Perhaps you are one of the many Americans who are planning a cruise this year. You have compared cruise lines, poured over the brochures, trimmed your diet in anticipation of the sumptuous cruise feasts, and even bought new vacation clothes. But have you called your doctor? Or your health insurance provider?

Although illness may not be on your vacation agenda, it is wise to do some medical planning. Onboard medical facilities are no substitute for a hospital. If you get sick while sailing the Caribbean waters, be prepared to shell out your own money. Most insurance policies and Medicare do not cover cruise ship medical treatment.

What to Expect From Onboard Medical Facilities

Because cruise ships originate from many countries and travel internationally, there are no common standards defining minimum credentials for doctors or equipment on cruise ships. The American College of Emergency Physicians (ACEP) developed recommendations for onboard medical facilities. These recommendations were adopted by the Cruise Lines International Association (CLIA). CLIA members voluntarily comply with these guidelines, which also include equipment standards.

"Reasonable" Emergency Medical Care

The goal of medical personnel aboard cruise ships is to provide "reasonable" emergency medical care. This means stabilizing the ill or injured traveler until definitive treatment is available on shore. At minimum, most ship infirmaries will contain:

• One or more doctors and nurses
• Oxygen
• Cardiac defibrillators
• External pacemakers
• EKG and x-ray machines
• Stretchers and wheelchairs
• Immobilization equipment for back and neck injuries
• Sutures
• Medicines
• Bandages

As cruise lines continue to grow and medical technology improves, some ships are equipped with telemedicine capabilities. Doctors aboard the ship can use a digital system to connect with specialists on shore, sharing video links and data.

Sanitation

Whenever large numbers of people congregate in a confined area, disease outbreaks from an infected person or a tainted food supply become a real threat. The Vessel Sanitation Program run by the US Centers for Disease Control and Prevention (CDC) inspects all ships that carry more than 13 passengers, visit a US port or territory, and sail an international itinerary. The inspections focus on:

• Medical facilities
• Water supply
• Food preparation
• Filtration of spas and pools
• Employee hygiene
• General cleanliness of the ship
• Ventilation systems to keep the air clean

Each ship starts with a score of 100, and points are deducted for violations. A score of 86 and higher is acceptable. All scores are updated in the CDC's Vessel Sanitation Program website. It is a good idea to review these scores before making your choice of cruise lines.

Medical Care Cruises

People with medical restrictions may face difficulties during long journeys on land or sea. Fortunately, there are agencies that specialize in making arrangements for people who have important medical considerations. One company called Special Needs at Sea provides rental equipment (eg, wheelchairs, lifts, oxygen equipment, hearing impairment kits) that can be delivered right to your cabin.

Before You Go

Follow these tips before getting on board:

• Check CDC sanitation scores.— Before you book your trip, review the cruise line's score on the Vessel Sanitation Program's website.
• Pick your cruise line and ship carefully.—Stick with cruise lines that are CLIA members. Ask the age of your ship and the cruise line's country of origin. The newest ships usually have the best medical facilities. North American and European ships are the most likely to have English-speaking medical personnel.
• See your doctor.— Have a check-up 6-8 weeks before your trip. Ask your doctor about any precautions that you should take.
• Read your insurance policy.—Check with your provider regarding coverage. If you will not be covered while onboard, consider buying supplemental health insurance.
• Research travel insurance.—Find out if travel insurance is right for you. Depending on the policy, this type of insurance can protect against vacation pitfalls, like cancellations and lost luggage. You can also buy medical travel insurance, which covers emergency evacuations and hospitalizations.
• If you need special equipment, research rental companies.—Online you will find companies that rent all types of medical equipment. If you need a motorized scooter, for example, it can be delivered right to your cabin.
• Notify the cruise line.— You are responsible for notifying the cruise line of any pre-existing medical conditions, including pregnancy.
• Bring medical records and supplies.— Bring the following on your trip:
  • Copies of medical records listing your current medicines and dosages, blood type, allergies, and immunizations
  • Extra prescription and over-the-counter medicines
  • Contact information for your home doctor and next of kin