Personal Travel Security Awareness Training

International SOS Control Risks

Dr. Andre Willemse

31 August 18
 Ebola: What is it?
Ebola is caused by a virus.

• Causes a severe illness, with

bleeding (“Ebola
haemorrhagic fever”)

• Approximately 25 to 90% of all

infected people die

• No vaccine, and no specific

treatment are commercially
available (although development
is underway)

• Once someone is infected, if With the proper precautions in place,

proper precautions aren’t taken, Ebola will not spread to other people.
an epidemic can spread quickly

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 Biggest risk is still malaria

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International SOS – Control Risks

4
Membership App

It knows
where I am
Access
Information

Real-time
notifications

Help when
I need it

5
Objectives

• To allow mobile workers to mitigate risk associated with international

travel by:

o Developing situational awareness and understanding of

key threats.
o Applying 6 Principles of Personal Security.
o Providing practical tools and advice to improve personal
security.

6
OBJECTIVES
Objectives

• Allow you to mitigate risks

associated with travelling
in remote environments:

• Providing you with

practical tools and advice
to reduce health risks;

• Developing your
awareness and
understanding of key
medical threats;

• Help you respond in case

of a problem while
travelling or after your
return
2. Most Common Travel
Security Threats

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 Most common travel security risks

Two most common threats :

• Opportunistic crime (petty theft)
• Road traffic accidents

Next most common:

Image 1 • Civil unrest

• Opportunistic crime (violent)

Image 2

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3. Principles of Personal
Security
PREPARE

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 PREPARE
SIX PRINCIPLES OF
PERSONAL SECURITY

6 1

5 2

4 3
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 PREPARE

PRINCIPLE 1
1 PREPARATION

• Your security is your responsibility. Make

an effort to:
o Understand the environment
o Identify the key threats/risks
o Understand your own vulnerabilities
o Take steps to mitigate risk
• On a practical level:
o What are your plans?
o What are your documentation
requirements?
o Company procedures/regulations?
o Medical considerations?
o Other trip specific factors?

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 PREPARE

PRINCIPLE 2
2 AWARENESS

• Understand the country, customs, attitudes and risk

environment:
• Normal versus abnormal…
• Consider risks specific to your industry
• Be alert and vigilant – protective physiology
• Most criminal activity involves some form of
surveillance
• Be particularly alert when leaving / arriving at
your home or places you visit regularly
• Maintain a healthy suspicion of anyone who shows
you undue attention
• Avoid situations where you may become isolated and
at risk
Image 1

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 PREPARE

PRINCIPLE 3
3 LOW PROFILE
• Criminals select targets for a reason
• To mitigate risk:
• Dress appropriately and try to blend
in
• Avoid displays of wealth
• Select suitable vehicle
• Do not discuss your plans/itinerary
with individuals you do not know
• Safeguard personal information
• Avoid talking loudly to the point
where people start to pay attention
to you

If your profile is high,

Increase security measures!

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 PREPARE

PRINCIPLE 4
4 VARIED ROUTINE

• Vary arrival/departure times

• Vary clothing and appearance
• Use different vehicles and transport
• Use different route, pick-up and set-down
points
• Vary places where you socialise
• Consider changing accommodation on
protracted visits

Setting a pattern allows a potential

attacker to assess your vulnerabilities

Image 1

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 PREPARE

5 PRINCIPLE 5
COMMUNICATION
• Journey Management Plans (JMPs)
• Always make sure someone is aware of your
journey and return time.
• Confirm safe return
• Essential
• Carry fully charged mobile phone at all times –
GSM tri/ quad band
• Install pre-programmed emergency
numbers
• Back up emergency numbers
– keep card separate
• Secondary
• International call cards
• Change for pay phone
• Useful for some locations
• Satellite Phone, push-to-talk
radios

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 PREPARE

PRINCIPLE 6
6 LAYERED PROTECTION

No single measure guarantees your security

• Use several layers of physical and
procedural protection
• Adopt appropriate measures and
maintain them – direct relation to risks
likely to face
• Remain alert – effective protection must
be 24 hours a day, even on return leg of
journey
• More layers…more protection

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West Africa
TRAVEL

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Travel Risk Ratings – West Africa

