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Coping With Medical Emergencies on Vacation: Preparing for a travel crisis
Date Posted: 06/Jul/2014
About to set off on a month-long family road trip, I suddenly realized I did not have a copy of my current vision prescription. My glasses were expensive, and if they wound up broken or misplaced my only extra pair were tinted to used as sunglasses. A quick trip to my optician solved the problem, but left me wondering what other — and far more serious — medical emergencies could be avoided with a little pre-travel planning.
Packing the Proper Paperwork
Just because we are nurses, that doesn’t mean we are not as vulnerable to emergencies as anyone else. Like most people, I prefer to avoid thinking about potential problems. But an ounce of prevention can prevent a truckload of disaster. After all, anything can happen on the road or in the air, from a sprained ankle to a heart attack. In a crisis, who wants to be frantically searching for phone numbers or copies of prescriptions? Carrying a first aid kit is fine, but there are other steps you can take to protect yourself.
In addition to carrying a list of any medications you may need, it’s important to have a card with your family doctor’s name and contact information, plus a brief summary of your medical history. The doctors looking after you at a facility far from home will have a much easier time diagnosing and treating you if, for instance, they know that you take a blood thinner, that you have a history of asthma or are diabetic. Many people wear wristbands or dog tags stating they are allergic to penicillin drugs or codeine, or that they have a rare blood type, a stent or an artificial heart valve. Such information should also appear on your medical history card.
International Emergency Rooms
While an ambulance may take a patient to whatever emergency room is closest or is accepting new cases, in a nonlife-threatening emergency such as a sprain or a possible fracture, it pays to ask locals to recommend a hospital if there is a choice of facilities. Travelers are usually unaware of the quality and quantity of medical facilities in a new area where they may suddenly find themselves. 
This point was dramatically brought home to me on a trip abroad. “Oh, by the way,” said the hotel clerk, “your husband was taken to the hospital.”
In an instant, a carefree holiday in Lisbon, Portugal, turned into a real-life nightmare. I had gone on an errand while he waited in the hotel lobby, and since he was in good health his sudden collapse was the last thing either of us expected. 
I spoke not a word of the language but, clutching my English-Portuguese phrase book, made my way through narrow, cobblestone alleys to the hospital — a massive, ancient stone structure where anxious, black-clad families wandered through the corridors. I tracked him down in the emergency room, where English-speaking doctors were kind and attentive. Although various blood tests, an electrocardiogram and a chest X-ray appeared to be normal, they suspected cardiac problems and kept him overnight before releasing him with two prescriptions.
“Go home,” they told us. We took their advice and got a flight back to the States the next day. My husband felt tired and occasionally short of breath, and two weeks later underwent a quadruple coronary bypass and aortic valve replacement with excellent results. But as a nurse I was dismayed by his experience in Portugal. 
The X-ray film quality was so poor the doctor could not read it. The needles used were not disposable. When I asked, they assured me they had tested for cardiac enzymes, but I couldn’t be sure. He wasn’t allowed to keep his watch, glasses or Portuguese phrase book with him overnight — quite a drawback since the nurses didn’t speak English. Then there were those inappropriate prescriptions, which I quickly discarded once I realized they were for hypertension. Not only was his blood pressure abnormally low, his pulse dropped alarmingly to 46 after taking just one of the prescribed pills.
Research Your Final Destination
For travel abroad it’s important to be prepared for health crises, rare as they are. There are resources you can tap into. The most thorough guidebooks usually list reliable medical facilities, and American embassies and consulates are a valuable source of information about local options.
Not only should you be aware of health conditions in the countries you’re visiting, but different regions within a country may also present specific health issues. In Costa Rica, for instance, malaria is endemic in certain low-lying areas, but not in the mountains.
Always carry aspirin, diarrhea medication (such as Imodium) and an antihistamine for mild allergic reactions to environmental pollutants or food. In fact, when searching for places to eat in third world countries, local restaurants where family groups are gathered are always a good bet since parents feel it’s safe enough to bring their children.
Travelers can also benefit from an awareness of cultural differences. In many less-developed parts of the world, pharmacists routinely provide primary diagnostic care and advice, and many locals turn to them before consulting physicians. Pharmacists often prescribe drugs on the spot and can administer injections, which eliminates the need for a medical appointment. They can also treat minor conditions such as respiratory infections, cuts and skin problems. They can even prescribe for recurring conditions you may recognize yourself, such as a urinary tract infection that has responded well to a specific drug in the past. Going to a pharmacy saves time, money and hassles.
Pack a Personal First Aid ˆKit
On the final day of a trip to Greece, my teenage daughter developed vomiting and diarrhea. Anxious to ensure she was well enough to travel home, I located a nearby pharmacy, where I mimed her symptoms. The druggist spoke a little English, but I felt guilty when he sold me Lomotil over the counter as casually as if it were aspirin. However, it alleviated the symptoms enough for her to make the flight home and see our family doctor. 
For travel beyond the U.S., make sure you have an adequate supply of prescription medications and keep them in their original containers. Labels should include the generic name of each drug, since the same generic drugs are manufactured and sold under different retail names in different countries. Your doctor’s contact information and a short medical history are also useful. If you don’t speak the language well, carrying a small dictionary or phrase book is vital for communication. In many parts of the world, doctors often speak at least some English and may have studied in North America or Europe for part of their medical training, while nurses and other hospital staff may not speak any English.
It is often a good idea to buy additional travel health coverage before traveling abroad. HealthCare International, HTH Worldwide, and other companies provide travel emergency insurance. You can find them on the Internet or through friends’ recommendations. Many travel health plans include air ambulance coverage to medically evacuate or “repatriate” a patient. The latter is important, especially if you are planning to visit third world countries where medical care may be limited and does not meet accepted Western standards. In addition, some high-limit credit cards include out-of-country medical expense provisions or cover transport home.
On the flip side just because hospitals are located overseas doesn’t mean they are automatically inferior to U.S. facilities. Some may even boast innovations that improve healthcare. Places like India and Thailand have become popular countries because the quality of care is excellent. And some of these hospitals are staffed almost entirely by RNs.   
Ignorance may be bliss, but it can cost you. No one wants to anticipate disaster. However, taking these simple precautions can facilitate treatment and help avoid unnecessary stress in a time of crisis. May you travel well, but travel in good health!   
About the author:
Diane Barnet, RN, is a legal nurse consultant. She has written for the Los Angeles Times, Backpacker and American Careers. Her book, What You Need to Know About Hospitals, was published by Crossing Press in 1998. 


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