Medical examinations of seafarers and training for medical doctors in maritime health
В соответствии с международными правилами врачи, работающие в области морской медицины, должны иметь специальную подготовку по профпатологии.Международному сотрудничеству врачей в области морской медицины уделяется внимание со стороны многих организаций. Международное сотрудничество в области морско...
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| Published in: | Актуальні проблеми транспортної медицини |
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| Date: | 2005 |
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Фізико-хімічний інститут ім. О.В. Богатського НАН України
2005
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| Cite this: | Medical examinations of seafarers and training for medical doctors in maritime health / S. Heikki // Актуальні проблеми транспортної медицини. — 2005. — № 1. — С. 124-129. — Бібліогр.: 9 назв. — англ. |
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| author | Heikki, S. |
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| citation_txt | Medical examinations of seafarers and training for medical doctors in maritime health / S. Heikki // Актуальні проблеми транспортної медицини. — 2005. — № 1. — С. 124-129. — Бібліогр.: 9 назв. — англ. |
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| description | В соответствии с международными правилами врачи, работающие в области морской медицины, должны иметь специальную подготовку по профпатологии.Международному сотрудничеству врачей в области морской медицины уделяется внимание со стороны многих организаций. Международное сотрудничество в области морской медицины должно строиться на основе этических норм. Международная ассоциация морской медицины (ММАМ - IMHA) может стать той инстанцией, которая начнет международную дискуссию среди специалистов по вопросам проведения профессиональных отборов. ММАМ должна также организовать международные унифицированные курсы по подготовке врачей в области морской медицины и проведению профессиональных отборов моряков. Курсы, организованные в различных странах по всему миру с привлечением курсантов из разных стран, должны сократить существующий в настоящее время значительный разброс в стандартах проведения профосмотров, критериях подбора и медицинского обслуживания моряков.
According to the international rules and regulations doctors working in maritime medicine need training in occupational medicine. The doctors must know:
- National and international rules and regulations; - Work and life on board ship;
- Health and fitness demands of the work on board ship; - Medical examination procedure;
- Ethics in maritime medicine;
- Risk evaluation procedure, when a seafarer has a disease; - Health promotion among seafarers International cooperation between
medical doctors in maritime medicine has been stressed by international bodies. Ethical rules are needed to form the basis for successful work in international maritime medicine. The International Maritime Health Association (IMHA) could be a suitable forum to start an international discussion among specialists about facts, evidence and principles in medical examinations. IMHA should also organise international, unified training courses for medical doctors in maritime medicine, and in seafarers' fitness evaluation. Training, organized in various countries around the world with international students would diminish the existing wide variation in medical examinations, fitness criteria and medical care of seafarers.
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ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã.
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ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005
IntroductionIntroductionIntroductionIntroductionIntroduction
The maritime industry is one of the most
international trades in the world. Ships sail from
sea to sea and transport cargoes from country
to country, from one continent to another. A
ship-owner lives in one country, his ships are
sailing under the rules and regulations of another
country, and his seafarers on board ship come
from different countries. Even more than 20
nationalities and cultures can be represented on
board a single ship. Each seafarer must have a
medical certificate attesting that he/she is fit for
work at sea.
International bodies such as The World
Health Organization (WHO), The International
Labour Organization (LO) and The International
Maritime Organization (IMO) have laid down
conventions, regulations and recommendations
which include training requirements for medical
doctors carrying out medical examinations for
seafarers. The European Union (EU) and the
Union Europeenne des Medecins Specialistes
(UEMS) have also laid down their own guidelines
and regulations. Almost every single country has
its own rules and regulations, together with
training courses, for their doctors.
This paper concentrates only on rules and
regulations laid down by WHO, ILO and IMO
concerning the competencies of medical
doctors carrying out medical examinations for
seafarers.
The most important inernational regulations laid
down by these bodies are as follow:
� ILO: Medical Examination (Seafarers)
Convention, 73/1946
� ILO: Health protection and medical care
(Seafarers) Convention 164/1987
� ILO/WHO: Guidelines for Conducting
Pre-sea and Periodic Medical Fitness
Examinations for Seafarers D.2/1997
MEDICAL EXAMINATION (SEAFARERS)
CONVENTION, ILO 73/1946
Medical Examination (Seafarers)
Convention, ILO 73/1946 (1), in its article 3,
states that every person on board ship must have
a medical certificate attesting to his fitness for
the work for which he is to be employed at sea,
signed by a medical practitioner. Article 4 states
that each country should prepare the nature and
the content of the medical examinations on a
tripartite basis (state authorities, employers and
employees) taking into account especially the
age of the seafarer and his duty on board ship.
The medical certificates shall attest that hearing,
eye sight and colour vision on deck service are
satisfactory. The medical certificate shall also
attest that the seafarer is not suffering from any
disease likely to be aggravated by, or to render
him unfit for service at sea, or likely to endanger
the health of other persons on board.
