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Telemedicine at sea: quality health care services across a deep sea

In today’s fast-paced world, people have become accustomed to quality health care services wherever they are onshore or travelling across a deep sea several thousands of miles away from land.

 

Special Correspondence

In the past, merchant ships are like floating prison, where the captains, crews, and passengers are not only far away from their family, but lack access to basic social services such as the internet and healthcare. Under this scenario, when a person is injured or ill at sea, there may be a need to seek medical advice from land, in this case a radio message is  sent to the ship owner’s office, that are at best ill-equipped with medical personnel. However, despite the vital role that the maritime industry plays in the global economy, it has traditionally lagged behind in terms of access to and availability of healthcare technology when compared to land-based environment in the adoption of advanced communications technology.

According to International Labour Organisation’s maritime labour convention, each member state must ensure that all seafarers on ships that fly its flag are covered by adequate measures for the protection of their health and that they have access to prompt and adequate medical care whilst working on board. The competent authority shall ensure by a pre-arranged system that medical advice by radio or satellite communication to ships at sea including specialist advice, is available 24 hours a day.

On shore, telemedicine has been introduced to improve access to healthcare services for people living in remote areas, as well as in cities. On ships, however, telemedical technology has only to a small extent been introduced to improve access to specialist advice beyond what can be given over radio or telephone.

Analysts have argued that the shipping industry is more and more becoming aware of the need for this technology on board of the international fleet. Tele-co-operation systems have become an essential component, facilitating the joint work of geographically distributed persons or groups. On board merchant ships, the captain and second officer are usually in charge of medical care for a patient at sea. Merchant vessels do not carry qualified doctors or paramedics on board and the training of persons responsible for medical treatment on merchant vessels varies considerably. In addition, evacuation of patients is expensive and sometimes impossible due to the cost of transportation under extreme weather conditions. The delivery of healthcare services to the merchant fleet also differs from the way passenger ships receive medical advice. Maritime telemedicine systems can enable a rapid assessment of the sick crew member so that decisions can be made together with medical specialists on land.

In July 2003, telemedicine equipment was firstly installed on board MS Jupiter (Fjord Line), a Norwegian passenger ship which travels from Norway to England. The ferry is at sea for 17 hours during the crossing and part of the time, the ship is so far from land that it cannot be reached by helicopter. Fjord Line has improved the information flow between the ship and the medical care units prior to any evacuation and to get more precise advice from the hospital for the treatment of their passengers. The results from the first years have shown that several unnecessary evacuations have been avoided. Since 2006 telemedicine equipment is continuously in use on board several international operating Norwegian merchant ships and also on North Sea platforms. The experiences gained with the use of this new technology have led to an improvement in intersectoral co-operation in connection with seafarers’ health care on board merchant ships and platforms.

Shipowners, merchants and the crew believe that telemedicine leads to a better healthcare for seafarers. In today’s shipping industry, the seafarers in the age of 50-60 years are   representing about 50% of the Europeans today. A lot of these people are in the risk zone for heart conditions and it is much easier to start the correct treatment if a proper diagnosis can be given by the use of telemedicine. According to a ship captain, it is a very easy way to cooperate and therefore a better opportunity to save a seaman`s life.”

Maritime telemedicine

Access to healthcare has always been one of the most critical issues for offshore crews. On board merchant ships, an emergency evacuation can be very difficult, sometimes even impossible, because of the long distance to shore. In general maritime medicine includes a lot of different medical specialities such as general practice, surgery, emergency medicine,  occupational health and telemedicine. Telemedicine experts have pointed out, that a lot of various actors with different national, professional and cultural background are normally working together in order to solve health issues in maritime medicine.

Accordingly, the panorama of diseases and injuries varied between the different maritime settings. Patients representing cruise liners and ferries reported frequently coronary heart diseases, while accidents were the main problem among the others. Seamen on merchant ships usually contacted Radio Medico for medical support, while the fishermen most frequently contacted the coast guard or the emergency medical dispatch centres.

There are also other medical problems that are not emergencies but nevertheless should be handled in an optimal way to reduce risks. This comprises medical diagnosis and treatment performed using digital information technology to transfer patient information. The number of people on board merchant vessels is also significantly lower than on passenger ferries, but the number of days on board increases the need for a medical call centre. The delivery of health services to the merchant fleet also differs from the way passenger ships receive medical advice.

According to the World Health Organisation, the second officer is responsible for the medical care of the crew. Radio Medico is normally contacted by phone and the advice is given verbally. The Norwegian Centre for Telemedicine (NST) has been using the following definition: “Telemedicine is the investigation, monitoring and management of patients and the education of patients and staff using systems which allow ready access to expert advice and patient information no matter where the patient or relevant information is located”.

Norwegian maritime telemedicine has existed since the introduction of radio communication some 75 years ago. It provides rapid access to share and to remote medical expertise. Information about the patient, especially vital signs will be transferred electronically in forms of images, video, sound, text, data of medical devices to a telemedicine competence centre where it is processed and, if necessary, distributed to a network of medical experts. The physician in the telemedicine competence centre is informed about the circumstances, external symptoms and first orientating findings. The involved physician directs the further diagnostics and treatment. A telephone based system has limitations when it comes to documentation of workflow, and documentation also represents a new situation of medical work flow and co-operation. Experts have also argued that the requirements for quality of video communication within a tele-co-operation session are much higher in a medical scenario where video data forms the basis for diagnosis and therapy planning, than they are in a business-orientated situation. The Norwegian Centre for Maritime Medicine (NCMM) collects and mediates knowledge about maritime medicine to seafarers and fishermen, shipowners, ships authorities, workers’ organizations, employers’ organisations and others.

According to the ILO`s Maritime labour convention, every seafarer has a right to health protection, medical care, welfare measures and other forms of social protection. In order to achieve high quality treatment of seafarers, the resources must be utilised in such a way that telemedical users on board and the Norwegian maritime society ashore including the Norwegian Maritime Directorate, ship owning companies, shipping industry, maritime institutions, hospitals, ship supplier as a whole, receive the best possible benefits.

 

 

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