Maritime medicine is not a well established, nor a well defined discipline within the medical world. There is no speciality in the field, and the establishment of academic degrees has just started. Tentatively, a definition of maritime medicine could be “any medical activity related to questions concerning the employment, working conditions, living conditions, health and safety of workers at sea” This would include workers in the commercial fleet, the navy, the fishing fleet, sea piloting, offshore installations, and leisure boats.
For the development of a scientific discipline, learning material is indispensable. Except for a valuable publication within ship medicine, no comprehensive textbook has been available in the field of maritime medicine. It was this fact that prompted us to start working with the present product. It was important to us that the material should be available to everybody, anywhere, at any time, and free of charge. Because a printed version would not be able to meet theses criteria, we decided to go for a web based solution.
The advantages of an internet solution are evident: The product will be interactive and dynamic. Corrections and additions can be made at any time. Referencing with direct linking makes source searching easy. The inclusion of a social network represents an attraction. The technical solution makes the product readable regardless of screen resolutions.
It is unavoidable that a novel product like the present will have some teething troubles and some experimental features. Because the product is dynamic and subject to continuous revision, we have granted ourselves the liberty to publish at a time when some limited material is still pending.
The interactive capabilities of the product will allow experts in the field to contribute with corrections, improvements and additions.
It is our genuine hope that the “Textbook of Maritime Medicine” will be instrumental in defining and developing the discipline of maritime medicine, and that it will serve as comprehensive learning material for students, and as a reference tool for practitioners. We extend our sincere gratitude to everyone who has contributed to this product without any kind of compensation, and in particular to the editorial board. Without their enthusiastic cooperation and encouragement, the product would not have materialized.
Seafarers are people who live and work in surroundings that are very different from those ashore, whether they are engaged in maritime transport, fishing or leisure activities afloat. This means that their health problems and concerns are brought into a different focus and that their health care needs, while similar to those of everyone else, have quite different consequences for them and for those they work with. Seafarers as a group have high rates of serious and fatal injuries, especially in fish catching. A number of types of illness are more common in seafarers than in comparable onshore populations.
The special features of seafaring and its consequences for the health, fitness and wellbeing of those who work, or indeed travel; by sea is the subject of this book. Subsequent chapters detail different aspects of maritime medical practice, indicate why they are important and show how good practice can reduce harm and improve the wellbeing and performance of those whose work and life takes them to sea.
Any ship is a community, usually a small and self-sufficient one, where those aboard have a range of duties all of which are essential to its effective operation. Some tasks require particular capabilities, such as good vision for lookouts and a low risk of sudden incapacitation for lone watch keeping. Physical fitness is needed for many routine manual tasks and may be essential for any seafarer faced with emergencies such as fire or the need to abandon ship.
Historically seafarers have been the source of transmission of infectious disease from country to country. While this is now less important, infections need to be identified so that their spread on board ship can be minimised – especially from those who handle food or who may have infections that can be readily passed from person to person.
An ill seafarer or one who is injured at sea does not have ready access to professional health care. Hence there must be medical equipment available, a person trained to use it and ready access to information on the prevention, diagnosis and treatment of disease. Normally this is in the form of a manual and this is supported by international arrangements for access to radio medical advice all over the world.
Seafaring is, by its nature, international. This means that national laws and recommendations alone will do little to ensure health and safety on the seas of the world. There is now a framework of international conventions which form the basis for common global standards of safety and, to an extent, for maritime health provision. Health and safety at sea are challenges in an industry where ships may be owned in one country, trading between a number of different ones and crewed from several others by crewmembers that have different cultures and only a limited command of a common language.
Work on board has its own occupational risks: from the operations of the ship itself, from the cargo and from the consequences of fatigue and adverse interactions between crewmembers. The nature and scale of any risks will vary markedly between those who have different duties aboard and even more between crews on different types of ship. The small fishing vessel or work boat and the huge container ship or cruise liner are hugely different, but still the framework outlined above is relevant to seafarers on all of them.
Living aboard can also pose strains from unfamiliar diets and climates, from limitations in accommodation and from crewmembers not understanding and being empathetic to one another. Distance from familiar places and loved ones is also often an important contributor to distress.
Good maritime medical practice plays a part in meeting each these challenging situations, for some it is compliance with international and national requirements, good leadership aboard and adequate provisions for crew welfare that is most important, with only a minor contribution from those with maritime health expertise. But for others the wise use of such expertise is crucial. The main aspects where health expertise plays a key role both in advising on policies and in day to day practice are:
- Decisions on who can safely and effectively work at sea without risk to their health or to that of others.
- Arrangements for responding to medical emergencies at sea: training, provision of equipment, telemedical advice, evacuation.
- The care and rehabilitation of seafarers who have become ill or been injured
- Advice on working and living conditions that will be safe and without risks to health and the monitoring of those exposed to such risks to confirm that they have not been harmed
- Recommendations on preventative measures that can help seafarers maintain good health throughout their working lives and into retirement.
- The collection and analysis of data on the health of seafarers and its use to improve the quality of prevention and care in future.
Good practice requires a sound understanding of life and work at sea, of the concerns and attitudes of those who manage or represent seafarers, of the legal provisions that underpin maritime health and of the ways in which health professionals can contribute effectively to the health, safety and wellbeing of seafarers. All these topics and many more form the contents of this book.