Knowing Crew's Medical Situation

[Foswick]

As mentioned in another thread, I have been working up a presentation on preparedness for onboard medical emergencies. One of the main points of emphasis is making sure that at least one person other than the patient knows about any pre-existing medical conditions, allergies, medications, DNR/advanced directives, and the general wishes of the patient. A lot of this information doesn't really change what crew can/should do, but it can be critical information to pass on to EMS when the arrive. It also serves the dual purpose of giving crew permission to feel OK about having done enough.

Since some medical conditions (like cardiac arrest) have a pretty grim prognosis when EMS is an hour away, I feel it is important to let your crew know what you do and don't expect, even if you don't have a formal directive in place. It is as much about helping them cope with difficult decisions as it is about one's own outcome.

I tried to figure out a way to get crews to think and talk about this in a structured way, in a way that is approachable and that they might actually do.

I came up with the attached form. The idea is that crew fills this out and it goes in the med kit with their name in bold letters. If someone (like a guest) is concerned about privacy, it can go in an envelope. I will tell you that this information can be invaluable to EMS and they will thank you for having it. The thing I like about this is that it is more-or-less set-and-forget. You update it once a year - takes 5 minutes.

As a bonus, you could attach a photo of the person, if there is a risk of identity becoming a point of confusion. This could be important if you are single-handing, but have multiple forms in your med kit.

I've had really strong feedback from other EMS and MD friends and am curious to get feedback from other sailors. Is this the kind of thing you might use? If not, why not? I am confident about the general format, but any suggested tweaks that would make this more useful or approachable? I get that this isn't for everyone. Just trying to make it as useful as possible for those folks who are inclined to use something like it.

 

[kappykaplan]

We did something like this on the Navy 44s when I taught in Annapolis. Tks for sharing.

 

[dLj]

While this is an interesting idea - you must implement a logged, controlled access method or you are actually in violation of HIPAA laws.

dj

 

[Foswick]

While this is an interesting idea - you must implement a logged, controlled access method or you are actually in violation of HIPAA laws.

That is not true and is a common misconception about HIPAA. A person can choose to disclose anything they wish and put that information anywhere they choose to put it. As the keeper of the information, one is only bound to HIPAA in a few situations. https://www.hhs.gov/hipaa/for-profe...omply-with-hipaa-privacy-standards/index.html

And, frankly, the actual privacy standards (even where applicable) are much weaker than most people realize.

 

[Stu Jackson]

Foswick, I disagreed with your original premise in your first post on this topic.

However, this one is a very good idea. In fact, we did this back in 2000-2006 when I was racing regularly.

Nice, helpful, healthy idea.

 

[dLj]

That is not true and is a common misconception about HIPAA. A person can choose to disclose anything they wish and put that information anywhere they choose to put it. As the keeper of the information, one is only bound to HIPAA in a few situations. https://www.hhs.gov/hipaa/for-profe...omply-with-hipaa-privacy-standards/index.html

And, frankly, the actual privacy standards (even where applicable) are much weaker than most people realize.

You do you.

I'm intimately aware of HIPAA laws and the strengths and weaknesses of the privacy standards.

dj

 

[Foswick]

I'm intimately aware of HIPAA laws and the strengths and weaknesses of the privacy standards.

Respectfully, you are not, if you believe HIPAA is even remotely applicable here. It simply is not - not under any interpretation, and not even in spirit. I worked for years in medicine and EMS and later extensively designing and implementing computer systems involving medical information. You are just wrong here.

But, you don't have to believe me (a relative stranger). Five minutes of even the most basic research (like the link I provided) will demonstrate this.

What is true is that many individuals and organizations choose to comply with what they imagine HIPAA requires of them. But, even a commercial charter could keep this information on paying customers and employees, and they would not be bound by HIPAA. HIPAA (the Health Insurance Portability and Accountability Act) applies to covered entities like hospitals, insurance companies, and certain healthcare providers—not to private individuals or boat skippers. Unless the skipper is acting as a healthcare provider billing insurance (which, on a recreational boat, would be quite the twist), HIPAA simply doesn’t apply.

 

[dLj]

I stand corrected.

