Making IT work on a cruise ship
Cruise lines using IT to improve seafaring care
No one goes on a cruise with the intention of falling ill, but bad things happen even to funseeking people. Since the average age of a cruise ship passenger is 46, and an estimated 14.3 million people— the populations of the Los Angeles and Milwaukee metro areas combined—sauntered up the gang planks of 220 North American cruise ships last year, based on cruise industry data, sick passengers are a mathematical certainty.
And when cruise ship passengers become ill, healthcare information technology is beginning to emerge in the cruise ship industry as part of the arsenal of care.
Sickness aboard ship occasionally makes the headlines, particularly when there is an infectious-disease outbreak. In 2010, according to the Centers for Disease Control and Prevention, more than 2,600 passengers and 230 crew members were stricken with gastrointestinal disorders in 14 cruise ship incidents severe enough to require reporting under U.S. law. But these serious bouts of the bug are an aberration.
What are far more common are the gamut of injuries and illnesses one would expect from such a sizable population of travelers, says Dr. Carter Hill, an emergency physician and a 22year veteran of the cruise ship business who serves as chief medical officer of the Seattlebased Holland America cruise line.
Hill says Holland America has 15 ships sailing 51 weeks a year on about 450 voyages a year and combined, its medical facilities “probably have 100,000 visits a year.”
Holland America is one of the 11 cruise ship companies owned by Carnival Corp. and Carnival PLC, based in Miami and Southampton, U.K., respectively. Taken together, the Carnival companies, the largest cruise operation in the world, own 96 ships.
Shipboard medical facilities are called infirmaries or clinics, Hill says, but they look very much like a hospital emergency room. And sometimes, there is just as much medical drama on board as there is in a land-based ER.
“We have ICU beds,” Hill says. “We have capabilities to do all of the cardiac enzymes and tests you need in heart conditions. But it’s still not home.” When you’re in the ocean between Hawaii and San Diego, moving at 20 to 22 knots, or upwards of 25 mph, it takes 4½ to 5 days to reach port, but not nearly that long to get outside of helicopter range, according to Hill.
“We’ve had a situation where we’re a day and a half out of Hawaii (and) somebody cuts loose with massive GI bleeding,” Hill says. “We can transfuse their blood (several crew members are designated universal donors, but the ship doesn’t carry its own blood bank). We get a call saying we have this massive bleeding, here’s the clinical situation. We can speed it up, or we can turn around and go back to Hawaii and they can meet us with a helicopter in maybe a day.”
Just such a turnaround will make the ship at least two and sometimes three days late reaching the West Coast, and the delay will cost the line “maybe between $2 million or $3 million” in hotel accommodations and other makegood payments to passengers, Hill says. “But, if that’s what you do, that’s what you do. That really happens.”
According to Hill, who still pulls midnight shifts in the ER at 160-bed Highline Medical Center in Burien, Wash., a Seattle suburb, emergency physicians are the doctors of choice to staff shipboard clinics and infirmaries, because even in the age of jet travel and rescue helicopters, the world remains a very large place when you’re sick and aboard a ship far out at sea.
“I’m still working full time in emergency medicine and those are the docs that we hire,” Hill says. “The skills of the people we have are quite good. They know how to do the routine procedures they used to do in emergency rooms.”
Improved telehealth communications between shipboard healthcare providers and specialists as well as information service providers “have dramatically changed the practice,” Hill says. “We used to just send people out there,” he says. If there was a serious illness or injury, “we would just get a message through to them and tell them, ‘Do the best you can.’ ”
“Now, we can help them, because there is access to good communication,” he says. “I would not consider it high-speed Internet connectivity like we are used to” on land. “But it’s still pretty good. All of our X-rays are done digitally, and we send those to the University of Texas and in 24 hours get overreads. They read all the Xrays for us. We get specialty consults with those folks as well. If you have a skin rash, I can get a jpeg and get a consult and practice pretty good medicine. But we can’t get them to operate, we can’t get CAT scans, but still, having access to that