D.2 Impact of a medical incident on board

Details

EVELYNE ROGGE

D.2.1 Introduction

The outcome of a medical incident, in terms of costs and effects or impact, is very difficult to predict. The impact can vary greatly and does not always show a proportional relationship between the severity of the incident and the sum of the effects. It is always important to consider the following, as there is usually some impact in all of these:

  • Impact on the seafarer
    • Physical impact on the seafarer
    • Psychological impact on the seafarer
    • Financial impact on the seafarer
  • Impact on the colleagues
    • Physical impact on the colleagues
    • Psychological impact on the colleagues
    • Financial impact on the colleagues
  • Impact on the ship’s operations
    • Practical impact on ship operations
    • Productivity impact on ship operation
  • Impact on the families of sick or injured seafarers
    • Physical impact on the families
    • Psychological impact on the families
    • Financial impact on the families
  • Impact on the company
    • Physical impact on the company
    • Psychological impact on the company
    • Financial impact on company

There is no script to follow and all impacts can vary in different scenarios. The scenarios and best practices are to be considered as a framework and not as a bible.

D.2.2 Impact on the seafarer

Physical impact on the seafarer

The physical impact on the seafarer ranges from minor to very painful and even permanent impairment.

The treatment of the physical symptoms of the seafarer obviously take priority and starts with assigning a medical officer on board who will remain available to the injured seafarer on a day to day basis. The role of the medical officer is described below. Other publications such as the International Medical Guide for Ships[1], or a national equivalent describe the purely physical treatment of a sick or injured seafarer, and this is beyond the scope of this book.

Major injuries or severe acute illness will be reported immediately and treatment instigated at the time of the incident. However, minor injuries and illness, which can lead to more severe injuries or other symptoms later, are not always reported and addressed immediately. Therefore, it is important that staff and coworkers remain vigilant as to the health of their colleagues.

Psychological impact on the seafarer

The injured / ill seafarer will have multiple feelings that all need to be addressed to enhance the healing process. These may include one or more of the following:

  • physical discomfort
  • psychological discomfort due to uncertainty of the
    • future
    • lack of physical presence of professional help
  • anger towards himself about the injury or illness – self blaming
  • anger towards the ship / company / colleagues
  • embarrassment / loss of professional face towards co workers
  • humiliation by co workers
  • fear to sign off or not to be re-employed, hence a financial impact
  • fear of not signing off in time to get professional help
  • fear of financial consequences once at home
  • fear for the future
    • job security
    • financial
  • the feeling of being disconnected from the incident, colleagues and the surroundings

Seafarers are not trained psychologists and cannot offer professional help. However, it is recommended that the sick or injured seafarer be assigned a confidant who will visit them throughout the day, on a frequent but irregular basis until professional help ashore is available and even beyond. The role of a confidant is described below. 

The feelings and emotional state of the seafarer will change over time and initial feelings can even conflict with feelings experienced in a later phase. The seafarer may initially feel supported but subsequently feel resentment towards the colleagues / staff / company.

The use of social media and fast communication is a blessing in terms of support, but can also cause additional pressure. It can have a huge emotional impact and the parties involved should consider this.

Although seafarers differ in their reaction to illness or injury, best practice would usually be to keep the seafarer on board to complete his Contract of Employment, provided of course that he is fit for duty (even after several days off duty) and does not pose a threat to the safety or health of the vessel or other crew. This will ensure a normal closure of the contract and the seafarer will often not experience further negative feelings.

Financial impact on the seafarer

The financial impact on the seafarer is mitigated by the fact that the company will bear the costs of the medical treatment, as stated in the Maritime Labour Convention 2006. However, there may still be a financial impact on the seafarer because, for example,

  • less to no overtime during the off-duty period
  • less income while on sick leave at home
  • less job / promotion opportunities after illness or injury
  • loss of job

D.2.3 Impact on colleagues on board

Physical impact on colleagues

The physical impact on colleagues is limited to the potential higher workload required to cover the sick or injured seafarer’s tasks, and, where necessary provide care for the ill or injured seafarer. This can add to fatigue and difficulties in physically performing some of the tasks required.

