Telemedical Maritime Assistance Service Research Articles

Medical treatment of seafarers in the Southern Indian Ocean - interaction between the French Telemedical Maritime Assistance Service (TMAS) and the medical bases of the French Southern and Antarctic Lands (TAAF).

The waters surrounding the French Southern Lands are a fishing zone, accessible only by sailing for several days in a region where weather conditions are often difficult. The scientific bases of the region have medical staff whose services can be called upon if seafarers require assessment and rapid medical treatment. We conducted an epidemiological study of the maritime teleconsultations carried out by the French Telemedical Maritime Assistance Service (TMAS), where patients navigating in the Southern Indian Ocean zone were advised to disembark on the medical bases in the French Southern Lands, between 2015 and 2020, to receive medical treatment. We extracted data from all of the maritime records from 1 January 2015 to 31 December 2020 relating to patients who attended a maritime teleconsultation with a French TMAS doctor in the Southern Indian Ocean zone and who had been redirected to the medical bases in the French Southern Lands. Data were collected on the patients' age, gender, nationality, rank, type of vessel, teleconsultation diagnosis, patient management on board and in the French Southern Lands medical bases, as well as the medical outcome. We carried out a descriptive data analysis. French TMAS doctors managed 11,908 cases including 76 in the Southern Indian Ocean zone (0.6%). Nineteen (25%) patients were redirected to the French Southern Lands over the study period. Eighteen patients were men with an average age of 45 ± 10 years. Eighteen patients were on board a trawler and 11 of them were sailors. Nine patients were treated for a trauma-related condition, 8 for a medical condition and 2 for a surgical disease. Eleven (58%) patients were evacuated to Reunion Island and 8 (42%) patients received medical treatment and were able to re-embark aboard their vessel. Relatively few patients are redirected to the French Southern Lands for medical assistance, but referrals occur on a regular basis. The presence of these medical bases is unusual in a maritime setting, but they can be a valuable asset when maritime medical assistance is required in this region. The type of condition encountered, and the patient profile, were typical of the fishing community. The presence of these bases and communication between the various stakeholders delivering maritime medical assistance provided these patients with optimal care despite their isolated location.

Role of teledermatology in the management of dermatological diseases among marine workers: A cross-sectional study comparing general practitioners and dermatological diagnoses.

BackgroundDiagnosis and treatment of skin disease in sea workers is an unmet need. The purpose of this study is to highlight how remote management of dermatological conditions appears inadequate in this scenario.ObjectiveThis study aimed to identify the best epidemiology for seafarers' diseases and analyze the adequacy of medical assistance in the diagnosis of dermatological maritime diseases.Material and methodsA total of 420 cases of requests for dermatological diseases received by the Telemedical Maritime Assistance Service of the International Medical Radio Center (C.I.R.M.). in a referral year were included in this cross-sectional study. All pictures of cutaneous lesions had been submitted to both C.I.R.M. doctors and an expert dermatologist who provided their diagnosis.ResultsThe most frequent diagnosis in both groups was infectious or inflammatory skin diseases. The main differences are represented by the amount of “unclassified dermatitis” or descriptive diagnosis, such as “cutaneous eruption” which were the most frequent diagnosis of C.I.R.M. doctors (p < 0.05 and p > 0.0001). In these cases, Cohen's K was <0.5 consistent with low concordance between dermatologic diagnosis and C.I.R.M. diagnosis.Conclusion and relevanceOur study emphasizes the magnitude of dermatological diseases in the maritime sector, although often underestimated, and highlights the difficulty in their diagnosis for doctors on call that need more training on specific dermatological issues.

Incidence of occupational injuries and diseases among seafarers: a descriptive epidemiological study based on contacts from onboard ships to the Italian Telemedical Maritime Assistance Service in Rome, Italy

ObjectivesWorkers at sea have high mortality, injuries and illnesses and work in a hazardous environment compared to ashore workers. The present study was designed to measure the incidence of occupational...

Conceptual Framework and Designing for a Seafarers' Health Observatory (SHO) Based on the Centro Internazionale Radio Medico (C.I.R.M.) Data Repository.

Background Health observatory (HO) models are helpful in gathering, analyzing, interpreting, and circulating reliable and quality information on population health and health service delivery. In this study, we proposed an HO conceptual model to enhance seafarer's health, which subjects to disease trends. Methods Three methods were followed during the study: a systematic collection of seafarer's health data from the Centro Internazionale Radio Medico (C.I.R.M.) repository, an integrative review of existing seafarer's policy, and both open and closed questionnaires were distributed to stakeholders to develop clinical knowledge. C.I.R.M. is the Italian Telemedical Maritime Assistance Service (TMAS). Results and Discussion. A three-layer HO framework was developed, and each layer had its components and functionalities. The proposed HO model integrated with the outcomes of the mentioned methods was working as the origin of the framework. In this way, we can design a standard infrastructure in ships and risk assessment conduction.

