Transporting a critically ill patient from the Canadian north - lessons learned from almost a decade of SkyService Medevac experience
International Journal of Infectious Diseases
Abstracts was 14 days. Thirty-five percent of international travelers were traveling to low-income countries, 46% to low-middle income, 16% to upper-middle income, and 2% to upper-income countries. The main purposes of travel were vacation/leisure (63%), business (20%), extreme-adventure travel (14%), education/research (11%), visiting friends and relatives (10%), non-medical service work (6%), and providing medical care (4%). Two percent of travelers were attending large gatherings. Ten
... were children less than 18 years of age; 4% were less than 5 years of age; and 6% of travelers were over 65 years of age. Sixty-four percent of travelers listed a medical condition; 70% were on daily medication. Ten percent of travelers reported a pre-existing neurologic or psychiatric condition; 7% reported a pre-existing intestinal condition; 2.5% were immunocompromised; and 0.4% of female travelers were pregnant or breastfeeding. We analyzed vaccine usage for prevention of hepatitis A, yellow fever, and influenza. Eightyone percent of travelers received immunization against hepatitis A; 7% were considered preimmune. Of the 38% of travelers visiting countries that included areas endemic for yellow fever, 67% received yellow fever immunization; 18% were considered pre-immune. Yellow fever vaccine was administered to 407 travelers 60 years of age or older. Forty percent of international travelers received influenza vaccine; 30% were considered pre-immune. Of the 2082 travelers traveling to countries that included areas endemic for malaria, 65% received malaria chemoprophylaxis. Of these, 66% received prescriptions for atovaquone-proguanil, 3.5% received doxycycline, and 14% received mefloquine. Conclusion: These data suggest that international travelers range widely in age and frequently have co-morbid medical conditions that heighten the need for pre-travel advice. Background: International travelers play a significant role in the global spread of infectious diseases, especially travelers to low and middle-income countries (LMICs). Despite this, limited data exist on sources of health information used by these travelers. Methods: To address this, we surveyed 1,254 international travelers who reside in the U.S. and were departing from Boston-Logan International Airport in 2009. Results: Of the 1,254 travelers, 671 (54%) were traveling to LMICs. The mean age of travelers to LMICs was 42 years, and 30% were traveling for more than 2 weeks. Purposes of travel included vacation/holiday (63%), business/work (11%), educational/cultural exchange (6%), performing volunteer work (10%), adventuring (7%), attending a large gathering (2%), providing medical care (3%), receiving medical care (0.5%), and adoption (0.3%). Nineteen percent were traveling as part of a family that included children, and 104 (16%) were born overseas and returning to visit friends or relatives (VFRs). Among travelers to LMICs, 50% did not seek any medical advice and 74% did not see a healthcare professional prior to travel. For travelers who did not seek medical advice, the most common reasons cited were lack of concern about health issues (60%), not thinking of it (35%), not having enough time (7%), inconvenience (3%), and expense (2%). A significantly lower percentage of VFRs sought anysource medical advice prior to travel compared with other travelers (37% vs 52%; p = 0.004). VFRs were less likely than other travelers to use the Internet (12% vs 24%; p = 0.004), and less likely to see a specialist practitioner prior to travel (2% vs. 15%; P < 0.001). VFRs and other travelers were equally likely to seek advice from primary care providers prior to travel (21% vs. 17%; p = 0.32). Conclusion: Our results suggest that half of travelers to LMICs do not seek any healthcare advice prior to their trip, and that most of such travelers do not seek advice from a health care professional. The most common reason these individuals cite for not seeking medical advice is lack of concern about health problems related to travel. These results suggest a need for health outreach and education programs targeting travelers to LMICs.