TIM CARTER
E.1.1 Introduction
Chapter xx provides an overview of the principles of maritime risk management. This chapter focuses on the various types of harm to the health and well-being of seafarers that may arise as a consequence of working and living at sea. The harms considered are those where good risk management can reduce the frequency and severity.
For risks that are directly attributable to tasks at work there is a clear obligation on the employer to have adequate precautions in place, normally formalised as part of the statutory Safety Management System (SMS). For others, such as certain illnesses and mental distress, where living conditions at sea may be a contributor, there are fewer formal requirements, but it is both useful and good practice to have effective preventative measures in place.
Most types of risk and their control measures are considered in the sections that follow. Other chapters provide information that relates to certain aspects of health risk management:
- Infectious disease risks (xx).
- Management of casualties and from illness at sea (xx)
- Risk reduction by crew selection (xx)
- The human element
E.1.2 Injuries and illnesses compared
Injury is almost always a direct effect of energy of some sort interacting with vulnerable parts of the body. Most commonly this is gravity, whether causing a fall or causing an item to fall on a person. It may also be the kinetic energy of a sharp or fast moving object. Less common causes include heat (burns) or electrical energy (burns or electrocution). Corrosive chemicals can also directly destroy tissues. An injury event can easily be defined by time and place and it is then possible to work back from this to establish the contributory causes of the injury and how they relate to each other.
By contrast the external causes of illness present a challenge to the biological processes of the body, which are not always able to respond to them and so become damaged. It is for this reason that harm sometimes only becomes apparent long after exposure, although occasionally it may be immediate, as with exposure to an acutely toxic substance such as carbon monoxide. This delay may be because the harm is the effect of cumulative exposure over a long period, as in deafness caused by noise, or because effects can take many years to become apparent, such as in the case of cancers. Processes may be reversible if identified early enough to reduce exposure or to treat the early stages of harm. The same biological process may be upset for several different reasons, some external and some inherent in variations between individuals. These features mean that harm to health usually has to be searched for, unless the effect is immediate, rather than becoming apparent in a similar way to an injury. Also if the harm is long-term then it may only be visible after a seafarer has ceased to work at sea and follow up may be needed.
E.1.3 Living at sea and ill-health
Most ill-health in seafarers is not directly related to work tasks. Patterns of disease tend to follow those in the seafarer’s home country. However living at sea may modify this pattern, for instance because of dietary changes, hours of work and rest, mental stresses, lack of opportunities for exercise and personal habits, such as smoking or substance abuse. For these sorts of lifestyle associated risk the style of prescriptive risk management that is acceptable for injury and work-related disease prevention is inappropriate. The emphasis needs to be on health promotion activities that give the individual insights such that they decide to change their behaviour. However, this may need culturally sensitive but active support from shipping management, for instance by the provision of the components of a healthy diet, exercise facilities and policies on smoking.
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