Schedule 3
(Regulation 8(5))
MEDICAL STANDARDS FOR SEAFARERS
3.1 Infectious Diseases
3.1.1 Gastro-Intestinal Infectious Diseases – until satisfactorily treated – category C. Special care should be taken in respect of catering staff.
3.1.2 Other Infectious or Contagious Diseases until satisfactorily treated – category C.
3.1.3 Active Pulmonary Tuberculosis.
.1 When the examining doctor is satisfied, on the advice of a chest physician, that the lesion is fully healed and that the patient has completed a full course of chemotherapy, then re-entry should be considered. In such cases, Category “A(T)” would be appropriate initially to allow for adequate surveillance.
.2 Cases where either one or both lungs have been seriously affected are rarely suitable for re-employment. All relapsed cases should be category E.
3.1.4 Sexually Transmissible Diseases
.1 All cases of acute infection or while under treatment – category C. Cases under surveillance having finished treatment will usually be fit for normal service but restricted service may be necessary if facilities for supervision are inadequate.
In all cases evidence of satisfactory tests of cure should be produced.
3.1.5 AIDS related complex and clinical AIDS – All confirmed cases – category E.
3.2 Malignant Neoplasms
3.2.1 Malignant Neoplasms – including Lymphoma, Leukemia and similar conditions.
3.2.2 Each case should be graded on diagnosis – category D. Later progression to Categories A, A(T), B or C should be dependent on assessment of progress, prognosis, measure of disability and the need for surveillance following treatment. No unrestricted category A grading should be given within 5 years of completion of treatment, except in cases of skin cancer.
3.3 Endocrine and Metabolic Diseases
3.3.1 Serving seafarers developing thyroid disease – for investigation – category C, then category A, A (T), B or C on case assessment.
3.3.2 All other cases of endocrine disease in serving seafarers – for investigation – category C upon which assessment will depend.
3.3.3 Diabetes Mellitus —
.1 all cases requiring insulin – category E;
.2 serving seafarers whose diabetes is controlled by food restriction; an initial period of 6 months should be allowed to achieve stabilization – category D. Thereafter, to be subject to medical review at appropriate intervals. The current treatment regimen should be confirmed with the general practitioner at each review. (Category A (T));
.3 serving seafarers requiring hypoglycemic agents: an initial period of 6 months should be allowed to achieve stabilization – category D. Thereafter, in the absence of any complication, service may be considered subject to 6 monthly medical reviews and assessment for suitable job and sea trade. (Category A (T) on assessment).
3.3.4 Obesity – A general degree of obesity, with or without complications, and adversely affecting exercise tolerance, mobility and general health – category C for treatment.
Refractory or relapsing cases – category E.
Note: When a body mass index (BMI – weight in kg/height in m2) is 30 or over, it is especially important to take into account other existing risk factors for mobility and mortality.
3.4 Diseases of the Blood and Blood Forming Organs
3.4.1 There should not be any significant disease of the haemopoetic system.
3.4.2 Unexplained or symptomatic anaemia – category C, then category A, A(T), B or E on case assessment.
3.5 Mental Disorders
3.5.1 Acute Psychosis – whether organic, schizophrenic, manic depressive or any other psychosis listed in the International Classification of Diseases – category E.
3.5.2 Alcohol Abuse (Dependency) – where persistent and affecting health by causing physical or behavioural disorder – category E.
3.5.3 Drug Dependence
.1 A history of abuse of drugs or substances within the last 5 years – category E.
.2 Neurosis – e.g. – Anxiety state, depression, or any other mental disorder likely to impair safe performance at sea – category C, for assessment. Chronic or recurrent – category E.
3.6 Diseases of the Nervous System and Sense Organs
3.6.1 .1 Organic Nervous Disease – especially those conditions causing defect of muscular power, balance, mobility and co-ordination – category E
.2 Some minor localized disorders not causing symptoms of incapacity and unlikely to progress, may be – category A.
3.6.2 Epilepsy
.1 Any type of epilepsy since the age of 5 years – category E.
.2 A single fit in a serving seafarer – category C for investigation. Then, providing that the post medical history is clear and investigation has shown no abnormality; re-entry can be considered after 1 year without seizure without treatment or after 1 year without seizure following the cessation of treatment.
.3 Serving seafarers who have had cranial surgery or significant traumatic brain damage – category D for 12 months – then category A, B or E on case assessment.
3.6.3 Migraine – slight infrequent attacks responding quickly to treatment – category A. Frequent attacks causing incapacity – category E.
3.6.4 Syncope or Other Disturbances of Consciousness for assessment – category C. Recurrent attacks with complete or partial loss of consciousness – category E.
3.6.5 Ménière's Disease – category E.
3.7 Cardiovascular System
3.7.1 The Cardiovascular System should be free from acute or chronic disease causing significant disability —
.1 Valvular disease – causing significant impairment or having required surgery – category E.
