Video of the giraffe that attacked Daniel Core, seconds before the incident
“I saw the giraffe pick up his right hoof and I thought, ‘he’s going to kill me.’”
While driving to their hotel inside Zimbabwe’s Mosi-oa-Tunya National Park, Daniel and Laura Core’s guide spotted two giraffes walking near the path. “The guide told us that it was OK to get out of the cart and take pictures,” said Daniel. “We were just filming the giraffes, didn’t get too close, and out of the corner of my eye is a really big giraffe coming from the opposite direction.”
An experienced veterinarian, Daniel was familiar with the signs of a hostile animal. “He didn’t lay his ears back, didn’t stomp, didn’t blow or anything like that. He just walked his way slowly up the game trail,” Daniel recalled.
Laura, Daniel’s wife, began filming the bull giraffe as it approached.
When the giraffe was 20 yards away, Daniel’s guide picked up a branch and waved it in the air to scare it away. “About 30 seconds after that, I walked up to see what was going on. I heard our guide scream ‘Run!’” remembered Daniel. “In Africa, when your guide screams ‘run,’ it’s bad.”
Bull Giraffe Attack
The giraffe took one more step and swung its head “like a wrecking ball,” catching Daniel in the chest. The impact lifted Daniel into the air and threw him onto a pile of rocks. “I’ve been hit by bulls and kicked by horses, and I played football all through college. But, I’ve never been hit that hard in all my life,” he said.
Ten feet away, Laura was lying on the ground, “playing dead” so the giraffe would not attack her. “I saw the giraffe pick up his right hoof and I thought, ‘he’s going to kill,’” Daniel recalled. “Fortunately, my wife had dropped her purse about a foot and a half away from her torso. What the giraffe had his eye on was the poor purse. He came down on it and it just exploded.”
Daniel scrambled to his feet, grabbed his wife, and rushed to the cart. The guide gunned the engine and the three raced down the path.
After escaping the giraffe, Daniel took stock of his injuries. “I had about a three inch cut on my head and I could tell big contusions and bruises were coming.”
An Emergency Call to Global Rescue
Daniel and Laura went to the game reservation’s clinic to get patched up. With basic medical facilities and a registered nurse as the only healthcare options, Daniel turned to Global Rescue. He took pictures of all his injuries and emailed them to the Global Rescue Operations team.
Global Rescue’s medical team immediately reviewed his injuries and provided medical advice. Global Rescue’s team of physicians determined that there were no broken bones, no blood in his lungs, and no symptoms of a head injury. Daniel lucked out. He was bruised, but he’d be fine.
The Cores took another cart to their hotel room. “Right before we arrived at the hotel room, guess who’s standing there, straddling the path? The giraffe.” Fortunately, this time the Cores were able to pass by the giraffe without any conflict.
Everything Ends Well
“I was very happy and pleased with the way Global Rescue handled my case. I’m a small animal veterinarian and I deal with bad stuff all the time, but I don’t know everything. I felt like I was in good hands and that, if I needed anything, Global Rescue would be able to handle it. Everything ended well.” said Daniel.
Undaunted by the giraffe attack, the Cores continued their vacation through Africa. “Everywhere we went, people would ask, ‘did you hear about the American couple that got attacked by the giraffe?’” Daniel recalled. “We’d say, ‘yes, we’re intimately associated with them.’”
(Courtesy of Fox News)
On Christmas Day 2012, Allan Lokos and his wife, Susanna Weiss, boarded a plane in Myanmar headed to Inle Lake, a popular tourist destination in the heart of the Shan Plateau and home to the Shwe Indein Pagoda – a white-washed stupa that enshrines a Buddha image and is surrounded by hundreds of ancient stupas. The couple, who run a meditation center in New York City, were drawn to the region for its many temples and monasteries.
Their lives changed forever when something went wrong during their approach for landing. The plane crashed short of the runway, broke into pieces and burst into flames. Miraculously, Allan and Susanna somehow survived the impact and managed to pull themselves out of the wreckage through the fire and debris. Both were badly injured, Allan critically. Local rescue teams arrived shortly after the crash and rushed them and other survivors to a nearby clinic.
Susanna suffered broken vertebrae, and feared for Allan’s survival. “I was told by the doctors that Allan was not going to make it,” she recalled.
Allan’s injuries were life-threatening. He was in critical condition, with severe burns over 33% of his body — including his head, face, neck, and hands. Not surprisingly, his injuries were well beyond the capabilities of the local clinic in rural Myanmar.
Global Rescue was contacted by the couple’s tour operator and immediately coordinated the dispatch of an aircraft to transport Allan and Susanna to Bangkok, Thailand, for treatment at one of the best hospitals in the region. Global Rescue paramedic personnel deployed from the company’s Bangkok Operations Center met the couple at the hospital, where Allan was admitted to the Intensive Care Unit.
