On the medical edge: preparation of expatriates, refugee and disaster relief workers, and Peace Corps volunteers.

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 Many fee-for-service directories of overseas medical centers are often out of date and do not include emergency contact information.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.