.2 Satisfactorily treated patent ductus arteriosus or arterial septal defect could be accepted.
3.7.2 Hypertension
.1 All cases for investigation – category C.
.2 Serving seafarers with hypertension whose blood pressure can be maintained below 170/100mm by dietary control – category A (T) for annual assessment.
.3 Serving seafarers whose blood pressure can be maintained below 170/100mm by anti hypertension therapy without significant side effect – category B; category A(T) to allow for health surveillance and to ensure that arrangements have been made for continuation of treatment.
.4 All other cases – category E.
3.7.3 Ischaemic Heart Disease
.1 A history of Coronary Thrombosis Myocardial infarction – category E.
.2 Confirmed Angina – category E.
3.7.4 Other Cardiovascular Disorders
Any clinically significant abnormality of rate or rhythm or disorder of conduction – category E.
3.7.5 Cerebro-vascular Disease
.1 Any cerebro-vascular accident including transient ischaemic attacks – category E.
.2 General cerebral arteriosclerosis including dementia and senility – category E.
3.7.6 Diseases of Arteries
A history of intermittent claudication – including any case where vascular surgery was required – category E.
3.7.7 Disease of Veins
.1 Varicose Veins B slight degree – A. Moderate degree without symptoms or oedema may be A, but with symptoms – category C for treatment. Recurrent after operation, with symptoms – category D for further surgical opinion or, where not suitable for further treatment – category E.
.2 Chronic varicose ulceration – E. Thin unhealthy scars of healed ulcers or unhealthy skin of varicose eczema – category E.
.3 Recurrent or persistent deep vein thrombosis or thrombophlebitis – category E.
.4 Haemorrhoids – not prolapsed, bleeding or causing symptoms – category A. Other cases should be category C until satisfactory treatment has been obtained.
.5 Varicocoele – symptomless – category A. With symptoms – category D for surgical opinion.
3.8 Respiratory System
The respiratory system should be free from acute or chronic disease causing significant disability.
3.8.1 Acute Sinusitis – until resolved – category C.
3.8.2 Chronic Sinusitis – where disabling and frequently relapsing despite treatment – category E.
3.8.3 Nasal Obstruction, septal abnormality or polypus – until satisfactorily treated – category C.
3.8.4 Throat Infections – a history of frequent sore throats or unhealthy tonsils with adenitis – until satisfactorily treated – category C.
3.8.5 Chronic Bronchitis or Emphysema – class depends on severity. Mild uncomplicated cases with good exercise tolerance may be – category A, but cases with recurrent illness causing significant disability in relation to the job should be – category E.
3.8.6 Bronchial Asthma – category C, for investigation. Where confirmed – category E subject to consideration of exceptions as follows —
.1 a history of bronchial asthma resolving, without recurrence, before the age of 16 may be disregarded.
.2 Well controlled asthma (confirmed by investigation and appropriate supporting evidence) treated with inhaled medication only and without a history of exacerbation requiring hospital admission or oral steroids, and subject to suitable follow up – category A (T) or E.
3.8.7 Occupational Asthma to avoid the allergen – category B.
3.8.8 Pneumothorax – All cases to be classified – category D for at least 12 months. With recurrences – category E.
3.9 Disease of the Digestive System
3.9.1 Diseases of the Oral Cavity —
.1 Mouth or gum infection until satisfactorily treated – category C.
.2 Dental defects – until satisfactorily treated – category C. Seafarers should be dentally fit.
3.9.2 Diseases of the Oesophagus, Stomach and Duodenum —
.1.1 Peptic Ulceration – for investigation – category C.
.1.2 Cases of proven ulceration should not return to seafaring until they are free from symptoms. There should also be evidence of healing on gastroscopy and the seafarer should have been on an ordinary diet, without treatment, for at least 3 months – category A (T).
.1.3 Where there has been gastro-intestinal bleeding, perforation or recurrent peptic ulceration, in spite of maintenance H2 blocker treatment, or an unsatisfactory operation result – normally category E.
.2 Recurrent attacks of Appendicitis – pending surgical removal – category C.
.3 Non-Infective Enteritis and Colitis – severe or recurrent or requiring special diet – category E.
.4 Intestinal Stoma – category E.
3.9.3 Diseases of the Liver and Pancreas —
.1 Cirrhosis of the Liver – for investigation – category C, then where condition is serious or progressive or where complications such as oesophageal varices or ascites are present – category E.
.2 Biliary Tract Diseases – after complete surgical cure – category A or A(T) on case assessment.
.3 Pancreatitis – recurrent pancreatitis and all cases where alcohol is an aetiological factor – category E.
