Liz Baugh
Lead Medical Consultant – Maritime at Red Square Medical
ABOUT ME: As the Lead Medical Consultant at Red Square Medical, I am responsible for the day to day contact with our clients, refining the services that we offer them to ensure that they are fully prepared and compliant with all aspects of international, flag state and clinical regulations for the delivery of Medical Care at sea.
TRAUMA SPECIALIST: With a strong military background in trauma care and mass casualty incident planning I have refined my skills and directed them toward the commercial maritime sector and developed a suite of leading Medical solutions for the maritime industry.
WHY I DO WHAT I DO: I love medicine. And I love problem solving. I also love to see a plan come together and those involved having that moment of realisation that actually, when done properly, the provision of First Aid and Medical Care at sea doesn’t have to be a scary prospect.
What is your current role in the shipping industry?
I am the Lead Medical Consultant for Red Square Medical, we provide medical support services and training to the shipping industry and all those that are involved ashore.#
Can you describe your role as Lead Medical Consultant? What does a typical day look like, and what are your primary responsibilities?
I am an early riser so armed with a bucket of a typical day starts with running through emails and flagging them in order of importance. Next, I run through my medical approvals. When a crew member joins a ship their medical lis sent to me for scrutinisation and you would be amazed how many of them are incorrect or missing critical information, so I check each one carefully to make sure they are accurately completed before approving them. I usually have a couple of calls a day with various companies/agencies/colleagues (we all mostly work remotely). Most days I have things to be working on like induction programs for new medical staff on ships or mass casualty plans, we have just completed a major document review for an expedition company that we look after ready for their Q1 2025 SMS update. I am involved in the World Extreme Medicine group so I will check into our group chat and read any new research papers or articles that have been shared and chat about the challenges they are facing in their areas of medicine. We provide continuous professional development for all that we work with so often I am reviewing the monthly topics that are going out. This month we sent out updates in the latest burns’ treatments, next month it will be crush injuries in response to an MAIB report we were asked to review by a client as he was worried about them and was doing a risk assessment and wanted to include a medical response. We are working with Portsmouth University at the moment on a business development program so I may have a call with the team there to check in and see how things are going. All medical staff are subject to clinical appraisals and these are conducted annually but they are spread out across the year so often I will be reviewing those and looking at how we can support them with their professional development in the upcoming year. I may be organising online training for Doctors and Nurses on ships in how to use a new piece of equipment that the ship has invested in or it may be on how to update the online inventory system. We are regularly asked to contribute to articles or give interviews about things that are on television so I may be writing those up. I get a lot of enquiries from people interested in working at sea as a medic so I always try and respond to them and give them as much information as I can to get them started. I will organise flights and accommodation for our instructors to go out to vessels to deliver training and I will always spend a bit of time sorting out medical kit. I also allocate time to read the latest journals and articles or listen to a podcast focussed on prehospital medicine. My main responsibilities on a daily basis are ensuring that our clients receive the level of service they expect and I will always look for ways to do better for them. Many of them subscribe to a 24/7 package and it is my responsibility to make sure that the phones are covered 24/7 in case of an emergency. Thankfully genuine emergencies are rare. Ensure that our team has everything they need to do their jobs properly and to facilitate their success and I am also responsible for the financial side of things so I have to make sure that our accounts are up to date for the accountant to do all the financial returns needed for a business. No 2 days are the same and there is so much diversity in what I do that I rarely get bored. There is a fair amount of admin work to get through but the benefit from being able to work from anywhere means that if I am working from home I can go and make a coffee and get some food in the slow cooker so dinner is sorted, or perhaps I need to take my daughters somewhere and I will pack up my laptop and sit in a coffee shop whilst they do what they have to do. Sometimes I have to teach and that is when it gets really hard because I believe that all of our clients deserve 100% from us and when I am teaching I have to give 100% to the students because that is what they deserve but it means that I need to catch up on all of my other duties around that meaning very very long and exhausting days. For that reason, I have reduced my teaching hours dramatically.
