Transatlantic health emergencies

[cruiserjt]

I have been a nurse for over 31 years - one thing I learned is that most people do not have a crystal ball to predict health emergencies. Heart attack and stroke often come suddenly without warning - One can have risk factors for decades before they actually have an acute event!

 

When anyone travels - they assume risk. Life in a bubble is not much fun. I will continue to take my chances.

 

The medical staff on a cruise ship must be trained in Emergency, Pediatric, Geriatric care as well as Primary Care for the crew and staff.

I had a friend (also a RN) who ended up providing critical care nursing to her husband as they sailed for two days to the next port where he was transported to the hospital. She monitored his heart, blood pressure and adjusted IV medications to ease the work of the heart muscle and keep his blood pressure stable. I am sure the medical staff appreciated her expertise. (This was about 10 years ago and he is still doing well). I have always wanted to learn more about emergency preparedness on a cruise ship - what a challenge.

[UFMOM]

The Holland America Westerdam Tahiti trip? We were there.

 

That's the one. Fabulous cruise, but sorry to miss the island. Hope the ill passenger was ok, especially with the plane being so late. I believe there were some passengers taken by ambulance at a port too, but I can't remember which one.

 

Mary Ann

[radsailor]

On our recent TA they announced overhead that they were needing blood donors. I just happened to have my card and was O-Negative. By the time I went to the room to get my card and back down to guest relations they already had enough volunteers. Not sure what happened, but we were nowhere close to land. Just hoped they were okay.

[constantcruiser]

A few years ago DH & I cruised to South America just 11 days after he underwent emergency quadruple bypass surgery. In ICU, his first words to me were "You didn't cancel the cruise, did you?" I was afraid he'd have another heart attack if I did!

[Pushka]

A few years ago DH & I cruised to South America just 11 days after he underwent emergency quadruple bypass surgery. In ICU, his first words to me were "You didn't cancel the cruise, did you?" I was afraid he'd have another heart attack if I did!

 

 

Goodness. You are braver than I am.

[blindrid]

On a recent QM2 behind the scenes tour this topic was raised. Medical evacuations by helicopter are extremely risky to the ship, passengers and crew and rarely used.

 

Huh? I've been aboard many cruises where there was a medivac. Not that unusual. Risks, yes like any landing. Rarely used, wrong.

 

I've been treated by a few docs (not serious) and they have had pretty good pedigrees, albeit older and retired.

Edited May 20, 2014 by blindrid

[Pushka]

Huh? I've been aboard many cruises where there was a medivac. Not that unusual. Risks, yes like any landing. Rarely used, wrong.

 

I've been treated by a few docs (not serious) and they have had pretty good pedigrees, albeit older and retired.

 

Just saying. They don't like using medivacs on Cunard. There is a significant risk to having a helicopter landing or hovering that close to a ship on the open sea. It is filled with a highly flammable liquid that represents a significant risk to everyone. It is hovering above the ship getting very close. The ship is moving on a moving ocean. It isn't like the medivac crew know the lay of the ship at all. One clip of the rotors to a structure on the ship and its full scale explosion. Makes sense to me.

 

The Doctors on Cunard are not retired but seem to be in their forties.

Edited May 20, 2014 by Pushka

[queen61]

EVERYONE on this thread has been great. What I found most interesting was the non response during the Q and A I think it was driven by the over arching message that cruising is.. " fun,relaxing, carefree, enjoyable etc. etc" thus must stay away from any discussion of ANYTHING that would be contra to that overt and subtle messaging. Hey if I was that concerned I could have gone down to the clinic. Last week out of the total blue came down with diverticulitis . I believe that without a CT scan I would have been in a world of hurt but even then. I guess they could have started a course of. AB's. Had a good friend in his 40 's recently die from appendicitis Wow everybody at the services was thinking the same thing...imagine in this day and age. I am a trouble maker... At another Q and A I asked if they had a jail. They took the microphone away from me :D happy cruising everyone

[Pushka]

The jail is called the brig. There is always a brig. :p

[blindrid]

One clip of the rotors to a structure on the ship and its full scale explosion. Makes sense to me.

 

The Doctors on Cunard are not retired but seem to be in their forties.

 

Good point but the medivac pilots I know can land on a gnats a** regardless of weather, motion, etc. Of course in a perfect world they would prefer not the risk.

 

The last doctor I had (on NCL) was probably late 50's, early 60's from Australia. I asked him why he did it and he said as screwed up as the Australian medical system is, it made sense to load up his wife and become a ship doctor. Made sense to me and he seemed to be a pleasant enough guy.

