what the cruise passenger should know

In an attempt to provide cruisers with the information they need before boarding we offer these suggestions of what a passenger should know about medical concerns before cruising 

Cruise passengers may or may not come on board prepared for their cruise. Some have embarked with little or no forethought to the situations they may encounter in their travels. Even passengers with complicated medical conditions may book a cruise with the thought that there is a doctor and a hospital on board so they can take care of me if I need attention while at sea. 
These same people may board the ship with medications removed from their original containers and with little or no written medical history. Piecing together a complicated jig saw of medical needs with limited resources can strain the medical facilities of any vessel and cause great anxiety for the patient. 

Know Before you Go
Too often the lure of a beautiful brochure showing enticing exotic destinations with full color 
photographs is all that is seen by a cruise passenger. That section at the end of any cruise brochure that explains the details of the cruise is often flipped past with no regard. This section outlines the terms of the contract between the cruise line and the cruise passenger. 
In the brochure the language is simple and straightforward. Most passengers can readily understand even the more detailed cruise contract that is delivered with every set of cruise tickets. The problem lies in getting passengers to understand that they are in fact entering into a contract with the cruise line, with the exchange of money the cruise line as well as the passengers have distinct obligations.

In most cruise contracts you will find language that will spell out that the cruise line must be notified of any medical condition that can impact the health and safely of the passenger or make them unfit to travel. This includes pregnancies, which some passengers see as a non-medical condition and feel that a fitness to travel endorsement by their physician at home is adequate for cruise travel.
In fact fitness to travel is such an important area within the cruise contract that it is one of the areas for which a passenger can be denied boarding at the embarkation port. It can also necessitate emergency disembarkation at ports along the route of the cruise. 

Do Your Research
Do a bit of research about the destination to determine if any special medical precautions are needed. Even better consult your physician or a travel medicine specialist 6 to 8 weeks before your trip. A physician familiar with travel medicine will address concerns that include not only your health but also any needed immunizations, health precautions, or medications that should be added to your first aid kit.

Plan for the weather and terrain; make sure that you pack appropriate clothing for any expected circumstance and sensible shoes for your destination.

Keep abreast of the political climate and any unrest in the area you will be visiting. Pay attention to any advisories that are placed in ships newsletter about the ports of call. 

How to Choose the Right Ship
The passenger with physical challenges or medical concerns should carefully select a travel consultant to assist them with their cruise plans. The tried and true methods of asking friends, family and member of support groups are still the best ways to find a qualified agent. It is much less important o find someone one who is a specialist in dealing with disabilities than to find someone who is excellent at their profession. An agent with good skills in meeting the needs of clients can certainly deal with your special needs just as effectively as they do the diverse travel arrangements that they make on a daily basis.
First and foremost make sure that your agent is someone that you enjoy talking to and that you feel comfortable with and trust. Their skills and experience with their suppliers will allow them to meet your needs effectively.

Experience, qualified agents will often have the credentials of MCC or CTC after their name. The MCC designation signifies that the agent has met the requirements of CLIA (Cruise Line International Association) to be designated a Master Cruise Counselor. The trade industry has a broader training program for full service agents or cruise only agents, which earns them the title of Certified Travel Counselor. Either of these designations indicates that the agent has invested a great deal of time, effort and money in making sure that they can serve clients effectively. 

With the help of your agent you can then begin the process of selecting the correct ship for you. It is wise to plan as far in advance as possible to ensure that you are able to get he ship and itinerary that is of greatest interest to you. If you will require a special accessible cabin you should plan on reserving about a year in advance. This is especially true if you want a suite or an inexpensive inside cabin, as these are the first to sell on modern ships. There are very few accessible suites in the market so make sure you discuss the type of cabin that you want early in your discussions with your agent.

A good rule of thumb to discuss with your agent is that the newer cruise ships are generally the most accessible. The cruise lines voluntarily strive for compliance of the guideline of the Americans with Disabilities Act and many of them offer some of the most barrier free accommodations in the travel industry. It is also a good idea to ask if the ship is marketed primarily to the North American market. These ships will have English speaking medical personnel and will meet the expectations of the North American passenger. Don’t forget to confirm that the cruise line is a member of ICCL.

Once you have narrowed down the field of possible ships, dates and the itineraries it is time to start looking at the ports of call. It is not a good idea to choose an itinerary with tender calls if you have mobility concerns. Tenders are much smaller boats that are used to shuttle passengers from the cruise ship to the shore. Most require the use of stairs or at the very least a transfer from the relatively stable cruise ship to a bobbing tender. Try to pick an itinerary where the ship docks at all or most of the ports. 

Purchase Travel Insurance
Many passengers feel that if they have an unusual or tragic event in their lives that prevent them from travel that the cruise line should offer them a full refund. Refunds when given for unforeseen covered expenses are paid by insurance companies and not by the cruise line. Therefore, passengers who must cancel a cruise due to circumstances such as illness or death of a family member will find themselves unreimbursed without travel insurance. The penalties accessed by each cruise line are clearly spelled out in cruise contract. 

The purchase of travel insurance does so much more than protect the purchase price of a cruise. In addition comprehensive travel insurance policies offer such peace of mind items as medical evacuation, travel accident or illness coverage, return of mortal remains and travel assistance. Travel insurance can be purchased directly through the cruise line or through a travel agent.

