COMPREHENSIVE PEME
and
MEDICAL REPATRIATION
DR. PASCUALITO GUTAY
SuperCare Medical Services, Inc.
Guidelines on the Medical
Examination of Seafarers
A brief history and background
1921
1946
• The Medical Examination of Young Persons (Sea) Convention was established,
concerning the compulsory medical examination of children and young persons
employed at sea.
• The Medical Examination (Seafarers) Convention was established, which later on
became one of the consolidating instruments of Maritime Labor Convention 2006.
• The STCW Convention was the first to establish basic requirements on training,
certification and watchkeeping for seafarers on an international level.
1978
• The ILO and WHO published the first international guidelines concerning the medical
examinations of seafarers.
1997
2006
2013
• The ILO recommended a revision, as did the IMO, in its review of the STCW
conventions. The ILO and the IMO subsequently agreed to create a joint working
group to develop revised Guidelines.
• The Maritime Labor Convention 2006, an international labour Convention adopted
by the ILO, entered into force and became a binding international law.
Medical Screening Objectives
Medical certification of physically fit
candidates
Lifestyle modification and disease
prevention or treatment of seafarers with
medical conditions but can still perform
the functions of their ship duties safely
Top Ten Most Common Causes of
Medical Repatriation
1
Appendicitis
2
Urinary Tract Stones
3
Hypertension
4
Gastritis
5
Inguinal Hernia
6
Cardiovascular Disease
7
Gall Stones
8
Haemorrhoids
9
Diabetes Mellitus
10
Cerebrovascular Disease
“A statistical study of the medical causes for repatriation among Filipino seamen”
~Dr. Nicomedes Cruz, August 2004
SuperCare Medical Services, Inc.
 Established on December 17, 2001
 Authorized by the DOH, POEA, MARINA
 Certified by Bureau Veritas for ISO 9001:2008
Quality Management System with a rating
of 100%
 Insured By Jardine Lloyds Thompson
Insurance Brokers, Inc.
SuperCare Enhanced PEME Package
 History & Physical Examination
 Blood Uric Acid
 Dental Examination
 Cholesterol
 Chest Xray
 Triglycerides
 Complete Blood Count
 SGOT
 Blood Typing
 SGPT
 Urinalysis
 HbA1c
 Audiometry
 HIV/AIDS Test
 Visual Acuity and Ishihara
 Hepatitis B Screening (HBsAg)
 VDRL/RPR
 Whole Abdominal Ultrasound
 Electrocardiogram
 Drug Test
 Fasting Blood Sugar
 Fecalysis (for Food Handlers)
 Blood Urea Nitrogen
 Stress Test (for >40 yo)
 Creatinine
Crew
Identification
• Referral form plus at
least 2 valid IDs
• Digital picture taking
Laboratory
Examinations
• Blood Extraction
• Clinical Microscopy
• Drug and Alcohol
Testing
Performance
of PEME
Tests
• Chest X-ray
• Medical History &
Physical Examination
• Medical Procedures
e.g. ECG, BMI,
Audiometry, Visual
acuity
• Dental
• Spirometry
Other PEME
Tests
• Treadmill Stress Test &
Whole Abdomen
Ultrasound
Initial
Evaluation
c/o Follow up
Doctors &
Assessment
nurse
• Completeness of tests
• PEME findings requiring
further evaluation
• Health Advice c/o the
Follow-up Physicians
• Daily PEME Status report
• Medical Updates
Final
Evaluation
c/o PEME
Manager
• Final medical fitness
assessment
• Release of Fit/Unfit
PEME certificates
PEME Output of Participating
Shipowners
June 2013 – May 2014
Total number of PEME
8,435
Total number of FIT
8,259
Total number of UNFIT
Total number of TEMPORARY UNFIT
107
69
Participating Shipowners
June 2013 – May 2014
Temporary
Unfit
Unfit
Total PEME
8,435
Total FIT
8,259
97.91%
107
1.27%
Unfit
Fit
Temporary
Unfit
69
0.82%
PEME SUMMARY
Causes of Unfitness
Hypertension, Diabetes and Obesity
27
(+) Confirmatory drug test
13
Lumbar X-Ray findings
12
PTB Class III
8
Hepatitis B reactive, new hire
7
ECG findings
7
Elevated Blood Pressure (new hire)
6
Inadequate audio
5
Pulmonary fibrosis
4
HIV (+)
3
Psychiatric findings
3
Gallstones
3
Hypertension and Diabetes Mellitus with maintenance medications
2
HPN new hire
2
Ishihara defective with watchkeeping duty
Renal mass (advised for nephrectomy)
Kidney stone
2
1
1
Recurrent Glaucoma
1
Medical Repatriations of Participating
Shipowners
Rank
Disease / Medical Condition
# of repat
patients
% of repat
patients
15
17.65%
14
16.47%
13
15.29%
11
12.94%
4
Back Pain (Lumbar Muscle Strain,
Degenerative Disc Disease)
Appendicitis
Muscle, Tendon and Joint Inflammation on
Upper Extremity; Musculoskeletal Pain
Acid Peptic Disease
5
Psychiatric condition
5
5.88%
6
Stroke
4
4.71%
Abscess
4
4.71%
Urinary Tract Stones
4
4.71%
Epididymitis
3
3.53%
Gallstones
3
3.53%
Hernia
3
3.53%
Carpal Tunnel Syndrome
3
3.53%
Gout
3
3.53%
1
2
3
7
Medical Repatriations of
Participating Shipowners

Total Number of PEME

Repatriated (Unfinished Contract)

Repatriation Rate:
1.00 %
=
8,435
=
85
Top 10 Common Medical Findings
Dyslipidemia
2472
22.01%
Elevated liver function test
1748
15.56%
Dental findings
1277
11.37%
Varicosities
1202
10.71%
993
8.84%
954
8.49%
927
8.25%
(Varicocoele, Prostatomegaly, r/o Hernia, Ureterolithiasis,
Umbilical Fascial Defect, Renal Cyst, Beginning hernia,
Hydrocoele, Elevated PSA quanti, Positive PSA Quali)
621
5.53%
Elevated Blood Uric Acid
533
4.74%
Hypertension
506
4.50%
Eyes/Ophthalmologic Findings
(Pinguela, pterygium)
Hemorrhoids
ECG Findings
(NSSTTWC, LVH, Sinus bradycardia, LAD, Sinus arrhythmia,
PPBF, PRWP, LAA, LAA, LAHB, ERP, IRBBB,Primary AV block)
Genitourinary Findings
THANK YOU
SuperCare Medical Services, Inc.