What happens if you get sick or injured (or bitten by a monkey) on a cruise ship

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When Jennifer Lautenschlager woke up with sniffles and a headache last month, she canceled her plans and went to see the doctor. The nurse took her temperature – she had about a 102-degree fever – and ran some tests, and the doctor examined her, before sending her on her way with several prescriptions.

It was a largely normal sick visit, except the 51-year-old software engineer was on a cruise ship along the coast of Mexico.

Lautenschlager had been looking forward to going kayaking on a stop in Cabo San Lucas during her 15-day Panama Canal sailing with Norwegian Cruise Line. Instead, she spent most of the day in her cabin before visiting the ship's medical facility, where she was diagnosed with an upper respiratory infection.

"(The facility was like) what I would think a typical urgent care was," said Lautenschlager, who lives in the Atlanta area. "Like a decent, good urgent care."

"Each of our ships has a state-of-the-art onboard medical center staffed with highly qualified doctors and nurses, to provide care for both guests and crew while at sea," Norwegian said in its 2021 ESG report. "We follow guidelines for our medical facilities provided by CLIA in conjunction with the American College of Emergency Physicians (ACEP)."

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Cruise ships are perhaps best known for amenities like buffets and swimming pools, but their medical facilities also have the capability to treat a wide range of illnesses and injuries, from common colds to heart attacks.

Here's what to know about getting sick or hurt on a cruise ship.

The Diamond Princess cruise ship approaching Daikoku Piervon on Feb. 6, 2020.
The Diamond Princess cruise ship approaching Daikoku Piervon on Feb. 6, 2020.

What are cruise ship medical facilities like?

Dr. Joe Scott, senior director of fleet medical operations at cruise line operator Carnival Corporation, said some of its ships' facilities look like urgent care centers passengers would find on land, while others on some of its larger vessels are bigger and more similar to doctor's offices. However, he noted that the facilities are generally set up like a typical emergency department.

Cruise line members of Cruise Lines International Association, the industry's leading trade group, worked with the ACEP "to develop and implement guidelines on cruise ship medical facilities," according to its website. Oceangoing CLIA member lines must follow them.

Scott, who is currently chair of the ACEP's Cruise Ship Medicine Section, said the guidelines are updated every couple of years.

Carnival Corp. medical facilities can treat a range of ailments.
Carnival Corp. medical facilities can treat a range of ailments.

The facilities are staffed by doctors and nurses, and the company's bigger ships may also have medical administrators, paramedics and health care assistants.

The ships also have alternate medical sites, as directed by the guidelines. "So, if the first medical center is compromised in any way, we have an alternative one so we can continue to provide treatment," said Scott, who oversees day-to-day operations for the company's North American brands, including Carnival Cruise Line, Princess Cruises and Holland America Line.

What can cruise ship medical facilities treat?

Carnival Corp. medical facilities can treat a variety of ailments, from rashes and earaches to heart attacks. "There really isn't (anything) we can't treat, at least for the first few hours," said Scott.

Doctors on the ship can prescribe medications to be dispensed and taken while on board, and treat serious illness either until passengers improve or as a stopgap measure until a passenger can be brought ashore, depending on the scenario. In the case of a heart attack, they can give patients thrombolytics – or "clot-busting drugs" – on board until they can get them to a cardiac catheterization lab, which the vessels do not have.

The cruise line operator has a formulary – a list of medications needed to treat most diagnoses made on the ships – and stocks the vessels with those, though supplies are limited given the finite storage on board.

The cruise ship environment can limit the team's capabilities in other ways, too. For example, the vessels have X-ray machines (medical staff are trained to operate radiology and lab equipment). But Scott said, "No one has really yet figured out how to put a CT scan on a ship that is moving through the ocean and have it work well."

And while all medical staff working on board are credentialed in their home countries, sometimes they need outside assistance.

Janice Mullin and her husband, Jeff, were waiting to tour caves as part of a shore excursion in Gibraltar during a 2012 cruise when a Barbary ape jumped up on a bench beside her. The animal reached for the band of her Timex watch, attempting to take it off her arm.

As she stood up, the ape bit her, leaving puncture wounds on her arm. "I tend to make light of most everything, so I said, 'It's no big deal,' " Mullin, now 77, said. "My husband said, 'No, I think you need to tell the tour guide,' and she absolutely freaked out."

Janice Mullin with a Barbary ape in 2012 just before she was bitten.
Janice Mullin with a Barbary ape in 2012 just before she was bitten.

The cruise line, Holland America, rushed her to the ship's medical facility. The doctor told Mullin he had never seen a monkey bite before, and the medical personnel called the Centers for Disease Control and Prevention for guidance. They gave her several injections and put her on antibiotic and antiviral medications.

Mullin, who lives in Enid, Oklahoma, said the cruise line covered her medical expenses and she felt the care she received was "wonderful," though she picked up an undesirable souvenir. "I had this great big black spot on my arm ... it was probably about the size of a softball," she said. "I had my 15 minutes of fame, and people would say, 'Oh, there's the woman who got bit by the monkey.' "

Scott said situations like that are "not that frequent." He also noted that the company developed Health Operations Centers at the start of the pandemic, which are based in offices on shore and can provide support to those working onboard.

Carnival Corp. has agreements with multiple university medical centers to conduct consultations with specialists.

How do cruise ships get sick or injured people to shore?

Scott said how cruise ships get sick or injured passengers to shore depends in large part on "the weather, the location and the assets available."

If the ship has a stop coming up, they may wait until they can get to a port. If not, they consider what is nearby, or if the U.S. Coast Guard (or equivalent officials in other countries) are available to them, which can provide a helicopter evacuation, or by boat if they are closer to shore.

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Scott said they remove sick or injured passengers at ports the vast majority of the time, which is the "safest way to do it." Even if there are not medical facilities near a given port, there may be an airstrip, allowing the team to schedule a medevac aircraft to come meet the ship, Scott said.

Does insurance cover medical expenses on a cruise?

Many health insurance plans do not cover medical expenses incurred at sea or in foreign countries, Scott said. Carnival Corp. requires passengers to pay for those services, and they can then submit the receipts to their insurance company.

He said he is "not aware" of any cruise line that accepts insurance in its medical facilities, and highly recommended passengers purchase travel insurance, which he said is more likely to cover those bills.

Scott said a medical evacuation can cost tens of thousands of dollars, though the amount varies depending on the circumstances.

Lautenschlager's medical costs on Norwegian totaled $371.96, including medication, according to a receipt she shared with USA TODAY. She plans to submit the expenses to her travel insurance provider.

While a medical issue can put a damper on vacation, even Mullin, who was bitten by the monkey, still loves cruising. She sails two to three times a year with her husband.

"It hasn't deterred us any, the idea of being sick," she said. "Because that's life, people get sick."

Have you had a medical emergency during vacation? How was that experience?

This article originally appeared on USA TODAY: What if I get sick or hurt on a cruise? Here's what to know