STCW Convention regulation

Department

Distance vision unaided or aided¹

Near/intermediate vision²

Colour vision³

Visual fields⁴

Night blindness⁴

Diplopia (double vision)⁴

One eye

Other eye

Both eyes together, aided or unaided

I/11

II/1

II/2

II/3

II/4

II/5

VII/2

Deck department:

masters, deck officers and ranks required to undertake bridge duties

0.7

0.5

Vision required for ship’s navigation (e.g. reading of chart and nautical publication reference, use of bridge instrumentation and equipment, and identification of aids to navigation)

See note⁵

Normal visual fields

Vision must be sufficient to perform all necessary functions in darkness without compromise

No significant condition evident

I/11

III/1

III/2

III/3

III/4

III/5

III/6

III/7

VII/2

Technical department:

all engineer officers and crew or others forming part of an engine-room watch

0.4⁶

0.4

Vision required to read instruments in close proximity, to operate equipment, and to reliably recognize and identify systems/components

Not re-quired

Sufficient visual fields

Vision must be sufficient to perform all necessary functions in darkness without compromise

No significant condition evident

I/11

III/6

III/7

Electro-technical department:

all electro-technical officers and electro-technical crew members

0.4⁶

0.4

Vision required to read instruments in close proximity, to operate equipment, and to reliably recognize and identify systems/components

See note⁷

Sufficient visual fields

Vision must be sufficient to perform all necessary functions in darkness without compromise

No significant condition evident

-

Catering department

0.4⁶

0.4

-

Not re-quired

Sufficient visual fields

Vision must be sufficient to perform all necessary functions in darkness without compromise

No significant condition evident

-

Other services

0.4⁶

0.4

-

Not re-quired

Sufficient visual fields

Vision must be sufficient to perform all necessary functions in darkness without compromise

No significant condition evident

Shipboard task, function, event or condition

Related physical capability

A medical examiner should be satisfied that the candidate:

Routine movement around vessel:

– on moving deck

– between levels

– between compartments

Maintain balance and move with agility

Climb up and down vertical ladders and stairways

Step over coamings (e.g. Load Line Convention requires coamings to be 600 mm high)

Open and close watertight doors

has no disturbance in sense of balance

does not have any impairment or disease that prevents relevant movements and physical activities

is, without assistance (without the use of another person), able to:

– climb vertical ladders and stairways

– step over high sills

– manipulate door closing systems

Routine tasks on board:

– use of hand tools

– movement of ship’s stores

– overhead work

– valve operation

– standing during a four-hour watch

– working in confined spaces

– responding to alarms, warnings and instructions

– verbal communication

Strength, dexterity and stamina to manipulate mechanical devices

Lift, pull and carry a load (e.g. 18 kg)

Reach upwards

Stand, walk and remain alert for an extended period

Work in confined spaces and move through restricted openings (e.g. SOLAS regulation 11-I/3-6.5.1 requires openings in cargo spaces and emergency escapes to have the minimum dimensions of 600 mm x 600 mm)

Visually distinguish objects, shapes and signals

Hear warnings and instructions

Ability to express him- or herself orally in a clear manner

does not have a defined impairment or diagnosed medical condition that reduces ability to perform routine duties essential to the safety of the vessel:

– can work with arms raised

– can stand and walk for an extended period

– can enter confined spaces

– fulfils the eyesight standards (table A-I/9)

– fulfils hearing standards set by a competent authority or the corresponding international guidelines in this regard

– can hold normal conversation

Emergency duties on board:

– escape

– fire-fighting

– evacuation

Don a lifejacket or immersion suit

Escape from smoke-filled spaces

Take part in fire-fighting duties, including use of breathing apparatus

Take part in vessel evacuation procedures

does not have a defined impairment or diagnosed medical condition that reduces ability to perform emergency duties essential to the safety of the vessel:

– can don a lifejacket or immersion suit

– can crawl

– can feel for differences in temperature

– can handle fire-fighting equipment

– can wear breathing apparatus (where required as part of duties)

ICD-10

(diagnostic codes)

Condition

(justification for criteria)

Incompatible with reliable performance of routine and emergency duties safely or effectively

- expected to be temporary (T)

- expected to be permanent (P)

Able to perform some but not all duties or to work in some but not all waters (R) Increased frequency of surveillance needed (L)

Able to perform all duties worldwide within designated department

A00–B99

Infections

A00–09

Gastrointestinal infection

Transmission to others, recurrence

T – If detected while onshore (current symptoms or awaiting test results on carrier status); or confirmed carrier status until elimination demonstrated

Not applicable

Non-catering department: When satisfactorily treated or resolved

Catering department: Fitness decision to be based on medical advice – bacteriological clearance/eradication may be required

A15–16

Pulmonary TB

Transmission to others, recurrence

T – Positive screening test or clinical history, until investigated

If infected, until treatment stabilized and lack of infectivity confirmed

P – Relapse or severe residual damage

Not applicable

Successful completion of a course of treatment in accordance with WHO Treatment of Tuberculosis guidelines

A50–64

Sexually transmissible infections

Acute impairment, recurrence

T – If detected while onshore, until diagnosis confirmed, treatment initiated and impairing symptoms resolved

P – Untreatable impairing late complications

R – Consider near coastal if oral treatment regime in place and symptoms non-incapacitating

On successful completion of treatment

B15

Hepatitis A

Transmissible by food or water contamination

T – Until jaundice resolved and liver function tests returned to normal

Not applicable

On full recovery

B16–19

Hepatitis B, C, etc.

Transmissible by contact with blood or other bodily fluids. Possibility of permanent liver impairment and liver cancer

T – Until jaundice resolved and liver function tests returned to normal

P – Persistent liver impairment with symptoms affecting safe work at sea or with likelihood of complications

R, L – Uncertainty about total recovery or lack of infectivity. Case-by-case decision-making based on duties and (planned) trading area/voyage pattern

On full recovery and confirmation of low level of infectivity

B20–24

HIV+

Transmissible by contact with blood or other bodily fluids.

Progression to HIV- associated diseases or AIDS

T – Until stabilized on treatment with CD4 level of >350 or when treatment changed and tolerance of new medication uncertain

P – Non-reversible impairing HIV-associated diseases. Continuing impairing effects of medication

R, L – Time limited and/or near coastal: HIV+ and low likelihood of progression; on no treatment or on stable medication without side effects, but requiring regular specialist surveillance

HIV+, no current impairment and very low* likelihood of disease progression. No side effects of treatment or requirements for frequent surveillance

A00–B99

Not listed separately

Other infections

Personal impairment, infection of others

T – If detected while onshore: until free from risk of transmission and capable of performing duties

P – If continuing likelihood of repeated impairing or infectious recurrences

Case-by-case decision based on nature of infection

Full recovery and confirmation of low level of infectivity

C00–48

Cancers

C00–48

Malignant neoplasms – including lymphoma, leukaemia and related conditions

Recurrence – especially acute complications, e.g. harm to self from bleeding and to others from seizures

T – Until investigated, treated and prognosis assessed

P – Continuing impairment with symptoms affecting safe work at sea or with high likelihood of recurrence

L – Time limited to interval between specialist reviews if:

- cancer diagnosed <5 years ago; and

- there is no current impairment of performance of normal or emergency duties or living at sea; and

- there is a low likelihood of recurrence and minimal risk of requirement for urgent medical treatment

R – Restricted to near coastal waters if any continuing impairment does not interfere with essential duties and any recurrence is unlikely to require emergency medical treatment

Cancer diagnosed more than 5 years ago, or specialist reviews no longer required and no current impairment or low continuing likelihood of impairment from recurrence.

