Health and medical emergencies on the road

by Dr Paul Rowe
Reprinted from the book for all in need.
Updated February 2013. This version is based on the AMH6.1 reprint

Adventure motorcycling travel health: short version

  • Get immunised against commonly-known diseases.
  • Avoid getting bitten by insects, snakes, rodents and, of course, larger predators.
  • Take malaria pills; better still use a mosquito net and repellent.
  • Take a first-aid kit containing at least the items listed below.
  • Drink frequently and if necessary rehydrate (see above).
  • Be sure that your water source is clean.
  • Eat nutritious freshly-cooked food and avoid re-warmed meals.
  • Travel insurance is useful but in the end medical cover is more important than property insurance.
  • Back home, if you don’t feel well (re-adjustment often produces some ailments), consult your doctor and tell them where you’ve been.

The key principle to avoiding illness and injury on your trip is that prevention is far better than cure. However, with some prior planning and a small first-aid kit you will be able to deal with most ailments which arise to keep you and your group riding.

  • First-aid kit
  • A small tuppaware box is ideal and should include the following:
  • Paracetamol
  • Strong painkillers (analgesics)
  • Anti-malarials
  • Antacids
  • Anti-diarrhoea tablets (Loperamide 2mg)
  • Laxatives
  • Anti-histamines
  • Rehydration powders
  • Broad Spectrum Antibiotics (eg amoxicillin 500mg)
  • Multi-vitamins
  • Equipment
  • Latex gloves (good for oily repairs too)
  • Tweezers (for tick removal)
  • Sterile syringe set. Two hypodermic needles per person
  • Sterile dressings, plasters, bandage
  • Alcohol wipes (‘Sterets’); can also be used to start fires
  • Superglue
  • Antiseptic cream
  • Durapore tape
  • Safety pins
  • Thermometer
  • Savlon anticeptic concentrate
  • Steristrips

Good painkillers could make the difference of being able to carry on riding in an emergency, so see your doctor prior to departure and request a supply of Codeine Phosphate 30mg or Tramadol 50mg tablets. Also ask for some amoxicillin or similar antibiotic (beware of any group member with penicillin allergy) as wound infections, dental abscesses, ear and urinary infections are all more common during remote travel.

Although contrary to the manufacturers’ advice, a lot of space can be saved by removing tablets from their blister packaging and putting them into small zip lock plastic bags. Just remember to label them clearly.

Obtaining supplies

Between a friendly doctor and your local pharmacy you should be able to obtain most of the kit for your trip. For anything else, try these sites:

UK

Minor injuries

Minor cuts and grazes are common ailments. Apply the following general principles:

  • Stop the bleeding.
  • Clean thoroughly to reduce risk of infection.
  • Keep it dressed to maintain cleanliness.

Bleeding is stopped by simply applying direct pressure, elevating the limb and bandaging firmly to hold the dressing in place. Dilute some Savlon concentrate in clean water and clean wounds thoroughly, picking out any gravel or other foreign material. If the wound is gaping you can close it with either Steristrips or ordinary household superglue (Loctite). Hold the wound edges together and smear the glue along the surface, maintaining that position for one minute. It will flake off after a few days once it has done its job. Steristrips are sticky paper strips which are very good at holding wound edges together but are less effective in humid environments.

Foreign bodies should be removed whenever possible but otherwise can be left in place for removal by a surgeon once you return home. The exceptions are any organic material (wood, splinters, thorns, fangs) which are likely to become infected or anything embedded in your palm or sole which will become too painful for you to function normally. For these you will have to venture to a local medical centre for removal. Any spills which leave gravel in your face need to be cleaned meticulously or may leave permanent scarring.

Planning for serious injury, illness and evacuation

Most riders give little forethought about what would happen if they were to become incapacitated during their trip. Thankfully these events are rare, but some pre-trip planning will help things run a lot smoother if things go wrong.

A worst-case scenario can be broken down into the following stages:

Casualty event – First aid – Stabilisation – Summon/move to help – Casualty evacuation – Repatriation.

