U.S. law requires all cruise ships making foreign journeys that include docking in a U.S. port to have at least one doctor or nurse on board.
The Cruise Vessel Security and Safety Act of 2010 says cruise ship staff must include someone who “possesses a current physician’s or registered nurse’s license.” This is on top of what cruise companies pledge themselves and what professional associations recommend.
According to the act, the medical staff on board must additionally have “3 years of post-graduate or post-registration clinical practice in general and emergency medicine,” or hold “board certification in emergency medicine, family practice medicine, or internal medicine.”
In addition to what U.S. law and the cruise companies say, professional organizations have also weighed in on this topic.
The American College of Emergency Physicians (ACEP) recommends that cruise ships have “medical staff (both physicians and registered nurses) who are on call 24 hours per day while at sea.” The Cruise Lines International Association (CLIA) – whose members number over two dozen global cruise lines, including the six prominent ones listed below, has adopted the ACEP’s recommendation for medical staffing.
What Do The Major Cruise Companies Have to Say?
Cruise companies will typically disclose their medical preparedness to make passengers feel secure. Here is what some of the major ones say:
Carnival Cruise Lines: “Our medical centers are staffed by qualified physicians and nurses who are committed to providing the highest quality of shipboard medical care. Medical staffing is correlated to the size of the ship and varies from one physician and three nurses to as many as two physicians and five nurses.”
Disney Cruise Line: “In the event of a medical emergency, a doctor and nurse are on call 24 hours a day, seven days a week.”
Norwegian Cruise Line: “A physician and nurse are on each ship to provide medical care and services at customary charges.”
Princess Cruises: “Our onboard medical facilities are staffed by full-time registered doctors and nurses. In addition to twice-daily office hours, they are available 24 hours a day in the event of an emergency.”
Regent: “Each ship has a licensed and registered doctor and nurse for professional and emergency services, which are available at customary charges.”
Royal Caribbean: “We have a minimum of one fully licensed doctor, and a minimum of two licensed nurses onboard every ship…Depending on the size of the ship and number of passengers and crew members, each RCL ship has one to three doctors and three-to-five Nurses, available to passengers and crew members 24 hours a day, seven days a week.”
Is There a Cost For Seeing The On-Ship Physician?
Seeing the doctor on your cruise usually isn’t free, with one big exception: if you’re being treated for a contagious condition that could jeopardize the health of other passengers. For all other cases, you will probably see a medical visit fee charged to your stateroom.
This is typically considered care provided outside the United States, and as such, you’ll need to get this settled before your final disembarkation. Costs can be comparable to a visit to an urgent care center. Check with your medical insurance company to see if they cover treatment abroad or specifically on cruises. If your doctor’s visit is covered, the medical center can provide you with all the paperwork you need for reimbursement by your insurer.
Who Are The Doctors and Nurses on a Cruise Ship?
Cruise ships operate internationally and are usually flagged in foreign countries. Your medical staff can be just as international. Medical staff may work for your cruise line, be independent contractors, or part of a medical company under contract by your cruise line.
They must meet the guidelines set by the Cruise Vessel Security and Safety Act of 2010. Additionally, the Cruise Lines International Association (CLIA) recommends the following:
- Certification in Advanced Cardiac Life Support (ACLS), Advanced Life Support (ALS), or equivalent, for all medical staff
- Certification in Pediatric Advanced Life Support (PALS), Advanced Pediatric Life Support (APLS), or equivalent, for at least one physician on board a ship with 12 or more children
- Competent skill level for Emergency Cardiovascular Care (ECC) for all medical staff
- Sedation as well as minor surgical, procedural, and orthopedic skills for physicians
- Serious Medical Emergencies
The medical staff aboard cruise lines are prepared to deal with many common emergencies. Serious situations, including those requiring an operation, can result in any of the following:
- The captain diverting the ship to the nearest medical facility
- The launching of a tender ship to transfer the patient to the nearest medical facility
- Rendezvous with a ship that has adequate medical facilities
- Air rescue by helicopter
In his article Confessions of a Cruise Ship Doctor for Yahoo Travel, 14-year-cruise-industry-veteran Dr. John Bradberry says a cruise ship is probably one of the best places to have a medical emergency like a heart attack. “At home, the ambulance might take 10-15 minutes or longer to arrive. By then, it could be too late. Onboard, doctors and nurses are typically only several minutes away from any location onboard ship.”
Unless you have a serious medical situation, you can expect to be out of the doctor’s office in no time and back in your stateroom resting until you feel normal again.
Medical Treatment Available on a Cruise
A ship’s medical facility is similar to an urgent care center. It typically has an examination room, an isolation room, and even an intensive care unit (ICU). You won’t see it, but the ship also has a lab. Some ships even have an x-ray machine.
Cruise ships must legally have a doctor or nurse on board who is adequately trained and able to conduct a forensic sexual assault examination and administer medicine that prevents HIV and STDs when an alleged sexual assault occurs. That’s another requirement that stems from the Cruise Vessel Security and Safety Act of 2010.
CLIA standards stipulate there must be one inpatient bed for every thousand passengers. The ship’s medical facility differs from a typical urgent care center in its preparedness to respond to infectious diseases. Essentially self-contained floating cities, an outbreak of a highly contagious bug on a cruise ship, can quickly turn a dream vacation into a nightmare.
The medical staff pays close attention to passenger symptoms, even before the cruise starts with pre-boarding questionnaires. If there’s any hint of a shipborne contagion, they go on red-alert. They do this for obvious reasons to keep everyone onboard happy and safe, but also for legal ones too.
Cruise Ship Outbreak Prevention Plans
Required by the U.S. Department of Health, all cruise ships must have an Outbreak Prevention Plan (OPP). With the population of some of the most massive cruise ships nearing 10,000, it’s no wonder there is serious concern about onboard epidemics. The doctors and nurses on board every vessel are instrumental in implementing the OPP, especially for initial diagnoses and ongoing treatment and response.
In 2016 during a 34-day cruise from England to the United States, 27 percent of the passengers contracted norovirus. Norovirus is a highly contagious gastrointestinal bug with the potential to cause severe vomiting and diarrhea, and even death in vulnerable populations. It was no wonder the CDC took an interest and boarded the ship in port to take samples and investigate.
Ivan De La Rosa, the senior doctor on Royal Caribbean’s 9,080-crew-plus-passenger-capacity Harmony of the Seas, described his ship’s OPP in detail for a 2018 article in Bloomberg. Doctors are ever-vigilant for a “six in six,” he explained. That’s shorthand for when six passengers become sick in six hours. At this point, the medical staff will notify the ship’s communication department to begin strong messaging via public announcements and cues about hand washing.
Suppose that doesn’t slow the rate of passenger illness. In that case, Harmony’s OPP forbids all passengers from touching any food that isn’t explicitly placed on their plates and simultaneously deputizes all crew members to become food servers until sickness rates fall.
Getting Medicine on a Cruise Ship
Doctors can prescribe the medication you would typically find in the United States and medicine available in other countries. Most pharmacies come well stocked with all the over-the-counter and prescription drugs you need.
Suppose you have a pre-existing medication condition that requires you to bring a supply of prescription drugs on board, including refrigerated medications. In that case, cruise companies can usually accommodate you with no extra hassle. You might even find some medications to be cheaper than what you’re used to back on the mainland. FDA laws about name-brand drugs and importation drive some domestic prescription prices up by as much as 80 percent more than what people might pay in another country like Canada. These don’t apply when you’re in the open ocean outside of U.S. territorial waters.