Issue: February 2014


Traveling to High Altitudes  Hotel Fire Safety


Travel Risk for Deep Venous Thrombosis - From the Assist America Case Files


Airlines May Ramp Up Electronic OfferingsHow to Pack Light

Regional Information

Africa - East Asia - Europe - Near East
South Asia - Western Hemisphere



When traveling to elevations above 6,000 feet (1,800 meters) some travelers may develop altitude-related health problems. Serious altitude illness usually occurs at elevations above 8,000 feet (2,400 meters), but each individual has his or her own level of tolerance. Susceptibility to altitude illness is not affected by training or physical fitness. There are three clinical manifestations of altitude sickness: acute mountain sickness (AMS), high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE).

At higher elevations, there is less oxygen in the air. The body tries to boost oxygen in the bloodstream by increasing heart rate and by increasing and deepening breathing. These shifts cause a change in fluid balance, and fluids may accumulate in the lungs and brain.

There are a number of precautions that should be taken when traveling to a high altitude area:
• Be alert for physical changes in yourself, and pay close attention to any companions' complaints and behavior.
• At altitudes over 8,000 feet (2,450 meters), ascend slowly; if you intend to remain at higher levels, ascend no more than 1,000 feet (300 meters) a day.
• Increase fluid intake.
• Sleep below your altitude level of tolerance.
• Keep a journal. Record starting altitude, amount climbed each day, and altitude at which you sleep. This information could be very helpful if you require medical assistance
• Avoid alcohol or any unnecessary medications, especially sedatives, tranquilizers, and narcotics. High altitude may increase their effects.
• Treat any illness as a symptom of altitude sickness, and descend.

There are various symptoms that may occur with each type of altitude illness:

Acute Mountain Sickness (AMS)
• Headache
• Shortness of breath
• Lack of sleep
• Weakness
• Fatigue
• Loss of appetite
• Dizziness
• Muscle aches

High Altitude Cerebral Edema (HACE)
• Increasingly severe headache
• Mental confusion
• Emotional behavior
• Hallucinations
• Unstable gait
• Loss of vision
• Loss of dexterity

High Altitude Pulmonary Edema (HAPE)
• Breathlessness with exertion and then with rest
• Tight-feeling in the chest
• Cough - first dry and then with mucus tinged with blood
• Extreme fatigue

Treatment for Altitude Illness

Descend immediately if you suspect HACE or HAPE—these two types of altitude illness are serious medical emergencies and may result in death. Oxygen and the use of a portable high-pressure bag may be required if descent is not possible. Dexamethasone, a strong steroid, may be used to treat HACE during descent.

AMS should be treated with rest, and allowing several days at each altitude level to allow the body to acclimate before continuing to climb. Descend if your AMS condition does not improve. Diamox (acetazolamide), a diuretic, may be prescribed for mild AMS. It may also be prescribed prior to arriving in high altitude to assist with acclimatization.

Additional Health Concerns:
• Travelers with underlying medical conditions, such as congestive heart failure, angina, lung disease, or any blood disorder, should consult with a doctor familiar with altitude-induced illnesses prior to travel.
• Pregnant women should avoid altitudes greater than 12,000 feet (3,658 meters). Women in late pregnancy or in a high-risk pregnancy should avoid altitudes greater than 8,200 feet (2,500 meters).


Fire safety features required in US hotels, such as sprinkler systems, smoke detectors, fire stairwells, and emergency lighting can be  either lacking or inoperable in foreign countreis and  accommodations that a traveler may be used to could  differ considerably from those found in North America and Western Europe. In some countries fire regulations do not exist, firefighting equipment is antiquated, water sources are inadequate and buildings are constructed to minimal standards.

Before you go
• Book your room in the most modern hotel possible, preferably a US or Western European chain.
• Request a room above the second floor and below the eighth. Although most fire departments have equipment that can reach above the second floor, most do not have equipment to reach beyond the seventh.
• Pack a portable battery-operated smoke alarm, a small flashlight, and a smoke hood.

