Vol 71, No 2 (2020)
Review article
Published online: 2020-06-27
Past, present, and future perspectives of telemedical assistance at sea: a systematic review
1
, 12
, 12
Abstract
Background: Telemedicine is an effective technology for evaluating, diagnosing, treating, and providing health care services for remote populations, including seafarers, in case of diseases or accidents on board. Delivery of telemedicine in a maritime environment is not an easy task and, in general, differs from what can be done onshore. The aim of this review is to provides an overview of Telemedical Maritime Assistance Services (TMAS) in Europe by describing the previous and current status in terms of communication technologies as well as the nature of services rendered at sea. Secondly, to discuss the areas needing improvement and future directions to improve the quality of offshore telemedicine services.
Materials and methods: Different databases, including PubMed (Medline), Google Scholar, Scopus, and journal of International Maritime Health, were searched between August 1 and September 15, 2019. Articles only published from 1969 to 2019 were considered. Relevant articles were selected by reviewing keywords, titles, and abstracts initially based on our inclusion and exclusion criteria. We critically reviewed the full-text articles included in this review. Information on the means of communication, telemedicine services, years of publication, and the name of the first author was extracted from selected studies. The quality of the selected studies was assessed using the criteria of the Newcastle-Ottawa scale.
Results: Initially, 135 articles were identified through searching various databases by using keywords, abstracts, and titles. After removing the duplicates, 121 articles remained. Then we performed an independent article assessment and selection based on the selection criteria, which removed an additional 61 studies, leaving 60 papers. Finally, 27 full-text papers left, and we critically reviewed it. In 27 accepted articles, email and telephone were used most often and accounted for 30% (17/57) and 28% (16/57) of all communication links, respectively. Teleconsultation was the most used telemedicine service on board and represented 58.6% (17/29) of accepted papers.
Conclusions: Email and telephone were the principal means of TMAS doctors to provide medical advice as well as assistance for patients at sea. Despite the potential offered by technological progress, there are still many limitations to the provision of adequate medical care at sea. The modernisation of telemedicine services will help decrease the gap in healthcare delivery at sea.
Keywords: telemedicinetelemedical maritime assistance servicemedical adviceseafarersteleconsultationtelemonitoringtelemedicine services
References
- IMO (International Maritime Organization). https://business.un.org/en/entities/13 (Accessed October 12, 2019).
- Center for Maritime Safety and Health Studies. Published online 2019. https://www.cdc.gov/niosh/programs/cmshs/port_operations.html (Accessed October 12, 2019).
- BIMCO, ICS. http://www.ics-shipping.org/docs/default-source/resources/safety-security-and-operations/manpower-report-2015-executive-summary.pdf?sfvrsn=16.
- Telemedicine: revolutionising healthcare for seafarers. Accessed August 10, 2019. https://www.ship-technology.com/features/featuretelemedicine-revolutionising-healthcare-for-seafarers-5673476/ (Accessed August 10, 2019).
- Lefkowitz RY, Slade MD, Redlich CA. Injury, illness, and disability risk in American seafarers. Am J Ind Med. 2018; 61(2): 120–129.
- European Commission. Maritime Year in Action. Marit Transp. Published online 2018. https://ec.europa.eu/transport/sites/transport/files/2018-maritime-year-brochure.pdf.
- Mulić R, Pero V. Comparative analysis of medical assistance to seafarers in the world and the republic of Croatia. 15th Int Conf Transp Sci. Published online. 2012: 1–8.
- Wenden AL. Handbook of Mautical Medicine. Vol. 3. 1981.
- Flesche C, Jalowy A, Inselmann G. Telemedizin in der Hochseeschifffahrt? Hightech aus Tradition. Medizinische Klinik. 2004; 99(3): 163–168.
- Bekkadal F. Novel maritime communications technologies. Marine Navigation and Safety of Sea Transportation. 2010.
- Technologies NEW. Maritime technology challenges 2030 safer, smarter and greener for a sustainable European maritime sector maritime technology challenges 2030 a vision for European maritime rdi 2030.
- Horneland AM. Maritime telemedicine - where to go and what to do. Int Marit Health. 2009; 60(1-2): 36–39.
- Jerončić I, Joško N. Maritime Medicine and Medicine for Seafarers. 6th IMSC 2014, B Abstr 1847. Published online. 2014: 1–5.
- Benger J. A review of telemedicine in accident and emergency: the story so far. J Accid Emerg Med. 2000; 17(3): 157–164.
- Amadi-Obi A, Gilligan P, Owens N, et al. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med. 2014; 7: 29.
- Keane MG. A review of the role of telemedicine in the accident and emergency department. J Telemed Telecare. 2009; 15(3): 132–134.
- Ward MM, Jaana M, Natafgi N. Systematic review of telemedicine applications in emergency rooms. Int J Med Inform. 2015; 84(9): 601–616.
- Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and Clinical Decision Making: a Systematic Review. Acta Inform Med. 2016; 24(4): 286–292.
- Woldaregay AZ, Walderhaug S, Hartvigsen G. Telemedicine Services for the Arctic: A Systematic Review. JMIR Med Inform. 2017; 5(2): e16.
- Collin SMH, Greasby L, Greene T. Boolean Algebra and Its Applications :Dictionary of Information Technology. Peter Collin. 2010.
- Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos PT. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm (Accessed June 4, 2020).
- Amenta F, Dauri A, Rizzo N. Organization and activities of the International Radio Medical Centre (CIRM). J Telemed Telecare. 1996; 2(3): 125–131.
- Rizzo N, Fulvio S, Camerucci S, et al. Telemedicine for airline passengers, seafarers and islanders. J Telemedicine Telecare. 2016; 3(1_suppl): 7–9.
- Anogianakis G, Maglavera S, Pomportsis A, et al. Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project. Int J Med Inform. 1998; 52(1-3): 93–103.
- Anogianakis G. Utilising multimedia for training merchant mariners as paramedics. Stud Heal Technol Inf. 2000; 72: 66–72.
- Norum J, Moksness SG, Larsen E. A Norwegian study of seafarers' and rescuers' recommendations for maritime telemedicine services. J Telemed Telecare. 2002; 8(5): 264–269.
- Aujla K, Nag R, Ferguson J, et al. Rationalizing radio medical advice for maritime emergencies. J Telemedicine Telecare. 2016; 9(1_suppl): 12–14.
- Jensen OC, Bo Bøggild N, Kristensen S. Telemedical advice to long-distance passenger ferries. J Travel Med. 2005; 12(5): 254–260.
- Mair F, Fraser S, Ferguson J, et al. Telemedicine via satellite to support offshore oil platforms. J Telemed Telecare. 2008; 14(3): 129–131.
- Webster K, Fraser S, Mair F, et al. A low-cost decision support network for electrocardiograph transmission from oil rigs in the North Sea. J Telemed Telecare. 2008; 14(3): 162–164.
- Westlund K. Infections onboard ship--analysis of 1290 advice calls to the Radio Medical (RM) doctor in Sweden. Results from 1997, 2002, 2007, and 2009. Int Marit Health. 2011; 62(3): 191–195.
- Dehours E, Vallé B, Bounes V, et al. User satisfaction with maritime telemedicine. J Telemed Telecare. 2012; 18(4): 189–192.
- Grappasonni I, Petrelli F, Amenta F. Deaths on board ships assisted by the Centro Internazionale Radio Medico in the last 25 years. Travel Med Infect Dis. 2012; 10(4): 186–191.
- Amenta F, Capone L, Sibilio F. Telemedical Assistance of Patients on Board Ships Activity of Centro Internazionale Radio Medico (CIRM), the Italian Telemedical Maritime Assistance Service (TMAS). Published online. 2013.
- Dahl E. Briefing notes on maritime teledermatology. Int Marit Health. 2014; 65(2): 61–64.
- Kurlapski M, Wójcik-Stasiak M, Klincewicz P, et al. TMAS - Maritime Telemedical Assistance Service at the University Centre of Maritime and Tropical Medicine in Gdynia. The first year activity report. Int Marit Health. 2014; 65(3): 174.
- Dehours E, Tourneret ML, Roux P, et al. Benefits of photograph transmission for trauma management in isolated areas: cases from the French tele-medical assistance service. Int Marit Health. 2016; 67(2): 83–87.
- Mahdi SS, Sibilio F, Amenta F. Dental hygiene habits and oral health status of seafarers. Int Marit Health. 2016; 67(1): 9–13.
- Mahdi SS, Amenta F. Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance. Int Marit Health. 2016; 67(4): 187–195.
- Westlund K, Attvall S, Nilsson R, et al. Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012. Int Marit Health. 2016; 67(1): 24–30.
- Dehours E, Saccavini A, Roucolle P, et al. Added value of sending photograph in diagnosing a medical disease declared at sea: experience of the French Tele-Medical Assistance Service. Int Marit Health. 2017; 68(2): 122–125.
- Marimoutou C, Tufo D, Chaudet H, et al. Infection burden among medical events onboard cargo ships: a four-year study. J Travel Med. 2017; 24(3).
- Holt TE, Tveten A, Dahl E. Medical emergencies on large passenger ships without doctors: the Oslo-Kiel-Oslo ferry experience. Int Marit Health. 2017; 68(3): 153–158.
