In cases where passengers are in critical shape, a special protocol kicks in. A ship's nurse escorts the patient until the patient is in the care of qualified shore medical personnel, de la Cruz said. The nurse also comes along in life-or-death situations when a passenger is taken off the ship by the U.S. Coast Guard, in a helicopter or vessel. But a helicopter is rarely an option, in part because of its fuel limitations, de la Cruz said. Cruise ships venture far from civilization and can travel for days between ports. And if a ship is in a port that does not have adequate medical care - a lower standard of care than aboard the ship - the patient will not be sent ashore, she added. Onboard Infirmaries Limited The medical care aboard ship has its limitations, said Malbin, the Tampa doctor, who now is medical director with an air ambulance based in Brooksville. A cruise ship infirmary can handle bumps and bruises, cuts and scrapes, sea sickness and headaches. It's ill equipped, however, to treat life-threatening aneurisms or heart attacks. "If push comes to shove," Malbin said, "they maybe can do appendectomies." Emergency treatment for a heart attack can often be done but only to stabilize a patient before removal from the ship. Typically, ships have EKG machines and a laboratory that can do basic work. Doctors can run IVs and they have basic cardiac drugs. Some may have X-ray machines and can do suturing and put splints on broken bones. Infirmaries typically don't have blood banks for transfusions and can't do procedures inside the body, he said. In the 1990s, Malbin worked as a doctor aboard the Regents Sun cruise ship out of Miami and New York City. He sent ashore one passenger a week, on average, when the infirmary couldn't do the job. "It was a lot more work than I thought it would be," Malbin said. "You get a lot of people with different ailments." The cruise and the medical profile of passengers vary widely, he said - young people and families on summer cruises in the Caribbean, for example, or older people taking the more expensive cruises to Alaska and Canada. But one thing is common to all: People with heart disease, high blood pressure and diabetes still have those ailments when they board a vessel, he noted. Yet they might do a lot of drinking, eating rich and fat-filled foods, and generally failing to take good care of themselves. Sometimes, those ailments catch up while at sea. Insurance Can Help Jack Clevenger was no cruise novice when he sailed with his family from Tampa last week on his sixth
birthday cruise in a row. At sea aboard Carnival's Legend, he noticed blood in his stool. He sought help at the infirmary, and was put off the ship with his son at the island of Roatan in Honduras. That was unnecessary, he said, because the symptoms quickly subsided. He never even sought care at the Roatan hospital. Two days, three flights and $2,500 later, they landed in Tampa. One lesson he learned, he said, is to buy travel insurance every time - a move strongly encouraged by Malbin and the cruise lines, too. Some travel insurers contract with air ambulances and pay for transportation from anywhere in the world, Malbin said. Travel insurance might also have helped Georgene Wells, 65, Shirley Smith, 64, and Virginia Harley, 91, all of New Port Richey, who embarked on the Inspiration for Grand Cayman and Cozumel. During the trip, Harley became disoriented and got lost on the ship, Wells said. She was found safe and sound, but the next day, Wells and Smith brought their traveling companion to the ship's doctor.
"We felt it was our responsibility to bring her down to the infirmary," Wells said. Harley was diagnosed with high blood pressure, Wells said. The doctor said they had to leave the vessel in Cozumel. The three women found themselves in a foreign port trying to figure out how to get home. It took 16 hours to get back to Tampa, she said, and cost them about $1,000. "People should be aware that this can happen," she said. They won't learn about it from the flashy ads or commercials that beckon passengers with promises of romance, fine food and snorkeling. But it's there in the fine print on the ticket contracts they sign. There might not even be a doctor or nurse onboard, one contract reads, but it also says the cruise line might front the money for onshore medical care. "The Vessel may or may not carry a ship's physician or other medical personnel at the election of Carnival," one of the cruise line's contracts reads. "While at sea or in port the availability of medical care may be limited or delayed. Guest acknowledges that all or part of their voyage may be in areas where medical care and evacuation may not be available. Guest agrees to indemnify and reimburse Carnival in the event Carnival elects to advance the cost of emergency medical care." Putting Sailing Over Safety Malbin said two stories from his service aboard a cruise line illustrate how passengers need to take responsibility for their own health. Once, while docked in a New York City port, Malbin saw paramedics treating a passed-out man in the cruise ship's terminal. That night, he saw the same man in the ship's infirmary and asked what happened. The man said he was taken to a hospital emergency room in the city, but the wait was long and he didn't want to miss the boat. He didn't much care about Malbin's explanation that medical care on the boat is limited. He was allowed to remain on the vessel. Another time, Malbin's cruise ship was docked in Quebec City and he was called to a cabin to treat an emergency heart problem. Since they were in port, he called for emergency help ashore and the passenger was taken by ambulance to a nearby hospital. Later that day, Malbin was called back to the same cabin to treat the same man. Malbin said the patient told him the Canadian doctors wanted to put a pacemaker in him, but he didn't want to miss his trip, so he returned to the ship. He was not allowed to sail. "The bottom line is that there are limited capabilities on cruise ships," he said. "If you are out at sea, there is only so much you can do."