A guest aboard a 60-foot trawler slips in the engine room while checking the oil, and puts his hand into the machinery. During a three-hour reconstruction and suturing, a doctor 2,000 miles away guides a telemed-trained crew as they administer a pain blocker, clean the wound and save the finger.
Far at sea, a guest slips and whacks his head hard on a cleat. No blood, but woozy and disoriented. A telemed team conducts a neurological analysis to determine if there is impairment from concussion. There is none, so the prescription is for hydration, rest and foods rich in Omega-3.
An owner clutches his chest while cruising off Central America. Two of his guests have taken telemedicine first-aid courses. In minutes, the owner is getting oxygen and intravenous fluids while an emergency-room doctor talks the guests through the procedures. The telemed service calculates the nearest port and schedules a medevac jet with dockside ambulances. The owner makes a full recovery.
These are the types of scenarios that telemedicine makes possible. Telemedicine provides instantaneous online communications with medical professionals, and has saved many lives at sea, aboard Arctic oil rigs, in jungle mining operations, on Mount Everest expeditions and more.
Having telemedicine service on board is especially important for cruisers who are more vulnerable to injury or illness because of age, chronic illness and pre-existing conditions. It’s also an important service to have as long-range trawler yachts cruise to more remote locations where owner-operators need self-reliance in all kinds of ways, including health.
“We can put a man on the moon faster than a yacht in mid-ocean can reach medical services,” says John Ross, medical director of telemed provider Praxes.
And he’s right: Apollo 11 astronauts walked on the moon just 109 hours after launch, while many yachts steaming at full speed can’t reach a hospital in that time.
A growing number of telemed companies offer a variety of services and products. The services come with onboard kits that usually include a tablet with a Wi-Fi link, blood pressure gauge, digital thermometer, electrocardiogram with multiple leads, pulse oximeter, glucose reader, electronic stethoscope, otoscope camera (for inner ear and throat) and high-definition macro camera for wounds.
Each kit is also tailored to the voyager’s needs. Arctic adventurers get meds for frostbite, Amazon explorers need snake-bite kits and malaria pills, and cruisers with children aboard have pediatric supplies. Some of the kits are digital; they can automatically link to the boat’s Wi-Fi, find the satphone and dial the number so you can tend to the patient while the service on the other end triages and routes your call to a doctor with the necessary training for the problem.
Generally speaking, when researching which telemedicine option might be right for your cruising plans, there are three things to consider: support, training and equipment.
Support
“Where are you going?” asks Peter Hult, CEO and founder of Vikand (founded with Miami Children’s Hospital), which supplies telemedicine to yachts, luxury cruise lines and commercial shipping. “For peace of mind, every yacht is protected for medical needs by having comprehensive protocols aboard, incorporated within the expedition planning.”
How do you connect to get support when you need it? The video monitor can range from an iPad app to a dedicated reader such as those used by paramedics in ambulances. Tablets are used for Voice-Over-Internet Protocol voice calls, video conferencing and data compression, and are linked wirelessly to the diagnostic medical tools aboard.
Digigone, which provides services through George Washington University Maritime Medical Access, recommends 150 kbps bandwidth. However, its system works well with 60 kbps for video links, via an Inmarsat FB150 satcom or LinkWav Inmarsat service. The Vikand service uses a secure, encrypted, low-bandwidth app (256 kbps) that works with Android or Apple devices to provide continuous connectivity across oceans.
Before choosing a provider, make sure that your electronics are compatible with the service, and determine whether you need additional equipment. Be sure your operating system is compatible as well.
Training
Telemed programs have been embraced by large yachts where regulations require at least one crewmember to have the medical training known as STCW Basic Safety Training Course. The course covers first aid and CPR, and can be built on with advanced certifications such as STCW Medical First Aid Provider (for more critical injuries) or STCW Medical Person In Charge, for cardiovascular and respiratory emergencies, suturing, intravenous injections and more.
It’s a good idea to have training yourself, or to have least two guests or crew trained, because there is always the possibility that the patient might be the trained person.
All of the telemed companies provide extensive training programs, either in-person, through hospitals or online. Digigone, for example, requires an online school (refresher class) annually, plus a competency test. Others require a full first-aid course every two years.
Equipment
Hult says Vikund’s team assesses existing supplies, analyzes itineraries and customizes each telemed kit to the number of guests and yacht size. Most telemed kits are delivered in waterproof, hard-back cases with clearly labeled modules for various needs. They can include supplies such as oxygen in portable tanks, inflatable splints, and a defibrillator if someone has a heart issue.
The success of telemedicine relies on preparation before departure. Basic training and a fully stocked telemed kit are the essentials, but cruisers should also file their medical data beforehand as well.
“Clients should use telemed for everything from hangnails to slight coughs, so small issues don’t mushroom into emergencies,” says Digigone founder Michael Dunleavy.
Costs should also be a part of due diligence when choosing a telemed service, since they operate on different models. Some charge an all-inclusive flat rate, while others are a subscription service.
Before telemedicine existed, I was designated the “medical officer” on a race boat, since I had no fear of blood. One of my training exercises was to stitch a sliced orange back together because it (my family physician assured me) was exactly like human skin. During the race, one of our crew laid his hand open doing something stupid, so I broke out the suture kit. I cleaned the wound and did a very tidy (if I say so myself) stitch called a continuous running suture. Once home, however, I met with my training physician to complain that the orange metaphor was totally wrong, because the orange wasn’t jumping around and screaming.
Telemed Providers: Digigone: Digigone.com, AMD Global Telemedicine: amdtelemedicine.com, Praxes: Praxes.ca, Medical Support Offshore: msos.org.uk
Questions to ask
• Is there a single phone number worldwide for 24/7 access?
• Are the providers trained in remote medicine, beyond typical emergency issues?
• Are they legally and logistically capable of providing medical advice across borders?
• Do they have secure storage for patient information, as well as immediate access to it in an emergency?
• Do they have global providers vetted, including pharmacies for prescriptions? In port, can they arrange local hospitals, doctors, translators and medevac?
• How (and how often) do they assess and restock your medical kit aboard?
This article was originally published in the October 2022 issue.
