Figuring out where to turn and what to do in an emergency can be difficult in even the best of circumstances, but for employees who have transferred recently for work and who are unfamiliar with their new location, the complexities often grow exponentially. Navigating language barriers, local health care or emergency response systems, and cultural nuances can be overwhelming for expatriates who find themselves in crisis mode.
When worst-case scenarios strike, transferees and their families need a support system they can turn to. Often, having a plan in place is the difference between a positive outcome and a full-scale disaster.
When planning for the unexpected, it is important to remember that emergency situations come in all shapes and sizes. The following scenarios are real anecdotes from Americans abroad.
Essentials of Pre-trip Planning
Employees should be advised to do their homework before travel, and if pre-trip education is not part of your company’s protocol, there should be serious consideration around updating policies to include this essential step in emergency and incident preparedness. The following 10 items should be on every soon-to-be-transferred employee’s required reading (and packing) list:
- Overview of seasonal patterns and typical weather conditions for the destination.
- List of endemic diseases (and how they typically are spread) and vaccination requirements (absence of proof of vaccination can preclude entry into some countries).
- Contact information for a local emergency medical service provider (911 is a uniquely American phenomenon and the destination country may have no such system in place).
- Location and contact information for the nearest hospital with Joint Commission International accreditation.
- Overview of capabilities at the nearest reputable hospital or medical center (Does the facility have radio imaging technology, an intensive care unit, operating rooms, specialists?).
- Overview of the current political climate in the destination as well as a history of any recent large-scale protests or military coups.
- Location and contact information for the nearest U.S. embassy (a reliable resource at times of trouble).
- Cell phone instructions, numbers, and codes to allow for international calling and the ability to roam.
- Written medical emergency response plan detailing procedure for attaining assistance in health and insurance matters while abroad.
- List of all prescriptions each traveler in the group currently takes, the generic name, and the frequency and dosage details.
Scenario One
“My baggage was lost by the airline and contains a prescription I have to take daily. Can I get a refill in Shanghai? Where? Can I trust that the pills I get will be safe?”
Whether an emergency is medical or security-related—and no matter how commonplace (a cut on the leg) or catastrophic (a terrorist attack)—determining how and where to find help can vary greatly depending on where you are. This is why it is essential to arm your employees with a support network of experts who not only understand crisis response, but understand the intricacies of foreign medical systems, have a grasp of local legal protocol, and knowledge of a wide range of geographies and cultures.
Take, for example, the fairly common crisis of losing one’s prescription drugs, an emergency that ranges in severity from low to extremely high depending on the condition for which the medicine is needed and the potential effects of a stoppage of treatment.
When a prescription drug is dispensed through a reputable pharmacy in the United States, the patient generally can be assured that the drug has been reviewed and approved by the U.S. Food and Drug Administration and that it meets a set of fairly stringent safety standards set out by organizations including the Drug Enforcement Agency, Agency for Healthcare Research and Quality, and the Centers for Disease Control.
Such a high level of oversight is not a universal phenomenon. Therefore, the refilling or purchase of prescription and over-the-counter drugs while abroad should be done with caution, as medicines might be mislabeled or contaminated. Having a medical expert on call for consultation is an important safety measure to help employees determine reputable sources for medications and avoid counterfeit, expired, or tainted prescription drugs.
Scenario Two
“I was driving in Mexico when I was rear-ended. I had trouble communicating with the other driver and the officer who came to the scene, and now have been put in jail.”
Motor vehicle incidents are the leading cause of injury and death for American business travelers abroad. There are a few reasons for this prevalence, and often several factors compound to create a sort of perfect storm.
Recently relocated employees, or those just passing through an area while stationed abroad, typically are unfamiliar with local roads, the rules that govern them, and the weather and terrain conditions that can affect driving. This unfamiliarity often results in a lower level of confidence behind the wheel and a higher level of distraction, leading to greater numbers of accidents that are more severe. Add alcohol use, speeding, or jet lag to the mix and the risk is heightened exponentially.
When an accident occurs, the employee may find him- or herself in a remote location and without legal counsel. In these cases, depending on location, the situation can become greatly exacerbated. In some areas, foreigners often are blamed for causing an accident even when they are not the guilty party. Even worse, those who seem to be reputable police officers can turn out to be unhelpful or even corrupt.
All employees should have a number they can call for assistance in case they are in an accident. Ideally, they have these emergency contacts listed on a small card they carry with them at all times with designated contacts for legal and well as medical assistance.
Scenario Three
“I cut myself badly and am in the emergency room of the nearest hospital I could find in Quito, Ecuador. Now the doctor says he won’t see me unless I pay in cash up front. I don’t have enough money on me.”
In 1986, Congress passed EMTALA (Emergency Medical Treatment and Labor Act) as part of the 1985 Consolidated Omnibus Reconciliation Act (COBRA): no patient who presents to an emergency room will be turned away or unnecessarily transferred. This fundamental American civil right ensures that indigent and/or uninsured individuals always will receive treatment in emergency situations. Such is not the case elsewhere. In fact, in many countries, regardless of the clinical emergency (i.e., multiple trauma with active bleeding and/or open fractures, chest pain, respiratory difficulties, and the like) only cash (typically American dollars) will guarantee admission through the door and only with more cash will the doctor (or facsimile) even appear.
Never take your organization’s medical insurance policy for granted because the worse time to find out if something is not covered is when an incident occurs. Insurance companies pay bills and manage claims but will not actually manage and coordinate medical care outside the United States; this task often is sub-contracted to an assistance company. For example, if an employee is based in Romania and needs a surgeon, an assistance company is called to find a qualified provider and send the doctor’s office a guarantee of payment so the patient gets medical care.
Savvy multinational companies have learned to work directly with assistance companies to ensure that an employee’s medical care is consistent with their organization’s standard of care, costs are managed effectively, and necessary communication takes place within an organization if an emergency occurs for business continuity reasons. Around-the-clock availability of doctors with local knowledge on the ground in many geographical locations is a critical factor when considering the choice of any assistance company.
Emergency Planning and Support Systems
Any traveler or expatriate who has experienced an incident like those described above likely needs no convincing that contingency planning and having a support system to call on is essential before beginning any international trip. Surprisingly though, according to the Control Risks’ 2007 “Business Travel Report,” more than 10 percent of U.S. business travelers said they never do any research on the countries they visit. Perhaps even more shocking, the same study found that as many as 70 percent reported they never carry an emergency phone number.
As mentioned in the sidebar, a support system should be in place for every employee traveling abroad. Whether this system is internal or made available through a partner assistance provider, it is essential that measures be in place to provide guidance and aid in both medical and security scenarios. A crisis does not differentiate between these two categories and neither should the assistance provider, as often these incidents occur simultaneously or even as a result of each other (for instance, an employee may be injured by shrapnel caused by a terrorist bomb explosion).
In an ideal world, the best laid emergency plans and support systems are never used and phone lines stay silent, indicating a safe and uneventful transfer or travel experience. But when things do go wrong—as they all too often do—employees need to have a name, a number, and a protocol in place and at their fingertips. Knowing who to call for help can make all the difference.
Robert Quigley, M.D., D. Phil, is regional medical director, Americas Region, International SOS Assistance, Inc., Trevose, PA. He can be reached at +1 215 942 8000 or e-mail robert.quigley@internationalsos.com.