Will Bruton investigates the growing market for telemedicine services and looks at what's available on the market for yacht cruisers.
Anchored in a remote lagoon in the Solomon Islands last year, Tom Partridge and his partner Susie Plume were into the third year of a circumnavigation on their Hylas 46 Adina, when Tom suddenly started to feel very unwell.
Consulting their copy of the Ship Captain’s Medical Guide, they determined that he was showing common symptoms of malaria. Susie contacted a friend in Vanuatu, who happened to be a qualified vet, for a second opinion. He shared their view and, after speaking to his own GP, suggested that as well as treating Tom for malaria, Tom should also be treated for infections he might have which show similar symptoms to those of malaria.
With a box of prescription drugs and extensive first aid kit on board, Susie was able to administer high doses of two broad spectrum antibiotics before sailing them 24 hours to Gizo. Having seen a doctor there, Tom and Susie then flew to Brisbane for intensive hospital treatment.
On arrival in Australia, the infection appeared to be subsiding. The antibiotics seemed to have helped. After multiple tests, Tom’s condition was diagnosed not as malaria, but as suspected septicaemia caused by a small abscess in the root of one of his teeth.
Having experienced a medical emergency so far from home, Tom and Susie are now convinced of the importance of having access to professional help by satellite phone. “I used email extensively and the satellite phone a few times throughout the period from Tom falling sick to reaching Brisbane. Not only was I receiving medical advice but also help with logistical arrangements and much-needed emotional support from family too.
“I could not have done what had to be done without this help. Most importantly I would not have known to give Tom the antibiotics in addition to the malaria treatment and I cannot bear to think about what could have happened. In short, it’s great to take training and carry equipment and drugs but you cannot beat the experience of professionals.”
Telemedicine more affordable
For sailors who don’t have a medical professional on their contacts list, there is now an ever-increasing range of telemedicine services that offer remote medical support. Dr Spike Briggs, an intensive care consultant, former Global Challenge sailor, and co-author of the next edition of the MCA’s Ship Captain’s Medical Guide, is managing director of Medical Support Offshore, a company providing medical services to sailors. Dr Briggs stresses that emergency medicine at sea is constantly evolving, with satellite communications now an established tool to deliver advanced levels of care remotely.
“The Ship Captain’s Medical Guide was first published in 1868. It was a ground-breaking text at the time and has continued to evolve. The latest edition will pay more attention to telemedicine. Combining basic training, a satellite connection to doctors that know the set-up on board, and a comprehensive medical kit has proven to be a life-saver for those sailing far from help.”
The cost of telemedicine, up until recently, was prohibitively expensive for many sailors. Most services were originally developed for commercial shipping and the largest of private yachts. However, over the past two years, an increasing range of services at more affordable rates have been developed for leisure sailors crossing oceans.
Whilst a patch to a doctor is possible in more developed parts of the world using a VHF or SSB radio, the most reliable link to professional medical help is obtained using a satellite connection.
Rory Gillard, a skipper on two Clipper Round the World Races, has used telemedicine on several occasions. “You’re immediately better informed, that’s the essence of it. They know what resources you have and what you’re likely to be able to achieve,” he comments.
In the most recent Clipper Race every yacht used telemedicine at some point; something that has led to a partnership between the race and PRAXES, a telemedicine provider based in Canada but available worldwide.
However, as Dr John Ross, medical director for Clipper Telemed points out, voice communication is only one aspect of how telemedicine can be utilised. “I was speaking to one of our small boat clients recently. He suspected one of their crew had suffered a stroke. Considering the symptoms and age, this sounded plausible.
Adventurer Martin Frey, the first person to climb seven summits and sail seven seas, was diagnosed with trench foot by telemedicine during the 2015-16 Clipper Race
“I asked the crew to email me one picture of him smiling and another of him not smiling. With this, and some other tests, we were able to rule out a stroke. The gentleman concerned actually had Bell’s Palsy, a condition where some of the facial nerves go to sleep. I think, more than anything, the combination of voice and email communication bought them all piece of mind.”
Any sailor can access advice from a doctor 24/7 by calling the UK’s Marine Rescue Coordination Centre at Falmouth, from anywhere in the world. However, the scope to deliver more advanced levels of care, and so the outcome, can depend heavily on what is carried on board and the confidence of the crew to carry out some basic medical procedures, such as giving injections, themselves.
Nigel Betts, an experienced amateur sailor currently preparing for the ARC and Oyster World Rally, has observed how far telemedicine has advanced since he raced in the 1996 Global Challenge. “We saw a lot of injuries in the Southern Ocean,” he recalls. “Preparing for this adventure, I did the MCA’s ten-day first aid course, purchased a range of drugs, and also bought a defibrillator. The drugs were provided by ANP Pharma, a specialist pharmacy catering for the marine market. I also subscribed to the Clipper Telemed+ service. It was competitively priced and I think you’d be verging on the irresponsible to embark on a circumnavigation without it or something similar.”
Medical training required
However, a telemedicine service is no replacement for training. Carrying prescription drugs on board is something any sailor can do, but the medical professional signing the prescription must be convinced that the individual the prescription is written for is suitably trained.
According to Dr Spike Biggs of MSOS, your statistical risk of requiring external medical advice is about 1:100,000 crew miles
Susie Plume says Adina’s medical set-up has evolved since Tom’s illness, but they had completed specific training well before they slipped lines three years ago. “We undertook a two-day bespoke medical course organised for us by Stormforce in Hamble. We agreed the content with the instructor in advance. With our first aid training already covered, the course was a cut-down version of the longer Medical Care Course and focused on more advanced training including learning how to suture wounds, give injections, use syringes and needles, make basic examinations. We also revisited CPR.
“For the drugs that were prescription-only in the UK we saw a private doctor and once he was satisfied we had an adequate understanding of the drugs and training to use them he wrote us a private prescription for everything we wanted. This included an array of antibiotics, steroids, strong pain relievers, tranquillisers, eye medications and more. I then created a spreadsheet to track all of the drugs and their expiry dates,” explains Susie.
Many sailors put together their own offshore medical kits with the help of a pharmacist or doctor, but those provided by companies such as MSOS, Clipper Telemed, and MedAire, promise more than a supply of drugs not available over the counter. “As sailors and consultants working in emergency medicine, we understand the environment that sailors are operating in, and make sure we understand the profile of the yacht to which we have supplied the kit,” explains Dr Biggs from MSOS. “We appreciate what they are capable of achieving in an emergency and the kits are laid out in a way that makes them easy to use,”
Buyer’s guide to telemedicine
Medical Support Offshore (MSOS)
Price dependent on level of telemedicine service
PRAXES (Clipper Telemed)
£199pp/year (£398/year minimum), short-term yacht guests are included at no additional cost
Wilderness Medical Training
Advanced Medicine Far From Help Course £720
Advanced Bespoke Medical Training from £300/day
Various providersMCA STCW Medical First Aid – a four-day course covering resuscitation, bleeding, burns, fractures, poisoning and more. No prior knowledge required (approx £450-£500) MCA STCW Medical Care – more advanced five-day course, including use of Category A drugs and medical kits (approx £580-£745)