[Pushka]

Australias health system is probably one of the best and fairest in the world. But that's another matter.

 

Of course you are right about the medivac training however this isn't the case all around the world where ships traverse.

 

Helicopters crash much more frequently than their representative proportion of aircraft.

[Honeybearhollow]

We were on a Holland America cruise back from Hawaii. We were a day out and had to go back within a hundred miles of Hilo to medevac 3 people off the ship. At least one was life or death. All were emergencies. We were told by one of the officers that they only do this as a last resort because of the danger. We were a day late returning to port. We had driven, so we loved getting the extra day. Some people were not happy, but no one would have wanted someone to die. The most unhappy was the next cruise, who got their cruise shortened by a day. It was pretty costly for HAL and terribly costly for the evacuees (I heard $150,000, good reason to buy trip insurance.)

[zoncom]

Agree with Happy.I was on my one and only HAL cruise. Floating nursing home. Even saw a dead lady on gurney in MDR. Take your long cruises before you are too ill to travel.You folks know who you are! Many areas at sea too far for helicopters to reach inc.parts of Transatlantic. I found Non profit insurance in rural Colorado which promises medical evacuation anywhere in World for a $200 copay.It costs up to 20K for a ride to our local hospital.

[TravelerThom]

Good point but the medivac pilots I know can land on a gnats a** regardless of weather, motion, etc. Of course in a perfect world they would prefer not the risk...

I'm pretty sure that Celebrity's newest ships (Silhouette and Reflection) did away with helicopter landing pads and only have hover points (with fixed railings rather than collapsible ones) located where the Solstice etc had pads. I was told that often the available rescue helicopter exceeded the load limit, and that pilots generally preferred to hover rather than land. The only evacuations I have personally seen were hover. I was greatly impressed with the pilot's control under difficult conditions.

 

Thom

[teecee60]

I suggest if anyone is thinking a cruise ship medical centre can provide Level 1 Trauma Support they are mistaken.

 

I equate the medical care on a ship to that available in most small isolated communities with a population of 3,000 people. Basic support pending removal is the best I would expect.

 

FWIW, and just my opinion but anyone with a serious chronic condition embarking on a T.A or T.P cruise knowing advanced support is days away is not only risking their own life but the lives of the rescue people who would try and help in an evacuation situation.

 

An absolutely spot on assessment that needs to be considered as a simple fact that may have life or death consequences, and should not be interpreted by anyone as "rude."

 

They don't like using medivacs on Cunard. There is a significant risk to having a helicopter landing or hovering that close to a ship on the open sea. It is filled with a highly flammable liquid that represents a significant risk to everyone. It is hovering above the ship getting very close. The ship is moving on a moving ocean. It isn't like the medivac crew know the lay of the ship at all. One clip of the rotors to a structure on the ship and its full scale explosion.

 

A realistic observation in almost all regards. The "full scale explosion" might be a somewhat overly melodramatic, done but still a concern.

 

You might enjoy this clip of how we (USN CH-46 Sea Knight pilots and crew) did a LOT of very similar stuff as a matter of routine.

 

We WOULD handle a medevac situation with somewhat more care as opposed to just these loads of cargo!

 

Edited May 21, 2014 by teecee60

[Pushka]

That's a great clip.

[jkgourmet]

Disgraceful treatment by your insurer IMHO.

 

Your trip was delayed due to circumstances completely out of your control.

 

I hate it when insurers find ridiculous reasons to decline valid claims and would have considered referring the case to the insurance ombudsman:mad:

 

I'm gonna take a guess here and say that this person only had medical travel insurance that did not include trio interruption. They are NOT the same coverages and most people really don't understand the complicated intricacies of insurance.

 

Or they didn't file the forms properly and completely.

Edited May 21, 2014 by jkgourmet

[canusa1]

Part of every crash cart are anti-coagulating drugs but as has been said without knowing whether the stroke is hemorrhagic or not they are not likely to administer them. The patient would already have to be on blood thinners for them to take that risk.

 

 

 

I seriously doubt they have TPA on board cruise ships and I know they do not have a CT scanner. A stroke in progress would be an acute situation calling for emergency evacuation as soon as possible.

 

 

My BIL was on a NCL 21 day cruise last week and suffered a stroke 7 days before the last port.He is a otherwise healthy 64 year old with no previous history of any medical issues. On no medication. Fortunate for him they did have TPA on board and it was given to him as it has to be administered within 4 hours to be of help. The doctor on board had previously worked in the neurological field. They were a day out of LA. They continued on till they reach LA and he was monitored in the sick bay till he could be met a port were a ambulance took him to a hospital in LA. He is now home and doing fine in British Columbia. I would hope that all cruise ships have TPA in their medical facility's as it can be a life saver. I think without it the outcome may not have been so positive.

