Travel and Health News, the latest issue is out

AirMed is there not only when you need us, but where you need us.

In this issue of Travel+Health, AirMed's member newsletter:

• How does AirMed work?
• A CEO's business trip turns terrifying
• The Number One Traveler's Health Issue 
• Our members sound off, and more!
  

Follow this link to see the full AirMed News. 

Don't let jet lag spoil your trip!

Jet lag, more formally known as desynchronosis, is a temporary disorder caused by a disruption of your body’s normal circadian rhythm or internal body clock. As any international traveler can tell you, jet lag occurs after rapid travel across multiple time zones. The most common symptoms are sleep disorders and daytime fatigue, but they can also include anxiety, constipation, confusion, dehydration, headache, irritability, nausea, dizziness and memory loss.

What’s in a Zone?

The cause of jet lag is the inability of the body to immediately adapt to a different time zone. Your body has an internal 24-hour clock located in the hypothalamus of the brain which is triggered by environmental factors, the most important of which is light.

When the hypothalamus senses light, it stops the production of melatonin. This allows your body to “wake up” and begin its normal daily functions. When the hypothalamus senses an absence of light, it signals for the production of melatonin which helps put the body to sleep. Therefore, when an air traveler leap frogs through time zones, and thus perceives dawn and dusk with several hours difference from what a biological clock is expecting, the hypothalamus triggers activities for which the rest of the body is not prepared.

Go West!

Travelers flying east typically experience more severe symptoms, because they “lose” time. For example, if your body believes it is 1 a.m. (New York time) but your brain is sensing the 7 a.m. bright morning sunlight in Paris (you lucky dog), you will still be very sleepy due to your preprogrammed sleep cycle. We cannot immediately adapt to the new time zone, but gradually the internal clock will acclimate–usually at the rate of 1 time zone per day.

Travelers flying west have a little easier time because it is easier to extend your waking cycle (when you “gain” time) than it is to shorten a waking cycle. Adaptation usually occurs at a rate of 1.5 time zones per day.

Early to Bed

To help prevent jet lag, you can start adapting your body prior to your trip by gradually moving your bedtime and/ or wake time towards your destination’s time zone. Stay well hydrated during your travel, and avoid caffeine and alcohol, which not only promote dehydration but also disrupt sleep cycles.

Once you board your flight, change your watch to your destination’s time zone. Try to sleep on the plane at times that are appropriate at the destination. Between naps, get up and move about the aircraft, stretch your legs and find some way to engage your brain (puzzles, books, conversations). If you are on a flight that will cross more than 8 times zones, consider scheduling your flight in such a way that you can take a 1-2 day layover halfway.

Why not just take a pill?

Medications may help, but should be used only after you have consulted your physician. Mild sedatives (benzodiapines, like Valium or Ativan) may help you get to sleep and adjust to the new time zones, however, using these medications on the flight itself will increase your risk of developing blood clots in the legs. Use of these medications may also cause morning-time “fuzziness” and even memory loss. Ambien, a well-known sleep aid, has the same potential side effects, but can also cause bizarre behavior and sleep walking, which could be an issue if you are staying in an unfamiliar place.

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Dr. Beth Phillips, MD, is the Director of Medical Operations at AirMed International

Winter Driving Tips, Surviving Jet Lag, the Smallest Heart Patient and More

The latest AirMed Travel + Health News is full of great information for all of your travel and health needs this holiday season.  Jet lag? No problem. We've got ways to combat it.  Read all about one of our smallest and most miraculous patients and so much more. 

Click this link to read all the AirMed News and even get a discount code to Give the Gift of AirMed to the travelers in your life!

Visit us anytime at airmed.com to find our more about our life-saving air medical memberships with great benefits such as Second Opinion Referrals, 24/7 Medical Services Hotline and more.

Travel, Health, AirMed's Latest Newsletter

In this issue of AirMed News, we spotlight some of the best travel apps for smart phones to help your travel worries be few and far between. Also, one of AirMed's own staff recalls the reason she supports organ donation in a heartbreaking and uplifting story. 

Check out the member questions, a professional racecar driver's AirMed transport story, and so much more.

Travel Health News from AirMed - 2013

Respiratory Illness striking some in the Middle East

More information about Middle East Respiratory Syndrome (MERS)

July, 2013 --  MERS is the term for a new severe respiratory illness very similar to SARS. This disease was first reported in 2012 in Saudi Arabia and has been confirmed to be caused by a new species of coronavirus . 

The virus itself has evolved from a species that is known primarily in bats. Since most patients with confirmed MERS have not had close contact with bats, it is thought that transmission is through an as-yet unknown vector (i.e. mosquitoes).

