Hong Kong Regulations
MERCHANT SHIPPING (SEAFARERS) (MEDICAL EXAMINATION) REGULATION - SCHEDULE 1
MEDICAL AND VISUAL STANDARDS FOR SERVING SEAFARERS
[sections 6(1), 11(5) & 17]
Introduction
1. Seafaring is a potentially hazardous occupation which calls for a high
standard of health and fitness in those entering or re-entering the industry.
A satisfactory standard of continuing good health is necessary for serving
seafarers throughout their career. These medical and visual standards
therefore give guidance on the health criteria to be met by a serving seafarer
applying for a medical fitness certificate.
2. In setting the standards, allowance has been made for the inevitable
impairment of health that time and chance bring, but firm recommendations have
been made to exclude applicants suffering from medical conditions considered
to be incompatible with continued seafaring. Such medical conditions include
amongst others neoplasms, hypertension and other cardiac conditions where the
uncertainty of prognosis makes the risks in continued seafaring unacceptable.
3. It is clearly impossible to encompass within the standards specific advice
on every relevant medical condition. However, as a general rule an approved
medical practitioner should be satisfied when examining an applicant for a
medical fitness certificate that no disease or defect is present which could
either be aggravated by working at sea or could represent an unacceptable
health risk to the individual seafarer or to other crew members.
4. Apart from the purely medical aspects, the occupational background of
seafaring should be considered especially in a case of doubt. It must be
remembered that a ship is not only a place of work requiring attention
throughout the day and night but also a temporary home in which the crew must
eat, sleep and find recreation. While much can be done to ameliorate living
and working conditions on board ship, certain inherent characteristics remain.
A crew is a closed community living in a ship that is seldom quiet or still.
Individual eating habits and tastes cannot easily be met; facilities for
physical exercise are limited; forced ventilation systems are used; the tedium
of routine can easily become oppressive in the absence of normal diversions
enjoyed by those ashore. An inability to fit in, or unwillingness to take
responsibility, or to accept a reasonable measure of necessary discipline,
could impair the safe and efficient working of the ship.
5 Very few merchant ships carry doctors on board nowadays. Acute illness or
injury is dealt with by designated ships' officers whose training is limited
to first aid or medical aid treatment. It should also be borne in mind that
the size of a crew complement is carefully adjusted. Sickness can throw a
burden on other crew members or even impair the efficient working of a ship.
An approved medical practitioner should therefore be satisfied that no
condition is present in the applicant which is likely to cause trouble during
a voyage and that no treatment is being followed which might cause worrying
side effects. It would be unsafe practice to permit a seafarer to serve at sea
suffering from a medical condition in which serious exacerbation requiring
expert treatment could occur.
6. The absence of a doctor in most merchant ships also means that seafarers
will not be able readily to consult a doctor or to obtain special treatment
until the next port of call. Ship turnaround in ports is often very rapid,
allowing no time for necessary investigation subsequent to consultation with a
doctor. The standard of medical practice varies from port to port also and
necessary medical facilities may not be available at the smaller, more remote
ports. It is doubtful if it is ever wise to permit a seafarer to serve at sea
if the loss of a necessary medicament could precipitate the rapid
deterioration of a medical condition.
7. Special care should be taken when examining an applicant who-
(a) has a doubtful medical history;
(b) is likely to spend long periods in tropical climates;
(c) is likely to join ships by air travel; or
(d) has recently served or is intending to serve on bulk chemical
carriers.
Notes:
(1) In addition to symptoms caused by acute conditions such as catarrh of the
ear and sinuses (baratrauma), air transport sometimes leads to other
disabilities such as breathlessness, dizziness, etc. becoming manifest. Such
cases will require further investigation since the findings may well reflect
on the applicant's suitability for further unrestricted sea service.
(2) An applicant in category (d) above should be subjected to a blood test in
addition to other medical examination procedures.
8. Physical requirements may vary between different types of ships, their
departments and individual jobs in them. However, all seafaring jobs need an
acceptable degree of fitness, in accordance with these standards, which is
uniform for all shipping trades. The imposition of a restriction under
section 6(2) of this Regulation may serve to avoid a particular type of trade
or a prolonged voyage where there is some specified medical contra-indication,
but careful consideration is necessary before any restriction is imposed. The
type of restriction and the length of time for which it will operate should be
made clear. The requirements of an advised treatment regime should never be
set aside.
9. Despite the shortness of the voyage, even coastal work can be arduous and
uncomfortable. A restriction to that type of work should be considered as an
alternative to refusal of a certificate only if the shortness of voyage will
permit adequate treatment of the medical condition causing concern.
