ALF MAGNE HORNELAND
C.8.1.1 Military navy
Working on naval vessels differs a lot from working on merchant ships. Naval ships cannot change flag like a merchant ship, unless they are decommissioned and sold to another country. The crew is composed of seafarers from one country - the country of the flag the vessels fly.
Crewmembers usually are young, and they are selected on stricter criteria than for merchant ships, usually including positive selection. The crew is much larger than on a merchant ship. The positions and job tasks are focused on warfare. Exposure hazards in the working environment encompasses hazards that are unusual on merchant ships.
The standards and criteria are strictly national, although some similarities can be found, especially between countries belonging to the same military alliance. Medical selection is carried out by naval doctors only.
It falls beyond the scope of this chapter to discuss naval medical selection in more detail.
Medical requirements for fishing vessel personnel
The STCW convention sets health requirements for vision and hearing, and recommendations for physical and mental capabilities. Fishing vessels are, however not included in the STCW-convention.
The International Convention on Standards of Training, Certification and Watchkeeping for Fishing Vessel Personnel, 1995 (STCW-F 1995) entered into force on 29 September 2012. The convention sets the certification and minimum training requirements for crews of seagoing fishing vessels of 24 metres in length and above.
The ILO issued the Work in Fishing Convention, 2007 (ILO Convention 188). The C188 states that no fishers shall work on board a fishing vessel without a valid medical certificate attesting to fitness to perform their duties. The competent authority – meaning the national authority – may grant exemptions to this main rule, regarding size of vessel, availability of medical assistance and evacuation, duration of the voyage, area of operation and type of fishing operation. No such exemptions can be granted for vessels 24 metres and above, which normally remains at sea for more than three days.
The requirements for a medical certificate are to be issued by the national authorities, and no detailed recommendations are given in the C188. The convention states that hearing and sight shall be satisfactory, and that the fisher shall not suffer from a medical condition that is likely to be aggravated by service at sea or to render the fisher unfit for such service or ton endanger the safety or health of other persons on board.
Some nations, like Norway, had already made the STCW convention mandatory for fishing vessels, before the STCW-F convention entered into force. According to these regulations, personnel on fishing vessels of 15 meters length and above need a medical certificate.
The STCW-F convention sets requirements for medical certificates for personnel on fishing vessels 24 meters and above.
The implementation varies from country to country, and more so than the corresponding requirements for the merchant navy.
Risk assessment for personnel on fishing vessels
The working places on board fishing vessels are among the most dangerous out at sea, regardless of country  . The working place differs a lot between those working solo and self-employed on small boats along the coast, to those working on large purse seiners or factory trawlers in remote locations, maybe icy waters, days from shore and out of reach of helicopters.
Fishing equipment installed on deck is dangerous, and accidents related to their operations are numerous. Such work demands more of the physical capability and awareness than most deck operations on a merchant ship. Hence it could be discussed whether the medical requirements developed for the merchant navy are too lenient for fishing personnel. The requirements based on the STCW, the MLC 2006 and the STCW-F conventions do not take the consequences of these aspects.
C.8.1.3 Cruise ships
The cruise industry has yet another approach to medical selection of employees. Most companies have developed their own enhanced PEME standards. Some of these are very detailed, including many laboratory tests. With reference to the discussion of laboratory testing in this chapter (see above), it is doubtful that the use of this testing is justified in terms of safety risk assessment, capacity to work or in terms of antidiscrimination law. One important aspect of these selection procedures could be to make sure that the company will not get the bill, should a medical incident occur with the slightest possibility that it is connected to something in the past and mentioned in the medical record of the individual.
Work on cruise ships usually means working in big multicultural crews. It also implies that job tasks will be influenced by the main objective of the company – to serve at the pleasure of the passengers. Cruise ships have many positions, which usually are not found on regular merchant ships, where the employees have job tasks more comparable with working in a hotel, a shop, or in entertainment.
