open access

Vol 68, No 3 (2017)
MARITIME MEDICINE Original articles
Published online: 2017-09-27
Submitted: 2017-08-22
Accepted: 2017-08-22
Get Citation

Medical emergencies on large passenger ships without doctors: the Oslo-Kiel-Oslo ferry experience

Thor-Erik Holt, Agnar Tveten, Eilif Dahl
DOI: 10.5603/IMH.2017.0027
·
Pubmed: 28952660
·
International Maritime Health 2017;68(3):153-158.

open access

Vol 68, No 3 (2017)
MARITIME MEDICINE Original articles
Published online: 2017-09-27
Submitted: 2017-08-22
Accepted: 2017-08-22

Abstract

Background: The Oslo-Kiel-Oslo route is currently the only direct ferry crossing between Norway and Germany, covered by 2 cruise-and-cars ferries carrying about 2,600 passengers each and sailing every day (20 h at sea, 4 h in port). Unlike most ocean going cruise vessels, they are not required to carry a physician but an on-board paramedic handles medical emergencies. The aim of the study was to provide data on medical emergencies leading to helicopter evacuations (helivacs) or other urgent transfers to facilities ashore from the two ferries during a 3-year period.

Materials and methods: Data about the ferries, passengers, crew, helivacs and other medical transfers were collected from official company statistics and the paramedics’ transfer reports.

Results: A total of 169 persons, including 14 (8.3%) crewmembers, were transferred from the ferries to land-based facilities by ambulance while alongside (n = 80; 47.3%) or evacuated by helicopter (n = 85; 50.3%) and rescue boat (n = 4; 2.4%) during the 3-year period. Transfer destinations were Denmark (n = 53), Germany (n = 49), Norway (n = 48) and Sweden (n = 19). The passenger helivac rate was 2.4 per 100,000 passenger-days. One person was airlifted from a ferry every 2 weeks. Among helivacs, 40% were heart-related, and more cardiac cases were airlifted than transferred by ambulance in port.

Conclusions: All helivac requests were made after discussion between the ferry’s paramedic and telemedical doctors ashore and agreement that the medical challenge exceeded the ferry’s capability. This close cooperation kept the threshold for arranging helivacs from the ferries low, enabling short transport times to land-based facilities for critically ill patients. Further studies, including feedback from the receiving hospitals, are needed to determine measures that can reduce possible helicopter overutilisation without compromising patient safety and outcome.  

Abstract

Background: The Oslo-Kiel-Oslo route is currently the only direct ferry crossing between Norway and Germany, covered by 2 cruise-and-cars ferries carrying about 2,600 passengers each and sailing every day (20 h at sea, 4 h in port). Unlike most ocean going cruise vessels, they are not required to carry a physician but an on-board paramedic handles medical emergencies. The aim of the study was to provide data on medical emergencies leading to helicopter evacuations (helivacs) or other urgent transfers to facilities ashore from the two ferries during a 3-year period.

Materials and methods: Data about the ferries, passengers, crew, helivacs and other medical transfers were collected from official company statistics and the paramedics’ transfer reports.

Results: A total of 169 persons, including 14 (8.3%) crewmembers, were transferred from the ferries to land-based facilities by ambulance while alongside (n = 80; 47.3%) or evacuated by helicopter (n = 85; 50.3%) and rescue boat (n = 4; 2.4%) during the 3-year period. Transfer destinations were Denmark (n = 53), Germany (n = 49), Norway (n = 48) and Sweden (n = 19). The passenger helivac rate was 2.4 per 100,000 passenger-days. One person was airlifted from a ferry every 2 weeks. Among helivacs, 40% were heart-related, and more cardiac cases were airlifted than transferred by ambulance in port.

Conclusions: All helivac requests were made after discussion between the ferry’s paramedic and telemedical doctors ashore and agreement that the medical challenge exceeded the ferry’s capability. This close cooperation kept the threshold for arranging helivacs from the ferries low, enabling short transport times to land-based facilities for critically ill patients. Further studies, including feedback from the receiving hospitals, are needed to determine measures that can reduce possible helicopter overutilisation without compromising patient safety and outcome.  