How do you ensure the services you provide align with international, flag state, and clinical regulations for medical care at sea?
For maritime regulations I study them in detail, write a list of points that are pertinent to the service that I need to deliver and then if I have any questions then I get in touch with the relevant agency to clarify those points. I ensure that I regularly review the information available via their websites and subscribe to loads of newsletters. I make sure that I have read their medical stores list and can ensure compliance. For clinical guidelines I use recognised tools such as BMJ Best Practice, NICE guidelines, Geeky Medics and dozens of other reputable tools to maintain clinical currency and also to ensure best evidence-based practice. My bookmark tab for medical resources is massive. I also make sure that I review the MAIB reports and look at causes of injury and death so that I can make sure that we have a medical response in place should the worst happen on board and a person is injured. That helps me understand whether a ship needs extra kit kept in certain areas that are generally more hazardous than others.
What inspired your transition from a military background in trauma care to the commercial maritime sector?
My time in the military was tremendous and I had a list of all the things that I wanted to achieve during my tenure. Once I had achieved it all I needed to move on as I knew I wanted to get into ship management somehow and the military are notoriously slow at change and I rea;;y wanted to work within an industry that I understood and knew I could help others with my experience gained from working on ships and on land in some seriously remote places with a complete lack of infrastructure so was totally reliant on myself and what I had available immediately.
Could you elaborate on the leading medical solutions you’ve developed for the maritime industry?
Are there any innovations you’re particularly proud of? We aren’t really doing anything new, we are just doing things the way a seafarer needs things to be done rather than how someone in an office wants it done. We are seafarers providing solutions for seafarers and as basic as that sounds, it really makes a difference. We are meticulous in our research and delivery and pride ourselves on our communications. I think I am particularly proud of our risk mitigation services where I have seen great success. Built on the lessons I learnt in the military when I was responsible for returning people to work after an injury or illness, I have applied those processes to the merchant navy seafarer and seen a reduction in people being off sick go from just over 5% of those on payroll to just 0.5% and also the initiatives that we have worked on has reduced the number of claims going through the P&I clubs. Much of the success of that initiative was formed by spending time with the P&I club claims teams and learning from them and then working alongside them on behalf of our clients. It actually got me super interested in the law so I started taking some legal courses to better understand things and am now working through my medico-legal training.
What are the key challenges in delivering medical care at sea, and how do your services address these?
A ship is limited in the medical care it can deliver. Sometimes it can be days from any kind of definitive care. Our services are designed entirely around the ships operations so we learn as much about a potential client as we possibly can, run a gap analysis on their current set up and then work out what they need to be safer at sea. Sometimes it is about the amount of kit and type of kit they carry, sometimes it is about the level of qualifications that the medical staff have and their previous experience. Often it is about the compliance with the various regulations that they are subjected to. Our services are tailored and designed to integrate with the company so we like to hope that by learning the company, working out what regulations apply to them, risk assessing and running gap analysis on their current operations then we can provide an end to end service that covers all of their needs. I often refer to myself as a gap filler!
How do you approach training seafarers and crew members in first aid and medical care?
These can be very dry subjects but they are crucially important. To engage the seafarers I make sure that the content is totally relevant to their areas of working so we use real case studies from ships and ask the seafarers to give us scenarios related to their workplace so that we can work through them. I believe in building confidence through a process driven method of medicine. We follow algorithms and checklists in medicine all the time and use scoring systems and that all helps but it is also important that they understand normal from not normal and sometimes this is just how someone looks and moves. Often, they come in just wanting the certificate, my job is to try and engage them in their own health and that of the crew that they work with and understand the importance of an accurate assessment to get the best outcome for their patient. It can be a challenge, I won’t lie. Most of the time though as long as you demonstrate credibility and currency they engage really well. They just want someone who understands what they will go through onboard, for real and I do understand that.
