We work closely with U.S. and other governmental public health authorities where our ships sail to ensure that we comply with their laws and regulations.
There are many guidelines and regulations that govern shipboard public health, including local, national and international regulations. The guidelines we follow throughout our fleet are contained in the US Centers for Disease Control and Prevention’s (CDC) Vessel Sanitation Program (VSP) comprehensive Operations Manual, which details standards, procedures and inspection criteria related to topics such as: communicable disease prevention and management, gastrointestinal illness surveillance, potable water, recreational facilities (including swimming pools, whirlpools and spa pools), food safety, integrated pest management, housekeeping and child activity centers. We also adhere to the guidelines of Brazil’s National Health Surveillance Agency (ANVISA) and the European Union’s Ship Sanitation Strategy and Program (SHIPSAN).
We work closely with U.S. and other governmental public health authorities where our ships sail to assure that we comply with their laws and regulations. To measure our compliance, our ships are inspected by governmental authorities, third-party public health experts and our own internal inspectors. Our ships routinely receive high ratings from ship inspections, and scores for our ships that call on ports in the U.S. are published by the CDC/VSP.
We also have a team of internal public health inspectors that visits each ship twice a year. In addition to evaluating the quality and effectiveness of water quality, food safety, pest management and outbreak prevention public health measures, they also provide training to our crew on the best ways to maintain a healthy ship.
The purity and cleanliness of our shipboard water systems is a very important part of the comfort and safety of our guests and crew. These systems include our potable drinking water and our recreational water used for swimming pools, whirlpools and spa pools. Potable water is either produced on the ship through reverse osmosis (desalination) or taken onboard (bunkered) while the ship is in port. As a further precaution, all potable water, whether bunkered or produced, is chlorinated to eliminate any harmful bacteria that may be present. All bunkered water is also tested for quality and held in a tank until test results demonstrate it is safe for shipboard consumption. Only then is the water approved for release and use onboard.
According to CDC standards, we are required to test our shipboard water four times per month. In keeping with our Above and Beyond Compliance policy, we exceed this standard by testing each ship’s water systems 60 times per month. The CDC also regulates our recreational water by specifying chlorination levels and monitoring frequencies. We exceed these levels and have installed electronic chlorine and acidity (pH) level recording devices to help ensure levels remain consistent.
Our food safety protocols and procedures are also based on CDC recommendations, and many even go Above and Beyond the stringent requirements stated in their VSP operations manual. These food safety practices include cleaning and disinfection of food preparation areas and equipment, employee hygiene, prevention of cross contamination, following instructions on proper handling of potentially hazardous foods that are susceptible to becoming contaminated, and many others.
Time control and temperature regulation are two of the most important factors in ensuring food safety. When supplies and provisions are landed on our ships, they must be at the right temperature, or we will reject them. Once we have accepted the supplies, we follow strict guidelines on the time for food supplies to be moved from the container or truck to the refrigerator or freezer onboard. There are also strict guidelines for how long food can remain out of the freezer or refrigerator before it is prepared, how foods are thawed, and how long foods can remain at a buffet station.
To ensure the safety of the food we serve, we have adopted the food industry’s Hazard Analysis Critical Control Point (HACCP) approach. The seven principles of HACCP are: hazard analysis, identification of critical control points, identification of critical limits for each critical control point, identification of critical control point monitoring requirements, corrective actions, record keeping, and verification to ensure the HACCP system is working.
Outbreak prevention plan
Our Outbreak Prevention Plan (OPP) is our guide for preventing and responding to any outbreak of illness onboard our ships. The emphasis of this plan is on gastrointestinal illnesses, which are the most common cause of land-based and shipboard outbreaks. The CDC closely monitors and regulates our performance in this important area.
