Risks during travel depend on travelers’ comorbidities and trip activities. Travel on cruise ships, for pilgrimages or large events, or into the wilderness carries unique risks. Asking travelers about what activities they have planned or may do during travel can tailor the subsequent pretravel counseling points and help guide decisions about vaccines and drugs. Some prescriptions (eg, doxycycline for prophylaxis against leptospirosis) depend on the planned activities while abroad. Travelers should be prepared for potential emergencies and should be encouraged to research unique customs and laws in the countries they plan to visit before departure. The US State Department’s website has resources that Americans traveling abroad should be familiar with, including information about the laws and customs of the destination country. It is important that travelers investigate the different insurance options or coverages before a trip, in case emergencies arise.

Case 4. DZ is a 71-year-old American patient with a history of heart transplantation 4 years ago who plans to travel to Europe for a monthlong vacation, including a 7-day cruise on the Mediterranean Sea. He comes to your office with his wife to discuss available resources if he were to require medical attention abroad. His wife also pulls you aside and asks for information regarding what should be done if he were to die abroad.

Emergency Preparedness and Resources for US Citizens

Although unexpected events can and do occur while traveling abroad, advance planning can ease upset and allow better outcomes. A good first step is for travelers to review the US State Department Country Information pages for the countries they plan to visit.¹¹⁸ For those who experience an emergency while overseas, the US Department of State’s Bureau of Consular Affairs provides contact information for US embassies and consulates, and information about local lawyers or physicians, but does not pay for these services.¹¹⁹ Having access to health insurance policies that provide coverage overseas is important, especially for travelers with more complex needs (eg, immunocompromised individuals, elderly people). Medical evacuation coverage allows travelers to return to the United States should it be required for their medical treatment.