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Passenger accidents and injuries reported during 3 years on a cruise ship
Abstract
The objective was to register and analyze data from all passenger injuries reported to the medical centre of a cruise ship with a median passenger load of 719 per day during a three-year period, and to determine high risk areas, equipment, and behaviour.
All reported passenger injuries were registered at first visit. An injury was 'serious' if it led to hospitalization ashore or if full recovery was not expected within two weeks.
During 3 years, 663 injuries (62.7% women) were reported aboard; 12.5% were classified as serious. The victims' median age was 72 (range: 1-97) years. The incidence rate was 0.8 injuries per 1000 passenger-days. Most victims (65.3%) suffered injuries aboard, 3.6% on tenders, and 31.1% ashore. The most common accident locations aboard were cabins (20.1%) and bathrooms (13.4), and ashore, streets (29.6%) and buses (16.1%). Slips/trips/falls caused 44.8% of injuries aboard and 69.4% ashore (p < 0.001). The most frequently injured body part was the lower extremity (43.0%), and open wounds the most common injury type (41.6%). More wounds and fractures/dislocations occurred ashore than aboard (p < 0.05). Only 2% were hospitalized in port, while 5% were referred to specialists in local ports and returned to the ship. There were no helicopter evacuations or ship diversions.
Passenger injuries contribute considerably to the workload of the medical team aboard. A well-equipped, competent medical staff will effectively treat most injuries aboard and thus reduce the number of costly and inconvenient helicopter evacuations, ship diversions, port referrals, and medical disembarkations.
... Passenger injuries significantly increase the workload of the medical team on board. A wellequipped, competent medical staff will effectively treat the majority of injuries on board, thereby reducing the number of costly and inconvenient helicopter evacuations, route diversions, port transfers and disembarkations [15]. In a study examining the medical practice of cruise ships, the data generated by one doctor and two nurses with an average of 464 passengers (51% female) and 615 crew members (22% female) during a 106-day cruise from Los Angeles to New York was recorded continuously and reviewed after the cruise [15]. ...
... A wellequipped, competent medical staff will effectively treat the majority of injuries on board, thereby reducing the number of costly and inconvenient helicopter evacuations, route diversions, port transfers and disembarkations [15]. In a study examining the medical practice of cruise ships, the data generated by one doctor and two nurses with an average of 464 passengers (51% female) and 615 crew members (22% female) during a 106-day cruise from Los Angeles to New York was recorded continuously and reviewed after the cruise [15]. The results turned out to be quite striking. ...
... Work accidents occur at different rates in different occupational groups, and foreign workers are more likely to be injured than local workers [27,28]. Accidents among passengers vary depending on factors such as travel time, passenger gender, age and the number of passengers, and the rate of serious injuries in reported accidents is revealed to be around 12% [15]. A 25-year study reported that fatalities occurred in 1.3% of treated patients with circulatory system disorders topping the list [21,29]. ...
Marine vehicles have an important place in international trade and tourism. There are various directives and studies on the prevention of health problems in marine vessels and injuries and deaths due to occupational accidents. In the literature, not enough studies have been found in which the issues to be considered in cases of injuries, sexual assaults, accidents, suicides and murders that are common in forensic medicine practice, and there are no guidelines or recommendations of internationally accepted organizations. It is important to determine the seafarer who is responsible for intervening in health emergencies on cargo ships, and to detect faulty ones, if any, in work accidents that result in serious injury and death. In addition, injuries, suicides and murders are encountered among the crew, and crime scene findings are lost until they are evaluated by the judicial authorities. Although rare, sexual assaults on cargo ships are also reported, but there are not enough scientific studies that indicate what should be done in terms of evidence evaluation. Our study emphasizes the issues to be considered, that one of the crew should be held responsible and necessary training should be given in order to make a forensic medical evaluation in forensic events that will be encountered on cargo ships, and that physicians and health workers should be competent in the first forensic medical evaluation in case of emergency on passenger ships. It is thought that the launch of the telemedicine application, which provides uninterrupted service for forensic medical emergencies in maritime vessels, under the leadership of organizations such as the “International Maritime Organization” (IMO), will make a significant contribution. In addition, suggestions are made for legal impasses in such cases that take place in high seas.
... 6,7 Given the increasing popularity of cruise tourism and the expansion of the industry into new markets, cruise industry researchers have raised concerns about passenger and crew safety. 8 For instance, as the industry continues to expand it is likely more passengers and crew will be exposed to life-threatening injury and illness. 9,10 The existing research literature has done well to identify traveler's diarrhea and respiratory infections as frequent illnesses incurred on cruise ships and cardiovascular incidents as a frequent issue leading to the death of elderly passengers. ...
... 12 For example, only a few known studies have investigated the mortality of cruise ship passengers and none have investigated the global occurrence of passenger and crew mortality on cruise ships. 8,16,19,20 Deaths on cruise ships often receive considerable media attention. In turn, this attention threatens to have a negative economic impact on the cruise industry and the travel destinations dependent on the industry. ...
... 3,14 Additionally, existing research investigating passenger injuries reports that almost one-third of the injuries occur while the passengers are onshore. 8 Bus crashes, swimming at beaches, and nature-based excursions were identified as common onshore activities leading to passenger injuries. While only 13% of all passenger deaths in the present study occurred while the passengers were onshore, bus crashes, float plane crashes, and swimming were the most common activities leading to death. ...
Introduction: This study reports the global occurrence of passenger and crew mortality on cruise ships. To date, no comprehensive study of passenger and crew mortality has been published. Methods: All data on passenger and crew mortality between 2000 and 2019 were obtained from 78 ocean and river cruise lines registered globally and analyzed by their age, gender, nationality, cruise line, and recorded cause of death. Results: There were 623 reported deaths. Out of all deaths, 89% were passenger deaths and 11% were crew deaths. United States residents accounted for 61% of passenger deaths and crew from India (18%) and the Philippines (17%) recorded the highest crew deaths. Falls overboard or onto lower decks (23%), suicide, murder, and a terror attack (19%), unspecified natural causes (18%), and cardiac incidents (16%) were the primary causes of passenger deaths. Suicide and murder (29%) and falls overboard or from height (24%) were the primary cause of crew member deaths. The most passenger deaths occurred on Carnival Cruise Lines (29%), Royal Caribbean Cruises (12%), and Norwegian Cruise Line (10%). The highest crew member deaths occurred on Carnival Cruise Line (19%) and Royal Caribbean Cruises (19%). Conclusion: Falls overboard or onto lower decks, cardiac incidents, and suicides are the leading cause of passenger deaths. Suicide and murder and falls are the leading cause of death for crew members. Travel health advisories targeting US citizen passengers and crew members from India and the Philippines are warranted. The addition of mental health care to ship infirmaries is also suggested.
... Studies specific to series injuries suffered by patients aboard cruise ships are limited in number and have relatively small sample sizes [8]. The studies with larger sample sizes are either not specific to cruise ships [9] or deal with injuries that do not require onshore hospitalisation [10]. This leaves a significant knowledge gap concerning the demographics, comorbidities, mechanism of injury, treatment modalities, and outcomes for patients who are injured seriously enough aboard passenger cruises to require transfer to an onshore hospital. ...
... Our analysis of patients who sustained an accidental traumatic injury warranting hospitalisation found that the geriatric population constitutes a substantial majority of this group (70%), and these injuries occur more often in women (60%). These findings are similar to those of Dahl [10] who found that 62% of all injuries who were treated in their onboard clinic occurred in women and the median age was 72. Bansal et al. [8] reported that 88% of the patients requiring hospitalisation from injury sustained on cruise ships were female and had a median age of 55. ...
... In fact, more than half (52%) of all patients in our study sustained a femur fracture, and of those, 86% were hip fractures (involving the acetabulo-femoral joint). These findings are similar to Dahl's series in which 63% of patients requiring hospitalisation from onboard injuries were hip fractures [10]. Likewise, Hudson et al. [9] found that femur fractures were the most common injury sustained in all patients hospitalised for injuries aboard water craft. ...
... Another research showed that nearly 70% of total onboard crimes were associated with sexual assaults from 2016 to the first quarter of 2017 (Panko and Henthorne 2019). Dahl (2010) reported that 663 injuries occurred on a luxury cruise ship from 2003 to 2006. The most common injury aboard was a femur fracture (Isom et al., 2018). ...
... The finding is aligned with previous research that injuries are frequently encountered by cruise ship physicians (Bansal et al., 2007). The high frequency of injuries can also be seen from the research of Dahl (2010) that more than 660 injuries were found on one single cruise ship within three years. Passengers may also get injured during shore excursions. ...
