Onderwerp: Bezoek-historie

Medical Examinations of Seafarers 2005 (uncontrolled version)
Geldigheid:01-07-2011 t/m Versie:vergelijk Status: Geldig vandaag

Dit onderwerp bevat de volgende rubrieken.

Regulation 23 December 2004, No. HDJZ/SCH/2004-1964, Legal Affairs Directorate, GG. 2005, 4, amended by Regulation of 6 June 2011, GG. 10255

The Minister of Transport, Public Works and Water Management,
Having regard to Article 48, second paragraph, of the Manning Act, as well as the Articles 104, third paragraph, and 106, first, second and third paragraphs, of the Manning Order Merchant Shipping and Sailing and the Articles 60, third paragraph, and 62, first, second and third paragraphs, of the Manning Order Fishery;

Decides:

Ingangsdatum: 01-01-2005

Regulation 23 December 2004, No. HDJZ/SCH/2004-1964, Legal Affairs Directorate, GG. 2005, 4, amended by Regulation of 6 June 2011, GG. 10255

The Minister of Transport, Public Works and Water Management,
Having regard to Article 48, second paragraph, of the Manning Act, as well as the Articles 104, third paragraph, and 106, first, second and third paragraphs, of the Manning Order Merchant Shipping and Sailing and the Articles 60, third paragraph, and 62, first, second and third paragraphs, of the Manning Order Fishery;

Decides:

Article 08 Procedure referee in case of re-examination

Ingangsdatum: 01-01-2005

Article 8 - Procedure referee in case of re-examination

  1. The Articles 3 and 4 are equally binding on the performance of the re-examination, provided that the sections of the examination which have already been approved by the doctor, need not be repeated, unless there are doubts about the result.

  2. Where appropriate, the re-examination may consist of the exclusive assessment of the available medical information.

  3. In case of fitness, Article 5 is equally binding.

  4. In case of unfitness, the first and fifth paragraphs of Article 6 are equally binding.

  5. For the issue of an exemption, the referee advices the Medical Advisor to the Head of the Shipping Inspectorate.

Article 1 Definitions

Ingangsdatum: 01-01-2005

Article 1 - Definitions

In this regulation the following terms shall mean:

  1. Act: Manning Act;

  2. examination: medical survey as referred to in Article 105, first paragraph, of the Manning Order Merchant Shipping and Sailing or Article 61, first paragraph, of the Manning Order Fishery;

  3. examinee: natural person who is subjected to an examination;

  4. risk area: area outside the Netherlands, where the risk of infection with tuberculosis is greater than the risk of infection for the Netherlands population, as appears from an annual recurrence of tuberculosis in the country concerned which is higher than 50 cases per 100,000 inhabitants and which has been registered as such by the World Health Organization.

Article 10 Registration of examination results

Ingangsdatum: 01-01-2005

Article 10 - Registration of examination results

The results of the examinations are recorded in the appropriate register by the doctor, having regard to the instruction of the Medical Advisor to the Head of the Shipping Inspectorate and the period to be determined by him.

Article 11 Forms

Article 11 - Forms

  1. The model for the medical certificate of medical fitness for service at sea is the model as included in Annex III.

  2. The examining doctor only uses the forms for the medical certificate, the notice of rejection and the examination form which have been provided to him free of charge by the Medical Advisor to the Head of the Shipping Inspectorate.

Ingangsdatum: 01-07-2011

Art. 11 Forms

  1. The model for the medical certificate of medical fitness for service at sea is the model as included in Annex III.

  2. The model for the ‘Notice of Rejection’ is the model, included in Annex 6.3 to the Inland Navigation Regulation.

  3. The examining doctor shall only use the forms for the medical certificate, the notice of rejection and the examination form that are provided to him free of charge by the Medical Advisor to the Head of the Shipping Inspectorate.

Article 12 Withdrawel

Ingangsdatum: 01-01-2005

Article 12 - Withdrawal of the Merchant Shipping Medical Examination Regulations 2002

The Merchant Shipping Medical Examination Regulations 2002 are withdrawn.

