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Old 14-06-2012, 06:36   #1
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Disqualifying crew based on medical

I've seen various threads discussing how to manage medical conditions and/or prescription drugs while cruising, handling medical crisis at sea etc and it got me to thinking......

I've heard it suggested that a captain should ask prospective crew to divulge any medical conditions that may cause a problem. I thought it might be interesting to have a discussion of the types of medical conditions that would preclude one from crewing on a yacht. Assuming you were vetting crew for a long passage, what medical issues would cause YOU to strike potential crew from the list?

Obviously a highly contagious disease such as tuberculosis would be an immediate disqualifier but what about insulin dependent diabetes?

What about a heart condition? High blood pressure?

HIV (is this considered contagious?) or hepatitis? (what types)

What about skin diseases like Psoriasis? (not contagious but can be disturbing)

Would you allow a grossly obese person to crew on a Pacific crossing? (define obese?)

What mental health issues would be a disqualifier and why? Depression? PTSD? Tourette's syndrome? Nervous tics?

So where do YOU draw the line?
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Old 14-06-2012, 07:02   #2
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Re: Disqualifying crew based on medical

I don't have any defined items. Guess if I had any real question that the person posed a danger to themselves or the boat due to medical condition while on the boat I would not take them.

The mental/personality issue would be a bigger problem to decide on as you don't really know this till the sh*t hits the fan.
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Old 14-06-2012, 07:07   #3
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Re: Disqualifying crew based on medical

In 2010, we had a crewman on our boat with Diabetes, on a 750 mile coastal passage, along a very remote area. I thought his medical condition should not be an issue, since he had been dealing with it for 20 years and had made the passage same passage on two other vessels...

After 24 hours on the water, we realised he was acting a bit goofy and asked how his blood sugar was? He replied that he had forgotten to take his insulin and had high blood sugar. This became a theme with him.. Basically acting like a child not managing his condition.

His lack of managing his diabetes, lead to him taking us 15 miles of course one night, while he was on watch. After that he made two very serious mistakes that could have caused serious injuries to the crew.

At that point, I told him he was a passenger, enjoy the ride and don't touch anything... It sounds rash, but the safety of the remaining crew and the boat took priority over his feelings.

With this experience, I do consider medical conditions of the crew and think it is the prudent thing for a Captain to do... That does not mean I will bar anyone with diabetes or any other chronic medical condition just on the basis of them having it.

You should consider if the condition is managable and will it effect the rest of the crew and the safety of your vessel. If the answer is yes, then you have an obligation to your crew and the vessel.
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Old 14-06-2012, 07:10   #4
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Re: Disqualifying crew based on medical

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Originally Posted by Don Lucas View Post
I don't have any defined items. Guess if I had any real question that the person posed a danger to themselves or the boat due to medical condition while on the boat I would not take them.

But WHAT would you consider a danger to you or the boat?
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Old 14-06-2012, 07:12   #5
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Re: Disqualifying crew based on medical

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Originally Posted by virginia boy View Post
I've seen various threads discussing how to manage medical conditions and/or prescription drugs while cruising, handling medical crisis at sea etc and it got me to thinking......

I've heard it suggested that a captain should ask prospective crew to divulge any medical conditions that may cause a problem. I thought it might be interesting to have a discussion of the types of medical conditions that would preclude one from crewing on a yacht. Assuming you were vetting crew for a long passage, what medical issues would cause YOU to strike potential crew from the list?

Obviously a highly contagious disease such as tuberculosis would be an immediate disqualifier but what about insulin dependent diabetes?

What about a heart condition? High blood pressure?

HIV (is this considered contagious?) or hepatitis? (what types)

What about skin diseases like Psoriasis? (not contagious but can be disturbing)

Would you allow a grossly obese person to crew on a Pacific crossing? (define obese?)

What mental health issues would be a disqualifier and why? Depression? PTSD? Tourette's syndrome? Nervous tics?

So where do YOU draw the line?

Please tell me how managed high blood pressure puts anyone at risk. I think we're just listing disorders there without thinking about them. What is "grossly" obese, and why should that person not be allowed on a boat? I know someone who is markedly obese and yet handles himself well on very small sailboats.

