It’s an old question and an old concern: what happens if you get sick or injured at sea? It can be a serious matter aboard a large, well-equipped ship on which some sort of medical help might be available; it is altogether a different matter when you find yourself aboard a small boat, perhaps miles from shore and many hours, if not days, from help. The extreme scenario is of the solo sailor many hundreds of miles at sea, injured or ill, unable to expect or to receive any assistance at all. What then?
That question took a new turn and had a dramatic and happy answer for a Russian sailor whose elbow became infected last November while sailing in the Around Alone Race for solo yachtsmen. Viktor Yazykov, 50, was en route from Charleston, S.C., to Cape Town on the first leg of the grueling race. Still 900 miles shy of his destination, his elbow became abscessed, discolored, and “felt dead,” so he sent an e-mail to Dr. Daniel Carlin of WorldClinic, Inc., in Boston describing the symptoms. He ended his message, “Waiting for your help.”
From Yazykov’s description, Dr. Carlin, an infectious disease specialist at New England Medical Center, analyzed the situation and shortly e-mailed Yazykov instructions to follow a 14-point procedure to cut into and drain the abscess. After successfully performing the surgery on himself, Yazykov began to bleed uncontrollably due to taking too much aspirin, but Carlin e-mailed further instructions to fix that problem, too. Yazykov, his arm and even his life endangered, began to improve. He eventually arrived safely in Cape Town aboard his vessel Winds of Change and, despite his ordeal and a late start in the race, finished the leg fifth out of nine racers. Followers of the Around Alone yacht race web site (www.aroundalone.com) were able to see video footage of Yazykov performing surgery on his abscessed right elbow.
Not surprisingly, the preparation for such an occurrence, the presence of the surgical tools and the right medicines aboard Yazykov’s boat, and the availability on the Russian’s boat of the very best communications technology had all been carefully planned and rehearsed. The Around Alone Race had contracted with WorldClinic, which was founded by and is run by Carlin, to provide the necessary medical assistance. WorldClinic specializes in providing medical care to groups or individuals while traveling, working, or living abroad. Providing boats with medical assistance is but one small part of its overall mission.
Providing medical advice and care to persons in remote or isolated places by electronic means today comes under the general heading of telemedicine, a large, fast-growing, and multi-faceted business found all over the world. The linking of modern communications technology with medical assistance goes back to the earliest uses of radio; perhaps a remote nursing station being advised by a doctor from a town or hospital 60 or 70 years ago. The capability to reach ships from shore-based radio dates from the beginning of this century, and it was quite commonplace by the World War I era. But telemedicine did not see regular use until 40 or 50 years ago, and its emphasis has always been on servicing remote land communities for the obvious reason that that is where the highest number of people are found and the greatest opportunity to help those most in need.
Four telemedicine organizations
Today in the U.S. there are four main organizations whose mission includes medical assistance to ships and, in two cases, small boats. They differ somewhat in their organization, what they emphasize or specialize in, and the extent and kinds of services they provide. All four of them are still evolving as the need for them changes and, perhaps most important, as the communications technology changes.· Maritime Health Services (MHS), 4050 Columbia Seafirst Center, 701 Fifth Avenue, Seattle, Wash. 98104-7016; tel. 206-340-6006. MHS is a subsidiary of AEA International, a leading global health care and assistance company. For 20 years AEA International has provided health-care services to subscribers in the far-flung corners of the earth, providing Alarm Centers and Medical Centers on five continents.
Doctors Mike Brown (206-781-8770) and Ray Jarvis started Maritime Health Services in 1991 and can utilize the parent company’s international medical connections at any time. MHS will equip medical facilities and ships with equipment and medications, including medical sea chests tailored to a ship’s or boat’s specific needs. They will provide training in all basic medical procedures. They also emphasize that they provide social as well as medical services.
The focus of MHS’ services is toward larger ships and fishing vessels, although they have an increasing number of voyaging boats under contract. A typical contract with a voyaging boat is usually $350 to $500 per year, but larger boats can cost much more. MHS claims to have almost 500 boats under contract with them at the present time, and to have managed more than 10,000 cases, many of them representing major medical problems. Medical assistance is available 24 hours a day. · Medical Advisory Systems, Inc. (MAS), Box 193, Chaneyville Junction, Owings, Md. 20736; tel. 301-855-8070. Contact Dr. Dale Hutchins (301-855-8070). MAS has been a provider of medical products and services to the maritime, aviation, and commercial industries for more than 15 years. It provides 24-hour medical consultation via the latest communications systems. It also provides drug testing and a program to monitor employees potentially exposed to workplace hazards. The staff includes physicians; multilingual communications/rescue coordinators; a large support staff; a network of physicians, hospitals, and clinics in the U.S.; and a worldwide network of medical and logistical contacts.