Thus, convention 73/1946 supposes that
the examining medical doctor should know:
� Health and fitness demands of the work
on board ship
ÓÄÊ 616.057.656.6:616.082:656.6-051
MEDICAL EXAMINATIONS OF SEAFARERS AND TRAINING FORMEDICAL EXAMINATIONS OF SEAFARERS AND TRAINING FORMEDICAL EXAMINATIONS OF SEAFARERS AND TRAINING FORMEDICAL EXAMINATIONS OF SEAFARERS AND TRAINING FORMEDICAL EXAMINATIONS OF SEAFARERS AND TRAINING FOR
MEDICAL DOCTORS IN MARITIME HEALTHMEDICAL DOCTORS IN MARITIME HEALTHMEDICAL DOCTORS IN MARITIME HEALTHMEDICAL DOCTORS IN MARITIME HEALTHMEDICAL DOCTORS IN MARITIME HEALTH
Heikki SaarniHeikki SaarniHeikki SaarniHeikki SaarniHeikki Saarni
M.D. Associate Professor, Chief Medical Officer, Head, Section of Occupational and
Maritime Health, Finnish Institute of Occupational Health (FIOH) Hämeenkatu 10,
FIN-20500 Turku, Finland. tel. + 358-30-4747518, fax +358-30-4747555, e-mail:
heikki.saarni@ttl.fi
Êàïóñòèíñêàÿ Î.À.
Èçó÷åíû ñòåïåíè âîçäåéñòâèÿ ôàêòî-
ðîâ ðèñêà ïåðâè÷íûõ ïðîÿâëåíèé íà íåéðî-
öèðêóëÿòîðíóþ äèñòîíèþ (ÍÖÄ) â ñòðóêòóðå
ðàçâèòèÿ ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé
ñ ó÷åòîì ïðèíàäëåæíîñòè ðàáîòíèêîâ ê òîé
èëè èíîé ïðîôåññèîíàëüíîé ãðóïïå. Âûÿâëå-
íû õàðàêòåðíûå èçìåíåíèÿ ìèíåðàëüíîãî
îáìåíà ñ íàêîïëåíèåì âíóòðèêëåòî÷íîãî
Nà+, çàäåðæêîé è íàêîïëåíèåì åãî â òêàíÿõ ñ
òåíäåíöèåé ê ïîâûøåíèþ ïîòåðè Ê+ íà ïîñ-
ëåäóþùèõ ñòàäèÿõ ïàòîëîãè÷åñêîãî ïðîöåñ-
ñà.
Èçó÷åíèå ýêñêðåöèè êàòåõîëàìèíîâ ñ
ìî÷îé (áèîìàðêåðû ñîñòîÿíèÿ ñèìïàòî-àä-
ðåíàëîâîé ñèñòåìû), àíàëèç ôàêòîðîâ ïðî-
èçâîäñòâåííîé ñðåäû è òðóäîâîãî ïðîöåññà,
ïðîâåäåíèå ïñèõîôèçèîëîãè÷åñêîãî òåñòè-
ðîâàíèÿ, ïåðâè÷íûõ ïðîÿâëåíèé çàáîëåâà-
íèé ñåðäå÷íî-ñîñóäèñòîé ñèñòåìû ïîçâîëÿ-
þò äèàãíîñòèðîâàòü ÍÄÖ íà ðàííèõ ñòàäèÿõ,
÷òî ñïîñîáñòâóåò ñòðàòèôèêàöèè ñòåïåíè
ðèñêà è îïðåäåëåíèå ïîðàæåíèé îðãàíîâ-
ìèøåíåé íà íà÷àëüíûõ ñòàäèÿõ, ïîçâîëÿåò
ïðåäîòâðàùàòü òðàñíñôîðìàöèþ çàáîëåâà-
íèÿ â àðòåðèàëüíóþ ãèïåðòåíçèþ è ñíèçèòü
ðèñê ðàçâèòèÿ ñåðäå÷íî-ñîñóäèñòûõ çàáîëå-
âàíèé.
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ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005
ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã.
� Effects of the age of the seafarer on his
fitness at sea (young seafarers, old
seafarers?)
� How to detect a possible disease of an
individual seafarer during the fitness
examination and how to make the
prognosis of that disease
� How to eliminate from on board ship
persons with diseases which could
endanger the health of other persons
� How to examine eye-sight, hearing and
colour vision, and the satisfactory
minimum limits of these senses.
Health and fitness demandsHealth and fitness demandsHealth and fitness demandsHealth and fitness demandsHealth and fitness demands
The examining doctor must be familiar with
maritime occupational medicine. The doctor
must know the work on board various types of
ships, in different departments and in different
ranks. The doctor must also know when the
health of the examinee is inadequate for work on
board ship. The annex of the
STCW-code helps the
medical doctor a lot in this
determination (2).
Fitness for work on
board ship is a very
complicated combination of
health status, ill health,
diseases, work motivation,
training, intelligence,
leadership and
management on board ship,
as well as social atmosphere
etc (Figure 1). How can all
these parts of fitness and
their combination be
evaluated in the case of an
individual seafarer?
The lack of clear
worldwide health demands
and methods to estimate the
effects of both medical
status and work
performance together with
the varying demands of
shipping companies lead to
a wide variation in medical
examinations in different
countries.
Very often the basic
health standards demanded
by, e.g. shipping companies
appear to be too high
compared with real needs
(“just for sure”). The
shipowner wants to have only “supermen”. As
long as there are enough candidates to select
from this practice will continue. However, the
attraction of a seafaring occupation is
decreasing and there is already a lack of new
seafarers. Supermen must soon be replaced by
“suitable, good enough seafarers”.
