Megan Walsh is a Clinical Nurse Consultant at the Ronald Sawers Haemophilia Centre, The Alfred Hospital, Melbourne. This article was printed in National Haemophilia, No.164 December 2008.
Travel for business or pleasure has become a part of our lives. For people with bleeding disorders improvement in treatment products have made things easier, especially with the newer, smaller, and more concentrated dose vials.
Here are a few tips to help make your travel a success.
It is a good idea if you intend to travel interstate to let your haemophilia centre know. It may be helpful to advise the centre in the state where you will be travelling, just in case you run into problems. Your treatment centre staff can assist with this.
Take your treatment product with you. Product is distributed differently in different states. Most haemophilia centres would require you to present to the centre for any product to be issued to you, even if you wanted to top up your prophylaxis stock.
Always carry your emergency treatment card issued by your centre which states what type of bleeding disorder you have and which product you are treated with.
As some of the smaller haemophilia centres have different hours of operation, it is a good idea to check in advance with the centre in the state where you are travelling so you know when health professionals are available and how to access treatment, if you need assistance. For example, you should check whether you would need to go directly to the haemophilia centre, or to a day treatment area or the emergency department of the hospital.
Carry sufficient amounts of your treatment product with you for your stay. Remember that some haemophilia centres may not stock the full range of products, or carry the full range of vial sizes.
Ask your centre to provide a letter stating you will be carrying needles and syringes with your treatment and that you must carry your product on board the plane in the cabin section as your product is temperature sensitive. If your luggage is lost, the product will not be replaced. It is also recommended that you carry a medical treatment letter stating the product you are treated with and recommended doses for emergencies, especially if you are traveling in more remote places.
Carry your product in a cooler bag. Even though the newer products can be stored at room temperature, once they are taken out of 2-8° C, their expiry dates drop to between 3-6 months depending on which product you use. Always ensure you use the remaining product first when you return home.
Planning is critical! Make sure you give your treatment centre plenty of notice, especially if you are planning to be away for a long time. There is quite a bit of work to be done to organise this part of your trip.
Telephone the consulate of the country where you will be travelling to and check if they have any special requirements for carrying product/equipment and medication through their border control. Permits are required to take prescription pain killers into some countries, such as Thailand, Some countries require specific documentation to carry your treatment product into that country. Remember this may also include stopovers.
If you require regular on demand treatment it is recommended that you take treatment product with you on your trip. You should at least have enough with you to give yourself 12-24 hours’ cover to get to a country where you can access adequate medical treatment. If you are on prophylaxis, you should take all of your required treatment with you for longer trips or organize for more to be delivered to you overseas.
It is important to note that your treatment product may not be available in the country in which you are travelling. There may be a range of different plasma derived and recombinant factor products available.
If you have infrequent bleeds, talk to your treatment centre staff about whether to take product with you. Unused treatment products cannot be returned.
FOR TRAVEL OVERSEAS FOR UP TO SIX MONTHS
The National Blood Authority currently allows haemophilia centres to provide treatment product to patients for travel overseas for up to six months and requires that all of the issued product is carried by the patient in the cabin section of the plane. It should be carried in a cooler bag.
The National Blood Authority has indicated that product which is lost or damaged will not be replaced. Please make sure you do not carry product in checked luggage where it can be exposed to extremes of temperature or lost, stolen or broken.
Some airlines have a medical allowance to carry a larger quantity of medication on board the aircraft, so it is a good idea to ring around to check their requirements, especially if you will be carrying six months worth of product with you. Your treatment product must be carried in a cooler bag with small ice bricks. This is to keep the product under 25 degrees. As this will not maintain the product between 2-8 degrees the expiry date is shortened. Check with your airline about how to carry your ice packs (ice bricks may need to be under 100mls and remember that gel packs may not be allowed due to security requirements, you should check with your airline and DOTARS - see below). Be careful where the cooler bag is placed in overhead bins as the reading lights can warm the product significantly.
People who are traveling for 6 months or less who want to receive delivery of product at overseas destinations must make such arrangements with the National Blood Authority via their treatment centres.
FOR DELIVERY OF PRODUCT OVERSEAS AND/OR TRAVELING FOR PERIODS LONGER THAN 6 MONTHS
People who are traveling for longer than 6 months who wish to either take product with them or have it delivered overseas are required to make such arrangements with the National Blood Authority via their treatment centres. The arrangements are complex, and may take time to put in place.
