Meetings & Conventions A Patient in a Strange Land
A Patient in a Strange Land
Be prepared for medical emergencies overseas
By Lisa Grimaldi
Before the accident, Margaret Domber was, in her own words,
"very naive" about the possibility of medical emergencies arising
during overseas incentive programs. "You think it will never happen
to you," says the Cranford, N.J.-based senior vice president for
Summit Bank. Three years ago, during a nonemployee program in
France for people who provided the bank with business referrals, a
participant slipped and broke his hip in the hotel's spa. Although
it didn't take long to get him to a hospital via ambulance, the
ordeal was a nightmare for all concerned.
"The hospital was a good facility, but there were problems. The
most frustrating part was the language barrier most of the doctors
and hospital personnel spoke only French. Luckily, someone with my
destination management company spoke English well and could
translate. Thank God she took the weekend off to help."
Complicating the matter was the fact that the patient had other
conditions: a bad heart and allergies to a number of medications.
In the event surgery was needed, "we were afraid to have it
performed there," says Domber. Fortunately, surgery was not
necessary, and after several days in the French facility, all
parties involved decided the best course of action was to fly him
home to be cared for by his personal physician.
Then the worst news arrived: His insurance did not cover all of
his medical attention overseas, nor did it allow for repatriation,
or evacuation back to the States. Without repatriation coverage,
the cost for medical evacuation (medivac) flights from
international destinations starts at about $50,000, and payment
must be laid out up front.
Domber looked for alternatives. The airline that brought the
group to France refused to take him back. Another commercial
carrier agreed to do it, but only if Summit Bank arranged for a
physician and nurse to accompany the patient and agreed to pay for
the seats that had to be removed to create 10 feet of space to
accommodate him. "On top of that," says Domber, "we had to get a
release from the hospital, transport him by ambulance to the
airport, and an ambulance had to pick him up at the airport when he
arrived back in the United States."
The terms were accepted, and all went well, but the experience
prompted Domber to enact a new policy: She now drafts a thorough
medical emergency plan before each program. Additionally, she has
beefed up the insurance for her programs, and she strongly
recommends participants augment their personal health insurance for
travel and medical evacuation coverage.
A critical plan
Planners too often are caught unprepared for international medical
emergencies, according to Jonathan Spero, M.D.
"They take care of so many details for meetings, but they often
avoid looking at medical issues because they're intimidating," says
Spero, president of InHouse Physicians, a Naperville, Ill.-based
firm that provides medical services for meetings, mostly
international. "This should be the biggest thing for planners.
People are like that about health care in general: Ignore it until
Among the critical issues to include in a basic
medical-emergency plan are the following.Names and numbers of at least two designated responders, people
to be contacted if a problem arisesName and number of an English-speaking local physician and
pharmacyLocal emergency number (it is not 911 in every country)Name and number of preferred hospital or medical facility
Beyond this foundation, other measures can further protect
groups in the event of a medical emergency. Consider the following
advice from experienced planners of overseas programs.
Do the research
Jalene Bowersmith, meeting planner for the Washington, D.C.-based
International Policy Council on Agriculture, Food & Trade, an
agricultural think tank, researches health conditions and services
before planning her meetings in Europe, Africa, the Middle East and
Asia. She checks the Web sites for the Centers for Disease Control
and Prevention and the U.S. State Department (see "Preventive
Medicine," page 58) for health warnings, such as disease outbreaks.
Additionally, she contacts the U.S. embassy in the country under
consideration. "Between the three, I'll get a good picture of the
true health situation in that country."
The extent of the legwork depends on where the meeting is. "My
next meeting is in Zimbabwe, at Victoria Falls," says Bowersmith.
"We're not going to be near a city, so I'll have to research the
hospitals, medical evacuation options, etc., more so than I would
for, say, a meeting in Italy."
Lance Wieland, director of incentives and sales promotion for
UnumProvident, an insurance firm based in Portland, Maine, also
does his homework. As a result, his company rejects many
international meeting sites because of insufficient local emergency
procedures and facilities.
"As part of the site inspection, we look at the closest fire,
police and medical emergency facilities," he says. "For a meeting
we did in Mexico, one of the things that concerned me was that the
fire department [which serves as the official emergency response
team for the area] was not what you'd expect in the United States.
