[Federal Register Volume 66, Number 243 (Tuesday, December 18, 2001)]
[Notices]
[Pages 65237-65243]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-31173]


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DEPARTMENT OF TRANSPORTATION

Coast Guard

[USCG 2001-11149]


Guidelines for Assessing Merchant Mariners through Demonstrations 
of Proficiency for Persons in Charge of Medical Care

AGENCY: Coast Guard, DOT.


ACTION: Notice of availability and request for comments.

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SUMMARY: The Coast Guard announces the availability of, and seeks 
public comments on, the national performance measures proposed here for 
use as guidelines when mariners demonstrate their proficiency as 
Persons in Charge of Medical Care. These measures were developed from 
recommendations and input provided by the Merchant Marine Personnel 
Advisory Committee (MERPAC).

DATES: Comments related material must reach the Docket Management 
Facility on or before February 19, 2002.

ADDRESSES: Please identify your comments and related material by the 
docket number of this rulemaking [USCG 2001-11149]. Then, to make sure 
they enter the docket just once, submit them by just one of the 
following means:
    (1) By mail to the Docket Management Facility, U.S. Department of 
Transportation, room PL-401, 400 Seventh Street SW., Washington, DC 
20590-0001.
    (2) By delivery to room PL-401 on the Plaza level of the Nassif 
Building, 400 Seventh Street SW., Washington, DC, between 9 a.m. and 5 
p.m., Monday through Friday, except Federal holidays. The telephone 
number is 202-366-9329.

[[Page 65238]]

    (3) By fax to the Docket Management Facility at 202-493-2251.
    (4) Electronically through the Web site for the Docket Management 
System at http://dms.dot.gov.
    In choosing among these means, please give due regard to the recent 
difficulties with delivery of mail by the U.S. Postal Service to 
Federal facilities.
    The Docket Management Facility maintains the public docket for this 
notice. Comments and related material received from the public, as well 
as documents mentioned in this Notice, will become part of this docket 
and will be available for inspection or copying at room PL-401 on the 
Plaza level of the Nassif Building, 400 Seventh Street, SW., 
Washington, DC between 9 a.m. and 5 p.m., Monday through Friday, except 
Federal holidays. You may also find this docket on the Internet at 
http://dms.dot.gov.
    The measures proposed here are also available from Mr. Mark Gould, 
Maritime Personnel Qualifications Division, Office of Operating and 
Environmental Standards, Commandant (G-MSO-1), U.S. Coast Guard 
Headquarters, telephone 202-267-0229, or e-mail address 
[email protected].

FOR FURTHER INFORMATION CONTACT: For questions on this Notice or on the 
national performance measures proposed here, e-mail or call Mr. Gould 
where indicated under ADDRESSES. For questions on viewing or submitting 
material to the docket, call Ms. Dorothy Beard, Chief, Dockets, 
Department of Transportation, telephone 202-366-9329.

SUPPLEMENTARY INFORMATION:

What Action Is the Coast Guard Taking?

    Section A-VI/4-2 of the Code accompanying the International 
Convention on Standards of Training, Certification and Watchkeeping for 
Seafarers (STCW), 1978, as amended in 1995, articulates qualifications 
for ensuring merchant mariners' attaining the minimum standard of 
competence through demonstrations of their proficiency as Persons in 
Charge of Medical Care. The Coast Guard tasked MERPAC with referring to 
the Section, modifying and specifying it as it deemed necessary, and 
recommending national performance measures. The Coast Guard has 
reviewed the measures recommended by MERPAC and has developed a final 
set that we are proposing here for use as guidelines for assessing that 
proficiency.
    The guidelines are set up as follows: First we set forth the 
Competency within the STCW a mariner must demonstrate to meet the STCW 
section. Next we give a series of examples of Performance Conditions, a 
set of Performance Behaviors for each Performance Condition, and a set 
of Performance Standards for each Performance Behavior.
    For example, if the Competency to demonstrate is: ``Provide medical 
care to the sick and injured while they remain on board,'' a 
Performance Condition for that Competency demonstrating knowledge, 
understanding, and proficiency is: In a graded practical exercise, 
given a patient simulating a head injury, * * *
    A Performance Behavior for that Condition is: * * * the candidate 
will demonstrate the techniques for conducting a neurological 
assessment.
    A Performance Standard for that Behavior is: The candidate 
correctly demonstrates the following assessment techniques and states 
the significance of each finding: (a) Pupillary reaction; (b) Level of 
consciousness; (c) Verbal communication; and (d) Sensory motor status.
    If the mariner properly meets all of the Performance Standards, he 
or she passes the practical demonstration. If he or she fails to 
properly carry out any of the Standards, he or she fails it.

