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Fire on cruise ships – An underestimated risk in travel medicine
Travel Medicine and Infections Disease (2015) 13, 509–510
CORRESPONDENCE
Fire on cruise ships – An underestimated risk in travel medicine
Dear Editor, Today, the largest cruise ships, namely the Oasis of the Sea and her sister ship Allure of the Sea of the Royal Caribbean International Cruise Line have a capacity of 6000 passengers and are served by a crew of 2500. Because of the growing market for cruise tourism, cruise ships accommodating more than 10,000 people on board are also planned. According to estimates of the umbrella organisation for the cruise industry, namely Cruise Line International Association (CLIA), 23 million tourists worldwide will be taking their vacation at sea in 2015. Growth markets such as China, so far untouched by cruise tourism, are also being developed [1]. More and more ship-owners are looking for new market niches, so that more and more remote areas are being opened up where coastal water- or air-based evacuations then become impossible. Only a few epidemiological studies have been published on the incidence and prevalence of certain diseases and traumas amongst multinational crew members and passenger patient collectives, on cruise ships. Scientific epidemiological studies on ships deal almost exclusively with the clientele of industry workers on cargo ships and fishing vessels. They often originate from occupational or preventive medical institutions, and are commissioned by national trade associations [2]. The fact that there are only a few descriptive epidemiological papers relating to cruise vessels may be because the cruise lines have little interest in making their data available so as not to compromise the image of the "Sunshine industry" [3]. Despite the dearth of epidemiological data at our disposal it is probably safe to say that thermal lesions on cruise ships primarily occur amongst crew members working in areas with an increased risk of incurring such injuries. In the deck and guest service departments on board a cruise ship, hundreds of crew members work in the ship's galley (kitchen) and laundry facilities around the clock; cruise ships only offer full board catering and housekeeping is done on a daily basis. Specific challenges with the http://dx.doi.org/10.1016/j.tmaid.2015.10.003 1477-8939/& 2015 Elsevier Ltd. All rights reserved.
treatment of burn injured patients, however, are presented by ship fires. Such incidents can result in serious burn injuries to one or even multiple patients, a situation which may even necessitate a subsequent triage. For cruise ships, fire on board is the most common serious emergency situation, as confirmed by a series of fires on cruise ships over the last two years. In 2012 in the Indian Ocean, for example, a fire broke out in the engine room of the MS "Costa Allegra" with 636 passengers on board. The ship was then disabled and adrift, meaning that it had to be towed. In the same year on the MS "Azamara Quest" with about 600 passengers a fire also broke out in the engine room off the coast of Borneo. Initially the ship was disabled, but it was then able to continue under its own power at a significantly reduced speed to the next port of its journey. Also in the same year a fire broke out on the MS "Carnival Triumph" in the Gulf of Mexico. There were also fires recorded on cruise ships in 2013, such as on the MS "Grandeur of the Seas" in the harbour of Freeport. On the MS "Zenith" in the port of Stockholm in 2009 there was a fire in the engine room of a ship which had already suffered a fire earlier in the year. Also in the same year there was a fire on the MS "Carnival Triumph" in the Gulf of Mexico. In 2010, the "Splendor" operated by Carnival Cruise Line also suffered a fire. The most serious fire disaster in cruise shipping history occurred in 1990 on the MS "Scandinavian Star" where 159 people lost their lives. The high number of deaths could be attributed to serious safety flaws, linguistic confusion and a lack of safety training amongst the crew [4]. When cruise ships operate near the coast they should be able to rely on standard rescue chains, at least when they operate near industrialised countries. Even here, however, emergency services or a specialised treatment facility cannot be reached within minutes, with rescue and transport times being measured instead in hours. Transportation whether by rescue ship or helicopter is neither gentle nor does it allow complicated therapeutic procedures to be carried out safely, especially under severe weather conditions. The handover to ships (usually via pier-height cargo ports or access gates) is already a manoeuvre fraught with danger in seas with wave heights of just one metre. For the severely burned patient this is always a heavy burden
510 which has to be weighed up when deciding on indicating a transport. Cooperation between the ship and the helicopter, which has to be done without allowing the two to touch each-other and cause a crash, is a challenge both for the nautical personnel on board and the flight crew [5]. Because of these considerations, handovers of patients at sea are only acceptable in cases of the direst need and for this reason the ship's doctor for a certain period of time would be solely responsible for coping with that particular emergency. For this situation, another contributing factor is that any departure from the usually very tight timetable of a cruise ship can entail considerable consequences for the rest of the affected passengers. This is the reason why today most shipping companies call on or recommend reliable emergency skills under stress. Whatever the individual situation demands, i.e. the interaction between various internal and external forces, applies all the more for complex situations [6]. A qualitative impact can also be expected if the abilities of a ship's hospital are quantitatively overstretched, especially if during the major incident of a ship's fire more than one burn injured patient needs to be evacuated on the basis of a triage procedure. In this regard, it should be discussed whether it makes more sense in such cases to dispatch a Burn Rescue Team consisting of anaesthesiologists, burn surgeons and paramedics on board.