Article 13 Entry into force

Ingangsdatum: 01-01-2005

Article 13 - Entry into force

  1. This Regulation enters into force as from the second day after the date of the Government Gazette in which it is published.

  2. If the date of the Government Gazette, in which this Regulation is published, is after 30 December 2004, this Regulation is retroactive up to and including 1 January 2005.

Article 14 Official title

Ingangsdatum: 01-01-2005

Article 14 - Official title

This Regulation is quoted as: Merchant Shipping Medical Examination Regulations 2005.

Article 2 Items to be submitted and checked during the medical examination

Ingangsdatum: 01-01-2005

Article 2 - Items to be submitted and checked during the medical examination

  1. Prior to the examination, the doctor verifies:

    1. the seaman’s book of the examinee, or

    2. in case the examinee does not have a seaman’s book, the statement by or on behalf of the ship’s manager that the examinee is or will be in his service, together with a valid identity document, or

    3. the certificate of registration of the examinee for a recognized training for seafarers, together with a valid identity document.

  2. The doctor further verifies:

  1. the result of an examination into tuberculosis (thorax X-ray or Mantoux test);

  2. the presence of a certificate of the blood group and the rhesus factor, and

  3. if applicable, a valid exemption, issued by the Medical Advisor to the Head of the Shipping Inspectorate as referred to in Chapter of the Manning Order Merchant Shipping and Sailing, respectively in Chapter 7 of the Manning Order Fishery.

Article 3 Examination and medical survey

Ingangsdatum: 01-01-2005

Article 3 - Examination and medical survey

  1. The examination takes place having regard to the examination directions and in accordance with the medical standards, included in Annex I, respectively Annex II.

  2. During the examination, the doctor uses the examination form. The doctor keeps the Examination form and possible other documents, related to the survey, during the period and in the manner, determined by or pursuant to the Medical Treatment Contracts Act.

  3. The examination of the general physical fitness includes an inquiry into the illnesses and diseases suffered previously (anamnesis or case history), hereditary and chronic diseases that occur in the family (family case history), a general assessment of the mental state of the examinee, determination of the blood group if unknown, chemical survey of urine and inquiry into tuberculosis, as well as a general survey of the body, the visual system and the auditory system in such a manner that can be determined whether the examinee meets the standards, as referred to in the first paragraph of this Article.

Article 4 Specialist report or partial survey

Ingangsdatum: 01-01-2005

Article 4 - Specialist report or partial survey

  1. If a specialist report has been prescribed in Annex II or in case of doubt about compliance with the standards, the doctor asks the doctor in attendance for information. When there is not sufficient information, the doctor refers the examinee for a partial survey to a medical specialist.

  2. The examination is completed by the doctor upon receipt of the information of the doctor in attendance or the result of the partial
    specialist survey.

Article 5 Issue of a medical certificate in case of fitness

Ingangsdatum: 01-01-2005

Article 5 - Issue of a medical certificate in case of fitness

  1. The doctor who has performed an examination of which the result is favourable, provides the examinee with a medical certificate of fitness for service at sea. The certificate mentions the category of functions, period and area of validity.

  2. The doctor authenticates the medical certificate with his signature and name stamp.

Article 6 Notice of rejection

Article 6 - Notice of rejection

  1. If the issue of a medical certificate must be rejected, the doctor informs the examinee, stating the reason(s) for rejection.

  2. The rejection may only take place if the entire examination has been performed in accordance with the Articles 3 and 4.

  3. The doctor also reports that the examinee is entitled to a re-examination.

  4. The doctor immediately notifies the Medical Advisor to the Head of the Shipping Inspectorate of every rejection for service at sea, through the appropriate ‘Notice of Rejection’, stating the reason(s) for rejection.

  5. The doctor provides the examinee with a copy of the ‘Notice of Rejection’ and states the reason(s) for rejection on it.

