Collaboration between the French TMAS and CRAPEM on the management of psychiatric emergencies at sea

Abstract

Doctors at the French Telemedical Assistance Service (TMAS) provide support to ship captains via teleconsultation for the management of medical emergencies during navigation. In response to this emerging demand for psychological or psychiatric care, TMAS doctors have been calling as and when required on a specialised platform known as the Resource Center for Psychological Assistance at Sea (CRAPEM), based in Saint Nazaire, France, since 2020. The study objective was to compare the management of psychiatric emergencies at sea by TMAS doctors alone versus TMAS doctors assisted by CRAPEM. We conducted a retrospective, descriptive epidemiological study between 1 January 2020 and 31 December 2021. We extracted data from AppliCCMM on patient characteristics, ship characteristics, management characteristics including final decision (treatment on board, disembarkation, diversion, evacuation or death) from previously identified diagnostic coding. Decisions were compared for “case” versus “control” using Chi-2 tests. Differences were considered significant if the P value was below 0.05. The analysis therefore focused on 21 patient cases and 63 patient controls. A comparison of the final decisions shows that patients in the CRAPEM group receive significantly (p < 0.001) less treatment on board. This difference is probably related to the fact that the patients for whom TMAS doctors seek advice from CRAPEM have more serious conditions. CRAPEM is a new organization aimed at improving the management of psychiatric illnesses in seafarers and, in our case, acute-phase psychological and psychiatric emergencies. Given the specific characteristics of the maritime environment, its intervention improves the management of patients at sea.