Cruise medicine is an integrated part of maritime medicine, but involves medical professionals (physicians / nurses) working and living aboard the vessel while caring for both passengers and crew. This gives them a unique opportunity to study seafarers in their ‘natural environment’ and offers them a perspective that is distinctly different from researchers visiting the ships and from doctors seeing seafarers in port.
Since cruise medicine requires the presence of medical professionals aboard, this text will focus on their various roles and duties and on their place of work, the Medical Center (MC). Thus, it is not a manual directing the practice of medicine on cruise ships, but addresses medical staffing, facilities, equipment and procedures for the MC.
The specific medical needs of a cruise ship are dependent on variables such as ship size, itinerary, anticipated patient mix, anticipated number of patients' visits, etc. These factors will influence the ship’s staffing, medical equipment and formulary, as well as the size and lay-out of the medical center aboard. The practice of cruise medicine will be very different on a small vessel with 50 people and a mega-liner carrying more than 8000 people, but many of the duties of the medical personnel aboard will be the same.
The individual patient treatment is the primary focus of cruise medicine, but procedures and particulars of medical examination, diagnosis and treatment are left to the skill, training and independent judgment of the ships’ doctors and nurses. However, over the years the medical staff members have also become increasingly involved in a variety of preventive shipboard measures, like:
- epidemiology and disease prevention
- hygiene measures
- systematic isolation
- vaccination programs (influenza, yellow fever, MMR, varicella, hepatitis, tetanus)
- drug and alcohol testing
- insurance – claims and law suits prevention
- assault investigations
- anti-terror activity & disaster planning
Standards for Health Care aboardCruise Ships
According to long established international rules (see: http://wikitravel.org/en/Freighter_travel), a ship must carry a physician if it has more than 12 passengers 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 of Care for 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” (APPENDIX 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’sHealth 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.
Definitions, Terms, and Abbreviations
Gender. Ship’s doctors were traditionally men and ship’s nurses were women. Although that is no longer the case, doctors are for practical reasons in this text referred to as ‘he’ and nurses and secretaries as ‘she’. However, any reference to one gender implies either gender.
The Ship’s Medical Center (MC) was in the old days called the ‘Ship’s Hospital’. Now it is referred to as the ship’s MC, Medical Facility or Infirmary, both for legal reasons and to avoid unreasonable expectations, since even on large ships the MCs are not like hospitals ashore.
The Medical Center Administrator (MCA)is usually the ship’s staff captain or hotel director, depending on whether the MC has been administratively assigned to the ship’s Deck or Hotel Department (company decision).