Clean Air Act, Health Effects and Rule Overview
Training for Environmental Justice advocates held in Detroit April 25-26, 2014
Presentation and discussion - EPA / MDEQ / Community EJ advocates
Air can be contaminated by a range of very different particles such as dust, pollen, soot, smoke, and liquid droplets. Many of them can harm our health, especially very small particles that can enter deep into the lungs.
What is known about the different health effects of particles?
AIR POLLUTION CONTROL course material by Prof S S JAHAGIRDAR,NKOCET,SOLAPUR for BE (CIVIL ) students of Solapur university. Content will be also useful for SHIVAJI and PUNE university students
AIR POLLUTION CONTROL course material by Prof S S JAHAGIRDAR,NKOCET,SOLAPUR for BE (CIVIL ) students of Solapur university. Content will be also useful for SHIVAJI and PUNE university students
PM is a complex mixture of air borne particles that differ in size, origin and chemical composition, all of which are <10 µm in size.
US EPA described PM pollution as ‘mixture of mixtures’.
PM is among the most harmful of all air pollutants.
MARPOL 73/78 –ANNEX 5
(including amendments)
Regulations for the Prevention of Pollution by Garbage from Ships
Introduction
A plastic bottle dumped into the ocean takes 450 years to degrade, an aluminum can takes 200-500, and tin can 100, according to numbers cited by the International Maritime Organization (IMO), a UN agency that regulates the shiping industry.
Regulation 1
definnitions
For the purposes of this Annex
Garbage means all kinds of victual, domestic and operational waste excluding fresh fish and part thereof, generated during the normal operation of the ship and liable to be disposed of continuously or periodically except those substances which are defined or listed in other Annexes to the present convention
Food wastes are any spoiled or unspoiled victual substances, such as fruits, vegetables, dairy products, poultry, meat product, food scraps, food particles, and all other materials contaminated by such wastes, generated onboard ship, principally in the gallery and dining areas.
Nearest land The term "from the nearest land" means from the baseline from which the territorial sea of the territory in question is established in accordance with international law.
Nearest land The term "from the nearest land" means from the baseline from which the territorial sea of the territory in question is established in accordance with international law.
Regulation 2
application
The provision of this Annex shall apply to all ships.
Regulation 3
disposal of garbage out side special areas
1) Subject to the provisions of regulations 4, 5 and 6 of this Annex:
the disposal into the sea of all plastics, including but not limited to synthetic ropes, synthetic fishing nets, plastic garbage bags and incinerator ashes from plastic products which may contain toxic or heavy metal residues, is prohibited;
the disposal into the sea of the following garbage shall be made as far as practicable from the nearest land but in any case is prohibited if the distance from the nearest land is less than:
(i) 25 nautical miles for dunnage, lining and packing materials which will float;
(ii) 12 nautical miles for food wastes and all other garbage including paper
products, rags, glass, metal, bottles, crockery and similar refuse;
disposal into the sea of garbage specified in subparagraph(b)(ii) of this regulation may be permitted when it has passed through a comminuter or grinder and made as far as practicable from the nearest land but in any case is prohibited if the distance from the nearest land is less than 3 nautical miles. Such comminuted or ground garbage shall be capable of passing through a screen with openings no greater than 25 mm.
2) When the garbage is mixed with other discharges having different disposal or discharge requirements the more stringent requirements shall apply.
Regulation 4
special requirements for disposal of garbage
1) Subject to th
The document summarizes key aspects of MARPOL Annex VI, which regulates air pollution from ships. It entered into force in 2005 after being ratified by enough countries. Key regulations limit emissions of NOx, SOx, VOCs, and prohibit deliberate emissions of ozone depleting substances. Requirements include engine certification, fuel sulfur limits, sampling procedures, and port state control guidelines. Looking ahead, further reductions in emissions are expected due to new technologies.
MARPOL Annex VI aims to reduce air pollution from ships. It regulates emissions of sulfur oxides, nitrogen oxides, particulate matter, and ozone depleting substances. The regulations establish emission control areas with more stringent standards for emissions of sulfur oxides and particulate matter. Ships must use low-sulfur fuel in these areas and meet emission limits for nitrogen oxides that become increasingly strict over time. Compliance is demonstrated through certification and testing of engines and fuels.
