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

susan@praxes.ca

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