Safe and Sound Part 2:
Getting Home When Injured
with CMO - APAC Region

SPEAKERS 

Dr Neil Slabbert, Cheryl Hood 

Cheryl Hood  00:04 

Hi, welcome to navigate. I’m your host Cheryl Hood, and I’m the client relationship director for World Travel Protection Australia. Joining me today is Dr. Neil Slabbert, our Regional Chief Medical Officer for APAC. Neil has more than 20 years of experience in emergency pre-hospital and aeromedical retrievals. He is currently a senior staff specialist in emergency medicine in South East Queensland, Australia, and holds an honorary contract at the Royal London Hospital and London’s air ambulance where he previously worked as an emergency medicine and pre Hospital Care Consultant for eight years. Thanks for joining us, Neil. 

Dr Neil Slabbert  00:41 

Lovely to be Cheryl. Thanks for the intro.  

Cheryl Hood  00:44 

In this episode, we’re going to hear from Neil about his clinical experience and how that underpins his decision making when supporting our customers who require medical assistance while away from home. At World Travel Protection, Neil works closely with our other two regional chief medical officers who are located in EMEA and the Americas. Some of you may have listened to part one of this series where we spoke with Dr. Joel Lockwood from our Canadian office. Our episode today will focus primarily on the APAC region, and is part two of a three part series. Something unique to World Travel Protection compared to other travel risk management providers is that our chief medical officers are clinically practicing physicians in their chosen field. I mentioned your experience briefly in the intro, Neil. But can you expand on that a little bit more please and share more on your medical background? 

Dr Neil Slabbert  01:35 

I’ve been an emergency physician for just over 15 years, having completed my fellowship with the Australasian College of Emergency Medicine. Originally I obtained my medical degree in Cape Town, South Africa, having worked there for four years before immigrating over to Australia. I’ve worked for some iconic brands in Australia, namely the Royal Flying Doctor Service, and I’m currently practicing in a large emergency department in southeast Queensland. In addition to this, I also practice pre hospital medicine with the Queensland ambulance service. In the past, as Cheryl said, I’ve also worked for almost eight years in London, both at the Royal London Hospital and for London’s air ambulance. 

Cheryl Hood  02:23 

So Neil, how do you think that medical assistance makes a difference if you’re in an emergency situation whilst you’re abroad? Can we maybe talk through an example? 

Dr Neil Slabbert  02:33 

Sure. I think where medical travel assistance is rarely in the forefront is, as we see more often and often is travelers in remote locations or remote areas. Many walking tours, and many cruise ships often are in these rural and remote locations. And often we see on large cruise ships, they do have medical facilities, but at times, if a customer is very sick, this is beyond the medical facilities on board the cruise ship. Where it becomes very challenging and interesting is cruise ships in our area will often go via the South Pacific Islands, and there’s varying degree of medical health care available in these islands. It’s a spread of some islands having very well developed medical systems, such as New Caledonia, and some islands being more as developing countries such as PNG or Vanuatu. As a recent example, and I have deidentified the information, there was a customer on a cruise ship who suffered a significant fall on a cruise ship in the waters of Papua New Guinea, where the ship was the only available facilities to offload the customer was far north PNG with very limited, non hospital clinic type facilities available. The cruise ship was unable to manage the limb fracture that this customer had sustained during a fall and through prior notification with the doctor on board of the cruise ship, World Travel Protection was able to arrange an ambulance to meet the customer a few hours after she was offloaded in a far north rural location of PNG. Why this is important to us is that with advanced notification or prior notification by the doctors on cruise ships and after the assessment of relevant coverage out of play, World TRavel Protection is able to reach out to our credentialled providers on the global care network and organize aeromedical evacuation like in this instance, to fly the customer, onboarding the ambulance with the medical team in attendance to the nearest Center of Excellence, or even sometimes, as in this case, to her home location in Brisbane. 