Why Is the Coast Guard Taking This Action?

    The Coast Guard is taking this action to comply with STCW, as 
amended in 1995 and incorporated into domestic regulations at 46 CFR 
parts 10, 12, and 15 in 1997. Guidance from the International Maritime 
Organization on shipboard assessments of proficiency suggests that 
Parties develop standards and measures of performance for practical 
tests as part of their programs for training and assessing seafarers.

How May I Participate in This Action?

    You may participate in this action by submitting comments and 
related material on the national performance measures proposed here. 
(Although the Coast Guard does not seek public comment on the measures 
recommended by MERPAC, as district from the measures proposed here, 
those measures are available on the Internet at the homepage of MERPAC, 
http://www.uscg.mil/hq/g-m/advisory/merpac/merpac.htm.) These measures 
are available on the Internet at http://dms.dot.gov, under this docket 
number [USCG 2001-11149]. They are also available from Mr. Gould where 
indicated under ADDRESSES. If you submit written comments please 
include--
     Your name and address;
     The docket number for this Notice [USCG 2001-11149];
     The specific section of the performance measures to which 
each comment applies; and
     The reason for each comment.
    You may mail, deliver, fax, or electronically submit your comments 
and related material to the Docket Management Facility, using an 
address or fax number listed in ADDRESSES. Please do not submit the 
same comment or material more than once. If you mail or deliver your 
comments and material, they must be on 8\1/2\-by-11-inch paper, and the 
quality of the copy should be clear enough for copying and scanning. If 
you mail your comments and material and would like to know whether the 
Docket Management Facility received them, please enclose a stamped, 
self-addressed postcard or envelope. The Coast Guard will consider all 
comments and material received during the 60-day comment period.
    Once we have considered all comments and related material, we will 
publish a final version of the national performance measures for use as 
guidelines by the general public. Individuals and institutions 
assessing the competence of mariners may refine the final version of 
these measures and develop innovative alternatives. If you vary from 
the final version of these measures, however, you must submit your 
alternative to the National Maritime Center for approval by the Coast 
Guard under 46 CFR 10.303(e) before you use it as part of an approved 
course or training program.

    Dated: December 6, 2001.
Joseph J. Angelo,
Director, of Standards, Marine Safety and Environmental Protection.

Assessment Guidelines for Table A-VI/4-2

Specification for Minimum Standard of Competency

Proficiency for Persons in Charge of Medical Care

    Each candidate for an STCW endorsement as Person in Charge of 
Medical Care must meet the standards of competence set out in STCW Code 
Table A-VI/4-2. To accomplish this, he or she must:
     Complete approved education and training and meet all the 
competencies listed in the table;
     Pass a written examination for the portion of the 
competencies on knowledge and understanding; and
     Successfully accomplish a practical demonstration of skill 
for selected competencies.

[[Page 65239]]

    The United States Coast Guard requires each mariner seeking 
proficiency as Person in Charge of Medical Care aboard ship to attend a 
course approved by the National Maritime Center. For this reason, these 
guidelines contain the assessment criteria for both requirements, 
knowledge (listed in the paragraph below) and skill, Table A-VI/4-2.
Written Assessments
    The knowledge-based or understanding-based portion of the following 
competencies may be assessed through a written multiple-choice 
examination. The candidate must achieve a minimum passing grade of 70% 
in each kind of knowledge or understanding within the competency: Signs 
and symptoms of bleeding; signs and symptoms of burns, scalds and 
frostbite; types of wounds and their treatment; signs of infection; 
procedures to manage systemic pain; procedures to manage pain before 
cleaning; uses of lidocaine with and without epinephrine; suturing a 
wound and removing sutures; identifying wounds that may be sutured and 
criteria for removing sutures; signs, symptoms, and emergency treatment 
for acute abdominal conditions; steps involved in minor surgical 
procedures; steps for treating an abdominal evisceration; bandaging a 
sucking chest wound; identifying general principles of nursing care; 
inserting or simulating inserting a urinary drainage catheter (male and 
female); inserting a naso-gastric tube; injecting medicine by 
intramuscular and subcutaneous route; signs, symptoms and treatments 
for hyperglycemia, anaphylaxis, dehydration, gonorrhea, syphilis, 
genital herpes, systemic infections, malaria, and hepatitis A and B; 
signs of alcoholism and drug abuse, signs of and treatment for 
toothache and other dental problems; sings, symptoms, and treatments 
for gynecological conditions, pregnancy and childbirth; methods to 
determine cause of death and how to prepare a body for storage at sea; 
personal hygiene; preventing disease aboard ship; preventing disease 
through vaccination; preparing a patient for evacuation; and methods of 
cooperation with health authorities in port.
Demonstrations of Skill
    In addition to passing a written examination, the competency 
entitled ``Provide medical care to the sick and injured while they 
remain on board'' requires a practical demonstration of skill to assess 
proficiency. These assessment guidelines establish the conditions under 
which the assessment will occur, the performance or behavior the 
candidate is to accomplish, and the standards against which to measure 
the performance. The examiner should use a checklist in conducting 
assessments of practical demonstrations of skill. Checklists allow a 
training institution or designated examiner to avoid overlooking 
critical tasks when evaluating a candidate's practical demonstration. 
Training institutions and designated examiners should develop their own 
checklists for use in conducting the assessments in a complete and 
structured manner.