Very rarely, cases of serious injury or death of a colleague have caused psychosomatic disorders in colleagues and have led to the resignation of these seafarers.
 

Psychological impact on the colleagues

The psychological impact on colleagues can be significant and vigilance among seafarers to observe and report any symptoms is important.

Colleagues can have a range of feelings:

  • no impact
  • guilt
  • anger
  • fear

Initially, most colleagues will show compassion and emotional support to the sick or injured seafarer. However, it is not unusual that negative thoughts towards the ill / sick  person develop over time due to the higher workload or assumptions that the affected crewmember is exaggerating for personal gain.

If the colleague was directly involved in the accident leading to the injury then he may also develop feelings of guilt and later, if the accident is being investigated, colleagues might develop a fear of involvement and a fear of blame.

Financial impact on the colleagues

Generally, there are no direct negative financial impacts on the colleagues of a sick or injured seafarer. Conversely, there may be positive impacts due to extra overtime and potential promotion.

Rarely there may be a long-term negative impact on promotion or employment if colleagues are found to be involved in the root cause of an accident.

D.2.4 Impact on the ship’s operation

Practical impact on ship operation

The practical impact on operations is due to the additional workload on the medical officer in treating the sick or injured seafarer and the additional workload on colleagues in covering tasks - watches may have to be reshuffled, organization changed, etc.

However, the ship is an entity that is used to coping with changes in the processes on board and it is very resilient in dealing with any necessary adjustments in work pattern. Hence, the impact will initially be manageable. However, the impact may be significant if the situation continues for an extended period. The company must avoid this and address the practical issues with additional or replacement staff. This is particularly relevant in the rare situation where the sick or injured seafarer is the only person on board with a specific skill set or qualifications. In this situation, urgent arrangements need to be made to replace him at the next port if he is unable to resume all of his workload.

Impact on productivity

The impact on productivity will depend on the severity of illness or injury to the seafarer. If the sick or injured seafarer is still able to perform light work, his productivity will be reduced but he will be able to carry out some tasks. This is also likely to be beneficial for the healing process of the seafarer hence to be fully supported by the ship and shore management. Alternatively, if the seafarer is unfit for duty then his colleagues will cover all of his tasks in addition to their own. Their workload will increase but at least in the short term, this does not necessarily incur a loss in productivity for the ship. As above, the impact may be significant if the situation continues for an extended period and this should be avoided.

 

D.2.5 Impact on the families of sick or injured seafarers

Physical impact on the families

Physical impact on the seafarer’s family will initially be rare to nonexistent but can increase if the sick or injured seafarer returns home and requires additional support and care.

Psychological impact on the families

In all cases, the psychological impact on the family is high. In the past families at home had little or delayed information from the ship. However, improved communications and the widespread use of social media mean that more and quicker information is often available to the families of seafarers.

The consequences are twofold:

  • increased support from home
  • increased concern from home

The additional emotional support has a positive influence on the healing process but families can equally create an additional stress on the seafarer. Family members are often over-worried and do not have insight into the ship’s organization or ongoing procedures. It is important that the ship’s staff is aware of the seafarer’s relationship with family members and that everybody is clear on what information should be released and to whom. In case of serious illness or injuries, the company must inform the family and keep them updated. They may also need to offer some sort of support or counselling.

Financial impact on families

The financial impact on the seafarer’s family can vary from nothing to a significant drop in income over an extended period. This may be due to less income because of less overtime (if applicable), earlier signing off and a potentially lower salary whilst on sick leave or in case of partial or permanent disablement.

D.2.6 Impact on the company and shore based staff

Physical impact on the company

The physical impact on the ship owner mainly consists of an increase in human resources on board as well as ashore.

