Joe Scott, MD, FACEP, a longtime emergency physician in South Florida, was first introduced to cruise ship medicine when a friend asked if he wanted to lead some courses at a conference for cruise medicine physicians and nurses. After doing that for several years, he started getting asked to be an expert witness for cruise ship medicine cases. In late 2019, Carnival corporation Chief Health Officer Grant Tarling, MD, MPH, wanted to build a hospital structure over the health care aspects of Carnival’s nine brands, and he contacted Dr. Scott to ask if he’d be interested in serving as a fleet medical operations director.

When he started the job in February 2020, Dr. Scott couldn’t predict that the pandemic would soon turn his new industry upside down. His hiring was part of the company’s plan to gradually build a hospital structure that would unify the global Carnival fleet into one cohesive team. When COVID-19 hit, the ‘gradual’ aspect went right out the window. Instead, Dr. Scott leaned on his disaster medicine background.

“It was probably the best and worst timing ever,” Dr. Scott said. “My skillset, at that time, was badly needed in an industry that had never done this before.”

In his role, Dr. Scott stays shoreside, hiring and overseeing the medical staff for the North American fleet of 60 ships. Cruise ship medical teams face some unique challenges. They do not have access to on-ship specialty services for consults or referrals, so much of those conversations are happening through 24/7 telemedicine hubs overseen by Dr. Scott and his team. Though they don’t see some injuries on board very often—i.e., almost no firearm injuries—they do care for a wide range of other trauma in their well-equipped medical centers. Post-COVID, Dr. Scott said they are seeing a lot of acuity on board.

Because some emergencies happen in the middle of the ocean, the onsite emergency care teams provide both acute and ICU care until the patient can be transported from the ship. Dr. Scott says they often try to hire physicians with both acute and long-term care backgrounds because some patients can’t be transferred for four to five days, depending on the location of the ships at the time of the emergency. Carnival’s medical teams also manage the chronic care for the crew members, many of whom stay on the ship for up to nine months at a time. Dr. Scott’s telemedicine team works hard to constantly monitor the status of its ships, trying to snuff out contagious outbreaks before they fully materialize.