Introduction
introduction
Textbook of Maritime Health
Introduction
Volume A
Volume A
Maritime Health and Maritime Medicine
Volume A
Volume B
Volume B
Maritime Industry
Volume B
Volume C
Volume C
Working and Living at Sea
Volume C
Volume D
Volume D
Medical Care at Sea and Beyond
Volume D
Volume E
Volume E
Health Risks to Seafarers
Volume E
Volume F
Volume F
Human Element
Volume F
Volume G
Volume G
Public Health and Infectious Disease
Volume G
Volume H
Volume H
Maritime Incidents and
Survival at Sea
Volume H
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Introduction

Welcome to the Textbook of Maritime Health!

Foreword

“Navigare necesse est” – it is necessary to sail, the Roman captain Pompeius famously told his crew in year 56 BC. Their ship was loaded with grain and due to return from Africa to Rome. The men were anxious. The crossing was dangerous and a storm was building up in the distance. Pompeius offered the men no comfort. “Vivere non est necesse”, he continued – to live is not necessary. Their mission had priority. Rome was starving and their ship was to return at any cost. 

Navigation of the seas is as important to modern societies, as it was to ancient Rome. The risk acceptance, however, the value placed on health and lives of the seafarers, has changed radically. Today, the health of seafarers is perhaps the most treasured of all goods carried at sea and considered the key to both safe and prosperous maritime operations. 

Maritime health is a multidisciplinary field concerned with the health of seafarers. It draws on principles of traditional shore-based medicine, such as public health, clinical individual-oriented medicine, occupational medicine and medical selection, integrated with knowledge of the maritime context. 

This textbook was first published as the Textbook of Maritime Medicine in 2009, edited by Aksel Schreiner. Following its success it was extensively revised. The second edition was published in 2013, edited by Tim Carter. 

The Textbook of Maritime Health is the third edition of this textbook. It has been extensively revised and amended. The scope has been extended to include more topics on the health and welfare of seafarers and the challenges of the maritime industries in general, with less focus on the management of a number of clinical conditions as in previous editions. 

For medical advice on management of clinical conditions at sea, we refer our readers to the International Maritime Guide for Ships (IMGS) by WHO, its national equivalents and the online Mariners Medico Guide (www.medicoguide.no).

The chapters in this textbook have been authored by international experts in their field and edited by experienced clinicians at the Norwegian Centre for Maritime and Diving Medicine (Sue Stannard, Tim Carter, Alf Magne Horneland and Jon Magnus Haga). I wish to thank all the authors and editors for their invaluable contributions and commitment to this project. Without the contributions of many, this project would not have been possible.

The aim of this textbook is to promote health at sea. We have included all topics we think will be useful for practitioners in the field. Although this textbook is comprehensive, it is by no means final or complete. It will remain a dynamic publication. We will continue to improve and amend it as the field develops and suggestions for change or additional topics are brought to our attention. I encourage all readers to get in touch with us, your input is most welcome!

Health builds on knowledge. Knowledge is to be shared. This textbook is provided online and free of charge. Please share this with anyone with an interest in the field. With an appropriate reference to the original source, the text may be freely reused and adapted for any non-commercial use. 

I hope you find this textbook useful and that you will enjoy your journey into the world of maritime health. I wish you all fair winds!


Bergen, 6.6.2022

Jon Magnus Haga, MD/PhD
Head of Norwegian Centre for Maritime and Diving Medicine
Department of Occupational Medicine
Haukeland University Hospital

logo_NSMDM.jpg

 

 


Endorsed by:

 

History of the Textbook

The textbook was first launched in November 2009, edited by Aksel Schreiner and with the aim of providing a comprehensive, web based and freely available source of information on the health, welfare and important issues affecting those at sea. Following its success it was extensively revised and a second edition, edited by Tim Carter, was published in 2013. Given the expansion in the field of maritime medicine, along with the ongoing wide spread use of the textbook from a global audience, it was decided to begin the next revision and produce this, the third edition. 

Suzanne Louise (Sue) Stannard worked as editor from 2017 to 2021, and Alf Magne Horneland and Jon Magnus Haga took over in the final phase when she moved on to other her new position.  Tim Carter has given important editorial advice and reviewed most of the texts. The editorial board (old and new) has given important input to the structure and content. A wide range of authors, some of whom had contributed to the first and second editions, has contributed to the extensive revision, which now is presented in a different format. The new design and technical solution is developed by Kjetil Horneland.

