Abesamis, Joseph

Denisenko, Ilona

Fimbault, Jean Cristophe

Forbes, Simon

Horneland, Alf Magne

Jacobs, Michael

Nikolić, Nebojša

Nilson, Roger

Pardal, Carmen Vaz

Thompson, Tomo

English

Via Medica Journals

www.intmarhealth.plInt Marit Health 2017; 68, 3: 178–182 DOI: 10.5603/IMH.2017.0033 www.intmarhealth.pl Copyright © 2017 PSMTTM ISSN 1641–9251LETTER TO  THE  EDITOR178Dr. Nebojša Nikolić, Riva Boduli 1, 51000 Rijeka, Croatia, e-mail: travel-medicina@ri.htnet.hrA Medical Support in Offshore Racing Workshop  on Learning Competences/Outcomes,  4–5 November 2016, Barcelona, Spain Nebojša Nikolić1, Alf Magne Horneland2, Ilona Denisenko3, Tomo Thompson4, Roger Nilson5,  Michael Jacobs6, Jean Cristophe Fimbault7, Carmen Vaz Pardal8, Joseph Abesamis9, Simon Forbes101Workshop Chairman, World Sailing Medical Commission, Croatia 2Norwegian Centre for Maritime Medicine, Norway 3International Maritime Health Association, President, Russia 4Volvo RWR, United Kingdom 5Volvo Ocean Race and Trophy Jules Verne, Sweden 6United States Sailing Safety at Sea Committee, Wilderness Medical Society, United States 7French Society of Maritime Medicine, France 8Spanish Olympic Sailing Team, World Sailing Medical Commission, Spain 9Medical Trainer MARCDOC, Philippines 10World Sailing, Technical and Offshore Manager, United KingdomINTRODUCTIONThe safety and health of sailors offshore is of major con-cern. World Sailing (WS) and International Maritime Health Association (IMHA) are taking seriously the potential dan-gers to the safety and health at sea. By the nature of their sport, the sailors’ racing in offshore racing environment can be exposed to injuries and other health problems that can endanger their lives. Being aware of the potential dangers caused by the distance from onshore health facilities and lack of professional help on board, IMHA and WS decided to support the activities that are leading to the enhancement of safety and health protection on board. There is an obvious overlap and the shared areas of concern of maritime medicine with the newly-emerging field of sailing sport medicine. Although on-board environment and the population of sailors is somewhat different in sailing, much value in commercial shipping guidelines and prac-tices will benefit sailors undertaking offshore yacht racing. Medical teams involved in planning and managing offshore yacht racing will benefit from an internationally recognised reference document which addresses all aspects of medical support for such events. Also, forming a central forum for discussing common medical problems that arise in this arena will facilitate future development of medical support for offshore yacht racing.With common initiative, such forum was formed in the format of the joint Workgroup on Medical Support in Off-shore Racing. The first Workshop on Medical Support for Offshore Yacht Races was held from 6 to 7 November 2015, in San-ya, China, during the WS Annual Conference. Its aim was to agree on the WS/International Sailing Federation (ISAF) position paper on best practice to promote and maintain health in offshore yacht racing that would set up the goals for further workshops and areas that should be cowered and agreed upon with the final aim to reach internationally recognised standard and reference document(s), which address all aspects of medical support for such events.General agreement on current situation was that discrep-ancies and lack of concordance between medical training, medical kits and recommended medical manual may cause suboptimal treatment of sailors suffering from serious illness or injures. WS/IMHA work group defined several major areas where further work should be taken — possibly in the format of the joined WS/IMHA Workshops: Medical training, Med-ical kit on board, Medical Manual and Telemedical advice systems (TMAS — Tele-medical Maritime Assistance Service). General position on each element was agreed upon while regarding the medical training it was agreed that it must consider the type of yacht racing undertaken, the time and the distance remote from definitive medical assistance, and the medical kit carried by the yacht. In general, yacht races venturing into more challenging environments require more extensive medical training. Ideally, medical training should involve theory, practical skills, and simulation of practical scenarios on board the vessel, including at sea.www.intmarhealth.pl 179Nebojša Nikolić et al., A Medical Support in Offshore Racing Workshop on Learning Competences/OutcomesSECOND WORKSHOP ON MEDICAL SUPPORT FOR OFFSHORE YACHT RACESBased on WS/IMHA position paper from Sanya that set up the field of further work, Second WS/IMHA work-shop was organised during the WS Annual Conference from 4 to 5 November 2016, in Barcelona, Spain. Following the recommendation on further actions from the ISAF/IMHA Position Paper — November 2015 Medical Support for Off-shore Yacht Races on examining the “Efficacy of medical training and learning outcomes” its aim was to produce the WS/IMHA position paper on learning outcomes in medical training for offshore yacht racing.Again, the