We weren't convinced that people there would be able to give the
right type of care in an emergency situation." In this instance,
Wieland decided to use the site, with the understanding that he had
to make contingency plans for medical emergencies.
Even an area with top-notch meeting facilities might be lacking
in medical facilities, Jonathan Spero points out. "There are many
places you expect to get the kind of care you get in the States but
don't," he says. "Bali is a good example& You have five-star
luxury hotels like the Ritz-Carlton and the Four Seasons, but the
ambulance service on the island is basically an unsanitary
In such situations, a planner might want to arrange an
alternative plan for emergency transportation. If the nearest
medical facilities are not up to snuff, planners can get
recommendations on alternative facilities from the U.S. Consulate,
the hotel or a DMC. Terri Ann DiJulio, meeting planner for SEI
Investments, an asset management/technology firm in Oaks, Pa., also
gets advice from the U.S.-based security firm she hires for
international programs.DON'T LEAVE HOME
It is impossible to predict whether a medical
emergency will occur during an event, but planners can take steps
to mitigate risks and prepare for the worst. Jonathan Spero, M.D.,
president of Naperville, Ill.-based InHouse Physicians, suggests
1. Check with the Centers for Disease Control (www.cdc.gov) for any shots or pills
required or suggested for visitors to the country or region.
2. Obtain a list of English-speaking physicians and pharmacies
(available from the U.S. consulate or embassy).
3. Check the coverage offered by your organization's travel
insurance. Is medical evacuation included? If attendees are not
employees, find out what type of coverage their individual plans
provide. If coverage is insufficient, planners can buy
supplementary coverage through one of many insurance companies,
such as New York International Group Inc. (212-268-8520; (www.nyig.com), that
offer such programs. Also, for about $3 per day, per attendee,
riders can be added to individuals' or groups' travel insurance to
include medical evacuation coverage.
4. Pack a simple medical kit (aspirin, bandages, rubbing alcohol,
Benadryl, etc.). "As long as they're over-the-counter drugs,
they're OK to be administered by a planner," says Spero.
5. Review government travel warnings (travel.state.gov/travel_warnings.html).
1. Have attendees complete medical questionnaires listing
allergies, chronic illnesses, medications, physician's name and
number and emergency contact.
2. Send out information sheets, including health warnings.
3. Tell attendees to carry medicines in flight, in case checked
bags are lost.
The local U.S. Embassy and/or consulate at your
meeting's destination can provide names of recommended physicians,
including English-speakers, as well as hospitals, pharmacies and
medical evacuation services. In addition, planners can line up
emergency assistance coverage before the trip from the following
International Association for Medical Assistance to
This nonprofit organization provides global health information and
lists of doctors who speak English and/or French. Individual
memberships are available in exchange for donations. 417 Center
Lewiston, N.Y. 14092
SOS provides medical assistance via its 24 global alarm centers to
both members and nonmembers; costs are substantially lower for
members. 8 Neshaminy Interplex, Suite 207
Trevose, Pa. 19053
(215) 244 1500; fax: (215) 244 2227
Worldwide Assistance Services Inc.
This is the North American subsidiary of Europe Assistance Holding
S.A., headquartered in Paris. It provides medical assistance around
the globe. Corporate memberships or event- specific coverage are
1133 15th St. N.W., Suite 400
Washington, D.C. 20005
(800) 777-8710; fax: (202) 828-5892
InHouse Physicians This group offers on-site
medical care for meetings and events. 25 W. 273 Concord Rd.
(800) 356-3627; fax: (630) 369-7657
Bring a doctor
One way to avoid subjecting injured or ill attendees to the great
unknown of foreign medical care is to hire medical professionals to
travel with the group. That's where firms like Spero's come in. "We
provide physicians, nurses, paramedics and equipment for mini
emergency rooms for programs in hard-to-access areas," Spero says.
For example, InHouse Physicians provided on-site emergency medical
facilities last month for Dr Pepper/Seven-Up's incentive program to
rural South Africa and Victoria Falls, Zimbabwe, where participants
were scheduled to do some whitewater rafting.
Although their presence might put a planner's mind at ease, the
cost of an on-site doc and a traveling emergency room is not cheap.
InHouse Physicians charges $2,000 to $3,500 per day, depending on
the location, size of group and other factors. "People hire us for
liability; corporations have a duty to provide the level of care
accessible to their people at home when they're outside the
country" on company business, says Spero.