Examination Procedures
1. When it is necessary to consult with other doctors the usual professional
ethical considerations will appertain, but it should be clearly understood
that the final decision on fitness in accordance with the required medical and
visual standards rests with the approved medical practitioner, subject to the
provisions of section 9(2) of this Regulation.
2. An applicant for a medical fitness certificate shall be placed in one of
the following categories by reference to the category letter ascribed in these
Standards to any medical condition diagnosed in respect of him- A. Fit for sea
service without restriction. B. Permanently unfit for sea service. C.
Indefinitely unfit for sea service. D. Temporarily unfit for sea service. E.
Fit for sea service subject to restriction. An applicant in respect of whom no
adverse medical condition is diagnosed shall be placed in category A.
3. (1) An applicant placed in category A shall be granted a
medical fitness certificate without restriction, but subject to the maximum
period of validity specified in section 8 of this Regulation.
(2) An applicant placed in category B shall be refused a medical
fitness certificate. Any medical fitness certificate in his possession shall
be cancelled.
(3) An applicant placed in category C shall be refused a medical
fitness certificate and informed that he may apply for a further examination
after a specified number of months. Any medical fitness certificate in his
possession shall be suspended until such further examination.
(4) An applicant placed in category D shall be refused a medical
fitness certificate and informed that he may apply for a further examination
after a specified number of weeks. Any medical fitness certificate in his
possession shall be suspended until such further examination.
(5) An applicant placed in category E shall be granted a medical
fitness certificate with specified restrictions operating for a specified
length of time and subject to the maximum period of validity specified in
section 8 of this Regulation.
(6) An applicant who fails to satisfy an approved medical practitioner only in
respect of colour visual standards shall be granted a certificate completed
only as to Part A.
Medical Standards
1. General
Any infectious or contagious disease-D. Malignant Neoplasms-B.
Note: Consideration can be given to passing cases of rodent ulcers which have
responded satisfactorily to treatment.
2. Ear, Nose & Throat
(a) Ear Acute and Chronic Otitis Externa-D. Should be completely healed
before returning to sea. Care is required in passing fit for tropics.
Acute Otitis Media-D. Chronic Otitis Media-D. May become A or E after
satisfactory treatment or surgery. Special care is required in passing
fit for tropics or where air travel is involved. Loss of hearing-A
degree sufficient to interfere with efficiency-B. -Unilateral complete
loss of hearing-B. Meniere's Disease-B.
Notes:
(1) No audio-metric standard has been set for the purposes of this Regulation.
(2) Impaired hearing acuity should be referred for full investigation by an
ENT surgeon.
(3) The use of a satisfactory hearing aid at work by certain catering
department personnel can be accepted where not hearing an instruction would
not result in a danger to the seafarer or others. The hearing aid should be
sufficiently effective to allow communication at normal conversational tones.
(4) The use of a hearing aid by those working in, or associated with, the deck
or engine room departments, including electricians and radio officers, should
not be accepted.
(b) Nose Nasal obstruction. Septal abnormality or polypus-D. Acute
sinusitis-D. Chronic sinusitis-if disabling and frequently
relapsing-B.
(c) Throat A history of frequent sore throats or unhealthy tonsils with
adenitis-D.
(d) Speech Defects If likely to render seafarer inefficient-B.
3. Respiratory System
The respiratory system should be free from acute or chronic disease causing
disability. Chronic Bronchitis and/or Emphysema-Category depends on severity.
Mild uncomplicated cases with good exercise tolerance may be A, but cases with
recurring illness causing disability should be B. Bronchial Asthma-B.
Pulmonary Tuberculosis-C. Most cases are unsuitable for further seafaring but
if the approved medical practitioner is satisfied that the lesion is firmly
healed, the radiological appearance is acceptable and the applicant has
completed a full course of chemotherapy, further service can be considered.
Cases where either one or both lungs have been seriously affected are never
suitable for further service. All relapsed cases will be B.
4. Cardiovascular System
The heart and blood vessels must be healthy. There should be no history, signs
and/or symptoms of heart failure. There should be no significant abnormality
of rate or rhythm or disorder of conduction. There must be no significant
disease of the haemopoietic organs. A material degree of general
arteriosclerosis-B. A history of coronary thrombosis or evidence of coronary
artery disease-B. (All cases that have required coronary artery bypass surgery
come within this category). A history of intermittent claudication, including
any case where vascular surgery was required-B. Any cerebral vascular
accident-B. Any cardiac valve replacement-B. Hypertension-all cases D for
investigation.
Notes:
(1) There should be no evidence of left ventricular hypertrophy and/or strain
on electrocardiography. The blood urea and chest X-ray should be normal.
