Seafarer with hyperactivity disorder on amphetamine

A general practitioner decided that a first-time Scandinavian seafarer with hyperactivity disorder, reasonably well-regulated on dextroamphetamine, was fit for unrestricted work at sea. Carrying amphetamine across US borders is drug smuggling, and when the cruise ship could not supply his medication from local ports, his behaviour became so erratic that he had to be signed off. Doctors providing medical fitness certificates for work at sea must understand the special requirements of seafaring life, know details about medicine use restrictions aboard, and be familiar with international import bans and national prescription regulations for controlled substances

Medical practice during a world cruise: a descriptive epidemiological study of injury and illness among passengers and crew

Study objective: To describe the medical practice of one physician and two nurses during a 106-day westward cruise from Los Angeles to New York in 2004 with an average of 464 passengers (51% women) and 615 crew (22% women) aboard. Methods: Patient data were registered continuously and reviewed after the voyage. Results: There were 4,244 recorded patient contacts (= 40 per day), 2,866 of which directly involved the doctor (= 27 per day). Passengers accounted for 59 % of the doctor consultations, while crew accounted for 59% of the nurse consultations. The most frequent consultation cause was respiratory illness (19%) in passengers and skin disorders (27%) in crew. Among 101 reported injuries (56 passengers, 45 crew) wound was the most common type (passengers 41%, crew 40%). The most frequent accident location for passengers was ashore (27%) and for crew galleys aboard (31%). 133 crew were on sick leave for a total of 271 days, and seven were medically signed off, six of them following injuries. Seven passengers and 13 crew were referred to dentists ashore, five passengers and two crew were referred to medical specialists ashore and returned to the ship, while seven passengers and one crew were hospitalized in port. Conclusion: The medical staff on long voyages will have a busy general practice. Broad experience in emergency and general medicine, good communication skills and previous cruise experience are useful qualifications. While the ACEP PREP may be sufficient for shorter cruises, additional equipment is recommended for long voyages

Referring cruise ship patients to specialists in Norway — a welfare state with a national health care system

Northern Europe is a popular cruise destination, but many non-Scandinavian cruise ship’s doctors who are used to enthusiastic service from specialists ashore, get frustrated when referring passengers or crew to out-patient medical evaluation. Norway’s national health care system is described and used as an example of medical conditions in a welfare state with a relatively well-functioning national health care system: Emergency cases are usually promptly admitted. Out-patient specialist consultations are available in public polyclinics, but waiting time can be considerable, also for patients from ships. Private specialists are fully booked weeks in advance and do not work from Friday to Monday and during holidays. Public and private medical service capacity is significantly reduced during the summer months. Hence, most specialists ashore are not eager to see demanding ship patients. Ship’s doctors should limit referral to conditions that require specific procedures that are not available on the vessel but are necessary for the patient to be able to continue cruising or working aboard. Crewmembers who are unfit for work aboard, should instead be signed off and repatriated for diagnostic work-up and follow-up at home. In cases of hospitalisation or necessary referral ashore, the ship’s doctor should always confer in advance with the company’s ship’s port agents and make necessary shore-side arrangements through them.

Large-scale helicopter rescue of cruise passengers and freighter crew off the coast of Norway in stormy weather

During a storm on the 23rd of March 2019, southbound Viking Sky was crossing the notorious Hustadvika bay off Norway with 1373 (915 passengers, 458 crew) aboard when power was lost and the ship drifted towards the shore. Mayday was called at 14:15. When the dropped anchors caught and one engine had started, the ship was about 100 m from the rocky coast. Helicopter evacuation was started at 15:30, but was slightly delayed around 19:00 when 9 crewmembers from a nearby powerless freighter, Hagland Captain, had to be airlifted to safety. The helicopter rescue from Viking Sky was called off at mid-day on the 24th of March. Using its own engines the ship arrived in Molde at 16:20 with 436 passengers and 458 crewmembers. In all, 479 passengers, many of them elderly and three seriously injured, had been airlifted off the ship one-by-one in rough weather by a relay of 6 helicopters, making this one of the most remarkable helicopter rescue operations ever.

Cruise ship’s doctors — company employees or independent contractors?

Traditionally, cruise companies have stated that they are in the transport business but not in the business of providing medical services to passengers. They have claimed not to be able to supervise or control the ship’s medical personnel and cruise ship’s doctors have therefore mostly been signed on as independent contractors, not employees. A United States court decision from 1988, Barbetta versus S/S Bermuda Star, supported this view and ruled that a ship’s owner cannot be held vicariously liable for the negligence of the ship’s doctor directed at the ship’s passengers. Some years ago a cruise passenger fell and hit his head while boarding a trolley ashore. Hours later he was seen aboard by the ship’s doctor, who sent him to a local hospital. He died 1 week later, and his daughter filed a complaint alleging the cruise company was vicariously liable for the purported negligence of the ship’s doctor and nurse, under actual or apparent agency theories. A United States district court initially dismissed the case, but in November 2014 the United States Court of Appeals for the Eleventh Circuit disagreed and reversed. From then on independently contracted ship’s doctors may be considered de facto employees of the cruise line. The author discusses the employment status of physicians working on cruise ships and reviews arguments for and against the Appellate Court’s decision

Briefing notes on maritime teledermatology

All coastal states must provide telemedical assistance services (TMAS) 24 h a day free of charge to all ships. Skin lesions account for many urgent TMAS consultations, but may be difficult to describe for seafarers without much medical training — and even for medical personnel on cruise ships. By following simple instructions provided in this article, good photographs — taken by digital cameras or smart phones and transmitted by e-mail to TMAS — can compensate for imprecise descriptions. The on-line TMAS physiciancan then easily consult with a dermatologist if necessary. Highly specialised teledermatology services are commercially available for cruise companies. Their ship’s doctors thereby get prompt access to expert medical opinion without the time, logistical issues and costs associated with seeking dermatologic care ashore. Teledermatology allows cruise medical staff to effectively manage skin conditions aboard and limits unnecessary dermatology clinic referrals. For the ships’ medical staff the teledermatology service is also an opportunity for continuous education which may benefit skin patients aboard in the future

Crew referrals to dentists and medical specialists ashore: a descriptive study of practice on three passenger vessels during one year

Study objective - To study crew referrals to out-patient port services from 3 passenger ships during 12 months (2004), with focus on dentist appointments. The median number of crew on Ship A was 561, on Ship B 534 and on Ship C 614. Methods - Crew referrals were registered continuously and after each cruise segment recorded in the ship’s doctor’s medical cruise report, from which the data were retrieved and reviewed. Results - During 2004 the doctors of the 3 sister ships had a total of 8888 crew consultations (Table 1). Mean number of doctor consultations for crew was 17.5 a day. On Ship A 50%, on B 59% and on C 70% of the port referrals were dentist appointments. A crew member was referred to a dentist every 7 (Ship C) to 10 days (Ships A + B). Among the specified dental referrals, 18% were extraction requests. Conclusions - The ship’s doctors had a busy crew practice, but were neither trained nor equipped to do elective dentistry aboard. Crew referral rate to services ashore was low, but 50-70% of the referrals for out-patient port services concerned dentistry. Inadequate health insurance caused low-wage crew to request free extractions instead of expensive repair in high-cost ports. As dentistry in local ports is a poor substitute for the person’s own dentist, doctors performing seafarer examinations should ensure that dental problems are solved before sign-on