The maritime program was created in response to a U.S. Coast Guard study of illness and injury occurring aboard ship and has been serving the maritime/offshore industry and recreational mariners since January 1982. A call from any ship or boat that has contracted with MAS puts it in immediate contact with a team of specially trained physicians. MAS will retrieve the patient’s medical history, diagnose the problem, prepare an emergency treatment plan, and tell the caller exactly what to do. If the vessel is at a foreign port, MAS will provide coordination with local emergency medical services and assist with shore transportation and evacuation if necessary. MAS also has a program to stock ships’ medical lockers, ensuring that appropriate supplies are aboard the vessel at all times. MAS is a registered pharmaceutical distributor and is licensed by the DEA to distribute controlled substances. The organization also has a complete line of First Aid Chests specifically put together for recreational boaters.
MAS has developed a training program, Response to Injury and Illness at Sea, that teaches how to get the best use of the radio medical advice and medical supply programs provided to its customers. It also teaches a general approach to recognition and immediate response to life-threatening emergencies, including a review of CPR. The training can be customized to the immediate needs of the requesting company.
· Maritime Medical Access (MMA) is managed by the Department of Emergency Medicine at the George Washington University Medical Center, 2140 Pennsylvania Avenue NW, Washington, D.C. 20037; tel. 202-994-3921; or call Robin Barnes, director of operations (202-994-4126). MMA has been providing maritime medical services to the commercial shipping, fishing, and cruise ship industries since January 1989. The organization is proposing to market its plan to the recreational boating industry in the near future.
MMA works with companies in the maritime business to provide medical advice through consultation via phone, fax, telex, or radio. Its doctors work with the vessel’s designated medical officer to obtain any important information concerning the patient’s condition, make a probable diagnosis, and recommend a treatment plan. MMA physicians are located in the emergency unit of the GWU Medical Center, where only the attending physician responds to maritime medical advice calls.
MMA is especially well known for its education and training programs, ranging from basic first aid and CPR to EMT and paramedic training. The most popular program is the four-day shipboard medicine training course. All of these programs are taught at GW University, or at locations your company prefers, or on board vessels. It is noteworthy that the North Pacific Fishing Vessel Owner’s Association (NPFVOA), itself located in Seattle, Wash., chooses MMA, located clear across the U.S., to provide its training. MMA also helps companies with disaster planning, quality assurance, litigation support, and development of company medical policies. It also provides routine and periodic incident drug testing, and medicine chest design.
·WorldClinic (WC), 1 Devonshire Place, Boston, Mass. 02109; tel. 617-636-7969; Dr. Daniel Carlin is the founder and director; e-mail: firstname.lastname@example.org. There are reasons why WC might be the most logical medical advice and assistance provider for the Russian sailor Viktor Yazykov and other participants in the Around Alone solo yacht race. WC works mostly with individuals or small groups, such as corporate employees who are stationed or traveling overseas, leisure travelers, live-aboard sailors, and American retirees living overseas. WC therefore focuses heavily on having on hand all the medical records and significant data necessary to make a quick diagnosis of an individual and to follow that up with the most appropriate treatment, as if it were acting as the individual’s personal physician. WC is a global medical company based in Boston and affiliated with New England Medical Center.
WC, after gathering the detailed medical information for each individual under a plan or contract, can then custom-design medical kits for individuals, provide consultations and training for both routine and emergency medical problems, and assist with pre-travel health care and prevention planning. When clients are abroad, WC can refer to and consult with local medical providers, and can intervene on a client’s behalf with foreign medical personnel. It can also arrange for evacuation services when necessary.
WC tries to take advantage of the latest communications technology. Carlin says the company likes to have e-mail addresses for each boat or group it is servicing, and so encourages its clients to have Inmarsat-C e-mail service or a satellite telephone service like Inmarsat Mini-M to transmit photographs. Digital SSB (PinOak Digital and Globe Wireless) can also be used to send e-mail. Transmission of video or photographs is such an aid to medical diagnosis and treatment that providing this is one of the main goals of telemedicine everywhere today.
WC’s services are easily tailored to the small group or family. It charges $600/year for two people, and children, no matter how many, are free. The medical kit, including surgical tools, drugs to fit the particular individuals, and broad-spectrum antibiotics, allergic reaction kits, etc., can cost from $600 to $800.
Each of these four services provides excellent health care to one part or another of the marine industry as an offshoot of a larger, more generalized type of plan. Depending on whether you are a company seeking a health-care plan for numerous employees on large ships or a small group seeking very individualized medical assistance, one of these organizations can bring you the type of telemedicine and health-care plan you need.
Two factors are most important in choosing a plan: in how isolated a situation you anticipate finding yourself, your group, or your boat; and how much an individual’s own personal medical historya heart condition, for example, or the need for special medicinesmight be a factor in getting the necessary medical assistance.
Dr. Bill Hallstein, medical advisor and relief captain for Sea Education Association (S.E.A.) in Woods Hole, Mass., stresses how different the situation for medical treatment can be aboard ship or on a small boat compared to shoreside. He equates the amount of medical pre-voyage preparation with the effectiveness of medical treatment, when and if it is required. Unless an individual’s particular needs are known and the necessary information is already gathered, he advises, when a medical problem arises a ship’s medical kit can prove to be carrying an awful lot of what you don’t need, and not nearly enough of what you do need!