Health risk classification patterns among Filipino seafarers. Analysis from a pre-employment clinic in the Philippines: a 5-year review.

BACKGROUND: Seafaring is a demanding profession that exposes individuals to unique health risks and challenges. This study investigates risk classification patterns among seafarers who underwent physical and medical examination at the Nordic Medical Clinic, a pre-employment clinic in the Philippines. MATERIALS AND METHODS: The analysis involved data obtained from medical records, including demographic information, diagnoses, medical risk classification, corresponding management, and occupational details. medical risk classification, based on guidelines from the Philippine Department of Labour and Employment, categorised fit to work seafarers into risk class A, B, or C. Descriptive statistics and statistical tests, with a significance level set at p < 0.05, were utilised for data analysis using R Studio (version 4.2.3). RESULTS: The study population consisted of 11,831 seafarers seen at the Nordic Medical Clinic between 2018 and 2022. The results revealed a significant proportion of seafarers falling into higher risk classifications, with risk class C being the most prevalent at 48.16%. Pre-employment medical examinations (PEME) to fit to work duration demonstrated a significant association with risk classification, revealing that lower-risk classes had shorter fit-to-work times compared to higher-risk classes. Moreover, risk classification exhibited uneven distribution across specific demographic and occupational characteristics, with older seafarers, males, married individuals, and those in higher-ranking positions having a higher proportion of risk class C. CONCLUSIONS: Our findings highlight the need for comprehensive and customised pre-boarding medical screening standards for seafarers based on factors such as their specific role, vessel type, voyage, contract length, and work location. Moreover, health implementation of health promotion and preventive strategies that are based on the specific occupational and demographic needs of the seafarers are needed.

Management of COVID-19 on board the mixed cargo ship Aranui 5.

BACKGROUND: During cruises, the management of coronavirus disease 2019 (COVID-19) infections poses serious organizational problems such as those encountered in 2020 by the Zaandam, the aircraft carrier Charles de Gaulle or the Diamond Princess. In French Polynesia, the mixed cargo ship Aranui 5 transports both tourists and freight to the Marquesas Islands. The purpose of this article is to show how COVID-19 infections were diagnosed and contained before and after passengers boarded a cruise. MATERIALS AND METHODS: On October 15, 2020, 161 passengers including 80 crew members embarked for a 13-day voyage from Papeete to the Marquesas Islands. Prior to boarding, all passengers underwent a reverse transcriptase-polymerase chain reaction (RT-PCR) test; the tests results were all negative. On Day 0, 3, 5, 8 and 11, Biosynex® rapid antigen diagnostic tests were carried out on all or some of the crew members and tourists who may have had contact with new positive cases. Each day, forehead or temporal temperatures were measured using an infrared thermometer and questions were asked concerning the subjects' health status. When a subject was positive, the person and their contacts were isolated in individual cabins. The infected person then left the vessel to be received in a communal reception centre on the nearest island. RESULTS: A total of 9 positive cases were observed, including two before departure (a tourist and a crew member). During the trip, 7 crew members tested positive. The patients and their contacts were isolated and then disembarked at the earliest opportunity. At the time of sampling, the subjects were asymptomatic. The patients and their contacts all became symptomatic within 24 to 48 hours after sampling. CONCLUSIONS: In total, the voyage could be completed without any transmission on board among the tourists and with a minimum transmission among the crew members, thus maintaining the tourist and economic activity of the islands during the times of COVID-19 pandemic.

Procedural aspects of COVID-19 vaccinations for seafarers on ocean-going vessels.

The increasing availability of safe and authorised coronavirus disease 2019 (COVID-19) vaccines for the first time provides the opportunity to vaccinate seafarers on board their ships while in port. Speedy vaccination of seafarers secures their health and serves to avoid the international propagation of COVID-19 virus variants via maritime traffic. As a port medical clinic, we will share our practical vaccination experience on board of merchant vessels in German/European ports with our esteemed coastal colleagues to stimulate their participation in this endeavour. You will have to adapt the procedure to your national particularities, otherwise please freely share the information with interested parties. Detailed guidance on COVID-19 vaccination in shipping and accompanying legal issues was published by the International Chamber of Shipping (www.ics-shipping.org).

