In his role as Global Chief Medical Officer for Royal Caribbean Cruise Lines for eight years and as a consultant and ultimately Medical Director for Carnival Cruise Lines for 15 years prior to that, Arthur L. Diskin, M.D., FACEP was able to witness tremendous advances in the delivery of medical care aboard cruise ships and help develop and participate in many of those advances.
he increasing size of the ships and advances in technology presented opportunities, challenges and increased expectations. Onboard and shoreside experiences created new risks and deployment to remote locations presented new challenges and considerations in crisis management, including the continuity of the delivery of medical care. The evolution of the development of policies and procedures to manage infectious diseases such as Norovirus, Legionella and Acute Respiratory Illnesses was both challenging and rewarding. Having learned to manage public health issues on board left the cruise lines better positioned to manage the COVID pandemic when it occurred.
Cruise ships offer a unique environment where medical care becomes an essential service. With a diverse range of guests and crew members from various age groups and backgrounds, cruise ship medical facilities face distinct challenges in providing appropriate and timely healthcare. This article aims to explore the medical challenges encountered while treating the crew and guests onboard cruise ships, highlighting the differences in the type of medical care needed and how it is provided.
Cruise ship crews, often comprising individuals from different nations working in close quarters for extended periods, encounter unique medical challenges. These challenges include exposure to infectious diseases, musculoskeletal injuries, mental health issues, and limited access to specialized care. The shipboard medical team serves as the primary care provider for all crew members, as many may only receive medical care onboard due to limited access back home. Ensuring continuity of care between contracts, especially for chronic conditions like hypertension, stroke, or diabetes, is a critical concern.
Managing pre-employment medical exams (PEMEs) to identify potential medical issues, which may not exclude employment, poses a perpetual challenge. Third-party vendors like AP Companies play a crucial role in auditing and vetting internally developed networks or implementing their quality network of global providers. This support proves highly beneficial for cruise line operations and the healthcare needs of the crew.
While the responsibility for medical care for guests generally concludes upon disembarkation, the care for crew requiring medical attention beyond onboard capabilities initiates a new set of challenges. Accessing medical specialty care or extensive diagnostic studies worldwide necessitates an extensive network, often facilitated by third-party providers like AP Companies. Challenges persist if a crew member needs admission to a local hospital, involving considerations of language and cultural isolation, communication with family, dietary issues, immigration concerns, and optimal repatriation timing. AP Companies, with extensive experience in supporting crew members and cruise lines during complex hospitalization cases, ensures crew members receive optimal treatment efficiently and at the best possible cost.
Addressing issues like sexual assaults, crewmember deaths, and mental health concerns onboard requires specialized services and an opportunity to implement telemedicine to augment onboard care. Regardless of size, all cruise lines must have access to robust psychological and mental health support services for crew and, in some instances, guests.
Crew requiring medical care at home may be repatriated directly from the ship or after a stay in a local port healthcare facility, encountering immigration, logistical, and timing considerations, along with deciding the best means of transport. AP Companies, drawing on years of experience and managing numerous cases for major cruise lines, provides relevant advice in such situations.
Providers shoreside and in the home countries are best selected with a knowledge of the industry and onboard operations. Light duty may not be available and there may be no access to required physical or occupational therapy. Providers must be familiar with the terms fit-for duty (FTD) and maximum medical improvement (MMI) as they apply to the cruise industry. Trying to protect crew from aggressive runners attempting to solicit business for attorneys is a worldwide challenge. One of my goals while working in the cruise industry was to attempt to develop regional Centers of Excellence around the world to centralize crew medical care and address all of these concerns.
I am happy to contribute my knowledge to AP Companies’ Home Country cases department, that successfully manages hundreds of complex medical cases daily and further enhances the cruise line’s ability to navigate legal matters with comprehensive record-keeping and reporting. Medical care for guests is episodic, with guests seeking treatment for acute problems of varying severity. Guests may be younger than the crew, presenting with pediatric problems or minor trauma, or older with potential major cardiovascular or neurological emergencies.
A highly skilled medical team is critical for the care of both guests and crew, as well as the smooth operation
of the ship, especially in cases requiring medical disembarkation. A proficient medical team, coupled with
robust shoreside support, may prevent costly diversions, ensuring the safe delivery of a sick or injured crew
member or guest to the next port.
Emergency evacuations from cruise ships in critical situations requiring specialized care or hospitalization are complex and time-sensitive. Weather conditions, distance to the nearest port, capabilities of the nearest or next port, and coordination with local authorities play crucial roles in ensuring timely medical transfers. The ability of the medical team to quickly recognize who can stay onboard and who needs to be disembarked creates the best opportunity for safe evacuation. Instances where guests should have been immediately disembarked but were kept onboard, resulting in later fatalities or requiring emergency disembarkation, underscore the importance of precise decision-making.
Handling emergencies and medical disembarkation for guests and crew in remote locations exacerbates the challenges of any medical evacuation. Several factors come into play, including arranging evacuation by coastguard and/or helicopter, coordinating with local authorities and emergency services, assessing the appropriateness of evacuation based on the patient’s clinical condition, considering weather and sea conditions, and determining the best country for the individual’s evacuation. Selecting the correct port with the necessary resources and assessing nearby ports’ capabilities is crucial. AP Companies plays a crucial role in facilitating emergency evacuations, leveraging a thorough understanding of available resources, medical considerations, and global logistics to ensure a timely and well-informed evacuation process.
Convincing guests and their families of the necessity of a medical disembarkation can be challenging yet crucial. Clear and empathetic communication about the situation, potential risks, and benefits of seeking advanced medical care is essential to ensure understanding and cooperation. Arranging adequate support services in the chosen port, including medical facilities, transportation, accommodation, and other necessary services, is crucial for the well-being and comfort of guests, their families, and crew during their stay.
Lastly, communicating the clinical condition and relevant medical information to receiving healthcare providers is essential for ensuring continuity of care. This involves providing detailed medical reports, test results, and any other relevant information to facilitate appropriate medical treatment. Treating crew members and guests aboard cruise ships poses unique medical challenges due to diverse demographics, limited resources, remote locations, infection control measures, and communication barriers.
Despite these challenges, cruise ship medical facilities continually strive to provide comprehensive healthcare services, ensuring the well-being and safety of everyone onboard. Continuous improvements in medical infrastructure, equipment, staff training, and coordination with onshore medical facilities and third-party support companies, such as AP Companies, will further enhance the provision of care on cruise ships.
The views presented are only those of the author and do not necessarily reflect those of SAFETY4SEA and are for information sharing and discussion purposes only.