Clean Air Act, Health Effects and Rule Overview
Training for Environmental Justice advocates held in Detroit April 25-26, 2014
Presentation and discussion - EPA / MDEQ / Community EJ advocates
Air can be contaminated by a range of very different particles such as dust, pollen, soot, smoke, and liquid droplets. Many of them can harm our health, especially very small particles that can enter deep into the lungs.
What is known about the different health effects of particles?
AIR POLLUTION CONTROL course material by Prof S S JAHAGIRDAR,NKOCET,SOLAPUR for BE (CIVIL ) students of Solapur university. Content will be also useful for SHIVAJI and PUNE university students
AIR POLLUTION CONTROL course material by Prof S S JAHAGIRDAR,NKOCET,SOLAPUR for BE (CIVIL ) students of Solapur university. Content will be also useful for SHIVAJI and PUNE university students
PM is a complex mixture of air borne particles that differ in size, origin and chemical composition, all of which are <10 µm in size.
US EPA described PM pollution as ‘mixture of mixtures’.
PM is among the most harmful of all air pollutants.
MARPOL 73/78 –ANNEX 5
(including amendments)
Regulations for the Prevention of Pollution by Garbage from Ships
Introduction
A plastic bottle dumped into the ocean takes 450 years to degrade, an aluminum can takes 200-500, and tin can 100, according to numbers cited by the International Maritime Organization (IMO), a UN agency that regulates the shiping industry.
Regulation 1
definnitions
For the purposes of this Annex
Garbage means all kinds of victual, domestic and operational waste excluding fresh fish and part thereof, generated during the normal operation of the ship and liable to be disposed of continuously or periodically except those substances which are defined or listed in other Annexes to the present convention
Food wastes are any spoiled or unspoiled victual substances, such as fruits, vegetables, dairy products, poultry, meat product, food scraps, food particles, and all other materials contaminated by such wastes, generated onboard ship, principally in the gallery and dining areas.
Nearest land The term "from the nearest land" means from the baseline from which the territorial sea of the territory in question is established in accordance with international law.
Nearest land The term "from the nearest land" means from the baseline from which the territorial sea of the territory in question is established in accordance with international law.
Regulation 2
application
The provision of this Annex shall apply to all ships.
Regulation 3
disposal of garbage out side special areas
1) Subject to the provisions of regulations 4, 5 and 6 of this Annex:
the disposal into the sea of all plastics, including but not limited to synthetic ropes, synthetic fishing nets, plastic garbage bags and incinerator ashes from plastic products which may contain toxic or heavy metal residues, is prohibited;
the disposal into the sea of the following garbage shall be made as far as practicable from the nearest land but in any case is prohibited if the distance from the nearest land is less than:
(i) 25 nautical miles for dunnage, lining and packing materials which will float;
(ii) 12 nautical miles for food wastes and all other garbage including paper
products, rags, glass, metal, bottles, crockery and similar refuse;
disposal into the sea of garbage specified in subparagraph(b)(ii) of this regulation may be permitted when it has passed through a comminuter or grinder and made as far as practicable from the nearest land but in any case is prohibited if the distance from the nearest land is less than 3 nautical miles. Such comminuted or ground garbage shall be capable of passing through a screen with openings no greater than 25 mm.
2) When the garbage is mixed with other discharges having different disposal or discharge requirements the more stringent requirements shall apply.
Regulation 4
special requirements for disposal of garbage
1) Subject to th
The document summarizes key aspects of MARPOL Annex VI, which regulates air pollution from ships. It entered into force in 2005 after being ratified by enough countries. Key regulations limit emissions of NOx, SOx, VOCs, and prohibit deliberate emissions of ozone depleting substances. Requirements include engine certification, fuel sulfur limits, sampling procedures, and port state control guidelines. Looking ahead, further reductions in emissions are expected due to new technologies.
MARPOL Annex VI aims to reduce air pollution from ships. It regulates emissions of sulfur oxides, nitrogen oxides, particulate matter, and ozone depleting substances. The regulations establish emission control areas with more stringent standards for emissions of sulfur oxides and particulate matter. Ships must use low-sulfur fuel in these areas and meet emission limits for nitrogen oxides that become increasingly strict over time. Compliance is demonstrated through certification and testing of engines and fuels.
This document outlines the process for conducting medical risk assessments for fitness for work. It discusses:
1) The different roles doctors may take on and perspectives they must consider, such as a general practitioner versus an occupational doctor.
2) The steps involved in a risk assessment, including identifying potential medical incidents based on a condition, assessing likelihood, potential job consequences, calculating risk, considering mitigation measures, and evaluating risk.
