White Paper: Standardized Compliance of Maritime Medical Surveillance

Standardized Compliance of Maritime Medical Surveillance

A White Paper by National Medical Systems

Copyright 2012 National Medical Systems. All Rights Reserved


Since humans first dugout canoes approximately 45,000 years ago in modern day Australia, humans have traveled the seas for food, exploration, commerce and war. As history has progressed, the seafarer has become increasingly more specialized and in-demand. One facet that has stayed constant throughout maritime history though is the threat of illness and injury to seafarers. Centuries old legendary tales of explorers embarking on famous expeditions, or countries participating in trade missions are typically accompanied with stories of crew dying due to diseases such as scurvy, cholera, or dehydration.

In present day, national economies are still reliant on the goods and services from maritime endeavors including industries such as tourism, energy, communications and food. However, despite the advent of modern medicine, seafarers continue to be at a much higher risk for illness and injury compared to typical land-based workers. According to OSHA, maritime work is traditionally more hazardous with an injury-accident rate more than twice that of land based labor. 1

Crews of merchant ships are exposed to extremes of weather, hazards connected with the operation of mechanical equipment, toxic cargoes and toxic substances used aboard. Seamen are swept overboard by heavy seas, and die as a result of vessel casualties (such as foundering, capsizing, explosions, fires). Their health is affected by noise, vibration, smoke inhalation, fatigue, overwork, and other exposures…" 2

As a result of higher physical job demands and higher-risk work environments, various international labor and maritime organizations such as the International Labor Organization, the United States Coast Guard and the UK Maritime & Coastguard Agency have required shipowners to provide medical examinations to seafarers prior to working at sea. The medical examinations are a criterion put in place for several reasons:

  1. To determine if a seafarer can perform his or her physical job requirements.
  2. To determine if the seafarer has medical abnormalities that will keep him or her from performing their duties.
  3. To determine if abnormal medical conditions that are found on the exam are likely to occur at sea.
  4. If medical abnormalities are found, to determine what type of risk the seafarer and other persons on board are susceptible to.

Based on these general requirements and the laws of each respective maritime organization, seafarers must meet certain health requirements in order to be deemed fit for duty.


Because maritime organizations have required shipowners to be compliant with the medical standards, shipowners are legally mandated to provide appropriate medical screenings for seafarers. Shipowners bare the burden of creating & setting medical protocols, providing an ongoing surveillance program, as well as researching & interpreting newly passed maritime legislation. The medical surveillance program must be carried out for multiple job functions (depending on the complexity of the vessel).

Failure to adopt an effective medical exam program compliant with regulations can have the following negative impacts:

  1. Seafarers working with undiagnosed and undocumented chronic medical abnormalities. Increasing occurrences of health risks that may lead to reportable injuries, payout of insurances claims and even death.
  2. Litigation and Workers Compensation payouts
  3. Fines from the respective maritime organization
  4. Negative publicity (violations are published)
  5. Uncontrolled costs
  6. Lost productivity and gap in labor from injured or sick seafarers
  7. The need to evacuate a sick or injured seafarer via helicopter.

Because the shipowners must comply with the appropriate maritime regulations, they must create a medical surveillance program that provides a comprehensive medical exam. The responsibilities include interpreting regulations, and finding appropriate physicians & medical clinics to conduct the examinations. In addition they must create a standardized process that ensures that each seafarer, regardless of their location receives the same medical exam every time. This means that each seafarer should be examined with the same medical protocol, receive the same diagnostic tests, and receive the same unbiased and professional opinion from each physician who conducts the medical exam.

Because of the dispersed nature of the maritime industry and the need to staff crew from multiple ports, dispersed crew results in the need for multiple clinics to conduct the medical exam. This in turn creates a high degree of variance from clinic-to- clinic since no two clinics are alike - physicians come from different educational backgrounds, and have different practice methods. Therefore each physician will have different opinions on work status. The outcome is that it becomes extremely difficult for the shipowner to create a standardized program.

In most cases, because the shipowner is unable to oversee a medical surveillance program, inconsistencies exist in the standards from clinic to clinic. The outcome is that many seafarers board vessels with medical conditions that can result in illnesses and injuries. For seafarers that are not screened properly, and have abnormal medical conditions, the shipowner is legally required to pay benefits for preexisting medical conditions. Had the seafarers received comprehensive exams, they would have been deemed unfit.