Excuse me, but you don't know whether HIV is considererd contagious or not? How is that possible in 2012?
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Old 14-06-2012, 07:35   #6
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Re: Disqualifying crew based on medical

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Originally Posted by Rakuflames View Post
Please tell me how managed high blood pressure puts anyone at risk. I think we're just listing disorders there without thinking about them. What is "grossly" obese, and why should that person not be allowed on a boat? I know someone who is markedly obese and yet handles himself well on very small sailboats.

Excuse me, but you don't know whether HIV is considererd contagious or not? How is that possible in 2012?
I simply threw some potential disqualifiers out for discussion. I didn't mean to imply that I personally considered them to be so.

HIV being contagious would depend on your definition of contagious. Eliminating crew because of it would depend on your personal comfort level. Certainly HIV would be contagious if you were having sex or perhaps if bleeding? Everyone wouldn't consider that to be contagious but some may not be comfortable having an HIV person aboard. I personally would not eliminate someone because of an HIV diagnosis.

I've seen people who were so obese they could barely walk. They waddled. Some captains may consider that to be a safety issue...some not so much.
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Old 14-06-2012, 07:37   #7
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Re: Disqualifying crew based on medical

I've been the medical person on offshore trips. I've required that crew notify me of all current medical conditions and medications and any significant medical history. I want to know the medications because it allows me to judge severity of the conditions. History is important because some infrequently recurring conditions could be a major problem offshore if not prepared.

I wouldn't take someone offshore with heart disease including angina or congestive heart failure. Those both get worse with stress and exertion and could add to the problems when the sh!t hits the fan. I also wouldn't take anyone taking anticoagulants other than aspirin because of the risk of uncontrolled bleeding. I wouldn't worry about someone with a history of a heart attack without current issues and I wouldn't worry about someone with controlled high blood pressure.

I wouldn't worry about a diabetic after clarifying that their blood sugar was well controlled and this wasn't their first time in an exposed environment. Unfortunately, good control at home is partly environmental so someone can decompensate with the weather/sleep/physical/emotional stresses of a passage. However, I'm OK with managing some level of decompensation and I'd want to have a store of insulin and sugar on board. Without some medical skills on the crew, I probably would only recommend taking a insulin-requiring diabetic if they had had offshore experience and no issues.

I wouldn't take someone with epilepsy who had had a seizure in the past year. Although my med kit could stop most seizures, the risk of injury or pitching overboard could create an out of control situation.

I wouldn't take someone with severe uncontrolled asthma or chronic obstructive pulmonary disease unless they had spent enough time at sea to know that their triggers didn't happen offshore. I wouldn't worry about a little wheezing, but some people get very sick very fast and often with stress meaning at the worst possible time.

As we age, I also want to evaluate mobility and sensory function. I don't want to rely on someone to get to the mast in bad weather whose knees won't let them move with a safety margin. Many people lose vision as they age, often most prominently at night. I want to know that the person is able to keep a prudent lookout alone on a night watch. Usually, if they're still driving at night and not having problems, that's good enough.

Beyond that, I would be making judgments based on the individual and my comfort managing potential bad consequences. My tolerance for the risk of bringing someone with a potentially problematic condition also varies with crew size. If there's some redundancy, I'll tolerate more. If it's me and the other, I don't tolerate much risk that they'll become non-functionning.
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Old 14-06-2012, 08:23   #8
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Re: Disqualifying crew based on medical

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Originally Posted by virginia boy View Post
I simply threw some potential disqualifiers out for discussion. I didn't mean to imply that I personally considered them to be so.

HIV being contagious would depend on your definition of contagious. Eliminating crew because of it would depend on your personal comfort level. Certainly HIV would be contagious if you were having sex or perhaps if bleeding? Everyone wouldn't consider that to be contagious but some may not be comfortable having an HIV person aboard. I personally would not eliminate someone because of an HIV diagnosis.

I've seen people who were so obese they could barely walk. They waddled. Some captains may consider that to be a safety issue...some not so much.

Sorry, but when we're talking about medical issues and use a medical term (contagious), then "contagious" is what we should mean.

