Medical Emergency Abroad

Anything can happen. Rob wrote an article earlier about getting good medical advice before a trip. Adding to that topic, what happens when something more than a case of the trots comes up? I think it is wise to prepare for as many contingencies as possible, considering of course, the practicality of carrying the stuff necessary.

First and foremost, I always buy emergency medical insurance that includes air evac coverage. I use Medex, it costs USD 4 per day for USD 100,000 coverage and gives me great peace of mind. I have seen too many gringos in car wrecks, shot, bruised and broken from whatever trauma, heart attack victims, rape victims, etc. That didn’t have any preparation for the situation in which they found themselves. Having the insurance, at least, allows one to get to a good hospital (usually hard to find in 3rd world haunts) for quality care. Without insurance, bank on at least USD 50,000 to get airlifted to a 1st world hospital.

For the more immediate medical emergencies, I carry my own medical bag. I don’t trust hospitals in the 3rd world to follow precautions and maintain sterile environments or equipment. One example is the Leonardo Maritinez hospital in San Pedro Sula, Honduras. One day I was working in the labor and delivery unit catching babies (for those of you keeping score at home, you do remember correctly that I am a dentist, but that doesn’t mean a whole lot in Honduras, you have to be ready to do everthing). The nurses in the hospital were preparing supplies in between babies. Following delivery, it is necessary, many times, to suture tears or episiotomy sites. Since there is a lot of blood, gauze sponges are used to keep the tissues dry while suturing. The nurses had an assembly line on an old, dirty, desk with a large roll of gauze. One would cut off a section, one would fold the section, the last would wrap it in brown packing paper and tape it. No gloves, no concern for sterility. After the tape, it was ready to use on an open wound.

So to prevent my own demise from other people’s illness, I want to be able to provide the hospital with all they need to keep me going until the air ambulance arrives.

My emergency medical kit (I take groups of people, some of this is for emergencies that may not apply to me, customize yours to fit your needs):
Suture/trauma instruments: Includes needle holders, hemostats, clamps, tissue pick-ups, disposable # 15 scalpel, suture scissors, tissue scissors.
Quick Clot: Clotting agent designed for battlefield use in massive trauma. Comes in a vacuum packed 3.5oz bag.
Box of sterile 4×4 gauze
roll gauze bandages
Abdominal pads
3-5cc syringes
3-3cc syringes
Epinephrine pen
3-18 ga 1″ needles
2-22 ga 1 1/2″ needles
1-23 ga 1″ needle
IV catheters large and small ga (2 each)
IV/IM benadryl
IV/IV phenergan
Small tube of cake icing
Albuterol inhaler
Lidocaine plain
Assorted sizes of steri-strips
4-0 chromic gut suture (cutting needle)
4-0 silk suture (cutting needle)
Alcohol swabs
Betadyne solution
Benadryl tabs
Phenergan tabs
Sublingual nitroglycerin
Rehydration salts

In the places I travel, IV solutions are readily available, but if you go where that is different,you may need to make arrangements to have a bag of saline or lactated Ringer’s solution in your kit.

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