Reasonable expectations in event of medical emergency

[Petronillus]

On another thread, somebody has mentioned the "nursing home flavor" that HAL's world cruises have taken on. That got me thinking: What can reasonably be expected of one's cruise line in the event of a medical emergency?

Let's suppose, hypothetically, that in the middle of your cruise you develop a constellation of symptoms. In the case of COVID-19, the symptoms would include high fever and a deep nagging cough and difficulty breathing but let's suppose, for the sake of our hypothetical, that you present a new and different set of symptoms. I don't suppose that it would be reasonable to expect that the ship would stock test kits for every conceivable viral or bacterial infection, but I would expect, especially given the experience we're gaining from COVID-19, that there would be at hand a set of kits covering a wide range of infections and that, in the event of an emergency, measures would be in place for additional, more pin-pointed kits to be procured. 

OK, now assuming you've tested positive for the biohazard du jour, what measures is it reasonable to expect your cruise line to keep on hand to deal with it? in terms of both protecting other passengers and caring for you. In the case of COVID-19, could one reasonably expect the sick bay to be equipped with ventilators, for example?

I understand full well that nobody has precise answers to these questions (which is why, in the Anglo-American legal system at least, reasonable-expectation questions get litigated on a case-by-case basis). But to us (DW and myself) they reinforce the absolute necessity of trip insurance, including evacuation in the event of a medical emergency -- with the extended (i.e., extra-cost) coverage that will require that you be medivacced to a facility of your own choosing.

[cbr663]

If a passenger experiences a medical emergency on a cruise ship, that passenger can reasonably expect to be taken off that ship.  When you can expect to be taken off depends on the nature of the emergency and whether it will be at the next port of call or immediately by helicopter.  

 

 

[3rdGenCunarder]

1 hour ago, Petronillus said:

 

I understand full well that nobody has precise answers to these questions (which is why, in the Anglo-American legal system at least, reasonable-expectation questions get litigated on a case-by-case basis). But to us (DW and myself) they reinforce the absolute necessity of trip insurance, including evacuation in the event of a medical emergency -- with the extended (i.e., extra-cost) coverage that will require that you be medivacced to a facility of your own choosing.

 

 

Anyone with an ongoing serious medical issue should check with the cruise line to see if needs can be met. Of course, that could lead the line saying "don''t travel." There are doctors who are "travel medicine" specialists who can give advice on travel with respect to individual needs. 

 

A for travel insurance, we get what you described. Only had to use it once, but we returned from England on a Learjet air ambulance when DH unexpectedly became ill and had a cascade of complications. We probably cost Travelguard $150,000 in hospital care and evacuation. As the old Amex commercial used to say, "Don't leave home without it."

 

 

 

[janmcn]

Think of your cruise ship as basic ER stuff...anything more, you will be taken off the ship...but keep in mind, as we had happen on a cruise returning from HI...we were 2 1/2 days out and someone had an emergency that couldn't be taken care of by the ship doctors with whatever they needed on board. We were too far out from either HI or the USA mainland to have a helicopter come for evacuation. So, the only solution at the time was for a C-130 to airdrop whatever they needed to help until the port on the mainland. We never found out what it was... So, in those kinds of instances, you are at the mercy of whatever they can do...and it may not be as extensive as on the mainland anywhere. They do a great job with what they have, though.

 

[npcl]

the norm for a cruise ship, is whenever there is a medical situation that cannot be managed on board, the passenger will be off loaded to the first available land based medical facility that is able to provide care. That may mean emergency air evac. Ship diverting to closest facility, etc.

 

Any evac insurance that includes transport to facility of their choice is between the patient, their insurance co, and the land based facility they were taken to.

[lazey1]

4 hours ago, 3rdGenCunarder said:

 

Anyone with an ongoing serious medical issue should check with the cruise line to see if needs can be met. Of course, that could lead the line saying "don''t travel." There are doctors who are "travel medicine" specialists who can give advice on travel with respect to individual needs. 

 

A for travel insurance, we get what you described. Only had to use it once, but we returned from England on a Learjet air ambulance when DH unexpectedly became ill and had a cascade of complications. We probably cost Travelguard $150,000 in hospital care and evacuation. As the old Amex commercial used to say, "Don't leave home without it."

