In relation to this requirement, a wiper is to be sufficiently trained on how to carry out firefighting operations; this includes the proper donning, assembly, use, and maintenance of all equipment involved should the need arise in order to facilitate the need for all seafarers to be fluent in lifesaving procedures These requirements are mandatory and are also adhered to on an international and involuntary basis with the need to renew the very same preliminary physical and firefighting examinations found within CFR 46. The global institution responsible for mandating standards for lifesaving procedures and equipment is commonly known as the International Convention for the Safety of Life At Sea (SOLAS). As a crew member, it is to be noticed that a Wiper may undergo a condition known as burnout syndrome. This is where a seafarer may be overcome by increased anxiety and stress by means of poor leadership, long hours, and high-risk applications. The implications of work-related stress stemming from seafaring operations can be largely alleviated through clear communication of crew and leadership and occasionally moderation through a human resources department. For this reason, it is of medical importance that a wiper finds employment where the safety and well being of workers is held to a high standard. Seafarers and labor unions, necessitated from this occurrence, are closely related in this nature. Little paperwork and qualification is needed to secure a position as a wiper as there are very few preliminary requirements to be found internationally. The only documentation needed is a Merchant Mariners Document (MMD) or a United States approved certification as a wiper. For those looking at work internationally, an International Maritime Organization (IMO) approved document will suffice for employment and will be required for any persons not sailing in the United States; A United States MMD is not recognized by international shipping organizations. A Transportation Worker Identification Credential (TWIC) is required to apply for an MMD or a QMED program. Requirements for those applying for a QMED credential include the following: One must be at least 18 years of age, undergo a medical evaluation, pass an illicit substance screening, and be able to fluently communicate in the English language in the ways that ship duties would require. Greater detail of this process can be illustrated in Code of Federal Regulations (CFR 46). By passing tests administered, an individual may claim a QMED credential and begin accruing sea time in order to apply for higher positions in the maritime industry such as the Third Assistant Engineer. Much of this same process applies for international wipers although there are minor discrepancies between the U.S. Coast Guard and other international licensure departments.