Mental health of Filipino seafarers and its implications for seafarers' education.

This narrative review examines current academic literature on the mental health of Filipino seafarers working internationally, including the mental health effects of coronavirus disease 2019 (COVID-19). Framed within a rights-based approach, it aims to identify and analyse emerging themes on Filipino seafarers' mental health literature to understand what these studies potentially mean for the improvement of seafarers' education on mental health. Based on a broad selection criteria, 28 eligible papers demonstrate collectively three key findings: firstly, there is paucity in published research on seafarers' mental health; secondly, the majority of published studies are associated with a recent piracy crisis, where a significant number of mariners were attacked, taken as hostages, or killed; thirdly, three key areas emerged under which research on Filipino seafarers' mental health can be organized: the medical repatriation of seafarers, system of care for the mental health of seafarers including the diagnostic standards used, and seafarers' experiences and conceptions of mental health including the mental health effects of COVID-19. Though the bulk of the current understanding of the mental health problems is associated with piracy, several risk factors for which the quality of quantitative and qualitative evidence are patchy. The few sources of primary data to date lack focus on mental health needs which makes it difficult to grasp the extent of the problem. Developing policies and programmes for the promotion of mental health through mental health education among seafarers is important for a couple of reasons. Seafaring remains a dangerous and socially isolating occupation where work-related accidents are likely and will be potentially traumatic to mariners. Research on occupational stressors is increasingly providing evidence of their contributions to poor mental health outcomes among seafarers. Thus, mental health education of seafarers in the context of their work is important for proactive training and development.

Outbreak of COVID-19 on an industrial ship.

BACKGROUND: People on ships are at high risk for outbreaks of infectious diseases including coronavirus disease 2019 (COVID-19). A rapid and well-coordinated response is important to curb transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied an outbreak on an industrial ship to improve outbreak control for ships and coordination between participating harbour partners. MATERIALS AND METHODS: Public Health Service (PHS) Rotterdam-Rijnmond performed an epidemiological investigation during the outbreak of COVID-19 among 77 seafarers on a ship in their port. The captain was interviewed about ship details and his experiences during the outbreak. The seafarers were asked to fill in questionnaires about symptoms suspicious of COVID-19 and date of symptom onset. Information about stakeholders involved in outbreak control was registered. RESULTS: The captain first contacted PHS about probable cases on March 31st 2020 via a physician ashore. One crewmember was hospitalised on April 8th and another died unexpectedly aboard on April 10th. Questionnaires distributed mid-April to the 75 remaining seafarers showed that 38 of 60 responders (63%) had had suspicious symptoms between February 15th and April 13th. None of them were tested but a total of 8 other crewmembers tested positive for COVID-19 after leaving the ship, including the hospitalised crewmember and the one who died aboard. On May 5th, the last case left isolation and the quarantine ended. Many different stakeholders were involved in the outbreak response and responsibilities were not always fully clear beforehand, causing coordination issues. CONCLUSIONS: Testing crew with COVID-19 symptoms underpins control measures and clarifies communication between stakeholders. Building a network beforehand to develop outbreak guidelines tailored to ships and local circumstances is essential to control future outbreaks on ships.

Estimating the risk of outbreaks of COVID-19 associated with shore leave by merchant ship crews: simulation studies for New Zealand.