To be confirmed by specialist report with evidence for opinion stated

D50–89

Blood disorders

D50–59

Anaemia/Haemoglobinopathies

Reduced exercise tolerance. Episodic red cell breakdown

T – Distant waters, until haemoglobin normal and stable

P – Severe recurrent or continuing anaemia or impairing symptoms from red cell breakdown that are untreatable

R, L – Consider restriction to near coastal waters and regular surveillance if reduced haemoglobin level but asymptomatic

Normal levels of haemoglobin

D73

Splenectomy (history of surgery) Increased susceptibility to certain infections

T – Post surgery until fully recovered

R – Case-by-case assessment. Likely to be fit for coastal and temperate work but may need restriction on service in tropics

Case-by-case assessment

D50–89

Not listed separately

Other diseases of the blood and blood-forming organs

Varied recurrence of abnormal bleeding and also possibly reduced exercise tolerance or low resistance to infections

T – While under investigation

P – Chronic coagulation disorders

Case-by-case assessment for other conditions

Case-by-case assessment

E00–90

Endocrine and metabolic

E10

Diabetes – Insulin using

Acute impairment from hypoglycaemia. Complications from loss of blood glucose control

Increased likelihood of visual, neurological and cardiac problems

T – From start of treatment until stabilized

P – If poorly controlled or not compliant with treatment. History of hypoglycaemia or loss of hypoglycaemic awareness. Impairing complications of diabetes

R, L – Subject to evidence of good control, full compliance with treatment recommendations and good hypoglycaemia awareness

Fit for near coastal duties without solo watchkeeping. Time limited until next specialist check-up. Must be under regular specialist surveillance

Not applicable

E11–14

Diabetes – Non-insulin treated, on other medication

Progression to insulin use.

Increased likelihood of visual, neurological and cardiac problems

T – Distant waters and watchkeeping until stabilized

R – Near coastal waters and non- watchkeeping duties until stabilized

R – Near coastal waters, no solo watchkeeping if minor side effects from medication. Especially when using sulphonylureas

L – Time limited if compliance poor or medication needs frequent review. Check diet, weight and cardiovascular risk factor control

When stabilized, in the absence of impairing complications

Diabetes – Non-insulin treated, treated by diet alone

Progression to insulin use

Increased likelihood of visual, neurological and cardiac problems

T – Distant waters and watchkeeping until stabilized

R – Near coastal waters and non- watchkeeping duties until stabilized

L – Time limited when stabilized, if compliance poor or medication needs frequent review. Check diet, weight and vascular risk factor control

When stabilized, in the absence of impairing complications

E65–68

Obesity/abnormal body mass –

high or low

Accident to self, reduced mobility and exercise tolerance for routine and emergency duties. Increased likelihood of diabetes, arterial diseases and osteoarthritis

T – If safety-critical duties cannot be performed, capability or exercise test performance is poor

P – Safety-critical duties cannot be performed; capability or exercise test performance is poor with failure to achieve improvements

Note: Body mass index is a useful indicator of when additional assessment is needed (cf. Exclusion criteria for fitness for service at sea, no. 7.1 of this Annex)

R, L – Time limited and restricted to near coastal waters or to restricted duties if unable to perform certain tasks but able to meet routine and emergency capabilities for assigned safety-critical duties

Capability and exercise test performance (Annex 2, no. 5) average or better, weight steady or reducing and no co-morbidity

E00–90

Not listed separately

Other endocrine and metabolic disease

(thyroid, adrenal including Addison’s disease, pituitary, ovaries, testes)

Likelihood of recurrence or complications

T – Until treatment established and stabilized without adverse effects

P – If continuing impairment, need for frequent adjustment of medication or increased likelihood of major complications

R, L – Case-by-case assessment with specialist advice if any uncertainty about prognosis or side effects of treatment. Need to consider likelihood of impairing complications from condition or its treatment, including problems taking medication, and consequences of infection or injury while at sea

If medication stable with no problems in taking at sea and surveillance of conditions infrequent, no impairment and very low likelihood of complications

Addison’s disease: The risks will usually be such that an unrestricted certificate should not be issued

F00–99

Mental, cognitive and behavioural disorders

F10

Alcohol abuse (dependency)

Recurrence, accidents, erratic behaviour, incorrect performance of safety measures, safety behaviour

T – Until investigated and stabilized and criteria for fitness met. Until one year after initial diagnosis or one year after any relapse

P – If persistent or there is co-morbidity likely to progress or recur while at sea

R, L – Time limited, not to work as master in charge of vessel or without close supervision and continuing medical monitoring, provided that: treating physician reports successful participation in rehabilitation programme; and there is an improving trend in liver function tests

After three years from end of last episode without relapse and without co-morbidity

F11–19

Drug dependence/persistent substance abuse, includes both illicit drug use and dependence on prescribed medications

Erratic behaviour, incorrect performance of safety measures, safety behaviour

T – Until investigated and stabilized and criteria for fitness met. Until one year after initial diagnosis or one year after any relapse

P – If persistent or there is co-morbidity likely to progress or recur while at sea

R, L – Time limited, not to work as master in charge of vessel or without close supervision and continuing medical monitoring, provided that:

- treating physician reports successful participation in rehabilitation programme; and

- evidence of completion of unannounced/random programme of drug screening for at least three months with no positives and at least three negatives; and

- continuing participation in drug screening programme

After three years from end of last episode without relapse and without co-morbidity

F20–31

Psychosis (acute) –

- Organic, schizophrenic or other category listed in the ICD.

- Bipolar (manic depressive disorders)

- Recurrence leading to changes to perception/ cognition, accidents, erratic and unsafe behaviour

Following single episode with provoking factors:

T – Until investigated and stabilized and conditions for fitness met. At least three months after episode

Following single episode without provoking factors or more than one episode with or without provoking factors:

T – Until investigated and stabilized and conditions for fitness met. At least two years since last episode

P – More than three episodes or continuing likelihood of recurrence. Criteria for fitness with or without restrictions are not met

R, L – Time limited, restricted to near coastal waters and not to work as master in charge of vessel or without (adequate) supervision and continuing medical monitoring, provided that:

- seafarer has insight;

- is compliant with treatment; and

- has no adverse effects from medication

R, L – Time limited, restricted to near coastal waters and not to work as master in charge of vessel or without (adequate) supervision and continuing medical monitoring providing that:

- the seafarer has insight;

- is compliant with treatment; and

- has no impairing adverse effects from medication

Case-by-case assessment at least one year after the episode, provided that provoking factors can and will always be avoided

Case-by-case assessment to largely exclude likelihood of recurrence at least five years since end of episode if no further episodes; no residual symptoms; and no medication needed during last two years

F32–38

Mood/affective disorders

Severe anxiety state, depression, or any other mental disorder that can impair performance

Recurrence, reduced performance, especially in emergencies

T – While acute, under investigation or if impairing symptoms or side effects of medication present. At least three months on stable medication

