Ingangsdatum: 01-01-2005
Annex 2 - Medical standards
Explanation of the concepts
- Fitness:
The examinee is fit, if he fully
meets the medical standards at all points, having regard to the
general examination directions, included in Annex II to this
Regulation.
- Unfitness:
- the examinee is temporarily unfit, if medical
expectations are that he will be unfit for not more than 3
years.
- the examinee is permanently unfit, if medical
expectations are that he will be unfit for more than 3
years.
- Specialist report:
If a specialist report is
prescribed, the retrieval of information from the specialist in
attendance may suffice sometimes. In case of insufficient
information is referred to a specialist not in attendance.
- Experienced:
A seafarer may be considered to be
experienced when sufficient seagoing service has been built up in a
specific function.
I. General fitness and physical skills
Seafarers must be sufficiently fit and must have sufficient physical
skills in order to be able to act adequately on board at all times (ref.
STCW Code, table B-I/9-2).
Subject to the guidelines
resulting from the other Articles is required that the seafarer
- is able to sufficiently climb or go down ladders and stairs and
without assistance;
- is able to sufficiently step over a sill of 60 cm and without
assistance;
- is able to sufficiently grab and lift, to work with tools
undisturbed, to open and close valves, and to work with lines and
warps;
- is able to sufficiently reach above shoulder height;
- is able to sufficiently bend, squat, kneel and crawl;
- is able to sufficiently stand and walk at least during a watch
period;
- is able to move through an opening of 60x60 cm without
assistance.
II. Use of medication
- The use of anticoagulants, other than platelet aggregation
inhibitors with a similar (side)effect pattern as acetylsalicylic
acid, constitutes grounds for unfitness.
The use of
immunosuppressants constitutes grounds for unfitness.
For the use of anti-diabetics and anti-epileptics
is referred to the guidelines in the relevant Articles.
- Being dependent on the use of medication with a narrow therapeutic
range constitutes grounds for unfitness.
- Permanent reliance on the use of medication which has side effects,
notably: dizziness, reduced ability to concentrate and react, mental
disorders or influence on the circulation, may constitute grounds
for unfitness.
- If medication is used which is reconcilable with the safety of
sailing, it must be considered at the issue of a medical certificate
whether the person involved understands the (side)effects of the
medication and whether he observes the regulations of the doctor
punctually.
- If medication is used which is reconcilable with the safety of
sailing, it has to be evaluated to what extent a sudden
discontinuance in the medication (seasickness, emergency) may cause
problems.
III. Infectious diseases
- All infectious diseases constitute grounds for unfitness
until adequate treatment has been given.
In case of
gastrointestinal infectious diseases, special attention has to be
paid to the personnel involved in the preparation of food and
catering.
- Pulmonary tuberculosis: if, after adequate treatment, the seafarer
is certified cured by a lung specialist, a medical fitness
certificate may be issued.
- Seropositivity (HIV) generally constitutes no grounds for
unfitness.
Profylactic use of AIDS-inhibiting
substances generally constitutes grounds for unfitness.
AIDS constitutes grounds for unfitness.
- Hypersensitivity or contraindications for vaccinations or
profylactica which are necessary in the sailing area of the
seafarer, constitute grounds for unfitness or limitation of the
sailing area.
IV. Malignancies
These generally constitute grounds for unfitness.
Approval requires a favourable specialist report, which shows that
complete recurrence has been reached and that there is no reason to
expect acute problems.
Benignant tumours which because
of their localization may cause complications constitute grounds for
unfitness.
V. Endocrine disorders
- Both Insulin Dependent and Insulin Independent Diabetes
Mellitus constitute grounds for unfitness.
Only in
case of a IIDM with experienced seafarers, therapy either with
Metformine, Acarbose or Thiazolidinediones may be allowed, if a good
and stable attitude has been reached.
Treatment
with SU-derivates constitutes in àll cases grounds for unfitness.
- Manifest hyperthyroidism and hypothyroidism constitute grounds for
unfitness.
- Other endocrine disorders: approval requires a favourable specialist
report, which shows that there is no reason to expect acute
problems.
VI. Blood diseases
- Immunodeficiencies constitute grounds for unfitness.
- After splenectomy, a certificate of medical fitness may be issued
for sailing in non-tropical areas, provided that the person involved
understands the risks and appears to meet the requirements as
regards the precautionary measures and vaccinations.
