Medical preparations

Medical insurance
Each team member should be covered by a medical insurance plan while on the mission trip and carry the medical insurance card with him or her. Each team member should also have emergency medical evacuation insurance. Ask each person to double check whether their medical insurance will cover them while they are overseas. If their coverage does not include overseas travel, they may want to consider getting a short-term policy with an insurer who will provide this coverage. Two options are insuremytrip.com and GOMissionTrip.com. EMM does not have any connection with these insurers and is not responsible for the service or options these websites provide.

Immunizations
Research immunizations that are required or recommended for your outreach location. You can do so by going to the website for the Center for Disease Control at cdc.gov/travel and looking at the “Traveler’s Health” section. You may also want to check with your family doctor or with agencies such as Passport Health.

Passport Health in Lancaster, Pa.
150 Farmington Lane #201
Lancaster, PA 17601
(800) 839-4007

After determining what immunizations are needed, pass this information on to your team as early as possible so that they can make arrangements to receive any needed vaccinations.

We frequently recommend the following for our short-term teams for all locations:
  • Tetanus and diphtheria (Td): All adults should have an updated booster every 10 years.
  • Measles, mumps, and rubella (MMR): All children or young adults should have a second MMR as a booster.
  • Prescription for traveler’s diarrhea
The following immunizations are dependent on location:
  • Polio: A one-time booster is needed as an adult if a booster has not been given since childhood. This is particularly critical for those traveling to developing countries.
  • Malaria: Medication and dosage varies depending on location. Consult with your doctor.
  • Hepatitis A: Risk increases with duration of travel and is highest for those who live in or visit rural areas or frequently eat or drink in settings of poor sanitation. However, it can also occur in normal accommodations and food consumption.
  • Hepatitis B: This vaccination should ideally begin six months before travel in order to complete the full series. However, the vaccination schedule should be initiated even if it will not be completed before travel begins. You may be able to receive a combined Hepatitis A and B series.
  • Typhoid fever: Vaccination is particularly recommended for those who will be traveling in smaller cities, villages, and rural areas off the usual tourist itineraries. Travelers should be cautioned that typhoid vaccination is not 100 percent effective and is not a substitute for careful selection of food and drink.
  • Yellow fever: This immunization can be given only at certain designated centers. In Lancaster, Pa., an appointment can be scheduled at Passport Health (800 839-4007) or    General Internal Medicine (717 397-2738). Some countries require a signed certificate; ask your physician for proper documentation and take it on the trip with you.
Emergency contacts and crisis planning
Check with your hosts about their plan for responding to an emergency should the need arise (location of closest medical facility, the best route, etc.). Thank them for preparing a contingency plan. Inform team members what to do in the event of an emergency or crisis (stay where they are or gather at a particular location, etc.). 

Carry with you the information you would need in the event of an emergency:
  • Name and phone number of designated emergency contact (someone staying at home who will receive any calls and pass on information as appropriate) and prayer coordinator
  • Emergency medical information forms
  • Host country contact person's phone, e-mail, etc.
  • Detailed itinerary including hotel/guest house addresses and numbers for each place your team will be staying
  • Phone number of local embassy or consulate for emergencies (embassy information worldwide can be found at embassyworld.org)

Emergency first aid

Bleeding
With a clean cloth or sterile dressing, apply firm, direct pressure over the wound to stop the bleeding. Maintain the pressure until trained medical personnel arrive. Have the person lie down to avoid fainting. Raise the person’s feet higher than their head. DO NOT use tourniquets unless an amputation has occurred and direct pressure cannot control the bleeding.

Broken bones and sprains
Immobilize the affected extremity in the position found. Apply ice packs to minimize swelling. If the broken bone protrudes through the skin, cover it with a dry sterile dressing but DO NOT try to push it back in. If bleeding is excessive, use direct pressure over the area to try to stop the bleeding. If you suspect multiple broken bones, or that the person’s neck, back, pelvis, or thigh might be broken, DO NOT attempt to move the person. Let trained medical personnel transport the person.

Burns
Remove the person from danger. Keep the burned person lying down. Raise burned arms or legs higher than person’s heart. Cover burned area with a cool, wet cloth. DO NOT break blisters or remove burned skin. DO NOT use butter, ointments, or other home remedies.