Cheryl Hood  05:15 

Thanks, Neil. That’s a really great example. We certainly see a lot of volume across that area in both the leisure and the corporate space. So certainly an area I’m sure you’re very familiar with. So Neil, with your extensive experience in emergency medicine and aeromedical retrieval, what would you say are some of the key trends and challenges that you’ve observed over the last few years? 

Dr Neil Slabbert  05:37 

The main thing we’ve observed with the resumption of travel after COVID is a much faster availability of our usual aeromedical providers. While the COVID pandemic was on, travel opportunities were very limited, and we’re some customers we could usually fly with commercial aircraft as a medical repatriation with a nurse. This was not available during the pandemic. And often these customers would then require an air ambulance. Normally, an air ambulance with all the clearances and certificates needed, would be able to launch in six to 12 hours. The challenges we saw with COVID was that often before an ambulance or an air ambulance could launch was that the crew first had to have proof that the swabs were COVID negative. Once that was done, the necessary airspace clearances would have to be obtained. And once that was done, were we only able to confirm an accepting or receiving hospital for the customer. This often lead from our usual six to 12 hour launch time, sometimes to 48 to 72 hours. 

Cheryl Hood  06:56 

So Neil, you mentioned commercial repatriations, in your earlier comment, can you perhaps explain to our listeners the difference between an air ambulance evacuation and commercial repatriation? 

Dr Neil Slabbert  07:10 

Sure, an ambulance evacuation by nature of the word air ambulance is almost a much more immediate response. Normally, air ambulances will have a medical team on board made up or be the nurse or paramedic and medical doctor of one of the critical care specialities. As mentioned previously, air ambulances are able to launch usually within sort of 12 to 24 hours. A commercial repatriation is by nature a less urgent mission. We often use commercial repatriations to return the customer home and this can be either at the end of their medical care in location or if they need ongoing medical care once they return. But their medical care is not such a nature that they need to be admitted into ICU. We do find though it is sometimes advantageous to use commercial repatriation so i.e. on commercial airliners, like the large airliners that fly from Europe or London via the Middle East, mainly Dubai or Singapore and into Australia. We do often use these sometimes for critically unwell patients the advantage being one that journey time is often a lot quicker. Two, the fuel stops they have is a lot less. Some air ambulances in order to fly from London to Australia would need four to six refuel stops. 

Cheryl Hood  08:55 

So Neil, would you find from time to time that you ever have misaligned recommendations between the customers treating team and your medical team here at World Travel Protection. 

Dr Neil Slabbert  09:07 

We often find that treating clinicians or physicians in location are unaware of a stretcher commercial repatriation. This is when a medical provider is tasked to repatriate a customer who’s either very unwell or with limited mobility that they’re unable to sit in the usual airline business class seat. Although the launch of this is not as quick as an air ambulance evacuation, due to the fact that the repatriation provider needs to get various medical clearances from the airline and the airline needs to fit a stretcher, it is a very effective option to get the customer home quickly and safely. The reasons for this is some ambulances  will require four to six fuel stops to fly from either Europe or UK into Australia, with airlines only requiring one fuel stop in the middle east be at either Dubai or Singapore. When there’s a prolonged layover at the transit in Dubai or Singapore, we sometimes do make use of medical facilities at the airport to admit the customer while the repatriation medical team is looking after them, while the customer is in transit. 

Cheryl Hood  10:36 

So how do you or your team know who to use in these sort of situations? How do you choose a provider? 

Dr Neil Slabbert  10:44 

We use the global care network. The global care network is something unique to WTP. And it is essentially our in house database of preferred providers. These providers have all been credentialed and audited and meet the high standards that WTP expects from a provider. This includes having all the necessary insurances in place, and a robust clinical governance framework. 

Cheryl Hood  11:18 

So Neil you’ve got a lot of experience with working, living and I assume traveling across the world. How does the APAC region differ from the other regions when it comes to medical assistance and evacuations? And how do we how do we address these sorts of differences at World Travel Protection? 