Consider what you would do at each stage after initial stabilisation, which is dealt with later in this chapter. Go through some scenarios in your mind asking yourself questions about how you would cope with an emergency at different parts along your proposed route.

How will you raise help? Will there be a mobile phone signal or do you need to carry a satellite phone? Are there any dwellings or bases with VHF radio? Who will you call? Is there an ambulance service and if so will you have to pay cash? Can you leave your travel plans with someone who will come looking for you? How can you signal an aircraft? How long might it take to get rescued? A list of worldwide contact numbers for local police, fire and ambulance can be found at http://www.sccfd.org/travel.html.

If you’re spending a significant amount of time in an area it may be worth identifying where the local hospitals are, roughly the level of care they provide and whether there are likely to be any English-speaking staff there.

In the event of a serious accident the involvement of an established international recovery agency can be a godsend. These 24/7 organisations are dedicated to the evacuation and, if necessary, repatriation of those injured or taken ill overseas. However, aeromedical transfer is expensive so you need to be sure that your travel insurance includes cover for this eventuality. Your insurance company will want to be involved from the earliest stages and can be a useful ally at this stressful time so should be contacted at the first opportunity.

First-aid training

Ideally, all members of a group should have some first-aid training. If you travel alone you take an accepted risk, but prior first-aid training could still save your own life. In the UK conventional first aid is taught by St John’s Ambulance Service (www.sja.org.uk), the British Red Cross (www.redcross org.uk) or look for ‘first aid training’ in your region. However, practising first aid in a remote environment with poor communications, adverse conditions and sub-optimal transport is challenging. Add to this that the responsibility may fall on you to straighten broken limbs, stem haemorrhaging and so on, it would be wise to undertake one of the more advanced first-aid courses aimed specifically at expedition first aid.

Aeromedical emergency transfer agencies

It is a good idea to keep all your important information and phone numbers together for use in an emergency. Write all of the following onto a piece of card, laminate it and keep it with your passport:

  • Information about any medical conditions you have, prescribed medications and known allergies.
  • Blood group if known.
  • Next of kin with contact details
  • Contact numbers of insurance company, travel agency and some.
  • One fallback number at home who can be contacted in any emergency to help you summon assistance.
  • First aid and basic trauma management

Significant injuries are rare amongst motorcycle travellers, despite the perception that it is a ‘dangerous’ form of transport. The key factor to improving survival in the event of a serious accident is prompt access to definitive care, i.e: a hospital with surgery and intensive care facilities. As soon as you have made the scene safe and performed a brief Airway, Breathing and Circulation assessment (‘ABC’, see below) your priority is to get help to the scene or, depending on experience, location and vehicles available, perform a rapid stabilisation and transport to hospital.

A B C

Although there follows a brief description of the ABC approach to trauma, it must be emphasised that a book is no place to learn such skills. Any group embarking on a serious motorcycle journey needs at least one person who is trained in first aid, for whom this should be an aide memoire.

A Airway and Cervical Spine

The airway extends from the mouth down to the larynx and ends where the trachea (windpipe) divides into the left and right lungs. After trauma the airway may be obstructed by dislodged teeth, blood, facial bone fractures or, most commonly, the tongue falling back into the pharynx (back of the mouth) because the patient has been knocked unconscious. The signs of an obstructed airway include noisy breathing, gurgling and distress. A patient who can talk has a clear airway.

If you suspect airway obstruction you must carefully remove any obvious blockage from the mouth and then perform a jaw thrust which will lift the tongue clear of the back of the mouth thus opening the airway. To do this, approach the casualty from their head end, place your thumbs on their cheekbones either side with your middle fingers tucked in behind their jawbone (mandible) in the groove just below the earlobe. Now push the jawbone vertically up towards the sky and hold it there, checking again to see if air is now moving in and out of the patient’s lungs. This manoeuvre is safe even in the presence of a possible spinal injury because the head is not tilted; only the jawbone is moved. Basic airway management of this type is the most important skill for any casualty carer. Without a clear airway the casualty will die in minutes.