Telemedical Maritime Assistance Service at the University Center of Maritime and Tropical Medicine in Gdynia. The analysis of 6 years of activity

In the 1960s, the International Labour Organization passed a convention under which all countries with national shipping were obliged to create a 24-h telemedicine center for ships. In accordance with the convention, Telemedical Assistance Service centers were to provide permanent access to medical advice given by qualified doctors and to create an international platform for the exchange of information and experience. In Poland, the Telemedical Maritime Assistance Service (TMAS) was established in 2012, and its duties in a 24-h system are carried out by doctors from the University Center of Maritime and Tropical Medicine (UCMTM) in Gdynia. The aim of this work was to determine the reasons for medical officers reporting for help from the TMAS doctor on duty and to create a database of the most common diagnoses and actions undertaken, and in particular evacuation. In the presented work, the authors analyzed TMAS telephony and e-mail advice provided by doctors of the UCMTM in Gdynia, in the period from October 2012 to the end of 2018. In the 6-year period, UCMTM doctors provided TMAS advice 225 times, recommending evacuation in over 20% of these cases. Infectious diseases were the most common cause of contact in the entire period under analysis - 61 cases were recorded, accounting for as many as 27% of all applications. Injuries were the second most frequent reason for seeking help from TMAS, and 20% of TMAS applications (44 cases) were related to trauma. The obtained data show that TMAS doctors face various medical problems; therefore, providing proper medical assistance to patients requires a close multidisciplinary cooperation between medical officers, TMAS doctors and emergency services. Med Pr. 2020;71(2):121-5.

Telemedicine in the era of COVID-19: The East and the West

Introduction: Telemedicine implies the application of clinical medicine by telephone, internet, or any other such networks for the purpose of consulting or performing various examinations or medical procedures. The present pandemic of COVID-19 is the ideal time to evolve telemedicine and increase its utilization for the well-being of humankind. Historical Background: Electrocardiogram transmission over telephone lines is the oldest record of telemedicine in the first half of the 20th century. Teleradiology commenced in India in 1996. The National Telemedicine Taskforce was set up by the Government of India, in 2005. The Arizona State Legislature established the Arizona Telemedicine Program in 1996. Medical devices to capture images were developed in the 1990s. Present Scenario in the East: Besides implementing various national-level projects, India has extended telemedicine services to South Asian and African countries. The Apollo Telemedicine Networking Foundation has grown to 115 centers, including 9 overseas. Recently, the Government of India has launched telemedicine solutions in the form of Social Endeavour for Health and Telemedicine and eSanjeevani. Comprehensive guidelines on telemedicine have also been issued during the COVID-19 pandemic. The Indian Navy is in the process of establishing teleconsultation centers on board several ships, submarines, remote locations, islands, and naval hospitals. Present Scenario in the West: Telestroke is the largest care provider for patients with stroke in the country. The field of dermatology is particularly suited for telemedicine. Telemedicine at sea is an integral part of rescue procedures. One of the fundamental components of medical assistance at sea is the Telemedical Maritime Assistance Service. Socioethical and Legal Considerations: Legal and regulatory measures will be a challenge with the rapidly spreading telemedicine network. Conflicting laws of different nations are some of the other legal issues in telemedicine. There exists an urgent need for specific legislation on telemedicine in India. In the USA, telemedicine covers various legal and regulatory issues at the state and federal levels. Limitations: Limited reimbursement or restrictions on reimbursement from insurance providers, quality of the patient–physician relationship, the quality of the examination, and the quality of care are a few barriers to telemedicine. The social limitation is probably the biggest limitation of telehealth. Conclusion: Despite several barriers, telehealth has shown remarkable growth during the COVID-19 pandemic. India with its large medical and IT manpower and expertise is emerging as a global leader in the field of telemedicine. The COVID-19 pandemic has made telemedicine more relevant than ever.

Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance.

A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM's official archives in Rome. The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers.