Once the extent of Allan’s injuries became clear, Global Rescue’s medical team consulted with Johns Hopkins Medicine specialists and determined that, given the severity of his burns, a transfer to the top burn center in Asia, located in Singapore, would give Allan the best possible chances in his fight for survival.
What followed was an evacuation by private, medically equipped ICU aircraft while Allan drifted in and out of consciousness. While his memories of the flight and his admittance to the Singapore burn unit are spotty due to the trauma and treatment, which included several skin graft surgeries, Allan later recalled the comfort of seeing Global Rescue personnel outside his hospital room around the clock.
Global Rescue’s medical team and partners at Johns Hopkins remained in close contact with the Singapore physicians, overseeing Allan’s additional skin graft surgeries.
Knowing that Allan could decline rapidly from the severity of his burns, Susanna faced another extremely difficult choice: whether to move Allan home to the U.S. or keep him in Singapore for long-term treatment. She knew that with burns, in particular, the danger of infection is the biggest risk. “I’ve kept him alive so far with the choices I’ve made,” Susanna pondered. She decided to move forward with his transport home.
(Courtesy of Allan Lokos)
Global Rescue transported Allan by ICU equipped air ambulance back to his home country hospital in New York City during a brief window when he was deemed stable enough to survive the journey. Allan was stable throughout and the aircraft landed in New York without incident. While their travels had finally had ended, both Allan and Susanna knew a long road to recovery awaited.
Susanna, now fitted with an orthopedic back brace, faced her own troubling medical issues, compounded by the psychological trauma of the crash and the physical toll of dealing with Allan’s care. “I hardly had a life during that time,” she said. “All I would do is go back and forth to my apartment late at night, kind of fall asleep, and go back early in the morning to the hospital.” She is still recovering from her injuries.
Two months after being admitted to a hospital in New York, Allan was released. Despite the homecoming, he was despondent. “That’s when you would think that finally things are going to return to some kind of normality, and it was anything but. I remember constantly thinking that I wanted my life back,” said Allan. “It was, for both of us, the most depressing time of our lives. I came home 25 pounds lighter off of an in-shape frame. I was incredibly weak. I had no use of my hands at that time. There was literally nothing I could do for myself; I was totally dependent.”
Allan is the founder and guiding teacher of The Community Meditation Center in New York City. He had practiced meditation for many years, studying with such renowned teachers as Thich Nhat Hanh, and ultimately visited Myanmar to enhance his spiritual practice and teaching.
Susanna partially credits Allan’s recuperation during this difficult period to his writing his book, Through the Flames: Overcoming Disaster through Compassion, Patience, and Determination. “Like the trauma therapy saved me, his writing saved him. He’s a teacher at heart, so he felt he would have something to offer. That was his salvation,” Susanna said.
Allan’s spiritual training was instrumental in his physical and mental recovery. “The mental recovery was more difficult because that’s when things were really awful,” he noted. “On the physical side, literally from the moments right after the crash and then for the next two months, much of the time I was drugged, in shock, and not cognizant at all of things that were happening. I have memories of very unpleasant procedures but physical pain is temporal. It can be very difficult but then it fades.” He noted, “I never have dealt with questions like ‘why me?’ or ‘why did this happen to me?’ and I think that was and continues to be a major part of why I’ve healed as well as I have.”
Despite their ordeal, Allan and Susanna have no reservations about traveling again. “I don’t think that we should alter our lives because of fear. I think we should be aware of what we’re doing, but I wouldn’t back away from something I wanted to do just out of fear,” said Allan.
Susanna said, “I don’t deny that the crash happened and that it has its effects, but I also don’t want that to determine how I live my life.”
In fact, Allan and Susanna traveled to Africa in 2015, their first trip outside the United States since the plane crash.
Susanna concluded: “At a time when I couldn’t handle anything else, there was nothing like the military calm of Global Rescue’s personnel. How could I have handled our evacuation? Even if I weren’t taking care of Allan all the time, I wouldn’t know how to do that. What was done was so competent, so steady. I am grateful that they were there for us.”
(Courtesy of Fox News)
Lieutenant Colonel Rick Steiner is a retired US Army Special Forces commander with 19 years of military experience. For the past 10 years, Steiner has relied on Global Rescue to be his “back up team” whenever he heads out on his hunting or fishing expeditions. “I’ve been to Afghanistan, Somalia, Uganda, Cameroon, Tanzania, and British Columbia, so having a rescue organization standing behind me that has the capability to come get me anywhere I might be is not a ‘nice to have’ -- it’s an absolute necessity,” said Steiner.
Steiner’s hunts take him to very remote areas. “All of the photos here are taken in the Sangha River area of southeast Cameroon, south of Lobeke National Park,” said Steiner. “On the other side of the river is the Central African Republic. We hunted the entire region as my outfitter there, Faro Lobeke Safaris, has over 500,000 hectares in two hunting blocks.
