The Changing Face of Medical Operations

Catching most of the world unawares as it spread around the globe on “invisible wings” in early 2020, the coronavirus pandemic has had a major impact on superyacht crew, ranging from being quarantined on board to widespread cancellations of cruising itineraries, marina bookings, charter contracts, yard periods, shore leave, flights home, and much, much more. Even as infection rates dip and curves flatten, COVID-19’s far-reaching effects continue to be seen, especially in the new techniques and tools that yachts are adding to their inventory in order to keep owners, guests, and crew safe on board.

“As part of the STCW training, we work with the crew to make an emergency response plan to an outbreak for their yacht,” says Dr. John Ross, medical director, PRAXES Medical Group, which provides telemedical support to yachts via a number of companies throughout the yachting industry, including Red Square Medical and ANP Pharma. “This is going to be something they are hugely focused on.”

“For the first time in many, many years, the medical kit and their telemedical support on board is at the top of the list [the crew] are attending to, rather than the last thing they attend to,” says Rebecca Castellano, RN, Americas and Caribbean sales manager, Medical Support OffShore Ltd (MSOS). “The requests we’ve had are for digital thermometers with covers, masks — the same things everyone is looking for, but on a larger scale. You know, when you’ve got twelve crew and you need N95 masks, twelve masks aren’t going to cut it.”

While supplementing your onboard medical kit with personal protective equipment (PPE) is now a priority for most yachts, this is only one of many changes you can expect to see in the near future. Yacht telemedicine providers agree that new, COVID-19-inspired protocols and devices will be changing the face of superyacht medical operations. Here is a look at some of them.

Telemedicine & Teleconsultation

For decades, yacht crew have relied on telemedicine services to provide them with professional medical guidance to supplement their onboard medical kits when their vessel is in remote locations and areas where shoreside medical facilities may be scarce or of uncertain quality. Thanks to “shelter-at-home” restrictions, which spawned the need for “virtual doctor appointments,” the rest of the world has now begun to catch up with telemedicine.

“Greater familiarity with telemedicine will help people ‘tell the story’ [in communicating virtually with medical professionals],” says Ross. “Our first go-to is going to be the telephone…we can often extract a lot of information just by question and answer. A still image is next, which is helpful [to diagnose] a rash, etc. Then a video would be next,” he says, but cautioned that for yachts, “Each one of those requires more bandwidth. The [satellite communications] technology is getting better, and people are now realizing the need to have some kind of reliable link system.” He adds, “However, the most important thing is who is on the other end of the line.”

Brent Palmer, RN, director medical instructors & strategic customer relationships for MedAire, reports that until the COVID-19 pandemic, about 25 percent of calls made by clients to MedAire’s telemedicine support center resulted in the decision that the patient should seek medical attention ashore. “Obviously, under the current circumstances, that is particularly difficult to do and [carries] a substantial risk of exposure [to the virus],” Palmer says.

While most medical issues on yachts are resolved by the crew with the help of the vessel’s telemedicine provider and medical kit, if a patient does require a “face-to-face” appointment with a shoreside doctor, instead of sending him ashore, today it’s often possible to arrange a “teleconsultation” that will allow the doctor to examine the patient virtually.

Individual countries and U.S. states have regulations governing medical teleconsultations, however, so it’s important when planning the yacht’s itinerary to find out in advance what the rules are in each port. “Just as with physical appointments, for a teleconsultation to occur, the doctor and the patient must be in the same country or state where the teleconsultation occurs,” Palmer says. “That means, if I am in Barbados waters, I talk to a Barbados doctor, and it has to be what’s termed a ‘personal relationship’, which traditionally was a face-to-face....” In the wake of the COVID-19 pandemic, however, “A lot of countries have taken that as being, if it’s by video, that is still considered a personal relationship or a personal interaction.” Many U.S. states also have relaxed their requirement that doctors only can provide teleconsultations to patients in the states where they are licensed to practice, due to the surge in demand created by “shelter-at-home” regulations.