Senegal, Ghana, Benin

Guinea, Togo, Mauritania,

Niger, Burkina, Mali,
Casamance, Abuja

Nigeria, Guinea-Bissau

Gao, Timbuktu, Kidal,

Borno

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 Main threats – West Africa

 Petty crime: Dakar, Freetown, Ouagadougou

 Violent crime: Port-Harcourt, Lagos

 Kidnapping: Nigeria Vs Mali

 Road accidents: Rural areas / main cities

 Socio-Political protests: Lagos, Accra, Abidjan

 Terrorism: Mali or Nigeria Vs Mauritania, Senegal

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Road accidents – West Africa
Roads, vehicles and driving standards are usually poor in
most West African countries:

 Do not self-drive (rural / urban centres)

 Avoid public transports

 Travel outside main cities should seek itinerary-

specific advice prior to travel and limit
movements to daylight hours to minimize the
risks associated with road traffic accidents.

 Asess whether a security provider is needed /

worth driving in convoy?

 Test your communication means and tracking

devices

 Make sure you are able to communicate with the

driver and that he knows emergency contact
details and contigency plans.

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6. If Things Go Wrong
RESPOND

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 RESPOND

TRANSPORT
ROAD TRAFFIC
ACCIDENTS
• Check for injury self / driver / other passengers &
apply first aid if trained and safe to do so.

• Remove yourself from immediate danger.

• Do not move the vehicles or leave the scene of the

accident.

• Wait for Police arrival / call.

• Comply with accident reporting procedures.

• Establish contact with your company.

• Call International SOS for assistance.

If in danger, repair to a safe haven and contact

the authorities.

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 RESPOND

ARMED
ROBBERY / CONFRONTATION

If Confronted by someone with a weapon

DO
• Remain calm and compliant; assume a docile posture.
• Hand over your wallet, purse or items the attacker is
seeking.
• Declare any movements prior to making them.
• Be aware the criminal may not be in a rational state of
mind.
DO NOT
• Plead with the attacker. He/she wants actions, not words,
as signs of compliance.
• Resist or attempt to subdue the attacker.
Image 1
• Challenge the attacker’s feeling of control.
• Move erratically or suddenly.

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 RESPOND

ATTACK ON HOTELS
RESPONSE GUIDELINES
• Lock the doors
• Fill the bath, soak towels, and dampen the walls
and doors
• Hang a sheet out the window to notify others
• Switch off the AC
• Stay in the bathroom
• Maintain communications – but place phones on
vibrate and keep a charger with you
• Don’t open the door to anyone even if they state
they are from the authorities

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 RESPOND

KIDNAP
FOR RANSOM

Statistics
• 91% of all victims are local nationals.
• 93% of all victims are released unharmed.
• 85% of foreign nationals are kidnapped for money.
Tips
• Never discuss ransom.
• Eat, drink and stay on top of personal hygiene.
• Establish a mental routine.
• Be aware of Stockholm syndrome.
• Preserve strength.
• Listen, make mental notes, plan.
• Identify routine and vulnerabilities.
• Best option is to be compliant.
Image 1 • Don’t believe everything you hear or are told!

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Summary
Apply the Six Principles in all
your daily activities to
mitigate threats:
o Preparation
o Awareness
o Low Profile
o Varied Routine
o Communications
o Layered Protection

Perform a mental review before you start your daily activities.

Think through your responses to anticipated threats.
In emergency situations, try and stay calm, recover to a safe location and call the Assistance Centre.

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PREPARE
• Health Preparation
PREPARATION – MEDICAL RISK RATINGS

Medical Risk Ratings

indicate:
• Standard of local medical
care
• Risk of serious infectious
diseases

Medical risk can vary

within country
• Major cities may have
lower risk
• Remote areas may have
higher risk

Take precautions:
• The higher the risk, the
more precautions you
should take before and
during your trip.
PREPARATION – SEE YOUR DOCTOR
Before you travel

• Complete any necessary medical AND

dental care before you leave
• Travel “fit”.
• Certain medical conditions may require
detailed preparation (e.g. diabetes)
• Understand that traveling to ‘hot spots’
will expose you

Inform your doctor of your destination

and planned activities so the doctor can
advise on specific precautions.
PREPARATION – SEE YOUR DOCTOR
Before you travel

Medical Summary
• Carry a summary of your medical
conditions with you when you
travel.

Medications
• Take your medications from home.
• Carry enough in your hand
luggage to cover the trip. Take
some extra in case of travel
disruption or delay.
• Carry copies of your prescription
and a letter from your doctor.
PREPARATION – MALARIA
Anti-malarial medications (preventive treatment)
may be prescribed: See your doctor!

• Several medications available on prescription

some are taken daily, others weekly.

• Atovaquone Proguanil (Malarone*) will be

recommended for a short trip to malaria countries.
• Start the day you travel.
• One tablet daily, taken with a meal.
• To be continued 7 days after returning home

• Purchase before you leave and carry enough for

the duration of the trip (and the period beyond
your stay when you must keep taking the
medication)
PREPARATION – USEFUL TRAVEL ITEMS
Things to pack
Health related items: See your doctor
• Chronic illness medications
• Spare glasses, sunglasses, contact
lenses, solutions, etc.
• Effective insect repellent (with DEET,
Picaridin, or IR3535)
• Sunscreen
• First aid kit: medications for diarrhoea,
pain killers, antiseptic hand wipes
• Hydro alcoholic solution - Hand rub

Wear your medical

identification tag if
you have special
medical
requirements
PREPARATION – DEEP VENOUS THROMBOSIS (DVT)
Definition and danger

• A DVT is a blood clot (thrombosis) in a large vein,

usually in the leg or pelvis.
• Part of the clot can break off and move to the heart.
and lungs. This causes shortness of breath and
chest pain, and can be fatal.

Risk factors
• Prolonged immobility.
• Prolonged air travel.
• More likely after air flights over 3-4 hours.
• Can occur after multiple flights within a short
period.
• The class of air travel is not a factor.
• Individual factors vary the risk (such as extremes of
height, obesity, or specific conditions that cause the
blood to clot).
• Using oral contraceptives probably increases the
risk of DVT.
PREPARATION – DVT PREVENTION

Prevention

• Wear loose fitting clothing and practice

relaxation exercises
• Wear flight socks to help your venous
system
• Drink plenty of water (rehydration)
• Walk down the aisle to the galley or
toilets at least once every hour
• Avoid excessive alcohol
• Don’t use sedatives, sleeping pills…
PREPARATION – JET LAG
The facts:
1/3rd of travellers severely affected
1/3rd have some effect
1/3rd not affected
More significant if you cross more
than three time zones.
West to East travel is worse :
longer re-adjustment… unless the
contrary!
Full physiological recovery:
between 3 to 8 days.
Prevention
• When you board the plane, set
your watch to the new time
zone.
• Try to rest and keep hydrated
• At destination:
- if daytime, go outdoors (and take
the sunlight as much as you can)
- do some exercise (jogging)
• Adopt the new time zone: eat
and sleep according to local time
• Avoid sleeping during the day or
only a short nap.
.
TRAVEL
• Healthcare while you are away
TRAVEL – HEALTHCARE
While you are travelling

• Healthcare may be very different from that in

your home country
• The standard of care may be lower
• Medical staff may not speak your language
• Tests and medicines may be unavailable
Seeing a doctor, or going to a
• Your condition and treatment options may not hospital, can be unnerving and
be clearly explained to you sometimes unsafe.
• Hygiene and cleaning may not be of an
international standard Contact your Assistance Company
• Blood supplies may not be safe
for advice:
• Nursing care sometimes is given by friends
• Standard of medical care?
and family • Best medical providers?
• Conditions can be safely
Avoid unnecessary medical care while in high treated?
risk countries. Get any medical or dental • Evacuation to another city or
attention you need before you leave home, country may be required
including routine care and procedures.
TRAVEL – PERSONAL HYGIENE
More important when you are travelling
Wash your body, clothes, towels and bed
linen regularly. This helps to keep you
healthy and prevents skin infections.
Brush your teeth twice a day (using safe
water)
When showering or bathing:
• Use soap, don’t forget skin folds
• Clean your hair
• Examine your body for ticks or other
insects
• Dry yourself afterwards, paying
attention to skin folds

STI prevention: Always use latex

condoms. They are highly effective against
most diseases.
TRAVEL – EXTREME HEAT
Stay healthy