“The entire area is triple canopy jungle with a few villages and logging camps. There are no paved roads --only logging trails maintained by the logging companies. Local fauna includes lowland gorillas, forest elephant and buffalo, bongo antelope, forest sitatunga, various duikers, leopards, a wide variety of monkeys, chimpanzees, and assorted snakes and insects. Daytime highs in May are around 100 degrees F, with 85% humidity, and it rains about every other night. The local people are baka tribesmen, also known as pygmies,” noted Steiner.
“It's a very tough place to hunt. I've taken just about every species available on two separate hunts there. You can only see 20 yards or less in the jungle, and you’re wet all the time -- sweat, rain, or a combination. But it's incredibly rewarding to hunt the place. Needless to say, there are a lot of hazards -- food, water, the gorillas, elephant, buffalo, snakes, car accidents -- so it's very important to be good at personal health management, risk management, and also to have a good medevac plan.”
This past spring, Steiner turned to Global Rescue for assistance when he was feeling feverish while traveling. “I called to get advice on dosages for medicine I was taking. What I got from Global Rescue was a level of follow up and service that approached family practice doctor level of engagement. Totally great.”
Steiner concludes: “Global Rescue is the only service provider of its type that has earned my confidence. I simply won’t go on a hunting or fishing expedition without the peace of mind that comes from having a Global Rescue membership.”
Angie Heister and her husband, Robert
In Part I of Angie Heister’s story, she described the horrific attack by a Cape buffalo in Zimbabwe four years ago. Global Rescue conducted a medical evacuation and deployed our paramedics to her bedside.
In Part II, Angie is back home in Dallas after Global Rescue evacuated her from Johannesburg. She shares her struggles with transitioning to her new life, along with the satisfaction of mentoring others and of traveling again.
“We were back in Dallas on the way to Baylor and the Global Rescue paramedic told the driver to slow down on the turns since I didn’t have good balance. He was watching out for things like that. He took the best care ever, ever, ever.”
After approximately six weeks in rehab, Angie was discharged to go home in August 2011.
“The first six months were pure hell,” said Angie. “You have to learn to take care of your bladder and your bowels, and trying to transfer and not fall, just so much. We had to have our bathroom remodeled because I couldn’t get in the shower. I had hired a caregiver to stay with me. At first I had to have 24- hour support, so it was the caregiver, my daughter, and my husband. Gradually I got stronger and started with two hours all by myself. It was May 2012 before we let the caregiver go and I was truly ok just to be by myself in the house.
“To put it in perspective, I was a software consultant before the accident. I traveled a lot. I was executive platinum and traveled 100,000 flight miles a year. I was at home two weekends a month usually. I went from that lifestyle to a complete shut-in except for weekends. It was a shock. It just turned my life upside down."
Four years after that fateful day, Angie maintains a positive outlook on life, despite remaining paralyzed from the accident. Her determination brought her to where she is today, enjoying traveling and her independence while helping others cope with the transition to life in a wheelchair.
“I took classes so I could drive again in October 2012, and bought a van that is modified with a ramp and hand controls. It was months before I dared to get on the highway. It was like learning to drive again but I was terrified. Now I drive to a lot of places every day by myself, even the highway. It’s no big deal but it really took a long time to get back to that. Now I’m perfectly good: I go places by myself all the time. If my husband is out of town, I’m ok in the house by myself, even during the night.
Importance of mentoring
“I had incredible support early on. There was a lady named Lynn I had worked with and when I was lying in the hospital in Africa, I remembered her coming to work in a wheelchair. There wasn’t anything special about it. To me, she’s superwoman. She has been in a wheelchair for 30 years and is so strong and independent. She won a silver medal on horseback at the Paralympics in Australia. Lynn would come over and show me things. For example, I was having trouble getting up a little one-inch step from the garage into the house. Now it’s no big deal, but at the time I didn’t have the balance or the strength, so she showed me a different way to do it. She told me that there were things like this they’ll never show you in rehab. You’re only going to learn this from other people in chairs. She was so right.
“I'm actually mentoring some ladies now. Statistically, people who end up with spinal cord injuries are usually young males between 15 and 30 years old, basically risk takers. A 50-year-old grandmother is not your usual spinal cord injury patient. So, occasionally when they have ladies who have gone through some car wrecks or other accidents, (Baylor) has called me. I try to help these ladies and tell them that when I came home from the hospital, I couldn’t do such-and-such either, but I do it all the time now. I try to give them that encouragement and tell them to keep working at it.
“Lynn told me it would take two years to adjust, but I think it’s more like three. Most days now it’s no big deal, but occasionally I have a bad day or something happens that I can’t do and it’s so frustrating. The whole family has adjusted. They say it’s not just the individual who goes through this; it’s your whole family because everybody has to adjust. It took a long time to get there and it took a lot of work and a lot of support from family.
