How to Manage a Medical Emergency Abroad
March 5, 2021
This post is republished here with the permission of our colleagues from Global Rescue LLC.
You’re currently working in Africa, with plans to travel home at the end of the month. You don’t have any coronavirus symptoms, but you need a negative test for travel. How do you find a healthcare facility offering COVID-19 test?
You’re traveling on business in a developing country. Crossing the street in front of your hotel shouldn’t be tricky, but motorbikes and compact cars sometimes turn two busy lanes of traffic into four—and you accidently step off the curb at the wrong moment.
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You’re climbing in Malaysia. There’s smoke from the annual forest fires blowing over Indonesia, creating a thick haze. You’ve got a scarf to cover your nose and mouth, but the higher you climb the harder it is to breathe.
According to Consumer Reports, 15% of travelers encounter a medical problem on their journey. What will your experience be as a traveler, injured or ill, seeking care at a foreign hospital? It’s hard to predict.
“Hospital layouts differ. The medication might not look the same. Some hospitals use IVs with glass bottles instead of plastic bags. Triage may be done differently than it is in the United States,” said Jeff Weinstein, medical operations supervisor at Global Rescue.
These three medical scenarios are unique and each country’s healthcare offerings vary, too, including the facilities available for coronavirus testing. Based on the examples above, let’s take a closer look at how each situation could develop and how you can be prepared.
In the United States, you can find a coronavirus testing facility online or by calling your state’s health department.
It’s not as simple if you’re located in Africa. Africa does not make testing kits locally, and is frequently outbid by richer nations. With a limited number of testing facilities in South Africa, finding a place to get a COVID-19 test and results in the time window needed for travel might not be an easy task.
It takes you a few hours, and who knows how many MBs of data on your cell phone plan, to find two hospitals in your area: Centre Hospitalier International, a private hospital near the Tunis-Carthage International Airport, and Institut Pasteur De Tunis, a public health center even closer to the airport.
The public health center has the information you need right on the home page. You make an appointment for a PCR-RT COVID-19 test by filling out the online reservation form. The results will be available online in 48 hours.
A passing vehicle bumps you on the left hip, but you don’t think anything is broken. You are advised by the hotel staff not to call an ambulance.
Emergency medicine is new in this developing country and drivers ignore the ambulance sirens as they jockey for position on the road. In fact, drivers ignore most traffic signs and signals, resulting in 6% of the global traffic-related deaths.
Your co-worker takes you to the casualty department—the emergency room—at a public hospital. The hospital is crowded; there’s one doctor for every 1,700 people compared to three for every 1,000 Americans. Many residents are living below the poverty line and, with Universal Healthcare provided by the government, care at hospitals is free.
Medical treatment, however, is not provided free of charge to visitors. You pay for your visit up front. The hospital also asks to see your passport.
Because your injury isn’t a major trauma (you were able to walk in), you wait your turn in a plastic bucket seat to see the doctor. It’s a resident who is not trained in emergency medicine, but he speaks English and the hospital has an X-ray machine. Nothing is broken, but you’ll be sporting some bruises over the next few days.
Mountain Mishap in Malaysia
Malaysia is known for its high-quality healthcare and most cities have well-equipped medical facilities. Many Malaysian doctors were trained in the United Kingdom, United States or Australia, so they speak English and are familiar with Western standards of care.
Your guide brings you to the nearest public hospital, KL General Hospital. You register, take a number and wait your turn. Your breathing is a bit easier at lower altitude, but the doctor refers you to a specialist in respiratory medicine.
The smog caused “sunburn of the lung”—the lining of your lungs is irritated and inflamed—and the doctor wants to keep you under observation for a few days to make sure your lung function hasn’t been permanently reduced.
Your health insurance, Cigna Global Health, is accepted in Malaysia. You also have traveler’s insurance, which provides a guarantee of payment. You bring both ID cards to the admission counter and request space in a first-class ward.
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It would take a substantial amount of space and time to outline the various healthcare options—and coronavirus screening and testing availabilities—in every country.
Fortunately, Global Rescue medical operations and security personnel have experience with a foreign doctor’s office, clinic, emergency room, public hospital or private hospital.
“Our extensive networks of assets, our extraordinarily experienced and professional team and our systems protocols guarantee the best-in-class service that we provide,” said Dr. Claudia Zegans, a medical director for Global Rescue. “Our professional, extensive, 15-year experience informs every case,” she said.
While each experience may start with a different illness or injury, there are common strategies to make a visit to a foreign hospital much easier and help you navigate a medical emergency abroad.
1. Check Your Insurance. Most health insurances provide partial coverage or no coverage when you are traveling overseas. Call your carrier directly to get specific policy details for hospital bills, lab and imaging fees and pharmacy costs, for example.
