Electronic Doctor Onboard article by Doctor Kenneth Prudhoe Club de Mar Medical Centre Palma de Mallorca

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"DOCTOR AT SEA" a monthly Column in The Islander Magazine

Electronic Doctor Onboard

Remote medicine is a challenge whatever the circumstances and not just in the middle of the ocean. I attended an oil and gas industry conference in Aberdeen, Scotland in early March and heard about the isolation of medical care laying a 1500 kilometre pipeline in the empty Caucasus Mountains of Georgia. There are less remote but similarly challenging situations in the highlands and islands of Scotland and this has led to a growth in expertise amongst emergency medical providers in Scottish centres.

European legislation on minimum safety and health requirements for improved medical treatment on board vessels (Council Directive 92/29/EEC) requires Member States to designate one or more centres to provide radio medical advice to ships. The Scottish Centre for TeleHealth is based in Aberdeen Royal Infirmary which is also one of the two main United Kingdom HM Coastguard Centres along with Queen Alexandra Hospital, Portsmouth. The Aberdeen experience of dealing with GPs in isolated crofts or distressed seafarers in difficulties around the coast is also a fertile breeding ground for answers to hard questions in remote circumstances. James Ferguson "Ferg" is the lead clinician in a team of twelve consultants plus supporting junior doctors who staff the Accident and Emergency Department and they are at the cutting edge of telemedicine.

Aberdeen has the privilege of the first chair of medicine in the world, founded in 1497 by King James IV of Scotland and, being half-Aberdonian, this gives me much personal satisfaction.

Ferg and his team kindly gave me three hours of their time to talk about their work and to see round their facilities. They are diversifying into aviation medical advice as well as extending their seafarer service as an International Centre for Maritime Medicine and they market their services to the international private sector as The First Call (www.thefirstcall.com) with an eye on charter jets, remote film locations, oil rigs, and, of course, yachts. Their website is well worth a visit and tells us about the advice they gave to the producers of Casino Royale when Daniel Craig as James Bond had to resuscitate himself. The office is adorned with autographed posters and Ferg is now the official medical adviser to the James Bond film producers.

Remote medical support may only need a radio link and many medical problems may be handled by radio-medical advice from an experienced emergency physician. The TeleHealth Centre handles about 2,000 calls per annum from Scottish doctors and, through The First Call, a proportion of calls through private contracts including a number of superyachts. I was struck by the range of queries which very much resembled a general practice surgery but clearly from patients on the high seas and unable to pop in to see their GP. A few of the problems were more challenging like propeller wounds which needed onboard stitching (or glueing!) after the doctor had time to examine a digital picture sent from the vessel.

Internet connections provide a reasonably cheap and convenient opportunity to access medical advice for non-urgent medical problems. It is clear that a combination of a direct phone link and a facility to transmit messages and pictures will be enough for many situations. This may not be enough for more challenging situations and various monitoring devices are coming onto the market and will allow comprehensive remote real time monitoring of the patient (eg blood pressure, pulse, breathing rate, temperature, oxygen saturation, ECG, video picture). These instruments facilitate transmission of whole-patient information to an emergency support centre from remote locations. They are currently quite expensive but no doubt, like colour televisions, they will get cheaper and become more generally available. One risk with them is that they will be underused and sit on the shelf between big emergencies and be held in awe by everyone. This lack of familiarity can be countered by including health training material for use, for example, in regular in-service crew training sessions or for informal personal refresher sessions. This educational potential is a very important feature to look for when thinking about spending out on telemedicine equipment.

Electronic remote medical advice is now becoming available from many different centres, both national statutory services but also international private services. The First Call is one good example of a private provider. They provide an important and unbiased quality monitoring function of equipment on offer and maintain commercial independence from the marketing of products but are happy to make recommendations. On this basis, they have teamed up with Ocean Medical International www.oceanmedicalinternational.com that has an office in Palma at Real Club Nautico Tel: 666289298 and provides a wide range of medical supplies to the yachting industry.

The pace of change in telemedicine is fast and the application increasingly imaginative - perhaps the remote electronic doctor really is at a computer near you!

Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca. Tel: (+ 34) 639 949 125.