Global Travel Preparation

Global Travel PreparationGlobal Travel Preparation

Debra Heitmann, MDDebra Heitmann, MD

Department of Emergency MedicineDepartment of Emergency Medicine

Phillip Fournier, MDPhillip Fournier, MD

Student Health ServicesStudent Health Services

Daniel Frank, MSV (soon MD)Daniel Frank, MSV (soon MD)

April 10, 2014


Main Goal: keep you safe and healthy Main Goal: keep you safe and healthy while having a fun, informative and while having a fun, informative and valuable travel experience!!valuable travel experience!!

►provide information in preparation for provide information in preparation for travel as a medical student involving travel as a medical student involving medical, environmental, safety and medical, environmental, safety and situational awarenesssituational awareness

►Build on prior attended events and Build on prior attended events and personal experiencespersonal experiences

April 10, 2014

ResourcesResourcesUMMS International Medical Education ProgramUMMS International Medical Education Program

http://www.umassmed.edu/ome/IntlMedEd.aspx

CoDtrs: Dr. Michael Chin and Dr. Ann Moormann CoDtrs: Dr. Michael Chin and Dr. Ann Moormann

UMass Office of Global HealthUMass Office of Global Healthhttp://umassmed.edu/globalhealth/travelpreparation.aspx POLICY AND REQUIREMENTS FOR INT’L TRAVEL TRAVEL REGISTRATION FORM

UMMS Student Health ServicesUMMS Student Health Services

http://www.umassmed.edu/studenthealth/index.asphttp://www.umassmed.edu/studenthealth/index.aspxx

April 10, 2014

►Who the heck are we??Who the heck are we??

April 10, 2014


OSHA guidelines OSHA guidelines

Water Water

PPEPPE

GlovesGloves

Disinfectant usage Disinfectant usage

Needle stick precautions Needle stick precautions

Mask N95Mask N95

Animal bites/ insect bitesAnimal bites/ insect bites

AntibioticsAntibiotics

Personal safetyPersonal safety

Situational awarenessSituational awareness

Cultural sensitivityCultural sensitivity

Contingency Travel Contingency Travel plans/emergency plans/emergency planning planning

Security of personal Security of personal valuablesvaluables

Register with US embassyRegister with US embassy

Passport copiesPassport copies

April 10, 2014

Global Travel Preparation- Global Travel Preparation- OSHAOSHA

►Clinical Care of patientsClinical Care of patients►Your primary role is to observeYour primary role is to observe►You should be not be expected to You should be not be expected to

exceed your skills setexceed your skills set► If asked to perform beyond your If asked to perform beyond your

comfort or your skill set, simply clarify comfort or your skill set, simply clarify that the school has limited your scope that the school has limited your scope of practice and you are not comfortable of practice and you are not comfortable with that duty.with that duty.

April 10, 2014


►WaterWater

assume all tap water is nonpotableassume all tap water is nonpotable

no icecubesno icecubes

uncap your own bottles and cansuncap your own bottles and cans

consider purification filters, UV lightsconsider purification filters, UV lights

tablets(chlorine dioxide + Vit C)tablets(chlorine dioxide + Vit C)

skin all fruitskin all fruit►Disinfectant usageDisinfectant usage

antibacterial soap/wipesantibacterial soap/wipesApril 10, 2014

Global Travel Preparation- Global Travel Preparation- OSHAOSHA Student Health Services +/- Travel ClinicStudent Health Services +/- Travel Clinic

medical screeningmedical screening review of standard universal precautionsreview of standard universal precautions vaccinations (leave lots of advance vaccinations (leave lots of advance

time)time) infectious risks based on travelinfectious risks based on travel antibiotics antibiotics prescriptionsprescriptions emergency contact infoemergency contact info

April 10, 2014

ImmunizationsImmunizations► Yellow fever-Yellow fever- needed minimum10 days priors to travel needed minimum10 days priors to travel

and good for 10 years. Received in travel clinic only. and good for 10 years. Received in travel clinic only. Check CDC.gov for indicationsCheck CDC.gov for indications

► Hepatitis A-Hepatitis A- needed minimum 10 days prior to travel, 2 needed minimum 10 days prior to travel, 2 shot series 6 months apart. SHS or travel clinic.shot series 6 months apart. SHS or travel clinic.

