This is the first major textbook on the emerging speciality of remote medicine. The modern concept emerged in the 1970s when the medical directors of the main oil companies operating in the North Sea — BP, Shell and Mobil — sought advice from the University sector since the morbidity and mortality levels of offshore workers had become unacceptable. A system of healthcare was jointly developed and applied by the industrial doctors and the academic doctors of Aberdeen University which worked well and greatly improved the healthcare of the offshore personnel. It was subsequently validated by duplication for the very different scientific population of the British Antarctic Survey where it worked even better. It was next introduced to the oilfields of the Middle East — Qatar (QGPC, Offshore and Onshore), Abu Dhabi (ADMA and ADCO) and Oman (PDO) where it worked equally well. The Aberdeen Universities next collaborated with the UAE University in Abu Dhabi to evaluate and develop telemedicine mainly in the area of education and research and they established early transcontinental courses and conferences together with joint supervision and production of higher degrees between collaborating universities in different parts of the world.
The recently established International Remote Healthcare Association (IRHCA), backed by the University of Glasgow, the UAE University in Abu Dhabi and the Siberian State Medical University has established an ongoing study to determine the education and skills required to produce a competent Remote Healthcare Practitioner. The chapters in this book contain the knowledge base currently thought by the IRHCA to be necessary to produce a competent remote healthcare practitioners and thus to allow curricular development of the new courses necessary for the establishment of University qualifications and for the regulating authorities to design examinations and establish appropriate registration. Since this is a new speciality the continuing research of the IRHCA is necessary to act as an audit to ensure that the information in the book, and the courses derived from it remain relevant and also to detect omissions as they are recognised.
Author(s): John Nelson Norman, Malcolm Valentine
Edition: 1
Publisher: World Scientific
Year: 2020
Language: English
Tags: Remote Medicine; Occupational & Industrial Medicine; Emergency Medicine; Wilderness Medicine
Contents
About the Editors
About the Authors
Foreword
Preface and Acknowledgements
Chapter 1 Remote Medicine: History, Development of the Concept and Research
Introduction
Development of Remote Medicine in the North Sea
First-Aid Training
Communications
Medical Co-Ordinating Centre
Evacuation
Research and Audit
Development of Remote Healthcare for the Antarctic
Case Study 1
Case Study 2
References
Chapter 2 First-Aid for Industrial and Remote Settings
Introduction
Determining Priorities
Approach to a Casualty
Unconsciousness
Recovery position
Fainting
Epilepsy
Diabetes
Stroke
Head injury
Levels of Unconsciousness
Respiration and Respiratory Failure
Respiratory failure
Choking
Drowning
Chest injury
Mouth-to-Mouth Breathing
The Heart, Circulation and Circulatory Failure
Circulatory failure
Heart attack
Wounds and Bleeding
The ring pad
Pressure points
Internal bleeding
Bleeding from special sites
Wounds
Puncture wound
Foreign bodies in wounds
Accidental Amputation
Burns
Immediate management of a burn
Chemical burns
Fractures
Classical features of a fracture
Management of a fracture
Eye Injuries
Chemical burns of the eye
Welders flash and snow blindness
Poisoning
Swallowed poison
Inhaled poison
Injected poisons
Shock
Causes of shock
Diagnosis of shock
References
Chapter 3 Preparation for Disasters in Remote Places
Introduction
The Major Incident Plan
Training
Casualty Clearing Area
Provision of External Medical support
Reference
Chapter 4 The Psychological Response to Major Trauma in Remote Locations
Introduction
What is “trauma”?
“We must do something”
Myths about Disasters
Self-care in the Trauma Zone
Those at risk?
What steps can we take to help ourselves?
How Communities and Individuals Cope with Major Adversity
Military conflict
Disasters
Community reactions
Individual reactions
Grief
A constellation of reactions to loss
Adjustment to loss
Pathological grief reactions
Cultural influences
Management
“Ambiguous loss”
Post-Traumatic Psychopathology
At risk factors
Predictors
Resilience
Post-traumatic stress disorder (PTSD)
Additional pathologies
Children and adolescents and trauma
Interventions
Aims
A stepped model of care
Psychosocial interventions
Conclusion
References
Chapter 5 Communications and Telemedicine
Historical Development
Development of Medical Communications and Telemedicine in Aberdeen
Development of Medical Communications and Telemedicine in the Middle East
References
Chapter 6 Acute Surgical Problems
The Acute Abdomen
Abdominal pain
Colic
Peritoneal pain
Referred pain
How to conduct a rectal examination
Management of the Acute Abdomen
Fluid and Electrolyte Therapy
Basic maintenance therapy
Replacement of electrolytes
Fluid requirements during illness
Monitoring fluid and electrolyte therapy
Bibliography
Chapter 7 Diagnosis and Management of Medical Emergencies
Introduction
Assessing the Acutely Unwell Medical Patient
Common Medical Complaints and Presentations
Chest pain
Pulmonary thromboembolism
Pneumothorax
Musculoskeletal chest pain
Palpitations and syncope
Respiratory problems
Asthma
Upper GI bleed, inflammatory bowel and liver disease
Upper GI bleed
Inflammatory bowel disease
Alcohol related hepatitis
Diabetes, DKA, and HHS
Hyperosmolar hyperglycaemic state
Common Neurological Presentations
Headaches
Seizures
Stroke and transient ischaemic attack
Stroke classification
Poisonings and Toxidromes
Sepsis
Ambulatory Care Systems, Pathways and In-Home Management Services
Telehealth and Communication Strategies
Transfer Decisions
Remote Clinician Resilience
Summary
References
Chapter 8 Remote Healthcare and Psychiatric Emergencies
Introduction
Differential Diagnosis — Is this Actually a Psychiatric Illness?
