Vibha Lifesavers - Hi flying aviation provides a general guideline for patients to choose the right air ambulance services for domestic and international patient transfers.

Questions you should ask - Answers you should get -

DOES THE AIR AMBULANCE SERVICE HAVE A MEDICAL DIRECTOR AVAILABLE FOR MEDICAL CONSULTATIONS?

Each patient should be evaluated by the medical director of the air ambulance service prior to transport. Because many medical conditions are affected by air travel, the Aviation Medical Specialist is trained to determine the proper equipment, personnel and aircraft required for each transport. Aviation physiology may affect the patient, so particular attention must be given to his/her condition and previous medical history.

WHAT ARE THE TRAINING REQUIREMENTS FOR THE AIR MEDICAL TRANSPORT TEAM?

All physicians, nurses and respiratory therapists should have extensive experience in critical care medicine. The doctors and nurses should be certified in Advanced Cardiac Life Support, and be further trained in aviation physiology.

WILL THE AIR AMBULANCE SERVICE PROVIDE BEDSIDE TO BEDSIDE CARE?

It is important that the aviation medical team takes patient responsibility at the discharging facility and relinquish this responsibility only at the patient’s final destination. Continuity of medical and nursing care is extremely important to the outcome of all patient conditions. The aviation medical team is the important “link” between the discharging and receiving patient care facility. The receiving facility should expect to receive all pre-flight medical records as well as verbal and written documentation of in-flight events.

WHAT ARE THE COSTS OF AN AIR AMBULANCE?

The cost of an air ambulance transport varies depending on type of aircraft used, length of flight, and medical personnel. Quotation for flight costs should include -
Aircraft Mileage – Flight Crew – Medical Personnel – Aviation Medical Consultations – Medical Equipment – Landing Fees – Ground Ambulance Transportation and should be all inclusive.

WILL THE PROPER AIRCRAFT BE UTILIZED? WILL IT COMFORTABLY ACCOMMODATE THE PATIENT?

The major factor to consider in selecting the type of aircraft is the patient’s condition. For most flights of more than one or two hours duration, jet aircraft is certainly preferable to a propeller aircraft. The patient’s “flight time” is substantially minimized in a jet. A jet’s flight will be above the weather, not bouncing around in it. All jet aircraft are pressurized. There will be fewer fuel stops (or none at all) than with a propeller aircraft. Some propeller aircraft are pressurized, others are not. For short flights, particularly when the patient is very stable, a propeller aircraft (even an unpressurized one) might be utilized for air ambulance flights.

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Staying healthy and safe while travelling.

You can reduce your chances of getting sick or injured while traveling by following these recommendations:
Hiker applying bug spray

* Use sunscreen with both UVA and UVB protection.
* Prevent mosquito and other bug bites.
o Use insect repellent (with DEET or picaridin) on uncovered skin when outdoors, especially during the day.
+ Repellents that have 30% - 50% DEET (N,N-diethyl-m-toluamide) are recommended for adults. If the repellent has less than 25% DEET, it may not protect you as long, so be sure to reapply more often.
+ Repellents that have up to 15% picaridin are also available. This type of repellent should be reapplied often to protect you.
+ For more information about using insect repellent on infants and children, see the “Insect and Other Arthropod Protection” in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.
o Wear long-sleeved shirts and long pants when outdoors at night in areas with malaria.
o Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: don't use permethrin on skin.)
o If you can, stay in hotels or resorts that are well screened or air conditioned.
o For more information about insect and mosquito prevention, see Insect and Arthropod Protection and Questions and Answers: Insect Repellent Use and Safety
* Be careful about food and water.
o Wash your hands often with soap and water, especially before eating or preparing food and after you use the bathroom, cough, or sneeze. If soap and water are not available, use an alcohol-based hand gel (with at lest 60% alcohol).
o In some countries, you should only drink bottled or boiled water or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
o Depending on where you are traveling, you may need to take extra precautions with the food that you eat. See country-specific tips for your destination.
* Try not to take risks with your health and safety. Make sure to follow local laws and customs.
o Limit alcohol intake, and do not drink alcohol and drive. Some countries have very strict laws against drinking and driving.
o Always wear a seatbelt, if one is available.
o Wear protective gear when doing adventure activities (for example, life jackets for water activities and helmets for biking, rappelling, etc.)
o Use caution when swimming and participating in other water activities.
+ Wear a life jacket when participating in water sports, such as boating and water skiing.
+ Only swim in chlorinated pools. Do not swim in freshwater in developing areas or where sanitation is poor.
+ Be aware of local weather conditions and forecasts. Watch for large waves, strong tides, and signs of rip currents.
+ Children should be supervised by an adult at all times near water.
o Be careful when traveling within your destination. Accidents involving cars, buses, motorcycles, and other motor vehicles, as well as pedestrians are more common during travel that you might think.
+ When possible, hire a local driver. Ask your hotel for a trustworthy driver or taxi company.
+ Do not travel with a driver who has been drinking.
+ Try not to travel on overloaded buses or mini-buses.
+ Avoid traveling at night. Some countries have curfew laws and safety concerns.
+ Try to travel with others and not alone.
+ Learn more about road traffic and other injuries abroad.
* Avoid animal bites by not handling or petting animals, especially dogs and cats. If you are bitten or scratched, wash the wound immediately with soap and water and seek medical attention to determine if medication or anti-rabies vaccine is needed. Learn more in the Rabies section of the Travelers’ Health website.
* Do not share needles for tattoos, body piercing, or injections, to avoid infections such as HIV and viral hepatitis.
* Always use latex condoms if you have sex to reduce the risk of HIV and other sexually transmitted diseases.
* Keep feet clean and dry, and do not go barefoot, especially on beaches where there may be animal waste, to prevent fungal and parasitic infections.
* When traveling with small children, make sure an adult is watching them at all times. Pay careful attention to their health and safety.

