Ask the Doc: Preparing for medical situations abroad

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Q: I'm planning my first adventure tour outside the United States. Should I have a medical evacuation plan? What else do I need?

So you've planned a non-continental United States (non-CONUS) two-wheeled vacation (holiday, for those not from the United States) to a fascinating and remote destination. Packing is a cinch thanks to Lemmy’s, Bill’s and Panhead Jim’s helpful tips. Waypoints are loaded into your GPS, a local map is tucked away just in case, you have a current passport, local currency, motorcycle rental and gear (I'm a trauma surgeon … did you expect that I would leave that out?) secured and you are good to go.

Well, not quite. Preparation for international travel should also include preparation for your care if something goes wrong. Things that do not go as planned include crashes, gashes, broken things, infection and worse.

Preparation: immunizations, medications

Regardless of where you are traveling, it makes sense to determine if you need specific immunizations (no, there is not one yet for Zika). A host of websites offer guidance, such as the Centers for Disease Control, which offers information for 245 destinations (as an example, here is a link to their information for Mexico), and many institutions, like PENN Medicine (yes, I work at PENN), have a specific Travel Medicine division and clinic to help. Similar agencies in other countries also offer guidance, such as Ireland's Travel Medical Bureau.

Once you are appropriately immunized, a variety of medications that you find at the 24/7 Walgreens or CVS should go into your travel kit, since the back country of Mozambique seems curiously devoid of those stores. Moreover, if you do find a local pharmacy, the names of medications are often quite different.  For example, acetaminophen (Tylenol) is commonly labeled as paracetamol overseas. Acetominophen, ibuprofen (or similar), and an anti-diarrheal agent are important to bring with you for pain management. Remember, your gut bacteria (called your microbiome) is rather different from that of individuals living in say, Egypt, due to eating different foods. When you are exposed to stuff that isn't yours, you body often tries to forcefully expel the offending agent(s). Yes, this will pass, but you should avoid dehydration while it happens, and an anti-diarrheal helps reduce your salt and water loss.

For minor scrapes, cuts, etc., your immunization against tetanus is essential, and some lightweight dressings are important. Clean water for washing out your injury along with soap is key. There are a host of water purification pens, iodine drops and filters from which you can select your device of choice. Soap and alcohol-based sanitizers each have their place and have been reviewed in an earlier article. Of course, I do recommend having a serious injury kit as well, especially if you are traveling outside of the urban sprawl, where obtaining help may be hours after your injury.

Unlike most major cities, where transport times to a major medical facility are measured in minutes, interesting destinations have transport times that can instead take hours, and some may require you to get to help, instead of help coming to you. Cell phones may work, provided you have the right setup, but if you are far afield, a satellite phone is more reliable. Check with your carrier prior to departing to determine where you will have coverage and whether your personal phone will work there (with or without roaming charges). Minor injuries, including most bites and stings, can be handled most anywhere, but what about a major injury, or a serious medical condition, be it infection, a heart attack, or an intestinal blockage?

Here is where travel medical insurance becomes essential. Travel insurance comes in two flavors: one gets you the non-CONUS medical care (hard to leave many countries without paying your bill), and the other gets you evacuated to either the United States or another suitable location for emergency (usually definitive) care.

According to Dr. William A. Walters, the Director for Operational Medicine for the U.S. State Department (and a long-time friend), the best starting point is your own insurance company to see if they cover medical care in say, Nairobi. If not, then multiple companies offer travel medical insurance including but not limited to Travelex, MEDEX, Travel Guard, CSA, and HTH. The U.S. State Department offers a listing of U.S. and foreign travel medical insurance providers (with the usual disclaimers). Importantly, this site also provides a list of travel warnings for different locations. Also included is a link to their Smart Travelers Enrollment Program (STEP), a program from Consular Operations that identifies your travel in the nearest appropriate U.S. Embassy or Consulate.

If you are on regular medications and they get lost, travel medical insurance can help with that, too. Be careful in selecting a plan if you have pre-existing conditions, as not all cover them. Some will only do so at a higher premium, and others only if you are already enrolled in a primary insurance plan (I think Obamacare will fulfill this requirement).

That covers medical care, but what about getting someplace for high quality care?

Medical evacuation

Dr. Walters has particular expertise in medical evacuation, as he crafted and directed the vastly successful and well popularized medical evacuation program during the Ebola crisis. If you need to be flown to the United States or a closer suitable location for emergency care (for example, injured in Nairobi and then evacuated to Paris for care) and do not have travel medical evacuation insurance, costs may reach $160,000 for a fixed-wing medical transport to the United States or a mere $65,000 to Paris. Providers with whom you directly contract for air evacuation service, such as AirMed, International SOS, or Global Rescue, help guarantee high quality airframes and medical providers en route. Otherwise, aircraft and provider quality may be highly variable and is often contracted through a broker using a bidding process where your evacuation care is generally not awarded to the highest bidder.

adventure touring

Getting Back On The Grid

Of course, you do need to be found once sick or injured in the hinterlands in order to get this whole ball rolling. Dr. Walters recommends using a satellite-based GPS tracker and attaching it to you (most are around 4 ounces in weight), not your rental bike or gear. Many are available, including the Spot 3 Gen-3 Messenger Personal Tracker. Such a device allows you to be tracked, as well as call for help. Affixing a card in the local language that reads “Press here in case of emergency” next to the “help” or “SOS” button enables someone to help you when you cannot help yourself, Dr. Walters noted.

Lastly, someone who is not on the trip should know the plan for medical care and evacuation. I recommend writing out the plan, the carriers, identification numbers and contact information, as well as your expected itinerary, leaving a copy with your CONUS family or friend, and laminating a copy for your pack as well.

Remember, if you are travelling in a group, everyone should have insurance, since the only law that always travels with you on vacation is the one from Murphy.

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