for Medical Emergencies
Health Information for International Travel, 2001�2002
Please see the Destinations
section for recommendations for specific countries.
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 http://www.travel.state.gov/acs.html#medical.
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
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.
Health Organization (WHO) Blood Transfusion Guidelines for
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
travelers should be made aware that:
- 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
- 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.
the following options should be recommended in emergency
- 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
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.
- 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
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,
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
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
For more information about cholera,
and other diseases mentioned on this page, see the Diseases