- Haemophilia generally constitutes grounds for unfitness. Approval
requires a favourable specialist report, which shows that there is
no reason to expect acute problems.
The use of
anticoagulants, other than platelet aggregation inhibitors with a
similar (side)effect pattern as acetylsalicylic acid, constitutes
grounds for unfitness.
- Other chronic blood diseases, anaemia, leucopenia and
thrombocytopenia: approval requires a favourable specialist report,
which shows that there is no reason to expect acute problems.
VII. Mental disorders
- Psychotic symptoms at the moment of the examination or a
history of psychoses with a chance of recurrence constitute grounds
for unfitness.
- A history of bipolar disorders or isolated manias constitutes
grounds for unfitness.
- Depressive symptoms at the moment of the examination or a history of
depressions which are not covered by the concept ‘bipolar disorder’
generally constitute grounds for unfitness. Approval requires a
favourable specialist report.
- Personality disorders with antisocial, borderline, theatrical,
narcissistic, evading, dependent or obsessively compulsive patterns
in general constitute grounds for unfitness.
-
- Chronic alcoholism, either continuous or periodic
in the last 5 years, in general constitutes grounds for
unfitness.
- A history of addiction to narcotics, stimulants or
other psychotropic substances in the preceding 5 years
generally constitutes grounds for unfitness.
- ADHD or ADD constitutes grounds for unfitness. Approval requires a
favourable specialist report, which shows that there is no reason to
expect acute problems.
The candidate has to be
familiar with international customs regulations of his
medication.
- Other psychiatric disorders: approval requires a favourable
specialist report.
- Concentration or imprinting disorders constitute grounds for
unfitness.
- Cognitive functional disturbances constitute grounds for
unfitness.
- Fear of heights and fear of narrows to an extent which affects
working safely, constitute grounds for unfitness.
VIII. Disorders of the central nervous system
- All disorders which are accompanied by disturbances of
consciousness or balance, as well as attacks of giddiness or
uncontrollable sleep, constitute grounds for unfitness.
- A history of all sorts of epilepsy, whether or not treated with
drugs, constitutes grounds for unfitness. Exceptions:
- Approval is possible if the last seizure has
occurred before the 5th year of life and no anticonvulsives
have been used afterwards.
- Approval (see sub d.) is possible 2 years after a
single epileptic attack, without obvious cause, without
treatment with anticonvulsives, if on a standard, sleep
deprivation and sleep EEG no abnormalities in an epileptic
sense are found.
- Approval (see sub d.) is possible 5 years after
stopping with anticonvulsives, if there have been no attacks
since having stopped and no abnormalities in an epileptic
sense have been found on a standard, sleep deprivation and
sleep EEG.
- The period of validity of the medical certificate in
case of the exceptions described sub b. and c. is at first
instance 1/2 year. If the person involved remains free of
attacks, the period of validity becomes subsequently 1 year
and afterwards 2 years.
- Systemic diseases of the central nervous system, such as multiple
sclerosis or M. Parkinson, generally constitute – depending on the
stadium of the disease – grounds for unfitness.
- Migraine, coupled with absenteeism, constitutes grounds for
unfitness.
- Somnambulism generally constitutes grounds for unfitness.
- Sensibility disorders in hands or feet to an extent which affects
working safely, constitute grounds for unfitness
IX. Speech
Speech impediments, which may impede safe communication, constitute
grounds for unfitness.
Also with background noise,
there must be sufficient speaking ability while raising one’s voice.
X. Disorders of the nose, mouth and throat
- A serious impediment of the inhalation through the nose,
for example by a strong deviation of the nasal septum, constitutes
grounds for unfitness.
- Extensive caries or disorders of the gingiva constitute grounds for
unfitness
- Recurrent tonsillitis and focal infections constitute grounds for
unfitness.
XI. Thoracic deviations
Thoracic deviations accompanied by
obstruction of normal cardiac and/or pulmonary function constitute
grounds for unfitness.
XII. Bronchial disorders
- All chronic bronchial disorders with the chance of acute
deterioration of the pulmonary function constitute grounds for
unfitness.
- Bronchial asthma accompanied by reduced employability constitutes
grounds for unfitness.
- Chronic bronchial infections and COPD with pulmonary function
disorders generally constitute grounds for unfitness.
-
- A first pneumothorax constitutes grounds for
unfitness during one year, unless adequate treatment in
order to prevent recurrence has taken place.
