Impact of IoT System Imperfections and Passenger Errors on Cruise Ship Evacuation Delay.

Cruise ships and other naval vessels include automated Internet of Things (IoT)-based evacuation systems for the passengers and crew to assist them in case of emergencies and accidents. The technical challenges of assisting passengers and crew to safety during emergencies include various aspects such as sensor failures, imperfections in the sound or display systems that are used to direct evacuees, the timely selection of optimum evacuation routes for the evacuees, as well as computation and communication delays that may occur in the IoT infrastructure due to intense activities during an emergency. In addition, during an emergency, the evacuees may be confused or in a panic, and may make mistakes in following the directions offered by the evacuation system. Therefore, the purpose of this work is to analyze the effect of two important aspects that can have an adverse effect on the passengers' evacuation time, namely (a) the computer processing and communication delays, and (b) the errors that may be made by the evacuees in following instructions. The approach we take uses simulation with a representative existing cruise ship model, which dynamically computes the best exit paths for each passenger, with a deadline-driven Adaptive Navigation Strategy (ANS). Our simulation results reveal that delays in the evacuees' reception of instructions can significantly increase the total time needed for passenger evacuation. In contrast, we observe that passenger behavior errors also affect the evacuation duration, but with less effect on the total time needed to evacuate passengers. These findings demonstrate the importance of the design of passenger evacuation systems in a way that takes into account all realistic features of the ship's indoor evacuation environment, including the importance of having high-performance data processing and communication systems that will not result in congestion and communication delays.

Successful Control of an Onboard COVID-19 Outbreak Using the Cruise Ship as a Quarantine Facility, Western Australia, Australia.

Onboard quarantining has been only partially effective to control outbreaks of coronavirus disease on cruise ships. We describe the successful use of the ship as a quarantine facility during the response to the outbreak on the MS Artania, which docked in Western Australia, Australia. The health-led 14-day quarantine regime was based on established principles of outbreak management and experiences of coronavirus disease outbreaks on cruise ships elsewhere. The attack rate in the crew was 3.3% (28/832) before quarantine commencement and 4.8% (21/441) during quarantine on board. No crew members became symptomatic after completion of quarantine. Infection surveillance involved telephone correspondence, face-to-face visits, and testing for severe acute respiratory syndrome coronavirus 2. No serious health issues were reported, no response staff became infected, and only 1 quarantine breach occurred among crew. Onboard quarantine could offer financial and operational advantages in outbreak response and provide reassurance to the shore-based wider community regarding risk for infection.

Increase in Hospital Admissions for Severe Influenza A/B among Travelers on Cruise Ships to Alaska, 2015.

An increase in hospital admissions for influenza occurred during the summer of 2015 at an acute care facility in Vancouver, British Columbia, Canada. Investigation identified 25 patients with recent history of cruise ship travel to Alaska. All characterized influenza A viruses were A(H3N2). We describe patient treatment regimens and outcomes.

Screening and early detection of communicable diseases on board cruise ships: An assessment of passengers' preferences on technical solutions.

BACKGROUND: Implementing technological solutions to screen for and detect early the most prevalent communicable diseases on cruise ships is contingent on, among others, willingness of passengers to accept use of such solutions. METHOD: We surveyed passenger preferences to record their willingness to accept technological solutions for screening and early detection of communicable diseases on cruise ships. Self-reported sociodemographic characteristics, use of technology and acceptance of solutions were recorded anonymously in paper format. Multiple logistic regression analyses investigated the association of demographic and other characteristics with willingness and barriers/concerns of passengers to endorse proposed solutions. RESULTS: Of a total of 1344 passengers on two successive cruises on board CELESTYAL OLYMPIA, 336 (1 every 4) participated in the survey. The vast majority of passengers (92.3 %, n = 310) agreed with at least one solution. Passengers showed lower levels of acceptance for more personalized solutions, such as use of wearable devices (45.5 %) and monitoring with cameras (64.0 %), whereas they were more receptive to less personally invasive solutions, such as integration of cabins with air purifiers (89.6 %) and air quality sensors (80.4 %). Age, self-employment status, educational level, and fear of contacting a communicable disease were significantly correlated with passengers' willingness to adopt proposed solutions. CONCLUSIONS: To successfully integrate screening and early detection technological solutions in cruise ships, it is imperative that targeted awareness and education interventions are implemented on passengers to strengthen understanding and acceptance of such solutions and assuage concerns around monitoring and handling of personal health data.

