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When Illness Strikes on Vacation ...

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As people prepare to go on vacation, they worry about what clothes to pack, about leaving home, their flights, their reservations, the weather, myriad things.

What most people don't worry about is getting injured or sick on their vacation. Why worry about such nasty stuff when the main focus is to have fun?

Hearing about the following incidents, however, can give everyone pause.

Ed Rosner, 60, a semi-retired attorney from Charlotte, N.C., and his wife, left in April from Ft. Lauderdale on a 21-day Holland America cruise to the southern Caribbean. A few days into the cruise, Rosner said he began to experience recurring chest pains. On the eighth day of the cruise, after spending several days in the infirmary, Rosner was told by the ship's doctor he should be treated ashore.

"Since we do a lot of travel, my wife thought it would be a great idea to sign up for MedJet Assistance (a membership program that provides its customers with air medical evacuation from almost anyplace in the world)," Rosner said. "My wife called MedJet Assistance and they took over."

The firm's doctors spoke with the ship's doctors and arranged for Rosner and his wife to be picked up in Grenada. Rosner said a ship's nurse and paramedic accompanied him to shore, where an ambulance was waiting to transport him to a private hospital.

"While we waited for a MedJet Assistance plane to arrive, the medical crew, with their equipment, stayed with me.

"When MedJet Assistance arrived, their nurse and paramedic took over. They were top-notch," Rosner said.

A medically equipped Learjet flew him and his wife from Grenada, via San Juan, to Charlotte-Douglas International Airport, where an ambulance was waiting to take them to a hospital. "The medical crew was in constant contact with my cardiologist and even had photocopies of my medical records."

Linda Sunderlage, 54, of Woodstock, Ill., and her husband were on a bicycle trip in the Czech Republic in August. While walking in a small town near Prague, Sunderlage tripped on a cobblestone street and broke her kneecap. When they got back to Prague, Sunderlage's husband called MedJet Assistance, which advised them to get Linda admitted to a hospital. The Czech doctor who stabilized her leg spoke little English, but MedJet Assistance got an interpreter on the phone in minutes to speak with the attending physician. In short order they arranged to have Sunderlage transported by another medically equipped Learjet from Prague back to Chicago's O'Hare International Airport. An ambulance was standing by at O'Hare to take her and her husband to Northern Illinois Medical Center in McHenry.

"Everybody was very professional," said Sunderlage, who is still on crutches. "They went far beyond our expectations." Sunderlage, who works with her husband in a consulting business, said she had heard about MedJet Assistance from a friend and joined because they both travel for business and pleasure. "We honestly thought the membership would never pay off. We never dreamed they would do all this, but they did exactly what they said they would do."

"We have a system that works very well," said Roy Berger, president of MedJet Assistance, based in Birmingham, Ala. "We have about 90 affiliates in over 20 countries around the world. So depending upon where our member is, and where they need to go, we would use the closest affiliate, which makes a lot more sense than launching an airplane from Birmingham."

MedJet Assistance sells annual memberships - $295 for families, $195 for an individual. Recently added are short-term travel protection plans for 7, 14 and 21 days, whose rates range from $69 to $199. If you are hospitalized more than 150 miles from home, MedJet Assistance will bring you back to the hospital of your choice. The medical evacuation/repatriation services require only that you be hospitalized as an inpatient and need hospitalization upon reaching your destination. (For more information, call 800-963-3538 or see

"Our biggest competitor is travel insurance products," Berger said. "The difference between what they do and what we do is most conventional travel insurance will evacuate you to the closest appropriate medical center. Our program repatriates you. We'll bring you back home."

What happens, typically, is that there are three people involved in the initial transport diagnosis and recommendation: the attending physician, the member's personal physician back home and a physician at the University of Pittsburgh Medical Center, who serves as the company's medical director, Berger explained. The three of them talk to determine the severity of the illness or injury, the need for hospitalization and when and if the member can be moved, he continued.

