What does the future of on board medical care look like?

Cutting-edge medical set-ups are suddenly on owners’ wish lists – and some say it’s long overdue...

Next time you're at the Monaco Yacht Show you might find yourself showing off a shiny new ultrasound, instead of a tender or toy. A cutting-edge medical set-up on board is suddenly on yacht owners’ wish lists – and some say it’s long overdue. 

Medical experts deem the current situation on most private yachts to be fairly sound. Captains and crew take emergencies on board seriously; most are well-trained, if perhaps a little rusty when it comes to more niche areas of expertise, and all boats carry the standard set of kit required. What’s on board is rarely personalised to an owner and their needs, and the emphasis is more often than not on how to get an ill or injured person to shore in the shortest amount of time. But things are changing.  

A handful of tech-savvy owners are investing in pocket-sized devices that are making diagnosis on the water more precise and powerful, while developing medical plans that are tailored to their hobbies and wherever it is they want to go.

A dedicated hospital room may be a luxury that few yachts have the space to afford, but a “hospital closet” filled with medical equipment, plus specialist medical staff-cum-crew to operate it, could soon be the new norm. So, why the sudden interest?

You might expect the trend to be driven by older owners hoping to retire on board while dealing with lingering health niggles, but in fact the reverse is true. It is the fit, young owners who are pushing the boundaries, as they tend to take part in higher-risk activities and watersports, and often head off into areas where those medical facilities on shore are further and further away.

“Out of the 80 yachts that we manage, probably 10 per cent are going to far-off, remote locations,” says Mark Paterson, director of yacht management at Y.CO. “We’re having proactive discussions with them, asking, ‘Have you thought about what happens if something goes wrong on board and you’re in the middle of nowhere? Do you have the right equipment?’ Nine times out of 10, their onboard equipment and contingency plan requires upgrading.”

Previously, yachts travelling to areas such as Antarctica might, in the event of an emergency, have hoped to get themselves to the nearest cruise ship – often incredibly well-equipped with hospital facilities that can cope with anything from stomach bugs to giving birth. But, as the Covid-19 pandemic continues, there are fewer of them around, and fewer commercial cargo vessels too. Help may be further away than you think.

Even when shore is close by, first-rate facilities are by no means a guarantee. “If you’re going to a completely undeveloped atoll, the hospital tech might be no better than what you already have on board,” says Paterson, “and helicopters can’t always get to the nearest location anyway – they have a finite range.”

Y.CO’s fleet includes 77.4-metre Legend, which has been to Antarctica, and 55-metre Driftwood, which has visited Central and South America. Clients include a West Coast American with a love of kitesurfing in the South Pacific, and another South Pacific traveller who “really pushes the boundaries in terms of the style of the diving she does and where she goes”. Both have invested heavily in what they need to stay safe.

Of course, even if your style of yachting is somewhat more sedate, age doesn’t necessarily factor in to emergencies on board. “You just don’t know what unidentified health conditions there may be. It could be a crew member with an underlying health condition,” notes Paterson, not just an owner or their guests.

“Basically, it’s going to happen at some point,” explains Brent Palmer, director of education and strategic customer relations at MedAire, one of the largest telemedical services used by yachts around the world. “By its very nature, an accident is something that is unexpected and not planned for.”

It’s easy to think of superyachts almost as luxury hotels, he continues, but from his perspective, a private yacht is “an industrial work site with industrial accidents”. There’s heavy machinery, fast-moving objects, tenders, props, storms and waves… all things that can cause serious harm.

Of course, the pandemic has had an effect too. “I really feel that Covid has fundamentally changed how we all feel about health,” says Isaac Bean, a research scientist from Covid Detect, which has been helping the company’s founder and Gene Machine yacht owner Dr Jonathan Rothberg develop a Covid-19 test on board his boat over the past few months. Dr Rothberg is a molecular biologist and the inventor of rapid DNA sequencing technologies.

