A patient in need of acute care that extends beyond first stage medical management, e.g. a coronary angiogram or a stent insertion after a heart attack, will need to be disembarked from a cruise ship for further investigation and treatment – and usually, cruise companies will disembark patients in a place that gives them access to this, says Dr Lynn Gordon, Chief Medical Officer Charles Taylor Assistance.
“It’s important to bear in mind that it’s not easy for a cruise ship to divert its course,” Dr Gordon told ITIJ, “weather conditions may not be favourable, while fuel supplies and the needs of potentially thousands of passengers on board also need to be taken into account. The logistical and financial implications of diverting a ship’s course are huge, and a diversion may not always help a patient to reach suitable care more quickly.”
Sometimes, disembarkation will be followed by a road or air transfer elsewhere, organised by the assistance provider. At other times, an assistance company may ask a ship to delay disembarkation until reaching an area with better medical facilities, if it is practical and safe to do so. Dr Gordon explained that disembarkation decisions are always taken with the patient’s best interests at heart and are usually reached collaboratively by onboard doctors and assistance providers, according to Dr Gordon.
In an ideal scenario, a ship or patient will notify the assistance provider about a Covid case as soon as possible, to optimise the assistance process. Offering the best assistance means being aware of in-country Covid regulations, being able to arrange access to the right medical care, overcoming difficulties such as a shortage of hospital beds or hotel accommodation, arranging provision for patients’ partners and so on. It also means establishing a patient’s particular vulnerabilities and meeting their specific needs, such as for escorted repatriation.
Acute psychiatric illness
Dr Gordon recalls one particularly challenging situation Charles Taylor Assistance handled recently, involving a patient onboard a cruise ship in the Caribbean, who was suffering from an acute psychiatric illness. She was considered a suicide risk, as well as a potential risk to fellow passengers.
“The ship’s doctor was originally planning to disembark the patient in the next port, but we knew that psychiatric facilities here were inadequate and asked for the patient to be treated onboard until she could be disembarked to a suitable facility,” Dr Gordon recalls.
Optimal onboard treatment was agreed collaboratively, including appropriate medication
After lengthy discussions, it was agreed with both the ship’s doctor and the captain to disembark her in a later port with medical facilities that met her needs. In the meantime, optimal onboard treatment was agreed collaboratively, including appropriate medication that was already proving to be effective. In the best interests of the patient and other passengers, the ship’s doctor ensured she was held securely in the medical facility with 24/7 medical oversight, necessitating considerable resources from the ship’s medical and security staff. This would not have been possible if the patient had been aggressive.
If a patient’s condition is covered by their policy, any necessary treatment and transport costs will be paid by the insurer – if not, it will be the patient’s responsibility to pay. As cruise ships often travel to destinations with limited medical facilities, it’s essential that passengers have cover for all pre-existing medical conditions and are not travelling against medical advice, as their insurance may not be valid.
The after-effects of Covid-19
Covid-19, too, continues to affect the cruise industry significantly. For instance, ports can worry about cruise ships bringing thousands of people carrying a new Covid variant into their community, testing and quarantine may still be applicable in different regions, air ambulance providers need to know that patients are Covid-free before they are transported – and so on.
“Much like the rest of the world and other travel and tourism sectors in particular, the cruise community is facing a challenge that is unprecedented in scale,” David Sanders, PR Manager at Cruise Lines International Association (CLIA), commented. “Still, people love to cruise, and that is part of what makes the cruise industry so resilient in the face of adversity. We are confident that people will return to the seas, just as they will return to restaurants, bars, movie theatres and the like. We are confident that we will emerge from current circumstances stronger.”
The cruise industry received a significant amount of bad press as Covid began to spread around the world, with well-publicised stories of lockdowns in cabins and ships being unable to dock. There were a high number of deaths of passengers and crews.
Dr Bruno Sicard of MedSSIS said infectious diseases were already an important issue for cruise lines due to the confined environments of cruise ships, the remote areas visited, and the fact that onboard medical care is never as good as on land, so passengers expect to be evacuated for better medical care. Going forward, he said that better communication is needed between crews and assistance providers, and that agility, flexibility and transparent processes need to be developed to address current and future issues.
Sanders says that CLIA members are communicating with health officials at destination ports so as to enable more efficient international medical assistance processes: “Cruise lines are working with ports and destinations so that future cruise itineraries are designed with public health considerations and pre-arranged contingency plans as a top priority.”
Infectious diseases were already an important issue for cruise lines due to the confined environments
What do cruise customers need?
Planning ahead and being aware of booking habits is essential to providing the kind of assistance cruise-goers need, explained Francine Abgrall, Head of Travel Product Line at Europ Assistance.
“We research overall growth in the cruise sector to make sure we understand our clients’ needs,” she said. “For example, we know cruises are spending longer periods with customers, and that bookings are sometimes registered years in advance. Insights like these help us precisely supply the products and services our cruise clients need.”
The decision about a patient’s disembarkation should ideally be a collaborative one between the ship’s doctor and the assistance provider and is not taken by the insurer; above all it is made in the best interests of the patient. In this context, it’s essential to recognise the challenges of diverting a cruise ship’s course; not least in relation to fuel supplies, inclement weather, and the needs of other passengers – and a diversion may not always enable more effective patient care.