Discussion

Highlights

• Three recurring challenges are identified across the seven studies: resource constraints that may exclude smaller shipping companies and fishing fleets, privacy and data governance across jurisdictions, and physiological side effects such as monitoring-induced stress
• Cross-jurisdictional data flows involve frameworks like GDPR, IMO guidelines and UNESCO AI ethics recommendations, with blockchain proposed for secure records though governance frameworks are still being written
• The economic case is concrete, avoiding medical evacuations at about 100,000 dollars and mental health repatriations at 168,000 dollars each, while the value proposition aligns across seafarers, ship owners, healthcare providers and vendors
• Six open frontiers are outlined, including adaptive architectures, integration with electronic health records, federated learning, reconfigurable digital twins, seawater field validation and larger randomized controlled trials
• Evidence exists at three scales, engineering prototypes, a clinical pilot and the Navy fleet deployment, yet even with 845 participants the field is still answering feasibility rather than effectiveness, and the acceptable latency question remains unresolved