Travel insurance and medical evacuation

To the Editor: Grace and Penny present some fascinating “travellers tales” concerning travel insurance and medical evacuation.1 Although I recognise that there may have been difficulties with individual cases, the article probably paints an unnecessarily bleak picture of travel insurance and medical assistance companies. About a fifth of travel insurance claims involve the successful use of the emergency assistance service, which mostly does not involve aeromedical evacuation.2 Evacuation by a dedicated air ambulance is uncommon among travellers.2 Almost all travellers in need of medical and dental treatment source treatment locally, for which they are generally reimbursed. Aeromedical evacuation, where needed, is more likely by scheduled airlines with or without an escort.

The article may raise unrealistic expectations among travellers for aeromedical evacuation. Air ambulances do not operate and respond in the same way as ground ambulances. Time is required to assess and prioritise cases, select suitable aircraft, obtain flight plan clearance, check and equip aircraft, brief retrieval and receiving hospital personnel, and develop contingency plans. Aircraft may be required to refuel en route, as air ambulances tend to be based where they can be maintained and staffed adequately and safely — this may be far from the retrieval site.

It is useful to raise travellers’ awareness of the possible difficulties in accessing adequate medical facilities in many developing countries, especially where tourism is promoted, and create a sense of travellers’ responsibility for their own health, safety and welfare. The International Society of Travel Medicine has articulated this in a recently released policy statement.3 Readers should be wary of generalising from a small number of case studies from a “popular tropical island holiday destination”.1 It would be useful to collect data on medical retrievals and emergency assistance provided from various sources and consult all interested parties before attempting to establish guidelines for medical evacuation.

Grace and Penny do raise the important issue of the need for appropriate travel insurance for all travellers. This message needs to be conveyed by the travel industry and by travel health advisers. The article referred to a study of the travel health advice provided by general practitioners in New Zealand, but did not mention that only about half the GPs in that study routinely discussed travel insurance.4 A similar study in Australia indicated that less than 40% of GPs routinely give advice on travel insurance.5