I know this is an older thread, but I feel I need to clarify some things for y'all. For reference, I am a travel nurse and worked in the ER at Schneider Regional Medical Center on St Thomas, USVI, for a year (7 months in 2021 and 5 months in 2022). I saw many, many people who came from cruise ships. Not a single one was brought by the Coast Guard. They were all on the ship in either the regular ward or in the ship's ICU and were transported by EMS from the pier. They were there for all sorts of reasons from head injury, septic appendix, broken hips, food boluses, CVA, MI and other things. We either treated them and released them back to the ship, treated them and released them to a hotel because the ship wouldn't take them back even with medical clearance or transferred them back to the US on a fixed wing. No helicopters do medical flights in the USVI besides the CG. The ONLY CG pt we received was someone who was stuck on some rocks during a tropical storm and even he came by EMS from the airport where the CG landed to drop him off. Even pts who come from Myrah Keating on St John come by EMS boat to Red Hook, then to Schneider by ground EMS.
For the pt's who needed to be flown to the US we used several different companies. Before we called them, the pt had to be accepted at a hospital. We used Miami, San Juan or Ft Lauderdale the most. We had a couple of special cases where the pt was able to be flown closer to home. If the pt didn't have insurance coverage then he/she stayed with us until either enough cash money was obtained or they recovered enough to go home on a commercial flight. These fixed wing companies don't play with their money. Period. The same for the locals who need to be flown to a higher level of care.
Most locals pay yearly to be in a "network" with one of the flight companies. Oh, and you (we) are at the mercy of the flight company. If the weather is bad or there are more serious pt's ahead of you that need to be flown then you wait. You WILL get bumped if you are triaged by the company to a lesser category than someone who just came in. We also had crews time out and no other crews available.
For those who are curious, if you are discharged to a hotel, there are liason's for the cruise companies who will help you find lodging, get meds, rides, etc. You are not just dumped out on the street.
There are only 8 ICU beds in the hospital so limited care can be given. No Interventional Radiology such as a cardiac cath lab. An interventional cardiologist used to come a few days a month, but not sure if she does that anymore. There are a couple of general surgeons who also do trauma, an orthopedic surgeon, OB/GYN, cardiologist and internal med docs. Just like any other hospital, I've seen good and bad things happen there.
I tell people ALWAYS, ALWAYS, ALWAYS purchase as much medical evacuation insurance as you can afford.
Oh yeah, one couple on their honeymoon had to max out their credit cards to pay for the ship (not disney) medical bill before they could get off the ship. Y'all would be amazed at some of the crap I've seen pulled by cruise ship physicians! I'll stop here. If you have any questions I'll be happy to answer them to the best of my ability.