MEDICAL CARE SAFETY ONBOARD CRUISE SHIPS Larger cruise

MEDICAL CARE & SAFETY ONBOARD CRUISE SHIPS Larger cruise ships, new safety challenges

Cruises have become one of fastest growing segments of the travel industry during the past 25 years averaging 8. 4% per year.

When people take a cruise, they think of spending a nice dream vacations, honeymoon, not the need for health services. Although cruise ships should not be considered a floating hospital or a comprehensive medical provider, the cruise lines understand that some people may have health needs during a cruise.

• Thus, they are committed to providing excellent first response and emergency care to passengers until they can be transferred to a shoreside medical facility. • The medical department onboard provides medical treatment for passengers and crew during clinic hours, and other times for emergencies and medical needs.

• The physician also makes decisions regarding admission of passengers and crew members to the ship's infirmary, and on whether or not a crew member or passenger should disembark for medical care on land. • Most cruise ship doctors are hired as independent contractors. licensed, trained in emergency medicine and family practice, and a majority of them must currently be in active practice when not serving on the ship

• All medical staff onboard is certified in Advanced Cardiac Life Support and at least one doctor on every ship is also certified in Advanced Trauma Life Support. • Number of medical staff onboard depends upon size of the vessel and ranges from one doctor and two nurses to two doctors and five nurses It is not uncommon for cruise ships to conduct "random" drug tests or crew cabin inspections.

• The medical facilities guidelines were developed in conjunction with American College of Emergency Physicians (ACEP) requirements. Member lines of the International Council of Cruise Lines have agreed to meet or exceed these requirements

The medical guidelines were put in place to provide : ØEmergency medical care for passengers and crew; ØThe capability to stabilize patients and initiate reasonable diagnostic and therapeutic intervention; ØThe evacuation of seriously ill or injured patients when deemed necessary by a shipboard physician

• The ACEP guidelines specify the type and • quantity of medicines and equipment that must be available on board, such as X-ray, (AED)defibrillators, EKG, wheelchairs and portable oxygen. The average cruise ship has more than 4, 000 smoke detectors and six firefighting teams on board. The average response time in an emergency is a matter of minutes, as trained emergency crews and fire teams are stationed on board.

Prevention Amendments to SOLAS and the STCW Conventions and supporting guidelines that focus on fire prevention, navigation safety, training and contingency planning

Improved survivability Amendments to SOLAS chapters II-1 and II-2 and supporting guidelines that focus on essential system redundancy, management of emergencies and casualty mitigation.

Regulatory flexibility Amendments to SOLAS chapters II-1 and III and supporting guidelines that focus on promoting, through rigorous evaluation and approval procedures, the regulatory approval of new safety technologies and arrangements.

Operations in areas remote from SAR facilities Action taken to develop amendments to SOLAS chapter III that will focus on reducing the time it takes to recover persons from survival craft and the water; supporting guidelines approved on external support from SAR Authorities, as well as guidance to assist seafarers taking part in SAR operations.

Health safety and medical care Supporting guidelines that focus on establishing medical safety programmes and a revised Guide on Cold Water Survival

The advanced age of the average cruise ship passenger and the isolation of the cruise environment create a need for high quality medical facilities and staff onboard cruise ships.

The regulatory framework should place more emphasis on the prevention of a casualty from occurring in the first place.

Future large passenger ships should be designed for improved survivability so that, in the event of a casualty, persons can stay safely on board as the ship proceeds to port.

The regulatory framework should permit alternative designs and arrangements in lieu of the prescriptive regulations, provided that at least an equivalent level of safety is achieved.

Large passenger ships should be crewed, equipped and have arrangements to ensure the safety of persons on board for survival in the area of operation, taking into account climatic conditions and the availability of SAR functions. Pantan Resort -Trogir Croatia Sinergy of Nature & History

Large passenger ships should be crewed and equipped to ensure the health safety, medical care and security of persons on board until more specialized assistance is available

All cruise ships must meet safety standards set by the International Maritime Organization enforced through the International Convention for Safety of Life at Sea (SOLAS). Ships operating from U. S. ports also are subject to U. S. federal and state regulations as well as periodic safety inspections by the U. S. Coast Guard.

According to FBI statistics, being on a cruise ship is safer than being virtually anywhere in the U. S. in terms of crimes of any type. Serious crime on cruise ships is extremely low. Crime statistics released by the International Council of Cruise Lines found that 206 complaints for passengers and crew were made between 2003 and 2005 in a period when 31 milion people took cruise holidays.

All cruise ships visiting U. S. ports are subject to periodic health inspections conducted by officers of the Vessel Sanitation Program (VSP), a segment of the U. S. Department of Health, Centers for Disease Control and Prevention (CDC). Ships are inspected twice a year to ensure that they meet the sanitation criteria established by VSP.

Two of the most prevalent diseases that spread through cruise ship populations are Influenza and Noroviruses. Annual influenza vaccination is the primary method for preventing influenza and its complications.

Any cruise ship gastroenteritis outbreaks with < 3% of passengers reporting ill should be considered for investigation.

Future of the medical care onboard cruise ships is the telemedicine system utilizes the satellite network as its communication element. With an certified doctors and nurses onboard, telemedicine also makes the specialist resources of various land-based at one of their affiliated Clinics or hospital experts available 24 hours a day.

It is an unfortunate fact that some people have their dream cruise vacation marred by an accident or injury. Cruise ships are essentially floating hotels and are susceptible to the same types of accidents as other buildings, and also have many unique danger areas.

Some of passengers or crew members are just ''fortune hunter'' and try to take legal advantage of these facts. The author of this article lost his first job pointing for impropriate, unsafe asbestos removals onboard.

The modern cruise giants have the power and speed to dodge the weather, they are particularly vulnerable to fire. Every passenger is a potential ignition source

A cruise offers all the things most people want in a vacation - romance, excitement, relaxation, adventure, escape, discovery, luxury. Mr. Gordan Baraka & Adria Mare Team Thank you!

PRESENTED BY dr. Mladen Pavić M. D. E-MAIL doctorpavic@hotmail. com