Correspondence
References [1] Castillo-Manzano JI, Lopez-Valpuesta L, Alanis FJ. Tourism managers' view of the economic impact of cruise traffic. Curr Issues Tour 2015;18(7):701–5. [2] McKay MP. Maritime health emergencies. Occup Med 2007;57 (6):453–5. [3] Seidenstücker KH, Neidhardt S. Ship doctor's qualification – the fast track? Int Marit Health 2015;66(2):118–9. [4] Mileski JP, Wang G, Beacham LL. Understanding the causes of recent cruise ship mishaps and disasters. Res Transp Bus Manag 2014;13:65–70. [5] Galea ER, Deere S, Brown R, Filippidis L. A Validation data-Set and Suggested Validation Protocol for ship evacuation Models. Fire Saf Sci 2014;11:208. [6] Mellick LB, Adams B. Resuscitation team organization for emergency departments: a conceptual review and discussion. Open Emerg Med J 2009;2:18–27.
C.Ottomannn, Medical-Shipmanagement, Hartengrube 52/9, 23552 Lübeck, Germany V.Antonic1 University of Maryland, School of Medicine, 685 W. Baltimore Street, MSTF 7-00A, Baltimore, MD 21201 USA E-mail address: [email protected] (V. Antonic) Frank Siemers Direktor der Klinik für Plastische und Handchirurgie/ Brandverletztenzentrum, BG-Kliniken Bergmannstrost, Merseburger Str. 165, 06112 Halle, Germany
Conflict of interest The corresponding author states that as CEO for the company Medical-Shimanagement a potential conflict of interest exists. Medical Shipmanagement will also be hosting the International Course in Cruise Medicine in 2016. VA and FS declare that there are no conflicts of interest.
E-mail address: [email protected] (F. Siemers) n Corresponding author. Tel.: +49 172 76 21088. E-mail address: [email protected] (C. Ottomann)
31 August 2015 Available online 17 November 2015
Tel.: +1 301 768 8750.
1
CORRESPONDENCE
Fire on cruise ships – An underestimated risk in travel medicine
Dear Editor, Today, the largest cruise ships, namely the Oasis of the Sea and her sister ship Allure of the Sea of the Royal Caribbean International Cruise Line have a capacity of 6000 passengers and are served by a crew of 2500. Because of the growing market for cruise tourism, cruise ships accommodating more than 10,000 people on board are also planned. According to estimates of the umbrella organisation for the cruise industry, namely Cruise Line International Association (CLIA), 23 million tourists worldwide will be taking their vacation at sea in 2015. Growth markets such as China, so far untouched by cruise tourism, are also being developed [1]. More and more ship-owners are looking for new market niches, so that more and more remote areas are being opened up where coastal water- or air-based evacuations then become impossible. Only a few epidemiological studies have been published on the incidence and prevalence of certain diseases and traumas amongst multinational crew members and passenger patient collectives, on cruise ships. Scientific epidemiological studies on ships deal almost exclusively with the clientele of industry workers on cargo ships and fishing vessels. They often originate from occupational or preventive medical institutions, and are commissioned by national trade associations [2]. The fact that there are only a few descriptive epidemiological papers relating to cruise vessels may be because the cruise lines have little interest in making their data available so as not to compromise the image of the "Sunshine industry" [3]. Despite the dearth of epidemiological data at our disposal it is probably safe to say that thermal lesions on cruise ships primarily occur amongst crew members working in areas with an increased risk of incurring such injuries. In the deck and guest service departments on board a cruise ship, hundreds of crew members work in the ship's galley (kitchen) and laundry facilities around the clock; cruise ships only offer full board catering and housekeeping is done on a daily basis. Specific challenges with the http://dx.doi.org/10.1016/j.tmaid.2015.10.003 1477-8939/& 2015 Elsevier Ltd. All rights reserved.