 

 

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[radsailor]

I'm pretty sure that Celebrity's newest ships (Silhouette and Reflection) did away with helicopter landing pads and only have hover points (with fixed railings rather than collapsible ones) located where the Solstice etc had pads. I was told that often the available rescue helicopter exceeded the load limit, and that pilots generally preferred to hover rather than land. The only evacuations I have personally seen were hover. I was greatly impressed with the pilot's control under difficult conditions.

 

Thom

 

 

Just off the Silhouette and got to go on the helipad. We asked how they landed and one of the officers did say they collapsed.

[Chazteach1]

My Mom and my DH got sick on-board, (2 separate cruises) and the medical staff was very helpful. We take the cruise insurance and BC/BS paid the claims when we got home. Mom needed a nebulizer treatment a couple of times throughout the cruise and they were very helpful.

 

We had to turn around shortly after leaving port in Mexico on a cruise in 2008 for a medical emergency. We never did hear anything else after the passenger was taken off ship.

[Clydesmom7865]

Fortunate for him they did have TPA on board and it was given to him as it has to be administered within 4 hours to be of help. The doctor on board had previously worked in the neurological field.

 

 

I would hope that all cruise ships have TPA in their medical facility's as it can be a life saver. I think without it the outcome may not have been so positive.

 

 

The key words are bolded. It is not just a matter of having TPA on board but knowing how to properly administer it and monitor the patient. If done wrong or there is a reaction TPA can be fatal. The other part of TPA is having the training to recognize whether it is a hemorrhagic stroke or not. If TPA is administered in a bleeding stroke it could also kill the patient.

 

 

It is not just a matter of having a particular drug on board and giving it to the patient. You must know the drug, its dosage, prescribing, and how to properly administer it and what to do if complications arise.

[canusa1]

He had a ishemic stroke so all I am saying in his case the TPA worked if he had had a hemorrhagic stroke no it would not have without causing adverse effects.

I am sure the ships doctor would not have administered the drug without doing the needed work up that he had available to him on the ship. Everyone in any medical emergency on a cruise ship have to put their trust in the medical team onboard and trust they have the knowledge to cope with the emergency.

 

 

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[Jade13]

Agree with Happy.I was on my one and only HAL cruise. Floating nursing home. Even saw a dead lady on gurney in MDR. Take your long cruises before you are too ill to travel.You folks know who you are! Many areas at sea too far for helicopters to reach inc.parts of Transatlantic. I found Non profit insurance in rural Colorado which promises medical evacuation anywhere in World for a $200 copay.It costs up to 20K for a ride to our local hospital.

 

We travel on both Celebrity and HAL and the age ranges are the same.

 

However with that said, Alaska (and apparently Hawaii) attract an older crowd.

[Clydesmom7865]

He had a ishemic stroke so all I am saying in his case the TPA worked if he had had a hemorrhagic stroke no it would not have without causing adverse effects.

I am sure the ships doctor would not have administered the drug without doing the needed work up that he had available to him on the ship. Everyone in any medical emergency on a cruise ship have to put their trust in the medical team onboard and trust they have the knowledge to cope with the emergency.

 

You are missing the point: the standard of care in a hospital is to do a CT scan and ensure the stroke is ischemic prior to administering TPA. That is not possible on a cruise ship. Your uncle was lucky that the ship's doctor had added training in neurology to enable him to accurately diagnose the difference between an ischemic event vs. hemorrhagic without a CT because had he been wrong the results would have been fatal.

 

Yes, you have to trust that they have the knowledge to deal with the emergency but assuming that they can handle every emergency adequately at sea with severely limited medical facilities is wrong. The reality is far more problems end up in death due to the limitations than the miracle that all the planets line up to enable an advanced treatment in a limited setting.

 

Even emergency rooms stocked with all the lifesaving equipment needed for an event cannot always save someone nor can they treat every situation.

[missm]

This post isn't about dealing with acute illnesses on a TA, but we live near the Outer Banks of North Carolina where there is a Coast Guard base and cruise ships are relatively close to land. Almost routinely once a month we hear about people being airlifted off of cruise ships headed to the Caribbean. Our local news outlets always give the age/sex of those who are airlifted, and there is the usual older demographic represented. However, I am always struck by how many younger (20s and 30s) people need evacuation. Also, many times it is a crew member who is ill and needs to be admitted to a hospital.