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Guest blog - Dr. Sean Miles

 Engineer, Medical Doctor, Flight Surgeon, Aviator, Submariner and diver with a wide range of experience in the delivery of operational healthcare in remote and extreme Environments.


Well, that’s quite some introduction for this month’s guest blogger, Dr Sean Miles, and we are more than delighted that he’s been able to share his incredible story with us. It’s hard to believe that one person could even fit this much into a career, and we were totally fascinated from the first sentence. We hope you enjoy it just as much.


My name is Dr Sean Miles, and I was born in London in 1967. As a child, I was always interested in First Aid and took part in what was known as the Casualty Union for the St John’s Ambulance Brigade. I even remember taking my first ever First Aid test at the age of 8 years old as a Cub Scout.

Unfortunately, my early education meant I wasn’t able apply to go into medicine directly after school. But, at the time I didn’t want to go into any areas of health anyway. At the age of 5, I wanted to be an astronaut, and this developed into setting my sights set on being a pilot in the Navy! (More on this later).


Prior to joining the Navy, I did work as a Nursing Assistant in a residential hospital for patients with special needs. Looking after children and adults with various conditions such as Downs Syndrome, Cerebral Palsy, and patients with numerous other conditions was a great thing to do as 18 years old and it enthused my interest in working in the healthcare sector.


In the Navy I qualified as a non-professional medic, and I continued to work in Naval Warfare environments before finally deciding to go to Medical School at the age of 32. The urge to scratch the medical itch never went away and so I just decided to apply and see what happened. I have always had the attitude that I would rather try something and fail, or find I don’t enjoy it, rather than being 65 years old and regretting I never did things!


I gained entry into medical school by completing suitable modules from the Open University and started at the University of Dundee medical school in 1999. During medical school, I spent time in the Royal Naval Reserve training junior officers and that helped to pay the bills before gaining a Royal Navy Medical Cadetship for my last 3 years of medical education.


I qualified as doctor by degree (MB ChB) in 2004 and obtained full registration with the General Medical Council (GMC) in 2005 after completing Pre-Registration House Officer (PRHO) jobs in General Medicine with Endocrinology, Respiratory Medicine, Lower GI Surgery and Orthopaedics.


2004/2005 was the last year of the PRHO scheme and was replaced with a 2-year foundation programme post medical degree. After completing my PRHO year I returned to the Royal Navy for my General Duties Medical Officer (GDMO) time and completed the New Entry Medical Officer’s (NEMO)

Course in which we were exposed to many aspects of maritime medicine. This course was very useful to prepare junior medical officers for duties at sea and continues to this day in various guises.


After the NEMO course I was sent to HMS NELSON to consolidate my naval and medical knowledge whilst the rest of my new entry medical colleagues headed off for their professional officer training at Britannia Royal Naval College, Dartmouth, which I was exempt from having served as Officer for over 13 years previously. During my time at HMS NELSON, I was attached to the Submarine Parachute Assistance Group (SPAG) for training and operational support. This is a team of Submariners who taught submarine escape training to all submariners but also formed a Submarine Rescue

Team that was able to deploy to the location of a submarine in distress by parachute insertion and provide medical and technical support quickly whilst awaiting rescue ships.


After my time at HMS NELSON, I started my formal submarine training in preparation to qualify as Submarine Medical Officer. I was originally heading off to the Royal Marines but due to various issues I was selected to go to submarines instead. Submarine training consisted of 5 months training with only a week dedicated to submarine medicine. The rest of course was mostly engineering and nuclear science alongside atmosphere generation and control, and numerous other non-medical courses such as media handling.


I then joined my first Submarine as a medical officer – HMS VIGILANT – a 16000 tonne Ballistic Missile Submarine and immediately went on 6 weeks of work up training followed by a 13-week underwater patrol. During this period, I completed the very mentally arduous basic submarine qualification and earned my ‘Dolphins’.