Cervical spine protection is included with Airway in ABC because of its fundamental importance. What is meant by this is that the force of impact may have fractured neck bones (cervical vertebrae) or disrupted the ligaments which hold the vertebrae together. Any further movement such as turning the head or moving the casualty without proper stabilisation could push the broken bone fragment into the spinal cord thus permanently paralysing the patient from the neck down. However, a patient who is confused, has the distracting pain of a broken limb, or is buzzing from an adrenaline surge may not perceive the pain of a fractured vertebrae, so it is prudent to assume that every trauma victim has a spinal injury. Keep the patient still and their head supported in line with their body until professional help arrives.

B Breathing

Management of specific chest injuries is beyond the scope of this book. However, you can help inbound medical personnel to guide you by exposing the casualty’s chest and relaying to them the following information:

  • Respiratory rate, i.e: number of breaths per minute.
  • Whether there are any open or gurgling chest wounds.
  • Whether one side of the chest is moving more than the other.
  • Respiratory distress; i.e: is the patient talking normally or short of breath?
  • Repeat your observations every few minutes.

C Circulation

Bleeding from open wounds may be easy to identify and stop but not from broken bones or internal organs. As an adult begins to lose some of their five litres of circulating blood, the body compensates by going into shock. This medical application of the word shock refers to significant blood loss not psychological fright.

  • Signs of shock
  • Fast heart rate.
  • Fast breathing rate.
  • Paleness.
  • Signs of severe shock include:
  • Reduced consciousness level.
  • Weak pulse; may be too weak to feel.

At an accident scene there are several things you can do to reduce bleeding: Always remember scene safety; airway and spinal injury first, no matter how spectacular a wound initially appears.

Apply firm pressure to wounds. If blood soaks through, apply more padding, always keeping the original directly pressed on the wound.

  • Elevate injured limbs.
  • Lay the casualty down and raise legs.
  • Realign and splint broken bones.
  • Internal bleeding into the chest, abdomen or pelvis can only be fixed by surgery. The best way to help here is to summon medical help as quickly as possible.

Fractures and splints

Broken bones are extremely painful, with most of the pain coming from the broken bones grating against each other and the jagged ends sticking into the surrounding muscles and skin at unnatural angles.

It follows that the pain can be greatly reduced by repositioning the broken limb into its normal realignment and holding it in that position. A comfortably splinted arm could make it tolerable to ride pillion on a bumpy track.

In addition to pain relief, the other major benefit of splinting fractured limbs is to reduce blood loss from the ends of the broken bones. To improvise a splint you will need something soft around the limb to provide padding, such as clothing or sleeping mat, followed by something stiff to fasten to the outside to provide rigidity eg sticks or tent poles. Straighten whilst providing traction (pulling along the length of the limb) and have the splint ready to apply by testing it on the good side beforehand. For the patient this will be extremely painful but you will rarely do any more damage and the end result will be worth it.

Once a limb is immobilised it must be elevated, either in a sling for an arm or onto a padded pannier for a leg.

Other points regarding bone and joint injuries

Dislocations occur when a joint comes out of its socket, typically the shoulder, elbow, fingers or kneecap. The joint will be very painful, immobile and appear deformed compared to the other side. They need to be located back in to the joint by a medically-trained person as soon as possible.

Fractures where the overlying skin is broken are called open fractures. These are serious injuries and need urgent medical attention. Spinal, pelvis, and leg fractures require a stretcher and proper immobilisation so are impossible to transport by motorcycle.

A fractured collar bone (clavicle) is relatively common following a fall from a motorcycle. The treatment here is to hang the affected arm in a sling for four weeks. Although intensely painful, there are reports of people continuing to ride with this injury.

Helmet removal

It cannot be emphasised enough that at the scene of a motorcycle accident, leave the casualty’s helmet on until professional help arrives. Attempts to remove a helmet by untrained persons can worsen a fractured neck and cause permanent total paralysis or even death. Even if you have had a little training or read the description that follows, the attending paramedics will have performed this manoeuvre many times, so leave it to them. This is true in all developed countries.

