MEGAN WALSH, PENNY MCCARTHY AND AMY FINLAYSON
Megan Walsh and Penny McCarthy are Clinical Nurse Consultants, Ronald Sawers Haemophilia Centre, Alfred Health, Melbourne
Amy Finlayson is Haemophilia/Haematology Clinical Nurse, Queensland Children’s Hospital, Brisbane
Travel, whether it is for business or pleasure, has become a part of our lives. For people with bleeding disorders planning is essential.
Here are a few tips to help make your travel a success.
COVID-19 has made travel of any kind a little more complicated.
What are the COVID-19 restrictions and requirements about vaccination, testing and quarantine?
Don't forget there may be departure and return requirements for your state/territory as well as requirements for the area you are travelling to.
Some useful websites with information from the Australian Government about Australia and overseas :
Haemophilia Treatment Centres
It is a good idea if you intend to travel interstate to let your Haemophilia Treatment Centre (HTC) know you are travelling. It may be helpful for your HTC to advise the HTC in the state or territory where you will be travelling of your presence, just in case you run into problems.
Each HTC has different hours of operation. It is a good idea to check in advance with the HTC in the state or territory where you are travelling so you know when health professionals are available and how to access treatment if you need assistance, or where to attend if the HTC is too far away. Haemophilia and other bleeding disorders are rare and not all hospitals have the expertise or treatment you find in your HTC.
Contact details of HTCs around Australia are on the HFA website:
Emergency treatment card
Carry your ABDR patient card as this is enough information to initiate emergency treatment in Australia if needed.
Your ABDR patient card explains your diagnosis, what treatment you should be given and who should be contacted for further advice. If you don’t have an ABDR patient card, ask your HTC to request one for you.
If you treat at home
- Take your treatment product with you.
- Carry enough of your treatment product with you for your stay. This is particularly important if you have changed to one of the newer products as some HTCs may not stock the full range of products or carry the full range of vial sizes.
- If you run out of factor while away, most HTCs would require you to visit the HTC and see a doctor for any product to be issued to you, even if you wanted to top up your prophylaxis stock. This is because factor is a prescribed medication.
- If you have an extended trip planned and your scheduled home delivery date is in that time, you may be able to have your delivery redirected to your holiday accommodation. This does require some advance planning and needs to be discussed with your HTC.
Product transport and storage
If you are flying, ask your HTC to provide a letter stating that the factor and needles and syringes must be carried on board in the cabin section, as the baggage hold in a plane is exposed to extreme temperatures which may affect the factor.
If your child has an implantable port-a-cath device, please ask your HTC to provide a letter stating that factor and port-a-cath consumables must be carried on board in hand luggage. You may not be asked to show the letter but better to be safe than sorry! And there is nothing worse than you arriving in Tasmania and your luggage arriving in Darwin!!
- The factor can be put through the scanner in airport security without harm.
- For all travel, carry your product in a cooler bag. Even though most products can be stored at room temperature, it is very easy for them to overheat in hot weather particularly in cars or when camping. Do your best to keep it cool
- Always ensure you use the remaining product first when you return home.
Planning is essential!
www.Smartraveller.gov.au has all the general information you need, but having a bleeding disorder requires extra planning.
The Therapeutic Goods Administration website also has more information about travelling overseas with medicines and medical devices .
With notice your HTC can provide a travel letter suitable to for customs that will allow you to take factor out of Australia and bring any remaining vials home. You will also require a medical letter from your haematologist in the unlikely event you need medical attention while away.
No matter how fit and healthy you are, you can’t afford to travel overseas without travel insurance.
You must have travel/medical insurance and the level of cover should include a medical evacuation/repatriation in the case of emergency, particularly if you are travelling to countries where there is limited or no access to haemophilia care. In many countries, even if you are able to get a similar level of care to what you would expect in Australia, you would be paying full price for all costs for your treatment and care, which could end up being over $100,000 for a single hospital stay.
The Australian government has reciprocal healthcare arrangements with several countries, including the United Kingdom, Republic of Ireland, Slovenia, Malta, Italy, Belgium, Norway, Sweden, Finland, the Netherlands and New Zealand. Australian travellers will be treated free of charge in these countries for emergencies. See Reciprocal Health Care Agreements on the Medicare Australia website for further information about access to health care in these countries, especially if you have other medical requirements in addition to your bleeding disorder.
Check your travel insurance fine print to make sure that it will cover everything you will need, including your bleeding disorder.
To have cover for haemophilia you must declare it as a pre-existing condition. You may be required to pay an additional premium for this level of cover. If you do not declare your bleeding disorder, your insurance may be deemed void if medical care is required.
It is worth considering having all your documentation letters translated if you are travelling to non-English speaking countries
Cruise cover should include medical expenses, as there is no Medicare when you’re on a cruise ship. This means you could be facing exorbitantly expensive international medical rates for something as simple as asking the doctor for some anti-nausea medication.
Hospitalisation costs on board can cost as much as $5,000 a day – and all consultations, treatments and medications are charged at private rates. Repatriation costs to get you home from an overseas port can run up to the tens of thousands.
Immunisations are necessary for some destinations and you should check well ahead of time (approx. 8 weeks). Discuss this with your general practitioner (GP) and HTC.
For people who treat at home
Ideally you would carry all the treatment required for the trip with you, but if you are planning to be away for a long time, arrangements can be made to access factor overseas. You will need to plan well ahead for this. Organising this part of your trip will involve a lot of work and it will take at least three months.
All documentation and approvals by the National Blood Authority (NBA) need to be completed and approved before you leave Australia.
The NBA pays for your factor on behalf of Australian governments. The NBA currently has agreed to fund overseas delivery of factor for up to 12 months in a 2-year rolling period. However, factor can only be supplied overseas in countries where the product is registered and the pharmaceutical company is able to supply it. Each country has different rules and regulations around this so be prepared that there may be costs involved. Costs that you may incur could be doctors’ appointments, travel to another country to collect the factor or import taxes. Unlike at home, delivery isn’t to your front door!
Product transport and storage
Some airlines have a medical allowance to carry a 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 enough vials to last 3 months.
- Treatment product must be carried on board the plane with you in a cooler bag in the cabin section as the baggage hold in a plane is exposed to extreme temperatures which may affect the factor.
- The National Blood Authority has stated that no lost or damaged product will be replaced other than in very exceptional circumstances. Product will not be replaced if it has been lost/damaged in checked luggage or has not been carried and managed with all proper precautions.
- Factor vials and needles and syringes in their original packaging can be put through the scanner in airport security without harm.
- Port-a-cath consumables (dressing packs, sterile gloves, etc) must be carried on board in hand luggage. It would ruin a holiday if they went missing in lost luggage!
- While most factor concentrates can be stored at room temperature, it is very easy for them to overheat in hot weather particularly in cars or backpacks. Do your best to keep it cool or at least room temperature.
- Always ensure you use the remaining product first when you return home.
Aviation security requirements
Aviation security has restrictions, including rules for taking liquids, aerosols and gels.
Medical products and devices are exempt but you must carry appropriate documentation. Be aware that gel or ice packs are not exempt and you may not be able to take these through security. 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. This means you should not unpack the vials from their packaging to save space. You may need to declare the product at some security points and customs, so keep the letters accessible if required.
If you have any medical devices aids or implants, e.g. a metal joint or port-a-cath, you must inform the screening officers prior to screening. It would be worthwhile having this mentioned in your medical letter.
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 HTC can arrange this to ensure you have appropriate documents. Please give your HTC plenty of notice!
When travelling with factor away always take a bit more than you think you will need.
Remember, you will probably be more active than you normally are when travelling, especially as you may be dragging heavy cases, lifting things and putting your bag in the overhead locker. We have reports of people who have been bumped by a taxi, badly bruised by an out-of-control motorbike, walked into a tow ball on safari, tripped and fallen under a rickshaw, and had shoulder bleeds from retrieving heavy cases from the luggage belt. Accidents do happen and you should be well prepared.
Consider taking a first aid kit with you. Here are some items others have found useful
- Instant ice packs or zip-lock bags for ice packs
- Scarf for a sling
- A simple analgesic such as paracetamol
- A styptic stick or pencil (shaving stick) for small cuts and abrasions
- Fess® nasal spray
- Tranexamic acid tablets for mouth and nose bleeds.
And not to forget Rest Ice Compression Elevation (RICE)! Talk to your HTC about the importance of using RICE while away.
If you are on regular home treatment and 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 the overseas HTC to investigate whether you can access assistance with your infusions and whether there will be costs for this. Be aware that your travel insurance may not cover this.
Are you travelling with a child or grandchild with haemophilia? Families travelling to places with limited access to safe paediatric health care or paediatric emergency care will need to advocate that they access their child’s port-a-cath device in the event of an emergency or to give factor treatment in a hospital setting. Please ask your HTC to provide a letter to support this.
If you need assistance to access the port-a-cath and require regular treatment, you will have to contact the HTC overseas to investigate whether you can access assistance with this and whether there will be costs involved. Be aware that your travel insurance may not cover this.
If your child or grandchild has a temperature of 38 degrees Celsius or above during your trip, you will need to attend the nearest emergency department for a medical assessment as this could be a sign that your child has a port-a-cath infection.
Finding an HTC overseas
For contact details of HTCs around the world, see the World Federation of Hemophilia (WFH) Global Treatment Centre Directory at www.wfh.org, ask at your HTC or contact HFA on freecall 1800 807 173.
For people who don’t normally have treatment at home
Talk to your HTC team about what they would recommend for your individual circumstance.
If you do not usually make up your product, consider learning 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.
Keep your documents safe
- Load all letters to your phone or email copies to yourself
- Take photos of your passport, Medicare card, letters and ABDR patient cards
For more information
HTCs in Australia – www.haemophilia.org.au/support-services/treatment-services
HTCs worldwide – WFH Global Treatment Centre Directory – www.wfh.org
International travel advice – www.smartraveller.gov.au
Travelling with medicines and medical devices – Therapeutic Goods Administration
And speak to your Haemophilia Treatment Centre.
And last of all have a great holiday!
This article is adapted from:
Walsh M, McCarthy P, Finlayson A. Travel tips. National Haemophilia Mar 2020; 209: 15-19.