Evolution of radio - telemedical assistance to ships: data form Centro Internazionale Radio Medico (CIRM), The Italian Telemedical Maritime Assistance Service (TMAS).

Due to the lack of doctors or adequately trained paramedic personnel on board of the majority of ships, the most reliable possibility of treating diseases or accidents of sailing seafarers is to provide medical advice via telecommunication systems. For more than 50 years, several radio medical services has been operational, starting by using radio signals and Morse code, evolving through telephones to full blown telemedicine solutions. This study has analyzed the evolution in medical assistance provided by Centro Internazionale Radio Medico (CIRM), the Italian Telemedical Maritime Assistance Service (TMAS) in the last 10 years. CIRM was established since 1935 and offers free medical assistance to ships without a doctor on board of any nationality and navigating in all the seas of the world. In this study analysis was accomplished by reviewing data of medical assistance of the Centre from January 1st 1999 to December 31st 2008. Analysis of total patients assisted revealed a significant increase of their number in the years, from 1159 in 1999 to 1963 in 2008 (41 % increase). The number of teleconsultations was also increased. Medical assistance was delivered primarily to merchant ships and to a lesser extent to passenger and fishing vessels in the order. The main changes were noticeable in the telecommunication systems used for medical assistance. Voice communications remained in percentage at the same levels throughout the years, whereas requests received via radiotelex and telefax remarkably decreased. The use of e-mail for contacts increased by about 6 times from 2001, the year in which this communication system was introduced at CIRM , to 2008. Pathologies assisted were classified according to the ICD-9 until 2007 and according to the ICD-10 starting from 2008. Accidents were pathologies most assisted (more than 20% of total cases), followed by diseases of the digestive system (18%), urinary system (10%) and cardiovascular system (7%). Cardiovascular pathologies represented the first cause of deaths on board ships, accounting for approximately the 45% of total fatalities (1.55% of cases assisted by the Centre). The observation that e-mail is becoming the system most used for medical assistance of patients on board ships represents an advantage in terms of possible evolution of medical care to seafarers. In fact, this system the most suitable for transmitting by store-and-forward images of affected areas and several biomedical data. Hence, from a technological point of view, a system supporting telemedical applications is at the present the most used for obtaining medical advice from CIRM. Unfortunately basic telemedical devices on board ships and a culture/training of their utility and use are still lacking. The wide use of telemedicine for medical assistance to ships has obvious technological limitations, but also significant medical challenges. Telemedicine solutions for ships must be able to use satellite communication, with the limits to message size and real time applications that this introduces. Flexible solutions are developed that are able to use several communication carriers depending on what is available at any time. On maritime telemedicine we are getting significant experience in its advantages as well as in its limitations, but it is the only means by which expert medical advice at sea can be obtained