Reasonable expectations in event of medical emergency

[kevingastreich]

On our recent N/A cruise, we were still in port in Ft. Lauderdale and I observed a male passenger in the 6th deck passageway by the main elevators receiving CPR from a crew member while his poor wife was watching and crying. I do not know how long it had been going on. It was a FULL 10 minutes after that before the "Medical Response Team TO Deck 6" call was sounded. Unfortunately, the poor man didn't make it. Moral of the story is, that if you have a medical emergency on board, help might not come as quick as you think it would.

[boone2]

1 hour ago, kevingastreich said:

On our recent N/A cruise, we were still in port in Ft. Lauderdale and I observed a male passenger in the 6th deck passageway by the main elevators receiving CPR from a crew member while his poor wife was watching and crying. I do not know how long it had been going on. It was a FULL 10 minutes after that before the "Medical Response Team TO Deck 6" call was sounded. Unfortunately, the poor man didn't make it. Moral of the story is, that if you have a medical emergency on board, help might not come as quick as you think it would.

 

[boone2]

10 mins is way quicker than the community  response time would be   The recommended response time on the ship is 8 minutes. So 10 mins is reasonable 

[TiogaCruiser]

The vast majority of people who receive CPR in the field do not survive. I believe the number is around 15%. The use of AEDs may have improved on that.

[leerathje]

5 hours ago, Mary229 said:

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.   

 

 

 

I used to be an insurance agent (I promise I won't try to sell you anything!) and I seriously doubt that any insurance company would agree to insure someone that has a do not fly order from a doctor.

 

As well, if an insurance company want to "fly you home", you have to go or your policy is void.  You don't get the choice to stick around until you're better.

 

L.

 

 

L.

[Copper10-8]

All HAL, as well as Princess,  passenger physicians (every ship has a crew doc also) as well as the majority of the nurses, are E.R.-qualified, and most work in E.R.'s at their respective home-based hospitals. Up until about four years ago on HAL, the majority of the pax docs were U.S. and/or Canadian nationals (the majority of the crew physicians have always been from the Philippines). Since that time, HAL had Princess take over the medical department onboard their ships. Dr. Grant Tarling, a South African then with Princess, became the chief medical officer for the Holland America group and the nationalities of the pax docs consequently changed to South African for the most part. 

 

I have worked with many of them, including in medical emergencies involving pax as well as crew onboard and, without exception, they are top notch in their field!

 

As was mentioned earlier, the medical centers onboard are able to function as emergency rooms with the main purpose of stabilizing the patient. As was also mentioned correctly earlier in this thread, it is in cases where a patient needs further medical care over a longer period of time, when the senior doc (the passenger physician) will recommend to the captain that a medevac (medical evacuation) of the patient take place. This will frequently involve course changes by the ship and, at times, a change in itinerary

 

When the captain agrees, and that is almost always the case, the nearest rescue coordination center is contacted via sat phone on the bridge. If the ship is close to land, a port will be selected and the ship will either dock in order to medically disembark the patient to a waiting ambulance, or will stop off-shore where a rescue (or police) boat will come out alongside one of the ship's tender platforms to conduct the medevac. If such a boat is not available, the patient will be loaded in one of the ship's tenders and brought ashore.

 

If a medevac via helicopter is the only fast option, in the U.S., this usually, but not always, will involve the U.S. Coast Guard. Before the helo will come out, a USCG flight surgeon based at the selected air station will have to sign off on this type of medevac. Once on station, the aircraft commander will always select the location (usually the bow or stern) of the ship from where the medevac will be performed and will lower a crew member (called a rescue swimmer in the USCG, the Canucks call them SAR techs) from the helo to the ship. When such a medevac via helicopter takes place, one of the ship's nurses will accompany the patient into the helo to the land-based hospital, no luggage and no family member(s) onboard! Some services, i.e. the French Navy will send one of their doctors with the helo in which case the ship's nurse will stay onboard. 

