Volume 30 Number 1 ISSN:1059-6518

By Frank Hubbell, DO

FACT: 1.1 billion people cross international borders every year!

How many of these international travelers know what is waiting for them at the end of the runway or on the other side of the border? At home you are most likely safe. You have potable drinking water, safe food to eat, reliable power, screens on your windows and doors to protect you from marauding insects, and have excellent, available, immediate health care when needed. To put it simply, most of us live in a bubble. The question is, are you sure that you are prepared for the times when you leave the safety of your bubble?

This is the material that we use in our Travel Clinic to help educate and prepare people for international travel. We offer it here for your review and, if necessary, take with you to a consult for travel medicine.           


Make Out a Trip Itinerary:

When are you going and for how long?



Where are you going?



What are you planning on doing while there?

Travel plans?

How are you planning on getting around?

Previous International Travel History:

When did you go?

Where did you go and for how long?

Past Medical and Surgical History:


Medications – name and dosage

Immune Status – any history of autoimmune diseases, HIV, DM

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Medications That an EMT Can Administer or Help Administer




The Backpack or Traveling Pharmacy

By Frank Hubbell, DO

A group of long time friends, three couples and various children, were always coming up with new adventures to share. One of the couples loves to sail and suggested that they should all get together and rent a sailboat for a couple of days and go for an ocean voyage. Over the next several months that idea for a great vacation grew, as did their enthusiasm. They eventually were able to rent a sailboat along with its captain in the US Virgin Islands for their Great Adventure. The ship could accommodate all ten of them for a grand week of cruising on the great blue Caribbean sea.

Off they went to the Caribbean and for the first three days all went well. In the evening of the forth day, several of the younger kids began to feel sick with scratchy, burning throats, itchy eyes, runny noses, and upset stomachs. Because they were all in such close quarters the adults decided that the kids were either coming down with colds or allergies. Over the next several hours their conditions worsened and two of the kids began to complain of a sensation of shortness of breath accompanied by wheezing. At the same time several of the adults confessed that they were also beginning to fell sick, with similar symptoms. One of the adults complained of a burning, peppery taste in her mouth. Obviously, they were all getting progressively alarmed.

After sailing all day, the group was now anchored in a nice little hurricane hole on a remote uninhabited island. They would have to wait until morning to head for the nearest port, about four hours away once under sail.

A call was placed to the US Coast Guard who after listening to all the symptoms, thought it might be scombroid poisoning from eating fish that was not properly stored and refrigerated. They explained that it was a form of histamine overdose from eating the fish, in this case mahi mahi, and they needed to treat everyone onboard with antihistamines plus anyone who was wheezing would also need use a rescue inhaler, a bronchodilator such as albuterol.


There were no pharmacists, nurses, EMTs, or docs on board. The group needed to figure this out themselves. They decided to gather all the medications that each of them had brought and see what they had that might be of help. What would have helped the most was good old fashioned KNOW HOW. By the way, no internet service was available, just advice from the Coast Guard via their marine radio that the Captain was required to have on board the boat. (And no, the boat was not the USS Minnow on a 3-hour tour.)


This article highlights standard information that is taught to EMTs. The medications mentioned are ones they can and will commonly use in providing emergency medical care. Some of these medications are over-the-counter meds while others are prescription meds. The following section covers the basic pharmacological aspects of EMT training.

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By Frank Hubbell, DO

Illustrations by T. B. R. Walsh

Unfortunately, heart attacks and premature death due to heart disease are very familiar problems, not only in the USA, but also, around the world.  Very common calls for EMS and for emergency departments in hospitals, they are universal issues. Heart problems occur in all environs, from urban to rural to austere. If you have a heart, you are at risk of heart disease.

US Data from the Center for Disease Control – 2104 Cardiovascular-system-copy

Cardiovascular Disease (CVD):

CVD includes:

coronary artery disease (CAD)

hypertension (HTN),

congestive heart failure (CHF)

heart failure

dysrhythmias (irregular heart beat)

valvular disease

stroke – cerebrovascular disease (CVA)

Since 1900, CVD has been the #1 killer in the US except for 1918 (Spanish flu).

600,000 Americans die per year from heart disease.

380,000 Americans die from an Acute Myocardial Infarction – “heart attack.”

1 in 4 Americans or 25% of all deaths in US are due to CVD.

1 in 4 (80 million) Americans have some form of CVD.

Men have a higher incidence of CVD until age 65, then women have a higher incidence.

An estimated 720,000 Americans will have a heart attack in 2014.

Of that number, 515,000 people will have their first heart attack in 2014, and

205,000 people will have a recurrent heart attack.

Cardiovascular Disease Terminology:

Arteriosclerosis: A disease of the arteries with thickening, hardening, and loss of elasticity in the arterial walls.

Atherosclerosis: The most common form of arteriosclerosis, marked by cholesterol-lipid-calcium deposits in arterial linings.

Coronary Artery Disease (CAD): Narrowing of coronary arteries sufficient to prevent adequate blood supply to the heart muscle.

Angina Pectoris: Pain around the heart caused by deficiency of blood supply to the heart.

Acute Myocardial Infarction (AMI): The condition caused by partial or complete occlusion of one of the coronary arteries. Infarct refers to a blood vessel that has been occluded by a blood clot, emboli, resulting in ischemia (lack of blood flow and oxygen) to the myocardial cells distal to the infarction.

Acute Coronary Syndrome (ACS): A collection of symptoms that can indicate a possible myocardial infarction, but before a definitive diagnosis has been made. This includes angina pectoris and acute myocardial infarction.

Clinical Death: Patient without a pulse.

Biological Death: Occurs within 10 minutes of clinical death due to lack of oxygen to the brain.

Sudden Cardiac Death (SCD):

SCD occurs when the heartbeat stops abruptly and unexpectedly, unassociated with any immediate illness or injury.

Most common underlying cause of SCD is a heart attack that results in ventricular fibrillation (V-fib).

80 % of SCD occurs at home; 60% are witnessed.

Approximately 95% of SCD victims die before reaching the hospital.

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Treating Fever

May/June 2008   ISSN-1059-6518   Volume 21 Number 3

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