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International SOS Worldwide Journal

hot line International SOS Worldwide Journal 20 T H ANNIVERSARY OF INTERNATIONAL SOS



W ELCOME to this special edition of Hotline. To mark the 20th anniversary of International
W ELCOME to this special edition of
Hotline. To mark the 20th
anniversary of International SOS, this
issue is devoted to a review of just some
of the milestones in the company’s
history. It looks back at a few of the more
dramatic events from the past 20 years.
There are memories of International SOS
in the early days, of individual clients and
members, and recollections from
International SOS people who have played
a key role in the company’s development.
It also highlights more recent initiatives,
which today support the delivery of
services to the millions of
clients and members that
International SOS is proud
to serve around the world.


A PASSION FOR QUALITY CARE AND SERVICE International SOS founders, Dr Pascal Rey-Herme and Arnaud Vaissié, talk about the genesis of the company and the changes they have seen over 20 years.


A DOUBLE SUCCESS Dr Rey-Herme remembers a day in 1985, which stretched International SOS resources to the limit.




focus on BP, with whom International

SOS has been working for 20 years to provide a duty of care to its employees, their families and local communities throughout the world.



A look at the vital work played by

International SOS’s global fleet of air ambulances around the world.


Designed by Andrew Kellard Associates +44 (0) 1483 549095.





PIONEERING A NEW SERVICE CULTURE Personal memories from Dr Inggriani Gandha of the opening of the very first International SOS clinic.






close-up of how International SOS’s


spotlight on SPIN - the tool for

clients can harness the power of technology to provide a global duty of care.

accessing International SOS’s 24-hour network of medical and other providers.


ALL HANDS ON DECK Recollections of the early days at International SOS’s first alarm center, and the rapid response they provide today.


A VITAL 20 HOURS International SOS medic Patrick Deroose recalls a mass medical evacuation from Bali.


SAFETY IN THE SKIES The story of how one Lufthansa passenger received vital medical care on a long- distance flight.


ANYWHERE IN THE WORLD How International SOS is delivering healthcare services in some of the remotest regions on earth.






STRAIGHT FROM THE TOP How International SOS’s most senior medical team is involved in delivering front-line care.


look at the new service provided to

patients who need to take prescribed medication long term.






ADDING VALUE How International SOS’s logistics expertise is helping clients to deliver premium services to their customers.


EVERYBODY OUT The dramatic events that unfolded during Indonesia’s civil unrest in 1998.


conversation with Dr David Cook about

the importance of occupational health services and how they have changed over the years.


MORE THAN AN EMERGENCY SERVICE How one International SOS doctor views the importance of membership.


WHERE OTHERS FEAR TO TREAD An insight into the work undertaken by International SOS for governments and NGO’s in some of the world’s hotspots.


KNOWLEDGE IS POWER Innovations in technology mean that patients can now be monitored in real time, irrespective of where they are in the world.



A passion for quality care and service

Since they founded the company in 1985, Dr Pascal Rey-Herme and his childhood friend Arnaud Vaissié have seen the company rise from humble beginnings to become the world’s leading provider of medical assistance, international healthcare and security services.

How did the company begin?

Pascal: I was working in Jakarta as Medical Attaché for the French Embassy and observed how medical care in Asia was very much based around the hospital. I felt that there was a big opportunity to bring in a European model of ‘pre-hospital care’, including a medical rescue service. Arnaud was based in San Francisco at the time and I persuaded him to join me in setting up this new venture.

Arnaud: I was told that you should never go into business with your friends – but we’ve proved that it can work! We gave each other support and fortunately our styles are complementary. Naturally we have our differences but when it comes to the major decisions, we have always been in agreement. Essentially our early vision was the same as it is now – to offer complete healthcare solutions to organizations and institutions – firstly in Asia and now globally. And from day one we have both been passionately committed to quality service – something that will never change.

How did the business develop in the early days?

Pascal: We started with medical evacuations and clinic services, with most of our patients being expatriates working in Indonesia and Vietnam. However, as many of these people were working in remote locations and employing large local populations, it was a natural progression to move into broader healthcare consulting services. Then Rio Tinto told us it was building an enormous

open-pit coal mine in Kalimantan, Borneo, and our remote site services began. Today we run over 200 such operations, with hospitals and clinics, taking care of tens of thousands of people including both employees and the local population.

Arnaud: We were very small at first, with just two small clinics in Singapore and Indonesia, and 14 staff. But we saw tremendous growth from day one. Although at first we only had small pieces of business, they were with large clients such as BP, Schlumberger and Alstom, with the potential to grow. I’m delighted to say that all our clients from our early days are still with us today, as are many of our original employees.

Pascal: Our first plane was a small Beechcraft that we had to convert ourselves by ripping out seats. On one of our first evacuations out of Dacca, we had to stop in Rangoon without permission and were promptly arrested! Our nurse was actually on her first ever flight and must have wondered what she was getting into. We now have a fleet of ten state-of-the-art air ambulances, and at any point in time at least one of our planes will be in the air.

Arnaud: Having clinics wasn’t part of our original idea, but we soon realized that this gave us a base to employ and train specialists, which is now one of our core strengths. Now we have 24 clinics around the world, but they all stay true to the initial concept of 24/7 pre-hospital and emergency services.


Tell us about some other key milestones

Arnaud: In many cases we’ve simply been responding to client demand. Security services are a good example of this natural evolution. During the 1998 crisis in Indonesia we had to carry out a large-scale evacuation of foreigners from Jakarta. At that time we weren’t openly offering specific security services but having proved our capabilities we have integrated this into our portfolio. By bringing in security specialists we utilize our existing global infrastructure, and the majority of our clients now use both security and medical services. We are always looking to improve existing services and grow new ones – in fact 40% of our existing business is with services developed in the past five years. We also encourage our operating units to

be innovative. Our Australian office developed

a patient compliance service with Roche,

offering support to patients on long-term therapies, and this has been so successful that we’ve now rolled it out worldwide.

Pascal: Our online services really proved their value during the SARS epidemic, where there was a huge need for accurate, practical information on a daily basis. Our general attitude is: “if it needs to be done, we’ll find a way to do it”. This was amply demonstrated during the recent SARS epidemic. We were told that we couldn’t evacuate patients due to the risk of infection, so our team lead by Dr Roger Farrow, quickly developed a Portable Medical Isolation Unit (PMIU).

What are the main challenges now that the company has grown so large?

Pascal: We have to sustain the same culture

and values that have driven us from the start:

a medical heritage and a passion for patient

care. Now that there are over 4000 people, we have to work harder to achieve this, and recruitment and training have a very big role to play to ensure we maintain quality control.

Arnaud: Logistics is a key development area, as we serve more and more clients and individuals, and IT plays a central role. We have recently invested millions of dollars and thousands of man-hours into a new global case management system called Magellan. This means that anyone dealing with a patient’s case from an alarm center will see the same details in real time, enabling us to create virtual coordinating teams with doctors from around the world. When you consider that we handle over 600,000 cases a

world. When you consider that we handle over 600,000 cases a Arnaud and Pascal relaxing on

Arnaud and Pascal relaxing on the Great Wall having obtained the right to open an International SOS clinic in Beijing in 1989

right to open an International SOS clinic in Beijing in 1989 Laurent Sabourin speaking at the

Laurent Sabourin speaking at the inaugural ceremony of the office in Taipei

“40% of our existing business is with services developed in the past five years”


year, this speeds up our service and radically improves the quality of our decision-making.

Pascal: It also allows us to stay true to our initial ideas – where a customer will always reach a trained professional who can understand his or her situation and quickly pass the caller onto a medical or security professional.

Arnaud: To achieve the global reach that our clients demand, we have had to expand quickly, and acquisitions have played a big part in achieving this. Of course the biggest single addition was the purchase of International SOS Assistance in 1998, which meant we became a global rather than a predominantly Asian company, with a far bigger US presence.

What about the future?

Pascal: My main aim is to ensure that we continue to offer the highest quality service to our clients. To achieve this we need to attract a new generation of dedicated professionals. Arnaud and I were 30 when we started the business and we want to bring in talented 30 year olds to keep driving the organization forward.

Arnaud: Innovation is the key: providing unique new services and as Pascal said, attracting the best talent in the world. I spend a lot of time interviewing, and see this as my number one responsibility – to ensure we all get the very best people to join us.

A double success We asked Dr Pascal Rey-Herme to tell us about some of the

A double


We asked Dr Pascal Rey-Herme to tell us about some of the first medical evacuations he was involved with for International SOS. Here he remembers one afternoon in 1985 when his team received two simultaneous calls for help.

A JAKARTA-BASED church which ran a small remote mission in Kalimantan,

Indonesia, heard that the wife of a foreigner working in the area had arrived at the mission’s medical center in premature labor. At that time, the only way to communicate with the mission was by radio. We already had an arrangement with Singapore Radio (which supported shipping fleets in that part of the world) whereby we could patch our telephone with their radio. In this way, we were able to establish a radio link with the mission.

Vital help and support

Through the night an obstetrician and pediatrician in Singapore gave vital help and support to the mission’s health officer by phone while the baby was delivered and then resuscitated. At the same time, we were assembling a pediatric team from Singapore and equipping an HS 748 aircraft to fly out to Kalimantan as soon as possible. Our team in Jakarta managed to contact the head of immigration in Banjarmasin at home that night to convince him to issue a travel document for the new-born baby.



A challenging flight

Unfortunately the landing field at the mission was too short for the HS 748, so we arranged for a light aircraft belonging to the missionaries to meet our incoming team at Banjarmasin and take them and whatever equipment they could fit into the small aircraft on to the mission. From Jakarta we contacted the Indonesian authorities to get landing clearances at Banjarmasin airport at sunrise (the airport had no facilities for night-time take-offs or landings). The pediatrician, the mother and her premature baby were squeezed into the light aircraft and taken to Banjarmasin, then transferred to the HS 748. The head of immigration was waiting at the aircraft with the necessary travel documents, and the mother and baby were rushed to Singapore. Weighing just 1.9kg, the baby was taken straight to hospital where I’m pleased to say both mother and baby recovered well from their ordeal.

Another emergency

At the same time as we were harnessing our resources to save the baby, another request came in, this time from Malaysia. An American oil worker had been transferred from an offshore platform to his company clinic in Kerteh. Suffering from a heart condition, he needed urgent transfer to hospital in Singapore. As the HS 748 was already being used to transport the baby, the only aircraft available to us was a much smaller plane called a Queen Air. With our Singapore escort team already flying to Indonesia to care for the baby, I went on the journey to Kerteh to escort the patient to Singapore. On arrival I discovered that he was 1.95m tall and weighed over 140 kg. (These days it’s standard procedure to check this type of information before a flight.) With considerable difficulty we got the patient, the pilot and me on board. We then flew back to Singapore where we landed at the same time as the baby. I will always remember one of our Singaporean nurses exclaiming at the time: “So, you put the big patient in the small plane and the small patient in the big plane!” After carefully extracting the patient from the small plane, we transferred him safely to hospital. Facing many challenges, we had successfully completed two evacuations at the same time.