During my general duties time I completed 3 deterrent patrols and several trials on HMS VIGILANT as well covering periods on HMS VENGEANCE. During my off-watch periods I spent two days a week working in a hospital respiratory department and Intensive Care Unit, and this enabled me to complete my Foundation Competences as a junior doctor that I was required to complete by the GMC in line with the new Foundation

Programme. During this period, I also completed Diplomas in Occupational Medicine and Intermediate Care, both of which have been used regularly since qualifying and completed a part time masters degree in Bioastronautics At the end of my submarine time, I applied to start General Practice training within the Military Deanery and then spent 3 and half years in General Practice Vocational Training (GPVT) that also included two tours in Afghanistan.


On completion of my General Practitioner (GP) training, where I also obtained a Diploma from the Royal College of Obstetrics and Gynaecology, I returned back to the Royal Navy again and began a placement at the Commando Training Centre Royal Marines (CTCRM) Lympstone. This was a short placement to resettle back into the military GP setting and then I was posted to RM Poole, in Dorset and served as Squadron Doctor and ultimately as the senior medical officer supporting maritime special operations.

Following my time at RM Poole I had a brief period at HMS RALEIGH, which is the basic training establishment for all new entry non-commissioned naval personnel and was another consolidation period for me post operations. After 3 months at HMS RALEIGH, I was posted to HMS OCEAN as a singleton GP and Principal Medical Officer (PMO).


HMS OCEAN was a helicopter assault ship, with capacity to carry a tailored air group of up to 20 helicopters as well as a large number of Royal Marines to conduct numerous different missions. This period enabled me to develop my medical management skills in running a solo medical practice supporting over 1000 personnel onboard. I also had to integrate a small surgical team into the medical support team and that was challenging particularly in equipment support and defining areas of responsibility. During my time on HMS OCEAN, we conducted several busy

 deployments in the Baltic and Mediterranean seas. 


The Baltic deployment also involved conducting ‘house calls’ via fast boats to around 25 landing craft holding big numbers of NATO and Finnish soldiers and marines at anchor off the coast of Sweden and on my Mediterranean deployment working with the United States Marine Corps (USMC) to develop an airborne MEDEVAC capability in an MV-22 Osprey tilt-rotor aircraft.


After spending 18 months on HMS OCEAN, I was selected to attend the 7-month course in  aerospace Medicine delivered by King’s College London and the RAF Centre of Aviation Medicine (RAF CAM). This course covered the entire  spectrum of aerospace medicine from visits to the European Astronaut Centre at ESA Cologne to  study aspects  of Space Medicine to studying the medical issues associated with flying balloons and

microlights. The course also covered all the  aspects of survival, aerospace life support

systems and clinical medicine related to aerospace operations.


On completion of this very intensive course in which I obtained my diploma in Aviation

Medicine (DAvMed) I was appointed to the RAF Centre of Aviation Medicine and assumed the role of Chief Instructor and responsible for the delivery of over 56 aviation medicine courses to the whole of the defence aviation communities’ as well as foreign armed forces.


During my time at RAF CAM, I conducted two operational deployments on HMS ECHO conducting migrant rescue operations in the Mediterranean Sea. This was a very tough role and I remember lots of challenges including trying to cannulate an Afro-Caribbean patient in the dark, in a force eight gale with water up to my knees, and on that same rescue dealing with a patient in Diabetic ketoacidosis (DKA – a serious diabetic crisis). The diabetic patient was unable to be evacuated ashore for further care due to the weather but luckily, we found his insulin in his bag, and I managed to deliver a bolus sliding scale and correct his Blood Glucose overnight. He could have easily died if I had not found his insulin as I only had 1 vial of insulin in the ship’s medical modules.


These experiences simply can’t be taught in a  book, and I always challenge my primary and secondary care colleagues, working most of their time in the NHS setting, that operational medicine is not by the book or rigid adherence to clinical guidelines (designed for practice or hospital settings). You have to do the best for the patient in less-than-ideal circumstances, with the resources you have, where standard guidelines and protocols just don’t work.