If there’s a gap, you might want to consider travel health insurance. Every policy is different, so read the fine print carefully to see if it will pick up costs where traditional healthcare coverage stops, covering some, or all, of the expense of an unexpected event, accident or medical emergency abroad.
You’ll also want to ask if coronavirus is included in the insurance’s definition of “sickness” and covered as part of benefits of the accident and sickness medical expense. Testing is supposed to be free, but asking in advance doesn’t hurt.
2. Check Yourself. Are you in fine physical shape and able to weather a head cold for a few days? Or are you the type to catch any germ that comes along and hang on to it for a few weeks? Checking in with a healthcare provider before any travel will be key to your decision-making process if you end up with an illness away from home.
It is why Global Rescue recommends a pre-travel health consultation—dedicated time with a travel healthcare provider so a traveler can discuss the health concerns that might arise during a trip and steps to decrease the risk.
“Certain health conditions and medications can increase your health risks of travel and these risks will vary by destination, activities and mode of travel,” said Zegans.
Smart travelers know their limits and their capabilities. It’s not easy to be realistic sometimes, but self-evaluation combined with a pre-travel health consultation will make your travel safer—and healthier.
If you’re still unsure, Global Rescue TotalCareSM memberships provide access to doctors 24/7, available through the My Global Rescue app, on the phone or on the web.
3. Have a List of Meds. For the most part, travelers can journey across most of the globe with prescription medications. If you’ve had a pre-travel consult with your healthcare provider, you know what medication is restricted, you’ve been prescribed the allowed alternative and you have a copy of the original prescription. Check out our blog on precautions for traveling with medication for more advice.
To help you manage your medications, Global Rescue’s Weinstein suggests writing a list, laminating it and adding it to your wallet. The list should contain the following information:
- Medical diagnoses
- Medications you take
- Drug names including the generic chemical name (You might be taking brand-name Zestril to treat your high blood pressure and may not know that Lisinopril is the generic form).
- Allergies to food or medications
“Bring plenty of medication with you. If you need to get a prescription filled abroad, the pharmacy might not have the same one you take in America,” Weinstein said. “And if you get a new script, the dosage or the ingredients could be different.”
That’s where a list of food allergies is helpful. In addition to active ingredients, medications may also contain bindings, coatings and fillers, which could include potential allergens like gluten, lactose and peanut oil. By looking at your list, a pharmacist would know if a compounded medication was necessary, Weinstein said.
4. Be Prepared to Pay. If you are traveling overseas, you should be prepared to pay up front for medical care. Most insurance providers don’t have global billing and payment relationships with doctors and hospitals.
The healthcare system in your destination may offer “Universal Health Coverage” but it doesn’t always apply to visitors and tourists. Doctors and hospitals might assist with minor needs, but they are under no obligation to do so.
So have cash or a credit card handy. And make sure you get a copy of the bill—along with your medical records and reports—so you can file a claim when you return home.
5. Know Where to Go. Backpacking throughout Europe and think you sprained your ankle? Should your first stop be a pharmacy or a health clinic?
It’s usually the last stop in the United States, but the pharmacy is your first stop in Europe.
European pharmacists can diagnose and prescribe remedies for minor ailments, such as sore throats, fevers, stomach issues, sinus problems, insomnia, blisters, rashes or muscle pain. Most cities have at least a few 24-hour pharmacies.
Topical remedies are common in Europe and the pharmacist prescribes a cream to apply to your aching, swollen ankle. You pay out of pocket for your ointment.
If there is a problem beyond the pharmacist’s expertise, they will recommend a local doctor.
At the health clinic or doctor’s office in Europe, you’ll be treated just as you would in the United States: sign in with the receptionist, answer a few questions, pay the fee up front and wait for the nurse or doctor.
Each country will have its own variations. In France, you pay the doctor in their office at the end of your visit.
Global Rescue’s medical advisory service can direct you to the best local medical resources around the world so you are not left guessing about how to best address your health concern.
6. Public or Private Hospital. What should you choose when you have a medical emergency abroad: a public or a private hospital?
Sometimes, you won’t have a choice. The ambulance will bring you to the nearest hospital, period. That’s the way it is in Canada. But once you get triaged into the system and the facility doesn’t have, for example, the cardiac care services you need, then the hospital will arrange ongoing transport to another facility with the correct specialists.
This is when a Global Rescue membership could help get you to the best location for care.
To ensure our members receive the highest quality medical care when they travel, Global Rescue constantly researches the capabilities of hospitals across the globe.
“Global Rescue has a list of criteria for vetting a hospital’s capabilities to be considered a Center of Excellence,” Weinstein said. “We call or visit a hospital, with a translator if needed, to make sure the facility aligns with a U.S. Level 1 hospital—24-hour ED, trauma and surgical services—and Joint Commission International (JCI) accreditation. We want to get you to the right hospital, not the closest.”