A 20-year partnership

International SOS has been working with BP for 20 years. Sandy Johnson who joined the company in 1985 recalls that right from the start, she saw the importance of combining international standards with local knowledge and experience.

I WAS BASED in Singapore in 1985 and met two charming French gentlemen

through a friend of mine who was a nurse and had done medical evacuation work for them. They were looking for somebody to communicate with American and Western clients operating in Singapore and Jakarta. Having grown up in Texas and with the oil industry, I was very aware of the importance of medical evacuations and was fascinated by the work that Pascal and Arnaud were doing. “I joined as Director of Marketing in July 1985. At that time there were many European and North American companies operating in Indonesia who were drilling for oil and gas in the area, as well as organizations providing support services to them. It was natural for us to work with these companies because they had a specific need we could help them with. “We also worked extensively with embassies, insurance companies and private citizens who were looking for real-time local, medical support. Unlike the European assistance companies at the time, who had no physical presence in Asia, we had people on the ground and had developed very strong relationships with doctors and hospitals in the region. “Our first client was BP. They had operations in Sumatra and at the time had a problem with malaria on one of their remote sites. Pascal heard about this through one of


“Our relationship with International SOS has been successful because they understand our business needs and our culture. International SOS teams can work seamlessly with our staff in the field and provide specialist skills, advice and experience where needed. International SOS has the global reach we need combined with vital local knowledge. Its network of alarm centers and family-based clinics is a very useful resource for BP worldwide.” Dr Alison Martin, Health Director, Exploration & Production, BP

“The security of our employees across the globe is of paramount importance. In order to assure ourselves of our ability to relocate any of them in times of crisis, we have contracted on a long-term basis with International SOS to take advantage of their expertise and capability to effect such emergency relocations, and have tested that capability in a real situation with great success.” Nigel Carpenter, Deputy Head, Group Security, BP

the managers who was using our clinic. He was invited to visit the site, undertake a survey and set up protocols for malaria. He also arranged an evacuation service using our clinics and alarm centers in Jakarta and Singapore. “The relationship with BP is ongoing. I think the reason why we’ve been successful is because we have common goals: we were able to provide them with locally based services. Local knowledge is so important. If you break your leg in Singapore, there’s no big problem because medical services are available. If on the other hand, you’re with a geo-thermal crew in Sumatra and you break your leg, it’s a completely different situation. It’s not possible to undertake night flights on helicopters. We had to develop detailed plans for BP to evacuate people by road ambulance to a point where the aeromedical evacuations could be done by fixed wing. “Over the years we’ve maintained an unwavering, uncompromising commitment to quality. I’ve always been absolutely sure that we would get the job done. Arnaud and Pascal lead from the front and there is accountability through every layer of the organization. I call the company a diamond – it has many facets, with a core integrity.”

Assistance in partnership

International SOS has been working with BP for 20 years, helping to ensure the well-being of employees, their families and local communities throughout the world. As one of the world’s major energy companies, BP is committed to meeting its corporate responsibilities to the environment, to its people, and to the communities in which it operates. It’s an ethos that International SOS readily understands and the two companies have worked closely together at a global and local level.

Work on projects

International SOS’s relationship with BP started in 1985, when Dr Pascal Rey-Herme was asked to assist with a malaria outbreak at one of BP’s remote sites. International SOS’s involvement with BP’s anti-malaria programs still continues today. Since then International SOS has been involved with many of BP’s largest projects. International SOS is often there right from the start – delivering primary and emergency

Picture courtesy of BP

care services to workers on site. As each project develops, employees’ families join them and local people are hired. So International SOS broadens its service to include the full spectrum of healthcare in the community, including family and occupational health services.

Global agreement

In 1999, after a number of highly successful projects, BP and International SOS recognized that a more strategic approach was needed. They developed a Global Membership Agreement which put in place consistent mechanisms for looking after the health of all BP’s personnel when they were outside their home countries. The agreement means that International SOS can work closely with BP in a consistent and structured way. International SOS’s medical teams are aligned with BP’s own medical divisions, and its global network of alarm centers and clinics are accessible to BP employees when they’re working abroad.


Among the many projects International SOS has been involved in, is one for BP in Tangguh - the development of a large liquefied natural gas (LNG) facility. As part of BP’s environmental impact assessment, International SOS developed and carried out a baseline health survey in the local area, Bintuni Bay. This work assessed the state of health of the community, so that BP could review the potential impact on the health of its employees and the project overall.



Security services

Four years ago, the Global Membership Agreement was broadened to include security assistance services, which International SOS provides to BP on the same partnership basis. Again, International SOS teams are organized to align with BP’s own security divisions. 24-hour security advice and evacuation assistance is available to BP employees abroad, and International SOS experts work on BP’s projects providing advice and support on security and risk management. In just one example, an International SOS team provided security consultancy to BP’s contractors and sub-contractors in Baku, Azerbaijan. Having carried out a detailed gap analysis of current procedures and systems, they made recommendations for effective security risk management and contingency plans that met BP’s standards and requirements. In Kuwait, International SOS was responsible for the evacuation of 65 BP employees just before war broke out in Iraq in February 2003.

Medical services support

International SOS’s medical services support some of the largest energy and exploration projects in the world today. International SOS is currently providing a full suite of project-based medical services to a number of BP projects across the globe including the:

Namconson Liquefied Natural Gas (LNG) project in Vietnam, Tangguh LNG project in the Papua region of Indonesia, various BP projects in the Caspian region and new ventures in Russia, including Sakhalin Island in far east Russia.

Growth and evolution

The partnership between BP and International SOS has grown from the close involvement of one doctor to the fully structured corporate response service it is today. Martin Dennett is Business Development Director for Energy, Mining and Infrastructure at International SOS: “By aligning ourselves closely with BP’s business, we can deliver comprehensive solutions to help provide a duty of care to its employees and their families. BP takes its corporate responsibilities seriously, and in partnership with them we can help to ensure that medical and security risks to employees, their families and local communities are managed effectively.”

Hospitals in the

International SOS’s air ambulances are a vital link in providing ‘bed-to-bed’ care for patients.

A SIX-YEAR-OLD child was lying in a hospital bed in Abidjan in the Ivory

Coast following a snake bite. International SOS doctors in Johannesburg were monitoring his condition, but one vital piece of information was missing: what kind of snake had bitten him? They decided it was too risky to wait. It was June 2000 and the newly commissioned Falcon 10 air ambulance was about to make its first medical evacuation. Within hours the boy had been picked up and flown, with the unidentified snake in tow, to a modern hospital in Johannesburg, where he

was placed in intensive care. It turned out that the bite came from the potentially deadly West African Carpet Viper and would probably have proved fatal in this child. The boy was given the appropriate serum but also needed to be on a ventilator. He made a full recovery and was able to return home a few weeks later.

“With its high quality of medical facilities, South Africa – and Johannesburg in particular

– is very strategically placed in relation to

the rest of Africa,” explains Dr Fraser Lamond, Regional Medical Director Southern Africa. “Logistically our jet air ambulances can access anyone up to fifteen degrees north of the equator. We are also supported by our air ambulances based in Europe which can also overlap this area into sub-Saharan Africa thereby allowing us to efficiently cover the entire continent.” And the demand for evacuations to South Africa has spiraled in recent years: “With

to South Africa has spiraled in recent years: “With three dedicated aircraft, we make over 100

three dedicated aircraft, we make over 100 medical transports a month between our resources based in South Africa, Botswana and Namibia. We have been as far afield as the Maldives, Ascension Islands, Canary Islands and Diego Garcia. Overall, more than two thirds of all the patients brought into South Africa for medical care are handled by International SOS.”

A growing fleet worldwide

From the early days it was a real challenge getting quick access to suitable aircraft for the medical teams operating out of Jakarta and Singapore. This prompted the company to think seriously about investing in its own jets. Since the Falcon 200’s maiden air ambulance flight from Singapore in 1997, International SOS has expanded its fleet to ten, making it one of the world’s largest air ambulance service providers. With bases in Germany, Russia, South Africa, Namibia, Botswana, Singapore, China and Papua New Guinea. The speed and range of the aircraft enables International SOS to reach patients virtually anywhere in the world. There are a variety of aircraft including Learjet, Falcon, Hawker and even turbo props that can land in particularly difficult terrain where there may be no proper airstrip. The aircraft are quite literally ‘intensive


care units in the sky’, carrying everything necessary to cope with a medical emergency, including resuscitation equipment, oxygen, infusion pumps and a full range of drugs, fluid and supplies. “All our medical staff is fully trained in aviation and emergency medicine and has extensive medical evacuation experience,” says Dr Arnaud Derossi, International SOS’s Regional Aviation Medical Director for the EMEA region. “They can manage adults, neonatal and pediatric cases, with the most common conditions being cardiac conditions, traumas, infectious disease, head and spinal injuries. “Medical missions need to be flown by pilots who are expert in air ambulance processes and knowledgeable about the medical team’s requirements. They also need to have the experience of dealing with the logistics of flying in and out of remote sites where conditions may be rudimentary. “Although the vast majority of flights are on our own jets, we also have access where necessary to a range of other aircraft including executive jets, helicopters and even military aircraft or wide-body aircrafts.”

Sophisticated logistics

Whilst the pilots and paramedics on board are at the sharp end, the aviation specialists in the




”FROM the moment we arrive on the scene, we’ve upgraded the quality of care”, says Dr Tyrone Richards, Deputy Medical Director, International SOS, South Africa. “Medical facilities are virtually non-existent in many parts of Africa, so we can offer real hope for the patient. “Each day is a new adventure; you never know where you may end up. One of our most dramatic rescues involved a fifty-year-old

woman in Mozambique with 60% burns. We had a very bumpy ride due to bad weather and we had to use a tube to get oxygen into her lungs. “On landing in Johannesburg we rushed her to a preferred hospital. It was touch and go but fortunately she pulled through and three months later was back home, working again. It’s so satisfying to know that you’ve made a difference.”

alarm centers manage all the logistical aspects of an evacuation. The nerve centers are the four regional aviation units in Frankfurt, Johannesburg, Singapore and Philadelphia. Dr Derossi explains some of the key challenges in creating an integrated support structure: “Access and landing permits are critical to the success of a mission and our centers can obtain landing clearances and coordinate the complex set of activities required at destination airports”. And when every minute can literally mean the difference between life and death, local knowledge and contacts can help get you through customs and immigration quickly. “We recently evacuated a seriously ill patient from Tajikistan to London, which required clearance across seven different countries’ air space.” The coordination activities also involve the utilization of ground ambulances and

helicopters, and communication with staff at clinics and hospitals to prepare them for the patient’s arrival.