(2) The maximum acceptable level is 170 mm systolic, 100 mm diastolic,
untreated. The diastolic pressure is to be measured at the fifth sound. Cases
treated with hypotensive drugs or diuretics are unsuitable for further
seafaring. The approved medical practitioner must establish that the use of
these drugs is essential and alternative acceptable therapy is not possible.
All cases should be kept under regular supervision.
5. Disease of Veins
Varicocele-symptomless-A. With symptoms-D for surgical opinion.
Haemorrhoids-not prolapsed, bleeding or causing symptoms-A. Other cases should
be D until satisfactory treatment has been obtained. Varicose Veins-slight
degree-A. Moderate degree without symptoms or oedema may be A, but with
symptoms D for treatment. Recurrent after operation, with symptoms-B. Chronic
varicose ulceration-B. Thin unhealthy scars of healed ulcers or unhealthy skin
or varicose eczema may be B if breakdown is thought likely. Deep vein
thrombosis or recurrent thrombophlebitis-B.
6. Gastro-Intestinal System
Mouth or gum infection-D. Dental defects-D. Seafarers should be dentally fit.
Gastro-intestinal Disease or Disorders-slight case-D. Severe or recurrent and
those requiring special diet and/or regular supervision-B. Peptic Ulceration-D
for investigation. Recurrent peptic ulceration or unsatisfactory operation
result-B.
Notes:
(1) No seafarer with proved ulceration should return to seafaring until free
from symptoms, and on an ordinary diet without treatment for at least 3 months
following evidence of healing on gastroscopy. Whenever possible evidence of
healing should be supported by endoscopic findings.
(2) Cimetidine maintenance therapy. The duodenal ulceration relapse rate while
on treatment is too high for safe seafaring.
Cirrhosis of Liver-B. Pancreatitis-All cases where alcohol is an aetiological
factor-B. Pancreatitis with associated gall bladder disease-after complete
surgical cure of the gall bladder condition and resolution of the
pancreatitis-A or E on case assessment. Recurrent pancreatitis-B.
7. Skin
Special care is required in passing fit for service in the tropics if there is
a history of skin trouble. Catering staff in particular should have no focus
of skin sepsis. Any condition liable to be aggravated by heat, sea air, oil,
caustics or detergents may have to be B. Fungus Infections-D. Acne-most
cases-A, but severe cases and those with cystic acne-B. Psoriasis-most cases
can be A, but some widespread or ulcerated cases should be D for treatment.
Severe cases resistant to treatment or frequently relapsing-B. Sensitization
Dermatosis-D. Refer for dermatological opinion. Acute Eczema-D. No man should
return to duty until skin is completely healthy. Recurrent Eczema-B.
Furunculosis-D. All other cases-D for investigation. Disposal will depend upon
the nature of the condition, probability of recurrence or necessity for long
term treatment.
8. Sexually Transmissible Diseases
All cases of acute infection are D while under treatment. Cases under
surveillance having finished treatment will usually be fit for normal service
but restricted service may be necessary if facilities for supervision are
inadequate. In all cases evidence of satisfactory tests of cure should be
produced.
9. Genito-Urinary System
Hypospadias-minor degree-A. Enlarged Prostate-D for investigation.
Hydrocele-small and symptomless-A; large and/or recurrent-B; if operation
desired-D. Abnormality of the Primary or Secondary Sexual Characteristics-D
for investigation, upon which final decision will rest. Intra-abdominal or
ectopic testis-D if treatment desired; otherwise B. Kidney and Bladder
Diseases-All cases of proteinuria, glycosuria or other urinary abnormalities
should be referred for investigation. Urinary Obstruction-from any cause-D for
investigation. B if not remediable. Acute Urinary Infection-D. Recurrent cases
should not be accepted unless full investigation has proved satisfactory.
Acute Nephritis-D. Subacute or Chronic Nephritis or Nephrosis-B. Renal or
Ureteric Calculus-D for investigation and any necessary treatment. An isolated
attack of renal colic with passage of small calculus may be A after a period
of observation, provided urine and renal functions remain normal and there is
no clinical and radiological evidence of other calculi. Recurrent stone
formation-B. Removal of Kidney-provided the remaining kidney is healthy with
normal function-E. Such cases are unsuitable for service in the tropics or
other conditions of high temperature. Renal Transplant-B. Incontinence of
Urine-B.
10. Endocrine Disease or Metabolic Disorder
Diabetes Mellitus- All cases requiring insulin-B. All gluiosuria cases should
be considered diabetic unless proved to be otherwise. Maturity Onset Diabetic-
Cases controlled by food restriction only and not requiring insulin or other
drugs may be accepted. An initial period of 6 months to cover sick leave and
later restricted service should be allowed to achieve this result. Thereafter,
accepted cases should be subject to medical review at intervals of 6 months.
