I love cruise ship vacationing and generally take at least one cruise per year. Having traveled with virtually every major cruise line I have had several discussions with heart disease prevention professionals and patient groups about vacationing or attending conferences on cruise ships and thought I would use the opportunity created by my latest cruise to investigate the subject in a more in-depth manner. The attitudes held about cruising with serious health conditions ranged from incapacitating fear to blissful, and potentially hazardous, ignorance. What I discovered about safe and healthy cruising was equal parts fascination and common sense.
I had the opportunity to discuss these matters at length onboard the Celebrity Cruise Lines ship “Century” with Senior Medical Officer Dr. Charles Laubscher who was extremely generous with his time. Additional thanks go to Hotel Director Niyazi Korkmaz for providing information on “healthy cruising” (I’ll have more in an upcoming article) and to Guest Relations Manager Bryan Cooper for the copious amounts of time he spent arranging interviews, clearing corporate hurdles, and compiling information for me - all based on my impromptu request to learn more about safe and healthy cruising.
Dr. Laubscher immediately caught my attention with his personal focus on prevention and the concept of “remote” medicine. Clearly, the best way to resolve onboard medical problems is to keep them from happening in the first place. More importantly, it is essential to keep in mind that a cruise ship is literally a floating city that is isolated in what are often extremely “remote” areas without access to the same medical resources as modern, land-based hospitals. It was not surprising to learn that many of the doctors who gravitate to shipboard medicine have experience practicing in “remote” areas such as the northern reaches of Canada or the rural regions of South Africa and that the nurses typically have ICU and trauma-team skills.
A second concept that Dr. Laubscher spoke of is “planning for the worst case scenario.” With the resources available in a modern, land-based hospital, care can be more conservative. For example, if you feel chest pains you may go to the emergency room for evaluation, stabilization, and observation and be sent home with instructions to return if the pain re-occurs. On a ship at sea one does not have the luxury of convenient trips to the emergency room and chest pain may well need to be approached as a frank heart attack and treated with a “worst case” plan to arrange for immediate evacuation to a shore-based hospital. The ship’s doctor has the final say on who stays onboard regardless of what any shore-based medical team may advise.
The remainder of the interview and tour of the medical facilities centered on what level of care can be expected onboard. The doctors tend to be general practitioners but, as you can imagine, may have significantly more experience with emergency situations under less than ideal circumstances. While these doctors certainly have many “MacGyver-like” stories of lives saved through medical skill and innovative use of tools at hand, passengers should expect a small clinic experience with a focus on stabilizing serious conditions for further treatment ashore.
crash_cartThe ship I cruised on was certainly not the largest class of ship in the fleet but was surprisingly well-equipped. There were ample exam, observation, and critical care suites. You will not find a CAT scanner but the ship did have state-of-the-art digital x-ray, EKG, and other diagnostic tools common to any emergency room. The infirmary offered a complete blood-testing lab as well as a well-stocked pharmacy. There were other uncommon tools specifically designed for shipboard use such as the mobile “crash cart” pictured at left.
Finally, we reviewed what and passengers can do to proactively prepare for their cruise.
1. Always let your doctors know you are planning a cruise so they may advise you of any restrictions. This is especially true if you have had any recent health changes or procedures. For example, last year I rescheduled my lithotripsy for kidney stones until after the cruise on the advice of my doctor. Passage of stone fragments and other complications in the weeks after the procedure could produce a critical situation leaving no choice but to have me evacuated from the ship (at great financial cost, pain, and a ruined vacation)!
2. Have your doctor prepare a synopsis of your general health condition, diagnoses/ prognoses, and medications. This information can greatly aid your shipboard treatment especially if you become incapacitated to any extent. For example, some cruise ship medical teams can provide thrombolytic therapy for heart attacks and stokes but such a treatment plan would be heavily dependent on a number of other health factors (is the stroke due to an occlusion or a hemorrhage) and any anti-platelet medications you may already be on.
3. Obtain travel health insurance and have ample financial resources for unplanned emergencies. Cruise doctors plan for the “worst case scenario” and so must travelers. Remember, other private or government insurance plans may not cover you at sea or in a foreign country. Typically, passengers are directly responsible for medical services and some service providers may require upfront payment. The last thing you want is an ambulance driver in a foreign port refusing to transport you to the hospital because you cannot guarantee payment. Finally, a severe medical problem requiring helicopter med-evac and in-flight treatment can be ruinously expensive. For example, my travel policy provides coverage limits for such an event at $500,000! That policy, including all of its other medical and travel coverage, cost only $118!
Cruising can be safe, fun, and even a healthy way to vacation or to combine business with pleasure for anyone. A little common sense and extra preparation is all that’s required.
Looking out for your heart health,