- Montocchio-Buadès C, Daurat M, Ducombs M, et al. Management of a polytrauma in the maritime environment. Int Marit Health. 2018; 69(2): 126–128.
- Herttua K, Gerdøe-Kristensen S, Vork JC, et al. Age and nationality in relation to injuries at sea among officers and non-officers: a study based on contacts from ships to Telemedical Assistance Service in Denmark. BMJ Open. 2019; 9(12): e034502.
- Szafran-Dobrowolska J, Renke M, Wołyniec W. Telemedical Maritime Assistance Service at the University Center of Maritime and Tropical Medicine in Gdynia. The analysis of 6 years of activity. Med Pr. 2020; 71(2): 121–125.
- Mulić R, Sumić D. Request for professional medical aid on board ocean-going ships in the Republic of Croatia. Int Marit Health. 2019; 70(1): 42–46.
- Binaisse P, Dehours E, Bodéré C, et al. Dental emergencies at sea: A study in the French maritime TeleMedical Assistance Service. J Telemed Telecare. 2019 [Epub ahead of print]: 1357633X18818736.
- Anscombe DL. Healthcare delivery for oil rig workers: telemedicine plays a vital role. Telemed J E Health. 2010; 16(6): 659–663.
- Henny C, Hartington K, Scott S, et al. The business case for telemedicine. Int Marit Health. 2013; 64(3): 129–135.
- Michaels E. Telemediciine: The best is yet to come, experts say Main enemy of telemedicine may be doctors ’ reluctance to use it. 1989; 141: 612–614.
- Dragos Panait DMF. Tele-cardiology in Remote O & G premises. 2013; 63(April): 16–18.
- Ricci G, Pirillo I, Rinuncini C, et al. Medical assistance at the sea: legal and medico-legal problems. Int Marit Health. 2014; 65(4): 205–209.
- The Evolution of Telehealth: Where Have We Been and Where Are We Going? | The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary | The National Academies Press. https://www.nap.edu/read/13466/chapter/4 (Accessed October 19, 2019).
- History. http://www.ncmm.no/about-radio-medico-norway/history (Accessed October 6, 2019).
- Çakır E, Arslan Ö. Turkish Telemedical Assistance Service: last four years of activity. Int Marit Health. 2018; 69(3): 184–191.
- Westlund K, Attvall S, Nilsson R, et al. Telemedical Maritime Assistance Service (TMAS) to Swedish merchant and passengers ships 1997-2012. Int Marit Health. 2016; 67(1): 24–30.
- Vallé B, Bounes V, Dehours E, et al. Use of morbidity and mortality conferences to analyze causes of death at sea: a useful tool in the process of training in maritime medicine. Int Marit Health. 2011; 62(2): 104–109.
- Jaremin B, Kotulak E, Starnawska M, et al. Causes and Circumstances of Deaths of Polish Seafarers During Sea Voyages. J Travel Med. 1996; 3: 91–95.
- International Labour Organization. Maritime Labour Convention, 2006, as amended (MLC, 2006). Marit LABOUR Conv 2006, as Amend. https://www.ilo.org/dyn/normlex/en/f.
- Hansen HL. Surveillance of deaths on board Danish merchant ships, 1986-93: implications for prevention. Occup Environ Med. 1996; 53(4): 269–275.
- Larsson TJ, Lindquist C. Traumatic fatalities among Swedish seafarers 1984–1988. Saf Sci. 1992; 15: 173–182.
- Roberts SE. Mortality from disease among seafarers in British merchant shipping (1976-1995). Int Marit Health. 2020; 53: 43–58.
- International Labour Organization. MLC, 2006: What it is and what it does. https://www.ilo.org/global/standards/maritime-labour-convention/what-it-does/lang--en/index.htm (Accessed May 31, 2020).
- Albertos SR, Palacio AV. Adapting European Legislation to the Maritime Labour Convention 2006 Regulations in Relation to the State Responsibilities of Both the Flag State and the Control of Ships by Port State Control. Beijing Law Rev. 2013; 04(04): 141–146.
- European Parliament (2007). Employment Policy, Call For Speedy Ratification of Maritime Labour Convention. Retrieved June 15, 2007 from the World Wide. http://www.europarl.europa.eu/news/expert/briefing_page/3713-071-03-11-%0A20070228BRI03712-12-03-2007-2007/default_p001c010_en.htm.
- Fotteler ML, Jensen OC, Andrioti D. Seafarers' views on the impact of the Maritime Labour Convention 2006 on their living and working conditions: results from a pilot study. Int Marit Health. 2018; 69(4): 257–263.
- Graham C. Representing Seafarers Health and Safety on Board Ships : The Limits of the Representing Seafarers Health and Safety on Board Ships: The Limits of the MLC. 2019 (August).