same format of the workshop was used where 8 participants (4 from WS and 4 from IMHA side were divided into task groups where each task group was formed from 1 participant from WS side and 1 participant from IMHA side. Before the task group work, several presentations were made, like presentation about the context of medical training for on-board medical providers in merchant marine and training of yacht crews in offshore yacht racing. As the tuning method of learning competences was used, one presentation introduced the tuning method of curriculum design in European medical schools that was already suc-cessfully used in MEDINE 1 and 2 project of the European Union programme Erasmus. Each task group had a task to evaluate, tune and refine the ‘Learning Outcomes/Competences for Undergraduate Medical Education in Europe’ document in the context of medical training for the crews in offshore yacht racing. That European Union document today presents the base model of designing the curriculums in European medical schools. That concept of defining the leaning outcomes is nowadays enabling European (and significant part of inter-national) medical schools to develop their own curriculums that differs one from the other, but at the same time to reach the same final product — equally well trained medical professionals that can work in any country regardless of the training programme.In the context of sailing, having the list of necessary competences of the person designated for providing med-ical help on board means that, regardless of what training programme a race organiser or national authority chooses, whether it is privately owned company or government run training programme, by reaching the set of agreed out-comes we will be sure that the sailors have appropriate level of medical competences on board. With such docu-ment agreed upon by the relevant international experts, WS and IMHA will set up the highest possible and realistic standard, which will allow race organisers to choose their own solution in fulfilling it. At the same time the race organisers will benefit from having the strong benchmark that will enable them to provide the appropriate medical support on board. The sailors will benefit from having the best possible safety and health protection in offshore environment of the race. The second workshop produced ‘Expert Consensus Pa-per’ on learning outcomes in medical training for crews in offshore yacht racing. As the tuning process included some more expert documents and further post-workshop tuning, document was completed and agreed upon as a part of the 3rd WS/IMHA Workshop on Medical Help in Offshore Races held in Lorient, France, 12–13 May 2017.WS/IMHA POSITION PAPER ON LEARNING OUTCOMES IN MEDICAL TRAINING FOR OFFSHORE YACHT RACINGAfter evaluating the gathered evidence on medical train-ing for crews in offshore yacht racing, each of the learning outcomes/competencies are rated on the extent to which they should have been achieved by a designated provider/ /crew on board who has successfully completed the training in medical care on offshore racing yachts on the following Likert scale, which is based on “Miller’s triangle” (Miller 1990): — Not Learned allocated “1” on Likert scale — Knows (about it) allocated “2” on Likert scale — Knows How (to do it) allocated “3” on Likert scale — Shows How (in simulation) allocated “4” on Likert scale — Does (in real practice) allocated “5” on Likert scaleFor each of the learning outcomes/competences in ‘Yacht Medic Professionalism’ learning outcomes/compe-tences relating to medical professionalism are rated on the extent to which they should have been achieved by a designated provider/crew on board who has successfully completed the training in medical care on off shore racing yachts: — Not Learned allocated “1” on Likert scale — Knows (aware of issues) allocated “2” on Likert scale — Knows How (understands  principles) allocated “3” on Likert scale — Shows How (in artificial  scenarios) allocated “4” on Likert scale — Does (consistently in  real practice) allocated “5” on Likert scaleAfter the training in medical help on board, designated provider on board/crew who has successfully completed the training in medical care on off shore racing yachts will have the ability to — see Tables below:Int Marit Health 2017; 68, 3: 178–182www.intmarhealth.pl180Outcomes Designated  providerCrewCarry out a consultation with a patientTake a history 4 1Carry out physical examination 4 1Make clinical judgements and decisions 3 1Provide explanation and advice to the patient 3 1Provide reassurance and support 4 1Assess the patient’s psychological state 4 1Assess clinical presentations, order investigations, make differential diagnoses, and negotiate a management planRecognise and assess the severity of clinical presentations 4 1Make differential diagnoses 2 1Provide immediate care of medical emergencies, including first aid and resuscitationRecognise and assess acute medical emergencies 4 4Treat acute medical emergencies 4 1Provide basic first aid 4 4Provide basic life support and cardio-pulmonary resuscitation according to