3) The need to justify decisions in writing by thoroughly explaining the medical condition, likelihood of incidents, job risks, risk evaluation and conclusions.
This document discusses tuberculosis (TB) regulations and control in Norway, including screening guidelines for individuals from high incidence countries. It notes that TB screening is required for those staying in Norway over 3 months from countries with TB incidence over 40 per 100,000 per year. Screening of seafarers primarily aims to exclude contagious pulmonary TB and involves a chest x-ray and clinical history review. Norwegian guidelines provide methods for TB screening, treatment, and infection control.
Moscow is an international hub city with many embassies and consulates. It has three international airports and was the first city in Russia to approve doctors for the NMD certificate in 1997. Since 2014, 187 Norwegian certificates have been issued to deck officers, engine officers, and scientists. There is a lack of Russian legislation for offshore work, so the NMD certificate is often used. Questions remain about accreditation, when and where NMD and offshore certificates can be used, and how to balance requirements with time spent with patients. Security and fake certificates from seafarers, crewing companies, and doctors are also concerns.
This document provides guidance on new regulations from the Department of Occupational Medicine. It aims to support doctors in their decision making and ensure harmonized, evidence-based risk assessments. The guidance covers topics like vision, hearing, physical capacity and common medical conditions. It is an online resource that will be updated regularly based on experience and feedback to aid doctors in evaluating seafarers' medical certificates.
The document discusses the responsibilities and procedures of Approved Doctors in conducting medical examinations of seafarers under new Norwegian regulations. It outlines that while the regulations introduce some changes, the doctors' main obligations remain the same - to follow administrative law, conduct thorough evidence-based medical assessments according to best practices, and justify their decisions. The document provides guidance on collecting relevant medical information, performing risk assessments based on the job and vessel, applying ethical standards, and explaining the rationale for certification decisions in writing.
This document discusses the role and responsibilities of seafarer's doctors under Norwegian law. It outlines that seafarer's doctors are authorized by the Norwegian Maritime Authority to conduct medical examinations and issue certificates to seafarers. However, they are only acting as a seafarer's doctor when performing duties described in the applicable regulations. As the medical examinations involve individual decisions about seafarers, seafarer's doctors must follow the Public Administration Act, ensuring impartiality and providing justified, written decisions that can be appealed. They must give guidance to help seafarers understand and safeguard their rights during the process.
This document discusses the requirements for quality management systems regarding medical examinations for seafarers in Norway. It outlines that both the Norwegian Maritime Authority and doctors conducting medical exams must have a certified quality management system in accordance with international standards. The key requirements for doctors include maintaining competence in maritime medicine, participating in training, having the proper equipment, and implementing a quality system. The document also provides an overview of the components of a quality management system, including establishing processes, monitoring effectiveness, ensuring resource availability, implementing improvements, and having a quality policy.
This document compares the requirements for pre-employment medical examinations (PEME) between the Norwegian Maritime Authority, Department of Health standards, and P&I Clubs. PEMEs are required to verify a seafarer's health and ability to safely perform duties at sea. The examinations assess medical history, physical and mental health, and ability to meet minimum performance standards. Certificates are valid for two years from DOH and P&I Club accredited clinics, but only one year for seafarers under 18. PEMEs ensure seafarers are fit to work without health risks to themselves or others on board ships.
1) Representatives from the UK, Netherlands, Germany, Denmark, and Norway met to discuss cooperation on maritime medical services.
2) They agreed on joint approval criteria for medical examinations and certificates, training for approved doctors, and that certificates would be valid across participating countries.
3) The group also agreed to link their websites to facilitate certificate issuance and finding doctors, publish standards and manuals, and include notes on certificates indicating equivalency across countries.
This document discusses restrictions and limitations that may be placed on seafarers' medical certificates due to health conditions. It outlines four categories of fitness: unfit for any duties, able to perform some but not all duties with restrictions, requiring increased surveillance, and able to perform all duties without restrictions. Restrictions aim to balance rehabilitation and safety by allowing seafarers to work within limitations of their conditions. Assessing fitness requires considering probabilities of impairment occurring and being able to mitigate its effects. Authorities must provide guidance and support to ensure consistent, evidence-based decisions are made regarding seafarers' medical restrictions.
This document outlines the regulations and procedures for medical examinations of employees on Norwegian ships and mobile offshore units. It discusses:
1) The legislation around medical certificates and examinations, including the Public Administration Act.
