Travel risk assessment: a medical checklist for families

What a travel risk assessment is

The UK’s National Travel Health Network and Centre (NaTHNaC) describes risk assessment as gathering information about the traveller and their plans, so that advice and precautions can be tailored to them; agreeing those precautions is risk management.¹ The US Centers for Disease Control and Prevention (CDC) builds the pre-travel consultation from three parts: risk assessment, risk communication and risk management.⁸

For organisations there is an international standard. ISO 31030:2021 gives guidance on managing the risks that travel creates for an organisation and its travellers: policy, programme development, threat and hazard identification, risk assessment, and prevention and mitigation.⁹ It applies to organisations of any type and size, but it excludes tourism and leisure travel unless the traveller is travelling on behalf of the organisation.⁹

Read against that wording, staff who travel on a family office’s behalf fall within the standard’s scope, while the family’s own holiday falls outside it. The method serves both equally well.

Families, family offices and the staff who travel with them

In the UK, every employer must make a suitable and sufficient assessment of the risks to its employees at work, record the significant findings once it has five or more employees, and review the assessment when circumstances change.¹⁰

Household staff are a special case. The Health and Safety at Work etc. Act 1974 does not apply to a person only because they employ a domestic servant in a private household,¹¹ and the Health and Safety Executive (HSE) names a live-in nanny, cook or chauffeur as examples.⁶ The Act can still apply when staff are supplied by an agency, are self-employed, or carry out specialist tasks such as complex healthcare.⁶

Switzerland takes the opposite approach. Article 328 of the Code of Obligations requires an employer to take the measures that experience shows are necessary to protect an employee’s health, in the workplace or the household, and Article 328a adds care and medical assistance for staff who live in the employer’s household and fall ill.⁷

Staff who travel ahead or work alone, such as a driver, a nanny or a security detail, fit the HSE’s guidance on lone working. It asks employers to consider whether the person is medically suitable to work alone, to keep in touch and to set up and practise emergency procedures.¹² Whether a particular family office counts as the employer depends on how it is structured, which is a question for its lawyers.

The medical core: the capable hospital, not the nearest one

The most useful single question in a medical travel risk assessment is which hospital along the route can treat a major injury, a stroke or a heart attack, and how long it takes to get there. Distance alone does not answer it.

Outside cities this capability thins out: the CDC notes that trauma centres able to treat serious injuries are uncommon outside urban areas.¹⁶ Mapping it leg by leg, before departure, is what turns a list of hospitals into a plan, and it shows where the plan needs an aircraft or a helicopter rather than an ambulance.

Health profiles, documents and medicines

The assessment starts with the travellers. The CDC lists what a clinician should know before a trip, including pregnancy, recent surgery, recent heart, lung or stroke events, a weakened immune system, disability, vaccinations, the order of countries and layovers, rural or urban settings, and whether children travel.⁸ NaTHNaC’s template form adds allergies, mental health, mobility and every medicine taken.¹⁷

Documents to carry

• A medical summary with diagnoses, regular medicines by generic name and allergies¹⁸
• A copy of any advance directive and an emergency contact card¹⁸
• An ECG for anyone with an earlier abnormal result, heart or lung disease, or over the age of 50¹⁸
• The international vaccination certificate and the insurance details¹⁸
• A clinician’s letter listing conditions, allergies, blood type and medicines by generic name, ideally translated¹⁹

Medicines need checking country by country. A medicine that is legal at home can lead to detention or arrest elsewhere, so the destination’s embassy is the authority on what may be brought in.²⁰ NaTHNaC advises keeping medicines in their original labelled packaging, carrying them in hand luggage with enough for the whole trip plus delays, and travelling with a prescriber’s letter that lists them by generic name.²¹ Many countries limit narcotic and psychoactive medicines to 30 days’ supply or less.¹⁸

Altitude, heat and the flight itself

Altitude illness can begin at a sleeping altitude of 2,450 metres. Above 3,000 metres the CDC advises raising the sleeping altitude by no more than 500 metres a day, and a descent of at least 300 metres usually eases acute mountain sickness.²² It lists a heart attack or stroke within the previous 90 days, unstable angina and severe chronic obstructive pulmonary disease (COPD) among the conditions that rule out high-altitude travel.²²

Heat is a risk of its own. The NHS says someone with heat exhaustion should feel better within 30 minutes of cooling and fluids; if they do not, or if there are signs of heatstroke such as confusion or hot skin that has stopped sweating, it is an emergency.²³ The World Health Organization (WHO) advises using electric fans only when the temperature is below 40 °C.²⁴