“We’ve started traveling,” continued Angie. “It took about a year but we’ve gone to Los Angeles several times to see family. My husband and I took a vacation and traveled to New England in September. We’ve been to Vegas a few times, and to Florida and North Carolina. We travel a lot so that’s good.
“During one of our trips, we spent an evening with one of the Global Rescue paramedics who deployed to help us. It was wonderful to see him. What does this tell you about the people at Global Rescue when, so many years later, we’re still staying in touch?”
“As I look back, I’m so thankful that we had a Global Rescue membership before we traveled,” said Angie. “My husband had been to Africa twice before and had had such a wonderful time. He loved it and wanted to share that with me. I was going with him on this trip. I’m the non-adventurous type and I insisted that we get it. He had seen Global Rescue at one of the safari conventions and was familiar with it so we bought the memberships. It never occurred to me I would be the one who would need it. I was always thinking, ‘It’s going to be my husband. What if something happens in the middle of the hunt or if he gets hurt by an animal?’ Never in a thousand years did it ever occur to me that I would be the one that needed the help from Global Rescue. I’m guessing it would have cost somewhere between $100,000 and $300,000 to get me home had we not been Global Rescue members.
“Any time my friends are traveling anywhere, I tell them they must get a Global Rescue membership. People don’t understand that travel insurance is so different than having Global Rescue personnel come to you and personally take care of you and bring you home. I can’t imagine my husband being able to get me home alone and having no one else to help me make the flight home. It’s just not the same when you’re in that kind of situation. You really need what Global Rescue provides. You need somebody there who has access to resources and experience and knows what to do, because you’re just lost and in shock and you just don’t know what’s going on. You’re so short sighted, just trying to get through the next day. You think, am I going to be breathing again tomorrow? You’re not in any kind of shape to be making arrangements to fly home.”
Angie’s advice for travelers:
--If you’re traveling to an area that’s not very well developed, do some research to get an idea of what hospitals and services are in the area. Is it like the U.S. where you get treated and then pay or do you have to pay before they admit you?
--Check whether your health insurance works in places you are traveling to and determine if you should purchase a special health insurance policy.
--Carry a satellite phone and extra batteries.
--Have a Global Rescue membership.
“I’m one of your best salespeople,” said Angie. “Anytime anyone is traveling, I tell them, ‘You’ve got to get Global Rescue.’ I can’t even imagine what would have happened had we not had Global Rescue. I would have ended up in Zambia in a less-than-stellar hospital. I might not even have lived had I not gotten to a tier-one trauma center. I would have gotten an infection in that wound. The fact that I never got an infection is a miracle and I know it’s because I got to a good hospital. As you probably know, I think very highly of Global Rescue.”
Angie Heister and her husband, Robert
Walking through the Tsitsingombe River Valley in Zimbabwe four years ago, Global Rescue member Angie Heister had no idea that her life was about to change dramatically. Angie and her husband were 10 days into their trip.
“Our guide was shooting birds to cook for us for lunch,” said Angie. “We’d already finished the dangerous game hunting and were in an area where we believed there weren’t any buffalo. We were going down a dirt road with the grass about 8 feet tall around us. With the direction of the wind and the noise we’d been making, that buffalo really should not have been there. He should have gone. Animals will usually run away when they see you but this animal didn’t. He waited for us. You never know what’s in the mind of a wild animal, but I often wonder if maybe he was injured and didn’t want to move, and we got too close and scared him. It was a loud sound, almost like a roar. I yelled ‘lion’ and took off running before I saw the animal.”
The male Cape buffalo emerged from behind a ziziphus bush and came rushing toward Angie and her husband. The bull first hit Angie’s husband, knocking him over. Angie was next.
“It was about four seconds from the time I saw the animal until it gored me. It just happened so fast,” she said. “The horn gored me, and I was thrown. What I didn’t know at the time was that it dislocated my spine. The animal had knocked my husband unconscious. The next thing I know, I’m lying on the ground. I’d heard stories about these animals and how mean they are, so I was trying to cover my head with my arms because I was expecting the animal to come back. That’s the reputation they have. It’s a miracle that the animal did not come back. He kept going.
“I realized I couldn’t move my legs but I wasn’t really processing what that meant,” Angie continued. “I didn’t realize that I was bleeding. The professional hunter came over to assess the situation. He and the guide realized I couldn’t walk, but didn’t realize how much I was bleeding. I knew was having trouble breathing, and it was all I could do to say, ‘I can’t breathe. I can’t breathe!’ We didn’t know it at the time but my ribs were broken and my lungs had collapsed.”
Angie was losing blood quickly, with a gaping wound on her left side. Their guide attempted to stanch her bleeding before bringing her to the nearest suitable landing area for a helicopter. He called Global Rescue.
A helicopter arrived within an hour and transported Angie to a facility in Victoria Falls. In the emergency room, she was stabilized and her injuries were assessed. She had no sensation in her lower extremities and had lost a life-threatening amount of blood.