2) The process for appealing a doctor's decision to deny a medical certificate, including applying for an exemption and preparing the case for the appellate body.
3) The responsibilities of the seafarer's doctor and the appellate body in thoroughly investigating cases and making impartial administrative decisions in accordance with regulations.
Kjell Grøndahl presented on testing seafarers' hearing capacity while using hearing aids. International standards require a pure tone average of 30 dB or less in the better ear and 40 dB or less in the poorer ear, measured at specific frequencies. Speech audiometry tests speech recognition but has calibration issues across languages. Aided hearing can be tested using speech-in-noise tests, which measure the signal-to-noise ratio required to correctly recognize 50% of words in background noise, simulating real working conditions. Acceptable results on such tests should allow seafarers to safely and effectively perform their duties, compared to reference data from young, normal-hearing subjects.
The document discusses the development of a common training module for medical examiners of seafarers. It proposes establishing an international system for training, approving, and ensuring quality of medical examiners. This would help harmonize differing national standards. The initiative involves maritime authorities from several countries collaborating to develop a draft curriculum based on Norway's experience training "petroleum doctors". The goal is a common international approach and medical certificate accepted by all parties involved in seafarer medical examinations.
The document discusses the UK system for approving doctors to conduct seafarer medical examinations and potential international collaboration on mutual recognition. It notes there are 225 approved doctors in the UK and overseas, who conducted over 54,000 examinations in 2013. The UK provides support to doctors through medical standards, training, and oversight. International meetings have discussed aligning medical standards between countries like Norway, Germany, the Netherlands and the UK. While progress has been made in understanding each other's systems, further work is still needed before mutual recognition of approved doctors across countries can be achieved.
The document discusses international cooperation and organizations that are important for maritime medicine. It outlines conventions and regulations related to maritime health, including those addressing medical examinations of seafarers. Specifically, the STCW Convention and MLC 2006 provide guidance on medical exams, while the ILO/IMO Guidelines provide criteria for assessing medical fitness. There is discussion of developing common standards and mutual recognition of medical examiners between countries to harmonize application of medical requirements internationally.
The Philippine System of Medical Examinations for Seafarers has the following key points:
1) The Department of Health regulates medical clinics performing examinations on migrant workers and seafarers to ensure standards and reasonable fees.
2) Administrative Order No. 2013-0006 updated guidelines to strengthen clinic regulations and medical examinations in line with new laws.
3) Monitoring finds some clinics need improvements to fully comply with personnel, facility and equipment requirements.
1. Aviation medicine has been more successful than maritime medicine in establishing an international system of medical standards due to the competitive nature and price-driven pressures of the aviation industry which require a "level playing field" with common safety standards.
2. While aviation has seen tremendous growth, aviation medicine has developed standards to ensure safety such as requirements for pressurized cabins, oxygen, and crash protection which has led to commercial aviation seeing its accident rate reduced by a factor of 50 since the 1960s.
3. However, being a pilot is still a high risk occupation with pilots having a standardized mortality rate of 46 for fatal occupational accidents compared to the general population, though disease risk is low, suggesting aviation medicine could improve
The document discusses the consequences of low quality medical examinations for seafarers. It provides three case histories where seafarers were declared fit for work but later became ill at sea due to inadequate checks at their medical examinations. This led to costs and problems. The document also compares medical examination standards between countries and lists common illnesses and those requiring seafarers to return home. It considers political, economic, social, technological, legislative and environmental factors related to improving medical examinations. The goal is to stop "burying heads" and take action to prioritize seafarer health.
The document summarizes the history and current status of the ILO and IMO guidelines on medical examinations for seafarers. It discusses how the original guidelines from 1997 were revised to provide more specific guidance and reflect changes in international standards. The current guidelines provide practical guidance for competent authorities and medical practitioners on conducting examinations and ensuring quality standards. Implementation of the Maritime Labour Convention is being monitored, including questions about countries' requirements for medical certification of seafarers. Port state control data on deficiencies found regarding medical certificates is presented. Remaining questions are raised about adherence to the ILO/IMO guidelines.
This document discusses why maritime health is an international issue rather than just a national responsibility. While ships used to operate within single countries, globalization has made fleets multinational with crews from different countries. This poses challenges for applying health standards consistently when countries regulate maritime health differently. The document examines historical examples like health issues for seamen in 19th century Callao, Peru to show how health problems have long transcended national boundaries in the shipping industry. It argues that principles now exist for international cooperation on maritime health management, but vested interests of different groups pose barriers to realizing a unified approach.