After my deployments and finishing my time at RAF CAM, I was appointed to HMS QUEEN ELIZABETH as the Principal Medical Officer and Flight Medical Officer. This was the UK’s first ‘super carrier’, and my job was to get the medical department to an operational footing in support of Carrier Strike Operations. During this period, I led the medical department to support Fast Jet (F35B) trials and Rotary Wing Operations, organising the medical response to emergencies and in action, delivery of force health protection, MEDEVAC procedures, healthcare governance. I also had to develop the medical support to Personnel Recovery, Humanitarian Operations and integration of surgery support etc. This was a very challenging period, but I was able to deliver a medical capability not seen at sea before, including deployed Mental Health support, Physiotherapy and Rehabilitation capabilities, laboratory and imaging support and a wide range of dental capabilities. We also pushed the boundaries for Crash on Deck (COD) response where previously all flying stops in an emergency and the aviation medicine support to our US Marine Colleagues who will regularly deploy a F35B squadron to the ship for deployments.


Other highlights of this role were taking the ship to sea during the COVID pandemic and keeping the ship safe and clear of the virus whilst conducting operational sea training in preparation for the ships first deployment. Along with my team we developed many of the policies for keeping the whole fleet operational during the pandemic. I left HMS QUEEN ELIZABETH at the end of the COVID lockdown in July 2020 and then moved to the Royal Marines as the Senior Medical Officer where I was plunged into a major transformation programme with the Royal Marines moving from a purely amphibious role to small team operations and other specialist tasks. It was a challenge to provide a greatly expanded medical support model with limitations in work force, equipment and some institutional inertia. Over the two-year period with the Royal Marines, I was heavily involved in the Royal Marines re-learning how to operate in the high North of Norway in the winter, developing personnel recovery capabilities and supporting trials with remote pilot air systems (Drones) for medical resupply, including blood products. Finally, I was instrumental in generating an official Paramedic cadre for the Royal Navy – something that had been resisted for many years.


After spending two years with the Royal Marines, I moved to my current role which is as an embedded officer in an United States Special Operations Headquarters deployed overseas. My role is as the Command Surgeon to a wide range of specialist medical teams supporting special operations. This role is definitely a culmination of all my medical training and experiences. Being in the Navy since I was teenager, I have always worked in the Maritime environment, but I did have experience in land operations via the Royal Marines and other specialist land units as well as serving on warships ranging from Minesweepers, Frigates, Destroyers, Tankers and Aircraft Carriers. So, once I qualified as a doctor it made sense to   return back to full time service in the Royal Navy and I just added the ‘Blood Red Stripe’ to my uniform in between my rank rings on my uniform and prefixed my rank with Surgeon. I have always been interested in spaceflight – and as mentioned earlier, at the age of 5, of course I wanted to be an astronaut! My original aim was to join the Navy and specialise in Aeronautical engineering and become a test pilot before working towards

becoming an astronaut. But I found air  engineering so very boring! In my flight class there were no options to become a fast jet pilot and only helicopters were available to train on.


Being British was also a major limitation to pursuing a career as an astronaut. The UK did not contribute to the European Space Agency Manned Spaceflight programme until I was in my early 40s and I had no chance of being selected by NASA due to the requirement to be a US Citizen. So, I maintained my interest in spaceflight via my flying and my warfare career. Once I got into medical school, I was able to conduct special study modules in areas of cold weather and aerospace medicine. This included a physiological research project on the use of therapeutic hypothermia in the management of head injury, psychological research in flight simulators on conditioning and spare capacity and the use of hyperbaric oxygen therapy in the management of stroke.

I studied for higher degrees in bioastronautics and was a member of UK Space Labs – a group of likeminded aerospace medicine and physiology students and academics and this continued my interest in Space Medicine.