Get Citation

Keywords

cruise ferry, medical patient transfer, helicopter evacuation (helivac), paramedic, Tele-medical Maritime Assistance Service (TMAS), maritime medicine

About this article
Title

Medical emergencies on large passenger ships without doctors: the Oslo-Kiel-Oslo ferry experience

Journal

International Maritime Health

Issue

Vol 68, No 3 (2017)

Pages

153-158

Published online

2017-09-27

DOI

10.5603/IMH.2017.0027

Pubmed

28952660

Bibliographic record

International Maritime Health 2017;68(3):153-158.

Keywords

cruise ferry
medical patient transfer
helicopter evacuation (helivac)
paramedic
Tele-medical Maritime Assistance Service (TMAS)
maritime medicine

Authors

Thor-Erik Holt
Agnar Tveten
Eilif Dahl

References (16)
  1. International Labour Organization. Maritime Labour Convention. http://www.ilo.org/wcmsp5/groups/public/@ed_norm/@normes/documents/normativeinstrument/wcms_090250.pdf (2006).
  2. Oxford English Dictionary. Oxford University Press, UK. https://en.oxforddictionaries.com/definition/ferry (2017).
  3. International Maritime Organization. International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW). http://www.imo.org/en/KnowledgeCentre/IMOAndTheUnitedNations/Pages/default.aspx.
  4. Norwegian Centre for Maritime and Diving Medicine. Radio Medico. http://www.ncmm.no/about-radio-medico-norway/contact-radio-medico.
  5. NHS Health Research Authority. Defining research – guidance from the Research Ethics Service. http://www.hra.nhs.uk/documents/2016/06/defining-research.pdf.
  6. Peake DE, Gray CL, Ludwig MR, et al. Descriptive epidemiology of injury and illness among cruise ship passengers. Ann Emerg Med. 1999; 33(1): 67–72.
  7. Dahl E. General practice at sea [Almenpraksis til sjø]. Tidsskr Nor Laegeforen. 1979; 99(6): 327–330.
  8. Dahl E. Anatomy of a world cruise. J Travel Med. 1999; 6(3): 168–171.
  9. Dahl E. Medical practice during a world cruise: a descriptive epidemiological study of injury and illness among passengers and crew. Int Marit Health. 2005; 56(1-4): 115–128.
  10. Thibodaux DP, Bourgeois RM, Loeppke RR, et al. Medical evacuations from oil rigs off the Gulf Coast of the United States from 2008 to 2012: reasons and cost implications. JOEM. 2014; 56(7): 681–685.
  11. Prina LD, Orzai UN, Weber RE. Evaluation of emergency air evacuation of critically ill patients from cruise ships. J Travel Med. 2001; 8(6): 285–292.
  12. American Heart Association. Advanced cardiovascular life support. Provider manual 2016.
  13. Reiner-Deitemyer V, Teuschl Y, Matz K, et al. Austrian Stroke Unit Registry Collaborators. Helicopter transport of stroke patients and its influence on thrombolysis rates: data from the Austrian Stroke Unit Registry. Stroke. 2011; 42(5): 1295–1300.
  14. Schellhaaß A, Popp E. Luftrettung: Aktueller Stellenwert und praktische Aspekte [Air rescue: current significance and practical issues]. Anaesthesist. 2014; 63(12): 971–980.
  15. Williams S, Dahl E. Briefing notes on emergency medical disembarks by helicopter at sea in North America. Int Marit Health. 2014; 65(1): 7–12.
  16. Hirshon JM, Galvagno SM, Comer A, et al. Maryland's Helicopter Emergency Medical Services Experience From 2001 to 2011: System Improvements and Patients' Outcomes. Ann Emerg Med. 2016; 67(3): 332–340.e3.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl