Shipboard medicine: A new niche for emergency medicine

Study objectives: To describe the spectrum of illness that presents to shipboard hospitals and thereby recommend optimal qualifications for the ship's medical personnel. Design: Retrospective review of medical logs from two cruise ships' hospitals. Settings: Two passenger cruise ships, with seven-to-ten day cruises in the Caribbean. Participants: All patients presenting to the ships' hospitals from January 4, 1989, to June 10, 1989, on one ship and from October 13, 1990, to November 10, 1990, on another ship. Methods: Analysis of ship medical logs with regard to patient complaint, diagnosis, and treatment. Results: Of 1,547 new patient visits, 12% were related to injuries and 88% to medical problems; 97% of visits were noncritical, and 3% required immediate emergency intervention. Among these were four cardiac arrests, two stab wounds, two serious ocular injuries, one closed-head injury, and one near-drowning. Five patients required endotracheal intubation. Conclusion: There is a sizeable number of visits to ships' hospitals by patients with acute and serious problems of a wide variety. Physicians and nurses with significant emergency training or experience are best qualified to deal with this broad spectrum of patient problems in this isolated environment.