 

My hat goes off to all these individuals, be it the ship's medical staff or the crew of the responding rescue boat or helicopter, for the outstanding work they perform, at times under very difficult circumstances, in order to get these patients the medical care they deserve and need. Having been involved in several of these from Puerto Rico, to Alaska, Vancouver Island, to Tahiti, I'm always amazed how routine they make it look. They are life savers in my book! Bravo Zulu  

Edited March 17, 2020 by Copper10-8

[boards]

Thank you for explaining the procedures of the medical team on a Hal ship.  I recently had a personal experience on the Noordam and can tell you they did exactly the care I needed as described above.  I am most grateful  to them and God for how they medically treated me, got me to a hospital for further treatment and also to Hal for the care and kindness they showed to my wife.  Thank you to all who took part.  God bless

 

[Caribbean Chris]

RMLincoln’s comments were spot on. A close friend (almost 70) was on a world cruise (not on HAL) last year with her dear mother (almost 90), heading a couple of days west from Oahu in a remote part of the Pacific. Mum had a heart attack and the ship’s medical staff could only give her a drug which failed to dissolve the blockage. They kept her comfortable but she soon died.

 

The daughter praised the cruise line and has said many times that Mum died doing what she loved most. They were realistic and aware that there are places in the world where you can’t be evacuated. After literally decades of world cruises, they accepted the risk of having limited facilities available in an emergency. The best travel insurance won’t help in such situations.

 

Being sent ashore is another roll of the dice. I lived in the US Virgin Islands for years and the health care facilities there have always been grossly inadequate by US mainland standards. Currently they are even worse, according to friends there, having not recovered from hurricane damage a couple of years ago. An eternally-corrupt and inept government only adds to the problem. 

[chengkp75]

20 hours ago, Petronillus said:

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?

Which insurance carrier?  Medical evacuation at sea is a SAR function, as outlined in the UN's SAR convention, and as such is carried out by national agencies, or in some cases, private firms contracted to national agencies, and at no charge.  As for notifying the patient's insurance that they are being transported to a land hospital, for whatever treatment is covered by the insurance, no, the ship will not do that.

[Mary229]

7 hours ago, leerathje said:

 

I used to be an insurance agent (I promise I won't try to sell you anything!) and I seriously doubt that any insurance company would agree to insure someone that has a do not fly order from a doctor.

 

As well, if an insurance company want to "fly you home", you have to go or your policy is void.  You don't get the choice to stick around until you're better.

 

L.

 

 

L.

I didn't ask you to offer me insurance.  I get insurance just fine from reputable sources and from my own resources.  I am happy to pay my way in life.

[boone2]

8 hours ago, Copper10-8 said:

All HAL, as well as Princess,  passenger physicians (every ship has a crew doc also) as well as the majority of the nurses, are E.R.-qualified, and most work in E.R.'s at their respective home-based hospitals. Up until about four years ago on HAL, the majority of the pax docs were U.S. and/or Canadian nationals (the majority of the crew physicians have always been from the Philippines). Since that time, HAL had Princess take over the medical department onboard their ships. Dr. Grant Tarling, a South African then with Princess, became the chief medical officer for the Holland America group and the nationalities of the pax docs consequently changed to South African for the most part. 

 

I have worked with many of them, including in medical emergencies involving pax as well as crew onboard and, without exception, they are top notch in their field!

 

As was mentioned earlier, the medical centers onboard are able to function as emergency rooms with the main purpose of stabilizing the patient. As was also mentioned correctly earlier in this thread, it is in cases where a patient needs further medical care over a longer period of time, when the senior doc (the passenger physician) will recommend to the captain that a medevac (medical evacuation) of the patient take place. This will frequently involve course changes by the ship and, at times, a change in itinerary

 

When the captain agrees, and that is almost always the case, the nearest rescue coordination center is contacted via sat phone on the bridge. If the ship is close to land, a port will be selected and the ship will either dock in order to medically disembark the patient to a waiting ambulance, or will stop off-shore where a rescue (or police) boat will come out alongside one of the ship's tender platforms to conduct the medevac. If such a boat is not available, the patient will be loaded in one of the ship's tenders and brought ashore.