I've just spent too many hours in court rooms in this arena to endorse the way you are doing this.

dj

 

[chuckwayne]

As mentioned in another thread, I have been working up a presentation on preparedness for onboard medical emergencies. One of the main points of emphasis is making sure that at least one person other than the patient knows about any pre-existing medical conditions, allergies, medications, DNR/advanced directives, and the general wishes of the patient. A lot of this information doesn't really change what crew can/should do, but it can be critical information to pass on to EMS when the arrive. It also serves the dual purpose of giving crew permission to feel OK about having done enough.

Since some medical conditions (like cardiac arrest) have a pretty grim prognosis when EMS is an hour away, I feel it is important to let your crew know what you do and don't expect, even if you don't have a formal directive in place. It is as much about helping them cope with difficult decisions as it is about one's own outcome.

I tried to figure out a way to get crews to think and talk about this in a structured way, in a way that is approachable and that they might actually do.

I came up with the attached form. The idea is that crew fills this out and it goes in the med kit with their name in bold letters. If someone (like a guest) is concerned about privacy, it can go in an envelope. I will tell you that this information can be invaluable to EMS and they will thank you for having it. The thing I like about this is that it is more-or-less set-and-forget. You update it once a year - takes 5 minutes.

As a bonus, you could attach a photo of the person, if there is a risk of identity becoming a point of confusion. This could be important if you are single-handing, but have multiple forms in your med kit.

I've had really strong feedback from other EMS and MD friends and am curious to get feedback from other sailors. Is this the kind of thing you might use? If not, why not? I am confident about the general format, but any suggested tweaks that would make this more useful or approachable? I get that this isn't for everyone. Just trying to make it as useful as possible for those folks who are inclined to use something like it.

I use a similar form; I would add a specific area for a list of doctors and contact info. I have my crew seal the form in an envelope and sign the seal, the envelopes are stored in my cabin. My trauma kit has a card that tells where to find the forms in an emergency.
I don't think you are violating HIPAA; they are providing that info voluntarily and you are not a medical provider - you're a good samaritan. It's no different than you're looking in the crew's wallet to find his medic alert card that he told you is there.

 

[Foswick]

[...] I would add a specific area for a list of doctors and contact info. [...]

Thanks! This was suggested by someone else a while back and I forgot to include it. I just added it.

 

[dLj]

Here's the wording from a professional sailing organization that provides recommendations for how a medical disclaimer should read for a sailing boat taking on crew in a crew contract:
________________________________________________________________________________________________________________
MEDICAL DETAILS:
The boat has a well equipped medical kit, and a powerful radio with which emergency help may be obtained. However, you must take full responsibility for any current or past medical conditions that may recur, or any medical or health problems that may occur during or as a result of this trip. Make sure that you have ample medication for at least twice as long as the expected passage. You must inform the skipper of any potentially serious conditions that could affect safety at sea. Give details below of any known drug allergies, conditions that might recur, and current medication(s):

mark "NONE" if none)_____________________________________________:

Medical insurance may help save your life.

List details of your medical insurance, if any and all contact details:
_________________________________________________________:

___________________________________________________________

Apart from spoiling your trip and making it harder for others aboard, seasickness can be dangerous, even fatal. Unless you know, from extensive experience, that you will not be affected, you must have, and be willing to use, reputable seasickness treatment. This is your responsibility.

_________ (initials, crew)

___________ (Initials, skipper)
____________________________________________________________________________________________________________

Extending to the level suggested is actually opening to door to significant legal complications in the event of a problem.

Adding in all the additional information as suggested is really TMI....

Just my opinion. take it for what's it worth.

dj

 

[Foswick]

Extending to the level suggested is actually opening to door to significant legal complications in the event of a problem.

Thanks for the follow-up - and I appreciate you acknowledging the HIPAA point.

Regarding your concern about "significant legal complications," I want to be very clear: there is no legal exposure created by someone voluntarily documenting their own medical information and sharing it with their skipper or crew. Not in the U.S., not in Canada, not in the EU, and I don't believe in Australia or most of Asia (though I am less familiar with the laws in those jurisdictions). There is simply no law that prohibits a person from voluntarily disclosing medical information - or another person from referencing it in an emergency.