Any policy that is purchased should cover pre-existing conditions as well as default of suppliers or carriers. Even when a major cruise line is involved with great stability, air carriers or others who are responsible for part of your vacation may be affected by such things as strikes and natural disasters making them unable to provide the contracted service. 

Notify of Special Requests
Most cruise lines have the ability to accommodate a large number of special requests, such as cribs in a stateroom, special diets and wheelchair accessible cabins.

Some lines have special equipment available for hearing and sight-impaired guests, but guests need to request this ahead of time due to limited supply. All of these things should be reported to the travel agent by the passenger who can then direct the special request to the correct department within the cruise line. This should be done at the time of the original booking.

Even clients who do not require a handicapped cabin but who will require wheelchair, walker or cane use full or part time should report this to the agent so that the cruise line can be notified. This assists in priority embarkation and disembarkation as well as convenient placement in the dining rooms. Physically challenged passengers should be placed as close to as elevator as possible and every effort should be made to place them near their dining room.

If there are any medical, physical or dietary conditions including but not limited to the following, report them at time of booking:

Mobility Impairment 
Vision or Hearing Impairment 
Pregnancy 
Allergies 
Diabetes 
Dialysis 
Oxygen Use 
Bleeding Disorders 
Injectable Medication 
Prescription Medications 
Dietary Requirements 

Each passenger should have the name and phone numbers for his primary and specialist physicians. Also please carry with you in your carry on luggage a copy of your latest medical records with such information as recent EKG, medications list and allergies. A medical information sheet with next of kin, hospital and health and travel insurance information is also helpful. Also place in your carry on luggage your medications and spare eyeglasses or contacts and a small first aid kit. 

If you have a medical condition and you do not have a Medic Alert neck tag or bracelet this would be a good time to purchase one and wear it. (Call Medic Alerts at 1-800-825-3785) It is also a good idea to have your travel agent’s non-800 number if you are going to be out of the United States and need to call them.

Special Needs at Sea (www.specialneedsatsea.com) does an excellent job in providing medical equipment for our clients. They provide oxygen, wheelchairs, scooters etc. but they should be contacted well ahead of time. 

Traveling with Infants and Toddlers
Not all cruise lines are equipped to accommodate infants and toddlers.

Many have age restrictions for infants below a certain age. The age of each child should be reported to the agent at time of booking. This will assure that the cruise line is able to accept the child and it will also allow the cruise line to properly prepare for each age group of children. 

What to Leave Behind
For your peace of mind make sure that you leave the following information behind for your friends and family. The name of the ship you will be on as well as your flight information, your cabin number and reservation number, your travel agent’s name and phone number and a photocopy of the first page of your passport.

In your cruise documents you should find information for ship to shore phone numbers and the fax number to the ship. Do keep in mind that many times ships can only receive faxes when they are at sea. In this case a copy of the ship’s itinerary would be very helpful. 

What about the Medical Facility On Board the Ship
Many modern cruise ships come under the umbrella of the industry organization of the CLIA. The CLIA with the assistance of the American College of Emergency Physician’s Section of Cruise Ship and Maritime Medicine developed a set of guidelines for the medical facilities on cruise ships. Their member lines have voluntarily agreed to support these guidelines on their ships. One of your questions as a passenger should be: Is the cruise line I am considering a member of CLIA? If not, you should investigate their medical capabilities before entrusting your well being to them.

Just as each ship has its own distinct style and personality that is dependent on design, age and intended itineraries the medical facility on each ship can vary as well. Some are compact and efficient while others are very spacious.

In the medical facility you will find one or more doctors along with highly skilled nurses. These dedicated professionals provide 24-hour coverage for health care needs. They have set office hours as well as a pager for instant notification of an emergency or urgent medical need. Please keep in mind that medical care is at the passenger’s expense and that insurance assignment is rarely accepted on or off the ship. U.S. Medicare does NOT reimburse subscribers for medical care rendered on board ships unless the vessel is registered and flagged in the United States.

Some facilities are state of the art and provide such things as telemedicine, digital X-rays and sophisticated laboratory diagnostics. But in all of them you will find basic life saving drugs and equipment for stabilization. When you are comparing a ship based medical facility with a land based facility it is important to remember that it is not a hospital.

It is much more kin to a free standing urgent care center that you would find on land. Although technology has allowed for a great deal of sophistication in both sea based and land based medical facilities the shipboard medical facility does not have the luxuries of on board specialists, large nursing staffs to offer 24 hour extended care, or highly specialized tests such as CAT scans.

For these reasons if a patient requires on going medical care it will be necessary for them to disembark at the first appropriate port of call for either care there or for emergency air evacuation to an appropriate medical facility. Since any air evacuation will require several thousand dollars it is imperative that passengers have insurance for this unexpected event. 

Life Boat Drills
Experienced cruisers as well as first time cruisers all too often endure lifeboat drills with only cursory attention. Saving your life in the rare event of a disaster will be up to you as well as the staff. Knowing what to do and where to go can make the difference of life and death or at the very least it can reduce the anxiety of not being prepared sufficiently. It is up to the passenger to know the ways to their life boat station and what items that should be carried to the boat with you. Don’t count on someone being at every turn to direct you, assume responsibility for your safety any time you set foot on a ship. 

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