 Table A-VI/4-2.--Guidelines for Assessment--Specification of Minimum Standard of Competence--Persons in Charge
                                                 of Medical Care
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                                      Knowledge,
         STCW competence           understanding and      Performance         Performance         Performance
                                      proficiency          condition           behavior            standard
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Provide medical care to the sick  Care of the         In a graded         The candidate will  The candidate
 and injured while they remain     casualty            practical           demonstrate the     correctly
 on board.                         involving head      exercise, given a   techniques for      demonstrates the
                                   and spinal          patient             conducting a        following
                                   injuries*.          simulating a head   neurological        assessment
                                                       injury.             assessment.         techniques and
                                                                                               states the
                                                                                               significance of
                                                                                               each finding:
                                                                                              1. Pupillary
                                                                                               reaction;
                                                                                              2. Level of
                                                                                               consciousness;
                                                                                              3. Verbal
                                                                                               communication;
                                                                                               and
                                                                                              4. Sensory motor
                                                                                               status.
                                  Care of the         In a graded         The candidate will  The candidate
                                   casualty            practical           use external        correctly:
                                   involving           exercise, given a   bandages to        Applies an
                                   injuries to ear,    patient             control bleeding    external bandage
                                   nose, throat and    simulating a        from the ear.       to stem bleeding
                                   eye*.               bleed from the                          of the ear; and
                                                       ear.                                   2. Does not pack
                                                                                               the ear.
                                                      In a graded         The candidate will  The candidate:
                                                       practical           demonstrate the    1. Positions the
                                                       exercise, given a   proper techniques   patient sitting
                                                       patient             to stop bleeding    upright with the
                                                       simulating a nose   from the nose.      head tilted
                                                       bleed.                                  forward;
                                                                                              2. Pinches the
                                                                                               bridge of the
                                                                                               nose; and
                                                                                              3. places ice on
                                                                                               the back of the
                                                                                               neck or the
                                                                                               forehead.
                                                      In a graded         The candidate will  The student:
                                                       practical           demonstrate the    1. Immobilizes the
                                                       exercise, given a   proper method of    object impaled in
                                                       patient             bandaging an eye    eye; and
                                                       simulating an       impaled by a       2. bandages both
                                                       object impaled in   foreign object.     the affected and
                                                       the eye.                                unaffected eye.

[[Page 65240]]

