User satisfaction with maritime telemedicine.

We assessed the satisfaction of onboard caregivers with the maritime telehealth service provided by the Centre de Consultations Médicales Maritimes (CCMM). We conducted a survey of captains and caregivers by email. Of the 385 surveys sent out, 165 (43%) were completed. Eighty four percent of responders (n = 110) thought that waiting time was satisfactory or very satisfactory, and 97% (n = 128) were satisfied or very satisfied with their relationship with the remote physician. Thirty eight per cent of participants (n = 50) considered that the physician understood the medical problem very well; understanding was good in 58% of cases (n = 76) and bad in only 4% of cases (n = 5). Sixty two per cent of participants (n = 83) sent pictures before consultation. The respondents were also satisfied with the telephone advice overall, the competence of the physicians providing the advice, the length of time spent waiting, the verbal prescription and the medical advice given. Onboard caregivers were generally well satisfied with the maritime teleconsultations and the advice provided by the CCMM physicians.

Use of morbidity and mortality conferences to analyze causes of death at sea: a useful tool in the process of training in maritime medicine.

BACKGROUND. Morbidity and mortality conferences (MandMC) are collective reviews of records of patients, whose evolution was marked by an undesirable event: death or the occurrence of complications. The MandMC aim to improve the quality of care. This article intends to present three cases analyzed in MandMC in the French Telemedical Assistance Service (TMAS). MATERIAL AND METHODS. Three cases were selected according to the occurrence of a death at sea or according to particular cases of pathology on board. The case presentation was done in plenary session in our French TMAS, describing the facts, analyzing the defective processes, and suggesting possible improvements for each case. RESULTS. Description of 3 cases: Gastroenteritis in Papua New Guinea with septic shock; traumatic brain injury on a training boat with organizational and evacuation problems, and fever in the Gulf of Guinea with negative thick blood smear test. CONCLUSIONS. The MandMC tend to develop in all medical fields and are of particular interest in maritime medicine. The achievement of MandMC in our TMAS highlighted some difficulties in our daily work: diagnosis difficulty in tele-consultation and organizational or operational difficulties related to maritime medicine. However, we hope that the proposals for improvement will be applied to improve the quality of maritime medical care.

Cardiovascular diseases and electrocardiogram teletransmission aboard ships: the French TMAS experience.

BACKGROUND: The aim of this study was to analyse emergency calls for teleconsultation received at French TMAS relating to cardiovascular pathologies, to assess the relevance of electrocardiogram teletransmission. MATERIAL AND METHODS: A two-year descriptive and retrospective study from the TMAS medical files database. We selected patients whose telemedical request was related to a possible cardiovascular pathology. The French TMAS receives calls from all kinds of ship (passenger or merchant vessel), and our analysis was conducted by comparing passengers and professional seamen. On board, the caregiver performs the ECG after medical prescription and sends it by satellite to the TMAS. RESULTS: A total of 179 cases of cardiovascular disease were selected, including 79 passengers (PG) (44.1%) and 89 professional seafarers (PS) (49.7%). In 11 cases (6.1%) patient status was not specified. The most frequent diagnoses were chest pain (58 cases) and STEMI (23 cases), followed by NON STEMI (21 cases). An ECG was performed in 70% of cases of chest pain. ECG diagnosed 23 STEMI, and all these patients had been evacuated by a medical team. This diagnosis led to the establishment of antithrombotic therapy. The mortality rate due to cardiovascular diseases was 9.5%. Ten occurred on board and 7 during the evacuation of the patient. Eleven were passengers and 6 were professional seamen. CONCLUSIONS: Calls regarding cardiovascular disease are infrequent but require an effective response. Recording and transmitting an ECG to the TMAS is technically feasible and enables treatment to be started with specific drugs, mainly in the management of STEMI.