• Drink more water and other non-alcoholic

beverages. Sports drinks help replace salts
and minerals that you lose through sweating.
Sugary drinks don’t help retain the extra fluid
you need – best avoided.
• Dress appropriately: cool and loose-fitting
items
• Find a cooler environment: air conditioning,
fan, breeze, shade, cool shower / pool
• Limit your physical activity to only what is
necessary

Avoid direct sun exposure as much as

possible. If you must go out, remember
sunscreen!
TRAVEL – CONTAMINATED FOOD AND WATER
1) Stress and fatigue can contribute to
developing traveller’s diarrhoea

Traveller's diarrhoea is the most common

cause of discomfort and illness for travellers.
More than 25% of travellers will experience an
episode of acute diarrhoea within the first 2
weeks of travelling. Fatigue and stress are also
participating to this occurrence.

2) Diseases can be spread through poor

hygiene, and also contaminated food and
water

Several infectious diseases are spread through

eating or drinking contaminated food and
water. These include:

• Hepatitis A (vaccine available)

• Typhoid (vaccine available)
• Cholera (vaccine available in some
countries)
• Norovirus
• Amoebiasis… and more
TRAVEL – WATER
Is the water safe?

Tap water is generally safe in large cities and

in international hotels.
Pristine water from the tap (no colour, no
smell) is generally safe.
If you are unsure, it is best to drink only
bottled or boiled water and drinks.
• Bottled drinks: make sure the seal is
intact
• Boiled water: boil for one minute
• Avoid ice: it may have been made with
unsafe water or manipulated by dirty
hands
• Carbonated drinks are often safer
TRAVEL – FOOD
Is the food safe?

In countries where food may not be safe:

• Eat at reliable establishments
• Make sure meat, poultry, eggs are
thoroughly cooked
• Avoid seafood, if not fresh from the sea,
and thoroughly cooked in front of you.
• Food that is freshly cooked and served
piping hot is safest. Cooking to 70°C
(160°F) kills all germs in food
• Avoid food that has been stored warm
(germs may develop in this nice culture
medium)
• Ensure dairy products have been
pasteurised

If you eat street vendor food, select food

that has been fully cooked in front of you
and served very hot immediately to you.
TRAVEL – FOOD

Is the food safe?

In countries or places
where food/ water may
not be safe:

• Avoid salad, raw

vegetables and pre-
peeled fruit

• To make raw fruit and

vegetables safe, first
wash with safe water
and then peel

Boil it, peel it, cook it or

forget it!
TRAVEL – BITE PREVENTION
TRAVEL – PREVENTING BITES
Preventing bites while outdoors
• Wear light-coloured clothing that covers most
of the body (long sleeves and long pants)
• Wear socks and shoes
• Use an effective insect repellent, such as one
containing DEET, Picaridin, PMD, or IR3535
• Consider treating clothing with an insecticide
or repellent as well

Preventing bites wile you are indoors or

asleep
• Make sure that there is fly-wire (mosquito
netting) on all of your windows
• Use "knock-down" aerosol spray or electric
insecticide vaporisers to kill insects in your
room
• Use air-conditioning when possible;
mosquitoes become less active
• Consider sleeping under an insecticide-
treated bed net
TRAVEL – MALARIA

