If you get sick on your next trip – really ill, you will probably never see Eugène Delaune. But chances are he and his partner, Jim Evans, are behind the scenes, advising your travel insurance company on how to treat you. Their travel medical assistance company might even save your life.
Delaune and Evans are emergency physicians who run a low-profile consulting firm called SentinelMED that advises insurance companies on critical medical decisions. They’re the guys on call when something really goes wrong while on vacation, from a car accident to a heart attack.
These doctors have seen it all. Travelers with gunshot wounds. Diabetics trapped in an airport during a riot. Patients with acid burns caused by a volcanic eruption. Terminally ill travelers dying abroad. In total, they process an average of 600 cases per month for their largest customer, Allianz Travel Insurance.
But nothing could have prepared them for the pandemic, an event that pushed them to the limit of their abilities. Even as the number of monthly cases fell to just 150, SentinelMED’s team of doctors and nurses had to become experts in pandemic travel rules and regulations – an ever-changing target that doubled the difficulty of every medical problem.
“COVID has made us more adaptable,” explains Delaune.
As the pandemic begins to subside, travel medical assistance experts like Delaune and Evans are playing a key role in restoring confidence in travel. Their recent experiences are both a cautionary tale and a roadmap for anyone planning a vacation this year.
Travel medical assistance: a rare specialty
Doctors and a small support team working out of an office in Alexandria, Virginia, have rare expertise – they specialize in treating people with serious health issues while traveling. Only a handful of other consulting firms, including AP Companies, International SOS, and Redbridge Assist, do this type of work.
Delaune, a former Air Force flight surgeon, honed his skills with periods of service in Germany and Iraq. He had to make decisions on how to treat injured soldiers. But he also learned to transport critically ill patients.
There are factors that would not even cross the mind of some experienced healthcare professionals. For example, can you transport a patient with heart disease abroad? Aircraft cabins are pressurized to 8,000 feet above sea level, reducing the amount of oxygen in the blood by about 8 to 10 percentage points.
“You only get 92% oxygen saturation,” explains Delaune. “If you have heart disease, it is not enough to make your heart beat.”
Delaune taught Evans in the emergency medicine residency program at George Washington University. Evans was fascinated by the subspecialty of medical transportation. Like Delaune, he saw an opportunity to help travelers get home safely. They decided to launch SentinelMED together.
Help on “M3” cases
Although the two doctors continue to practice as emergency physicians as part of a team of traveling emergency physicians with American Physician Partners, their primary focus is on solving the more complex travel medicine problems, called internally case “M3”.
Every morning, Allianz sends them their most difficult cases. These are medical problems that require the intervention of a person with experience in travel medicine. “Should anyone seek treatment at a local hospital or be relocated?” Said Delaune. “How should they be moved? And where?
Allianz keeps patients anonymous, indicating only their age, gender and health status. Typical cases in an average day may include travelers with broken bones, cardiac arrests, animal bites, and some unexpected injuries.
Delaune remembers a patient in Belize who suffered an eye injury and then disappeared. Her team found her and obtained medical attention.
“We were surprised to find out that his eye injury was actually a gunshot wound,” Evans recalls.
Another memorable case of travel medical assistance involved an overweight traveler who was too tall to be airlifted to a hospital in the Bahamas. SentinelMED helped charter a barge that could bring him back to Miami.
The last hurray and the acid burns
There is a kind of case that doctors call “the last hurray.” It is an elderly or terminally ill person who leaves for his last vacation. Delaune remembers a cancer patient who fell into a coma while in Italy. It was clear that he would never wake up and that he had hours to live. His wife had to decide whether to resume her cruise or stay with her husband. Remarkably, she decided to continue her vacation, leaving instructions to have her spouse cremated.
Some cases involve mental illness. There was the couple who couldn’t leave Brazil because of an airport riot. One of the travelers started to suffer from complications from his diabetes and had to be treated in a hospital. In the meantime, his wife suffered a nervous breakdown and was sent to another hospital. The two had to be evacuated separately.
One of the most horrific medical issues involved a 2019 volcanic eruption on White Island in New Zealand. Hydrofluoric acid gas emitted by a volcano attached itself to ash particles, which fell on a group of tourists. Hydrofluoric acid is strong enough to eat through glass. He chewed skin, flesh and bones.
There is no antidote for the toxicity of hydrofluoric acid. Instead, doctors try to lessen the damage by administering massive doses of intravenous and topical calcium. The patients survived.
SentinelMED doctors are there primarily in an advisory capacity, so they recommend patient arrangements and then work with the travel insurance company and field doctors to help patients get home. But sometimes, SentinelMED doctors get directly involved in a resolution, using a team of trained nurses to help with medical evacuations.
How the pandemic changed travel medical assistance
As hard as it sounds to believe, these cases were relatively straightforward compared to the challenges Delaune and Evans faced during the pandemic. Each country had a stringent and ever-changing list of entry, exit, and quarantine requirements. What should have been simple medical evacuations suddenly turned into time-consuming cases. Some patients couldn’t just leave the country. SentinelMD had to make arrangements for quarantine and COVID-19 testing. They had to apply for special permission from governments or airlines to transport patients.
“We had to make sure that every I was pointed, every T crossed,” says Delaune.
The pandemic has also underscored the value of travel insurance, he adds. In some countries, hospitals won’t even admit you unless you fork over for a credit card. Travel insurance can help by dealing directly with the establishment and guaranteeing payment. Insurance is also much less expensive than having to hire a company like SentinelMED directly. Even something as simple as a broken arm or appendicitis can cost you $ 50,000.
For major surgeries and intensive care, the costs can run into the hundreds of thousands of dollars. SentinelMED services can range from $ 6,000 to over $ 100,000 when an air ambulance is required.
The latest Allianz Vacation Confidence Index suggests travelers remain nervous even as they start planning other trips. Spending on summer vacation this year will hit $ 153 billion, a 160% increase from last year and a 50% increase from 2019. But 44% of those who prefer not to travel say it’s because they are always concerned about health and safety. .
Travel medical assistance companies like SentinelMED can resolve, but not eliminate, some of these concerns.