When the last suitcase is packed and all of the pre-boarding forms have been filled out, it's time to relax and anticipate your upcoming cruise so long in the planning. It probably doesn't enter your mind, though, that you could get sick at sea. Trust me -- it's a fact of life, and it could happen to you.
An unexpected medical crisis can turn that dream trip into a nightmare. Not long after boarding Silversea's Silver Shadow in Dublin for a long-awaited transatlantic cruise to New York, my husband developed chest pains. It was a recurrence of angina he'd first suffered some 23 years earlier. (And it was 21 years after bypass surgery.)
I immediately called the ship's medical center and explained his history and symptoms. Within minutes, a nurse arrived with a wheelchair to accompany us to the center. The ship's doctor conducted tests and took blood during the quite thorough exam. While some of the symptoms had abated, the doctor explained he would be checked into a landside hospital at the next port of call -- which happened to be Torshavn, in the Faroe Islands.
In my mind, I expected we'd eschew the planned shore excursion for a quick hospital visit, and then get back onboard. But, while cruise ship medical facilities are increasingly sophisticated, the onboard physician opted to keep my husband in the hospital. We were told to pack up completely and prepare to disembark. We wound up spending a full week in Torshavn!
All cruise ships have some kind of medical facility onboard to treat mostly nonserious maladies, from broken bones and seasickness to sun overexposure and respiratory ailments. Indeed, as cruise ships have grown in size, many have invested seriously in creating medical facilities that could (almost) rival those on land. On NCL ships, for instance, the line says that its onboard facilities are equipped to handle everything "from thrombolyic therapy to X-ray." Some Holland America ships have digital radiology capabilities that enable doctors to send X-rays to the University of Texas Medical Branch, the company's land partner, in extremely complicated situations.
And, just as equipment and facilities have evolved, so too has medical care itself. Those cruise lines that are part of Cruise Lines International Association -- which includes all of the majors -- agree to follow healthcare guidelines, based on requirements set by the American College of Emergency Physicians (ACEP).
Still, there are some illnesses that, in most cases, cruise ships won't treat -- serious heart problems and strokes are right up there -- so it's a good idea to be prepared before you even leave home.
The following roundup offers details, cruise line by cruise line, about what you should expect. Before we get started, however, let me share some tips from my experience:
The ship's doctor is the boss. If he feels you should disembark for treatment, that's it. The cruise is over.
A lot of folks are under the misperception that their regular travel insurance will cover expenses on trips outside the U.S. You'd better clarify that before you head out of the country. Medicare doesn't cover medical emergencies outside American borders, and most health insurance policies don't offer medical evacuation at all. Even scarier, if medical evacuation is required, you should know that it's rarely a covered expense. (And it's not cheap. The cost of an air ambulance can run from $10,000 to $25,000!) The solution? Buy travel insurance that covers health-related issues, as well. For U.K. travellers, it's a lot simpler -- insurance policies will cover cruise holidays like they would cover land-based trips, and medical emergencies and repatriation expenses are usually part of each policy. Just be sure you have comprehensive cover, and check the excess you have to pay -- on medical claims, the excess can range from around £50 up to £250.
Newer vessels, such as Royal Caribbean's innovative Oasis of the Seas and the Freedom-class vessels, have helicopter pads just for the purpose of medical evacuations, but I have seen other patients evacuated from the top decks of cruise ships. It is definitely more stressful, dangerous and difficult.
Read the fine print in your cruise documents, and make sure you understand what your financial responsibility may be.
Because of guidelines created within the cruise industry in 2000, ships are now more prepared to treat situations like the one my husband faced. Telemedicine keeps heart patients in touch with a land-based physician so that more than one expert treats the patient.
Let the line know if you have a pre-existing condition. Have high blood pressure and need a low-salt diet? Are you diabetic? Need to carry oxygen with you? Use a wheelchair? Cruising in far-off waters calls for honesty with the carrier.
Even with more sophisticated facilities, most cruise lines will not accept pregnant women in their last trimesters -- check with your line of choice before booking.
Most medical centers schedule daily office hours when the doctor sees patients, and all offer 24-hour emergency service. Ship's daily newspapers print hours when doctors see patients. Costs per visit vary from $45 to $60.
Medical care is in no way impacted by the registry of the vessel. In other words, whether the ship is registered in Panama, the Bahamas or the U.K., medical care of passengers falls under ACEP guidelines and has no connection to the ship's flag.
Among those with outstanding facilities are the large vessels of Holland America Line, Princess Cruises, Royal Caribbean and Celebrity. Technology is state-of-the-art, and telemedicine is a modern-day tool, offering consulting availability when one or two doctors (most usually one) are treating patients alone at sea.
It is a safe assumption that the newer the vessel, the more modern and comprehensive the medical facilities will be. Royal Caribbean claims that Oasis of the Seas has the most modern medical facilities at sea -- it is equipped to handle cardiac problems, there is a compact laboratory for better diagnostics, and it has a digital X-ray machine.
Many ships -- particularly newer, bigger models -- actually have small hospital-like units onboard; among those are Princess' Grand-class ships and Crystal's Symphony and Serenity.
