The ship, MS Maasdam, was about 55 miles south of Point Loma when Coast Guard Sector San Diego received a call from the ship’s crew about 11:30 p.m. stating that an 86-year-old woman was suffering from internal bleeding.

A Coast Guard flight surgeon was consulted and determined the woman needed medical attention onshore.

An M60 Jayhawk helicopter was dispatched from San Diego. A rescue swimmer was lowered from the helicopter to the ship to assist in the hoist of the patient.

At the time, seas were about 14 feet and winds were gusting to 25 knots, said Mark Mutchler, Coast Guard operations controller.

The woman was taken to Scripps Memorial Hospital La Jolla and was in stable condition.

Earlier Friday, a Coast Guard helicopter from San Diego flew to Bahia de Gonzaga in Baja California, Mexico, to airlift a 67-year-old U.S. citizen who had an undisclosed life-threatening medical condition. He was taken to a hospital in Yuma, Ariz., and was in stable condition.

In a statement issued today to USA TODAY, Star Clippers confirms several reports in small Caribbean news outlets that the woman, identified as Nina Elisabeth Nilssen, was attacked and killed on Tuesday after she went ashore from the 227-passenger Royal Clipper.

"According to Antiguan police officials, Nilssen's body was discovered around 5 p.m. on a secluded trail at Windward Bay, near Pigeon Point Beach," the statement says. "Authorities have a description of the alleged assailant, but have not made an arrest."

A story in the Antigua Sun says Nilssen's body was found with what appeared to be a stab wound to the neck and was partially unclothed.

The murder is just the latest serious crime against tourists in Antigua. A 38-year-old Australian man visiting the island last year on his yacht was shot dead while walking with his girlfriend and daughter, and in 2008 the island was the scene of a double murder of a honeymooning British couple -- incidents that have raised questions about the safety of visiting the island. The British couple were shot in their room at Antigua's Cocos Hotel.

Antigua's tourism industry also suffered a black eye in September when six Carnival cruise passengers were arrested after a brawl with local police. Carnival announced shortly after the incident that it was ending most cruises to Antigua. The Carnival Victory's last stop on the island took place earlier this month.

Star Clippers says Nilssen's family disembarked Royal Clipper Tuesday evening and received assistance from both Star Clippers and the Antiguan government with accommodations, flights home and arrangements to return Nilssen's body to the United States.

"Star Clippers CEO Mikael Krafft has expressed his heartfelt sympathy and condolences to the members of Ms. Nilssen's family," the line's statement says.

"Star Clippers also is cooperating with Antiguan authorities in their ongoing investigation and search for the assailant."

A spokesperson for Star Clippers says the line hasn't decided whether the Royal Clipper will return to the island. The ship normally visits every two weeks.

Getting a Grip on Cruise Ship Pollution was authored by Dr. Ross Klein, a professor at Memorial University's school of social work, and an expert on the cruise ship industry. It was released by the U.S.-based environmental group Friends of the Earth.

"The report lays out the deleterious effects of pollution from cruise ships — many having significantly negative impacts on human health and the health of the marine environment," Klein said in a statement.

Since 1998, Klein said, the cruise industry has been fined more than $60 million for environmental violations.

He said the industry has come out against a Canada-U.S. call for an emission control area that would require ships to use cleaner burning fuels because it would add between $8 and $15 a day to a passenger ticket. Even with this measure, Klein said, the fuel required would still be much dirtier than fuel used in automobiles.

His report was produced in part to provide supportive documentation for the Clean Cruise Ship Act currently before the U.S. Congress. He said he has also been contacted by members of parliament who are interested in addressing the problem in Canada.

The report says a cruise ship can produce every day more than 180,000 litres of sewage, over two million litres of grey water (produced by bathing, cooking or cleaning), 18,000 litres of oily bilge water and as much as 17 tonnes of solid waste.

"Much of this waste is discharged into the environment directly, or indirectly as incinerator smoke and ash. In addition, a cruise ship, like all ocean-going vessels, produces significant air emissions from burning large amounts of fuel and contaminates waters through ballast water that introduces non-native species," the report says.