Telemedicine is becoming an important tool in maritime healthcare. How do you integrate it into your solutions?
What are its advantages and limitations in a maritime context? We use a private provider for most of our clients as this allows us greater control over the service levels we want to utilise. We use a service provider that has very robust clinical governance in place as well as an electronic medical records system that allows us to store medical data securely in compliance with GDPR and HIPAA. It also allows us to use messaging services, video calling, image sharing etc with the Doctors ashore as well as a 24/7 access to Doctors on the telephone within just a couple of minutes. We do also work with companies that use the free to use services which are excellent as well but there is less of an oversight for the case management side of things which is important for us when managing fleets of vessels as we need to keep track of crew members ongoing care if they need to be medically repatriated. I don’t think there are any disadvantages in telemedicine and we actively advocate for the use of telemedical services at a very early point as often if we get in when the initial symptoms develop we can prevent the patient’s condition from worsening which in turn can prevent unnecessary vessel diversions to get someone off. Limitations are only really there when you look at language barriers
Mental health is a growing concern in the maritime sector. How does your work address this issue?
We do not have a mental health expert on our team but we work closely with mental health support lines that are specifically for seafarers. One of the P&I clubs that we work with actually offers its members a subscription through their existing package to a brilliant mental health service. We have utilised them for real situations and found them to be incredibly supportive to the crew member, have helped the Captain onboard as the crisis unfolds and then provided follow up care for as long as required once the person is repatriated. Working with seafarers on the STCW courses to understand the impacts of poor mental health on their physical health and their ability to reach their potential in the workplace is an interesting session. There are still discrepancies in how mental health is viewed by different people but our job is not to pass judgement or make diagnosis it is to raise awareness and provide signposting to professional support when needed which is why these services that are available are where I prefer to access mental health support because they are experts and I am not.
Can you walk us through your process for creating customized medical kits for ships? How do you ensure these kits meet the diverse needs of different vessels and crews?
First of all, we look at what Flag State the ship is registered to then find out how many crew are onboard and whether or not there are any passengers carried or additional people onboard. Then we look at the ship’s itinerary and cross reference the locations to what diseases and medical issues are present in those areas, next we work out whether the ship needs an uplift in Medical supplies due to any of our findings as the stores’ lists provided by Flag States are a minimum requirement to be held for compliance. So, for example we may find that a tanker doing long sea passages would benefit from a demand valve for the oxygen resuscitator which conserves their oxygen supplies or perhaps the ship is operating in the Caribbean in which case we know that Ear infections are super common so would put in more ear drops or perhaps there are more elderly passengers and we need to enhance the cardiac medications. Once we have drawn up a list we then share that with suppliers to provide sales quotes which are then presented to the client for them to decide upon.
In your experience, how does prolonged care at sea differ from typical trauma or emergency care situations? What unique strategies are required?
Trauma and emergency medical situations is all about the immediate responses and following an algorithm which normally ends in a medical evacuation as soon as possible whereas Prolonged care takes in the extended period required of time we need to look after someone without access to definitive resources so we need to think carefully about long term pain management, antibiotics may be indicated, pressure area management, hydration and nutrition, monitoring their vital signs and recording them, there is a lot more nursing care involved and that takes time and empathy.
Could you share an example of a successful mass casualty incident plan you’ve developed for the maritime industry? What were the key takeaways?