Bed-to-bed care

“It’s capability, continuity and quality of care that distinguishes our service,” Dr Fraser Lamond tells us. “We offer a high standard of medical care and attention throughout the transportation process. And every detail counts: we deliver a safe reliable service to those who need it. “The integrated nature of International SOS’s local, regional and international network means that from the very first call, we can manage just about any logistical challenge and deliver medically appropriate services and support. There are many decisions to make during an emergency: finding the quickest and best transportation should not have to be among them.”




a new service culture

to work at the clinic. “What Dr Rey-Herme emphasized right from the start was that the patient was at the center of any decision that was made”, says Dr Inge. For her, this was perhaps the most important aspect of the clinic at that time. “We were teaching our doctors to see their patients as customers. This was a very different ethos for clinical services in Jarkarta – and is still the foundation of every International SOS clinic today.”

the foundation of every International SOS clinic today.” Dr Inggriani Gandha joined AEA International, now

Dr Inggriani Gandha joined AEA International, now International SOS, in 1985. She was part of the team that opened the first clinic in Jakarta.

Growth and change

As the years passed, the number of clients and members visiting the clinic grew steadily. “At the first clinic we saw around 900 expatriate patients and the numbers just went up. By 1991 we needed new premises to accommodate our growing client base and we opened our second clinic – where we’re still based today.” Increasingly the client base grew to include local people as well as expatriates and eventually the balance tipped. “These days we see around 6,500-7,000 patients every month”, says Dr Inge, “With around 60% of them coming from the local population”.

The clinic today

Today’s busy clinic has around 300 staff, including 40 doctors on site. “We see patients of all ages, and many of the children at the International School in Jakarta come to us”, says Dr Inge. The range of services has expanded over time to include a dental practice, a pediatric practice, a diabetic clinic, a well-woman clinic and a weight-control

D R INGGRIANI Gandha (known locally as Dr Inge) trained as a doctor in

Indonesia. She spent 11 years in Germany, studying in Aachen and specializing in gynecology. In 1983, she returned to Indonesia and joined AEA International (now International SOS). In 1985 she was part of the team that opened the first clinic, in Jakarta.

As well as delivering primary healthcare services to expatriates and their families, the clinic pioneered emergency care to patients before they were evacuated, often to hospitals in Singapore. “We have always been strong on our emergency response capabilities. Back when we first started, the type of service we offered was virtually unheard of in Indonesia.”

Changing the culture

As well as pioneering new services, the clinic was forging a new, more service- oriented culture among healthcare professionals. Dr Pascal Rey-Herme recruited and trained a team of local doctors

First beginnings

“We set up the first clinic in 1985 in Jakarta because we needed a place where patients could be stabilized before being evacuated”, Dr Inge explains. “At that time, there were 24-hour clinics in the city, but they were staffed by operations people who would ring a doctor only if they decided it was necessary. With around 31,000 doctors and a population of 180 million in Indonesia, getting to see a doctor could be difficult. Ours was the first clinic to offer direct access to a full clinical team, around the clock.”

direct access to a full clinical team, around the clock.” Establishing services Opening the new clinic

Establishing services

Opening the new clinic was fraught with practical difficulties and challenges. “We struggled even to get a telephone line installed,” she remembers. After just a few months, and with a small medical and operations team in place, the clinic opened its doors. “In the early days, a large proportion of our clients were international oil and mining companies”, says Dr Inge. “They came to us because they knew their people would get access to international standards and procedures they recognized.”

Reception of the International SOS clinic in Jakarta clinic. “We also do a lot of

Reception of the International SOS clinic in Jakarta

clinic. “We also do a lot of medical check-ups for companies as part of their employee healthcare programs. Of course the percentage of emergency cases is small – but we provide dedicated intensive care,” she says. “Our clients today still value international medical training and standards. While English language capabilities are critical, the spectrum of nationalities among our staff is wide, including Australian, South African, American, Malaysian, Philippine, French, German and British.”

International standards

During her career, Dr Inge has traveled extensively and gained experience of

“Dr Rey-Herme emphasized right from the start that the patient was at the center of any decision that was made”


healthcare services on every continent. She speaks six different languages and understands cultural differences in the delivery of healthcare around the world. “My time in Germany was instructive in terms of getting experience of international standards”, she says. “I’ve learned about the differences in emphasis and expectation in different countries. And of course sometimes you have to adjust your approach to your environment. But international standards of medical care are essentially the same everywhere – and that’s what we are here to provide. Whether you’re in Moscow or Beijing, the standard of care you’ll receive is the same.”

the standard of care you’ll receive is the same.” ■ FIRST CLINIC INTERNATIONAL SOS clinics operate



INTERNATIONAL SOS clinics operate in countries where medical care of an international standard is unavailable, or where cultural and language barriers make it difficult to receive appropriate care. Each clinic offers primary care, diagnostic care and 24/7 emergency care. Services include family practice consultations, pediatrics, ophthalmology and occupational health programs. Clinics are well equipped with the facilities needed to stabilize a critically ill or injured person before evacuation. Many clinics have international-standard pharmacies, laboratory services and diagnostic services. Many are also equipped to offer x-ray and ultrasound tests, dentistry, physical therapy and counseling. There are 24 International SOS clinics worldwide in the following locations:







Phnom Penh









Jakarta (2)











Port Harcourt






Hanoi Ho Chi Minh City Vung Tau

All hands on deck at the first International SOS alarm center Dr Roger Farrow has

All hands on deck

at the first International SOS alarm center

hands on deck at the first International SOS alarm center Dr Roger Farrow has been with

Dr Roger Farrow has been with International SOS since 1987. He first started on a locum basis when he was Commanding Officer at the New Zealand Military Hospital in Singapore and is now Chairman of the Corporate Assistance Department.

F OR 18 YEARS, Dr Farrow has been closely involved with the development of

the International SOS alarm center network. Here he looks back at the early days, at what has changed – and what has stayed the same. “Back when we first started, it was all hands on deck”, he says. “Arnaud [Vaissié] and Pascal [Rey-Herme] were involved with every case, with Pascal and I always on call to give medical assistance to clients and undertake medical evacuations. This was in the days before mobile phones, when we each carried pagers and bags of 10-cent coins ready to rush to the nearest public phone. I

remember sharing our very first Ericsson

mobile phone. It was huge, and the networks weren’t great, but even then we were leading edge in terms of telecoms and technology.”

Early days

Sharing and swapping apartments and traveling between Jakarta and Singapore, Dr Farrow and Dr Rey-Herme were on constant call at the Singapore and Jakarta alarm centers when in 1989 the Hong Kong alarm center opened and additional medical staff came on board. “There were a lot of mining and infrastructure companies in Asia, and a large population of expatriates and families. Medical facilities were certainly not what

they are today, but we were doing frequent medical evacuations so the level of expertise was high and the process very efficient. We learnt right from the start about the importance of harnessing the complementary skills of both expatriate and national staff – just as we continue to do globally today. This mix of expertise has been a key element in the company’s success.” Zaleha Hassan also worked at the Singapore alarm center in the early days. “Back then we did everything ourselves”, she remembers. “We rushed to embassies to apply for visas, picked up medication, filled up

oxygen tanks locally, and went to the airport to check in patients ahead of repatriation.”

Pioneering evacuations

Modern aviation has made the medical transportation of patients faster and less stressful. Roger Farrow continues: “I remember in 1988 we completed a pioneering evacuation of an extremely sick patient by air ambulance from Singapore to a hospital in London. This was before the advent of the non-stop long haul 747 400 aircraft and when there were few air ambulance aircraft available. We used a Lear 36 to make the transcontinental flight, stopping at Madras, Abu Dhabi and then Lanaka in Cyprus before finally landing at Heathrow. Stopping in the middle of the night, while the aircraft was being refueled needed careful planning. With little of the

“The soul of the company, its humanity and compassion, have been preserved”



INTERNATIONAL SOS delivers services specifically designed and tailored for its Japanese clients and members. Lisa Tan joined International SOS in 1988. She spent two years setting up and upgrading International SOS's alarm center operations in Seoul and Hong Kong. In 1991 she returned to the Singapore alarm center as Operations Manager. She remembers how the International SOS Japanese Desk first came about. "Our Japanese clients and members have always been important to us. They were the first clients in Asia willing to invest in our services despite medical assistance being almost unknown in this region in the late 1980's", she explains. "Both AIU Insurance Company and former Mitsui Marine & Fire Insurance Company, now known as Mitsui Sumitomo Insurance Company, were the first Japanese insurance companies to show a keen interest in including medical services to give added value to their insurance products. Both companies have grown to become key clients and our business partners in many ways. "In 1992 we reached another milestone when Tokio Marine chose us as their appointed assistance company for Asia Pacific. Before choosing International SOS, Tokio Marine sent teams to Singapore,

Jakarta, Hong Kong and Brisbane to audit our operations. We were able to demonstrate our consistency of approach. More importantly, we demonstrated our understanding of Asia and the Japanese market, and showed intimate local and cultural knowledge. The key win for us was our geographically balanced network, which met the expectations and requirements of Tokio Marine in Asia Pacific at that time. Today, we provide services to Tokio Marine on a global basis. "In 1993, we set up the Japanese desk at the Singapore alarm center, dealing exclusively with assistance to our Japanese clients and members. This was the start of the fully-fledged Japanese service department that has continued till this day in Tokyo, serving more than 90% of Japanese non-life insurers and all our global members from Japan. "International SOS has always believed in the importance of providing services to customers in their own language and in accordance with their own customs and traditions, even when they're overseas. The attention to detail and commitment we demonstrated to our Japanese clients in the early days is still fundamental to the service we offer today, even though we have grown such a lot in the past 20 years."




sophisticated medical equipment available today, we had to take the utmost care to monitor the patient to make sure he remained stable through each stage of the flight.” On another occasion, a Singaporean boy had to be flown back urgently from Kota Kinabalu, where the airport was already closed. Dr Pascal Rey-Herme asked Lisa Tan, who was the only Malaysian in the company at that time, to talk to the Malaysian authorities to convince them to open the airport especially for the mercy flight. The airport authorities readily agreed to do so once the urgency of the situation was explained.