  6. If the doctor notices during an interim examination, on the basis of Article 23 of the Act, that the examinee is temporarily or permanently unfit for service at sea, he acts as described in the first through fifth paragraphs of this Article.

  7. The examinee who wants to be re-examined, shall apply to a referee, submitting his copy of the ‘Notice of Rejection’.

Ingangsdatum: 01-07-2011

Article 6 - Notice of rejection

  1. If the issue of a medical certificate must be rejected, the doctor shall inform the examinee, stating the reason(s) for rejection.

  2. The rejection may only take place if the entire examination has been conducted in accordance with the Articles 3 and 4.

  3. The doctor shall also report that the examinee is entitled to a re-examination.

  4. The doctor shall immediately notify the Medical Advisor to the Head of the Shipping Inspectorate of every rejection for service at sea, through the appropriate ‘Notice of Rejection’, stating the reason(s) for rejection.

  5. The doctor shall provide the examinee with a copy of the ‘Notice of Rejection’ and shall state the reason(s) for rejection on it.

  6. If the doctor notices during an interim examination, on the basis of Article 23 of the Act, that the examinee is temporarily or permanently unfit for service at sea, he shall act as described in the first through fifth paragraphs of this Article.

  7. The examinee who wants to be re-examined, shall apply to a referee, submitting his copy of the notice of rejection.

Article 7 Re-examination

Ingangsdatum: 01-01-2005

Article 7 - Re-examination

  1. After the issue of a certificate of temporary unfitness, re-examination can only be performed by the same doctor who has found the examinee to be unfit, unless he wants to exercise his entitlement to re-examination by an appointed referee.

  2. After the issue of a certificate of permanent unfitness, the re-examination can only be performed by an appointed referee.

Article 9 Examination for tuberculosis

Ingangsdatum: 01-01-2005

Article 9 - Examination for tuberculosis

  1. To examinees, coming from or living in a risk area, a medical certificate of fitness for service at sea can only be issued after a favourable result of the examination for tuberculosis.

  2. Examinees, not coming from a risk area, may abandon the examination for tuberculosis.

  3. If the examinee has abandoned the examination for tuberculosis, the sailing area on the medical certificate is limited to voyages between ports in Northern and Western Europe located between Kirkeness and Gibraltar, in the Baltic Sea bordered to 20° EL, and ports at the northern coast of the Mediterranean Sea.

Explanatory notes

Ingangsdatum: 08-01-2005

General
This regulation serves to implement the recent changes in the Ships Manning Order for merchant ships and sailing vessels and the Ships Manning Order for fishing vessels and is an elaboration of the completely integrated medical examination for seafarers, as already detailed in both orders. The changes with respect to the decree "Medical examinations for seafarers 2002" are explained below.
The experiment in which a number of examining physicians performed the six-yearly examination of the eyes and ears for was successfully completed. No notable problems were reported with regard to general physicians' carrying out these examinations, providing that they had the necessary equipment and were sufficiently competent. In case of doubt or if indicated in the directions and standards, an additional examination by a specialist must be carried out.
The integration of the three medical certificates into a single document increases the efficiency. In addition to this, the period of validity has been adjusted, and has now been set at a maximum of two years, instead of the period of one year adopted up to now. This is in accordance with the international regulations from ILO Convention no. 73, concerning the medical examination of seafarers.1 international regulations of the International Labour Organisation (ILO) of the United Nations. Up until now, the specific function of the seafarer was always stated on the medical certificate. This gave the impression that there were also many different function-specific medical requirements: an officer could not be declared fit for the position of captain and vice versa. In order to remove this apparent precision, the duty category for which a declaration of fitness has been issued will be stated from now on.
The Decree "Medical examinations for seafarers 2002"was already geared to this and no adjustment was needed with respect to the medical standards.
The Examination Form for the anamnesis and physical examination was previously made available to examining physicians on a voluntary basis. Their use has now become compulsory. The underlying intention is to realise a greater uniformity in the medical examination whilst at the same time standardising the recording of the data. If further tests are necessary, data can easily be exchanged.
The examination results have always been recorded by the examining physician in the register designated for this purpose. An electronic register is now available as well, and the Medical Adviser of the Netherlands Shipping Inspectorate will soon make the use of this compulsory by enforcing article 10 of the Decree "Medical examinations of seafarers 2005". This will prevent delays due to the manual transfer of the examinations in the database. The phenomenon of "doctor shopping" can be detected at an early stage and eventually it will be possible to analyse trends in the numbers and types of rejections.
The examination card has been a valuable instrument for detecting doctor shopping, but places an extra administrative burden on the examining physician. With the introduction of the compulsory use of the electronic register, this card will become obsolete. The Medical Adviser of the Netherlands Shipping Inspectorate will receive a warning as soon as the database detects a declaration of fitness following a previous rejection.
With the present medical standards, Table B-I/9-2 of Code B (Guidance on assessment of minimum entrylevel and in-service physical abilities for maritime personnel) has also been implemented. This Code is part of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers that was amended in London on 7 July 1995 (Trb. 1996, 249).