P – Persistent or recurrent impairing symptoms

R, L – Restrict to near coastal waters and not to work as master in charge of ship, only when seafarers has:

- good functional recovery;

- insight;

- is fully compliant with treatment, with no impairing side effects; and

- a low* likelihood of recurrence

Case-by-case assessment to largely exclude likelihood of recurrence after at least two years with no further episodes and with no medication or on medication with no impairing effects

Mood/affective disorders

Minor or reactive symptoms of anxiety/depression

Recurrence, reduced performance, especially in emergencies

T – Until symptom free. If on medication to be on a stable dose and free from impairing adverse effects

P – Persistent or recurrent impairing symptoms

R, L – Time limited and consider geographical restriction/restriction of trading area if on stable dose of medication and free from impairing symptoms or impairing side effects from therapy

Case-by-case assessment at the earliest after one year from end of episode if symptom free and off medication or on medication with no impairing effects

F00–99

Not listed separately

Other disorders, e.g. disorders of personality, attention (e.g. ADHD), development (e.g. autism)

Impairment of performance and reliability and impact on social behaviour

P – If considered to have safety-critical consequences

R – As appropriate if capable of only limited duties

No anticipated adverse effects while at sea. No incidents during previous periods of sea service

G00–99

Diseases of the nervous system

G40–41

Single epileptic seizure

Harm to ship, others and self from seizures

Single seizure

T – While (condition) under investigation and for one year after seizure

R – At the earliest one year after seizure and on stable medication. Non-watchkeeping duties in near coastal waters

At the earliest one year after seizure and one year after end of treatment. If provoked, there should be no continuing exposure to the provoking agent

Epilepsy – No provoking factors

(multiple seizures)

Harm to ship, others and self from seizures

T – While under investigation and for two years after last seizure

P – Recurrent seizures, not controlled by medication

R – Off medication or on stable medication with good compliance: case-by-case assessment of fitness, restricted to non-watchkeeping duties in near coastal waters

Seizure-free for at least the last ten years, has not taken anti-epilepsy drugs during that ten-year period and does not have a continuing likelihood of seizures

Epilepsy – provoked by alcohol, medication, head injury (multiple seizures)

Harm to ship, others and self from seizures

T – While under investigation and for two years after last seizure

P – Recurrent fits, not controlled by medication

R – Case-by-case assessment. At the earliest after two years’ abstention from any known provoking factors, seizure-free and either off medication or on stable medication with good compliance; restricted to non-watchkeeping duties in near coastal waters

Seizure-free for at least the last five years, has not taken anti-epilepsy drugs during that five-year period, provided there is not continuing exposure to the provoking agent

G43

Migraine (frequent attacks causing severe impairment of general condition)

Likelihood of recurrences leading to restrictions

P – Frequent attacks leading to severe impairment of performance

R – With appropriate/adequate restrictions if only capable of limited duties

If no anticipated performance-impairing adverse effects (of the condition) while at sea. No incidents during previous periods of sea service

G47

Sleep apnoea

Fatigue and episodes of sleep while working

T – Until treatment started and has been successful for at least three months

P – Treatment unsuccessful or not being complied with

L – Once treatment demonstrably working effectively for three months, including compliance with CPAP (continuous positive airway pressure) machine use confirmed. Six-monthly assessments of compliance based on CPAP machine recording

Case-by-case assessment based on job and emergency requirements, informed by specialist advice

Narcolepsy

Fatigue and episodes of sleep while working

T – Until controlled by treatment for at least two years

P – Treatment unsuccessful or not being complied with

R, L – Near coastal waters and no watchkeeping duties, if specialist confirms full control of treatment for at least two years

Annual review

Not applicable

G00–99

Not listed separately

Other organic nervous disease,

e.g. multiple sclerosis, Parkinson’s

disease

Recurrence/progression. Limitations on muscular power, balance, coordination and mobility

T – Until diagnosed and stable

P – If limitations affect safe working or unable to meet physical capability requirements

R, L – Case-by-case assessment based on job and emergency requirements, informed by specialist advice

Case-by-case assessment based on job and emergency requirements, informed by specialist advice

R55

Syncope and other disturbances of consciousness

Recurrence causing injury or loss of control

T – Until investigated to determine cause and demonstrated control of any underlying condition

Symptoms:

(a) simple faint;

(b) not a simple faint; unexplained disturbance, not recurrent and without any detected underlying cardiac, metabolic or neurological cause

T – Four weeks

(c) Disturbance; recurrent or with possible underlying cardiac, metabolic or neurological cause

T – With possible underlying cause that cannot be identified or treated; for six months after event if no recurrences

T – With possible underlying cause or cause found and treated; for one month after successful treatment

(d) Disturbance of consciousness with features indicating a seizure. Go to G40–41

P – For all of above if recurrent incidents persist despite full investigation and appropriate treatment

R, L – Case-by-case decision, near coastal with no lone watchkeeping

R, L – Case-by-case decision, near coastal with no lone watchkeeping

Simple faint; if no reoccurring states of debility

Three months after event if no recurrences

With possible underlying cause found but not treatable; one year after event if no recurrences

With possible underlying cause found and treated; three months after successful treatment

With seizure markers – not applicable

T90

Intracranial surgery/injury, including treatment of vascular anomalies or serious head injury with brain damage

Harm to ship, others and self from cerebral seizures. Defects in cognitive, sensory or motor function. Recurrence or complication of underlying condition

T – For one year or longer until seizure likelihood low*, based on advice from specialist

P – Continuing impairment from underlying condition or injury or recurrent seizures

R – After at least one year, near coastal, no lone watchkeeping if seizure likelihoods low* and no impairment from underlying condition or injury

Conditional on continued compliance with any treatment and on periodic review, as recommended by specialist

No impairment from underlying condition or injury, not on anti-epilepsy medications. Seizure likelihood very low*

Conditional on continued compliance with any treatment and on periodic review, as recommended by specialist

H00–99

Diseases of the eyes and ears

H00–59

Eye disorders: Progressive or recurrent (e.g. glaucoma, maculopathy, diabetic retinopathy, retinitis pigmentosa, keratoconus, diplopia, blepharospasm, uveitis, corneal ulceration and retinal detachment)

Future inability to meet vision standards, risk of recurrence

T – Temporary inability to meet relevant vision standards and low likelihood of subsequent deterioration or impairing recurrence once treated or recovered

P – Inability to meet relevant vision standards or, if treated, increased likelihood of subsequent deterioration or impairing recurrence

R – Near coastal waters if recurrence unlikely but foreseeable and treatable

with early medical intervention

L – If risk of progression foreseeable but unlikely and can be detected by regular monitoring

Very low likelihood of recurrence. Progression to a level where vision

standards are not met during period of certificate is very unlikely

H65–67

Otitis – External or media

Recurrence, risk as infection source in catering staff, problems using hearing protection

T – Until treated

P – If chronic discharge from ear in food handler

Case-by-case assessment. Consider effects of heat, humidity and hearing protection use in otitis externa

Effective treatment and no excess likelihood of recurrence

H68–95

Ear disorders: Progressive (e.g. otosclerosis)

T – Temporary inability to meet relevant hearing standards and low likelihood of subsequent deterioration or impairing recurrence once treated or recovered