Our plan was developed in consultation with both internal and external public health and medical experts and is designed to first prevent outbreaks from occurring and then to halt the spread if one develops. The plan is an eight-step strategy that includes screening of guests and crew before boarding, surveillance of any suspected outbreaks on a ship, high levels of sanitation and cleaning of the ship, effective communication with guests and crew in the event of an outbreak, isolation of affected guests and crew as appropriate, complimentary medical treatment, electronic reporting of cases and symptoms to better identify the potential origin or source of the outbreak, and appropriate disembarkment of any guest or crew member who requires hospitalization or medical treatment that cannot be provided onboard the ship.
Every ship in the Royal Caribbean Group fleet has a dedicated medical facility, staffed with contract medical doctors and nurses. Shipboard medical facilities are available to both guests and crew in the event medical treatment becomes necessary while they are onboard. The medical facilities are generally open six hours daily, but medical professionals are available 24 hours a day for acute guest or crew medical needs that may arise. There are procedures for emergency communications and deployment of the medical teams anywhere on the ship where services are needed. These teams are supplemented by personnel trained to carry equipment and stretchers if needed.
Our shipboard medical facilities and operations are subject to guidelines from national and international agencies and organizations. The principal guidelines applicable to our shipboard medical facilities are those established by the American College of Emergency Physicians (ACEP), Cruise Ship & Maritime Medicine Section. Our shipboard medical facilities are built, stocked, equipped and staffed to meet or exceed ACEP’s guidelines.
Each ship is staffed by one to three medical doctors and two to five nurses, generally depending on the size of the ship and the number of guests and crew. We follow strict requirements regarding the credentials of medical staff in our facilities. We confirm licenses and medical school graduation and closely examine post-graduate training for prospective medical personnel. Prior to serving onboard, medical personnel must also successfully complete Basic and Advanced Cardiac Life Support Training Courses. In addition to cardiac care skills, our medical staff are expected to be able to manage complex problems, such as respiratory and airway emergencies, sutures, orthopedic issues, interpret routine x-rays and perform and interpret basic, but comprehensive, laboratory analysis.
To meet the needs of our guests and crew, medical facilities stock a variety of equipment, including cardiac monitors and defibrillators, ventilators, x-ray machines and processors, laboratory equipment for a variety of acutely needed tests, and minor surgical and orthopedic supplies. Each ship also has a well-stocked formulary of medications (including “clot-busting” thrombolytics), based upon ACEP-established, shipboard appropriate categories of pharmaceuticals.
We are constantly evaluating new technologies and equipment that could improve the quality of our onboard medical care. For example, we have equipped our ships with Automated External Defibrillators (AEDs), which are small portable machines that can restart the heart of a person who has collapsed from a sudden cardiac arrhythmia, often due to a heart attack. We have installed digital x-ray technology on all of our ships, allowing x-ray images to be transmitted to onshore experts for further consultation. Each of our ships is also stocked with portable First Responder Bags to help the medical team respond to emergencies.
In conjunction with the University of Miami, we have implemented a Teledermatology program that permits high-definition digital photographs and case histories to be transmitted over the internet and reviewed by expert dermatologists ashore, to obtain timely consultations and treatment advice, the same service they provide to the U.S. military.
We are also able to perform life-saving blood transfusions at sea. Our medical staff has the ability to type blood donors and to screen their blood for communicable diseases (including HIV). Eligible family member donors of the same blood type are considered first; however, in the event a family member is not available or suitable, voluntary donors from the shipboard guest or crew population are considered. We have had the opportunity to utilize this life-saving intervention on numerous occasions.
In emergency medical care situations, such as heart attacks, congestive heart failure and cardiac arrhythmias, our ships maintain special medications onboard to stabilize the patient until the patient is able to be medically evacuated to an appropriate shoreside medical facility. Evacuation of emergency medical patients from a ship may take place at a scheduled port-of-call, or may require a deviation from the ship’s scheduled itinerary to the nearest appropriate port. Another alternative that may be available for use in life-threatening situations is evacuation via helicopter from a ship’s helipad or via basket lift.