current international guidelines 4 4Provide advanced life support according to current international guidelines 2 1Provide trauma care according to current international guidelines 4 1Prescribe drugsPrescribe drugs (if no contact with TMAS) according to guidelines 4 1Treat pain and distress 4 1Carry out practical proceduresMeasure blood pressure and other vital signs 4 4Cannulation of veins 4 1Administer IV therapy and use infusion devices 4 1Fluid administration: hypodermoclysis, intraosseous and rectal 3 1Subcutaneous and intramuscular injection 4 1Administer oxygen 2 1Move and handle patients 4 4Wound closure 4 1Splinting 4 1Bladder catheterisation 4 1Bleeding control (clotting) 4 4Urinalysis 4 1Basic respiratory function tests 2 1Communicate effectively in medical contextCommunicate with patients 4 1Communicate with TMAS 4 1Communicate in breaking bad news 2 2Communicate with others (social media, internet, media) 2 2Communicate in seeking informed consent 2 1Communicate in writing (including medical records) 3 1Communicate in dealing with aggression 2 1Communicate by telephone/VHF/radio 4 1Æwww.intmarhealth.pl 181Nebojša Nikolić et al., A Medical Support in Offshore Racing Workshop on Learning Competences/OutcomesOutcomes Designated  providerCrewAbility to apply ethical and legal principles in medical practiceMaintain confidentiality 4 3Apply ethical principles to patient contact 3 1Obtain and record informed consent 3 2Certify death 2 1Apply flag state and international law to clinical care 2 1Assess psychological and social aspects of patient’s illnessAssess psychological factors in presentations and impact of illness 3 2Assess social factors in presentations and impact of illness 3 2Detect stress in relation to illness 3 2Detect alcohol and substance abuse, dependency 2 2Apply the principles, skills and knowledge of evidence-based medicineKeep accurate and complete clinical records 3 2Use information and information technology effectively in a medical contextUse computers/communication equipment 4 3Access information sources 4 2Store and retrieve information 3 1Promote health Provide patient care which minimises the risk of harm to patients 3 3Apply measures to prevent the spread of infection 4 4Recognise own health needs and ensure own health does not interfere with professional responsibilities 3 3Conform with regulation to be in charge of medical care on board 4 1Engage in health promotion at individual level 2 2TMAS — Tele-medical Maritime Assistance Service Yacht medic professionalism Designated providerCrewProfessional attributesProbity, honesty 4 4Commitment to maintaining skill competency and knowledge 4 2Interpersonal skills 5 2Professional workingAbilities to recognise limits and ask for help 5 3Capacity to deal with uncertainty 4 2Ability to lead others 4 1Ability to solve problems 4 2Ability to make decisions 4 2Ability to work safely and independently when necessary 4 2Ability to communicate with shore-based TMAS and Search and Rescue (SAR) services 4 3Capacity and ability to organise and plan medical support 5 1Ethics/confidentialityMaintaining confidentiality 4 5Informed consent 4 1Concept of ‘Acting in the patients best interests’ 4 2Probity, honesty 4 4Int Marit Health 2017; 68, 3: 178–182www.intmarhealth.pl182After the training in medical help on board, designated provider on board/crew who has successfully completed the training in medical care on offshore racing yachts should be able to demonstrate knowledge of — see Table below:Knowledge outcomes Designated providerCrewBasic sciencesNormal function (physiology) 2 1Normal structure (anatomy) 2 1Normal body metabolism and hormonal function (biochemistry) 2 1Drugs and prescribingUse of antibiotics and antibiotic resistance 2 1Principles of prescribing 2 1Drug side effects 2 1Drug interactions 2 1Individual drugs 2 1Public healthDisease prevention 2 2Ethical and legal principles in medical practiceRights of patients 2 1After the training in medical help on board, designated provider on board/crew who has successfully completed the training in medical care on offshore racing yachts should have experienced the practical work in these areas — see Table below:Experiential learning Designated providerCrewCare of acutely ill or traumatized patients 4 3Care of general (internal) medical patients 3 2Care of general surgical patients 3 2Care in the community/family practice/primary care 2 1Further WS/IMHA workshops are planned in 2016 on med-ical chest on board and for 2017 with the participation of tele-medicine experts where already created position papers will be put in the context of telemedical advice in offshore racing with the aim to reach completely synchronized and tuned system that will enable higher level of protection of health and lives at sea.

A Medical Support in Offshore Racing Workshop on Learning Competences/Outcomes, 4–5 November 2016, Barcelona, Spain

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A Medical Support in Offshore Racing Workshop on Learning Competences/Outcomes, 4–5 November 2016, Barcelona, Spain

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