Prof Wayne Derman MBChB,BSc (Med)(Hons) PhD, FFIMS. Pre-travel Preparation and Medical Issues During Travel: What the team physician should do

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1 Prof Wayne Derman MBChB,BSc (Med)(Hons) PhD, FFIMS Pre-travel Preparation and Medical Issues During Travel: What the team physician should do

2 Before the journey: Due Diligence Travel to destination for scoping visit Or if not: much of the investigatory work can be done over the internet Tools to use include: CDC/WHO website Host country tourist website Host country Dept of Health Website - meds Plug points Google images Google earth situation of hotel and proximity to pharmacy and A&E unit 2

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Hepatitis A + B Yellow fever Hepatitis A + B Yellow fever Hepatitis A + B + E Malaria Dengue fever Bilharzia Cholera Elphantiasis Japanese Encephalitis Hepatitis A + B Malaria

11 Hepatitis A + B Yellow fever Hepatitis A + B Yellow fever Hepatitis A + B + E Malaria Dengue fever Bilharzia Cholera Elphantiasis Japanese Encephalitis Hepatitis A + B Malaria Cholera Typhoid Meningitis Yellow fever Hepatitis A + B Malaria Bilharzia Cholera Typhoid Meningitis Yellow fever Hepatitis A + B Malaria Cholera Typhoid Meningitis Yellow fever

12 Before the journey: Due Diligence Environmental factor checklist 12

13 Environmental Factor Check List Altitude & Time zone Temperature Allergens & Pathogens Atmospheric pollution Ultraviolet radiation Access Food, Water & Electricity quality

14 Problems: Exercise-induced bronchospasm (EIB) Allergic rhinitis

15 A graphic depiction of the Pollen calendar for South Africa Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trees Grass Weeds Data source: south Africa Allergy Society

16 Signs and Symptoms of Allergic Rhinitis in Athletes.

17 Atmospheric Particle Pollution Particles are classified according to aerodynamic diameter: Coarse (<10mm; PM10) Fine (<2.5mm; PM2.5) Ultrafine (<0.1mm; PM0.1) Quality standards for PM10 and PM2.5 in the United States and the United Kingdom are 50mg.m -3 and 15mg.m -3 respectively

18 Atmospheric Chemical Pollution Ozone (O 3 ) Nitrogen dioxide (NO 2 ) Sulphur dioxide (SO 2 ) Volatile organic compounds (VOCs)

19 Guidelines for each pollutant Pollutant Guidelines Organisation Nitrogen dioxide 200µg/m 3 - hourly mean World Health Organisation Suphur dioxide 125µg/m 3-24 hourly mean World Health Organisation Ozone 120µg/m 3-8 hour running mean World Health Organisation Lead 0.5µg/m 3 - annual mean World Health Organisation Particulates (sub 10 microns) 50µg/m 3-24 hour running mean United Kingdom Obtained from

20 Ultraviolet radiation UVB index scale Burn-time 15min 20min 30min 60min 120min Description Very dangerous Dangerous High Moderate Low Obtained from

21 Ideally, UV-B exposure should not exceed moderate at any time during the year Moderate between 0 and 7 MED High between 7 and 14 MED Dangerous between 14 and 24 MED Very dangerous above 24 MED Obtained from

22 Before the journey: Get certificate of able to practice or local colleague IOC/IPC network Source nearest AE unit, pharmacy, imaging Next of kin, get power of attorney for underage Medical Insurance Policy 22

23 Lessons Learnt from my time as a CMO: Plan for the worst Death of an athlete or official Serious illness in athlete or official Criminal act towards athlete or official Missing team member or kidnapping Natural disaster Terrorism or political instability Athlete returns an AAF or has an anti-doping infringement Disciplinary hearing or infringement Personal crisis 23

Before the journey: Jet lag strategy Airline course for adapted travel Seating plan (housing plan) One hour before-one hour after 27 Delays at connecting flights (movement, II, CP)

27 Before the journey: Jet lag strategy Airline course for adapted travel Seating plan (housing plan) One hour before-one hour after 27 Delays at connecting flights (movement, II, CP) Upgrade for high need individuals Access is main challenge List of medications & supplements and disclaimer Schedule education session at camp Identify your high risk travelling athletes

28 During the journey: Usual movement guidelines (modified) Advise on hydration and nutrition Remember anti-infection protocol Assist to bathroom and back Remove prosthetic devices Keep a stock of emergency meds & catheters to use onboard 28

29 29 Q: Are things different with Paralympic athletes: YES and NO!

30 The journey home: Leave as soon as possible. My busiest day was after competition Alcohol Sunburn Lacerations Unprotected intercourse Sprained ankle DVT unilateral swollen leg Some conditions present after return to home Malaria.. 30

31 Thank you for your attention! Prof Wayne Derman MBChB,BSc (Med)(Hons) PhD, FFIMS

Our Mission. To promote healthy and safe travel by providing medicines, preventive vaccines and health counseling to a diverse group of travelers

Our Mission. To promote healthy and safe travel by providing medicines, preventive vaccines and health counseling to a diverse group of travelers Our Mission To promote healthy and safe travel by providing medicines, preventive vaccines and health counseling to a diverse group of travelers The Travel Clinic utilizes national and international travel