Soul of the company

The years since have seen the rapid growth of International SOS, with hundreds of new staff joining and new alarm centers and clinics opening throughout the world. This might have meant a lot of change – particularly for longer-serving members of the team. Dr Farrow doesn’t agree. “Yes, today’s alarm centers are incredibly efficient operations, with systems and technology that we wouldn’t have recognized even 10 years ago. But the heart of what we do is the same. The soul of the company, its humanity and compassion, have been preserved. “I always liken Pascal and Arnaud to the queen bee in a bee hive. Just as the queen bee affects and directs the behavior of the whole hive, so in the same way Pascal and Arnaud’s strong medical and personal ethics and their passion for excellence have shaped this company and the people who work in it. I’ve been strongly influenced by them both since the day I first met them. And in turn those longer serving members of the company are passing onto those who joined later, the same values and standards.

A hands-on approach

“What is so important and so unusual for a large company like ours, is that Pascal and Arnaud are still directly involved in medical and operational decision making. There is no serious medical case which senior management are unaware of. What we all value – and the reason so many of us stay with International SOS – is the opportunity to work for a compassionate, medically driven, ethical company. “In another 20 years we’ll probably look back at 2005 and say that what we’re doing now was pioneering. It’s all a question of perspective. But it is extraordinary to see just how far we’ve come in such a relatively short time.”





Patient calls International SOS and speaks to Operations Coordinator

Patient calls International SOS and speaks to Operations Coordinator

Patient calls International SOS and speaks to Operations Coordinator
Patient calls International SOS and speaks to Operations Coordinator
calls International SOS and speaks to Operations Coordinator Patient speaks to Intl. SOS doctor Doctor calls
Patient speaks to Intl. SOS doctor

Patient speaks to Intl. SOS doctor

Patient speaks to Intl. SOS doctor
Patient speaks to Intl. SOS doctor
to Operations Coordinator Patient speaks to Intl. SOS doctor Doctor calls Beijing AC Beijing AC recommends
Doctor calls Beijing AC

Doctor calls Beijing AC

Doctor calls Beijing AC
Doctor calls Beijing AC
Patient speaks to Intl. SOS doctor Doctor calls Beijing AC Beijing AC recommends admittance to hospital
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong

Beijing AC recommends admittance to hospital in Hong Kong

Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
Beijing AC recommends admittance to hospital in Hong Kong
AC Beijing AC recommends admittance to hospital in Hong Kong International SOS calls insurers Intl. SOS
AC Beijing AC recommends admittance to hospital in Hong Kong International SOS calls insurers Intl. SOS
AC Beijing AC recommends admittance to hospital in Hong Kong International SOS calls insurers Intl. SOS

International SOS

calls insurers

to hospital in Hong Kong International SOS calls insurers Intl. SOS stays in contact with insurers

Intl. SOS stays in contact with insurers

Intl. SOS arranges flight and escort Intl. SOS doctor calls patient to make recommendation
Intl. SOS arranges
flight and escort
Intl. SOS doctor calls
patient to make

Intl. SOS stays in contact with patient

recommendation Intl. SOS stays in contact with patient Patient discharged from hospital and contacts Intl. SOS

Patient discharged from hospital and contacts Intl. SOS

Patient discharged from hospital and contacts Intl. SOS Intl. SOS arranges hotel and taxis Patient arrives

Intl. SOS arranges hotel and taxis

and contacts Intl. SOS Intl. SOS arranges hotel and taxis Patient arrives home safe and well

Patient arrives

home safe

and well

An Australian lady, Sue Williams, lives in Inner Mongolia, China, with her husband, who is working on an Australian aid project. At home one day she falls and hits her head. As well as a bump to her head she receives a black eye, but chooses not to visit the local doctor. Over the course of the next few weeks she suffers frequent fatigue, nausea and vertigo. Finally after ten weeks, when her condition worsens and she experiences debilitating earache, headache and dizziness, she calls the International SOS alarm center in Sydney.

Expert response After talking at length with Mrs Williams, an International SOS doctor determines that she needs neurological investigations and treatment. He contacts his medical colleagues at the Beijing alarm center to discuss suitable medical facilities. Having completed their research, they identify Hong Kong as the nearest center of excellence in this field. Because of her medical condition, the International SOS doctor recommends that she travels on commercial flights from Yinchuan to Hong Kong with a medical escort. This recommendation and a quotation is provided to, and approved by, Mrs Williams’ insurer.

The International SOS alarm centers in Beijing and Hong Kong work together to arrange all logistical aspects of the transportation, including her medical escort and Mrs Williams’ admission to hospital in Hong Kong. Throughout, International SOS staff keep in constant contact with Mrs Williams to keep her fully informed and reassured. They also maintain communications with the underwriter. On being discharged from hospital, Mrs Williams asks International SOS for help to make her hotel arrangements before flying back home to Inner Mongolia. International SOS not only arranges and pays for the hotel, but also arranges taxis within Hong Kong.

A safe conclusion On her safe return, Mrs Williams contacted International SOS to express her gratitude for the service provided. “I wish to commend all the staff I had contact with, from my initial telephone contact in Sydney, to the staff in Beijing and Hong Kong. Everyone was concerned and professional. I cannot praise your organization too much.”




Straight from the top

Dr Neil Nerwich is Deputy Group Medical Director and Regional Medical Director for International SOS, EMEA. When we spoke to him about the approach to medical and operational decision making, and the role of the Corporate Assistance Department (CAD), he echoed many of Dr Roger Farrow’s comments.

“O UR OVERRIDING aim is to consistently provide medical duty of

care at the very highest levels”, he says. “The International SOS service delivery model puts the best people with the right expertise at the front end. That’s why we have full-time medical teams – not medical consultants – on duty in all our alarm centers. They provide real-time medical advice, direction and reassurance to our members and patients. Their skill is to listen to what’s being said, assess and interpret in the context of the individual’s situation, and then to respond appropriately.” “The decisions taken will depend as much on the condition of the patient as on the implications posed by the local environment. In consultation with our other medical teams

around the world who are experts in their region, we decide on the best local solution, or alternatively evacuate them if local resources are insufficient. “And when a situation is particularly challenging, all our staff know they have the Corporate Assistance Department to call on.”

Expert advice and opinion

The Corporate Assistance Department (CAD) comprises a global roster of senior medical directors with the knowledge and experience to deal with the most complex or challenging cases. On call 24 hours a day, seven days a week, they make decisions on a real-time basis in the best interests of the patient and the client. A strict set of operating procedures ensures that they are always contacted in scenarios where:

there is a complex case involving evacuation across continents or where technical difficulties need to be resolved

or where technical difficulties need to be resolved “Ever since the company started, senior medical staffs

“Ever since the company started, senior medical staffs have provided round-the-clock support to members of assistance teams”


the condition of a patient deteriorates while they are being evacuated

a major medical or security incident requires a crisis response

“Ever since the company started, senior medical staffs have provided round-the-clock support to members of assistance teams,” explains Dr Nerwich. “But as the organization grew, we realized we needed a more formalized approach, and in 2000 the Corporate Assistance Department was formed. The Department ensures there is total transparency and that any element of medical or security risk is dealt with proactively. This is particularly important in a crisis situation.” In response to the most recent Bali bombing in October 2005, Dr Philippe Barrault, a fellow CAD member, poignantly commented that International SOS had learned so many lessons from previous bombings that this time the decision was taken to proactively launch mercy medical evacuation flights. “One of the lessons was to mobilize as quickly as possible,” says Dr Barrault. “As soon as we realized that help was needed, our largest air ambulance left Singapore in the early hours of Sunday morning.” “Our processes ensure that clinical need is put first,” continues Dr Nerwich. “Patients are in direct communication with medical staff right from the outset, so their access to a doctor is in real time. The ethos of International SOS comes from the very top. Through the Corporate Assistance Department we make sure that our collective experience is applied where it matters most – responding to our members when they need our help.”

Indonesians demanding the resignation of President Suharto





SECURITY EVACUATIONS Out Everybody International SOS evacuated 4000 members from Indonesia during the civil unrest that

International SOS evacuated 4000 members from Indonesia during the civil unrest that followed President Suharto’s resignation in May 1998. Jim Williams was at the center of the drama.

B EARLY 1998, President


the economy in crisis,


Suharto’s thirty-year grip on power

Indonesia was loosening. With

demonstrations, violent clashes and riots erupted on the streets. By May 21st the pressure on the leader had grown to such an extent that he was forced to step down. Appointing his Vice President as successor did little to stop the strife. Not surprisingly expatriates, as well as local citizens, were desperate to leave the country, but it was virtually impossible to get a flight on a commercial airline from Jakarta or other airports. The situation was considered so dangerous that the US government advised all its citizens to leave the country as soon as possible.

“It was absolute mayhem. I remember hearing of people driving their cars to the airport and abandoning them or selling them on the spot”, recalls Jim Williams, who was in charge of International SOS’s Indonesian

spot”, recalls Jim Williams, who was in charge of International SOS’s Indonesian HOTLINE - ANNIVERSARY EDITION



operations at this time. “Once the phones started ringing they never stopped, so we immediately set up a crisis center in our alarm center and mobilized all our team. People expected International SOS to be able to help them and we were determined to justify this faith.”