If you are planning a cruise trip, here are some additional t

Trauma and Injuries

According to the World Health Organization, injuries are among the leading causes of death and disability in the world, and they are the leading cause of preventable death in travelers. Of the approximately five million people killed due to injuries in the world, approximately 1.2 million people died of road traffic incidents, 815,000 from suicide and 520,000 from homicides. In addition to the considerable number of deaths, millions more are wounded or suffer other nonfatal health consequences. Worldwide, among persons aged 5–44 years, injuries account for 6 of the 15 leading causes of death.

In 2007, just over 64 million Americans traveled outside the United States. The vast majority of these trips occurred without any serious health problems, but fatal and serious injuries occur to Americans every year while traveling internationally. Among travelers abroad, injuries are one of the leading causes of death. Compared with injuries, infectious diseases, for example, only account for a small proportion (2%) of deaths to overseas travelers.

The U.S. Department of State collects data on U.S. citizens who die in a foreign country from non-natural causes for the most recent 3-year period and makes these data available on the Department of State website. These deaths are categorized by location where the death occurred, date of death, and cause of death. These deaths should be considered a conservative estimate of the true number of U.S. citizens who die in foreign countries, as some deaths may not be reported to the Department of State. We analyzed these data and found that from 2003 to 2005 an estimated 2,276 U.S. citizens died from injuries and violence while in foreign countries (excluding deaths occurring in Iraq and Afghanistan). Road traffic crashes headed the list of causes (34%), followed by homicide (17%), and drowning (13%) (Figure 2-3). By comparison to U.S. injury fatalities in 2003, road traffic crashes accounted for 27%, homicide 11%, and drowning 2% of all injury deaths.

Depending on travel destination, duration, and planned activities, other common injury and safety concerns include natural hazards and disasters, civil unrest, terrorism, hate crimes against Americans, falls, burns, poisoning, drug-related overdose, and suicide. If seriously injured, emergency care may not be available or acceptable by U.S. standards. Trauma centers which are capable of providing optimal trauma care are uncommon outside urban areas.

Males, compared with females, are more likely to die from injury causes while traveling internationally. Acquaintance rape and sexual assault are among the important risks to women travelers. Travelers should be aware of the increased risk of certain injuries while traveling abroad, particularly in low-income countries, and be prepared to take preventive steps to avoid them.

Health advisors should counsel the traveler to:

* Use safety belts and child safety seats whenever possible. Safety belts reduce the risk of death in a crash by 45%–60%, child safety seats by 54% and infant seats by 70%. When traveling, rent newer vehicles with safety belts and airbags and bring a child safety seat from home.
* Rent larger vehicles if possible, because they provide more protection in a crash.
* Try to ride only in taxis with functional safety belts and ride in the rear seat.
* Wear helmets when riding motorcycles, motorbikes, and bicycles. If helmets are likely to be unavailable at the destination, they should be brought from home.
* Avoid drinking alcohol and driving or biking. U.S. data show that an alcohol-impaired driver has a 17 times greater risk of being involved in a fatal crash.
* Visit the websites of the Association for Safe International Road Travel (ASIRT) (www.asirt.org) and Make Roads Safe (www.makeroadssafe.org), both NGOs, which have useful safety tips for international travelers, including road safety checklists and country specific driving risks.
* Check the safety and security information from the U.S. Department of State (www.travel.state.gov).
* Consider hiring a driver familiar with the destination, the language and an expert in maneuvering through local traffic.
* Avoid riding on overcrowded, overweight, top heavy busses, or minivans, or riding with any driver who has consumed alcohol.
* Be aware of pedestrians and be aware as a pedestrian of the dangers. Walk with a friend, rather than alone, as this helps with safety.