However, a description of the correct technique for helmet removal is included here on the premise that in a remote motorcycling emergency where the casualty’s airway is compromised, some knowledge is better than none at all. If you’re heading on a long, remote trip, go on a first-aid course which covers helmet removal and practice at home until you can get the helmet off without moving the neck at all. Two rescuers are required.

Rescuer 1 kneels above the patient’s head. Grasp the helmet as shown left with fingertips curled around its lower margin touching the mandible (jawbone). Hold firmly to immobilise the head in line with the body.

Rescuer 2 kneels alongside the patient’s torso, opens the visor and checks the airway and breathing, then undoes or cuts the chin strap. Rescuer 2 then places one hand so that the mandible is grasped between the thumb on one side and the index and middle fingers on the other side. The other hand is placed at the back of the neck with the finger tips reaching up under the back of the helmet. The rescuer now clamps the patient between their forearm (front) and back (wrist) bracing the head, taking over in-line immobilisation.

  • Rescuer 1 now pulls the sides of the helmet apart and rotates the helmet up and backwards by pulling the mouthguard over the patient’s nose.
  • Next the helmet is rotated the opposite way so that the back of the helmet slides up around the curve of the back of the head.
  • Now Rescuer 1 can gently pull the helmet off. After helmet removal, in-line immobilisation must be maintained at all times.

Immunisations

Vaccinations need to be sorted out at least six weeks prior to departure as some may require several doses and also to allow time for your sore arm and mild flu-like symptoms to subside.

They’re available from your doctor or travel clinic. Depending on where you’re going and your prior immunisation status, your doctor will select vaccinations based on current state Health Department and WHO guidelines. Due to these variables your vaccination list might not exactly match that of your travelling companions; a source of anxiety for some but nothing to worry about.

Online you will find a useful vaccine recommendations generator at www.fleetstreetclinic.com.

Apart from Yellow Fever, which remains the only disease for which you must hold a WHO-approved certificate for entry into some two-dozen countries, mostly in Latin America and Central Africa, there is no legal obligation to have any of these jabs prior to travel.

Vaccination course notes

  • Hepatitis A Single dose.
  • Hepatitis B Three doses at 0, one and six months. Spread by sexual intercourse and blood. Advisable for a prolonged trip.
  • Japanese B Encephalitis Three doses at 0, seven and 28 days. Recommended for Southeast Asia. Rare but fatal in 30% cases.
  • Meningitis Single dose. Africa’s ‘Meningitis Belt’ runs from Senegal to Ethiopia.
  • Rabies Three doses at 0, seven and 28 days. Rare but 100% fatal. Prior vaccination only buys time and medical attention must be sought in event of contact with source.
  • Tetanus Single dose. Get up to date before any trip.
  • Typhoid Oral or injection. Common in all developing countries.
  • Yellow Fever Single dose.
  • Diphtheria, Polio and Tuberculosis (BCG) Vaccinations are routinely given in childhood in developed countries. If you think you may not have had them, ask your doctor about a booster dose.

With all these conditions it is worth remembering that having a vaccination does not make you immune and it is always best to avoid coming into contact with the source of the disease in the first place. Having said that it is important to keep perspective that all these conditions are incredibly rare and it would be a shame to let paranoia about contracting some exotic condition dissuade you.

There are many sources of information about travel vaccinations and other health issues on the internet:

Diarrhoea

Loose bowel movements occurs in up to 80% of travellers, usually simply from an altered diet or the stresses of an upset body clock, while infective diarrhoea is caused by contaminated food or water. It follows that the latter may be avoided by taking food handling and preparation precautions:

  • Prepare your own food.
  • Wash hands frequently.
  • Protect food from insects and rodents.
  • Keep food preparation surfaces spotless.
  • Cook food thoroughly and eat immediately.