AIM: We aimed to estimate the risk of COVID-19 outbreaks in a COVID-19-free destination country (New Zealand) associated with shore leave by merchant ship crews who were infected prior to their departure or on their ship. METHODS: We used a stochastic version of the SEIR model CovidSIM v1.1 designed specifically for COVID-19. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics and plausible control measures. RESULTS: When no control interventions were in place, we estimated that an outbreak of COVID-19 in New Zealand would occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1,000 population per week, crews of 20 with a voyage length of 10 days and 1 day of shore leave per crew member both in New Zealand and abroad, and 108 port visits by international merchant ships per week). For this example, the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combination of PCR testing on arrival, self-reporting of symptoms with contact tracing and mask use during shore leave increased this median time to 1.0 year (14 days to 5.4 years, or a 49% probability within a year). Scenario analyses found that onboard infection chains could persist for well over 4 weeks, even with crews of only 5 members. CONCLUSION: This modelling work suggests that the introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. But the risk can be substantially mitigated by control measures such as PCR testing and mask use.

Coronavirus variant COVID-19 pandemic: a report to seafarers.

We report the current situation regarding the COVID-19 pandemic with particular regard to seafarers and with the indications drawn up by the Centro Internazionale Radio Medico (C.I.R.M.) in this regard.

Past, present, and future perspectives of telemedical assistance at sea: a systematic review.

BACKGROUND: Telemedicine is an effective technology for evaluating, diagnosing, treating, and providing health care services for remote populations, including seafarers, in case of diseases or accidents on board. Delivery of telemedicine in a maritime environment is not an easy task and, in general, differs from what can be done onshore. The aim of this review is to provides an overview of Telemedical Maritime Assistance Services (TMAS) in Europe by describing the previous and current status in terms of communication technologies as well as the nature of services rendered at sea. Secondly, to discuss the areas needing improvement and future directions to improve the quality of offshore telemedicine services. MATERIALS AND METHODS: Different databases, including PubMed (Medline), Google Scholar, Scopus, and journal of International Maritime Health, were searched between August 1 and September 15, 2019. Articles only published from 1969 to 2019 were considered. Relevant articles were selected by reviewing keywords, titles, and abstracts initially based on our inclusion and exclusion criteria. We critically reviewed the full-text articles included in this review. Information on the means of communication, telemedicine services, years of publication, and the name of the first author was extracted from selected studies. The quality of the selected studies was assessed using the criteria of the Newcastle-Ottawa scale. RESULTS: Initially, 135 articles were identified through searching various databases by using keywords, abstracts, and titles. After removing the duplicates, 121 articles remained. Then we performed an independent article assessment and selection based on the selection criteria, which removed an additional 61 studies, leaving 60 papers. Finally, 27 full-text papers left, and we critically reviewed it. In 27 accepted articles, email and telephone were used most often and accounted for 30% (17/57) and 28% (16/57) of all communication links, respectively. Teleconsultation was the most used telemedicine service on board and represented 58.6% (17/29) of accepted papers. CONCLUSIONS: Email and telephone were the principal means of TMAS doctors to provide medical advice as well as assistance for patients at sea. Despite the potential offered by technological progress, there are still many limitations to the provision of adequate medical care at sea. The modernisation of telemedicine services will help decrease the gap in healthcare delivery at sea.

[Healthcare for migrants on the high seas. The case of the operation EUNAVFOR MED "Sophia".] / El caso de la operación EUNAVFOR MED "Sophia".

Since 2015, the Spanish Navy participates in the Operation EUNAVFOR MED Sophia, a naval operation of the European Union against the trafficking of human beings in the Mediterranean in which our ships carry out an important humanitarian work in the rescue and assistance of migrants on the sea. The attention and health care of these migrants lies mainly in the military Health Group and it is based on a series of principles and procedures among which the application of a triage adapted to the special conditions of rescue and assistance on the sea and in the diagnosis and treatment of various pathologies present among migrants. In this context, a series of epidemiological data is provided, especially the most frequent pathologies attended by rescued migrants and emphasizing the importance of adopting a series of measures to prevent the transmission of infectious pathologies that are rare or already eradicated in our country.

