One of the major exposures of any company with staff overseas is the number of emergency medical evacuation and repatriations. Based on the analysis of a single year (9/07-9/08) of case activity in one industry segment we will recommend a method for cost effective preventive measures.

5057 cases including 40 companies in the energy, mining and infrastructure (EMI) industry were analyzed. We analyzed medical evacuations and repatriations for different diagnostic categories (using ICD9 codes) for business travelers and expatriates. To facilitate the process we developed a proprietary country medical risk assessment tool. Based on a matrix differentiating staff (business traveler and expatriate), diagnostic category, and country medical risk profile we are able to identify cost effective prevention programs based on the basic prioritization system previously described by Issel et al (2004) in the context of an overall occupational health strategy.

The overall incident rate for medical evacuations and repatriations was 7% of all assistance cases in the entire population of 5057 members in the examined 40 companies within the EMI industry segment. Within the entire population the three main reasons for emergency medical evacuation were 28% accident and injury, 14 % cardiovascular disorders, and 14 % gastro-intestinal disorders. This distribution, however, was different for business traveler when compared to expatriate. The cost per case in high risk country is double as compared to a moderate risk country where risk is quantified by geography, economy, stability and local healthcare.

Our results clearly indicate that companies can target their preventive programs to achieve the best return on investment in an overall occupational health strategy which comprises preparation, compliance, tracking, and communication, with overarching support of medical and security expertise and assistance services.

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