Emergency medical care at sea - is Telemedicine the answer?

What is Telemedicine?  

Maritime Telemedical Assistance Services (TMAS), sometimes referred to as RADIOMEDICO services, provide remote expert medical advice for seafarers, passengers and others on board ships. Traditionally this was obtained by radio but now this service more frequently makes use of modern communication devices, including satellite and internet, to provide video as well as audio communications with medical providers. TMAS specialists can offer assistance to a Master in the diagnosis and treatment of ill or injured individuals on board a ship or offshore facilities where shore-based care is not possible. Prompt and effective treatment can make the difference between life and death or permanent disability.

International standards

The case for using Telemedicine has been strengthened following the implementation of the International Labour Organization’s Maritime Labour Convention (ILO/MLC) and the International Maritime Organization Standards for Training, Certification and Watchkeeping, Manila 2010 (IMO/STCW) amendments. From 1 January 2012, ocean going vessels and flag states have been required to “provide seafarers medical care as nearly as possible with 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”. The provision of TMAS is not consistent from one flag state to another. They rely instead on countries providing TMAS through MRCC’s (Maritime Rescue Co-ordination Centres) or on employers arranging emergency response and remote medical assistance via private sector contractors.

Benefits and downsides

Using TMAS can offer benefits to shipowners and employers such as:

• Reductions in deviations and dangerous emergency evacuation operations

• Reductions in number of individuals needing treatment on arrival in port

• Enhanced goodwill of crews  knowing they have access to advanced medical services

• Reductions in Lost-time illness and injuries

In a recent Gard case, a crew member was presumed dead following a sudden illness during the course of a voyage.  However, the Master felt he should undertake a two day deviation to the nearest port in order to confirm the death with medical authorities and assure the crew that there was no danger in continuing the voyage. Following contact with a TMAS, the cause of death was confirmed and the crew was reassured that they were not in danger. The voyage was completed without deviation with the crew feeling at ease.

That said, there can be significant risks involved in using Telemedicine providers, for example:

• Use of sophisticated electronic equipment requires extensive training - misuse of or mishandling the equipment could have very serious consequences

• Shore-side doctors may not have specific training/experience relevant in a marine environment

• There may be language difficulties between the ill/injured individual and the shore-side medical personnel

• Many countries have restrictions on sharing an individual’s medical records and conditions, which may be violated by using a TMAS service without the express permission of the person being treated.

Finally it should be noted that the costs of engaging private TMAS providers can be high and therefore increase daily operating costs of a ship.

Where is Telemedicine available? 

It is important to draw a distinction between public and private TMAS services.

Public TMAS services are available world-wide and free of charge with many nations providing access to all ships and others providing services only to ships of their flag. One of the oldest and possibly most well-known of the public services is Centro Internazionale Radio Medico (C.I.R.M.).  Located in Rome, the CIRM has been providing 24 hour services since 1935. A comprehensive list of public providers can be found here.

The number of private TMAS services has increased significantly during the past ten years and there are many services and pricing plans available with fierce competition on service and pricing levels. Some private TMAS providers offer enhanced onboard medical capacities which can include state of the art medical diagnostic tools.  Such tools (when used by trained crew members) can increase the odds for a better outcome for an ill or injured individual. Gard does not cover general subscription or membership charges for private TMAS services, as these are deemed to be operational costs and expenses for the owner’s account. However, specific additional expenses incurred in connection with injury, illness or death may be covered under our Rule 27. The same applies to passengers pursuant to Rule 28.

Summary

Telemedicine has become an important tool in the safe and efficient operation of a modern ship.  Services are available 24 hours a day and can be obtained (in many countries) without charge. Private TMAS services are available and many offer a high level of service which although can be very expensive, in the right cases these charges can be minimal compared to the costs involved in e.g. deviating a ship.

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Questions or comments concerning this Gard Insight article can be e-mailed to the Gard Editorial Team.