With the expansion of the shipping and cruise ship industries, there is a need for a more complete understanding of the mortality risks at sea. We conducted a retrospective review of shipboard deaths coming under the jurisdiction of the County of Los Angeles Department of Coroner during the years 2000-2011. Sixty-one shipboard deaths were identified, of which 24 (39%) were among crew, and 37 (61%) were among passengers. Among both crew and passengers, there was a prominence of deaths due to cardiovascular disease. Also prevalent were accidents due to blunt trauma, accidents involving ethanol or medications, and suicides. The identification of multiple potentially preventable deaths after onset of symptoms at sea underscores the need for further improvements in maritime telemedicine, crew medical capability and long-distance evacuation.