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Global Travel Preparation

Global Travel Preparation. Debra Heitmann, MD Department of Emergency Medicine Phillip Fournier, MD Student Health Services Daniel Frank, MSV (soon MD). Global Travel Preparation. Main Goal: keep you safe and healthy while having a fun, informative and valuable travel experience!!

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Global Travel Preparation

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  1. Global Travel Preparation Debra Heitmann, MD Department of Emergency Medicine Phillip Fournier, MD Student Health Services Daniel Frank, MSV (soon MD) April 10, 2014

  2. Global Travel Preparation Main Goal: keep you safe and healthy while having a fun, informative and valuable travel experience!! • provide information in preparation for travel as a medical student involving medical, environmental, safety and situational awareness • Build on prior attended events and personal experiences April 10, 2014

  3. Resources UMMS International Medical Education Program http://www.umassmed.edu/ome/IntlMedEd.aspx CoDtrs: Dr. Michael Chin and Dr. Ann Moormann UMass Office of Global Health http://umassmed.edu/globalhealth/travelpreparation.aspx POLICY AND REQUIREMENTS FOR INT’L TRAVEL TRAVEL REGISTRATION FORM UMMS Student Health Services http://www.umassmed.edu/studenthealth/index.aspx April 10, 2014

  4. Who the heck are we?? April 10, 2014

  5. OSHA guidelines Water PPE Gloves Disinfectant usage Needle stick precautions Mask N95 Animal bites/ insect bites Antibiotics Personal safety Situational awareness Cultural sensitivity Contingency Travel plans/emergency planning Security of personal valuables Register with US embassy Passport copies Global Travel Preparation April 10, 2014

  6. Global Travel Preparation- OSHA • Clinical Care of patients • Your primary role is to observe • You should be not be expected to exceed your skills set • If asked to perform beyond your comfort or your skill set, simply clarify that the school has limited your scope of practice and you are not comfortable with that duty. April 10, 2014

  7. Global Travel Preparation- OSHA • Water assume all tap water is nonpotable no icecubes uncap your own bottles and cans consider purification filters, UV lights tablets(chlorine dioxide + Vit C) skin all fruit • Disinfectant usage antibacterial soap/wipes April 10, 2014

  8. Global Travel Preparation- OSHA Student Health Services +/- Travel Clinic medical screening review of standard universal precautions vaccinations (leave lots of advance time) infectious risks based on travel antibiotics prescriptions emergency contact info April 10, 2014

  9. Immunizations Yellow fever- needed minimum10 days priors to travel and good for 10 years. Received in travel clinic only. Check CDC.gov for indications Hepatitis A- needed minimum 10 days prior to travel, 2 shot series 6 months apart. SHS or travel clinic. Typhoid- PO is 4 doses Q48 hrs good for 5 years IM is 1 dose good for 2 years SHS or travel clinic. Rabies- 3 shots at 0, 7, 21 or 28 days. High risk areas. SHS or travel clinic. D-tap- tetanus every 10 years, pertussis one time booster. SHS or travel clinic. IPV (polio)- Check CDC.gov for booster indications Bring copy of your vaccinations with you on your trip April 10, 2014

  10. Malaria Chloroquine- 500mg once a week starting 1-2 weeks prior to travel once a week during travel and continue 4 weeks upon return. Check CDC.gov for resistant areas. Larium (mefloquin)- 250mg once a week starting 1 week prior to travel once a week during travel and continue 4 weeks upon return. S.E. include sleep disturbance Doxycycline- 100mg daily starting 1-2 days prior to travel and continue 4 weeks upon return. S.E. include sun sensitivity Malarone (naphthoquinone\dihydrofolate)- one daily starting 1-2 days prior to travel and continue 1 week upon return. April 10, 2014

  11. Medications GI illness\diarrhea- include ciprofloxacin, azithromycin, Zofran. (prescription needed) Anti-diarrheal- Imodium (OTC) Acid reflux\heartburn-prilosec\ranitidine (OTC) Fever\pain-tylenol\ibuprofen (OTC) Altitude sickness- acetazolamide (drug of choice) or dexamethasone. Consider for travel above 2500m (prescription needed) Mosquito prevention-DEET Oral replacement powder- i.e. powdered Gatorade or equivalent. Travel sickness- bonine (meclizine), scopolamine patch, Dramamine, ginger.(OTC or prescription) April 10, 2014

  12. Needlesticks/ Fluid exposures • Remove yourself from event • Make staff aware/get help • Wash well with soap/antiseptic and water • Consider PEP • Contact UMMS and return to US if PEP initiated April 10, 2014

  13. PEP Post exposure Prophylaxis, medications used to prevent transmission of HIV. Used for high risk blood borne pathogen exposures i.e. needle sticks or body fluid exposures in open wounds, sexual assault. Truvada and Raltegravir (antiviral medications) provided by SHS and brought with the students on trip in case of exposure. Start meds within 3 hours of high risk exposures. Protocol details on SHS website. PEP medications needed typically for 4th yr students doing higher risk medical clinics in more remote areas i.e. ob\gyn\trauma\surgery. April 10, 2014

  14. Global Travel Preparation- OSHA • PPE (eye shields) • Gloves (non sterile vs sterile) • Mask surgical mask respirator N95 (TB, H1N1) must be fitted Environmental Health & Safety April 10, 2014

  15. Global Travel Preparation- OSHA Animal bites/ insect bites wound care antibiotics rabies vaccine April 10, 2014

  16. Emergency Contact Carry OGH number exit code- 508-856-2840 Carry Faculty Advisor contact number Email addresses for SHS, Umass US Embassy number and address Insurance contact April 10, 2014

  17. Questions on OSHA ?? • Where there is No doctor • Hesperian Health Guides • hesperian@hesperian.org • www.hesperian.org April 10, 2014

  18. International Travel Safety April 10, 2014

  19. Personal Safety Visual and Auditory cues - Be aware of your surroundings (security guards, dogs, walled houses). - Are locals walking alone? Are women or people in business attire walking about? Things to Remember -You are a $ sign -Taxis are taxis - Bribing is an active part of life unfortunately. April 10, 2014

  20. Keeping your Valuables Safe -Where to keep cash, wallet, passport? It all depends on where you go. -To PDA or not to PDA -Jewelry – ask why you need it and what it tells the people you are working with. Hostels/Hotels/Homestay - April 10, 2014

  21. Cultural Sensitivity -Do homework ahead of time (guidebooks, online, etc) -Hospital culture – be clear on your role for yourself and the patients -Locals and patients will perceive you differently -Talk to locals and other students / residents Be aware of local laws eg Photography/video – ask permission! April 10, 2014

  22. Emergency Planning -Be aware of risks in area you are in (natural disasters, crime, sickness) -Phone numbers (local police?, embassy, Umass contact, family) -Plan ahead – photocopies, emergency money, meds. April 10, 2014

  23. Other -Register with U.S. Embassy -Copy of Passport EVERYWHERE (visa) -Travel Health Insurance -Exercise April 10, 2014

  24. Thanks • Have a Great Trip and Pack Light! April 10, 2014

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