Why Experience is Still the Foundation of Medicine at Sea

Pre-Employment Medical Examinations (PEMEs) have long been an established pillar of maritime safety. They are a proactive safeguard that protects seafarers, supports safe operations and reduces disruptions across the fleet.

More than a routine administrative requirement, PEMEs offer valuable insight into the evolving health landscape of today’s maritime workforce.

And they are working. Today’s operating environment is more complex, scrutinised and exposed to risk than ever, but PEMEs are revealing important patterns that demand our attention and action.

Why PEMEs matter more today

The modern maritime workforce spans four generations, with a fifth soon entering service. Health profiles are changing accordingly.

Chronic lifestyle-related conditions are more prevalent, mental health awareness is elevated and the physical and psychological demands of life at sea remain significant. At the same time, owners are running more complex, visible operations that are increasingly open to regulatory scrutiny.

Within this context, PEMEs are foundational to risk management and preventive healthcare. They establish a documented baseline of fitness, identify vulnerabilities before deployment and provide operators with early indicators of potential operational risk.

What PEMEs are showing us about crew health

If we analyse PEME data from a range of operators, several clear patterns emerge.

First, chronic lifestyle-related conditions remain a leading concern. Hypertension, diabetes and elevated cardiovascular risk are frequently identified during examinations. In many cases, these conditions are manageable, but the distinction between controlled and uncontrolled cases is critical.

PEMEs increasingly result in temporary unfitness or conditional clearance, highlighting the need for follow-up and more nuanced management rather than a simple pass or fail dichotomy.

Second, dental health continues to be a recurring and operationally relevant issue. Preventable dental conditions identified during PEMEs correlate strongly with downstream medical disembarkations. Early intervention consistently proves more effective than managing acute problems once a vessel is underway.

PEMEs are also bringing attention to mental health and psychological readiness, acting as an early indicator of vulnerability. More examinations now include a mental fitness assessment, recognising that stress, fatigue, isolation and undeclared pre-existing conditions can have a cumulative effect on safety and performance.

The impact of missed or unmanaged conditions

Medical findings that seem manageable on paper can have major downstream consequences. Health issues that are missed, downplayed or revealed too late often lead to medical disembarkations, ship diversions, unplanned crew replacement and operational downtime, all of which are costly to operators.

Industry data shows that approximately 20 percent of ship diversions are caused by medical emergencies. Between 2019 and 2023, 11 percent of recorded seafarer deaths were due to suicide, a figure that reportedly surpassed fatal accidents at sea in 2024. These outcomes underscore the limitations of light PEMEs that fail to identify deeper psychological risk.

VIKAND’s 2024 case management data found that the top diagnostic drivers for sick leave and repatriation were, in order:

• Mental health conditions
• Musculoskeletal disorders
• Gastrointestinal illness
• Cardiovascular issues
• Workplace injuries, particularly in food service and deck and engine departments

Acute Stress Reaction was the most common diagnosis, frequently linked to work-related stress or undisclosed pre-existing conditions. Last year’s health data suggest that many struggling crew members may have lacked the resilience or personality fit for maritime life from the beginning. This implies that more rigorous pre-employment psychological assessments would help prevent future crises.

Consistency, interpretation and follow-up

The outcomes of PEMEs vary widely depending on depth of assessment, consistency across regions and the quality of interpretation and follow-up.

Many exams are effectively box-ticking formalities designed to meet minimum STCW requirements. In developing port cities, operators may find it challenging to ensure consistent clinic standards, equipment quality and clinical governance, which undermines the reliability of exam findings.

As a result, many operators prioritise clinics recognised or approved by their P&I Clubs, adding an additional layer of institutional scrutiny and accountability. Alignment with P&I expectations strengthens both the process and the operator’s risk exposure.

A deeper issue is that PEMEs often miss complex mental health issues and poorly managed non-communicable diseases. This inconsistency exposes operators to undue risk. Without stronger oversight, they may unknowingly sign on crew members who are technically clear to work but vulnerable to costly health events.

A structured secondary review, conducted by an independent maritime medical expert, serves as the risk underwriter. This offers deeper evaluation of cardiovascular profiles, metabolic markers and psychological indicators before a seafarer is cleared for deployment and insured for a voyage. For P&I Clubs, a second layer of analysis materially strengthens confidence in the fitness-for-duty decision process.

Regulatory and duty-of-care considerations

Under the Maritime Labour Convention of 2006, shipowners carry a duty of care for the health and safety of seafarers. A thorough and defensible PEME is the first documented line of that duty. When examinations are superficial or inconsistent, operators face increased legal and financial exposure.

Some operators have expressed concern that deeper scrutiny, particularly around mental health, could introduce privacy or discrimination issues. However, properly structured and anonymised trend analysis can identify systemic risk patterns without compromising individual confidentiality. This approach strengthens strategic planning while protecting both seafarer rights and the operator’s legal position.

Flag States and Port State Control authorities are increasingly attentive to crew health data, particularly where medical diversions present safety and operational concerns. PEMEs that go beyond the compliance minimum and utilise best practice can significantly reduce the risk of regulatory intervention.

Part of a proactive healthcare strategy

The strategic value of PEMEs increases when they are integrated into a broader health framework. This means shifting from a narrow fit-for-duty mindset to a fit-for-deployment approach that links PEME outcomes to chronic condition management, mental health support and ongoing monitoring.

Secondary PEME reviews and structured case management help identify recurrent challenges that standard clinics may miss, such as poorly controlled diabetes or concealed psychological distress. By addressing these risks before deployment, operators can reduce serious onboard medical incidents and avoid costly diversions and disembarkations.

These are not the only costs. Over the long term, operators face lost productivity, increased risk and reputational damage. Proactive crew health management shifts a company’s exposure from volatile capital losses to more predictable operating costs. This not only protects budgets but also reinforces brand credibility, regulatory confidence and human sustainability across the fleet.

From compliance requirement to strategic advantage

Far from failing to secure the maritime labour force, PEMEs highlight where deeper insight and stronger follow-through are needed. Secondary reviews are not solely a risk-control mechanism for owners and insurers. They serve to safeguard seafarers, helping to ensure that underlying conditions are properly assessed, managed, and treated before exposure to the physical and psychological demands of life at sea.

When supported by consistent standards, secondary reviews and integrated case management, PEMEs evolve from a compliance obligation into a strategic asset. Operators who invest in a robust PEME process benefit from healthier crews, safer operations and a more resilient maritime workforce prepared for the realities of modern shipping.