3.10 Diseases of the Genito-urinary System
3.10.1 All cases of proteinuria, glycosuria or other urinary abnormalities should be referred for investigation.
3.10.2 Acute Nephritis – until resolved – category C.
3.10.3 Subacute or Chronic Nephritis or Nephrosis – for investigation – category C, then category B or E on case assessment.
3.10.4 Acute urinary infection – until satisfactorily treated – category C. Recurrent cases – category B unless full investigation has proved satisfactory.
3.10.5 Renal or Ureteric Calculus – for investigation and any necessary treatment – category C. An isolated attack of renal colic with passage of small calculus may be – category A after a period of observation, provided urine and renal function remain normal and there is no clinical and radiological evidence of other calculi. Recurrent stone formation – category E.
3.10.6 Urinary Obstruction B from any cause for investigation – category D, where not remediable – category E.
3.10.7 Removal of Kidney – in serving seafarers, provided remaining kidney is healthy with normal function – category A(T). Such cases may be unsuitable for service in the tropics or other conditions of high temperature, in which case – category B.
3.10.8 Renal Transplant – category E.
3.10.9 Incontinence of Urine for investigation – category C. Where irremediable – category E.
3.10.10 Enlarged Prostate for investigation – category C.
3.10.11 Hydrocoele – Small and symptomless – category A. Large or recurrent – category C or, where untreated – category E.
3.10.12 Abnormality of the Primary and Secondary Sexual Characteristics for investigation – category C, upon which final assessment will depend.
3.11 Obstetrical and Gynaecological Conditions
3.11.1 There should be no persistent gynaecological disorder or disease affect working capacity at sea.
3.11.2 Pregnancy
.2.1 The doctor should discuss with the seafarer the implications of continuing to work at sea, particularly if it is a first pregnancy.
.2.2 A seafarer with a normal pregnancy before the 28th week may be permitted to work on short haul trips or a long haul trip on a vessel carrying a doctor – to allow for ante-natal care – category B.
.2.3 Employment shall not be permitted after the 28th week of pregnancy until at least 6 weeks after delivery.
3.11.3 Abnormal Pregnancy, on diagnosis – category D.
3.12 Skin
Special care is required in passing fit for care in the tropics where there is a history of skin trouble. Catering staff in particular should have no focus of skin sepsis.
Any condition liable to be aggravated by heat, sea air, oil, caustics or detergents or specific occupational allergens may be – category A(T), B, C, D or E on case assessment.
3.12.1 Infections of Skin
.1 until satisfactorily treated category C.
.2 Acne – Most cases – category A, but severe pustular cystic acne – category E.
3.12.2 Other Inflammatory Skin Conditions
.1 Atopic Dermatitis and Related Conditions until satisfactorily treated – category C.
.2 Contact Dermatitis. Refer for dermatological opinion – category C.
.3 Acute Eczema. No seafarer should return to duty until skin is healthy – category C.
.4 Recurrent Eczema of more than minimal extent – category E.
.5 Psoriasis – category B. Most cases can be – category A, but some widespread or ulcerated cases should be – category C for treatment. Severe cases resistant to treatment, frequently relapsing or associated with joint disease – category E.
3.13 Musculo-skeletal System
It is essential that seafarers should not have any defect of the musculo-skeletal system which might interfere with the discharge of their duties; muscular power, balance, mobility and co-ordination should be unimpaired.
3.13.1 Osteo-arthritis for assessment – category C. Advanced cases where disability is present – category E.
3.13.2 Limb prothesis normally would not be acceptable.
3.13.3 Back Pain – recurrent incapacitating back pain – category E.
3.13.4 Hernia
.1 Hernia until repaired – category C.
.2 Diaphragmatic Hernia – to be assessed according to the disability.
3.14 Speech Defects
3.14.1 Where likely to interfere with communication – category E.
3.15 Hearing
3.15.1 Acute and Chronic Otitis Externa – category C. Should be completely healed before returning to sea. Care is required for passing fit for tropics.
3.15.2 Acute Otitis Media – category C. Until satisfactorily treated.
3.15.3 Chronic Otitis Media – category C. May become category A or B after satisfactory treatment or surgery. Special care is required in passing fit for tropics, where air travel is required, or where the job requires food handling.
3.15.4 Loss of Hearing – category A; degree of impairment sufficient to interfere with communication – category E.
3.15.5 Unilateral Complete Loss of Hearing in serving seafarers – assessment of this condition should be considered in relation to the job.
3.15.6 A serving seafarer in whom impaired hearing acuity is found should be referred for full investigation by an ENT surgeon.
3.15.7 .1 Hearing Aids. The use of a satisfactory hearing aid at work by certain catering department personnel could be considered where not hearing an instruction would not result in a danger to the seafarer or others. The hearing aid should be sufficiently effective to allow communication at normal conversational tones.
.2 The use of a hearing aid by those working in, or associated with, the deck or engine room departments, including electricians and radio officers, should not be permitted.