treatment of burn injured patients, however, are presented by ship fires. Such incidents can result in serious burn injuries to one or even multiple patients, a situation which may even necessitate a subsequent triage. For cruise ships, fire on board is the most common serious emergency situation, as confirmed by a series of fires on cruise ships over the last two years. In 2012 in the Indian Ocean, for example, a fire broke out in the engine room of the MS "Costa Allegra" with 636 passengers on board. The ship was then disabled and adrift, meaning that it had to be towed. In the same year on the MS "Azamara Quest" with about 600 passengers a fire also broke out in the engine room off the coast of Borneo. Initially the ship was disabled, but it was then able to continue under its own power at a significantly reduced speed to the next port of its journey. Also in the same year a fire broke out on the MS "Carnival Triumph" in the Gulf of Mexico. There were also fires recorded on cruise ships in 2013, such as on the MS "Grandeur of the Seas" in the harbour of Freeport. On the MS "Zenith" in the port of Stockholm in 2009 there was a fire in the engine room of a ship which had already suffered a fire earlier in the year. Also in the same year there was a fire on the MS "Carnival Triumph" in the Gulf of Mexico. In 2010, the "Splendor" operated by Carnival Cruise Line also suffered a fire. The most serious fire disaster in cruise shipping history occurred in 1990 on the MS "Scandinavian Star" where 159 people lost their lives. The high number of deaths could be attributed to serious safety flaws, linguistic confusion and a lack of safety training amongst the crew [4]. When cruise ships operate near the coast they should be able to rely on standard rescue chains, at least when they operate near industrialised countries. Even here, however, emergency services or a specialised treatment facility cannot be reached within minutes, with rescue and transport times being measured instead in hours. Transportation whether by rescue ship or helicopter is neither gentle nor does it allow complicated therapeutic procedures to be carried out safely, especially under severe weather conditions. The handover to ships (usually via pier-height cargo ports or access gates) is already a manoeuvre fraught with danger in seas with wave heights of just one metre. For the severely burned patient this is always a heavy burden
510 which has to be weighed up when deciding on indicating a transport. Cooperation between the ship and the helicopter, which has to be done without allowing the two to touch each-other and cause a crash, is a challenge both for the nautical personnel on board and the flight crew [5]. Because of these considerations, handovers of patients at sea are only acceptable in cases of the direst need and for this reason the ship's doctor for a certain period of time would be solely responsible for coping with that particular emergency. For this situation, another contributing factor is that any departure from the usually very tight timetable of a cruise ship can entail considerable consequences for the rest of the affected passengers. This is the reason why today most shipping companies call on or recommend reliable emergency skills under stress. Whatever the individual situation demands, i.e. the interaction between various internal and external forces, applies all the more for complex situations [6]. A qualitative impact can also be expected if the abilities of a ship's hospital are quantitatively overstretched, especially if during the major incident of a ship's fire more than one burn injured patient needs to be evacuated on the basis of a triage procedure. In this regard, it should be discussed whether it makes more sense in such cases to dispatch a Burn Rescue Team consisting of anaesthesiologists, burn surgeons and paramedics on board.
Correspondence
References [1] Castillo-Manzano JI, Lopez-Valpuesta L, Alanis FJ. Tourism managers' view of the economic impact of cruise traffic. Curr Issues Tour 2015;18(7):701–5. [2] McKay MP. Maritime health emergencies. Occup Med 2007;57 (6):453–5. [3] Seidenstücker KH, Neidhardt S. Ship doctor's qualification – the fast track? Int Marit Health 2015;66(2):118–9. [4] Mileski JP, Wang G, Beacham LL. Understanding the causes of recent cruise ship mishaps and disasters. Res Transp Bus Manag 2014;13:65–70. [5] Galea ER, Deere S, Brown R, Filippidis L. A Validation data-Set and Suggested Validation Protocol for ship evacuation Models. Fire Saf Sci 2014;11:208. [6] Mellick LB, Adams B. Resuscitation team organization for emergency departments: a conceptual review and discussion. Open Emerg Med J 2009;2:18–27.
C.Ottomannn, Medical-Shipmanagement, Hartengrube 52/9, 23552 Lübeck, Germany V.Antonic1 University of Maryland, School of Medicine, 685 W. Baltimore Street, MSTF 7-00A, Baltimore, MD 21201 USA E-mail address: [email protected] (V. Antonic) Frank Siemers Direktor der Klinik für Plastische und Handchirurgie/ Brandverletztenzentrum, BG-Kliniken Bergmannstrost, Merseburger Str. 165, 06112 Halle, Germany
Conflict of interest The corresponding author states that as CEO for the company Medical-Shimanagement a potential conflict of interest exists. Medical Shipmanagement will also be hosting the International Course in Cruise Medicine in 2016. VA and FS declare that there are no conflicts of interest.
E-mail address: [email protected] (F. Siemers) n Corresponding author. Tel.: +49 172 76 21088. E-mail address: [email protected] (C. Ottomann)
31 August 2015 Available online 17 November 2015
Tel.: +1 301 768 8750.
1