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Case Studies

Incident at Sea

Incident at Sea

Scenario:

A Pakistani registered merchant vessel was steaming South following its collection for a consignment of gas at the port of Karachi. The vessel was off the coast of Goa on the West Coast of India when a seaman was sent to the bowels of one of the holding tanks to carry out some routine checks. Unbeknown to all, one of the gas canisters in the holding area was leaking. It was only as the seaman was three quarters of his way back up the ladder exiting the holding area that the inhaled gas took effect rendering the seaman unconscious.

The seaman fell backwards to the bottom of the hold causing a massive head injury and fractures to two of the neck vertebrae. He was airlifted by helicopter to a hospital in the region of Goa, where Doctors immediately performed an operation on the head to relieve the build up pressure between the skull and brain. The complexity of the operation also necessitated a blood transfusion.

After 7 days the patient regained consciousness and the operation was considered a success. The next hurdle to be addressed was the neck fractures.

At this time the Ship’s Owners alerted their Crew Medical insurers that they were faced with an immediate decision. Should it be considered that the crew member should be viewed as Permanently Totally Disabled and qualify for a large and unrestricted Disablement benefit, or should they fund any required treatment in order that there may be an opportunity for the seaman to return to normal duties.

The insurers then contacted Specialty Assist. This was the start of our involvement to investigate the medical situation, treatment options and the percentage chances of treatment being ultimately successful. Specialty Assist set about obtaining all the medical information that was available and appointed a Consultant at the Centre of Neuro-Sciences to assess the patient’s condition and make a treatment recommendation. His opinion was that the neck fractures were treatable and that a return to good physical conditioning could be considered as highly likely. The consultant also indicated that he was prepared to treat the patient if this was at all helpful.

Specialty Assist then used our Medical In-flight specialist doctor to provide an opinion on what may be required to facilitate a patient transfer. He was confident that as the brain issues had resolved the patient presented no travel risk at all as long as he was secure on a stretcher, with the appropriate Doctor and Nurse team in attendance.

Specialty Assist also carried out an assessment as to whether appropriate treatment was available in India or in other local countries. It was decided that the best treatment possible was not available in India, and as a long haul flight was going to be required the recommendation from Specialty Assist to the Insurers was that treating the patient was appropriate and that moving the patient to London was the best location for a positive outcome.

Our recommendation was referred to the Insurers with costs and the plan was immediately approved.

Specialty Assist then put into place the solutions to the substantial logistical problems that this situation created. A medical crew was mobilised from London and almost simultaneously our local agents arranged an Air Ambulance from Goa to Bangalore. The patient and medical crew overnighted in Bangalore and after a formal medical handover the Specialty Assist medical crew assumed responsibility for the patient from Bangalore to London. The patient travelled on a stretcher on a British Airways flight and after a medically uncomplicated trip was admitted at the Centre for Neuro-Sciences at Queens Square, London.

Within a few days the patient was operated on and it soon became clear that the operation was a complete success without any loss of movement or sensation in any part of the anatomy. The patient now started on the long road of rehabilitation.

Within days of the rehabilitation process starting the patient showed signs of a significant lung infection. To the bewilderment of the treating medical staff he did not respond to treatment and in fact grew progressively worse. Further pathology was carried out and to the distress of all concerned it was confirmed that the patient was HIV positive.

Sadly the patient never recovered and eventually died. Specialty Assist also undertook the immediate repatriation of his mortal remains to Pakistan so that he could be buried consistent with his religious beliefs.

Other Case Studies