You're in the Atlantic Ocean; one of the crew has severe chest pains - what do you do next?
With the advent of telemedicine, it is now possible to monitor a patient remotely. However, until recently this technology has been of little use to the lay person working onboard a ship, as it has typically required the user to have expert medical knowledge.

If telemedicine is to be of use in the handling of maritime medical incidents manufacturers need to make sure the technology simplifies, rather than complicates the situation. This is a challenge, as the crew will tend to use this equipment on an infrequent basis. They need systems that eliminate pressure by providing simple, intuitive help at all times. If it is not easy to use, it will not gain their acceptance.

With this in mind, RDT, a UK based company, has recently launched the Tempus 2000 remote medical monitoring system. The device is specifically designed for use by non-medical experts, even on an intermittent basis. The development of systems such as this look set to be a major breakthrough in the handling of maritime medical incidents by reducing costly “false alarm” medivacs, while improving the overall quality of medical care onboard ships.

“False alarm” medivacs waste time and money
The Tempus 2000 provides 24-hour access to expert medical advice from any remote location. The system uses an in-built modem to send a sick crew member's or passenger's blood pressure, pulse rate, temperature and blood oxygen level, via the ship's telephone system, to land based doctors. It also includes a full 12-lead Electrocardiogram, which can easily be operated by one of the ship's crew.

All this clinical data allows the land based doctors to clearly differentiate minor conditions, such as chest pain caused by severe indigestion, from something much more serious such as a developing cardiac condition. This should result in significant long-term savings by avoiding unnecessary medical diversions or medivacs.

The system includes a number of ease of use features such as full colour help screens and an integrated hands free voice link that automatically connects the user to the doctors on the land. There is also a still video, which can help with diagnosis and allow the doctor to see what is happening on the ship. The doctors also have remote control of the device from the ground.

All these proved to be an important addition in crew trials as they enabled the land based doctors to offer genuine support to the crew throughout the incident. They also help keep training to an absolute minimum by guaranteeing effective use of the equipment even on an intermittent basis. This is particularly important in the shipping environment, where crew turnover is still relatively high.

Existing customers
The system has already proved to be a hit in the aviation market, where airline companies have been looking for a simple solution to handling the increasing number of in-flight medical incidents their crews have to deal with. The typical cost of diverting a long haul aircraft is in the region of £40,000, with some running into the hundreds of thousands. Both Virgin Atlantic Airways and British Midland have already adopted the Tempus 2000TM for their long haul fleets, as they believe it will significantly improve their passenger service and prevent unnecessary diversions.

Virgin Chairman, Sir Richard Branson, said “Virgin Atlantic has been committed to implementing telemedicine onboard for many years now and the Tempus 2000 is a major breakthrough in this area.
All airlines have a duty to their passengers on long haul flights to provide comprehensive medical
back up and I challenge other airlines to follow our lead! This new technology will have many life
saving applications.” The cost of some “false alarm” diversions for commercial ships can run into even bigger numbers as the diversions may take several days rather than hours and result in late delivery charges. Any telemedicine system therefore needs to be able to assist in as many medical incidents as possible, ranging from cardiac to pulmonary, gastrointestinal to orthopaedic.

To be most effective, it is important the doctors can also recommend remote treatment. To do this safely, they need diagnostic quality information, such as a 12-lead Electrocardiogram. In some cases, having the ability to actually show the crew what to do using marked-up video images could prove invaluable.

Crew shortages are expected to increase
Another concern for commercial shipping is the increasing shortage of skilled seafarers with the International Transport Workers' Federation (ITF) stating 48% of seafaring officers from industrialised countries of the OECD are now over the age of 50. As a result, shipping companies now have to pick skilled crews from a smaller pool and are therefore very keen to do what they can to keep them. This includes making sure they have sufficient medical capabilities to both support them and prevent costly and stressful unnecessary medivacs or diversions. This increase in average age has also increased the awareness of health issues as the older crews are, the more likely they are to have pre-existing medical conditions that may need to be addressed while at sea.

It is also well documented that improving overall care to employees leads to improved productivity. As the demographics in the commercial shipping environment are shifting upwards and previous sources of recruitment are less plentiful, such as those from developing countries, overall safety including medical safety has become an even greater priority in this sector.

Other applications
Cruise ship companies are also looking at telemedicine as the next practical step in improved onboard medical facilities. The Tempus 2000 is about to be trialed on a Sun Cruises liner (a division of Airtours), who are investigating the addition of telemedicine for some of their vessels. Even though most cruise ships have a doctor onboard, companies are considering telemedicine as an additional tool that
would enable quick and simple access to a second expert opinion, such as a leading cardiologist or pulmonary specialist etc.

The Tempus 2000 system was recently demonstrated to NATO members at a Joint Operations medical conference in Belgium, where members were assessing its capabilities and ease of use for both maritime and land-based military personnel. They believe it could improve medical cover, while reducing unnecessary medical expenses.

In addition, a trial is about to take place on an oil platform in the North Sea, where medical cover is a big issue due to the remoteness of some of the platforms and the extreme weather conditions sometimes making a medivac very precarious. Although crew safety remains paramount, oil and gas companies are looking at ways to improve the overall quality of crew care, while decreasing the number of unnecessary medical evacuations.

More definitive information
Dr David Streitwieser, medical director of MedAire, a Phoenix, Arizona based company providing the MedLink 24-hour emergency telemedicine centre says: “We are active supporters of the Tempus 2000 and all of our MedLink team have been trained in the use of the system.”

MedAire's vice-president for marketing, Steve Holstein, says: “The Tempus 2000 system can be a significant tool for our MedLink physicians in working with our maritime clients. Currently, they base
their assessments and recommendations on the information they are provided. That information is
as accurate as the person providing it. For the most part, this information is adequate in allowing physicians to do their job.

“But it is not unusual that a physician will have to take a very conservative approach to their assessment and recommendations, due to the incompleteness or being somewhat uncomfortable with the competence of the information they are receiving.

“The Tempus 2000 takes a lot of variables out of the equation, allowing the physician to come back with more definitive assessments relative to a patient's situation. Also the video images can be very helpful to our doctors as it allows them to see exactly what they are dealing with. As a result, in certain cases, this more definitive information can mean the difference between recommending the patient be evacuated or the ship diverted, or not needing to do anything.

“We have seen strong interest for the system when demonstrating it at aviation and maritime trade shows. A number of our corporate and commercial aviation customers have already started equipping with the Tempus and we will be actively following its progress.”

Any solution to the problems created by medical incidents onboard commercial ships must be both practical to implement and cost effective to run. Shipping companies will need to believe this technology will help their bottom line and significantly improve crew care. Given the increasing age of skilled crew and the need to reduce the risk of unnecessary medivacs or diversions, telemedicine for the maritime market looks like it is here to stay.

ENDS