Improving health literacy of passengers of cruise ships: readability of passenger-facing COVID-19 information provided by commercial cruise lines-an infodemiology study.

Readability of COVID-19 information from 35 cruise lines was examined. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level scores (±standard error of mean) were 46.6 ± 1.3 (target ≥60) and 10.9 ± 0.3 (target ≤ 8.0), respectively. Two (6%) cruise lines met readability reference targets. Readability tools may aid in preparing more easily read passenger-facing health-related information on existing infections, including COVID-19, other respiratory infections, as well as gastroenteritis (e.g. norovirus), as well as providing a methodology for improving the readability of information prepared for newly emerging infectious diseases.

Assessment of the performance of cruise ship waste management: Case study of the Rio de Janeiro port, Brazil.

The significant growth of the cruise ship industry has resulted in economic benefits, but there are also waste management-related challenges. The aim of this case study was to contribute to the research of cruise ship waste management at the Port of Rio de Janeiro. A3 methodology, applied for the first time in this context, was used to create questionnaires to assess the stakeholders involved, revealing that institutional bureaucracy has a negative effect on waste management. In addition, secondary data on unloaded waste, obtained from the transport manifests, showed that 56 % contained reliable information. The main wastes were plastics (57 %), glass (17 %), metal (9 %), and others. With respect to destinations, 41 % were sent to landfills, 55 % recycled and 4 % thermally treated. Only 5 % of cruise ship moorings removed waste at the Port of Rio de Janeiro, attributed to factors such as high costs.

Lessons Learned From a COVID-19 Biohazard Spill During Swabbing at a Quarantine Facility.

The need for increased testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has resulted in an increase of testing facilities outside of traditional clinical settings and sample handling by individuals without appropriate biohazard and biocontainment training. During the repatriation and quarantine of passengers from the Grand Princess cruise ship at a US military base, biocontainment of a potentially infectious sample from a passenger was compromised. This study describes the steps taken to contain the spill, decontaminate the area, and discusses the needs for adequate training in a biohazard response.

Segmenting Cruise Consumers by Motivation for an Emerging Market: A Case of China.

After around four decades of fast growth, the cruise industry has become the most profitable and dynamic segment in the entire global leisure and tourism sector. Behind this growth is a significant shift in the profile of cruise consumers/passengers/tourists, with growth rates twice as fast as those of other types of tourists. China has become a strategic emerging market for the global cruise industry, quickly developing their cruise reception business and holding about 10% of the market share of global cruisers. In this paper, we examine and categorize various travel motivations of Chinese cruise tourists by means of a questionnaire via factor analysis, mean analysis, and K-cluster analysis. The results of the study indicate that Chinese cruise tourists are primarily encouraged to participate in cruise tourism by the motivational dimensions of family leisure/relaxation, natural and cultural exploration, bond/communication, social respect, tourism shopping, and cruise-promotion information sources. The strongest motivations for Chinese cruise tourists were found to be family leisure/relaxation and natural/cultural exploration. We identify four types of cruisers using the K-means cluster method. We find that for all cruiser demographics, leisure/relaxation is the most important motivational factor. Based on these results, we propose some specific solutions for expanding the customer pool in the Chinese cruise market.

Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships.

The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.

Ports closed to cruise ships in the context of COVID-19: What choices are there for coastal states?

In the COVID-19 context will coastal States open their ports to cruise ships to meet the needs of people in danger? Can they prefer a more self-centered approach to protect their territory and exercise their sovereignty? The purpose of this study is to analyze the legal framework for the management of health risk by coastal States in the context of the coronavirus threat on cruise ships. The lack of a clearly defined common management strategy in face of major health risk complicates the situation. Only cooperation between flag States and port States will make it possible to overcome any conflicts of implementation between the State sovereignty principle and assistance to persons in distress at sea.

Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018.

BACKGROUND: Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. MATERIALS AND METHODS: A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. RESULTS: One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. CONCLUSIONS: The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.

Management of cruise ship-generated solid waste: A review.

This article presents a literature review of solid waste management on cruise ships using a bibliographic search of the main databases. Articles that discuss waste management were spread over different research areas, demonstrating that the topic is cross-sectional and interconnected, involving social, economic and political considerations. The text is organized into four topics: generation, treatment, disposal and impacts. Recent years have seen increasing interest in cruise ship waste management, likely due to the growing tourism market, with an annual increase of 7.4% in the number of passengers between 1990 and 2018. However, this growth may aggravate environmental, social and economic impacts, making it essential to promote research and studies in the area.

