Training in the detection of psychological distress on board ships through health simulation during the COVID-19 epidemic.

BACKGROUND: An innovative medical simulation course was offered to seafarers during their statutory medical education refresher course. During the coronavirus disease 2019 (COVID-19) pandemic, they experienced difficulties dealing with mariners' mental health problems. MATERIALS AND METHODS: One hundred and fifty-three seafarers underwent training at the C3S medical training centre in Lorient Hospital. At the end of the module they were asked to fill in a questionnaire. RESULTS: Ninety-seven per cent of them were satisfied with their training. They felt that their training had given them confidence to deal with these problems when returning to sea. On this occasion, we tested their feelings on the psychological consequences of the COVID-19 pandemic on board and compared their answers with the data available in our telemedical assistance service (TMAS) and in the literature. CONCLUSIONS: Simulation training is an appreciated and effective educational tool for raising awareness and training medical managers in psychological or psychiatric situations.

Management of COVID-19 on board the mixed cargo ship Aranui 5.

BACKGROUND: During cruises, the management of coronavirus disease 2019 (COVID-19) infections poses serious organizational problems such as those encountered in 2020 by the Zaandam, the aircraft carrier Charles de Gaulle or the Diamond Princess. In French Polynesia, the mixed cargo ship Aranui 5 transports both tourists and freight to the Marquesas Islands. The purpose of this article is to show how COVID-19 infections were diagnosed and contained before and after passengers boarded a cruise. MATERIALS AND METHODS: On October 15, 2020, 161 passengers including 80 crew members embarked for a 13-day voyage from Papeete to the Marquesas Islands. Prior to boarding, all passengers underwent a reverse transcriptase-polymerase chain reaction (RT-PCR) test; the tests results were all negative. On Day 0, 3, 5, 8 and 11, Biosynex® rapid antigen diagnostic tests were carried out on all or some of the crew members and tourists who may have had contact with new positive cases. Each day, forehead or temporal temperatures were measured using an infrared thermometer and questions were asked concerning the subjects' health status. When a subject was positive, the person and their contacts were isolated in individual cabins. The infected person then left the vessel to be received in a communal reception centre on the nearest island. RESULTS: A total of 9 positive cases were observed, including two before departure (a tourist and a crew member). During the trip, 7 crew members tested positive. The patients and their contacts were isolated and then disembarked at the earliest opportunity. At the time of sampling, the subjects were asymptomatic. The patients and their contacts all became symptomatic within 24 to 48 hours after sampling. CONCLUSIONS: In total, the voyage could be completed without any transmission on board among the tourists and with a minimum transmission among the crew members, thus maintaining the tourist and economic activity of the islands during the times of COVID-19 pandemic.

Medical kit for single-handed offshore yacht races.

BACKGROUND: The medical kit is the basis of medical support in maritime environment; it is defined by international or national regulations and guidelines. For offshore races, rules and recommendations are proposed by national or international sailing federations. Sailing and racing offshore alone presents specificities that sometimes make it difficult to apply the usual recommendations. The epidemiology of single-handed offshore race is dominated by traumatic risks. Medical events are relatively rare because competitors are high-level athletes, generally young and subject to complete medical assessments. The scarcity of available scientific data makes it necessary to choose appropriate methods for developing recommendations. The purpose of this work is to propose a medical kit adapted and applicable to these situations. MATERIALS AND METHODS: The method used was that of "Professional recommendations by formal consensus of experts" derived from the Rand/UCLA method. After a critical analysis of the literature, a panel of 19 experts having expertise in medicine in maritime environment was gathered from various medical specialties (cardiologist, internist, intensivist and emergency physician, ear-nose-throat physician and general practitioner) and from varied medical activities. They had not declared any direct conflict of interest. RESULTS: A medical kit proposal has been developed. The choice of drugs was based on the analysis of the epidemiology of medical events observed during the last offshore races. The experts' choice was to reduce the quantity of medication and medical devices in order to limit the risk of confusion of medicines and dosages. Drugs with significant side effects or requiring third party monitoring have been removed. Medical devices designed to do an intervention impossible to perform on oneself have also been eliminated. CONCLUSIONS: Solo sailing remains a marginal maritime activity with specific risks. The development of single-handed races requires an adaptation of medical support through the development of a specific medical kit and adapted training. The formalised consensus of experts seems to be an appropriate method for developing recommendations in the field of maritime medicine.

A Medical Support in Offshore Racing - Workshop on Medical Kit Inventory in Offshore Yacht Racing, 12-13 May 2017, Lorient, France.

No abstract.

Fields of promoted actions for facilitating multitasking activity during a medical emergency.

Background: An adverse clinical event requires emergency team coordination and multitasking activity. Based on studies in ecological psychology, we propose that a structured ambient environment can implicitly facilitate these requirements. Method: We designed a new configuration of work in which spatial zones were specified as fields of promoted actions for doctors, nurses and nursing auxiliaries. 6 emergency teams were confronted with scenarios in a simulation setting, either with a traditional configuration of work or with the new configuration. Results: Significantly, each kind of caregiver respected the delimited spatial zones: 91.5% of occupation time for doctors, 97.1% for nurses and 95.3% for nursing auxiliaries. The mean durations of occupation of a same zone by the nursing auxiliaries and another caregiver decreased significantly, thus reducing the likelihood of mutual disturbance. Readiness for multitasking activity measured before and after experiencing the work configuration increased significantly among caregivers. An ergonomic evaluation scale showed a high level of satisfaction among caregivers (68.5 points out of 100). Participants also indicated the advantages and disadvantages of this new work configuration. Conclusions: This study is a first step towards recommendations to standardise the positioning of emergency team members and for a new spatial arrangement of equipment.