“We have a stronger awareness now about our own health status, the status of other people around us, and there’s been a tectonic shift in the zeitgeist in how we think about keeping healthy. People might have had kit on board just for insurance reasons before, but now they’re more interested in taking an active role.”

Some owners are spending more time on board, hence paying more attention to what medical facilities they have. Y.CO has noted a clutch of owners who’d rather convert an entire guest suite into a hospital room on their boat than risk heading on shore to an overstretched hospital, potentially full of sick Covid-19 patients.

There’s the rise in wearable, health-related tech too, explains Gene Machine’s captain Matthew Gow. “I had to do an ECG [electrocardiogram – a test to check your heart’s activity] for one guest on our Tempus unit because the alarm kept going off on his Apple Watch,” he says. “If you have the correct tools on board, why not? Then you can go on enjoying your holiday in Tahiti.”

Testing is the future

The first thing to say about the future of medical care on board is that testing is certain to play a much larger role. As any captain knows, viruses, flu, stomach bugs and the like are common complaints, and it’s far easier to keep them off the boat in the first place than to try to contain them on board.

Covid-19 has, of course, brought all this into focus. At the start of the pandemic, the entire upper deck of 55-metre Gene Machine was transformed into a molecular biology lab – complete with the freezers and refrigerators needed for storing enzymes, stainless-steel work desks, a full suite of prototyping tools including a 3D printer, laser cutter, CNC machine [a type of cutting machine] and a willing set of “15 crew guinea pigs”, as captain Gow puts it, to allow Dr Rothberg and his team to develop a reliable and accurate Covid-19 test.

They believe they’ve been successful. While living on board over the summer they managed to prevent two people with Covid-19 from coming on board; the crew tested themselves every day and continue to do so. The test awaits FDA approval, but “we know it’s safe and we know it works”, says Bean, who passionately believes in its efficacy, stating the test is more sensitive, and therefore gives far fewer false-positive results, than others on the market.

“The even more beautiful thing is that this test isn’t just applicable to Covid-19,” he adds. “It’s what we call a nucleic acid test, so it looks for the actual genetic sequence, essentially what a PCR [the gold-standard test for pathogen detection] does.” This means the test can be used to monitor a whole host of infectious diseases in the future, “keeping yachts, crew and owners really safe”, he explains. The team is currently working on one for identifying the flu.

MedAire has also seen the change in this area. “We’re currently focused on PCR for Covid-19 testing as the gold standard for testing, but that technology is already being used to test for other things,” says Palmer. “So I can take a throat swab and see if that person has Covid-19, strep throat, RSV [a virus that causes cold-like symptoms], a whole series of potentially nasty viral and bacterial infections. You can extrapolate that out and test for sexually transmitted infections as well, and up to 44 other diseases, using PCR devices on board.”

In the future, you’ll be able to take a swab of a wound and put it through a PCR device and it will also tell you what type of antibiotics the infection is resistant to. “That, for me, is a game changer,” he says.

There’s also going to be more of an emphasis on diagnostic trending on board, monitoring a person’s health and responding when there seem to be changes. “In the old days, the question was: can you take a pulse or work out someone’s blood pressure?” continues Palmer. “Now you could take an ECG and have it as a baseline, and then if they start getting sick or having palpitations, they can take another ECG and have a cardiologist look at it. Once you’ve got a trend line you can start to predict what’s happening. Are they getting better or worse? You can start thinking about interventions far ahead of the problem.”

Bean agrees, and explains that one of Dr Rothberg’s research companies (he owns seven), Quantum-Si, is focusing on protein sequencing. In layman’s terms, this is going to make it much easier for doctors to test blood for a number of different markers.

“When we take blood it’s like the stone age,” Bean says. “We have to do all these processes where we separate out the blood, and then we do this one test just for troponin, the heart attack marker. This [new technology] will allow us to do parallel sequences so we’ll be able to look across the board and see what’s in there.”

