Transcript Slide 1

Arctic Ocean Technology –
Opportunities & Challenges for
Emergency Preparedness
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My Objective today
• Tell you about our experiences providing
medical services to remote locations
• Make some suggestions for things to
consider when setting up remote
operations.
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Who is PRAXES?
PRAXES provides 24/7 global emergency
telemedicine support for industrial, government
sectors:
– Since 1997
– National “bench” of multilingual Emergency Doctors
on 24/7 standby across Canada now
– Clients include oil and gas, marine, fishing fleets,
Canadian Navy, Coast Guard, mining sites, Clipper
Round the World Race.
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Clipper Round the World
Race chose PRAXES
Canadian Physicians deliver global emergency
medical support for 12 vessels, 650 crew.
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Reality - Remote workers
can’t call 911
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Challenges
1. Aging workforce
– Workers in oil and gas, mining & construction
getting older.
– Existing HEALTH issues that pose risk for
remote operations.
– Need to proactively manage this.
– Roughly 50% of medical evacuations are due
to ILLNESS, not Injury. (Ref 1).
Ref 1: The business case for telemedicine, Henny, Hartington, Scott, Tveiten, Canals, Int Marit
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Health, 2013; 64, 3:129-135
2. Medevacs are
Expensive & Risky
• Government medevac programs have limited
resources
• Vessel Diversions – $100/minute
• Air medevacs - $50,000 to $100,000
• Shipping industry (Ref 1) - €100,000 Direct +
€60,000 indirect costs
Ref 1: The business case for telemedicine, Henny, Hartington,
Scott, Tveiten, Canals, Int Marit Health, 2013; 64, 3:129-135
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3. Communications
• Communications challenges in remote locations
• Satellite telephone expensive, can be unreliable
(esp. in polar regions).
• Internet expensive, unreliable.
• telemedicine systems expensive, require
connectivity.
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4. Public Health System
doesn't understand OH
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Public health systems deal with illness.
MD’s have minimal OH training
Don’t understand impact of time off for employers.
Seldom ask patient about their work environment,
Often don’t look for work-related causes.
Minimal experience with:
– Modified duties
– Return to work programs
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5. Providing Telemedicine
advice a unique skill
• Many physicians NOT comfortable talking
to or about patients on phone
• Local ER may not provide needed support
• MD’s may be concerned about medical
liability so they default to “bring him in”.
• Physicians need right skills
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6. Most of Canada is
REMOTE!
• People don’t realize how
remote Canada’ north is!
• Unprepared for risks,
delays.
• Unaware of huge
distances and lack of
facilities.
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Additional Challenges
• No standardized training for
TM providers.
• Licensing challenges
• Medical Liability insurance
• In Canada – no standardized
requirement beyond 1st Aid.
• Med. Equip. & supplies
provided by employers
(unregulated)
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What is Telemedicine?
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Telephone
Send images
Send Video Clips
One way video & two-way video
Additional digital data available
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Telemedicine - an
opportunity
• Provides required “medical oversight” for
paramedical personnel
• For triaging & diagnosing medical events
• Medication & procedure orders (delegated
medical acts).
• Coaching medics on procedures.
• Advice re medevac requirements
• Discuss case with receiving medical facility.
• Reassurance for patients
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PRAXES approach
to telemedicine
• EMdocs selected & trained for remote
triage skills.
• EMdocs available 24/7, bilingual
• Canada - wide
• Personal Health Record for Patients
• Electronic medical record for every call.
• Email photos, video option
• Fax to receiving medical facility.
• Flag for OH follow up.
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Opportunities Medical Kits
• Mandatory medical kits & equip. for large
vessels in arctic waters.
• Chronic disease mgmt. meds. to manage illness
more than injury.
• Minimum standards- medical training for cruise
ship (or other remote site) medical personnel.
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Opportunities Communications
• Ensure Sick Bay has direct phone access to
Medical Assistance (vs calling from bridge).
• Direct internet access in Sick Bay
• Pre-arranged (standby) access to a quality telemedical advice service
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Opportunities Crew and Passengers
• Pre-hire or pre-cruise medical exam –
standardize.
• Take DOUBLE amount of required
medications
• Electronic Personal Health Record.
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Opportunities Telemedicine
• Keep it simple – phone call is always first
• Determine if more info. needed – photos, video
clips, ECG, etc.
• Avoid glamorous technologies – expensive,
need internet, bandwidth. May not work in far
north, lots of user training, more difficult to fix.
• Won’t provide medical care!! (Still need a person
to do that.)
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Some telemedicine
examples
• Vessel in high arctic
– Bell’s Palsy case – closest port Pond Inlet
– Case discussed with onboard RN. Photos
sent by email. EMdoc confirmed Bell’s Palsy.
– Medevac Avoided – cost savings $100,000+
• Clipper Round the World Race
– 14 Virtual clinics have provided reassurance
for patients.
– 10+ hospital visits avoided so far. (Cost
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savings TBD).
Remote health support improves
business results
Testimonial
“PRAXES has helped us:
1. Improve our "at sea" medical support
2. Reduce injury costs & diversions
3. Improve our WCB ranking
4. Saved in excess of $500,000 annually."
Colin MacDonald, CEO, Clearwater Fine Foods Inc.
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Summary
• Many challenges to providing medical care
for remote work sites.
• Need to consider HEALTH management,
not just incident response.
• Access to quality telemedicine services
can reduce cost and risk: reduce need for
medevacs/ diversions.
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Resources and
References
Please go to our web site at
www.praxes.ca/news/
for a copy of this presentation, as well as
other papers and links.
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Thank you!
Susan Helliwell, CEO
[email protected]
www.praxes.ca
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