► Typhoid- Typhoid- PO is 4 doses Q48 hrs good for 5 yearsPO is 4 doses Q48 hrs good for 5 years

IM is 1 dose good for 2 years IM is 1 dose good for 2 years

SHS or travel clinic.SHS or travel clinic.► Rabies- Rabies- 3 shots at 0, 7, 21 or 28 days. High risk areas.3 shots at 0, 7, 21 or 28 days. High risk areas.

SHS or travel clinic.SHS or travel clinic.► D-tap- D-tap- tetanus every 10 years, pertussis one time tetanus every 10 years, pertussis one time

booster. booster. SHS or travel clinic.SHS or travel clinic.► IPV (polio)- IPV (polio)- Check CDC.gov for booster indicationsCheck CDC.gov for booster indications► Bring copy of your vaccinations with you on your Bring copy of your vaccinations with you on your

triptrip April 10, 2014

MalariaMalaria► Chloroquine- Chloroquine- 500mg once a week starting 500mg once a week starting

1-2 weeks prior to travel once a week during 1-2 weeks prior to travel once a week during travel and continue 4 weeks upon return. travel and continue 4 weeks upon return. Check CDC.gov for resistant areas.Check CDC.gov for resistant areas.

► Larium (mefloquin)-Larium (mefloquin)- 250mg once a week 250mg once a week starting 1 week prior to travel once a week starting 1 week prior to travel once a week during travel and continue 4 weeks upon during travel and continue 4 weeks upon return. S.E. include sleep disturbancereturn. S.E. include sleep disturbance

► Doxycycline- Doxycycline- 100mg daily starting 1-2 days 100mg daily starting 1-2 days prior to travel and continue 4 weeks upon prior to travel and continue 4 weeks upon return. S.E. include sun sensitivityreturn. S.E. include sun sensitivity

► Malarone (naphthoquinone\Malarone (naphthoquinone\dihydrofolate)- dihydrofolate)- one daily starting 1-2 days one daily starting 1-2 days prior to travel and continue 1 week upon prior to travel and continue 1 week upon return.return.

April 10, 2014

MedicationsMedications► GI illness\diarrhea- include ciprofloxacin, GI illness\diarrhea- include ciprofloxacin, azithromycin, Zofran. (prescription needed)azithromycin, Zofran. (prescription needed)► Anti-diarrheal- Imodium (OTC)Anti-diarrheal- Imodium (OTC)► Acid reflux\heartburn-prilosec\ranitidine (OTC)Acid reflux\heartburn-prilosec\ranitidine (OTC)► Fever\pain-tylenol\ibuprofen (OTC)Fever\pain-tylenol\ibuprofen (OTC)► Altitude sickness- acetazolamide (drug of choice) Altitude sickness- acetazolamide (drug of choice) or dexamethasone. Consider for travel above or dexamethasone. Consider for travel above 2500m (prescription needed)2500m (prescription needed)► Mosquito prevention-DEETMosquito prevention-DEET► Oral replacement powder- i.e. powdered GatoradeOral replacement powder- i.e. powdered Gatorade or equivalent.or equivalent.► Travel sickness- bonine (meclizine), scopolamine Travel sickness- bonine (meclizine), scopolamine patch, Dramamine, ginger.(OTC or prescription)patch, Dramamine, ginger.(OTC or prescription)

April 10, 2014

Needlesticks/ Fluid exposuresNeedlesticks/ Fluid exposures

►Remove yourself from eventRemove yourself from event►Make staff aware/get helpMake staff aware/get help►Wash well with soap/antiseptic and Wash well with soap/antiseptic and

waterwater►Consider PEPConsider PEP►Contact UMMS and return to US if PEP Contact UMMS and return to US if PEP

initiatedinitiated

April 10, 2014

PEP PEP ► Post exposure Prophylaxis, medications used to Post exposure Prophylaxis, medications used to

prevent transmission of HIV.prevent transmission of HIV.► Used for high risk blood borne pathogen Used for high risk blood borne pathogen

exposures i.e. needle sticks or body fluid exposures i.e. needle sticks or body fluid exposures in open wounds, sexual assault.exposures in open wounds, sexual assault.

