Sailing off across serene waters to far-off destinations can be a dream come true for many cruise passengers and crewmembers. But when a patient requires medication, how do cruise ships and assistance providers offer help while far from port?

Seeking medication and medical data

When a patient falls ill on board a cruise ship, one of the most vital considerations, while assessing the situation and obtaining appropriate medication, is how to provide support – both emotionally and physically.

Crystol Lasley, Director of Maritime Medical Operations at AP Companies, explained that the onboard doctor’s first move would be to contact the patient’s doctor at home.

“Historically,” she reported, “the doctor on board would speak with the guest’s treating physician in their home country if possible, and discuss alternative medications from the ship’s formulary with which to treat the guest if their prescribed medication is unavailable.”

Until the correct medication can be obtained, or until their cruise ends and they disembark, Lasley added, the patient will then be monitored carefully to ensure their condition does not worsen.

She continued: “In some countries, scripts from the onboard doctor are accepted and the guest can take this ashore and purchase the correct medication, if available.

This enables guests to obtain valid local prescriptions, ensuring medication compliance with national regulations and bypassing jurisdictional barriers that might otherwise prevent pharmacy access.”

On other occasions, she explained, telemedical consultations could be facilitated with licensed physicians in the ship’s next port of call to support treatment.

Dr Lynn Gordon, Chief Medical Officer at Charles Taylor Assistance, agreed, stating that the provision of medication is seen as especially vital by cruise lines because “customer satisfaction is key” to how they operate, and “onboard medical staff see themselves as an integral part of the customer service team”.

Because of this, onboard medical staff will do “everything they can to support passengers, both medically and emotionally”.

Fully fledged medical departments

However, Dr Gordon noted that, at present, there is not usually a reason for medication to be delivered to cruise ships that are out of port.

“Cruise ships typically have their own fully fledged medical departments, and carry a reasonable supply of medication both for passengers and crew,” she said, adding that some crewmembers may be on board for a year at a time.

Consequently: “If a passenger runs out of essential medication, or has forgotten to bring it with them, the ship’s medical team will either dispense the medication themselves from their pharmaceutical supplies, substitute it with a suitable alternative, or obtain it via their port agents.”

This is backed up by the US Centers for Disease Control and Prevention (CDC), which stated: “Generally, shipboard medical centres can provide medical care comparable to that of ambulatory care centres; some are capable of providing hospital-level services or renal dialysis.”

Historically, the doctor on board would speak with the guest’s treating physician in their ‎home country if possible

Gordon explained that if a passenger’s medication isn’t available on board, doctors are usually able to dispense a suitable alternative as an interim measure, until the original prescription can be obtained, and will monitor the patient closely throughout.

However, she acknowledged that, despite the typically thorough approach to medication displayed by most cruise lines, there may be times when there simply is no substitute for the required medication.

“On the rare occasions that essential medication isn’t available – for instance, if a passenger needs a difficult-to-obtain drug in a remote area – crews may very occasionally organise a courier delivery, or even need to disembark a passenger at the closest port, in line with their safety-first policy,” Dr Gordon said.

From that point onwards, the passenger may then be transferred from the port to an area with suitable medical provision, if no such facilities are available nearby.

Dr Gordon explained that, in the case of Charles Taylor Assistance, “we would usually only get involved in supplying additional medication if a cruise passenger has already been disembarked”.

This is especially important during periods of time before and after the patient has been transferred to an appropriate hospital, she explained.

“The passenger may, for example, have run out of medication whilst staying in a hotel after being discharged from hospital, but before their onward travel,” Dr Gordon said. “In cases like this, we would [usually] arrange for a doctor to visit them at their hotel. We have also been involved in the ‘pay and claim’ stage.”

Telemedicine and other technology

Alternatively, Dr Gordon suggested, they would set up a consultation via a telemedicine service to ensure that the appropriate medication could be prescribed.

Lasley also praised telemedicine services as a critical aspect of how medical assistance is provided to ships at sea – something she said AP Companies “broadly utilise and advocate for”.

She explained that while delivering medicine to ships is not often necessary or possible, the provision of expertise often is.

“Telemedicine provides essential medical consultation, oversight, and advice – though it cannot physically deliver medications,” Lasley said. What it can do, however, is let a telemedicine physician “confer with the onboard doctor regarding formulary-compatible substitutions, and reassure guests that both medical professionals endorse the alternative treatment”.

In addition to this, she explained, telemedicine can offer further benefits for those who need extra medication while away from home.

On the rare occasions that essential medication isn’t available, crews may very ‎occasionally organise a courier delivery

“[They] offer a practical way to obtain local prescriptions,” Lasley noted, “but only if the guest is well enough to leave the ship during port calls and purchase the medication at a nearby pharmacy.”

Outside of this, drones are another potential technology that could offer a more physical response to pharmaceutical emergencies on cruise ships – however, at present, such initiatives are limited by red tape.

Lasley explained that while drone deliveries were an “interesting thought” that has potential to change how medicine is delivered to cruise ships, such a technique would require regulatory processes in most countries to be heavily reworked to facilitate it.

“Currently, drone deliveries remain geographically and operationally constrained,” she said. “Regulatory grey zones – such as customs clearance and airspace permissions – as well as connectivity limitations in remote transit corridors, and unresolved liability frameworks, prevent their use in safe, scalable deployment across global cruise routes.”

Guidance offered before departure

Lasley added that while cruise lines will often sail to remote areas such as the Arctic or faraway islands, with the potential for logistical challenges to result when considering crew and passengers’ access to medicine, they will typically aim to prevent those with potentially dangerous health issues from embarking in the first place.

“Cruises to remote locations will offer guidance to passengers prior to sailing, regarding the challenges with situations such as this,” she said.

Beyond this, there is an onus on passengers to inform the cruise line of any potential health issues in advance of departure.

This is in line with advice provided by the CDC, which recommends that travellers with “chronic illnesses and … disabilities, who have additional needs (e.g. dialysis, supplemental oxygen, wheelchairs), should inform their cruise line before travelling, to ensure the ship can support their needs”.

The CDC Yellow Book on Cruise Ship Travel also noted that when it comes to pregnant travellers, “most cruise lines have policies that do not permit women to board after their
24th week of pregnancy” and these travellers should be proactive in contacting cruise lines directly for specific guidance before booking.

However, the CDC also argued that, from the cruise line’s perspective, and due to the “unique combination of health concerns” presented by cruise ship travel – in which travellers from diverse regions are brought together in  crowded, semi-enclosed environments – additional care must be made for passengers and crew who are vulnerable.

Around 95% of acute illnesses or injuries reported to cruise ships’ health centres are treated or managed on board

“Some people (e.g. those with chronic health conditions, or who are immunocompromised, older, pregnant, or very young) merit additional considerations when preparing a cruise,” the agency said. “Because travellers at sea might need to rely on a ship’s medical capabilities for an extended period, people with pre-existing medical conditions or special needs who are considering cruise travel should prepare accordingly by contacting the cruise line’s customer service centre to learn what types and level of healthcare services are (and are not) available on specific ships.”

The CDC concluded by highlighting that around 95% of acute illnesses or injuries reported to cruise ships’ health centres are treated or managed on board, with the remaining cases requiring evacuation and shoreside consultation.

Most medical centre visits, it said, are the result of acute illness or injury, with 30–40% being for respiratory illness; 12–18% for slips, trips and falls; 10% for gastrointestinal diseases; and another 10% for seasickness.

Conclusion

Ultimately, while cruise ships are well equipped to manage most medical needs on board, proactivity from travellers and crew, cruise lines, and assistance firms is still valuable. This is particularly true for cases when onshore or telemedicine consultations may be required, or alternative medications need to be provided.

While advanced solutions such as the use of drones for medicine deliveries at sea remain limited by regulation, such challenges can be overcome through solid pre-departure guidance from cruise ships, and the disclosure by passengers of any pre-existing medical conditions.