The existing literature on cruise-related risks is mainly from an individual organisation's
perspective, while it is a pressing need to conduct risk analysis from a supply chain
perspective considering the various risks along the chain and the fact that a risk faced
by one player may also affect other players in the chain. Understanding such, this
paper makes the first attempt to investigate and assess risks in the cruise supply chain
(CSC). This paper proposed a novel model based on Rule-based Bayesian Network,
Evidential Reasoning, Degree of Belief and Failure Modes and Effects Analysis. Based
on this model, this paper then investigated the risks in the CSC by taking account of
opinions from disparate stakeholders. Based on thirteen questionnaires, the
assessment results suggest that from a supply chain perspective, "Communicable
disease", "Ship accidents", "Injuries", "Geopolitical risks", "Climate change and weather issues" were distinctly significant. This study not only indicates the most significant risks in the CSC but also presents an effective tool and contributes to the existing studies on CSC risk assessment models. Moreover, this study provides implications for further developing mitigation strategies.
... In recent decades, cruise industry has experienced a significant growth rate [9,21,22]. The aforementioned growth is the result of continuous shipbuilding and the increase of traffic in the area of Arctic and Antarctic. ...
In recent decades, there has been noticed a continuous growth of passengers on cruise ships. Technical as well as technological development follow this growth side to side as far as construction, transport of passengers and strict legal regulations are concerned. However, recent maritime accidents, such as the Costa Concordia’s accident, question the level of maritime safety on cruise ships.
Maritime accidents on cruise ships are almost entirely linked to human factor, directly or indirectly. Apart from the parameters affecting human factor, the literature mentions very frequently the importance of education, training and crew competences in the process of reducing the number of maritime accidents. However, very few researches have been done on competences that can affect strongly the level of maritime safety on cruise ships, i.e., that can reduce the effects of human factor on it.
The purpose of this study was to find a connection between reducing the effects of human factor on accidents and the crew competences on cruise ships. The research lasted for two years and consisted of two phases. Qualitative as well as quantitative methods of analysis were used in both phases. Competences that are the essential part of obligatory programmes the crew members on cruise ships have to master, and that are prescribed by the STCW Convention were analysed in the first part of the research. The second part of the research analysed competences that are essential part of programmes resulting from the cruise companies’ demands. Cruise companies have defined and determined additional programmes and competences that seafarers, navigating on their ships, have to complete and develop. The aim of the research was to determine what type of competences the cruise companies look for through additional education programmes and to determine the amount of time needed to develop them.
... Study 10: Non-fatal occupational injuries related to slips, trips and falls in seafaring [15]. Merchant seafaring often involves hazardous occupational operations and several studies have shown increased fatal injury incidence often related to slips, trips and falls on board and falls overboard [16,17]. In all 27 authors cited the study. ...
Background:
The article is based on a review and follow-up of the citations of 13 epidemiological studies that aimed to improve maritime health and safety. While it's well-recognised that epidemiology is needed in occupational health and safety, the main research question: "How can epidemiology help workers to return healthy from the sea" was unanswered.
Materials and methods:
The 13 articles were selected as a representative sample of different epidemiological design studies intended to contribute to improving safety management in fishing, merchant shipping and offshore industry. The PubMed, Research Gate, Cochrane-Library and Google Scholar were searched for authors that had cited our articles by using full bibliographic information and the results analysed.
Results:
In all, 213 citation records were identified. After duplicates and records with insufficient information were removed, 123 full-text articles were eligible for evaluation with answers to the research questions: how did other authors use the studies, how has the injury epidemiology been developed, which recommendations are given for new policies and new studies and how can epidemiology help workers return safe and healthy from the sea?
Conclusions:
The answer to the main research question is yes, epidemiological studies are not only useful but a necessary component by providing the needed evidence for successful prevention programmes.
... Examples of other industries where slips and falls pose a significant occupational health and safety hazard include healthcare and social assistance, manufacturing, retail, and transportation and warehousing [4], postal services [5], and merchant shipping [6]. Slips and falls also constitute a significant share of injuries of people in their home environments [7,8], for patients in hospital settings [9] or in a home care environment [10], and during leisure, for instance on board cruise ships [11]. Based on official statistics from different countries [12], falls can be classified as falls to a lower level and falls on the same level [13]. ...
Slip and fall incidents at work remain an important class of injury and fatality causing mechanisms. An extensive body of safety research has accumulated on this topic. This article presents an analysis of this research domain. Two bibliometric visualization tools are applied: VOSviewer and HistCite. Samples of 618 slip and fall related articles are obtained from the Web of Science database. Networks of institutions, authors, terms, and chronological citation relationships are established. Collaboration and research activities of the slip and fall research community show that most contributors are from the United States, with the (now closed) Liberty Mutual Research Institute for Safety the most influential research organization. The results of a term clustering analysis show that the slip and fall research can be grouped into three sub-domains: epidemiology, gait/biomechanics, and tribology. Of these, early research focused mainly on tribology, whereas research on gait/biomechanics and epidemiological studies are relatively more recent. Psychological aspects of slip and fall incident occurrence represent a relatively under-investigated research topic, in which future contributions may provide new insights and safety improvements. Better linking of this research domain with other principles and methods in safety science, such as safety management and resilience, may also present valuable future development paths.
... Advanced Pediatric Life Support (APLS/PALS), and Advanced Trauma Life Support (ATLS). These guidelines are followed to a large extent in cruise line requirements for hiring medical doctors onboard and are supported by the literature (DiGiovanna et al., 1992;Bansal et al., 2007;Dahl, 2010;Ottomann, 2015). ...
Background: Maritime medicine deals with the health of seafarers, fishermen and off shore employees and more specifically with their employment, working, living conditions, health and safety at sea. Maritime doctors should have the appropriate training and competencies to provide equivalent service as in land. This review discusses the required skills and competencies of maritime doctors and explores the associated ongoing discussions for the establishment of a global accredited training programme in maritime health. Methods: Literature review was done in two databases PubMed and Google scholar. Search terms included: maritime doctors, maritime medicine, occupational health, skills and competencies. Literature published between 1990 and 2018 was prioritised. Thirty-five articles that discussed the skills, competencies and education of maritime doctors and health professional were retrieved, reviewed and discussed plus 8 reports and documents from relevant International Organisations webpages. Results and discussion: The doctors who serve in the sector, should have extensive knowledge about medical practice but also about the environment of seafaring. The complexity of their roles coupled with the provision of high quality of services in global shipping call for high quality accredited training and harmonisation of maritime health practices. The analysis for policy using two policy models i) the health triangle and ii) the Kingdon model showed that a window of opportunity appears to be in favour of such a policy regarding the recognition of the maritime medicine as a medical specialisation. The international stakeholders together with the International Maritime Health Association should actively advocate such a perspective which will be in favour of the seafarers who will enjoy better health and wellbeing with higher income avoiding ill-health as well as the shipping industry which will employ satisfied and loyal employees and enjoy higher reputation.
... Maritime incidents are only one contributor to death and morbidity in passenger shipping [25,27]. Both passengers and crew members can sustain injuries and, in the case of crew these are frequently work-related [28][29][30]. Both groups can develop illness while at sea. ...
Background:
There is very limited systematic analysis of the causes and consequences of maritime accidents across the whole passenger sector during the twentieth century either in United Kingdom (UK) or in other maritime nations, but some of the larger events have been the subject of detailed investigations that led to improved safety measures. In recent years, there has been increased attention to the analysis of passenger ship accidents, especially in relation to the two now dominant markets: vehicle/passenger ferries and cruise ships.
Materials and methods:
Long-term trends since 1900 in passenger and crew deaths on UK seagoing pas- senger ships that have sustained a maritime accident, as defined by Lloyds Register, have been collated and analysed.
Results:
Over the course of the 20th century, there has been a continuous fall in the number of incidents and in their severity. This may be a reflection of improved vessel safety, however the scale and nature of UK passenger shipping has also changed markedly over the period.
Conclusions:
In addition to the reducing frequency of deaths it is apparent that the majority of fatalities in both crew and passengers came from a very small number of major events during the study period. Altho- ugh there has been no major disaster involving a UK passenger ship in the last 30 years, major casualties with heavy loss of life continue in the world passenger fleet, in recent years involving flags such as Greece, Indonesia, Italy, Panama and The Philippines.
... The most frequent type of injuries was related to open wounds, with the share of 83.2 %, and then contusions, sprains, and strains. The authors also indicated the importance of educated and competent medical personnel and equipment to enable treatment of illness or injury on board (Dahl, 2010). Some authors also dealt with the study of rates of illness of passengers and crew in the four year period at a Caribbean cruise port (Marshall et al., 2016). ...
The Republic of Croatia is a leader in maritime passenger transport in the Adriatic with indications of the further growth. The paper analyses current regulations for providing medical care on board vessels in Croatia for the category C2 of navigation, referring to vessels in the national coastal navigation. The prescribed quantities of medicinal products and equipment on ferry vessels were compared with the data of most common diseases and injuries of passengers on board, retrieved from the relevant literature. The comparison was conducted based on two indicators: the frequency and urgency of diseases and injuries. The analysis indicated the insufficient quantity of medicines and equipment, especially in the cases of life-threatening medical conditions. The regulations should follow the growing maritime passenger transport, where the large inflow of passengers is expected regularly in the summer period. All the personnel on board appointed for the provision of medical care are required to provide immediate treatment, increase the level of preparedness, and improve the prevention of possible health risks onboard vessels. The authors want to emphasize the importance of passenger safety on board as well as the preservation of strategic resource for the Croatian economy.
... Already published studies (Dahl 2005a(Dahl , 2005b(Dahl , 2006(Dahl , 2010Dahl, Ulven, and Horneland 2008;Sobotta, John, and Nitschke 2008) show a high number of daily medical consultations for crew members and passengers in the on board hospital. Dental treatments make up the largest percentage Nitschke 2007, 2008). ...
Background: The human resources required on large cruise ships can only be secured with crew members from different countries of origin with different health statuses. Method: The present secondary data analysis is to determine whether there is an increased frequency of treatment for crew members for certain diseases or injuries, or a difference in the frequency of treatment for certain groups and/or countries of origin; whether an increased use of dental procedures could be confirmed, and their average costs. The data were collected over six months in 2015 from a major cruise ship company. Results: There were 1,627 treatments for 1,026 crew members. The illness and injury rates were significantly different both in the occupational groups (p < .001) as well as the countries of origin (p = .004). It was confirmed that dental procedures were most frequent (n = 915 cases), in particular for Asian crew members; in contrast to Germans they had a 1.6-fold higher chance of dental procedures.Conclusions: A mixed calculation for dental and jaw treatments for the crew members and the expected passenger treatments would justify the employment of a dentist on the ship. However, medical follow-up costs for crew members on board could be minimised by a previous thorough assessment of their state of health.
... 11 In this study, the crude mortality rate was defined as the number of deaths of German cruise passengers per 100 000 German cruise travellers during the 11 years under examination; it was calculated both for all German travellers and for males and females separately-assuming a similar gender distribution of guests aboard passenger vessels, as has been repeatedly described. 7,9,[13][14][15] In this study, all German passengers were included who had died on board a passenger vessel of the worldwide fleet within this time period (according to the mentioned death certificates)-irrespective of the ship's stay en route or in port abroad. Additional fatal cases of passengers that had occurred beyond the stay on the ship (e.g. during organized shore excursion or while off the ship by themselves) were not included. ...
Background. In the past two decades, more and more Germans decided to spend their holidays on a passenger vessel. This study examined the frequencies and causes of deaths of German travellers aboard passenger vessels of all flags.
Methods. The shipboard deaths of all German travellers within the time period from 1998 to 2008 were counted using the German civil central register in Berlin. The available documentation in this register provides information on frequencies, circumstances and causes of deaths on ships. In the above-mentioned period of time, the total cohort of German travellers on cruise ships is estimated to be 5.97 million persons.
Results. During the 11-year examination period, 135 shipboard deaths of German passengers [102 males (75.6%) and 33 females (24.4%)] were recorded. Out of these travellers, 110 died on cruise ships. When considering only the passengers on cruise ships (without those on ferries) an average crude mortality rate of 1.8 per 100 000 German passengers was calculated. The crude mortality rate of shipboard death for males and females was 2.5 and 0.8 per 100 000 German passengers with a mean age of 71.2 years [standard deviation (SD) 16.0 years] and 73.3 years (SD 16.0 years), respectively. Significantly, more deceased travellers older than 70 years were observed on traditional cruise ships and resort vessels than on passenger ferries ( P = 0.001). The causes of death were documented in 85 cases (63.0%). Out of these documented deaths, 82 (96.5%) cases were regarded to be natural causes (particularly circulatory diseases) and 3 (3.5%) as unnatural causes (twice drowning and once an accidental fall).
Conclusions. In spite of the large proportion of unknown causes of death, this study argues for a high significance of internal causes of deaths among German passengers. Thus, ship’s doctors—particularly those on traditional cruise ships—should be well experienced in internal and geriatric medicines.
... 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, the makeup of which depends on which cruise line they are travelling under, and which market segments are being catered for [1][2][3][4][5][6][7]. The designated ship's doctor, however, needs to be aware of the variety of medical risk profiles that await him on the cruise ship depending on the crew or passengers which the ship is carrying. ...
This contribution is intended to fertilise the current discussion of ship's doctors qualifications required for cruise ships. Therefore 10 points are added to the debate containing different considerations focussing on the recommendations of the German Society of Maritime Medicine, the American College of Emergency Physicians (ACEP's) Health Care Guidelines for Cruise Ship Medical Facilities and the different skills a ship's doctor should have from the perspective of the recruiter.
... The epidemiological publications showed that up to 70% of cruise ship patients are general or internal medicine cases [9]. The surgical cases were mostly less severe as sprained ankles, abrasions, minor cuts (galley) and burns (engine) [10,11]. These numbers gave an idea of where to go. ...
While a steady growth of cruise tourism since the 1970s created an increasing demand for ship doctors medical postgraduate specialty training did not sufficiently reflect the scope of skills and knowledge required from a physician being left to himself at sea. The German Maritime Health Association therefore tasked a working group with analysing the situation and coming up with suggestions for an adequate postgraduate training for ship doctors.
The working group consisted of 19 experts with various backgrounds in maritime medicine. A literature review was done on cruise ship epidemiology as well as an assessment of tasks and environmental factors influencing medical care on board of cruise ships. Necessary knowledge and skills were derived and compared with those imparted by standard German medical education.
Mandatory knowledge and skills were identified as well as elements of standard medical education contributing to these goals. Those aspects that would or could not be adequately covered by German standard education were catalogued and summarised in a course curriculum.
In 2013 after approval by its board of directors the German Maritime Health Association published a qualification and training recommendation addressing colleagues planning to muster as ship doctors.
Die Einführung des Early Warning Score (EWS) innerhalb eines Klinikkonzerns hat gezeigt, dass eine Reduzierung der innerklinischen Reanimationen um 5,2 % durch Risikostratefizierung erreicht werden konnte. Durch die Nutzung der EWS als Aufnahmeparameter einer Notaufnahme konnte im Verlauf der EWS als wichtiger Monitoringparameter ermittelt werden, da der EWS Punktwert sowohl signifikant die Behandlungszeit in der Notaufnahme (33 Minuten pro EWS Punktwert), sowie dass Potential der Veränderung des EWS Wertes (0,75 pro EWS Punktwert) zur weiteren stationären Behandlung (3,5 Verweildauertage pro EWS Punktwert) beeinflusst. Patienten der EWS Gruppe 4 waren im Rahmen ihrer stationären Behandlung besonders gefährdet, da eine erhöhte Verlegung und eine erhöhte Todesrate die Folge waren.
The cruise sector is one of the most characteristic examples of globalised business. This characteristic makes the cruise supply chain (CSC) likely to expose to a variety of risks, such as the geopolitical environment and inclement weather, which requires an urgent need for risk mitigation strategies. A review of the literature revealed that supply chain risk mitigation strategies often remain at a conceptual level, and they mainly focus on a specific risk or a perspective of a specific cruise sector; there is therefore a gap in the absence of practical risk mitigation strategies in the cruise industry from a supply chain perspective. To address the gap, this paper interviewed and analysed opinions of eight types of CSC players. Twenty risk mitigation strategies in the context of a CSC were identified and examined into control and detection, relationship-based strategies, marketing strategies, policy-based strategies, risk transfer and share, and flexibility strategies. A broad picture and a deep understanding of strategies to deal with risks in the CSC were provided. The findings contribute to the literature and practice by linking theoretical strategies to practical strategies and exploring the mitigation strategies with actual practice in the CSC that can be used directly by practitioners and researchers.
