Medical evacuation on high seas.

A previously healthy Indian male seafarer aged 34 years, presented with vague perianal symptoms to the Master on a Very Large Crude Carrier (VLCC) in the Pacific Ocean. Over a few days, his condition deteriorated, and the company's medical consultant ashore, based on telephonic consultation, transmitted information and photos, diagnosed the condition as a life threatening case of Fournier's gangrene. The ship was then almost 1140 nm from the port. The consultant instructed the Master to intensify antibiotic treatment and started necessary procedures for an urgent complex medevac. Arranged by the United States Coast Guard, it involved deployment of two helicopters, two fixed wing aircrafts and an air tanker. Helicopters needed to be refuelled mid-air to increase their range of operations. Rendezvous point was 478 nm from Santa Barbara, California. 3½ hours after lift off from the vessel, the helicopter landed at Santa Barbara airport and the patient was transported to hospital. State-of-the-art treatment ashore preserved both testicles and after long term recovery the seafarer was again fit for ship duty.