On Arrival at Your Hotel
• Begin planning your escape from a fire as soon as you check into a hotel. Should a fire occur, you will be able to act efficiently and without panic.
• Avoid accepting a room that is not near an exit. Do not reserve a room that is in the middle of long hallway or in an isolated wing.
• If the hotel has a fire alarm system, locate the alarm nearest your room and learn how to use it; you may have to activate it in the dark or in dense smoke.
• When you leave the room for the first time, follow the exit signs down the stairs to the lobby and outside. Watch for bottlenecks, unusual turns, blocked or locked doors or other hazards that could delay an escape. If possible, also check the exit to the roof.
• Ensure that your room windows open, and that you know how the latches work.

Planning for a Fire
• Form a mental map of your escape route.
• Devise a contingency plan, and discuss it with your traveling companions.
• Count the number of doors between your room and the closest exit or stairway. In a smoke-filled or darkened hallway, you may have to feel your way to an exit.
• Mentally rehearse an escape route through a window, if possible, noting ledges or decks that will aid in escape.
• Test the room's smoke detector, if one is present, by pushing the test button. If it does not work, have it fixed or request another room. If there is no smoke detector, turn on the one you brought and test it. Place it close to the door and as close to the ceiling as possible.
• Always keep the room key and your flashlight on the bedside table so that you may locate them quickly if you have to leave your room.

If Fire Breaks Out
• If you smell smoke, call the fire department or police, and then call the front desk. If possible, hang a bed sheet out the window as a signal to rescuers.
• If there is smoke in your room, take a wet washcloth, your key and flashlight, and crawl to the door on your hands and knees. Do not stand -- smoke and gases rise while fresher air remains low.
• Before you open the door, feel it with the palm of your hand. If the door or knob is hot, the fire may be right outside. If the door and knob are not hot, open the door slowly. Be ready to close it immediately if the fire is close by. If your exit path is clear, crawl into the hallway.
• In case you have to return to the room, close the door behind you to keep smoke out.
• Stay close to the wall to avoid running into others or into rescuers. If there is smoke in the hall but no fire, crawl to the exit, with your eyes closed if necessary.
• Cover your mouth and nose with the wet washcloth in case the smoke becomes too thick for you to breathe.
• As you make your way to the fire exit, stay on the same side as the exit door and count the doors to the exit.
• When navigating stairs, hold the handrail for guidance. This will also help protect you from being knocked down by other occupants.
• If you encounter heavy smoke in the stairwell, do not try to run through it. You may not make it. Turn around and walk up to the roof exit or return to your room.
• Do not use elevators during a fire. They may malfunction, or if they have heat-activated call buttons, they may take you directly to the floor where the fire is located.

Staying in Your Room
• If all exits are blocked, or if there is heavy smoke in the hallway, you will be safer in your room.
• If there is smoke in your room, open a window and turn on the bathroom vent. Do not break the window unless it cannot be opened or is absolutely necessary. You may want to close the window later to keep exterior smoke out.
• Fill the bathtub with water to use for firefighting. Bail water onto your door or any hot walls with an ice bucket or a wastebasket.
• Stuff wet towels into cracks under and around doors where smoke might enter. Tie a wet towel over your mouth and nose to help filter smoke.
• If there is fire outside your window, take down the drapes and move everything combustible away from it.

If possible, maintain contact by telephone with the fire department and front desk, ensuring that both know your room number.



Deep Venous Thrombosis (DVT) is a blood clot that forms deep within a vein, usually within a muscle group, secondary to a condition known as thrombophlebitis. This condition is an inflammation of a vein or veins typically in the legs, and is caused by lack of movement or awkward positions that cut off or stagnate blood flow. When a blood clot forms, pieces of it can break off and can be life threatening if any of them reach the lungs. Since travelers are often sitting for long periods of time, often in cramped quarters, they can be at high risk for DVT.

