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.

They constitute the fourth link in the preventive action carried out by the provincial and local health at sea centres( Social Marine Institute provincial and local directorates ). The aim is to influence the health knowledge of workers, involving them as an element responsible for their health and providing the necessary means to prevent the appearance of the pathologies with the highest effect in that population.

The following campaigns, among others, are worth mentioning:

• Prevention of sexually transmitted diseases, especially AIDS.
• Malaria prevention.
• Prevention of drug addiction.
• Prevention of occupational risks in the sector.
• Accident prevention on board.
• Risk prevention on deck.
• Mental health campaign.
• First aid on board.
• Smoking Prevention.
• On Board Physical Exercise Benefit.

• Healthy Eating.

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.

The mandatory on-board medical kits are regulated by Royal Decree 258/1999, of 12 February, establishing minimum conditions for the protection of the health and medical care of seafarers, amended by Royal Decree 1120/2021, of 21 December (Official State Gazette 305, 22.12.21). The control of the health and hygiene conditions of ships is a major task in the prevention of accidents and diseases on board ships.

There are different types of medical kits on board, depending on how far from shore the vessels work and how long it would take medical assistance to reach the vessel in case of emergency.

The periodical revisions of the regulatory medical kits  are carried out by the designated health personnel in the ISM Health at Sea Centres, located in the Provincial and Local Directorates of the Social Marine Institute, and their results are recorded in the corresponding medical kit revision certificate, valid for one year.

In all inspections, it shall be verified that the on-board medical kits are adequately stocked, that the conditions of conservation of the container and contents are adequate, that the expiry dates of the components are respected and that they are duly marked and identified. Likewise, the existence, registration and custody of the obligatory health documentation shall be verified, depending on the type of medical kit.

The application for the periodic review of the on-board medical kit will be made on the unified application form to be completed by companies (point 2) -available at the bottom of this information-, and must be submitted through the REVIEW SERVICE FOR MEDICAL KITS (REM) available at the Social Security E-Office. Applications for the revision of a medical kit may be submitted no later than two months after the expiry date of the previous medical kit revision certificate.

The application must be accompanied by the document checking the contents of the medical kit(s) for which the review is requested, duly completed by the on-board health officer, dated not more than 15 days prior to the application for review (see form at the bottom of this information).

Evidence must also be provided on the above aspects to verify compliance with the requirements established in relation to the container, contents, location, signage, maintenance of the on-board medical kit and availability of the health documentation of the medical kit (responsible declarations, invoices for the purchase of medicines, images relating to the container, signage and location of the medical kit, etc.).

Once it has been carried out, the skipper, captain or person in charge of health on board must keep the documents controlling the contents of the medical kit together with the Certificate of Health Check signed by the shipowner, until the next check-up. 

In order to apply for the prescription of the medicines included in the pharmacological provision of the medical kits of the ships, the unified application form to be completed by the companies (point 1) will be sent through the REVISION SERVICE FOR MEDICAL KITS (REM) available at the Social Security Electronic Headquarters.

The request for the documentation comprising the medical kit shall be made, where applicable,  in the unified application form to be completed by companies (point 3), through the REVISION SERVICE FOR MEDICAL KITS (REM) available at the Social Security E-Office.