Most people in developed nations take medical care for granted. The COVID-19 pandemic, and the following lockdowns to contain it, brought to light the many gaps in healthcare systems to public attention. 

One such gap was health services for seafarers like merchant ship crews. Roughly 90 percent of the world’s food, fuel, raw material, and manufactured goods are transported by sea. Anything impacting the maritime industry can quickly ripple throughout the global economy.

Diseases like COVID-19 can especially hit hard since most crews lacked regular medical staff, making treatment challenging and expensive. The pandemic made things worse as ports (and their life-saving medical clinics and hospitals) turned away ships, leaving crews stranded at sea for weeks to sometimes months. Maritime organizations are turning to technological solutions like telemedicine to fill this gap in medical care. 

No Doctors on Board

Merchant vessels do not employ a full-time, onboard physician. Most have few crew members (less than a dozen) to justify the high costs. Instead, ship officers receive basic medical training and a well-stocked medical chest filled with essential medications. 

This setup is similar on smaller, naval ships like cruisers and submarines. There, a Navy Corpsman usually performs first aid and basic medical tasks. The only exception involves fleets with aircraft carriers. Seriously ill crew members can be transported to the carrier which employs a full-time medical staff including surgeons.  

First Aid via Radio: TMAS

When a crew member is too ill to treat, injured too severely, or the medical chest is simply out of the right meds, the ship can radio for assistance. This service, called Maritime Telemedical Assistance Services or TMAS, connects the crew to on-shore medical personnel like a clinician. This is a free service and is available 24/7. 

TMAS has several limitations. Many are because it relies primarily on radio. Adrian Schindler, business development manager at Marlink, a maritime remote communications company, has pointed them out in interviews. 

“How it’s [(TMAS)] done today, [a designated person on the ship] would call a hospital and they would vocally give some measurement readings from the equipment on board. The doctor might also ask to be sent some images or file transfers over email. That is quite cumbersome in a stressful situation when you have a medical emergency.

”You also have to consider the [language barriers] and various English accents. Sometimes you can encounter very basic problems, with people confusing ‘fifteen’ and ‘fifty’, or using different scale measurements.”

Costs for Diversions

As previously mentioned, TMAS connects ship crews to clinicians via radio. Fax, email, telephone, or ﹘ on very select ships ﹘ video conferencing are sometimes available. 

Clinicians have only two choices if the crew member is too seriously ill or injured to be further treated onboard. They may be flown to the ship via helicopter, or have it diverted to the nearest port for treatment. 

Such diversions are costly. The International Maritime Health journal, in a 2013 study, found one in five ships each year had to make such a diversion for medical emergencies. Each one averaged $180,000, costing the maritime sector nearly $170 million a year. This does not include the cost of fuel used to get to the port, and additional crew wages for the travel and any wait time once there. And when the ship is finally underway, there may be financial penalties on the cargo for its late arrival at the destination. All these “hidden” expenses further drain shipping companies’ already tight profit margins.

Bringing Telemedicine to the High Seas

The above 2013 study revealed that at least 20 percent of the medical emergencies resulting in a  diversion could have instead been resolved using telemedicine. That represents such a savings in both time and money that even the navy has stakeholders in the emerging technology. 

XChange Telemed illustrates how one such telemedicine system would work. Created by Marlink and launched in 2016, the portable kit is composed of three parts:

  • Medical devices such as an electrocardiograph, an otoscope, a dermascope, a stethoscope, a glucometer, a thermometer, and an ultrasound scanner. All have been certified by the European Union. 
  • A satellite and communication exchange system platform.
  • Web portal access by clinicians for 24/7 access anywhere there’s Internet connectivity. 

Crew members use the devices as per the included instructions. The secured data is sent to the clinician in real-time, who gives treatment plans. Crew medical records from on-shore healthcare groups can be synced with the kit and vice versa to provide better triage.  

Continued Schindler: “The values measured by each device are digital, so it gets synchronized to the station, and from the station to shore. The important point here is that the person making the examination doesn’t have to connect any USB cables, or make any transfers. It’s really about saving time and it’s automatic.”

The e-healthy ship project aims to be a much more comprehensive program. Started by the EU itself in 2017, this web-and-cloud based system aims to make healthcare on merchant ships more like those found on land-based medical clinics complete with on-line medical books and EMR. This hopefully will allow officers to make more informed decisions when treating crew members. Telemedicine, especially video-conferencing, is also a part of this program. Unfortunately, adoption has been slow as most ships lack the proper equipment and connectivity bandwidth, especially for video. 

Closing Thoughts

Seafarers, from those transporting cargo aboard merchant ships to sailors prepared to defend their nations, have extremely limited access to prompt medical care while at sea. Maritime organizations are turning to telemedicine to address their crews’ well-being. Contact an expert at Cybernet if you’re interested in learning more about this technology and how to apply it to your marine business. 

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