Development of software for handling ship’s pharmacy

Ships are required to carry a given amount of medicinal products and medications depending on the flag and the type of vessel. These medicines are stored in the so called ship's "medicine chest" or more properly - a ship pharmacy. Owing to the progress of medical sciences and to the increase in the mean age of seafarers employed on board ships, the number of pharmaceutical products and medical devices required by regulations to be carried on board ships is increasing. This may make handling of the ship's medicine chest a problem primarily on large ships sailing on intercontinental routes due to the difficulty in identifying the correspondence between medicines obtained abroad with those available at the national market. To minimise these problems a tool named Pharmacy Ship (acronym: PARSI) has been developed. The application PARSI is based on a database containing the information about medicines and medical devices required by different countries regulations. In the first application the system was standardised to comply with the Italian regulations issued on the 1st October, 2015 which entered into force on the 18 January 2016. Thanks to PARSI it was possible to standardize the inventory procedures, facilitate the work of maritime health authorities and make it easier for the crew, not professional in the field, to handle the 'medicine chest' correctly by automating the procedures for medicines management. As far as we know there are no other similar tools available at the moment. The application of the software, as well as the automation of different activities, currently carried out manually, will help manage (qualitatively and quantitatively) the ship's pharmacy. The system developed in this study has proved to be an effective tool which serves to guarantee the compliance of the ship pharmacy with regulations of the flag state in terms of medicinal products and medications. Sharing the system with the Telemedical Maritime Assistance Service may result in avoiding mistakes in drug administration. Last but not least the availability of PARSI could help reduce/ avoid problems with maritime health authorities in case any of the required medicinal products are missing.

Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012.

Telemedical Maritime Assistance Service (TMAS) for seafarers and traveling passengers is important and can be crucial for the optimal medical treatment on board ships. The aim of this study was to analyse and to compare the data from consultations and evacuations from merchant ships and passenger ferries for possible improvements. Data for seafarers from 1997, 2002 and 2007 and for passengers on Swedish ferries for the years 2007, 2009, 2011 and 2012 from the Swedish Radio Medical were studied. Symptoms and diseases were classified according to the International Classification for Primary Care (ICPC-2). The distribution of symptoms, accidents and diseases, treatments/actions taken, evacuations and the communication forms were analysed. One thousand ninety-five contacts for seafarers from merchant ships and 651 passenger patients from Swedish ferries were analysed. While the evacuations for the seafarers gradually decreased over the years from 18% in 1997 to 14% in 2007, still 39.5% of the passenger patient contacts were evacuated mainly by helicopters and 70 patients were picked up by an ambulance on the quay. Accidents were 20% for seafarers and 25% for passengers of the contacts. Evacuations for passengers were mainly in the diagnostic groups: unspecific (A), digestive (D), cardiology (K), musculoskeletal (L) and neurology (N). The use of VHF, radio communications and fax machines have been greatly reduced while the use of e-mail and satellite phone increased. No significant differences in reasons for contact or actions over the years have been identified. The evacuations of seafarers decreased over the years but was stable among the passenger patients (39%). The circumstances and reasons behind the evacuations should be analysed for prevention. Standard forms and digital images for documentation can facilitate knowledge exchange and further studies.

Dental hygiene habits and oral health status of seafarers.

This study has assessed the dental hygiene habits and problems of seafarers and their attitudes/ perceptions regarding oral hygiene using a dental hygiene/habits questionnaire. A research questionnaire on oral hygiene habits was prepared along with a summary of all the questions and sent to ships via e-mail by Centro Internazionale Radio Medico (CIRM) networks. CIRM, is the Italian Telemedical Maritime Assistance Service (TMAS), and represents the Centre with the largest number of seafarers assisted on board ships worldwide. CIRM proposed the questionnaire to all ships (n = 1,198) asking for medical advice from 1 July 2014 till 31 October 2014. Two dental professionals were involved in the development and analysis of the questionnaire. Seafarers are at risk of several dental health problems due to their oral hygiene and dietary habits, smoking and alcohol consumption, poor oral hygiene knowledge and motivation. Dietary habits during voyages were also questionable and seafarers consume food rich in fermentable carbohydrates, which is a major risk factor for dental caries. Seafarers need better oral hygiene education and care to enable them to manage their oral health in a better way. Life at the sea, under challenging circumstances is not without stress, that is why it is important that seafarers are given complete information about correct oral hygiene protocols and dental hygiene and the advantages for their health of keeping a healthy mouth.

