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Grand Canyon Medevac, part 1

When you run a travel program that sends groups of people away from home or far overseas, you’re dealing with lots of competing risk management interests.  One is the safety and wellbeing of each person, of course. That comes right to mind.  

But there’s also the collective care of the rest of the group when there’s an emergency. And then also the administrative challenges for the organization that sent the group. Its liability and reputation too. There’s lots of ways in which these interests collide when there’s a serious accident or an illness; we’ll discuss them.  

Can the subtle complexities around medical emergencies be managed with a product that’s as ancient and basic as the horseshoe crab…travel insurance?  It’s not a natural fit. Resolving that fit is what I do.

This is a blog about travel insurance, but not about how individuals use it. This is a blog about how groups and their organizations use travel insurance. It’s about managing the risks of medical emergencies on your group travel program and how your group travel insurance should respond to them.

I remember being on a wilderness survival trip in the Grand Canyon years ago. We had climbed down from the rim and then back up and then back down again; I think we were about ten days into a three-week trip.  It was amazing; the changing microclimates, the rock stratigraphy, the weight of the pack, the tiny fine painful needles of the teddybear cactus and the camaraderie of the group. I’ve often thought that the way a group comes together is one of the best reasons to go on a trip like that.

One of the members of the group began complaining of pain. He was a guy who was well-enough liked, but maybe not very well known. He gave off a funny loner vibe but was clearly excited to be part of the trip and fully contributory. He started slowing down and talking to the trip leader about what he was feeling, and finally the whole group just stopped and sat down and waited somewhere at the narrow base of the Grand Canyon. I remember the rock walls rising up from the sandy soil there, eventually a mile high.

Somehow we were lucky enough to have a doctor on the trip with us;  he was a nephrologist, a kidney specialist. He and the trip leader conferred for a while.  And then the trip leader came over to me.

“We’re having a medical problem with Harry,” he said. (A fictional name.) “Trying to figure out if he should keep going with us or get to a hospital. He wants to keep going.  And I’ve just been hearing what the doctor has to say. But I know that you are a specialist in risk management for travel-based groups like ours, so I want to hear what you have to say too.”

“What did the doctor say?”  I asked.

“The doctor said we should get him out of here.”

“Well, you know,” I said, “then I think that decision is made.”

“Actually”, he said, “I believe that this is my call to make.”

“No”,  I said.  “Unless you have a medical degree too, at this point it’s not.”

He wasn’t happy. He was a gracious, eminently resourceful, memorable guy. But this was twenty years ago, before the protocol of risk management had taken the draconian hold it has on us now. At that time the tussling relationship between organizational liability and traveler care was still in debate. Many organization leaders told me in those days that they were confident that they’d fully avoided liability through the use of tools like waivers and contractors.   Later on it became clear that they had not.

He transferred essential items into his day pack, left us hunkered down with the patient and the other trip leader, and started the ascent by foot. We watched him use the mountain rest step for steady progress up the side of the Grand Canyon until he was out of sight. We figured we’d see medical help in two days.

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Grand Canyon Medevac, part 2

While we waited for medical help to arrive, we told stories and walked the shrubby terrain at the bottom of the Grand Canyon. We hung out with the patient, who lay on the sand under a rocky overhang. Over the course of the next day he proved to be very sick, having a hard time breathing.  

We got out all our rain gear and used it to make a giant colorful X on the floor of the canyon to show the helicopter where to land. Then we looked at it for a while. We marveled at how any aircraft could make its way down into such a narrow space. It was about as wide as your living room.

But when the helicopter came into sight, that hazy inertia shifted into hyperspace. We were taken off guard, as the aircraft arrived so much more swiftly than we expected. Somehow our slow-moving leader had gotten to his high destination and gotten assistance to us within just twenty-four hours.

The helicopter dropped perilously down into the space between the rock walls and hovered up at what I thought was a ridiculous height. Three people in flight suits jumped down and raced over to the sick guy. It seemed that even before they reached him they were working on him with IVs and saline and other kinds of equipment. Expertly all these arms lifted him up and into the aircraft and ten seconds later, it seemed, they were all gone.   

It felt like an alien invasion, frankly. I had never seen such a high-tech intervention in my life, especially considering that the most sophisticated piece of equipment our group had with us at the time was probably a spoon. We gathered our things together and resumed our trek, kind of stunned.

We heard later that it was a good thing that Harry made it to the hospital when he did. He had double pneumonia, something incompatible with a long hike in the Grand Canyon. It took him several weeks to recover, we heard. Afterwards we also heard that he had been on a variety of prescription medications for conditions about which the organization had been unaware.

This was in the days before HIPAA took hold; later on medical information like this would become much more privately guarded. But it served to show me what it’s like to witness a medevac, what a tough line trip leaders have to walk when there’s peril, what it means to consider a traveler healthy enough to join a group. Also how a group responds to an emergency, and how organizations have to anticipate and manage them. Not to mention who gets to pay for a pricey helicopter medevac.

In the twenty-five years I’ve specialized in group travel insurance, I’ve been at the admin end of hundreds of medical evacuations taking place all over the world, some of them using very dramatic transport. But most of them just use regular planes and vehicles, backed by a boatload of planning and accommodation and a highly involved travel organization.

Behind every medical emergency is, of course, a sick or injured traveler, and their wellbeing is the prime objective of any organization who is responsible for them. Travel-based organizations have two major risk management objectives: the first is the health and safety of their people. That’s all that most people think group travel medical insurance is for.

But the second risk management objective is the protection of an organization’s ability to carry out its mission, even with all the liabilities it brings. Keep that in mind as a key role for group travel insurance too. It shouldn’t just handle medical and travel costs. It should also protect the organization from liability, help its operations along, carry out its values, delight its travelers. Want to find out how?