Cruise-ship medical problems were thrust into the public eye the past 18 months when a nasty stomach virus sickened several thousand passengers on various ships. However, the Centers for...

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Cruise-ship medical problems were thrust into the public eye the past 18 months when a nasty stomach virus sickened several thousand passengers on various ships.

However, the Centers for Disease Control and Prevention gives the industry high marks for handling the crisis quickly and for improving the state of shipboard medical care during the past 10 years.

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“The industry response was phenomenal,” says David Forney, chief of the Atlanta-based federal agency’s vessel-sanitation program, of the cruise lines’ fight against the norovirus, a widespread ailment that is easily contagious in close quarters such as ships.

But what about medical care, where viruses or bacteria don’t play a role? What happens, for example, if a passenger suddenly has a heart attack during dinner or during a vigorous game of shuffleboard on deck?


More information: See the U.S. Centers for Disease Control Web site,

Technically, there is no U.S. oversight for medical care aboard cruise ships because virtually all the major cruise lines are foreign-flagged — registered outside the United States.

However, both the CDC and the U.S. Coast Guard play key roles in ensuring passenger health and keeping potentially contagious diseases from reaching U.S. shores.

The Coast Guard works with the cruise industry to evacuate the sickest passengers by helicopter to nearby medical facilities, whenever possible, while the CDC conducts two unannounced inspections annually to evaluate food and water safety on ships, issuing sanitation ratings to each vessel.

“The most common symptom for many (shipboard) illnesses is gastrointestinal distress,” Forney says. “And the major outbreaks are usually caused by problems with food or water.”

The CDC requires all ships carrying more than 13 passengers from a foreign port to a U.S. port to file a report on any gastrointestinal illness onboard.

“Every time the Disney Magic comes back to Florida, it must report to us within 24 hours on every gastrointestinal case, even if the number is zero,” Forney says. Such information gives the agency a handle on potential outbreaks. Beyond infectious diseases or food-borne illness, however, the industry has improved shipboard medical care since the mid-1990s.

“Yes, a cruise ship could go out without a doctor onboard,” but that’s highly unlikely, says Angela Plott, vice president of the International Council of Cruise Lines, an industry trade group that represents 15 major cruise lines.

Linked informally to the Texas-based American College of Emergency Physicians, the industry strives to meet or exceed the college’s guidelines for shipboard medical care and the medical equipment on hand. Plott says the council and the emergency-physician group recommend, for every 1,000 passengers, there be at least one physician onboard, with that number rising based on passenger count, the demographic makeup of passengers and the length of a cruise.

“When cruise lines first started, they used to be staffed largely by a bunch of medical retirees, and the ships were small and didn’t go that far,” says Arthur Diskin, medical director for Carnival Cruise Lines and chairman of the emergency department at Mount Sinai Medical Center in Miami.

But in recent years, increasing numbers of emergency physicians have taken a more active role in cruise-ship medicine, many becoming medical directors who “began pushing the level of care on ships,” he says Among the improvements:

Requirements for medical personnel. Doctors must have a minimum three years’ post-medical-school experience, with a defined set of medical skills.

Teleradiology. The ability to transmit X-rays digitally to onshore medical personnel for consultation with the ease of an electronic e-mail.

Larger drug selections, including lifesaving clot-busters for heart disease called thrombolytics, and drugs for a far wider range of illnesses than in the past.

Defibrillators that can shock the heart back into rhythm. Michael Sheehan, a spokesman for Royal Caribbean Cruise Line, said the cruise line routinely places defibrillators outside its medical infirmaries, such as at the purser’s desk, so that “someone having a cardiac episode can get help fast.”