 

If a medevac via helicopter is the only fast option, in the U.S., this usually, but not always, will involve the U.S. Coast Guard. Before the helo will come out, a USCG flight surgeon based at the selected air station will have to sign off on this type of medevac. Once on station, the aircraft commander will always select the location (usually the bow or stern) of the ship from where the medevac will be performed and will lower a crew member (called a rescue swimmer in the USCG, the Canucks call them SAR techs) from the helo to the ship. When such a medevac via helicopter takes place, one of the ship's nurses will accompany the patient into the helo to the land-based hospital, no luggage and no family member(s) onboard! Some services, i.e. the French Navy will send one of their doctors with the helo in which case the ship's nurse will stay onboard. 

 

My hat goes off to all these individuals, be it the ship's medical staff or the crew of the responding rescue boat or helicopter, for the outstanding work they perform, at times under very difficult circumstances, in order to get these patients the medical care they deserve and need. Having been involved in several of these from Puerto Rico, to Alaska, Vancouver Island, to Tahiti, I'm always amazed how routine they make it look. They are life savers in my book! Bravo Zulu  

And as one of the nurses involved in a medivac and winched up on to a helo I was more than happy with the professionalism of the USGC. scariest thing I’ve ever done but it cured me of my fear of heights !!

[kevingastreich]

11 hours ago, TiogaCruiser said:

The vast majority of people who receive CPR in the field do not survive. I believe the number is around 15%. The use of AEDs may have improved on that.

The medical response team did bring an AED with them and they did use it to no avail.

[grest]

My husband is a transplant recipient who has had to change meds quite often, and sometimes has nasty side effects.  We no longer schedule transatlantic voyages...much too risky, and that's on us, not the cruise line.

[npcl]

10 hours ago, Copper10-8 said:

All HAL, as well as Princess,  passenger physicians (every ship has a crew doc also) as well as the majority of the nurses, are E.R.-qualified, and most work in E.R.'s at their respective home-based hospitals. Up until about four years ago on HAL, the majority of the pax docs were U.S. and/or Canadian nationals (the majority of the crew physicians have always been from the Philippines). Since that time, HAL had Princess take over the medical department onboard their ships. Dr. Grant Tarling, a South African then with Princess, became the chief medical officer for the Holland America group and the nationalities of the pax docs consequently changed to South African for the most part. 

 

I have worked with many of them, including in medical emergencies involving pax as well as crew onboard and, without exception, they are top notch in their field!

 

As was mentioned earlier, the medical centers onboard are able to function as emergency rooms with the main purpose of stabilizing the patient. As was also mentioned correctly earlier in this thread, it is in cases where a patient needs further medical care over a longer period of time, when the senior doc (the passenger physician) will recommend to the captain that a medevac (medical evacuation) of the patient take place. This will frequently involve course changes by the ship and, at times, a change in itinerary

 

When the captain agrees, and that is almost always the case, the nearest rescue coordination center is contacted via sat phone on the bridge. If the ship is close to land, a port will be selected and the ship will either dock in order to medically disembark the patient to a waiting ambulance, or will stop off-shore where a rescue (or police) boat will come out alongside one of the ship's tender platforms to conduct the medevac. If such a boat is not available, the patient will be loaded in one of the ship's tenders and brought ashore.

 

If a medevac via helicopter is the only fast option, in the U.S., this usually, but not always, will involve the U.S. Coast Guard. Before the helo will come out, a USCG flight surgeon based at the selected air station will have to sign off on this type of medevac. Once on station, the aircraft commander will always select the location (usually the bow or stern) of the ship from where the medevac will be performed and will lower a crew member (called a rescue swimmer in the USCG, the Canucks call them SAR techs) from the helo to the ship. When such a medevac via helicopter takes place, one of the ship's nurses will accompany the patient into the helo to the land-based hospital, no luggage and no family member(s) onboard! Some services, i.e. the French Navy will send one of their doctors with the helo in which case the ship's nurse will stay onboard. 