It also says treatment of waste water has been found by the U.S. Environmental Protection Agency to not adequately meet water quality standards set for onshore sewage treatment plants. It adds that while the cruise industry has introduced initiatives to better deal with cruise ship waste streams, "these measures often fall short."

Klein proposes a wide-ranging set of recommendations for reform of the cruise industry, which earns billions of dollars a year around the globe.

Among them: limits on the discharge of waste and bilge water at sea; electronic transponders to alert land-based authorities when a discharge line is open as well as observers on board ships; research on the effects of untreated sewage on marine life; a requirement for cruise ships to sort other waste onboard and off-load recyclables only at ports with recycling facilities; and establish penalties for violations.

The cruise lines only have to report crimes involving Americans to the FBI, and even those are underreported. The cruise lines don't want their passengers or their crew members to be crime victims.

Charles Lipcon, Maritime Attorney, said "The cruise lines only have to report crimes involving Americans to the FBI, and even those are underreported. The cruise lines don't want their passengers or their crew members to be crime victims." The public statistics show the FBI opened 184 cases of crimes on cruise ships between October 2001 and February 2007, including 101 sexual assaults, 12 missing persons, and 13 deaths.

Charles Lipcon is a maritime attorney with the law firm of Lipcon, Margulies & Alsina, P.A. This firm handles many cases against the cruise lines both for passengers as well as crew members. Charles Lipcon has also been featured as a top Miami Maritime Lawyer by Florida Trend's Legal Elite and a top attorney by Super Lawyers.

Charles Lipcon is the author of one of Amazon's top 30 selling travel books, Unsafe on the High Seas. This book details some of the dangers of cruise ship travel from assaults to missing people. It also covers the victim's rights and how they can defend themselves. The book does not try to persuade you into not taking a cruise, but rather teaches you how to cruise safer. The book can be ordered from Amazon.com.

About Lipcon, Margulies & Alsina, P.A.
Lipcon, Margulies & Alsina, P.A. is a Miami, FL, Law Firm focusing on maritime and admiralty personal injury claims against cruise lines and other boat owners. Lipcon's maritime lawyers represent passengers and crew injured on ships worldwide.

The Coast Guard says crew members aboard Royal Caribbean's Monarch of the Seas reported Neha Chhikara missing Thursday afternoon as the ship was headed from Nassau to CocoCay.

Royal Caribbean spokeswoman Cynthia Martinez says the guest was reported missing by her husband. Security camera footage showed the 23-year-old woman going overboard from the 11th deck early that morning.

Martinez said Friday that Bahamian government officials reviewed the footage and determined that the woman jumped overboard.

The ship left Port Canaveral, Fla., on Monday for a five-day cruise through the Bahamas. It's due to return Saturday.

The Coast Guard says crew members aboard Royal Caribbean’s Monarch of the Seas reported Neha Chhikara missing Thursday afternoon as the ship was headed from Nassau to CocoCay.

Royal Caribbean spokeswoman Cynthia Martinez says the guest was reported missing by her husband. Security camera footage showed the 23-year-old woman going overboard from the 11th deck early that morning.

Martinez said Friday that Bahamian government officials reviewed the footage and determined that the woman jumped overboard.

The ship left Port Canaveral, on Monday for a five-day cruise through the Bahamas. It’s due to return Saturday.

Gian M. Novaro, MD, of Cleveland Clinic Florida (Weston, FL), and colleagues examined data they collected between January 1, 2004 and December 31, 2005 from 100 consecutive adult cardiology consultations for passengers aboard 5 large cruise lines.

The most common symptom was chest pain (50%) followed by dyspnea (19%), palpitations (13%), syncope/near syncope (10%) and “other,” which included vague symptoms such as nausea, rashes and weakness (10%).

