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*Cho!era, hepatitis A, hepatitis B, immune globulin, Japanese encephalitis, malaria prophylaxis, meningococcal meningitis, plague, rabies, tick-borne encephalitis, tuberculosis, typhoid iever, yellow fever

*Cho!era, hepatitis A, hepatitis B, immune globulin, Japanese encephalitis, malaria prophylaxis, meningococcal meningitis, plague, rabies, tick-borne encephalitis, tuberculosis, typhoid iever, yellow fever

If you have a history of heart disease please attach a copy of a recent EKG. Provide a copy of this form to family members and emergency contact designees Take this form with you when you seek medical attention.

Figure 17.1 (cont)

3. Encourage research on cruise ship medicine.

4. Provide educational opportunities for cruise ship medical and administrative staff members.

5. Promote the importance and enhancement of onboard medical care.

6. Educate the medical establishment about the content and complexity of cruise ship medicine.

There are minimal international maritime regulations pertaining to medical services aboard cruise ships and these mainly address the needs of the crew members, not cruise ship passengers; for example, there is no international requirement to have a doctor aboard ship. Additional regulations may apply to cruise ships depending upon the country of registry, but many of these regulations are vague in nature and do not address specific recommendations for a cruise ship's medical facility or its medical staff.

One of the major accomplishments of the ACEP Cruise Ship and Maritime Medicine Section has been the development of the Health Care Guidelines for Cruise Ship Medical Facilities, first released in 1995 and then revised in 1997 (American College of Emergency Physicians, 1997) (see Additional Resources). The guidelines are the recommendations of several cruise line medical directors and experienced ship's physicians from within the industry and authorized to practice medicine in United States, British, Canadian, Norwegian and other land-based facilities. The guidelines provide invaluable assistance to cruise ship medicine practitioners in the development of shipboard medical departments, and to the cruise industry as a quality improvement tool for medical services at sea.

These guidelines are an adjunct to the international maritime safety regulations (International Safety Management Code (ISM), Safety Management System (SMS) and Safety of Life at Sea (SOLAS)) as established by the International Maritime Organization and International Labor Organization. The International Council of Cruise Lines (ICCL), a major cruise industry trade group based in the United States and representing 16 of the world's largest cruise lines, has adopted a modified version of the guidelines for its membership. The major cruise lines sailing to United States ports and many other cruise lines worldwide currently adhere to the ACEP and ICCL guidelines on a voluntary basis. The ICCL is working within the cruise industry to integrate the guidelines into the ISM code and the SMS as the standard for medical services aboard cruise ships.

The ACEP Cruise Ship and Maritime Medicine Section is currently reviewing the Health Care Guidelines for Cruise Ship Medical Facilities for another revision. Topics that are being considered for addition to the Policy Resource and Education Paper (PREP) include recommendations for a standardized formulary list, contingency plans for medical services in the event that the infirmary becomes inaccessible, expanded laboratory capabilities, travel insurance, emergency evacuation procedures and shore-side medical facility evaluation.

Cruise Ship Physician

The cruise ship physician's main responsibility is to provide medical services for all shipboard personnel and passengers. He or she is also involved in public health, hygiene and safety issues on board ship. In addition, the physician is a ship's senior officer who represents not only the medical department but also the ship and the cruise line. The ship's physician should never underestimate his or her responsibilities aboard ship, nor overestimate his or her authority. Cruise ships typically have a strict hierarchy of command and it is very important that the physician keep superiors informed of any health issues that could impact the ship's operations, such as an infectious disease outbreak or the need for an emergency medical evacuation.

As with the cruise industry in general, cruise ship medicine is made up of an international group of participants. North American physicians staff about 10% of the world's fleet. Physicians from various countries, such as the UK, Norway, Sweden, Denmark, Greece, Italy and South Africa, staff majority of the remainder. Tours of duty aboard ship run from a few weeks to several months, as determined by the respective cruise line's staffing policy. Depending upon the size of the ship and the number of passengers and crew members, the doctor may be the only medical staff member aboard ship or he or she may be part of a medical team consisting of an additional doctor and 3-5 nurses. Cruise ship nurses are typically well trained and experienced in emergency and critical care services. They play a pivotal role in providing quality medical care to the passengers and fellow crew members. They also often serve as triage officers for the ship's sickbay and office managers for the Medical Department.

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