 

My hat goes off to all these individuals, be it the ship's medical staff or the crew of the responding rescue boat or helicopter, for the outstanding work they perform, at times under very difficult circumstances, in order to get these patients the medical care they deserve and need. Having been involved in several of these from Puerto Rico, to Alaska, Vancouver Island, to Tahiti, I'm always amazed how routine they make it look. They are life savers in my book! Bravo Zulu  

South African doctors are very well trained.  The ones HAL uses are all emergency room certified.  Pay for doctors in SA is pretty low, as a result they are willing to take better paying cruise line jobs.  A friend of mine is a doctor on Princess ships.  Her husband sales with her.  She makes more in one contract then what her and her husband (a chemical engineer) make working all year in SA.

 

[Copper10-8]

2 hours ago, kevingastreich said:

The medical response team did bring an AED with them and they did use it to no avail.

 

 

There is an AED located in every front office of all fourteen ships and all front office staff are trained in its use. Certain guest relations staff is designated as first responders in medical emergencies, so one of them is tasked to grab the AED and run to the scene as part of the medical response, the former "Bright Star," now "Medical Response" which is broadcast over the P/A system. One of the nurses is tasked to bring what's known as the "crash cart"  (it's on wheels) from the infirmary to that scene

[AncientWanderer]

12 hours ago, Copper10-8 said:

All HAL, as well as Princess,  passenger physicians (every ship has a crew doc also) as well as the majority of the nurses, are E.R.-qualified, and most work in E.R.'s at their respective home-based hospitals. Up until about four years ago on HAL, the majority of the pax docs were U.S. and/or Canadian nationals (the majority of the crew physicians have always been from the Philippines). Since that time, HAL had Princess take over the medical department onboard their ships. Dr. Grant Tarling, a South African then with Princess, became the chief medical officer for the Holland America group and the nationalities of the pax docs consequently changed to South African for the most part. 

 

 

 

 

This is really interesting.  I have a friend whose husband, a retired M.D. in the U.S., worked on HAL ships and she traveled with him.  About that time frame, four years ago, they stopped cruising and she was vague about it, just, "Oh, we aren't doing that anymore; things have changed."

I had a lot of confidence in the HAL doctors because I knew this gentleman to be highly qualified.  BUT....

I still have great confidence, because our own family physician and two specialists we see are from South Africa, and I also know them to be top-notch and excellently trained.

 

As usual, Copper10-8, you provide useful and interesting information.  Thanks for that.

[RMLincoln]

Several years ago I began CPR on a fellow passenger - as we were exiting the theater on our way to dinner she literally collapsed in front of me and fell at my feet.  I thought maybe she had fainted, hitting her head hard on the rock flooring.  I immediately knelt at her head, felt for a pulse and breathing, but when finding neither called to my husband (also licensed in EMS through our fire department) for him to call 911 (it's good to observe where the "house" phones are located on a ship.)  Another passenger heard and saw what was happening, announced he was a physician; he and I began CPR together.  I had to request a drink-server near us to assist us by routing passengers to exit the theater another way as they were kicking into us.  It was only a few minutes before the medical team arrived with an AED but by then this passenger had revived!  We had been immediately told by her companions that she had a pacemaker (apparently one with a built in defibrillator! but they didn't know that).  I saw her later in the cruise and she expressed her appreciation, told me she was fine and had spent the night in the medical center for observation and supportive care.   By the way, this happened  3 nights out of San Diego on the way to Hawaii; I doubt a helicopter would come that far. 

 

AED stands for Automatic External Defibrillator.  They have become very commonplace in public places and can be very effective for a heart that is in ventricular fibrillation (quivering instead of beating; or in another type of ineffective arrhythmia...) by automatically analyzing the heart rhythm and then using an electric shock to interrupt the quivering, thus giving the heart a chance to have its own system of restarting itself take over - kind of like giving the heart a chance to "re-boot" itself.  An AED does not "jump start" a heart that has completely stopped (in asystole or "flat line") so it is imperative that the AED be used in the first few minutes.  

 

As others have said, dying on a cruise ship while enjoying the life we have is not a bad way to go, but in reality it is not the dying that is difficult, it might be the living through the difficulties of the end of life experiences for ourselves and our loved ones.  