The Seafarer’s Health Improvement Programme
guidelines for the medical examination of
seafarers (S.H.I.P’s, 3) from the USA provide a
new, modern model of how the effects and risks
of an individual disease on sea fitness should be
estimated. SHIP’s clear “health risk evaluation
thinking” should be taken as a basis when
renewing and unifying the medical examinations
of seafarers. This risk evaluation process has
also been adopted by ILO/WHO Guidelines (4).
Without such a new aproach, old and often even
false beliefs and traditions guide modern medical
examinations.
Effects of age on fitness for work at seaEffects of age on fitness for work at seaEffects of age on fitness for work at seaEffects of age on fitness for work at seaEffects of age on fitness for work at sea
Age
Seafarer's
working
ability
Lifestyle
Motivation
Ship
mates
Actors having influence:
Shipowner
management, leadership
Occup. health services
General health care
Social insurance
Seafarer him-/herself
MeansHousing
Work,
means
Skills,
training
Ship's /
company's
culture
Society
Lifestyle
Family,
economy
worries
Working
commun-i
ty
Leader-
ship,
manage-
ment
H.Saarni/2004
Physical
ability
Disease/
illhealth
ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã.
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ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005
Seafarers under 18 years of age should be
examined once a year so that the seafering
occupation does not cause any harm to their
health and development (1, 5). Nobody has
estimated this “ piae cantiones” in practical life;
what to look for and how! Most seaferers today
are over 18 years, so the problem of young age
has been solved in most countries.
Today’s problem is formed by old
seaferers. Ageing correlates with an increased
appearance of various health defects and
diseases. Although the body gets older, slower
and maybe weaker, long work experience and
knowledge can compensate for some parts of
the aging losses. How can a medical doctor take
this into account when carrying out medical
examinations?
Finding a disease and making the prognosisFinding a disease and making the prognosisFinding a disease and making the prognosisFinding a disease and making the prognosisFinding a disease and making the prognosis
The efficacy of a single medical
examination is rather often overestimated.
The doctor has usually no or only limited
knowledge of the previous medical history of the
seafarer to be examined. Most of the information
the doctor has in the examination situation is
based on the subjective report of the examinee,
on the report which the seafarer is willing to give
to the doctor voluntarily, e.g. the diagnosis of
epilepsy is usually impossible during a routine
medical examination without the patient’s own
report or other information about his previous
health history.
Laboratory measurements and functional
tests of muscles, joints and cardiopulmonary
performance give information about the
functional capacity of the seafarer. The
functional capacity is not, however, the same as
work performance! Weight lifting is not the same
as stair climbing! Can the medical doctor test a
seafarer in his/her normal working
surroundings? The answer is NO.
A common medical slogan is that “only an
unexamined person is a healthy person”. How
wide a range of medical tests should be
connected with routine medical examinations of
seafarers? Do the tests used identify all health
defects affecting the working ability of a
seafarer? What are the most relevant tests clearly
connected with the working ability of the
seafarer?
No international body has even objectively
thought which diseases, medical diagnoses as
such, are an obstacle to service at sea. And what
are the relevant tests to detect these diseases
when doing a medical examination? Why, e.g.
can HIV-infection, which at the early stages does
not cause any symptoms, prevent service at sea
in some countries? Which of us knows for sure
that he or her does not have HIV?
As stated above, the past and today are
rather unclear when thinking about medical
fitness. What about the future? Should the
prognosis of a disease of an experienced
seaferer be made for the following 2 years, the
usual time to the next medical examination, or
for a longer time period? For the rest of his life?
In today’s business life, even two years seem to
be a rather long time.
Need for treatment on board shipNeed for treatment on board shipNeed for treatment on board shipNeed for treatment on board shipNeed for treatment on board ship
The treatment needs of a medical
condition on board ship should, of course,
always be remembered, whether the sailing
period is shorter or longer. But how can we
assess the occurrence of the treatment needs
on board ship when the medical condition varies
from time to time? Who gives the doctor a
chrystal ball to see the future with?
EU directive 29/92 (6) provides EU
member states with a regulation concerning the
contents of a ships medicine chest. IMO has also
given a recommendation for the first-aid bag on
Ro-Ro-passenger vessels sailing without a
doctor on board ship (7). The International
Council of Cruise Lines (ICCL) has its own
guidelines for medical facilities on board cruise
ships (8). Nearly every country has its own
national regulations concerning ships medicine
chest. Every medical doctor working in the
maritime world should know at least the national
and flag-country regulations concerning medical
facilities on board ship.
Elimination of sick persons from work at seaElimination of sick persons from work at seaElimination of sick persons from work at seaElimination of sick persons from work at seaElimination of sick persons from work at sea
There are many diseases which at least in
certain positions on board ship can endanger the
health and well-being of other persons on board
ship. A master with eye-sight defect is not fit to
steer the ship. But what about a steward with the
same disease in the galley? The situation is totally
the opposite with salmonellosis.