With all my experiences and training I am often the used as the ‘troublemaker’ in the room when I see lots of plans for manned spaceflight such as moon bases and expeditionary flights to Mars and   asteroids by students and industry, and I have the credibility after serving in several spaceship   analogues such as remote Polar Regions and 

 underwater in submarines and as a diver and  pilot.


I have always been attracted to small teams as a specialist, so working as the Medical Officer in a small team of other specialists is very attractive. I also like having to use lots of other skills, often not normally associated with being a doctor. On a submarine I was the only doctor with two medics and my other roles included navigation,

meteorology and intelligence analysis as well as being the sports and education officer. A perfect background to advise on medical support for long duration space flights. I am also fascinated by the psychology of small teams & operations and, apart from radiation and microgravity effects associated with long duration spaceflight, the psychological health of astronauts is one of the biggest risks to mission success.


On ships and submarines at sea there are similar issues with team and leadership dynamics, especially whilst away from home for extended periods and working in dangerous environments. 


My current patients are mostly US Armed Forces. Even though I am a UK qualified Primary Care Physician (General Practitioner) I also hold US qualifications and so I understand and able to practice with a US deployed population. I only do about 2 sessions of clinical time a week and I find that is enough. I definitely don’t miss seeing loads of patients all day. I prefer to spend more time  with individual patients and provide a more holistic care package, far more than my military and civilian colleagues can whilst they are having to deal with large patient loads.


In my current role I am the Command Surgeon to the Joint Special Operations Joint Task Force-Levant. This means I am the Command Advisor to the Commanding General on all aspects of  medical support to Special Forces Operations, including the evaluation of medical risk for all operations and the specialist advisor on special tactics, techniques and procedures for the delivery of Special Forces Medicine. This is mostly US pre-hospital emergency care that has very little doctor involvement unlike the UK PHEM community. But the role is very different here and I lead highly qualified Special Forces Operatives who also have extensive medical training along with their other special skills. The role involves commanding over 56 medical elements made up of personnel from the US, UK, France, Italy, Spain, Canada and Poland special forces and delivering training, pre-hospital emergency care, primary health care, aviation medicine, In-transit and critical care medicine and environmental health. I also develop training policies for our partner forces, mainly working with Iraqi Armed Forces, but also for other nations we support such as the Lebanese and Jordanian Defence Forces. As well as the individual standards I am responsible for the delivery of preventative medicine, behavioural health services, physiotherapy, dental care, veterinary support and numerous other supporting medical services to support our mission. I also coordinate medical intelligence support to ensure all Commanders have a full threat assessment for their intended operations, not just enemy threats. At the headquarters I lead one of the best teams I have have ever had the pleasure to work with. I have a deputy command surgeon whose is a US Army Reservist and whose primary role is medical planning and operations. In her civilian role she has a background as a psychologist working in behavioural health and is a medical readiness specialist.


You also need to develop plenty of other skills and not just be a doctor. Just imagine being a doctor on a long trip to Mars with 4 or 5 other people – a difficult thing to do and the last thing you need is a doctor with acute depression on landing, because they have had nothing to do throughout the entire trip. I was lucky that I started life as an engineer, then drove ships and was a pilot and I have completed lots of courses in subjects like geology, geochemistry and microbiology as well as photography. Along with my military education, which at the last count probably amounts to over 20 million pounds of investment, I have lots of other skills to offer.


As for my go to piece of kit to take on an  expedition. Well, that could fill a book on its own but whatever item you choose to take, make sure it has at least 3 uses! The best reference is the Oxford Handbook of Expedition and Wilderness Medicine (an absolute must).


Finally, the best advice I’ve ever been given is ‘Sean, don’t do that!’. Then I ignore them. Life is for living!


We hope you’ve enjoyed this Guest Blog from Sean, we certainly did!