In addition be particularly cautious with:

  • Shellfish and crustaceans As filter feeders they tend to concentrate whatever organisms may be in the local sewage outfall which may also contain poisonous biotoxins.
  • Raw fruit and vegetables Although ‘healthy’, the locals may well use human faeces as fertiliser. Clean thoroughly or peel.
  • Dairy products. Boil milk before consumption.

Infective diarrhoea may be caused by viruses (which will not be helped by antibiotics), bacteria (E. Coli) or other parasitic micro-organisms (eg Giardia, Campylobacter, Shigella). Whatever the cause, the symptoms will be loose stools, abdominal cramps and loss of appetite with or without vomiting and high temperature. There may be bloody diarrhoea. These illnesses are usually self-limiting and will settle in a few days without treatment. One exception is amoebic dysentery (caused by an organism called Entamoeba) which is distinguished by a slower onset and bloody diarrhoea without fever. Medical attention with a full course of medicines for around two weeks is always needed.

Treatment

The most important aspect when treating diarrhoea of any cause is adequate rehydration. Powder sachets (eg Dioralyte) should be made up with clean water or you can make your own by adding four teaspoons of sugar plus one teaspoon of salt and a little lemon juice to a litre of water. Water which has been used to boil rice makes a good alternative.

Antidiarrhoea tablets (Imodium, Arret, etc) temporarily mask the symptoms but prevent the body from flushing the harmful bacteria from the intestines. As such they are best avoided unless you absolutely have to keep riding. The antibiotic Ciprofloxacin (500mg taken twice a day), is effective against most infective causes of diarrhoea but it is only worth considering obtaining a supply from your doctor if you’re heading somewhere very remote or tropical.

Medical assistance needs to be sought if you have:

  • Diarrhoea for more than four days.
  • Diarrhoea with blood.
  • Fever (temperature greater than 39∞C/102∞F) for over 24 hours.
  • If confusion develops.

Spiders, snakes, and scorpions

Films like Arachnophobia, Anaconda and The Mummy have much to answer for. Apart from some non-venemous blood sucking/flesh eating spider species, none of the above have much to gain by running up and biting you; you’re just too big to eat. They will only resort to doing so as a self-defence measure if they feel threatened.

Of the many spider species throughout the world that will give a painful bite, only four are actually dangerous to humans. The Sydney Funnel Web is the most poisonous, although no fatalities have occurred since the introduction of antivenom in 1980. First aid for a bite by this spider is similar to that for a snake bite (see below). The other notorious species include Latrodectus (Black Widow, Redback), Loxosceles (Recluse spider of North and South America) and Phoneutria (Brazilian Wandering spider), all of which caused fatalities in the days before the introduction of antivenom. Treatment of these bites consists of cleaning the site, applying a cold pack, giving a pain killer and getting the victim to a hospital.

Snake bites

Irrational fear of snakebites is common among travellers despite the fact that they are exceedingly rare and, with correct management, rarely fatal. The most sensible precaution with snakes is simply to avoid the places where they are likely to be. This means wearing covered footwear in long grass or deep sand, stepping well clear of fallen trees and avoiding hollows. Never approach or provoke a snake.

When camping, keep your tent zipped up at all times, shake out your boots, helmet and jacket each morning if left outside, and be extra careful when collecting firewood. Snakes are attracted to your campsite for warmth (your cooling engine or warm body) and food, such as rodents feeding on your scraps. If any of your group are unlucky enough to get bitten by a snake, you will need to take the following action:

Reassure the victim. They will be terrified and as such their heart will be pumping harder, accelerating the venom through the system.

Calmly explain that only a small minority of snakes are lethal to humans and of these, only 25% of bites inject enough venom to be harmful to an adult. You can also add that death from snakebite is not immediate, as depicted by Hollywood, but with appropriate first aid there’s time to get to medical help

Cover the bite with a clean dressing. Never suck or wash a wound as it does not help and the hospital will need to swab the site to identify the venom.

  • Bandage the limb tightly and immobilize by splinting, for example by strapping it to a stick. This is called the Pressure Immobilisation Technique.  It is important to do this correctly – see below.
  • Give paracetamol or codeine painkillers, not aspirin.
  • Transport to hospital immediately, moving the patient as little as possible.