Seafarers coming from areas where active
tubeculosis is a common disease should be x-
ray tested to eliminate the risk of tuberculosis
spreading among the shipboard personnel. But
what is the evidence-based time period between
x-rays to be sure that the seaferer is not suffering
from tuberculosis? How often should
salmonellosis be checked for among the
catering personnel?
Eye-sight, hearing and colour visionEye-sight, hearing and colour visionEye-sight, hearing and colour visionEye-sight, hearing and colour visionEye-sight, hearing and colour vision
The national eye-sight standards for
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ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005
ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã.
seafarers usually concern only distant vision with
and without spectacles. Though the IMO has
given its recommendations for minimum eye-
sight and hearing demands, adopted later also
into ILO/WHO Guidelines for conducting medical
fitness examinations for seafarers (4), they still
vary a lot from one country to another.
The testing of vision aquirance should be
a rather simple procedure. The situation is
identical when testing colour vision or hearing.
However, in practice, every-day testing
procedures are far from constant leading
variation in test results depending on the testing
person and testing method. Thus, even simple
basic medical examinations should be guided
and unified.
ILO: HEALTH PROTECTION AND MEDICAL
CARE (SEAFARERS) CONVENTION 164/1987
Convention 164/1987 (9) by the ILO states
that health and medical care on board ship
should also include the prevention and treatment
of diseases and medical facilities on board ship.
Article 12 states that there should be a standard
medical form for medical records on board ship.
Medical doctors should have closer international
cooperation, they should participate in rescue
activities and in the training of seafarers and their
health promotion.
Disease prevention and health promotion
among seafarers are thus the responsibility of
shipping companies (and company doctors,
company occupational health service?). The
doctors have an important role in health
education and health promotion among
seaferers. This information and support should
can be given, e.g. during every medical
examination. In training syllabus of medical
doctors, training in preventive medicine is given
only a small number of hours if any, so it should
be included in their postgraduate training in
maritime health.
ILO/WHO: GUIDELINES FOR CONDUCTING
PRE-SEA AND PERIODIC MEDICAL FITNESS
EXAMINATIONS FOR SEAFARERS D.2/1997
The clearest requirements concerning for
the competence of medical doctors carrying out
medical examinations for seafarers are given by
ILO/WHO guidelines from the year 1997 (4). A
medical examiner, so authorized by the
competent authority, should be a licensed
physician; and should be experienced in general
and occupational medicine or maritime
occupational medicine. The examiner doctor
should have a knowledge of the living and
working conditions on board ships and should
be provided with written guidance on the
procedures for the conduct of medical
examinations of seafarers, including information
on appeals procedures for persons denied a
medical certificate as the result of an
examination. He/she should also enjoy absolute
professional independence from employers,
workers and their representatives in exercising
their medical judgement in terms of the medical
examination procedures.
Thus, there is a clear parallelism between
occupational and maritime medicine. Seafarers’
medical examinations are seen as occupational
on-entry or follow-up medical examinations.
The professional independence of
examining doctors is very important, especially
when many doctors are working for the shipping
companies. The doctors must know and follow
ethical rules especially stricktly in the present
situation when no comprehensive lists of
contraindications for sea fitness on the level of
the individual seafarer exist. The list of diseases
in the quidelines can only provide some
guidance, it cannot replace sound medical
judgement. The final decision lies in the hands
of the examining doctor!
Estimating the risks of a diseaseEstimating the risks of a diseaseEstimating the risks of a diseaseEstimating the risks of a diseaseEstimating the risks of a disease
The principles of SHIP (3) as mentioned
above have been included in the guidelines. The
examining doctor should be able to evaluate
� the critical time needed for treatment /
access to appropriate land-based care
� the extent of the threat and danger
caused by the medical problem to the
patient and to the safety of the vessel
� the current risk of occurrence of the
medical problem.
When there is a health problem which
affects the fitness of a seafarer but does not
make him/her totally unfit for work at sea,
restrictions on time, position, trade area or type
of ship, as mentioned in the guidelines, may be
needed.
The risk evaluation process is rather
unfamiliar to medical doctors and should be
taught during postgraduate training in maritime
medicine.
The need for evidence based-medicine
when carrying out medical examinations and
when evaluating medical needs on board ship
has arisen recently. However, where does the
doctor get objective data about seafarers’ fitness
to carry out his/her work on board ship?
Every seafarer, every work task on board
ship, every ship, every sailing region / sea and
every harbour and event on board ship is a
unique case. Even though, in the light of
statistics, general rules and trends can be found,
ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã.
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ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005
the final decision about sea fitness will be left in
the hands of the examining medical doctor also
in the future.
The problem of sea fitness is a rather
difficult one even among fleets where all the
seafarers are hired on a permanent basis, so that
the company’s occupational health service
learns to know their problems and has good
possiblitities to follow their fitness from year to
year. The situation is much more complicated
when the seafarer seeks a fitness certificate on
shore, seeing the doctor for the first and last time
at the same time. The situation is only a little
better with company doctors, they have (in
theory?) the possibility to follow a seaferer’s
health at work, at least for one working period.
References:References:References:References:References:
1. Medical Examination (Seafarers) Convention,
73, ILO, Geneva, 1946.