James Griffiths - Guest Blog

by Rachel Smith • 6 November 2024
Welcome to our latest guest blog where we’ve been chatting to James Griffiths, General Manager of Ocean Operations for Scenic Group and finding out more about what happens behind the scenes in order to keep a fleet of luxury expedition ships running. Here’s what James told us… As General Manager of Ocean Operations, I’m responsible for the operations of our fleet which includes four ships in service with around 850 colleagues. I currently live in Mumbles, near Swansea in the UK, but due to the nature of my work I spend a significant amount of time living in Croatia. Prior to this role, I spent many years working at sea and worked up through the ranks to Captain and over the last 15 years, my main focus has been on polar expedition travel. I hold a master mariner certificate of competency in addition to a degree in engineering and a post graduate diploma in law. Part of my job is to work with our medical service provider (Red Square Medical) to ensure that our ships are offering medical services that are appropriate for their deployment, and this can often be to some of the most extreme and remote locations around the world. It’s extremely varied, though during the COVID-19 pandemic, I came ashore when our operations paused for a significant period of time. I was fortunate enough to be given the opportunity to lead the restart of our Ocean Operations, which included setting up everything from a company to manage the ships, to selecting our crewing, medical, helicopter and submarine partners and providers, amongst many other things. Our areas of operation, and the nature of our cruises (expedition), plus having aircraft and submersibles onboard some, do mean additional elements involved in the management of these ships. You could say that this current position is more of a happy coincidence than one that I actually planned for! In some ways this is a great positive - I do think it’s possible to plan a little too much and then be disappointed if things don’t go quite the way you had imagined. But there’s no danger of that here!

Paramedic on tour - Simon Lawton heads to Mexico

by Rachel Smith • 3 October 2024
Back in February 2022, we brought you one of our very first guest blogs from Simon Lawton, a Paramedic who has swapped out his ambulance for a Superyacht! You can read the original blog here: https://www.redsquaremedical.com/superyacht-paramedic-a-guest-blog-from-simon-lawton Over the last 2+ years, we’ve followed Simon’s career, and some of you may even recognise him as he does put a Red Square Medical instructor hat on from time to time. But, as for all healthcare professionals, Simon has to keep his skills up to date. So, we asked him to tell us a bit more about how he juggles this along with a rota onboard. Here’s what he told us… I’m originally from Stoke-on-Trent in the UK and trained as a HCPC registered Paramedic. I’ve spent almost 5 years working at sea now, with almost continuous employment on three different vessels, after leaving the ambulance service in 2019. My first role was as a Paramedic/Deck hand on Superyachts, and I now work as a Medical Officer on a maritime vessel. Even before I applied to become a Paramedic, I intended to complete my studies to help find employment in a remote or offshore environment. I had always been attracted to the idea of being able to travel the world while earning a salary. Working at sea has meant that I have travelled extensively, earnt a higher salary, and have a better work/rest balance than would be possible in a role on land. Note: At the time of writing, a qualified Paramedic’s starting pay in the UK was £28,407 and Simon’s old rota was 2 days, 2 nights (all 12 hours) and 4 days off with very inflexible annual leave. This year I decided to carry out some continual professional development (CPD) at a hospital in Mexico, to keep my skills up to date. I was interested in travelling to find out more about how healthcare services are provided outside the UK and Europe. The CPD activity in Mexico allowed me to do exactly that, while caring for and treating a wide variety of patients who had either self-presented in the emergency department, or been conveyed to hospital by ambulance.

Inequalities in CPR on Women

by Rachel Smith • 25 September 2024
Welcome to our September blog, and as we all start (in the UK at least!) to think about adding a few layers for warmth, we’d like to talk about getting naked! Well, to be more specific, getting bra’s off. Fact: Women are dying because bystanders are less likely to carry out CPR on women than men. Research shows that women are 27% less likely to receive CPR than men and if a defibrillator is used, their chance of survival is affected by bra’s being left on. Most of us have never had the chance to train using a female manikin. The #BraOffDefibOn campaign aims to address the inequality in CPR for women and we’re supporting it.

