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Worldworx Travel Travel Health: Medical Emergency Preparation

Prepare for Medical Emergencies
Health Information for International Travel, 2001�2002

Please see the Destinations section for recommendations for specific countries.

Illness Abroad

If Medical Care Is Needed Abroad
If an American citizen becomes seriously ill or is injured abroad, a U.S. consular officer can assist in locating appropriate medical services and informing family or friends. If necessary, a consular officer can also assist in the transfer of funds from the United States. However, the traveler should be advised that payment of hospital and other expenses is his or her personal responsibility. See the U.S. Department of State website at

Protection against potentially hazardous drugs is nonexistent in some countries, increasing the risk of adverse reactions. Travelers should be advised not to buy medications "over the counter" unless they are familiar with the products.

Before going abroad, travelers should be advised to learn what medical services their health insurance will cover overseas. If the health insurance policy provides coverage outside the United States, travelers should be advised to carry both the insurance policy identity card (as proof of insurance) and a claim form. Although some health insurance companies will pay "customary and reasonable" hospital costs abroad, very few will pay for medical evacuation to the United States. Medical evacuation can easily cost $10,000 or more, depending on the location and medical condition.

World Health Organization (WHO) Blood Transfusion Guidelines for International Travelers
There is a growing public awareness of the acquired immunodeficiency syndrome (AIDS) epidemic and a resulting concern about acquiring human immunodeficiency virus (HIV) through blood transfusion. Accurate and systematic screening of all blood donations is not yet feasible in all developing countries. Travelers planning international itineraries have requested to have their own blood or blood from their home country available to them in case of urgent need. These requests raise logistical, technical, and ethical issues that are not easy to resolve. Ultimately, the safety of blood for such travelers will depend on the quality of blood transfusion services in the host country. The strengthening of these services is of the highest priority. While efforts are being made to achieve this end, other approaches are also needed.

Basic Principles:

  • Unexpected, emergency blood transfusion is rarely required. It is needed only in situations of massive hemorrhage, such as severe trauma, gynecologic and obstetric emergency, or gastrointestinal bleeding.
  • In many cases, resuscitation can be achieved by use of colloid or crystalloid plasma expanders instead of blood.
  • Blood transfusion is not free of risk, even in the best of conditions. In most developing countries, the risk is increased by limited technical resources for screening blood donors for HIV infection and other diseases transmissible by blood.
  • The international shipment of blood for transfusion is practical only when handled by agreement between two responsible organizations, such as national blood transfusion services. This mechanism is not useful for the emergency needs of individual travelers and should not be attempted by private travelers or organizations not operating recognized blood programs.
Therefore, travelers should be made aware that:
  • There are no medical indications for travelers to take blood with them from their home countries.
  • The limited storage period of blood and the need for special equipment negate the feasibility of independent blood banking for individual travelers or small groups.
  • Blood should be transfused only when absolutely indicated. This applies even more forcefully in those countries where screening of blood for transmissible diseases is not yet widely performed.
Therefore, the following options should be recommended in emergency situations:
  • When urgent resuscitation is necessary, the use of plasma expanders rather than blood should always be considered.
  • In case of emergency need for blood, use of plasma expanders and urgent evacuation home might be the actions of choice.
  • When blood transfusion cannot be avoided, the attending physician should make every effort to ensure that the blood has been screened for transmissible diseases, including HIV.
  • International travelers should be advised to:
    • Take active steps to minimize the risk of injury, such as avoiding night driving, employing safe driving practices, and wearing safety belts whenever possible.
    • Establish a plan for dealing with medical emergencies.
    • Support the development within countries of safe and adequate blood supplies.
This information is taken from the WHO publication "World Health Organization Global Programme on AIDS: Blood Transfusion Guidelines for International Travelers." See also "Blood Transfusion", in International Travel and Health, also from WHO.

Death Overseas

Importation or Exportation of Human Remains
There are no federal restrictions on the importation of human remains unless the death was the result of one of the following communicable diseases: cholera or suspected cholera, diphtheria, infectious tuberculosis, plague, suspected smallpox, yellow fever, suspected viral hemorrhagic fevers (Lassa, Marburg, Ebola, Congo-Crimean, and others not yet isolated or named). If the death was the result of one of these diseases, the remains must be cremated or properly embalmed; placed in a hermetically sealed casket; and be accompanied by a death certificate, translated into English, that states the cause of death. The local mortician handling the remains following their importation will be subject to the regulations of the state and local health authorities for interstate and intrastate shipment.

The United States has no requirements for the exportation of human remains; however, travelers should be advised that the requirements of the country of destination must be met. Travelers should also be advised that information regarding these requirements may be obtained from the appropriate embassy or local consulate general.

The Post-Travel Period
Some diseases might not manifest themselves immediately. If travelers become ill after they return home, they should be advised to tell their physician where they have traveled.

Most travelers who acquire viral, bacterial, or parasitic infections abroad become ill within 6 weeks after returning from international travel. However, some diseases might not manifest themselves immediately; for example, malaria might not cause symptoms for as long as 6 months to a year after a traveler returns to the United States. The traveler should be advised to inform his or her physician of the countries visited within the 12 months preceding onset of illness. Knowledge of such travel and the possibility the traveler might be ill with a disease the physician rarely encounters will help the physician arrive at a correct diagnosis.
For more information about cholera, diphtheria, and other diseases mentioned on this page, see the Diseases section.

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