworks for structured decision-
taking to aid consistency in fitness certification. a standard format has
The manual can be navigated through interactive links which are
been used and guidance has been prepared for seventeen conditions
highlighted in the contents page and text and through the clearly
that are common and which have previously led to questions about
marked navigational buttons. The interactive decision trees in Chapter 4
the correct issue of fitness certificates.
are designed to aid decision making by clearly showing each logical
Changes to a number of medical fitness standards in the table in step in the process of making diagnoses.
MSn 1822 have been made to enable more seafarers to continue
If you wish to search for topics in particular the search button at the top
working safely at sea. These changes are either because there is now
of the text pages will open a new window. This window can be enlarged
by dragging the right hand side of the box, which will then show more
(L to r) Becky Haines,
Caroline Livingstone, information and help to decide the context of the results returned.
Dr. Tim Carter,
rachael Humphries If you have any difficulty using the manual or have any comments
and ruth Kibble to make please contact the Medical administration Team at
seafarer.s&[email protected]
Dr Tim Carter
MCA Chief Medical Adviser
5
Chapter 1
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Health of seafarers
1.1 Introduction 1.1 Introduction
1.2 Legal requirements for medical examination
1.1.1 It is universally accepted that seafaring is a potentially
hazardous occupation which calls for a high standard of
1.3 Purpose of the seafarer health assessment
health and fitness for all those working in the industry.
1.4 Maritime working conditions regulations place a duty on seafarers on board uK ships to
take care of their health and safety and to co-operate with
1.5 Treatment and welfare onboard ship
their employers.
1.6 Medical stores and the Doctor’s Bag
1.1.2 Ships require a range of expertise at all crew levels and the
use of new technology to maximise efficiency is becoming
1.7 Training of seafarers in first aid and medical matters
more commonplace. However, despite the development of
1.8 radio medical advice modern technology it will never replace the most valuable
resource on a ship: the crew. The requirement that seafarers
1.9 Occupational health and safety for seafarers
must be fully fit to carry out the full range of their duties
remains as important today as it did when scurvy took its toll
1.10 Special hospital care in the uK
on the first oceanic voyages.
1.11 Expenses of medical and other treatment during a
1.1.3 The assessment of medical aspects of fitness is only one part
voyage on a uK registered ship
of the arrangements for seafarers’ health. Living and working
conditions need to be safe and free of health risk, care is
needed for injury and illness at sea, and access to onshore
health care facilities is required.
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1.2 Legal requirements for medical certification of the crew is one area that may be checked.
It is therefore important that certificates are correctly issued.
examination
Other relevant requirements
Medical examination
1.2.5 all officers and ratings serving on uK flagged merchant
1.2.1 The Merchant Shipping (Medical Certification) regulations
vessels must hold relevant Certificates of Competency and
2009 (referred to in this manual as ‘the regulations’) in
the International Convention on Standards of Training,
force from 6 april 2010, make it a legal requirement for any
Certification and Watchkeeping for Seafarers 1978, as
seafarer (defined as any person, including the master, who is
amended in 1995, (STCW 78) and its associated Code
employed or engaged or works in any capacity aboard a ship
(STCW Code) sets the standards which govern the awards of
on the business of the ship) to hold a valid medical certificate
these certificates and controls watchkeeping arrangements.
attesting to their medical fitness to perform their duties.
In the united Kingdom, the Merchant Shipping (Training
and Certification) regulations 1997 implement some of the
1.2.2 MSn 1822 (M) which describes the Seafarer Medical
requirements of STCW 78.
Examination System and Medical and Eyesight Standards,
contains the detailed mandatory requirements specified
1.2.6 STCW 78 prescribes the mandatory requirements for
by the Secretary of State under the regulations, and gives
certification of deck and engineer officers and watch ratings
guidance on the application and provisions of
including requirements relating to age, medical fitness,
the regulations.
seagoing service and standards of competence. To satisfy
these, candidates for uK Certificates of Competency have
1.2.3 although some seafarers have relatively long periods at home
to meet certain medical standards (including eyesight);
between periods of sea service, others will need to arrange a
satisfactorily complete a minimum period of seagoing
medical examination during a short port call, and approved
service; reach the required vocational and academic
Doctors (aDs) should, where possible, be reasonably flexible
standard; undertake ancillary technical training, and in the
to accommodate such requirements.
case of officer candidates, on completion of programmes
of education and training approved by the Maritime and
1.2.4 When a ship is in a foreign port, Port State Control
Coastguard agency (MCa), pass an oral examination
inspections may be carried out, and the medical fitness
conducted by an MCa examiner.
