Emergency response for maritime sudden cardiac death: framework for pre-hospital rescue procedures and analysis of clinical characteristics.
Frontiers in cardiovascular medicine · 2026-01-01 · Observational study
Abstract
INTRODUCTION: Sudden cardiac death (SCD) is a critical public health issue. Occupational workers face increased SCD risk, especially in high-risk maritime environments. Emergency care in these settings is limited by limited medical access and scarce pre-hospital emergency systems research. METHODS: To address the risks associated with SCD incidents on offshore operational platforms, our study constructed a novel Telemedicine Maritime Assistance Service (TMAS) service framework for emergency response. This TMAS framework integrated real-time telemedicine supported by satellite communication and land-based hospital specialists, standardized on-site maritime emergency response protocols, and implemented coordinated aeromedical transport with geospatial-optimized helicopter deployment. We conducted a retrospective study of offshore workers in China's Bohai Bay region who experienced SCD between 2019 and 2023, and the resuscitation success rates were calculated. Additionally, a representative case study was included to document a real-world SCD emergency response scenario under the TMAS framework. To further assess long-term health implications, we analyzed surveillance data from annual health examinations to identify clinical characteristics and trends among the affected workers. RESULTS: Seven male SCD cases (mean age 45.4 ± 5.8 years) occurred among offshore workers. A 42.86% resuscitation success rate was observed among these patients under the TMAS system. TMAS activation was contribute to successful aeromedical transport of approximately 2 h (35 nautical miles) in a representative 2022 case of SCD occurring in a 45-year-old worker at a Bohai Bay offshore drilling platform. Long-term continuous health surveillance was performed from 3 to 19 years (mean 15 years) in individuals who had experienced SCD. We identified five indicators with the highest overall abnormal detection rates, including low-density lipoprotein (100%), glycated hemoglobin (100%), glucose (57.1%), body mass index (57.1%), and systolic blood pressure (42.9%). Based on long-term trends in health surveillance data, the monitored indicators were classified into four categories, including long-term stable pattern (body mass index, white blood cell count, creatinine), downwards-trending in the 3 years preceding SCD pattern (low-density lipoprotein, high-density lipoprotein, glucose, etc.), upwards-trending in the 3 years preceding SCD pattern (lymphocytes, bilirubin), and uncertain trend pattern (diastolic blood pressure, systolic blood pressure, triglycerides, etc.). CONCLUSION: The TMAS-based emergency response mechanism was observed a higher success rate in SCD resuscitation among offshore workers. This study provides critical evidence supporting the optimization of emergency response strategies for occupational populations, indicating that long-term continuous health surveillance combined with an optimized maritime rescue mechanism should be established and reinforced.