Dr. Will Duffin - Joint Medical Director WEM

by Rachel Smith • 4 September 2024
In August, we brought you a Guest Blog from Mark Hannaford, the founder of World Extreme Medicine. This month, it’s the turn of another of the key WEM faculty members… introducing Dr Will Duffin. Hello everyone, I’m Dr Will Duffin and I’m a GP in Devon in the UK. I’m the Joint Medical Director of World Extreme Medicine (WEM) and the Lead Medic for the US CBS TV show ‘Survivor’ - for Seasons 43, 44, 46 and 48, which is also through WEM. Extreme Medicine is healthcare that is delivered across the full spectrum of remote, austere and challenging environments. This includes high mountains, deep oceans, jungles, deserts, polar, low earth orbit and refugee camps… the list is endless. Being a part of the wider Extreme Medicine community through WEM has been a portal into new worlds of possibility and opportunity in my medical career as an NHS GP. It’s a huge privilege to treat patients in a remote setting. You get to do proper ‘hands on’ medicine that truly tests your clinical skills, risk management and decision making. Even basic techniques and principles done well can transform patient outcomes. That’s the big reward. I graduated from Bristol Medical School in 2008 and completed my GP Training in Cornwall, UK in 2016. In between, I spent 18 months in Australia to gain as much emergency department experience as I could, whilst doing Wilderness Medicine Courses. I landed my first expedition gig 12 years ago when I was post-FY2 (Foundation Years follow on after qualifying as a doctor). I covered a Kilimanjaro Trek after another doctor dropped out at the last minute. Once I had this under my belt, I was able to leverage this experience to get the next trip. So, I soon found myself providing regular medical cover for various commercial and charity sector expeditions. These expeditions have taken me all over the world: Kilimanjaro, the Peruvian Andes, the Himalayas, Northern China, Eastern Europe, Myanmar and Madagascar. One highlight was working as the private doctor for a Luxury Trans-Siberian Train! Though I became frustrated having to constantly wrangle annual leave to go away, so I made the switch to being a freelance (locum) GP, which has given me the flexibility I need. I joined WEM in 2018 after responding to a Facebook Ad for the ‘Survivor’ job. I was invited to a selection weekend in the Peak District, which is when I first met Mark Hannaford WEM founder and CEO and Dr Joe Rowles, WEM’s other Medical Director, and it all went on from there. Early on, I was given the opportunity to lead on the content for the annual World Extreme Medicine Conference and our various podcasts and webinars. Through doing this, I have met a colourful cast of characters; other extreme medics who are as audacious as they are inspirational! We have a lot of fun at the conference every year, learning from one another. https://worldextrememedicine.com/registration/wem-conference-2024 (Note from the RSM team – the conference is highly recommended and well worth a visit!)

Mark Hannaford - Founder and CEO of World Extreme Medicine

by Rachel Smith • 5 August 2024
Last year, the Red Square Medical team descended on the World Extreme Medicine (WEM) conference for the very first time. We’d been aware of this unique organisation for many years, but just not had the chance to get involved. Liz was involved in a panel discussion and spoke at the conference, and we came away literally buzzing with enthusiasm - our first impressions were that WEM is a place with no ego’s, where everyone wants to learn, and is willing to share. We met some of the most fascinating people ever and can’t wait to go back this year. But what about the person who started it all… We spoke to Mark Hannaford, founder of World Extreme Medicine and its far reaching impact. Here’s what he had to say. I’ve been involved in expeditions, working in low resource environments and extreme medicine for the past three decades! My family was made up of generations of seafarers from Cornwall although I was brought up variously in Devon, Antigua in the Caribbean and the Middle East; reflecting my father’s job as a Master Mariner. My father was at one time the youngest captain aboard the UK’s largest registered vessel, and my grandfather was Harbour Master for Malta and the first in that role in Plymouth at the start of Queen Elizabeth’s reign. I wear a number of hats but primarily I am the founder and CEO of World Extreme Medicine, and the annual WEM Conference. I also founded the MSc in Extreme Medicine at the University of Exeter and Graduate Certificate program at Bouvré College of Health Sciences, Northeastern University, Boston.

