title: Medical emergency announcements on cruise ships: an audit of outcome.
abstract: BACKGROUND
  Public address announcements are an effective way of alerting staff on cruise ships to life -threatening medical emergencies on-board, but should only be used when truly necessary. An audit to investigate the outcome following this method of activating the medical emergency response team (MERT) suggested system flaws. A new elementary first aid training programme for the crew was then developed, emphasising patient assessment and the correct determination of appropriate levels of response. Following fleet-wide implementation, post-intervention audits were performed on two other company ships to evaluate the impact of the new approach.
  
  
  METHODS
  Data from all MERT activations initiated by public address announcement were prospectively collected during the audit periods, including subsequent means of transfer to the ship's medical centre and duration of medical intervention as indicators of clinical severity.
  
  
  RESULTS
  After changing the training programme the overall rate of public announcements for medical emergencies fell by 43%. The proportion of patients requiring transfer by stretcher increased from 5% to 33%, whilst the proportion of patients requiring ≥ 4 h of medical intervention increased from 5% to 44%.
  
  
  CONCLUSIONS
  The audits suggest that the new training programme may have improved the first aid responders' decision-making as there were fewer inappropriate emergency announcements over the public address system. However, two-thirds of all MERT activations were still for patients either well enough to walk or only needing a wheelchair for subsequent transfer, indicating ongoing opportunity for improvement.
authors.affiliation: Cruise Ship Physician, Nottinghamshire, England. taylorcj@doctors.org.uk.
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: Taylor
mesh_terms: D003142:Communication; D003422:Critical Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D060731:Emergency Responders / Q000193:education; D005392:First Aid; D006801:Humans; D007318:Inservice Training; D007899:Leisure Activities; D011446:Prospective Studies; D012767:Ships
keywords: STCW 1978; code; education; first aid training; medical emergency response team; passenger ship; seafarer