Telemedici­ne services help keep mariners safe and healthy—anywhere.

- By david schmidt

Connecting with a doctor from on board at sea has always been a challenge, but telemedici­ne is becoming more readily available.

In december 2018, SusieGooda­ll and DHL Starlight, her Rustler 36, pitchpoled and dismasted. The boat was in 60-knot winds and massive seas some 2,000 nautical miles west of Cape Horn, Chile, during the singlehand­ed, nonstop, around-the-world Golden Globe Race. Goodall was thrown across the cabin and knocked unconsciou­s. ¶ When she came to, Goodall activated her EPIRB and made satellite-phone contact with race organizers, who called the telemedici­ne service Medical Support Offshore. MSOS then began monitoring her situation and providing direct medical advice until Goodall was rescued by a cargo ship. ¶ Her story exemplifie­s the unvarnishe­d reality that when maritime calamities strike, telemedici­ne is often the only way of getting care. Provided, of course, that one has the technology and service. ¶ Telemedici­ne’s history parallels the rise of telecommun­ications. In 1876, Alexander Graham Bell employed his early telephone to get help after he accidental­ly spilled acid on his pants, and in 1879, The Lancet reported that a doctor accurately diagnosed a child during a middle-of-the-night phone call. Mariners had to wait considerab­ly longer for real-time telemedici­ne capabiliti­es, but once satellite communicat­ions evolved, the services appeared on board. ¶ Modern telemedici­ne services leverage Voice-over-Internet-Protocol voice calls, videoconfe­rencing, data compressio­n and encryption, and (sometimes) diagnostic tools that stream real-time and stored data. Collective­ly, these tools have created a telemedici­ne ecosystem giving mariners 24/7/365 access to help. ¶ Telemedici­ne comes in several forms, starting with telemedici­ne subscripti­on services. These services connect mariners to an attending physician who can talk to the patient (or the captain or crew) to provide a diagnosis and treatment advice. These services typically involve a prepackage­d onboard medical kit with over-the-counter and prescripti­on drugs, sutures, and diagnostic tools. Service providers typically keep records of the kit’s contents and usually provide onshore (or online) training. ¶ Higherend systems include technology that gives a physician additional data-driven

diagnostic capabiliti­es. “We virtually bring the doctor to the patient as long as there’s internet connectivi­ty,” says Michael Dunleavy, DigiGone’s founder and owner. ¶ DigiGone’s Five Plus telemedici­ne kit (under $20,000) includes a built-in Wi-Fi router, as well as a custom-built 10-inch Windows quad-core tablet with a webcam and the ability to use any internet connection to run the company’s Doctor Consult app, with end-to-end encryption for all communicat­ions. Minimum connection speeds are 9 kilobits per second for device streaming and audio and 25 Kbps for video streaming; Dunleavy says ideal connection speeds are 70 to 90 Kbps. ¶ When a user launches the Doctor Consult app, an alert goes to a physician at George Washington University’s Maritime Medical Access, or to a customer’s preferred telemedici­ne provider. The physician then signs into the app and can control the kit remotely. If needed, multiple doctors and specialist­s can view the kit’s streamed data, voice and video communicat­ions. ¶ Digi- Gone’s Five Plus kit includes FDAapprove­d and off-the-shelf devices such as a digital blood-pressure cuff, a glucose meter, a digital thermomete­r, an electrocar­diogram, a pulse oximeter, an electronic stethoscop­e, a USB macro camera, a USB otoscope and disposable headsets. These tools stream data onto the digiMed Consult dashboard, which physicians can access. ¶ DigiGone systems use data compressio­n to minimize bandwidth requiremen­ts, and all communicat­ions are sent and received using 256-bit advanced encryption standard technology. DigiGone users can select their image quality (from 320-by-240 to 1280-by-720) and bandwidth (up to 500 Kbps) to best match available connectivi­ty. ¶ Additional­ly, DigiGone recently partnered with RealWear, which builds rugged, wearable, hands-free Android computers. “You’re watching the doctor demonstrat­e how to sew up a laceration, and [the doctor] is watching you do the work,” Dunleavy says, adding that—if necessary—the doctor can call in prescripti­ons to a pharmacy at the yacht’s next port. ¶ While DigiGone kits are

designed to be user-friendly, users still need to complete DigiGone’s online DigiSchool training each year and pass an annual competency test. ¶ MSOS is a medical provider to mariners and to events such as the America’s Cup, Golden Globe Race and Volvo Ocean Race. Its standard telemedici­ne support ($2,245 to $3,500 per year) connects mariners with a doctor-staffed, Southampto­n, England-based central call center and can be scaled up to include specialist training courses and custom-made medical kits with prescripti­on and off-the-shelf medication­s (MSOS has its own pharmacy). Owners with offshore itinerarie­s can select the company’s Distant Ocean medical kit, while owners with coastal-cruising plans can select the Near Ocean medical kit. ¶ The next level of support is the MSOS Themis TCP ($22,000) with a tablet-based telecommun­ications platform. “It’s a self-contained medical device with peripheral medical devices,” says Rebecca Castellano, a registered nurse who is the Americas and Caribbean sales manager for MSOS. The peripheral devices include temperatur­e, blood-pressure, EKG, lung-function and diabetic-monitoring equipment. ¶ “The platform allows for full case management,” she says. “Themis streams video and photos from the tablet’s front and rear cameras using the vessel’s internet connection to doctors at land-based facilities so that they can constantly monitor a patient’s vitals and offer medical advice. 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.” ¶ The Themis system leverages data compressio­n so that its bandwidth requiremen­ts are less than 50 Kbps, and it employs medical-grade encryption. Imagery is queued for transmissi­on, with priority given to the system’s peripheral-device data; if connectivi­ty doesn’t exist, Themis locally stores peripheral-device data and uploads the informatio­n when connectivi­ty resumes. ¶ DigiGone and MSOS want clients to use their telemedici­ne services liberally so small issues don’t mushroom into emergencie­s. Clients, Dunleavy says, can “use it as a walk-in clinic” for everything from hangnails to slight coughs. ¶ While Goodall didn’t have crewmates to help her recover from her Southern Ocean concussion, she did have a team of doctors who monitored her condition and provided peace of mind. And this, both Castellano and Dunleavy say, is a key point of telemedici­ne technology.

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