Administrative burdens
This regulation is part of a project aimed at considerably reducing the administrative burdens involved in the medical examination of seafarers.
The reduction is quantified and further explained in the explanatory notes of the Decree of 13 December 2004 (Bulletin of Acts and Decrees 2004, 711), concerning amendments to the Ships Manning Order for merchant ships and sailing vessels [Besluit zeevaartbemanning handelsvaart en zeilvaart] as well as the Ships Manning Order for fishing vessels [Besluit zeevisvaartbemannin]) (revision of the system of medical certificates for seafarers and several other amendments).

Medical examination procedure
The periodic examinations will be carried out by physicians, who in accordance with article 40, subsection 1, of the Ships Manning Act [Zeevaartbemanningswet] (hereafter referred to as: the act) have been appointed for this purpose by the Minister of Transport, Public Works and Water Management.
Prior to the actual examination, the person who subjects himself to the - legally required - examination hands over a number of documents which will be checked by the examining physician. The fitness examination will then take place, including a complete examination of the eyes and ears. In the case of doubt or if required in the medical standards, the examining physician will request information from the attending physician or will refer the candidate for an additional examination. The examination can be completed once the respective reports have been received.

Article 1
The World Health Organisation (WHO) periodically publishes information about the prevalence of tuberculosis. The basic premise of the current regulation is that countries where the prevalence of tuberculosis is higher than 50 cases per 100,000 residents should be viewed as risk areas. The risk of infection here is greater than that for the Dutch population in general.

Article 2
Prior to the medical examination, the examining physician should verify the identity of the candidate and establish whether the additional tests have been performed.

Article 3
The examining physician carries out the examination on the basis of the examination directions and medical standards, and records and enters the data in accordance with the Examination Form. The medical examination data are archived and retained for the applicable periods. The medical examination should be completed in full before a judgement is made.

Article 4
If the examining physician does not have sufficient information to reach his judgement then he can, with the candidate's consent, request information from the attending physician. Should this information not be available or transpire to be insufficient, the examining physician will refer the candidate for an additional examination by a specialist. This will also happen if the regulation specifically requires this. For the examination, the examining physician can refer the candidate to a specialist of choice. When all of the information is available, the medical examination can be completed.

Article 5
After the seafarer is declared fit, he receives the Seafarers' Medical Certificate.

Article 6
If the examining physician is of the opinion that the candidate cannot be declared fit, he gives the candidate a so-called Notice of Rejection. The examining physician is expected to state the reasons for rejection and to draw the candidate's attention to his right to a re-examination. The Notice of Rejection states how the candidate can request a re-examination.

Article 7
After a period of temporary unfitness, a candidate can be re-examined by the same examining physician who rejected him. If the examining physician is of the opinion that the original objections are no longer present, the candidate will be declared fit. The re-examination will be performed by the referee if the candidate does not want to be re-examined by the first physician or in the case of permanent unfitness.
Article 43, subsection 1, of the act states that a declaration of fitness issued by a physician other than one of the approved physicians, is not valid.

