Travel Medicine

Col Scott McPhersonLTC Bryan Delage

TRAVEL MEDICINEThe number one cause of illness in travelers is

diarrhea

• SELF LIMITED

• 30 – 60% WILL NEED TREATMENT

• LOPERAMIDE OR ANTIBIOTICS

MILITARY INSTALLATIONS HAVE QUALITY CONTROL FOR WATER

SO THIS MAY BE A HIGH ESTIMATE, BUT IF YOU HAVE BEEN

DEPLOYED YOU KNOW HOW IT CAN BE

First one airman stops by complaining of diarrhea, then two then a dozen

MALARIA

Accidents

Traveled to Turkey? Italy? Crete?Not only are the driverscrazy but you can’t even read the signs

THE CHANCE OF DYING IN ANOTHER COUNTRY FROM

AN

ACCIDENT IS TWO TO THREE TIMES HIGHER THAN IN

THE US

•Mopeds are fun, but not a safe way to travel

•Blood alcohol limits are often lower than .08 in other

places

Where is this sign sending you?

Where is this sign sending you?

Stress and TravelSuicide prevention can begin with reduction of stress

• Some deployers have never traveled overseas

• Remind members of the mental health counselor available

• Marital stress; Financial stress; Separation anxiety

• Expenses – Per Diem; Phone charges

Food and WaterDespite excellent monitoring and Health Department surveillance outbreaks of foodborne illness occur in the US

It is much better, though than even Europe and Asia let alone some of the places to which we deploy

TRAVEL MEDICINETraveler’s Diarrhea

1. Number one cause of illness in travlers

2. 80-85% caused by bacteria – 10% Parasites – 5%

viruses

3. Most are susceptible to oral antibiotics

4. Be prepared to treat large numbers if you are

providing supplies

5. It is usually not necessary to treat prophylactically

6. Hand-washing and hand sanitizers lower the risks

7. But even compliance does not guarantee 100%

protection

TRAVEL MEDICINEThe number one cause of illness in travelers is diarrheaFood Preparation-

At most bases the local restaurants have been checked out by Public Health

BUT. . .That has never stopped an airman From finding a new place to eat

Foods to Avoid• Rare or raw meat; raw fish, shellfish,

crayfish, and sushi that have not been previously frozen

• Raw vegetables, especially leafy salads served in restaurants

• Fruits not peeled by you and fruits with punctured skins

• Aquatic plants in Asia (water chestnuts) • Raw eggs, undercooked eggs,

unpasteurized milk and cheese• Street vendor food unless it is hot and well

cooked• All food that has been left out in the sun,

especially dairy products• Buffet food that has been re-warmed or

recycled

When they get home

A Presentation

LEISHMANIASIS:

Cutaneous is most common – 2-6 months incubation

Transmitted by the sand fly:smaller than a typical mosquitosilentSouthwest Asia locations

Don’t ignore possibility of visceral leishmaniasis

LEISHMANIASIS:

Cutaneous is most common – 2-6 months incubation

Transmitted by the sand fly:smaller than a typical mosquitosilentSouthwest Asia locations

Don’t ignore possibility of visceral leishmaniasis

When they get home

MALARIA:

Unexplained high fever – even if prophylaxis was taken correctly – RESISTANCE Typically 4-6 weeks after finishing medication

DENGUE FEVER:

Painful rigors and high fever – not uncommon in Central and South America – PREVENTION

3-7 days incubation – remember “Bone-break fever”

MALARIA:

Unexplained high fever – even if prophylaxis was taken correctly – RESISTANCE Typically 4-6 weeks after finishing medication

DENGUE FEVER:

Painful rigors and high fever – not uncommon in Central and South America – PREVENTION

3-7 days incubation – remember “Bone-break fever”

Again the most common symptom upon the return From overseas is Diarrhea. Skin rashes are close behind

Again the most common symptom upon the return From overseas is Diarrhea. Skin rashes are close behind

Travel Medicine

Of course you need to tailor all of yourAdvice to specific locations.

Do the research, utilize your resources, intel and public health

Of course you need to tailor all of yourAdvice to specific locations.

Do the research, utilize your resources, intel and public health

What We Didn’t Talk About

• “Athletic” injuries – cuts, bruises, coral burns, sunburn, fractures

• Common infections – URI, UTI, STD’s• Working with the base medical

facility commander (credentialing)• Air Evacuation• Local economy “medical support”

I invite your comments on the AANGFS web page – share your experiences

Scott McPherson, MDCol, MC,SFSJFHQ, NENebraska State Air Surgeonsmcdoc1@gmail.com

Bryan Delage, M.D.LTC, MC, FSNorth Dakota State Air SurgeonBryan.delage@ang.af.mil