This document outlines the process for conducting medical risk assessments for fitness for work. It discusses:
1) The different roles doctors may take on and perspectives they must consider, such as a general practitioner versus an occupational doctor.
2) The steps involved in a risk assessment, including identifying potential medical incidents based on a condition, assessing likelihood, potential job consequences, calculating risk, considering mitigation measures, and evaluating risk.
3) The need to justify decisions in writing by thoroughly explaining the medical condition, likelihood of incidents, job risks, risk evaluation and conclusions.
This document discusses tuberculosis (TB) regulations and control in Norway, including screening guidelines for individuals from high incidence countries. It notes that TB screening is required for those staying in Norway over 3 months from countries with TB incidence over 40 per 100,000 per year. Screening of seafarers primarily aims to exclude contagious pulmonary TB and involves a chest x-ray and clinical history review. Norwegian guidelines provide methods for TB screening, treatment, and infection control.
Moscow is an international hub city with many embassies and consulates. It has three international airports and was the first city in Russia to approve doctors for the NMD certificate in 1997. Since 2014, 187 Norwegian certificates have been issued to deck officers, engine officers, and scientists. There is a lack of Russian legislation for offshore work, so the NMD certificate is often used. Questions remain about accreditation, when and where NMD and offshore certificates can be used, and how to balance requirements with time spent with patients. Security and fake certificates from seafarers, crewing companies, and doctors are also concerns.
This document provides guidance on new regulations from the Department of Occupational Medicine. It aims to support doctors in their decision making and ensure harmonized, evidence-based risk assessments. The guidance covers topics like vision, hearing, physical capacity and common medical conditions. It is an online resource that will be updated regularly based on experience and feedback to aid doctors in evaluating seafarers' medical certificates.
The document discusses the responsibilities and procedures of Approved Doctors in conducting medical examinations of seafarers under new Norwegian regulations. It outlines that while the regulations introduce some changes, the doctors' main obligations remain the same - to follow administrative law, conduct thorough evidence-based medical assessments according to best practices, and justify their decisions. The document provides guidance on collecting relevant medical information, performing risk assessments based on the job and vessel, applying ethical standards, and explaining the rationale for certification decisions in writing.
This document discusses the role and responsibilities of seafarer's doctors under Norwegian law. It outlines that seafarer's doctors are authorized by the Norwegian Maritime Authority to conduct medical examinations and issue certificates to seafarers. However, they are only acting as a seafarer's doctor when performing duties described in the applicable regulations. As the medical examinations involve individual decisions about seafarers, seafarer's doctors must follow the Public Administration Act, ensuring impartiality and providing justified, written decisions that can be appealed. They must give guidance to help seafarers understand and safeguard their rights during the process.
This document discusses the requirements for quality management systems regarding medical examinations for seafarers in Norway. It outlines that both the Norwegian Maritime Authority and doctors conducting medical exams must have a certified quality management system in accordance with international standards. The key requirements for doctors include maintaining competence in maritime medicine, participating in training, having the proper equipment, and implementing a quality system. The document also provides an overview of the components of a quality management system, including establishing processes, monitoring effectiveness, ensuring resource availability, implementing improvements, and having a quality policy.
This document compares the requirements for pre-employment medical examinations (PEME) between the Norwegian Maritime Authority, Department of Health standards, and P&I Clubs. PEMEs are required to verify a seafarer's health and ability to safely perform duties at sea. The examinations assess medical history, physical and mental health, and ability to meet minimum performance standards. Certificates are valid for two years from DOH and P&I Club accredited clinics, but only one year for seafarers under 18. PEMEs ensure seafarers are fit to work without health risks to themselves or others on board ships.
1) Representatives from the UK, Netherlands, Germany, Denmark, and Norway met to discuss cooperation on maritime medical services.
2) They agreed on joint approval criteria for medical examinations and certificates, training for approved doctors, and that certificates would be valid across participating countries.
3) The group also agreed to link their websites to facilitate certificate issuance and finding doctors, publish standards and manuals, and include notes on certificates indicating equivalency across countries.
This document discusses restrictions and limitations that may be placed on seafarers' medical certificates due to health conditions. It outlines four categories of fitness: unfit for any duties, able to perform some but not all duties with restrictions, requiring increased surveillance, and able to perform all duties without restrictions. Restrictions aim to balance rehabilitation and safety by allowing seafarers to work within limitations of their conditions. Assessing fitness requires considering probabilities of impairment occurring and being able to mitigate its effects. Authorities must provide guidance and support to ensure consistent, evidence-based decisions are made regarding seafarers' medical restrictions.