2. Seafararers’ training, certification and
watchkeeping (STCW) Code. Part B:
Recommended guidance regarding provisions
of the STCW Convention and its annex, IMO,
London 1995.
3. Reference guire for physicians. Physical
examination for retention of seafarers in the U.S:
merchant masrine. Seaman Health Improvement
Programme (S.H.I.P.), 1995
4. Guidelines for Conducting Pre-sea and
Periodic Medical Fitness Examinations for
Seafarers, ILO/WHO, Geneva, 1997.
5. Medical examination of young persons (sea),
Convention 16, ILO, Geneva, 1921.
6. Minimum safety and health requirements for
improved medical treatment on board vessels,
Council directive (EU) 92/29), EU, 1992.
7. List of contents of the “emergency medical kit/
bag” and medical consideration for its use on Ro-
Ro passenger ships not normally carrying a
medical doctor, MSC/circ. 1042, IMO, London,
2002.
8. Health care guidelines for cruise ship medical
facilities, ICCL, 2000.
9. Health protection and medical care
(Seafarers), Convention 164, ILO, Geneva,
1987.
ÐåôåðàòÐåôåðàòÐåôåðàòÐåôåðàòÐåôåðàò
ÌÅÄÈÖÈÍÑÊÈÅ ÎÑÌÎÒÐÛ ËÈÖ ÏËÀÂÑÎÑ-
ÒÀÂÀ È ÏÎÄÃÎÒÎÂÊÀ ÂÐÀ×ÅÉ Â ÎÁËÀÑÒÈ
ÌÎÐÑÊÎÉ ÌÅÄÈÖÈÍÛ.
Õåéêè Ñààðíè
 ñîîòâåòñòâèè ñ ìåæäóíàðîäíûìè
ïðàâèëàìè âðà÷è, ðàáîòàþùèå â îáëàñòè
ìîðñêîé ìåäèöèíû, äîëæíû èìåòü ñïåöèàëü-
íóþ ïîäãîòîâêó ïî ïðîôïàòîëîãèè. Âðà÷è
äîëæíû çíàòü:
- íàöèîíàëüíîå è ìåæäóíàðîäíîå çàêîíî-
äàòåëüñòâî â äàííîé îáëàñòè;
- óñëîâèÿ ðàáîòû è æèçíåîáèòàíèÿ íà áîð-
òó ñóäíà;
- òðåáîâàíèÿ, ïðåäúÿâëÿåìûå ê óðîâíþ
çäîðîâüÿ, íåîáõîäèìîìó äëÿ ðàáîòû íà
áîðòó;
- ïîðÿäîê ïðîâåäåíèÿ ìåäèöèíñêèõ îñìîò-
ðîâ;
- ýòè÷åñêèå òðåáîâàíèÿ, äåéñòâóþùèå â
îáëàñòè ìîðñêîé ìåäèöèíû;
- ìåòîäû îöåíêè ðèñêîâ â ñëó÷àå áîëåçíè
÷ëåíà ýêèïàæà;
- ìåòîäû ïðîïàãàíäû çäîðîâîãî îáðàçà
æèçíè ñðåäè ÷ëåíîâ ýêèïàæà.
Ìåæäóíàðîäíîìó ñîòðóäíè÷åñòâó âðà-
÷åé â îáëàñòè ìîðñêîé ìåäèöèíû óäåëÿåòñÿ
âíèìàíèå ñî ñòîðîíû ìíîãèõ îðãàíèçàöèé.
Ìåæäóíàðîäíîå ñîòðóäíè÷åñòâî â îáëàñòè
ìîðñêîé ìåäèöèíû äîëæíî ñòðîèòüñÿ íà îñ-
íîâå ýòè÷åñêèõ íîðì. Ìåæäóíàðîäíàÿ àññî-
öèàöèÿ ìîðñêîé ìåäèöèíû (ÌÌÀÌ – IMHA)
ìîæåò ñòàòü òîé èíñòàíöèåé, êîòîðàÿ íà÷íåò
ìåæäóíàðîäíóþ äèñêóññèþ ñðåäè ñïåöèàëè-
ñòîâ ïî âîïðîñàì ïðîâåäåíèÿ ïðîôåññèî-
íàëüíûõ îòáîðîâ. ÌÌÀÌ äîëæíà òàêæå îðãà-
íèçîâàòü ìåæäóíàðîäíûå óíèôèöèðîâàííûå
êóðñû ïî ïîäãîòîâêå âðà÷åé â îáëàñòè ìîðñ-
êîé ìåäèöèíû è ïðîâåäåíèþ ïðîôåññèî-
íàëüíûõ îòáîðîâ ìîðÿêîâ. Êóðñû, îðãàíèçî-
âàííûå â ðàçëè÷íûõ ñòðàíàõ ïî âñåìó ìèðó ñ
ïðèâëå÷åíèåì êóðñàíòîâ èç ðàçíûõ ñòðàí,
äîëæíû ñîêðàòèòü ñóùåñòâóþùèé â íàñòîÿ-
ùåå âðåìÿ çíà÷èòåëüíûé ðàçáðîñ â ñòàíäàð-
òàõ ïðîâåäåíèÿ ïðîôîñìîòðîâ, êðèòåðèÿõ
ïîäáîðà è ìåäèöèíñêîãî îáñëóæèâàíèÿ ìî-
ðÿêîâ.
AbstractAbstractAbstractAbstractAbstract
According to the international rules and
regulations doctors working in maritime
medicine need training in occupational
medicine. The doctors must know:
� National and international rules and
regulations
� Work and life on board ship
� Health and fitness demands of the work
on board ship
� Medical examination procedure
� Ethics in maritime medicine
� Risk evaluation procedure, when a
seafarer has a disease
� Health promotion among seafarers
International cooperation between
medical doctors in maritime medicine has been
stressed by international bodies. Ethical rules are
needed to form the basis for successful work in
international maritime medicine. The
129129129129129
ACTUAL PROBLEMS OF TRANSPORT MEDICINE � # 1, 2005
ÀÊÒÓÀËÜÍÛÅ ÏÐÎÁËÅÌÛ ÒÐÀÍÑÏÎÐÒÍÎÉ ÌÅÄÈÖÈÍÛ � ¹ 1, 2005 ã.
Îñîáëèâîñò³ ïðàö³ ïëàâñêëàäó –
ñïåöèô³÷í³ óìîâè ïåðåáóâàííÿ íà áîðòó
ñóäíà, ïåðåâàæíî îïåðàòîðñüêèé õàðàêòåð
ïðàö³, íåñåííÿ âàõò, çá³ëüøåí³ âèìîãè äî
ïñèõ³÷íèõ ôóíêö³é, ïîñò³éíà ä³ÿ íåãàòèâíèõ ³
øê³äëèâèõ ôàêòîð³â (øóì, â³áðàö³ÿ,
íåñïðèÿòëèâèé ì³êðîêë³ìàò òà òåìïåðàòóðà
çîâí³øíüîãî ïîâ³òðÿ) – ïðåä’ÿâëÿþòü
çá³ëüøåí³ âèìîãè äî ñòàíó çäîðîâ’ÿ ÷ëåí³â
åê³ïàæó (1, 2).
Îäíèì ³ç çàõîä³â, íàïðàâëåíèõ íà
äîïóùåííÿ äî ñïåöèô³÷íî¿ ðîáîòè íà ñóäí³ â
ÿêîñò³ ïëàâñêëàäó çäîðîâèõ ³ ïðèäàòíèõ
÷ëåí³â åê³ïàæ³â, º ïîïåðåäí³ ïðè
ïðàöåâëàøòóâàíí³ ³ ïåð³îäè÷í³ ìåäè÷í³
îãëÿäè. Âàæëèâ³ñòü ¿õ ïðîâåäåííÿ íà
âèñîêîìó ïðîôåñ³éíîìó ð³âí³
ï³äòâåðäæóºòüñÿ íå ò³ëüêè â³äïîâ³äíèìè
̳æíàðîäíèìè Êîíâåíö³ÿìè (íàïðèêëàä, 73-
1946 ð.), (14), à é çíà÷íîþ ê³ëüê³ñòþ
íàö³îíàëüíèõ íîðìàòèâíî-ïðàâîâèõ àêò³â
Óêðà¿íè (3-12).
Ìåäè÷í³ îãëÿäè ìîðÿê³â íà
Äí³ïðîâñüêîìó áàñåéí³ ïðîâîäÿòüñÿ â òðüîõ
áàñåéíîâèõ ë³êàðíÿõ (Êè¿âñüêà öåíòðàëüíà
êë³í³÷íà, Äí³ïðîïåòðîâñüêà ³ Çàïîð³çüêà), à
òàêîæ â ë³êàðí³ Ñóâîðîâñüêîãî ðàéîíó ì.
Õåðñîíà ³ êë³í³÷í³é ë³êàðí³ Ìèêîëà¿âñüêîãî
ìîðñüêîãî ïîðòó.
Ïðîôñï³ëêà, êåðóþ÷èñü ñòàòòåþ 30
Çàêîíó Óêðà¿íè «Ïðî ïðîôåñ³éí³ ñï³ëêè, ¿õ
ïðàâà òà ãàðàíò³¿ ä³ÿëüíîñò³», ùîð³÷íî
çä³éñíþº ãðîìàäñüêèé êîíòðîëü çà
ïðîâåäåííÿì ïîïåðåäí³õ ³ ïåð³îäè÷íèõ
ìåäè÷íèõ îãëÿä³â ïëàâñêëàäó.
 2003 ð. ïèòàííÿ íàäàííÿ ìåäèêî-
ñîö³àëüíî¿ ïîìîãè ïðàö³âíèêàì ãàëóç³,
âêëþ÷àþ÷è ñòàí ïðîâåäåííÿ ìåäè÷íèõ
îãëÿä³â ïëàâñêëàäó, áóëî äåòàëüíî
ÓÄÊ 616.004.58:656.6-051
ÏÎ˲ÏØÅÍÍß ÌÅÄÈ×ÍÈÕ ÎÃËßIJ ÏËÀÂÑÊËÀÄÓ – ØËßÕ ÄÎÏÎ˲ÏØÅÍÍß ÌÅÄÈ×ÍÈÕ ÎÃËßIJ ÏËÀÂÑÊËÀÄÓ – ØËßÕ ÄÎÏÎ˲ÏØÅÍÍß ÌÅÄÈ×ÍÈÕ ÎÃËßIJ ÏËÀÂÑÊËÀÄÓ – ØËßÕ ÄÎÏÎ˲ÏØÅÍÍß ÌÅÄÈ×ÍÈÕ ÎÃËßIJ ÏËÀÂÑÊËÀÄÓ – ØËßÕ ÄÎÏÎ˲ÏØÅÍÍß ÌÅÄÈ×ÍÈÕ ÎÃËßIJ ÏËÀÂÑÊËÀÄÓ – ØËßÕ ÄÎ
ÇÁÅÐÅÆÅÍÍß ÇÄÎÐÎÂ’ß ² ÏÐÀÖÅÇÄÀÒÍÎÑÒ² ×ËÅͲ ÅʲÏÀƲÂÇÁÅÐÅÆÅÍÍß ÇÄÎÐÎÂ’ß ² ÏÐÀÖÅÇÄÀÒÍÎÑÒ² ×ËÅͲ ÅʲÏÀƲÂÇÁÅÐÅÆÅÍÍß ÇÄÎÐÎÂ’ß ² ÏÐÀÖÅÇÄÀÒÍÎÑÒ² ×ËÅͲ ÅʲÏÀƲÂÇÁÅÐÅÆÅÍÍß ÇÄÎÐÎÂ’ß ² ÏÐÀÖÅÇÄÀÒÍÎÑÒ² ×ËÅͲ ÅʲÏÀƲÂÇÁÅÐÅÆÅÍÍß ÇÄÎÐÎÂ’ß ² ÏÐÀÖÅÇÄÀÒÍÎÑÒ² ×ËÅͲ ÅʲÏÀƲÂ
Áàðàíîâñüêà Ì.². – Ãîëîâà Óêðà¿íñüêî¿ ïðîôñï³ëêè ïðàö³âíèê³â ð³÷êîâîãî
òðàíñïîðòó, ê.ì.í. Ñòîâáóí À.². – ãîëîâíèé äîâ³ðåíèé ë³êàð-òåõí³÷íèé
³íñïåêòîð ïðàö³
International Maritime Health Association (IMHA)
could be a suitable forum to start an international
discussion among specialists about facts,
evidence and principles in medical examinations.
IMHA should also organise international, unified
training courses for medical doctors in maritime
ðîçãëÿíóòî íà III-ó Ïëåíóì³ ïðîôñï³ëêè.
Ñòàí ïðîâåäåííÿ ìåäè÷íèõ îãëÿä³â
ïëàâñêëàäó ðîçãëÿäàºòüñÿ òàêîæ ïîñò³éíî íà
çàñ³äàííÿõ Ìåäè÷íî¿ Ðàäè ïðè Êè¿âñüê³é
öåíòðàëüí³é áàñåéíîâ³é êë³í³÷í³é ë³êàðí³.
 ö³ëîìó ïî ãàëóç³ ñòàí ïðîâåäåííÿ
ïîïåðåäí³õ ìåäè÷íèõ îãëÿä³â ïëàâñêëàäó ñë³ä
âèçíàòè, ÿê çàäîâ³ëüíèé: ïðàö³âíèêè
á³ëüøîñò³ ë³êóâàëüíî-ïðîô³ëàêòè÷íèõ
çàêëàä³â âèêîíóþòü âèìîãè íàêàçó ÌÎÇ ¹
347-96, äîïîâíþþ÷è ¿õ ñïåö³àëüíèìè
äîäàòêîâèìè äîñë³äæåííÿìè çà ïîêàçàííÿìè
çã³äíî ç ðåçóëüòàòàìè îãëÿäó.
Íåîáõ³äíî â³äçíà÷èòè, ùî â îñòàíí³ ðîêè
ÿê³ñòü ³ ïîâíîòà ìåäîãëÿä³â ïîë³ïøèëàñü: â
ïåðâèííèõ ìåäè÷íèõ äîêóìåíòàõ ïëàâñêëàäó
ñòàëè á³ëüø äåòàëüíî â³äîáðàæàòèñÿ
ðåçóëüòàòè îãëÿäó îôòàëüìîëîãà (ïîëÿ çîðó,
âíóòð³øíüîî÷íèé òèñê òà ³íø³),
îòîðèíîëÿðèíãîëîãà (âåñòèáóëÿðíà ïðîáà òà
àóä³îãðàìà), êàðä³îëîãà (âåëîåðãîìåòðè÷íå
äîñë³äæåííÿ) òà ³íøèõ ôàõ³âö³â.
ijëîâèé çâ’ÿçîê ìåäè÷íèõ ïðàö³âíèê³â ç
â³ää³ëàìè êàäð³â ï³äïðèºìñòâ ³ âïðîâàäæåííÿ
êîìï’þòåðíî¿ ïðîãðàìè ìîí³òîðèíãó çà
ïðîâåäåííÿì ïîïåðåäíüîãî ìåäè÷íîãî
îãëÿäó (Äí³ïðîïåòðîâñüêà áàñåéíîâà ë³êàðíÿ,
ïîë³êë³í³êà Ñóâîðîâñüêîãî ðàéîíó ì.
