Thursday, 30 July 2009

Vital Signs: the future of Telemedicine at sea

Facilities for emergency medical assistance at sea have to be cost effective. If there is a casualty or a sick crewmember, decisions made have enormous financial consequences either way: diverting a ship when not required costs money, and not diverting a ship when required can have deadly repercussions for the sick or injured crewmember.

Modern technology can assist a Master enormously in promoting prompt and pertinent medical treatment. Telemedicine, as this service is commonly called, has made staggering progress on the back of satellite based communication systems nowadays. With complex satellite technology, video conferencing and email, real time medical specialist consultation is a reality today. Gone are the days when the crew were completely on their own in the event of an accident, or had to be content with a phone call or two to shore based specialists, as started happening in the eighties.

Another tool that is becoming increasingly available to Masters of ships when it comes to seeking specialist help: remote diagnostic monitoring of vital signs. This process is as simple as “plugging in a USB line," says Frank August, Director of business development for Inmarsat, the satellite network people. “I don't believe the industry is fully aware of the current capabilities and ease of use," he adds.

As we well know, satellites can transmit all kinds of data anywhere on earth. Bandwidths, speeds and newer technology used by satellite companies like Inmarsat and Iridium have upgraded this now to a stage when the entire world, including the polar regions, are covered by wireless networks: Iridium, for example, has a 66 satellite network and launched its special ‘OpenPort’ service last year, connecting networks at speed up to 128 kilobits per second (kbps). It is therefore possible, today, to transmit digital camera images of a crewmember’s injury to a specialist doctor ashore in almost real time. Not just that, dedicated lines ensure that data can be sent simultaneously when, say, a phone call is in progress, allowing a Master to consult a doctor at the same time as the camera is showing him what exactly the injury looks like. The next generation of OpenPort technology will allow video footage to be broadcast similarly as well; present systems allow only compressed video files to be broadcast. Inmarsat 4 goes further, transmitting data at 432 kbps.

Photographs and video footage are being increasingly seen as important data inputs for a doctor to give correct advice when he or she is located thousands of miles away from a ship. Diagnostic data transmission is, likewise, a staggeringly effective tool when a patient may be seriously sick on a ship. Although shore based networks allow streaming media without fluctuation in speed or fuzziness, these systems have not been available at sea so far, but times are changing fast.

However, the transfer of medical data, video and camera footage from a ship to a shore doctor is just half the equation; accurate diagnosis and follow up is as critical. Organisations that assist the Master with specialist doctors and nurses on call twenty four hours a day have existed for many years. Now, they too, are streamlining their operations to take advantage of new technology.

One such well known organisation in the US is MedAire. Although it has provided medical expertise to mariners and aviators for more than two decades through its global emergency response centers, technology advances in telemedicine allow it to go much further now. "Clients are now leveraging the Internet more," says Jill Drake, Marketing Director for MedAire. "They call us for an initial diagnosis, and then can follow up via email. With email you can send a picture of a wound, and it's often easier to read and understand a diagnosis when it's in email form.” In addition, communication issues with doctors and crew speaking different languages become minimal with remote diagnostics allowing crew to collect and transmit data on a patient's vital signs, including EKGs, to shore side medical services. MedAire collaborates with Remote Diagnostic Technologies Ltd. (RDT) of the United Kingdom; the monitor sends the patients vital signs to MedAire’s response centre in Phoenix, Arizona.
"It's virtually like being in a hospital emergency room because you're receiving information directly from a vessel," Drake says. Images are high resolution and amazingly clear.

MedAire says that subscription to its Medical Advisory Service (MAS), gives crew “access to unlimited telephone and email consultations from licensed doctors and registered nurses”. MAS matches remote medical expertise with onboard medical equipment and stores, with response teams comprising “emergency doctors, registered nurses certified in advance cardiac life support and communication specialists who handle case logistics”. Moreover, MedAire will coordinate, if necessary, medical evacuations, repatriations, and the location of appropriate shore side medical facilities “so the captain can focus on maritime operations.”

Companies offering remote medical advice work on an annual contract basis, with a fee ranging from below US$ 1000 to up to $6000 or so, depending on crew size, the run of the vessel, the level of training of personnel aboard and other factors. Many shipping companies see this as an additional expense not worth the price tag. However, as a spokesperson for one company providing these services says, "It only takes one case where we either treat appropriately and avoid a vessel diversion, or we direct an immediate evacuation versus waiting two days to get to port, to recover the cost of the service for years to come." Besides, increased competition is pushing lower costs.

While Masters are always responsible for making the decision to divert or evacuate a crewmember, remote specialist medical teams and services can give excellent recommendations and provide input in an area outside his expertise, thus allowing him to weigh the risks and take appropriate decisions in the best interests of the patient, the ship and other commercial interests.



No comments:

Post a Comment