Ticari gemilerde tespit edilmiş tıbbi yetersizlikler ve çözüm önerileri
The medical inadequates and solution disposals in commercial ships
Yazar: BETÜL EŞSİZ
Danışman: PROF. DR. ÖZCAN ARSLAN
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / Deniz Ulaştırma Mühendisliği Ana Bilim Dalı / Deniz Ulaştırma İşletme Mühendisliği Bilim Dalı
Derece: Yüksek Lisans, 2019
Konu: Denizcilik = Marine

Özet:
Denizcilik mesleği çalışma koşullarının ağır olması, çeşitli risklere maruz kalması açısından dünyanın en tehlikeli mesleklerinden biridir. Gemiadamları çalışma saatleri dahil boş zamanlarını, dinlenme saatlerini de gemide geçirmek durumundadırlar. Bu durum gemiadamlarını çeşitli ve çok sayıda tehlikeyle karşı karşıya bırakmaktadır. Bu tehlikeler, kimyasal ve biyolojik malzemelerden kaynaklanan tehditler, ağır hava koşulları, fiziksel zorluklar, gemideki operasyonların çeşitliliği, makine operasyonları da dahil olmak üzere, zorlu çalışma ortamı ve yetersiz sağlık koşullarından kaynaklanan tehlikeler olarak belirlenir. Gemideki zorlu çalışma koşullarına ek olarak, gemiadamlarının kapalı alanlarda, limanlarda gerçekleşen yükleme ve tahliye operasyonları sırasında çok yönlü tehlikeler farklı kazalara sebebiyet verebilir. Seyir esnasındayken ani iklim değişiklikleri ve değişen hava koşulları kazalara ve yaralanmalara neden olabilir. Kara hastanelerin denizden uzak olması, tıbbi ekipmanların ve ilaçların yetersiz olması, tıbbi olanakların sınırlı olması, gemide oluşabilecek herhangi bir kaza ve yaralanma durumunda gemi adamları için kapsamlı bir tıbbi yardım yapılamayacaktır. 
Bu çalışmada, gemilerden gelen çağrı sayıları, çağrı tipine göre vaka dağılımı, gemilerde yaşanan en sık hastalıkların dağılımı Türk tele-sağlık merkezi veri tabanı dikkate alınarak yapılacaktır. Ayrıca, bu çalışma yukarıdaki tıbbi sorunlara daha net çözümler bulabilmek için, yabancı ve Türk bayraklı ticari gemilerde çalışan gemiadamlarına anket uygulayacaktır. Sonuç olarak, gemideki sağlık ile ilgili riskleri mimimize edecek önlemler alınacaktır. 
Verilerin analizinde SPSS (Sosyal Bilimler İçin İstatistik Paketi)yazılımı kullanılmıştır. Anketin güvenilirlik değeri, SPSS programı ile incelenmiş ve anketin yüksek derecede güvenilir olduğu belirlenmiştir. Elde edilen verilerin analizi sonucunda uygulamadaki eksiklerin belirlenmesi amaçlanmıştır.

Abstract:
Maritime profession, due to the diversity of risks involved and harshness of work conditions, is acknowledged to be among the most dangerous professions in the world. Seafarers are mandated to spend their work hours and their leisure time saved for relaxing at the end of work day in the very same environment -the ship-. This reality shows that in their work and leisure hours alike seafarers are exposed to a myriad of hazards and risks. To name a few; threats originating from chemical and biological materials, harsh weather conditions, physical challenges, a range of different operations to perform, machine operations combined with dangers and risks stemming from tough work environment and unsatisfactory health conditions.In addition to harsh working conditions on ships, various and multi-aspect hazards that seafarers come across in closed spaces on ships and during the loading/unloading operations at ports could lead to different accidents. Further to that, depending on the sailed country, sudden climate changes and consequential unbearable weather conditions could also fuel accidents and injuries. 
Maritime – related professional enviroments can potentially make the work pattern harder when compared to work on land. The situation in itself, that the work at sea far away from medical services, rescue services or police services in an emergency contribute to a challenging enviroment on board. An accident that occurs at sea may be attended with the most serious consequences than it would happen on land.
Providing emergency medical treatment on board ships at sea can be difficult due to the limited available medical resources and compentence of on board medical personnel. For this reason, even minor ones can cause bigger problems. In a potential accident or injury case on the ship, due to above-listed reasons, medical assitance is far from being a comprehensive approach. Also, although Ship master and officers have certificate for advanced medical intervention, they may face challenges in applying satisfactory and effective practices in cases that requie emergency medical intervention and occupational diseases since seamen's traingis are not periodically updated. Given that, achieving a maximum performance at the sea may be a challenge due to adverse medical condition of certain personnel. All seafarers, but ship master and officers primarily, would receive modules on advanced and basic firs-aid practices depending on their ranks.
 Although International Authorities issued medical examinations standards, there is absence of inernationally acceted continuous trainin program for the maritime dosctors who perform these examinations. Maritime doctors both qualified to issue medical fitness certificate to seafarers as well as working in tele-medical service have little knowledge of shipping and seafaring. For this reason, maritem doctors should be required to be familier with the health risk of seafarers and different circumstances, issues and potential threats on board merchant vessels. For the above mentioned reasons, training and seafarers to provide basic and qualified medical assitance on board are mandatory in case of sudden ilness or an accidentand injury during the ship's voyage. In addition, maritime doctors should be increase their knowledge and expertise to better to respond to seagoing population.
Turkısh Tele Health Center providing servise over 12 years about medical aid consulting to health aid claims from authorized staff of sea and air vehicles to be under national and international way, in urgent cases actualizing medical evacuation organization with collaboration of other corporations and enterprises, to satisfythe submission of health service by coordinating emergency health service to patients or injured people in search and rescue activities. And organising some medical trainings for seafarers and doctors who are performing in that areas.
In this study, a comparative risk assessment about medical situations on board will be carried out by considering Turkish tele-health center database about medical emergency calls from ships around service area. Is also aimed that medical compentency reports issued to seafarers would not be regulated by general practitioners but instead, by certified maritime doctors that is the synonym of physician who have theoretical background knowledge on maritime prfossion and work conditions at sea. So this study aim to improve coordination between health staff and seafarers to enhance medical health quality in ships.
 On the other hand, this study will based on self diagnostic method based to find more clear solutions for above medical problems. With this aim Turkish seafarers who are working at trade ships which are carrying Turkish and also foreing flags will applied a questionairre. Finally, preventive measures which will reduce health related risks on board will be proposed.
For the analysis of the data, SPSS (Statistical Package for the Social Sciences) package software was used. At the end of the research, it has been specified that the questionairre is higly confidential. It has been tried to determine the deficiencies in the implementation at the end of tha analysis of the attanied data.