What happens if a passenger has a heart attack on a cruise ship

• Around 16% of passenger deaths on cruise ships are caused by cardiac incidents, one study found.
• Most cruise ships should have at least two defibrillators onboard.

Passengers board cruise ships expecting rest and relaxation — not deadly heart attacks.

Unfortunately, cardiovascular emergencies on cruise ships are not uncommon and are often serious, a 2010 study published in The American Journal of Cardiology found.

Approximately 16% of passenger fatalities (89 out of 557) reported on cruise ships from 2000 to 2019 were caused by cardiac incidents, according to research conducted by Travis Heggie, a professor at Bowling Green State University who specializes in health and safety risks in the tourism industry.

This is in part due to the age demographic of cruise passengers. Around one-third of passengers are age 60 or older, data from the industry trade group Cruise Line International Association (CLIA) shows, an age group that's at a higher risk of heart complications.

If you have pre-existing conditions or are at a high risk of cardiovascular disease, here are some things to keep in mind before embarking on a cruise.

What kind of medical care is available on cruise ships?

If you have a heart attack on a cruise ship, you might receive initial treatment in the ship's medical center.

While most cruise ships adhere to medical guidelines set by The American College of Emergency Physicians (ACEP), the level of medical care available on a cruise ship is typically not as advanced as that offered in U.S. hospitals.

Cruise lines can contract medical staff from different countries around the world, meaning they don't always have the same credentials, training, or educational background required of staff employed in American hospitals, Jamie Barnett, the president of the International Cruise Victims Association, told Insider.

The ACEP guidelines set standards for the qualifications, experience levels, certifications, and skills of cruise ship doctors and clinical staff. For example, physicians employed by the cruise ship must have "competent skill levels" in emergency cardiovascular care as well as minor surgical skills, and at least one physician must be certified in advanced trauma life support.

All cruise ship clinical staff, including nurses, must have at least three years of post-graduate experience.

The ACEP also requires cruise ships to have at least two defibrillators, one of which should be a portable automated external defibrillator (AED), a device non-medical personnel can use during sudden cardiac arrest.

"The ACEP guidelines, which are mandatory for CLIA oceangoing Cruise Line Members, specify that cruise ships must have at least one qualified medical professional available 24/7 for medical bay visits or cabin 'house calls,'" a CLIA spokesperson told Insider in a statement. "Also, cruise ships must have an examination room, an intensive care room, and equipment and procedures for processing labs, monitoring vital signs, and administering medications."

Patients who require more comprehensive facilities or treatment are typically referred to a shoreside medical facility, the spokesperson added.

Another thing to be aware of is that if you do receive medical treatment on a cruise ship, you may end up footing the bill. Most regular health insurance policies do not cover cruise ship medical services.

Some Medicare plans may cover the costs if you receive medically necessary treatment no further than six hours away from a U.S. port. Otherwise, your best bet is to purchase cruise insurance prior to your trip.

Medical evacuations on cruise ships

If a passenger needs treatment beyond the capabilities of the ship's medical center, they may be evacuated by air or transferred after the ship has reached the nearest port. If the ship is located in American jurisdiction, the U.S. Coast Guard will handle medical evacuations.

Medical evacuations don't always go smoothly. In April, a Coast Guard helicopter nearly crashed into the ocean during the medical evacuation of a 76-year-old passenger who was experiencing heart attack-like symptoms aboard the cruise ship Carnival Dream.

During cardiac emergencies, time is of the essence — half the deaths from a heart attack occur in the first three to four hours after symptoms begin, Cedars Sinai Hospital warns its patients.

Medical checklist for cruise ship passengers

To prepare for cruise ship travel, Cleveland Clinic physicians suggest passengers take the following steps:

1. Pack an adequate supply of all medications and bring an updated medication list.

2. For passengers with known coronary artery disease, travel with sublingual nitroglycerin.

3. Bring a hard copy of a 12-lead electrocardiogram if baseline is abnormal.

4. For passengers with pacemakers, defibrillators, coronary stents, or heart valves, carry a manufacturer's card.

5. For passengers with known cardiovascular disease, travel with physician's contact information and a recent summary of medical history.

6. For the elderly, sedentary, or those with known cardiovascular disease, consider pre-travel evaluation with physician.

7. Evaluate new cardiovascular symptoms or change in clinical status with physician before travel.

8. Check with physician regarding safety of initiating an exercise program.

9. Consider purchasing medical evacuation insurance if not covered under own health insurance.