Red Square Medical and PRAXES Medical Group

Welcome back to our brand new blog series, where we take an in depth look at some of the key partners we work with. These are the companies and people who work away behind the scenes to help us keep our clients safe. We thought it would be a fun and useful exercise to review what makes them special and such an important part of the team.

Red Square Medical partnering with PRAXES Medical Group

We started the series in January with our telemedicine partner, PRAXES Medical Group. Last month we focused on who PRAXES are and what they do. This month, we’re taking a look at how Red Square Medical works with them and what the biggest medical challenges are in these remote locations.

We started off by asking the PRAXES team about some of the biggest, but most common, challenges their clients face and this is what they told us:

●      Being unable to access specialist advanced care facilities such as Cardiac (PPCI) centres, major trauma centres, stroke centres, hyperbaric facilities or even obstetrics and neonatal.

●      The distance needed to travel in order to be in range for air medevac or other search and rescue resources and support.

●      The weather and sea state affecting the time taken for a ship to divert to a suitable facility to offload the patient in a timely manner. Weather and conditions can also impact the ability for an air medevac without the ship motoring to an RV point.

●      Many locations are limited to nurse led outposts ashore – this leads to limited clinical decision making and the likelihood of a further medevac.

●      Medevacs are often delayed by the weather, mechanical issues, lack of medical escort staff, lack of available aircraft.

●      Communication and connectivity issues – even with the best equipment available, communications via satellite comms, the internet, radios and phones can be tricky.

●      The onboard medics may not always be qualified or have the experience to handle every situation, especially in the case of critical illness and injury.

●      The medical facility, equipment and medications available may not be adequate for all eventualities.

●      Improper or no screening of passengers (and clients) can lead to some challenging medical conditions that require managing onboard and ashore.

●      The resupply of medical equipment and medicines is extremely difficult. This is often due to the location, but also involves getting medicines and equipment through multiple country customs and being able to maintain temperature control when needed.

Remote locations, with limited access and resources can be challenging

All of this leads to working out the balance of what’s best for the patient and what’s achievable in the circumstances. At Red Square Medical we normally refer to Plan A, B and C.

Plan A is keeping a patient onboard and managing their illness or injury, with PRAXES telemedicine input as required.

Plan B is managing the patient onboard until the next port - either speeding up to reach one on the itinerary, or involving a diversion. An ambulance or other transport may then be needed to get them to definitive care.

Plan C is an immediate medevac by whatever methods are possible.

The weather and sea state play a huge part in these decisions - plus the ship speed, ability to transfer, and of course, ship safety. A medevac decision may be made early to avoid an approaching weather system, or may be impossible due to the conditions. Sometimes, keeping a patient onboard for longer and getting to the most appropriate facility for the issue, with a higher level of care, may be the right decision. The medic onboard, in conjunction with telemedicine from the PRAXES doctor may also decide to treat and monitor, if the risk is acceptable.

In contrast, there may be situations where an acceptable treatment ashore could be antibiotics, such as for appendicitis. However, if the vessel is heading further away from definitive care, the decision may be to medevac because the risk of deterioration and needing surgery is significant and a medevac could become more complex as the vessel gets further away. Imagine if you’re 3 days from help, the appendix ruptures and the patient becomes septic… it’s much harder (and more expensive) to get them to a suitable facility at that point.

Many factors affect clinical decision making onboard

PRAXES has been working with Red Square Medical (RSM) for over five years now and on a day-to-day basis, including full telemedicine support for a fleet of discovery cruise vessels where RSM manages the medical operations onboard.

PRAXES doctors respond to calls and secure messages from onboard teams. They are often used as a second opinion, just as doctors would do in a hospital setting. Tasks include reviewing and interpreting x-rays taken onboard, clinical discussions, minor trauma injuries, and considering the best options for undiagnosed abdominal pain (something that’s complex even in a hospital).

It’s a case review service and the chance for peer-to-peer discussion for the team onboard who may feel quite isolated, especially in areas such as the Antarctic. PRAXES provides an experienced doctor to chat through cases, check that the treatment plan is appropriate, or to discuss other diagnostics and possible treatment options, especially if the case isn’t in the onboard team’s area of expertise.

PRAXES Connect is used for securely storing patient records and for medical inventory control. It provides PRAXES doctors with an overview of what medications and supplies are available onboard so they can prescribe treatments. Delivery to ships in remote areas is a challenge, and it’s really important that the shipment is waiting for the ship on arrival into port.

New doctors joining the RSM team are evaluated by the PRAXES Medical Director to ensure they have the high quality standard and clinical expertise needed to work on vessels in some of the most remote locations in the world. The PRAXES Medical Director also assists with doctor appraisals annually to make sure standards are maintained.

RSM and PRAXES also provide remote training to their clients. The fleet of discovery cruise vessels were recently equipped with Point of Care Ultrasound and RSM facilitated training from a PRAXES doctor, spanning across 5 time zones and 3 continents for the onboard teams.

PRAXES and RSM pride themselves on being responsive; adding value and a good degree of personal service to clients. Providing a 24/7 service is a necessity in providing exceptional client care, something which passes directly on to the patient experience.

Looking to the future, PRAXES advise that as more and more expedition cruise fleets emerge and grow, it will become more important to ensure that the guests who book these cruises have some form of screening or risk assessment completed before boarding.

The increase of technologically advanced vessels means more vessels and more passengers will be heading to the most remote locations. Locations where there aren’t many, or sometimes any places for sick or injured patients to go, if they need to be evacuated from the vessel.

The hospitals on board the vessels that RSM and PRAXES look after are already comprehensive and allow for 3 days of ICU equivalent care. But facilities and medical teams will need to continually develop to keep up with the demand and look after passengers and crew onboard.

Both Red Square Medical and PRAXES firmly believe this progress will happen as they maintain and grow their special partnership and strive to provide the most professional support for the vessels and teams they look after.

For more information, please visit the Red Square Medical and PRAXES Medical Group websites.