BY WENDY LAURSEN 2018-12-17 17:58:27
The limited ability to provide medical care at sea has been classified as one of the “special risks” for seafarer stress. The authors of a 2015 article published in the Review of Psychology observed that stress resulting from treatment of disease at sea is due, in part, to the fact that medical care on board is administered by someone who is not a medical professional and that treatment options are generally limited.
The uptake of telemedicine in recent years has helped change all that. Expert medical advice at sea is now just a phone call away. “In many instances, the crew’s knowledge, alone, that expert medical advice is available 24/7 onboard ship promotes psychological comfort and well-being,” says Larry Jacobson, Managing Director of Future Care, a leading medical management company exclusively serving the worldwide maritime community.
The Telemedicine Advantage
Remote diagnostics also benefits the ship operator. “We calculate that the average cost of a portside medical examination can range between $2,000 and $5,000, depending on a number of variables including landside transportation, visas, launch and agency fees, lost work time and, in some cases, salary – not to mention the actual clinic/medical fees,” Jacobson adds.
“Our data in 2017 for several of our largest clients, derived from Future Care’s telemedical service, Physician Advice at Sea, confirms that between 40 and 50 percent of seafarers were successfully treated onboard ship with the individual crewman’s agreement, thereby avoiding an unnecessary portside exam.”
Jacobson estimates that a fleet of 50 ships will require approximately 250 telemedicine calls per year. “Utilizing our lowest numbers for the cost of a portside examination and lowest percentage of clearance rate onboard ship yields a gross savings of $200,000 for the fleet,” he calculates. “Mind you, this is at the lowest range. Elevating average port costs to $3,000 with a clearance rate of 45 percent shows a gross savings of $337,500.”
Future Care statistics confirm that approximately 20 percent of shoreside examinations result in an unscheduled repatriation of the crewman. “We calculate that the price for an unscheduled repatriation to be between $5,000 and $10,000 when considering the costs incurred for a portside examination plus airfare, lost work time and manning replacement costs. These latter expenses can be even greater when repatriating ship’s officers.”
Future Care was a pioneer in the introduction of telemedical services at sea. “Since those early days,” Jacobson recalls, “we have expanded our capacity to include the option of remote visual consultation with digital instruments. This new advance in service assists our physicians in more accurate remote diagnosis and treatment.”
A growing range of medical measurements can now be made available to support services ashore through the wonders of technology. Nearly all cruise ships, for example, and a growing number of cargo fleets use SeaCare, a software platform developed by Tritan Software Company specifically for the maritime industry.
Nedko Panayotov, Director of Program Management at Tritan, says clients can manage every aspect of medical operations from anywhere in the world. The system provides one centralized view of medical activities in real-time and allows users to automatically calculate key performance indicators across interactive dashboards.
SeaCare integrates every component of medical operations and management including onboard medical incidents, wellness programs, third-party referrals, compliance reporting, inventory and cost management. The system has ship and shoreside components that are synchronized and the ability to include third parties such as clinics. Seafarers’ pre-deployment medical examinations also form part of their integrated medical history.
“A shipping company can follow a person from company to company, so there is never, ‘Oh, I lost it. I don’t know.’ Now, you have a full history of everything that has happened to them,” says Panayotov. X-ray and ECG machines are the most common medical devices that connect to the system, and the resulting images become part of the system’s digital record. No paper records are needed.
“Communication with public health agencies is such that an email or a phone call just won’t cut it anymore,” he adds. “With SeaCare, the documentation on what was done, how it was done and when are all recorded. It’s legible, and lawyers do not challenge it as much as pen and paper in court.”
The system includes medical inventory functionality. “As we all know, medical departments onboard ships, especially cruise ships, are not revenue-generating departments. They are there for the well-being of the customers, but the system facilitates some return on investment from savings on either medical inventory management or the supervision of medical referrals,” says Panayotov.
SeaCare has evolved over time and now links to a range of other Tritan systems including the SeaEvent management platform, which supports event reporting, audits, policy and safety management systems.
For commercial shipping and the fishing industry, Tritan has a “light” version of its systems suited to situations where there is just a medical officer and a medical kit on board rather than the hospital services offered on many cruise ships. The functionality is generally similar, however, and includes educational material to support decision-making as well as support for telemedicine using minimal bandwidth.
Jon Bloomberg, New York State 911 emergency medical technician and CEO of Core Medical Systems, emphasizes the importance of planning to support onboard decision-making during a medical emergency – even before a phone call for assistance is made: “The essence of emergency medical treatment is planning. Not that you know what will happen – no one knows that – but planning for what might happen. We sell medical kits at many conferences and shows, and at every one someone will come up and say, ‘Boy these are great, complete kits, but tell me, what do I really need?’ I always say, ‘You tell me what will happen to you and I’ll tell you what you need. Otherwise, you need everything.’”
Bloomberg highlights the importance of knowing upfront that certain crew members or passengers have medical conditions. Next comes recognition of the problem, treating it and calling for help. “Being prepared and recognizing that medical problems are unpredictable in both scope and kind goes a long way toward making the situation turn out positively.”
CHIRP Maritime (a charitable trust for the confidential reporting of hazardous incidents) and University College London have released a booklet titled Perception, Decision-Making and Fatigue at Sea designed to help seafarers maintain optimum well-being at sea so that they can deal effectively with emergency situations.
Regardless of the length of voyage, research indicates 61 percent of seafarers feel more tired at the end of the voyage than at the beginning, says CHIRP’s Maritime Director, Captain Jeff Parfitt. Among the booklet’s recommendations is that ship operators have procedures in place and available for easy reference to ensure that in emergency situations crew members are able to respond ASAP. Practice makes all the difference, he says.
Mental Health Issues
Seafarers can now undergo training in occupational health and safety while at sea. Sea Health & Welfare and Seagull Maritime have developed a new course, targeting members of the safety committee, to promote health and safety on ships. Sea Health & Welfare offers a wide range of courses, including psychological crisis management, and also provides psychological help for people affected by an incident.
Vivek Menon, Head of the Occupational Health & Safety Department, says the industry has seen a growing range of initiatives for seafarer mental health in particular: “It’s a topic that has received a lot of attention. Insurance companies are concerned that they will be getting more cases associated with mental health and have developed packages for psychological care. They are thinking of prevention: Don’t fight the fire. Try and prevent the fire in the first place.”
Sometimes this is as simple as just talking to seafarers. “I remember having a chat with a captain where all I had to do was listen to him for 30 minutes, and then he was fine,” Menon says. “He was debriefing after an incident, and at some point I asked him, ‘How are you feeling?’ The whole conversation then changed to how he was feeling rather than the things that he had to do. It can sometimes be easy to miss that the captain is an individual who may feel something.”
A video call is more personal than just a phone call. “Some people like to see the other person’s face, to understand the body language of the person and understand how they really feel,” he adds. “A lot of our psychologists use it as a cornerstone. They need to know the body language of the person as well as what they say.”
Remote care does have its limitations. “Technology such as telemedicine can optimize our work and help us be more efficient,” Menon concludes, “but it may not always allow us to see them face-to-face, offer a handshake and then ask, ‘How are you?’ So technology is very good and important, but at the end of the day I think it’s good to realize that people have feelings, and feelings cannot be entirely captured by just technology. We’ll get there one day, perhaps, but we have yet to get that far.” – MarEx
The opinions expressed herein are the author’s and not necessarily those of The Maritime Executive.