1. Love to Travel?

5. Issues… What type of travel? Fitness to Fly
How do you help prevent illness?
What if you do get ill?
What if you’re called to help?

6. Think about insurance…
EHIC
Check cover depending on trip

7. Fit to fly?

9. Getting ill on board a flight….
Anyone been there???

10. Why are there restrictions on people flying?

12. Can I fly? I had my appendix out 6 days ago?
My husband had a heart attack when he was on a business trip. When can he fly home?
Dad’s got COPD, we’d like to take him on holiday to get some sun as he’s getting down. Is it ok?
My son has got epilepsy: is it ok to go on holiday?

13. Can I fly?
My 3 year old’s got a rash, we’re going on holiday to Lanzarote in 2 days.
It’s chicken pox.
I’ve got anaemia from MDS, it’s not going to get better. I really want to go and see my sister in America as she’s dying. It might be the last time.

14. Can I fly? I broke my arm snowboarding
I’ve got diabetes, what do I do with my insulin?
My son is allergic to peanuts, he should be ok shouldn’t he?
I’m pregnant
Last time I flew I had a real problem with my ears…

15. Can I fly?
I’m on holiday here, I’ve just had a DVT… I feel ok when can I fly home?
I had a dvt after my pregnancy last year: do I need any special precautions?
I’ve got a colostomy
I’ve got an implanted defibrillator: is there a problem with the security machines?

18. Things to consider to take with you

19. Things to consider to take with you
Normal meds, General analgesics
Bite avoidance
?antimalarials
?Sterilising tabs
?antibiotics
?anti diarrhoeals
contraception : think STD/HIV
?IV kit

20. Immunisations/Malaria
Changing recommendations: always look at current
Pulse charts

22. High Altitude -High Altitude: 1500 - 3500 m (5000 - 11500 ft)
-Very High Altitude: m ( ft)
-Extreme Altitude: above 5500 m
Unlikely to be a problem <2,500m (8,000ft)

24. Normal changes at altitude

25. Normal changes at altitude
Hyperventilation (breathing faster, deeper, or both)
Shortness of breath during exertion
Changed breathing pattern at night
Awakening frequently at night
Increased urination
(Periodic breathing)

26. AMS Headache + 1 or more of Loss of appetite, nausea, or vomiting
Fatigue or weakness
Dizziness or light-headedness
Difficulty sleeping

27. HA Cerebral Oedema confusion, changes in behavior, or lethargy. Ataxia
Happens when ascend with preexisting AMS. Severe, life-threatening hours or 1-2days

28. HA Pulmonary Oedema Extreme fatigue
Breathlessness at rest-Fast, shallow breathing
Cough, possibly frothy or pink sputum
Gurgling or rattling breaths
Chest tightness, fullness, or congestion
Blue or gray lips or fingernails
Drowsiness

29. Prevention
If possible, you should spend at least one night at an intermediate elevation < 3000m
above 3000 m (10,000 ft), sleeping elevation should not increase > m m ( ft) per night.
Every 1000 m (3000 ft) spend a second night at the same elevation.
"climb high, sleep low".

31. Medication/Prophylaxis
for persons on forced rapid ascents (e.g. flying into Lhasa, Tibet, or La Paz, Bolivia),
for climbers who cannot avoid a big altitude gain due to terrain considerations,
for rescue personnel on a rapid ascent
for persons who have repeatedly had AMS in the past

32. Acetazolamide (Diamox®)
mg (depending on body weight; persons over 100 kg (220 lbs) should take the higher dose) BD starting 24 hours before ascent, and discontinuing after the second or third night at the maximum altitude

33. Treatment Mild: simple analgesia
Don’t go higher (acclimatisation 24-48h)
Acetazolamide hastens acclimatisation (250mg bd)
Dexametasone 4mg x 2 6h apart (symptoms helped rapidly but doesn’t speed aclimatization) (12-20mg if HACE/PE)
O2 (if available: usu for severe)

34. Treatment
GOLDEN RULE I: If you feel unwell at altitude it is altitude illness until proven otherwise.
GOLDEN RULE II: Never ascend with symptoms of AMS.
GOLDEN RULE IIIIf you are getting worse (or have HACE or HAPE), go down at once.