One advantage of working on a cruise ship is that they all have doctors and nurses working on board. Should a medical incident occur, medical assistance would be at hand immediately, although more complicated medical treatment in hospital on shore will be just as far away as on any ship in the same trade area.
C.8.1.4 Offshore petroleum industry
Amongst working places out at sea, we also find the offshore petroleum workers, working on installations for the production of oil or gas. Some of these units are afloat; others are standing on the seabed. Some floating units are mobile, others fixed with anchors.
There are no international requirements for workers on such installations, except for those installations that come under the STCW convention. In some periods the unit could be regarded as a ship (while moving) and hence covered by the STCW, and in other periods as an installation (when fixed during seabed operation), hence not covered by the STCW.
Most industrial oil and gas operations at sea occurs on the national continental shelf of a country. Hence, it is not ‘international’ in the same way as the shipping industry. The medical requirements are those of the national authority in the region where the operations are carried out, which means that the requirements may differ from country to country. In some cases, where operations are overlapping or the sea beds verge on each other, efforts have been made to achieve as similar requirements as possible. An example of this is the agreement (“Hardanger agreement”) between OGUK (UK), NOGEPA (Netherlands) and the County Governor of Rogaland, Norway. According to the agreement, a medical certificate issued according to the requirements in one of the three countries will be fully valid for work in the other countries.
Working places in the petroleum industry have similarities to working places on ships, but there are many positions and job tasks, which will not be found on ships. Hence, risk assessment is different.
It falls beyond the scope of this chapter to discuss the standards and criteria in detail.
C.8.1.5 Sea pilots
Sea pilots have work similar to navigators, but are not always regarded as seafarers. Their jobs differ a lot, from steering in and out of port to long distance piloting following complicated routes along a coastline. They are employed by organisations on shore, sometimes private, sometimes governmental. Medical requirements differ from country to country, and there is not international consensus as to their medical certificates. In Norway, they are employed by the Norwegian Coastal Administration. They have separate medical requirements, which are developed as close to the requirements for seafarers as possible. Risk assessment is simplified, as compared to seafaring. Physical requirements are stricter, as sea pilots on a regular basis have to climb ladders up to 8 meters length, but the area of operations always will be near-coastal, a fact that makes risk assessment different from that of seafarers.
 ILO C 188 – Work in Fishing Convention, 2007. Entry into force: 16 November 2017, at present ratified by 14 countries (per 29 October 2019).
 Regulations of 5 June 2014 No. 805 on medical examination of employees on Norwegian ships and mobile offshore units, Section 2, second paragraph, letters a and b.
 Bull N, Riise T, Moen B E. Occupational injuries to fisheries workers in Norway reported to insurance companies from 1991-1996. Occup Med. 2001;51(5):299-304. https://doi.org/10.1093/occmed/51.5.299
 Poggie J , Pollnac R B, and van Dusen C. Intracultural Variability in the Cognition of Danger Among Southern New England Fishers. Marine Resource Economics 11, no. 1 (Spring 1996): 23-30.
 Murray M, Fitzpatrick D, O’Connell C. Fishermens blues: Factors related to accidents and safety among Newfoundland fishermen. Work & Stress. 2007; 11(3):299-297. https://doi.org/10.1080/02678379708256842
 The Hardanger agreement: The e Offshore Operators Association from three countries involved in the North Sea: the UK (UKOOA); Norway (OLF); and The Netherlands (NOGEPA) have signed a reciprocal agreement known as the Hardanger Agreement which states that a valid medical certificate in one country will be valid in the two other countries within the agreement.https://www.nogepa.nl/download/hardanger-agreement-2000-07/?lang=en
 Oil & Gas UK
 Netherlands Oil and Gas Exploration and Production Association
 Regulations No 2257 of 20th December 2018 regarding medical examination of sea pilots and sea pilot apprentices (Only available in Norwegian at https://lovdata.no/dokument/SF/forskrift/2018-12-20-2257).