But along with the advantages of having a doctor on hand come
limitations. Christine Woidi, the Toronto-based manager for
meetings, incentives and convention services for Nesbitt Burns
Inc., an investment services firm, says she'd rather work with
recommended local physicians, because doctors licensed to practice
in the United States or Canada (like those affiliated with InHouse
Physicians) cannot prescribe medications or admit patients to
hospitals in a foreign country. She briefly considered bringing a
doctor along for a meeting she planned in China but ended up
working with English-speaking local doctors instead.
Spero's firm also offers less costly alternatives to setting up
a medical facility on site for a meeting. InHouse Physicians is
affiliated with a network of 1,000 English-speaking doctors
overseas who can be on call, rather than on site, for the duration
of the program. The approximate cost, says Spero, is $1 per
attendee, per day.
Some planners, like UnumProvident's Wieland, prefer having an
emergency medical technician on site, rather than an M.D. "When
we're in circumstances where things get 'squishy,' we bring an EMT.
An EMT with a jump kit is better in the field than a doctor," he
contends. Also, Wieland has a pretty good idea of the types of
medical ailments his attendees, most of whom are in their 20s and
30s, will incur: cut feet, falls on buses, heat exhaustion and
sports-related injuries. These injuries, he feels, are best handled
by EMTs, who specialize in emergencies.PREVENTIVE
The following Web sites provide valuable, free
information on the health conditions of international
Centers for Disease Control and Prevention
The CDC site offers useful geographic health information, updates
on global disease outbreaks and travel precautions, including
recommended shots or pills for travelers.
U.S. State Department
Consular information sheets online list health conditions for every
country in the world. Additionally, travel warnings are issued when
the State Department decides, based on all relevant information, to
advise that Americans avoid travel to certain areas.
What are a planner's legal responsibilities
when it comes to medical emergencies? There are no hard-and-fast
rules, according to meetings industry attorney John Foster of
Atlanta-based Foster, Jensen & Gulley LLC. "It really depends
on the circumstances of the event or the site." Foster developed
the following guidelines with Naperville, Ill.-based InHouse
Planner's legal duties
1. Determine risks.
2. Warn attendees about risks.
3. Plan for the safety and well-being of every attendee (minimize
4. Avoid unreasonable risk of harm.
First responder criteria
1. Two or more responders (designated on-site medical emergency
contacts) must be available 24 hours a day.
2. Responders should be CPR- and first aid-certified.
3. First aid should be readily available, as should oxygen, in
situations where attendees might need it (including high altitudes
or during physical activities).
4. Standard response protocols should be established.
Consider supplemental coverage if
1. The meeting is outside the United States.
2. Group size is more than 1,000.
3. Potentially dangerous activities are part of the agenda.
4. Remote locations are involved.
5. A high-risk attendee group (elderly, for example) is
Waivers/agreements The following documents will
further protect planners from liability.
1. Have attendees sign waivers for risky events.
2. Get hold harmless agreements from suppliers, so the planner
and/or meeting sponsor is not held liable for negligence on the
part of supplier.
Call a specialist
Meeting planners who are concerned about the quality of local care
might choose to hire a company that will step in and handle medical
emergencies, should they occur. A number of firms, of which the
best-known is International SOS, provide such services.
According to John Knapp, vice president of marketing for
International SOS, which has headquarters in Singapore, London and
Philadelphia, the organization has 24 alarm centers around the
world, staffed by 250 physicians, that clients can call in an
emergency situation. Staff at the centers will assess the urgency
of the situation, speak with a local doctor and work out a care
plan, which could include admission to a hospital, transfer to
another facility, medical evacuation to the best and closest
facility and/or repatriation back to the United States. The
organization monitors and communicates with the patient and planner
until the patient is discharged. Planners can purchase contracts
with such an organization prior to a program. Costs, according to
Knapp, vary according to group size but are based on a fee of $50
to $70 per month, per person; costs are adjusted to the duration of
International SOS also will respond to emergency calls from
planners who are not enrolled in its plan, but Knapp says the costs
in those situations, particularly for medical evacuations, can be
prohibitively high, generally starting at $50,000.
Medical evacuation services can be found on the Web or through
the local U.S. Consulate.
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