How and When to Make a Telemedicine Call?
Welcome to the first feature in our Supporting Seafarer Health series, created in partnership with Red Square Medical. Together, we’re sharing practical guidance and insights to help crews stay prepared and supported when medical situations arise at sea.
Access to healthcare providers has always been one of the most critical issues for offshore crews and the International Labour Organization (ILO), dictates that access to medical treatments and health services should be guaranteed to seafarers in the same way as for people working ashore. Of course this presents challenges on ships in some of the most remote locations on earth.
So, what is telemedicine? What does it do and how does it work?
Quite simply, telemedicine is driven by distance and technology.
It’s the provision of remote clinical services, via real-time two-way communication between the onboard medic (trained crew or healthcare professionals) and/or the patient themselves, and a shore-based healthcare professional, using electronic audio and visual means.
Maritime Telemedical Assistance Services (TMAS) are now considered an integral part of a shipowner’s emergency medical response operations. The advent and uptake of onboard internet connection in both the commercial and leisure sectors can only be a positive from a medical perspective.
The modern history of telemedicine starts as early as the 1920s, when radio communications were being used to pass medical information to patients at sea on ships and on remote islands.
More recently, the COVID-19 pandemic has brought telemedicine to the forefront of healthcare and service provision has relied heavily on telephone and video consultations since March 2020.
One in five commercial ships a year are forced to divert for a medical emergency. Consider the cost and time involved, plus the stress to both the patient, and their medic who is managing a situation onboard, possibly alone!
Distance changes the way we work. Remote access to and availability of healthcare are the key benefits of telemedicine, combined with less exposure to illness for the patient and healthcare professional, lower cost and less travel. But there can be privacy issues, there’s no physical contact with the patient, information can be lost in transmission, cameras are not as good as eyes, and remember that we use telemedicine BECAUSE we already have limited resources.
Communication is at the core of telemedicine.
But communication over distance can cause technical difficulties such as static, delay, disconnections and background noise. On a personnel level we may experience language and cultural barriers, interruptions, lack of privacy, the time of day restricting shore-based services and significant timezone differences.
Communication works best with exceptional technical/medical knowledge, well designed and fail-safe systems, well-rehearsed commands/phrases, consideration for misunderstanding and recognition of possible breakdowns.
So, when should you contact your telemedicine provider?
Liz Baugh, Lead Medical Consultant at Red Square Medical told us that calling early and calling often has definitely reduced the number of vessel diversions and medical evacuations for the fleets that Red Square Medical Manages. Having direct access to a team that knows our clients and the unique challenges that they are faced with when a person is ill or injured onboard has greatly improved the services that we are able to provide.
Dr Adam Lenny of PRAXES Medical Group also told us it’s important to remember that carrying out medical care, on a boat, in a remote location, is not a routine practice of medicine! So, there is absolutely no shame in asking for support because we’re doing it in the patient’s best interests.
The questions we need to ask are:
- Do I need help?
- Or maybe a better option is, could I use some help right now?
- Do I feel uneasy?
- Have I ever done this before?
Put into perspective, you’re not expected to know everything and that’s why telemedicine is there. Not everything is an emergency either, but you may need some input, options or a second opinion if it’s not something you’ve dealt with before, or it’s a bit more complex.
When you do call, what does your telemedicine provider want to know? Dr Lenny advises small packets of clear, well-thought-out information, covering the basics of Who, What, When, Where and Why?
Patience when replying to questions, or waiting for returned messages is also important. Interruptions meant to save time usually end up costing time and leading to misunderstandings.
A call to telemedicine may look like:
“Hi, this is Fred. I’ve got a patient here who’s pretty sick and I need to get her out.”
This clearly raises more questions than it answers. Who is Fred? Where is he? What does ‘pretty sick’ mean? Where does the patient need to go and how quickly? And if you already know, what do you need the Doctor to do?
A much more concise and impactful call should look like:
“Hello, this is Fred, I’m the first officer onboard M/V PRAXES. I’m calling you from the Mediterranean, approximately 10nm South of Nice. It’s 22.00 here and we are underway. I have a 26-year-old female crew member who fell down the stairs on the way to her cabin. She hit her head and lost consciousness. I’m worried that she might have a traumatic head injury. I could use a second opinion to see if we need to return to Nice.”
The ATMIST handover tool located on the inside front cover of the Ship Captain’s Medical Guide is great for making sure you have just the right information to hand over to Telemedicine.
Dr Lenny confirmed that you can dispense with the pleasantries. A ‘Hi Doctor, how are you today?” is nice, but not needed. Whereas “Hi Doctor, I have a very sick patient with a head injury” demands a state of instant alert from the Doctor, whatever the time of day or night.
Our top tips for a good quality call to Telemedicine are:
- Try to find a good time to call (unless it’s an emergency) from a quiet location.
- Prepare the content of the call and remember that information can get lost easily.
- Be clear about what you’re asking – do you want a second opinion, advice about the suitability of a medication, to discuss your treatment plan, to review the assessment to see if anything else is needed, or to decide on the next steps.
- Tell the story from beginning to end, chronologically.
- Clear communication.
- The Doctor should listen attentively without interruptions, but may need to ask short questions to clarify points and confirm understanding.
- A summary of the information relayed is important. This closed-loop communication style corrects misunderstandings that might arise.
It might be useful to be familiar with the Phonetic Alphabet. Developed by the International Civil Aviation Organisation (ICAO), it’s a globally recognised tool to help spell out any words that may get lost in transmission.
They say pictures are worth a thousand words and that’s definitely the case in telemedicine! If you are able, send photos, videos and pictures of documents to help the Doctor build up his/her picture of your situation and your patient.
The telemedicine provider may know what resources you have if they are also your supplier. But be ready to discuss what you have and are familiar with using. In remote places, multiple patients or prolonged care requirements impact on how much of what is used from your inventory.
Liz Baugh told us that in her previous life as an autonomous medical practitioner on warships, she used to dream of having 24/7 access to experts. A role like this is a lonely place to be professionally and whilst she relished the challenge, it meant she did not sleep very well for about 10 years!
With the improvements in technology and communications, it is a no brainer to her. The Doctors and Nurses supported by Red Square Medical should be able to access their peers for a second opinion at any time.
Whether it’s for the reassurance that their treatment plan is robust or whether they want a second opinion on an X Ray, having an expert on the end of the phone is the ultimate reassurance and insurance.
Make sure you build some telemedicine calls into your drills and training too. They are easy to set up and it helps build confidence in the crew, so that anyone is comfortable picking up the phone to the telemedicine provider.
In summary, Dr Lenny advises that when contacting your telemedicine provider, be concise, pass on small packets of information in chronological order with a clear question that needs answering, and send pictures when possible!
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