- Recurrent pneumothorax constitutes grounds for
unfitness, unless adequate treatment has taken place.
XIII. Cardiovascular disorders
- Heart valve abnormalities and congenital heart defects with
haemodynamic consequences constitute grounds for unfitness.
An artificial valve generally constitutes grounds
for unfitness.
- Rhythm or guiding disorders with a chance of cerbrovascular
accidents, haemodynamic complications or consciousness disorders
constitute grounds for unfitness.
- Wearing a pacemaker generally constitutes grounds for unfitness.
Approval requires a specialist report, which shows
that the person involved disposes, in case of failure of the
pacemaker, of sufficient escape rhythm and that the pacemaker cannot
be affected by electromagnetic radiation.
- Wearing an ICD constitutes grounds for unfitness.
- Myocardial disorders, resulting in a reduced, ergometrically defined
capability of the heart, constitute grounds for unfitness.
- Angina pectoris constitutes grounds for unfitness.
Approval requires a favourable specialist report which shows that
there is no reason to expect acute problems.
- Aneurysma aortae generally constitutes grounds for unfitness.
Approval requires a favourable specialist report
which shows that there is no reason to expect acute problems.
- Hypertension: a diastolic pressure of > 105 mm Hg on repeated
measurement constitutes grounds for unfitness.
- Symptoms of peripheral vascular disorders, arterial or venous,
constitute grounds for unfitness.
A vascular
prosthesis generally constitutes no grounds for unfitness.
- A history of any cerebrovascular accident, including T.I.A.’s,
generally constitutes grounds for permanent unfitness.
XIV. Gastrointestinal disorders
- A gastric or oesophagic disorder with an increased chance
of bleeding or perforation, including the peptic ulcer constitutes
grounds for unfitness.
Approval is only possible
after endoscopic recovery has been diagnosed.
- Chronic intestinal diseases generally constitute grounds for
unfitness.
- With a stoma on colon or jejunum, a certificate of medical fitness
may be issued if the underlying intestinal disease has been
completely cured, provided that the person involved understands the
risks and appears to meet the requirements as regards the daily care
and hygiene.
- Inguinal hernia constitutes grounds for unfitness.
Umbilical hernia with the risk of constriction constitutes grounds
for unfitness.
XV. Disorders of the liver, gall bladder and pancreas
Disorders of the liver, gall bladder or pancreas, as well as the presence
of gall stones, constitute grounds for unfitness.
Approval requires a favourable specialist report, which shows that
there is no reason to expect acute problems.
XVI. Disorders of the urinary passages
- Disorders of the higher or lower urinary passages, resulting in
recurrent complaints or a reduced kidney function, generally
constitute grounds for unfitness.
- A kidney stone constitutes grounds for unfitness.
- Having one kidney generally constitutes no grounds for unfitness,
provided that the kidney function is undisturbed.
XVII. Gynaecological disorders
Menorrhagia, metrorrhagia, uterus prolapse, endometriosis and recurrent
salpingitis constitute grounds for unfitness.
XVIII. Pregnancy
The seafarer herself finally decides whether she wants to qualify for
approval.
Extra attention has to be paid to a first
pregnancy and to a history of pregnancy complications.
Sailing can only be allowed in case of an uncomplicated pregnancy from
the 13th till the 28th week. The first and last trimester and the
recovery period post partum have to be considered as a period of
unfitness.
Sailing in the second trimester can only
be allowed on ships in a limited sailing area within which adequate
medical supplies are available.
Sailing in the second
trimester in an unlimited sailing area is allowed on ships with a doctor
with sufficient skills in obstetrics.
XIX. Skin disorders
Skin disorders which recur frequently or which repeatedly form a serious
impediment to the performance of duties on board, constitute grounds for
unfitness.
XX. Disorders of the musculo-skeletal system
- Recurrent back pain accompanied by absenteeism constitutes grounds
for unfitness.
- Arthritic disorders and other diseases of the musculo-skeletal
system constitute grounds for unfitness if the disorder is
progressive, results in pain or limited functions.
- Contractures which have resulted in a significant motion limitation
constitute grounds for unfitness.
- Mutilations or congenital abnormalities resulting in a reduced
fitness for work or an increased accident risk, constitute grounds
for unfitness.
- Limp prostheses generally constitute grounds for unfitness.
