In a previous post, the skeptical cardiologist was dealing with a patient about to embark on a 16 day cruise through the Panama Canal who was having frequent episodes of atrial fibrillation.
I was concerned about the medical care on board her cruise ship and had not been able to contact medical personnel on board.
I’m happy to report that I have been in email contact with Dr. C, of Celebrity Cruise Lines who is on board the Celebrity Infinity as it sails down the Pacific coast of Mexico and prepares to dock in Cabo San Lucas today.
Dr. C tells me that they have excellent medical personnel and resources available and should my patient go into afib they will be very comfortable dealing with the situation:
“Well I can not speak for any other cruise line but Celebrity, Royal Caribbean and Azamara (the 3 are part of Royal Caribbean Intl), which I have work on the 3 lines. As requirements for the Physicians and Nurses is to have BLS, ACLS, PALS and ATLS certification every 2 years, but most of us like to perform it at least once a year. Most of the ships have 2 Physicians and 3 Nurses, except the Oasis class ships, where there are 3 Doctors and 5 Nurses.
Regarding equipment, we have the necessary equipment to stabilize cardiac emergencies (obviously not all of them)… we have the mentioned monitors with described capabilities, a portable pressure/volume ventilator (used in the US Army in areas of combat). For IV cardiac medications, we have Adenosine, epinephrine 1:1000 and 1:10000, atropine, amiodarone, procainamide, dopamine, dobutamine, furosemide, metoprolol, diltiazem, verapamil, labetalol, digoxin, calcium gluconate and chloride, furosemide lidocaine 2%, magnesium sulfate, norepinephrine, sodium nitroprusside, nitroglycerine, enoxaparin, clopidogrel (oral), aspirin and tenecteplace as fibrinolytic.”
What Is The Scope Of Cruising Cardiac Emergencies?
After publishing my last post , Dr. Sergio Pinski tweeted me a link to a paper from 2010 entitled “Cardiovascular Emergencies in Cruise Ship Passengers” that he co-wrote.
The Cleveland Clinic Florida apparently provides “contracted cardiology consultations” to cruise ships and they recorded the nature and outcome of their consultation over a two year period.
“One hundred consecutive patients were identified (age 66 +/- 14 years, range 18 to 90, 76% men). The most common symptom was chest pain (50%). The most common diagnosis was acute coronary syndrome (58%; ST elevation in 21% and non-ST elevation in 37%). On-board mortality was 3%. Overall, 73% of patients required hospital triage. Of the 25 patients triaged to our institution, 17 underwent a revascularization procedure. One patient died. Ten percent of patients had cardiac symptoms in the days or weeks before boarding; all required hospital triage. Access to a baseline electrocardiogram would have been clinically useful in 23% of cases.”
As a result of these observations they recommended the following:
“A pre-travel medical evaluation is recommended for passengers with a cardiac history or a high-risk profile. Passengers should be encouraged to bring a copy of their electrocardiogram on board if abnormal.”
Finally, the authors write (and this seems a little self-serving and not supported by data) that:
“Cruise lines should establish mechanisms for prompt consultation and triage.”
Dr. Pinski also tells me he has witnessed two electrical cardioversions performed onboard cruise ships.
I don’t know if Cleveland Clinic is consulting with my patient’s ship but I’d prefer cardioversions be done on land, preferably in a hospital with appropriate anesthesia (see my post on defibrillation).
More Research Needed: Volunteers Saught
If any of you are aware of cardiac emergencies or episodes of atrial fibrillation on cruise ships and how they were handled please let me know. I’ll collect as much first hand information as I can and share it with you.
In my office this morning I spoke with an afib patient who is planning on a several week cruise in the Mediterranean on a Royal Caribbean ship. He has agreed to be my investigative reporter on the status of medical care on that cruise.
I don’t know if you can expect this level of cardiac medical care on every cruise but it makes sense, if you are a heart patient, to find out what is available in terms of medical personnel, cardiac and pulmonary monitoring/pacing/cardioversion equipment and medications should you go into afib or another cardiac emergency on your particular ship.
Finally, ask the cruise company if they contract for cardiology consultation services with any entity and, if so, what that entity is and how the consultation works.
Cruise on my friends, but query as you go!
-ACP