Global Rescue physicians consulted with Angie’s attending physician and recommended that Angie be transported immediately to South Africa. Global Rescue performed a medical evacuation, bringing Angie via a medically equipped jet to a world-class trauma center in Johannesburg.
“Luckily it was decided that Global Rescue could take me to Johannesburg, which was a fantastic thing,” noted Angie. “It was a tier one health center -- a fantastic hospital with great medical care. Later, I did some research which confirmed it was a really great hospital. But at the time, all you know is that you’re in a country that you didn’t plan to go to, you’re in a hospital, you can’t move your legs, and you can’t feel your legs. You just don’t even have any idea what’s ahead.”
In Johannesburg, Angie was evaluated by neuro and trauma surgeons. In the meantime, Global Rescue dispatched the first of three paramedics to oversee her care. After a thorough review of Angie’s condition with specialists from Johns Hopkins medicine, the physicians determined that she required emergency surgery to fuse the vertebrae in her spine. The buffalo attack left her spinal cord severely bruised and her lower extremities would remain paralyzed for an unknown period of time.
“The trauma surgeon cleaned out the wound and tried to determine the extent of my injuries while trying to keep me alive,” said Angie. “The doctor later told me that the wound was big enough to fit his wrist and forearm through, and that he could see my bowels and the bottom of my lungs. It really is unbelievable that the horn didn’t hit an artery and I didn’t bleed to death. They said my spinal cord was dislocated and they needed to do surgery, but it would probably be two weeks before I was stable enough for that surgery. They put rods in my spine, and the doctors told me the area was very bruised and swollen.
“Global Rescue sent over their first paramedic to assess my situation,” Angie continued. “My husband was still in shock. Family had asked if they should come over but he told them no because he still didn’t know what was going on. He said several times that it was a tremendous help to have Global Rescue’s paramedic there to sit down and explain to him all the different things that were happening to me, and to say ‘we’re checking everything that they’re doing and what they’re doing is the right thing.’ You just can’t imagine the feeling when you’re that far away from home and in shock. You just can’t process what happened. Having Global Rescue there was an incredibly important thing.
“Global Rescue sent a second paramedic who took charge of gathering all of the medical tests and coordinating with the doctors there to validate that I was getting the right treatment. Before the accident, I was a health nut. I worked out four or five days a week, running and lifting weights. I was in reasonably good shape. After the accident, I had trouble even holding a fork.”
As rehab progressed, the Global Rescue team worked closely with Angie on her options for rehabilitation back in Dallas.
“Global Rescue started the conversation about where to take me when I got home,” said Angie. “I didn’t know anything about rehab centers, yet it looked like I would have to go to one. At this point, I didn’t realize that I would be paralyzed for the rest of my life, you know? My thinking was, I had the surgery and the doctor said I’ve got to give it six months. I thought I would start working on learning how to live like that, just in case. I wasn’t going to wait six months before trying anything. But it hadn’t set in mentally that this was going to be the new world.
“We were looking at rehab places in the suburbs of Dallas Metroplex. Now I laugh when I drive around and see all these little places because most of them are guaranteed to get you back on the football field really fast. They’re all geared toward a high school sports injury. I didn’t realize what a specialized rehab it is for spinal cord injury. Global Rescue had been recommending Baylor as the best one. As I look back, so much of the advice we received from Global Rescue was so critical because at the time, we just didn’t know anything.
“At the same time, Global Rescue began to discuss how we would be getting back home. There were countless logistics that Global Rescue handled that we would never have considered – what type of aircraft, ideal countries in which to refuel, and on and on. The medical oversight by Global Rescue was fantastic. The Global Rescue paramedic suggested that I do more rehab before I traveled. At the time, I thought he’d lost his mind. Now looking back, I can see that he was 100% right.
“Having the Global Rescue team look at my situation and say, ‘In this many weeks you should be so much stronger and then you should be able to do this’ – well, it was just imperative. I don’t quite have the words to explain how important it was having Global Rescue help us figure out where we were going to be in a day or a week or a few weeks, because we were just lost.
“After I was moved to the rehab unit of the Johannesburg hospital, I was learning how to transfer from the bed into my wheelchair or from the wheelchair into another seat. It’s a very hard thing to learn. A few days before we were scheduled to travel, Global Rescue’s third paramedic arrived. He was wonderful. I can’t even imagine had it been just my husband and me trying to get home. There’s no way physically we could have done it.”
Global Rescue evacuated Angie back home to Dallas.
(Part II to follow)
In January 2015, TIME Magazine published an article stating that the Ebola epidemic may end by June 2015 in Liberia. That outcome can be achieved, according to researchers, only if current hospitalization rates continue, as well as changes in cultural norms and burial practices.