HIV Is spread through sexual contact, sharing needles, blood transfusion contamination (all but eliminated with current safeguards), etc. It's not contagious in the way that flu or a cold is. If you've got the flu, PLEASE don't get on my boat. If you are HIV positive, welcome aboard.
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Old 14-06-2012, 08:25   #9
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Re: Disqualifying crew based on medical

Quote:
Originally Posted by virginia boy View Post
I've seen various threads discussing how to manage medical conditions and/or prescription drugs while cruising, handling medical crisis at sea etc and it got me to thinking......

I've heard it suggested that a captain should ask prospective crew to divulge any medical conditions that may cause a problem. I thought it might be interesting to have a discussion of the types of medical conditions that would preclude one from crewing on a yacht. Assuming you were vetting crew for a long passage, what medical issues would cause YOU to strike potential crew from the list?

Obviously a highly contagious disease such as tuberculosis would be an immediate disqualifier but what about insulin dependent diabetes?

What about a heart condition? High blood pressure?

HIV (is this considered contagious?) or hepatitis? (what types)

What about skin diseases like Psoriasis? (not contagious but can be disturbing)

Would you allow a grossly obese person to crew on a Pacific crossing? (define obese?)

What mental health issues would be a disqualifier and why? Depression? PTSD? Tourette's syndrome? Nervous tics?

So where do YOU draw the line?

Actually I have denied someone from sailing again on my boat because of mental health issues. In close quarters you need crew who know how to get along with other people without creating uproar. But "mental disorders" is an umbrella term. I didn't bar this person because of any label. I barred this person because of unacceptable behavior.
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Old 14-06-2012, 08:32   #10
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Re: Disqualifying crew based on medical

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Originally Posted by jeremiason View Post
In 2010, we had a crewman on our boat with Diabetes, on a 750 mile coastal passage, along a very remote area. I thought his medical condition should not be an issue, since he had been dealing with it for 20 years and had made the passage same passage on two other vessels...

After 24 hours on the water, we realised he was acting a bit goofy and asked how his blood sugar was? He replied that he had forgotten to take his insulin and had high blood sugar. This became a theme with him.. Basically acting like a child not managing his condition.

His lack of managing his diabetes, lead to him taking us 15 miles of course one night, while he was on watch. After that he made two very serious mistakes that could have caused serious injuries to the crew.

At that point, I told him he was a passenger, enjoy the ride and don't touch anything... It sounds rash, but the safety of the remaining crew and the boat took priority over his feelings.

With this experience, I do consider medical conditions of the crew and think it is the prudent thing for a Captain to do... That does not mean I will bar anyone with diabetes or any other chronic medical condition just on the basis of them having it.

You should consider if the condition is managable and will it effect the rest of the crew and the safety of your vessel. If the answer is yes, then you have an obligation to your crew and the vessel.

I don't think that was rash at all, but it comes back to what I said -- often it will be about the behavior, not the diagnosis. Most people with diabetes treat it seriously, monitor their blood sugar levels and use their meds for it responsibly. A person with diabetes should explain to the other crew members what the symptoms of a blood sugar would be. He or she will know how they react. Then you can help that person get stable pretty quickly.

I have mild cerebral palsy. It affects my legs only, and having lived with them for 66 years I know what they can and cannot do. I do badly on small boats that don't have much to hold on to, narrow cat walks, low benches to sit on, etc. On my Hunter 31' I'm quite safe and have no problem moving around it safely. I can pull up the anchor, raise and manage the sails, etc. I've handled it (or my previous boat) in a number of potentially dangerous situations. I personally have no problem with me being on a boat and would consider it discrimination if anyone wanted to exclude me because of this without finding out how I cope with it (you would never spot it unless I told you).

But what don't i do? I don't race. When a boat is racing, the crew has to move quickly and as a team. Rushing around a strange boat is not a good idea for me or for the race team.

Don't worry. If Joe over there is impatient when I move as I need to move (very carefully sometimes) then I will self-select not to sail with Joe. I've already made that call for myself with one friend.
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Old 14-06-2012, 08:35   #11
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Re: Disqualifying crew based on medical

Quote:
Originally Posted by Don Lucas View Post
I don't have any defined items. Guess if I had any real question that the person posed a danger to themselves or the boat due to medical condition while on the boat I would not take them.

The mental/personality issue would be a bigger problem to decide on as you don't really know this till the sh*t hits the fan.

