In some form or other, telemedicine has been around for a long time. Doctors have advised caregivers at sea and in other remote locations for as long as two-way radio communications have been possible. But without diagnostic tools, a medical professional could do little more than provide arm’s-length advice to those on the scene. The limited range of communication meant what was at best a difficult task often became a desperate one.
Today, reliable high-speed satellite communications, round-the-clock call centers and sophisticated diagnostic devices have changed all that. In the United States there is now a number of telemedicine organizations that specialize in serving the long-range medical needs of the maritime industry and offshore voyagers.
WorldClinic, with offices in Tulsa, Okla., and New London, N.H., provides what the company’s president, David LaGere, describes as “distance medicine.” Founded by Dr. David Carlin, the company relies on the expertise of on-call board-certified emergency medicine physicians and other specialists at the Lahey Clinic in Burlington, Mass., and the University of Pittsburgh.
Database of records
Here’s how it works. A subscriber to the service places a call to a 24-hour response center and is immediately routed to a physician for advice. The attending physician has access to a database of crew medical records and a complete inventory of the ship’s medicine chest. Once this direct telephone contact is established and a diagnosis made, any follow-up can be carried out via phone, fax or email.
LaGere said 90 percent of the cases his company handles can be resolved in this manner. In more complicated cases, WorldClinic can arrange for specialists to be brought in, and the company can coordinate patient evacuation when necessary. WorldClinic also maintains a database of foreign doctors and hospitals, and can provide case management if the patient is treated in a foreign port.
LaGere said Carlin personally reviews each case daily. In one case involving a yacht off the coast of South America, a patient suffered severe ear pain. Once diagnosed, Carlin faxed the onboard caregiver a diagram of the inner ear and walked him through a minor surgical procedure that, while straightforward, was delicate and risked penetrating the patient’s ear drum.
LaGere said the success of telemedicine is directly related to improvements in communication technology. “Communications makes this all work. The Internet makes it easy to exchange medical information quickly, and redundancy in our system assures communication.”
WorldClinic’s services are offered on a subscription basis. The client may place unlimited calls to the clinic for advice.
Directly to the ER
Maritime Medical Access is also a subscription-based provider of telemedicine services. The company is based at the George Washington University Medical Center in Washington, D.C. Maritime calls come into the emergency room on a direct line. Physicians are alerted by a red light, and the calls are given priority status. MMA doctors are all associated with the hospital’s department of emergency medicine and are board certified.
The cost of subscription is based on geography and risk assessment. MMA’s program director, Karen Roberts, noted that while commercial vessels are major users of the service, they also provide services to yachts. “We have covered several yachts that have circumnavigated,ï¿½VbCrLf Roberts said. “We have one yacht out now on a circumnavigation. We also cover two East Coast yachting races, the Marion-Bermuda Race and the Bermuda Ocean Race.ï¿½VbCrLf MMA is contracted by the race committees to provide unlimited medical advice to boats in the race.
For users of MMA’s service, the annual fee covers unlimited calls and a review of the ship’s medicine chest to ensure that it is stocked appropriately. The company can provide repatriation services and travel staffing assistance should a doctor or a nurse be required while transporting a patient to a hospital.
MMA also works with U.S. Coast Guard physicians, who have the final say in making the decision to evacuate a patient.
Roberts says she has seen a big improvement in communications over the last few years. She said satellite phones have made a big difference, as have digital cameras for sending images. Roberts said video might be useful, but it is just too expensive to transmit images via satellite at this time.
MedAire of Tempe, Ariz., provides medical services to the maritime and aviation industries as well as a network of worldwide clinics. According to company spokesman Bill Mahaffy, MedAire’s maritime division, Medical Advisory Systems, offers client vessels medical advice at sea through its two call centers. Having two call centers assures clients will be able to reach a board-certified emergency room physician without delay or loss of connection. The follow-up phase is often by email. Patients can receive continuing care through one of MedAire’s worldwide clinics or at local medical facilities. The company maintains a database of foreign doctors and hospitals, and has translators available.
Like other providers, Medical Advisory Systems reviews the contents of the client’s medicine chest and makes recommendations. The company maintains a database of the medical gear and drugs on hand.
Mahaffy said reliable communications and new diagnostic devices, such as remote medical monitoring devices, have dramatically improved the attending physician’s ability to diagnose and treat. One such device, the Tempus 2000, (made by Remote Diagnostic Technologies Ltd., Hampshire, England) is easily operated by nonmedical personnel. Through simple menus and voice prompts, the caregiver can measure vital signs and transmit the data via satellite or cell phone at connection speeds as low as 2,400 k baud. The Tempus 2000, which can be controlled by the caregiver or the doctor at the response center, has the ability to transmit still videos of the patient. The device also records all the data it receives.
Although remote monitoring devices are expensive (about $50,000) and are used more by commercial mariners than by recreational voyagers, they could be the wave of the future as prices come down and broadband access becomes widely available.
Advances in communication technology are the key to improvements in telemedicine. MedAire’s Mahaffy noted that the reliability of inbound and outbound calls has improved dramatically. As bandwidth increases, the ability to monitor and transmit more complete patient data will lead to better health care for mariners. n
Contributing Editor John Snyder is a freelance writer in New Hampshire.