Preventive Medicine

In accordance with the directives of  the ILO , in its Conventions 16, on the Medical Examination of Young Persons, 73, on the Medical Examination of Seafarers, and 113, on the Medical Examination of Fishermen, the ISM  provides free medical examinations for sea-service to all sea workers.

These examinations, which are compulsory and take place prior to the employment of sea workers, aim to ensure that an applicant's psychological and physical condition is compatible with the characteristics of their job post and does not entail any risk for the health and safety of the individual or the rest of the crew. Nor should an applicant's condition put maritime navigation at risk.

Medical examinations not only guarantee that workers go on board ships in the best possible psychological and physical condition, but also, from a health care perspective, provide a starting point for assessing the health of the working population, which is extremely useful if a worker requires on-board medical attention from any of the health care units that make up the Maritime Health Care Programme.

To be eligible to undergo the medical examination for sea-service, in accordance with Royal Decree 1696/2007, of 14 December, the interested parties, who must be over the age of 18 and not in a situation of temporary disability or sick leave, or in a period of employment relationship suspension due to risk during pregnancy, must request it at any of the Maritime Health Care Centres of the ISM, in the Provincial Directorates and Local Offices of the ISM, and meet the following requirements:

• Applicants with Spanish nationality must submit their seafarer's discharge book and a document certifying that they have passed the basic training course or equivalent in compliance with section A-VI/1 of the Training Code of the STCW-78/95 Convention.
• Citizens of the European Union or any country that is part of the European Economic Area Agreement must submit their foreigner identity number, passport or residence card and be in possession of a certificate proving that they have passed the basic training course or equivalent in compliance with section A-VI/1 of the Training Code of the STCW-78/95 Convention.
• Citizens of countries that are not included in the foregoing paragraphs must submit their foreigner identity number, passport or residence card and work permit or equivalent authorisation, along with a certificate proving that they have passed the basic training course or equivalent in compliance with section A-VI/1 of the Training Code of the STCW-78/95 Convention.
• Professional divers must also have active contributor or assimilated contributor status in the Social Security's Special Scheme for Sea Workers. Likewise, they must provide a seafarer's discharge book including a record of the last three years and an underwater activities log book.

In any event, the ISM forewarns workers of the periodic medical examinations for sea service by sending them information letters reminding them that their previous examination has expired and that they need to attend for renewal at any of the Maritime Health Care Centres of the ISM, in the Provincial Directorates and Local Offices of the ISM.

The period of validity for these medical examinations is determined in each case by the doctor performing the examination, who carries them out according to the worker's health condition, age and type of work to be undertaken. The maximum period of validity is generally two years or one year for young persons under the age of 21 and adults over the age of 50.

Article 9 of the International Labour Organization Convention 164, on Health Protection and Medical Care for Seafarers, of 1987, states that persons in charge of medical care on board who are not doctors shall have satisfactorily completed a course approved by the competent authority of theoretical and applied training in medical care. It sets out an elementary and a higher level training course depending on the tonnage of the ship and the time it takes to obtain qualified medical care.

To this regard, Royal Decree 258/1999, of 12 February, which sets out minimum conditions for health protection and medical care of sea workers (BOE  of 24 February), governs certain basic matters related to health protection of sea workers: the contents of medicine chests on board ships including the On Board Health Care Guide, minimum health care facilities on board ships, obligatory health care training for crew member and the designation of the Radio-Medical Centre of the Social Marine Institute as the fleet's permanent health care centre.

Subsequently Order PRE/646/2004, of 5 March, sets out the minimum of contents of specific health care training programmes and the conditions for the issuance and certification of health care training certificates for sea workers. Two health care training certificates for sea workers have been created:

• Beginner Specific Health Care Training: This is equivalent to training in on board first aid set out in Rule VI/4 section 2 of Appendix 1 of 2001/25/EC Directive on the Minimum Level of Training for Seafarers (Rule VI/4-2 of the STCW-78/95, section A-VI/4-1). The persons required to be in possession of this certificate are: all officers in charge of engine room watch.
  Captains, skippers and officers in charge of navigation watch on ships required to carry Medicine Chest C in accordance with the provisions of Royal Decree 258/1999, of 12 February.
• Advanced Specific Health Care Training: This is equivalent to training in on board medical care set out in Rule VI/4 section 1 of Appendix 1 of 2001/25/EC Directive on the Minimum Level of Training for Seafarers (Rule VI/4-2 of the STCW-78/95, section A-VI/4-2). It is obligatory for:
  Captains, skippers and officers in charge of navigation watch on ships required to carry Medicine Chest A or B, in accordance with the provisions of Royal Decree 258/1999, of 12 February.

Specific Health Care Training certificates shall have a maximum validity of five years and, once this period has passed, a new Specific Health Care Training (Beginner or Advanced) course must be taken in order to renew them.

The information gathered during the medical examinations for sea service is used to design and run preventive health advertising campaigns.

These campaigns are the fourth step in the preventive actions carried out by provincial and local maritime health care centres (Provincial Directorates and Local Offices of the ISM). They aim to increase health awareness among sea workers by involving these in their own health and providing them with the necessary tools to avoid the pathologies that most commonly affect this group.

The campaigns are on issues such as:

• Sexually-transmitted disease prevention, especially AIDS.
• Malaria prevention.
• Drug addiction prevention.
• Industrial risk prevention in the Sector.
• On-board accident prevention.
• On-deck risk prevention.

Vaccination campaigns are implemented through the Maritime Health Care Centres, located in the Provincial Directorates and Local Offices of the ISM, either working independently or with other Public Health Organisations.

In addition, many Maritime Health Care Centres carry out important preventive work by running national, provincial and local vaccination campaigns against particularly serious diseases such as tetanus, influenza and hepatitis B.

Monitoring health and hygiene conditions is an extremely important part of preventing accidents and diseases on board ships.

Since the publication of Royal Decree 258/1999, of 12 February, health care personnel assigned to this task by the Social Marine Institute (ISM), have been carrying out periodic inspections of on-board medicine chests.

There are several types of medicine chests, depending on the distance from shore the vessels normally work and the length of time it would take for appropriate medical care to reach the vessel in case of medical emergency.

The inspections are carried out annually at the Maritime Health Centres of the ISM, located in the Provincial Directorates and Local Offices of the ISM,  when the medicine chests are easily transportable (Medicine Chest C for ships), or on the vessel itself (Medicine Chests A, B, C for life jackets and antidotes), to which the competent health care personnel of the Maritime Health Centres travel.

In the inspections it is checked that the medicine chest complies with the provisions in Royal Decree 568/2011, of 20 April, which amends Royal Decree 258/1999 with regard to both the container and the content, as well as the provisions on health-related documentation (control documents, inspection certificates, etc.) which must be included in every medicine chest.

The medicine chest control documents shall be filled in by the on-board health coordinators, prior to their inspection. Once the inspection has been carried out, the skipper, captain or on-board health coordinator must keep the control documents until the next inspection, together with the inspection certificate of the medicine chest(s), which certifies the validity of the inspection. These documents must be provided to the inspector in the next inspection.

The On-Board Health Guide is a compulsory item in a ship's medicine chest. It has been published and distributed free of charge by the ISM and has been designed as a reference handbook containing the basic knowledge that ship health coordinators should have, as well as a practical list of the procedures to follow, but always upon the medical advice of the doctors at the Institute's Radio Medical Centre.

The medicine chest control documents (Excel files) and the Royal Decrees that regulate this area (PDF documents) are attached below: