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A Guide to the Medical Resources of Ports Served by Cruise Line Vessels
Patient transfers from a cruise ship to a medical facility in Southeast Alaska are common. This section of the Guide includes information on optimizing the patient transfer process.
In nearly all cases, however, there is adequate time for planning the orderly transfer of patients from the vessel to the shoreside medical facility. It is essential that a physician planning to transfer a patient to a medical facility in Alaska contact the appropriate physician at the receiving facility prior to initiating the transfer. This contact helps to ensure that the receiving facility is capable of providing the level of care required for the patient and that prehospital and hospital personnel are adequately notified and prepared.
Accurate communications also increase the likelihood that the correct level of emergency medical services provider is sent to the vessel to assist in patient transfer. In larger communities, such as Juneau, Sitka, and Ketchikan, this is rarely a problem. In smaller communities, however, which are staffed by a mixture of EMT-Is, EMT-IIs, and/or EMT-IIIs, it is important that the receiving facility be contacted in advance to ensure that the level of EMT is matched to the patient's needs (see the description of the various EMS certification levels on page 33 of this Guide).
While on board your vessel, the prehospital medical providers will work under your direction, unless you defer to their physician medical director. If the patient must receive care during transport which exceeds the scope of practice for the prehospital providers, arrangements must be made to ensure that the patient is accompanied by an appropriately qualified individual. The patient's records or summary of treatment must accompany the patient. If a physician does not accompany the patient, the emergency responders will be under the medical direction and standing orders of the local EMS physician medical director once off the vessel. Non-physician medical personnel, designated by the ship's physician to accompany the patient, may continue to provide care when en route, but do so under the auspices of the ship's physician. Should the standing orders for the ship's personnel accompanying the patient differ from those of the local emergency medical service's physician medical director, efforts should be made to resolve the conflict by communicating with the local physician. In the event that communication can't be established, the local standing orders will be used by Alaska certified EMS providers.
Since local hospitals and clinics are more knowledgeable about available resources, capabilities of regional facilities, and transfer options, it is imperative that they be contacted as early as possible when the transfer of a patient off a vessel is planned. This is particularly important when it is likely that air medical resources may be requested to transfer a patient from a clinic or hospital to a referral center. Notifying the receiving facility of the planned transfer as soon as the need is identified allows resources to be made available in a safer, more efficient manner. For example, in some cases, transfer could be arranged during daylight hours as opposed to more difficult flights at night
If the patient speaks a language other than English, it is recommended that the ship's medical officer confirm the availability of a translator with the receiving facility, or that a translator accompany the patient.
If the vessel is in port when the medical emergency occurs or is discovered, it is recommended that shipboard medical personnel implement its emergency response system and access shore-based emergency medical services resources as soon as practicable, dialing "911" when appropriate.
In summary, it is imperative that facilities which will be receiving patients from a cruise ship be notified as soon as possible after the determination is made to transfer the patient. This contact is in the patient's best interest, should take little time, ensures that the process is efficient and minimizes medical and legal risks.
Although the EMT/EMT-Instructor certification regulations mandate a core curriculum, in some cases, the emergency medical service's physician medical director has chosen to add procedures and/or medications to the EMT's arsenal of treatment methods. The ability of the physician medical director to tailor emergency care practices to the community's needs (and the EMT's capabilities) results in a higher level of care than would be possible otherwise. In many ports in Alaska, emergency medical responders are trained to the EMT-II level or above.
Emergency Trauma Technician (ETT)
An ETT is trained in a 40 hour program to provide basic life support, including splinting, bandaging, bleeding control, and the use of free flow oxygen. This level of training is prevalent in small communities and industrial settings in Alaska. Some ETTs are trained to use automated external defibrillators (AEDs).
Emergency Medical Technician-I (EMT-I)
The Emergency Medical Technician-I is equivalent to the National Standard EMT-Basic, as described in the United States Department of Transportation (USDOT) curriculum. The EMT provides basic life support such as splinting, hemorrhage control, oxygen therapy, suction, & CPR. Most EMTs are trained to use AEDs. Some are trained and authorized to use manual defibrillators.
Emergency Medical Technician-II (EMT-II)
The Emergency Medical Technician II level exceeds the National Standard Training Program EMT-Intermediate, developed by the USDOT. The EMT-II class prepares the student to initiate intravenous lines and administer fluids and certain medications, such as 50% dextrose.
Emergency Medical Technician-III (EMT-III)
The EMT-III program is designed to add some advanced cardiac care skills to those the EMT has learned already. Also included in the training program is manual defibrillation and the use of morphine, lidocaine, atropine, and epinephrine.
Mobile Intensive Care Paramedic (MICP)
Mobile Intensive Care Paramedics are licensed by the Alaska Department of Commerce and Economic Development through the Alaska State Medical Board. MICP's provide care in excess of the EMT-III level and function under the direct or indirect supervision (standing orders, etc.) of a physician. Generally, paramedics are found in the most populous areas of Alaska, including Anchorage, Fairbanks, Kenai, Soldotna, Nikiski, Juneau and Ketchikan. In some of these communities, all pre-hospital emergency medical care is provided by Mobile Intensive Care Paramedics. In others, the MICP may act as a supervisor or EMS director.
In the event of a disaster or multiple casualty event occurring outside a port, the vessel's physician should, through the means prescribed by the vessel's Master, advise the United States Coast Guard's Rescue Coordination Center of:
· the number and types of patients;
· basic information about the care which is being provided; and
· anticipated needs for additional resources.
Because most port communities in Alaska cannot handle more than a few critically injured patients, it is important to know as much about the types and numbers of patients as early as possible so facilities and evacuation resources can be identified, contacted, and activated.
Since time and communications resources are both at a premium during a mass casualty incident, it is important to efficiently communicate medical information to those coordinating the rescue. Adequate mechanisms for patient tracking should be implemented at the earliest possible time, however, specific medical details and patients' names are not communicated initially by radio or telephone early in the event when competing activities may take precedence.
It is often useful to have an assistant with strong logistical and record-keeping capabilities assigned to assist the physician.