for Cruise Research
centre for research and for
Dahl, E "Dealing with gastrointestinal illness on a cruise ship,"
2004, 55(1-4) 19-29
Recent outbreaks of
gastrointestinal illness (GI) on
passenger ships have caused cruise companies to expand their sanitation
programs. To describe sanitation procedures and measures involving the
medical staff of one cruise ship (Part 1), and to show how one of the
new measures, isolation, influenced medical practice (Part 2).
Consecutive GI logs were reviewedfrom 17 cruises of a ship with an
average of 590 passengers and 611 crew per day. During a 250-day period
207 persons were isolated for a total of 419 days: 113 passengers (75
with GI, 38 asymptomatic contacts) and 94 crew (57with GI, 37
contacts). The percentage of GI cases per 7 days varied between 0.10%
and 0.43% among passengers and between 0 and 0.39% among crew, except
for one cruise when the percentage per 7 days reached 2.16% among
passengers and 0.61% among crew. A detailed operational directive
all aspects of sanitation is helpful for prevention and control of GI
outbreaks on ships. A strict isolation policy is an expensive, but
critical measure, which in particular challenges the medical staff.
"Social status versus formal rank of medical and other
officers--an informal survey among passengers and seafarers on cruise
2004, 55:1-4, 165-75.
Modern cruise ships
have a rigid hierarchic structure,
status of the officers may have changed over time. To get an impression
of how cruise officers and crew (=staff) and experienced passengers
perceive the status of various shipboard positions, particularly Doctor
and Nurse, and compare with present ranks. Passengers and
staff during a World Cruise (Ship 1) and staff on a sister-ship (Ship
2) during a voyage without passengers were asked by questionnaire to
rank shipboard jobs by assigning 0-4.5 stripes to each position
according to perceived social status. Median values were reported.
29% of 109 passengers and 11% of 899 staff responded. Captain
was assigned 4.5 stripes by both female and male passengers and staff,
followed by Vice Captain (4 stripes, as now, by all). Chief Engineer (4
stripes) was downgraded by male passengers and female staff. Hotel
Director (4 stripes) was rated as now by all but male passengers.
Executive Housekeeper (2.5 stripes) was upgraded by all but male staff.
Doctor (3 stripes) received 4 stripes from passengers and 3.5 from
staff. Nurse (2 stripes) got 3 stripes from passengers and 2 stripes
from staff. All upgraded Security Officer (2 stripes). The participants
seemed to accept the hierarchic rank structure aboard, with the captain
alone on top. Marine officers, especially those considered responsible
for safety, security and health, were ranked high by all, while
passengers also tended to upgrade hotel officers with visible
problem-solving positions. Passengers and staff agreed that the Doctor
and the Security Officer deserve more stripes, while the Nurses were
upgraded by passengers, but not by staff.
Dahl E. "Passenger
mortalities aboard cruise ships,"
Maritime Health, 2001,
OBJECTIVES: to study the
epidemiology of passenger
mortalities on cruise ships. METHODS, MATERIAL AND RESULTS: during six
years (April 1995 to April 2001) deaths aboard two similar cruise ships
(A & B) were registered and studied. Each ship had an average of
approximately 800 passengers with median age about 65 years. Twenty
five passengers died: 9 men and 3 women on ship A and 10 men and 3
women on ship B. There was an average of one death every six months per
ship. More men than women died, although there were more female
passengers on both ships (P<0.05). Eleven passengers were found dead
in their cabins. Five deaths outside the medical centers were
witnessed; four of them had asystole and one ventricular fibrillation
when medical staff arrived. Nine patients died after 1/2 to 52 hours of
intensive care in the medical centers aboard.
Dahl E. "Anatomy of a world
cruise," Journal of
Medicine, 1999, 6:3
We registered the
patient-related activities of a large
cruise ship's medical center during a 103-day worldwide voyage and
compared data from 694 passengers (53% women) with median age 66 years
with data from 540 crew (27% women) with median age 30 years of age.
The medical staff had 3033 (1537 crew, 1496 passenger) consultations
(=206 consultations per week) and performed 982 diagnostic procedures.
Skin disorders dominated in the crew and were more frequent than in the
passengers (29% versus 13%, p<.01), respiratory problems dominated
in the passengers and were more frequent than in the crew (26% versus
17%, p<.01), while cardiovascular disorders were more common in the
passengers (7% versus 1%, p<.01). Forty-six injuries (35 passengers,
11 crew) were recorded. One passenger died aboard. Seventy-six crew
(14%) were not able to work for a total of 110 days (1.1 crew sick per
day), while five crew were signed off for medical reasons. To be a
doctor or nurse on a large cruise ship during a long sea voyage is no
vacation. The medical staff should expect a varied general practice
with a higher consultation frequency rate than shoreside, even higher