P – Inability to meet relevant hearing standards or, if treated, increased likelihood or subsequent deterioration or impairing recurrence

L – If risk of progression foreseeable but unlikely and can be detected by regular monitoring

Low likelihood of recurrence. Progression to a level where hearing standards are not met during period of certificate is very unlikely

H81

Ménière’s disease and other forms of chronic or recurrent severely impairing vertigo Inability to balance, causing loss of mobility and nausea

See STCW

T – During acute phase

P – Frequent attacks leading to severe impairment

R – As appropriate. If only capable of limited duties

R, L – If frequent specialist surveillance required

Low* likelihood of impairing effects while at sea

I00–99

Cardiovascular system

I05–08

I34–39

Congenital and valve disease of heart

(including surgery for these conditions)

Heart murmurs not previously investigated/examined

Likelihood of progression, limitations on exercise

T – Until investigated or adequately examined, and, if required, treated

P – If exercise tolerance limited or episodes of severe impairment of performance occur or if on anticoagulants. If permanent high likelihood of impairing event/deterioration of condition

R – Near coastal waters if case-by-case assessment indicates either likelihood of acute complications or rapid progression of disease

L – If frequent surveillance is recommended

Heart murmurs – Where unaccompanied by other heart abnormalities and considered benign by a specialist cardiologist following examination

Other conditions – assessment based on specialist advice

I10–15

Hypertension

Increased likelihood of ischemic heart disease, eye and kidney damage and stroke. Possibility of hypertensive episode/crisis

T – Normally if >160 systolic or >100 diastolic mm Hg until investigated and treated in accordance with national or international guidelines for hypertension management

P – If persistently >160 systolic or >100 diastolic mm Hg with or without treatment

L – If additional surveillance needed to ensure levels remain within the limits

If levels within the limits and free from impairing effects from condition or medication

I20–25

Cardiac event, i.e. myocardial infarction, ECG evidence of past myocardial infarction or newly recognized left bundle-branch block, angina, cardiac arrest, coronary artery bypass grafting, coronary angioplasty

Sudden states of debility, exercise tolerance limited. Problems of managing repeat cardiac event at sea

T – For twelve months after initial investigation and treatment, longer if symptoms not resolved

P – If criteria for issue of certificate not met and further reduction of likelihood of recurrence improbable

L – If likelihood of recurrence is very low* and fully compliant with risk reduction recommendations and no relevant/significant co-morbidity, issue six-month certificate initially and then annual certificate

R, L – If likelihood of recurrence is low.* Restricted to:

- no lone working or solo watchkeeping; and

- operations in near coastal waters, unless

working on vessel with ship’s doctor

Issue six-month certificate initially and then annual certificate

R, L – If likelihood of recurrence is moderate* and asymptomatic. Able to meet the physical requirements or their normal and emergency duties:

- no lone working or watchkeeping/ lookout; and

- operating within one hour of port, unless

working on vessel with ship’s doctor

Case-by-case assessment to determine restrictions

Annual review

Not applicable

I44–49

Cardiac arrhythmias and conduction defects (including those with pacemakers and implanted cardioverter defibrillators (ICD))

Likelihood of impairment from recurrence, sudden severe impairment of performance/states of debility, exercise limitation. Pacemaker/ICD activity may be affected by strong electric fields

T – Until fully investigated, treated and adequacy of treatment confirmed

P – If disabling symptoms present or excess likelihood of impairment from recurrence, including ICD implant

L – Surveillance needed at shorter intervals and no impairing symptoms present and very low* excess likelihood of impairment from recurrence, based on specialist report

R – Restrictions on solo duties or for distant waters if low* likelihood of acute impairment from recurrence or foreseeable requirement for access to specialist care

Surveillance and treatment regime to be specified in detail. If pacemaker implanted, duration of certificate to coincide with pacemaker surveillance

Surveillance not needed or needed at intervals of more than two years; no impairing symptoms present; and very low* likelihood of impairment from recurrence, based on specialist report

I61–69

G46

Ischaemic cerebrovascular disease (stroke or transient ischaemic attack) Increased likelihood of recurrence, sudden loss of capability, mobility limitation. Increased likelihood of developing other circulatory disease causing sudden loss of capability

T – Until treated and any residual impairment stabilized and for three months after event

P – If residual symptoms interfere with duties or there is significant excess likelihood of recurrence

R, L – Case-by-case assessment of fitness for duties; exclude from lone watchkeeping. Assessment should include likelihood of future cardiac diseases. General standards of physical fitness should be met

Annual assessment

Not applicable

I73

Arterial-claudication

Likelihood of other circulatory disease causing sudden loss of capability. Limits to exercise capacity

T – Until assessed/examined

P – If incapable of performing duties

R, L – Consider restriction to non- watchkeeping duties in coastal waters, provided symptoms are minor and do not impair essential duties or if they are resolved by surgery or other treatment; general standards of fitness are met or must be met. Assess likelihood of future cardiac diseases (follow criteria in I20–25).

Review at least annually

Not applicable

I83

Varicose veins

Possibility of bleeding if injured, skin changes and ulceration

T – Until treated if impairing symptoms. Post-surgery for up to one month

Not applicable

No impairing symptoms or complications

I80.2–3

Deep vein thrombosis/pulmonary embolus

Likelihood of recurrence and of (serious) pulmonary embolus

Likelihood of bleeding from anticoagulant treatment

T – Until investigated and treated and normally while on short-term anticoagulants

P – Consider if recurrent events or on permanent anticoagulants

R, L – May be considered fit for work with a low liability for injury in national coastal waters, once stabilized on anticoagulants with regular monitoring of level of coagulation

Full recovery with no anticoagulant use

I00–99

Not listed separately

Other heart disease, e.g. cardio- myopathy, pericarditis, heart failure

Likelihood of recurrence, sudden loss of capability, exercise limitation

T – Until fully investigated, treated and adequacy of treatment confirmed

P – If impairing symptoms or likelihood of impairment from recurrence

Case-by-case assessment, based on specialist reports

Case-by-case assessment, very low* likelihood of recurrence

J00–99

Respiratory system

J02–04 J30–39

Nose, throat and sinus conditions

Impairing for individual. May recur. Transmission of infection to food/other crew

T – Until resolved

P – If impairing and recurrent

Case-by-case assessment

When treatment complete, if no factors predisposing to recurrence

J40–44

Chronic bronchitis and/or emphysema

Reduced exercise tolerance and impairing symptoms

T – If exacerbation

P – If repeated severe recurrences or if general fitness standards cannot be met or if impairing shortness of breath

R, L – Case-by-case assessment

More stringency for distant water duties. Consider fitness for emergencies and ability to meet general standards of physical fitness

Annual review

Not applicable

J45–46

Asthma (detailed assessment with information from specialist in all new entrants)

Unpredictable episodes of severe breathlessness

T – Until episode resolved, cause investigated (including any occupational link) and effective treatment regime in place

In person under age 20 with hospital admission (due to the asthma) or oral steroid use in last three years

P – If foreseeable likelihood of rapid life-threatening asthma attack while at sea or history of uncontrolled asthma, i.e. history of multiple hospital admissions

