Team Preparation – Safety and Health

Before leaving, all mission team members should visit their primary physician and dentist to ensure all are in good health and require no special medical management. See Appendix J - "Oral Care Humanitarian Mission Briefing."

Medical Issues – Prescription and Non-prescription Items

Team members should inform their physician or travel medicine professional approximately four to six weeks before the trip that they will be traveling to an area that may have limited resources and ask about health advisories for the area.  Additional medication, such as antibiotics (e.g., ciprofloxacin) and antidiarrheal medications may be recommended.  If traveling to an area of the world with malaria, prophylaxis should be considered. The recommendation for prophylaxis varies depending on the location, it is important to seek advice and recommendations from a medical healthcare professional.

Immunizations

The CDC publishes the Yellow Book every two years, as a reference for those who advise international travelers about health risks. The Yellow Book is written primarily for health professionals, although others will find it useful. Online access is available at: CDC - Yellow Book Homepage.

Most vaccines take time to become effective following inoculation and some vaccines must be given in a series over a period of days or sometimes weeks. If it is less than four weeks before departure, the team member(s) should still visit their physician(s), as they would still benefit from shots or medications and other information about illness and injury prevention while traveling.

CDC divides vaccines for travel into three categories: routine, recommended, and required.

Routine Vaccinations

Ensure that team members and their families are up-to-date on routine vaccinations. These vaccines are necessary for protection from diseases that are still common in many parts of the world even though they rarely occur in the United States. The CDC has a site: "Adult Immunization Schedule - Details for Health Care Professionals," which has a printable schedule feature.

Recommended Vaccinations

These vaccines are recommended to protect travelers from illnesses present in other parts of the world and to prevent the importation of infectious diseases across international borders. Which vaccinations are required depends on a number of factors including destination, the season of the year, and a team member's age, health status and previous immunizations. Another excellent resource is the CDC’s "Destinations" page.

Required Vaccinations

The only vaccine required by International Health Regulations is the yellow fever vaccination prior to travel to certain countries in sub-Saharan Africa and tropical South America.

Volunteer Health and Safety Coordinator

Copy and complete a Worker Health Information Form (see Appendix E - "Worker Health Information Form") before leaving on a mission. One person on the team should be assigned the primary responsibility for overseeing the medical needs of the team members, including maintaining the confidential medical history forms for each member. Keep health records in a safe location and restrict them on a need-to-know basis.

Update individual health records at least annually to ensure that they reflect the current health status of each team member.

Preparing for Emergencies, Including Exposure and First Aid

In addition to the medical history, each oral health mission volunteer should complete an Emergency Medical Release form (Appendix F - "Emergency Medical Release Form"), authorizing by signature medical treatment by emergency personnel, a physician, or a medical treatment facility in the event that permission for treatment cannot be provided or obtained in a timely manner.

Before leaving on the trip, prepare for the possibility that someone may become seriously ill and require a level of care beyond the capacity of the local facilities. Make provision for a rapid evacuation. Often, such services are not covered by individuals’ medical insurance plans. Encourage all team members to consult with their insurance provider and purchase additional travel insurance that includes emergency medical evacuation, if needed. Be sure several team members know the emergency plan and list appropriate telephone numbers in several places and with different people.

A standard first aid kit should be purchased or assembled for use by volunteers who have headaches, allergies, cold symptoms, diarrhea or who sustain simple injuries. A first aid kit should include the following:

  • band aids, gauze, ace bandage, adhesive cloth tape
  • instant cold and hot compresses
  • antibiotic ointment, topical steroid, eye drops
  • antihistamine, diphenhydramine (e.g., Benedryl), non-steroidal anti-inflammatory drug (NSAIDS), dimenhydrinate (e.g., Dramamine)
  • tweezers   
  • loperamide (e.g., Imodium)
  • Ciprofloxacin with physician prescription and/or an alternative antibiotic

Prepare emergency kits and keep them on hand in treatment areas. The ADA Council on Scientific Affairs recommends seven core emergency kit items including:1

  • oxygen
  • glucose
  • diphenhydramine
  • nitroglycerine
  • albuterol
  • epinephrine
  • aspirin

An expanded emergency kit when providing dental care in remote areas should include additional supplies to treat medical complications, including:

  • pocket masks with one-way valves for cardiopulmonary resuscitation (CPR)
  • portable external defibrillator (AED)
  • diazepam (e.g., Valium)   
  • versed
  • glucagon
  • atropine
  • xylocaine
  • hydrocortisone
  • morphine
  • naloxone
  • flumazenil
  • various syringes to administer these medications in appropriate doses

In addition to emergency and first aid kits, be prepared to manage occupational exposures to blood and body fluids. Post-exposure antiretroviral prophylaxis (PEP) must be administered within 72 hours of exposure to bloodborne pathogens and continued for an additional four weeks to be effective. Necessary post-exposure supplies include:

  • Hepatitis B immune globulin (HBIG), which is administered to directly neutralize the hepatitis B virus (HBV) following exposure.
  • Vaccine against HBV.
  • Rapid OTC oral tests for HIV antibodies.
  • Antiretroviral regimens of two or three agents from different classes need to be administered depending on the type of exposure. The types of exposures, classes of antiretroviral drugs, and dosing regimens, as well as drug interactions and potential side effects are well described by the CDC at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm#tab1

Make sure that all team members have discussed the risks and side effects of post-exposure treatment with a qualified healthcare professional before leaving for the mission.

Advanced Volunteer Training

Before departing, ensure that team members are prepared to handle injuries and emergencies.

  • Cardiopulmonary resuscitation (CPR) – trained and certified volunteers
  • Assign responsibility for the first aid kit to a volunteer trained in first aid, ideally someone who is Emergency Medical Technician (EMT) certified.
  • If an Advanced Cardiovascular Life Support (ACLS) certified volunteer is participating, he/she should be given responsibility for the emergency kit and its use.

Local Safety Issues

When traveling in unfamiliar locations, personal safety is very important. Understanding local culture norms, political situations, crime statistics and recent history of riots or terrorism is essential. Specific information regarding issues of personal safety when traveling internationally is available from the US Department of State (Current Travel Warnings). All team members should be aware of such information.