The most obvious revision is the new name, “Textbook of Maritime Health”. This was felt to be necessary to reflect the broad nature of the specialty to include not only ‘traditional’ medical subjects but also the importance of health and wellbeing amongst seafarers. Issues such as fatigue, stress, depression and other mental health issues are seen frequently among the seafaring population. In addition, lifestyle issues and illness such as obesity, alcohol and drug use and abuse and sexually transmitted disease have become or remain a major cause of illness and injury on board, possibly contributing to medical evacuation, early repatriation and early retirement.

How to use the book

Scope and limitations

The Textbook of Maritime Health aims to provide a broad basis of information 

  • in areas of the maritime industry that are particularly relevant to the health of seafarers, 
  • in areas of medicine and health that are particularly relevant at sea and 
  • in those areas that are essential to assess, maintain and manage a population of healthy seafarers who will, of course be taken ill, become injured or suffer issues related to their health and welfare. 

As stated above it is not intended to replace the IMGS or to be a clinical textbook for medical professionals working at sea. Rather it is a source of information for all those involved in the health and welfare of the seafarer be they working at sea themselves or shore based.

Given the intended scope of the book there will obviously be limitations in the detail provided for some users in some sections. However, we hope that with the use of the references and additional sources of information that are included in the text, all users will find what they are seeking. This may be directly within the Textbook of Maritime Health or indirectly through it. 

Practical assistance

Indexing

As a new development for the third edition the Textbook of Maritime Health now has a full index of subjects that can be found at the end of the book. Topics are indexed for their main area of content and if there are further sections of interest these will be mentioned within the text.

References

References are given at the end of each section and are given using the Vancouver referencing system. Please rememeber that if you are using the textbook offline, references given as a hyperlink will not be immediately available if there is no access to the internet. It is therefore recommended that you also download any references that may be of particular interest if this is your preferred way of using the textbook.

Feedback

If you have any comments on the content, format, aims or access of the textbook please do let us know by using the email addresses………

 

