title: Mapping the knowledge base for maritime health: 4 safety and performance at sea.
abstract: There is very little recent investigative work on the contribution of health related impairment and  disability to either accident risks or to reduced performance at sea, the only exception being  studies on fatigue and parallel data on sleep related incidents. Incidents where health related  impairment, other than fatigue, has contributed are very rarely found in reports of maritime  accident investigations. This may either indicate the irrelevance of these forms of impairment to  accidents or alternatively point to the effectiveness of existing control measures. The main approach  to risk reduction is by the application of fitness criteria to seafarers during medical  examinations. Where there is a knowledge base it is either, as in the case of vision, a very old one  that relates to patterns of visual task that differ markedly from those in modern shipping or, as  with hearing, is based on untested assumptions about the levels of impairment that will prevent  effective communications at sea. There are practical limitations to the assessment of cognitive  functions as these encompass such a wide range of impairments from those associated with  fatigue, medication, or substance abuse to those relating to age or to the risks of sudden incapacitation  from a pre-existing illness. Physical capability can be assessed but only in limited ways  in the course of a medical examination. In the absence of clear evidence of accident risks  associated with health-related impairments or disabilities it is unlikely that there will be pressure  to update criteria that appear to be providing satisfactory protection. As capability is related to  the tasks performed, investigations need to integrate information on ergonomic and organizational  aspects with that on health and impairment. Criteria that may select seafarers with health-  -related impairment need to be reviewed wherever the task demands in modern shipping have  changed, in order to relax or modify them where indicated in order to reduce unjustifiable  discrimination.
authors.affiliation: Norwegian Centre for Maritime Medicine, Department of Occupational Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway. Tim.carter@mcga.gov.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Carter
mesh_terms: D000062:Accidents, Occupational / Q000706:statistics & numerical data*; D006804:Ergonomics; D055317:Evidence-Based Practice; D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D038622:Internationality; D051188:Knowledge Bases; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control; D016272:Occupational Health / Q000706:statistics & numerical data*; D009792:Oceans and Seas; D010807:Physical Endurance; D012893:Sleep Wake Disorders; D013647:Task Performance and Analysis