 
                                                      In a graded         The candidate will  The candidate
                                                       practical           demonstrate the     flushes the
                                                       exercise, given a   proper method of    affected eye for
                                                       patient             treating a          at least 20
                                                       simulating a        foreign liquid or   minutes with
                                                       foreign liquid or   solid substance     copious amount of
                                                       solid substance     in the eye.         water (saline, if
                                                       in the eye.                             immediately
                                                                                               available) to
                                                                                               wash away
                                                                                               chemicals or
                                                                                               solid particles.
                                                      In a graded         The candidate will  The student:
                                                       practical           demonstrate the    1. Anticipates a
                                                       exercise, given a   proper method of    compromised
                                                       patient             treating a soft-    airway; and
                                                       simulating a soft-  tissue injury to   2. Maintains
                                                       tissue injury to    the throat.         airway management
                                                       the throat.                             techniques.
                                  Care of the         In a graded         The candidate will  The candidate
                                   casualty            practical           demonstrate         correctly
                                   involving           exercise, given a   application of      demonstrates the:
                                   external and        patient             pressure dressing  1. Location of the
                                   internal            simulating          and location of     brachial and
                                   bleeding*.          bleeding wound.     pressure points.    femoral pressure
                                                                                               points; and
                                                                                              2. Application of
                                                                                               a pressure
                                                                                               dressing at the
                                                                                               would site.
                                                      In a graded         The candidate will  The candidate
                                                       practical           state when to use   correctly states
                                                       exercise, given a   a tourniquet.       that a tourniquet
                                                       patient                                 will only be
                                                       simulating an                           applied when:
                                                       arterial bleed of                      1. All other
                                                       an extremity.                           methods of
                                                                                               controlling
                                                                                               bleeding have
                                                                                               failed; and
                                                                                              2. Continued
                                                                                               bleeding is life-
                                                                                               threatening.
                                  Care of the         In a graded         The candidate will  The candidate
                                   casualty            practical           demonstrate the     correctly applies
                                   involving           exercise, given a   splinting of an     a pillow splint
                                   fractures,          patient             ankle fracture      to an ankle
                                   dislocations and    simulating a        and                 fracture,
                                   muscular            fracture of the     immobilization of   following the
                                   injuries*.          ankle and a         a dislocated        following
                                                       dislocated          shoulder.           procedures:
                                                       shoulder, and                          1. Manually
                                                       materials for                           stabilizes the
                                                       splinting.                              fractured ankle
                                                                                               or leg;
                                                                                              2. Assesses distal
                                                                                               neuro-vascular
                                                                                               function;
                                                                                              3. Applies pillow
                                                                                               to the ankle and
                                                                                               lower leg,
                                                                                               wrapping it
                                                                                               around the ankle
                                                                                               and leg and
                                                                                               keeping the foot
                                                                                               exposed;
                                                                                              4. Secures pillow
                                                                                               using cravats or
                                                                                               other device to
                                                                                               tie ends
                                                                                               together;
                                                                                              5. Re-assesses
                                                                                               distal neuro-
                                                                                               vascular
                                                                                               function; and
                                                                                              6. Seeks medical
                                                                                               advice by radio.
                                                                                              The candidate
                                                                                               correctly
                                                                                               immobilizes a
                                                                                               dislocated
                                                                                               shoulder using
                                                                                               the following
                                                                                               procedures:
                                                                                              1. Assesses distal
                                                                                               neuro-vascular;
                                                                                              2. Applies sling
                                                                                               using triangular
                                                                                               bandage or
                                                                                               commercial-type
                                                                                               sling (knot of
                                                                                               sling should not
                                                                                               be pressing on
                                                                                               neck);
                                                                                              3. Using a cravat
                                                                                               or other binding,
                                                                                               applies a swath
                                                                                               over sling and
                                                                                               around body; and
                                                                                              4. Re-assesses
                                                                                               distal neuro-
                                                                                               vascular
                                                                                               functions.

[[Page 65241]]

 
                                  Care of the         In a graded         The candidate will  The candidate
                                   casualty            practical           demonstrate a       correctly
                                   involving           exercise, given a   method to suture    demonstrates a
                                   techniques of       simulated wound,    a would and         standard
                                   sewing and          suturing needle     method to remove    instrument tie to
                                   clamping*.          and thread,         sutures.            include the
                                                       clamps, and                             following:
                                                       suture-removal                         1. Ties all knots
                                                       scissors.                               to one side of
                                                                                               the wound;
                                                                                              2. Begins sutures
                                                                                               at center of
                                                                                               wound and
                                                                                               proceeds outward;
                                                                                               and
                                                                                              3. Uses strategic
                                                                                               sutures to match
                                                                                               up obvious points
                                                                                               in irregular
                                                                                               wounds.
                                                                                              The candidate
                                                                                               correctly
                                                                                               demonstrates
                                                                                               suture removal to
                                                                                               include the
                                                                                               following:
                                                                                              1. Lifts suture
                                                                                               with forceps;
                                                                                              2. Cuts suture
                                                                                               near skin
                                                                                               surface; and
                                                                                              3. Pulls suture
                                                                                               out holding the
                                                                                               knotted end of
                                                                                               the suture.
                                                      In a graded         The candidate will  The candidate
                                                       practical           bandage a sucking   correctly
                                                       evaluation, given   chest wound.        demonstrates the
                                                       a simulated chest                       following:
                                                       wound, occlusive                       1. Surveys and
                                                       dressing                                determines the
                                                       materials, and                          entrance (and
                                                       tape.                                   exit) wound(s);
                                                                                              2. Covers wound(s)
                                                                                               with occlusive
                                                                                               dressing;
                                                                                              3. Tapes three
                                                                                               sides of the
                                                                                               dressing over the
                                                                                               wound; and
                                                                                              4. Monitors
                                                                                               respiratory
                                                                                               effort of victim.
                                  Nursing care*.....  In a graded         The candidate will  The candidate
                                                       practical           insert or           correctly
                                                       evaluation, given   simulate            demonstrates the
                                                       a real patient or   inserting a         following:
                                                       urinary-            urinary-drainage   1. Maintenance of
                                                       catheterization     catheter (male      correct sterile
                                                       simulator, and      and female).        techniques;
                                                       supplies for                           2. Cleansing of
                                                       urinary-catheter                        the meatus;
                                                       insertion.                             3. Lubrication of
                                                                                               the catheter;
                                                                                              4. Insertion of
                                                                                               the catheter into
                                                                                               urethra until
                                                                                               urine drains; and
                                                                                              5. Opening of the
                                                                                               roller clamp of
                                                                                               the tubing.
                                                      In a graded         The candidate will  The candidate
                                                       practical           insert a naso-      correctly
                                                       evaluation, given   gastric tube.       demonstrates the
                                                       a mannequin and                         following:
                                                       supplies for                           1. Utilizes proper
                                                       nasogastric tube                        precautions for
                                                       insertion.                              isolating bodily
                                                                                               substances;
                                                                                              2. Measures length
                                                                                               of tube to
                                                                                               insert;
                                                                                              3. Lubricates
                                                                                               tube;
                                                                                              4. Positions
                                                                                               patient;
                                                                                              5. Inserts tube
                                                                                               through nose;
                                                                                              6. Demonstrates
                                                                                               one test to
                                                                                               confirm
                                                                                               placement; and
                                                                                              7. Secures tube to
                                                                                               nose with tape.

