Case study: medical help on a cruise ship in the Pacific Ocean

Repatriation route map - Pacific Ocean to Croatia via Japan, Amsterdam and Switzerland
A long way from home

Dr Ilya Rapoport, Medical Director at AP Companies, reports on the decisions faced by his assistance team in a case involving a spinal stroke suffered on a cruise ship in the Pacific Ocean

Background
Each year, international cruise line companies bring tourists to new destinations in beautiful and remote parts of the world. These large vessels are temporarily home to a huge number of passengers and staff from all around the world but, unfortunately, their excitement about being onboard is sometimes shattered by a sudden illness or onset of disease while at sea. In many such situations, the passenger or crew’s insurance company, the port agent, medical assistance company and local healthcare provider all have to work in close co-operation in order to save their life and deliver them back to their home country or to a medical facility as close to their home city as possible.

In the Pacific Ocean, cruise lines have a number of routes, along which local healthcare providers are scarce; and, where they do exist, they often do not provide even the most basic care, never mind more complicated care, such as neurosurgery or modern rehabilitation. It is also a well-known fact that in cases of neurological disorder and muscle impairment, it is extremely important to start rehabilitation as soon as possible in order to restore function.

The request
On a winter’s night last year, AP Companies Global Solutions received a request to arrange medical help for a Croatian crewmember onboard a large cruise vessel on its way to Noumea, New Caledonia. She had suddenly begun suffering from low paraplegia, a result (as it was discovered later) of a spinal stroke of vascular origin.

The plan
Our plan was to deliver the patient to the hospital in New Caledonia – after arranging all visa and legal formalities – for stabilisation and diagnosis, then transfer her home to Europe for further medical care. It was clear that she would need either an air ambulance transfer or to be transpoterd on a stretcher on a a regular flight with a medical escort. We started to check the local air ambulance providers immediately. We prefer to use our own experienced medical team onboard, however – whether our in-house team or a contracted partner – for medical escorts and patient evaluations, so we had to also consider visa arrangements for the incoming medical team.

Transportation from ship to hospital 
AP Companies considered several options when deciding on the quickest way to deliver the patient from the ship to the hospital. Unfortunately, due to severe winds in the area, air evacuation was not possible. The ship was due to reach port in 12 hours, so we opted to arrange a ground ambulance transfer for the patient upon her arrival for immediate transport to the hospital in Noumea.

one can only imagine the cost of an air ambulance from the Pacific to Europe!

Transfer to Europe
After a week in ICU in the hospital in Noumea, which our network department confirmed was relatively well-equipped in terms of first aid and diagnostics, she was transferred to a neurological ward and a Fit To Fly form was issued, allowing us to commence arranging the patient’s transfer home. However, one can only imagine the cost of an air ambulance from the Pacific to Europe!

An important part of assistance providers’ jobs is keeping the balance between the patient’s health and the insurance company’s interests when it comes to cost control and reasonable and customary rates. After a brief discussion with the treating doctors in New Caledonia, we came to an agreement with all parties that the patient would stay a little longer in the local hospital and begin her rehabilitation treatment there, allowing the opportunity to subsequently transfer the patient home via a business class seat on a regular flight.

Thankfully, following an additional week’s stay at the hospital, she was able to walk with a walker and so we began to check our list of escort doctors to select one with excellent experience in emergency medical care and neurology.

After the successful resolution of various visa issues, and tickets clearance, which required negotiations with different airline companies and the completion of several forms, including the patient’s vital parameters, our doctor began their long flight to Noumea.

Concurrently, the patient informed us that she didn’t want to travel back to Croatia, but rather to Switzerland, where she had family who could assist her. The insurance company agreed to fulfill this desire, so we began to source a good clinic to provide her neurological rehabilitation treatment that would accept her at short notice. Since such clinics are in very high demand, with long waiting lists, this was a challenge. However, our network team performed excellent negotiations and a clinic in Switzerland agreed to accept her (after clearance from an emergency hospital in the country).

At last, the long transfer from Noumea began, our doctor and patient travelling via Tokyo and Amsterdam to Geneva. The flight was without incident.

A ground ambulance transfer from Geneva airport to the local emergency hospital was arranged, some investigations were carried out and, after confirmation that nothing acute was going on with the patient, she was successfully transferred to the rehab clinic.

Positive outcome
After several months in the rehab facility in Switzerland, the patient recovered and could be transported with only a nurse escort to Croatia. She was placed with another rehab clinic and, after five months, she was fully recovered and returned happily to her everyday life.