As with any new employer, part of joining a new team can involve completing a medical examination – this is often par for the course in many places.
But it’s long been known that the medical received before joining a ship, is not in-depth enough to truly cover the needs of all staff.
One part of the shipping company’s role is to ensure that all crew are in as safe an environment as possible whilst in their employ.
It’s not until you consider the risks all around the seafaring crew and within the maritime professions that you really start to get a grasp on what an undertaking this is.
One particular area where the medical exams are not meeting the needs of the crew is around heart conditions. The medical exams don’t currently go into enough detail to uncover any underlying heart conditions so would be missing a crucial piece on how much risk that member is under once aboard.
Simply by stepping onto a ship, you are already in a much more dangerous setting – after all, it goes with the territory doesn’t it?
That perspective is often so widely accepted, that it would be easy to be a little blase about the fact you’re merely following procedural protocol while checking over the health of a new member. If the current measures are also falling short where potential heart issues are concerned, it makes it almost impossible to predict with any accuracy whether an underlying heart problem could cause any future incidents or developments.
So how can shipowners ensure that measures to keep their crew safe are sufficient when the risk of physical injury or loss of health is significantly heightened by the setting?
It’s widely accepted that ship crew are naturally exposed to far more risks than their land-loving peers. Besides the dangers of the ship itself, there are also additional factors such as:
- Sudden climate change exposure
- Being exposed to epidemic diseases, both on the ship and in port environments
- Being exposed to devices with sudden electromagnetic, vibration or sound radiation
- Heightened stress, physical and psychological strain through the nature of the work
- Being in countries with low-quality healthcare
- Logistics of being at sea causing delays in medical assistance.
Other implications to be borne in mind by ships are those involved in ensuring that the staff can get the vital help that they need should health issues crop up while at sea.
According to international regulation set out in the Maritime Labour Convention (MLC 2006), it is expected that:
“seafarers must receive equal quality of care as the population onshore”
When we look at the challenges of the environment, in the case of injury or illness this can pose many a logistical problem.
- Transporting the patient to the hospital from the ship
- Admission to hospital in a multitude of countries
- Accessing medicines and ensuring they are administered correctly
- Transporting the patient to their home country
- Provision of salary and sickness benefits during their illness and recovery.
From the shipowners perspective, they will also need to factor in additional costs such as production loss while the patient is recovering, the cost of replacing the worker’s output, the potential increase to their insurance premium as well as any time spent on managing the repatriation of the patient.
Add all of that up and what it equals is expensive.
The shipping industry is also on a tight turnaround. Time is most definitely money in this business, with any slippage potentially costing a fortune.
So what’s the point here?
If you’re in the shipping world – none of that is news to you. So with that in mind, it’s easy to see why any crew member with potential illness, particularly a heart-based one, may be a little loose with their version of the truth when filling in their medical forms.
Disclosing that you may be a heightened risk to a shipowner could easily feel like you’re risking the job itself, so many crew members keep vital medical information to themselves.
One such incident happened in March 2018, when the master of the Sage Amazon bulk carrier suffered a cardiac event while standing on the access ladder above the cargo hold.
Their ship was just about to receive a cargo of cement so the crew been down into the hold to sweep and dry the top of the tank. The master and chief officer went to verify that the work had been done with the chief officer using the port ladder and the master using the starboard ladder.
Literally minutes later, a muffled sound was heard, and the master was seen lying unconscious on the main deck. Help was called for immediately via a portable radio by the Chief Officer and the ICE advisor on-board called the harbourmaster for guidance and requested a boat to bring the master ashore.
A call to 911 was made and the master’s vital signs were shared with the 911 operator – it was confirmed at this point that the vessel was not carrying an automated external defibrillator. Under guidance, the crew administered medical oxygen and shared the details of the head injury, before handing over to the Coast Guard, who then took the call to dispatch the resources needed to carry out the medical evacuation.
At this point, the master was still breathing, but his forehead was reporting to be cold –
CPR began but it was reported that the master no longer had a pulse and that the colour of his skin had changed.
Over three hours later, the fast rescue craft had managed to reach the master and their AED went through eight diagnosis cycles but did not initiate defibrillation as the vital signs were not being found.
CPR was resumed alongside remote medical counselling, but shortly afterwards the physician recommended the CPR stop due to the lack of response to CPR, and no presence of vital signs, pronouncing the shipmaster dead.
The post mortem was conducted and showed that the master had a deep laceration on his scalp. His cause of death was initially thought to be the severe cranial trauma, causing the haemorrhage and resulting in the cardiopulmonary arrest. Upon further investigation during the autopsy, it was revealed that the master had, in fact, died of acute myocardial infarction, a heart attack.
And that although the head injuries were serious, his skull and brain were intact with no presence of cerebral haemorrhage. It transpired that the master had an enlarged heart and that this was not the first incident of the myocardial infarction.
The toxicological analysis showed that the master was taking metformin, a drug used to treat type two diabetes. The master had heart and arterial conditions and had been taking 12 different types of medication to treat diabetes, high blood pressure, renal dysfunction, and heart arrhythmia.
But it was unknown as to whether a physician had prescribed these and family and crew members were totally unaware that any of his medication was being taken.
Despite all of this, the master had undergone a medical examination, a year before, when the medical practitioner, conducting the exam certified him to be fit for duty at sea.
On further exploration, it was revealed that the master had answered ‘no’ to the following questions…
- Have you ever been hospitalised?
- Are you aware that you have any medical problems, diseases or illnesses?
- Are you taking any non-prescription or prescription medications?
- Do you have high blood pressure?
- Do you have heart or vascular disease?
The master had declared with his signature, that he had fully disclosed all of his medical history and that all of his information was true to the best of his knowledge.
The form did not allow for the master’s medical records to be released for review by a medical practitioner. in this, in this instance, the master had stretched the truth, somewhat.
In this instance, the medical practitioner conducting his initial medical exam had been extremely thorough, and the issue was being held back.
This most definitely isn’t an isolated case.
One unfortunate piece of this though is that there wasn’t an AED on-board. You can never be certain if an AED would have saved the masters life, but statistics don’t lie and AEDs save hundreds of lives every day through being administered in those crucial first few minutes of cardiac arrest.
There is a 70% chance of survival if defibrillation is administered within 3 minutes of cardiac arrest
Most cardiac arrests are sudden – they strike without warning. Whether your crew members have disclosed a cardiac illness or not, the fact remains that AEDs save lives within minutes.
The only thing proven to improve the chance of survival after cardiac arrest is with an electric shock to the heart with an AED to restore a normal heart rhythm. The survival rate drops by 10% with every passing minute.
In the case of this master, even with the fast response crew attending, the medical team with their AED took over 3 hours to reach him to deliver that vital electric shock, which seriously reduced his chances of survival.
That wasn’t the fault of the medical team. At sea, it’s virtually impossible for any emergency response unit to reach your vessel in that time, so it’s up to you to have the right equipment on-board to save a life when necessary.
Lifeforce AED is the only marine approved device for this job. Tested to IP55 rating and rugged military standards, the simple to use device can be operated by anyone in an emergency. Spoken instructions guide the user to aid the patient at each step, including a metronome for CPR cycles.
The device will automatically analyse the patient and determine if a shock is required (i.e. if the problem is sudden cardiac arrest). If this is the case, the rescuer need only press one button to deliver a shock. If no shock is required, it is impossible to deliver one – so the device is incredibly safe to use.