Acute Confusional States
History and examination
Management
Psychoses
Schizophrenia
Positive symptoms
Negative symptoms
Hypomania and mania
Hypomania
Mania
Depression
Cause
Symptoms
Red flags
Agitated depression
Suicide
Management of suicide risk
Management of a successful suicide
Management of the Acutely Disturbed Patient
Bibliography
Chapter 9 Remote General Medical Practice
Section 1 — The Approach to General Medical Practice
Introduction
Illness Behaviour and Influences to Consult
Contrasting General Practice and Secondary Care
The consultation
1. Discover why the patient is bringing an issue to your attention
2. Define the clinical problem
3. Address the patient’s problems
4. Explain the problem to the patient
5. Make effective use of the consultation
6. Achieve reasonable outcomes
Conclusion
Section 2 — A Clinical Approach
The Extended Scope of Primary Care
Clinical Attributes Guide
1. Generic attributes
2. Emergencies
3. Dermatology
4. Ear, nose, and throat
5. Medical issues
6. Obstetrics and Gynaecology
7. Ophthalmology
8. Paediatrics and child health
9. Mental health
10. Musculoskeletal problems
Conclusion
References
Chapter 10 Delivering Pharmaceutical Services in Remote Locations
Introduction
Traditional Pharmaceutical Service
Legal Aspects
Introduction
UK medicines regulatory system
UK medicines legislation
Medicines Act licensing system
Marketing authorisation (previously known as product licence)
Wholesale Distribution Authorisation [WDA(H)]
Legal classification of medicines in UK
Management of Medicines at Remote Locations
Selection of medical conditions to be catered for
Selecting inventory list medicines
Written Instructions
Medicines which may cause sedation or impair judgement
What can go wrong with the system
Procurement, Supply & Logistics
Supplier selection
Shipment to site arranged by remote site company
On-Site Storage of Medicines
Sickbay general arrangements
Ambient medicines
Cold-chain medicines requiring storage between +2 °C and +8 °C (35°F to 46°F)
Dealing with temperature excursions
Pharmaceutical Waste
Reference Sources
British National Formulary (BNF)
Electronic Medicines Compendium (eMC)
Importance of Assessing Medicines Brought On-Site by Personnel Before Selecting a Medication
Assessment of medication
Prescribed or Purchased Medicines which Raise Concerns
Supplying Medicines to Individuals on Remote Sites
Supply of an over the counter medicine in a manufacturer’s original pack
Dispensing medicines
Labelling of dispensed medicines
Dispensing a POM in a manufacturer’s original pack
Dispensing a quantity of medicine from a manufacturer’s original pack into another container for a patient to take away from the sickbay
Producing labels on a remote site
Containers
Records
Training
Bibliography
Chapter 11 Occupational Health in Remote Environments
Introduction
Health Risk Assessment
Health Plan
Who is at Risk?
Occupational Health Services
Staffing
Occupational Health Benchmarks
Fitness for Task
Health Surveillance
Absence Management
Non-Occupational Hazards
Health Interfaces
Summary
References
Chapter 12 Industrial Medicine and Remote Healthcare in Russia
Introduction
The History of Industrial Medicine in Russia
Problems of Industrial Medicine
Organization of the Healthcare System at Remote Sites
Telemedicine: History of Development and Current State
Conclusion
An Illustration of New Ways of Working in Remote Healthcare
References
Chapter 13 Work and Experience of an Oil Industry Remote Medical Practitioner
Introduction
Remote Healthcare and Offshore Medics
Remote Health Practitioners in The Oil Industry: Scope of Practice
Remote Health Practitioners Training
Skill Decay
Technology
Secondary Roles and Potential Role Conflict
Safety Management
References
Chapter 14 Hyperbaric Medicine and Diving
Introduction
Tunnels and Mines
Diving
Free swimming divers
Bounce divers
Saturation diving
Effects of atmospheric pressure on the body
Gases in the body
Gases are in the blood
The Dysbaric Illnesses
Barotrauma (pressure injury)
Preventing Barotrauma
Decompression Sickness (The Bends)
Symptoms of decompression sickness
Management of decompression sickness
Effects on Divers of Gases at Pressure
Other Diving Problems
Management of Diving Injuries
References
Chapter 15 Environmental Medicine: The Physical Environment — Heat and Cold
Introduction
Cold
Maintenance of Body Temperature
Conditions Caused by a Cold Environment
Frostnip
Frostbite
Cold burn
Chapped hands and lips
Chilblains
Trench foot
Hypothermia
Conditions Caused by Heat
The Heat Illnesses
Hyperthermia Associated with Fever
References
Index