Research Questionnaire on Perception of Seafarers about Oral Hygiene and Oral Dietary Habits

ABSTRACT Objectives Dental problems are among the main concerns of seafarers and a relevant cause of medical consultations aboard international vessels. Seafarers may neglect their oral hygiene during long voyages and are known for their excessive intake of beverages or unhealthy food which contains copious amounts of fermentable carbohydrates and sugars, which are prime risk factors of dental caries. Majority of studies done on oral health status of seafarers are dated. This paper presents a questionnaire developed by Centro Internazionale Radio Medico (CIRM), the Italian Telemedical Maritime Assistance Service (TMAS) to investigate the oral hygiene condition of seafarers and to assess their awareness and sensitivity on this pertinent health problem. Methodology A questionnaire including 26 questions covering general information about the subject, including denture status, smoking, drinking and eating habits, general appearance of gingiva, oral muscosa and lips was developed. The research questionnaire was created to assess the oral health situation of Seafarers on board various ships around the world. The questionnaire was forwarded to different ships using the platform of Centro Internationzionale Radio Medico in Rome. Twenty-six questions on various oral hygiene indicators were part of the questionnaire. Captains of the ship were requested to summarize the results on a summary sheet provided by CIRM. CIRM started out sending questionnaire at the end of June 6 and the project concluded in October. Results In the 3 months of the survey, CIRM assisted 1,198 ships. All these ships were requested to take part in the research survey. CIRM received positive response from 65 vessels. The rate of return was 5.4%. Two thousand and sixty seamen filled the questionnaire. No difficulty was reported by ship's captains in summarizing the results of the survey. Conclusion The findings of the research will be presented in an original research article after completion of data analysis. Captains of the ships who took part in the project were awarded certificates of appreciation for their effort. The results of the project will be useful in future policy initiatives regarding oral healthcare of seafarers. How to cite this article Mahdi SS, Mancini M, Sibilio F, Amenta F. Research Questionnaire on Perception of Seafarers about Oral Hygiene and Oral Dietary Habits. World J Dent 2015;6(1):1-4.

Medical assistance at the sea: legal and medico-legal problems.

In case of pathologies or accidents on board which require medical intervention but lacking on-board medical or paramedical personnel, the ship's captain, or his delegate can contact a Telemedical Maritime Assistance Service (TMAS). International Maritime Organisation considers telemedicine at sea as an integral part of rescue procedures. Five key elements contribute to the delivery of good medical assistance at sea: one or more coordination and rescue centres; the TMAS; the possibility of intervention at sea; an organisation of appropriate institutions on ground and common operating procedures. This paper analyses the responsibility of the ship's captain and of the TMAS doctor in case of diseases or injuries on board in the frame of the main important international regulations. In case of a disease or injury on board a ship, the captain must contact the TMAS as soon as possible. A captain not acting promptly and not doing whatever it is possible for the ill/injured person by consulting the TMAS or a physician and/or not following prescriptions received, could be charged for omission of responsibility. A captain underestimating a medical problem and knowing that the patient's condition could worsen, but still not consulting a medical centre for assistance, should be ready to accept the consequences of his choices. The doctor of TMAS has full responsibility for the diagnosis, prescription and treatment, while the ship's captain is responsible for the final decision. Regarding the medical treatment and assistance on board a ship, the TMAS doctor should pay attention not only for the diagnosis, but also for the prognosis. Telemedicine implies that the doctor should make decisions without a clinical examination, often without some additional medical examinations and by maintaining a contact with other people who are in direct contact with the patient. The physician usually has to rely on the account of colleagues of the sick seafarer as far as medical history is concerned. This may make harder to take a decision. The ship's captain is guilty if he fails to contact a TMAS in case of diseases or accidents on board. Similar to a traditional relationship between a patient and a physician, the doctor consulted via telecommunication systems is also responsible for his diagnosis and treatment. However, in telemedicine the contrasts with the most basic principles of the traditional medicine are obvious. This makes the delivery of medical care of seafarers on board ships quite complicated.

Deaths on board ships assisted by the Centro Internazionale Radio Medico in the last 25 years

Data on occupational diseases of seafarers and of causes of death during their career are sparse. The causes of deaths on board ships assisted by Centro Internazionale Radio Medico (CIRM), the Italian Telemedical Maritime Assistance Service (TMAS) were reviewed by examining 29,146 files of patients treated from 1986 to 2010. In the 25 years, 383 deaths occurred (1.31%). Diseases of the circulation were the most frequent, followed by external causes such as accidents and violence, infectious and parasitic diseases, alcohol and drug addiction, respiratory system diseases. Cardiovascular and external causes were the principal causes of deaths among seafarers. This investigation is the first study on the causes of death on board ships obtained from data of a maritime telemedical centre, that has assisted seafarers when they were alive or immediately after their death. The fact that diseases of the circulatory system are the first cause of death of sailing seafarers deserves specific initiatives. They should include campaigns for adequate lifestyles and the availability on ships of medical devices useful for diagnostic purposes, resuscitation as well as for verification of death.