Polish system of education in maritime health care and medical assistance for seafarers.

The Polish public awareness of the crucial importance of the own maritime economy to the very existenceof the national state has its historical reasons. The Polish maritime involvement has seen several dramaticcrises, but the Polish nationals have become an established group in the global marine trade workforceand are entitled to the proper health care. In this paper the main maritime health issues are mentioned.To meet the issues, also the national education system provides the opportunities for both seafarers andmedical professionals. The Polish doctors can specialise in the maritime medicine. In many cases the generalmedicine students formations include these topics as well. The psychological aspects are also takeninto account, both of the education of the seafarers and the organisational structure of the Polish healthcare system. Some recent aspects of the Polish participation in the international cooperation in the fieldof the medical support of the maritime economy are also described.

Sudden cardiac event on a sea-going ship and recognition of a work-related accident.

OBJECTIVES. Evaluation of the effect of selected work environment factors on a sea-going ship on the occurrence of a sudden cardiac event and its recognition as a work-related accident. BACKGROUND. Sudden cardiac events, myocardial infarction in particular, among crews of seagoing ships are the most frequent reasons for fatal morbid events. In more than 20% of such cases, conditions and organization of work at sea are found to be of essential importance. Problems with certification are related with the assessment of the significance and impact of specific work environment factors overlapping with classic genetic and environmental factors of diseases of atherosclerotic origin. MATERIAL AND METHODS. The analysis embraced medical documentation on the state of health and working conditions at sea concerning 30 crewmembers of Polish sea-going vessels, who had suffered from sudden cardiac events in the years 1998-2009. The impact of selected work environment factors on the legitimacy of legal recognition of the event as a work-related accident was analysed by Fisher's test and multi-factorial regression. RESULTS. The presence of classic genetic and environmental risk factors of cardiovascular events was confirmed in all persons examined. A significant effect on destabilization of the disease, deterioration of health, and the occurrence of a sudden circulation event was shown to be strictly related with isometric and dynamic effort, particularly with heat discomfort in the maritime work environment. This satisfied the legal criteria for recognition of a work-related accident in half of the cases examined. CONCLUSIONS. Isometric and dynamic effort associated with work under heat stress conditions may be regarded as a decisive causative factor for a sudden cardiac event and the recognition of a work-related accident at sea.