Ha! I don’t think I can really answer this one as the mass casualty plans that I have designed have never been tested for real, thankfully and if I am being honest I would say that no mass casualty plan is really successful because each situation is totally different. The whole point of a mass causality plan is to provide a framework for people to work with so that they understand their roles. Mass casualty is all about resource management and the best resource a ship has is its medical staff. I recently gave a talk at the World Extreme Medicine Conference about mass casualty planning on ships and by walking them through the process of planning and table topping and drilling the incidents we found gaps and filled them but if you are dealing with a genuine mass casualty onboard then it falls to best efforts and those best efforts will be so much better if you have a strategy in place for setting up your treatment area, assessing the casualties using triage, formulating a treatment plan, prioritising transportation of the ship when help arrives and by far the most important feature of any major incident is COMMUNICATION so actually we focus heavily on the comms strategy because remember a mass casualty incident has happened because something major has gone wrong onboard so there will be people dealing with that emergency as well as recovering casualties etc
How do you ensure that medical audits and reviews remain thorough and effective across vessels? Travel health planning is one of your specialties. What are the key considerations you focus on for seafarers traveling internationally?
Their general health, vaccination history and what they should have, the areas that they are travelling to and preparing them for things such as bite avoidance or sexual protection, making sure that we always know where reliable medical facilities are located and that the ship has access to all of that data. One of my team members has been focussed on building a global database of reliable medical facilities listing what services they offer etc. Each port has a port medical guide on what issues are current, what reporting requirements there may be and anything else that we believe is noteworthy. With regard to their general health we are always focussed on things that may present as a problem and in a remote setting could become a lot more serious as we can’t access definitive care so screening is super important. With our medical teams onboard, we provide them with area specific training for things like marine injuries in Australian waters, or hypothermia in polar regions.
What role does operational support play in your day-to-day work, and how does it enhance onboard medical care? What technological advancements do you see as game-changers for maritime healthcare?
Decent satellite communications are the number one gamechanger. Ask any remote medical professional what would be their go to if they were only allowed one item of kit and the majority will say a sat phone so they can call someone.
How do you stay ahead of these trends?
I don’t tend to be an early adopter of technology. My husband was an Electro-Technical engineer in the Navy before moving into software engineering and he always says don’t be an early adopter. The reasoning being that I want something that is tried and tested and has evidence to support its use rather than getting in early only to find that it has lulled us into a false sense of security and then fails when we really need it. I do love tech though so continuously read to stay abreast of what is coming so that I can track its success before deciding to get in amongst it.
In your experience, what are the most common misconceptions about providing medical care at sea? How do you address and correct them?
With the seafarers doing their STCW medical care courses they often feel that they need to diagnose a patient in order to treat them. You do not need to diagnose in order to manage their symptoms to keep them comfortable until you can get them to a more definitive clinical setting. I always tell them my story about medicine being like a jigsaw puzzle. Onboard we can find the corners and put in the straight edges. This is all about collecting information and asking loads of questions using your flag state reference material to help you. Some of the middle bits are pieced together when you speak to a Doctor ashore via Telemedicine and the puzzle is only completed when they end up in a hospital where all the diagnostics are available and specialists are on call to complete the puzzle. I find this often reassures the seafarers that they don’t need to have all the answers, they just need to be curious and keep asking questions. Pass the information on and take advice early!
How do you evaluate the success of the medical solutions and services you offer?
So, there are two elements here to address. I collect data and analyse it. That allows me to offer objective evidence to my clients that what we are doing is working. The second element is feedback from individuals that have benefited from our services. When you get a phone call from a Captain on a ship in China who recognised someone having a Hypoglycaemic episode and knowing what to do and saving his life thanking you for teaching him about it then that is the best reward ever. Or the time a chief officer off the coast of Portugal messages you to say that his Captain had a Cardiac Arrest and he immediately recognised it and started CPR and shouted to the other people around him to get the EAD and put it on because he remembered how important it is from his training with us. There are many cases of crew how have been medically disembarked and you help them access further care and return them to fitness and see them back onboard always give you a warm feeling of a job well done.
What do you find most rewarding about your role as a medical consultant in the maritime sector? Could you share a particular story or experience that highlights the impact of your work?
