What Happens If You Go Into Atrial Fibrillation On A Cruise?

This question popped into my head as I was talking to a patient (we’ll call her Barb)  who has paroxysmal atrial fibrillation (PAF) and was about to embark on a 17 day cruise from San Diego through the Panama Canal and on to Fort Lauderdale.

Screen Shot 2016-04-11 at 6.12.04 PM
The recording I pulled up shows atrial fibrillation going at a rapid rate.

On a rainy Sunday afternoon while watching the Cardinals pummel the Braves, I had logged onto my AliveCor account to pull up some office patient recordings I had made earlier in the week when I noticed that Barb had made a recording the day before which was interpreted as atrial fibrillation at a rate of 133 beats per minute. I had heretofore been aware that she was having  recurrent episodes of PAF and so I called her and found out she was in San Diego.

At her last office visit in early March she was in normal rhythm as usual but reported having spells of palpitations, usually at night. We discussed various monitoring methods and I demonstrated the Alivecor device to her. She purchased one and had been making recordings but had not let me know that some of them were showing atrial fibrillation.

Fortunately, she was on the blood thinner Eliquis and  was protected against clots in the heart or stroke but I was worried that she might go into Afib on the cruise, persist in it and develop problems.

What, I wondered, would the cruise ship crew or doctor do in that situation?

Would  they be capable of even monitoring my patient’s heart rhythm or would the AliveCor Mobile ECG device she had on her smart phone be the best monitor on the ship?

Are there any medications, like beta-blockers available that could be given to slow the heart rate?

I’m still waiting for the answer to the questions.

What Do We Know About Medical Care on Cruise Ships?

No so much.

Consumer Reports has an informative  article entitled:  “What you need to know about medical care on cruise ships.”

The middle four items are relevant to any cardiac issue:

“-Cruise ships aren’t hospitals

Many ships have a doctor on board who is trained in emergency medicine—but not all of them. According to international maritime law, they aren’t required to; a crew member with medical training is sufficient, says Ross Klein, Ph.D., author of “Paradise Lost at Sea: Rethinking Cruise Vacations.” The medical facilities are generally more like an infirmary or walk-in care clinic than a “floating” hospital. You might find a ventilator and a small X-ray machine and the doctor may be able to perform simple laboratory tests to check for infection or electrolyte or blood sugar levels. But there’s no MRI or CT scanner, intensive care unit, or blood bank (although the crew has usually been blood-typed and may be asked to serve as donors if a passenger needs a transfusion).

– In an emergency, you may be on your own

. You probably could get basic treatment, such as stitches or IV fluids, but for anything serious, there’s a very good chance that you will have to disembark at the next port of call—whether you want to or not. It’s up to the ship’s medical personnel, not you, to decide, You’d be treated at a local hospital, and the ones in more remote areas may not have the same standards of medical care or facilities available in the U.S. And once you recovered, you’d have to arrange another way to get back home.

What if you have a heart attack or develop appendicitis miles from dry land? Don’t assume the Coast Guard will airlift you out. Bad weather can make flying a helicopter dangerous, and the Coast Guard isn’t obligated to take that risk. Even in calm waters, if the ship is 500 miles or more away from shore, it’s unlikely that the Coast Guard will respond, Klein said.

-Get ready for sticker shock

Check with your health insurance company before you set sail to be sure, but most plans don’t cover medical services you get on board, … (In fact, this is usually the case anytime you receive medical treatment from a doctor or hospital outside the U.S.) This means you pay out-of-pocket. The bill can range from a few hundred to several thousand dollars…

Travel health insurance is your best protection. Consumer Reports recommends avoiding commission-driven policies sold by tour operators, cruise-line representatives, and travel agents. Instead check out an online broker, such as insuremytrip.com, that sells coverage from multiple companies and allows you to tailor a plan to your needs. Ask for quotes, but be sure you’re comparing apples to apples. What’s covered under policies can vary. For example, some may not include emergency evacuation.

-Your Ship Does Not Have A CVS

Most ships do have common prescription drugs on board, but you can’t count on it. What’s more, if you needed one, you’d be charged full price—not just your insurance co-pay—for each drug dispensed on the ship.

The Plan

I developed a plan for my patient and called in a prescription for her to fill prior to getting on the Celebrity Infinity.

Then I tried to get some information on what medical support would be available on her ship.

I called  Celebrity Cruise Lines to see if they had a doctor and whether I could communicate with him.  I was immediately told yes, however when I asked what the doctor’s qualifications and if I could talk to him this was apparently a novel request. After multiple transfers I spoke to someone in “Special Needs” who gave me an email address. I’m told by email that they have my contact info and the doctor will contact me if needed.

At this time, I’m assuming Barb is on the Celebrity Infinity and cruising down the Pacific Coast of Mexico, enjoying the cool ocean breezes and lounging by the ship’s pool.

Hopefully she won’t have a prolonged episode of afib that needs any urgent medical care.

If she does or if the cruise ship doctor gets back to me,  I may get that information I’ve been seeking on  how cardiac urgencies and emergencies are handled on cruise ships and I will be sure to share it with all of you.

Nautically Yours

-ACP

 

 

 

 

7 thoughts on “What Happens If You Go Into Atrial Fibrillation On A Cruise?”

  1. I’m doing a transatlantic crossing from Southampton to New York in June on QM2, my first cruise, so will report back if I have any issues, but two years post ablation – I hope not!

  2. Have you got a information since writing this? We were just about to go on a cruise when my dad had an episode. I think his stress of flying with fb triggered it. and how dangerous is it to fly with fb?

    1. I did write this follow up (https://theskepticalcardiologist.com/2016/04/14/cardiac-care-revealed-on-celebrity-cruise-lines-afibbers-fear-not/). Celebrity cruise lines seems to be very well staffed for medical problems, usually with several doctors and appropriate cardiac monitoring equipment. I debrief any of my patients after their cruises and am trying to get more detailed information on other cruise lines. Viking river cruises do not have any medical personnel but they are usually very close to major European cities with medical facilities.
      In general, with pretty much all stable cardiac conditions, flying is not a problem. This would included afib, heart failure, coronary disease, valvular disease.
      Someone who was marginal in terms of their status could decompensate as a result of the general stresses involved with travel (moving faster than normal with luggage, anxiety about lines, waiting or missing flights).
      If low oxygen levels are a problem, they will drop further while on a flight but this is more of a problem for lung patients than cardiac.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s