“Right now, our current product is going to be for research labs, hospitals and care centres. But it’s easy to see how it could move on to a setting such as a yacht, where somebody who does have a certain health condition, such as heart disease, could easily be able to live the life that they love, go on board and keep testing themselves and say, ‘Oh gosh, my troponin [level] is starting to come up.’” They might, he explains, detect a heart attack up to five days before it would actually happen – and get to shore in time to mitigate the effects.

Other areas in development include augmented reality. “I’d love to have a pair of VR goggles and when, say, suturing on board, a doctor could see what I’m seeing and overlay their hands on top of mine so they could walk me through the procedure step by step as if they were guiding my hands,” says Palmer.

Robot surgery, too, is potentially on the horizon.  A device already exists called the da Vinci Surgical System, which allows surgeons to perform procedures such as cardiac surgery through incisions as small as one or two centimetres. It uses four robot arms, each of which carries a different tool, while a movable cart next to the operating table holds the arms, and the surgeon sits at a control console with a magnified three-dimensional view of the operating field. That might not be something that comes on board any time soon, but that and other high-tech robotics are already being used in the hospitals of some smaller, more remote communities.

“I recently heard of a hospital in the Caribbean where they don’t have a stroke specialist on site, so they got a consultant to dial in on one of those portable iPad robots,” says Palmer. “The robot itself could move around the patient, see what’s going on and then provide a stroke consultation remotely.

“On a telephone you lose a lot of the nuance of facial expression and body language, that sort of stuff, and the ability to zoom in on a particular part, turn to the left or right to talk to a consultant... that makes  a big difference.”

Pocket-sized powerhouse

Part of this new, diagnostic approach to health on board, of course, involves the use of new machinery. Although professionals are keen to emphasise that the new devices on the market need to be in the right hands, it’s easy to see the appeal of a pincer approach, whereby trained onboard staff use sophisticated equipment to monitor a person’s health, with specialists on shore then advising on treatment.

“A lot of point-of-care testing that is currently used commonly in ICUs [intensive care units] will be eminently transferable offshore, to be used with good support from telemedical support services,” says Spike Briggs, managing director of MSOS, a company that supplies medical kits and telemedical services to yachts around the world. Briggs is also a full-time intensive care consultant for the National Health Service.

“All these advances mean that we will increasingly be able to make diagnoses offshore, rather than the situation at the moment, where most of the time we are looking to control symptoms without necessarily knowing the exact diagnosis. If we know the diagnosis, we can make sure the treatment is appropriate, and thus improve outcomes.”

Equipment is becoming smaller, increasingly user-friendly and more valuable on a vessel where space is at a premium. “Ultrasound wands are becoming cheaper all the time, and may be integrated into the onboard medical kit,” says John Ross, medical director of Praxes, another big 24/7 telemedical service often used by yachts. Although it requires training and practice to use it, he describes it as “a reliable method to send the images in real time to a shore-based doctor for interpretation and clinical decision making.”

Dr Rothberg is a big advocate of small-scale, easily usable medical technology, and is ahead of the curve with Butterfly iQ+, the world’s first whole-body ultrasound that you can fit in your pocket. “The Bill & Melinda Gates Foundation has invested heavily in it because of the potential it holds for places like Africa and other developing areas, but it just so happens that it also works perfectly for a setting such as a yacht, where you can’t store huge pieces of equipment,” says Bean. “Ultrasound is essentially becoming the next stethoscope, because it helps you get diagnostic data so accurately. If you’re doing a long crossing and someone’s got a stomach pain, you could easily use the Butterfly iQ+ and telemedicine to help determine if it is appendicitis or not.”

One of Rothberg’s other companies, Tesseract Health, is developing a camera that you hold up to your eyes like a pair of binoculars while it gathers health data such as glucose levels and blood pressure – “a lot of different things that could help in the diagnosis of an acute event, but also would just generally help make sure that a yacht owner and their family are staying healthy”, says Rothberg.