Special arrangements usually need to be made to import and export plasma derived clotting factors and different countries have different requirements and restrictions (see below). Some suppliers of treatment products in Australia have advised they can deliver product to patients to some selected overseas locations where the product is registered, and often can only deliver to an overseas haemophilia centre. You may incur some costs for delivery or import tax. You may only be able to receive the local registered product under this arrangement and although it will be the same product it may be labeled differently or it may have a slightly different reconstitution device, for example. You must give plenty of notice for this option and you will still need to carry some product with you on departure from Australia to cover you until your delivery arrives.
You must have travel/medical insurance and your cover should allow a medical evacuation in case of emergency. Some insurance companies will cover product cost. Be mindful some countries do not have access to any treatment products at all, and other countries will only be able to offer you products made from fresh blood products manufactured with varying quality and safety standards.
The Australian government has reciprocal healthcare arrangements with UK, Republic of Ireland, Malta, Italy, Norway, Sweden, Finland, the Netherlands and New Zealand. Australian travelers will be entitled to receive health care free of charge in these countries. Treatment is generally for emergencies only, but not for prophylaxis. See www.medicareaustralia.gov.au and www.smartraveller.com.au for further information about access to health care in these countries especially if you have other medical and health requirements in addition to your bleeding disorder. A current Medicare card and Passport is required for treatment. It is essential to check the countries you are visiting carefully, as some countries also require a medical document which needs to be completed by your treating doctor prior to departure in order for you to access treatment.
The Australian Department of Transport and Regional Services (DOTARS) implemented new aviation security requirements for carry-on baggage at international airports in March 2007, including new rules for taking liquids, aerosols and gels (see web site www.dotars.gov.au) Medical products and devices are exempt, however you must carry appropriate documentation. It is essential that you carry letters describing your product, the active ingredients, its presentation and how many vials you are carrying. The letters must state that the product is for your personal use and that the vials must not be opened when they are being checked by security officials. The product must be carried in its original packaging and you should declare the product at security points and customs.
You are advised to consider having all your documentation letters translated if you are travelling to non English speaking countries.
If you are traveling on cruise ships or booking budget type accommodation you should check whether you will have a refrigerator in your room to store your product and make arrangements for a refrigerator to be provided in your room. This will be particularly critical if you are visiting tropical countries.
If you are travelling with plasma products produced in Australia (such as plasma derived factor VIII Biostate® or plasma derived factor IX MonoFix®) you will require an export permit to take the product out of the country. Your centre will help you to arrange this with the ARCBS and to ensure you have appropriate documents from the Therapeutic Goods Administration if required (see web site www.tga.gov.au).
Immunisations are necessary for some destinations and you should check well ahead of time with your doctor. Usually these need to be administered subcutaneously, however you should check with your haemophilia centre for their recommendations. If you have HIV, always check with your infectious diseases specialist as to what vaccinations are recommended and note there are some vaccinations you will need to be careful with.
If you do not usually make up your product, you should learn how to reconstitute it before you leave home! This can be helpful especially in places where the medical staff are unfamiliar with your treatment product.
If you are travelling to places with limited access to safe health care it is a good idea if a partner or your travelling companion learns to access your veins and give your treatment in case of emergency.
If you cannot access your own veins and you are on regular treatment you will have to contact overseas treatment centres to investigate whether you can access such treatment assistance and whether there will be costs for this. Be aware that your travel insurance may not cover this. For details of haemophilia treatment centres around the world see the WFH Passport at www.wfh.org, ask at your haemophilia centre or contact Haemophilia Foundation Australia on freecall 1800 807 173.
Be prepared, even if you have not had a bleed for years and remember you will probably be more active than you normally are when travelling, especially as you may be dragging heavy cases and lifting things onto an ever increasing number of airport screening belts! We have had patients who have been bumped by a taxi, grazed by an out of control motorbike, walked into a towball on safari or tripped and fallen under a rickshaw and seen shoulder/elbow bleeds from heavy cases. Accidents do happen and you should be well prepared.
Remember, if you return home with treatment product always use this product first.
And………… last of all, have a great holiday!
USEFUL TRAVEL WEB SITES
Smarttraveller - www.smarttraveller.gov.au
World Federation of Hemophilia Passport (global treatment directory) - www.wfh.org
Medicare Australia (Travelling Overseas section) - www.medicareaustralia.gov.au/public/migrants/travelling/
Important Note: This information was developed by Haemophilia Foundation Australia for education and information purposes only and does not replace advice from a treating health professional. Always see your health care provider for assessment and advice about your individual health before taking action or relying on published information.
This information may be printed or photocopied for educational purposes.