A triumph of logistics

Within the first few hours, we established a plan of action that was on the scale of setting up an airline. One room was set up specifically to track the 15-20 aircraft that International SOS could call on to make evacuations. All employees helped out no matter what their normal jobs were. Every detail for each passenger’s flight needed to be covered. Our staff had to do everything from schedule the aircraft and crews to assign passenger seats, deal with immigration paperwork and help them pay the exit tax. “At the airport most people were waiting eight hours in a government line to pay the exit tax. We took the situation into our own hands and agreed to a new procedure with officials to help with the paperwork

ourselves. This enabled our members to go through the system in a fraction of the time,” explained Jim. The Singapore operations provided all of the reception services. They were tasked with arranging ground transportation, travel arrangements and hotels

TOWARDS RISK MANAGEMENT “INTERNATIONAL SOS is no longer just helping organizations respond to events,” says
“INTERNATIONAL SOS is no longer just
helping organizations respond to events,”
says Richard Culver, Senior Director, Security
Services, EMEA/CIS. “In an uncertain world,
we’re increasingly being asked to look at
the complete security infrastructure to help
reduce the risks of terrorism or crime. We
also help clients manage the consequence
of crisis, not just the incidents themselves,
through the provision of holistic crisis
management services.”
“We can evaluate site security, travel
policies and the quality of security firms
used. We can also provide a full-time or
seconded security manager to oversee all a
client’s activities and prepare crisis
management and emergency evacuation
Clients can access our comprehensive
web services, giving security updates and
other useful information. They can also call
into our alarm centers 24/7 and receive
immediate advice and assistance from our
on-call security specialists. “Our security
specialists typically have a military
background with further experience in
consulting and corporate security. They’re
all accustomed to working in war zones
and other hostile regions.
“It’s all about knowing the risks you
face, managing those risks and making
informed decisions. In 2004 a construction
client needed to establish business
operations in Afghanistan. We embedded a
security consultant with their project team,
and as an integral part of the client
structure assisted in the management and
reduction of risk to enable the business. We
supervised security provider selection, and
deployed with the client advance party to
ensure that their security management in-
country was up to the standards required.
That client is still successfully operating in
Afghanistan, and our
plans and procedures
have assisted in the
prevention of death
and injury to their staff
on a number of
Richard Culver,
Security Services,
occasions.” Richard Culver, Security Services, EMEA/CIS for the members we evacuated. Organizing the evacuation of

for the members we evacuated. Organizing the evacuation of so many people in such a short time was an enormous logistical operation. In spite of this we managed to launch several medical evacuations with our own air ambulance. One of these was a neonatal case. During an intense three-day period, over four thousand people were successfully airlifted out of the country. “Overall many of us in Jakarta and Singapore didn’t sleep for 56 hours. When members are in trouble, they immediately call International SOS. Our job is to help them, whatever their needs.”

“I remember hearing of people driving their cars to the airport and abandoning them or selling them on the spot”



More than an emergency service

MEMBERSHIP More than an emergency service Dr Rene de Jongh has worked for International SOS since

Dr Rene de Jongh has worked for International SOS since 1992. He’s a passionate believer in the importance of membership – and he’s at the end of the phone when members call for help.

S INCE he started working for International SOS back in 1992,

Regional Medical Director for Assistance, Dr Rene de Jongh has seen the benefits of membership time and time again. “People aren't always clear what membership really gives them,” he says. “I think the value of membership is two-fold: Members have access to myself or any of my physician colleagues day or night should they have a medical concern, and as medical professionals, we have the opportunity to get to know a little more about them. Knowing our members' background and situation helps us to deal more effectively with issues or emergencies when they arise. What’s more, membership ensures that administration and payment is already sorted. When you’re dealing with someone who’s had a serious accident, the last thing you want to talk about is who’s going to foot the bill.” Sometimes International SOS helps members with problems that they didn’t even know they had. “I remember one lady who had been a member for some time,” says Rene. “I was delighted to get a call from her telling me that she and her husband were expecting a baby – I knew they’d wanted a family. But during our conversation, she told me she’d been experiencing nasty headaches. She presumed these were a normal symptom of her condition and had been suffering bravely because she didn’t want to take any painkillers. As she was talking I realized that these headaches weren’t just another side effect of pregnancy. They sounded much more serious. Speed was important, so we

got her examined at the nearest International SOS clinic. She had in fact a significant previously undiagnosed neurological problem, so we arranged to evacuate her by commercial flight to London so that she could immediately receive the care she needed to make a recovery.”

Managing risk

Of course membership isn’t just there for emergencies. Members have access to travel and security advice to help keep themselves and their families safe while abroad. “It’s human nature to get excited when you’re going on a trip. People tend not to think about what might go wrong,” says Rene. “I don’t want to take the fun out of traveling; I just want to help people manage the risks.” One International SOS member was starting a mine site survey trip to Africa and called Rene on the suggestion of a colleague. He outlined his plans and the vaccinations he’d been given on the advice of his GP. It soon became clear that he would pass through countries where it is a requirement to have been vaccinated against yellow fever. “If you’re not covered, quite apart from the risk of the disease to you personally, you may either be deported or be given a jab there and then at the airport, which won’t always be safe,” explains Rene. During their phone conversation Rene advised his client to re-route in order to have the yellow fever vaccination, take time to develop immunity and collect documented proof to take with him. Getting this kind of advice reduces the likelihood of ever having to call on

International SOS in an emergency. “I’m not interested in just sticking to the bare facts,” says Rene. “I want to give people proper, detailed advice on how to manage themselves while they’re traveling. If someone is a diabetic planning a trip to China, they’ll want to know where they can buy needles, where they can keep their insulin cold during flights, and whether they can get their needles through customs. We give them the whole nine yards.”

Clinical need

For Rene, membership is about much more than just a fast service. “The first person you’ll speak to when you call is a trained customer service executive. The second will be a medical professional who will already have an idea of who you are, what your problem is, and at least a partial solution already in place.” This reflects a principle that attracted Rene to International SOS in the first place. “The service we give our members when they travel is unique,” he says. “Every decision is based first and foremost on clinical need – even before they’ve stepped off the plane.”

Dr de Jongh is a New Zealand citizen who joined International SOS in 1992 and is now Area Medical Director for SOS’s operations in the South Asia Region. His specialty is in hospital-based emergency and intensive care medicine. He is also qualified in pre- hospital emergency care, advanced cardiac, pediatric and trauma life support and was awarded a MSc in Travel Medicine.


ONLINE The world at your fingertips Hi-tech online solutions help mitigate the risks of international travel.

The world at your


Hi-tech online solutions help mitigate the risks of international travel.

O NE OF THE downsides of living in the ‘Information Age’ is data overload.

This is particularly true for international companies with hundreds or thousands of employees traveling or working abroad. With so many sources of information, it’s virtually impossible to access the specific details they need to help keep staff safe and secure. “The aim from the start was to make

International SOS’s website and associated online services the only places you would ever need to look,” says Tim Daniel, Chief Operating Officer, International SOS Online. From humble beginnings in 1997, the main International SOS members’ website has developed into a comprehensive guide to traveling and working around the world, as Tim explains: “We now have more than two hundred country guides of around 25-30

pages each, available in English, French, Spanish, Japanese and Chinese. You can find out all you need to know about health, security, climate, culture and customs. And information is constantly updated 24/7 to keep users fully informed.”

Towards full interactivity

Customers are always searching for ways to help manage risk more effectively: “The idea for our ‘Traveler Locator Service’ came following a client discussion shortly after 9/11. Tragically, the company had had employees on one of the hijacked planes, and wanted a system that could track every traveling member of staff anywhere in the world. “Traveler Locator takes data from travel management systems and travel agencies to give an instant snapshot of the movements of employees. You can track individuals by region, by country, by flight number or hotel booking. It also lets you assess the risks facing these people and gives automatic medical and security alerts if they’re likely to face dangers or hazards. “The service is web-based and accessible from anywhere in the world, yet also highly secure with restricted users. As you would expect, the amount of data processed is

ONLINE enormous, with 120,000 travel itineraries entered every day.” Over the past few years a


ONLINE enormous, with 120,000 travel itineraries entered every day.” Over the past few years a number
ONLINE enormous, with 120,000 travel itineraries entered every day.” Over the past few years a number

enormous, with 120,000 travel itineraries entered every day.” Over the past few years a number of other online services have emerged, such as ‘Automated Travel Advisories and ‘Travel Ready’. These help travelers prepare for the next trip, giving up-to-date information on destinations through email alerts, making sure they have the right vaccinations and even letting them know the status of visa applications.

Customized services

As with many International SOS offerings, the client is often the trigger for improvements. For example, when IKEA wanted to improve its global crisis

“This new online tool contributes to our employees’ awareness of the importance of maintaining their health and of the services our company provides in this field”


management, it asked International SOS to create a dedicated portal. This contains action plans and procedures, relevant local information such as fire, police and ambulance services, and details on all employees, including scanned copies of passports. If there is a crisis, management can act quickly, contact all relevant parties and make evacuations or close facilities. There are even detailed maps helping to locate expatriate workers. Renault in France has chosen to provide a similar service to its employees and decided to incorporate a customized medical section into the site. Daniel Mahé, General Manager of the International Mobility Department succinctly summarises the benefits: “This is an additional risk prevention tool for our company. This new online tool contributes to our employees’ awareness of the importance of maintaining their health and of the services our company provides in this field.” “The future of online services is all about getting the right information to the right people in real time,” says Tim, “Whether it’s epidemics, natural disasters or political unrest, the use of email alerts, websites and portals will give clients the tools they need to take important decisions and mitigate risk.”

A vital

P ATRICK Deroose is General Manager at International SOS’s Corporate Assistance

Department. A trained nurse, he has been with International SOS since 1993. Soon after he joined, Patrick was part of a team sent to care for the victims of a serious road accident on Bali. Here he remembers how events unfolded. “A couple of weeks after I started work with International SOS there was a terrible crash on Bali. A group of elderly French and Belgian tourists were traveling in a mountainous area when their coach tumbled into a ravine.

Many of the passengers were injured, some

20 hours

Memories of the first International SOS mass evacuation.

seriously, and several people were killed. Local services arrived at the scene as quickly as possible and took the injured passengers to the local hospital. As soon as they were informed of what had happened, the French insurance company contacted International SOS and the Singapore alarm center was immediately alerted. Knowing that local medical facilities would not be sufficient to deal with the situation, our mandate was to bring the patients to major trauma centers in Singapore for treatment and repatriation.

Combining resources

The operations team at Singapore quickly put together a plan that combined the resources of three International SOS alarm centers:

Singapore, Jakarta and Bali. The Singapore and Bali teams would triage the patients (that is, determine their injuries in order to decide the order and urgency of treatment) ready for repatriation. The Jakarta team would provide the necessary equipment and personnel for the aircraft. One of our Bali-based doctors was immediately sent to the hospital in Bali to assess the situation. Understandably, conditions at the busy emergency room of

this Government hospital were crowded, with staff struggling to cope. The doctor carefully and sensitively explained the plan that International SOS had put in place. Meanwhile a medical team was sent from Singapore to Bali, comprising myself, Dr Roger Farrow and Dr Peter Heron. With the necessary language capabilities between us, we took with us the medical equipment we would need, including 15 stretchers.

Directing triage

One of our Bali team met us at the airport and took us to the hospital. Dr Farrow directed the triage and we prepared the patients for transport out of Bali to Singapore. 15 were seriously injured and another five had more minor injuries. A lack of ground transport in Bali meant that there were only five ambulances available




“20 hours from the time of the first call, the patients had arrived safely in hospital in Singapore”

to us. We quickly organized for the least injured patients to go first, with the most critical patients following last so that they would spend as little time as possible out of hospital. Meanwhile, our logistics team were sorting out passports and the necessary papers in collaboration with the insurance company and the relevant consul on Bali.

