Emergency doctors by sea to Antarctica: small ship medicine in polar regions

Patterns of illness and injury on Antarctic research cruises, 2004-2019: a descriptive analysis

BACKGROUND

Before the impact of the coronavirus disease 2019 pandemic, cruise travel had experienced exponential growth in the preceding decade. Travel medicine practitioners were increasingly called upon to provide pre-cruise travel advice and medical clearance. Demand for these services will return at some time in the future.

METHODS

The clinical conditions seen in those presenting for care on six small-vessel scientific cruises to Antarctica were analysed.

RESULTS

Personnel presented on 196 occasions resulting in 257 consultations (when initial plus all follow-up consultations were included). Personnel presented with a clinical condition at a rate of 17.9 per 1000 person-days at sea. The total consultation rate was 23.5 per 1000 person-days at sea. Injury accounted for 24% of all presentations at a rate of 4.3 per 1000 person-days at sea. Dermatological, soft tissue and musculoskeletal, general malaise and motion sickness were the four most common presentations.

CONCLUSIONS

Pre-cruise advice for travellers planning small-vessel cruises to polar regions needs to include skin care, prevention and management of sea sickness and how to reduce the risk of injury. Those providing medical care on such cruises should be prepared to manage a wide range of clinical presentations.

Burn Care on Cruise Ships-Epidemiology, international regulations, risk situation, disaster management and qualification of the ship's doctor

With the increasing numbers of passengers and crew on board vessels that are becoming larger and larger, the demand for ship's doctors who can adequately treat burns on board has also increased. In the cruise ship industry it is usually those doctor's with internal and general medical training who are recruited from an epidemiological point of view. Training content or recommendations for the treatment of thermal lesions with the limited options available in ship's hospitals and where doctors with no surgical training operate do not yet exist. The guidelines recommended by the Cruise Lines International Association (CLIA) regarding medical staff have only included physicians with minor surgical skills until now. With the introduction of the ATLS(®) course developed by the American College of Surgeons, the requirements for the qualification of the ship's doctor on board cruise ships shall change from January 2017. The article discusses the question of whether having completed the ATLS(®) course, the ship's doctor is trained to adequately treat thermal lesions or severe burns persons on-board, and presents the current discussion on the training content for ship's doctors within the International Maritime Health Association (IMHA). It also provides an overview of existing international regulatory frameworks, the risks presented by a fire on board, the problem of treating burns victims out of reach of coastal rescue services, and alternative training concepts for ship's doctors regarding the therapy of thermal lesions on-board.

Pattern of passenger injury and illness on expedition cruise ships to Antarctica

BACKGROUND

Expedition ships to Antarctica travel to remote areas with limited medical support.

OBJECTIVES

This study determines the rate and patterns of passenger illness and injuries among those traveling on expedition ships to Antarctica. We hypothesize that severe medical conditions are encountered that require physicians serving on these ships to be skilled enough to care for critically ill or injured patients.

METHODS

We performed a retrospective analysis of the medical records of all passengers who were provided medical care on 26 Antarctica voyages from October 2010 to March 2011 (four different expedition ships). A structured system was used to categorize the diagnoses from each patient encounter. The pattern of traumatic injuries was noted, including location of occurrence. Treatments rendered including patient evacuations were documented. The population is described with incidence rates.

RESULTS

A total of 2,366 passengers traveled on 26 trips, for a total of 34,501 person-days. In all, 680 physician visits were done, including 150 consultations for motion sickness preventive care, leaving 530 visits (15.4 visits per 1,000 person-days) for active medical care. Median age was 50 (range 10-90) years and 51% were females. Incidence rates per 1,000 person-days for the most common processes include motion sickness (4.2), infections (3.5), and injury (2.0). Injuries were more likely to occur on the ship (66%, 95% CI: 54-77%) compared to off the ship (34%, 95% CI: 23-46%). Four subjects (0.12/1,000 person-days) were evacuated (three due to traumatic conditions and one due to medical complications) and one person died (medical complication).

CONCLUSION

Passengers on expedition ships to Antarctica may experience significant illness and injury. Ship physicians should be aware of the patterns of injuries and illnesses that occur on expedition ships and should have appropriate training to treat various medical and traumatic conditions including life-threatening illnesses.