R, L – Near coastal waters only or on ship with doctor if history of moderate** adult asthma, with good control with inhalers and no episodes requiring hospital admission or oral steroid use in last two years

or history of mild or exercise-induced asthma that requires regular treatment

Under age 20: If history of mild or moderate** childhood asthma, but with no hospital admissions or oral steroid treatment in last three years and no requirements for continuing regular treatment

Over age 20: If history of mild or exercise-induced asthma and no requirements for continuing regular treatment

J93

Pneumothorax (spontaneous or traumatic)

Acute impairment from recurrence

T – Normally for 12 months after initial episode or shorter duration as advised by specialist

P – After recurrent episodes unless pleurectomy or pleurodesis performed

R – Duties in harbour areas only once recovered

Normally 12 months after initial episode or shorter duration as advised by specialist

Post surgery – based on advice of treating specialist

K00–99

Digestive system

K01–06

Oral cavity diseases

Acute pain from toothache. Recurrent mouth and gum infections

T – If visual evidence of untreated dental defects or oral disease

P – If excess likelihood of dental emergency remains after treatment completed or seafarer non-compliant with dental recommendations

R – Limited to near coastal waters, if criteria for full fitness not met, and type of operation will allow for access to dental care without safety-critical manning issues for vessel

If teeth and gums (gums alone of edentulous and with well-fitting dentures in good repair) appear to be good. No complex prosthesis; or if dental check in last year, with follow-up completed and no problems since

K25–28

Peptic ulcer

Recurrence with pain, bleeding or perforation

T – Until healing or cure by surgery or by eradication of helicobacter and on normal diet for three months

P – If ulcer persists despite surgery and medication

R – Consider case-by-case assessment for earlier return to near coastal duties

When cured and on normal diet for (at least) three months

K40–41

Hernias – Inguinal and femoral

Likelihood of strangulation

T – Until surgically investigated to confirm no likelihood of strangulation/herniation and, if required, treated

R – Untreated: Consider case-by-case assessment for near coastal waters

When satisfactorily or successfully treated or exceptionally when surgeon reports that there is no likelihood of strangulation

K42–43

Hernias – Umbilical, ventral Instability of abdominal wall on bending and lifting

Case-by-case assessment depending on severity of symptoms or impairment. Consider implications of regular heavy physical effort

Case-by-case assessment depending on severity of symptoms or impairment.

Consider implications of regular heavy physical effort

Case-by-case assessment depending on severity of symptoms or impairment. Consider implications of regular heavy physical effort

K44

Hernias – Diaphragmatic (hiatus)

Reflux of stomach contents and acid causing heartburn, etc.

Case-by-case assessment based on severity of symptoms when lying down and on any sleep disturbance caused by them

Case-by-case assessment based on severity of symptoms when lying down and on any sleep disturbance caused by them

Case-by-case assessment based on severity of symptoms when lying down and on any sleep disturbance caused by them

K50, 51, 57, 58, 90

Non-infectious enteritis, colitis, Crohn’s disease, diverticulitis, etc.

(Physical) impairment and pain

T – Until investigated and treated

P – If severe or recurrent

R – Does not meet the requirements for unrestricted certificate but rapidly developing recurrence unlikely: near coastal duties

Case-by-case specialist assessment

Fully controlled with low likelihood of recurrence.

K60 I84

Anal conditions: Piles (haemorrhoids), fissures, fistulae

Increased likelihood of episode causing pain and limiting activity

T – If piles prolapsed, bleeding repeatedly or causing symptoms; if fissure or fistula painful, infected, bleeding repeatedly or causing faecal incontinence

P – Consider if not treatable or recurrent

Case-by-case assessment of not fully treated cases for near coastal duties

When satisfactorily treated

K70, 72

Cirrhosis of liver

Liver failure. Bleeding from oesophageal varices

T – Until fully investigated

P – If severe or occurrence of ascites or oesophageal varices

R, L – Case-by-case specialist assessment

Not applicable

K80–83

Diseases of biliary vesicle and biliary tract

Biliary colic from gallstones, jaundice, liver failure

T – Biliary colic until definitely treated

P – Advanced liver disease, recurrent or persistent impairing symptoms

R, L – Case-by-case specialist assessment. Does not meet requirements for unlimited certificate. Sudden onset of biliary colic unlikely

Case-by-case specialist assessment. Very low likelihood of recurrence or worsening in next two years

K85–86

Pancreatitis

Likelihood of recurrence

T – Until resolved

P – If recurrent or alcohol related, unless confirmed abstention

Case-by-case assessment based on specialist reports

Case-by-case assessment based on specialist reports, very low* likelihood of recurrence

Y83

Stoma (ileostomy, colostomy) Impairment if control is lost – need for bags, etc. Potential problems during prolonged emergency

T – Until stabilized

P – Poorly controlled

R – Case-by-case assessment

Case-by-case specialist assessment

N00–99

Genito-urinary conditions

N00, N17

Acute nephritis

Renal failure, hypertension

P – Until resolved

Case-by-case assessment if any residual effects

Full recovery with normal kidney function and no residual damage

N03–05, N18–19

Sub-acute or chronic nephritis or nephrosis

Renal failure, hypertension

T – Until investigated

R, L – Case-by-case assessment by specialist, based on renal function and likelihood of complications

Case-by-case assessment by specialist, based on renal function and likelihood of complications

N20–23

Renal or ureteric calculus

Pain from renal colic

T – Until investigated and treated

P – Recurrent stone formation

R – Consider if concern about ability to work in tropics or under high temperature conditions. Case-by-case assessment for near coastal duties

Case-by-case assessment by specialist with normal urine and renal function without recurrence

N33, N40

Prostatic enlargement/ urinary obstruction

Acute retention of urine

T – Until investigated and treated

P – If not remediable

R – Case-by-case assessment for near coastal duties

When successfully treated; low* likelihood of recurrence

N70–98

Gynaecological conditions – Heavy vaginal bleeding, severe menstrual pain, endometriosis, prolapse of genital organs or other

Impairment from pain or bleeding

T – If impairing or investigation needed to determine cause and remedy it

R – Case-by-case assessment if condition is likely to require treatment on voyage or affect working capacity

Fully resolved with low* likelihood of recurrence

R31, 80, 81, 82

Proteinuria, haematuria, glycosuria or other urinary abnormality

Indicator of kidney or other diseases

T – If initial findings clinically significant

P – Serious and non-remediable underlying cause – e.g. impairment of kidney function

L – When repeat surveillance required

R, L – When uncertainty about cause but no immediate problem

Very low likelihood of serious underlying condition

Z90.5

Loss of kidney or one non- functioning kidney

Limits to fluid regulation under extreme conditions if remaining kidney not fully functional

P – Any reduction of function in remaining kidney in new seafarer. Significant dysfunction in remaining kidney of serving seafarer

R – No tropical or other exposure to extreme heat. Serving seafarer with minor dysfunction in remaining kidney

Remaining kidney must be fully functional and not liable to progressive disease, based on renal investigations and specialist report

O00–99

Pregnancy

O00–99¹

Pregnancy

Complications, late limitations on mobility. Potential for harm to mother and child in the event of premature delivery at sea

T – Late stage of pregnancy and early postnatal period

Abnormality of pregnancy requiring high level of surveillance

R, L – Case-by-case assessment if minor impairing effects. May consider working until later in pregnancy on near coastal vessel