The increased frequency and severe consequences of risks in the cruise industry have attracted increasing attention from both academics and practitioners, especially after the 2012 ‘Costa Concordia’ disaster and the 2020 coronavirus outbreak on the ‘Diamond Princess’. Although the literature on risk studies associated with the cruise industry and supply-chain risk management is growing, the extant literature lacks a study to view risks in the cruise industry associated with the supply chain. This paper addresses this gap by reviewing the literature on risks related to the cruise industry and general supply-chain risks to create a framework of cruise supply-chain risks. Then, semi-structured interviews were conducted to validate the identified risks and explore potential undiscovered risks. A novel risk typology of the cruise supply chain was then built based on the literature review and the empirical study. This includes macro risks, safety, security, and health risks, information risks, and supply risks. This framework can be applied for the purpose of systematically identifying the risks and their impacts on the cruise supply chain. This paper contributes to the development of a comprehensive cruise supply-chain risk classification with a detailed explanation of each risk in the cruise supply chain, which can be used by stakeholders in the cruise industry to identify and measure the impact of each risk. Additionally, this paper provides avenues for future research by scholars interested in assessing and managing cruise supply-chain risks.
Background:
Prior to the impact of the Covid 19 pandemic, cruise travel had experienced exponential growth in the preceding decade. Travel medicine practitioners were increasingly called upon to provide pre-cruise travel advice and medical clearance. Demand for these services will return at some time in the future.
Methods:
The clinical conditions seen in those presenting for care on 6 small vessel scientific cruises to Antarctica were analyzed.
Results:
Personnel presented on 196 occasions resulting in 257 consultations (when initial plus all follow up consultations were included). Personnel presented with a clinical condition at a rate of 17.9 per 1000 person days at sea. The total consultation rate was 23.5 per 1000 person days at sea. Injury accounted for 24% of all presentations at a rate of 4.3 per 1000 person days at sea. Dermatological, soft tissue and musculoskeletal, general malaise and motion sickness were the four most common presentations.
Conclusions:
Pre-cruise advice for travelers planning small vessel cruises to polar regions needs to include skin care, prevention and management of sea sickness and how to reduce the risk of injury. Those providing medical care on such cruises should be prepared to manage a wide range of clinical presentations.
The Cambridge Handbook of Disaster Risk Reduction and International Law - edited by Katja L. H. Samuel February 2019
Das Kapitel wirft einen Blick auf die verfügbare Literatur zur Epidemiologie auf Kreuzfahrtschiffen und leitet daraus Schwerpunkte in der Aufgabenstellungen für Schiffsärzte ab, die Ausbildung, personelle und materielle Ausstattung sowie zu etablierende Verfahren determinieren.
This book addresses innovation management and product development in the cruise tourism industry. It explains how experience management has evolved from a strictly company-level, product- or service-focused tactical task to an industry-wide strategic challenge, and analyses the role of intangible reputational aspects of cruise experiences, as well as peripheral components and stakeholders, as increasingly important factors for customer acquisition and retention. Safety and risk issues are a central theme, as well as the cruise sector’s environmental and socio-economic impacts. Lastly, the book considers the increasing size of cruise vessels and the accompanying standardisation of facilities and itineraries, in conjunction with the hybridisation of cruise passengers in connection with expanding the competitive boundaries and intensity of competition in the cruise sector. The book approaches these issues as more than a mere public relations campaign, recognising the fact that they have since become the very essence of strategic cruise business development.
This paper investigates the analytical methods that are used in 125 quantitative and empirical cruise tourism studies published from 1984 until and including 2014, as well as the relationship between the applied methods. On average, two different methods were used per study (0.9 bi- or univariate and 1.1 multivariate), but with a slight trend from the former to the latter. During the latest 5-year period, 2010–2014, which comprises almost two thirds or 82 of the identified studies, a regression analysis was used in 39 %, a factor analysis in 27 % and Structural Equation Modeling in as much a 21 % of the studies. The relations between the methods are analysed via correlation and factor analysis, and the results are visualised in a multidimensional scaling (MDS) diagram.
The objective of this study was to examine the relationship between slip, trip and fall injuries and obesity in a population of workers at the Idaho National Laboratory (INL) in Idaho Falls, Idaho. INL is an applied engineering facility dedicated to supporting the US Department of Energy's mission. An analysis was performed on injuries reported to the INL Medical Clinic to determine whether obesity was related to an increase in slip, trip and fall injuries. Records were analysed that spanned a 6-year period (2005-2010), and included 8581 employees (mean age, 47 ± 11 years and body mass index [BMI], 29 ± 5 kg/m(2); 34% obesity rate). Of the 189 people who reported slip, trip and fall injuries (mean age, 48 ± 11 years), 51% were obese (P < 0.001 compared with uninjured employees), and their mean BMI was 31 ± 6 kg/m(2) (P < 0.001). Obesity in this population was associated with a greater rate of slip, trip and fall injuries.
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