This document outlines the regulations and procedures for medical examinations of employees on Norwegian ships and mobile offshore units. It discusses:
1) The legislation around medical certificates and examinations, including the Public Administration Act.
2) The process for appealing a doctor's decision to deny a medical certificate, including applying for an exemption and preparing the case for the appellate body.
3) The responsibilities of the seafarer's doctor and the appellate body in thoroughly investigating cases and making impartial administrative decisions in accordance with regulations.
Kjell Grøndahl presented on testing seafarers' hearing capacity while using hearing aids. International standards require a pure tone average of 30 dB or less in the better ear and 40 dB or less in the poorer ear, measured at specific frequencies. Speech audiometry tests speech recognition but has calibration issues across languages. Aided hearing can be tested using speech-in-noise tests, which measure the signal-to-noise ratio required to correctly recognize 50% of words in background noise, simulating real working conditions. Acceptable results on such tests should allow seafarers to safely and effectively perform their duties, compared to reference data from young, normal-hearing subjects.
The document discusses the development of a common training module for medical examiners of seafarers. It proposes establishing an international system for training, approving, and ensuring quality of medical examiners. This would help harmonize differing national standards. The initiative involves maritime authorities from several countries collaborating to develop a draft curriculum based on Norway's experience training "petroleum doctors". The goal is a common international approach and medical certificate accepted by all parties involved in seafarer medical examinations.
The document discusses the UK system for approving doctors to conduct seafarer medical examinations and potential international collaboration on mutual recognition. It notes there are 225 approved doctors in the UK and overseas, who conducted over 54,000 examinations in 2013. The UK provides support to doctors through medical standards, training, and oversight. International meetings have discussed aligning medical standards between countries like Norway, Germany, the Netherlands and the UK. While progress has been made in understanding each other's systems, further work is still needed before mutual recognition of approved doctors across countries can be achieved.
The document discusses international cooperation and organizations that are important for maritime medicine. It outlines conventions and regulations related to maritime health, including those addressing medical examinations of seafarers. Specifically, the STCW Convention and MLC 2006 provide guidance on medical exams, while the ILO/IMO Guidelines provide criteria for assessing medical fitness. There is discussion of developing common standards and mutual recognition of medical examiners between countries to harmonize application of medical requirements internationally.
The Philippine System of Medical Examinations for Seafarers has the following key points:
1) The Department of Health regulates medical clinics performing examinations on migrant workers and seafarers to ensure standards and reasonable fees.
2) Administrative Order No. 2013-0006 updated guidelines to strengthen clinic regulations and medical examinations in line with new laws.
3) Monitoring finds some clinics need improvements to fully comply with personnel, facility and equipment requirements.
1. Aviation medicine has been more successful than maritime medicine in establishing an international system of medical standards due to the competitive nature and price-driven pressures of the aviation industry which require a "level playing field" with common safety standards.
2. While aviation has seen tremendous growth, aviation medicine has developed standards to ensure safety such as requirements for pressurized cabins, oxygen, and crash protection which has led to commercial aviation seeing its accident rate reduced by a factor of 50 since the 1960s.
3. However, being a pilot is still a high risk occupation with pilots having a standardized mortality rate of 46 for fatal occupational accidents compared to the general population, though disease risk is low, suggesting aviation medicine could improve
The document discusses the consequences of low quality medical examinations for seafarers. It provides three case histories where seafarers were declared fit for work but later became ill at sea due to inadequate checks at their medical examinations. This led to costs and problems. The document also compares medical examination standards between countries and lists common illnesses and those requiring seafarers to return home. It considers political, economic, social, technological, legislative and environmental factors related to improving medical examinations. The goal is to stop "burying heads" and take action to prioritize seafarer health.
The document summarizes the history and current status of the ILO and IMO guidelines on medical examinations for seafarers. It discusses how the original guidelines from 1997 were revised to provide more specific guidance and reflect changes in international standards. The current guidelines provide practical guidance for competent authorities and medical practitioners on conducting examinations and ensuring quality standards. Implementation of the Maritime Labour Convention is being monitored, including questions about countries' requirements for medical certification of seafarers. Port state control data on deficiencies found regarding medical certificates is presented. Remaining questions are raised about adherence to the ILO/IMO guidelines.