Uncomplicated pregnancy with no impairing effects – normally until 24th week

L00–99

Skin

L00–08

Skin infections

Recurrence, transmission to others

T – Until satisfactorily treated

P – Consider for catering staff with recurrent problems

R, L – Based on nature and severity of infection

Cured with low likelihood of recurrence

L10–99

Other skin diseases, e.g. eczema, dermatitis, psoriasis

Recurrence, sometimes occupational cause

T – Until investigated and satisfactorily treated

Case-by-case decision

R – As appropriate if aggravated by heat, or substances at work

Stable, not impairing

M00–99

Musculoskeletal

M10–23

Osteoarthritis, other joint diseases and subsequent joint replacement

Pain and mobility limitation affecting normal or emergency duties. Possibility of infection or dislocation and limited life of replacement joints

T – Full recovery of function and specialist advice required before return to sea after hip or knee replacement

P – For advanced and severe cases

R – Case-by-case assessment based on job requirements and history of condition. Consider emergency duties and especially requirements in the event of the evacuation from ship. Should meet general fitness requirements

Case-by-case assessment. Able to fully meet routine and emergency duty requirements with very low likelihood of worsening such that duties could not be undertaken

M24.4

Luxation or subluxation of shoulder or knee joints

Sudden limitation of mobility, with pain

T – Until satisfactorily treated

R – Case-by-case assessment of occasional or rare occurrence of luxation/subluxation

Treated; very low* likelihood of recurrence

M54.5

Back pain

Pain and mobility limitation affecting normal or emergency duties.

Exacerbation of impairment

T – In acute stage

P – If recurrent or severely impairing

Case-by-case assessment

Case-by-case assessment

Y83.4

Z97.1

Limb prosthesis

Mobility limitation affecting normal or emergency duties

P – If essential duties cannot be performed

R – If routine and emergency duties can be performed but there are limitations on specific non-essential activities

If general fitness requirements are fully met. Arrangements for fitting prosthesis in emergency must be confirmed

General

R47, F80

Speech disorders

Limitations to communication ability

P – Incompatible with reliable performance of routine and emergency duties safely or effectively

R – If assistance with communication is needed to ensure reliable performance of routine and emergency duties safely and effectively

Specify assistance

No impairment to essential speech communication

T78 Z88

Allergies (other than allergic dermatitis and asthma)

Likelihood of recurrence and increasing severity of response. Reduced ability to perform duties

T – Until fully investigated by specialist

P – If life-threatening response reasonably foreseeable

Case-by-case assessment of likelihood and severity of response, management of the condition and access to medical care

R – Where response is impairing rather than life-threatening, and reasonable adjustments can be made to reduce likelihood of recurrence

Where response is likely/rather likely to only be impairing rather than life-threatening, and effects can be fully controlled by long-term non-steroidal self-medication or by lifestyle modifications that are practicable at sea with no safety-critical adverse effects

Z94

Transplants – Kidney, heart, lung, liver (for prosthetics of joints, limbs, lenses, hearing aids, heart valves, etc. see condition-specific sections)

Possibility of rejection. Side effects of medication

T – Until condition stable after surgery and under anti-rejection medication

P – Case-by-case assessment, with specialist advice

R, L – Case-by-case assessment, with consideration of specialist advice

Not applicable

Classify by condition

Chronic-progressive conditions, which are currently within criteria, e.g. Huntington’s chorea (including family history) and keratoconus

T – Until investigated and treated if indicated

P – Consider at pre-sea medical if likely to prevent completion or limit scope of training

Case-by-case assessment, with consideration of specialist advice. Fitness nevertheless possible if harmful progression before next medical is judged unlikely

Case-by-case assessment, with specialist advice. Such conditions are acceptable if harmful progression before next medical is judged unlikely

Classify by condition

Conditions not specifically listed

T – Until investigation and treated if indicated

P – If permanently impairing

Use analogy with related conditions as a guide. Consider likelihood of sudden incapacity, recurrence or progression and limitations on performing normal and emergency duties. If in doubt, specialist advice should be obtained or consider restriction or referral to experienced referee

Use analogy with related conditions as a guide. Consider likelihood of sudden incapacity, of recurrence or progression and limitations on performing normal and emergency duties. If in doubt, specialist advice should be obtained or consider restriction or referral to experienced referee

I. All departments

    Medical service

Contents

Medical Fees Schedule (GOÄ) item no.

Incremental factor

    Taking of medical history

Taking of comprehensive medical history, including questionnaire

1

3.5

    Full body check up

Physical check up including RR, heart rate, height and body weight measurement and calculation of body mass index

8

2.3

    Eyesight test

Assessment of visual acuity by determination of visual acuity according to Snellen or an equivalent test method; assessment of near vision with plates according to Nieden

1200

2.3

    Urine test

Urine test for glucose, protein and blood

3511

1.15

    Communication of results

Informing the examined person about the contents of the certificate and his or her right to a review in accordance with section A-1/9, paragraph 6 of the STCW Code

Included in no. 1

N/A

    Issue of certificate

Entering of the results of the examination into the fitness for service at sea register, issue of the certificate of fitness for service at sea

75

2.3

II. Additional examinations

    (a) Deck department, electro-technical department

        Colour vision test

Assessment of colour vision using colour plates of two recognized systems

Included in no. 8

N/A

    (b) Catering department

        Stool test

Stool test for salmonellae and shigellae

4530

4538

1.15

1.15

    (c) X-ray examination at the request of the Maritime Medical Service

        Chest X-ray

X-ray of the chest, 1 view PA

5135

1.8

    (d) Laboratory tests at the request of the Maritime Medical Service

        Laboratory tests

Laboratory blood tests

In accordance with the Medical Fees Schedule (GOÄ) item nos. of the section on laboratory tests

1.15

Contents

Theory (T)

or Practice (P)*

Advanced training course in accordance with Section 15(1)
(40 teaching hours)

Basic training course in accordance with Section 15(2)
(16 teaching hours)

Assessment of the danger situation

Learning objective: The master/officer recognizes - preventively and in emergency situations - dangers to life and limb, takes precautions and observes them in every phase to minimize risks to him- or herself and to the injured/ill person.

Dangers to oneself/others

T

X

X

Precautions for:

    Infectious diseases

T

X

    Hazardous atmospheres (e.g. CO, CO2)

T

X

X

    Lack of oxygen in enclosed spaces (e.g. tank)

T

X

X

    Chemical and other accidents involving dangerous goods

T

X

X

    Electrical accidents

T

X

X

    Fire, smoke development

T

X

X

    Person in the water

T

X

X

Rescue

Learning objective: The master/officer prepares and carries out the rescue him- or herself in accordance with accepted procedures, keeping the strain on the patient to a minimum and taking into consideration his or her own protection.

    Rescue from immediate danger area

P

X

X

    Rescue from hatches, access shafts

T

X

X

    Water rescue

T

X

X

    Helicopter rescue

T

X

X

Immediate measures in the event of accidents and diseases

Learning objective: The master/officer recognizes emergencies and reliably and immediately initiates measures in accordance with recognized medical practice in the case of injuries and diseases that require immediate treatment.

The following section contains the required basic anatomical and physiological knowledge as well as knowledge of the symptoms of injuries and diseases that is to be transferred.