As the focus shifts to ending the Ebola epidemic in the affected region of West Africa, there is cautious hope. According to the WHO situation report for 28 January 2015, there were fewer than 100 new confirmed cases reported in a week in the three most-affected countries (Guinea, 30; Liberia, 4; Sierra Leone, 65) for the first time since the week ending 29 June 2014. However, the WHO situation report for 4 February noted that the weekly case incidence increased in all three countries for the first time this year. There were 124 new confirmed cases reported in the week to 1 February.
While travel and commerce have resumed in other regions of Africa amidst decreased Ebola-related concerns, travelers to Africa should remain vigilant.
Global Rescue advises members to:
-- Adhere to the U.S. Centers for Disease Control and Prevention (CDC) warning against non-essential travel to Guinea, Liberia and Sierra Leone. Travel to these affected West African countries should be avoided unless absolutely necessary.
-- Pay attention to U.S. State Department and WHO updates. Follow the World Health Organization guidelines.
-- While hospital workers, laboratory workers and family members are at greatest risk of contracting the virus, individuals traveling to Ebola-affected countries should exercise basic health precautions including:
-- Avoid areas of known outbreaks
-- Avoid contact with infected individuals
-- Strict personal hygiene including frequent hand-washing should be adhered to while traveling in endemic areas
-- Report any symptoms to health officials immediately
See more detailed recommendations in our previous post, Ebola: What you should know.
Contact Global Rescue at 617-459-4200 or email@example.com with questions or concerns regarding Ebola.
According to the latest update by the World Health Organization (WHO) on 5 October, a total of 8,033 (probable, confirmed, and suspected) cases and 3,865 deaths from the Ebola virus have been documented in Guinea, Liberia, and Sierra Leone. Some cases have also been reported in Nigeria and Senegal.
Late September yielded the first case imported to a non-African country, after a Liberian national traveled to Dallas, Texas. He succumbed to the virus on 8 October in Dallas. Most recently, a healthcare worker in Madrid, Spain, contracted the illness while caring for an infected patient transported to Spain for treatment. Both the U.S. and Spain cases did engage in contact with the public while symptomatic, and intense contact-tracing efforts were enacted by both nations.
In recent months, authorities in multiple nations have introduced a wide range of preventative measures in response to the deteriorating Ebola outbreak, including border closures, flight bans, and stricter screenings at country gateways. Individual airlines have also implemented their own restrictions.
U.S. authorities announced on 8 October that travelers from Guinea, Liberia, Nigeria, and Sierra Leone will undergo mandatory screenings for the Ebola virus at certain domestic airports. The measures will include questionnaires as well as temperature scans. The checks will be implemented at New York City’s John F. Kennedy International Airport (JFK), Washington D.C.’s Dulles International Airport (IAD), Chicago’s O’Hare International Airport (ORD), Atlanta’s Hartsfield-Jackson International Airport (ATL), and New Jersey’s Newark Liberty International Airport (EWR).
Global Rescue has air assets in Africa to perform air ambulance evacuations. Response time depends upon many factors, including weather, local asset availability, location, and local laws. However, we can and will assist in supporting our members with any and all services that are medically appropriate, and which fall within the guidelines of the incident and destination countries regarding quarantine and infectious disease transportation. Global Rescue will provide these services within the capabilities of our air providers, and the medical resources available locally, regionally, and at the member’s destination. For members with Ebola or suspected Ebola, Global Rescue will transport pursuant to all required quarantine and infection control procedures and restrictions, which may delay or prevent transport.
As the Ebola outbreak continues, here is an update on this rapidly changing situation as well as advice for Global Rescue members regarding travel:
The current outbreak of Ebola virus disease (EVD) in West Africa began in Guinea in December of 2013; however it was not identified as Ebola until March 2014. This delay likely allowed the virus to gain significant traction within the locales where EVD is now present. By May, EVD spread to Liberia and Sierra Leone, likely aided by very porous regional borders. EVD was imported to Nigeria by a single sick traveler in July from Guinea, which is not geographically contiguous with any of the original affected countries. Senegal also reported an imported case in late August. A Senegalese student who had been studying in Guinea was infected, developed symptoms and returned home to Senegal. There have been no confirmed cases of EVD importation elsewhere in the continent, or world, since the Senegal case.
As of the most recent World Health Organization (WHO) Situation Report dated 18 September, the current total number of cases associated with the West Africa outbreak is 5,335. This figure includes 2,622 fatalities as of 14 September. Currently, the only countries affected by the West Africa outbreak are Guinea, Liberia, Sierra Leone, Nigeria, and Senegal. Widespread transmission exists in Guinea (942 total cases), Liberia (2,710 total cases), and Sierra Leone (1,673 total cases). In Sierra Leone, dozens of new Ebola cases and deaths were recorded as the country concluded its three-day nationwide lockdown on 21 September. Nigeria, and Senegal have fewer than 25 total combined cases, and thus far have not seen the intense transmission noted in other affected countries. This is likely due to aggressive isolation efforts within both countries once import-vectors were identified, as well as public-health campaigns and response posturing by international healthcare organizations.
