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Coast Guard Planning To Set Guidelines for Medical Exams

Passing the U.S. Coast Guard-required medical examination for a merchant-mariner license or document has never been the most rigorous test of one's fitness.

An eye exam certifies visual acuity and tests for color blindness; there is a nominal hearing test ("Can you hear me now?" the attending physician has been known to ask in a whisper from across the examination room); and the physician is asked to determine whether the applicant is "fit for duty."

But exactly how is one's fitness determined? It is not specified.

Of the thousands of physicians, physician assistants and nurse practitioners around the country who are certified by the Coast Guard to authorize mariners as fit for duty, none is required to determine anything more than general fitness-no guidelines whatever currently exist regarding what constitutes fitness. Mariners must currently take a medical exam every five years, when a license or document is renewed.

This is all about to change.

Beginning in the not-too-distant future (the Coast Guard has not yet announced when such a change could take place) mariners can expect to have their medical exams more closely resemble those of other transportation industry personnel, such as the Department of Transportation and Federal Aviation Administration, which both require extensive medical checks of licensed personnel. Such exams could include lifting and carrying a 55-pound object for a specific distance; agility tests; climbing ladders; walking heel-and-toe in a straight line; walking up and down a stairway within a certain period of time; donning an immersion suit; moving through a hole measuring 2 feet by 2 feet; and performing numerous crouches, crawls and deep-knee bends.

The draft document also included standards for evaluating an applicant's condition due to numerous illnesses, diseases and medical problems, including diabetes, hemophilia, certain types of cancer, cardio problems, neurological and psychological disorders, allergies, and infectious diseases. The standards also discussed numerous medications.

STCW (International Convention on Standards of Training, Certification and Watchkeeping for Seafarers) stipulates that each governing agency draft medical standards. Spurred by that requirement, the Coast Guard is concerned about the current lack of medical guidelines, according to Stewart A. Walker, chief of the Licensing and Evaluation Branch of the National Maritime Center.

"There are some areas where the existing guidance is insufficient to inform an examining medical conditions," Walker said in an email interview.

And as ships' crews become further reduced for cost-saving measures, it is clear fewer people are being given more responsibility, whether navigating on the bridge, operating damage-control equipment like fire hoses and lifeboat falls, or monitoring sensitive equipment in the engine room and machinery spaces.

The Coast Guard recently drafted a sample medical evaluation and list of standards, asking for public comment.

One of the more nebulous areas in the new testing requirements could well be in the section that discusses the allowable use of pharmaceuticals.

"The guidelines are vague about certain conditions like depression. There are a lot of mariners who take medication for depression, for example," said Dr. Ray Jarris, a physician with Health Force, a company that offers medical evaluation and consultation with transportation companies. "Under the guidelines that were circulated, anyone being treated for depression will require a waiver. Is the National Maritime Center prepared to handle all these waivers?"

Jarris said that he sees the Coast Guard's attempt to impose medical standards on the maritime industry as a good idea, but he regards the process as a bit of a Pandora's box. Health Force responded to the Coast Guard's request for comment in a detailed letter, which outlined numerous potential conflicts and vagaries.

"The proposed standards are a good effort," Jarris said. "They show promise, but I would like to see better guidance, since mariners might find themselves in unfair situations. As a doctor, I have serious questions about whether the new standards adequately answer the question. "Who is healthy enough to go to sea?" At this point it's very incomplete."

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