Here's our guide to medical centers at sea:
Azamara Club Cruises
The Basics: Medical centers on all Azamara Club Cruises ships are staffed by one fully qualified medical doctor and two registered nurses. There is no helipad on either ship.
Medical Training: Doctors and nurses meet or exceed guidelines established by the American College of Emergency Physicians (ACEP), including, but not limited to, a credentialing process to verify current physician or registered nurse licensing and three years of post-graduate/post-registration clinical practice in general and emergency medicine -- or board certification in emergency medicine, family practice or internal medicine. Medical staff must also have skills in life support and cardiac care and be fluent in English (and/or the predominant language of the respective ship guests).
Hours: Set office hours are offered in addition to the availability of 24-hour emergency services.
Additional Equipment: All ships have 24/7 professional medical consultations available through affiliation with The Cleveland Clinic (Weston, Florida).
Medical Training: Each doctor is required to have a current and valid license from the U.S., one of its territories or Canada, or have full registration with the British General Medical Council of the United Kingdom or other European Union member country, Australia, New Zealand or South Africa.
Hours: 8 a.m. until 8 p.m.; patient visits to doctor 9 until 11 a.m., 3 until 6 p.m. Emergency service is available 24 hours a day.
Additional Equipment: Standard lifesaving equipment like defibrillators, 12 lead EKG machines, external pacemakers and ventilators are available. Infirmaries carry the latest medical technology, including fibrinolytic therapy and clinical testing equipment for measuring cardiac enzymes. X-ray machines are available on all ships built after 1997. Teleradiology systems on Carnival Spirit (built in 2001) and vessels built after it feature the means to digitally transmit X-rays and other patient information shoreside for consultation.
The Basics: Medical centers on each Celebrity ship are staffed by two fully qualified doctors and three registered nurses.
Medical Training: Medical staff meet ACEP guidelines and have been credentialed to verify current physician or registered nurse licensing. Also required are three years of post-graduate/post-registration clinical practice in general and emergency medicine -- or a board certification in emergency medicine, family practice or internal medicine. Medical staffers must also have skills in life support and cardiac care. Staff must be fluent in English.
Hours: Set office hours are offered in addition to 24-hour emergency services.
Additional Equipment: All ships have 24/7 professional medical consultations available through affiliation with The Cleveland Clinic (Weston, Florida). Helipads for medical evacuation are available on Celebrity Century and the line's Millennium- and Solstice-class ships.
Basics: A trained physician and nurses are on call 24 hours a day.
Medical Training: Doctors are professionally trained in Europe and speak English.
Hours: The medical center is open and manned by the nurse on duty from 8 a.m. until noon and from 3 until 4 p.m. Doctor's consultation hours are 9 until 10 a.m. and 5 until 6 p.m. A nurse is on duty for 24-hour emergencies.
Additional Equipment: Each ship has X-ray capabilities, an electrocardiograph, ventilators or respirators, anesthesia, a reflotron lab machine and cardiac monitoring. The medical facilities onboard also have hospital-like wards available.
The Basics:QM2 and Queen Victoria each have two doctors, four nurses and one medical technician onboard. Cunard claims that QM2 has the largest medical facility at sea.
Medical Training: All doctors and nurses are registered in the U.K.
Hours: Ships have regular office hours twice daily, but patients are seen 24/7 for emergencies.
Additional Equipment: There are three well-equipped Critical Care Units in addition to regular hospital beds. Teleradiology, which allows all X-rays to be sent via satellite and reported on by consultant radiologists, is a standard feature on both ships.
Disney Cruise Line
The Basics: A physician and a nurse provide services on Disney ships.
Medical Training: Staff meet or exceed the guidelines adopted by ACEP, have recent general medical and emergency medical experience and are certified in advanced cardiac life support.
Hours: Medical staff are on call 24 hours a day, while the onboard medical center has daily operating hours.
Additional Equipment: Each ship's facility is equipped with a portable ventilator and two cardiac monitoring machines; these include external pacemakers and pulse oximeters in addition to EKG capabilities. Ships are also outfitted with five advanced cardiac life support stations and six automatic external defibrillators. Disney Wonder has digital X-ray capabilities.
The Basics:Fred. Olsen has one doctor and two nurses onboard each ship.
Medical Training: Doctors have at least three years post-graduate experience from general practice and emergency medicine background. All staff are trained in advanced life support.
Hours: Office hours are 8 a.m. to 11 a.m. and 5 p.m. to 7 p.m, with 24-hour on-call doctor and nurses.
Additional Equipment: Fully equipped medical centers are capable of handling defibrillation, external pacing, pulse oxymetry, near-patient blood tests including reflatron diagnostics, and thrombolysis. An ECG machine, 24-hour telemedicine for ECG, and backup shoreside access to medical advice 24 hours a day are also available.
Medical Training:HAL hires physicians and nurses from the U.S. and Canada. Physicians must have at least three years of post-graduate work in the field of emergency diseases or similar specialties.
Hours: Office hours are scheduled daily; emergency 24-hour service is available.
Additional Equipment: Holland America uses telemedicine connections with the University of Texas Medical Branch in Galveston and has the ability of live feed for radiology and consultations (and the capability to consult via e-mail, phone and fax, as well).
