Would you know what to do if a fellow traveller had a seizure or an asthma attack? Dr Jane Wilson-Howarth helps you help companions with specialist needs
What’s worse than experiencing a medical emergency in a far-off location? Watching a friend or companion getting into extremis and not knowing what to do. Forearmed, you’ll cope – so how do you prepare for the worst?
If you’re travelling with someone with a pre-existing condition, it’s crucial to make sure you’re both fully insured and that any on-going medical challenges are declared. Admitting to background problems may increase premiums, but it means such conditions are properly covered. Don’t let someone travel uninsured just because cover is expensive or hard to find. Try specialist patient groups for advice.
Every traveller needs to prepare properly, seek advice and get fully immunised before departure. For those taking regular medication, or with long-standing health problems, this is even more vital: it is best to set out with a doctor’s blessing, after appropriate medical checks.
Those with recurrent ailments should also consider wearing alert jewellery that will be visible to medics (www.medicalert.org.uk), and finding out where hospitals are at their destinations.
Unfamiliar foods, packaging and languages all mean that it’s easy for a person even with known allergies to swallow something they shouldn’t, or for a new form of allergen to catch them off guard. Note that while severe allergic reactions are certainly frightening – both to experience and to witness – very few are life-threatening.
At the first sign of an allergic reaction – redness, swelling, itching – the sufferer should swallow an antihistamine tablet; those commonly available over the counter in the UK (cetirizine or loratadine) are highly effective.
Usually symptoms settle quickly, but if things get worse, some sufferers will use an EpiPen. This is an easy-to-use adrenaline/epinephrine injection that is prescribed by the patient’s GP and tends to be used if breathing is compromised.
If the reaction is bad enough to need the EpiPen, the sufferer should be encouraged to attend a clinic for a check-up straight away. The victim’s companion should know where the EpiPen is kept and must look at the (simple) operating instructions before needing to use it.
Reactions confined to the skin but causing persisting itching should be helped by a sedating antihistamine such as Piriton or Phenergan at bedtime. Raised red itchy wheals respond well to a steroid cream or ointment such as Eumovate.
Medical kit must-haves: Antihistamines; steroid cream; EpiPen.
Asthma is an annoyingly unpredictable condition and new environments can cause an unexpected attack (although equally travel often improves symptoms). Big cities with bad pollution (eg Mexico City, pre-monsoon Kathmandu) can make asthmatics wheeze, sometimes for the first time since childhood.
The first action is to remove the sufferer from the polluted air. Then someone should go in search of a salbutamol (Ventolin) inhaler; these can be found in pharmacies worldwide. If the sufferer is struggling to breathe, sitting them in a steamy environment (eg a shower) can help. A mask can be improvised by shoving the inhaler through the end of a polystyrene cup.
Medical kit must-haves: ‘Blue’ inhaler; preventative inhaler (if a known recent asthmatic); a course of steroid tablets (from GP); list of the generic names and doses of regular medications.
If you’re travelling with someone with diabetes ask them how ‘well controlled’ their blood sugars are, and whether they’ve ended up in hospital. Many factors, including a change in foods and routine, can compromise normally excellent control if changes have to be made with insulin dosing.
If the dosing isn’t quite right, the sufferer’s blood sugar can plummet to almost nothing; if this happens, they feel unwell (pale, sweaty, shaky, nauseated, anxious, etc) and can even slip into a coma. Many people who live with diabetes recognise the early signs, check their blood sugar and take in sugar: a ‘dose’ is two teaspoons or three lumps.
However, low blood sugar can make people muddled so your companion might need encouragement to eat. Having a few sweets to hand is a useful precaution and may aid a sufferer. Illness can also majorly upset control of diabetes, causing blood sugar to go too high. If the victim seems to be deteriorating – despite extra sugar – you’ll need to find the local hospital.
Medical kit must-haves: Sweets; carbohydrate snacks in case of delays; glucagon injection; FRIO medication wallet to transport insulin; glucose meter.
It’s not a great idea to travel with unstable epilepsy. The traveller should have had a review to ensure they are on the right medication before setting out. It is worth asking them how often fits strike and what precipitates them.
An epileptic seizure is terrifying to witness although fortunately most stop without treatment in less than a minute. During that time though, the victim isn’t breathing and is at risk of hurting themselves by crashing or falling into danger or into water.
If the victim is in a safe situation, the best action is simply to move any hard objects, such as furniture, away from the sufferer and let the fit stop on its own. It isn’t necessary to force anything into the mouth – tongue biting is common but tends to happen at the beginning of the fit so intervention won’t work.
Once the fit has stopped the victim will awake feeling vague and confused and will need somewhere quiet to sleep it off. They may also have been urine-incontinent, so might need to change.
The main threat to life is if the fit doesn’t stop on its own – in which case you’ll need to get to a paramedic or hospital for intravenous or rectal diazepam.
Medical kit must-haves: Paracetamol, in case of a feverish illness; list of the generic names of regular medications.
25% Approximate percentage of Brits that suffer some form of allergic reaction at some time in their lives.
1 in 100 Proportion of people living with epilepsy.
5.4 million Asthma sufferers in the UK.
3 million Number of people in the UK who have been diagnosed with diabetes.
50% Percentage of people with epilepsy that will be affected by flashing lights.
Dr Jane Wilson-Howarth has briefed many ill-prepared co-travellers; her goldmine
of travellers tips, How to Shit Around the World, is now available in Kindle format.
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