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A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound
, 1, 2, 2, 13
Affiliations- The George Washington University, 2120 L Street NW, Suite 450, 20037 Washington, DC, United States
- No affiliation
- Massachusetts General Hospital, Boston, MA, United States
open access
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.
Keywords
cruise ship medical evacuation, point-of-care ultrasound, ectopic pregnancy, tele-ultrasound
About this articleTitle
A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound
Journal
Issue
Article type
Case report
Pages
42-45
Published online
2020-03-21
Page views
1870
Article views/downloads
1281
DOI
Pubmed
Bibliographic record
IMH 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
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- Cruise Industry News, “Cruise Ship Orderbook”. Retrieved from . https://www.cruiseindustrynews.com/pdf (Accessed August 18, 201).
- 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).
- Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2017; 69(5): e27–e54.
- Cruise Compete. Pregnancy policies by cruise line. Retrieved from. https://www.cruisecompete.com/pressrelease010810.php (Accessed August 18, 2019).
- 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.
- Britton N, Miller MA, Safadi S, et al. Tele-Ultrasound in resource-limited settings: a systematic review. Front Public Health. 2019; 7: 244.