Verification, restoration and maintenance of vital functions

    Consciousness

        Stages of consciousness

T

X

X

        Verification of consciousness

T

X

X

        Recovery position

P

X

X

    Circulatory arrest

        Cardiopulmonary resuscitation, with and without aids, using the one-person or two-person method

P

X

X

        Use of a semi-automatic defibrillator (AED)

P

X

    Respiratory disorder

        Measures in the event of an obstruction of the airways

            Manual or mechanical (head-down position, Heimlich manoeuvre) removal of a foreign body

P

X

X

            Use of the suction apparatus

P

X

X

        Maintaining the airways

            Demonstration of the use of the aids in the ship's dispensary

P

X

X

        Ventilation

            Practising the use of the aids in the ship's dispensary

P

X

X

            Administration of oxygen

P

X

X

        Positioning in the event of respiratory disorders

            Head tilt and chin lift when providing ventilation

P

X

X

            Semi-sitting position/sitting position facilitating respiration

P

X

X

External/internal bleeding

    Sterile wound dressing, elevation

P

X

X

    Compression bandage

P

X

X

    Arterial pressure points

P

X

X

    Tourniquet application

T

X

X

    Shock treatment

T

X

X

        Shock position

P

X

X

    Cardiovascular monitoring, shock index

T

X

Eye injuries (foreign bodies/chemical burns)

    Eye rinsing

T

X

X

    Removal of foreign bodies (eyelid eversion)

T

X

    Administration of eye salve/drops

T

X

X

    Eye bandage

P

X

X

Burns/scalds/electrical injuries/frostbites

    Degree classification based on depth and size of affected area

T

X

X

    Determination of affected area (rule of thumb is that the palm including the fingers of the patient amount to approx. 1 % of the body surface)

P

X

    Assessment of the severity of the thermal injury

T

X

X

    Treatment

T

X

X

Hypothermia

    Degree classification based on depth and size of affected area

T

X

X

    Particularities within the framework of resuscitation

T

X

X

    Treatment

T

X

X

Chemical burns

    Acid burn and alkali burn

T

X

X

    Treatment

T

X

X

Radio medical advice

Learning objective: The master/officer is familiar with the procedure for obtaining radio medical advice in accordance with generally accepted procedures and recommendations. He or she performs all the clinical examinations required for the consultation and transmits their results.

    Accessibility

T

X

X

    Obtaining the necessary medical findings

T

X

X

    Transmission of the necessary information

T

X

X

    Form

T

X

X

Transfer and transport

Learning objective: The master/officer prepares and carries out the transport operation him- or herself in accordance with accepted procedures, keeping the strain on the patient to a minimum and taking into consideration his or her own protection.

    Transfer to the stretcher

P

X

    Immobilization of vertebral injuries with the help of a vacuum mattress

P

X

    Immobilization of the cervical spine

P

X

    Stretcher transport

P

X

Examination techniques

Learning objective: The master/officer determines signs of disease by interviewing and examining the patient. He or she immediately recognizes and is able to assess the meaning of the findings and of changes in the patient's condition.

    Taking of medical history

T

X

X

    Physical examination

        “Body check”

P

X

X

        Check of peripheral blood circulation, sensitivity and motor coordination

P

X

X

    Feeling the pulse

P

X

X

    Measuring blood pressure

P

X

    Measuring body temperature

T

X

    Cardiac rhythm monitoring with the help of a semi-automatic defibrillator (AED)

P

X

    Urine test

P

X

    Assessment of excretions

T

X

Specific diseases

Learning objective: The master/officer treats the injury or disease appropriately. The treatment is in conformity with generally accepted medical practice as well as with the medical instructions (para. 3 of the second sentence of Section 107(2) of the Maritime Labour Act) published by the Occupational Accident Insurance Fund for Transport and Traffic (Maritime Medical Service) and the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods (MFAG). Differentiation between minor health disorders and serious emergencies. Within the framework of the following section, the required basic anatomical and physiological knowledge as well as knowledge of the symptoms of injuries and diseases is to be transferred.

Head injuries

    Concussion

T

X

X

    Fractures (skull/upper jaw/lower jaw)

T

X

X

    Cerebral haemorrhage

T

X

X

    Positioning in the case of skull/brain injuries

T

X

X

    Seizure

T

X

X

    Monitoring

T

X

X

    Bleeding from head laceration, ear, nose, tongue, tooth socket (loss of tooth)

T

X

X

    Foreign body in ear and nose

T

X

    Treatment

T

X

X

Spinal injuries

    Paraplegic symptoms

T

X

X

    Check of peripheral blood circulation, sensitivity and motor coordination

P

X

X

    Urinary bladder paralysis

T

X

        Insertion of urinary catheter

P

X

    Immobilization in the case of cervical spine injuries

P

X

    Transfer, transport

P

X

    Positioning in the case of spinal injuries

P

X

X

    Monitoring

T

X

    Treatment

T

X

Bone fractures

    Open/closed fractures

T

X

X

    Reliable and unreliable indications of a fracture

T

X

X

    Fracture locations

        Rib and serial rib fracture with paradoxical respiration

T

X

        Shoulder/collarbone fracture

T

X

        Upper arm/forearm fracture

T

X

        Wrist/hand fracture

T

X

        Finger fracture

T

X

        Pelvic fracture

T

X

            Bladder puncture

T

X

        Thigh/lower leg fracture

T

X

        Ankle and foot fracture

T

X

        Toe fracture

T

X

    Complications

        Disorder of the peripheral blood circulation, sensitivity and motor coordination

T

X

        Blood loss (internal/external bleeding)

T

X

        Compartment syndrome

T

X

        Tension/pneumothorax

T

X

Treatment of fractures

    Reduction of fractures

T

X

    Immobilization by splinting

P

X

X

    Immobilization with the help of a vacuum mattress

P

X

    Thoracentesis

T

X

    Transfer, transport

P

X

X

    Positioning, elevation, cooling

P

X

X

    Monitoring

T

X

X

Dislocations

    Location

        Shoulder dislocations

T

X

        Finger dislocations

T

X

    Treatment

        Pain management

T

X

        Reduction of dislocations

T

X

        Immobilization

P

X

X

Muscle injuries, sprains, strains

    Types of injuries

T

X

X

    Treatment

        Immobilization

P

X

        Positioning

P

X

Wound treatment, minor surgical interventions

    Types of wounds

T

X

X

    Working under sterile conditions

P

X

X

    Wound cleansing and disinfection

P

X

X

    Local anaesthesia

P

X

    Different methods of wound closure

P

X

    Leaving in place and fixation of foreign bodies

P

X

X

    Removal of small foreign bodies

T

X

X

    Wound healing complications, treatment

        Wound infection (lymphangitis)

T

X

        Gaping of wound edges

T

X

    Incision and drainage of abscesses

T

X

    Vaccinations

        Vaccines on board

T

X

        Indication

T

X

        Performance of vaccination and documentation

T

X

Cardiovascular diseases

    Acute coronary syndrome and heart attack

    Hypertensive crisis

T

X

X

    Cardiac arrhythmias

T

X

X

    Arterial occlusion

T

X

X

    Thrombosis

T

X

X

    Treatment principles

Neurological emergency

    Stroke

        Detection

T

X

X

        Treatment

T

X

Treatment of acute abdominal diseases

    Gastroenteritis

T

X

    Injury of the abdomen (blunt, perforating)

