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TRAVEL RISK ASSESSMENT
In 2011 U.K. citizens made 55.7 million visits
abroad, despite the recession
Ref: (ONS 2012 & Health Protection Agency 2012)
Travel Risk Assessment – 6 D’s
Destination
Date of Departure
Duration of stay
‘Deeds & doings?’
Diagnosed conditions
Diagnosed allergies
DESTINATION
Country / countries being visited in the order
being visited?
Type of transport being used to arrive and
travel between?
Time zones/ periods in transit?
DATE OF DEPARTURE
Time for vaccination programme?
Time for patient education for
destination(s)
Time for specific guidance re long term
condition
Time to address concerns/ liaise with
specialist team(s)
DURATION
How long away from home?
How long in each country if multi-centre
trip?
How far away from medical care?
“Deeds & doings!”
Are you planning any
special activities?
Are you planning to
drive overseas?
How do you intend to
spend you time whilst
away?
DIAGNOSED CONDITIONS
Current medication
Co-existent conditions
Drug interactions e.g. malaria
chemoprophylaxis / antibiotics.
Compliance/concordance with existing
treatment
Self management experience
Diagnosed allergies
Including intolerances and sensitivities – e.g. nut allergy
– epi pen use & carrying through customs
food intolerances - changes in blood glucose control
egg allergy – vaccine safety options
VACCINATIONS -1
Starting point = completion of current UK
vaccination programme
Mandatory vaccines
Recommended vaccines for country+
being visited
VACCINATIONS - 2
Vaccines needed in light of trip
requirements – special itinerary
Discuss timings of any programme of
vaccines needed
Discuss cost implications as necessary
Ensure general health stable prior to
course of vaccinations
CHECK LIST FOR PATIENTS WITH
DIABETES
Diabetes identification
“Emergency care package” – sick day
rules, when to change management of
condition
Details of local medical care centres for
expertise and advice – check out
www.diabetes.co.uk / 0800 585 088
before leaving UK
Checklist continues
GP letter – i.e. headed paper detailing
confirming condition / detailing current
prescription / known allergies and
relevant PMH.
Insurance: check small print!
EHIC – European Health Insurance Card
LOCATE
UK driving license & DVLA feedback if
insulin user
Ideally………….
Complete a baseline assessment with 4+weeks prior to travelling.
Check-out that patient competent to self manage
Liaise with specialist services as necessary
ALWAYS recap the basics – even experienced travellers benefit from a refresher
Special Risks
WARM CLIMATE risks
e.g. sun/ heat can impact on dehydration &
energy loss
Food hygiene –insects / cross contamination
with food preparation & storage
All inclusive !
Care of feet – burns from pool tiles/ objects in
sand/ hot swollen feet from climate change =
blisters
Special risks
COLD CLIMATE risks
Impact of cold – slows down insulin absorption but shivering increases energy loss
Hypothermia
Foot care – frost bite, enclosed sweating feet, blisters
Accidental slips and falls – minor trauma =risks from infection
Special Risks
TIME ZONE CHANGES
If travelling for less than 4 hours – monitor
as normal -minimal impact on insulin/
blood sugar likely
WEST VS EAST dilemma ?
Special Risks
ALTITUDE SICKNESS
Trekking at altitude increasingly popular:
but results in huge energy expenditure,
even over short durations,
with potential effects on those travellers
with diabetes
ALTITUDE SICKNESS ……………….2
Walking for a distance of 4,000 metres
=
4-6 hours
= re-hydration needs of >4 litres
Suggest 2-3 hourly blood sugars/insulin monitoring
www.medex.org.uk
and
www.moutainmed.org
TIME OUT !
GROUP ACTIVITY
“What would you carry in your hand
luggage?”
(Think health & diabetes – not swimsuit &
suncream !”)
“Take Home Messages !”
1. Diabetes is not a contra-indication for travelling !
2. Careful planning is the key- short term & long term travelling
3. Diabetes medications offer no additional risk – greatest risks are acquired.
REFERENCE LIST
o Department of Health (2006) Immunisation against Infectious
Diseases (The Green Book) the Stationery Office, London
http://immunisation.dh.gov.uk/category/the-green-book/
o Philips A (2012) Principles of Diabetes Care Quay Books, London
o www.fitfortravel.nhs.uk/advice
o www.diabetes.co.uk or tel: 0800 585 088
o www.ehlc.org.uk
o www.nathnac.co.uk
o www.medex.co.uk
o www.moutainmed.co