Mean age was 66 years and the most common principal diagnosis was acute coronary syndrome (58%; ST-elevation MI in 21% and non-ST elevation MI in 37%). Other diagnoses included atrial arrhythmias (15%), syncope (5%), noncardiac chest pain syndromes (5%), decompensated heart failure (4%), acute pericarditis (3%) and dyspnea (3%). Over the 2-year period, the on-board mortality was 3%. These deaths occurred in patients who presented with non-STEMI, pulmonary edema and profound hypotension.

Nearly 75% of patients requiring a cardiology consultation were triaged off the ships to a shore-side hospital. Of these, 10% reported active cardiac symptoms in the days to weeks before cruise ship travel. Triaged passengers were similar in age to those not requiring triage and had a similar prevalence of pre-existing coronary artery disease. During hospitalization, at least 20 patients required cardiac catheterization followed by PCI or CABG. Mortality among these patients was 4%.

Better Safe Than Sorry

Dr. Novaro and colleagues say while the risk of cardiovascular events aboard cruise ships is low, their report highlights the not insignificant risk of morbidity and mortality for passengers who do develop symptoms

While the medical staff aboard the cruise lines had access to ECG, continuous telemetry monitoring, chest radiography, oxygen saturation, arterial blood gas, and laboratory studies, there was variation in the types of available medical therapy.

Therefore, the researchers say it is important for passengers to inform themselves about cruise ship medical capabilities. While most large cruise lines adhere to guidelines set by the American College of Emergency Physicians, many smaller or independent cruise lines do not, and only minimal information about their medical evacuation or telemedicine capability may be available.

They recommend the following medical checklist for passengers prior to cruise ship travel:

- Pack an adequate supply of all medications and bring an updated medication list
- For passengers with known coronary artery disease, travel with sublingual nitroglycerin
- Bring a hard copy of a 12-lead ECG if baseline is abnormal
- For passengers with pacemakers, defibrillators, coronary stents, or heart valves, carry a manufacturer’s card
- For passengers with known cardiovascular disease, travel with physician’s contact information and a recent summary of medical history
- For the elderly, sedentary, or those with known cardiovascular disease, consider pretravel evaluation with physician
- Evaluate new cardiovascular symptoms or change in clinical status with physician before travel
- Check with physician regarding safety of initiating an exercise program
- Consider purchasing medical evacuation insurance if not covered under existing health insurance

In addition, Dr. Novaro and colleagues say prospective passengers should keep in mind that some behavioral changes related to travel such as dietary indiscretions, altered sleep cycles, increased alcohol intake, and increased physical exertion may worsen or precipitate cardiovascular events.

The packages range from £20.75 per night for a much beer as you can swallow, through to £89 per night for the ‘Captain's Package’ which includes specially selected premium wines. A drinks package that offers such strong choices as bourbon and vodka, costs £31 per night. While Celebrity says that it wishes to promote sensible drinking, several charities and anti-alcoholism groups have criticised the cruise line for encouraging people to drink excessively. Their concerns are based on the fact that it can be very difficult to keep track of who much you have drunk if you’re simply showing a pass to a bartender, and that the effects of over-drinking can lead liver damage, infertility, a range of cancers and depression.

However the results don’t have to be long-term to be disastrous: it’s claimed that recent problems in Antigua where cruise passengers fought with police and were left behind in custody when their ship sailed, may have been due to alcohol. And of the 130 people who have jumped off cruise ships in American waters in the past 15 years, at least half had been drinking heavily before they chose to enter the water, and while many are recovered, some are never found again: in March 2008 a woman jumped from a cruise ship off Key Lago during an argument with her boyfriend. Her body was never found.

The rescue teams managed to find five bodies earlier in the day. During the morning, the bodies of a woman and a child had been taken from the water as well. The victims have yet to be identified.

According to the local authorities, the shipwreck took place in late Monday between the municipalities of Prainha and Monte Alegre, when the boat named Almirante Barroso overturned and sank.

It is not known what caused the ship to overturn. One of the possibilities is that the boat may have hit a sandbank and the waters at that point of the Amazon River are muddy, which may have hindered visibility.