 

 

 

I understand that the medical doctors are all board certified emergency room specialists.

 

[boone2]

They do have ventilators. Usually a couple. The issue is the amount of oxygen on board needed to run the ventilators. For a TA crossing with no hope of medivac the oxygen may only last 5-6 days for one ventilator

[Mary229]

All of those people can expect anything they want and perhaps the cruise lines could do a better job of managing expectations but I have never known any cruise line that has trouble saying “NO”.   If the cruise line doesn’t make it their concern then we don’t need to make it our concern.     
 

these various discussions are dangerously close to discrimination and bigotry.   

[Wehwalt]

I don't see how this is anyone's business except the cruise line and the passengers in question. The cruise line permits them to embark..

[HAL4NOW]

Just because a person is not fit to fly doesn't mean they are not fit to cruise. A person recovering from brain surgery may be told by their doctor to not fly. That same person shouldn't have to stop their life or interest in travel because flying may be harmful to their health. 

Anyone can have a medical emergency during a cruise, even if they leave the dock healthy and young. If a person is medically evacuated from a ship they will have medical personnel with them during the flight. That is different than having to spend 30 hours in the air on commercial flights.

I say, let people that want to cruise go and enjoy themselves. Insurance is a personal decision. If I choose to cruise without the insurance, than I am responsible for any costs incurred during an emergency. Even with insurance, a medical emergency will most likely cost something in addition to the cost of the insurance.

 

[Petronillus]

16 hours ago, Wehwalt said:

I don't see how this is anyone's business except the cruise line and the passengers in question. The cruise line permits them to embark..

 

We are all potential "passengers in question" and thus, by your own reckoning, it's the business of all of us. I think it's a valid cause for reflection.

As the OP, I appreciate the reminder that several contributors have offered, that in the event of a medical emergency the ship offloads the affected passenger with all due dispatch. Presumably, it is up to the sole discretion of the captain and her/his advisers to determine that a medical emergency exists, but my questions (per the original post) still hold for that interim period while the determination is pending.

Further, when the decision is made to put the patient/passenger ashore or to medivac, as the case may be, does the ship notify and make arrangements with the insurance carrier?

[Wehwalt]

12 minutes ago, Petronillus said:

 

We are all potential "passengers in question" and thus, by your own reckoning, it's the business of all of us. I think it's a valid cause for reflection.

(snip)

Having the potential for being in that situation does not place you in that situation. When you are, than you have a dog in the fight. Until then you do not, and you are kibbitzing on the subject of whether HAL should carry someone else, which is their concern, and HAL's.

Edited March 16, 2020 by Wehwalt

[Petronillus]

4 minutes ago, Wehwalt said:

Having the potential for being in that situation does not place you in that situation. When you are, than you have a dog in the fight. Until then you do not, and you are kibbitzing on the subject of whether HAL should carry someone else, which is their concern, and HAL's.

By that logic, this entire board should not exist.

[iancal]

I believe that HAL’s duty of care ends when the person has been evacuated off the ship and the ship has sailed.  Any health insurance issues  then become the concern of the evacuee and the organization that is caring for him/her.   
 

HAL, and other cruise lines, offer you a contract of passage not cradle to grave care as it were.  Nor are they a social services agency.

Edited March 16, 2020 by iancal

[RMLincoln]

In our experience, the medical department on a HAL ship offered tests to determine proper meds (we were in the Med, one of us developed pneumonia); if the meds didn't improve our situation we were to be debarked for transfer to hospital care.  They are not an ER on board, more like a higher than average Urgent Care level, but don't expect angiograms or stents for example.

 

Oxygen concentrators can be used to concentrate oxygen from the atmospheric concentration of 22% to higher levels, 90-95% but not to 100%.  Although the oxygen concentrators do not ever run out of oxygen they do require electrical power.  

 

Insurance for an air medivac will be good only to the facility of THEIR choice.  It may or may not cover getting you home, that depends on your policy.  

