Novembre 2011

Cruise Medicine & International Symposia on Maritime Health: From Odessa 2011 to Brest 2013

Pr Eilif Dahl, MD, MHA, PhD,

University of Bergen / Norwegian Centre for Maritime Medicine, Bergen, Norway                                                                                                               

    After the 11^th International Symposium on Maritime Health (11ISMH) in Odessa this year, I’m left with the impression that the organizers had not really grasped the fact that cruise medicine is an important part of maritime health. One session on ‘Cruise Medicine’ was announced.  Six papers were to be presented, but the only confirmation the authors received prior to the meeting was a program draft circulated shortly before the symposium started. At that point two of the authors had made other plans. When the final program was distributed at registration in Odessa, the cruise medicine presentations had been reduced from 15 to 10 minutes each and the cruise session had been moved to a time when one of the two remaining presenters should already be on his return flight home. In the end the session was moved forward, but without proper announcements and to a double-booked small auditorium. Despite all these problems and shortcomings, the turn-out was surprisingly good, - with eager audience participation on subjects like guidelines for asymptomatic, stable HIV-positive crew members; handling and costs of varicella cases and outbreaks among crew; a case series on life-saving blood transfusions aboard; results from fleet-wide use of a standardized ‘first responder bag’ for emergencies outside the cruise ship infirmaries; and outcome after treatment of cardiac arrest on cruise ships.

    Recommendations to put automatic external defibrillators (AEDs) on ships without medical professionals aboard are highly controversial and triggered heated discussions on several occasions during 11ISMH. In contrast, there is no doubt that AEDs should be part of the standard equipment on densely populated cruise ships with a highly trained medical staff on 24/7 call. Preliminary data from Royal Caribbean Cruise Line ships showed survival rates that exceed those from out-of-hospital cardiac arrests in all major US cities. Hence, cardiac arrest is likely to be riskier at home than on a well-equipped and well-staffed cruise ship.

    Within the maritime medical community it has been argued that cruise medicine concentrates on passengers, and therefore is of less interest to the maritime health of crew. Clearly, the passengers’ expectations and demands are the primary impetus to advance medical care on cruise ships. However, the passengers are only on board for a very limited time, whereas the ship’s doctors are the primary physicians for the crew for many months at the time. The majority of patients seen in most cruise ship infirmaries are crew members. Hence, they certainly benefit from all the medical resources available to the passengers. Furthermore, after experiencing cruise medical care the crew members will bring their expectations of higher quality medical service to other ships and thus push for improved maritime health internationally.

    According to John le Carré, a desk is a dangerous place from where to view the world. -‘And the sea’, one could add. Cruise ships employ a steadily growing number. In Odessa, medical representatives from the two largest cruise corporations were in attendance, representing more than 100.0000 seafarers. Some of the cruise vessels have more than 2.400 crew members aboard. Every ship carries physicians and nurses. They are on board to observe conditions related to health and medicine and to intervene when irregularities occur. This means that every cruise ship can be viewed as a potential medical laboratory, and thus the experience of the medical staff should be valuable to all involved with maritime health.

    Both the US and the European Centers for Disease Control and Prevention (CDC & ECDC) are land-based organisations that have turned cruise ships into de facto epidemiological laboratories. The knowledge gained through reports from the medical staff aboard cruise ships about prevention and management of outbreaks aboard have also proven valuable for handling of infectious diseases ashore.

    Even the amputated cruise ship session in Odessa demonstrated that the cruise industry is a front runner regarding maritime health, and all involved with this subject will gain from medical information gathered by cruise companies. Likewise, the cruise industry will benefit from contact with the rest of the maritime health community. There are numerous issues of mutual interest.

    France is a major builder of cruise ships. Therefore, the Brest organizers of the 12^th International Symposium on Maritime Health in 2013 hopefully realize the importance of cruise medicine for general maritime health and will take this into consideration when they arrange the conference program:

§        They should actively encourage cruise representatives to participate at 12ISMH

§        Enough time should be allotted to cruise presentations and discussions

§        Cruise reports of general interest should be presented in plenary sessions, and

§        Sessions on subjects of mutual interest should be carefully scheduled to avoid collisions 

The road to success is always under construction; - see you all in Brest 2013!