Dr Neil Slabbert  11:35 

The South Pacific and Southeast Asia is essentially the back yard or Australia and New Zealand either be it for corporate or for leisure travelers. Australians love to travel there- the areas offer very diverse experiences. And as we all know, as travelers, these areas are also very affordable. This gives us great volume, and gives us local expertise specifically in these areas. We do find sometimes that the language barrier might be an issue specifically as travelers are more in rural and remote locations. However, we do have a strong network of local area providers or local area agents on the global care network that we can obtain most reports in English. 

Cheryl Hood  12:32 

So considering how large our backyard is, Neil, would you say there are some geographical differences though between one part of a country and another in regards to how we support customers. 

Dr Neil Slabbert  12:45 

I would say as far as we support customers, the support we offer as a business be they corporate leisure customers is always the same. What we do see is a difference of medical care between countries in South East Asia. And this even becomes more apparent in rural remote areas. As an example, we do sometimes have to transfer either via road or by a local ambulance, some customers from rural areas into the larger cities in the same country. This is often because the rural remote area isn’t equipped to perform the necessary surgery via abdominal surgery, orthopedic surgery that the customer may need urgently. And hence it is necessary to bring them into a larger Medical Center. It is also not an option to delay the surgery in such a timeframe that they are able to return to their home country, be it Australia or New Zealand. 

Cheryl Hood  13:55 

So when we think about the APAC region, specifically, what would you say perhaps are some unique medical risks that our travelers might face? And how can these risks be mitigated by those customers before they head off on their trip? 

Dr Neil Slabbert  14:12 

I’d say specifically in Southeast Asia, the most frequent medical risks we see all moped accidents, mosquito borne diseases and the risk of rabies either from dog bites or monkey bites. As with anything, prevention is always better than cure. And the last thing that we want is for customers to ruin their holiday from something that is very preventable. So prior to leaving home, make sure your insurance policy be it leisure or business has the necessary insurances. If you are planning to ride motorcycles, make sure that policies got the necessary provisions and cover. We find very few folk are actually rabies vaccinated. And depending on the category of rabies bite that they received, the most often one we see is what’s called category three bite where the skin is broken and blood is drawn. In this instance, what the customer requires is both a combination of four doses of rabies vaccine, and that’s usually performed over a month. But more importantly, in order to begin to fight rabies immediately, they need an injection around the wound called rabies immunoglobulin. We do sometimes see there’s limited or no availability of this rabies immunoglobulin in some of the countries and often the only option is to fly the customer either into another country or to fly them home. The great thing about rabies immunoglobulin is that you do have up to seven days to actually administer it. With mosquito borne diseases., prevention is definitely better than cure. And if you are going to country that’s known with mosquito borne disease be it either Dengue or malaria. It is advisable, firstly, fine not to travel there in the wet season. If it is a malaria high risk area to see your GP six to eight weeks before you go to consider whether you need malaria, chemo prophylaxis. And also then when you’re on holiday, avoid mosquitoes if you can. This is obviously mosquitoes are most active at the hours of sunrise or after sunset. Use mosquito repellent. Make sure if it’s very heavy with mosquitoes, the room you have has also got the necessary mosquito netting. 

Cheryl Hood  16:54 

Thankfully, from a technology perspective, the World Travel Protection team have the travel assist app available to our business travelers. Would you recommend that something that our travelers utilize to obtain some information as well? 

Dr Neil Slabbert  17:09 

The WTP travel assist that is a great tool for up corporate travelers. The advantage of this app is it provides real time security and health information of the area that are actually in at that time. They can also prior to leaving, research the area and just see what risks be at either medical or security that they need to be aware of.  

Cheryl Hood  17:40 

Thanks, Neil. And of course, they can also call into World Travel Protection Command Center for pre travel security and medical advice as well, which is certainly something that we encourage our travel risk management clients to do before they head off on their journey. So what would you say are some of the best practices for travelers and for organizations to ensure that they’re receiving the best possible assistance and care whilst they’re on the journey? 

