Let’s say you’re taking a nice, relaxing vacation. Maybe riding a motorcycle through the mountains of Peru on a rainy night with your special someone, enjoying the breathtaking vistas of the Andes as the shiny road speeds by under you. As the air gets thinner, you start to feel a little lightheaded, and next thing you know you’re nodding off. Your bike goes skidding off the road, throwing you and your partner into a farmer’s ditch.
When you come to, your legs are in explosive pain, and your friend isn’t doing much better. You have no idea where the nearest hospital is. All you know how to say in Spanish is ¿dónde está la biblioteca?, and while you’re not technically sure what a biblioteca is, you’re pretty sure it’s not an ER.
So what happens next? Well, that depends on where you are, who you’re with, and if your phone still works. Foreign physicians, hospitals, and health care systems don’t work like they do stateside, and getting injured abroad is a special kind of complicated.
To get some basics on how to proceed, we consulted John Gobbels. He deals with these problems — including that unfortunately true Peruvian motorcycle scenario — every day as the Vice President and Chief Operating Officer of Medjet, an Alabama-based company that helps out people who’ve been hospitalized in other countries. It sells memberships that covers medical air transport — essentially flying ambulances that will pick you up anywhere in the world and get you to any hospital back home. His company takes over only once you’ve reached a medical facility, but he knows what you need to know if you find yourself in a roadside ditch. Turns out that process is even rougher than you’d guess.
First thing: Get to a hospital — and tell them you’re coming
Most adventure travel companies or groups will handle the first steps after any big injury. So if you’re on a hunting trip in Africa and your buddy accidentally shoots you instead of a wild leopard (true story), the hunting outfit you went out with will get you to a local hospital. Of course, if you’re not with an organized trip, your next few hours are going to really suck. Take our friends in the ditch in Peru, for example. They fortunately had cell phones in an area with some coverage, and were able to call the local emergency response number to get help.
Off-the-grid travel doesn’t always lend itself to great cell service. Gobbels told us about a young woman who was on a bike tour of Mexico who crashed and broke her arm. She and her partner had to wait by the side of the road and flag down trucks, who took them to the nearest hospital.
“They do what they need to do,” says Gobbels. “Sometimes they call us from the back of a farm truck and tell us to get ready. And we just go from that point.”
If you can tell the hospital you’re en route, as Medjet does in its cases, all the better — especially if you’re expecting a language barrier. You’re likely to be treated more quickly if they know you’re coming and can get English-speaking staff on-hand.
Second thing: Internationally, hospitals and air ambulances are nests of red tape
Great, you made it to the hospital. You’re going to live. Now, about that logical next step of getting the hell out and going home? Not so fast.
“Facilities (in some countries) don’t like to transfer people out,” says Gobbels. “They like to keep people hospitalized there as long as possible because the longer people are there, the more money they make. It becomes difficult when people want to hold patients.”
So even if you get a hold of your home physician, and that doctor says to release you back to a US hospital, that doesn’t mean it’s going to happen — the local doctors will have the final say. Unless you decide to overrule them, in which case things can go back to being exciting in a bad way.
If you can leave under your own power, sure, no problem, jump on a plane home. But if you need dedicated medical aircraft to get you home, sometimes the government won’t allow overnight visas for the medical personnel to come in and get you.
“This happens in China a lot,” says Gobbels. “We’ve had some transfers where they will not allow air ambulance to stay overnight. So we have to get air ambulances to stage outside the country overnight, then fly in and fly back out.
“Nobody thinks about that when you’re on a tour over there, and it’s great,” he adds. “But sometimes you have to call all these visa offices and get the US government involved just to get someone out of the country. It helps having somebody who knows what they’re doing.”
Third thing: If you need extreme measures, the bill is going to be outrageous
An ambulance across town ain’t exactly cheap. An air ambulance inside the US will run you an average of $30,000. And abroad? You’re talking about the cost of a medical degree just to get you to a medical facility. Gobbles mentions an 18-year-old from Colorado who had a heli-skiing accident in Dunedin, New Zealand, and who had to be air transported back home at the cost of $137,000. The couple that wrecked off the road in Peru? Their airlift cost $97,000.
So your options there boil down to staying safe, racking up a huge bill, or reading the fine print on your coverage. Most travel insurance pays only for treatment in the country where you were injured, not special transport home (which obviously is where Medjet is trying to fill a market niche). You may decide to recoup in the local hospital after all and then hop a commercial flight when you’re well enough to get around.
Bottom line is be prepared: Know enough of the local language that you can call for help. Have a working cell phone. Make sure you can reach someone in-country in case of emergency. Don’t take huge risks that you can’t pay for in case of disaster. And have a backup plan. That might be travel insurance, or it might be a doctor back home who’ll go to the mat for you. Or both. That moonlight in the Andes can get awfully intoxicating, after all.