All other cases of Endocrine Disease-D for investigation upon which decision
will depend. A degree of obesity, with or without complications, adversely
affecting exercise tolerance/mobility/general health-D for treatment. A set of
height/weight tables should be used making allowance for up to 20% excess
weight but none for age. Refractory or Relapsing Cases-B.
11. Central Nervous System
Any type of Epilepsy-B. A single epileptic fit-provided that the past medical
history is clear and investigation has shown no abnormality; re-entry could be
considered after one year without any treatment. Fainting Attacks-D for
assessment. Recurrent attacks with complete or partial loss of consciousness
should be B. Organic Nervous Disease-usually B. Some minor localised disorders
not causing symptoms or incapacity and unlikely to progress may be A.
Migraine-slight infrequent attacks responding quickly to treatment-A. Frequent
attacks causing incapacity-B. Psychosis-B. Psychoneurosis-D for assessment.
Chronic or recurrent-B.
12. Alcohol Abuse
If affecting health by causing physical disability or behavioural disorder-B.
13. Drug Dependence
Dependence on dangerous drugs-B.
14. Musculo/Skeletal System
It is essential that seafarers should have full use of sound upper and lower
limbs throughout a career at sea. Balance, mobility and co-ordination should
be unimpaired. Hernia-D until repaired. Osteo-arthritis-D for assessment.
Advanced cases where disability is present-B.
15. Female Seafarers
There should be no significant gynaecological disorder or disease likely to
cause trouble during the voyage. Employment at sea shall not be permitted
during the term of pregnancy.
Visual Standards
1. No person should be accepted for sea service if any morbid condition of
either eye, or of the lid of either eye, is present and liable to aggravation
or recurrence.
2. New cases of monocular vision are unacceptable for any category of
seafaring. However, monocular seafarers in the engine and catering departments
with a satisfactory record of service prior to 1986 may be allowed to continue
at sea in those departments.
3. Approved medical practitioners should use Ishihara plates to test for
colour vision.
4. Distant vision and colour vision tests may be taken with or without visual
aids (spectacles or contact lenses). However, an applicant who uses visual aid
must reach the required visual standard for both aided and unaided vision.
5. Distant vision tests comprise a letter or shape test and are to be
conducted on Snellen's principle at a virtual distance of 6 metres from the
eye.
6. Unaided vision should be tested first and each eye must be tested
separately.
7. In all cases where visual aids are required for the efficient performance
of an applicant's duties, it shall be a condition of the validity of a
medical fitness certificate that a spare pair is carried when seafaring. Where
different visual aids are used for distant and near vision, a spare pair of
each must be carried. Spare pairs of visual aids must be produced to the
approved medical practitioner during the examination.
8. The following visual standards should be attained by an applicant intending
to serve at sea in the departments specified-
Department Standard
(a) Deck Officers and Deck Ratings (including General Purpose Ratings) Age
Below 22
years 22 years
and above -Distant vision with or without visual aid Better eye 6/6 6/9*
Other eye 6/9 6/12*
Better eye 6/36 6/60 -Distant vision without visual aid when visual aid
necessary for above Other eye 6/36 6/60 -Near, intermediate and colour vision,
both eyes together, aided or unaided Vision required for ship's navigation
(for example, chart and nautical publication reference, use of bridge
instrumentation and equipment, and identification of navigational aids)
-Visual fields Normal visual fields -Night blindness Vision required to
perform all necessary functions in darkness without compromise -Diplopia
(double vision) No significant condition evident
* If the applicant marginally fails to meet this standard he should be
referred to the Authority. The Authority may permit relaxation of the standard
in particular causes.
(b) Engineer officers, Radio, Electrical and Electronic Officers and
ratings forming part of an engine room watch -Distant vision, aided if
necessary Better eye
Other eye 6/15
6/15 -Distant vision without visual aid when visual aid necessary for above
Better eye
Other eye 6/60
6/60 -Near, intermediate and colour vision, both eyes together, aided or
unaided Vision required to read instruments in close proximity, to operate
equipment, and to identify systems and components as necessary -Visual fields
Sufficient visual fields -Night blindness Vision required to perform all
necessary functions in darkness without compromise -Diplopia (double vision)
No significant condition evident
(c) Catering and Miscellaneous -Distant and near vision, aided if
necessary
(monocular vision will be B Visual acuity sufficient to carry out duties
efficiently; but less than 6/60 in "other) eye" unacceptable -Colour vision
need not be tested (Enacted 1995)
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