If you’re alone follow the same protocol but leave out the splint; you will still be able to ride. Move quickly but do not run. Never attempt to kill or capture the snake. Ignore local snake-bite remedies; it’s the antivenom available from a hospital which will save your life should envenomation have occurred.

Pressure Immobilisation Technique for the treating snakebite.

If you’re unfortunate enough to get bitten by a snake on your motorcycle travels the correct immediate actions and prompt transfer to a medical facility could save your life. This is a description of the pressure immobilization technique which slows the spread of venom into your body. It is important to note that this in itself is not cure but it will buy you time to get to medical help and is to be taken with the further advice on snake bites as listed above.

The pressure immobilization technique is recommended for the significant majority of snakebites, including all those in Australia. However for the viperid family of snakes, which include American rattlesnakes and pit vipers, the technique is not recommended as although it does slow the spread of venom it may significantly worsen tissue damage from the bite itself. However, for the remote motorcyclist who has no choice but to ride to help themselves, slowing the spread of venom into your body may be the top priority.

The advice is that if you’re sure it was a rattlesnake or other viperid, just keep the bitten limb dangling below the level of the heart and get to hospital immediately. For all other snakes, or if you can’t identify it, carry out the steps shown below then get yourself to hospital.  Never attempt to catch or kill the snake for identification purposes.

snake1

Step 1. Cover the bite wound with a clean dressing and a simple bandage. Never suck or wash the bite.

snake2

Step 2. Bandage the entire limb. The bandage should be about as tight as you would strap a sprained ankle and it should be difficult to insert a finger under the edge of the bandage. Doing this slows the venoms spread into the body (by occluding the lymphatic vessels).

snake3

Step 3. Splint the limb by strapping to a stick or tent poles. Preventing the limb from bending in this way stops muscle movements squeezing venom into the rest of the body.
Now get the victim to a medical facility, preferably flat in a car. If riding is absolutely necessary, leaving off the splint is an acceptable compromise.

snake4

Never do this. A single tourniquet or ligature is universally a bad idea

If the bite is not on a limb, some sustained direct pressure on the site may help but the emphasis is on getting to hospital and the anti venom available there without delay.

Some prior reading on the types of snakes you might encounter and planning on what you would do if one of your group were to get bitten is a well worthwhile.  Wikipedia actually has a well written snakebite section and is a good place to start.

Scorpion stings

Although dangerous scorpions do exist in Africa, North and South America and the Middle East, the chances of a sting being life threatening are almost zero. The most common effects are severe localised pain, swelling and numbness which begin to subside after one hour, similar to an intense wasp sting. Signs of a more severe sting include sweating, shortness of breath, abdominal pain, high temperatures, progressing very rarely to death. Antivenom exists for these cases. Debate exists as to whether it is necessary to visit hospital after a scorpion sting at all. I would say almost certainly not unless the symptoms are progressive. First aid is as for spider bites (see p.117).

 Back pain

Long days spent hunched over the ‘bars (as opposed to at bars) makes back pain common amongst motorcycle travellers, even in young people and those who have never had any previous problems. Poor posture and relative inactivity cause the muscles of the lower back to go into painful spasm and can irritate the nerves where they run through the muscle causing pain down the back of the leg. This is called sciatica and symptoms can be quite debilitating.

The muscles in question do not work in isolation but rather in an important balance with other muscle groups, namely the deep abdominal muscles (Transversus Abdominis), deep back muscle (Multifidus), pelvic floor muscles and the diaphragm. The key to alleviating low back pain is to redress the balance by exercising these other muscles; something which can be done with a few simple exercises as you ride:

Regularly tense your pelvic floor muscles gently and hold for ten seconds whilst breathing normally. These are the same muscles you use to stop yourself passing urine. If you feel your abdominal wall muscles tighten you are clenching too hard.

Tilt your pelvis by pushing your hips forward so that your back is straight from top to bottom. Hold for fifteen seconds.