Article 8
The refereer follows the same procedures and standards, with the understanding that elements for which the candidate has already been declared fit, do not need to be repeated. Furthermore, for a reexamination it is not always necessary to perform a physical examination on the candidate. The assessment of medical data can be sufficient to allow the referee to reach a result.
The re-examination by the referee is organised along the same lines as the first examination. A general referee takes the advice from additional examinations by specialists and then decides whether to declare fit, reject or issue a dispensation.
In cases concerning the vision and hearing, advice will be requested from a professor in ophthalmology or otolaryngology.

Article 9
The decree of 2002 already offered the possibility of exemption or dispensation from this examination for crew members on sea fishing vessels with sailing area II, crew on sailing ships with sailing area IIIa and crew on seagoing vessels travelling near the coast from a named Dutch working harbour. For this, copies of the certificate of seaworthiness, accompanied by the employment contract or the partnership contract, a declaration from the Vereniging Beroepschartervaart BBZ or a declaration from the Head of the Netherlands Shipping Inspectorate had to be submitted to the examining physician.
Allowing seafarers who do not stay in a risk area to choose whether or not they want to undergo a test for tuberculosis, with the consequence that -if they decide not to- the permitted sailing area will be geographically limited, has led to a number of administrative duties being scrapped.

Article 10
After a transition period the examining physicians will supply the examination results electronically. This will enable "Doctor shopping" to be monitored efficiently and as a consequence of this the examination card will be withdrawn.

Article 11
With the new regulation the quantity of forms has been more than halved. Examining physicians should make use of the models of the Seafarers' Medical Certificate, the Notice of Rejection and the Examination Form supplied by the Medical Adviser (of the Netherlands Shipping Inspectorate in order to prevent fraud and abuse.
The Seafarers' Medical Certificate is presently available on paper with a watermark.

Annex II Medical standards
In general, small modifications have improved the text of the medical standards. Sections for which an explanation was frequently requested from the Medical Adviser of the Netherlands Shipping Inspectorate have been explained in greater detail. The examining physicians have been given greater responsibilities, as a result of which the time-consuming re-examinations for seafarers can be limited. Where possible, the requirements have been adjusted to take into account new medical developments and changed insights.

General physical condition and physical skills
Up until now the general physical requirements were overlooked, due to the focus on detecting diseases and conditions. Yet these also form an essential part of being able to function safely onboard ship.
This issue was tackled by a workgroup in 2000, and following their deliberations a supplement to the STCW Code was published: Chapter B-I-9 with Table B-I/9-2. Being able to negotiate stairs without any problems and the ability to move around on a swaying ship are important in terms of safety, as is the physical ability to be able to stand and walk during a full watch. The regulation about being able to move through an opening of 60x60 cm relates to the requirement with respect to obesity, which has been effective since 1 July 2000.

Element VIII.2 Conditions of the nervous system
Epilepsy has long been a reason for rejection. For the re-examination by a referee an internal policy has developed over the years for making exceptions based on an individual consideration of the risks.
Discussions with experts and literature research has made it possible to realise a differentiation in this as well. The conditions under which the general medical examiner can issue a declaration of fitness are specified.

Element XIII.3 Cardiovascular complaints
Wearing a pacemaker has also long been a reason for rejection. Modern developments have opened up the possibility of introducing a distinction with respect to these medical devices. If the candidate wears a pacemaker which cannot be deregulated by electromagnetic radiation and if the condition is satisfied that a life-threatening situation does not immediately arise should the pacemaker fail, a declaration of fitness can be issued by the general medical examiner.

