Telemedicine, or the use of electronic equipment to provide remote diagnosis and medical treatment, can trace its roots back to the 1960’s “Space Age”, when the U.S. National Aeronautics and Space Administration (NASA) first put human beings in space.[1] Beginning primarily with the use of electronic signals to simply transfer medical data, it has grown into a sophisticated, indeed futuristic, system of remote diagnosis and treatment. Telemedicine is now used to provide acute and primary healthcare to patients living in remote areas, as well as to patients employed in less distant workplaces. The marine environment provides the ultimate challenge, being both remote and a workplace.
As noted by Dr. Brian Bourgeois, Future Care’s[2] lead telemedicine physician advisor and member of the Medical Advisory Board for the United States Coast Guard:
Mariners work under a variety of conditions, many are physically demanding and stressful. The remote location of many mariners heightens the need for appropriate medical advice and care so that small problems do not become big problems. The great majority of mariner’s health issues can be cared for and resolved onboard. This obviates the need for difficult logistics of shore side medical treatment in foreign ports.
The undisputed and growing ability of telemedicine to provide medical diagnosis and acute care onboard ship, deservedly, has received increasing approbation and attention recently. This development likely will continue to garner praise as the practice becomes more widespread and the practitioners more proficient. A growing number of hospitals are devoting considerable resources and sophisticated equipment to bridge the distance between ship and shore, especially within the cruise industry.
Yet there is a second, equally important use for telemedicine onboard ship, and that is primary healthcare or “wellness”. While less dramatic than emergency medicine, attention to primary healthcare is extremely beneficial to the seafarer and employer. Currently, the extent of many seafarer’s employer-related primary care treatment begins and ends with the Pre-Employment Medical Examination or PEME. The PEME undoubtedly has saved or prolonged the lives of numerous seafarers by identifying serious medical conditions before heading seaward, allowing for personal, shore-side treatment.
However the PEME also identifies the chronic illnesses that afflict many mariners – hypertension, diabetes, cardiovascular and gastrointestinal problems – which he then takes onboard ship. Obviously, these chronic conditions, as well as untreated minor ailments, often can turn severe, potentially leading to expensive shoreside medical visits; unscheduled repatriation and at worst, ship deviation or emergency evacuation. Incredibly, treatment of these identified ailments frequently is left to the individual mariner, without any further professional medical support, at least until he is again landside.
While the cruise industry has the physical and financial capacity to maintain sophisticated medical equipment onboard, the seafarer on the typical bulker, tanker or container ship enjoys no such benefit. Fortunately, the technology required to implement a productive shipboard wellness program is both minimal and inexpensive. The cost of an electronic glucose meter, 6 or 12 lead ECG, blood pressure cuff, microscope and related equipment is eminently affordable and easily stowed.
The key component of a successful and cost-effective shipboard wellness program is not primarily the technology – it is the implementation and maintenance of a scheduled review with an experienced physician. The consultation need not necessarily be (remotely) face-to-face. The ship’s medical officer or the mariner himself can take the vital signs and transmit the readings, accompanied by a subjective assessment of health, to the physician for review. In a program of shipboard wellness such as that offered by Future Care, the reviewing physician will have to hand the PEME data, medical records, prior readings, and related data needed to provide a comprehensive analysis.
The time taken from onboard work for this program is minimal; the time and money saved is incalculable.
The Maritime Labour Convention 2006 states that the shipping community and flag states are required to:
‘(…) provide seafarers with medical care as nearly as possible equivalent to the care they would receive ashore.’ and to ‘(…) ensure by a prearranged system that medical advice by radio or satellite communication to ships at sea is available at any hour of the day or night’ and thus provide an appropriate harmonized level of healthcare for seafarers on board ships.
Clearly, primary healthcare while at sea is a component of the MLC mandate and most importantly, the capability exists now to make it a reality.
[1] 1. University of Tennessee Medical Center Telemedicine Network
http://ocean.st.usm.edu/~w146169/teleweb/telemed.htm#top
[2] Future Care, Inc., is a leading provider of medical management and cost containment services, including telemedicine, exclusively to the maritime community, world-wide.
