I work in a very busy ER in Las Vegas and without the proper testing equiptment (cat scan, ultra sound, radiology) doctors can only do so much. Everyone that comes in with a blow to the head gets a cat scan to see if there is a bleed. The ship's docotr should just stabalize and send to the nearest ER or trauma center. Basically, they have just a small clinic on board like a quick care or urgent care. There are always doctors and nurses and pharmacists on board as passengers if needed. It is up to the ship's doctor to ask for assistance. The man that had the heart attack case is inexcusable. They must of run an EKG or two. He should of been taken off the ship and had a full cardiac work-up in a real hospital. That doctor should take the responsibility. I do think that ship's doctors should all be trained ER docs and not some retired country doctor. There definitely should be an accredidation for ship doctors to pass some kind of an international exam. And they should have continuing education to get re-certified every few years.