[Telemedicine in the maritime environment--hightech with a fine tradition]

Access to health care always has been one of the most critical issues for offshore crews. Therefore, telemedicine has a long and outstanding tradition in the maritime environment. Since 1931 Cuxhaven medical center (Medico Cuxhaven) operates as a hospital-based radio medical advice center (RMA) for ships worldwide providing one of the first routine telemedical services worldwide. For a long time this task was performed on a honorary basis by the hospital's physicians. In 1994 Germany accepted the IMO/ILO (International Maritime Organisation and International Labour Organisation) solution 164. Therefore, in 1998 a formal contract of the German Ministry of Transport officially installed Medico Cuxhaven as the TMAS Center for Germany. According to IMO/ILO solution 164, the RMA provides an expert level of care 24 h/day, 365 days/year. Cuxhaven hospital is a busy general hospital with departments of anesthesia and intensive care, internal medicine, surgery, gynecology and obstetrics, urology, pediatrics, ENT, radiology, and pain medicine. All physicians directly responding to TMAS calls have practical experience in maritime routine and emergency medicine. All incoming emergency calls are primarily handled by board-certified anesthesiologists, experienced in martime emergency medicine (e. g., staffing coastal SAR helicopters, working on rescue boats, carrying out repatriation services for sailors worldwide). If needed, other medical specialists are included. Today, Medico Cuxhaven takes an average workload of one to two emergency calls (response time < 20 s), two to three follow-up calls and approximately one informative call per day. Since 2000 transmission of digital photos has been used for routine RMA. Recently, a system for online and trenddata telemetry of twelve-lead ECG, NIBP (noninvasive blood pressure measurement), CO(2), SaO(2), pulse and respiration rates including the transmission of video images was developed. This system allows worldwide communications as it is capable of all possible means of telecommunication such as GSM, Inmarsat-ISDN or Iridium-Satellite-Transmission. So far, this system has been installed on board several German SAR rescue boats.However, radio telephone and the simple transmission of digital photography remain the basis of maritime radio medical advice service.