Head injury in a cruise passenger during a shore excursion

A 66-year-old overweight insulin-dependent male passenger with diabetes and severe arthritis was on a 4-week circle-Pacific cruise. He fell ashore and hit his head. The ship was about to leave on a non-stop voyage - without any evacuation possibilities for the next 8 days. He was examined and had X-rays taken at the local hospital, but as his head injury was considered mild, he returned to the ship "for 48 hours of observation for signs of intracranial bleeding" - against the ship's doctor's advice. Delayed suspicion of a non-displaced cervical fracture caused extra work and worries and could have, but did not complicate matters. When there are no life-saving therapy and no timely evacuation possibilities in case of deterioration, on-board observation is counterproductive. The patient should be kept in - or near - the local hospital during the necessary observation period, followed by safe repatriation.