Desde 2015, la Armada española participa en la operación EUNAVFOR MED Sophia, una operación naval de la Unión Europea contra el tráfico de seres humanos en el Mediterráneo, en la que nuestros buques realizan una importante labor humanitaria en el rescate y asistencia de migrantes en la mar. La atención y asistencia sanitaria de estos migrantes recae principalmente en el Grupo de Sanidad militar, y se basa en una serie de principios y procedimientos entre los que destacan la aplicación de un triaje adaptado a las especiales condiciones del rescate y asistencia en alta mar, así como en el diagnóstico y tratamiento de diversas patologías presentes entre los migrantes. En este sentido, este trabajo proporciona una serie de datos epidemiológicos, incidiendo en las patologías más frecuentes entre los migrantes rescatados, y destacando la importancia de la adopción de una serie de medidas para prevenir la transmisión de patologías infecciosas poco frecuentes o ya erradicadas en nuestro país.

Mental health problems and suicide in the younger generation - implications for prevention in the Navy and merchant fleet.

Psychologists and psychiatrists worldwide are expressing concerns regarding the growing prevalence of mental health problems and the incidence of suicide in young adults. The reasons are seen in the extremely high tempo of social changes, information pressure, and values evolution in the younger generations, which are exposed to growing inequalities, loneliness and lack of social support. Poverty, social isolation, consumerism, hedonism, and unrealistic expectations of the future generate in the vulnerable part of the young adults inevitable frustrations, which give way to depression, anxiety, addictions, and suicide. This creates additional risks for the situation on board ships, both military and merchant, and requires greater efforts during pre-admission selection and in the course of the service or voyages. Suicides in the Navy are better registered than in the cargo fleet and are lower than in the same age and gender groups from the general population, and usually lower than in other types of forces. Data on suicides in the civilian maritime sector are less conclusive, but suggest it as a growing problem, especially considering stress on board. Recent studies revealed quite a lot of mental health problems in the merchant fleet crews, including depression, anxiety, and suicidal thoughts. Among the reasons such factor as "flag of convenience" strategy that implies lower standards, recruiting of the less trained and lower-paid workforce, multinational and multilanguage rotating crews, higher workload and stress and insufficient level of the pre-employment medical examination are mentioned. Recent trends in the mental health of the youth demand higher awareness both in the military ships and in the merchant fleet. We consider that more education and training aimed at mental health problems identification and stress-resilience promotion are needed both for the military and civilian staff on board. Better education of the whole personnel and "healthy ship" approach (better recognition of the crew members' needs, attention to mental health problems, nutrition, physical activity, etc.) may be applied both for the Navy and merchant fleet.

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound.

Cruise ships travel far from shoreside medical care and present a unique austere medical environment. For the cruise ship physician, decisions regarding emergency medical evacuation can be challenging. In the event that a passenger or crew member becomes seriously ill or is injured, the use of point-of-care ultrasound may assist in clarifying the diagnosis and stratifying the risk of a delayed care, and at times expedite an emergent medical evacuation. In this report we present the first case reported in the literature of an emergency medical evacuation from a cruise ship triggered by handheld ultrasound. A point-of-care ultrasound performed by a trained cruise ship physician, reviewed by a remote telemedical consultant with experience in point-of-care ultrasound, identified an ectopic pregnancy with intraabdominal free fluid in a young female patient with abdominal pain and expedited emergent helicopter evacuation from a cruise ship to a shoreside facility, where she immediately underwent successful surgery. The case highlights a medical evacuation that was accurately triggered by utilising a handheld ultrasound and successfully directed via a tele-ultrasound consultation. American College of Emergency Physicians (ACEP) health care guidelines for cruise ship medical facilities should be updated to include guidelines for point-of-care ultrasound, including training and telemedical support.

Assessing Surgical Task Load and Performance: A Comparison of Simulation and Maritime Operation.