Element XXIII Eye and vision
The requirements for visual acuity had already been adjusted in line with the international guidelines of the ILO and WHO. The use of these has led to few problems.
The inability to distinguish colours remains a reason for rejection in about 8-10% of cases, which is in line with the expected prevalence of colour blindness amongst men in general. Under the present criteria a mild form of colour blindness can be accepted. However with the tests currently used, the problem remains that seafarers do not see the relationship between the coloured numbers in the textbooks and, for example, the red and green lights which they must be able to observe at sea. They therefore experience difficulties in accepting the rejection. Yet at present no better test methods can be recommended.
The number of seafarers that undergo refraction correction is increasing. Also students at nautical college are increasingly deciding to undergo the operation in order to make it possible to start a career at sea. This operation does not form a reason for rejection, as long as all of the criteria for visual acuity are satisfied and there are no negative side effects.

Element XXIV Ear and hearing
There are no changes with respect to the Decree "Medical examinations of seafarers 2002".

Annex 1 Examinations directions

Ingangsdatum: 01-01-2005

Annex 1

Examination directions
The maintenance and promotion of the safety at sea entail inter alia conscientious medical examinations of seafarers to whom the Netherlands manning legislation applies.
In general, the person involved should be free from any abnormality, disease or injury which obstructs a safe performance of the duties, in order to qualify for a medical certificate.
A seafarer should at all times be able to act adequately in case of an emergency. He must not only be able then to bring himself in a safe position, but he must also be able to assist in fire fighting, in launching of life-saving devices and assist crew members and passengers.
Furthermore, his (her) presence on board may cause no danger to the health of the other persons on board. In this connection it is of particular importance to promptly recognize and treat (or have treated) those disorders which clearly increase the risk to the safety on board.

Assessment of experienced seafarer
At the examination of the fitness of those who have performed a maritime job for a length of time, it is reasonable to be flexible in a number of cases.
For the issue, after all, of a medical certificate of fitness, incidentally and in an individual case, when there are grounds for unfitness, is required that agreement has been reached upon this beforehand with the Medical Advisor to the Head of the Shipping Inspectorate.

Consultation of the Medical Advisor to the Head of the Shipping Inspectorate
If the assessment of the fitness or the degree of unfitness gives rise to doubts, consultations should be held with the Medical Advisor to the Head of the Shipping Inspectorate.
Specific activities on board During the examination, one should be thoroughly aware of the specific working conditions on board, which, depending on the ship type and the sailing area, may vary greatly though:

  1. the work on board exhibits irregular physical and mental peaks;

  2. the work on board is not infrequently performed under extreme climatic conditions;

  3. depending on the type of ship, one has to work in more or less restless surroundings with much background noise and movement;

  4. the work on board is accompanied by considerable physical stress, where plenty of going up and down the stairs, manoeuvring around obstacles and limited room for movement with sometimes an unfavourable working position, bring along additional stress for the musculo-skeletal system;

  5. the nature of the duties is such that there is not always an opportunity to eat and sleep at regular times, and

  6. the number of crew members on board has reduced considerably compared to the past. If a person on board is out of circulation through ill-health, his job must be taken over by colleagues.

Alertness and power of concentration
In this connection, it is also important to realize that many activities on board require constant alertness:

  1. navigating, where constant alertness is especially required when sailing at night, in fog or in bad weather conditions;

  2. watch keeping in the engine room, particularly in so-called ‘stand-by’ situations, which require extra alertness in order to be able to manoeuvre at any given moment;

  3. working with and being responsible for the transport of dangerous goods;

  4. working on and in the vicinity of machinery with moving parts, such as cranes, winches, windlasses and such;

  5. the performance of work on electrical wiring and steam conduits, and

  6. the performance of work at great heights both inside and outside deep holds.

Limited medical care on board
It should be borne in mind that if careless examination results in, for example, an ulcer or inguinal hernia being overlooked, the life of the seafarer may be endangered if he suffers a severe stomach haemorrhage or if his inguinal hernia becomes strangulated on the open sea.
Adequate medical assistance is very remote at such a moment. It is therefore important to recognize disorders for which treatment is to be expected during the examination. Thus one, for example, has to reckon with the limited – and often late – opportunities for dental assistance.