Water Injuries

Drowning accounts for 13% of deaths of Americans abroad. The risk factors have not been clearly defined, but are suspected to be related to unfamiliarity with local water currents and water conditions. Drowning was the leading cause of injury death to Americans visiting countries where exposure to water recreation was a major activity such as Fiji, Dutch Antilles, Aruba, and Costa Rica. Studies have found that young men are particularly at risk of head and spinal cord injuries from diving into shallow water, with alcohol a factor in some cases. In 2000, approximately 449,000 people drowned worldwide; the exact number of travelers who suffer from nonfatal drowning is not precisely known.

Alcohol is also a suspected contributing factor to both drowning and boating mishaps.

Scuba diving is a frequent pursuit of travelers in ocean destinations. Travelers should either be experienced divers, or dive with a reliable dive shop and instructors. They should be reminded not to dive on the same day they arrive by airplane. The fatality rate among all divers, worldwide, is thought to be 15 to 20 deaths per 100,000 divers per year.
Other Unintentional Injuries

From 2003 to 2005, other than drowning, airplane crashes, natural disasters, and other unintentional injuries accounted for over a third of all injury deaths to Americans in foreign countries (see Figure 2-3). Fires can be a substantial risk in low-income countries where building codes are not present or enforced, where there’s an absence of smoke alarms, where there is no emergency access to 9-1-1 services, and where the fire department focus is on putting out fires rather than on fire prevention or victim rescue.

The U.S. Department of State website (www.travel.state.gov) has useful information regarding safety and security.
Summary

Injuries and violence are as much a public health problem to travelers overseas as are infectious and chronic diseases—and they are in many ways more deadly. Injuries are still the most frequent cause of death abroad in developing countries. Effective prevention strategies are available, particularly for travelers who find themselves in new environments and who may be more likely to be unaware of risks or complacent in exotic surroundings. Despite greater understanding and increased research efforts in this field, data on the magnitude and severity of injuries is still incomplete or unreliable in many countries. Existing data indicate that injury and violence are among the most important causes of premature death and ill-health to U.S. travelers overseas. Travel health advisors and other health-care providers should alert the public to the known risks and especially about simple and effective preventive measures to implement during international travel.

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Immunisations and Tablets


If you're heading for developing or tropical areas you should discuss your itinerary with your GP or local travel health centre at least six weeks before departure.

Few vaccines provide complete protection - you should still take care with food, drink and personal hygiene. In addition, some countries have adopted HIV/AIDS-related entry restrictions. Travellers with HIV should consult their GP for a detailed assessment and advice before travelling.

When you have your check-up at your local surgery, it's a good idea to review your medical history, present state of health, medications and any allergies. Keep your immunisation certificates (and list of current medication) with your passport for use during your travels and as a record for the future.

The vaccinations you need will depend on the country you're visiting. Your GP or practice nurse will be able to give you specific, up-to-date information on the jabs required for your particular destination.

Cholera
An oral vaccine is available in the UK for travellers to endemic or epidemic areas, where the risk of cholera is greatest. In most cases, a cholera vaccination certificate is no longer required. If it is, your travel company should alert you.

Diphtheria
Diphtheria is one of the childhood immunisations in the UK. There have been recent outbreaks in some parts of the world - if you're travelling to one of these areas, a booster may be recommended.

Hepatitis A
The hepatitis A virus is present in faeces and can be spread from person to person, but it's usually caught by consuming contaminated food or water. Those travelling to places where sanitation is poor need to be especially aware of the risk of infection.

A vaccination can help to reduce the risk, but it's also vital to be scrupulous about personal hygiene. Be careful what you eat and drink, and wash your hands after using the toilet and before handling or eating food.

Hepatitis B
This serious infection of the liver is common in many parts of the world. It's caught via contact with contaminated blood - including sharing needles, blood transfusions or inadequately sterilised equipment - and intimate sexual contact.

Immunisation is available but not routinely recommended for travellers unless they're likely to be at increased risk through work or other activities.

Japanese encephalitis
This occurs throughout south-east Asia, mainly in rural areas and during the monsoon season. A vaccine is available for those who are travelling to rural areas in the monsoon season and staying more than two weeks. However, it isn't usually free on the NHS

Before you travel - Prepare

Before you travel it's a good idea to think about what you may need to ensure you stay healthy and enjoy your trip.

Check-ups
The most important thing to take on holiday is you - in the best health possible. If you've been putting off a dental check-up or any other routine medical matters, consider dealing with these before you leave. Medical and dental care outside Europe may not meet EU standards and can be expensive.

