Nebojša Nikolić

Self-reported injuries among seafarers Questionnaire validity and results from an international study

International surveys of occupational injuries among seafarers have so far been missing. It was the aim to test the method of self-report of injuries and length of time at risk during the latest duty period and second to study the injury incidence rate among seafarers by use of the method. A pilot study was conducted (n = 1068) in Finland, Denmark, the Philippines, Croatia and Spain using self-completed questionnaires with questions about the person, the ship, the duration of latest duty period and injuries. The duration of the self-reporting duty period was in the Danish part compared with information from the crew register of the Maritime Authority. For seafarers from merchant ships in the Danish sub-study there was acceptable correspondence between the information from the seafarers and the Maritime Authority, but not when referring to ferries and non-specified types of ship. Unadjusted and adjusted injury incidence rates-ratios (IRRs) based on number of injuries per number of work hours were calculated. Adjusted IRRs for ordinary seamen/officers: IRR = 2.43 (95% CI: 1.25-4.72); for age < 35/35+ years: IRR = 1.97 (1.02-3.81); length of tour: 117 days or longer compared with < 117 days: IRR = 0.46 (95% CI: 0.22-0.95); 57-70 working hours per week compared with < 57 h: IRR = 1.26 (0.48-3.29), 71+h compared with < 57 h: IRR = 2.12 (0.84-5.36). Non-significant IRRs >1.00 were found for ships under 10,000 GT compared with larger ships and for own flagged ships compared with ships under flag of convenience. In conclusion, more than 70 h of work per week was related to a higher rate of injuries for seafarers on merchant ships, but the result was not statistically significant. Self-report of the duration of the latest tour of duty is useful for seafarers from merchant ships with short-term employments, but not for ferries and other, non-specified types of ship with other or permanent employment.

Piracy on the high seas-threats to travelers' health.

BACKGROUND Piracy has been threatening international sea trade and creating risk for crews and passengers worldwide. The problem is largely confined to the Somalia coast, West Africa, South America, and Southeast Asia. The targets are merchant ships, cruising yachts, and passenger ships with several thousand people on board. Such attacks can result in loss of lives, short- and long-term health problems, and can further be complicated by the consequences of hostage situations on shore. The purpose of this article is to present the problem of piracy, its relevance to the field of travel medicine, and help travel medicine practitioners to deal with its specifics before, during, and after attack. METHODS Comprehensive literature research was done and published data from 2002 until 2012 from the International Chamber of Commerce specialized division-International Maritime Bureau (IMB)-on 3,806 attacks and 7,635 incidents involving human victims are analyzed. Available occupational health data in merchant marine and epidemiological data acquired on board cruise ships were used to estimate the health risks. RESULTS From 2002 until 2012, 3,806 ships were attacked including 82 yachts and 13 passenger ships. A number of reported piracy attacks worldwide continued to threaten security and lives on sea. In 2012, 297 incidents of piracy and armed robbery were reported, a total of 585 crew members were taken hostage, 26 kidnapped, and 6 killed as a direct result of the incident.(1) CONCLUSION: The risk of being injured or killed by pirates on board cruise ships is actually very low. Piracy on the worlds seas is in decline and remains a reasonably localized issue. While this improvement is a result of continued efforts of international naval forces, that protection is only partial and fails to suppress piracy completely. Piracy still presents significant threat to international travel, and future involvement of travel medicine practitioners in providing advice to travelers to piracy regions or victims of piracy is expected.

Medical problems in cycling tourism

I total there were 40 interventions: 7 injuries, 27 cardiovascular emergencies, and 6 other medical problems. Of 8 medical conditions encountered, 5 temporarily or 3 permanently prevented participants from actively participating in the cycling tour. One incident required treatment by a specialist (dislocated shoulder) in the community health care center, and one required hospital treatment in the, and one required hospital treatment in the regional clinical hospital. Only one patient was repatriated prior to the end of the tour. Cycling can be a dangerous sport, mainly because of the possibility for falls, and as a rule cyclists should wear helmets. In the tourist cycling tours, in wich amateur cyclists without previous medical examinations and fitness selection engage in a strenuous activity in unpredictable weather conditions, special attention must be paid to the organization of their medical assistance to ensure that intervention in the field can be provided in a reasonably safe time window and that adequate transport to a higher level of medical care is avaiable if needed.

A Medical Support in Offshore Racing Workshop on Learning Competences/Outcomes, 4–5 November 2016, Barcelona, Spain

1Workshop Chairman, World Sailing Medical Commission, Croatia 2Norwegian Centre for Maritime Medicine, Norway 3International Maritime Health Association, President, Russia 4Volvo RWR, United Kingdom 5Volvo Ocean Race and Trophy Jules Verne, Sweden 6United States Sailing Safety at Sea Committee, Wilderness Medical Society, United States 7French Society of Maritime Medicine, France 8Spanish Olympic Sailing Team, World Sailing Medical Commission, Spain 9Medical Trainer MARCDOC, Philippines 10World Sailing, Technical and Offshore Manager, United Kingdom

A Medical Support in Offshore Racing Workshop, 6 November 2015, Sanya, China

1Workshop Chairman (ISAF Medical Commission Member), Croatia 2President International Maritime Health Association, Russia 37 Whitbread RTWR/Volvo Ocean Races + 2 Multihull Circumnavigations, Sweden 4Medical Support Offshore Ltd., Great Britain 5Emergency Medic Douarnenez Hospital, France 6Bergen Telemedical Support, Norway 7Chairman ISAF Medical Commission, Netherlands 8ISAF Technical and Offshore Manager, United Kingdom