Women's Health

by Rachel Smith • 3 July 2024
Women’s health is a huge topic, while it’s true that in the maritime sector women make up just 2% of seafarers at sea, up to 34% of the shore based staff are female. Looking at the bigger picture, women’s health directly affects just under half of our population globally, and indirectly (whether you like it or not!) the other half, we thought it was worth a blog about some of the issues, and the taboo’s, that could be affecting our maritime workforce and the women in our lives. It's common knowledge that women experience huge hormonal changes at puberty and menopause, both of which can have significant physical and mental health impacts. In the UK, there is a growing discussion and openness about peri-menopause (the years before periods stop altogether) and how for some women, this has devastating effects across all aspects of their lives, including work. Of course men experience changes at puberty, but their later life changes are less significant and generally don’t affect their ability to work. In December 2023 the World Health Organisation (WHO) issued a statement to advise that every year, at least 40 million women are likely to experience a long term health problem caused by childbirth. So there’s a good chance that we all know one or more women affected, or if you are female… this could be you. As part of a special series on maternal health, the study showed a high burden of postnatal conditions that persist in the months and years after giving birth. These issues include more than a third of women experiencing pain during intercourse, urinary incontinence (8-31%), anal incontinence (19%), anxiety (9-24%), depression (11-17%), perineal pain (11%), a fear of childbirth (6-15%) and secondary infertility (11%). All in all it doesn’t paint a great picture of life after childbirth for some women. If any of your workers experience these issues, either on or off shore, it could have a significant impact on areas of their working life and it’s something they may be reluctant to open up about. Even before childbirth, we may take it for granted that contraception is available, certainly in the developed world. But in developing countries where sexual violence is not uncommon, contraception is considered lifesaving due to the high level of unsafe abortions carried out. Around 13 million women (and girls) under 20 give birth annually and complications in the pregnancy and birth is a leading cause of death. Consequently abortion is an option, but this carries its own huge risks.

Guest Blog - Wendy Sullivan

by Rachel Smith • 25 June 2024
We just love speaking to and finding out more about the people who inspire us and we guarantee that this month’s blog will not disappoint! We first got in touch with Wendy Sullivan via LinkedIn and thought she seemed like a pretty awesome human. Wendy and her company, Maritime Medical Solutions in Australia, certainly share the same outlook as Red Square Medical. Fast forward a couple of years and we’re now collaborating on a project in Australia and the Pacific Islands. What we’ve learnt along the way is simply fascinating and Wendy has kindly agreed to share her story with us… Here is Wendy’s Guest Blog: I was born in Canada, grew up in Africa and now call Australia my home. I feel lucky to live in paradise where the weather allows us to be on the water year-round. I had to work hard to gain my Australian citizenship and I credit my work in the marine industry with giving me a pathway to stay in Australia permanently. It took years of hard work and uncertainty to gain my residency and is still one of the achievements I am most proud of. I started sailing in Canada and since emigrating to Australia gained my professional and commercial qualifications as a vessel master, marine engine driver, trainer and assessor. I also have a Diploma of Paramedical Science, ship masters medical qualifications, business administration and development and there is still so much more to come.

Safety of Lives at Sea

by Rachel Smith • 17 June 2024
Working at sea can be one of the most rewarding and fulfilling careers. But you can’t gloss over the fact that it can be dangerous. Whether you’re working on a tanker, ploughing up and down the oceans, a Superyacht enjoying a busy season of charters, or any vessel in between; our love/hate relationship buddy Neptune takes no prisoners! The Safety of Lives at Sea (SOLAS) Convention in its successive forms is generally regarded as the most important of all international treaties concerning the safety of merchant and other vessels. The first version was adopted in 1914, in response to the Titanic disaster, and went through several iterations up to 1974. The Convention in force today is generally referred to as SOLAS 1974, as amended. SOLAS regulations cover all areas of safety at sea, including construction, fire prevention and detection, life saving equipment, cargo carriage, navigation, communications and a host of other areas. Regulation 33 of the SOLAS Convention applies to all ships, and places an obligation on Masters to respond to distress calls at sea and proceed ‘with all speed’ to their assistance. Anyone working in the maritime sector, hopes that they are never on the receiving end of this regulation, but we’ve experienced two quite different instances, where the ships we work with have responded and our Medical teams have played an important part in rendering aid.