► Truvada and Raltegravir (antiviral medications) Truvada and Raltegravir (antiviral medications) provided by SHS and brought with the students provided by SHS and brought with the students on trip in case of exposure.on trip in case of exposure.

► Start meds within 3 hours of high risk Start meds within 3 hours of high risk exposures.exposures.

► Protocol details on SHS website. PEP Protocol details on SHS website. PEP medications needed typically for 4medications needed typically for 4thth yr students yr students doing higher risk medical clinics in more doing higher risk medical clinics in more remote areas i.e. ob\gyn\trauma\surgery.remote areas i.e. ob\gyn\trauma\surgery.April 10, 2014


►PPE (eye shields)PPE (eye shields)►Gloves (non sterile vs sterile)Gloves (non sterile vs sterile)►MaskMask surgical masksurgical mask respirator N95 respirator N95 (TB, H1N1)(TB, H1N1) must be fittedmust be fitted Environmental Health & SafetyEnvironmental Health & Safety

April 10, 2014


Animal bites/ insect bitesAnimal bites/ insect bites

wound carewound care

antibioticsantibiotics

rabies vaccinerabies vaccine

April 10, 2014

Emergency ContactEmergency ContactCarry OGH number Carry OGH number

exit code- 508-856-exit code- 508-856-28402840

Carry Faculty AdvisorCarry Faculty Advisor

contact numbercontact number

Email addresses for Email addresses for

SHS, UmassSHS, Umass

US Embassy number and US Embassy number and address address

Insurance contactInsurance contact

April 10, 2014

Questions on OSHA ??Questions on OSHA ??

► Where there is No Where there is No doctordoctor

► Hesperian Health Guides► [email protected]

g • www.hesperian.orgApril 10, 2014

International Travel SafetyInternational Travel Safety

April 10, 2014

Personal Personal SafetySafety

Visual and Auditory Visual and Auditory cues - Be aware of cues - Be aware of your surroundings your surroundings (security guards, (security guards, dogs, walled houses).dogs, walled houses).

- Are locals walking - Are locals walking alone? Are women or alone? Are women or people in business people in business attire walking about?attire walking about?

Things to RememberThings to Remember

-You are a $ sign-You are a $ sign

-Taxis are taxis-Taxis are taxis

- Bribing is an active - Bribing is an active part of life part of life unfortunately.unfortunately.

April 10, 2014

Keeping your Keeping your Valuables Valuables SafeSafe

-Where to keep cash, -Where to keep cash, wallet, passport? It all wallet, passport? It all depends on where you depends on where you go.go.

-To PDA or not to PDA-To PDA or not to PDA

-Jewelry – ask why you -Jewelry – ask why you need it and what it tells need it and what it tells the people you are the people you are working with.working with.

Hostels/Hotels/HomestayHostels/Hotels/Homestay

--

April 10, 2014

Cultural Cultural SensitivitySensitivity

-Do homework ahead of time -Do homework ahead of time (guidebooks, online, etc)(guidebooks, online, etc)

-Hospital culture – be clear -Hospital culture – be clear on your role for yourself and on your role for yourself and the patientsthe patients

-Locals and patients will -Locals and patients will perceive you differentlyperceive you differently

-Talk to locals and other -Talk to locals and other students / residentsstudents / residents

-Be aware of local laws eg Be aware of local laws eg Photography/video – ask Photography/video – ask permission!permission!

April 10, 2014

Emergency Emergency PlanningPlanning

-Be aware of risks in -Be aware of risks in area you are in area you are in (natural disasters, (natural disasters, crime, sickness)crime, sickness)

-Phone numbers -Phone numbers (local police?, (local police?, embassy, Umass embassy, Umass contact, family)contact, family)

-Plan ahead – -Plan ahead – photocopies, photocopies, emergency money, emergency money, meds.meds.

April 10, 2014

OtherOther

-Register with U.S. -Register with U.S. EmbassyEmbassy

-Copy of Passport -Copy of Passport EVERYWHERE (visa)EVERYWHERE (visa)

-Travel Health -Travel Health InsuranceInsurance

-Exercise-Exercise

April 10, 2014

ThanksThanks

►Have a Great Trip and Pack Light! Have a Great Trip and Pack Light!

April 10, 2014

Documents

Global Travel Preparation