Seafarers on cruise ships and commercial vessels often face occupational hazards that can lead to musculoskeletal injuries, particularly back pain. The physical demands of maritime work and the challenging environment make it essential to accurately assess seafarers’ clinical conditions, determine when maximum medical improvement (MMI) occurs, and evaluate their fitness for duty (FFD) for their specific onboard responsibilities.

This article builds upon the insights shared in our previous publication, Understanding Maximum Medical Improvement (MMI) and Fitness for Duty (FFD) in the Maritime Industry, published last month. We explore the difficulties in these assessments, the standard workup for back pain, and the role of diagnostic modalities and physical therapy in the process.

The Challenge of Determining Maximum Medical Improvement

Acute and chronic back pain presents significant difficulties in evaluating both MMI and FFD. Back pain can result from various causes, including herniated discs, muscle strains, or degenerative conditions, each presenting unique diagnostic and treatment challenges.

MMI does not mean the condition causing back pain is cured. Indeed, the specific cause of the pain may never be determined. Treatments such as physical therapy, pain management, and sometimes surgical interventions have varied efficacy, and the subjective nature of pain complicates these assessments. Psychological components and issues of secondary gain related to continued disability may play a role, particularly if a crew member becomes represented by legal counsel.

MRI, considered the diagnostic gold standard, often shows poor correlation with subjective clinical complaints. Patients with significant back pain may have a normal MRI, while those with significant MRI findings may report minimal or no pain. Only when MRI findings and clinical complaints align closely can a diagnosis be made with certainty.

AP Companies plays a critical role in navigating these complexities, serving as the link between the medical provider, the patient, and the shipowner. By providing clarity on the treatment process and timelines, AP Companies ensures that crew members receive necessary care while keeping shipowners informed. This coordination helps avoid unnecessary procedures and ensures well-informed decisions regarding MMI and FFD.

Fitness for Duty Evaluation

Evaluating a crewmember with chronic back pain for FFD can be complex. Maritime work often involves lifting heavy objects, standing for long periods, and performing manual labor, all of which can exacerbate back pain. It is vital to determine whether the crew member can perform these tasks without risking further injury. The confined and often rolling environment of a ship can aggravate injuries, adding another layer of complexity.

Comprehensive assessments are necessary, often involving occupational health specialists, ergonomic evaluations, and sometimes trial work periods to observe the crew members’ capabilities in real-world settings. The lack of availability of light duty or workplace accommodations on ships can impact FFD determinations.

Key to any FFD determination is consideration of job demands, including physical demands, working conditions, and safety concerns. For example, a seafarer with back pain may not be fit for heavy lifting or prolonged standing but could perform less physically demanding tasks if available. Given the fluctuating nature of back pain, continuous monitoring and reassessment are essential.

Companies should have a comprehensive plan for dealing with back injuries and complaints of back pain. Onboard physicians (in the case of cruise ships), telemedicine providers, and port and home country healthcare providers must be chosen and educated on the proper initial assessment of back pain patients, including critical documentation considerations. All healthcare providers must be familiar with the specific work requirements and environment of the crew member, which is especially important in FFD determinations.

AP Companies takes a proactive approach to managing seafarers’ health. We work closely with healthcare providers to ensure they understand the maritime work environment and the importance of appropriate care. Our experienced case managers maintain regular communication with providers, ensuring that crew members stay on track for a timely return to work. We prioritize expedited appointments and diagnostic studies, and we ensure crew members have access to physical therapy—whether at home, in port, or even by having therapists come to the ship when possible. By doing so, we minimize the risks associated with prolonged absences and help crew members achieve the best possible outcomes.

Physical Therapy and Rehabilitation

Physical therapy plays a vital role in managing chronic back pain in seafarers. It helps improve mobility, reduce pain, and strengthen muscles to prevent further injury. For seafarers, who must return to physically demanding work, physical therapy is often a crucial part of the rehabilitation process.

Rehabilitation programs should be tailored to the individual’s needs, considering the specific physical demands of their job. For instance, a seafarer working in the engine room may require a different rehabilitation approach than one working in housekeeping. AP Companies collaborates with experienced physical therapists who understand the unique challenges faced by seafarers and can design programs that address these specific needs.

In some cases, it may be necessary to modify the seafarer’s work environment to reduce the risk of re-injury. This could involve ergonomic adjustments or changes to work practices. AP Companies’ extensive network of healthcare providers includes specialists in occupational health who can advise on such modifications, ensuring that seafarers can return to work safely and effectively.

The Role of Communication and Coordination

Effective communication and coordination are critical to the success of any medical management plan. This is especially true in the maritime industry, where seafarers may receive treatment from multiple providers in different locations. AP Companies excels in this area, acting as a central point of contact for all parties involved.

Our case managers regularly update shipowners on the progress of their crew members’ treatment, ensuring that they are kept informed at every stage. This includes providing detailed reports on the seafarer’s condition, treatment plan, and expected return-to-work date. By maintaining open lines of communication, we help to avoid misunderstandings and ensure that everyone involved is on the same page.

In addition to coordinating care, AP Companies also assists with the logistical aspects of medical management. This includes arranging transportation to and from medical appointments, securing necessary medical supplies, and facilitating communication between the seafarer and their healthcare providers. Our goal is to make the process as smooth and stress-free as possible for both the seafarer and the shipowner.

Conclusion

Navigating the complexities of back pain management, MMI, and FFD evaluations in the maritime industry requires a nuanced understanding of the unique challenges seafarers face. With its extensive experience in healthcare coordination and legal case management, AP Companies is well-positioned to support both shipowners and crew members. Our commitment to timely and appropriate care, coupled with our focus on effective communication, ensures that the health of the crew and the operational needs of the vessel are maintained, ultimately contributing to safer and more efficient maritime operations.

Dr. Arthur L. Diskin is a graduate of the University of Miami School of Medicine with specialty training in Emergency Medicine and an interest in critical care. He is certified by the American Board of Emergency Medicine and is a Fellow of the American College of Emergency Physicians. He has held leadership roles such as the Past President of the Florida College of Emergency Physicians and is the former Chief of the Department of Emergency Medicine at Jackson Memorial Hospital in Miami, Florida, and Mount Sinai Medical Center in Miami Beach, Florida. Dr.Diskin has also as an examiner for the American Board of Emergency Medicine as an examiner and is a past Chair of the Section on Cruise Ship and Maritime Medicine within the American College of Emergency Physicians. His medical experience includes a notable tenure as the VP and Global Chief Medical Officer for Royal Caribbean Cruise Lines from 2008-16.