Safe arrival in Singapore

The patients were flown out of Bali on a Fokker aircraft, which had been prepared by the Jakarta team, including medical staff, monitoring equipment and enough food and drink for the patients. Once the aircraft was loaded, we called the Singapore alarm center with our arrival time so that ambulances would be waiting on the tarmac at Singapore airport.

Offloading the patients in Singapore was easier because there were 14 ambulances waiting to transport them to the casualty departments of Singapore General Hospital, the National University Hospital and other private hospitals in the city. Allocations were made by the Singapore alarm center to ensure that each patient received the treatment they needed. 20 hours from the time of the first call to International SOS, the patients had arrived safely in hospital in Singapore where the 15 most seriously injured remained until being repatriated for treatment or rehabilitation. Out of the five people with more minor injuries, three went home and the two others stayed in Singapore to be with their loved ones who were being treated in hospital. All the uninjured were flown home within 24 hours.”







REMOTE SITE SERVICES where IN THE WORLD Taking healthcare to some of the world’s most remote

Taking healthcare to some of the world’s most remote regions.

O RGANIZATIONS working in oil, gas, mining and construction operate in some of the harshest, hostile and most inaccessible environments, with

employees carrying out dangerous work, often in extreme weather conditions. Whole communities can spring up around these sites, and keeping employees and their families healthy is a major challenge. International SOS first became involved in this field in 1988, when a French airport construction company was commissioned by the Indonesian government to build Jakarta’s new international airport. The company was eager to offer a high standard of care to their construction teams at a site that was three hours’ drive from the city. After consultation, Dr Pascal Rey-Herme recommended creating a field clinic offering the same emergency and primary care services as his city center operation. The doctor not only designed and equipped the clinic, he also supplied and supervised local medical staff. Some time later a senior mining company executive asked International SOS whether it could help develop medical services for a huge coal mine that was being built in Kalimantan in

Borneo. With the mine employing 300 expatriates and 2000 local Indonesian workers and their families, the company needed to be able to make medical evacuations and manage day-to-

day healthcare, as well as provide preventative treatment for malaria and other tropical diseases. “What began with just one doctor in a single clinic has now grown into a complete medical infrastructure operation incorporating a small hospital, outpatient and emergency facilities, and satellite clinics with occupational health programs and award winning public health programs,” explained Dr Myles Neri, Group Medical Director for International SOS’s Global Medical Services.

A natural development

Fast forward to 2005 and International SOS now manages around 200 remote sites across five

forward to 2005 and International SOS now manages around 200 remote sites across five HOTLINE -




“The occupational health program aims at prevention, detection and surveillance of occupational illnesses and injuries on the site”


injuries on the site” DR DAVE KNIGHT , INTERNATIONAL SOS continents, from the new tarsand oil

continents, from the new tarsand oil fields in Canada to gold mines in Papua New Guinea; from pipelines in Chad and Cameroon to petrochemical plants in China. Dr Neri continues:

“Companies take their duty of care towards employees very seriously, and they’re looking to achieve a high standard of medical service for all their operations. These facilities may range from a simple first aid station to 120-bed fully managed hospitals.” Over the years, International SOS has developed its services to encompass the full spectrum of health care specialist services from primary and emergency care to occupational and public healthcare. And having gained an intimate understanding of remote site medical needs, it also offers expert consulting advice and guidance to its clients. Dr Neri continues: “Our first step typically involves a site survey, looking at everything from local living and working conditions to the availability of medical care and accessibility of emergency transport. From here we work with the client, the local health authorities and local resources to define the appropriate scale of medical services.” The oil and gas fields on the island of Sakhalin, off the easternmost coast of Russia, present a different challenge altogether. There are 16 field sites scattered around the island, where the severe winters can last for up to 7 months. International SOS provides doctors and paramedical staff for all these sites and has nine permanent clinics on the larger work sites, plus a doctor, medic and health and safety adviser

nine permanent clinics on the larger work sites, plus a doctor, medic and health and safety
on the huge offshore platform that supports a crew of 132 people. Helping the wider

on the huge offshore platform that supports a crew of 132 people.

Helping the wider community

Large, remote sites not only create their own communities, they also impact upon the wider local population. International SOS is active in helping clients build health capacity with their neighbouring communities by providing programs to monitor, treat and prevent diseases, improve sanitation and manage and counter sexually transmitted diseases (including HIV), TB and malaria. Dr Dave Knight, International SOS Medical Director at Batu Hijau, Indonesia told us: “The occupational health program aims at prevention, detection and surveillance

Water sampling as part of a malaria control program

Large, remote sites not only create their own communities, they also impact upon the wider local population.

of occupational illnesses and injuries on the site. The dual aim is workers’ health protection as well as health promotion.” In recent times governments and aid agencies have called upon International SOS to provide similar services to them in areas of reconstruction, following conflict (Iraq/Afghanistan) or devastation (Aceh/Pakistan). The emphasis is on rapid deployment, quality medical services, medical evacuation capacity and local staffing, training and development. Companies, governments and aid organizations will continue to operate in remote areas, to respectively extract raw material and energy, develop the infrastructure or to help the local population. And in extreme heat or arctic cold, in deserts or offshore, International SOS will be there with them, helping keep the workforce – and their families – healthy.


DR Patrick O’Neill, who worked as Chief Medical Officer at the Kaltim Prima coal mine in Indonesia when International SOS first set up its on-site operation, remembers the many challenges of those early days. In addition to carrying emergency operations out in remote jungle clinics, and

riding 90 minutes by boat to transport patients to the nearest local hospital (before

a hospital was built on site), he also had to handle patients of a hairier variety! One day an orang-utan managed to find

its way into the site and severed its thumb in

a conveyor belt. The unfortunate animal was

sedated with tranquillizers and then taken

into the site clinic, where visiting plastic surgeons involved in a company public health surgical program for cleft lip repair, were on hand to sew it back on. After a difficult period of readjustment the orang-utan was finally released back into the wild with both hands fully intact.

a difficult period of readjustment the orang-utan was finally released back into the wild with both

A change of gear in occupational health

Dr David Cook was originally Chief Medical Officer in Burma for International SOS between 1996 and 1997, working in Jakarta, Singapore and Papua New Guinea. After 10 years working abroad he returned to the UK to pursue occupational health as his specialty in 2003.

“I ’D SPENT YEARS delivering general medical services on remote sites

around the world”, he says. “And it was clear that what was increasingly critical was occupational health. Where there are employees, it’s not just a question of delivering primary healthcare. You need to ensure that there’s an appropriate fit between employer work and employee – that the job doesn’t cause ill health, and that ill health doesn’t affect the health and safety of anyone in the workplace.” David was given the remit to develop occupational health services globally for International SOS, working in the UK and supporting its network of occupational health professionals at its regional centers worldwide.

David, what does occupational health mean?

There are two types of occupational health. There are occupational health services in first-world countries like the UK and US. These countries benefit from a good medical infrastructure, resources, training and research, and full health and safety legislation that is enforced. Here occupational health focuses on prevention of work-related ill-health, promotion of wellness and on managing health and safety programs in the workplace. Then there’s occupational health in emerging countries where there is little medical infrastructure, where medical training can be variable and resources scarce. Classic industrial diseases – like lead poisoning, dust induced lung diseases and hearing loss – may prevail and public health problems are far more prevalent, for example HIV, tuberculosis, under-vaccination, and so on. Services are often delivered at remote sites and include employment screening and health and safety management, with disease management an inevitable component.

What occupational services does International SOS offer?

International SOS offers services across the whole occupational health spectrum. We’re second to none in terms of resources – medical, intellectual, transport, communications, and security. Remote sites are usually in emerging countries, where International SOS delivers occupational health services along with general medical services in places where employees don’t have ready access to a GP or a local A&E. We also develop comprehensive occupational health programs

designed to suit a particular company’s needs. We can deliver fully managed occupational health services on behalf of clients. We are the only company in the world that can offer consistent levels of care – globally. And that’s a capability that’s becoming increasingly important for many of our clients.

How has occupational health changed over the years?

Occupational health has always been in place. More recently the emphasis has changed towards preventative medicine and public health, not just general medical health. Companies recognize that occupational health directly affects safety and productivity. We are also moving towards evidence- based occupational health. Companies are keen to meet their corporate responsibilities, to improve the health, safety and environment of local employees and to make a positive contribution to communities.

What is evidence-based occupational health?

It’s about developing management and reporting systems that enable organizations to manage risk proactively and coherently. Specific initiatives can be designed to combat particular issues that are identified based on evidence. It’s also about implementing coordinated systems and processes to ensure that employees are treated consistently, wherever they work. International SOS delivers a thoroughly researched, evidence-based medically driven service, comprehensively thought through and comprehensively delivered.

How is evidence generated?

Data reporting and measurement is critical to effective occupational health management. At International SOS we have developed our own occupational health tool called GO- Care (Global Occupational Care). Its backbone is a bespoke piece of software, which is fully integrated with the other International SOS systems. We use GO-Care to manage a complete suite of occupational health services for our clients. These include comprehensive fit-for- work programs and vaccination programs. We also use GO-Care to manage and support our occupational health consulting services and our occupational health staff on-site.

Can clients access GO-Care?

A very important component of GO-Care is the online statistics and reports that it can generate. As GO-Care is web-based, some of our clients can access it to generate and download their own reports. So it’s a tailored service, with tailored data recording and reporting. And employees with some of our clients can download their own paperwork (while individual medical records remain confidential). GO-Care is all about quality management



– a quality system and a quality service. We call it quality, quality, quality. That was our mantra back in the 1990s and it hasn’t changed today.

What new developments are there in occupational health?

International SOS is continuing to develop new occupational health services. At the moment, we’re working on an evidence- based service to manage sickness absence for our clients in Europe. Believe it or not,


TOYOTA Motor Corporation is one of Australia’s leading car manufacturers. It has over 4,500 employees in Australia, spread over six locations with 90% based at its two main sites in Port Melbourne and Altona.

Objectives for Toyota Australia Toyota’s key objective is to ensure that ‘every employee is treated as an elite athlete and the best treatment possible is rapidly sourced so that they can be returned to their workplace as soon as possible.’ Back in 2003, with concerns about costs spiraling, its own health services not widely used, and work injuries (particularly musculoskeletal injuries) increasing, Toyota Australia needed a more proactive approach to managing the health of its employees. It wanted its Health Centers to be the first port of call for any employee with a health concern, whether work-related or not. Toyota Australia needed an expert partner who understood its business and had the capability to deliver a full range of healthcare services. It asked International SOS to work in partnership with its occupational health and safety team to design, deliver and monitor a comprehensive occupational health management program.