Because of the serious implications of non-compliance of maritime standards, National Medical Systems has developed a Standardized Compliance Program (SCP) for maritime medical examinations. The SCP provides a complete, all-encompassing process that fully customizes medical surveillance programs across all maritime occupations and risk factors. It is designed to support organizations by providing an expertise of medical solutions, management, cost-savings, compliance, and IT. With the SCP, shipowners can realize ROI by promoting a healthy workforce.


The Standardized Compliance Program (NMS Model)

In 1994 National Medical Systems was founded with the goal of establishing a Standardized Compliance Program for medical surveillance. The SCP was created after a comprehensive analysis of mandatory medical requirements and the shortfalls organizations encounter trying to be compliant.

Shortfalls include:

  • Lack of standardization and centralization
  • Lack of communication
  • Limited understanding of proper maritime medical protocol
  • High variance of medical results
  • Uncontrolled costs

With shipowners executing a non-standardized medical exam scheme, they will inevitably carry much higher risk and increase cost due to a higher incidence of sick and injured seafarers.

Conversely, the SCP offers a standardized approach that provides a managed layer of protection. Through its various resources and organizational philosophies, NMS has created a proven process of program creation and execution. The end product is a customized but standardized compliant medical surveillance program.

The SCP was founded on six core values:

Maritime Health Experts - Consisting of a Corporate Medical Director who oversees and provides direction on all medical surveillance initiatives, NMS comprehensively reviews all current maritime regulations.

Centralized Management - At the core of SCP is NMS's centralized management approach. All information and communication enters into NMS's management crux and is delivered to the shipowner directly. This eliminates the need for the shipowner to deal with a multitude of clinics and clinical contacts. This eliminates administration and variance.

Standardized Medical Review - Medical review of employee health screenings is overseen by NMS's Medical "Clearing House". When medical records are passed down from the clinic to NMS, they are checked for completeness and then rated as fit or unfit. All medical reviews follow a strict, literal interpretation of the medical guidelines. Maritime regulations are intentionally strict because of the higher job demands, and the lack of access to emergency treatment. By following strict medical guidelines, NMS eliminates variance in its medical clearances and thus eliminates risk for shipowners.

Standardized Pricing - As part of their SCP model, all medical screenings are priced with a single charge, regardless of location and other variables. With the ability to offer clients 'exam widgets' that have set prices, organizations have the ability to accurately forecast their medical surveillance budget with 99% accuracy.

Multi-Channel, Multi-Directional Communication - NMS preaches a policy of open communication. All communication at NMS travels in a dynamic multi-directional model. NMS communicates with all related parties, including the organization, in a two-way feed- back loop. Information about medical results flows from various clinics to NMS for review; similarly NMS manages and gives direction to clinical staff on information such as correct medical protocol and maritime medical standards. NMS also communicates with the organization in a two-way feedback loop: NMS delivers medical clearances to the organization; similarly the organization communicates with NMS via consultation on aspects of the program such as standards or program execution. In regards to technology, NMS communicates with various mediums including its employee tracking system, the Health Depot. By adding a multi-layer communication structure, transparency is added to the program which results in less administration for the shipowner.

Integration - As part of standardization, NMS designs its medical surveillance program to integrate into the shipowners management scheme. Therefore, all communication tactics are created to fit in sync with the organization. This results in minimal administration for program adoption - a turnkey solution.

NMS utilizes these core values for its main processes involved in Program Creation and Execution:

Program Creation:

NMS' management approach for maritime medical surveillance

Understanding Need

With each shipowner having different job demands, dispersed in different ports, and dealing with different health & safety hazards, there is a high variance of needs. This requires the need for a customized program. Therefore, NMS first interviews the shipowner that is requesting a medical exam program. During its initial fact finding, NMS discusses and learns job functions, safety hazards & risks , locations of the ports, and current surveillance measures.?Fig 1. The SCP Model which demonstrates the standardized approach. It involves centralization of tasks, integration into the client organizations processes and interpretation of the medical results in accordance with established medical guidelines.

Medical Standard Creation

Upon the completion of its initial interview, NMS's Medical Department meets to create medical protocols for each respective job function. Using information obtained in the interview, and reviewing current maritime regulations, NMS creates a medical protocol that fulfills all requirements. Factors such as risk, age, job capacity, and work environment are considered. A list of medical procedures are generated that provides surveillance of the seafarers health. The final medical protocol is fully vetted and approved by NMS's Corporate Medical Director.