There are only very few cases where disease has been attributed to human-to-human transmission. For this reason, this new coronavirus is NOT considered a “human coronavirus”, and should not be referred to as such. The World Health Organization and the Saudi Ministry of Health have agreed upon the term “MERS-CoV” to refer to this new virus, and this is how it will be referred to by the CDC and other health agencies around the world.

MERS presents as a nonspecific but severe respiratory illness. A patient should be considered highly suspicious for MERS if they meet the following criteria:

• Acute onset of respiratory infection with fever (38C/100.4F) and cough

          AND

• Suspected pulmonary parenchymal disease (i.e. pneumonia, ARDS) with consolidation on chest xray

          AND

• History of travel from the Arabian Peninsula within the last 14 days

If any other source of fever is identified (UTI, other known community-acquired pneumonia, wound infection, etc…), the concern for MERS is significantly lessened.

Arabian Peninsula Most at Risk at This Time

Almost all cases of MERS have been in patients who are from or have recently traveled from or live in the Arabian Peninsula (Saudi Arabia, Jordan, the UAE, Qatar). The few cases diagnosed outside of this area (specifically in the UK) were in patients who had either recently travelled from the Arabian Peninsula or in prolonged close contact with someone who met this criteria. No cases have been identified in the U.S.

At this time, no agency (CDC, WHO, etc.) has recommended restricted travel for individuals or denying entry to ill passengers. However, personal protection to prevent viral transmission is recommended for all travelers.

The usual handwashing and droplet prevention (i.e. covering mouth and nose when sneezing or coughing) is important. Also, individuals who are already ill should postpone travel plans. 
http://www.cdc.gov/coronavirus/mers/index.html.

--Dr. Beth Phillips, MD
AirMed Director of Medical Operations

Security Scenarios, Sunscreen, Summer News from AirMed!

Important health, travel, air medical safety and other information from the leading air ambulance team.

AirMed Summer News is in!  Read all about it! Topics include:  

Skin cancer is the most common type of cancer in the United States with more than 3.5 million skin cancers in over 2 million people diagnosed annually. One in five Americans will develop skin cancer in their lifetime.

Security Assessments: How AirMed helps members caught in an unsafe situation, where civil unrest is occurring in or near the city they have traveled.

Hurricane Evacuation:  What you and your family need to know.

Staff interviews, medical team training and more.

For more information on how to save your life and become an AirMed member, visit airmed.com.

Important tips for those traveling with heart disease

Prepare Before Traveling Internationally

AirMed Members Ask Important Health Questions

My husband and I are planning a wonderful safari in Botswana. We are both so excited to fulfill this life-long dream! However, I have some concerns because I have recently undergone a cardiac cath and had stents placed in two arteries. I’ve done well and feel so much better since surgery, but I am afraid that if I have a problem while we are so far away I’ll be unable to get to the medical care I need. Do you have any suggestions?

Excellent choice of adventure vacation! I certainly understand your concern regarding access to quality medical care when traveling to such a remote location. My first suggestion would be that you discuss these plans with your physician at least three months prior to your planned departure. Make sure that he or she understands certain details of your trip, particularly the level of difficulty and exertion. 

Your physician can then best advise you individually on whether your exercise tolerance will allow you to safely participate in this adventure. Of course, you will also need to ensure that you are taking all of your medications as prescribed, and that you have an adequate supply of your medications for the duration of your excursion. Also, as I have mentioned in previous columns, keep your medications in your carry-on luggage – NEVER in your checked bags!

I believe, though, that you are asking more about what to do in case you experience chest pain or other symptoms indicative of a “heart attack” while in a remote area. If you experience these symptoms and you are a long way from medical care, chew an aspirin immediately (even if you already take one per day). In addition, use nitroglycerin tablets as directed. 

Since you have a cardiac history, I expect that your physician has given you a prescription for these, even if you rarely or never use them. Ensure that you take these with you, and that they are not expired. You still may be hours, if not days, away from reaching a medical facility, so I would suggest that you begin that process at the first sign of trouble and not wait to see if you “feel better.” Any additional delay could mean significant damage to your heart muscle, and could put your life at risk.

Contact AirMed prior to your trip. We can look at your travel itinerary and identify recommended hospitals and clinics in the areas you will be visiting. We can also ensure that you have all the contacts you might need with the embassy or consulate, legal assistance, and ambulance services. During your travels, if you experience any medical issues, you can contact us and we will assist you through the process of getting to definitive medical care, as well as begin the process of planning your air ambulance return home if that is required.

All of these suggestions hold true whether you are traveling in exotic locals such as Okavango Delta in Botswana or a business trip three states away from your hometown. We are here to help you plan safe and healthy travel just as much as we are here for your medical transport needs!

