Teleradiology signals sea change in cruise ship medicine

The latest tonic in cruise ship medical care is telemedicine, which allows ship's doctors to send real-time images and consult with specialists at leading onshore medical centers.

All newer vessels are equipped to manage complex emergency situations with the help of satellite hook-ups. In addition to providing live, two-way video links, these virtual emergency room visits allow x-rays, electrocardiograms, and other physiologic signals to be transmitted via satellite to hospital specialists from a ship located anywhere in the world.

Three Princess ships, for instance, have arrangements with the Cleveland Clinic's facility in Florida and also with the University of Texas Medical Branch (UTMB) at Galveston.

Renaissance Cruise Lines has announced a similar partnership with Johns Hopkins University in Baltimore. Passengers and crew aboard Renaissance cruises who become ill or have an accident while at sea receive consultative medical care from physicians in Hopkins' emergency department. Physicians in Maryland are available to ship's doctors to discuss treatment decisions through telemedicine connections that enable quick online exchange of patients' medical histories, test results, and other vital information, including x-rays. Hopkins' telemedicine program extends to oil rigs and private yachts.

Holland America's newest cruise ship, the 1380-passenger Amsterdam, has been outfitted with MedServe, a system that allows the ship's onboard physicians to seek expert second opinions from UTMB physicians via telemedicine. UTMB does more telemedicine than any other medical center in the U.S.

The International Council of Cruise Lines (ICCL), with assistance from the American College of Emergency Physicians, has developed a set of minimum standards for medical staff and equipment, although the standards vary depending on number of passengers, itinerary, and length of cruise. The ICCL standards are voluntary, however, and the council does not enforce them.

A 1999 New York Times investigation of medicine on cruise ships found great variation in onboard medical standards, including physician competence. Most cruise ships are registered in countries such as Panama, Liberia, and the Bahamas, which have far less stringent regulations for physicians than the U.S.

High-seas telemedicine and teleradiology systems are meant to augment the quality of onboard care and to lower costs by reducing the chances that patients have to disembark unexpectedly in a foreign country or be airlifted to emergency medical treatment.

A medical emergency requiring airlift off the ship can cost $20,000 or more.