1. Arctic Ocean Technology – Arctic Ocean Technology – Opportunities & Challenges for Emergency Preparedness 1

2. My 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. 2

3. 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. 3

4. Clipper Round the World Race chose PRAXES Canadian Physicians deliver global emergency medical support for 12 vessels, 650 crew. 4

5. Reality - Remote workers can’t call 911 Reality - Remote workers can’t call 911 5

6. Challenges 1.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

7. 2. Medevacs are Expensive & Risky 2. Medevacs are 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 7 Ref 1: The business case for telemedicine, Henny, Hartington, Scott, Tveiten, Canals, Int Marit Health, 2013; 64, 3:129-135

8. 3. Communications Communications challenges in remote locations Satellite telephone expensive, can be unreliable (esp. in polar regions). Internet expensive, unreliable. telemedicine systems expensive, require connectivity. 8

9. 4. Public Health System 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 9

10. 5. Providing Telemedicine advice 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 10

11. 6. Most of Canada is REMOTE! People don’t realize how remote Canada’ north is! Unprepared for risks, delays. Unaware of huge distances and lack of facilities. 11

12. Additional Challenges Additional Challenges No standardized training for TM providers. Licensing challenges Medical Liability insurance In Canada – no standardized requirement beyond 1 st Aid. Med. Equip. & supplies provided by employers (unregulated) 12

13. What is Telemedicine? Telephone Send images Send Video Clips One way video & two-way video Additional digital data available 13

14. Telemedicine - an opportunity Telemedicine - an 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 14

15. PRAXES approach to telemedicine PRAXES approach to 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. 15

16. Opportunities - Medical 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. 16

17. Opportunities - Communications Opportunities - Communications 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 17

18. Opportunities - Crew and Passengers Pre-hire or pre-cruise medical exam – standardize. Take DOUBLE amount of required medications Electronic Personal Health Record. 18

19. Opportunities - Telemedicine 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.) 19

20. Some telemedicine examples 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

21. Remote health support improves 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. 21

22. Summary 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. 22

23. Resources and References Please go to our web site at www.praxes.ca/news/ for a copy of this presentation, as well as other papers and links. 23

24. Thank you! www.praxes.ca Susan Helliwell, CEO susan@praxes.ca 24