Copper 10-8: A Medical Emergency Question

[rkacruiser]

While she was entering the channel in Port Everglades on July 26, Caribbean Princess reported a medical emergency. A guest had suffered a stroke soon after the ship left her dock. She needed to return to port to disembark the guest, which the ship did, as soon as she was able to do so.

 

Depending upon the cause of the stroke, there is a drug that can be administered within a time period of 1-3 hours that can lessen the effects of the stroke. Of course, such a cause needs to be properly diagnosed.

 

Are the medical facilities aboard the HAL ships (if on ships of any cruise line) sufficently sophisticated that the doctor is able to determine if a stroke is clot related (which TPA would be of use) or if the stroke is caused by a bleeding issue?

 

For this lady on Caribbean Princess, if the doctor was able to determine what was the cause of the stroke, there was, I think, enough time before she was disembarked to communicate that to the hospital to which she was taken and she would have benefited from such knowledge.

 

Many of us on this Message Board would appreciate what you can tell us about such a situation and the abilities of the Medical Center.

 

Thank you!

[janmcn]

The test you're referring to would be having a CT scan to determine if it was a blockage or brain bleed. No CT machines are on any cruise ships to my knowledge.

[PathfinderEss]

No they don't have CT scanners on board, but its to bad because they have some wonderful portable hand CT scanners that would work well, especially on a cruise ship, I would think.

Edited July 27, 2014 by PathfinderEss

[CruiserBruce]

No they don't have CT scanners on board, but its to bad because they have some wonderful portable hand CT scanners that would work well, especially on a cruise ship, I would think.

 

Married to an ER nurse of almost 40 years. The "hand held CT scan" technology is extremely new, and not widely available yet. Plus, after TPA administration, an ICU type setting is required. A cruise ship is not the place for TPA at this point. Plus, the side affects to TPA can be truly severe. So one has to be very sure it is the correct course of action.

Edited July 27, 2014 by CruiserBruce

[sail7seas]

Is that the same drug they use for heart attacks? If so, I would think TPA would be available to a ship's physician?

[Lizzie68]

Is that the same drug they use for heart attacks? If so, I would think TPA would be available to a ship's physician?

 

I don't believe so. The clot-buster has to be used very, very carefully - imagine what would happen if used if in fact the stroke was due to a bleed and not a clot. The patient has to undergo a CT scan before it can be used, which is why time is of the essence.

[CruiserBruce]

Again, for cardiac issues, TPA may be appropriate, but not until the right tests and diagnotic tools are available and completed. According to my wife use of TPA in cardiac incidents is even more specialized than in strokes, and significant support is required. Again, not realistic in the cruise setting. At least not yet.

[sail7seas]

Again, for cardiac issues, TPA may be appropriate, but not until the right tests and diagnotic tools are available and completed. According to my wife use of TPA in cardiac incidents is even more specialized than in strokes, and significant support is required. Again, not realistic in the cruise setting. At least not yet.

 

I don't believe so. The clot-buster has to be used very, very carefully - imagine what would happen if used if in fact the stroke was due to a bleed and not a clot. The patient has to undergo a CT scan before it can be used, which is why time is of the essence.

 

 

Thanks. Sounds like a life (tissue) saver but also risky if not used wisely.

 

[Vict0riann]

I seem to remember Copper saying he was cruising to Alaska this week. Perhaps when he gets back (was it Oosterdam? - the ship Father Himself was on) he'll find this - have to keep boosting it to the top of the queue!:)

[Typhoon1]

In the event of a stroke, it's best to get the patient to a fully equipped medical facility with all the staff and equipment needed to diagnosis the problem and administer any needed medication.

 

Preferably, in the US or Canada.

[Linda&Vern]

Again, for cardiac issues, TPA may be appropriate, but not until the right tests and diagnotic tools are available and completed. According to my wife use of TPA in cardiac incidents is even more specialized than in strokes, and significant support is required. Again, not realistic in the cruise setting. At least not yet.

I think your wife would agree that at the first sign of a cardiac issue you should chew an adult aspirin or 4 baby aspirin. According to our Cardiologist I saved my DH some serious heart muscle damage because I insisted he chew one when I suspected he was having a heart attack. From looking at the films done during heart cath, the Doc said one artery appeared to have been 100% blocked, but the aspirin opened the blockage just enough for some blood to flow thru, so DH suffered only minimal damage. In my area the EMT's carry an aspirin bottle in their coat pockets.

[CruiserBruce]

I think your wife would agree that at the first sign of a cardiac issue you should chew an adult aspirin or 4 baby aspirin. According to our Cardiologist I saved my DH some serious heart muscle damage because I insisted he chew one when I suspected he was having a heart attack. From looking at the films done during heart cath, the Doc said one artery appeared to have been 100% blocked, but the aspirin opened the blockage just enough for some blood to flow thru, so DH suffered only minimal damage. In my area the EMT's carry an aspirin bottle in their coat pockets.

 

Absolutely correct.

[Island Lovers]

I agree with all above. The cause of a CVA (stroke) must be diagnosed by CT scan before TPA can be administered. It is a "clot buster" drug. If the drug is given in a case where the stroke is caused by a brain hemorrhage (rather than a clot), then the likely result would be death, medical malpractice, etc.

 

I had a great conversation with a nurse on board a tender in the South Pacific about 20 months ago about what medical situations were most difficult to deal with on board (especially with remote locations and many sea days). She said CVA and GI bleeds! There isn't the CT scanner on board to diagnose source and cause of bleed, etc. She said it is a risk of travel and something passengers should be aware of and consider. I don't believe many people are aware of the medical facilities' limitations on board and also the inability to medevac from remote locations in the Pacific.

