Once upon a time a medical emergency at sea was a newsworthy event. Nowadays with so many people cruising, it has become a frequent occurrence, cared for with such expertise, that it is largely ignored by the news media of today. Since the tragic events of September the 11th, concerns for safety, when travelling, have become a primary concern of those planning a vacation. While the distressing North American terrorist attacks are still very fresh in our memories, people are trying to make wise choices for their own health and safety. If you are concerned, it is smart to become informed and rate the relative security of the vacation you are planning.
With awareness of North American vulnerability to terrorist attack, public carriers have stepped up their security precautions. Although airline safety measures have been newsworthy, little has been heard about cruise line safety. It is interesting to note that long before September 11th, cruise lines made a priority of caring for the health and safety of their passengers. Shipboard security was tight and is now tighter. Royal Caribbean reports that their Security Officers are highly trained military veterans. Passengers, guests and crew must produce photo ID when embarking on a ship. Like airport security, cruise ships use metal detectors during check-ins. X-rays, sniffer dogs and hand checks are all employed to scrutinize luggage, carry-on articles and provisions brought onboard cruise ships. The crews aboard cruise ships are drilled to follow security and safety procedures at all times. One of the first things you discover upon arrival onboard a ship is that you are expected to attend a lifeboat drill immediately after the boat sets sail. Once that is over, your fun and relaxation can begin, knowing that should a need arise, the crew will be ready to assist you.
We do not like to think about the possibility of our becoming ill while on a wonderful vacation, however those things do happen, just the same as in everyday life. During dinner my first evening aboard a cruise ship, I noted some slight irregularities in the sounds and motion of our ship. I discovered later that one of the ship pilots, a man who had come on board to take the ship out into open water, had become seriously ill. The ship has a fully equipped mini-hospital where the man's condition was stabilized by the ship's medical team. He was then evacuated to the nearest hospital.
Several days into the cruise another passenger suffered a stroke (cerebral vascular accident) during breakfast. Again an emergency team was on hand within minutes and the man was quickly taken to the infirmary. While the resident physician and nurses were stabilizing this patient, communications were established to arrange for his transfer to the nearest land-based hospital. The huge liner changed course and began to head for the nearest port. Passengers were informed what was happening. A helicopter soon appeared, circled the ship while assessing the situation. It was a windy morning, therefore helicopter transfer was not the method of choice. Instead a coast guard boat was dispatched from the mainland to perform this rescue on the high seas. In a short time the launch came into view and was soon alongside the ship. The efficiency of the crew and the coastguard was evident in the competent and caring manner they all displayed while moving the patient, carefully bundled on a stretcher, onto the boat, then securing it for transport. In what seemed only a few minutes, the coast guard boat was under way again, heading for the nearest port. Our ship resumed its journey, soon making up the time lost by the medical emergency. Before the ship reached the next port, word came back that the patient was doing well.
Having been a health professional during one of my earlier incarnations, my curiosity was aroused by these events. I wondered how well the Holland American ships were equipped to handle medical emergencies. I was impressed with what I discovered. The ship's hospitals (infirmaries) are staffed with at least one qualified physician and three nurses who are available 24 hours a day. The mini-hospital has its own X-ray machine, lab facilities, orthopedic equipment and a good variety of pharmaceutical supplies, with an intensive care unit appropriately equipped - really quite a sophisticated setup! The doctor on duty at the time of my visit was on a leave of absence from his regular practice of emergency medicine in a stateside hospital. Sally van Boheemen RN, manager of medical services for Holland America passed along the information that the majority of physicians on their ships are American or Canadian licensed doctors who are actively practicing as board-certified emergency room physicians or internal medicine/family practice physicians experienced in advanced cardiac life support in particular. Only the QE2 has a full time surgeon aboard.
Most of the time the infirmary is a rather quiet area. Relatively minor complaints appear in their treatment rooms: upper respiratory infections, twisted ankles from shore excursions, patients who have forgotten medications, assistance with a pre-existing medical condition, all turn up there. During my visit, an American lady was having some stitches removed. She said it was cheaper to have it done there than at home before she boarded the ship!
Immediate and appropriate intervention in the event of a cardiac arrest, can mean the difference between life and death. Since November 2000, Holland America's luxury cruise ships have each been equipped with three automatic external defibrillators (AEDs), designed to be used promptly by non-medical personnel. Its subsidiary company, Windstar Cruise Ships are also each equipped with an AED. Originally front desk and key dining room personnel were trained in the use of the AEDs, with plans to also train other key staff members stationed throughout the ship, in the use of this advanced equipment. It was not long before the system was put to use, with a passenger successfully resuscitated by a properly trained staff member using an AED. Guests who experience a cardiac arrest aboard one of these ships will probably receive much more prompt intervention than if they had experienced an arrest in their own homes.
Also in the fall of 2000, Holland America launched their newest ship, the MS Amsterdam, with a telemedicine system built into the medical facility during construction. The 'MedServe' telemedical system allows the ship-board physician to work with shore-based specialists' collaboration. The medical centre can transmit high quality X-ray images, ECG's and live video images, from the ship sailing anywhere in the world, to the University of Texas Medical Branch in Galveston, where specialists can become involved in the care and treatment of the patient. This medical centre was selected because it practices more telemedicine than any other facility. This can be of tremendous value in assisting the onboard physician to diagnose and treat some medical conditions. For the global traveller who falls seriously ill, this reduces the chance that they will have to leave the ship, in a foreign port, to be treated in that country.
Cruise ships are also taking steps to assist handicapped or chronically ill persons who consider adding cruising to their lifestyle. In the summer of 2000, HAL began installing its first wheelchair-accessible tender-transfer system aboard its cruise ships. This system was designed to provide safe transfer of wheelchairs between ship and tender; or tender and shore, thus enabling those wheelchair-bound guests to participate in shore excursions.
Another surprise for me was the discovery that, on a variety of specific cruises, a medical team comes aboard complete with the specialized equipment, to enable passengers on kidney dialysis to enjoy the delights of a vacation at sea, while still keeping abreast of their regular treatments. This is a specialized service that must be arranged thorough a travel agent or cruise specialist.
Observing an emergency rescue at sea set me off on this investigation. I was very reassured regarding the medical capabilities of some of the cruise ships that ply the seven seas. The safety, security and medical well being of their passengers and crew are not haphazard happenstances left to chance, instead taking care of those contingencies has been well planned and, if need be, carried out by the officers and crew charged with your care and safety onboard their cruise ships.
Story and Pictures by M. Maxine George
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