Additionally, the fact that the number of passengers had surpassed the ship's maximum capacity may also be the cause of the tragedy. The Almirante Barroso had a maximum capacity of 100 people, but was transporting at least 101.

Teams of divers as well as boats and a helicopter were sent to the area and are currently searching for other victims, who might have gotten trapped in the cabins.

Ninety four of the ship's occupants were rescued by other boats which were passing by. Most are currently staying at a nearby farm, but some injured were taken to hospitals. (PNA/Xinhua) ALM

But after a deep clean of all the cabins, the ship was sent back out to sea Friday evening. Now 50 passengers aboard the 900 capacity ship are again thought to be showing sickness symptoms and, reportedly, the cruise liner has been forced to turn back. Fred Olsen were due to release a statement later today.

The cruise liner firm has a bad record of passenger sickness - this bug would be the sixth time in the past three years one of its fleet has been hit with illnesses.

The lights are just one reason witnesses and survivors are struggling to understand why the Coast Guard boat crashed into the packed recreational boat Sunday night at the 38th annual San Diego Bay Parade of Lights, a popular showcase for boats decked in Christmas lights.

DeWeese had borrowed his father's boat and invited two other families to watch the parade on its 5-mile route past downtown skyscrapers and the famed Coronado Bridge. The 33-foot Coast Guard patrol boat, meanwhile, was responding to a report of a grounded vessel.

"It seemed like it was going full speed when it hit," said Barbara Maloney, who watched from her 6th-floor hotel room. "We didn't notice them slow down at all. I assume they didn't see it."

The Coast Guard has not yet provided answers. It expressed condolences to the DeWeese family Monday and said three probes were under way. The National Transportation Safety Board sent investigators to San Diego, and the Coast Guard and San Diego Harbor Police also are investigating.

"We look forward to discovering what the facts were," Capt. Thomas Farris, commander of the Coast Guard's San Diego sector, told reporters Monday.

There were 13 people aboard the DeWeese boat Sunday. Anthony Cole DeWeese, 8, died in the crash. Two other children were injured and taken to Rady Children's Hospital, and three adults were transported to University of California, San Diego Medical Center, Fire Department spokesman Maurice Luque said.

None of the five people on the Coast Guard boat were injured.

Bob Furry was watching from his hotel room when he said he saw a boat blaze across the bay with a flashing blue light.

"We said, 'Jeez, it's going really fast.' We thought it was some kind of hot-dogger," he said.

Alan DeWeese turned around, but it was too late. He estimates the Coast Guard boat was traveling 35 mph to 45 mph and that he was moving no faster than 3 1/2 mph.

"I thought, why is he going so fast? I figured he was going to turn at some point but he kept coming at us," DeWeese, 44, told The Associated Press on Monday.

"He came up so fast I didn't have time to react," DeWeese said.

Roger DeWeese said his deceased grandson had been an ice hockey goalie.

"He was a spark plug," said DeWeese, who was not on the boat during the crash. "He liked just about everything."

The boy's father, also a hockey player, said his son enjoyed life to the fullest.

During the parade in San Diego Sunday, boaters festooned their decks with Christmas lights. In keeping with this year's theme, "Christmas at the Zoo," some participants dressed up as giraffes and pandas.

There were about 80 boats in this year's parade, from a 12-foot canoe to a 157-foot yacht.

The parade drew about 80,000 people on Dec. 13 and again Sunday, said Ron Sheehan, vice chairman.

Associated Press Writer Greg Risling in Los Angeles contributed to this report.

Is this an accident? An idiosyncratic decision by a cruise line official? Far from it. The moment you begin analyzing the itineraries of the other gigantic new ships that have begun sailing or are about to (the 4,300-passenger Freedom of the Seas, the 4,200-passenger Norwegian Epic, the 3,800-passenger Carnival Dream), you find that all of these humongous vessels, on at least every other week and sometimes every week, will be devoting three of their six days of sailing to simply wandering at sea, without stopping. On other alternating weeks, they will spend one of their remaining three days at either a private beach in the Bahamas or a private beach in Mexico.