Following are traveler risk factors for DVT:

• Sitting for prolonged periods in a car, train, or airplane in a cramped position with little room to move and stretch legs.
• Dry air in airplanes and possibly long car rides, leading to dehydration and causing thicker blood.
• Pooling of the blood in the legs, particularly on planes, where pressure in the cabin is low.
• Alcoholic beverage consumption, which can lead to dehydration and increase the risk of DVT.
People with certain underlying conditions are more prone to developing blood clots, and are therefore at a greater risk for developing thrombophlebitis in their legs, which can lead to DVT. These conditions include:
• Having been recently confined to bed due to surgery or illness.
• Having certain types of cancer which increase pro-coagulants in the blood.
• Being a stroke patient with hemi-paralysis.
• Having the insertion of a medical device that impedes blood flow in anyway, such as a cardiac pacemaker.
• Being a woman who is pregnant or on hormones (including oral contraceptives) or has varicose veins.
• Being a smoker.
• Having a positive family history of blood clots.

Although some DVTs can occur without warning signs or symptoms, particularly in adults over 40, the most common symptoms of DVT to be aware of are:

• Swelling, typically below the knee of the affected extremity.
• Pain in the leg (similar to a cramp).
• Redness and occasional warmth.
• Shortness of breath, sudden chest pain, coughing, and fainting. These symptoms are present with the more deadly pulmonary embolism. If the clot is large enough, it can cause sudden death.

Here's how you can reduce the risk of DVT:

• If traveling by air, try to walk for at least 10 minutes per three-hour flight. If driving, take a break for a short period every 1 to 1 ½  hours of driving time. Use a similar rule for traveling by train.
• Sleep for short periods of time on planes and trains, unless in a sleeper car.
• Reduce alcohol and caffeine intake, and replace with water to prevent dehydration.
• Consider wearing compression stockings or support hose to enhance circulation.
• Ask your healthcare provider if aspirin might be appropriate as a preventive precaution.
• Wear clothing that is not restrictive in any way to impede blood flow.
• Do isometric exercises whenever possible in your seat to promote good blood flow and maintain comfort.

If you have symptoms of a DVT and have potential risk factors, seek the immediate attention of a professional healthcare provider for evaluation. DVTs are often diagnosed through history, clinical evaluation, and ultrasound. Medication, particularly blood thinners, are the treatment of choice for DVTs. Occasionally, surgery is required to prevent the clot from reaching the lung.


Skiing in Colorado

Joan* traveled to Durango, Colorado to enjoy a week-long ski trip with her sister. While exploring a particularly adventurous trail, Joan lost control and fell, twisting her ankle. The ankle began to swell instantly so Joan was brought to a nearby hospital for evaluation. Upon arrival at the hospital, Joan's sister contacted Assist America.

The Assist America coordinators contacted the hospital and began the process of monitoring Joan's care. The X-ray confirmed that the ankle was not fractured, but there had been a significant sprain. The hospital provided an immobilizer for the ankle and crutches which would make traveling uncomfortable and difficult. After being discharged, Assist America arranged and paid for Joan to fly home first class allowing for space to elevate the injured leg. Assist America also arranged for Joan's sister to accompany her on the flight as a non-medical escort. Joan returned home safely and was extremely grateful for Assist America's help.

*name changed for privacy

Member's comment:

"Outstanding service. Everyone I spoke to was truly concerned about my well-being and comfort."



With fliers getting the all-clear soon to start using personal electronic devices during takeoff and landing, airlines might seize the chance to rent passengers portable devices or provide them with new content, some industry watchers say.

Travelers learned this past November that the Federal Aviation Administration would allow them to read e-books, play games, and watch downloaded movies during the start and end of a flight as long as the airline has shown the jet won't be at risk because of potential interference from the devices.

John Walton, director of data for the flight search website Routehappy, said that could pave the way for airlines to beef up their electronic offerings. "Airlines will also have the chance to offer passengers electronic services," he said. "That could easily include iPads to rent, seatback entertainment that can be enjoyed from gate to gate, or even e-reader in-flight magazines."