First aid kit
A standard kit, which you can put together yourself, should contain:

Plasters or adhesive dressings
Insect repellent
Antiseptic cream
Water sterilisation tablets
Anti-diarrhoea tablets
Oral rehydration tablets
Painkillers
Calamine lotion
Sunblock


Emergency medical travel kits are available, containing sealed, sterilised items such as needles, syringes and suture materials. Your GP or local travel centre can advise you further.

These kits should carry identification to ensure customs officials accept them, but the contents shouldn't be opened.

Medication
Remember to pack any medications you're currently taking. Make a note of the non-branded, generic name of the medication so you can get hold of it easily abroad.

Don't forget your malaria tablets, if required.

Travel insurance
Make sure your travel insurance is up to date. Take the documents with you - and don't forget the insurer's emergency phone number. Keep a photocopy of the policy separate from your important documents, in case of theft.

Take any vaccination/immunisation certificates, in case you're asked to present them at a clinic or customs.

Cardiovascular diseases account for around half of travellers' deaths overseas. If you're at risk, get a physical examination from your GP. Also make sure your travel health insurance covers pre-existing conditions.

If you're the adventurous type, check your insurance covers you for all extreme pursuits. Not all policies cover activities such as mountaineering, scuba diving, bungee jumping, motorcycle riding and white-water rafting.

In Europe
If you're travelling to a country within the European Economic Area (EEA) or Switzerland, you should carry a European Health Insurance Card (EHIC). This entitles you to free or reduced-cost medical treatment.

An EHIC is normally valid for three to five years and covers any medical treatment that becomes necessary during your trip. It gives access to state-provided medical treatment only, and you'll be treated on the same basis as an 'insured' person living in that country.

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There's no guarantee that you won’t pick up an infection such as a cough or cold, but you can lessen your chances of becoming a victim of these. Keep your immune system strong by getting enough sleep and relaxation, eat a healthy diet that’s rich in fruit and vegetables, exercise regularly, and don’t smoke. Wash your hands regularly during the flight as you may come into contact with contaminated surfaces whilst moving around the cabin - if this isn’t easy then use a travel hand-sanitizer. Encourage those who are coughing and sneezing to cover their mouth and nose when doing so with a disposable tissue.

Air Ambulance.

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Dealing with a terminal diagnosis.

When someone is given a terminal diagnosis it doesn’t mean that nothing more can be done, but the aim of treatment changes and becomes focussed on reducing their symptoms.

Managing pain
Not all terminally ill patients have pain but if they do, it’s generally well-controlled with painkillers, and these can be adjusted as needed. Other options for controlling pain include:

Radiotherapy
Nerve blocks
Acupuncture
Hypnotherapy
Relaxation techniques


Nausea and vomiting can be very troublesome in terminal illness and may be caused by the cancer or as a side-effect of medicines like morphine. It's important that the doctor knows about it, as this can often be well-controlled by changing or adjusting medicines. Eating small meals more often can also help.

Talking about the diagnosis
Talking to family and friends about the diagnosis is often difficult and can be very distressing for them and the patient. Often they don't know what to say or how to react but if it can be talked about openly and honestly, it can be a comfort. It's important to understand that everyone will react differently and some will seem unsympathetic or deny the truth. This doesn't mean that they don't care - it's often their way of coping.

It's best to be honest with children even if it's painful. How much they need to be told will depend on their age, and it's often better to talk to them with other relatives around so they feel supported. Sometimes people with terminal cancer don't want to talk or see anyone and their wishes should be respected.

Getting affairs in order
Often when confronted with a terminal diagnosis the patient may find comfort in getting their affairs in order - they see it as looking after their loved ones. This may include making a will, making arrangements for children, making memory boxes for children and planning the funeral.

Support
Generally, people who have been given a terminal diagnosis are at home. The GP is the doctor who will look after them, helped by a number of others, including:

District nurses
Macmillan nurses (who are specialists in palliative care and symptom control)
Marie Curie nurses
Home-helps
Carers
Physiotherapists
Occupational therapists


Their aim is to attend to all the patient's needs and to keep them as comfortable as possible in their own home.

Sometimes, if symptoms aren't well-controlled a doctor will suggest that the patient go into a hospice or hospital to improve things. This may only be for a short time and then the patient can go home again. Hospices specialise in controlling symptoms and caring for people dying of cancer and their families. Many hospices have day care facilities that patients with a terminal illness can attend. Hospices also have services such as physiotherapy, complementary therapies, spiritual care and bereavement support.

Choosing where to die
Most people want to die in their own homes, with their family there. Often, for lots of reasons, this isn't possible. It may be that the patient develops symptoms that cannot be well-controlled at home and they need to be in a hospital or hospice to be made comfortable. For families, it's very hard work, both physically and emotionally, caring for someone dying at home and they need to know that there is support for them when they need it. It is a good idea to talk things through with the community nurses and or GP so that there is a plan in case of emergencies.

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