--Dr. Beth Phillips, MD, FACEP, FAWM, is AirMed's Director of Medical Operations and a regular contributor to this blog

Capillary Leak Syndrome, a Serious Blood Disorder

Advice From the AirMed Doctor on Blood Disorders

An AirMed member recently wrote to us and shared that he has a rare bleeding disorder called Capillary Leak Syndrome. He asked what to do if he has an episode while travelling. Specifically, he asked whether he would do better to seek local hospital care or request a transport home to his treating physician if he should find himself hospitalized while away from home.

-----------------------------------------------

To address the question about remaining for local care vs. a medical transport home to your treating physician. Well, the answer is “That depends!” If you happen to be in the United States/Canada (or countries with similar standards) with access to a community or academic hospital large enough to have the critical care capability, medications and blood products you need for appropriate treatment, I would recommend staying put until you are stabilized. The admitting physician will usually be happy to consult your treating physician at home, so that your doctor can provide insight into your specific case. After this treatment you may be treated and released, either to carry on with your travel or to return home via your originally planned means.

More importantly, LISTEN to your doctor! If he/ she expresses any concerns about your plans, then perhaps you should re-evaluate those plans. You should carry a letter from your physician, describing your medical condition (s) and any prescription medications, including the generic names of prescribed drugs. You should also check with the foreign embassy of each country through you are intending to travel to ensure that none of your medications are specifically banned or limited (http://travel.state.gov/travel).

For ALL prescriptions medications you will travel with, you should have a printed list with YOUR name, the name of the prescribing physician, the medication, dose, and quantity. Your pharmacy may be able to print this for you, or make one at home at a computer – do not use a handwritten list! Each medication should be transported in its’ pharmacy bottle with an accurate label.

TRAVELING WITH BLEEDING DISORDERS

Patients with bleeding disorders (i.e. hemophilia, systemic capillary leak syndrome, vonWillebrand’s disease, etc…) may need to travel with blood products. These may include red blood cells, platelets, or–more typically–plasma products such as Factor VIII, Factor IX, or IVIG (immunoglobulin). Blood products and other medically necessary fluids are an exception to the TSA 3-3-1 rule, but are still subject to inspection.

If your blood product requires temperature control or to remain frozen, you will need to invest in a carry-on means of transporting your product. Your physician and the blood bank he/she utilizes should be able to help with that.

Obviously, even if you travel to a remote area with all of the required medications and blood products you might need to start therapy should you have an episode while away, you cannot administer them yourself! Prior to your trip, you may research your intended destination at www.travel.state.gov for information regarding recommended hospitals and clinics.

As an AirMed member, you also have the advantage of just calling us! We have the State Department information as well as additional resources to best advise you on facilities and points of contact should you need help while away from home, both foreign and domestic.

Knowing all of this, patients may travel with a better sense of security should they have a crisis while away from home.

For more information on how to save your life, visit airmed.com. 


--Dr. Beth Phillips, MD, FACEP, FAWM, is AirMed's Director of Medical Operations and a regular contributor to this blog



Resources:

http://travel.state.gov 
http://www.state.gov/s/cpr/rls/dpl/32122.htm
http://travel.state.gov/travel/tips/tips_1232.html
http://travel.state.gov/travel/tips/tips_1232.html#medications
http://www.cdc.gov
http://www.miusa.org/ncde/tipsheets/medications
http://www.tsa.gov/traveler-information/medically-necessary-liquids
http://www.hemaware.org/story/traveling-medication

Serious Heat Related Illnesses, What You Should Know

AirMed Advises About Heat Stroke and Related Illness

Heat-related illnesses are a spectrum of disorders ranging from relatively benign heat cramps to potentially lethal heat stroke.  These are due to environmental heat exposure, when the body’s ability to cool itself through its usual mechanisms (i.e. sweating, radiation) is overwhelmed.

HEAT CRAMPS, EXHAUSTION

Heat cramps are very painful muscle cramps, usually in the legs, that occur during exercise.  These are usually resolved with rest, cooling off, and replacing fluids and electrolytes.  Heat exhaustion is a bit more severe, and may be considered a precursor to heatstroke.  Symptoms include heavy sweating, rapid breathing and a fast, weak pulse.  In this case, the victim should be moved to a cool area (indoors, or at least in the shade) and clothing removed to promote heat loss (passive cooling).

Active cooling methods such as a fan and cold compresses to the torso, had, neck and groin will help significantly.  Again, fluids and electrolytes should be given.  Water alone may suffice in mild cases (heat cramps), but sports beverages such as Gatorade G2 or Pedialyte are preferred for more significant heat injuries.  Thirst is NOT a reliable indicator for the need for rehydration.