Some U.S. carriers already provide fliers with devices. Recently, Southwest announced that its passengers taking a Wi-Fi-equipped flight between Chicago Midway, Denver and Oakland International airports could borrow an iPad 2 for the trip. Through a partnership between the airline and satellite provider, Dish, fliers can check out a tablet for free at the airport, then return it to the next airport's library once they land.

Hawaiian Airlines rents iPad Minis for flights aboard its 767 fleet. The device is $15 at the airport gate, and $17 during the flight.  Alaska Airlines rents a player containing movies, music and other downloaded content for $8 to $10, with the price varying according to the flight's destination.

Southwest spokeswoman Michelle Agnew says "it's too early to tell whether" the relaxed rules will affect how many iPads are loaned.  Passengers will also still be unable to access the Internet when they're flying below 10,000 feet. But more passengers, knowing they can use their devices in some way for the duration of the flight, may pay for Wi-Fi once their jet hits cruising altitude.

"The provision of WiFi is not a profit center for airlines," says Jay Sorensen, whose consulting company IdeaWorks specializes in airline revenue. "The money airlines make from it doesn't cover the cost of the equipment or ongoing operational expense for providing the service. They're doing it because it's an expectation that's developed among business travelers to be always connected."

Many airline passengers can't wait to make more use of their electronic gadgets now.  A survey released in May 2013 found that 99% of adult airline passengers carried at least one personal electronic device with them during the previous year, according to the Airline Passenger Experience Association and the industry group Consumer Electronics Association.

The most common gadgets used during flights are smartphones (28%), laptops (25%), tablets (23%), audio players (23%) and e-readers (13%), according to a national survey of 1,629 conducted in December 2012.

"Airline passengers have come to rely on their smartphones, tablets and e-readers as essential travel companions," says Doug Johnson, vice president for technology policy at the Consumer Electronics Association.


Packing requires practicality—not only must you carefully plot what items to bring, but you must also strategically organize them into one compact carry-on. With steep checked-baggage fees increasing flight costs, experienced globetrotters often suggest stripping down to the absolute essentials in order to hold on to save some money. Add the burden of shouldering a bulky bag through terminal walkways and you can see why savvy travelers are taking advantage of smart, minimalist packing.

While carrying less cargo certainly has its benefits, even the most seasoned travelers agonize over how to limit excess baggage. But no matter where you're headed, these nine handy techniques will help you pack as efficiently as possible for your next trip.

Size Up Your Carry-On
You'll run the risk of paying a hefty sum if your bag exceeds your carrier's size requirements for carry-on luggage. Before you consider which particular suitcase to take, check your airline's carry-on baggage restrictions to avoid extra fees. Carry-on bag size dimensions vary by airline. Most domestic carriers allow you to bring luggage as large as 45 linear inches (the total length, width and height of a bag) on board; however, some smaller international airlines like Ryanair impose much stricter dimensions. By opting for a suitcase that doesn't exceed 20 inches in length or 20 pounds fully packed, you should have no problem boarding domestic carriers. New, cutting-edge luggage designs are rolled out every year, but you should stick to the style that suits you. A roll-aboard with soft sides that can be easily laid into an overhead bin allows you to breeze through the terminal on wheels, while a lightweight duffel bag allows you to traverse a variety of terrains.

Make a Checklist
It may seem like a no-brainer, but making a packing list forces you to differentiate between what's necessary and what's not. Write down exactly how many shirts, pants and shoes you will need, taking into account the climate of your destination. Also, don't forget to use logical numbers to determine necessary clothing -- for example, the number of shirts you bring probably shouldn't exceed the number of days you'll be away. And while you're at it, pare down your list once more if you'll be able to wash garments on your trip. After you've thoughtfully calculated what to bring, cross off each item as you lay it next to your bag, and ignore the urge to add any extra articles of clothing at the last minute.

