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Home > Health & Wellness > It won’t happen to me !!

It won’t happen to me !!

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Stood at the bottom of the passarelle I asked the young, tanned and immaculately dressed deck hand how their yacht handled a medical emergency.

“We are all well trained, fit and healthy. Nothing ever happens on board, it certainly won’t happen to me.”

The deck hand’s bright white uniform was only matched by the dazzling white from the highly polished transom and tender garage door. He definitely was fit and healthy and clearly enjoying his role fending off sales guys like me. There was just one thing out of place, his lips had really taken a beating from the sun. Cracked and clearly sore I handed him a branded lip balm and wished him a great day.

 

Telemedicine in its most basic form is quite simply access to medical care through some form of telecommunication. Today that generally means by a satellite phone and to a lesser extent now, by video and data transfer across wifi, mobile and satellite networks. For some years there have even been machines that you can hook up a patient to and they go “bing” sending vital signs information across the ether to a waiting doctor to help him diagnose an issue. To be fair, the information delivered by these machines could be very easily obtained by the on board first aider or medic, but they do bring confidence to the patient and user.

 

Free medical advice to seafarers has been available from various flag state coastguard services for many years. In an emergency a British flagged vessel can contact the Maritime Rescue Coordination Centre in Falmouth and the coastguard there will patch your call through to a waiting emergency doctor working within the A&E department of either the Queen Alexander Hospital in Portsmouth or the Aberdeen Teaching Hospital.
I cautiously used the word “waiting” as these doctors will perform a fabulous service in helping to coordinate medical advice, but their priority has to be the patient in front of them at the hospital. The road traffic accident in Trauma Room 1, the heart attack victim now in recovery or simply the four hour list of mixed patients out in the waiting room will all take precedence over your patched call and whilst the best possible service will be given it is likely that your yacht will be diverted to a nearby landfall or you will be told to get to medical care ashore as quickly as you can.

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But, long before than even the coastguard services were available it was the inventor of the radio himself, Guglielmo Marconi, that was pivotal in creating the first ever telemedicine service to seafarers. In 1935 Marconi was the chairman of CIRM Rome. The International Radio Medical Centre in Rome still exists today. A free service provided to all seafarers from any flag wherever they are in the world can speak to doctors in Rome at any time of day. CIRM Rome has without doubt saved many a seafarer’s life, many no doubt claimed, “It won’t happen to me,” prior to tripping on a heaving deck or scalding themselves in a galley.

 

Today many superyacht operators have moved beyond the radio medical centre in Rome or those available from coastguard stations and are turning to more inclusive paid for service providers.
The modern telemedicine provider will help maintain a compliant medical kit, provide great training for crew and will hold details of those crew should an emergency occur. When that emergency does happen, this modern breed of telemedicine provider will spring into action with expert medical advice for the first aider to help keep his patient stable whilst the medevac to the nearest approved medical centre is coordinated.

For the vast majority of yacht crew who have previously never needed more than a packet of band aids from the comprehensively stocked medical kit the value of these services only become apparent when an emergency does happen and then the quality of the advice comes into its own as the first aider is calmly talked through some quite remarkable clinical procedures.

 

In my own little bubble of being part of a well-known global yacht race we see accidents and potential emergencies almost every single day.

In previous race editions after an emergency we would medevac the injured crew member at the earliest opportunity or we would divert the yacht to a closer landfall.

Either way, that leg of the race would be lost by the yacht.

With no alternative solution it was, of course, wise to err on the side of caution, but you could not remove the frustration when the injured crew member wasn’t as seriously hurt or critically ill as originally believed.

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In the race we actually established that approximately 80% of the emergencies we had previously had no choice but to call were actually not emergencies at all. In a great many instances, given appropriate triage prior to calling a diversion the huge inconvenience of turning the yacht around could have been avoided.

 

The same inconvenience applies to superyachts, to the cruising yachtsman or even commercial shipping. A huge number of medevacs, diversions and even dockside visits to hospital can be avoided by appropriate triage by the medical professional at the far end of the phone.

By making the correct diagnosis the consulting physician can also advise the true best course of action to treat the patient quickly and as comfortably as possible.

Instead of diverting a superyacht, arranging a medevac, the time away from a busy schedule with additional bunkers burned, salaries lost, the patient can be recovering comfortably in their bunk and within a day or so be back at work.

 

In the last edition of our own race we teamed up with a medical support partner who had been working in this fashion for almost two decades.
The consulting physicians to the race were the original physicians working in a hospital on Canada’s east coast taking calls from shipping. They recognised that they could not provide the comprehensive advice they wished and created the commercial service that they offer today. This commercial service takes one small step back from the emergency to assess what has really happened before making the diagnosis.

This approach was nothing particularly new or extraordinary and is actually exactly how the doctors would treat a patient who was in a consulting room in front of them.

What was extraordinary was the results the service had on our racing crew.

Diversions now only took place when they really had to. The on board medic was helped in carrying out some quite surprising procedures from setting broken bones to suturing lacerations and providing appropriate pain relief.

When true emergencies did take place the doctors cool head helped keep calm on board and the patient could be transferred as quickly and smoothly as possible to the nearest appropriate facilities.

 

This triage style of dealing with all emergencies can have a remarkable effect on the operational effectiveness of a yacht and it can naturally go one step further. The true emergency care will always be there, but we now move more to an occupational health concept for medical care. In our own race our medics were encouraged to call the moment they need reassurance. By so doing crew with minor illnesses, bumps and bruises would be given expert treatment. Communicable illness on board was reduced and crew would treated immediately before an infection took hold.

By taking prompt action crew would be back racing within a day or so whereas previously they would lie in their bunk for anything up to several weeks at a time.

In our own race we noted a 50% drop in visits to hospitals when we made landfall. As a business we noticed a 57% drop in the costs of those visits along with medevacs and diversions avoided.

 

Back in my own little bubble of the yacht race we do see a highly concentrated number of incidents over those of the young and healthy yacht crew of the superyacht industry. Perhaps we might be forgiven for thinking that every vessel plying the world’s oceans is an accident waiting to happen. Or perhaps it is just that? An accident waiting to happen.
What will happen on your yacht in the event of an accident, big or small?

Will you call the coastguard, simply step onto the dock to a waiting ambulance, call an emergency telemedicine provider or even call the provider that we use in our race?

 

Almost exactly a year on I was walking the dock and at the bottom of the passarelle was the young man who said, “It won’t happen to me”.

He recognised me before I recognised him and he thanked me for the lip balm of the year before.

His lips were now as well kept as his immaculate uniform, but his existing stick from the local pharmacy was almost out so I handed him another branded one as he recounted the story of how he was racing a yacht in a regatta three months after we had met when a series of minor mistakes built and built culminating in one big one from him that saw him hit in the head with a flying block.

His yacht used the fine services of the UK coastguard for what was clearly a critical emergency. The young deck hand was in and out of consciousness, he was coughing blood and from the dent in his head, most likely had a fractured skull. His own Captain and crew coordinated an immediate medevac and perhaps his life was saved by their calm actions.

 

Over the next few days at the “show”, I chatted a number of times to that young deck hand. Older and very much wiser, I don’t think he enjoyed talking about his accident, but he certainly needed to. A really nice guy who knows that no matter how healthy you are and how experienced a sailor you are it may just happen to you.

 

So to all those who say, “It won’t happen to me”.
How will you or your crew deal with it if it does?

 

Tom Bettle
ClipperTelemed+

(Partners Clipper Ventures Plc & PRAXES Medical Group)

Service as described above for €240 per crew member per year.