- Artificial joints generally constitute grounds for unfitness
Approval with a hip prosthesis requires a favourable specialist
report, which shows that the risk of dislocation can reasonably be
neglected and that no problems may arise from working in a moving
environment with an increased risk of falling and bumping.
- Recurrent dislocation of the shoulder constitutes grounds for
unfitness.
XXI. Overweight
- Uncomplicated overweight: a Quetelet-index = 30 with a significantly
reduced capability and indications that the candidate is impeded in
performing his function, constitutes grounds for unfitness.
- Complicated overweight: a Quetelet-index = 30 with a normal physical
capacity, but with additional risk factors such as, for example,
hypertension and increased serum lipids, constitutes grounds for
unfitness.
XXII. Allergies
Serious allergic reactions as a consequence of contact with substances
available on board, constitute grounds for unfitness.
XXIII. Eyes and vision
A. All seafarers with look-out or watch duties
- Visual acuteness is assessed by means of the Chart of Landolt TNO,
the Snellen character chart or another test which may be considered
to be equivalent.
- Service on deck and on the bridge with look-out or
watch duties
With each eye separately, a
vision of 0.7 for the best eye and 0.5 for the worst eye has
to be reached, if necessary with own (spare)glasses or
contact lenses.
Vision without optical
correction devices with each eye separately has to be not
less than 0.1.
- Engine room service with watch duties
With each eye separately, if necessary with own
(spare)glasses or contact lenses, a visual acuteness of 0.4
has to be reached.
Vision without optical
correction devices with each eye separately has to be not
less than 0.1.
- To close vision applies that, if necessary with own correction
devices, a visual acuteness corresponding to one of the following
results must be reached:
- Precision Vision test at 40 cm;
- Laméris ‘The Dutch’ at 30 cm D=0.6;
- Oculus Landolt C’s at 30 cm line indicator =0.9;
- Nieden Jaeger at 30 cm J=3.
Visual
acuteness for reading monitors of computers or radar and for
reading of navigation or measuring devices and control
devices at 70 cm has to be sufficient, if necessary
adequately corrected.
- If optic correction devices must be used at the examination for
close vision or remote vision, adequate spare glasses must be shown
to the examining doctor.
The use of coloured,
correcting glasses or contact lenses during the examination,
constitutes grounds for partial specialist examination by an
ophthalmologist.
- During the examination of the colour discernment, carried out with
lighting as prescribed in the test concerned, a score of 2 errors
with the Ishihara test constitutes grounds for more detailed
examination with a specialist colour test, unless a report of a
previous examination by an ophthalmologist already shows that the
limits below are not exceeded.
A greater deviation
than the following results constitutes grounds for unfitness:
- Hardy, Rand and Rittler: ‘mild’; or
- Tokyo Medical College: ‘second degree’; or
- an equivalent result with an equivalent colour test.
- A sight disorder found during the confrontation method according to
Donders, constitutes grounds for partial specialist examination by
an ophthalmologist.
At a perimetric survey, the
visual field has to be free from restrictions that interfere with
the function of the seafarer.
- Refraction correction:
- Within 2 years after the
operation: a specialist report is required, which shows that
all vision criteria are met and that there are no adverse
symptoms as regards contrast perception, glare and night
myopia.
- More than 2 years after the operation: a single
specialist report is required, which shows that all vision
criteria are met, that there are no adverse symptoms as
regards contrast perception, glare and night myopia and that
there is no reason that changes in the operation area will
occur.
- When night-blindness (case history or by acts of the candidate) is
assumed, partial specialist examination has to take place.
An adaptation disorder larger than 1 logarithmic
constitutes grounds for unfitness.
- Double vision may not exist.
- A progressive or chronic eye disorder constitutes grounds for
partial specialist examination by an ophthalmologist.
Approval is possible when it has been determined
that vision will not be endangered within 2 years in such a way that
the criteria can no longer be met.
B. All seafarers without look-out or watch duties
- Visual acuteness is assessed by means of the Chart of
Landolt TNO, the Snellen character chart or another test which may
be considered to be equivalent.
With both eyes
simultaneously, a vision of 0.4 has to be reached, if necessary with
own (spare)glasses or contact lenses. Vision without optical
correction devices with each eye separately has to be not less than
0.1.
- If optic correction devices must be used at the examination for
close vision or remote vision, adequate spare glasses must be shown
to the examining doctor.
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