These principles and exercises are the fundamental basis of Pilates, a system of exercise which can be of great benefit to back pain sufferers. If you are prone to back pain when you ride you would be well advised to go to some Pilates classes prior to embarking on a long trip. The numerous subtleties are best taught by an instructor and you will learn a number of exercises which you can do while riding.

 Exercise

Although motorcycling undoubtedly uses up more calories than driving a car or sitting at home channel surfing, it’s important for your general wellbeing to do some regular aerobic exercise at the end of a day’s riding. Anything which gets your limbs moving and heart pumping will make you feel healthier, sleep better and have more energy to cope with whatever the trip throws at you. Playing keepie up with a hacky sack or running after a frisbee are good sociable activities using items which take up little room in your panniers. Skipping with your tie-down rope is another good one.

 Dentistry

The phrase ‘prevention is better than cure’ has never been more applicable when it comes to teeth problems on the road. A visit to the dentist several months in advance is an essential part of your pre-trip preparation for the following reasons:

Almost all dental problems are predictable.

Any small, previously unnoticed dental cavity can turn into a painful infection under the conditions of poor oral hygiene associated with overland travel.

As Dustin Hoffman found out in The Marathon Man, toothache can become one of the worst types of pain and can be incapacitating.

Dentists are few and far between in the developing world.

Hygiene standards are not assured in such places. Transmission of HIV, Hepatitis B and C are possibilities.

Should a gum infection occur the symptoms can be subdued with painkillers, frequent teeth cleaning, hot saltwater mouthwashes and the antibiotics from your first-aid kit. Oil of cloves is a well-known remedy to numb toothache; keep some in your first-aid kit.

 Altitude sickness

Humans can start to feel the effects of lack of oxygen over about 2600m/8500 feet, a height at which your bike engine will still be functioning without a problem.

Most people will feel unwell if they ascend above 3000m (9850ft), with much variation in individual symptoms and their speed on onset. Headache, fatigue, shortness of breath, dizziness and difficulty sleeping are the common complaints which develop within 36 hours and settle within a few days as acclimatisation occurs. They occur simply due to lack of oxygen and are nothing to do with your level of physical fitness or smoking. Acclimatisation is the process by which the body adjusts to the lack of oxygen with increased heart rate, faster breathing rate and more frequent urination. Vivid dreams are normal during this time.

Acute mountain sickness is the most severe form of altitude sickness experienced by mountaineers who climb too rapidly. It can be fatal and must be treated by immediate descent, although ordinarily would not occur at altitudes normally attainable by a motorcycle.

 Heat-related illness

Heat-related illness describes a range of symptoms which occur as the body temperature rises; from heat cramps through to heat stroke which can be fatal. Humans need to maintain their internal (core) body temperature within a relatively narrow range of their normal temperature of 36.5∞C/97.7∞F in order to function properly. Heat acclimatisation is a process that occurs mainly during the first ten days after moving to a hot climate and is aided by exercising at cool times of day for an hour. The body adapts by gradually lowering its core temperature and making the sweat less salty, meaning that you actually have to drink more to stay healthy once acclimatised.

The important factors leading to the development of overheating are:

  • High ambient temperature.
  • Humidity: cooling by sweating is less efficient in high humidity.
  • Heat production: exercise, feverish illness.
  • Reduced heat dispersal: heavy protective clothing.
  • Dehydration.
  • Bodily factors: obesity, lack of acclimatisation.
  • Alcohol: exacerbates dehydration, reduces perception and appropriate response to overheating.

Symptoms of heat illness include headaches, muscles cramps, nausea and fainting. Swelling hands and feet are common after travel to a hot climates but settle in a few weeks. Any reduced consciousness or confusion in a person with body temperature over 40°C means that heat stroke is setting in, requiring urgent cooling treatment and transfer to hospital.

Treatment of heat illness in all cases consists of cooling and rehydration. Stop all activity, find shade and lie in a place which allows air to circulate. Evaporation is an efficient cooling technique: undressing the patient, keep the skin moist while fanning. Bathing in water, application of ice packs or transfer to an air-conditioned environment/vehicle also help.