Choking
  • If the person can speak or cough, then he or she is able to breathe and the airway is not totally blocked. Encourage the person to cough out the object. DO NOT interfere with efforts to do so.
  • If the person cannot speak or breathe but is still conscious, you must quickly dislodge the object that is blocking the airway by using the heel of your hand and giving four, quick, very hard blows on the person’s back between the shoulder blades.
  • If the object does not dislodge with the back blows, then use the Heimlich Maneuver.
    1. Stand behind the person and place one clenched first just below the ribs in the middle, upper abdomen. Place your other hand on top of the first hand.
    2. Very forcefully pull the clenched first directly backward and upward under the rib cage (as in a bear hug from behind). This should loosen the object.
  • If the person has already collapsed, call for emergency medical help immediately. Place the person on his back, turn the head to one side, open the mouth and look for and remove any visible foreign material. If none is seen, place the heel of your hand on the person’s middle-upper abdomen and give a forceful push. This should dislodge the foreign material into the mouth, from which you can remove it.
Convulsions
Call for emergency medical help immediately. Protect the person from further injury. Turn the person onto one side so that saliva is able to drain out without being inhaled into the lungs. DO NOT force anything into the person’s mouth. DO NOT try to restrain the convulsive movements.

Fainting/dizziness
If a person reports “feeling faint,” have him lie down on his back until he feels better. Raise his feet higher than his head. Check the person’s airways, breathing, and pulse. Apply a cold compress to the person’s forehead and have him inhale aromatic spirits of ammonia. If fainting is associated with chest pain, convulsions, or severe headache, or if it lasts more than one or two minutes, transport the person by ambulance to a hospital. Fainting is a relatively common problem. Nevertheless, heart attack, stroke, internal bleeding, insulin reaction or other serious conditions should be considered.

Head injuries
Call for emergency medical help immediately. Always consider whether there might have been an associated injury to the neck. If so, DO NOT move the person until trained medical help arrives. Apply a sterile dressing over the wound and secure it snugly with a roller bandage. Severe, deep lacerations should not be cleansed. Heavy pressure should not be applied to severe lacerations. Make sure the person’s pulse and respiration are normal.

Heart attack
The person may experience pain or feel heavy pressure in the center of his chest. Pain may extend to the jaw, shoulder, and arms. The person may feel a burning sensation in their chest similar to a feeling of indigestion. He or she may perspire, feel nauseated, vomit and/or have difficulty breathing.
  • DO NOT wait to see if the pain/discomfort goes away.
  • Call for emergency medical help immediately.
  • Have the person lie down, and make the person as comfortable as possible. Loosen the    clothing at neck, chest, and waist. Keep the person warm, but not hot.
  • If the person suddenly collapses and loses consciousness, try to awaken him or her. If the    person cannot be awakened, and if he or she is not breathing and has no pulse in the neck, begin CPR.
Neck or back injuries
Call for emergency medical help immediately. Immobilize the head, neck, and shoulder area to prevent movement. DO NOT move the person at all unless absolutely necessary to save their life. DO NOT touch or prop up the person’s head. If the person stops breathing, begin mouth-to-mouth resuscitation immediately (four quick breaths followed by two breaths every five to ten seconds.). DO NOT move the person’s neck unless absolutely necessary to open the airway.

Poison/overdose
  • Swallowed poison: Do not give anything by mouth until you have called for professional advice. 
  • Chemicals or household products: Unless victim is unconscious, having convulsions, or is unable to swallow, give milk or water immediately and then call for professional advice about whether you should make the victim vomit. Call the Poison Control Center or hospital emergency department and describe the product, the amount swallowed, and the time ingested. Look inside the person’s mouth for burns that might indicate the ingestion of an acid or alkali. Also, smell the person’s breath to see if it smells like a petroleum product (gasoline or kerosene). If either sign is present, DO NOT induce vomiting. Loosen clothing at person’s neck and waist. Keep person quiet and warm. Take container of suspected poison along to the emergency department.
  • Inhaled poison (fumes): Immediately get the person to fresh air. Avoid breathing fumes. Open doors and windows wide. If victim is not breathing, start artificial respiration.
  • Poison on the skin: Remove contaminated clothing and flood skin with water for 10 minutes. Then wash gently with soap and water and rinse.
  • Poison in the eye: Flood the eye with lukewarm (not hot) water poured from a large glass 2 or 3 inches from the eye. Repeat for 15 minutes. Have victim blink as much as possible while flooding the eye. Do not force eyelid open.
Unconsciousness
Call for emergency medical help immediately. Check for an open airway and for a pulse. If the person cannot be roused but is breathing well and has a good pulse, they should be placed on one side in case of vomiting. Do not induce vomiting. If the person is not breathing and has no pulse in the neck, begin CPR. If drug ingestion or poison is suspected, take the container of the suspect toxin along to the emergency department.
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