In fact, laws across these jurisdictions (including Good Samaritan laws) are explicitly designed to protect laypeople acting in good faith during medical emergencies, and that includes protection about information disclosed. The idea that filling out a form like this could create legal liability is not only unsubstantiated - it could discourage people from taking reasonable steps to prepare, and that is potentially harmful.

You're absolutely entitled to your personal preferences. But I do want to push back strongly on the idea that this kind of preparedness “opens the door to legal problems.” It does not. That’s not how the law works, and it’s not how medical professionals, risk managers, or judges interpret it.

Adding in all the additional information as suggested is really TMI....

Too much information for whom? The contents of this form were not pulled out of thin air. Go show this form to an EMT, paramedic, or ER doctor and ask them what they think. (Spoiler: I am this and have done this.) This is EXACTLY the information they want. In fact, when EMS does their report, most organizations use what is called the SAMPLE format.

This stands for signs & symptoms, allergies, medications, past history, last intake, and events leading to the incident. It is no coincidence that this form covers A, M, and P - which makes up most of the form. It also has DOB because they will need to report the age and sex of the patient. The only other piece on here, really, is the directive piece - and if a person has one, they definitely want people to know about it, or it does no good.

I would point out that the form you posted asked for the same information: "Give details below of any known drug allergies, conditions that might recur, and current medication(s)" So, what is on the form I provided that is "TMI" that is not on the form you provided?

Or, show this to an attorney that knows medical law. (I've done this too.) They will tell you the law is really clear on this, provided the information is not willfully mishandled with the intent to harm the person identified in the document (and such harm need to be proven). This applies to situations like when someone discloses on Facebook that someone has an STD. (There is a case involving exactly this, but even that was brought primarily against the hospital.)

I have a 10-page document, drafted by our attorney (for a related question on another project), that explores legal exposure involving handling of voluntarily-discosed information. It goes into case law and precedence. I would be happy to share that in a private message, but I think it is counterproductive to drag it into this thread. The Cliff's Notes version is that a private individual must willfully or maliciously make the information public with the intent to harm and that harm has to be proven. So, if you disclose you are HIV positive on your form, and I post that to Facebook, I could (and should) be in trouble. If you fill out this form and I accidentally leave it in the bathroom at the marina, while irresponsible, does not place me in legal jeopardy.

But, I think we've probably taken this side discussion as far as it's productive to go.

 

[dLj]

I'd be delighted to read your 10 page document. Do please send it to me.

Your proposed document has no language in it that puts the responsibility of providing for their own health requirements and providing the medical information required for the safety of all on board. The language of your document is written such that you are taking on that responsibility.

I would never want to have the DNR type documents on board. And the second line, where they don't have one but are now going to write one just for you, should be removed. Having DNR documentation on board is where I feel you are seriously opening yourself up to potential problems. Of course it's all moot if no one has a problem.

dj

 

[Foswick]

Your proposed document has no language in it that puts the responsibility of providing for their own health requirements and providing the medical information required for the safety of all on board. The language of your document is written such that you are taking on that responsibility.

That is something you completely invented. There is no such language. It is a form that makes no guarantees about how the information will or will not be used. You are very confused about how the law works. This is not the place to hash that out.

I would never want to have the DNR type documents on board.

Once again, you fundamentally do not know what you are talking about here. A DNR is only valuable if rescuers have access to it. Most people carry a copy with them, for exactly this reason. Are you saying you wouldn't want to store one on board? That's fair - then don't do that. If I had one, I would want to keep a copy on my boat. Most people would.

And the second line, where they don't have one but are now going to write one just for you, should be removed.

Nope, wrong again. The rationale is long and I have already replied to this side discussion one time more than I had planned.

 

[MFD]

Wow, has this thread gone sideways a little bit? ‍

Flat tracking motorcycles or going upwind against a strong current, going sideways makes sense a little bit - to me at least.

Let’s not have anybody, no matter how qualified they are, turn this forum into a one upsmanship of legal opinion when it is primarily about sailing and basic safety?

 

[jaysweet]

Oh, jeez...