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An ER Doc's Guide to Safe Travel

What’s in Her Suitcase?


What does an ER physician pack before heading on a beach vacation?

“There are four things I never leave without – sea sickness remedies, topical medications, drying drops for ears and, of course, sunscreen,” said Cindy Bitter, MD, emergency physician. “And when I take a hiking trip, I always bring extra wound care supplies, ACE wraps and enough Motrin to take daily.”

Whether you’re planning a trip near home, traveling across the U.S., or you’re one of the nearly 39 million Americans who travel abroad each year – planning ahead can go a long way to a healthy, safe vacation.
Dr. Bitter, a world traveler, has visited 50 countries and every continent. Here’s her stay-prepared travel check list.



• Match your trip to your daily activity level.
• Anticipate medications and immu­nizations needed well in advance.
• Watch the altitude – consider a short trek in the U.S. at a similar altitude prior to hiking, biking or mountain climbing in a foreign country. 



According to the Centers for Disease Control, blood clots can develop in your legs during long flights due to sitting and dehydration.

You can help prevent blood clots by:
• Flying business or first class.
• Drinking plenty of water in-flight; avoid alcohol.
• Taking medications prescribed by your physician.
• Wearing graded compression stock­ings or support hose.
• When permitted, moving about during the flight and doing ankle exercises.



Jet lag is a temporary “disorder” among air travelers who cross three or more time zones; their internal clock hasn’t re­set to the new environment. Symptoms include fatigue, headaches, irritability, decreased concentration, poor sleep and gastrointestinal problems.

Getting seven to eight hours rest a night and avoiding caffeine, alcohol and large meals during flight can help reduce the effects of jet lag. 



Some 60 percent of travelers to Latin America, Africa, the Middle East and Asia will acquire diarrhea. People with a weakened immune system, inflamma­tory-bowel disease, diabetes, or those taking antacids are at higher risk.

“It may interrupt a day’s activities, but usually doesn’t cause enough dehydra­tion to seek medical attention,” said Dr. Bitter. “It’s due to ingestion of bacteria in contaminated food or water. And, it’s generally preventable.”

The main treatment is hydration. Drink plenty of bottled water or tea and pasteurized juices. Electrolyte supple­ments are not usually necessary. Speak with your physician about taking anti-diarrhea medications, such as Imodium and lomotil for one to two days. Seek medical attention when you have:
• Fever.
• Blood in the stool.
• Moderate to severe abdominal pain.
• Lightheadedness, dizziness when standing or passing out (symptoms of dehydration).



Think before trying risky activities while away from home. “People sometimes do silly things when they travel like signing up for resort scuba diving for the first time, going cage-diving with sharks, tackling the Alps or feeding the stingrays,” said Dr. Bitter.

Motorcycle and auto accidents are the most common cause of death for travelers. When traveling abroad, remember that driving customs are very different. Avoid motorcycles (use a helmet if you must ride one). Be extra cautious in countries where they drive on the wrong side of the road – hiring a local driver is generally safer than driving yourself.
Violence, especially street crimes in poor nations, is the second most common travel injury. Be aware of surroundings and travel in groups, especially at night. Do not display valuables or money, and keep a small amount of cash easily acces­sible, with credit cards and most money hidden in a money belt.

Drowning is the third most common injury, especially in the Caribbean and Pacific Islands. Do not swim or boat while drinking alcohol, wear appropriate fitting life jackets, and know your limita­tions. Ocean swimming is strenuous; do not touch coral or harass marine life.



The most important advance planning “to do” before any extended trip is a conversa­tion with your primary care physician six to eight weeks prior to departure. Discuss pre-existing medical conditions, medica­tions for self-treatment, your risk of blood clots during air travel, and vaccinations.



“I never plan a trip without it,” Dr. Bitter explained. “My dad got sick and I couldn’t travel. I got every penny back. People need to think about the health of their children and parents. It’s not just your own health you should be concerned about.”

Medicare and most U.S. health insurance policies do not cover medical treatment or air ambulance evacuation abroad. The need for insurance usually increases with age and preexisting medical conditions.


“Africa. I love South Africa. It is really special. It’s the culture. You can go on a winery tour one day, then sleep in a tent and hear a lion roaring the next day.



While medical care abroad can be harder to reach, travel is the most amazing way of connecting with the world and its people. Go! Do it! But – take precau­tions. Be smart.

For more safe traveling tips visit the following websites: www.cdc.gov and www.acefitness.org.
This information is designed to present general information and is not intended to replace counseling by your physician or travel health specialist.

Cindy Bitter, MD, MA, FACEP, FAWM, is board-certified in emergency medicine and on staff in the Emergency Department at Missouri Baptist Medical Center. She received her medical de­gree from the University of Kansas and com­pleted her internship in internal medicine at Northwestern University and her residency in emergency medicine at the Medical College of Wisconsin/Milwaukee County Hospital.


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