The flight changes the body’s environment as well. The UK Civil Aviation Authority (CAA) says cabin altitude is typically 5,000 to 7,500 feet and should not exceed 8,000 feet, where a healthy traveller’s blood oxygen saturation falls to about 90 percent and trapped gas expands by about 30 percent.²⁵ A traveller with a medical condition should send the airline’s medical clearance details well before the flight; the airline makes the final decision.²⁶

Insurance, and what a consulate cannot do

Insurance is part of the medical plan, not a substitute for it. The UK Foreign, Commonwealth and Development Office (FCDO) advises declaring every existing condition, including those still under investigation, because failing to do so may invalidate cover, and checking that the policy covers every country on the route, repatriation and emergency transport.²⁷ UK law requires consumers to take reasonable care not to misrepresent anything to an insurer.²⁸

Exclusions the FCDO asks travellers to check

• Claims linked to alcohol or drugs²⁷
• Travel to places the FCDO advises against²⁷
• Mental health conditions that were not declared²⁷
• Age limits²⁷
• Sports such as winter sports, jet-skiing and skydiving, and riding quad bikes or mopeds²⁷
• Limited cover for terrorism, natural disasters and civil unrest²⁷

The costs explain why the details matter. The FCDO’s own examples run from £25,000 or more for a broken leg in Spain to £150,000 or more for treating a stomach bug in the USA,²⁷ and the CDC puts a medical evacuation from a remote location at more than US$250,000.⁵ When an insurer covers the evacuation, it is the insurer, not the traveller, who decides whether it takes place.⁵

Consulates help within clear limits. The FCDO can contact family, help local doctors reach UK doctors or the insurer, and give information on local medical facilities, but it cannot pay medical bills or arrange or pay for a medical repatriation.⁴ The US government does not pay overseas medical bills either.²⁰ The FCDO’s consular data for 2024 lists 3,268 cases in its medical care facility category.²⁹

The checklist: before, during and after the trip

Before the trip

1. Decide what the assessment covers: who travels, on whose behalf, and which country’s law applies to the staff.⁹⁶⁷
2. Collect every traveller’s health profile, medicines and vaccinations.⁸¹⁷
3. Map each leg of the route against the nearest hospital that can treat major trauma, stroke and a heart attack, and note the gaps.¹⁴²³
4. Arrange in advance any care that cannot wait, such as dialysis or obstetric care.¹⁹
5. Check every medicine with the destination’s embassy and carry a prescriber’s letter with generic names.²⁰²¹
6. Pack the documents: medical summary, ECG where indicated, advance directive, emergency contacts, vaccination certificate and insurance details.¹⁸
7. Plan for altitude and heat, and clear any medical condition with the airline in good time.²²²³²⁶
8. Buy insurance that declares every condition and covers every country, emergency transport and repatriation.²⁷
9. Agree how an evacuation would be arranged and paid for, because a consulate can do neither.⁴
10. For staff who travel alone, check medical suitability, agree check-ins and practise the emergency procedure.¹²

During the trip

1. In an emergency, call the local emergency number and go to the hospital the plan names, not simply the nearest one; the FCDO lists emergency numbers in each country’s travel advice.⁴¹⁴
2. Call the insurer’s 24-hour line at once, expect to pay upfront, and keep every receipt and doctor’s note.⁴
3. Watch the clock: 4.5 hours for clot-dissolving stroke treatment, 120 minutes for the heart attack window.²³
4. At altitude, never climb higher with symptoms; descend at least 300 metres.²²
5. Before a scheduled flight home after an illness, ask the treating doctors for the confirmation of fitness to fly that the airline may require.⁴

After the trip

1. Ask for the records of any treatment abroad and pass them to the doctors at home.¹⁹
2. Review the assessment after any incident or change, and keep the record.¹⁰
3. Claim with the receipts and medical notes.⁴

When a professional assessment earns its place

A family can work through this list on its own. It becomes harder when the route is long, the destinations are remote, someone travels with a serious condition, or the plan has to hold for the staff as well as the family. Then the work is no longer a form but a map of real capability, with names and numbers attached.

Shadow ICU’s travel risk management is built that way: movements are shared in advance, medical risk is mapped against real local capability along the route, and hospital liaisons are made before arrival, so that the first call in an emergency goes to people who already know the plan.