Supporting Seafarer Health: Common Reasons for Medical Referrals Ashore
At a conference last year, we were asked to discuss the most common reasons for crew and guests to be referred for additional tests and investigations, medically disembarked, and in an emergency, medically evacuated. It’s a fascinating area and has a direct impact on the ship in terms of operations and costs. Losing a crew member for a few hours shouldn’t cause too much of an issue, but if they are kept in hospital, or even repatriated home, there is a financial and crewing implication.
Medical evacuation can be an extremely stressful and costly exercise. It’s stressful for the medical team onboard, the Captain and deck team, the patient, and the operational team ashore - largely because when a medical evacuation is needed, it’s because the patient is seriously ill. It’s also a high risk exercise for the rescue team carrying out the medical evacuation. In such cases, cost alone doesn’t make the decisions as saving a life is the priority. But cost does have implications which must be taken into account when making decisions. For crew members, care extends to getting them home and fit to return to work, which may involve a medical repatriation, time off work and follow up care in their home country.
Medical referrals and disembarkations happen when someone is sent ashore for further investigation or treatment. If it turns out to be a simple procedure, or something that can be completed quickly, there is every chance that the patient can return to their vessel. But if it’s something that takes a bit longer, or if they need to be admitted to hospital, then the vessel may need to continue on its itinerary, or to its destination port, and a referral then becomes a medical disembarkation.
Other considerations of medical referrals include the level of medical care accessible where you are located. Is the right kind of specialist care, equipment, investigations or interventions available? The nearest port may not always have the medical facilities best equipped for your needs and of course we know that the weather plays to its own rules!
Then you need to think about the patient, whether crew or a passenger/guest. Are they well enough to return to the vessel straight away or meet it at a different location? For crew, they may need to return to their home country to recover before returning to the vessel fit enough to work. For guests, a family member or friend may need to disembark to be with them. In all cases, they can find themselves ill and feeling very alone in a country where no one speaks their language and where the culture is very different from what they are accustomed to.
While a guests insurance company may handle their medical disembarkation (or evacuation) once they have left the vessel, we know from experience that this doesn’t always happen as it should. For crew, the company is responsible to ensure they receive the right medical care. In some cases, for crew or guests, a medical or companion escort will also be needed to make sure they get home safely.
For commercial vessels, any diversion due to a medical case can amount to tens of thousands of dollars lost per day. For cruise ships it can impact on the itinerary, and therefore organised excursions that have been paid for. It also impacts on the other guests, some of whom are sympathetic, others less so! Surprisingly, superyachts are probably the most flexible in how they can respond, particularly if a guest needs a medical disembarkation.
As Health Partner to the UK P&I Club, and being involved in medical operations for Cruise Ships and Superyachts, we analyse data on common medical cases to help create and implement prevention strategies.
Added to this, over the last 2 years, we have overseen over 4,000 crew and guest medical cases handled by our onboard medics. A low percentage of these result in a medical referral, even less in disembarkations, and thankfully medical evacuations are extremely rare. This data provides great insight and allows us to implement health educational programs and monitoring onboard to support our clients crew.
By far the biggest reason for medical referrals ashore for crew is for dental treatment. Some of this is unavoidable, but in many cases it is due to a history of poor dental health in the crew member's home country. Even in the UK, the difficulty in finding an NHS dentist (for accessible; it’s not totally free treatment!) is well documented. In countries where treatment must be paid for, a large number of the population are unable to access dental care at all.
Diagnostics is the next biggest reason for a medical referral. This includes cases where maybe a CT scan, X-ray, specific blood test, or other test is needed. All of our ships have a range of diagnostice available and while some carry Ultrasound and X-ray capability onboard to guide clinical decisions, a definitive diagnosis and treatment plan can mean a trip ashore to hospital.
Working down the list we see lower numbers requiring dermatology investigations, acute medical problems, orthopaedic issues and urology.
When we look at commercial vessels, the data tells a slightly different story. Acute medical complaints are the highest percentage at over 17% of cases and largely unavoidable. However education about healthy living and effective screening of crew medical certificates could help to identify risk areas and put plans in place to mitigate that risk.
For instance, if a crew member receives a new diagnosis of hypertension (high blood pressure), Red Square Medical will set up a blood pressure monitoring program for them onboard, combined with lifestyle and diet advice, and an exercise plan. We also monitor their progress from contract to contract.
Back pain and other musculoskeletal issues are the next highest ranking complaints and account for nearly 14% of cases. Education and training in moving and handling and in dynamic risk assessment could make a huge difference in this area.
Mental health issues feature near to the top of the list and while this area is receiving a lot of attention, with significant improvements, the response to it varies hugely from company to company.
Maintaining its position with nearly 3% of cases is our old favourite, kidney stones! This great article from the UK P&I club tells you more, but the simple solution to avoid kidney stones is to drink more water. Educating crew and leading by example can help to avoid referrals ashore, or in the worst case scenario, a costly medevac that leaves the vessel one crew member down.
In summary, many of the key reasons for medical referrals ashore are preventable with education and support. By taking a pro-active approach to health onboard (for crew and guests), medical referrals can be reduced. In turn this can help to prevent a small medical issue developing into a much bigger problem that later requires a medical debarkation or medevac.
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