1. 1867 medical examination guidelines PRO file MT9/40/2328/1868

2. Merchant Shipping Act 1867 Provision for medical examiners in ports – concerns about fitness esp. alcohol and VD. Examinations voluntary at request of ship master. Later debates about compulsion. Act also covered medical stores, lime juice and first requirement for Ship Captains Medical Guide. Proposals for regulation of food, water and accommodation not included – laissez-faire.

3. Board of Trade response We have appointed a large array of Medical Inspectors of Seamen and they are constantly bothering us for instructions Dr Harry Leach of Dreadnought Seamans Hospital asked to propose medical standards. (He also wrote first Ship Captains Medical Guide)

4. Dr Leachs Letter proposing Medical fitness criteria

5. Part of Proposals - BoT – very slight and wholly medical. Should mention the Law.

6. Instructions as published

7. Remuneration!

8. List of doctors

9. First ENG1

10. MCA revised medical fitness standards Tim Carter

11. Basis Merchant Shipping (Medical Certification) Regulations 2009 To comply with ILO Maritime Labour Convention Includes ML5 certificates Duty on seafarer to report medical condition and be assessed by AD Keeps validity periods (<18 yrs one year, 2 yrs from issue)

12. What is happening and when? Consultation on revised standards complete Final legal checks then to printers Aim to distribute to ADs before 1 Jan 2010 for use from then on – full year statistics You will get: - replacement for MSN 1765 - completely revised manual - new manual will include 17 sections of approved doctors guidance on specific conditions No change to ENG 1, 2, 3 forms. We hope to provide searchable electronic version of standards, manual and guidance later in the year.

13. Standards Same one less column than before – separation of absolute and discretionary standards removed Some new conditions added More structured decision-taking aided by AD guidance which is cross referenced e.g. HIV+, insulin use, seizure, cardiac event Some increase in flexibility e.g. Hernias, joint replacements Some new conditions – sleep disorders, heart murmurs

14. AD Manual Re-ordered - Purpose of medicals - Governance - Reference section - FAQs - The medical examination - Standards and guidance - Appendices Few major changes

15. AD Guidance – common questions or sensitive topics 1.Pulmonary TB 2.HIV and hepatitis 3.Cancers etc 4.Diabetes 5.Obesity 6.Mental disorders 7.Loss of consciousness 8.Blood pressure 9.Cardiac events 10. Asthma 11. Dental inspection 12. Urine testing 13. Hearing 14. Vision 15. Medication 16. Allergies 17. Physical capabilities

16. AD Guidance - format Varies a bit e.g. for vision, medication and physical capability testing. Others: – Impairment and risk – why have a standard? -Rationale and justification – evidence for it -Clinical assessment and decision taking – decision trees -Other – advice, subdivision of condition etc.

17. AD Guidance - HIV When fit and unfit, role of tests and effects of medication – intended and side effects Presentation follows

18. AD Guidance - Asthma Categorisation of risk of sudden severe episode based on severity in past Separate consideration for late teens and for adults Presentation follows

19. AD Guidance - diabetes, loss of consciousness/seizure, cardiac event Probability of recurrence and of sudden incapacity given more prominence Better definition of time periods, restrictions and of situations, if any, when an unlimited certificate may be given More liberal than before More emphasis on what adaptations need to be made to keep person at work

20. TYPE 1 AND 2 4. Treatment includes insulin. Has the insulin regime been stable with good blood glucose control as judged by blood glucose and HbA1c levels results for the last three months? Is there full awareness of impending hypos, with no reported or observed significant hypoglycaemic episodes in the last year? Yes – Restricted category 2 fit for near coastal duties with no lone watchkeeping. Conditional on informing master/responsible officer of insulin use and side effects, carrying a remedy, maintenance of present treatment regime, regular recording of blood glucose levels and absence of hypos. Compliant with advice on vascular risk control, annual specialist assessment. Only fit for work in distant waters, but without lone watchkeeping duties, if on vessel with ships doctor. An individual risk assessment by a medical adviser familiar with the vessel and with the routine and emergency duties to be performed is recommended prior to embarkation. No – control and documentation imperfect but no hypos. Restricted time limited category 2: duration until next assessment only, may be acceptable for non watchkeeping duties without lone working or work at heights on vessels that return to port daily for off duty periods, e.g. short crossing ferries and harbour craft. + Advise on vascular risk control. Otherwise permanently unfit category 4.

21. AD guidance - hearing Use of web based RNID hearing test recommended rather than whisper test. - Needs PC with speakers, can be done is consulting room in <5 minutes. - Well validated. Uses three number sequences progressively obscured with white noise. These are keyed in and hearing is categorised as normal, possibly impaired, impaired. Not needed at every medical but for new starts, periodically and if there is suspicion of hearing difficulty. More clarity on hearing aid use.

22. What will changes mean? If seafarer has no health problems, no change to procedures. If they have a health problem it is important to consider it in individual terms (DDA etc) and to follow the aids to decision taking provided. If you follow them, it is a problem for MCA if the decision is challenged. If you dont then it is primarily your problem. MCA needs to know of any problems with applying the new standards ASAP. So if you dont know what to do, ask. If you have tried and it doesnt work let us know. We hope for more consistent decisions that are better based and fewer referrals to referees.