So, in addition to offering a new kind of onboard experience filled with toys and games, the four new gigantic ships – larger than any others – will be cruising unusual itineraries, to say the least. Their routes will be designed to keep all their thousands of passengers together for almost all of the cruise, and walled off from the cruel realities of nearby islands. Foreign travel will not be their specialty.

Why has this policy been adopted? I have three theories:

(1) By devoting half of their six days per week to simply sailing at sea, the ultra-large ships retain all the income that passengers would normally spend in ports. Instead of that income going to land-based restaurants, bars and shops, it goes to restaurants, bars and shops within the cruise ship. Instead of income going to land-based casinos, it is spent at ship casinos. Instead of income being spent at jewelry and liquor shops on land, it is spent at jewelry and liquor shops at sea. This is all so painfully obvious, and points up the desperate need of the cruise lines to earn extraordinary amounts from onboard spending to pay back their billion-dollar investments in these humongous new ships.

(2) By featuring stops at fake villages like Costa Maya or fenced-in private beaches like Labadee (surrounded by barbed wire and guards to keep out the unfortunate people of Haiti), the cruise lines again retain much of the spending that passengers would otherwise direct to foreign entrepreneurs. Obviously, the merchants that one finds on the “private beaches” and fake villages will be mainly in the employ of the cruise lines.

(3) And finally, the ships are so large that they really can't go to interesting small ports, such as those of Grenada, Dominica, St. Lucia or elsewhere. The only actual ports able to receive them are the overcrowded docks of St. Thomas, St. Maarten and Nassau.

And that's why the giant new ships will spend most of their time wandering the open sea or heading to "private beaches," while their passengers play with toys and games on deck.

So a recent spate of armed attacks on visiting cruise ship passengers, must have sent a shudder of panic through the local authorities and Oasis's owners, Royal Caribbean.

The ship's maiden call on Friday went ahead as planned, but passengers were warned of the risks before going ashore. As Thea Rutherford reports in the Nassau Guardian, the 6,000 passengers were advised to be "mindful of their personal safety" during their time on the island.

The warning was printed in Cruise Compass, the daily newsletter provided for each cabin on the 225,000-ton ship.

"Nassau is one of the most beautiful cities, and the residents are warm and welcoming," it said. "However, recently Nassau has experienced an increase in crime. Visitors to Nassau, like visitors to all large cities in the world today, need to be mindful of their personal safety."

During a ceremony in which the ship's captain was presented with a plaque to commemorate the visit, Prime Minister Hubert Ingraham said: "I assure Royal Caribbean and, indeed, all cruise lines calling at Nassau, that the government takes seriously its obligation to provide a safe environment in our city."

"We want every visitor to our country to feel good about being here. We seek to make visitors' stay safe and enjoyable so that they look forward not only to returning but also to sending their friends."

A man has appeared in court accused of robbing 18 cruise passengers at gunpoint in November and there have been 79 murders in The Bahamas this year.

Tourism Director General Vernice Walkine said, "It's troubling to all of us. We're continuing to talk about how we can together try to mitigate those kinds of incidents and so we continue to collaborate with all of the cruise lines, talk through what measures we can take to ensure that their passengers, our visitors, continue to be safe in The Bahamas."

Noting that millions of cruise ship passengers enjoyed safe visits to the country each year, she said, "We continue the quest to make sure that they all have a safe and enjoyable time... Everybody's understandably concerned and committed to ensuring that we work very hard to prevent those kinds of incidents from recurring."

Colombian maritime authorities searched Sunday for an Italian chef believed to have gone overboard from a U.S. cruise ship off Colombia's Caribbean coast, officials and the man's family said.

There were different accounts about when and where Angelo Faliva, 31, was last seen as the Princess Cruises "Coral Princess" sailed from Aruba to Cartagena, Colombia, between Nov. 24 and 25.