 

Whenever we have cruised far afield, as in half way around the world to Sydney and New Zealand, or to places of where it would be great distances to medical assistance, such as the islands of the south Pacific and Patagonia, we have had to first carefully consider our potential options if we were to be debarked a long way from home.  We took the risks and the wonderful trips without mishaps but we did have insurance, credit cards and assets to cover additional costs if needed, plus we left a lot of information with friends/family "just in case".  If not everyone does these things, maybe more will after absorbing the happenings of the current times, even as unprecedented as they are.  I know I learned some things after the Concordia incident: I took more care to have our essentials better marked and more readily available... meds, passports, cash, credit cards in the safe instead of in multiple locations in the cabin, for example. 

 

No plan is perfect but having planned ahead for some potential changes can bring a calmer position when life happens and the plan has to change.  

Maureen

PS I work as a volunteer EMT in the rural areas about a 90 minute drive north of Albuquerque where our fire department helicopters patients about once very month or two; helicopters charge upwards of $30,000 for that trip, and it probably is only partly covered by insurance.   But if the National Guard picks a patient up from a ship at sea I believe there is no charge for that.   

[S&B]

Well, I think it is time that I chime in here a little bit.  We are very fit senior citizens but all of a sudden things can happen and did.  We were on the 2018 Grand Asia ready to depart in Sydney and all of a sudden two days before departure my DH had to go to medical.   The lady Dr. on the ship was excellent and after a few tests very quickly determined what was the problem.   We were transferred to a beautiful, new university hospital and had a wonderful Dr. from Sri Lanka.   The problem:  He suddenly needed a pace maker.  (Two days prior he was doing the "twist" in the Crow's Nest).  Absolutely no warning!!

 

While in the ER I received this call from someone that I did not recognize.  It was HAL calling us from Seattle.  Wanting to know if we were o'k and if we wanted HAL to notify our children.  The next day they called again and then the day we were discharged they called my DH and told him they would keep track of us until we left the country.  

 

HAL and the port authority took very good care of us.  The medical team on the ship called our insurance company to make sure everything was in order.  The hospital Dr. talked to Travel Guard so the insurance company would know every procedure.   Travel Guard paid every penny of the $16,000.00 bill.  

 

Sorry this is so long but I wanted to relay our experience.  Oh, and by the way, he is doing excellent and just went on a 22 day cruise to South America.  However, me lugging around two 29" suitcases and 4 carry-ons to get home from Australia was no picnic and therefore he has limited me greatly!!!

[RuthC]

S&B, I'm happy that everything worked out so well for you. Thanks for letting us know how supportive HAL, both on the ship and Seattle, as well as the Port Agent, were.
It's good to know, especially speaking as a solo cruiser, that there is someone there to pick up the slack when we are stricken so far from home. 

[boards]

3 hours ago, S&B said:

Well, I think it is time that I chime in here a little bit.  We are very fit senior citizens but all of a sudden things can happen and did.  We were on the 2018 Grand Asia ready to depart in Sydney and all of a sudden two days before departure my DH had to go to medical.   The lady Dr. on the ship was excellent and after a few tests very quickly determined what was the problem.   We were transferred to a beautiful, new university hospital and had a wonderful Dr. from Sri Lanka.   The problem:  He suddenly needed a pace maker.  (Two days prior he was doing the "twist" in the Crow's Nest).  Absolutely no warning!!

 

While in the ER I received this call from someone that I did not recognize.  It was HAL calling us from Seattle.  Wanting to know if we were o'k and if we wanted HAL to notify our children.  The next day they called again and then the day we were discharged they called my DH and told him they would keep track of us until we left the country.  

 

HAL and the port authority took very good care of us.  The medical team on the ship called our insurance company to make sure everything was in order.  The hospital Dr. talked to Travel Guard so the insurance company would know every procedure.   Travel Guard paid every penny of the $16,000.00 bill.  

 

Sorry this is so long but I wanted to relay our experience.  Oh, and by the way, he is doing excellent and just went on a 22 day cruise to South America.  However, me lugging around two 29" suitcases and 4 carry-ons to get home from Australia was no picnic and therefore he has limited me greatly!!!

I would like to add that Hal and the Port Authority did the very same for DW and myself when I was taken off the Noordam in Noumea, New Caledonia last Nov. 2019 and hospitalized for eight days.   We could have asked for greater care taken of us and helped us return home safely.   Thank you Holland America and Fabian of the Port Authority in Noumea.

