1. Travel Medicine Col Scott McPherson LTC Bryan Delage

2. TRAVEL MEDICINE The number one cause of illness in travelers is diarrhea SELF LIMITED 30 – 60% WILL NEED TREATMENT LOPERAMIDE OR ANTIBIOTICS MILITARY INSTALLATIONS HAVE QUALITY CONTROL FOR WATER SO THIS MAY BE A HIGH ESTIMATE, BUT IF YOU HAVE BEEN DEPLOYED YOU KNOW HOW IT CAN BE First one airman stops by complaining of diarrhea, then two then a dozen

3. MALARIA

4. Accidents Traveled to Turkey? Italy? Crete? Not only are the drivers crazy but you can’t even read the signs THE CHANCE OF DYING IN ANOTHER COUNTRY FROM AN ACCIDENT IS TWO TO THREE TIMES HIGHER THAN IN THE US Mopeds are fun, but not a safe way to travel Blood alcohol limits are often lower than.08 in other places

5. Where is this sign sending you?

7. Stress and Travel Suicide prevention can begin with reduction of stress Some deployers have never traveled overseas Remind members of the mental health counselor available Marital stress; Financial stress; Separation anxiety Expenses – Per Diem; Phone charges

8. Food and Water Despite excellent monitoring and Health Department surveillance outbreaks of foodborne illness occur in the US It is much better, though than even Europe and Asia let alone some of the places to which we deploy

9. TRAVEL MEDICINE Traveler’s Diarrhea 1.Number one cause of illness in travlers 2.80-85% caused by bacteria – 10% Parasites – 5% viruses 3.Most are susceptible to oral antibiotics 4.Be prepared to treat large numbers if you are providing supplies 5.It is usually not necessary to treat prophylactically 6.Hand-washing and hand sanitizers lower the risks 7.But even compliance does not guarantee 100% protection

10. TRAVEL MEDICINE The number one cause of illness in travelers is diarrhea Food Preparation- At most bases the local restaurants have been checked out by Public Health BUT... That has never stopped an airman From finding a new place to eat

11. Foods to Avoid Rare or raw meat; raw fish, shellfish, crayfish, and sushi that have not been previously frozen Raw vegetables, especially leafy salads served in restaurants Fruits not peeled by you and fruits with punctured skins Aquatic plants in Asia (water chestnuts) Raw eggs, undercooked eggs, unpasteurized milk and cheese Street vendor food unless it is hot and well cooked All food that has been left out in the sun, especially dairy products Buffet food that has been re-warmed or recycled

12. When they get home A Presentation LEISHMANIASIS: Cutaneous is most common – 2-6 months incubation Transmitted by the sand fly: smaller than a typical mosquito silent Southwest Asia locations Don’t ignore possibility of visceral leishmaniasis LEISHMANIASIS: Cutaneous is most common – 2-6 months incubation Transmitted by the sand fly: smaller than a typical mosquito silent Southwest Asia locations Don’t ignore possibility of visceral leishmaniasis

13. When they get home MALARIA: Unexplained high fever – even if prophylaxis was taken correctly – RESISTANCE Typically 4-6 weeks after finishing medication DENGUE FEVER: Painful rigors and high fever – not uncommon in Central and South America – PREVENTION 3-7 days incubation – remember “Bone-break fever” MALARIA: Unexplained high fever – even if prophylaxis was taken correctly – RESISTANCE Typically 4-6 weeks after finishing medication DENGUE FEVER: Painful rigors and high fever – not uncommon in Central and South America – PREVENTION 3-7 days incubation – remember “Bone-break fever” Again the most common symptom upon the return From overseas is Diarrhea. Skin rashes are close behind Again the most common symptom upon the return From overseas is Diarrhea. Skin rashes are close behind

14. Travel Medicine Of course you need to tailor all of your Advice to specific locations. Do the research, utilize your resources, intel and public health Of course you need to tailor all of your Advice to specific locations. Do the research, utilize your resources, intel and public health

15. What We Didn’t Talk About “Athletic” injuries – cuts, bruises, coral burns, sunburn, fractures Common infections – URI, UTI, STD’s Working with the base medical facility commander (credentialing) Air Evacuation Local economy “medical support” I invite your comments on the AANGFS web page – share your experiences

16. Scott McPherson, MD Col, MC,SFS JFHQ, NE Nebraska State Air Surgeon smcdoc1@gmail.com Bryan Delage, M.D. LTC, MC, FS North Dakota State Air Surgeon Bryan.delage@ang.af.mil