INTRODUCTION: This study examined the effects of simulated and actual vessel motion at high seas on task load and surgical performance. METHODS: This project was performed in phases. Phase I was a feasibility study. Phase II utilized a motion base simulator to replicate vessel motion. Phase III was conducted aboard the U.S. Naval Ship Brunswick. After performing surgical tasks on a surgical simulation mannequin, participants completed the Surgical Task Load Index (TLX) designed to collect workload data. Simulated surgeries were evaluated by subject matter experts. RESULTS: TLX scores were higher in Phase III than Phase II, particularly at higher sea states. Surgical performance was not significantly different between Phase II (84%) and Phase III (89%). Simulated motions were comparable in both phases. CONCLUSIONS: Simulated motion was not associated with a significant difference in surgical performance or deck motion, suggesting that this simulator replicates the conditions experienced during surgery at sea on the U.S. Naval Ship Brunswick. However, Surgical TLX scores were dramatically different between the two phases, suggesting increased workload at sea, which may be the result of time at sea, the stress of travel, or other factors. Surgical performance was not affected by sea state in either phase.

TelePharmaSea: proposing a novel approach to automate, organize and simplify management of medical chest on board commercial vessels.

BACKGROUND: The on-board pharmacy is the kit that allows the implementation healthcare on board ships, since it should contain everything that may be needed to guarantee proper and efficient health care interventions for seafarers. There are several problems that can lead to a difficult and non-optimal management of the on-board pharmacy. This work illustrates the "TelePharmaSea" software, specifically developed to optimise the management of the on-board pharmacy of commercial vessels without medical personnel. MATERIALS AND METHODS: We collected the Medical Scales of the various Flag States and brought them all into a standardised format which could be used. The Active Ingredients and Pharmaceutical form of each medicine is linked with the ATC Codes. Active Ingredients having similar effect are linked by ATC codes. Items that did not have an ATC code were given a unique system-generated code. Due to the proprietary nature of the software of which the database structure and functioning is unique, we cannot share the exact structure; however, the approach regarding the same has been highlighted. RESULTS AND CONCLUSIONS: The proposal of the TelePharmaSea software can be an effective tool capable of a significant improvement of the overall quality of medical and pharmacological assistance provided on ships without a doctor on board. The system can guarantee a better management of the on-board pharmacy's inventory, and it may also reduce the risks of mistakes in drugs administration.

Efficacy of Medical Operations and Layout Planning Onboard Nontraditional US Navy Vessels at High Seas.

INTRODUCTION: Attempting to expedite delivery of care to wounded war fighters, this study aimed to quantify the ability of medical and surgical teams to perform lifesaving damage control and resuscitation procedures aboard nontraditional US Navy Vessels on high seas. Specifically, it looked at the ability of the teams to perform procedures in shipboard operating and emergency rooms by analyzing motion of personnel during the procedures. METHODS: One hundred and twelve damage control and resuscitation procedures were performed during a voyage of the US Naval Ship Brunswick in transit from Norfolk, Virginia, to San Diego, California. The ability of personnel to perform these procedures was quantified by the use of motion link analysis designed to track the movement of each participant as they completed their assigned tasks. RESULTS: The link analysis showed no significant change in the number of movements of participants from the beginning to the end of the study. However, there was a learning effect observed during the study, with teams completing tasks faster at the end of the study than at the beginning. CONCLUSION: This shows that the working conditions aboard the US Naval Ship Brunswick were satisfactory for the assigned tasks, indicating that these medical operations may be feasible aboard nontraditional US Navy vessels.

An acute coronary syndrome in Antarctica.

Cruise tourism to Antarctica is constantly growing. Passengers and crewmembers may experience illnessesor injuries while traveling to remote areas with harsh weather conditions from where prompt evacuationis mostly unavailable. While a small explorer ship was at Wilhelmina bay (64°39' South and 62°08' West)in the Antarctic Peninsula, a 73-year-old male passenger presented with acute chest pain after two shortexcursions off the vessel in cold weather conditions. He was treated on board and remained clinicallystable until the ship reached Ushuaia at the end of the cruise which was 5 days after the symptoms onset.