While some of these items are still not widely used on board, “it’s a nearer future than most people realise”, says Bean.

Share and share alike

If you’re not yet sold on the benefits of a medi upgrade, then there is one more upside to consider. “I think there’s a case for disaster relief,” says Gow. “If you go to a remote place with a hospital-like infrastructure on your yacht, you suddenly become much more useful.  If we could help people who might need it more than us, it’d be a huge benefit.”

Palmer advises that donating medicines before you leave and get your resupply is a definite bonus to the local community. “They are desperately needed in some cases, but you do have to caveat that it’s not a dumping ground. The medicines have to be useful, which in most cases they are. They cannot be expired and they need to be climate controlled or looked after so they aren’t damaged by heat or humidity.”

There is, of course, a limit to just how much can be achieved on board, and in many cases, evacuating to land might still be the best course of action. Captains and crew are keen to emphasise that there’s only so many hats they can wear. “I believe in good training, regular drills, up-to-date basic equipment that has stood the test of time and acknowledging that there are limits to who should be venturing off on ships,” notes Ross, and there are many who share his opinion that “money cannot buy everything”.

There’s no doubt, however, that the options available to owners today are expanding. “There are limitations,” says Palmer. “At the same time, the technology is just going to keep pushing those limitations further and further.”

Simple upgrades

The new advances in medical care and the possibilities they bring with them are exciting, but there are more straightforward, immediate changes you can make to what you have on board too. “An oxygen saturation monitor (pulse oximeter) is a very useful and inexpensive piece of medical equipment,” says Susan Helliwell, CEO of Praxes, while replacing a manual blood pressure cuff with an automated digital one is “much easier to use, especially on a noisy ship”.

“A classic case would be the Neil Robertson stretcher,” says Briggs. “There are stretchers now that are lighter, more compact, give better spinal protection and are easier to use. Having said that, the Neil Robertson stretcher has been used to save the lives of many mariners over the years, so  I don't want to be overly critical of it.” If you’re planning ahead for one specific trip, it’s worth noting that you can hire equipment purely for more high-risk itineraries. “You can charter a decompression chamber or get hyperbaric equipment on board, and you’ll need a qualified person to operate it,” explains Paterson. “Then you’ll look at the logistics of whether you have space to put this on board, or if you need to charter a support vessel to hold it.”

Whether it’s MSOS, MedAire, Praxes or another service, telemedical support offshore – if you don’t already have it – is also a no-brainer when it comes to being better prepared. “These are the guys who are trained doctors or paramedics, and they can really make a difference in saving a life or a limb,” says Paterson. But you need to have a strong VSAT connection so there’s less risk of getting cut off at the crucial moment.

There’s a lot that can be added to the standard industry medical kit. Palmer would always advise having a defibrillator on board. “If you have a heart attack and go into cardiac arrest, and you're more than 15 minutes away from a defibrillator, the chances of surviving are close to nil,” he explains. “Ideally you’d have an AED [a portable, automated external defibrillator] so anyone can use it, but in some situations an ECG [electrocardiogram] might be worthwhile. From a three-lead ECG you can get useful arrhythmia information. Other systems, such as the Tempus IC2, can do a 12 lead ECG and do things such as glucose readings and send that data away to medical support onshore.”

Sarah Futhazar, head of client experience at YPI, has been tasked with helping owners get PCR tests and finding qualified nurses to carry them out during the pandemic. “It’s not easy to find nurses at all,” she says. “They are overloaded with work and it’s challenging with the time frame. If an owner wants to leave port tomorrow, then they might need a test carried out in the next couple of hours, as well as a lab that can turn it around in 12 hours. Some countries will accept the antigen test [which has a quicker result time] instead, but not all of them.”

Like Palmer, Futhazar agrees it’s a challenge to find nurses that understand yachting. “You need people who are used to working with high-profile clients, who can be discreet and are flexible with their time. A common scenario is that a nurse comes on board, and the owner’s not ready, so they have to wait. They don’t want that because they have 10 more people to go and see afterwards.”

