Illness to Fitness Determination
Advice on Quickly Obtaining Fit for Duty Status in the United States
Crew members sometimes need medical care. This surprises no one. Even with the best planning and practices in place, injuries and illnesses occur. Fortunately, ship owners and crew members need not resign themselves to hapless floundering when faced with medical adversity. SphereMD has identified concrete, practical steps that can be taken to minimize disruption when medical incidents take place. Based on extensive experience, SphereMD has identified the following four specific actions that can help streamline treatment and recovery. This practical advice benefits ship owners and crew members alike.
#1: Get Help While at Sea
As soon as a medical issue arises, communicate! Start the process of treatment and help before the ship arrives at its intended or nearest port of call. The sooner communication begins, the sooner the crew member may be returned to fit for duty status.
Specifically, seek medical advice via email or radio. Contact a medical provider, such as a physician’s assistant or nurse, to discuss the issue. This contact is proactive. Medical providers can describe the best way to care for a crew member while the ship is at sea. Treatments will typically be simple to implement, such as immobilizing the injured crew member, applying ice treatments, administering anti-inflammatory medication, enabling rest or relief, and so forth. These treatments can clear the way for an easier transition to a care facility as soon as the ship reaches port.
#2: Schedule Medical Appointments Two Days Prior to Port
When the ship is two days out from the next port, reassess the situation. If the crew member continues to
suffer from an injury or illness, a land-based medical appoint should be scheduled to take place as soon as possible after the ship docks. This is when a professional medical manager’s knowledge and contacts can be invaluable.
If a ship owner contracts with a medical manager, the medical manager can gather the most up-to-date information about the crew member’s medical condition along with the ship’s arrival schedule. Armed with this information, the medical manager can schedule an appointment with a prescreened
and appropriate medical facility, physician, or medical specialists.
Scheduling early ensures appropriate medical resources will be available when the ship arrives. If the crew member recovers before the ship reaches port, the medical manager can easily cancel the arrangements.
Warning: Waiting to make medical arrangements until after the ship arrives in port can result in unnecessary delays and expensive trips to hospital emergency rooms. Emergency room visits are especially problematic for a quick return to fit for duty status, as described in the sidebar.
Best Fit for Medical Services
Emergency rooms in the United States are expensive. Avoid them! Exorbitant costs aside, they also bring a host of complications regarding fit for duty status releases. Emergency rooms:
- Tend to issue more restrictive fit for duty statuses.
- May require follow-up appointments or treatments that fail to consider ship movements.
- Are often unwilling to complete ship medical paperwork (U.S. law does not require emergency room physicians to complete fit for duty paperwork).
- May omit mention of fit for duty status during the original visit, which means the physician must be revisited later (requiring extra time, paperwork, and costs) to acquire a fit for duty status.
To avoid emergency room pitfalls and access the best medical services in each port, work with a medical manager. A medical manager, like SphereMD, can ensure that each crew member in need visits the most appropriate physician (such as an eye doctor for an eye injury) and clinic or facility. Over 90% of medical treatments can be handled by clinics or non-urgent care facilities. This approach is cost effective, medically sound, and streamlined. As an added benefit, identified care providers are already familiar with completing medical paperwork for ships, including Fit for Duty forms.
#3: Share Requirements and Flexibility of Duties
Be prepared to provide information about a crew member’s roles, responsibilities, and duties. In other words, keep communicating! This information needs to be specific. A medical manager can help convey this information to medical care providers. As much as possible, physicians should understand ways the crew member may be able to modify tasks or receive flexibility in assigned duties.
The goal is to expand the medical provider’s options in terms of granting fit for duty status to the crew member. When a medical provider understands how a crew member’s duties may be adapted to allow continued healing, the possibility of granting fit for duty status increases.
A couple examples of communicating flexibility:
- Suggest allowing light duty restrictions, such as two-hour work shifts with intermittent breaks, if possible and appropriate.
- Explain that the crew member’s responsibilities mainly consist of bridge duty, which enables the crew member to stay seated.
#4: Share Port-of-Call Schedule
Among other information provided to physicians, the port-of-call schedule should be shared. This may seem unnecessary, but physicians, especially in the United States, want to be reassured that crew members will have access to quality care. Any near-term visits to other U.S. ports will indicate that adequate follow-up medical care will be accessible, as needed. With this reassurance, physicians are more likely to approve fit for duty status.
Further, if a crew member is not fully fit for duty, U.S. physicians will be more confident about granting a “fit to sail” status pending a near-term stop in another U.S. port. With a fit for sail status, the crew member can return to the ship in compliance with its crewing certificate. Fit to sail status can eliminate unnecessary repatriation costs.
As you can see in the actions described, SphereMD’s experience emphasizes the need for early and ongoing communication, including:
- Early intervention
- Efficient scheduling
- Clear communication of duties and flexibility
- Transparent ship schedule