Global Rescue will also help members find testing facilities and coronavirus-capable hospitals.
7. Should I Call the Ambulance? It’s a no-brainer in the United States. For any traumatic injury or emergency health crisis, call local emergency services.
But who do you call when you are traveling abroad? The Department of State provides an alphabetized list of emergency numbers around the world. In Taiwan, you’d call 119 for the ambulance. In Malaysia, the number is 999.
No one wants to plan for accidents, but it’s a good idea to include emergency services research in your itinerary planning. Program the number into your cell phone, just in case.
In some parts of the world, calling a taxi might be a better idea. A travel tour agency in Vietnam advises “ambulances are not equipped with sophisticated technology and seriously ill visitors are recommended to take a taxi to the nearest facility rather than wait for an ambulance.”
“Some countries don’t have a standardized ambulance service,” said Weinstein. “Going on your own might be the better option. Or you could call the hospital and ask them to send a private ambulance.”
Members can always contact Global Rescue when in need of transport. Global Rescue critical care paramedics and nurses are able to determine the severity of the injury (how bad is your current state and how quickly will it worsen?), assess local emergency services information and determine the best access for you, Weinstein said.
8. Know Some Key Words. In developed countries, the staff most likely speaks English or there’s a formal interpreter on duty.
In developing countries, you’re likely to be less lucky.
“A private hospital or a larger public hospital most likely has an international patient’s department with translators,” Weinstein said. “But a government-run hospital probably won’t. You may have to ask them if someone speaks English or if there is a translator available.”
This is when a little bit of research goes a long way. For example, if you have a pre-existing condition, research translations before your trip. Knowing how to say “high blood pressure” or “chronic obstructive pulmonary disease (COPD)” in the native language will help guide your care in the right direction.
Download a translation app to your phone. iTranslate has phrasebooks with predefined useful phrases. Google Translate allows you to translate 103 languages by typing and TripLingo offers an information pack tailored to your destination (for example, Spanish for a trip to Barcelona). All have offline capabilities or pro versions for an additional fee.
Global Rescue members can also call 24/7/365 for translation help. Retired registered nurse Linda Quinn relied on Global Rescue’s expertise to find a bilingual healthcare provider for her injury during a month-long family vacation overseas.
9. Be Aware of Cultural Differences. In China, people make eye contact when they are angry. In South Korea, eye contact is appropriate when speaking to younger people or people of a low social status. In the United States, eye contact is extremely important in many circumstances, as are breaks so the conversation doesn’t seem too intense. In Greece, breaking eye contact during communication can create unease and distrust.
Eye contact is just one example of a cultural difference. All are appropriate, as each learned behavior is based on the traditions of a person’s geographical location.
What might get confusing is that there are many more cultural differences at play when you are traveling—and seeking healthcare—in a foreign country.
You won’t be able to plan for every scenario before traveling but knowing the basics will help you navigate your care.
10. Local Remedies. A Chinese doctor may ask to look at your tongue and take your pulse. The tongue is the start of the digestive tract and reflects the state of the gut. Pulse indicates overall health and strength of energy. This is part of Chinese medicine, a system of healthcare based on ancient philosophy, thousands of years of clinical practice and treatments to restore the body’s balance.
You probably won’t be running into either of these situations if you break a bone in a city center in China. The care is consistent with Western medical standards—putting the bone back in place and placing the cast, splint or brace on the affected area.
But in more remote locations, there may be less access to Western technology and more Chinese medicine. Depending on your health emergency, you might be asked some questions common for doctors in their country but not-so-typical for you.
Know Before You Go
Here is a list to keep in your desk drawer or on your computer—someplace handy—when you start to research your next travel adventure:
- Call insurance for international travel policy details
- Schedule a pre-travel health consultation
- Write a list of your medications
- Be prepared to pay up front
- Research the healthcare system and coronavirus testing facility in your destination
- Recognize the difference between public and private healthcare
- Understand when to call the ambulance or take a taxi
- Plan for a language barrier
- Be aware of cultural differences
- Realize technology and treatment might be different
No time for research? Global Rescue services can take care of many of the items listed above. A Global Rescue membership is like having your own resource, ready to offer advice or assistance during trip planning or if you find yourself in medical crisis while abroad.
Members are always able to access up-to-date travel data compiled by Global Rescue’s intelligence and security teams. From daily event reports, monthly destination reports, free coronavirus travel updates and specific information requests, a Global Rescue membership is a perfect way to travel prepared. Click here to learn more.
The above information does not constitute advice. Always contact your employee benefits broker or trusted adviser for insurance-related questions.