Psychological impact on the company

Although the incidents happen at a distance, the owner may still feel guilt or anger. Shore-based managers and other operational staff may also experience such feelings and the company needs to offer appropriate support. Equally, the inability to take any positive action can be frustrating and stressful to shore based staff.

Financial impact on the company

The financial impact on the company can range from nothing to several million dollars depending on the severity of the illness or injury, the treatment required and any subsequent impact on operations. The effect of a single incident can vary from the single use of first aid equipment that was already part of the budget to the deviation of the vessel with commercial impact and human resources issues, to huge compensation to the victim.

In most of the cases, the costs are underestimated as any loss in productivity or breach of contract to the customer is not recorded or not in accounted for in full and is rarely directly attributed to the illness or injury.

At the very least, incidents result in a reduction in productivity but can extend to salary costs for human resources ashore (agent, operator assistance), salary costs for replacement crew, medical bills, travel costs, claim compensation, retraining of crew, incident investigation costs, negative commercial impact, etc. Some of these costs may be covered by the insurers and more information about the role of the P&I company is available in Chapter xxx

Accidents, including medical treatment injuries, lost time injuries etc. are also reflected in the company’s safety statistics and can have a negatively impact on the company image and future commercial commitments.

D.2.7 Best practice to mitigate the impact of a medical incident

Create a culture of trust

It is important that long before the incident happens an atmosphere of trust and no blame is created onboard the vessel. This is a lengthy process that starts at a corporate level ashore and should be demonstrated on a daily basis through

  • the availability of medicines and equipment onboard
  • the availability of professional assistance ashore 24/7
  • no discussion about a seafarer’s request for a doctor’s visit
  • accessibility of the officer responsible for medical care on board
  • confidentiality in medical matters onboard and in shore side offices
  • repatriation when required and the swift replacement of crew

Create a culture of abundancy

A seafarer should know and feel that there are no material restrictions when it comes to his health, firstly through an abundancy in medical supplies and the availability of ship and shore resources and secondly that there is an open atmosphere to express even his minor issues.

Although the abundancy of something is usually correlated to abuse, it is important that the crewmembers work and live in an atmosphere and know that any physical or psychological issue can be raised and will be attended to. In fact, often when the crew know and trust that there is an unlimited access of what is needed, the consumption/use is self-regulating and they will no longer feel the need for exaggeration or abuse as they feel comfortable.

Ship owners, operators, Captains and other interested parties all play an important role in creating the feeling of abundancy through

  • offering an environment of remote assistance
  • having a network of medical care providers available
  • supplying medical equipment and medicines
  • the availability of human resources to send replacement crewmembers, etc.

It should be clearly visible to the crew that there are no restrictions on the availability of medicines or doctors’ visits. This will positively influence any seafarer to bring issues forward.

However, a strict policy needs to be implemented to avoid abuse and every case should be assessed in a firm but fair manner. Once seafarers see and feel that their needs are attended to on board in a timely and correct manner and without blame, they will come forward with injuries and illnesses.

This is an important point of attention both shore side and on board ship.

Create a no blame culture

Due to the more stringent reporting procedures in Health Safety Environmental Quality (HSEQ) methodology and the consequent mandatory root cause analyses, seafarers are less forthcoming to report minor physical or emotional issues and illnesses. If illness or injury is the result of an accident or the working environment, it is important that all parties learn from the incident and appropriate risk management steps are implemented to prevent future similar incidents or to mitigate their effects. It is also paramount that the further reporting of an incident by the seafarer and Master to the operator or other party does not adversely affect the seafarer. This requires discipline from the company to ensure that the seafarer’s details are not disclosed and that the investigation is conducted in such a manner that the seafarer or colleagues do not feel under such scrutiny that they would withhold from future reporting. The ‘blame culture’ must be avoided.

