Productive cruise operations depend on high-performing crew members, and identifying the best candidates begins with data-driven medical examinations and fit-for-duty evaluations. A medical certificate is also a global requirement set forth within Maritime Labour Convention Code, with limited exceptions.

To ensure that candidates are fit to work aboard a cruise ship, new workers undergo a Pre-Employment Medical Examination (PEME) that includes things like a written medical questionnaire, full physical exam by a doctor, mental health evaluation, and anything else needed to meet the operator’s unique employment requirements.

In this article, we’ll explore in more depth the importance of PEMEs to the cruise sector, recent health trends, their impact on business and more.

Why are PEMEs Important to Cruise Operators?

Pre-employment medicals are particularly important to the cruise industry due to its unique working conditions and global regulatory environment. These conditions include confined living quarters, physically and mentally demanding labour, and the psychological impact of long-term separation from friends and family.

PEMEs ensure that crew members meet the health standards set by various international maritime and health authorities. Each port may have its own unique health requirements, and PEMEs include checks on client required vaccinations to ensure crew members are cleared to enter various countries included in their ship’s travel itinerary.

Beyond physical and immunological fitness, many PEMEs check for mental fitness through psychological evaluations and risk assessments. This verifies that candidates are emotionally prepared for the unique demands of working at sea. Issues such as anxiety, depression and insomnia, if left unmanaged, can increase the risk of workplace accidents, injuries or even death, all of which present serious consequences to crew morale, productivity, operational stability and a company’s bottom line.

PEME Management from VIKAND

VIKAND’s PEME review service, part of our overall Medical Management platform, is streamlined through an online dashboard where all health data is stored on secure, HIPAA- and GDPR-compliant servers. Here, clients can track the status of each crew member’s evaluation review through a secure online dashboard. We also help cruise operators determine and set PEME standards based on the regulations and policies of their flag state and destination governments.

In addition to verifying local clinics and providers, we review crew medical certificates and arrange secondary reviews as they are needed. Clients are kept up to date throughout the process with full transparency.

PEME Trends and Insights

Along with handling PEME evaluations for several global cruise lines, VIKAND reviews hundreds of pre-employment medicals each year for ad hoc clients. Year-over-year data from one major operator shows that the number of seafarers found unfit for duty nearly doubled from 2023 to 2024.

Here are the top reasons candidates did not pass their PEME, and some insight into the threshold for employing workers with these conditions:

1. HIV: Blood tests must meet minimum ILO/IMO requirements.
2. Type 1 Diabetes: Certain Type 1 sufferers may be excluded based on the position they’re applying for or how controlled their diabetes is.
3. Anxiety & Depression: These must be under active treatment, with 2-5 years of documented stability before onboard work is permitted.
4. ADHD: Certain medications are not permitted for onboard use.

Other leading factors include abnormal electrocardiogram results, previous stroke, previous cancer and uncontrolled high blood pressure.

Our maritime doctors and screening nurses review PEMEs and make recommendations on which candidates should not join the workforce until specific health criteria are met, as well as exam results that require further investigation. Our reviews often reveal medical issues that could lead to costly and time-consuming medical diversions.

However, the goal is not to exclude people from an already challenged labour market. The goal is to mitigate risk. While risk can never be eliminated, we’re able to identify crew members with manageable pre-existing conditions – ones that may have led to an exclusion in the past – and keep them working to avoid losing experienced talent.

One notable trend worth mentioning is the wider inclusion of psychological exams in PEMEs. Employers are recognizing the importance of mental health, leading to the incorporation of mental health screenings, stress management assessments and overall psychological well-being evaluations.

According to a letter issued by one leading maritime insurer, there is a “pressing need” for more thorough pre-employment mental health assessments. They acknowledge that shame and stigma often drives seafarers to conceal mental health struggles, making them difficult to detect. However, without transparency and proactive intervention, untreated issues may grow worse over time and create serious consequences to human health and operational stability.

From the standpoint of an insurer, mental health problems pose an unacceptable risk. VIKAND shares this perspective. Our crew asset management approach is a proactive investment in risk reduction designed to minimise operational interruptions and support long-term careers in the maritime industry.

The Impact of PEMEs on the Cruise Sector

At this point, it’s worth asking: Are PEMEs making a positive impact? At VIKAND, we believe the answer is yes. As pre-employment medicals become more sophisticated, we’re able to form a deeper, more detailed picture of human health to determine who is truly at risk, and to differentiate between manageable and unmanageable conditions.

In the cruise sector, there’s a broader shift towards promoting overall physical, mental and emotional health, as well as proactive healthcare. Rather than eliminating people from the workforce after a chronic condition manifests, crew members are now screened for indicators of obesity, diabetes, cardiovascular disease and more, then placed on wellness plans before they’re reassessed for duty.

This is not only more practical and optimistic, but cheaper. Early health interventions are a fraction of what it costs to recruit new talent or handle a medical event at sea. The future of cruise sector work depends on attracting the best people, verifying their health, and working proactively to keep them fit for duty.

Evaluating PEMEs is just one part of VIKAND’s comprehensive Medical Management platform. By adhering to exam standards in line with a ship’s flag state and analysing results, we provide a clear understanding of each crew member’s physical and mental well-being. To learn more about how VIKAND can help keep your crew healthy, happy, and productive at sea, contact us today.