How International SOS has helped Philippe Arnaud, Group General Manager GMS Development explains International SOS’s approach: “We have delivered a fully integrated occupational health program in partnership with Toyota Australia. Our medical teams run Health Centers at Toyota Australia’s two main sites. They offer a full range of services to promote employees’

return to work after ill health, including primary first aid, diagnosis, support, treatment planning, active support and advice. Staff assess and advise on a wide range of health issues, and provide stability and familiarity for workers visiting the centers. We also carry out pre-employment and employment assessments, monitoring, reporting and education. Recent health education initiatives have included healthy eating and keeping hearts healthy. To raise awareness of healthy practices in the workplace, we are working closely with Toyota Australia to identify workplace concerns and put in programs to minimize risk of injury.”

Measuring progress International SOS carries out detailed monthly reporting against key performance indicators agreed with Toyota Australia. Data is used to target healthcare and education initiatives. Key measures this year include a fall in the number of musculoskeletal injuries, and a reduction in the cost of third-party medical providers. Paul Furtado is Health Support Advisor on Toyota Australia’s Occupational Health and Safety Team. “The Toyota/International SOS relationship is now over 12 months old. In this time a strong relationship has been established and quality health outcomes are being delivered. Toyota looks forward to continuing to work with International SOS in the important area of employee health to ensure that we retain our competitive advantage both locally and globally.”



£13.2 billion is lost annually in the UK through sickness. There is plenty of evidence that employed people who stay in work are healthier, get better faster and to a greater degree if sick or injured, compared to those who are unemployed or stay out of the workplace too long. As I always say, work is good for you!

Is that something that companies in other parts of the world would benefit from?

When we develop a service in one region, we always look for opportunities to apply it in other regions where appropriate. Our network of occupational health practitioners regularly meet to share interesting cases and learning – and to cross-fertilize ideas. This exchange is crucial for delivering international-standard services to our clients.


AS anxieties increase over the spread of the avian influenza virus, International SOS’s most senior medical staff has been working over the last 18 months to thoroughly research the implications of a potential influenza pandemic and to develop pandemic preparedness plans. The concern is that if the current virus mutates and gains the ability to spread easily from person to person, it may emerge as the cause of the next influenza pandemic. Dr Doug Quarry, Medical Director, International SOS Online, is a member of the International SOS Avian Flu and Pandemic Preparedness team. “As well as monitoring the situation 24/7 and making the latest information available through our dedicated website, we wanted to give our members practical guidance so that they could put contingency plans into place for their businesses,” he says. “After extensive research, we have developed nine chapters of protocols and over 120 pages of information to ensure employers have the key documentation they need to develop a company- and employer-specific Pandemic Preparedness Plan.”

and employer-specific Pandemic Preparedness Plan.” Where others Non-governmental organizations (NGO’s) often

Where others

Non-governmental organizations (NGO’s) often arrive in a country when everyone else is leaving. So who can they turn to in time of need?



(NGO’s) often arrive in a country when

everyone else is leaving. So who can they turn to in time of need? Whenever there is a war, famine or environmental disaster, most people’s first reaction is to get out of the area as quickly as possible. But for organizations like the UN, Red Cross, WHO, Oxfam, Save the Children and Medecin sans Frontières, this is typically where their work is just beginning. Like any large international concern, NGO’s and indeed government agencies also need to safeguard the health of their employees.

Emmanuel Chevron, head of Sales and Marketing in International SOS’s Geneva office explains: “With the ever-present threats surrounding them, our clients need to be able to

threats surrounding them, our clients need to be able to Banda Aceh – chaos and destruction

Banda Aceh – chaos and destruction caused by the Tsunami

GOVERNMENTS & NGO AGAINST ALL ODDS DR Jean-Bernard Carbonnel, who has been with International SOS





DR Jean-Bernard Carbonnel, who has been with International SOS since 1992, recalls an urgent medical case that he coordinated for the Red Cross:

“In March 2002 we received a call in our Geneva alarm center about a four year old girl with severe hepatitis in Kinshasa, Democratic Republic of Congo. She was the daughter of a Red Cross delegate in the country and needed an urgent liver transplant. We decided that the best place to get a quick operation was Geneva, despite it being 11 hours away, and commissioned a long distance jet. We took a chance in sending the plane immediately and only received a

landing permit 2 hours before arrival in Kinshasa. On reaching Geneva a large ambulance was waiting to take the patient to the intensive care unit in the Cantonal Hospital, where a successful operation was followed by a full recovery. This project was a triumph of logistics, with our team arranging visas, landing clearance, ambulances and hospital facilities.”

landing clearance, ambulances and hospital facilities.” fear to tread get medical assistance at a moment’s notice,

fear to tread

get medical assistance at a moment’s notice, anywhere in the world. Thanks to our global coverage, we have been able to help a number of government bodies provide high levels of primary medical care to employees in different parts of the world.”

Security climbs up the agenda

With the breakdown of former political structures and the rise in religious fundamentalism, security is also an issue. NGO’s are not always seen as neutral organizations and may get labeled as ‘tools of the west’, leaving them increasingly vulnerable. Security has consequently become a far higher priority and a number are turning to International SOS for advice on protecting staff and facilities and minimizing the risk of terrorism, kidnapping and crime. “Where NGO’s may once have been seen as a group of well-meaning amateurs they are now large, established, professional organizations with full time staff,” explains Mike Penrose, Regional Security Manager, International SOS. “The security and medical needs of their

employees are essentially no different to those of a commercial corporation.” Having previously worked in a number of NGO’s in war and disaster zones around the world, Mike is only too aware of the dangers. Indeed, he was once kidnapped by Chechen rebels for two months. “When planning their security, NGO’s must be very conscious about how they are perceived. Surrounding yourself with bodyguards may be counter-productive and only serve to alienate local groups; it’s more important to project an image of absolute neutrality.”

Tsunami: helping when disaster strikes

With its global infrastructure and experienced staff, International SOS can offer much-needed advice and on-the-ground support to both governments and NGO’s. Following the 2004 Tsunami that devastated Sri Lanka, Indonesia, Thailand, Maldives and Malaysia, it gave valuable logistical aid to the UN and AUSAID (the development wing of the Australian Government), providing a team of 20 medics on the ground in North Sumatra, and carrying

out over 100 evacuations. Mike Penrose was also seconded to the WHO for six weeks to help set up disaster aid:

“In an environment with so much suffering and a totally traumatized population, it’s very difficult to coordinate the aid effort. International SOS’s experience in similar situations helped us put together appropriate strategies and assist the Indonesian Ministry of Health to re-establish its own structure.”


THANKS to the generosity of customers and staff, International SOS has been able to raise over $330,000 dollars to help victims of the disaster in Banda Aceh. These funds are being used to sponsor 80 young Indonesians from Aceh over the next four years to become nurses, so that they can actively participate in the rebuilding of their community.




Widening the net

GLOBAL ASSISTANCE NETWORK Widening the net Thierry Watrin, Corporate Director, Global Assistance Network, joined

Thierry Watrin, Corporate Director, Global Assistance Network, joined International SOS in 1998. He has been responsible for developing the global network of medical and other providers that International SOS can call on anywhere and at any time.

automatically. It is also integrated with our case management system, to ensure that the process of dealing with each individual case is as smooth and efficient as possible. For a small number of our largest clients, we’ve developed tailor-made provider networks, available via the Internet. In particular, we can make details of key providers available to members through our online country guides.

Into the future

“W HEN I joined International SOS there was already a strong network

of providers established in Asia, with more informal networks in place in other regions. Years previously, the company had sometimes relied on the co-operation and resources of our correspondents to record information about medical providers in different parts of the world. All cases were handwritten or typewritten, and to search for individual cases required a trawl through stacks of physical files. The big change came when an important client, the insurance company Tokio Marine, asked us to establish a cashless network of medical providers for its clients worldwide. Timothy Yee and Dr Doug Quarry at our Singapore alarm center established a system to document assessments and details of medical providers onto a database and to set up guarantees of payment with providers as part of our service. This was the genesis of the vast Global Assistance Network (GAN) that we have today. The other strong building block was to develop a whole team of Global Assistance Network managers able to develop our network anywhere we have a case.

About SPIN

Launched in November 2002, the Service Provider Information Network – or SPIN – is the key means of accessing our Global Assistance Network and spans every country in the world. SPIN is a powerful on-line database and search tool that pinpoints a particular provider according to the criteria that our staff choose, for example by location, medical specialty or type of agreement. But it’s much more than that. SPIN is a


tool used daily by our GAN managers and coordinating doctors for managing the quality of service delivered by our worldwide network, from assessing and credentialing providers, to ensuring smooth payment and administration when help is needed. When someone from International SOS visits a provider, they use SPIN to record details about its organization and services. This helps us make the right choices on behalf of our clients and means we can develop a set of preferred providers. SPIN also holds comprehensive records about providers, including licenses to practice, medical qualifications, terms and conditions, and site audits.

Widening access

As a web-based tool, SPIN is accessible worldwide and updates are available

The Global Assistance Network, which now includes a team of more than 40 dedicated personnel based in all our alarm centers, is set to develop – not only with the numbers of providers and preferred providers growing, but with the depth and quality of information continuing to improve. Key areas, like China, are expanding quickly, and new parts of SPIN, for example a whole new function for provider credentials, is being released. Thanks to the energy and dedication of the Global Assistance Network team, we have managed to formalize our network rapidly while continuing to meet the urgent needs we deal with every day. The network is the backbone of International SOS and a vital part of the way we deliver services to our clients. There is still much to do, but the last three years have seen a lot of progress in our development of such an unique resource.”

much to do, but the last three years have seen a lot of progress in our



Safety in the skies

When a Lufthansa passenger suffered a heart attack on a long distance flight, he was in the safe hands – of a doctor hundreds of miles away.

I N FEBRUARY 2003 a middle-aged man suffered a myocardial infarction whilst his

Lufthansa flight was passing over Siberia. This was cause for serious concern. Fortunately the pilot was able to contact a German-speaking International SOS doctor by satellite phone at the Frankfurt alarm center. The doctor assessed the patient’s symptoms and concluded that it was imperative to get him to a hospital as soon as possible. Having checked the database, he confirmed that the nearest appropriate facilities were in Almaty. The pilot agreed to land at the local airport and the patient was

rushed in for emergency treatment. “In-flight medical assistance is a highly specialized service requiring an in-depth knowledge of emergency treatment and an understanding of how patients react when at 35,000 feet,” says Dr Michael Weinlich, Medical Director International SOS Germany. “You have to know the nature of on-board conditions and be familiar with flight

procedures. Our doctors will calm everyone down and help the captain decide whether a diversion is necessary.” International SOS offers in-flight services to Lufthansa, Singapore Airlines (SIA) and a number of other carriers, as well as supporting several fleets of private jets for multinational corporations.Training is provided for the airline flight crew in

“It’s the closest thing to having a doctor next to you”


emergency medical treatment procedures, which includes simulation exercises.