 

Although anything can happen to anyone at any age, it amazes me how some people aren't cognisant of this. We waited almost 24 hours off of Christmas Island (Fanning Island doesn't have an air strip) for a medevac plane to come from Honolulu to pick up an ill passenger. That is over 1300 miles one way! Needless to say, the ship's schedule was blown and next port was missed. But we hope it gave the person a chance.

[Copper10-8]

While she was entering the channel in Port Everglades on July 26, Caribbean Princess reported a medical emergency. A guest had suffered a stroke soon after the ship left her dock. She needed to return to port to disembark the guest, which the ship did, as soon as she was able to do so.

 

Depending upon the cause of the stroke, there is a drug that can be administered within a time period of 1-3 hours that can lessen the effects of the stroke. Of course, such a cause needs to be properly diagnosed.

 

Are the medical facilities aboard the HAL ships (if on ships of any cruise line) sufficently sophisticated that the doctor is able to determine if a stroke is clot related (which TPA would be of use) or if the stroke is caused by a bleeding issue?

 

For this lady on Caribbean Princess, if the doctor was able to determine what was the cause of the stroke, there was, I think, enough time before she was disembarked to communicate that to the hospital to which she was taken and she would have benefited from such knowledge.

 

Many of us on this Message Board would appreciate what you can tell us about such a situation and the abilities of the Medical Center.

 

Thank you!

 

 

Morning RKA; your question needs to be answered by someone with experience and expertise in the medical field, neither of which I possess. Have a nice Sunday!

[Tampa Girl]

In light of all of the foregoing, would you think it would be too dangerous to cruise in areas where medical help is not readily available if, as in my DH's case, one has recently had a TIA, cardiac induced? No apparent damage, however. I really wonder whether booking a South Pacific cruise, for instance, would be a good idea.

[CruiserBruce]

In light of all of the foregoing, would you think it would be too dangerous to cruise in areas where medical help is not readily available if, as in my DH's case, one has recently had a TIA, cardiac induced? No apparent damage, however. I really wonder whether booking a South Pacific cruise, for instance, would be a good idea.

 

This provoked a lot of discussion between DW and I last night. People may incorrectly believe that each ship has what amounts to an ER/ED on board. The fact is that most ships carry what is more like an advanced Urgent Care Center. Advanced in that it has the ability to keep people in a hospital bed in an "admitted" status until evacuation can be arranged. But not really much advanced over an Urgent Care Center in any other manner.

[sail7seas]

In light of all of the foregoing, would you think it would be too dangerous to cruise in areas where medical help is not readily available if, as in my DH's case, one has recently had a TIA, cardiac induced? No apparent damage, however. I really wonder whether booking a South Pacific cruise, for instance, would be a good idea.

 

 

 

I think this is a question best posed to your DH's doctors.

It is a serious and very important question.

 

Hope your DH is recovering well.

 

[cashier]

Absolutely correct.

I am an EMT in NJ and we do not carry aspirin with us. We can only assist patients with the aspirin if they have their own.

[Copper10-8]

In light of all of the foregoing, would you think it would be too dangerous to cruise in areas where medical help is not readily available if, as in my DH's case, one has recently had a TIA, cardiac induced? No apparent damage, however. I really wonder whether booking a South Pacific cruise, for instance, would be a good idea.

 

TG; just an FYI; back in October 2013, one of Statendam's crew members incurred a serious health issue which required advanced medical care. The ship was a day out from Tahiti, French Polynesia. After consulting with the Maritime Rescue Coordination Centre Papeete via radio, the locally based (Faa'a, Tahiti) French Navy SAR squadron (Flotille 35F) came out with one of their helos and proceeded to medevac the crew member from an area near the Sea View (aft) pool of the ship (see pics). They flew him back to Papeete where he received the needed care from French doctors at Mamao General Hospital, Tahiti's largest. There are also hospitals on Moorea and Raiatea.

 

You should know however, that once out of range of helos days after departing Hawaii, there are no medical facilities that can provide urgent/advanced care in the immediate vicinity until reaching French Polynesia. Same goes for the trip back to the States after leaving the French islands in the South Pacific and before coming into range of U.S. mainland-based (San Diego) air assets. Just something to keep in mind

 

Nobody wants it to come to a Medevac but, when one is required, there are assets with brave men and women, plus medical facilities available in areas of the South Pacific

 

 

 

 

 

[Vict0riann]

Great photos, Copper. And a very interesting thread. If a bit scary!

[Typhoon1]

Great photos, Copper. And a very interesting thread. If a bit scary!

 

Not scary. The reality is medical emergencies can and do anywhere, anytime.

[Vict0riann]

Not scary. The reality is medical emergencies can and do anywhere, anytime.

 

Very true, and I guess it's something we need to think about.

[rkacruiser]

Copper John: I have witnessed such a medical evacuation last Summer when I was on the Eurodam. I have seen such on YouTube as well on other vessels. What I don't understand is why the ship continues to be in motion during such operations. I would think it would be much more safe for the ship to be stopped and not have to coordinate the movements of the helicopter with the ship.

[CruiserBruce]

The copter wants the movement for better lift. Similar to why an aircraft carrier turns into wind when launching planes.

Edited July 27, 2014 by CruiserBruce

[rkacruiser]

The copter wants the movement for better lift. Similar to why an aircraft carrier turns into wind when launching planes.

 

Thank you for that explanation!