Management of the Corporate Traveller.

 

Global economic expansion and proliferation of world markets has seen a corresponding growth in business travel.  Unlike package tourists, the nature of business travel often places undue stress on the business traveller.  Tight schedules in multiple time zones, limited recovery and jet-lag, frequent separation from family and possible safety issues may all play a role in the physiological, psychological and business performance of the corporate traveller.

 

Good pre-travel assessment and advice can not only reduce morbidity and mortality but also ensure productivity and business performance of the traveller.

 

 

Health AssessmentCorporate Traveller by Louise Williams

 

A key component of the health assessment for the international business traveller is to determine fitness to travel, through the following process.

 

 

 

Review of Health History

 

A simple questionnaire can provide enough information about the employeeís health to determine the need for a medical evaluation.  Questions should include

 

        Chronic medical conditions

        Allergies

        Pregnancy

        Medications or recent disease exposure

 

Determining the need for physical examination

 

 

 

 

Identifying Risk Factors

 

Risk factors that could pose a threat to the health and possible business performance of the traveller should be identified from assessment of health history, the following areas should be explored:

 

 

E.g. A traveller with a chronic respiratory problem may experience difficulties if travelling to a city with high levels of pollution.

 

Vaccination Recommendations

 

The rationale for recommending vaccination is dependent on the risk of acquiring the disease opposed to the efficacy and possible side effects of the vaccine.  Recommendation should be based on the following:

 

Country/ies to be visited

Exposure risk: rural, urban, remote areas

Length of stay

Sequence of Travel

Time of Year

Living conditions

 

The nature of corporate travel often necessitates the traveller having to leave on very short notice.  In these instances it is often difficult to follow vaccination schedules.  It may be prudent to ensure the business travellerís routine vaccinations tetanus/diphtheria and polio, measles, mumps, rubella are up to date.

 

Presently, Yellow Fever is the only regulated and required immunization (see the Blue Sheet CDC).  The Business traveller should be vaccinated at least 10 days before entering a country that requires proof of vaccination.

 

 

Travellerís Diarrhoea

 

One of the most effective measures in the prevention of Travellerís Diarrhoea is careful personal hygiene, and meticulous food and water precautions. 

 

 

The use of chemoprophylaxis with an antimicrobial agent in the prevention of Travellerís Diarrhoea remains controversial.  However, with regard to a business traveller time lost to illness can spell disaster.  Consideration will need to be given on the importance of the trip and the risk-benefit assessment of the individual travellerís needs.

 

An alternative is the use of bismuth subsalicylate prophylactically (two tablespoons or two tablets four times daily) which is estimated to be around 65% protective against TD and with less side effects than anti-microbials.

 

The other option is self-treatment with an antiperistaltic such as Imodium and/or a quinolone such as Ciprofloxacillin 500mg twice daily for three days.

 

 

Insect Spread Diseases

 

The most significant of the insect spread diseases is Malaria.  The business traveller to malarious zones needs careful advice about an appropriate drug regimen, with emphasise on compliance.  Recommendations will be based on the area to be visited, time spent in the area and any contraindications the traveller may have to the medication.

 

Malarone may be a convenient option for short-term travellers in chloroquine resistant areas having only to be taken 1-2 days before entering a malarious area and for 7 days after leaving the malarious area.

 

Equally as important as prophylaxis is protection against insect bites.

 

As no prophylactic is 100% protective advise the business traveller to report any fevers that develop 7 or more days after exposure.

 

Dengue Fever can cause significant morbidity.  It often occurs in urban areas where typical business travellers tend to visit.  Protection against insect bites should be advised.

 

For those business travellers who may spend extended periods of time in rural settings in certain parts of Asia and South East Asia, Japanese B Encephalitis would be a concern.  Vaccination may be prudent if time permits.  Transmission and prevention of Leishmaniasis, filariasis etc. should be included as part of the pre-travel consultation.

 

 

Jet Lag

 

The crossing of several time zones causes disruptions in the sleep rest patterns.  Symptoms of jet lag can lead to fatigue, irritability and poor concentration.  These conditions may lower business performance or even put the corporate traveller at increased risk for injury.

 

Some suggestions could include:

 

 

 

Personal Behaviour

 

Information and advice should be given regarding sexually transmitted diseases and the increase prevalence and risk of Hepatitis B and HIV in many of the developing countries.  If the business traveller seems reluctant to talk about these issues information can be included in the travel kit or given as separate handouts.

 

A HIV test may be required of the business traveller before a business visa will be issued.  Counselling should be offered to the traveller and the implications of conducting such a test explained.

 

 

Travel Health Kit

 

An appropriately stocked travel health kit is often helpful, as business travellers have neither the time or access to over the counter remedies for minor ailments.

 

Careful instruction would be needed to educate these travellers on the use of such kits.  Certain supplies will be included based on the region and risk assessment.  The kits could include items such as:

 

 

Prescription Medication could include:

 

 

The kit should be checked periodically for expired medication.


 

Psychosocial Health Problems

 

Psychosocial problems such as anxiety, stress, culture shock, separation from families and adjustment problems can occur when travelling and working in new physical, cultural and organizational environments.

 

Helping the business traveller become aware of their own needs, susceptibilities and vulnerabilities forms the key to effective coping.  Encourage any methods that the traveller may have in coping with psychological issues, i.e. deep breathing and relaxation exercises.  Explore the use of alcohol and illicit drugs, discourage their use as coping techniques.  Medication may be appropriate for certain travellers.

 

Miscellaneous Concerns

 

 

Although not covered in this outline due to the coverage elsewhere, the following issues should also be included as part of the travel risk assessment.

 

        Prevention of thrombosis/embolism.

        The importance of comprehensive travel health insurance.

 

 

Bibliography

 

Saphire, L & Doran, B, (1996) International Travel Preparedness, A guideline for occupational health professionals. AAOHN Journal. March, Vol 44 No.3, 123-128

 

Thompson, M., Holihan, MacNeal, B. (1996) Health On The Road-Developing a program for international travellers, AAOHN Journal June, Vol 44 No 6 300-309

 

Liese, B., Mundt, K.A., Dell, L.D., Nagy, L., Demure, B. (1997) Medical insurance claims associated with international business travel Occupational and Environmental Medicine, Vol. 54, 4999-503

 

Ide, C.W. (1994), Strains and Bloats and Trains, or how to travel hopefully and return safely. The Safety & Health Practitioner, September, 14-17

 

Kenmmerer, T.P., Cetron, M., Harper, L & Kozarsky, P.E. (1998) Health Problem of Corporate Travelers: Risk Factors and Management Journal Travel Medicine, Vol. 5 184-187

 

Rogers, H.L. & Reily, S.M. (2000) Health Problems Associated with International Business Travel AAOHN Journal Vol. 48, No8 376-385

 

DuPont, H & Steffen, R., (1997) Textbook of Travel Medicine and Health Blackwell Science Inc

 

 

Submitted by:

 

Louise Williams RN

Tel: 604-987-5526

louise@tmvc.com