List of abbrevations

AB Able Bodied Seafarer
ACEP American College of Emergency Physicians
ACLS Advanced Cardiovascular Life Support
ADA Americans with Disability Act
AED Automatied External Defibrillatior
AGE Acute GastroEnteritis
AJMEDP Allied Joint Medical Planning Doctrine (from the NATO)
AJMP Allied Joint Medical Publication (from the NATO)
AJP Allied Joint Publication (from the NATO)
ALRS Admiralty List of Radio Signals (from Admiralty Maritime Data Solutions, UK)
ALS Advanced Liffe Support
AMedP Allied Medical Publication (from the NATO)
ANVISA Agência Nacional de Vigilância Sanitária (Brazil National Health Surveillance Agency)
AoS Apostleship of the Sea
APLS Advanced Paediatric Life Support
APS Assigned Protection Factor
ARI Acute Respiratory Infection
ATC system Anatomical Therapeutic Chemical Classification System (for classification of medicines)
Athens Convention / PAL Athens Convention relating to the Carriage of Passengers and their Luggage by Sea (PAL) (from the IMO)
ATLS Advanced Trauma Life Support
ATV Akademiet for de Tekniske Videnskaber (Denmark)
BIMCO Baltic and International Maritime Council
BLU Bande Latérale Unique (fr.), corresponding to Single Side Band (SSB)
BMA Bahamas Maritime Authority
BMJ British Medical Journal
BPM Best Management Practice
BRM Bridge Resource Management
BS British Standard – BS denotes Britain's National Standards which are controlled by the British Standards Institute (BSI)
CBA Collective Bargaining Agreement (contracts of seafarer's employment)
CCNR Central Commission of the Rhine
CDC Center for Disease Control (USA)
CEM Crew Endurance Management
CEMAC Communauté économique et monétaire d’Afrique centrale
CESNI The European Committee for drawing up Standards in the field of Inland Navigation”, or in French: «Comité européen l’élaboration de standards dans le domaine de la navigation intérieure
CHIRP Aviation and Maritime Confidential Incident Reporting
CICOS Commission Internationale du bassin Congo-Oubangui-Sangha
CIE Comission International d'Éclairage (International Commission on Illumination)
CIRM Centro Internazionale Radio Medico (Rome)
CLIA Cruise Lines International Association
CLIA Cruise Line International Association
CMSS Center for Maritim Sundhed og Sikkerhed (Centre for Maritime Health and Safety) (Denmark)
CO Carbon monoxide
COLREG Convention on International Regulations for Preventing Collisions at Sea
COVID-19 Coronavirus disease 2019
CRM Crew Resource Management
CRPD UN Convention on the Rights of Persons with Disabilities, 2007
CTV Crew Transfer Vessel
DAN Divers' Alert Network
DCI Decopmression Illness
DCS Decopmression sickness
DMLC Document of Maritime Labour Compliance
DOHSA Death on the High Seas Act (USA)
DON Dysbaric osteonecrosis
DSV Diving Support Vessel
DWT Dead weight tonnage
ECDC Europeand Centre for Disease Prevention and Control
ECG ElectroCardioGraphy / ElectroCardioGram
ECSA European Community Shipowners' Association
EDTC European Diving Technology Committee
EEZ Economic Exclusion Zone according to UNCLOS
EHS Environment, Health and Safety (see also: HSE: Health, Safety and Environment)
EMCIP European Marine Casualty Information Platform
EMSA European Maritime Safety Agency
EN EN denotes a Standard which is adopted by the European community and is controlled by the European Committee for Standardisation (CEN).
ENT Ear, Nose and Throat
ERM Engine Resource Management
ETF European Training Foundation
EUSIS EU SHIPSAN ACT Information System
FMC [US] Federal Maritime Commission
FOC Flag of Convenience
FPSO Floating production storage and offloading vessel
GDP Gross Domestic Product
GMDSS Global Maritime Distress and Safety System
GPS Global Position System
GRIB (GRIdded Binary)
GSM Global System for Mobile Communications
HELIOX Breathing gas mixture fontaining Helium
HELIVAC Medical evacution by the means of a helicopter
HEPA filter High efficiency particulate air filter
HF High frequency (HF) is the ITU designation for the range of radio frequency electromagnetic waves (radio waves) between 3 and 30 megahertz (MHz).
HRA High Risk Area
HRS High Risk Ships (according to PSC)
HSC High-spees craft
HVDC High Voltage Direct Current
IACS International Association of Classification Societies
IAMSAR Manual International Aviation and Maritime Search and Rescue Manual, jointly published by IMO and ICAO
ICAO International Civial Aviation Organisation
ICCPR International Covenant on Civil and Political Rights, 1976
ICD-10 International Classifiaction of Diseases, 10th edition (From the WHO)
ICESCR International Covenant on Economic, Social and Cultural Rights, 1966
ICMA International Maritime Christian Association
ICNIRP The International Commission on Non-Ionizing Radiation Protection
ICS International Chamber of Shipping (an association of national shipping companies' associations)
ICSW The International Committee on Seafarers' Welfare (established to implement ILO Conventions9
IDLH Immediate Dangerours to Life or Health