HEAT STROKE

Heat stroke is a medical emergency, and if untreated can lead to significant neurological damage or death.  This occurs when the body’s ability to regulate core temperature has been completely compromised, and body temperatures may exceed 40.6 °C (105.1 °F).  One of the hallmark signs of heat stroke is a change in mental status, such as confusion, slurred speech, or unconsciousness. 

Do NOT rely on the “lack of sweating” sign – that is not always true!  If someone is demonstrating signs of heat stroke, do not give them anything to eat or drink (they may aspirate these if they are semi-conscious), but do start other cooling measures while you are otherwise calling EMS or seeking medical care.

BEST TREATMENT

The best treatment for heat related illnesses is to prevent them from happening.  During the warmer months, reduce your risk by observing precautions to avoid overheating and dehydration. Light, loose-fitting clothing will allow perspiration to evaporate and cool the body. Wide-brimmed hats in light colors keep the sun from warming the head and neck and block the powerful radiation from hurting the eyes; vents on a hat will allow perspiration to cool the head.

Strenuous exercise should be avoided during daylight hours in hot weather, as well as remaining in enclosed spaces without cooling or ventilation.  When the outside temperature is 70 degrees Fahrenheit (21.1°C), the temperature inside the car can exceed 120 degrees (48.8°C), even when the windows are partially open.  NEVER leave children, elderly or disabled adults, or pets alone in a vehicle!

Medications and substances that inhibit cooling and cause dehydration such as alcohol, caffeine, stimulants, anti-cholinergics (i.e. for Parkinson’s disease) predispose individuals to heat related injury and illness.  Individuals at the extremes of age (younger than 5, older than 65) are also at risk.  

--Dr. Beth Phillips, MD, FACEP, FAWM, is AirMed's Director of Medical Operations and a regular contributor to this blog

http://www.awls.org/index.php

Tintinalli, Judith (2004). Emergency Medicine: A Comprehensive Study Guide (6th ed.). McGraw-Hill Professional. p. 1186. ISBN 0-07-138875-3.

http://www.nlm.nih.gov/medlineplus/heatillness.html

Extreme Heat Guide, Centers for Disease Control and Prevention (CDC)

For other ways to help save your life check out AirMed.com

Read the latest travel, health and medical transport information from AirMed

Get the Latest Information About Travel Health Insurance From AirMed's Newsletter

In the latest issue of AirMed News, we spotlight Emory University's important research work in Africa. Emory is one of the many university programs who use AirMed memberships to protect its students.  

Also featured:

• An in-depth look at cardiac and heart related matters;
• Travel destination: San Antonio, an ideal family vacation spot;
• Members share their AirMed stories;
• Meet the Staff, our new blog, and more!

For more information visit AirMed.com

What do you do when a loved one dies while away from home?

Transporting Deceased Loved Ones

An AirMed member wrote to us recently with the following story, "Two years ago, my uncle died unexpectedly while we were on a family vacation in Orlando. No one in my family had the first clue about transporting him back home to Illinois. Can you tell me more about AirMed’s benefit of transporting mortal remains?"

Transporting a loved one who has died while away from home is truly one of the most daunting situations any of us could ever entertain in theory, let alone face in actuality. The questions and details seem endless amidst the grief process itself. That’s why all of us at AirMed know the importance of being there for our member and for everyone else involved during such an extremely emotional time. 

We offer the deceased transport as a member benefit for just that reason.  When a loved one dies, the deceased must be taken to a licensed funeral home or mortuary before being transported elsewhere. AirMed’s medical coordination staff is available by phone 24/7 to give you complete assistance with any part of this process, from whatever city you may be in.

As an AirMed member, we will manage all efforts for you, between ground transportation, funeral homes in different geographic locations, and any other arrangements that must be made, and we will keep your family informed during the entire deceased transport process. AirMed has transported mortal remains on our own aircraft but also on commercial aircraft, depending on individual family needs, but you can always rest assured that we will coordinate every detail to bring them to their final resting place.

A repatriation situation—when someone dies in another country—is handled a little differently depending on the laws governing the city and country where the death occurred. The term repatriation literally means ‘to send someone back to the country that is their own.’ In this circumstance, AirMed would arrange the same ground transportation and other details from a domestic transfer, but would also obtain the necessary documentation for the deceased to cross international boundaries.

We extend our sympathies to you and your family on the loss of your uncle. Thank you for taking the time to inquire about this important and too often overlooked benefit of being an AirMed member.

Dennis Scott, MD
Medical Director, AirMed International 

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AirMed is the premier global air ambulance and medical solutions company that protects your greatest asset: your health. Within the U.S. or internationally, an AirMed membership includes air medical transport to the hospital of your choice with no co-pays or out of pocket costs. AirMed also includes a host of other benefits ranging from transport to a domestic facility that specializes in life-saving treatment, referrals to leading medical consultants, international prescription assistance and more. For more information, visit airmed.com