Õåðñîíà) äîïîìîãëî óíèêíóòè ôîðìàë³çìó
ïðè ïðîâåäåíí³ ïîïåðåäíüîãî ìåäîãëÿäó
ïëàâñêëàäó.
ßê íà ïåâíèé íåäîë³ê ó ïðîâåäåíí³
ïîïåðåäíüîãî ìåäè÷íîãî îãëÿäó ñë³ä âêàçàòè
íà â³äñóòí³ñòü ó á³ëüøîñò³ ÷ëåí³â ïëàâñêëàäó
àíàìíåñòè÷íèõ äàíèõ ç ìåäè÷íî¿
äîêóìåíòàö³¿ (àìáóëàòîðíà êàðòà çà ô.25) çà
ì³ñöåì ïîñò³éíîãî ïðîæèâàííÿ, à òàêîæ
â³äñóòí³ñòü îá’ºêòèâíèõ äàíèõ ùîäî îö³íêè
ñòàíó îðãàí³â äèõàííÿ (âèçíà÷åííÿ ôóíêö³¿
medicine, and in seafarers’ fitness evaluation.
Training, organized in various countries around
the world with international students would
diminish the existing wide variation in medical
examinations, fitness criteria and medical care
of seafarers.
|
| id | nasplib_isofts_kiev_ua-123456789-22063 |
| institution | Digital Library of Periodicals of National Academy of Sciences of Ukraine |
| issn | 1818-9385 |
| language | English |
| last_indexed | 2025-12-07T15:40:35Z |
| publishDate | 2005 |
| publisher | Фізико-хімічний інститут ім. О.В. Богатського НАН України |
| record_format | dspace |
| spelling | Heikki, S. 2011-06-20T14:36:52Z 2011-06-20T14:36:52Z 2005 Medical examinations of seafarers and training for medical doctors in maritime health / S. Heikki // Актуальні проблеми транспортної медицини. — 2005. — № 1. — С. 124-129. — Бібліогр.: 9 назв. — англ. 1818-9385 https://nasplib.isofts.kiev.ua/handle/123456789/22063 616.057.656.6:616.082:656.6-051 В соответствии с международными правилами врачи, работающие в области морской медицины, должны иметь специальную подготовку по профпатологии.Международному сотрудничеству врачей в области морской медицины уделяется внимание со стороны многих организаций. Международное сотрудничество в области морской медицины должно строиться на основе этических норм. Международная ассоциация морской медицины (ММАМ - IMHA) может стать той инстанцией, которая начнет международную дискуссию среди специалистов по вопросам проведения профессиональных отборов. ММАМ должна также организовать международные унифицированные курсы по подготовке врачей в области морской медицины и проведению профессиональных отборов моряков. Курсы, организованные в различных странах по всему миру с привлечением курсантов из разных стран, должны сократить существующий в настоящее время значительный разброс в стандартах проведения профосмотров, критериях подбора и медицинского обслуживания моряков. According to the international rules and regulations doctors working in maritime medicine need training in occupational medicine. The doctors must know: - National and international rules and regulations; - Work and life on board ship; - Health and fitness demands of the work on board ship; - Medical examination procedure; - Ethics in maritime medicine; - Risk evaluation procedure, when a seafarer has a disease; - Health promotion among seafarers International cooperation between medical doctors in maritime medicine has been stressed by international bodies. Ethical rules are needed to form the basis for successful work in international maritime medicine. The International Maritime Health Association (IMHA) could be a suitable forum to start an international discussion among specialists about facts, evidence and principles in medical examinations. IMHA should also organise international, unified training courses for medical doctors in maritime medicine, and in seafarers' fitness evaluation. Training, organized in various countries around the world with international students would diminish the existing wide variation in medical examinations, fitness criteria and medical care of seafarers. en Фізико-хімічний інститут ім. О.В. Богатського НАН України Актуальні проблеми транспортної медицини Клиническая медицина Medical examinations of seafarers and training for medical doctors in maritime health Медицинские осмотры лиц плавсостава и подготовка врачей в области морской медицины Article published earlier |
| spellingShingle | Medical examinations of seafarers and training for medical doctors in maritime health Heikki, S. Клиническая медицина |
| title | Medical examinations of seafarers and training for medical doctors in maritime health |
| title_alt | Медицинские осмотры лиц плавсостава и подготовка врачей в области морской медицины |
| title_full | Medical examinations of seafarers and training for medical doctors in maritime health |
| title_fullStr | Medical examinations of seafarers and training for medical doctors in maritime health |
| title_full_unstemmed | Medical examinations of seafarers and training for medical doctors in maritime health |
| title_short | Medical examinations of seafarers and training for medical doctors in maritime health |
| title_sort | medical examinations of seafarers and training for medical doctors in maritime health |
| topic | Клиническая медицина |
| topic_facet | Клиническая медицина |
| url | https://nasplib.isofts.kiev.ua/handle/123456789/22063 |
| work_keys_str_mv | AT heikkis medicalexaminationsofseafarersandtrainingformedicaldoctorsinmaritimehealth AT heikkis medicinskieosmotrylicplavsostavaipodgotovkavračeivoblastimorskoimediciny |