Arctic Ocean Technology – Arctic Ocean Technology –
Opportunities & Challenges for Opportunities & Challenges for
Emergency PreparednessEmergency Preparedness
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My Objective todayMy 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?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 Clipper Round the World Race chose PRAXES Race chose PRAXES
Canadian Physicians deliver global emergency medical support for 12 vessels, 650 crew.
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Reality - Remote workers Reality - Remote workers can’t call 911can’t call 911
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ChallengesChallenges
1.1. Aging workforce 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 Health, 2013; 64, 3:129-135 6
2. 2. Medevacs are Medevacs are Expensive & Risky 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
7Ref 1: The business case for telemedicine, Henny, Hartington, Scott, Tveiten, Canals, Int Marit Health, 2013; 64, 3:129-135
3. Communications3. 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 4. Public Health System doesn't understand OH doesn't understand OH
• 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 5. Providing Telemedicine advice a unique skilladvice 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 6. Most of Canada is REMOTE!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 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) 12
What is Telemedicine?What is Telemedicine?
• Telephone• Send images• Send Video Clips• One way video & two-way video • Additional digital data available
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Telemedicine - an Telemedicine - an opportunity 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 PRAXES approach to telemedicineto 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 - Opportunities - Medical KitsMedical 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 - Opportunities - CommunicationsCommunications
• 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 tele-
medical advice service
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Opportunities - Opportunities - Crew and PassengersCrew 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 - Opportunities - TelemedicineTelemedicine
• 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 Some telemedicine examplesexamples
• 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 savings
TBD). 20
Remote health support improves Remote health support improves business results 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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SummarySummary
• 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 Resources and ReferencesReferences
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! Thank you!
www.praxes.ca
Susan Helliwell, CEO
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