Unrelated Outbreak – Democratic Republic of Congo
There is an additional outbreak of EVD in Equateur province in the Democratic Republic of Congo. While the strain identified in the DRC is the same as the strain affecting West Africa, it has been confirmed to be epidemiologically unrelated. The DRC outbreak is believed to have started in the village of Ikanmongo, where a pregnant woman died on 11 August. She was reported to have recently butchered a bush animal, and then fell ill with flu-like symptoms. As of 17 September, there have been 71 cases reported, and 40 fatalities.
The outbreak zone within the DRC is remote – approximately 1,200 kilometers from Kinshasa. There are no major transportation routes that connect the zone with other regions of the DRC, and risk of transmission/importation to other major population centers is considered unlikely. U.N. analysis suggests that the outbreak there is under control at this time
Prevention is primarily guided by awareness of how the disease is transmitted, and practicing safe hygiene. These preventative measures may include:
- Avoid nonessential travel to Liberia, Guinea, and Sierra Leone.
- If you must travel, please make sure to do the following:
- Practice safe hygiene. Avoid contact with blood and body fluids of people who are sick with Ebola. Regular hand-washing is essential and highly recommended.
- Do not handle items that may have come in contact with an infected person’s blood or body fluids.
- Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.
- Avoid contact with wild animals and with raw or undercooked meat (bushmeat).
- Avoid hospitals where Ebola patients are being treated. Global Rescue can provide advice on facilities that are suitable for your needs.
Is it safe to travel during an outbreak?
While travelers should always be vigilant with regard to their health and those around them, the risk of infection for travelers is very low since person-to-person transmission results from direct contact with the body fluids or secretions of an infected patient.
Is it safe to travel to West Africa?
The risk of travelers becoming infected with Ebola virus during a visit to the affected areas and developing disease after returning is extremely low, even if the visit included travel to the local areas from which primary cases have been reported. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animals, all of which are unlikely exposures for the average traveler. That being said, the Centers for Disease Control and Prevention (CDC) has issued Level 3 (Avoid Nonessential Travel) notices for Liberia, Guinea, and Sierra Leone. Should travel to one of these locations be necessary, be mindful of the prevention guidance noted above.
Snakes are an integral part to many ecosystems and, as an outdoor enthusiast, it is only a matter of time before you encounter one in the backcountry. Venomous snakes are most prevalent in temperate and tropical climates, with April-October being peak snakebite season. There are roughly 15-20 deaths per year in North America related to venomous snakes. The risk of dying from a venomous bite increases when multiple bites are involved and when the bite occurs in the very young, old, or in persons with underlying respiratory or cardiovascular problems. In the US, venomous snakes account for only about 20% of all snakebites and out of that 20%, many do not result in envenomation. Some studies suggest that up to 20% of rattlesnake bites are deemed ‘dry’ bites, with no venom being injected. Dry biting is a sign of maturity in the snake; more experienced snakes will use a dry bite as they try to gauge the level of a perceived threat and since snakes do not have an infinite amount of venom they will try to use it sparingly.
The majority of poisonous snakes in the US are pit vipers. Rattlesnakes, copperheads, and cottonmouth (water moccasins) snakes are in this family, known as Crotalidae. Typically, pit viper victims tend to be young males, 11-19 years old, who are bitten on the hand while trying to pick up the snake. Alcohol has been shown to be a common factor in these incidents.
The best guideline for snakes is complete avoidance. The old adage that ‘it’s more afraid of you than you are of it’ is generally true, and most snakes only bite when they feel threatened. If snakes are encountered, give them a wide berth and continue on your trek.
As there are many types of snakes, venomous vs. nonvenomous, and different types of venom, hemotoxic vs. neurotoxic, opinions on treatment methodologies can be as numerous as the different snakes themselves. However, many experts tend to agree that certain folklore treatments should be avoided. These include pouring alcohol over the bite, making an incision over the bite site, cauterization, amputation, use of electric shocks, and packing the extremity in ice. Many of these so-called treatments are urban legends. The use of suction (attempting to ‘suck’ the venom out of the bite) is controversial but all experts agree that if attempting this technique you should not use your mouth to apply suction.