This document discusses why maritime health is an international issue rather than just a national responsibility. While ships used to operate within single countries, globalization has made fleets multinational with crews from different countries. This poses challenges for applying health standards consistently when countries regulate maritime health differently. The document examines historical examples like health issues for seamen in 19th century Callao, Peru to show how health problems have long transcended national boundaries in the shipping industry. It argues that principles now exist for international cooperation on maritime health management, but vested interests of different groups pose barriers to realizing a unified approach.
More from Norwegian Centre for Maritime Medicine (20)
1. Medisinsk behandling av våre sjøfolk
- god nok?
Alf Magne Horneland
Leder
Norsk senter for maritim medisin
2. MLC 2006
Regulation 4.1 – Medical care on board ship and ashore
1. … access to prompt and adequate medical care
whilst working on board
2. … no cost to the seafarer
3. … access to medical facilities on shore
4. The requirements for on-board health protection and
medical care set out in the Code include standards for
measures aimed at providing seafarers with health
protection and medical care as comparable as
possible to that which is generally available to
workers ashore.
28.03.2011 A M Horneland 2
3. Skipssikkerhetsloven
• § 27. Legemidler og behandling av syke
• Et skip skal være utstyrt med legemidler og annet som er
nødvendig til behandling av syke og skadede og til forebyggelse av
sykdom om bord.
• Syke og skadede kan i nødvendig utstrekning tas under
behandling.
• Departementet kan gi nærmere forskrift om kravene i første og
annet ledd, herunder om hvem som kan utføre behandlingen.
28.03.2011 A M Horneland 3
4. Lov om helsetjenesten i
kommunene
• § 1-1. (Kommunens ansvar for helsetjeneste)
• Landets kommuner skal sørge for nødvendig
helsetjeneste for alle som bor eller midlertidig oppholder
seg i kommunen.
• Hvilken kommune er Stillehavet?
• Havet er 1100 ganger så stort som Norsk landområde
• Havet er Norges største helseregion
– Helse Austafor Aust og Vestafor Vest (HAV)
2008-03-27 4 A M Horneland
5. Forskrift om skipsmedisin
• Skip med et mannskap på 100 arbeidstakere eller flere
på en utenriksreise som overstiger tre døgn, skal ha en
lege om bord med ansvar for den medisinske behandling
av arbeidstakerne.
• Utlevering av legemidler bare til ombordværende
• Reseptpliktige legemidler bare etter kontakt med lege
28.03.2011 A M Horneland 5
6. ... minst 90 prosent av befolkningen skal nås av legebemannet
luftambulanse i løpet av 45 minutter ...
… medical care as comparable as possible to
that which is generally available to workers ashore...?
... Prompt and adequate care... ?
28.03.2011 A M Horneland 6
7. ”En kjede er ikke sterkere enn det svakeste ledd”
• Skipshospital
• Medisinkisten
Skip • Kommunikasjon
• Bemanning
• Helseundersøkelsen
Mannskap • Utdanningen
• Ferdigheter/trening
• Erfaring
• Tilgjengelighet
• Utstyr
Radio • Kunnskap og erfaring
Medico • System
• Forskning – epidemiologi
• Avstander
• Risiko
Fartsområde • Medisinsk evakuering mulig
• Deviasjoner og havner
28.03.2011 • JRCC
A M Horneland 7
8. Skipshospital – Ship Medical Facilities
• Det siste som planlegges
• Størrelsen varierer – men pasienter er like store
• Hensiktsmessig planlegging
• ”Ship Medical Facilities”
– Norsk senter for maritim medisin 2006
28.03.2011 A M Horneland 8
9. Medisinkisten
• Skipsmedisinforskriften
• EU-direktiv 92/29
• ILO C 164
– The Health Protection and Medical Care Convention 1987
• ILO R 105
– Ship’s Medicine Chest Recommendation – 1958
• International Medical Guide for Ships (IMGS) 3. utg.
• WHO List of Essentila Drugs
• IMHA Interim List to IMGS 3. utg.
• WHO Addendum to IMGS 3. utg.
28.03.2011 A M Horneland 9
10. Kommunikasjon
• Krav til optimal bruk av teknologi
– ILO C 164 Article 7.3
• Det betyr at kravet endres i takt med utviklingen
• MORSE BREDBÅND ?
• Maritim telemedisin
• Lagre og sende
• Sanntids overvåkning
• Interaktive tjenester
• Nettverk om bord?
