A Medical Support in Offshore Racing - Workshop on Medical Support for Offshore Yacht Races, Telemedical Advice Service (TMAS), 1-2 December 2018, London, United Kingdom.

The safety and health of sailors offshore is of major concern. World Sailing (WS) and International Maritime Health Association (IMHA) are taking seriously the potential dangers to the safety and health at sea. By the nature of their sport, the sailors racing in offshore racing environment can be exposed to injuries and other health problems that can endanger their lives. Being aware of the potential dangers caused by the distance from onshore health facilities and lack of professional help on board, IMHA and WS decided to support the activities that are leading to the enhancement of safety and health protection on board. With common initiative, joint Workgroup on Medical Support in Offshore Racing has been formed and the series of workshop organised. The WS/IMHA Workgroup on Medical Support for Offshore Yacht Races previously reached consensus on the common competences and learning outcomes for medical training for offshore racing. In addition, the Workgroup has also set standards for required medical kit inventory for yachts par- ticipating in the various categories of offshore yacht races. Documents were both approved by WS Medical Commission and the IMHA Board. Fourth workshop on Medical Support for Offshore Yacht Races was held in London, United Kingdom, 1-2 December 2018 and workgroup reached consensus on the standards for availability of Telemedical Advice Services (TMAS) for the various categories of offshore yacht races held under the authority of WS. This position paper sets out how the TMAS should be integrated with the practical usage of medicines and medical equipment on board offshore racing yachts. In addition, this position paper also sets out how the level of medical training integrates with appropriate use of the TMAS. Overall, the three WS/IMHA position papers on the triad of medical inventories, medical training and TMAS, are aimed at providing the best possible medical care on offshore racing yachts, by fully integrating each part of the triad of medical support.

Medical emergencies on large passenger ships without doctors: the Oslo-Kiel-Oslo ferry experience.

BACKGROUND: The Oslo-Kiel-Oslo route is currently the only direct ferry crossing between Norway and Germany, covered by 2 cruise-and-cars ferries carrying about 2,600 passengers each and sailing every day (20 h at sea, 4 h in port). Unlike most ocean going cruise vessels, they are not required to carry a physician but an on-board paramedic handles medical emergencies. The aim of the study was to provide data on medical emergencies leading to helicopter evacuations (helivacs) or other urgent transfers to facilities ashore from the two ferries during a 3-year period. MATERIALS AND METHODS: Data about the ferries, passengers, crew, helivacs and other medical transfers were collected from official company statistics and the paramedics' transfer reports. RESULTS: A total of 169 persons, including 14 (8.3%) crewmembers, were transferred from the ferries to land-based facilities by ambulance while alongside (n = 80; 47.3%) or evacuated by helicopter (n = 85; 50.3%) and rescue boat (n = 4; 2.4%) during the 3-year period. Transfer destinations were Denmark (n = 53), Germany (n = 49), Norway (n = 48) and Sweden (n = 19). The passenger helivac rate was 2.4 per 100,000 passenger-days. One person was airlifted from a ferry every 2 weeks. Among helivacs, 40% were heart-related, and more cardiac cases were airlifted than transferred by ambulance in port. CONCLUSIONS: All helivac requests were made after discussion between the ferry's paramedic and telemedical doctors ashore and agreement that the medical challenge exceeded the ferry's capability. This close cooperation kept the threshold for arranging helivacs from the ferries low, enabling short transport times to land-based facilities for critically ill patients. Further studies, including feedback from the receiving hospitals, are needed to determine measures that can reduce possible helicopter overutilisation without compromising patient safety and outcome.