This Policy Resource and Education Paper is an explication of the Policy Statement Health Care Guidelines for Cruise Ship Medical Facilities.

Revised January 2010

The specific medical needs of a cruise ship are dependent on variables such as: ship size, itinerary, anticipated patient mix, anticipated number of patients' visits, etc. These factors will modify the applicability of these guidelines especially with regards to staffing, medical equipment and the ships' formulary.

Medical care on cruise ships would be enhanced by ensuring that cruise ships have:

1. A ship medical centre with medical staff (physicians and registered nurses) on call 24 hours per day, examination and treatment areas and an inpatient medical holding unit adequate for the size of the ship. A medical centre with adequate space for diagnosis and treatment of passengers and crew with 360° patient accessibility around all beds / stretchers and adequate space for storage.

   • One examination / stabilization room per ship
   • One ICU room per ship
   • Minimum number inpatient beds of one bed per1000 passengers and crew
   • Isolation room or the capability to provide isolation of patients
   • Access by wheelchairs / stretchers
   • Wheelchair accessible toilet on all new builds delivered after January 1, 1997
   • A contingency medical plan defining:
     • One or more locations on the ship that should:
       • be in a different fire zone (from the primary medical centre)
       • be easily accessible
       • have lighting and power supply on the emergency system.
     • Portable medical equipment and supplies including:
       • Documentation and planning material
       • Medical waste and personal protective equipment
       • Airway equipment, oxygen and supplies
       • IV Fluids and supplies
       • Immobilization equipment and supplies
       • Diagnostic and laboratory supplies
       • Dressings
       • Treatment - medications and supplies
       • Defibrillator and supplies
     • Communication equipment for each member of the medical staff
     • A clear procedure in case the primary medical space cannot be used
     • Crew assigned to assist the medial staff
       

2. Medical staff who have undergone a credentialing process to verify the following qualifications:

   • Current physician or registered nurse licensure

   • Three years of post-graduate / post-registration clinical practice in general and emergency medicine

     OR

   • Board certification in:
     • Emergency Medicine or
     • Family Practice or
     • Internal Medicine
   • Competent skill level in advanced life support and cardiac care.
   • Physicians with minor surgical skills (i.e. suturing, I&D abscesses, etc)
   • Fluent in the official language of the cruise line, the ship and that of most passengers
     

3. A medical record and communication system that provides:

   • Well organized, legible and consistent documentation of all medical care
   • Patient confidentiality
     

4. Emergency medical equipment, medications and procedures:

   • Equipment:
     • Airway equipment - bag valve mask, ET tubes, stylet, lubricant vasoconstrictor, suction equipment (portable)
     • Cardiac monitor and back-up monitor (2)
     • Defibrillators, two (2) portable, one of which may be semi automatic
     • External cardiac pacing capability
     • Electrocardiograph
     • Infusion pump
     • Pulse oximeter
     • Nebulizer
     • Automatic or manual respiratory support equipment
     • Oxygen (including portable oxygen)
     • Wheelchair
     • Stair chair and stretcher
     • Refrigerator / Freezer
     • Long and short back boards cervical spine immobilization capabilities
     • Trauma cart supplies

   • Medications
     Emergency medications and supplies for management of common medical emergencies, to include:

     • Thrombolytics and sufficient quantities of advanced life support medications, in accordance with international ALS guidelines, for the management of two complex cardiac arrests
     • Gastro-intestinal system medications
     • Cardiovascular system medications
     • Respiratory system medications
     • Central nervous system
     • Infectious disease medications
     • Endocrine system medication
     • Obstetrics, gynaecology and urinary tract disorder medications
     • Musculoskeletal and joint disease medications
     • Eye medications
     • Ear, nose and oropharynx medications
     • Skin disease medications
     • Immunological products and vaccines
     • Anaesthesia medications
   • Procedures
     • Medical operations manual as required by international safety management code
     • Medical staff orientation to the medical centre
     • Maintenance for all medical equipment as recommended by manufacturer
     • Code team trained and updated regularly
     • Mock code and contingency medical plan drills on a recurrent basis and as recommended by ships' physician
     • Emergency preparedness plan as required by the international safety management code
     • Internal and external audits
       

5. Basic laboratory and X-ray capabilities

   1. Haemoglobin / haematocrit estimations, urinalysis, pregnancy tests, blood glucose (all with quality control program as recommended by the manufacturer)
   2. X-ray machine for new builds delivered after January 1, 1997
      

6. A process whereby passengers (prior to embarkation) are requested to provide information regarding any medical needs that may require medical care on board. (FYI-ACEP Board)

7. A TB screening program every two (biannually) years for all medical personnel

8. Each ship will carry a minimum of two (2) sexual assault evidence collection kits