Upon being awarded the program by the organization, NMS holds a second meeting with its Administration and IT Department. During this meeting, the medical surveillance program is introduced and protocols are explained in detail. Administration and IT work conjunctively to create customized Physical Examination forms; communicate standards to each clinic; and create the online environment for the organization to access NMS's employee tracking system, the Health Depot.

Upon the completion of the Program Creation steps, the medical surveillance program is executed.

Program Execution

Roster Review and Examination Scheduling

The program is first executed with a roster review. All seafarers who are under the umbrella of the medical surveillance program are entered into an NMS database. Demographics and exam expiration dates are reviewed and entered. 30-60 days prior to the exam expiration, NMS begins to contact employees to make arrangements for their examination.

Clinic Management

NMS makes arrangements with the clinic and gives specific instructions and direction on the type of examination that is to be administered. NMS communicates the maritime medical standards to the clinical staff including the examining physician. NMS provides the clinic documentation on medical guidelines as well the necessary medical supplies.

Baseline Health Assessment

The examination is performed in accordance to the medical protocol that was designed by NMS. The employee's health is documented to create an initial assessment that will be used as a comparative basis for future screenings, and as a starting point - the seafarer's baseline medical finding is documented to prevent an attempt to claim an illness after the commencement of employment.

Medical Review Process

Upon completion of the baseline health assessment, NMS's "Clearing House" rigorously reviews the medical record in accordance with the medical guidelines. All abnormalities or potential risk factors are investigated. Any seafarers who list questionable medical history are contacted personally for consultation with the NMS Medical Director.

Reporting of Results to Shipowner

After the completion of the medical review, NMS reports the results to the client with a fit or unfit rating through a secure, encrypted connection in their employee tracking system, the Health Depot

Reporting of Results to Seafarer

All and any abnormal findings are noted on the medical record. NMS creates a letter documenting the abnormal findings and provides a copy of the physical exam to the seafarer. The letter serves as a medical record that the seafarer uses when visiting his/her personal physician for treatment of the problem.

On-Going Surveillance

One of the most important facets of the medical surveillance program is the continual process of screening seafarers. By screening seafarers on a year-to-year basis, all findings can be compared from one year to the next. As NMS performs its on-going surveillance, it makes comparison to prior year's results. This promotes a healthy workforce. It ensures that the organization is not only compliant, but is taking an active role in ensuring the health of its workers.

On-Going Consultation

As the program progresses, inevitably organizations change, and expand. To adjust to these to changes, NMS continually provides on-going consultations to the shipowner for expansions or changes in their current business scheme.

Medical Record Retention

Upon the completion of a medical screening, NMS becomes the custodian of the medical record for the shipowner. The records are stored and retained in compliance of maritime regulations.


All invoices are sent directly from NMS to the organization. Rather than from various clinics, a single monthly invoice is sent to the appropriate department and can be customized to include cost-center numbers for quicker processing. Simple invoicing allows for the organization to eliminate administration.


As organizations assess their management options for a standardized medical surveillance program, the SCP not only provides the best approach but also the best value in terms of removed risk and cost. Because of the "Clearing House" model for medical review, medical results are put through the proverbial "wringer" to ensure fit employees are in-line with the program's guidelines. The centralization of tasks means the program is managed by NMS's corporate structure and not satellite locations. Compiled together, all of the elements add a layer of protection to the organization. The SCP assumes the risk for the program which removes the liability from the organization.

In addition, because of the standardized pricing model, organizations can forecast their medical surveillance expenses within 99% of the predicted cost. The SCP allows for organizations to make exam requests that have set prices similar to ordering a widget or product.


In today's climate, with the need for shipowners to follow and adhere to maritime regulations, an organization must provide a comprehensive medical surveillance program for its seafarers that is cost effective. The benefits of medical surveillance is that by promoting a healthy working staff, seafarers are more productive. In addition, shipowners reduce the risk of injury and health claims. However, because of the burden that is needed to carry out an effective program, organizations must contribute various resources in terms of staff, capital and time. NMS's SCP model was built to provide a standardized turnkey program. The SCP not only removes liability from the organization but allows the organization to concentrate on more direct business matters by alleviating the administrative burden of managing medical surveillance. Thus, what was once an organizational responsibility becomes the responsibility of NMS.