Princess Cruises spokeswoman Julie Benson said Faliva was last seen on a deck at about 8:30 a.m. Thursday, when he spoke with another crew member as the ship neared Cartagena.

His family, however, said they had been told that he had unexpectedly walked out of the ship's galley at about 8:15 p.m. the night before, while he was working the dinner shift, and never returned and hadn't been seen since.

The family suspects that there was an accident or homicide. Princess Cruises spokeswoman Julie Benson said that Faliva's cabin had been sealed, the ship has been searched and its CCTV footage reviewed. However, no cameras captured video of a crew member going overboard.

The Faliva family said it was alerted Thursday that he had been reported missing and that a life preserver was also missing, with its nighttime illumination flares torn off and left aboard the ship.

"He surely didn't jump off. It wasn't suicide," his sister Chiara Faliva told The Associated Press from the family's home in Cremona. "We think there was an accident or a homicide."

Italian chef missing at sea on Caribbean cruise

The commander of the Colombian Coast Guard station in Cartagena, Lt. Javier Sanchez, said officials there received a report from the "Coral Princess" at 10 a.m. Thursday that one of the cooks had last been seen the night of Nov. 25 between 7-8 p.m. when the ship was navigating Colombian waters near La Guajira.

But like the Princess spokeswoman, he too said the Coast Guard received word from the ship later Thursday that a person had seen the chef at about 6 a.m. Thursday morning.

The ship docked in Cartagena at 10 a.m. Thursday. By 3 p.m., the Coast Guard began searching for the chef, using a helicopter and two boats.

The search continues, using boats. "The case is not closed," Sanchez said.

An Italian Foreign Ministry official, speaking on customary condition of anonymity, said Italian embassy officials in Bogota were working with Colombian maritime authorities conducting the search and that the FBI was expected to investigate as well since the ship is part of the U.S.-based Carnival Corp. cruise empire.

The family is hoping Venezuelan maritime authorities also will take part in the search since the ship passed through Venezuelan waters during the time Faliva is believed to have gone overboard.

Carly Milne was one of almost 30 cruise tourists that have been robbed while on Nassau shore excursions in the last two months.

Last week, she was robbed at gunpoint while on a Segway excursion, one of 18 passengers in two groups that were targeted on the same day.

None of those passengers were hurt, and the cruise lines involved, Disney Cruise Line and Royal Caribbean International, are no longer offering the Nassau Segway tour. In a similar October incident, 11 Carnival Cruise Lines passengers were robbed near Nassau's Queen’s Staircase attraction, also at gunpoint.

Milne, who declined to mention what ship she was on, said she was shocked to learn that none of these were isolated incidents.

On the day her group was targeted, she met a woman at the Nassau police station whose husband had been robbed in the shopping district. Later, Milne read an article citing another man robbed that day of his wallet.

“We were repeatedly assured by police that ‘this never happens,’ and yet, 21 people were victims of aggravated theft in one day, each in busy tourist areas that are supposedly safe,” Milne said. “I was horrified when I started doing the research online and saw just how much armed robbery, theft and violence is happening in Nassau these days.”

Milne said if she had known this, “I would’ve never gotten off the ship."

A travel writer, Milne said she has been all over the world, and knows well that tourists are often targets for criminals. But she believes Nassau is not doing enough to counter what is clearly a trend.

“I don’t think it’s unreasonable to expect that if a city or country is experiencing a vast amount of criminal activity that targets tourists, that they take as many strides as they can to ensure their safety to the best of their ability,” she said. “That means armed guards and police presence at heavily populated tourism destinations. As I walked with our group from the cruise ship to the taxi through a little of the shopping area, I saw no security presence. As we drove through town on the way to the Segway tour, nothing. And at the tour itself, zero police – at least, not until five minutes after we were violently robbed.”

Milne believes that cruise lines and their passengers should not visit Nassau until the town beefs up its security.

“I don’t think they’ll really step things up unless the tourism industry is severely impacted,” Milne added. “Right now, the cruise ships and their clientele have the ability to affect change. I sincerely hope they do so.”