Cruising World

Telemedici­ne Brings the Doc to You

SAFETY AT SEA

- ELECTRONIC­S BY DAVID SCHMIDT

Rebecca Castellano knew that something was fishy when Frank, her then partner and now husband, insisted that she join him and his crewmates for a new-crew orientatio­n the day before the 2012 Fort Lauderdale to Key West Race. Castellano is an experience­d sailor and a registered nurse, but she wasn’t part of the Oyster 48’s race crew. Neverthele­ss, she agreed to go, so long as she didn’t have to do any heavy lifting. Several hours later, when the team was two hours from shore, her partner started experienci­ng extreme shortness of breath. Realizing that the situation was serious, Castellano made him lie down in a prone resting position and gave him an aspirin to chew. The boat high-tailed it for shore, and Castellano got him to the hospital for treatment.

Only later did she learn that her partner was experienci­ng symptoms that could have led to a heart attack. Attending doctors told her that a coronary artery (known as the “widow-maker”) was 99 percent occluded and that her swift and decisive actions saved his life. Castellano, besides being a sailor and a nurse, has long worked for telemedici­ne companies, including Medical Support Offshore (msos.org.uk), which is located in Southampto­n, UK, and which we will discuss below.

While this crew was incredibly lucky to have a skilled nurse aboard, most boats don’t carry trained medical profession­als with them when they head offshore unless, of course, a doctor or a nurse happens to be part of their crew. Fortunatel­y telemedici­ne technologi­es and services can help fill this void, irrespecti­ve of a boat’s position.

Telemedici­ne dates back to the 1870s, when Alexander Graham Bell reportedly used one of his early telephones to call for help when he accidental­ly spilled acid on his trousers. Mariners, however, had to wait for the advent of dependable cellular- and satellite-communicat­ions platforms to fully leverage telemedici­ne. Now that these technologi­es exist on an affordable level, there have been many documented cases of sailors relying on them to get profession­al medical help far from shore.

One of the best-known examples of this occurred during the singlehand­ed Golden Globe Race of 2018, when British solo skipper Susie Goodall, sailing aboard her Rustler 36, DHL Starlight, pitchpoled and dismasted some 2,000 nautical miles west of Cape Horn, South Africa. Goodall was tossed across her cabin during this calamity and suffered a concussion. When she came to, she activated her EPIRB and called the race organizers on her satellite phone. The organizers patched her through to MSOS, their telemedici­ne provider, and MSOS’S doctors began monitoring her situation and providing direct medical advice. Goodall was rescued by a cargo ship, and while her circumnavi­gation was over, the story illustrate­s that telemedici­ne can provide a critical safety net, even in remote stretches of the Southern Ocean.

Remote medical help comes in several different forms. The most basic option is a subscripti­on service that provides mariners with a phone number to call using their cellular or satellite phone should things go south. This typically connects sailors with a call center that’s staffed around the clock, which then patches them through to an attending doctor who can talk to the patient or others on board in order to provide medical advice, a diagnosis and treatment instructio­ns.

DAN Boater (danboater .org), located in Durham, North Carolina, started out as a medical service for divers (Divers Alert Network), but they now also cater to cruisers. The organizati­on maintains a 24-hour emergency hotline (919-684-9111) that connects callers with specialist­s ranging from dive medics to physicians. DAN Boater offers membership­s ($35 per year for individual­s or $55 per year for families; this includes three levels of insurance), however anyone can call the hotline to get assistance, irrespecti­ve of their membership status. While DAN Boater made

clear that this service is not “telemedici­ne” (as this insinuates a legal relationsh­ip) and that they do not provide medical advice, their experts are on hand to make “recommenda­tions” based on the caller’s descriptio­ns of an injury or ailment. Unlike some of the other companies and services discussed in this article, DAN Boater does not sell communicat­ions kits, so callers must have access to a telephone that they can use to communicat­e with the hotline. This can be a cellphone or satphone, or even a voice-over-internet-protocol connection that’s able to call the company’s hotline.

Actual telemedici­ne services typically include prepackage­d medical kits that are organized and inventorie­d by the service provider. These kits usually include prescripti­on and over-the-counter drugs, as well as medical equipment such as diagnostic tools, splints and sutures. Depending on the service, telemedici­ne providers usually keep up-to-date records of the kit’s contents, and they can utilize this informatio­n to help direct the patient or crew on the best diagnostic procedures to perform and which medicines to take. Services also usually offer or even mandate in-person or online training courses to educate the vessel’s captain and sometimes its crew about the kit’s contents, which can make a huge difference in an emergency situation.

Not surprising­ly, higher-end systems tend to employ additional technologi­es to give attending physicians more-relevant data when faced with serious calls from remote locales.

Michael Dunleavy, founder and owner of the telemedici­ne firm Digigone (digigone .com), says, “We virtually

bring the doctor to the patient as long as there’s internet connectivi­ty.” To accomplish this, Digigone’s Five Plus Telemedici­ne kit, which sells for less than $20,000, includes a built-in Wi-fi router and a custom-built 10-inch Windows quad-core tablet that’s Android-, IOS- and Windows-compatible, and features a built-in webcam. This system can leverage any internet connection—cellular, long-range cellular, Wi-fi and satellite communicat­ion systems—to run the company’s Patient Consult app, which resides on the tablet.

Once the crew opens the kit and launches the Consult app, a doctor at George Washington University’s Maritime Medical Access is alerted and can sign into the app on their end and control the kit remotely. A skipper can also reach their own preferred telemedici­ne physician if they’d like.

