MEDEVAC Operations at Sea

Full text

MEDEVAC Operations
a t S e a
P r o f. K o n s t a n t i n L o g o u n o v
S t . P e ters b u r g , R u s s i a
www.telemed-russia.ru Rosmorrechflot RCC
SPb University Clinic HMSPbIC

Konstantin Logounov, professor, St. Petersburg, Russia
Telemed-Russia
(Medicon LLC)
•commercial service
•know-hows
•20 yrs; 2,500+ cases
www.telemed-russia.ru

Health service
rationale
•how often do people get sick
•encountered problems
•the ratio of diseases

Objectives
•urgent medical evacuation from ship to shore
reasons & patterns
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

MEDEVAC operations
SAR operations
•Rosmorrechflot RCC, Moscow
•Russia SAR-regions
•all told ship-to-shore evacuations
for health reasons
•ships in accidents (20 cases, 30
men)
•sick and injured persons on
board unscathed ships (186 men)
•total number 205
•mean duration 14 hrs (1…91 hrs)
Radio-Medicals
•Baltic Maritime Hospital
•free access
•self-appointed
•Russian-speaking crews
•up to 2-3 cases every month
•total number 111
Rosmorrechflot RCC
www.telemed-russia.ru

Methods and Subjects
Methods
Subjects
Review
SAR operations coordinated through Russian
MRCC (RSCs) in 5 years (2009
-2013)
Review
SPbUC
-HMIC free-access Radio-medicals for
MEs on board ships in 5 years (2012
-2016)
Analysis
All cases of medical evacuation
www.telemed-russia.ru Rosmorrechflot RCC
SPb University Clinic HMSPbIC

Free-access Radio Medicals
Reason for call
R e c o m m e n d a t i o n s g i v e n
Medevac
Visit the
doctor Not fit Problem
fixed All
NOT URGENT
0
4
1
0
5
MEDICAL ADVICE
6
16
5
13
40
MEDICAL
EMERGENCY
27
19
13
7
66
Sum total
:33 39 19 20 111
www.telemed-russia.ru Konstantin Logounov, professor, St. Petersburg, Russia

Recommendations
vs
reasons for call
Reason for call
Recommendations given
Medevac Non-urgent
solution All
Non
-urgent
problem
5
35
40
Medical
Emergency
25
35
60
Sum total
30 70 100
www.telemed-russia.ru Konstantin Logounov, professor, St. Petersburg, Russia

Health Problems Number of cases
Diseases 54
Acute abdomen (abdominal pain) 18
High blood pressure and complications 4
Coronary syndrome and other heart diseases 10
Psychiatry and convulsions 6
Acute respiratory infections (ILI) 4
Bleeding (external and internal) 1
Other 11
Injuries 19
Head trauma 2
Back and torso trauma 4
Limb damage 13
ME in Free-access Radio Medicals

Radio-Medicals for ME
In total –73 cases, 65%
ME subject of call –60%
MEDEVAC advice –30%
www.telemed-russia.ru

Means of evacuation Number of
accidents
Helicopter 44
Speedboat 35
Harbor tug 27
Another ship going in the same direction /
the same ship in distress 75
Total: 181
Ship-to-shore Evacuation Means
Rosmorrechflot RCC
www.telemed-russia.ru

Konstantin Logounov, professor, St. Petersburg, Russia
Evacuation means
do not correlate
with medical
diagnoses
Findings 1
www.telemed-russia.ru

Means of evacuation Avrg Duration,
hrs
Helicopter 15 (4…35)
Speedboat 7 (3…11)
Harbor tug 12 (1…91)
Another ship going in the same direction /
Emergency ship itself 13 (1…66)
Mean: 14 (1…91)
Rescue Operations’ Duration
www.telemed-russia.ru Rosmorrechflot RCC

Helicopter is not the
fastest medevac option
at sea
Findings 2
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

Health Problems Number of cases
Diseases 146
Acute abdomen (abdominal pain) 48
High blood pressure and complications 10
Coronary syndrome and other heart diseases 23
Stroke 12
Psychiatry and convulsions 6
Acute respiratory infections (ILI) 12
Bleeding (external and internal) 7
Other 14
Unspecified morbidity 14
Poisonings 3
Injuries 37
Head trauma 5
Back and torso trauma 7
Limb damage 25
Ship-to-Shore Evacuation Reasons
(Unscathed Ships)

Reasons for MEDEVAC Operations
due to Ship Accidents
www.telemed-russia.ru Rosmorrechflot RCC
limbs
40%
head
25%
spine
10% thorax
10% hypothermia
5%
diseases
5%
poisonings
5%
Other
15%
injuries –25
hypothermia –2
poisoning –1
diseases –2

Injury reasons are
relevant for medevacs
due to ship accidents
Findings 3
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

Ship-to-Shore Evacuation Reasons
Ships in Accident
Certain diseases
Consequences
of external
causes
5
:
95
Unscathed Ships
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru
Certain diseases
Consequences
of external
causes
80
:
20

PEMEs are not effective
in preventing diseases
in seafarers
Findings 4
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

Injuries
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

Most injuries are not
life threatening
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru
Findings 5

MEDEVAC Diseases
Most frequent:
•Acute abdomen
•CVD
•Psychiatry
•ILI
Rosmorrechflot RCC
www.telemed-russia.ru

Medevac operations
lack medical expertise
Findings 6
www.telemed-russia.ru Konstantin Logounov, professor, St. Petersburg, Russia

Diseased evacuees
- 1/3 need surgery
- 1/3 need intensive care
Findings 7
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

Unlike in space flights,
medical evacuation at sea
is often stalled for days
Dutch Straits, 2012
M-ko, 54 yrs, Peritonitis (Perforated Peptic Ulcer)
20 hrs MEDEVAC Duration
….
Findings 8
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru

MEs & MEDEVACs at Sea
Ship-in-accident
Unscathed Ship
Limb Injuries
40
Acute abdomen
25
Head Injuries
25
CVD
25
Spine Injuries
10
Injuries
20
Thorax Injuries
10
Psychiatry
10
Diseases
5
ILI
5
Other causes
10
Other
causes 15
Challenges:
•MRCC –
medical expertise is vital
•Ambulance & ED –
special preparedness issues
•Clinical medicine –
off the beaten track
•Telemedicine –
one of many possibilities
Konstantin Logounov, professor, St. Petersburg, Russia
www.telemed-russia.ru