Stay Neutral
A general rule of thumb for packing light is selecting neutral shades. If you're traveling on business, bring along shirts, pants and blazers that complement each other in whites, blacks and browns. If basics aren't really your style, pick an eye-catching color like red and work around it. Another tip: If you're traveling for work, bring along a crisp, white-collared shirt. You'll find it's easy to mix and match pieces on the road. Plus, you'll allow yourself extra room for packing casual clothing and heavier items like shoes.

Pack Ahead of Time
It probably goes without saying, but if you pack at least one day prior to your departure, you'll be far less likely to hastily insert extras that aren't necessary. Allow yourself enough time to assess the pieces you need. You should lay all your items in a way that allows you to see everything -- this will help you lighten your load and prevent you from bringing that extra bathing suit or pair of shoes that you could probably do without. Plus, by starting the packing process early, you'll give yourself enough leeway to thoughtfully pack your bag instead of trying to balance stuffing your suitcase with scrambling to get to the airport on time.

Learn to Layer
If you're headed somewhere cold, you're going to need to pile on the layers. But instead of stacking a hefty winter jacket into your carry-on, pack thermal gear and thin sweaters. Another trick for keeping your suitcase slim: Wear your bulkiest items (such as a long sleeve shirt or your heavy coat) on the plane. If you're too warm, you can always stow away your extra layers in an overhead bin.

Compress and Conserve
What's the secret to bundling it all in? Compiling your bulkiest items into compression packing bags. These helpful bags allow more room for your clothes and other items by reducing excess air. Spacepak Bags available from Flight 001 or Space Bags from Ziploc are ideal if you're packing for a longer trip; these bags allow you to fit bulkier items into a smaller bag. If your trip doesn't require clunky articles of clothing, skip the space bag and tuck accessories and smaller necessities into larger items. For example, stuff socks, underwear and belts inside running shoes to save space.

Shoe It In
Before you toss any shoes inside your bag, ask yourself one question: "Do I really need these?" Many frequent travelers agree that two or three pairs of shoes -- at most -- should suffice. Whether you're traveling on business or for pleasure, you can probably make do with one pair of dressier footwear and another more casual pair (you'll also save room in your bag by wearing your bulkiest shoes on the plane). Once you've decided which shoes to bring, be sure to place them in your suitcase first and to the side as shoes tend to take up a lot of room. By doing so, you'll not only maximize your space, but also evenly distribute your heaviest items.

Roll It Up
Instead of folding, start rolling. You'll be surprised how much room you'll save if you roll your clothing instead of laying it out flat. Stack the bulkiest items, such as pants and sweaters, into the corners of your bag (after shoes, of course) to distribute weight evenly, and then continue compiling rolled items at the center of your bag. Pack everything snugly to conserve as much space as possible. If you're looking to keep your formalwear wrinkle-free, your best bet is folding rather than rolling. You'll want to place your dress wear into a dry-cleaner bag or insert a piece of tissue paper between each article to prevent extra creases and wrinkles in-transit. All rolled items should be placed at the bottom of your bag, with dressier attire arranged neatly and tightly at the top of your suitcase.

Save the Lightest Items for Last
Once you've bundled the bulkiest articles of clothing inside your carry-on, it's time to stow lighter items like toiletries. And with the Transportation Security Administration (TSA) adhering to three-ounce liquid restrictions, you're going to have to pare down to the essentials to stay within size requirements. Opt for a two-in-one shampoo and conditioner or a shampoo bar that can double as soap. You may purchase specific toiletries on the road or rely on hotel shampoo bottles to save extra space, too. After you've trimmed down your toiletry kit, place it on top of your bag so it's within easy reach at security checkpoints. You'll also need to reduce your tech gear to the essential travel tools—must-haves include your cell phone, camera, headphones, chargers and laptop or tablet (if you're planning to work while on the road). Remember that you'll need to remove these items along with your toiletries at the TSA checkpoint.

For the latest, up-to-date information regarding key regions, click on the links below:







Sources for this document include, but are not limited to:  iJet, and

For pre-trip information: Assist America members may directly access travel information via the Assist America website, Log in using your Assist America ID/Reference number.

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