Because cruise ships are essentially floating cities, major lines contain infirmaries with staff available 24 hours a day to care for passengers. These facilities are typically equipped to treat only minor nonemergency conditions. You can get seasickness tablets for free, for example, or standard over-the-counter meds for an upset stomach or cold symptoms, for a fee.
But if your illness is serious or you find yourself needing emergency treatment, you'll be referred to a facility on land and disembarked to get care. Make sure you have up-to-date insurance and any contact information for your carrier and primary care physician available, in case you're faced with an emergency.
Here's a look at what to expect if you get sick at sea.
Services, Equipment and Treatments
Pharmacy stocks are available onboard, which means you will be able to get basic medicines. The size of the inventory varies by ship, but staff will be able to provide you with antibiotics, seasickness pills (often complimentary), aspirin and other common medicines. The pharmacy stocks typically will include medications for gastro-intestinal and cardiovascular issues; respiratory problems; infectious diseases; eyes; ears, noses and throats; and urinary tract, as well as vaccines. The cost of these meds will be more than if you shopped at Walgreen's in your hometown but about the same as getting off the ship and buying them in port.
If you're injured or become ill, you might need to visit the ship's infirmary. The facility typically is located on a lower deck. The medical center generally will have regular hours, but staff are on call 24 hours for emergencies. The facility contains several beds and is set up to treat minor nonemergency conditions or to stabilize passengers facing life-threatening conditions. Ship doctors and nurses are most likely to deal with passengers suffering from respiratory (influenza) or gastrointestinal (Norovirus) illnesses, motion sickness or injuries, the World Health Organization says.
The U.S. Centers for Disease Control and Prevention says ship infirmary capabilities vary depending on size, length of sailing and passenger demographics. The CDC compares shipboard facilities to ambulatory care centers. Staff are expected to provide emergency medical care for passengers and crew; stabilize patients and perform reasonable diagnostic and therapeutic interventions; and help evacuate seriously sick or injured patients.
Cruise Line International Association, the world's largest cruise industry trade organization, sets standards of care for its member cruise lines. Ship facilities must adhere to the American College of Emergency Physicians guidelines, which outline the necessary qualifications for medical personnel onboard ships.
The ACEP guidelines dictate that the infirmary must contain the proper equipment to handle a range of treatments and diagnostics. Among its equipment, the facility should have wheelchairs, a stretcher, back board for spine immobilization, lab capabilities for tests, oxygen, EKG capability, two defibrillators, cardiac monitors and other equipment to gauge vital signs.
Medical Staff and Training
Ships from the main cruise lines all will have at least one doctor and two nurses onboard. Many larger ships sail with two doctors and three or four nurses. According to American College of Emergency Physician guidelines, ships must have medical staff on call 24 hours. Medical personnel (both physicians and registered nurses) must have at least three years of post-graduate experience in general and emergency medicine or board certification in emergency medicine, family medicine or internal medicine.
To get an idea of the staff's credentials, consider that Carnival Cruise Lines, the world's largest line, requires that its physicians be registered in the United States, United Kingdom, Canada, Australia, New Zealand, Ireland, South Africa, a European Union country or any other country approved by the fleet medical director. Medical personnel also must have completed the required number of years of training in a recognized school of medicine.
The staff will be able to perform advanced life support practices, emergency cardiovascular care and minor surgical procedures. Doctors and nurses also are required to be fluent in the predominant language of the ship.
Cruise ship policies dictate that if you feel like you might be getting sick or have signs of a serious ailment, such as vomiting or diarrhea, you must tell the ship's medical staff immediately. Passengers can be restricted to their staterooms if the ship's physician decides their illness poses a risk of outbreak. Cruise lines are especially wary of influenza or Norovirus (gastrointestinal illness), which can quickly spread.
If Norovirus is suspected, crew will enact measures to isolate you from other passengers. You will be told that you must remain in your cabin, and your keycard will be deactivated to discourage you from attempting to leave. The quarantine is not just a suggestion; the lines take this seriously. Cruise lines' guest conduct policies outline consequences for not adhering to the conditions -- security staff or law enforcement may intervene, or you could be banned from cruising with the line in the future.
When under quarantine, you typically will be required to remain in your room and take all your meals there until you are symptom free for 72 hours. Crew will bring you meals, drinks and anti-nausea medication, but you are not to leave, even if you're feeling better.
You expect that you'll be able to get assistance and relief onboard when you have a cold or are battling a bout of seasickness. But what if a life-threatening injury or illness, such as a serious fall or heart attack, occurs? How capable are cruise ships of handling these scary situations?
Cruise line policies outline conditions under which passengers could be medically disembarked. The ship's medical staff owns the discretion to determine whether a passenger is unfit to continue on a sailing. Cruisers will be disembarked if they are in a condition "likely to endanger health or safety," according to MSC Cruises' conditions of travel, for example. Cruise doctors can make arrangements to have passengers transferred to a health facility at any port, at the passengers' expense.
In dire cases, a patient might need urgent care that can't be administered onboard. You might have noticed your cruise ship's helicopter landing area. Sometimes the only option is to evacuate a passenger by helicopter for transportation to a shoreside medical facility. (This is often the Coast Guard in the U.S. and sometimes a foreign military when you're overseas.) This is typically reserved for only the most critical cases because a chopper evacuation can put the patient under added physical and emotional stress. The medevac units are staffed by medics who are expertly trained in emergency treatment.
Some cruise lines also utilize telemedicine to assist patients. The technology allows physicians to connect to shore to access specialists and data that can help treat patients onboard.
Oh, and about that matter of the cost. When you get sick or worse and need treatment or emergency services, you will pay for it. Travel insurance can help mitigate the costs and alleviate any worries you have before starting your cruise.
If you receive treatment or medicine from ship physicians, the cost will be charged to your cabin folio. You would then file a claim with your personal insurance carrier to recoup what's covered by your health policy. Travel insurance, which usually costs between 5 percent and 8 percent of the total cost of the trip, would cover the rest. In addition to medical costs, you can buy insurance policies that cover a wide range of trip interruption and cancellation situations, as well as evacuation.
This type of policy comes in particularly handy if an expensive emergency procedure, such as evacuation from the ship and a hospital stay in a foreign port, is necessary. Also consider that transportation to a full-service hospital from a remote cruise location like Greenland or Antarctica can be extremely costly.
--By John Roberts, Cruise Critic contributor