 

A dear friend of mine was airlifted into Darwin, Australia, last year off a cruise ship (more or less as John described above), and died in the hospital there a few days later.  His children had to make their way there to go through the process far from home.  His wife had died the year before, and he was cruising with friends, but friends are not family and cannot make the end of life decisions or medical decisions for someone like a spouse or next of kin can.  If you have an advanced directive and are not traveling with a next of kin, consider bringing your documents with you.  Maureen-- 

Edited March 17, 2020 by RMLincoln

[RuthC]

1 hour ago, RMLincoln said:

If you have an advanced directive and are not traveling with a next of kin, consider bringing your documents with you.

Good idea. Thanks for suggesting it. 

[Tricia724]

11 hours ago, Mary229 said:

I didn't ask you to offer me insurance.  I get insurance just fine from reputable sources and from my own resources.  I am happy to pay my way in life.

 

I think perhaps you have misinterpreted the poster's tongue-in-cheek comment about "not trying to sell you an insurance policy." As an insurance professional, I think his/her point was that the insurance industry regards an individual who is unwilling to fly as someone who  may not be in compliance with their travel policy. Seriously, how are you going to get home from half way around the world without flying. I think that's what the poster was trying to convey.

[Copper10-8]

15 hours ago, boone2 said:

And as one of the nurses involved in a medivac and winched up on to a helo I was more than happy with the professionalism of the USGC. scariest thing I’ve ever done but it cured me of my fear of heights !!

 

Thanks a bunch for your work onboard! This is Jennifer, one of our nurses onboard Maasdam a few years back. She's being hauled up in the basket from Maasie's bow to the hovering USCG Dolphin helo from Coast Guard Air Station Borinquen in Puerto Rico. It was her first time also and she was "just a bit" 😉 anxious. It was all good on the way to and at Borinquen however, because the air crew "were a bunch of good looking guys" 

[boone2]

I feel her pain. My experience was on the MADM too. 

[TiogaCruiser]

My stomach dropped just looking at those pictures 

[boards]

On 3/17/2020 at 7:13 AM, chengkp75 said:

Which insurance carrier?  Medical evacuation at sea is a SAR function, as outlined in the UN's SAR convention, and as such is carried out by national agencies, or in some cases, private firms contracted to national agencies, and at no charge.  As for notifying the patient's insurance that they are being transported to a land hospital, for whatever treatment is covered by the insurance, no, the ship will not do that.

When I was taken off the Noordam in New Caledonia, as of Oct. 1, 2019 it was reported that you had to have medical coverage in order to be taken of a hospital in Noumea.  Some time in process of my being cared for in the ship, the information of my coverage was obtained from my wife, because the next day a form was given me stating that my insurance carrier knew of my condition and had assigned a case number to me.  DW doesn't recalled when it happened because of the concern over me, but it did.  The good news is we were well taken care off by Hal medical staff,, the Port Authority, the hospital and Hal head office,   they contacted us a number of times to enquire of how I was recovering, even when we got home.

[3rdGenCunarder]

On 3/17/2020 at 5:22 PM, RMLincoln said:

  If you have an advanced directive and are not traveling with a next of kin, consider bringing your documents with you.  

 

It is a good idea, but a US document may not meet standards of another country. When my DH was in the hospital in England, he had a few days in ICU. I had a rather morbid conversation with his nurse about end of life decisions, not because I expected to need to make such a decision, but because I wondered if having our advanced directives with us would make a difference in another country. Neither of us was a lawyer, of course, but their end of life decisions are made differently and she wasn't sure US paperwork would overrule their process. 

 

As for the question of insurance, I don't know if I could have made different choices about how to get home. Travelguard was very helpful all the way. They made the plans to get home and it never occurred to me to say "can we do this another way or another day?" We wanted to get home and they made it happen. 

 

[sail7seas]

On 3/15/2020 at 12:19 PM, cbr663 said:

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.  

 

Bingo !

On 3/15/2020 at 12:19 PM, cbr663 said: