New Guidelines for Medical Care Afloat

Medical care aboard cruise ships is expected to improve, thanks to new guidelines issued last month by the International Council of Cruise Lines, a Washington, D.C.-based industry group. Suggestions for medical staffing, equipment and facilities are included.

The guidelines, which are voluntary, are aimed at standardizing medical treatment in an industry that is international and, thus, subject to varying ideas of what constitutes adequate medical care.

They were created to address three issues in particular: providing reasonable emergency care for passengers and crew; stabilizing patients or beginning diagnosis or therapy; and easing evacuation of seriously ill or injured passengers.

They were issued following the June meeting of the American Medical Assn., which called for standards mandated either through federal legislation or international treaty.

Industry reaction has been positive, said Mercedes McDonnell, spokeswoman for ICCL, whose membership includes 17 cruise lines that represent more than 80% of the world’s deep-sea cruise ships. Most ICCL members already meet most of the guidelines, McDonnell said.

The ICCL guidelines are almost identical to shipboard medicine guidelines issued last year by the American College of Emergency Physicians, said Dr. Carter Hill, medical director of Holland America/Windstar Cruises and past president of the College’s cruise ship and maritime medicine section. Hill began developing the guidelines in 1990 and has worked extensively with ICCL on its version.

Under the ICCL guidelines, cruise ship physicians should have a valid medical license, either international or domestic, and be conversant in English. A background in general medicine or general practice is suggested, along with emergency or critical care experience, medical board certification or equivalent experience in emergency medicine, family practice or internal medicine. Two or three years of clinical work with patients, along with minor surgical skills, such as suturing, are suggested. Doctors should also have experience in intravenous line and tube placements and be skilled in basic life support, advanced life support and cardiac care.

Under the guidelines, ships should maintain a minimum of one infirmary bed per 1,000 passengers and crew members and maintain intensive-care capabilities. The ship should have an examination-stabilization room, an isolation area and the ability to quickly disembark patients too sick to be cared for on board. The clinic should have wheelchairs and stretchers.

Recommended medical equipment and medications include airway equipment, cardiac monitors, defibrillators, electrocardiograph, chest tube and suction equipment, and portable oxygen. Glucose, pregnancy, urinalysis and hemoglobin/hematocrit tests should also be available.

Also recommended are procedures for operating medical equipment and maintaining it and for screening the crew for tuberculosis.

The effect will be significant, according to Hill.

“What the guidelines will do is establish a level that will raise industry standards.” Currently, conditions of medical care aboard ships are variable, he said, ranging from excellent to substandard.

“The idea of having standards is an excellent one,” said Dr. Stephen Brunton, director of family medicine at Long Beach Memorial Medical Center and a former cruise line physician. “It sounds like it’s a major step forward. Once [the guidelines are] established, perhaps companies will start to promote [them]. It will be another quality indicator. Few passengers think about medical care in anticipation of a cruise and once you’re on board you don’t have the luxury of shopping for a doctor.”

But even with the improvements, Hill cautions passengers not to think of on-board medical facilities as full-fledged hospitals but, rather, as medical departments or infirmaries. There will always be inherent limitations in maritime medicine compared with land-based medicine.

Not everyone seems convinced that the guidelines are enough.

At its meeting in December, the AMA will look at the issue of shipboard medical care again, said Dr. Yank D. Coble, an AMA trustee and former chairman of the Council on Scientific Affairs. The AMA resolution introduced in June had called for federal legislation or international treaty to develop standards for passengers aboard cruise ships entering or leaving United States ports. The AMA will discuss whether to push for legislation or treaty.

Fortunately, most health problems encountered by passengers on cruise ships are minor. Sunburn, motion sickness, gastrointestinal upset, ear problems and colds are most frequent, according to cruise ship officials.

Still, doctors must be prepared for emergencies as well, including airlift to medical facilities.

Planning ahead by passengers can help, especially since equipment and staff still vary from ship to ship. Passengers with medical-related questions should consult their personal physician before taking a cruise, said Fran Sevcik, spokeswoman for Norwegian Cruise Lines. Next, consider calling the line and asking the passenger courtesy department for answers to specific medical questions, Sevcik suggested.

ICCL’s members include Carnival Cruise Line, Celebrity Cruises, Commodore Cruise Line, Costa Cruises, Crystal Cruises, Cunard Line, Disney Cruise Line, Dolphin Cruise Line, Holland America Line, Majesty Cruise Line, Norwegian Cruise Line, Princess Cruises, Regal Cruises, Royal Caribbean Cruises, Royal Olympic Cruises, Seabourn Cruise Line and Windstar Cruises.

The Healthy Traveler appears the second and fourth week of every month.