01 June 2009
U.S. Emergency Room Answers Mariners’ Calls for Help
George Washington hospital reaches out globally with telemedicine
Washington — When the Maersk Alabama was beset by pirates in the dangerous waters off Somalia in April, emergency room doctors at a hospital in Washington began preparing to assist in any medical treatment and evacuation of the crew that might be needed once the vessel reached port in Mombasa, Kenya.
The 17-ton container ship is one of 220 oceangoing vessels to look to an unusual, around-the-clock telemedicine program at George Washington University Medical Center for help in navigating medical emergencies.
In this case, none of the crew was injured. With a U.S. Navy escort, crew members made it to port unharmed, while Navy SEALs rescued Captain Richard Phillips by shooting the pirates holding him captive on a lifeboat. (See “Global Coordination Can Stop Pirates.”)
But the contingency planning that the doctors in Washington did with the ship’s owners was one of the services provided by the hospital’s 20-year-old Maritime Medical Access program, which gives mariners advice on how to treat problems from cysts to heart attacks. Maersk Line Limited of Norfolk, Virginia, has 31 commercial ships in its own fleet and operates 20 others for the U.S. Navy’s Military Sealift Command. Its U.S. crews are covered under the Maritime Medical Access program.
Dennis Houghton, maritime personnel director for Maersk, said the company was able to stay in continuous contact with the ship and “was aware of the condition of the crew during the situation. Fortunately, none of the crew required medical evacuation.” But Maritime Medical Access helped arrange for two medical professionals with extensive experience in post-trauma stress to accompany the Maersk team that flew to Kenya to greet the Maersk Alabama, Houghton said.
Maersk has had other incidents in which timely medical advice from these emergency room doctors helped save lives. One incident involved a mariner who thought his shortness of breath and heavy chest was due to a cold. The MMA doctors thought otherwise, advised the ship to get him to shore as soon as possible and “saved the mariner from having a full-blown heart attack,” Houghton said.
Most illnesses and injuries aren’t that serious. But Dr. Neal Sikka, who oversees all telemedicine programs at the hospital as director of innovative practices, said colleagues don’t hesitate to recommend that a ship head to port or arrange a helicopter evacuation when life hangs in the balance.
The program also provides medical advice to luxury yachts, fishing vessels and clinics that primarily serve U.S. citizens in remote places such as Antarctica, Greenland and fishing ports in Alaska. The ships in the Maritime Medical Access program are all U.S.-flagged vessels with American crews.
Ships plying the world’s oceans carry well-stocked medicine chests “to effectively treat probably 90 percent of the conditions that come up frequently,” said Michael Hite, a registered nurse and director of Maritime Medical Access.
By telephone, e-mail and fax, the emergency physicians can walk a ship’s medical officer through most illnesses or injuries, Hite said.
“We know early on what’s life threatening and what can wait,” said Sikka, one of 30 board-certified emergency physicians at the hospital, the same one that the Secret Service rushed U.S. President Ronald Reagan to after he was shot in a 1981 assassination attempt.
DOCTORS ON CALL 24/7
The calls for help come into a dedicated communications center in a medical building across from the hospital. Technicians typically field six to 10 calls or e-mails for help daily. They quickly patch calls through any hour of day or night to an emergency physician.
The center tracks ships’ locations on a Google Earth map shown on two large computer screens, with anchor-shaped icons pinpointing each ship. Center employees know where the best medical facilities are near each distant port.
Bumps and bruises are routine; the possibility of bloodshed at the hands of pirates is not. “But we’ve always been on standby for anything that comes up,” Sikka said. “We’ve made our physicians aware that they might see … a gunshot wound.”
Clients such as Maersk pay an annual fee for this service. They are not charged by the call.
The transmission of digital pictures over the Internet gives the physicians an additional diagnostic tool. “It’s great for abscesses or lacerations,” Hite said. “They can send us a picture, and we are able to mark and draw … the shape of the incision. It gives that medical officer a much clearer understanding of how to proceed.”
Appendicitis cases often pose the thorniest problems. What first sounds like a bellyache may prove far more serious, Sikka said. Guiding a medical officer with limited training through a hands-on examination and making the correct call is something that emergency physicians are uniquely qualified to do.
Ship owners, of course, want to keep their huge cargo ships on course and on time. “While we try to keep the corporate goals of continued operation in mind, our main focus is on patient safety,” Hite said. When a life is at stake, the physicians do not hesitate to advise a captain to head for the nearest port. But one thing they cannot do, he added wistfully, is “make the boat go any faster.”