The Basics: Staff consists of a surgeon/general practitioner and two nurses selected from European hospitals.
Medical Training:MSC doctors are European and are selected by recruiting agencies directly from the main city hospitals where they live and practice; all speak English. Nurses have experience in first aid, and in the U.S., they are also qualified in basic pediatrics.
Hours: Medical center hours -- in all ports and at sea -- are from 8 a.m. until noon and from 4 until 8 p.m. (doctor attending or on call for all these hours). The only variations are for island calls (like Cayo Levantado), where medical staff set up a facility on the beach. In these cases, the ship's medical center remains open for passengers still onboard.
Additional Equipment: Emergency assistance is available 24 hours a day.
Norwegian Cruise Line
The Basics: The number of doctors and nurses is dependent upon the size of the vessel.
Medical Training:NCL meets or exceeds ACEP medical guidelines.
Hours: There are set office hours, plus 24-hour emergency services.
Additional Equipment: The line also has facilities to handle things like trombolyic therapy and X-rays.
The Basics: There are one doctor and one nurse per ship.
Medical Training: ACEP guidelines are utilized. Doctors are international.
Hours: Daily hours vary, but medical staff is available 24 hours a day.
Additional Equipment: Ships feature full operating rooms, which may be used in extreme emergencies.
The Basics: All ships carry two doctors, three or four nurses and a medical technician. (Artemis carries just one doctor and two nurses.)
Medical Training: All staff have a minimum of three years post-registration experience in acute specialties, such as Emergency Medicine, Intensive Care/Anaesthetics, Acute Medical Admissions or General Practice. All are registered in the U.K. with the appropriate body or an equivalent recognized by the GMC/NMC. All are fully trained in resuscitation procedures as per the U.K. Resuscitation Council or recognized overseas equivalent, such as the American Heart Association.
Hours: The clinic is open for two hours in the morning and two hours in the evening. There is 24-hour access to emergency care if needed.
Additional Equipment: Ships have full noninvasive intensive-care capabilities, including intubation and ventilation if required. They carry full pharmacies of medication to treat a wide range of medical conditions. They have full monitoring and defibrillation capabilities. All ships have well-equipped laboratories with the capability to provide a wide range of blood investigations and other tests.
The Basics: The number of medical staff onboard depends upon the size of the vessel and ranges from one doctor and two nurses to two doctors and five nurses.
Medical Training: All doctors have at least three years of post-graduate medical training experience in primary care, minor surgery, and emergency medical and cardiac care. All medical staff onboard are certified in Advanced Cardiac Life Support, and at least one doctor on every ship is also certified in Advanced Trauma Life Support. Shipboard medical staffmembers are British-registered and fluent in English.
Hours: Twice-daily office hours are offered, plus medical staff are on call 24 hours a day and can be reached via the ship's emergency telephone number.
Additional Equipment:Princess pioneered the use of telemedicine on ships and uses Automatic External Defibrillators (AED) to treat sudden cardiac arrest. The medical facilities on Grand-class ships also have hospital-like wards available.
Regent Seven Seas Cruises
The Basics: Typically one doctor and one nurse staff a ship.
Medical Training: Doctors are in accord with ACEP guidelines, and most are certified in the U.S. Larger ships include an operating room. Doctors can perform minor surgery in case of an emergency, though in most situations, guests are evacuated at the earliest opportunity to shoreside hospitals.
Hours: Daily consulting hours and 24-hour emergency services are available.
Additional Equipment: Facilities are stocked with cardiac monitors, electrocardiograph machines, trauma supplies, primary backup defibrillators, pulse oximeters, oxygen, an intensive-care unit and a microscope computer-controlled pharmacy.
The Basics: Medical centers on all Royal Caribbean ships are staffed with a minimum of two fully qualified medical doctors and three registered nurses. Oasis-class ships have a complement of three doctors, five nurses and one medical secretary.
Medical Training: Staff meet ACEP guidelines and have been credentialed to verify current physician or registered nurse licensing. Also required are three years of post-graduate/post-registration clinical practice in general and emergency medicine -- or board certification in emergency medicine, family practice or internal medicine. Medical staffers must also have skills in life support and cardiac care. Staff must be fluent in English.
Hours: Set office hours, plus 24-hour emergency services, are available.
Additional Equipment: All ships have 24/7 professional medical consultations available through affiliation with The Cleveland Clinic (Weston, Florida). Helipads for medical evacuation are available on all of the line's Radiance-, Voyager-, Freedom- and Oasis-class ships.
The Basics: Each ship is staffed with one physician and one nurse.
Medical Training: Medical centers are in compliance with ACEP. Most doctors hail from Europe.
Hours: Hours are posted daily, and emergency assistance is available 24 hours a day.
The Basics: Ships are staffed with one doctor and one nurse apiece.
Medical Training: Centers are in line with ACEP guidelines. Physicians are generally European.
Hours: The medical center is open for walk-in patients during specified daytime hours, and staff is on call 24 hours a day.
--by Marcia Levin, Cruise Critic contributor. Updated by Kelly Ranson, U.K. Editor.