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INTRODUCTION

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The operational environment of commercial travel can be as challenging as any other for the EMS physician to provide quality emergency medical care. As an aging population remains mobile and continues to travel, the importance of planning and preparation for emergency medical care has become more important than ever. Planning for and providing emergency medical care in commercial travel environments such as a cruise ship or passenger airline require a thorough understanding of the limitations those environments produce.

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OBJECTIVES

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  • Describe the cruise ship medical operations and the EMS physician role onboard.

  • Discuss unique challenges in patient management at sea.

  • Describe airline medical operations and the EMS physician role as medical director for airline operations.

  • Discuss unique challenges in patient management in the air.

  • Discuss basic jurisdictional and FAA regulations pertaining to in-flight medical emergencies.

  • Describe the process of flight diversion for a medical emergency.

  • Describe typical resort medical operations and the concept of “concierge medicine” for resort guests.

  • Discuss licensure and liability issues for EMS physicians practicing travel medicine.

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Consider the example of delivering clinical care during an in-flight medical emergency requires the EMS physician to not only understand the pathophysiology of a given medical condition, but also appreciate operational considerations such as altitude and flight physiology, providing medical care within the equipment and resource-limited environment, and consider the overall impact of deciding whether or not to divert a flight.

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Provision of medical care onboard a cruise ship is no less challenging. It is typically the medical officer's responsibility to plan for medical care and potential onboard disasters, respond to emergencies, monitor and respond to potential epidemiologic events, oversee ancillary medical staff, and be the overall “medical conscience” for the command staff of a vessel. The challenge in making the decision to divert to a nearby port or have a patient medically evacuated from sea requires proper forethought and planning on the part of the medical officer. Resort medicine can be challenging since many of the typical services provided may not be emergent in nature depending on the type of resort; however, at any moment a medical emergency can be encountered and the EMS physician must be ready to respond especially since many resorts may be located somewhere advanced medical care is not available.

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Consider other aspects of EMS medicine which have similar planning and operational considerations to airline cruise ship and resort medicine. Operational preplanning for anticipated illnesses and preventive health services in the urban search and rescue, fireground support, or tactical medical environment is performed to minimize injury or illness to team members as well as maximize the overall success of the mission. This approach has great relevance to medical care planning for cruise ship or airline medicine. Delivering medical care in the unique physical environment such as a passenger airline draws on practices and principles of helicopter and air medical transport which may ...

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