 Water Purification

Water is lost through sweating, urination and vomiting and in hot climates must be drunk constantly. Unfortunately many diseases are transmitted in water or caught from food prepared in unclean water. Even then, it is common to be squeamish about water when on the road. A life lived with taped water makes you forget that this is a natural resource which falls from the sky and runs down rivers to the oceans where it evaporates to fall as rain again. Along with wells, rivers in wilderness areas as well as shady rockpools in desert areas are most likely all safe sources of natural, clean water.

Polluted water is most commonly found around settlements or other places of human activity and is caused by poor sanitary conditions and unhygenic practices. Luckily, bottled water is now commonly available throughout the world. Use it but check the cap seals as refilling empties is a well-known scam in poorer countries.

Eliminating bugs from water can be done in three ways:

  • By boiling for four minutes (but see below).
  • By sterilising with chemicals like chlorine, iodine or silver.
  • By filtration.

Boiling uses up fuel and, along with tablets, does not remove impurities in dirty water. Furthermore, water boils at lower temperatures as altitude increases, so add a minute to your boil for every 1000 feet/300m above sea level.

Sterilising tablets (or liquids) are a less fiddly way of getting pure drinking water. Cheap and effective, their drawbacks include giving water an unpleasant taste (especially in the case of chlorine-based tablets), the need to wait from ten minutes to two hours for the tablets to take effect, and the fact that they don’t clean the impurities from dirty water. Iodine can be poisonous if overdosed and silver takes a couple of hours to be effective. For visibly dirty water it’s a very good idea to sieve it through a filter; this removes cysts in which some bugs (notably giardia or amoebic dysentery) lie dormant.

Manually-operated filter pumps, like the well-known Katadyns, or the MSR are a quick way of safely cleaning even the dirtiest of water. Purifying and sterilising at up to half a litre a minute (depending on the state of the water) they can be easily cleaned and last for months. In most cases, however, tablets added to water pre-cleaned with a filter bag will do in those rare situations where no fresh or bottled water is available.

Malaria

Malaria is endemic throughout the tropical world as far north as southern Turkey, down to the northern part of South Africa. It kills 1-2 million people every year, with travellers being more susceptible than those indigenous to malarial areas.

Since the disease can only be transmitted to humans by the mosquito, the simplest measure is to avoid being bitten.

Mosquito avoidance

  • Wear long sleeves and long trousers between dusk and dawn when mosquitoes are active.
  • Use DEET (50% is enough) containing insect repellent applied to all exposed skin.
  • Use individual lightweight mosquito nets. Soak in Permethrin every six months to increase insect repellence.
  • Use vaporising insecticides or slow burning mosquito coils in sleeping areas

Antimalarial medication

There are two vitally important points here which cannot be stressed enough.

  • Taking these medicines alone will not prevent you from catching malaria; they must be combined with the anti-mosquito measures listed above.
  • The course of tablets must be completed as directed (i.e. four weeks after returning) even if you are symptom-free, as the organism can lie dormant in your liver.

The choice of anti-malarial drugs which your doctor will prescribe depends on geographical area, time of year and emergence of resistant strains in that area. The tablets will be either daily or weekly. Most of those drugs available will have some side effects, the only one worthy of mention here being Mefloquine (Lariam). The side effects of this drug have been well publicised and include stomach ache, diarrhoea, insomnia, loss of co-ordination and psychological changes, albeit in a minority of people.

However, it is effective against the most dangerous form of malaria (multi-resistant Plasmodium Falciparum strains) and currently recommended for high-risk areas in Africa, the Amazon and South East Asia. Due to the possibility of intolerable side effects occurring, it’s advisable to start taking Mefloquine up to a month prior to departure to allow time to change drugs if necessary.

Useful malaria info websites

This entry was posted in Resources. Bookmark the permalink.

One Response to Health and medical emergencies on the road

  1. Pingback: Horizons Unlimited - The HUBB

Comments are closed.