We were recently asked by a CruiseSafely Subscriber, “do you have any advice on when to evacuate a cruise ship and how to go about arranging an evacuation?” This subscriber sent us a detailed email concerning a medical problem that arose during their cruise. The medical issue was the result of an injury sustained during a shore excursion. To summarize, he felt that the care he received was substandard.
The question is a complicated one with many variables. Let’s start with the situation that is foremost in peoples mind: evacuation by helicopter. Stories of the US Coast Guard performing medical evacuations at sea from cruise ships are common. On average, the Coast Guard does so about once a week. Some travelers believe it is their right to be evacuated from a ship, but that is not the case. The U.S. Coast Guard mainly operates in U.S. Waters and only minimally in international waters. So if you are in Mexican waters, they most likely will not assist.
Medical evacuations are dangerous, not only for the patient but for the rescuers and other passengers aboard ship. As such, the Coast Guard generally only deploys for a rescue in the most dire of circumstances. For passenger ships, the Coast Guard Search and Rescue (SAR) units will coordinate with the onboard medical personnel. A CG flight surgeon will evaluate the case based on the medical doctor’s evaluation. Together they will weigh the health risk against the safety risk, as well as possible alternatives before deciding on the course of action.
It may be that the next port of call is of less risk. One option that is often considered is to recommend closer government or commercial non-aerial evacuation. Recently, the Miami-Dade Fire and Rescue unit evacuated three guests off a cruise ship by boat. Keep in mind, the captain of the ship is under no obligation, and may even be prohibited, from changing course to get you to a hospital sooner.
Medical Evacuation Insurance
If you are evacuated by the Coast Guard there is no cost. However, after delivering you to the nearest hospital, the costs incurred there are your responsibility. If you are in an area not usually covered by the Coast Guard, you may be liable for the cost of evacuation.
If a commercial medical helicopter is used, the cost can be upwards of $10,000 to get you to the nearest hospital. Additionally, it’s common for a patient in a local foreign hospital to require transportation back to the United States for further treatment. As an example, from a Caribbean country to the US, the cost can easily reach $30,000. The average cost for an Intensive Care transfer from China to the United States, $250,000. The point being- a travel insurance package that includes emergency medical evacuation is extremely important.
All insurance policies are not created equal. If commercial evacuation is required, payment must be made before you are evacuated. Generally, this is by coordination between the ship/hospital and your insurance company. The method of transportation must be approved by the insurance company and acceptable to the medical team. Insurance companies have payment procedures in place with different providers so that once an agreement has been reached, the transportation can be paid evacuation commenced within minutes.
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In the specific case our Subscriber described, they sustained an injury and received inadequate care from the on-board facilities. They debated whether or not to request evacuation but ended up waiting until arrival home. It’s very important to note that if the Doctor does not think a medical evacuation is necessary and you choose to request it anyway, travel insurance will not cover the costs. Another option for our Subscriber would be to wait until the ship arrives at the next port and find a local doctor. That doctor could advise if local treatment is better than what the passenger has been receiving on-board. If that’s the case, the doctor could discuss it with the insurance company and allow local treatment or hospitalization.
One option to seriously consider when choosing a travel insurance policy with medical evacuation is a self care clause. In these policies, you and not the doctor, has the primary authority to determine if you need treatment only available if evacuated to another location.