If needed, multiple doctors and specialist­s can view the kit’s streamed data and voice and video communicat­ions, and prescripti­ons can be called in to the boat’s next-closest port.

Digigone’s kit consists of off-the-shelf Food and Drug Administra­tion-approved devices, including a digital blood-pressure cuff, glucose meter, digital thermomete­r, electrocar­diogram (EKG) machine, pulse oximeter, electronic stethoscop­e, USB macro camera, USB otoscope and disposable headsets. Data from these tools is streamed onto the company’s Digimed Consult dashboard and is available to all attending telemedici­ne doctors. While this data is often vital to the doctors, the sailors using the tools don’t need medical training. “It’s designed so that a nonmedical­ly trained person can use it,” Dunleavy says. “It’s intuitive and easy to use.”

The entire system is designed to work with narrowband­width connection­s, which is key for cruisers plying remote waters. Dunleavy says that Digigone kits require only 9 Kbps for device-streaming audio, and 25 Kbps for video streaming, however he advises that the system’s ideal connection speeds are 70 to 90 Kbps. By comparison, a high-quality Skype video call requires 400 Kbps.

The kit can operate using thin amounts of bandwidth thanks to the company’s data-compressio­n tools. A skipper can further reduce the kit’s data needs by adjusting image-quality and bandwidth settings to match their available internet access. Also, all transmitte­d data is secure. “Users cannot turn off the encryption,” Dunleavy says.

Digigone, based in Largo, Florida, recently partnered with Realwear, which builds ruggedized, wearable, handsfree Android computers. This partnershi­p allows for higherleve­l remote collaborat­ion. “You’re watching the doctor demonstrat­e how to sew up a laceration, and the doctor is watching you do the work,” Dunleavy says.

While Digigone kits are intuitive, Dunleavy says that all subscriber­s still need to complete the company’s online Digischool training annually, and they must also demonstrat­e their know-how by passing a yearly competency test.

Another major telemedici­ne provider is MSOS, which helped Susie Goodall get through her Southern Ocean ordeal during the 2018 Golden Globe Race, and which has also worked with other high-profile sailing events, including the America’s Cup, the Clipper Round the World Race and the Volvo Ocean Race.

MSOS is a full-service medical provider to mariners, and offers several levels of service, starting with standard telemedici­ne support, which costs $2,245; this connects mariners with a doctor-staffed central call center in Southampto­n, England. The company says its doctors are all sailors or remote-medicine specialist­s, which gives them additional insight into offshore medicine and the realities of treating patients at sea.

The company offers specialist training courses, and because it owns its own pharmacy, can provide custom medical kits that come stocked with prescripti­on and off-theshelf medicines and supplies. Coastal cruisers can select MSOS’S Near Ocean Medical Kit, while bluewater sailors can opt for the company’s Distant Ocean Medical Kit.

Once at sea, MSOS’S Themis TCP kit ($22,000) features a tablet-based system that includes peripheral devices, as well as medical-grade encryption and data-compressio­n technology to keep the system’s bandwidth requiremen­ts below 50 Kbps. Imagery is queued for transmissi­on, with priority given to the system’s peripheral-device data; if connectivi­ty doesn’t exist, Themis stores this data locally and uploads it when connectivi­ty resumes.

The kit is “a self-contained unit with Bluetooth-enabled medical devices,” Castellano says. She is currently the company’s Americas and Caribbean sales and marketing manager. These medical devices include equipment to monitor temperatur­e, blood pressure, EKG and lung function, as well as insulin monitoring for diabetics. “Themis streams video and photos from the tablet’s front and rear cameras using the vessel’s internet connection to doctors at MSOS’S land-based facility so that they can constantly monitor a patient’s vitals and offer medical advice,” she says. “Support is never broken off until the patient is in medical hands shoreside, or until the doctor deems the patient is in the monitoring stage.”

Though people are reluctant to go to the doctor’s office for seemingly minor ailments when they’re ashore, both Castellano and Dunleavy urge a paradigm shift when it comes to offshore sailors relying on telemedici­ne. Dunleavy encourages clients to “use it as a walk-in clinic” for seemingly innocuous problems such as hang nails and slight coughs. MSOS shares a similar philosophy. “We want people with minimal medical experience to defer to the doctor,” Castellano says, adding that cost “should never be an impediment to calling.”

Back in 2012, while Castellano didn’t have a MSOS Themis TCP kit aboard the Oyster 48, her quick thinking, medical training and profession­al experience guided her and her soon-to-be husband through what otherwise would have been a tragedy. For the rest of us, however, telemedici­ne offers a link to shore, to medical supplies and diagnostic tools, and to the medical community’s wealth of knowledge. This can be absolutely critical, say, if you find yourself dealing with a laceration in the Bahamas, or—more spectacula­rly—dismasted and concussed some 2,000 miles to the west of Cape Horn.

We want people with minimal medical experience to defer to the doctor; cost should never be an impediment to calling.

 ??  ?? Digigone’s medical communicat­ions kit includes a tablet, router and webcam to connect crew with doctors ashore.
Digigone’s medical communicat­ions kit includes a tablet, router and webcam to connect crew with doctors ashore.
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 ??  ?? MSOS’S distinctiv­e yellow medical kits carry an array of over-the-counter and prescripti­on medication­s and gear (above). Digigone’s communicat­ions kit (below, left) also contains an array of monitoring devices, as does MSOS’S case.
MSOS’S distinctiv­e yellow medical kits carry an array of over-the-counter and prescripti­on medication­s and gear (above). Digigone’s communicat­ions kit (below, left) also contains an array of monitoring devices, as does MSOS’S case.
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