Risk of infection
Seafarers are living close together for quite a long time. Infectious diseases are therefore a serious problem and may endanger the safety of the ship. Especially during the examination of personnel which is involved in preparing food and catering, extra attention must be paid to this.

Safety
Wearing personal protective means must be possible without any problem and must not be obstructed by physical disorders or restrictions.
One should think in this case of safety helmets and safety goggles, masks, hearing protection, safety shoes and protective clothing.
Wearing a compressed-air apparatus of 15 kg for minimally 20 minutes requires a good physical condition. Special protective clothing is worn then.
While extinguishing a fire, one has to work under great pressure in a warm atmosphere where manoeuvres through narrow holes or corridors are possible.

Examination directions, general principles for rejection, medical standards
Apart from the examination directions in this Annex I and the general principles for rejection mentioned below, the medical standards described in Annex II have to be applied for the examination of seafarers.

Principles for rejection
While deciding on rejection, the doctor is guided by the following general guidelines.
Medically unfit for service at sea is the person, who suffers from a disease, abnormality or injury:

  1. which can obstruct a safe performance of the duties;

  2. because of which the seafarer is not at all times able to act adequately in case of an emergency;

  3. which may deteriorate during the performance of duties on board, in such a way that this causes an unacceptable risk to the health or safety of himself or the other persons on board, or a serious nuisance to other persons on board, or

  4. which needs a treatment, which requires prolonged medical supervision or which can necessitate immediate medical intervention.

Annex 2 Medical standards

Ingangsdatum: 01-01-2005

Annex 2 - Medical standards

 

Explanation of the concepts

  1. 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.

  2. Unfitness:

    1. the examinee is temporarily unfit, if medical expectations are that he will be unfit for not more than 3 years.

    2. the examinee is permanently unfit, if medical expectations are that he will be unfit for more than 3 years.

  3. 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.

  4. 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

  1. is able to sufficiently climb or go down ladders and stairs and without assistance;

  2. is able to sufficiently step over a sill of 60 cm and without assistance;

  3. is able to sufficiently grab and lift, to work with tools undisturbed, to open and close valves, and to work with lines and warps;

  4. is able to sufficiently reach above shoulder height;

  5. is able to sufficiently bend, squat, kneel and crawl;

  6. is able to sufficiently stand and walk at least during a watch period;

  7. is able to move through an opening of 60x60 cm without assistance.

 

II. Use of medication

  1. 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.

  2. Being dependent on the use of medication with a narrow therapeutic range constitutes grounds for unfitness.

  3. 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.

  4. 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.

  5. 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

  1. 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.

  2. Pulmonary tuberculosis: if, after adequate treatment, the seafarer is certified cured by a lung specialist, a medical fitness certificate may be issued.

  3. Seropositivity (HIV) generally constitutes no grounds for unfitness.
    Profylactic use of AIDS-inhibiting substances generally constitutes grounds for unfitness.
    AIDS constitutes grounds for unfitness.

  4. 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

  1. 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.

  2. Manifest hyperthyroidism and hypothyroidism constitute grounds for unfitness.

  3. Other endocrine disorders: approval requires a favourable specialist report, which shows that there is no reason to expect acute problems.

 

VI. Blood diseases

  1. Immunodeficiencies constitute grounds for unfitness.

  2. 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.

  3. 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.

  4. 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

  1. Psychotic symptoms at the moment of the examination or a history of psychoses with a chance of recurrence constitute grounds for unfitness.

  2. A history of bipolar disorders or isolated manias constitutes grounds for unfitness.

  3. 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.

  4. Personality disorders with antisocial, borderline, theatrical, narcissistic, evading, dependent or obsessively compulsive patterns in general constitute grounds for unfitness.

  5.  
    1. Chronic alcoholism, either continuous or periodic in the last 5 years, in general constitutes grounds for unfitness.

    2. A history of addiction to narcotics, stimulants or other psychotropic substances in the preceding 5 years generally constitutes grounds for unfitness.

  6. 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.