IEC International Electrotechnical Comission
IFC Information Fusion Centre
IG [P&I] International Group of P&I Clubs
IHR International Health Regulations (from the WHO)
ILI Influenza-like Illness
ILO International Labour Organisation (a UN Agency)
ILO C 188 ILO Work in Fishing Convetntion 2007
ILO C016 Medical Examination of Young Persons (Sea) Convention, 1921 (from the ILO)
ILO C073 Medical Examination (Seafarers) Convention, 1946 (from the ILO)
ILO C159 Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (from the ILO)
ILO C163 Seafarers' Welfare Convention, 1987 (ILO)
ILO R048 Recommendation concerning the Promotion of Seamen’s Welfare in Ports 1936 (ILO)
ILO R138 Recommendation concerning Sefarers' Welfare in Ports 1936 (ILO)
ILO R173 Seafarers' Welfare Recommendation, 1987 (ILO)
IMB the ICC International Maritime Bureau, is a specialised division of the International Chamber Of Commerce (ICC).
IMB PRC International Maritime Bureau Piracy Reporting Centre ( of the ICC)
IMCA International Maritime Contractrs' Association
IMDH International Maritime Declaration of Health
IMGS International Medical Guide for Ships - a WHO publication
IMHA International Maritime Health Association
IMHF International Maritime Health Foundation
IMO International Maritime Organisation (A UN Agency)
IMPA International Maritime Pilot's Association
INMARSAT International Mobile Satellite Organization
INTERCARGO International Association of Dry Cargo Shipowners
INTERMANAGER An organisation representing ship and crew managers as well as associated organisations worldwide
INTERTANKO Independent tanker operators
IPWP International Port Welfare Partnership
ISAN International Committee on Seafarers' Welfare
ISM Code International Safety Mangement Code (from the IMO)
ISO International Standards organisation
ISO ISO denotes a worldwide standard issued by the International Organisation for Standardisation.
ISWAN International Seafarers' Welfare and Assistance Network
ITF International Transport Workers' Federation
IWMS Integration of Women in the Maritime Sector (a global programme by IMO)
JRCC Joint Rescue Coordination Centre
LGBT LGBT is an initialism that stands for lesbian, gay, bisexual, and transgender.
LL 1972 International Convention on Load Lines
LNG Liquefied Natural Gas
LRS Low Risk Ships (according to PSC)
MARPOL International Convention for the Prevention on Pollution from Ships 1973 (from the IMO)
MCA Maritime and Couastguard Agency (UK)
MCI Mass Casualty Incident
MDAT-GOG Maritime Domain Awareness Trade - Gulf of Guinea
MDH Maritime Declaration of Health (according to the IHR)
MEDEVAC Medical Evacuation
MENA region Middle East and North Africa region
MEPC Marine Environment Protection Committee - and IMO committee
MF Medium frequency is the ITU designation[1] for radio frequencies (RF) in the range of 300 kilohertz (kHz) to 3 megahertz (MHz).
MFAG Medical First Aid Guide for Use in Accidents Involving Dangerous Goods (IMO)
MLC 2006 (or only MLC) Maritime Labour Convention 2006 (from the ILO)
MMPG Maritime Medical Planning Guide (a Nato Publication)
MMR vaccination Measles, Mumps and Rubella Vaccination
MOB boat Man over board boat
MoU Memorandum of Understanding
MPHRP Maritime Piracy and Humanitarian Response Programme
MRCC Maritime Rescue Coordination Centre
MRM Maritime Resource Management
MSC Maritime Safety Committee (an IMO committee)
MSDS Material Safety Data Sheet
NATO North Atlanctic Treaty Organisation
NEMAM North European Maritime Authorities Medical Group
NIR New Inspection Regime (From EMSA)
NIS Norwegian International Register
NMT Nordic Mobile Telephone, the first automatic mobile telephone system in the world
NOGEPA Netherlands Oil and Gas Exploration and Production Association
NORTRASHIP Norwegian Shipping and Trade Mission (during the 2nd world war)
NSA Norwegian Shipowners' Association
NYK Group Europe NYK Group Europe is the European regional site for the global transportation company, Nippon Yusen Kabushiki Kaisha
OCIMF Oil Companies International Marine Forum
OEL Occupational Exposure Limits
OGUK Oil&Gas UK
OOW Officer of the Watch
OPEC Organization of the Petroleum Exporting Countries
OR Open registry (where shipowners from any nation may register their ship)
OSH Occupational Safety and Health
OSV Offshore Supply Vessel (see also PSV: Platform supply vessel)
P&I Protection and Indemnity
P&I Club Mutual insurance club of shipowners regarding protection and indemnity insurance
PAL Athens Convention relating to the Carriage of Passengers and their Luggage by Sea (PAL) (from the IMO)
Paris MoU Port state control organisation with 27 member states from the North Atlantic basin
PCASP Private Contracted Armed Security Personnel
PEME Pre-employment medical examination
PEOEA Philippine Overseas Employment Administrationg
PER Regional Economic Programme
PLO Palestine Liberation Organisation
PPA Philippine Port Authority
PPE Personal Protective Equipment
PPU Personal Pilot Unit
PRC Piracy Reporting Centre