Dr Neil Slabbert  18:08 

The best example is, notify us early. That’s what we are for we open 24/7 365 days a year. We operate three command centers, one in London, one in Toronto, and one in Brisbane, Australia that are manned round the clock 24/7. The important thing of notifying us early should you require medical assistance is that we can provide what’s called directional care. Directional care means you can either be referred to what’s called a virtual health care doctor. So have a medical appointment in the comfort of your hotel room on a mobile phone. Or we can direct you to a local health clinic, or if necessary, to the best most suitable hospital with early notification to World Travel Protection when you are in medical need, we can ensure that you have the right care at the right place at the right time. And if necessary, we can also arrange you move to a higher level of care be that in the same city or even in another location. 

Cheryl Hood  19:22 

So Neil, can you perhaps share an example of this to our listeners? 

Dr Neil Slabbert  19:28 

As an example, if you have got an extensive cardiac history and you’re traveling and you suddenly begin to experience some angina or chest discomfort – One it is very important that you seek urgent medical care. And secondly, very important that you notify WTP early. The reason for notifying us early is that on the global care network, we can evaluate the capability of the hospital. The medical team consisting of medical consultants, nurses and paramedics can also contact your treating physician and clinician to revalidate the capability of the hospital. Of concern is specifically if you’re having a heart attack, or you’ve had a mini heart attack, we might deem it medically necessary to move you to another hospital in order for you to get the best care. 

Cheryl Hood  20:27 

So call us early, and we’ll help you from there to ensure you’re getting the right level of care. Neil, is there anything else you’d like to add that our travelers could do to prepare themselves before they head off on their journey? 

Dr Neil Slabbert  20:39 

The most important thing for both leisure and corporate travelers is to go and see their regular health care practitioner six to eight weeks prior to departure. The advantages of this is that some countries require vaccinations to enter, namely the yellow fever vaccination. But more importantly, if you do have any pre-existing medical conditions to ensure that you have a sufficient supply of these medications prior to departure, your local health care practitioner will also be able to advise you whether some of these medications are prohibited in the countries you’re traveling to. It is also really important to note that certain medications may not be available in certain countries where you’re traveling and hence, it is really important that you have a sufficient supply of your own. World Travel Protection will often get calls from customers that have run out of their medications or lost some of their medications. To ensure that you don’t lose your medication, it’s really important to make sure when you’re traveling that your medication is always carried as hand luggage. 

Cheryl Hood  21:53 

So Neil, do you have any final thoughts for our listeners on how to stay safe and healthy whilst they’re traveling? 

Dr Neil Slabbert  22:00 

Sure, final thoughts are. As said previously, we are a medical assistance and travel risk management company. If you require medical assistance, it is really important that you notify us early. This ensures you get the right care at the right place at the right time. Early notification also leads to the medical team being able to speak to the treating clinician or physician in location to obtain up to date medical information about your condition. And should your condition needed it, WTP can also begin arranging either a commercial repatriation or air ambulance evacuation. The other advantage of course of early notification and us ensuring that you’re in the correct health care facility is that for our leisure and corporate travelers, you’re able to either resume your dream holiday a lot earlier or for our business travelers, get back to business. 

Cheryl Hood  23:06 

Thanks for your time today, Neil. It’s been great to chat and learn more about the support that we provide our customers across the APAC region and beyond. Watch out for episode three of the series where we shift our focus to the EMEA region. And we hear from Dr. Luke Banks from the UK Command Center WTP. Looking for the best travel podcasts to inspire your upcoming adventures while also helping you travel smarter? Listen to NAVIGATE – the top travel podcast that enhances the way you explore the world found on our world travel protection.com site under our travel assist help. In each episode, a World Travel Protection host speaks with a travel industry expert or experienced everyday traveler to bring you thought provoking travel insights, experiences and advice helping empower you to travel the world confidently. Subscribe wherever you listen to podcasts to always catch our latest episode. That’s all for today’s episode. Thanks for listening goodbye and safe travels.