Stay Medically Connected at Sea

One of sailing’s greatest joys is the opportunity to step away from the often hectic pace of onshore life. But with this freedom comes hard-boiled ­realities, chief among them being that medical help can be hours—or days—away. Fortunately, telemedicine allows prepared mariners to experience the joys of cruising while having the means to cope with unexpected medical problems.

While the first examples of telemedicine date back to the 1870s, mariners had to wait for satellite communications to evolve for this service to become widely—and globally—available. For example, during the Golden Globe Race 2018, British-flagged skipper Susie Goodall relied on telemedicine after she sustained a concussion some 2,000 nautical miles west of Cape Horn when DHL Starlight, her Rustler 36, pitch-poled and dismasted in 60-knot winds and massive seas.

While the technology varies based on the provider, modern telemedicine services leverage voice-over-internet-protocol voice calls, video conferencing, data compression and encryption, and—in some cases—­diagnostic tools that stream real-time and stored data. The result is a telemedicine ecosystem that can provide mariners with around-the-clock access to medical help, irrespective of their location.

Telemedicine generally begins with subscription services. These plans allow mariners to use their cellphone or the boat’s satellite phone to call their provider and reach an attending physician for a diagnosis and/or treatment advice. These services usually require an onboard medical kit that’s packaged by the service provider and includes over-the-counter and prescription drugs, as well as diagnostic tools.

Higher-end systems ­leverage additional technologies. “We virtually bring the doctor to the patient as long as there’s internet connectivity,” says Michael Dunleavy, DigiGone’s founder and owner. DigiGone’s Five Plus Telemedicine Kit includes a built-in Wi-Fi router and a ­custom-built 10-inch Windows quad-core tablet that includes a dedicated webcam and the ability to use any internet connection to run DigiGone’s Doctor Consult app. The system’s minimum connection speeds are 9 kilobits per second (Kbps) for device streaming and audio, and 25 Kbps for video streaming (ideal connection speeds are 70 to 90 Kbps). Once a user launches the Doctor Consult app, a physician at George Washington University’s Maritime Medical Access (or a customer’s chosen telemedicine provider) is alerted, and can sign into the app and control the kit remotely. If needed, multiple doctors can view the kit’s streamed data and communications.

DigiGone’s Five Plus Telemedicine Kit includes FDA-approved off-the-shelf devices, including a digital blood-­pressure cuff, glucose meter, digital thermometer, electrocardiogram (EKG), pulse oximeter and electronic stethoscope. These tools stream their data onto the doctor-accessible DigiMed Consult dashboard. “It’s designed so that a nonmedically trained person can use it,” Dunleavy says, adding that users still need to complete DigiGone’s annual online DigiSchool and pass a yearly competency test.

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DigiGone systems leverage data-compression technologies to minimize the system’s bandwidth needs, and all communications are sent and received using end-to-end 256-bit AES encryption. “Users cannot turn the encryption off,” Dunleavy says, adding that DigiGone users can select their image quality and bandwidth to best match available connectivity. DigiGone recently partnered with RealWear, which builds wearable Android computers, allowing for remote, hands-free collaboration. “You’re watching the doctor demonstrate how to sew up a laceration, and [the doctor] is watching you do the work,” Dunleavy says.

Medical Support Offshore (MSOS) is a full-service medical provider for mariners and has provided telemedicine services to events including the America’s Cup and the Golden Globe Race 2018. MSOS’s standard telemedicine service connects mariners with a doctor-staffed call center in Southampton, England, and can be expanded to include specialist training courses and custom-made medical kits that include prescription (MSOS owns a pharmacy) and off-the-shelf medications. Bluewater sailors can select the company’s Distant Ocean Medical Kit, while coastal cruisers can buy the Near Ocean Medical Kit.

Mariners who want next-level capabilities can purchase MSOS’s tablet-based Themis TCP. “It’s a self-contained unit with Bluetooth-enabled ­medical devices,” explains Rebecca Castellano, RN, MSOS’s Americas and Caribbean sales manager, adding that these devices include temperature, blood-­pressure, EKG, lung-function and ­diabetic-monitoring equipment. “Themis streams video and photos from the tablet’s front and rear cameras using the vessel’s internet connection to doctors at MSOS’s land-based facility so that they can constantly monitor a patient’s vitals and offer medical advice,” she says. “Support is never broken off until the patient is in medical hands shoreside, or until the doctor deems the patient is in the monitoring stage.”

MSOS’s Themis TCP leverages data compression to keep its bandwidth requirements below 50 Kbps, and it employs ­medical-grade encryption. Imagery is queued for transmission, with priority given to the system’s peripheral-device data; if connectivity isn’t available, Themis stores data locally and uploads it when internet access resumes.

DigiGone and MSOS were clear that they want clients to use their telemedicine services liberally. Clients, Dunleavy says, can “use it as a walk-in clinic,” for everything from hangnails to slight coughs. Castellano agrees: “We want people with minimal medical experience to defer to the doctor. [Cost] should never be an impediment to calling.” •