MedJet Assistance, which has about 26,000 members, doesn't like to talk about the number of people it evacuates annually, but Berger described last August, with 17 airlifts, as "a very busy month for us." He said 60 to 65 percent of the transports are domestic because more people are traveling in the U.S. rather than overseas.

What's jarring about medical evacuations is how costly they are. Rosner's medevac would have cost about $22,800, Sunderlage's $50,000.

This doesn't mean that every traveler should rush to buy medevac or travel insurance, for that matter, but it does mean that people should take time to realistically evaluate their needs and what their personal health insurance covers. Seniors must be aware that Medicare does not cover them outside the U.S.

And, as Berger pointed out, travel insurance doesn't necessarily provide what MedJet Assistance does. But there are always variables.

At Wisconsin-based Travel Guard International, which recently increased medical evacuation coverage to $300,000, its travel insurance policy provides evacuation to "the nearest adequate medical facility or home if medically required."

"It's one of those situations where there's a number of factors that come into play," said Travel Guard spokesman Dan McGinnity. "One factor is the need for expediency. In some cases, medically it might make more sense to take the person to the nearest medical facility. And in other cases the decision might be to send the person home. It's a determination made among the attending physician, medical consultants for Travel Guard and the personal physician, if that person is involved, something we attempt to do."

McGinnity related a recent case in which a Los Angeles woman on a Princess cruise in Alaska experienced chest pains. The ship's doctor didn't have the equipment to make a detailed diagnosis so, at the next port of call, the woman was taken by ambulance to Providence Hospital in Anchorage. She was diagnosed with congestive heart failure.

After a few days, the attending physician determined the woman was stable enough to return home. McGinnity said Travel Guard booked Business Class seats on Alaska Airlines for her and a medical escort, arranged for oxygen on the flight and ambulance transport to her hospital, all covered by her Travel Guard policy. (For more information, call 800-826-4919 or see

"At Access America (a travel insurance firm based in Richmond, Va.), we get the people to the nearest place where he or she can get good medical care," said Beth Godlin, senior vice president for sales and marketing. "And we bring them back home once they are stabilized. We do get them home, absolutely."

Godlin said all the decisions are made by medical professionals, using doctors at the University of Maryland. "We'll have medical people talking to medical people to find out the nature of the illness or injury, what the local care protocol is, and we'll monitor the case. We'll use private air ambulances or commercial airlines, and we'll put medical people with them." (For more information, call 866-807-3982 or see

Cruise lines, for example, deal with medical emergencies fairly regularly. Bill Wright, a captain for Royal Caribbean International and a spokesman for Cruise Lines International Association, a marketing arm for major lines, said ships have well-staffed and -equipped medical facilities on board staffed with doctors and nurses.

Wright, who currently is senior vice president for safety, security and environment for RCI and will become captain of the line's newest (no name or launch date yet) ship, explained the protocol that cruise lines use:

"What normally would happen is that the ship's doctor would make (the captain) aware that there's a guest or a crew member that has a medical condition, presumably life-threatening, in need of immediate medical attention. We start working. It depends on where the ship is in determining what options we have. We would normally contact our office in Miami and it would facilitate contact with the Coast Guard, if helicopter evacuation was an option. We would review where we are relative to ports that we know have hospitals and the ability to get someone to a hospital relatively quickly. It might require a diversion from the ship's itinerary."

Added Wright: "I've always felt that if you have to get sick, especially a serious illness, a heart attack-from my experience the most common medical emergency - a cruise ship is actually a pretty good place to have it. You have doctors and nurses with equipment on the scene within a couple of minutes, which will beat most big city emergency medical services."

While medical emergencies in the U.S. normally can be addressed with a 911 call, it's not the case overseas. Americans traveling abroad are advised to check out the State Department's Bureau of Consular Affairs Web site,

Being aware of all the medical options should you need them can take some of the serious worry out of your trip.




(c) 2003, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.

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