1. Mitigating Risks for Medical Evacuations
November 13, 2018
Dr. Ken McDonnell Medical Director & Vice President International SOS Government Services
The information contained in this document is the property of International SOS and further dissemination is prohibited without the written permission of International SOS.

2. Proprietary and Confidential
Business Travelers' Perspective
According to a recent survey of US and UK business travelers:
38% said they never do any research on the countries they visit.
78% said they never carry an emergency phone number.
86% of travelers believe their firm has a legal obligation to support them while abroad.
50%+ would consider taking legal action in the event of an emergency being mishandled.
(Business Travel Report)
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3. Proprietary and Confidential
The Reality
Based on a study of health problems experienced by 100,000 individuals who traveled to a developing country for one month, the following could be expected to occur:
50,000 will develop some health problem
8,000 will see a doctor
5,000 will be confined to bed
1,100 will be incapacitated in their work
50 will be admitted to a hospital
30 will be evacuated
1 will die
Steffen, R. et al.: "Health Problems After Travel to Developing Countries,”
Journal of Infectious Disease (1987) 156, 84
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4. Proprietary and Confidential
Hostile/High Medical Risk Areas
LOW RISK HIGH RISK
International Medical Cases
1 in in 21
International Hospitalizations
1 in in 137
International Medical Evacuations
1 in 6, in 268
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5. Proprietary and Confidential
Global Health Trends: Evacuation and Repatriation
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6. Proprietary and Confidential
Air Ambulance Evacuation Data Analysis
Top 10 Medical Categories of Cause for Evacuation
32.6 25
11.1
8.7
4.8
3.1
2.4
1.7
1.2 1 5 10 15 20 30 35
Trauma
Circulatory system conditions
Infectious diseases
Digestive/abdominal system conditions
Respiratory system conditions
Systemic and other conditions
Neoplasm
Pregnancy and childbirth
Nervous system conditions
Genitourinary system conditions
Mental health disorders
Hematological conditions and immune disorders
Dermatologic conditions
Musculoskeletal system conditions
Medical Condition
PERCENT
24-Month Review: 2014/2015
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7. Proprietary and Confidential
Pre-Deployment Medical Screening
US CENTCOM Policy Modification 13
Targeted medical history, laboratory testing, physical examination, vaccinations, dental care
Remove individuals who are at highest risk for medical complications
Travel Risks
Trauma
Infectious Disease
Public Health measures
Prompt Medical Advice
Cost-effective Patient Movement and Evacuation Options
Steffen, R. et al.: "Health Problems After Travel to Developing Countries,”
Journal of Infectious Disease (1987) 156, 84
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8. Prior to Departure
Mobile friendly dynamic content, as seen from a general traveler's point of view
Links to your own resources
Comprehensive presentation of destination country

9. Aeromedical Evacuations

10. Proprietary and Confidential
Commercial Airlines vs. Air Ambulance
Considerations
Cost
Fuel Stops
Privacy
Impact on other passengers (risk of flight diversion)
Medical resources (equipment and personnel)
MEDIF
Commercial
Air Ambulance
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11. Cutting flight time up to 50% compared to air ambulance
Keflavik
Goose Bay
Frankfurt
Richmond
Larnaca
Dubai
06.40 hrs flight time
Caracas
09.30 hrs flight time
Lufthansa LH 503
Lufthansa LH 629
Ambulance flight
Sao Paulo
11.45 hrs flight time
23.00 hrs flight time

12. No room to medically intervene, if needed
If you have a choice, try not to transport a sick patient in Economy Class
No room to medically intervene, if needed

13. Stretcher Options on Commercial Carriers Varies by Airline

14. The Importance of Immediate Medical Advice
From Physicians with Local Knowledge and Experience with Foreigners
Quality of Case Outcome
Duty of Care
Employee Self-referral
Exposure
Medical Assistance
Intervention based on what the employee thinks is wrong
Intervention based on what a physician thinks is wrong

15. Discussion