I work with a company that places real value on their crew health. We had a case of a young crew member who suffered from a stroke and the way that the company managed her medical evacuation from the ship, hospital stay in the country she was evacuated to and then her onward repatriation and rehabilitation was an absolute pleasure to be part of. They were so dedicated to returning her to full health and getting her back to work, I really loved seeing how everyone pulled together in a time of genuine crisis and made everything happen. I am super pleased to report that she is now back onboard and working again having fully recovered thanks to all of the efforts of everyone involved. That is why I love what I do. Seafarers get stuff done.
Looking ahead, what do you think are the biggest challenges and opportunities for improving medical care at sea?
I think the major challenges are in the preventative part of medicine. How we screen our seafarers’ fitness for duties is not consistent at all and I think the one size fits all medical is not really sustainable moving forward. I would really like to see seafarers’ medical examinations improved across the board and have more of an occupational assessment carried out. The current levels of eyesight and hearing are mandatory requirements for all crew but especially bridge watchkeepers and engineers but how are we assessing people’s fitness to don a BA set and fight a fire or get down on their knees and perform CPR for 2 full minutes or carry a stretcher bearing a 90kg person in it up a steep stairwell or get through escape hatch?? So much work to do in that area.
What skills and experiences have been most valuable to your role?
My training in the Royal Navy has been integral to my success, the best advice I ever got was “don’t bring me problems, bring me solutions” and that is how I approach every situation I am faced with. Being a solo medical practitioner responsible for the health and wellbeing of up to 220 people with no recourse to definitive care meant that I got really good at listening to my patience and understanding what the difference was between big sick and little sick. I am an avid reader and consume books and papers and just about any other method of getting information so I think that is a huge benefit. I am also autistic and have the ability to hyper focus and have an extreme attention to detail in my work and I think that it is a massive positive.
What educational background or specialized training would you recommend for someone aspiring to excel in this sector?
Anything that prepares you for a life at sea such as cadet forces, Duke of Edinburgh award, camping – all of that will help build resilience which you most definitely need lots of, it is not a life for everyone. From an educational perspective you should try and get at least your A levels done and ideally then you could apply for a degree apprenticeship. If you struggle academically which I did at secondary school then you can also work your way up from the bottom. This is how I did it and it helped me really appreciate the life of a sailor at every level and not just see it from the privileged position of being an officer. Once I found my professional calling then all the opportunities opened up for the taking but I had to work really really hard to get to where I needed to be as I was amongst a very strong peer group. Luckily, I am not afraid of hard work and am good at studying when I really love the subject.
How do you maintain a healthy balance between your professional and personal life?
If I am being honest I don’t maintain a balance. My work defines me and without it I feel like I am missing a limb. My family are amazing and ship talk and medical chatter are their normal. My husband is a brilliant father and is retired so picks up the bulk of the domestic work as well as reminding me to eat, move, drink fluids etc. I also run every single day and have done for years so that keeps my head decluttered.
Throughout your career, what are the most valuable lessons you’ve learned?
Less talking and more listening. Take time to process your thoughts and most importantly don’t be afraid to say no.
What drives your passion for the shipping, and how do you stay motivated in such demanding roles?
I am a very curious person and there is so much to learn within the industry. I have found myself taking courses in Law and Business and International Safety Management and spending time with Flag States, P&I providers, approved medical clinics ashore. I also network with medics not just within the industry but also from other areas of remote medicine. There is so much to learn from other industries and other organisations. Literally you never stop learning and for me that is what motivates me.
What one piece of advice would you offer to young professionals who aspire to work in the field and to a medical professional looking to transition into the maritime industry?
Research the companies offering opportunities and make sure that you find out what processes are in place to support you as a medic. Choose a company that values integrity and can offer you the career that you are looking for. Always seek out other medics in the industry and pick their brains as much as you can and when you have finished with their brains ask them who else they could talk to.
Looking back, what advice would you give to your younger self?
Be braver. Challenge more often. Don’t be afraid of who you are. Don’t rely on others to advocate for me when I could be doing it myself.