[[Page 65242]]

 
                                                      In a graded         The candidate will  The candidate:
                                                       practical           administer         1. Confirms the
                                                       evaluation, given   medication          medicine order,
                                                       a real or           injection by        calculates proper
                                                       simulated           intramuscular       dosage,
                                                       patient, and        route.              identifies
                                                       supplies for                            correct medicine
                                                       injections of                           and confirmed
                                                       medicine.                               expiration date;
                                                                                              2. Draws up
                                                                                               correct dosage
                                                                                               from medicine
                                                                                               vial using
                                                                                               sterile
                                                                                               technique,
                                                                                               checking medicine
                                                                                               to medicine order
                                                                                               at least three
                                                                                               times and using
                                                                                               correct needle
                                                                                               and syringe for
                                                                                               injection based
                                                                                               on location of
                                                                                               injection and
                                                                                               amount of
                                                                                               medicine;
                                                                                              3. Locates the
                                                                                               injection site
                                                                                               (deltoid,
                                                                                               glutens, or
                                                                                               vastus
                                                                                               lateralis);
                                                                                              4. Cleanses the
                                                                                               injection site
                                                                                               with alcohol pad
                                                                                               using circular
                                                                                               motion;
                                                                                              5. Inserts the
                                                                                               needle into
                                                                                               muscle at 90 deg.
                                                                                               angle; and
                                                                                              6. Aspirates the
                                                                                               syringe, and, if
                                                                                               no blood, injects
                                                                                               the medication.
                                                      In a graded         The candidate will  The candidate:
                                                       practical           inject medicine    1. Confirms the
                                                       evaluation, given   by subcutaneous     medicine order,
                                                       a real or           route.              calculates proper
                                                       simulated                               dosage,
                                                       patient, and                            identifies
                                                       supplies for                            correct medicine
                                                       injections of                           and confirms
                                                       medicine.                               expiration date;
                                                                                              2. Draws up the
                                                                                               correct dosage
                                                                                               from medicine
                                                                                               vial using
                                                                                               sterile
                                                                                               technique,
                                                                                               checking medicine
                                                                                               to medicine order
                                                                                               at least three
                                                                                               times and using
                                                                                               correct needle
                                                                                               and syringe for
                                                                                               injection based
                                                                                               on location of
                                                                                               injection and
                                                                                               amount of
                                                                                               medicine;
                                                                                              3. Locates the
                                                                                               injection site;
                                                                                              4. Cleanses the
                                                                                               injection site
                                                                                               with alcohol pad
                                                                                               using circular
                                                                                               motion;
                                                                                              5. Inserts the
                                                                                               needle into
                                                                                               subcutaneous
                                                                                               tissue at 45 deg.
                                                                                               angle; and
                                                                                              6. Aspirates the
                                                                                               syringe, and, if
                                                                                               no blood, injects
                                                                                               the medicine.
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* Indicates a proficiency from Table A-VI/4-2


[[Page 65243]]

[FR Doc. 01-31173 Filed 12-17-01; 8:45 am]
BILLING CODE 4910-15-M