Field management for snakebites should focus on limiting the systemic spread of the venom and rapid evacuation of the victim to a hospital equipped to handle envenomations. During the evacuation, you should do the following:
1. Keep the patient calm and inactive. Remove jewelry and constrictive clothing.
2. Clean around the bite site and keep the wound free from dirt and debris by covering with a sterile dressing.
3. Immobilize the limb in a neutral position.
4. Avoid the use of compression bandages unless bite is from a neurotoxic snake (coral snake, cobra, krait, or other).
For those with advanced medical training, continue to monitor vital signs, ensure airway is patent, be prepared to treat victim for anaphylaxis, nausea/vomiting, and pain. The patient should be continuously monitored for the first 4-6 hours. If after 6 hours the victim does not display any adverse signs or symptoms, it is generally safe to suspect a bite without envenomation. Support hydration orally if possible, start an IV in an unaffected limb if available. Defer food ingestion during prompt evacuations; if a prolonged evacuation is presented, nourishment will become important to support strength and health. Avoid alcohol intake. Evaluate victim’s tetanus status and consider giving tetanus toxoid. Antivenin is the only proven therapy for snakebite but only when it is specific for the snake involved. DO NOT try to kill or capture the snake for identification purposes. Dead snakes, even several hours later, can reflexively bite injecting venom causing either a second bite or biting another member of the group. Embrace technology and snap a photo with your smartphone…using the zoom!
Wherever your travel takes you, Global Rescue encourages you to do a thorough area study of your destination and research the native flora and fauna that might be harmful.
Read here about a medical evacuation we conducted for a member bitten by an African cobra in Namibia.
With the spread of the Ebola virus in West Africa, many organizations are seeking guidance on how to best protect their employees in the region. The majority of questions have been about the risk of travelling into the affected and nearby countries: Is it safe to travel? Should there be suspension of employee travel to certain countries? If so, for how long?
Global Rescue recommends evaluation of the best course of action for your organization within a range of possible options and your decision-making process.
The World Health Organization (WHO) declared an international public health emergency on August 8th, signifying the outbreak of the Ebola virus as an extraordinary event with possible international consequences if the virus continues to spread. The situation on the ground is very fluid, with new cases and deaths being reported daily in the three primary affected countries (Sierra Leone, Liberia, and Guinea). In addition, there have been 13 cases, including two deaths, identified in Nigeria as of August 11th. Health screenings have been implemented at airports and border crossings in the region, and multiple airlines have ceased their activities to and from the three primary affected countries. Authorities in the affected areas are implementing strict screening and quarantine measures, and movement of people across borders, with illness symptoms similar to those found in Ebola (fever, vomiting, diarrhea) will likely be impossible. Despite these control measures, the outbreak is expected to continue for a period of at least one or more months.
Three alternatives exist for travel policy as current choices for organizations doing business in the geography impacted by Ebola:
Option #1: No restrictions on travel
This choice provides for corporate travel into the impacted area with the understanding that the risk to your employees is very low --- assuming they are not engaged in direct healthcare activities, preparations of remains for burial, or ingestion of infected animal products. It assumes that your employees can aggressively and consistently adhere to the recommended avoidance and protection practices recommended by the WHO and the Centers for Disease Control and Prevention (CDC). It also assumes your employees will monitor alerts and other travel warnings in their region, and that they will be able to take action to adjust their travel and movement as needed to minimize further risk.
There are indeed many organizations and corporations which are currently employing this strategy (within the affected areas), particularly if their work is mission-critical, and unable to be interrupted.
Risks to consider with this option:
--Travel may become limited or restricted further, i.e. employees may not be able to move out of the country when they need or want to.
--Limited access to safe and adequate health care in local or nearby facilities. There is no way to guarantee that a facility will not have Ebola cases in house. Transmission within the hospital setting is a very real concern in the affected areas.
Option #2: Restriction of travel to business critical
The second option is a curtailment of travel to business critical trips only. The CDC has recommended against all non-essential travel to Liberia, Sierra Leone, and Guinea. This strategy prohibits non-essential travel to these areas, as well as recommends strong consideration for removing personnel currently in these areas. An organization’s management would need to be able to define what activities and projects are “business critical,” both in terms of requiring on-the-ground presence and that the activity cannot be deferred until the outbreak is over.
Global Rescue has a number of clients that are adopting this strategy for the three affected areas as well as Nigeria.
Option #3: Banning travel
The highest level of protection for employees is a complete ban on corporate travel to one or more of the affected countries. This approach also includes consideration of facility shutdown and potential removal of all employees currently in the named country.
While providing the highest level of protection against possible exposure to the Ebola virus, this option severely limits an organization’s ability to continue business-as-usual in these areas, and may require shifts in project timelines and resource allocation. This kind of restriction can be very disruptive, but is sometimes chosen in very high risk situations.
There are a number of corporations and/or organizations that have adopted this strategy in response to this current Ebola outbreak, despite the disruption to business activity. For example, the Peace Corps has temporarily removed its volunteers from Liberia, Sierra Leone and Guinea.
Only an organization’s management can decide what is their best approach given the risks to their employees. Global Rescue is available to provide guidance, information, training and support to our members regarding travel to West Africa and other countries of concern. Stay informed with alerts from GRID, the travel risk product from Global Rescue. Contact us at 617-459-4200 or visit www.globalrescue.com for assistance in developing your corporate travel advisory policy and for additional recommendations on employee education and pre-travel procedures.