When employees are injured, what’s the best way to get them back to work and back to their normal lives? At CORA Physical Therapy, we think the best way is with our Workers’ Compensation program, WorkTracks.
WorkTracks integrates treatment with employers’ return-to-work plans, emphasizing the performance of essential job duties and involving the injured worker in every phase of the recovery process.
This case study demonstrates how CORA was able to successfully provide weekly on-board treatment for an injured Carnival Cruise Line (CCL) employee via its WorkTracks program.
Background
CORA staffs roughly 20 CCL ships and provides weekly treatments to crew members and performers. The majority of the injuries occurring on cruise ships are due to overuse, heavy lifting, and accidents.
Aboard ships, when a crew member is injured and cannot work it can cause a major disruption in ship operations because of the challenge of getting an immediate replacement. The workload must be reassigned to other on-board employees. CORA targeted this issue with its shipboard physical therapy program.
Challenges of Providing Care on Cruise Ships
Cruise ships employ a unique population of crew members. The workers can be drawn from more than 50 countries, with diverse jobs, workloads, cultural backgrounds, and education. To meet the needs of such diverse crews, CORA has implemented Fit for Duty testing for Carnival Cruise Line employees with a high body mass index (BMI) or contraindicated medical histories. Such testing not only helps prevent injuries but also helps determine if crew members are safely able to perform their jobs in alignment with current Maritime laws.
The average CCL ship completes a full cruise in approximately 4-7 days. The ship’s homeport, where it loads and unloads passengers, is sometimes the only port of call with access to healthcare. Homeport stops provide a very small window of opportunity to treat physical conditions before an injury becomes more severe.
Additionally, providing Carnival ships with on-board physical therapy allows the patient (aka crew member) to continue PT on the ship which benefits both the cruise line and the injured worker. When ships have no access to physical therapy, patients are commonly referred directly to an orthopedist for more aggressive treatments. This means that injured workers often are sent back to their home countries to continue treatment, resulting in increased company costs, a strain on the workforce, and lost wages for the injured worker.
One or two ICU or Emergency Specialized (EM) doctors and three or four nurses are assigned to each Carnival ship. They’re responsible for the medical care of 1,000 to 1,400 crew members and thousands of guests, so these measures are essential to ensuring a happy, healthy, and productive crew and, most importantly, a positive experience for all Carnival guests.
Sample Case and Solutions
Here’s an actual CORA shipboard case, which demonstrates how outcomes can change when on-board treatment is available to cruise line workers.
Case: A 48-year-old male crew member with a previous medical history of right shoulder pain presented to on-board therapists with the same complaint. The patient stated that he was struggling to lift heavy objects with his right arm due to the pain. A physical exam was unremarkable for swelling or rotator cuff tear; X-rays revealed no fractures, therefore, said patient was referred to an orthopedic specialist. An MRI was ordered by the orthopedic specialist and performed at St. Thomas Port revealing mild rotator cuff (supraspinatus and infraspinatus) tendinosis with articular surface fraying and mild peritendinous edema – thickening of the inferior glenohumeral ligament with pericapsular edema – which may be seen with adhesive capsulitis and diffuse labral degeneration.
Treatment plan: In this particular case, the 48-year-old male crew member was a perfect candidate for therapy. Our highly trained staff was able to quickly assess and diagnose the patient to determine that he had inflammation of his rotator cuff tendons, and was beginning to develop frozen shoulder. Both are successfully treated via PT. The patient agreed to a trial of physical therapy aboard ship and a course of non-steroidal anti-inflammatory drugs (NSAIDs) with proton pump inhibitor (PPI), commonly used to treat the pain of arthritis and prevent stomach problems from the NSAIDs. Duties were temporarily restricted to light lifting with the right shoulder; however, the crew member was able to continue safely on board the cruise ship thanks to a dedicated team of physical therapists prepared to begin treatment.
Outcome: The patient remained on board and received weekly physical therapy sessions with a take-home program. The patient continued to work with full wages and had a full recovery from physical symptoms.
Results: CORA Physical Therapy’s on-board conservative approach to treatment allowed the crew member to stay in the workforce with minimal staffing disruption. No claim was opened, and no surgery was attempted, minimizing employer cost while providing an optimal clinical outcome.
CORA Physical Therapy’s Treatment Approach
For more information on how the WorkTracks program can expand employee treatment options while reducing employer costs, contact us to discuss our evidence-based treatment options and approach to preventing work-related accidents.
