Healthcare on the High Seas : A telemedical perspective on quality

Sammanfattning: The Telemedical Assistance Service (TMAS) plays a vital role in medical care at sea by linking the medically responsible officers (MROs) on board with onshore physicians. This project aims to investigate telemedical providers’ perceptions of maritime health care quality today, as well as future potential improvements in this field. A qualitative methodology was chosen as its strength lies in focus on the processes – the people, situation and events that lead to certain outcomes. Semi-structured interviews with TMAS professional staff focused on current communication limitations, perceptions of overall care quality, and what developments, technological or otherwise, might improve healthcare at sea. Following interview transcription and coding against the aims, results with a good degree of consensus were as follows. Poor communication is clearly an issue. High speed data transmission would allow TMAS medical staff to directly observe and evaluate injured crew, and to direct MROs with greater certainty. A touchpad-based system to codify onboard pharmaceuticals was recommended. Standardised initial communication templates would save time and uncertainty and are congruent with how ship’s officers deal with many other situations. Given the difficulty MROs have with IV placement, a shift to intraosseous delivery was recommended. A smaller, more focused and integrated TMAS physician cohort in Sweden was suggested. Pulse oximeters, glucometers and defibrillators were seen as ‘must have’ items on board. Developments in point of care blood analysis, especially for detection of inflammation and infection, were seen as important to evaluate. As a general conclusion, progress could be made in improving onboard medical care via a collaboration between TMAS personnel, MROs, and maritime training staff. This would allow for dialogue on what changes to training and onboard equipment might be agreed now; what should be further evaluated; and a mechanism by which developments in communication, techniques, and portable analytic devices might be effectively implemented in the future.