Safety and security in Travelers

 A personal safety and security assessment is an important area that should be covered by a travel health advisor for virtually all destinations. It should include among other things : travel health insurance – medical assistance abroad -  contingency plan –

Epidemiology of Mortality in Travelers:

The most common cause of death among travelers is cardiovascular events ( MI and CVA).

The most common cause of preventable death and second most common cause of death is injury  : Motor vehicle traffic accidents are the leading cause of injury-related death followed by drowning

The third most common cause of death was medical illness  (Pneumonia-liver disease- cancer-)

Death among American Travelers 1975-1984

• Cardiovascular 49.0%
• Injury ( preventable) 22%
• Medical 13.7%
• Cancer 5.9%
• Others: 5.5%
• Suicide / Homicide 2.9%
• Infectious Disease: 1%

Prepare- Research and Plan your trip: Assess Risk of accidents- Civil Strife

·        All travelers should be directed to sources of travel advisories ( Foreign affairs services: DFAIT – US State Department). This information should be examined prior to departure. It can also be accessed while traveling in case of emergencies through the internet or from a local embassy or diplomatic mission. Knowledge is power.

• In case of civil unrest – terrorism – demonstration – the traveler should keep a low profile and stay as far away as possible from the area of unrest.
• Carefully evaluate your level of preparedness ( physical fitness)   .
• Underestimating risks or overconfidence can lead to trouble.
• Do not yield the responsibility for your safety to others.
• Having a guide does not eliminate risk. Research adventure company very carefully.
• Travel health insurance may not cover illness secondary to terrorism. Long term travelers should consider registering with local diplomatic mission ( can be done on the internet ).

 www.dfait-maeci.gc.ca/passport : passport office

www.dfait-maeci.gc.ca  : DFAIT

www.tc.gc.ca  : Transport Canada

www.ccra-adrc.gc.ca  : Canada Customs

Check weather at destination

Will you need an International drivers licensed.

Visit to travel medicine specialist for risk assessment – vaccinations etc.. prior to departure.

Packing for your trip

• Detail equipment and clothing needed -
• Place all items that could be perceived as threatening into your checked  luggage.
• Bring small flashlight
• Bring money for emergencies ( US funds) 
• Avoid over packing – check size of carry-on suitcases. Avoid oversize suitcases – use suitcases with wheels – Pack lightly – Test weight by pack walking around the block with your luggage. Bring small day pack.
• Identify them with a distinctive marker- label with you work address not your home address- place extra address label and name of first destination hotel inside suitcase.
• Pack medical kit + supplies ( original pill containers) in a medical looking bag. Some prescription medications may be illegal ( codeine in Greece).Carry a waiver letter from an MD.  So vital drugs such as asthma  Inhalers may be confiscated by local authorities ( Japan- Germany) because of ecology concerns with inhalers. Restriction lists can be found in the Internet.
• Pre-existing medical conditions information on MediAlert bracelet
• Solvents and other common items may pose a health
• Brings locks for trip but do not lock suitcases prior to security check.
• Leave expensive jewelry – cameras, etc…  at home.
•  
• Have a pre departure check list: Tickets – Money ……
• Confirm flights.

Airport:

• Arrive early
• Expect increase security- dogs - heavily arms officers in some countries.
• Expect and prepare for multiple identification checks. Keep documents at hand. Passports- driver’s license – official photo ID
• Prepare electronics to be demonstrated.
• Never wrap gifts
• Review new regulation for airport security : unlocked bags, unattended bags, carry-on regulations ( sharps – needles) – Identification papers – Metal detect ( removal of metal containing articles such as belts, shoes).
• Maintain awareness – keep your possessions always at hand.
• Check luggage receipts
• Only take officially licensed taxis and shuttles.
• Sharp objects such as knives ski poles- hockey sticks- razors-darts  are prohibited. As are guns- handcuffs-power tools

Flying:

·        Stay aware – read emergency instructions- know exits. Pay attention to safety briefing.

·        Bring essential medication with you on the plane

·        Always use restraints while seated.

·        Be careful when lifting luggage and opening and closing overhead luggage holders.

·        Avoid excessive use of alcohol.

·        Be courteous

During Travel :

