Integrated evidence-based medical policy for seafarers: a novel risk stratification framework for high-risk and circumpolar zones

Maritime medical fitness is vital for safety in high-risk and medically isolated environments, yet current international policies remain inconsistent, opaque, and weakly evidence-based. This paper presents the Integrated EBM-Policy Framework (IEPF), a three-tier model integrating systematic clinical evidence appraisal, a maritime-specific risk stratification matrix, and adaptive regulatory feedback. Developed via a mixed-methods study of 112 maritime health professionals across nine jurisdictions, the IEPF increases clarity, defensibility, and international harmonization of fitness-to-embark decisions, especially for cardiovascular and mental health risks. It reduces unnecessary exclusions and strengthens applicability in circumpolar and remote operations, positioning IEPF as a scalable benchmark for global maritime health governance and high-risk occupational policy.