Textbook of Maritime Medicine

According to old international rules, a ship must carry a physician if it has more than 12 passengers aboard. When the present cruise boom started in the 1960s, the shipping companies were not very concerned about their physicians’ qualifications and seemed to be willing to employ any doctor with a license. There were no standards for the doctor’s qualifications, for the ship’s infirmary or for medical equipment to be available aboard.

The image of cruise medicine suffered, and ship’s doctors with professional pride were bothered by poor medical facilities at sea and the varying quality of ships’ medical staff. So in the early 1990s a group of frustrated ship’s physicians organized a Section for Cruise Ship and Maritime Medicine (SCSMM) within the American College of Emergency Physicians (ACEP), and its first and most important task was the creation of an ACEP Policy, “Guidelines for Care of Cruise Ship Medical Facilities”, which was approved by the board of the organization in September 1995 (www.acep.org).

At first there was considerable resistance from the International Council for Cruise Lines (ICCL), the cruise lines’ interest organization, as it feared more litigation and higher costs. ICCL therefore made its own set of guidelines, based primarily on suggestions from a team of cruise line lawyers. However, after years of negotiations the two sets of guidelines have merged into ACEP’s present ‘Health Care Guidelines for Cruise Ship Medical Facilities” (Appenix 1). ICCL was later incorporated in Cruise Lines’ International Association (CLIA), a non-profit trade association that represents over 97 percent of the cruise capacity marketed from North America. CLIA now actively supports - and actively promotes - the ACEP guidelines, which have become the commonly accepted US standards. They are not in any way evidence-based, but a result of negotiated compromises and represent a consensus for a minimum standard that is acceptable to ACEP’s SCSMM and to cruise lines that are CLIA members.

Cruise ships are floating cities which at times are way outside helicopter range and far from ports with modern medical facilities. The ship’s doctors must therefore be prepared to handle all kinds of medical emergencies, in addition to the challenges of general practice.  Not least thanks to the ACEP guidelines, the ship’s doctors’ reputation has gradually improved.

According to CLIA, its members aim to provide limited medical services through a shipboard medical center, which meets or exceeds ACEP’s Health Care Guidelines, staffed by licensed physicians and nurses, whose goal is to:

• Provide quality maritime medical care for passengers and crew.
• Stabilize patients and/or initiate diagnostic and/or therapeutic intervention.
• Support, comfort, and care for patients on board ship.
  • Facilitate the evacuation of seriously ill or injured patients, as deemed appropriate by the shipboard physician.

But there are still no internationally accepted standards for cruise medicine.