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2017 ; 5
(2
): e16
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Telemedicine Services for the Arctic: A Systematic Review
#MMPMID28659257
Woldaregay AZ
; Walderhaug S
; Hartvigsen G
JMIR Med Inform
2017[Jun]; 5
(2
): e16
PMID28659257
show ga
BACKGROUND: Telemedicine services have been successfully used in areas where
there are adequate infrastructures such as reliable power and communication
lines. However, despite the increasing number of merchants and seafarers,
maritime and Arctic telemedicine have had limited success. This might be linked
with various factors such as lack of good infrastructure, lack of trained onboard
personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather
conditions, remoteness, and other geographical challenges. OBJECTIVE: The purpose
of this review was to assess and analyze the current status of telemedicine
services in the context of maritime conditions, extreme weather (ie, Arctic
weather), and remote accidents and emergencies. Moreover, the paper aimed to
identify successfully implemented telemedicine services in the Arctic region and
in maritime settings and remote emergency situations and present state of the art
systems for these areas. Finally, we identified the status quo of telemedicine
services in the context of search and rescue (SAR) scenarios in these extreme
conditions. METHODS: A rigorous literature search was conducted between September
7 and October 28, 2015, through various online databases. Peer reviewed journals
and articles were considered. Relevant articles were first identified by
reviewing the title, keywords, and abstract for a preliminary filter with our
selection criteria, and then we reviewed full-text articles that seemed relevant.
Information from the selected literature was extracted based on some predefined
categories, which were defined based on previous research and further elaborated
upon via iterative brainstorming. RESULTS: The initial hits were vetted using the
title, abstract, and keywords, and we retrieved a total of 471 papers. After
removing duplicates from the list, 422 records remained. Then, we did an
independent assessment of the articles and screening based on the inclusion and
exclusion criteria, which eliminated another 219 papers, leaving 203 relevant
papers. After a full-text assessment, 36 articles were left, which were
critically analyzed. The inter-rater agreement was measured using Cohen Kappa
test, and disagreements were resolved through discussion. CONCLUSIONS: Despite
the increasing number of fishermen and other seafarers, Arctic and maritime
working conditions are mainly characterized by an absence of access to health
care facilities. The condition is further aggravated for fishermen and seafarers
who are working in the Arctic regions. In spite of the existing barriers and
challenges, some telemedicine services have recently been successfully delivered
in these areas. These services include teleconsultation (9/37, 24%),
teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%),
telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37,
27%). However, the use of telemedicine in relation to search and rescue (SAR)
services is not yet fully exploited. Therefore, we foresee that these implemented
and evaluated telemedicine services will serve as underlying models for the
successful implementation of future search and rescue (SAR) services.
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