Telemedicine - access to a healthcare professional

by Rachel Smith • 29 May 2024
This week’s blog is an introduction to telemedicine as although it’s probably been around for longer than you think, you might not be familiar with what’s available to help you. So whether you’re a leisure sailor taking on the ARC; work in commercial shipping, spend your time on a Superyacht, or anything in between, read on for more information… According to the UKs National Institute for Clinical Excellence, (NICE: https://www.nice.org.uk/), ships being on the water for months at a time mean that health can be a life-threatening challenge for sailors and seafarers. Access to healthcare providers has always been one of the most critical issues for offshore crews and it’s worth remembering that the International Labour Organization (ILO), dictates that access to medical treatments and health services should be guaranteed to seafarers in the same way as for people working ashore. Nowadays, telemedicine technology has emerged to improve healthcare delivery in many remote areas where there is no direct access to healthcare services using telecommunication services. Among them, maritime Telemedical Assistance Services (TMAS) have become more readily available and are now considered an integral part of a shipowner's emergency response operations. The advent and uptake of Starlink in both the commercial and leisure sectors can only be a positive from a medical perspective. So, what is Telemedicine? What does it do and how does it work? Telemedicine is a term that’s becoming more and more common in the maritime world. Quite simply, it is the provision of remote clinical services, via real-time two-way communication between the onboard medic (trained crew or healthcare professionals) and/or the patient themselves, and a shore-based healthcare professional, using electronic audio and visual means. The modern history of Telemedicine can be traced back as far as 1905, when a Dutch physician used long distance transfer of ECGs (electrocardiograms) to be read remotely. But as early as the 1920s onwards, radio communications were being used to pass medical information to patients at sea on ships and on remote islands. More recently, the COVID-19 pandemic has brought Telemedicine to the forefront of healthcare. Though we may not easily recognise what it actually is, the majority of GPs (certainly in the UK) and other allied healthcare professionals in the non-acute world, such as Physiotherapists and Mental Health support, have relied heavily on telephone and video consultations since March 2020. A survey conducted by Nautilus International and Martek Marine (2017) showed that a staggering 98% of seafarers believed that greater access to Telemedicine support would save lives at sea. Of those questioned, 68% had been on a vessel that was forced to divert due to a medical emergency and 70% had been on a vessel where there had been a medical evacuation. Emergencies experienced at sea ranged from severed limbs and broken bones, to gunshot wounds, tropical diseases, allergic reactions and sudden cardiac arrest. Whether you’re a commercial seafarer or leisure sailor, it would improve confidence in making a decision on whether an injury, or illness was severe enough to warrant a diversion, or evacuation, if there was a trained medic on the end of the phone or radio. Ever improving communications also means that we can now go far beyond voice calls. Photos of injuries, files of test results and even live streaming is all possible and helps to provide a much more indepth service. Our own team member, Rachel, received Telemedicine support via SatPhone and email, on a 7 metre Ocean Rowing Boat (yes, you did read that right!) in the middle of the Atlantic, when her rowing partner developed a painful injury. Remote intervention from a Doctor onshore helped to maximise use of the medical kit contents for the short and long term, rule out immediate worries of infection, and develop a pain management plan for the rest of the rowing race. One in five commercial ships a year are forced to divert for a medical emergency, with unknown numbers of other, non-commercial vessels on top. So there is also consideration for the cost and time involved, plus the stress to both the patient, and their medic who is managing a situation onboard, possibly alone!

Guest blog: Jordan Lin

by Rachel Smith • 8 May 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
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