Serving the aviation industry

“The development of our services to the aviation industry can be traced back to the 1980’s, when we provided medical assistance to members of SIA’s frequent flyer program, Priority Passenger Services (PPS),” Kasey Khaw, Regional Director, Global Accounts Asia, explains. “The airline was impressed with International SOS’s ability to provide remote medical care and assistance. We had successfully carried out some medical evacuations for individual customers whilst on business and personal trips. Offering in- flight services was just a natural progression, where we combined our on-board medical experience with our geographical knowledge of appropriate medical providers and facilities. Our in-flight medical assistance teams are all aero-medical specialists trained in aviation medicine.” Today, International SOS is also working with airlines’ medical departments to help reduce the risk of medical incidents by providing pre-flight screening for both passengers and crew. Whilst you’ll never be able to guarantee that there’s a doctor on every flight, a ‘virtual’ medical team is the next best thing.



Supporting patients in a new way

With help from International SOS nurses and specialists, patients on prescribed medication are benefiting from a new service provided by International SOS.

from a new service provided by International SOS. T HE PROBLEM of non-compliance has been plaguing

T HE PROBLEM of non-compliance has been plaguing the healthcare sector for

years. In some cases as many as 80% of patients fail to finish their course of treatment or take their medication correctly. This can have very serious consequences for the patient’s health, as well as costing the health service the time and expense of re-admissions and further treatment. There are many reasons why so many patients seem unable to follow dosage regimes or make lifestyle changes. For some it’s simply a matter of poor motivation, whilst others don’t really believe they’re ill, especially when the symptoms are hidden, such as with high cholesterol. While poor compliance is often attributed to simple forgetfulness, in fact, the majority of patients can articulate their reasons for ceasing therapy. In a bold move, doctors, pharmacists, health managers and the pharmaceutical industry have joined forces to combat non- compliance, with the additional help of International SOS. The Patient Support program offers patients on specific medications a support network of

healthcare professionals who can guide them through the weeks and months of their therapy. Primarily telephone-based, they receive a combination of information and encouragement, helping them to understand

the treatment and make necessary behavioral changes.

Holding their hands

“We’re there to provide ongoing support to the patient, holding their hands through the journey,” says Ben Connor, International SOS Operations Manager, Pharma Services. “Our aim is to give patients a better understanding of the medication and what effects it may

have. We talk to them about their lifestyle and for certain treatments, the importance of a healthy diet. Many people expect a quick fix, so we also have to manage their expectations and educate them on the long term nature of the benefits.” Patients enrol voluntarily, usually after hearing about the program from their doctor or pharmacist. International SOS will then work to a contact plan, calling at critical

Reasons given by patients for ceasing antidepressant therapy

60 50 40 30 20 10 0 Feeling Adverse Better of Events Fear Dependence with
Feeling Adverse Better
of Events
with Drugs
of Efficacy
Must Solve
Without GP Drugs

Ref: K. Demyttenaere et al. Compliance with antidepressants in a Primary Care Setting, 1:

Beyond Lack of Efficacy and Adverse Events; J Clin Psychiatry 2001; 62

points, during a prescribed period. This can vary between three and six months depending on

points, during a prescribed period. This can vary between three and six months depending on the therapy. The level of attention is a vital factor, according to Maggie Butler, a registered nurse who works on one of the programs:

“Doctors just don’t have the time to talk to patients at length, and sometimes it can take days to simply get an appointment. We’re on the other end of the phone any time they want to call us.”

Highly rewarding

Patient support is relevant for a wide range of longer term or chronic conditions such as cardiovascular conditions, diabetes, high cholesterol, multiple sclerosis, osteoporosis, obesity, rheumatoid arthritis and HIV. Ben Connor continues: “We have nurses, exercise physiologists, nutritionists and a range of other specialists who have developed an in- depth understanding of the various treatments we support. Most importantly, we can give patients all the time they need, whether they’re concerned about side effects or merely want some encouragement. In over twenty years of working, this is the most rewarding job I’ve ever had, knowing that I can make a real difference to people’s lives.” And International SOS nurse Maggie Butler, who provides support to obese

patients, echoes Ben’s sentiments “We get so much positive feedback from patients. One woman recently told me she had just got out of her wheelchair and hung the washing up for the first time in fourteen years, after successfully losing weight. Whilst another improved her health and became pregnant, and rang to tell me that I had changed her life.”


Patient Support is proving increasingly popular, with International SOS working with pharmaceutical companies across Europe, Asia and Australasia. It’s essentially a win-win

“This is the most rewarding job I’ve ever had, knowing that I can make a real difference to people’s lives”




“Non-compliance with prescribed medication continues to be a significant and widespread problem. The idea of providing proactive telephone support to patients is looking increasingly promising. We support the development and evaluation of these schemes to establish what works and what doesn’t, for the benefit of patients.”

Geraldine Mynors, project manager for Medicines Partnership

works and what doesn’t, for the benefit of patients.” Geraldine Mynors, project manager for Medicines Partnership

approach: the patient improves his or her condition; the health service saves time and money; and the pharmaceutical company benefits from longer treatment regimes, helping them establish their therapies. One client reported that the average treatment duration has subsequently more than doubled, with patient satisfaction with the program running at over 85%. Importantly, the concept has the blessing of health organizations who realize the benefits of a healthier population. Indeed the UK Department of Health is so concerned with non-compliance that in 2002 it set up The Medicines Partnership, a task force aimed at helping patients get the maximum benefit from their medicines and therapies.

Patient Support is an intrinsic element of this initiative

The last word goes to Ray Rowden 1 , an adviser to the UK Health Service, who

believes we need: “

patients who are empowered to take action, with the health professional caring for them. Patients will receive the support to take more control of their own health and treatment and to make more appropriate use of health and social services.”


create a generation of

1. Rowden R. The Expert Patient, Pharmaceutical Field, April 2002.



technological infrastructure gives our team the ability to search for solutions quickly.”

Personal service

‘Concierge’ services are being offered to customers across a number of industries as a way of adding value to the core product or service. Just one call will put you in touch with a dedicated team of personal assistants, who can sort out birthday presents for a loved one, find you tickets for the latest top show or even get you prices for a private helicopter! “A number of card issuers ask us to deliver concierge services for them because they know they can trust us with their most valuable customers,” says John, “At our Sydney alarm center we offer seven different languages 24/7, and people who have the right answers at their fingertips.” Since International SOS first started managing such services for Visa’s premium customers in Asia-Pacific in 1997, they have added a range of other offerings including domestic tradesmen (for home insurance customers) and emergency medical assistance to mobile phone users. Expectations are high, says John: “Our clients want comprehensive feedback on who is making the calls and how quickly and effectively their customers are dealt with. Our management information systems - initially developed to manage complex medical cases - are able to give the kind of detailed reports they’re looking for. But above all, they have the confidence of knowing that International SOS is always fully committed to keeping the customer happy - no matter what they’re demanding.”

Adding value

International SOS is using its remote servicing skills and logistics expertise to help clients deliver premium services to their customers.

E VERY DAY a team of skilled car mechanics arrives at International SOS’s

alarm center in Sydney. But they’re not wearing overalls and they won’t be getting their hands dirty. Their job is to take calls from worried motorists, talk them through their concerns and if necessary arrange to send a breakdown vehicle. This is part of a specialized service provided for drivers of new Saabs, Ferraris, Maseratis, Alfa Romeos, VW’s and other top marques. “Because the mechanics really understand the cars, one in three calls gets resolved without having to send out a breakdown truck,” explains John Jessup, Managing Director, International SOS, Australasia. “With our expertise, we can handle calls on behalf of our clients and help offer something extra to their customers.” ‘Auto Assist’ is just one of a number of ways in which International SOS is providing

premium services to help clients around the world differentiate themselves from the competition. “One of our core competencies is highly skilled and trained specialists who are determined to solve any caller’s problem.” John Jessup continues: “Our sophisticated

“SUBARU has entrusted International SOS to provide Premium Assistance Service to our customers across Australia since February 2002. Customer interaction and high quality service is a vital part of our business, and we have found International SOS to be a highly valuable and professional partner. From a flat tyre to an accident, International SOS provides assistance and peace of mind. They understand our business, our culture and our customers. They have proven to be flexible and provide skilled automotive

technicians as operators who have a real understanding of the customer’s needs together with a focused account management team. Subaru’s philosophy is based on doing the common things uncommonly well and International SOS is a key part of that strategy.”

Derek Ashby Subaru National After-Sales Manager Subaru Australia

W HEN International SOS members get sick or injured, they may well have to

be passed through more than one medical facility and possibly be evacuated across hundreds or even thousands of miles. In such situations it’s vital to keep a constant watch on the patient’s progress and have a full medical history to hand.

A fully integrated system

International SOS’s new global ‘case management’ system (codenamed Magellan) which is currently being rolled out to all of its 28 alarm centers, provides full, regularly updated details for doctors monitoring cases around the world. “If a patient is moving between time zones, then doctors in different alarm centers will all view the same information on screen, letting them discuss the case more efficiently. All details are entered directly on to the paper-free system which already contains the patient’s medical history,” explains Mark Crawford, Global Systems Development Director. “This innovative technology is fully integrated with virtually all our other systems across the organization, helping us to reduce administration and speed up data entry, giving the doctors more time to focus on the patient’s needs.” And with the digital age well and truly upon us, information such as x-rays and scans can be attached and viewed from any of the centers, greatly aiding the decision- making process.

Invisible life support

So, when a patient calls from Nigeria with chest pains, the coordinating doctor, taking the call from International SOS’s alarm center in Paris, is immediately able to access the man’s details, arrange transport to the nearest approved hospital and automatically generate a Letter of Guarantee to cover any medical expenses. When the patient is evacuated to South Africa, the case can be simply and seamlessly taken up by the alarm center in Johannesburg. “This whole system has been two years in the making, involving millions of dollars of investment and a tremendous effort by a team of over 100 people. It is an invisible life support system for our members. Our doctors are delighted with this new development as it helps them deliver a better quality of care.” Mark continues: “This software effectively lets us watch over a patient twenty-four hours a day from anywhere in the world.”



Knowledge is


Advanced technology lets International SOS globally monitor a patient’s condition in real time.

Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom Phone: +44
Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom Phone: +44
Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom Phone: +44
Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom Phone: +44
Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom Phone: +44

Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom


+44 20 8762 8000


+44 20 8762 8400