Medical Concierge & Yacht Care in the Gulf: Scope, Governance & Escalation for Western-Trained Clinicians

Scope & governance (draw the line first)

• Licence & privileges: add domiciliary to the privilege list; specify procedures you are authorised to perform outside hospital.

• Insurance: occurrence vs claims-made; name home/hotel/yacht explicitly; confirm tail if claims-made.

• Medical lead: one consultant of record; all changes to plan flow through this lead.

• Consent & privacy: written consent; neutral language in semi-public areas; no clinical content on personal apps.

Medication custody & devices (copy/paste controls)

• Locked storage; temperature log for cold-chain items.

• Two-person check for high-risk meds (insulin, anticoagulants, opioids, electrolytes).

• No decanting/relabelling; pharmacy packaging only.

• Devices: IFU available; cleaning/maintenance schedule; disposables stock with batch/expiry tracked.

Staffing & rota (stability over heroics)

• Pair high-risk sessions (sedation support, chemo interfaces, complex dressings) with a second clinician.

• MAX 3 consecutive nights; post-call rest protected.

• Weekly micro-brief (15 min): incidents, near-misses, one change adopted.

Documentation that travels

• Domiciliary note with time, assessment, actions, and numeric escalation thresholds.

• MAR or medication chart where applicable; waste log for controlled drugs.

• Handover to medical lead via approved channel; SBAR with “R” = next steps + who to call.

Escalation & transfer (calm choreography)

• Pre-agreed receiving hospital and contact path.

• Numeric triggers (e.g., SpO₂ <92% for 5 min, MAP <65, uncontrolled pain, active bleeding).

• Prepare a transfer pack: SBAR summary, last vitals, MAR copy, devices/lines list.

• Household PA/security handle logistics only, not clinical decisions.

Yacht-specific additions

• Stabilise → transfer mindset; marina/helipad routes pre-planned.

• Equipment secured against motion; cold-chain monitored; comms (VHF/phone) tested before departure.

• Location handover includes GPS/berth plus nearest receiving facility.

Mini-audits (weekly, 5 items)

1. Cold-chain logs complete; excursions documented.

2. High-risk med double-checks recorded.

3. Last two visits include a numeric escalation line.

4. Device cleaning records up to date.

5. Privileges/insurance certificates current and visible in the pack.

Red flags—and fixes

• Domiciliary work requested but no rider on insurance → add rider before visit.

• Household pushes beyond scope → restate boundaries; escalate to medical lead.

• Lack of safe storage → defer administration; document reason; re-schedule.

• Solo clinician on high-risk session → re-staff; do not proceed.

Ready checklists

Arrival (home/hotel/yacht)

• Consent confirmed; allergies reviewed; emergency address/coordinates ready

• Equipment check; meds counted; waste containers present

• Vital signs baseline; red-flag screen done

Before exit

• MAR updated; waste counted/signed

• SBAR to medical lead sent; next visit agreed

• Environment left secure; log filed

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