There’s also another potential hidden challenge to teleconsultations, Palmer cautions. “Let’s say you are in port and you are quarantined on board…and get a prescription for antibiotics. The conundrum is, ‘How do I get my medication,’ if you can’t get off the vessel due to the quarantine? When we’re setting up teleconsultations in different countries, [we ask], ‘Are you able to provide medicines delivered to the yacht in port? If that’s not possible, are you able to provide a pharmacy that’s at the port or close to the port?’”

With adequate planning, however, remote teleconsultations can help lower the risk of exposure to COVID-19 for yacht owners, family, and crew. Palmer also predicts that advances in cell phone camera technology one day will make it an even more powerful tool. “If you are looking at the future of teleconsultation…the camera has the capability of measuring your breathing rate, and your pulse rate…. They are able to measure, using some AI [artificial intelligence] assistance, the stress in your voice,” he says. “There are also algorithms available — and this is very early in the moment — that based on your questions and answers, the AI side potentially could… [help] to make sure the doctor doesn’t miss something. Future cameras also could [measure] temperature. From a future perspective, I think as the technology gets better, the algorithms that assist the doctor in making the diagnosis will also improve the service dramatically as well.”

Medical Kits & Devices

Superyachts around the world are working with their telemedicine providers to update their emergency medical kits and inventory of medical devices in order to prepare for more potential coronavirus outbreaks. “The World Health Organization has a marine medical kit that’s pretty extensive, but that’s probably going to have to be revised again,” says Ross. Currently, there is no portable “home test kit” for COVID-19 that a yacht could stock on board, although that may change in the future. In the meantime, telemedicine providers say they are receiving requests from yachts for other medical devices that can help to diagnose coronavirus. One of these is a pulse oximeter, which is used to measure blood oxygenation and pulse rate. “[It] will have a very important role going forward in the early diagnosis of a more severe COVID infection,” Palmer says. “It appears that a drop in the blood oxygen is a good indicator of a more severe infection.”

A peak flow meter — a portable device that measures the lung’s ability to expel air — is another instrument that can be used to help detect COVID-19. “Pulse oximeter, peak flow meter, and thermometer would be the big three right now,” says Castellano. Her company, MSOS, offers the Themis Telemedical Communication Platform (TCP), an onboard “case management” system for yachts. These devices connect to the Themis kit’s tablet via Bluetooth, she says. “The information appears on the screen, and that transmits to the doctors who are on the receiving end. Data is streaming in real-time and it refreshes every 15 seconds.”

DigiGone’s digiMed Five Plus medical kit also incorporates devices such as a pulse oximeter and digital thermometer. DigiGone President Michael Dunleavy reports that his company is now offering yachts another potential diagnostic device — ultrasound. “We just happened to be finishing up the development of our handheld ultrasound and come to find out you can use ultrasound for examination of the lungs to assist in the diagnosis of COVID-19. Our medical partners at George Washington University alerted us,” he says. The digiMed Five Plus with optional wireless handheld ultrasound unit was scheduled to be available as of July 2020.

If a yacht owner, guest, or crewmember aboard a yacht should be diagnosed with COVID-19, the vessel’s supply of oxygen also may become a priority. “They are finding with COVID pneumonia, and even with patients who are asymptomatic, they’ll put a pulse oximeter on and find the saturation levels are 80, 70 (90 is where they want to be) and that’s what’s so alarming,” Castellano says. “They can crash very quickly. They go from being asymptomatic to shortly thereafter needing massive oxygen support…. I foresee with the fact that COVID is going to be around for a while, and it manifests itself as largely a respiratory ailment, that having two oxygen tanks [on board] isn’t going to be enough,” she says, adding this is especially true for yachts that voyage to remote destinations. Yachts should consider adding an oxygen concentrator to its inventory. “These machines take room air and concentrate it down and deliver oxygen at a higher concentration,” she says.

Of course, with all of these medical devices, proper training for the crew in how to use them is essential. “I tell them it’s like a three-legged stool: Medical kit, telemedical support, training on how to respond appropriately,” Castellano says.

This article originally ran in the August 2020 issue of Dockwalk.