Selecting sustainable alternatives for cruise ships in Venice using multi-criteria decision analysis.

The rapid growth of cruise ship tourism increases the use of historic port cities as strategic hubs for cruise ship operators. Benefits derived from increased tourism for the municipality and cruise ships are often at odds with the environmental and social impacts associated with continued historical port use. This study illustrates the use of Multi-Criteria Decision Analysis (MCDA) for weighing of various criteria and metrics related to the environment, economy, and social sustainability for the selection of a sustainable cruise line route. Specifically, MCDA methodology was employed in Venice, Italy to illustrate its application. First, the four most representative navigational route projects among those presented to local authorities were assessed based on social, economic, and environmental considerations. Second, a pool of experts representing the local authority, private port businesses, and cruise line industry were consulted to evaluate the validity and weight assignments for the selected criteria. Finally, a sensitivity analysis was employed to assess the robustness of the recommendations using an evaluation of weight changes and their effects on the ranking of alternative navigational routes. The results were presented and discussed in a multi-stakeholder meeting to further the route selection process.

Gastroenteritis outbreaks on cruise ships: are sanitation inspection scores a true index of risk?

BACKGROUND: The utility of cruise ship sanitation scores as indicators of future gastroenteritis outbreak was investigated by means of a 5-year review of inspection scores and outbreaks of gastroenteritis as reported under the Vessel Sanitation Programme of the United States Public Health Centers for Disease Control. MATERIALS AND METHODS: Between 2012 and 2017 a total of 1197 inspections were published online, with a mean score of 95.7 out of 100. During the same interval there were 50 separate outbreaks of acute gastroenteritis. RESULTS: No significant difference was found between pre-outbreak inspection scores, mean 96.4, and inspections that were not followed by an outbreak, mean 95.1 (z = 0.81, p = 0.42). CONCLUSIONS: This study shows that the current format of the inspection audits carried out under the Vessel Sanitation Programme generates scores that have no prognostic value with regard to future outbreaks of gastroenteritis on board cruise ships.

Legionella risk assessment in cruise ships and ferries.

Introduction. The increasing development of marine traffic has led to a rise in the incidence of legionellosis among travellers. It occurs in similar environments, especially closed and crowded, and aboard ships Legionella survives and multiplies easily in water pipes, spreading into the environment through air conditioning systems and water distribution points. Although in recent years in the construction of cruise ships preventive measures aimed at curbing the proliferation of Legionella (design, materials, focus on the operation and maintenance of the water system), have been taken account, little or no attention has been paid to small ships which, in many cases, are old and not well maintained. Objective. The aim of the study was to evaluate the frequency and severity of Legionella contamination in ferries and cruise ships in order to adopt more specific control measures. Materials and method. A prevalence study was carried out on 10 ferries and 6 cruise ships docking or in transit across the port of Messina (Sicily, Italy). Water and air samples collected from many critical points were tested for qualitative and quantitative identification of Legionella. Results and conclusions. Legionella pneumophila sg 1 was isolated from the samples of shower and tap water in 7 (70%) of the 10 ferries examined, and in 3 (33%) of the 6 cruise ships examined, and L. pneumophila sg 2-14 in 8 (80%) and 1 (16.7%) of these ships, respectively. No Legionella contamination was found in whirlpool baths, air and ice samples. In conclusion, the data obtained confirm higher levels of Legionella contamination in local ferries and cruise ships, underlining the need to adopt corrective actions more specific for these smaller vessels.

Debriefing of the medical team after emergencies on cruise ships.

Done to improve safety and patient outcome but not to lay blame, debriefings on cruise ships should preferably be conducted as standard practice in the medical facility immediately after all critical events aboard. The key questions to be asked are: What went well, what could have gone better and what must participants do to improve care? Post-debriefing the ship's doctor might have to deal with team members' mental stress resulting both from the event and from debriefing it. Required by most cruise companies, standardised advanced life support courses teach effective high-performance team dynamics. They provide the multinational medical staff with a clearer understanding of the rescue sequence, which again will reduce the risk of mistakes and simplify post-event debriefings. Their systematic approach to the chain of survival is also helpful for post-event debriefings if something went wrong.