• Avoid traveling alone- Avoid being alone in remote areas ( beach – off beaten track ) . Group tours are best ( but not without risk) for remote areas or high security risk destinations.
• In remote areas bring extra supplies : food – water –emergency kit
• Always have an emergency alternate plan.
• Avoid illegal behavior – drugs – sex trade - etc…Avoid being an inadvertent drug smuggler ( lock bags when traveling outside airports - check your bags at border crossings)
• Inform friends – family – embassy of itinerary
• Take precautions and stay alert against theft- mugging – scams
• Carry personal safety devices: alarms-door jams-whistles-.
• Never accept food drink from strangers ( drugged)
• Check out the room and it’s locks before paying for it.
• When selecting hotel room: avoid ground floor or room with easy access from outside. Avoid rooms higher than 10 floors up in case of fire. Book a room close to elevators –
• Never open hotel door to unannounced strangers or hotel staff.
• Leave hotel keys at reception
• Use hotel safes
• Invest in small smoke and security alarm
• Avoid excessive alcohol use. Do not accept food  drinks from strangers or new acquaintance - Drinks may be spiked leading to mugging.
• Do not flash expensive possessions
• Make copies of all important documents and information-leave copy at home
• Bring emergency money in USF
• Use money belts – polycotton safety pouches for vital documents-possessions.
• Use front carrying day bag with heavy straps and good quality  fasteners
• Dress according to local customs – avoid under dressing- avoid being conspicuous
• Stay in safe – reputable areas
• Use Bank machines only  in visible safe areas – stay alert
• If mugged give up your wallet and not your life- always have a few extra USF bills to give to muggers.
• Report mugging to authorities – seek medical care if needed- keep copies of all reports – charges- . Notify travel Insurance provider and foreign service ( if serious incident).
• During marine sports care should be taken of current-riptides-heavy waves- dangerous marine animals – low standard scuba operators-

Transportation during Travel

• The most common preventable  cause of death among travelers
• Avoid poorly  maintained vehicles. Rent- use- hire – the best form of transport you can afford.
• Consider renting a cell phone for emergencies
• Do not pick up hitchhikers
• Avoid traveling at night or bad weather
• Avoid driving yourself in foreign countries –
• Avoid speeding – alcohol – breaking laws of the road
• Avoid light vehicles such a scoters- motorbikes- bikes- tuktuks-pushbikes
• Use helmets if using bikes ( not always required by local law)
• Use seat belts ( if available)
• Check your directions before departure.
• Keep doors locked especially at traffic lights
• On trains or buses chain luggage if you plan to leave it unattended or while you are sleeping.
• When going out after sundown arrange for a taxi to take you out and back.
• Avoid areas of armed conflict
• Expect road checks – police corruption – need to use bribes.
• Travel in caravans if armed bandits expected.
• Check safety of the area with local consulate.

Cultural sensitivity

Research culture and customs. Be aware of local sensitivity such as dress,  behavior when eating, greeting, etiquette.  Prepare for different attitudes. A faux pas could have serious implications. Read up  cultural etiquette for destination country( guide books, Internet, meeting with intercultural groups).

Traveling  with children :

·        Children now need their own passport

·        Bring along child safety carrier or infant car seat- book sky crib and bulk head seat.

·        Minimal movement inside aircraft without restraints- avoid sleeping on the floor.

·        Ask airline for special seat restraints that may be available.

·        Hold child securely in parent’s arms for take off –landing- turbulence

·        Check emergency measures checklist on take off – check exits.

·        Keep some form of identification in child’s pocket in case of accidental separation. Bring a recent picture of your child for emergency identification.

·        For children under 16 carry a custody waiver signed by the non traveling parent.

Woman Travelers:

• Increased security risk warrants extra vigilance. Consider self-defense course .
• Security half-slips are available to hide documents - money.
• Travel with a partner to reduce chance of harassment.
• Eye contact with men may be unacceptable in some cultures ( wear sunglasses)
• Never hitchhike or accept ride from strangers.  
• Use reputable taxis ( always best to double up with another traveler).
• Dress appropriately – error on the side of modesty.
• Check out Journeywoman website for worldwide  dress codes.
• After sundown go out with an escort or in a group, and stay close to hotel. Going out alone may not be “respectable” in some countries.
• Maintain connection with at least one person at home – notify them of location and next destination.
• Carry a business card from your hotel in case you get lost.

Business traveler

• Always meet your business contacts in the lobby of your hotel. Avoid giving your room number.
• Carefully study acceptable behavior – dress- cultural does and don’t- especially for businesswoman working abroad.

Travel Insurance

A must for all travelers

Medical and Dental assistance insurance

Evacuation insurance

Lost luggage and documents

Cancellation insurance

Legal cost

Additional cost for travel – accommodations incurred do to illness.

Transportation of body in case of death during travel

Seeking Health Care In Foreign Countries.

• Patients with chronic or unstable disease should travel with adequate medical supplies and full documentation of their illness ( Recent ECG – medical record summary). Consider placing your medical record on line or using a service that does.  Use Medic Alert services.
• Do not assume that the Health care system is similar to the one left at home.
• Seek out units that have a reputation of caring for foreigners.
• Contact embassy – consulate- hotels for referral to a good medical facility.
• Carry a IAMAT booklet and membership
• Clarify payment issues from the start
• Make Doctor/Nurses comfortable and willing to help you. Or smile a lot
• Avoid dictating your needs on foreign providers.
• In some cultures asking questions may be perceived as challenges to the authority of the doctors.
• Have an exit strategy that will allow you to bow out gracefully from the care if you are dissatisfied.
• Have plenty of good travel insurance.
• Expect to pay cash before being treated.

Dr Paul Assad

References :

Travel Medicine Advisor

Catmat Website

IAMAT

Travel Medicine and Health ( DUPONT-STEPHEN)

JTM VOL 8 No1 Pages 46-50

Health and Travel : Eric Coumes

“Her Own Way”, DFAIT

The Globetrotter’s guide : Caryl  Dolinko