Maritime health care

The Epidemiology of Maritime Patients Requiring Medical Evacuation: A Literature Review

This literature review aims to provide an analysis of the current trends in at-sea medical evacuations (medevacs), with the objective of providing insights to decision-makers to improve patient outcomes. Sixteen sources spanning diverse research methodologies were employed for data collection. The findings point to medical disease processes outweighing trauma and psychiatric conditions as the primary justifications for medical evacuations in the international maritime community. In particular, suspected cardiovascular pathologies emerge as the most prevalent grounds for recommended evacuations, underscoring the impact of their diagnosis and treatment in maritime healthcare scenarios. Enhancing the capabilities of on-site maritime healthcare providers to obtain cardiovascular diagnostic data to facilitate shoreside interpretation is proposed to mitigate the speculations inherent to long-distance medevac decisions. Furthermore, existing research indicates that sustaining a proactive approach focusing on pre-voyage health screenings for seafarers and passenger vessel patrons holds promise in minimizing the risk of emergency evacuations resulting from the exacerbation of chronic medical conditions. This review reveals that while a limited portion of the cruise ship industry possesses established tactical medevac data on crucial aspects of patient care (such as transportation delay, pre- and mid-transport level of care, and ultimate patient outcomes), there exists a dearth of equivalent informatio-n for comparable maritime communities. This knowledge gap necessitates further exploration and research to understand and address diverse seafaring populations' unique challenges. In conclusion, this literature review holistically examines the landscape of at-sea medical evacuation statistics. By assimilating the collective knowledge gleaned from internationally sourced data, this study underscores the urgent need for continued research, comprehensive data collection, and strategic interventions to optimize patient care, enhance tactical decision-making, and ultimately shape a more resilient and responsive healthcare network for maritime communities worldwide.

[Challenges in the context of medical care during a naval research expedition. A case report]

Exploration for natural resources in the seabed of the Indian Ocean was undertaken by the German government institution of earth sciences and resources ("Bundesanstalt für Geowissenschaften und Rohstoffe", BGR) in November 2012. To provide for the medical safety of crew and scientists, a cooperation between the BGR and the trauma department of the Hannover Medical School was established. Research by physicians accompanying the naval expedition revealed that medical consultations mainly occur because of respiratory infections, abdominal discomfort, genitourinary discomfort and seasickness, with the rate of traumas being between 31% and 41%. Di Giovanna et al. stated that 97% of all emergencies on cruise ships are not critical and only 3% need an immediate emergency medical intervention. Consultations were already performed on the mainland prior to departure and included minor traumas due to non-appropriate footwear, otitis and respiratory infections. Seasickness was the main reason for consultation during the first days at sea. Strong seas resulted in some bruises. Minor injuries and foreign body injuries to the hands and feet also required consultation. First-degree sunburns resulted from exposure to the sun, while air-conditioning caused rhinosinusitis and conjunctivitis. A special consultation was a buccal splitting of tooth 36. An immediate emergency medical intervention was not necessary due to the relative low level of pain for the patient; however, due to the risk of further damage caused by nocturnal bruxism, a protective splint was formed using a small syringe. Other reasons for consultation were similar to those reported in the general literature. Medical activities at exotic locations may create the vision of a holiday character at first; however, intensive planning and preparation are needed. We recommend contacting police, customs, the federal institute for drugs and medical devices as well as the labour inspectorate, preferably in both the originating country and the destination, to prepare custom formalities and to obtain formal documents and approvals beforehand. It is advisable to be prepared not only for emergency situations, but also for general medical and dental problems. Improvisation in the treatment of special health problems is an unavoidable requisite.