open access

Vol 71, No 1 (2020)
Case report
Published online: 2020-03-21
Submitted: 2020-02-07
Accepted: 2020-02-21
Get Citation

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound

Keith S. Boniface, Neal Sikka, Nicholas Page, Asi Peretz, Hamid Shokoohi
DOI: 10.5603/IMH.2020.0010
·
Pubmed: 32212147
·
International Maritime Health 2020;71(1):42-45.

open access

Vol 71, No 1 (2020)
MARITIME MEDICINE Case report
Published online: 2020-03-21
Submitted: 2020-02-07
Accepted: 2020-02-21

Abstract

Cruise ships travel far from shoreside medical care and present a unique austere medical environment. For the cruise ship physician, decisions regarding emergency medical evacuation can be challenging. In the event that a passenger or crew member becomes seriously ill or is injured, the use of point-of-care ultrasound may assist in clarifying the diagnosis and stratifying the risk of a delayed care, and at times expedite an emergent medical evacuation. In this report we present the first case reported in the literaturę of an emergency medical evacuation from a cruise ship triggered by handheld ultrasound. A point-of-care ultrasound performed by a trained cruise ship physician, reviewed by a remote telemedical consultant with experience in point-of-care ultrasound, identified an ectopic pregnancy with intraabdominal free fluid in a young female patient with abdominal pain and expedited emergent helicopter evacuation from a cruise ship to a shoreside facility, where she immediately underwent successful surgery. The case highlights a medical evacuation that was accurately triggered by utilising a handheld ultrasound and successfully directed via a tele-ultrasound consultation. American College of Emergency Physicians (ACEP) health care guidelines for cruise ship medical facilities should be updated to include guidelines for point-of-care ultrasound, including training and telemedical support.

Abstract

Cruise ships travel far from shoreside medical care and present a unique austere medical environment. For the cruise ship physician, decisions regarding emergency medical evacuation can be challenging. In the event that a passenger or crew member becomes seriously ill or is injured, the use of point-of-care ultrasound may assist in clarifying the diagnosis and stratifying the risk of a delayed care, and at times expedite an emergent medical evacuation. In this report we present the first case reported in the literaturę of an emergency medical evacuation from a cruise ship triggered by handheld ultrasound. A point-of-care ultrasound performed by a trained cruise ship physician, reviewed by a remote telemedical consultant with experience in point-of-care ultrasound, identified an ectopic pregnancy with intraabdominal free fluid in a young female patient with abdominal pain and expedited emergent helicopter evacuation from a cruise ship to a shoreside facility, where she immediately underwent successful surgery. The case highlights a medical evacuation that was accurately triggered by utilising a handheld ultrasound and successfully directed via a tele-ultrasound consultation. American College of Emergency Physicians (ACEP) health care guidelines for cruise ship medical facilities should be updated to include guidelines for point-of-care ultrasound, including training and telemedical support.

Get Citation

Keywords

cruise ship medical evacuation, point-of-care ultrasound, ectopic pregnancy, tele-ultrasound

About this article
Title

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound

Journal

International Maritime Health

Issue

Vol 71, No 1 (2020)

Article type

Case report

Pages

42-45

Published online

2020-03-21

DOI

10.5603/IMH.2020.0010

Pubmed

32212147

Bibliographic record

International Maritime Health 2020;71(1):42-45.

Keywords

cruise ship medical evacuation
point-of-care ultrasound
ectopic pregnancy
tele-ultrasound

Authors

Keith S. Boniface
Neal Sikka
Nicholas Page
Asi Peretz
Hamid Shokoohi

References (7)
  1. Cruise Lines International Association (CLIA) reveals growth in global and North American passenger numbers and insights. Retrieved from. https://cruising.org/news-and-research/press-room/2019/april/clia-reveals-growth (Accessed August 18, 2019).
  2. Cruise Industry News, “Cruise Ship Orderbook”. Retrieved from . https://www.cruiseindustrynews.com/pdf (Accessed August 18, 201).
  3. Health care guidelines for cruise ship medical facilities. Policy resource and education paper. January 2019. Retrieved from . https://www.acep.org/globalassets/new-pdfs/preps/health-care-guidelines-for-cruise-ship-medical-facilities---prep.pdf (Accessed December 6, 2019).
  4. Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2017; 69(5): e27–e54.
  5. Cruise Compete. Pregnancy policies by cruise line. Retrieved from. https://www.cruisecompete.com/pressrelease010810.php (Accessed August 18, 2019).
  6. Moore C, Todd WM, O'Brien E, et al. Free fluid in Morison's pouch on bedside ultrasound predicts need for operative intervention in suspected ectopic pregnancy. Acad Emerg Med. 2007; 14(8): 755–758.
  7. Britton N, Miller MA, Safadi S, et al. Tele-Ultrasound in resource-limited settings: a systematic review. Front Public Health. 2019; 7: 244.

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