[BJzink]

On 3/15/2020 at 8:14 AM, Petronillus said:

On another thread, somebody has mentioned the "nursing home flavor" that HAL's world cruises have taken on. That got me thinking: What can reasonably be expected of one's cruise line in the event of a medical emergency?

Let's suppose, hypothetically, that in the middle of your cruise you develop a constellation of symptoms. In the case of COVID-19, the symptoms would include high fever and a deep nagging cough and difficulty breathing but let's suppose, for the sake of our hypothetical, that you present a new and different set of symptoms. I don't suppose that it would be reasonable to expect that the ship would stock test kits for every conceivable viral or bacterial infection, but I would expect, especially given the experience we're gaining from COVID-19, that there would be at hand a set of kits covering a wide range of infections and that, in the event of an emergency, measures would be in place for additional, more pin-pointed kits to be procured. 

OK, now assuming you've tested positive for the biohazard du jour, what measures is it reasonable to expect your cruise line to keep on hand to deal with it? in terms of both protecting other passengers and caring for you. In the case of COVID-19, could one reasonably expect the sick bay to be equipped with ventilators, for example?

I understand full well that nobody has precise answers to these questions (which is why, in the Anglo-American legal system at least, reasonable-expectation questions get litigated on a case-by-case basis). But to us (DW and myself) they reinforce the absolute necessity of trip insurance, including evacuation in the event of a medical emergency -- with the extended (i.e., extra-cost) coverage that will require that you be medivacced to a facility of your own choosing.

I was in the medical center on Maasdam in January, twisted my knee & had internal derangement.  While I was waiting in the exam room, I looked around at what was in their cupboards & on shelfs, pretty basic ER supplies including chest tubes and drainage set.    However, there was definitely not enough to care for hundreds of patients at a time, nor would I expect it to be a "hospital ship".  I carry evacuation insurance at all times which covers me anywhere in the world, don't have to be on a cruise.  

Edited March 16, 2020 by BJzink
pushed the save button too soon.

[BJzink]

Just now, BJzink said:

internal derangement.  While I was waiting in the exam room, I looked around at what was in their cupboards & on shelfs, pretty basic ER supplies.  However, there was definitely not enough variety to care for hundreds of cases, 

 

 

[iancal]

The challenge with taking a cruise when you cannot fly for medical reasons is obvious.  What if you become ill, are disembarked, and the only reasonable method to travel home is by air??

[Mary229]

3 minutes ago, iancal said:

The challenge with taking a cruise when you cannot fly for medical reasons is obvious.  What if you become ill, are disembarked, and the only reasonable method to travel home is by air??

Air travel is modern, there are always traditional methods of travel.  What is wrong with staying put until you are feeling better and travel capable?   What if a passenger suffers a condition  that they are not capable of flying? 
 

It really isn’t dangerous or irresponsible not to fly anymore than people who participate in adventure travel.   If you are in the middle of the wilderness and have issues you better have a plan and that doesn’t include air travel. 

The cruise line is not going to escort anyone home.  They are going to evacuate you and that is where their responsibility ends.   

 

 

[iancal]

Exactly!  Not just for travel home but for travel to specialized medical facilities that may not be available where you  originally happen to be evacuated to.

Edited March 16, 2020 by iancal

[cb at sea]

A ship's clinic is just that....sort of a "stop gap" for common emergency situations.  A broken bone, a sprain, stomach issues or cold or flu symptoms.  If you have much more than that, you can expect to be disembarked to a REAL hospital.....in whatever port is closest.  The ship is NOT equipped for true "life-threatening" emergencies.  

[npcl]

1 minute ago, cb at sea said:

A ship's clinic is just that....sort of a "stop gap" for common emergency situations.  A broken bone, a sprain, stomach issues or cold or flu symptoms.  If you have much more than that, you can expect to be disembarked to a REAL hospital.....in whatever port is closest.  The ship is NOT equipped for true "life-threatening" emergencies.  

A minor point.  The ship is actually prepared to deal with life threatening emergencies, just as an emergency room is prepared to do.  What it is not prepared for is to provide care after initial emergency response treatment.