Another trend Fraser is noticing is that more crew are suffering from the psychological side-effects of the pandemic, being unable to leave a quarantined vessel and isolated from family for longer periods than usual. “One of the responses to this is specialist training, and a Mental Health First Aid for Seafarers course may well be one of the required items on future client job briefs for nurses and officers,” says Caïlbourdin.

The right people for the job

So, who’s going to lead the charge on board? Most yachts don’t have the luxury of a dedicated medical professional but positions such as a paramedic-deckhand or a stewardess-nurse are far more common. Doctors tend to be hired only when an owner or guest already has a pre-existing medical condition.

Louise Caïlbourdin, crewing manager for The Crew Network in Antibes, has noticed an increase in inquiries about these kinds of roles, largely due to the pandemic. Fraser is widening its search to find qualified people to fill these medical positions, and is advising owners who are building yachts, particularly explorers, to take medical facilities and staff into consideration. As a general rule, medical staff command “an increase of about €500 to €1,000 [£445 to £890] more on their basic salary than their counterparts,” Caïlbourdin says.

Paterson reports that Y.CO hasn’t found it difficult to find professional nurses willing to move to a life offshore. “Whether it’s in private villas or ski resorts or even on cruise liners, there’s a big attraction to come into yachting,” he says.

Palmer advises that the recruitment process can be more complicated when catering to a specific medical condition. “You might have someone looking for an ICU nurse with chemotherapy knowledge, a female because that’s the only cabin available, and 10 years-plus experience,” he says. “There’s a big pool of people, but it’s hard to find the right one because they’ve got to have good interpersonal and communication skills too.”

Use it or lose it

Of course, there’s a caveat to impressive new medical pieces. “Having lots of shiny equipment is not a substitute,” says Helliwell. “Training, refresher training, regular drills and practice make a difference, including having some medical oversight to provide feedback and refinement.”

Whatever your set-up, it’s clear that having the right person overseeing operations on board is key. “Someone who can generally assess a situation, obtain a basic story, conduct a limited physical examination, obtain basic vital signs using reliable inexpensive tools, and communicate clearly has 75 per cent of the important part done,” says Ross. “A piece of tech that does the same, possibly with jerky, pixellated video, may add five per cent.” If your budget is limited, “investing in good basic equipment, and practice scenario training, is likely to be a better use of money,” than an ‘all in one’ telemedicine suitcase that “is glamorous, but often not used in emergency medical situations,” he says.

One thing is for sure, which is that most crews are somewhat unprepared.  “The basic first aid courses that the guys would typically do on a yacht simply aren’t enough,” says Gow. Palmer adds that even if individual members of a crew have done recent training, it’s often the case that they haven’t worked together as a team with others on board. “The minimum requirement for a full first aid course is once every two years, but in reality, if you don’t pick up a textbook your skills could rapidly degrade within six months. So it’s a strong medical recommendation that you should run a drill every six months as a minimum.”

Developing a “pit crew” mentality, where members of the crew have clearly defined roles for an emergency situation – for example, taking vital signs, or administering an IV drip – can help make things slicker and save valuable time.

Medi yacht checklist

• A trained doctor, paramedic or nurse on board
• Someone trained in mental health first aid for seafarers (mhfa)
• Access to a telemedical service, and a crew well-drilled in using it
• A pocket ultrasound
• An ECG, to record and monitor the rhythm of your heart
• A defibrillator, to restart the heart during cardiac arrest
• An oxygen saturation monitor, to measure how well oxygen is binding to your red blood cells
• A digital blood-pressure monitor – easier to use on loud yachts than a manual version
• A stretcher – a modern version that is light and kind to the spine

This feature is taken from the March 2020 issue of BOAT International. Get this magazine sent straight to your door, or subscribe and never miss an issue.