TMCM’s Crew Medical team explains the capabilities and philosophy of its Bluemed service, which makes expert marine medical advice available directly to vessels, and provides medical case management worldwide once a crewmember has left a vessel.
The arrival of the Maritime Labour Convention 2006 (MLC) acknowledged a growing understanding of the importance of safe and healthy crew, and transferred significant responsibilities to vessel owners and managers. Pre-employment medical (PEME) schemes have evolved to raise the baseline health standards of the industry as a whole, in parallel with studies and initiatives on fatigue, nutrition and mental health.
However, medical issues can and will continue to arise at sea. For most owners, operators and managers crew health is a daily operational issue. No vessel can carry an inactive crewmember for long, and if treatment on board or ashore does not solve a medical problem, either repatriation or substitution will be needed.
Thomas Miller Claims Management has created a complete marine medical package, “Bluemed”, which combines remote “telemedicine” advice, P&I-style case management, and arrangement of repatriation and home-country care.
”We have a team which resembles a medical assistance company as you might find in your travel insurance policy, but coming at it from a very marine perspective, which is sensitive to marine operational needs, marine crew contracts and benefits and the latest regulations,” said Stephen Hunt, TMCM Director and Bluemed Lead.
The “sharp end” of Bluemed is the telemedicine service, provided by a team of remote and emergency doctor, based in Aberdeen. They give advice to vessels on routine matters, around the clock, anywhere in the world, helping to stop small problems becoming bigger ones, but also to interpret symptoms properly.
“Most vessels, apart from cruise ships and some of the specialised ships, don’t have any medical personnel on board,” explains Mr Hunt. “They may have crewmembers trained in basic first aid but otherwise they are completely reliant on remote advice. Having access to quality remote advice can be critical from an operational point of view but also from a dollars and cents perspective too – it’s a risk management tool in the most critical ways.”
“Ship owners, operators and managers are not like other employers. They have a very particular relationship with their crews and follow cases very closely. A crew emergency can also be a major commercial and technical issue. Unscheduled calls at unfamiliar ports, deviation from charter, dangerous transfers by launch or helicopter – it’s not the same as getting back to work while you wait for an ambulance. You need a medical adviser from a service like Bluemed who understands the context,” said Mr Hunt.
“Some of the telemedicine products have been around a while but the quality is variable,“ says fellow Director, Patrick Bond. “The free radio medical services aren’t what they were, and some of the commercial operations might leave a vessel waiting an hour or more before they actually get a doctor on the line. We’ve integrated a first-class service which is fully in tune with the marine environment – they were working with the shipping, offshore and military sectors even before we came along – and the partnership with TMCM’s shore-side case management team works seamlessly.”
“If a crewmember is going to be hospitalised ashore , we work with the vessel and Agent, and the P&I Club and its correspondent where necessary, to make sure the care being provided is appropriate, the reporting is sufficient and the costs are properly controlled. If there are concerns at any stage we can put doctors and translators on the phone to the hospital, arrange visits to the crewmember, or transfer them to a different facility if necessary.
Through this process, TMCM’s team establishes the prospects of a crewmember returning to the vessel, or the need to repatriate them to start sick leave at home. In some cases, they may need assistance during their journey, from a medical escort. In the most serious cases, a decision may need to be made to transport them home in an air ambulance.
“The air ambulance is the sexy bit of medical assistance,” says Mr Hunt, “and we will often have to weigh up the benefits of getting someone out of where they are, against the risk of moving them at all – any transfer is a risky transfer. And as ever, there are cost implications too, and the insurers will have an input. So they’re delicate situations, on many levels – there’s no room for ego or adventurism, both of which are sadly prevalent in the medical assistance industry!
“In the majority of cases a crewmember is repatriated normally after a very brief stay ashore, and the focus shifts to treatment and rehabilitation at home. Sometimes doctors will recommend an escort, to provide help with mobility, give medication and change dressings, or look after a psychiatric patient. If that’s the case we’ll set it all up, and make sure the crewmember’s care is picked up as necessary when they get home.”
Medical leave in the home country is one area where TMCM believes significant costs can be saved in many cases, through active case management. “Sometimes, the leave entitlements under contracts, Collective Agreements and now the MLC can be treated as invitations to spend time at home, on pay, without much pressure to get better. Long waiting lists for state care can frustrate the best intentions. With active management and targeted use of private treatment to reduce waiting times, it’s often possible to get crew signed back to work faster, which is better for crew planning and better for budgets.”
The types of illness and injury the team handles varies, and each case has to be treated on its merits. “Musculoskeletal conditions are common, particularly lumbar spine problems, and these can take time to resolve,” said Helen Small, Bluemed’s Senior Nurse Case Manager. “There are challenges of location, language and helping local medical teams to understand the specific and relevant information we need for the client, while all the time working to achieve the best possible outcome for the crewmember.”
In the major crew-source countries like the Philippines there are high quality medical facilities which are used to dealing with the demands of working at sea, but this is only part of an ever-changing crew medical picture. The search goes on worldwide for quality crew at a competitive cost.
“For the cruise lines in particular the emphasis is mainly on hospitality industry experience, so we see crew from Hungary, Nepal and a dozen other land-locked countries in addition to the familiar places like the Philippines, India and Croatia,” said Ms Small.
“We see crewmembers from the Chinese regions of Xinjiang and Heilongjiang thousands of miles from the familiar port cities and with very limited resources in rural areas,” says Case Manager, Liang Kay. ”Herbal and traditional medicines are still an established part of medicine in many places. It’s similar in parts of Eastern Europe. Traditional ‘wellness’ treatment, which tends to be several weeks of gentle therapy at a thermal baths, is deeply ingrained in medical practice in Eastern Europe, and it does have its place; but it doesn’t go down well with US owners and operators, for instance.”
One of the most notable features of the crew medical picture in recent years has been the growing number of psychiatric cases. Mr Hunt explains, “With internet access on board, crewmembers can feel so close to home and yet they’re still thousands of miles away, and if they’re missing their family or something is wrong, that can make them feel powerless and extremely anxious. And if they spend a lot of time online and not so much time with their crewmates, it can make it harder to look for support on board. All that can have a profound effect on younger crewmembers, who aren’t familiar with the feeling of distance; or older ones, who are suddenly connected in a way they weren’t before. In one sense, the present industry focus on crew mental health is long overdue, but in another sense it’s needed to address some very modern factors.”
A recurrent area of concern for the industry is the high cost of treatment in the US. “Unless it’s managed carefully from the start, even a minor case in the US can quickly become a major cost. There is no real limit to what a foreign seaman, with no US domestic insurance, can be charged in a US facility, and the usual solution is to engage a cost auditor who will be paid a percentage of the savings they can negotiate. A casual observer might look at this and say it’s just legalised piracy, but it’s a fact of life, and we simply use the best local partners we can to steer the client through the process. The same goes for parts of Latin America, where you can get mobster practices with US costs – not a great cocktail for an insurer!”
Both TMCM and Bluemed have expanded their networks in Asia-Pacific through Thomas Miller’s Sydney office and in Spain, Portugal and Latin America through a joint venture in Madrid. “It’s about working with the right people who can do what’s necessary when the time comes. We’ve developed a great network of hospitals, specialists, repatriation providers and local agents to meet the specific needs of marine operators and insurers – there’s nothing else like it, anywhere.” said Mr Hunt.