The first time I shipped out, an old able-bodied seaman showed me that WD40 could be used to treat joint pain. We were working hard on the deck of a platform supply vessel that day and had stopped to take a break. “It works,” said this AB, defending himself against my astonishment and massaging the chemical into his knees. I remember other shipboard remedies too, like Lysol for athlete’s foot and Nyquil for sleeping. I am sure that experienced mariners could continue this list at length, but the point is that even a young seafarer may tell you that his or her medicine chest is quite different from what a doctor would normally recommend.
As a cadet, through the statistics in my text books and the “war stories” shared by the many mariners who mentored me, I learned that good and proactive medical care was not always available for most mariners in earlier eras. It seems the opposite was often true – that many seafarers were needlessly ordered into harm’s way. I remember a captain telling me that in “his day and age,” he would wash out the chemical-ridden tanks of his vessel wearing only a particle mask. “[Expletive] particle masks,” he said, speaking slowly and staring into his cup of coffee.
There is an operational difference between safety and medical care, but I have not distinguished one from the other because the two are closely related. Even in this decade, aboard ships belonging to large commercial companies, I have seen medical care systems where human resources are treated like liabilities instead of assets. In systems like these, crew members are likely to hide their illnesses and injuries, for fear of stressing out the captain or being removed from the ship. Likewise, health risks are more likely to take place aboard vessels that still harbor the idea that being safety-minded is a sign of weakness.
With nearly 40 years of advancing technology and regulation since the 1980s, we, as an industry, are still maturing slowly toward a collective consciousness where proactive care for mariners is considered “best practice.” Culturally, we continue to evolve past the fear based “don’t ask, don’t tell” philosophy of risk management (a way of thinking that may prevail regardless of the safety management system that is in place). And while the human interest aspect of this argument is clear, proactive medical care is also best practice in the business sense.
Proactive Medical Care – Visualizing and Mitigating Health Risk with Case Management
Proactive medical care is good business and the case to prove it requires only basic concepts. To start, in the absence of proactive medical care, health risks are often hidden from management and therefore cannot be mitigated. Creating an environment where crew can comfortably disclose their medical history is one that provides great visibility of health risks, and therefore the ability to mitigate said risks.
Case management is the medical practice of mitigating health risks through ongoing collaborative assessments and care coordination. When case management is applied to a ship’s crew, it becomes the force that prevents health risks from turning into expensive delays and insurance claims. It is also the force that helps keep mariners alive and well, improving their productivity and longevity.
The Organizations Leading the way to a Medical Renaissance
“We have created a new ecosystem that allows operators to improve outcomes through better care and controlled costs,” says Andrew Carricarte of Tritan Software, acknowledging his hope of helping to improve medical care at sea.
Andrew’s team spent four years designing a maritime-specific electronic health management platform. Incorporated into the system are every bell and whistle desired for an onboard and shoreside user interface. The software also includes a web portal for the patient/ crew member to monitor health, receive educational material and communicate with medical providers. The product is called SeaCare.
Core features for the SeaCare platform, in addition to the electronic health record include robust clinical tools, clinical decision support, referral management, public health and compliance, medical inventory, and guest visits and charge capture.
Tritan widens the scope of their tools still with the SeaEvent Management Platform, which is the industry’s first and only risk mitigation enterprise software platform that allows organizations to capture, analyze, and prevent incidents across a global operation in real-time.
Currently, SeaCare is being used by approximately 90% of the cruise line industry. While the commercial shipping industry is a growing frontier, Tritan provides a vital component for a medical renaissance to occur.
Also vital to the cause is the legacy of Future Care Inc. CEO Christina DeSimone was a social worker before founding the company, and her inspiration for Future Care was in witnessing injustice to workers, particularly maritime workers, in the 1970s and 1980s.
Lindsay Malen, Christina’s daughter, told me that the mission at Future Care is about focusing on the human element. Lindsay is Director of Business Development at Future Care, and she is also the CEO of the marketing and business development firm Malen Maritime. She explained to me that when owners invest in the health of their crews it results in a well-functioning ship. Her perspective is that the human resources are the most valuable asset aboard a vessel, and that Future Care helps ship owners retain their human resources.
Vivek Menon of SeaHealth is also focused on seafarers' well-being. After eleven years of sailing, Vivek now invests his time in educating and raising awareness for medical care at sea. Vivek knew from personal experience what it was like to be a medical provider in an emergency at sea and is pleased by the technology now available to mariners.
While technology is good, Vivek emphasized the importance of medical provider training for cadets and professional mariners. “It’s a continued learning process,” said Vivek in regards to a mariner's medical knowledge.
SeaHealth was founded over twenty years ago to improve the well-being of Danish sailors. By being effective at what they do, SeaHealth has become a global standard-bearer for knowledge and services for safety, medical care, and wellness.
As the Head of Department for Crisis Counseling, Vivek says that SeaHealth's services are relied upon by the industry, and that awareness for wellness and psychological care is on the rise.
As Vivek suggests, awareness for wellness and psychological care is indicated in the availability of programs and services that are offered by medical providers. For example, Vikand, a maritime medical provider based in Fort Lauderdale, offers a Wellness at Sea program focused on fitness, nutrition, mental health and stress management, among other topics.
Vikand is a medical practice, employing physicians and nurses aboard vessels, and it also incorporates many other services, such as telemedicine, medical equipment management and medical consulting. The firm also provides support for pre-employment medical examinations, EHR selection, auditing, regulatory compliance and more.
SphereMD is another example of maritime focused medical practice. Based in Portland, Oregon, SphereMD has more than twenty clinical staff, including doctors, physician assistants, and nurses. The firm provides comprehensive care, with services ranging from case management to OSHA respirators and audio services.
Chief operating officer David Shubin points out the value of the global network SphereMD uses to sort through the geographic variability of cost, regulations, and quality of care. “It’s often difficult to understand what is needed in these situations.” said David, referring to shipowners dealing with a medical event.
When asked about the future of medical care in the maritime industry, David suggested that the business was becoming “kinder and gentler” and that the value of the crew was being realized. “There is a shortage of qualified crew [and]it’s valuable to take care of your crew . . . they [ship owners] are just getting it,” said David.
UMMSC – Universal Marine Medical Supply International
Warren Casey, Chief Digital Officer of UMMSC, believes that the standards for medical care at sea are on the rise. “We’ve seen tremendous change . . . and there is more change coming,” he says. Specifically he points to how social media has connected the maritime community and increased awareness of seafarers' well-being.
UMMSC has been a medical supplier to the maritime industry for 40 years. In this role, it obtains plenty of insight as to how common (or uncommon) it is for a vessel’s medical chest to be in compliance. In working to improve compliance, Warren suggests that the certification method leaves something to be desired. “These certificates go up on the wall [but] the problem is they are just reflecting a single point in time . . . it’s not a solution for tracking and managing inventory in a meaningful way,” he says. Warren believes that UMMSC will soon offer a technological solution.
Technology and the Way to Better Medical Care
It is the unique nature of the maritime profession that an individual get injured thousands of nautical miles from a hospital. Perhaps someday we will be able to “beam” ailing crew members ashore, like in Star Trek. In the meantime, though, we look to bridge this gap with better internet connectivity, telemedicine, electronic medical data and intelligent end-user software. When married with clinical expertise, prudent seamanship and proactive management, this new technology is creating a renaissance for maritime medicine.
The opinions expressed herein are the author's and not necessarily those of The Maritime Executive.