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1.2.7 There are equivalent national provisions, including medical (c) freedom from foreseeable risk of disease while at sea,
fitness requirements, for those taking charge of vessels falling especially where this might either spread to others on
outside the scope of the STCW Convention. board, require emergency treatment or lead to evacuation
or diversion
1.3 Purpose of the seafarer medical
(d) recognition that seafaring careers can be terminated
assessment
prematurely by conditions which can be prevented, such
as ischaemic vascular disease and lung cancer
1.3.1 The fundamental purpose of the seafarer medical assessment
is to ensure that the individual seafarer is fit for the work for (e) absence of discrimination based on disability or medical
which he or she is to be employed, taking into account the condition, except where this can be justified
particular risks associated with working at sea. The seafarer by requirements (a) to (c)
medical examination is a key element in this process. as a
general principle the aD should be satisfied in each case 1.4 Maritime working conditions
that no disease or defect is present which could either
be aggravated by working at sea, or which represents an 1.4.1 The occupational circumstances which apply at sea should
unacceptable health risk to the individual seafarer, other crew be fully considered when a decision on a seafarer’s medical
members or the safety of the ship. fitness is taken. Particular factors to take into account are:
1.3.2 Fitness to undertake the full range of tasks on board ship ƒ the potentially hazardous nature of seafaring, which calls
and to cope with living conditions at sea has long been a for a high standard of health and continuing fitness;
requirement. More recently the focus of medical assessment
ƒ the restricted medical facilities likely to be available on
has been on:
board ship (few ships carry doctors and first aid training
(a) fitness to navigate a ship safely for crews is limited);
ƒ the likelihood of limited medical supplies and delay
(b) fitness in both physical and psychological terms
before full medical treatment is available;
to deal with emergencies at sea
ƒ the possible difficulty of providing/replacing required
medication; as a general rule a seafarer should not be
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accepted if the loss of a necessary medicine e.g. treatments knowledge of the living and working conditions on board
for high blood pressure, hay fever or asthma, could ships and an understanding of the demands of the different
precipitate the rapid deterioration of a medical condition; types of work involved.
ƒ the limited crew complements which mean that illness 1.4.3 In many circumstances, the aD and/or the seafarer will not
of one crew member may place a burden on others or know the particular area of operation, and an unrestricted
compromise the safe and efficient working of the ship; medical certificate will enable the seafarer to work anywhere
in the world. The following sections give an overview of the
ƒ the potential need for crew members to play a role in
range of vessels and types of work for which a seafarer may
an emergency or emergency drill, which may involve
be employed.
strenuous physical activity in adverse conditions;
ƒ the confined nature of life on board ship and the need to 1.4.4 Vessel types
be able to live and work in a closed community;
The shipping industry is a world wide activity which uses a
ƒ the likelihood that a seafarer will need to join and leave whole variety of vessels of which the following are the most
ships by air, which means that they should be free from any common types:
condition which precludes air travel or could be seriously
Tankers
affected by it;
used to transport crude oil, petroleum products, and chemicals
ƒ the especially high levels of physical fitness required for work
Container ships
on some vessels, such as standby vessels in the oil industry;
Carry a whole variety of manufactured goods.
ƒ the area of operation of the vessel. This and the effects of
Dry bulk carriers
climate will affect the risk of diseases and the pattern of
used for the transportation of raw materials such as iron ore,
work and rest.
coal and grain.
1.4.2 Shipping operations and shipboard duties vary considerably.
Cruise ships
The seafarer’s intended position on board ship and, as far
Floating hotels with large crews up to 2000 or more on the
as practicable, the physical and psychological requirements
very large ships. The crew will include many support staff and
of this work should be established. The aD should have
include hairdressers/entertainers/gaming staff.
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Passenger ferries Main functions of the deck department:
The size of the vessel and crew numbers vary considerably.
ƒ navigation
On some of the larger long distance ferries the support staff
may include entertainers. ƒ Cargo handling and stowage
Domestic passenger ships ƒ Control and operation of the ship and care for persons
Passenger ships operating pleasure trips around the uK coast. on board
These are often seasonal, and may operate in a variety of roles
ƒ radio communications
– e.g. daytime tourist trips, evening charters.
Main functions of the engineering department:
Specialist ships
Examples include tugs, heavy lift vessels and support vessels ƒ Marine engineering
to the oil industry, including standby vessels.
ƒ Electrical, electronic and control engineering
Yachts
ƒ Maintenance and repair
May be motor or sail, for commercial or pleasure use.
Medical standards only apply to commercial yachts and any ƒ radio communications
paid crew of pleasure yachts.
Certificates of Competency for both deck and engineering
1.4.5 Seafarers’ functions and levels of responsibility departments are issued for the following levels of responsibility:
ƒ Management level
Merchant Ships
On all merchant vessels there are two distinct areas of ship ƒ Operational level
operation known as the deck department and engineering
ƒ Support level
department. Provided they meet the training and medical
requirements, and have suitable seatime experience, all
officers may be issued with Certificates of Competency by
the MCa, in order to carry out the functions and serve in the
following capacities.
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