T

X

    Gastrointestinal bleeding

T

X

    Peritoneal irritation/peritonitis

T

X

    Cause and treatment of colics

T

X

    Intestinal obstruction

T

X

    Treatment principles

T

X

X

    Positioning

P

X

X

Urinary tract

    Urinary tract infection/treatment

T

X

    Urinary retention/treatment

T

X

Psychiatric emergencies

    Psychiatric disorders

T

X

    Suicidality

T

X

    Alcohol and drug abuse

T

X

X

        Detection of alcohol, prescription drug and drug abuse

T

X

X

Infectious diseases

    Tropical, infectious, sexually transmitted diseases

T

X

    Disease transmission

T

X

    Hygiene practice (isolation, disinfection)

T

X

    Prevention (malaria prophylaxis, vaccinations, behaviour in ports with infection risks, protection against sexually transmitted diseases, delousing, rat control, pest control)

T

X

    National and international regulations

T

X

    Cooperation with port health services

T

X

Poisoning, accidents involving dangerous goods

    Medication poisoning, food poisoning, alcohol poisoning, poisoning from chemical substances and warfare agents

T

X

X

    Dangerous goods accidents: Systematics of the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods: “MFAG – Medical First Aid Guide”

T

X

X

    Treatment

T

X

Treatment of dental conditions

    Inspection of the oral cavity

P

X

    Detection and assessment of acute dental conditions

T

X

    Sealing of a dental defect

T

X

    Incision and drainage of a tooth root abscess

T

X

Gynaecology, pregnancy, childbirth

T

X

Death on board

    Determination of death/reliable and unreliable signs of death

T

X

    Will drawn up at sea (Seetestament)

T

X

    Storage and transport of bodies

T

X

    Documentation of deaths

T

X

X

Further treatment measures

Learning objective: The master/officer treats the injury or disease appropriately. The treatment is in conformity with generally accepted medical practice.

    Pain management

        Immobilization

P

X

X

        Cooling

P

X

X

        Medications

T

X

X

    Administration of infusions

P

X

    Practising of various injection techniques required for the administration of medications from the ship's dispensary

P

X

X

    Dressing materials, application of dressings (materials from the ship's dispensary)

P

X

X

    Basic principles of nursing care

T

X

Ship's dispensary

Learning objective: The master/officer is familiar with the systematic structure of the ship's dispensary. Dosing and administration of medicines follow the manufacturer's recommendations and the instructions of the radio medical advice service.

    System of the ship's dispensary

        Structure of the medicine cabinet

T

X

        Packing order and numbering of the medications, aids and medical devices

T

X

X

    Narcotics

T

X

        Storage

T

X

        Keeping of the controlled drugs register

T

X

    Medicines requiring refrigeration

T

X

    Dispensing and documentation of the dispensing of medications

T

X

X

Medical instructions

Learning objective: The master/officer is to be put in a position that allows him or her to prevent health hazards as well as to detect and treat injuries and diseases based on knowledge of the contents, structure and organization of the medical instructions (para. 3 of the second sentence of Section 107(2) of the Maritime Labour Act) published by the Occupational Accident Insurance Fund for Transport and Traffic (Maritime Medical Service).

    System of the medical instructions

T

X

X

Forms

Learning objective: The master/officer is familiar with the forms intended for medical care on board as well as their contents. He or she is able complete them in accordance with the requirements.

    Forms available on board

T

X

X

    Documentation

T

X

X

Legislation

Learning objective: The master/officer is aware of the laws, regulations and provisions on which his or her authorization to treat members of the crew is based.

    STCW Convention

T

X

        Section A VI/4, paragraphs 4 to 6, table A-VI/4-2

T

X

    Maritime Labour Convention (MLC), Regulation 4.1

T

X

    Maritime Medicine Ordinance

T

X

X

Contents

Advanced training course in accordance with Section 15(1)
(40 teaching hours)

Basic training course in accordance with Section 15(2)
(16 teaching hours)

1. Equipment of the rooms

    The classrooms shall be suitable, based on their type, size and equipment, to ensure the transfer of the teaching contents in the form of theoretical and practical lessons for a maximum of 18 participants and group lessons with up to six participants.

X

X

2. Anatomical models

    Skeleton (life size)

X

    Skull model, 3 parts

X

    Lumbar vertebrae, at least three vertebrae

X

    Take-apart torso, at least twelve parts

X

3. Medical simulators

    AED training system in the form of a semi-automatic defibrillator with ECG display

X

    Cardio-pulmonary resuscitation (reanimation) dummy

X

    Catheterization simulator, transurethral catheterization in male patients

X

    Suture practice arm or suture practice leg

X

    Practice arm for intravenous injections and infusion

X

4. Teaching and practice materials

    The teaching and practice materials shall be in conformity with the contents of the ship's dispensary as prescribed by the “Committee for medical equipment in the marine sector”.

Lists
A and B

List
C

     (a) Articles for examination

        Tongue blade

X

        Thermometer (32 - 43 degrees Celsius)

X

        Protective covers for thermometers

X

        Urine test strips to test for glucose, protein, blood

X

        Stethoscope

X

        Sphygmomanometer

X

        Test kit for the diagnosis of heart attacks

X

        Flashlight

X

     (b) Instruments and aids

        Disposable syringes 2 ml, 5 ml, 10 ml

X

        Disposable hypodermic needle

X

        Sharps container

X

        Pledget for skin disinfection

X

        Hand and nail brush

X

        Disposable shaver

X

        All surgical instruments needed for the surgical treatment of wounds, minor surgical interventions as well as the application of dressings

X

        Surgical suture materials

X

        Disposable surgical gloves, packed sterile

X

X

        Disposable aperture drape

X

     (c) Nursing care products

        Disposable plastic catheter

X

        Urine collection bag

X

        Hypodermic needle for bladder puncture

X

        Disposable kidney dish

X

     (d) Disinfectants

        Disinfectants for skin and hands

X

X

     (e) Rescue equipment

        Stretcher

X

        Vacuum mattress

X

     (f) Various items

        O2 oxygen apparatus

X

        Oropharyngeal airway

X

X

        Nasopharyngeal airway

X

        Bag valve mask with oxygen reservoir

X

X

        Mask for bag valve mask

X

X

        Suction device

X

X

        Tourniquet

X

     (g) Dressing materials, splints

        Dressing materials and splints suitable for the conduct of the practical exercises

X

X

     (h) Legislation, forms, instructions

        The newest edition of the medical instructions published by the Occupational Accident Insurance Fund for Transport and Traffic (Maritime Medical Service)

X

X

        “Medical First Aid Guide”, MFAG, newest edition

X

X

        Controlled drugs register

X

        Publication of the state of medical knowledge by the Federal Ministry of Transport and Digital Infrastructure in accordance with Section 108(2) of the Maritime Labour Act

X

X

        Excerpts from the STCW Convention, as amended (Section A VI/4, paragraphs 4 to 6, table A-VI/4-2)

X

        Extract from the Maritime Labour Convention (Regulation 4.1)

X

        Maritime Medicine Ordinance

X

X

        The medical report and documentation forms prescribed by the “Committee for medical equipment in the marine sector” (paras. 2 and 3 of the second sentence of Section 107(2) of the Maritime Labour Act)

X

X