  7. Other psychiatric disorders: approval requires a favourable specialist report.

  8. Concentration or imprinting disorders constitute grounds for unfitness.

  9. Cognitive functional disturbances constitute grounds for unfitness.

  10. 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

  1. All disorders which are accompanied by disturbances of consciousness or balance, as well as attacks of giddiness or uncontrollable sleep, constitute grounds for unfitness.

  2. A history of all sorts of epilepsy, whether or not treated with drugs, constitutes grounds for unfitness. Exceptions:

    1. Approval is possible if the last seizure has occurred before the 5th year of life and no anticonvulsives have been used afterwards.

    2. 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.

    3. 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.

    4. 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.

  3. 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.

  4. Migraine, coupled with absenteeism, constitutes grounds for unfitness.

  5. Somnambulism generally constitutes grounds for unfitness.

  6. 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

  1. A serious impediment of the inhalation through the nose, for example by a strong deviation of the nasal septum, constitutes grounds for unfitness.

  2. Extensive caries or disorders of the gingiva constitute grounds for unfitness

  3. 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

  1. All chronic bronchial disorders with the chance of acute deterioration of the pulmonary function constitute grounds for unfitness.

  2. Bronchial asthma accompanied by reduced employability constitutes grounds for unfitness.

  3. Chronic bronchial infections and COPD with pulmonary function disorders generally constitute grounds for unfitness.

  4.  
    1. A first pneumothorax constitutes grounds for unfitness during one year, unless adequate treatment in order to prevent recurrence has taken place.

    2. Recurrent pneumothorax constitutes grounds for unfitness, unless adequate treatment has taken place.

 

XIII. Cardiovascular disorders

  1. Heart valve abnormalities and congenital heart defects with haemodynamic consequences constitute grounds for unfitness.
    An artificial valve generally constitutes grounds for unfitness.

  2. Rhythm or guiding disorders with a chance of cerbrovascular accidents, haemodynamic complications or consciousness disorders constitute grounds for unfitness.

  3. 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.

  4. Wearing an ICD constitutes grounds for unfitness.

  5. Myocardial disorders, resulting in a reduced, ergometrically defined capability of the heart, constitute grounds for unfitness.

  6. Angina pectoris constitutes grounds for unfitness.
    Approval requires a favourable specialist report which shows that there is no reason to expect acute problems.

  7. Aneurysma aortae generally constitutes grounds for unfitness.
    Approval requires a favourable specialist report which shows that there is no reason to expect acute problems.

  8. Hypertension: a diastolic pressure of > 105 mm Hg on repeated measurement constitutes grounds for unfitness.

  9. Symptoms of peripheral vascular disorders, arterial or venous, constitute grounds for unfitness.
    A vascular prosthesis generally constitutes no grounds for unfitness.

  10. A history of any cerebrovascular accident, including T.I.A.’s, generally constitutes grounds for permanent unfitness.


XIV. Gastrointestinal disorders

  1. 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.

  2. Chronic intestinal diseases generally constitute grounds for unfitness.

  3. 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.

  4. 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

  1. Disorders of the higher or lower urinary passages, resulting in recurrent complaints or a reduced kidney function, generally constitute grounds for unfitness.

  2. A kidney stone constitutes grounds for unfitness.

  3. 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

  1. Recurrent back pain accompanied by absenteeism constitutes grounds for unfitness.

  2. 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.

  3. Contractures which have resulted in a significant motion limitation constitute grounds for unfitness.

  4. Mutilations or congenital abnormalities resulting in a reduced fitness for work or an increased accident risk, constitute grounds for unfitness.

  5. Limp prostheses generally constitute grounds for unfitness.

  6. 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.

  7. Recurrent dislocation of the shoulder constitutes grounds for unfitness.

 

XXI. Overweight

  1. 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.

  2. 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

  1. 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.

    1. 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.

    2. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Refraction correction:
    1. 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.

    2. 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.

  7. 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.

  8. Double vision may not exist.


  9. 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

  1. 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.

  2. 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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