• Kommunikasjon fra skipshospital sykelugar?
• Integrert bruk av teknologi?
28.03.2011 A M Horneland 10
11. Bemanning
• Lege når > 100 passasjerer
• Lean manning – manglende redundans
28.03.2011 A M Horneland 11
12. Helsekrav
• Internasjonalt
– STCW konv – MLC 2006
– 1997: ILO/IMO/WHO Guidelines
– 2011: Revisjon: ILO/IMO Guidelines.
• Norske helsekrav fra 2001
– Revisjon nødvendig
– Revisjon bør ta hensyn til de internasjonale kravene
• En enestående mulighet nå for å få til internasjonal
konsensus og kan gå bort fra nasjonale særkrav.
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13. Hvor mye er helseerklæringen verdt?
• Utdanning og kvalitetssikring av sjømannsleger
• Veiledning
• Tilsyn og kontroll
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14. Utdanning, trening og ferdigheter
• STCW-kursene,
– Elementær førstehjelp
• IMO 1.13 modellkurs – STCW Code A-VI/1-3 (IMO 60)
• 15 timer
– Medisinsk førstehjelp
• IMO 1.14 modellkurs – STCW Code A-VI/4-1 (IMO 80)
• 30 timer
– Medisinsk behandling
• IMO 1.15 modellkurs – STCW Code A-VI/4-2 (IMO40)
• 40 timer (45,5 – 6)
• Skal oppdateres minst hvert 5. år
– EU Direktiv 92/29 - Skipsmedisinforskriften
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15. Kapteinens/styrmannens erfaring
• Mannskap på 20
– I sin beste alder
– Selektert etter helsekrav annethvert år
– Medfører at det er sjelden noe skjer.
• Erfaringen for med.beh.-ansvarlig er derfor minimal.
• Resultatet er at man glemmer.
– Dette er ikke hovedfaget for navigatører
– Dette er ikke hoved-interessefeltet for navigatører
– Man holder det derfor ikke ved like uten
• REPETISJON
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16. REPETISJON
• Liten eller ingen erfaring om bord
• Dette handler om MEDISINSK behandling – ikke
førstehjelp.
• Repetisjon av IMO 60 eller IMO 80 er IKKE
REPETISJON AV Medisinsk behandling (IMO 40)
• Man skal repetere hvordan man gjør
– Medisinsk undersøkelse
– Medisinsk behandling
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17. Radio Medico - tilgjengelighet
• Hva er god nok tilgjengelighet?
• Varierer en del
– Direkte pr telefon
– Via sentralbord
– Radio
– E-post
• Behov for døgnkontinuerlig bemannet sentral?
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18. Radio Medico
• Utstyr • Relevant erfaring:
– Optimal bruk – hva er – Wilderness medicine
det? – Allmennmedisin
– E-post – Generell
– Bilder indremedisin/irurgi?
– Video – Andre spesialiteter i
– Real-time overvåkning 2.linje.
– Videokonferanse
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19. Radio Medico - epidemiologi
• Forekomst
– Hyperakutte tilfeller < 1%
– Deviasjoner <2 %
– Akutte tilfeller < 5%
– Allminnelige tilstander >95%
• AKUTTMEDISIN ER FØRST MEN IKKE STØRST
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20. En blindtarm er en blindtarm er en blindtarm er en blindtarm...
Fowlers leie
Blindtarmbetennelse Blindtarmbetennelse ombord
På land
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21. Fartsområde og avstander
• Utenfor helikopterrekkevidde eller innenfor
• Hvor langt utenfor
– 3 uker over Stillehavet
– 2 uker over Atlanterhavet
• Medisinsk evakuering kanskje umulig MÅ behandles
ombord
• Visse områder spesielle risiki
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22. Medevac
• Grensene tøyes når liv står på spill.
Andre kommer i fare
Medevac kan i seg selv være risikabel for pasienten
• Idealtilstand (les: UTOPI) at tilstrekkelig behandling kan
fås ombord
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23. Havner
• Ikke alle havner kan brukes for medevac
– Krig og ufred
– Destabilisert område
– Manglende hospitalsressurser og medisiner
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24. Medisinsk behandling av våre
sjøfolk - god nok?
• SVAR 1:
– NEI
• SVAR 2:
– Den kan aldri nå endepunktet = Samme kvalitet som på land
• SVAR 3:
– Det betyr en kontinuerlig forbedringsprosess langs hele kjeden.
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