Malaria facts

• A serious and sometimes fatal

disease
• Transmitted by infected mosquitoes
• Caused by one of five species of
Plasmodium (a parasite)
• Largely preventable by preventing
mosquito bites, and by using
preventative medication as
recommended
Last but not least: When a person
develops malaria:
• It is a medical emergency Malaria is diagnosed by looking at
• It must be diagnosed and treated blood under a microscope or by a
promptly rapid antigen test (something like a
rapid test using a micro droplet of
blood – finger prick test ).
TRAVEL – MALARIA
Symptoms
• Can occur from 1 week to several months after
being infected by a mosquito bite
• Can start like a simple flu (non specific) and include:
• Fever
• Sweating, shaking (rigors)
• Headaches
• Muscular pain
• General fatigue
• Vomiting, diarrhoea and jaundice
• Can quickly deteriorate to coma and death
Learn the symptoms of malaria. Seek medical
attention PROMPTLY if they develop, even if you
have been taking preventive medication. Tell your
doctor that you may have been exposed to malaria
during your travels
TRAVEL – DENGUE FEVER
Severe dengue - bleeding occurs.
People who have dengue more
than once are at higher risk.
• Dengue fever is a common viral disease found in most
tropical and sub-tropical countries. Transmitted by
mosquitoes that bite during day time.
• Often occurs in cities and towns (where malaria may have
been eradicated). Usually a severe illness and occasionally
fatal particularly among young children)
• Avoided by preventing mosquito bites. A vaccine is available
in certain countries for the local population.
Symptoms come on suddenly:
• high fever
• headaches
• joint and muscle pain
• rash
Treatment: purely supportive including simple pain
killers. Usually recover in about 10 days.
TRAVEL – ZIKA
Zika virus is commonly transmitted through the
bite of an infected Aedes mosquito (the same
mosquito spreads dengue, chikungunya and
yellow fever).
• These mosquitoes mostly bite during the day
- inside and outside.
Other modes of transmission:
• During pregnancy from mother to foetus, also
around time of delivery to newborn
• Through sexual contact
• Blood transfusion

Research is ongoing to see whether other human

body fluids (e.g. urine, saliva) might transmit
infection.
 TRAVEL – RABIES
Rabies is present in most developing countries
• Rabies is transmitted through the bite of an infected animal
• (usually dog, bat or monkey)
• This disease is always fatal
• Travellers who have been bitten (exposed) may require
international evacuation to obtain rabies immunoglobulin's.

Prevention
• Stay away from wild or stray animals but also domestic pets
• Do not touch, pet, handle, or feed any dogs, cats or other
mammals
• Prevent children from approaching, touching, or annoying
animals
• Beware of monkeys

Should you be vaccinated?

Recommended for expatriates, long timers particularly children
or professionals exposed to the risk (vets…).
Are you participating in activities that put you at risk?
TRAVEL – SNAKE, SPIDER, SCORPION
Bites and sting prevention

• Wear closed shoes and long pants in

areas where venomous snakes, scorpions or
spiders may be present.

• Sleep under a mosquito net.

• Use insect repellents to deter scorpions or

spiders.

• Check for spiders and scorpions in your

clothing and shoes before putting them on.

• . snakes.
Do not try to handle or kill

• If you see a snake, back away from it slowly.

In case of envenomation

• Calm down the injured person – lay down and

give pain killers, remove ring, watch…

• Take patient on stretcher / car to nearest

hospital.
TRAVEL – ACCIDENTS AND INJURIES
Common causes
Road accidents are the most common.
Others include:
• Drowning and near-drowning
• Don’t over estimate your capabilities
• Don’t drink alcohol and swim
• Remember:“Alcohol and water do
not get well together”
• Leisure sports: hang gliding, parasailing,
rafting
• Fitness is important
• Be sure the operator is reputable
• Alcohol associated injuries
• Limit alcohol consumption
• Assault
• Don’t walk alone in unfamiliar areas
• Leave valuables at home
RESPOND
• How to respond to health incidents
RESPOND – REMOTENESS

Remote travel

• Some medical problems can

deteriorate and become serious.
• A “wait and see” approach makes
sense when quality medical care is
available.
• Depending on the problem and the
local standard of medical care, “wait
and see” may not be safe
• Get quality medical advice early. It
will help you know what to do next.
• It may be safer to move to an area
where a better standard of care is
available.
RESPOND – ACCIDENTS AND INJURIES
Road traffic accidents

• This is the first cause of

hospitalisation, death and medical
evacuation for travellers
• If you are seriously injured, most
often the local emergency service will
take you to the nearest hospital
• Some of the hospital may not be
suitable to treat your injuries
• Blood transfusion will be strongly
discouraged
• You may have to be evacuated
internationally
• This is when your assistance
company and medical insurance
company may play a critical role to
help you out.
RESPOND – DIARRHOEA +/- VOMITING

Up to 30% of travellers develop

diarrhoea when in developing
countries.
Usually this is “travellers’ diarrhoea”
caused by bacteria or parasites
contained in contaminated food or water:
• Can vary from three to twenty loose
stools per day
• Can also have fever, abdominal
cramps, and vomiting
• Usually lasts 1-2 days and settles
with no treatment
• Can also last one week and tarnish
your stay!