I was very lucky because the sh*t hit the fan after the cruise was over, but boy was it messy. I had spent a fair amount of time with this person before inviting her on a weekend cruise and had had no indication that she was so unstable.

There's another fellow I would never have back on the boat because he was a know-it-all who actually knew very little and forcefully made dangerous suggestions. In retrospect I'm quite sure that on a watch he would have made bad calls and not bothered to wake me, since "he knew so much." There's no real diagnosis for that, but he won't ever sail on my boat again.
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Old 14-06-2012, 08:52   #12
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Re: Disqualifying crew based on medical

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snip

There's another fellow I would never have back on the boat because he was a know-it-all who actually knew very little and forcefully made dangerous suggestions. In retrospect I'm quite sure that on a watch he would have made bad calls and not bothered to wake me, since "he knew so much." There's no real diagnosis for that, but he won't ever sail on my boat again.
LOL! I can think of some descriptive words for that "condition" but would rather not write them.
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Old 14-06-2012, 08:56   #13
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Re: Disqualifying crew based on medical

I have had just plain old seasickness cause enough problems that I would not let the individual sail with me again. If someone becomes highly agitated because of the seasickness, they can become a real threat to the vessel's safety. I have sailed with both type I and type II diabetics and know what to look for when there is a sufficient imbalance to cause problems. (1) type I diabetic would act like he was drunk when his blood sugar level became too low. After the first couple of times it occurred I could spot the precursors and was able to avoid it by instructing him to eat something and rest for a bit. One should always be careful of blood borne pathogens and carry the equipment to prevent exposure. I would definitely want to know if someone was HIV positive or Hep A,B,C positive in order to protect myself should an emergency arise involving broken skin or bleeding. I would not exclude those individuals from my crew because of that, just prepare for it. In my book, mentally unstable people are far more risky than health related problems. Most people actually improve with a long sea voyage, fresh air, greatly reduced stress, usually good food all contribute to a healthier body. Bad joints can be problematic, you just have to learn to operate within design parameters.
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Old 14-06-2012, 09:36   #14
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Re: Disqualifying crew based on medical

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Originally Posted by virginia boy View Post
..... Assuming you were vetting crew for a long passage, what medical issues would cause YOU to strike potential crew from the list?
..... dis what about insulin dependent diabetes?
Would not stop me from taking them aboard

What about a heart condition? High blood pressure?
Would not stop me from taking them aboard
HIV (is this considered contagious?) or hepatitis? (what types)
No Freaking way

What about skin diseases like Psoriasis? (not contagious but can be disturbing)
Would not take them on a long passage
Would you allow a grossly obese person to crew on a Pacific crossing? (define obese?)
Did it once before and never again. There are times when agility or lack of can be life threatening for the individual and those around them.

What mental health issues would be a disqualifier and why? Depression? PTSD? Tourette's syndrome? Nervous tics?
Depression or PTSD - Definitely not!
Tourette's or nervous tics? While distracting at times, it wouldn't bother me so I would ask the rest of the crew and only say yes if it was a unanamous decision.
So where do YOU draw the line?
We all have different levels of tolerance. Great thread though.
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Old 14-06-2012, 09:51   #15
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@viriginia boy...great thread, never thought about having a no-go list but after reading the thread I realise that I actually do have an unofficial list.

@rakuflames...thanks for adding mental health as a disqualified as this would be the one we all use to disqualify people...when there isn't a "fit" with potential crew really what we are feeling is that there is not a psychological symmetry, this does not include the crazies that we all encounter out there.

We don't take crew as I have a young family, but in the past I have many times and I have also been crew and there are similar criteria on taking crew and being crew when evaluating your potential future crew mates.

I wouldn't take any crew that were unable to perform all duties required. If they were obese I don't care, but if so obese they couldn't reef a sail or hank on a storm sail on the inner forestry then no they wouldn't be allowed. Pretty easy to spot based on how they get out of the dingy and onto the boat.

Regarding medical...tough to say. As long as not contagious, don't care. As long as when I look at them I don't think "unhealthy" then don't care. But when taking crew I never take them at first glance. Always have dinner, go for walks get to know, etc. when there is an issue usually the ol "spidey sense" tingles.

And re the HIV thing, wouldn't bother me a bit worse things than that to worry about in the world...
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