PSC Port State Control
PSCO Port State Control Officer
PSV vessel Platform Supply Vessel (see also OSV: Offshore supply vessel)
PTC Passenger Ticket Contract
RAND Corporation RAND (Research and Development) is an American nonprofit global policy think tank[1] created in 1948 by Douglas Aircraft Company to offer research and analysis to the United States Armed Forces.
RCCL Royal Caribbean Cruise Line
RIB Rigid Inflatable Boat
Ro-Ro-ferries Roll-on Roll-off Ferries
ROV Remote Operated Vessel (or Vehicle)
RPE Respiratory Protective Equipment
SAR service Search and Rescue service
SCI Seamens' Church Institute
SCUBA Self-contained underwater breathing apparatus
SDU Syd-Danske Universitet (University of Southern Denmark, Esbjerg)
SEV Security Escort Vessel
SHIP Seafaers' Health Information Programme (Project by ISWAN)
SHS Seafaers Hospital Society
SIM Social Interaction Matter (a project by ISWAN to help shiping sompanies improve seafarers' social interaction on board
SMCP Standard Marine Communications Phrases
SMLC Ship's Maritime Labour Certificate
SMS Safety Management System (according to the ISM Code)
SOLAS The Internaitonal Convention on the Safety of Life at Sea 1914 (from the IMO)
SOV Service Operation Vessel
SRP Ship Risk Profile (according to PSC)
SRS Standard Risk Ships (according to PSC)
SS The Sailors Society
SSB Single Side Band Radio
SSB An SSB radio modulates a special type of wave during transmission, also known as short-wave radio. Short-wave radio equipment on ships is part of the Global Maritime Distress and Safety System (GMDSS) established under SOLAS, the International Convention for the Safety of Life at Sea.
SSC Ship Sanitation Certificate
STANAG Standardization Agreement (from the NATO)
STCW International Convention on Standards of Training, Certification and Watchkeeping for Seafarers 1978 (from the IMO)
Stella Maris Stella Maris is an International Maritime charity supporting seafarers, fishers, and their families in the UK and around the world.
SUA Convention for the Suppression of Unlawful Act against the safety of maritime navigation (1988)
TEU Twenty-foot equivalent unit. One TEU refers to the dimensions of a twenty-foot container and is used as a standard unit of measure in container shipping
THETIS An information system developed by EMSA to monitor port state control
TMAS Telemedical Maritime Assistance Service
TOCA Transfer of Class Agreement (between IACS members)
UDE Union douanière équatoriale
UDEAC Union douanière équatoriale-Cameroun (UDE-Cameroun)
UDHR Universal Declaration of Human Rights,1948
UKMTO UK Maritime Trade Operations Office
UMAC Central African Monetary Union
UNCLOS United Nations' Convention on the Law of the Sea, 1982
UNCTAD United Nations Conference on Trade and Development
UNSC United Nation's Security Council
USCG United States Coastguard
VHF Very High Frequency (radio) is the ITU designation[1] for the range of radio frequency electromagnetic waves (radio waves) from 30 to 300 megahertz (MHz).
VOC Verenigde Oost-Indische Fompagnie
VOC Volatile Organic Compound
VPD Vessel protection detachment
VRA Voluntary Reporting Areas: Established by regional reporting centers such as UKMTO, IFC, or the new MDAT-GOG.
VSP Vessel Sanitation Program
WHO World Health Organisation (a UN Agency)
WLAN Wireless Local Area Network

1.3 Target Audiences

The primary target audience for the book are maritime health professionals, including physicians, nurses, occupational health advisers and others. It is anticipated that uses will include:

  • As a reference book to help respond to questions that arise in maritime health practice
  • As support to formal training courses in maritime health
  • As a self-directed distance learning aid for those wishing to improve and enhance their understanding of maritime health.
  • As a source of text to indicate features of maritime health practice or to support advice being given, for example, in the making of policy or within case reports.

It is also expected that other potential users are:

  • Other health professionals who want background information on maritime health
  • Other health professionals who wish to obtain information on specific maritime health issues
  • Other people in the maritime sector who need background information on health issues
  • Other people in the maritime sector who wish to obtain information on specific maritime health issues
  • Web searchers of all backgrounds who ask a question that relates to maritime health.

We have attempted to ensure that maritime terms are described in ways suitable for a non-maritime audience and medical terms and concepts are described in a way that is appropriate for non-medical professionals accessing the textbook. However we have also tried to ensure that this does not detract from the content and level of detail that can be found throughout the textbook. When we feel they may be useful we have used explanatory pop ups to give additional information.