One may quickly become

dehydrated. Look for dry mouth,
reduced urine output and lethargy.
Seek urgent medical help.
RESPOND – DIARRHOEA +/- VOMITING
Management
• Prevent dehydration: drink bottled water,
soda, sports drinks or other clear fluids.
Use Unicef rehydration solution powder
(ORS) if you have them. Keep sipping even
if vomiting – you ARE keeping some fluids
down
• Avoid milk / dairy drinks
• Choose low-residue, bland foods, such as
rice, biscuits or dry bread
• Antidiarrheal/ antisecretant medications
(loperamide /racecadotril ) may help. Do
not take if you have fever or see blood in
the stool.
• Seek medical attention if symptoms last
more than 2 days or if severe (blood,
unable to keep any fluids down, severe
diarrhoea)
• Antibiotics can shorten the illness but very
high risk of bacterial resistance in certain
areas
• Ask the doctor.
RESPOND – FEVER
Infection is the most common cause of
fever in a developing country.
Many infections resolve without specific
treatment (e.g. head cold / seasonal flu).

Serious causes of fever

• Sometimes serious infections are the
cause (malaria, dengue, typhoid, etc.).
• These should always be considered if
the disease occurs while travelling or
after returning from your trip.
RESPOND – FEVER

When to worry

• If you have symptoms that indicate what

type of infection you have, then manage
that condition (diarrhoea, head cold,
etc.)

• It is more worrying if you have a high or

prolonged fever and there are no
specific symptoms.

• If you have a fever and there is no

obvious cause, doctors may be
concerned about serious infections such
as malaria or typhoid fever.

• The possible causes relate to your

location. Special tests may be required.
RESPOND – FEVER
Fever in (or returning from) a malarial area
is an emergency. Seek urgent medical
help. Fever AFTER visiting a malarial area
MIGHT be malaria! BE SURE to tell the
doctor your fever might be malaria: very
serious complications may develop fast.
Managing the symptoms:
• If your symptoms are minor, no specific
treatment is required
• Use a simple over-the-counter medication
such as acetaminophen / paracetamol to
lower the fever
• Drink plenty of fluids
• Rest
Seek medical attention
• If your condition is deteriorating
• If you develop serious symptoms, if high
fever persists more than 3 days
• If diagnostic and treatment capabilities (no
ICU) are limited or overwhelmed as often
in developing countries
• If you are in an area with serious infectious
diseases such as malaria seek immediate
help.
RESPOND – RASH

Rashes can be limited or

generalized, have minor or
serious causes, including:
• Heat
• Bites
• Skin infections (bacterial /
fungal)
• Viral illness (e.g. mumps,
measles, dengue, zika…)
• Exposure to irritants /
allergy
• Serious illness (e.g.
meningitis)
• Other serious causes….
RESPOND – RASH
Management
If the rash itches, use simple remedies
such as:
• Cool compresses
• Calamine lotion
• Drying wet areas of the body (between
the toes / armpits)
• Anti-histamine tablets (choose non-
sedating)

Do NOT:
Use antibiotics without medical advice
RESPOND – RASH
When to seek medical help
• If there are other worrying symptoms (e.g.
headache, fever, vomiting)
• Rash is painful
• Rash is getting worse or spreading
• If the rash does not settle in a few days
• If someone else has the same rash
(infectious)
• If there is obvious infection
RESPOND – COUGH
A cough can indicate a lung
problem.
Causes include:
• Common infection (e.g. cold / flu /
bronchitis)
• Serious infection (e.g. tuberculosis)
• Underlying respiratory condition
(e.g. asthma)
• Irritation (e.g. exposure to smoke,
chemicals) …..
RESPOND – COUGH

Initial management Is it serious?

• Most household cough Seek medical attention if:
mixtures / elixirs aren't • There are other symptoms
(e.g. fever / weight loss)
effective
• There is blood in the sputum /
• Try other simple remedies phlegm
such as throat lozenges • The sputum / phlegm is dark
• If asthmatic, increase coloured
treatment and seek • There is wheezy breathing or
medical help shortness of breath
• Cough is getting worse / not
improving after a few days
? QUESTIONS