Callahan Michael V, Hamer Davidson H
Biodefense and Mass-Casualty Care Center for Integration of Medicine and Innovative Technologies, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02139, USA.
Infect Dis Clin North Am. 2005 Mar;19(1):85-101. doi: 10.1016/j.idc.2004.10.010.
Travelers to extreme environments and those who spend long periods of time in settings with limited health care resources need to have more detailed pretravel screening and education than the routine short-term traveler. Expatriates, relief workers, and Peace Corps volunteers need to receive careful pretravel medical, dental, and psychologic screening before deployment. Knowledge of special risks associated with the environment in which they will be stationed is necessary to provide effective education about ways to reduce or eliminate the risk of illness and death. The travel medicine practitioner should also provide detailed, region-specific recommendations regarding emergency care while traveling in remote regions. Information on foreign medical facilities and practitioners should be gathered in advance and regularly updated. Many fee-for-service directories of overseas medical centers are often out of date and do not include emergency contact information. Once deployed, systems should be in place to ensure the traveler's continued personal safety and maintenance of good health. Although these systems are generally beyond the scope of work of travel medicine providers, it is important for the long-term traveler to be aware of the need to be prepared to deal with unexpected medical events. In the event of an overseas emergency, the travel medicine specialist may be called on to facilitate ground or air medical evacuation to the most appropriate medical center, to communicate treatment priorities and pertinent medical details to foreign medical providers, and to facilitate international air evacuation or repatriation if necessary. In each of these cases, the experience for the patient and the travel health professional is dramatically improved by adhering to risk-reduction measures, such as pretravel screening, pretravel health and safety education, and preparing for emergencies in advance.
前往极端环境的旅行者以及那些在医疗资源有限的环境中长时间停留的人，需要比常规短期旅行者进行更详细的行前筛查和教育。外派人员、救援人员和和平队志愿者在部署前需要接受仔细的行前医疗、牙科和心理筛查。了解他们将要驻扎的环境所带来的特殊风险，对于提供关于降低或消除疾病和死亡风险方法的有效教育是必要的。旅行医学从业者还应提供关于在偏远地区旅行时紧急护理的详细的、针对特定地区的建议。应提前收集并定期更新有关国外医疗设施和从业者的信息。许多海外医疗中心的收费服务名录往往过时，且不包括紧急联系信息。一旦部署，应建立相应系统以确保旅行者的持续人身安全和保持良好健康。尽管这些系统通常超出了旅行医学提供者的工作范围，但对于长期旅行者来说，意识到需要做好应对意外医疗事件的准备很重要。在发生海外紧急情况时，旅行医学专家可能会被要求协助将患者通过地面或空中转运至最合适的医疗中心，向国外医疗提供者传达治疗优先级和相关医疗细节，并在必要时协助进行国际空中转运或遣返。在上述每种情况下，通过坚持采取降低风险的措施，如行前筛查、行前健康和安全教育以及提前为紧急情况做准备，患者和旅行健康专业人员的体验都会得到显著改善。
