Fighting sickness at sea
Mark and Sue Brady had just sailed from Fort Lauderdale, Fla., on a holiday cruise with their daughter and her husband, granddaughters and their son-in-law’s parents when the unthinkable happened: Mark, 58, had a seizure.
“The medical staff was there quickly and took him to the infirmary,” Sue Brady recalls. “The doctor there said the best thing to do was for the ship to turn around and take him back to Fort Lauderdale – we were only an hour and a half out of port – but the captain said no. We couldn’t get off until the next morning.”
Fortunately, the Bradys had taken out travel insurance with Travel Guard, which made arrangements to get Mark to a shoreside hospital. A helicopter flew him and Sue to Eleuthera, where a Lear Jet air ambulance took them on to a Fort Lauderdale hospital. He recovered quickly.
Most medical problems at sea aren’t as serious – or as expensive. But getting sick on a cruise ship can happen to anyone.
The most publicized at-sea ailment is norovirus, a stomach flu that can spread quickly. To avoid that, cruise lines have instituted comprehensive cleaning policies.
“We have a color-coded, three-step process,” says Vince Warger, director of medical services for Royal Caribbean and Celebrity cruise lines.
“Green is our standard operating procedures – cleaning of cabins twice a day, wiping down handrails, etc.,” he explains.
“Yellow requires more enhanced cleaning and curtailing of certain activities. We may stop passengers from using tongs at the buffet and have only kitchen staff serve guests. We discourage hand-shaking, which is the most common way the virus is transmitted.
“Code Red means even more cleaning, more frequent curtailments.”
Frequent hand-washing with soap and water is the best preventative measure against norovirus, Warger says.
“Hand-sanitizing stations are not a substitute,” he emphasizes.
Passengers who contract norovirus – or any other infectious malady – may be confined to their cabins in order to prevent its spread to other passengers and crew.
One reason norovirus is a problem is that passengers bring the disease with them.
“People say they get sick on ship, but actually many get sick while traveling to the ship by plane or car,” says Steve Williams, director of medical operations for Carnival Cruise Lines.
Carnival’s embarkation staff is trained to recognize sick people and hopefully intercept them before they get on board, Williams says: “If we do, we give them a refund and send them home.”
The cruise line may also help such passengers with travel expenses or may offer to reschedule a cruise.
Royal Caribbean has a similar policy. NCL says if embarking passengers show visible gastrointestinal symptoms, it gives them three options: sail but stay in their cabin for 24 hours, meet the ship at the next port of call or cancel the cruise and receive a future cruise credit certificate.
Onboard medicine has come a long way since the days when some ship doctors couldn’t speak English and infirmary facilities were minimal.
Today, cruise lines belonging to the Cruise Line Industry Association – all the major lines – adhere to American College of Emergency Physicians guidelines.
That means doctors must be board certified or the international equivalent and on ships serving the U.S. market, they must speak English. Medical facilities and equipment also have to meet certain standards.
“Our on-board capabilities often exceed that of smaller communities,” says Michael Crye, executive vice president of CLIA.
Required equipment includes X-rays, defibrillators and electrocardiographs. An important factor is the capability to consult land-based experts via telephone and/or Internet.
Royal Caribbean, for example, has 24/7 consultation with two landside medical centers: Jackson Memorial Hospital and the Cleveland Clinic. Decisions to evacuate a patient are taken in consultation with shoreside doctors.
Consultations also help determine patient treatment aboard. When a recent guest who had had eye surgery developed problems, Williams says, the ship doctor had photos taken of the afflicted eye and transmitted it to the guest’s shoreside physician.
While ship doctors can treat minor illnesses such as seasickness, colds, norovirus and even broken bones on board, they cannot handle serious illnesses such as heart attacks and strokes. In those cases, they stabilize patients with emergency treatment and ready them for evacuation to a shoreside hospital.
“Cardiovascular cases are the No. 1 reason we evacuate, followed by bleeding gastroenteritis and traumatic injuries,” says Williams.
Evacuations may take place at the next port of call, or in life-or-death cases, the afflicted person may be taken off the ship by helicopter. Warger cites a recent case where a sick passenger was transferred to a U.S. Navy ship that had helicopters with longer range and refueling-in-air capability.
Medical evacuation is expensive and is not covered by ordinary health insurance. From a cruise ship in the Caribbean back to a city in the United States, the cost may run $10,000 to $15,000 or more. From remote locales or in particularly complicated cases, the cost can exceed $100,000. That’s why travel insurance that offers evacuation coverage is a good idea, as the Bradys learned.
“It was the first time we had ever taken out travel insurance. We never thought our health would be a problem,” Sue Brady says.
Travel Guard paid for the evacuation, hospital and hotel stay in Fort Lauderdale, meals, clothes they had to buy – even $200 to have their luggage shipped from the ship to their home in Denver.
The total ran to $16,600, not including what their regular health insurance covered.
Passengers should choose their travel insurance carefully. Make sure payment limits are sufficient to satisfy possible costs. Know that Medicare and some other health plans do not cover medical treatment out of the country. Be sure your policy covers problems incurred ashore as well as on board.
Air ambulances and other emergency services require payment up front, so policies that cover medical evacuation should provide for that. Otherwise, patients or their families have to come up with a large amount of money before they can be evacuated, a daunting task even if they will be reimbursed later.
Prospective passengers also should know that cruise lines will not board persons with certain medical problems, including infectious diseases and pregnant women in their third trimester.
Passengers with some chronic conditions, however, can be accommodated. Commercial companies such as Dialysis at Sea can arrange to service dialysis patients on board.
In any case, patients with medical problems should consult with their personal physician first and have him call the cruise line, Warger advises. Indeed, to avoid disappointment, anyone with substantive medical issues should discuss them with the cruise line before booking passage.
That said, it’s comforting to know that the vast majority of passengers never experience any ailment on their cruise, with the possible exception of a hangover.
But that’s another story.