ADG 17 - ASSESSMENT OF PHYSICAL CAPABILITIES

Introduction

The physical capability requirements for work at sea vary widely and have to take account of both normal and emergency duties. The functions that may require assessment include:
1.Strength
2.Stamina
3.Flexibility
4.Balance and co-ordination
5.Size – compatible with entry into confined areas
6.Exercise capacity – heart and respiratory reserve
7.Fitness for specific tasks – wearing breathing apparatus

In addition exercise may be used as a stimulus for assessing other risk factors such as the liability to bronchospasm and asthma and the state of the blood supply to the heart. These are not covered by this guidance document but can be found in ADG 9, ADG 10 and ADG 16

Medical conditions and physical capability

Physical capability assessment may be applied to all seafarers or it may be used selectively where there are indications that there is an increased probability of limitations. Limitations may arise from a range of conditions:

• Obesity
• Severely reduced muscle mass
• Musculo skeletal disease, pain or limitations
• After an injury
• Lung disease
• Heart and blood vessel disease
• Some neurological diseases

Physical capability testing

The following approaches can be used:

• Observed ability to do routine and emergency duties in a safe and effective way
• Tasks that simulate normal and emergency duties (see STCW Section B-I/9 para 6 and Table B-I/9-2)
• Assessment of cardio-respiratory reserve. This will predict maximum exercise capacity and hence the person’s ability to perform physically demanding work. A large reserve will also indicate that heart and lung performance is less likely to be compromised in the next few years.  The benchmark test is maximum oxygen uptake (VO2 max). This requires dedicated equipment. Step tests such as the Chester, or less reliably, the Harvard step test are simpler alternatives. Details of a range of tests can be found at http://www.nrpt.co.uk/training/advice/tests/fitness/index.htm

Details of the Harvard test are given in Annex 2

• Informal testing of reserve, for instance climbing 3-6 flights of stairs and assessing any distress plus the speed of pulse rate decline on stopping.  This is not readily reproducible but can be used for repeat assessment at the same location by the same doctor
• Clinical assessment of strength, mobility, co-ordination etc

Additional information may come from activities recently or regularly undertaken, as described by the seafarer, such as:  

• Physically demanding duties on the vessel e.g. carrying weights, handling mooring equipment
• Attendance at physically demanding course within last two years e.g. firefighting, helicopter escape, safety of life at sea
• Confirmed personal pattern of regular strenuous exercise

Interpretation of results

1. Is there any evidence that the person is not able to perform their routine and emergency duties effectively?

2. Are there any observed limitations on strength, flexibility, stamina and co-ordination?

3. What is the outcome of tests for cardio-respiratory reserve?

a) test performance limited by shortness of breath, musculoskeletal or other pain, exhaustion. Causes need to be investigated and taken into account in determining fitness
b) unable to complete test
c) completed but stressed or with poor recovery after stopping
d) completed to good or average standard

4. Discuss subjective feelings during test with subject and also go over experiences of fitness and capability when doing normal tasks and emergency drills.  Obtain corroboration from others if performance at work uncertain

Decision taking

1. Physical capability testing is not required as a routine, unless there are good reasons for not applying it selectively. Information from a range of sources is required and many of these are not easily accessed in the course of a medical examination. Is there any indication that physical capability may be limited? (e.g. stiffness, obesity, history of heart disease)

No – do not test
Yes – consider what tests or observations will enable the person’s capability to perform routine and emergency duties to be determined. This should be based on the nature of the anticipated limitation (see options as above). Go to 2   

2. Do the test results indicate that capabilities may be limited?

No – Fit category 1 – provided there are no underlying conditions that affect decision
Yes - but duties can be modified to enable safe working, without putting excess responsibilities on others. Restricted category 2.
Yes – but cause of limitation can be remedied. Temporarily unfit category 3.
Yes – incapable of performing routine or emergency duties without scope for remedy Permanently unfit category 4.