Captain (and all ships personnel) to remain vigilant

The Captain and all of the officers and crew should remain vigilant and invest time to get to know one another through small talk and casual interactions, while mandatory inspections and meetings will remain at a corporate level. It is encouraged for the Captain to pass by the different departments at various times of the day or week. Casual chats about the crew’s interests might reveal small injuries, hidden illnesses or emotional problems. Equally, it may be that fellow seafarers reveal problems in colleagues that could develop into a serious injury or illness, with the potential to harm that seafarer, other crewmembers or ship operations.

Assignment of medical officer

It is important and mandatory to assign a dedicated officer responsible for medical care who is accessible to all crew. All crew signing on to the vessel should be made aware of the rank of the officer responsible for medical care during the initial familiarization procedures and the name should be displayed at a prominent place e.g. the door of the hospital or dispensary.

The officer responsible for medical care is trained to provide the on board treatment of injuries and illnesses, he reports to the Captain and will be assigned for continuous and formal medical observation of the patient.

Assignment of confidant

The ship is a closed entity with only a limited number of crew to ensure ongoing ship operations. Human resources can be limited. However, it is of the utmost importance that the injured or ill seafarer is not left alone but supported. Therefore, it is recommended that a confidant be assigned.

The choice of a confidant needs to be carefully considered and balanced. It should not be based on his or her medical skills, experience, rank, nationality, religion or race. The confidant can be one person or multiple persons regularly visiting the injured or ill seafarer. The confidant does not need to have a formal task but can be used as a way of talking to the seafarer and getting additional information on their physical and emotional state through small talk, bringing some food, sharing a movie, etc.

A few minutes of real interest can seriously contribute to the healing process.

Care and support culture

The treatment of the injury or illness is obviously paramount. Secondary but still very important is showing real care about the general health and welfare of the seafarer. Assigning a confidant and having other crewmembers visiting and chatting with the ill or injured person are very important. Social media contact can also contribute - not only with people ashore but also with others on board, particularly if the seafarer is isolated for any reason.  

It is equally beneficial to integrate the injured or ill person into the ship’s life again, as far as is reasonably possible. Too often, seafarers declared ‘unfit for duty’ are put in their cabin until they are healed and declared fit for duty again or until they are disembarked, with others assuming that ‘watching movies’ is the best way to get better. Physical rest is important but social interaction is equally important and once a seafarer is deemed fit to return to work, a phased approach may be appropriate to encourage their reintegration to the crew. This must be done in compliance with any medical restrictions in place. Rendered support and a support culture reduce the psychological impact whereas a blame culture increases it.

D.2.8 Death on board

Although no specific difference has been made between accidents and illnesses throughout the chapter, it is important to highlight one specific situation, death on board.

Death on board has a more significant impact on the colleagues of the seafarer than any other illness or injury. The impact will depend whether the dead person was a member of the crew or not and whether he died from a professional accident or from a natural cause.

If the dead person was not a member of the crew then the influence and emotional commitment will be lower but still exist. If the dead person was a member of the ship’s crew then the atmosphere is depressed and it is beneficial to keep the communication lines open between the crew and to seek professional and potentially religious / spiritual help.

Whilst the body remains on board e.g. while transiting to a safe haven for disembarkation, the atmosphere will be very low, as the mourning process is unlikely to start as long as the body is physically on board. This is likely to improve once the dead body has been disembarked. More information regarding the practical aspects of dealing with death on board are available in Ch. 9.6

D.2.9 Conclusion

The physical, psychological, financial and commercial impact of a medical incident on board is determined (to a certain extent) long before the actual occurrence, through corporate decisions ashore and on board and through the general company and shipboard culture.

There is no common impact or approach to an incident on board and every event is unique with a different impact and requiring a different approach to the issues that arise.

The best practices described here can serve as a tool to mitigate the different impacts of an incident.

 

[1] International Medical Guide for Ships. ISBN-13: 978-9241547208 ISBN-10: 9241547200