When travelling away from home, it’s best to be well prepared for possible emergencies before you go, so you can relax and enjoy your trip with the knowledge that you have thought of just about everything that could – and hopefully won’t – go wrong. Below we hear from Senior Endocrine Nurse Nikki Kieffer, for her top tips.

Whether you are heading to a caravan in Cornwall or a motel in Manila, here are some tips to help you make the most of your holiday.

To note: hydrocortisone sodium succinate (previously known as Solu-Cortef) is more stable in hot weather (above 25ºC) so this may be a prudent choice for those planning a trip abroad.

1. Check online before you leave home, to identify the nearest hospital with an emergency department to your holiday destination/s. Make a note of the address and store map details on your mobile or a similar convenient look-up. You might want to identify a local GP practice, and make a note of the local emergency medical phone number. 

2. Ask a travel companion to watch the injection videos online with you and learn how to give an injection. They should also know when it might be necessary. If you are travelling on your own with an escorted tour, make sure the tour leader knows about your possible need for emergency medical treatment and where to locate your injection kit. 

3. Check that your travel insurance covers medical expenses and that you have declared all pre-existing conditions, not just your adrenal condition. 

4. Order your next repeat prescription well in advance, and ensure you have enough medication to take double the amount of steroid medication that you will need with you on your trip, in case you become ill and need to follow sick-day rules. It’s advisable to keep a copy of your repeat prescription with each supply.

5. Consider taking a copy of the ADSHG hospital wallet with you. This is a waterproof A5 size ziplock wallet that can go with you poolside or beachside, containing the emergency treatment guidelines and other useful documentation. 

6. If your everyday medical alert jewellery doesn’t have a waterproof strap, you might want to order an ADSHG silicone alert band for beach and swim wear.

7. Carry your main set of medication and your injection kit in hand luggage, so it is with you on the plane, train - or in your car seat rather than in the boot. Carry a second set of medicines in a different piece of luggage. 

8. Keep tablets and injectables out of direct sunlight - but avoid placing tablets in a cool bag packed with a chill block, as this causes a build-up of condensation. If your tablets become damp, they will degrade more rapidly than if they overheat. It’s best not to place any medicines in checked hold luggage, in case they go astray. Hydrocortisone sodium succinate (previously known as Solu-Cortef) is more stable in hot weather (above 25ºC) so this may be a prudent choice for those planning a trip abroad.

9. Pack your emergency injection kit in your hand luggage, with a letter from your doctor explaining why you need hypodermic needles on the plane, or with a copy of the ADSHG emergency card or A4 adrenal crisis guidelines, stamped and authorised by your GP practice. It’s rare for security to question an injection kit if it well labelled (such as the kits available from our online shop). Read 'Plan for airport restrictions' on the ADSHG Travelling page.

10. Take multiple injection ampoules, in case of breakages – and preferable to travel with a pack of up to five ampoules, especially if a hospital with an emergency department is not easily reached at your destination. Each drug ampoule costs the NHS less than £2 and an injection could save your life. 

11. Make sure you carry a copy of your repeat prescription with you, in case you need to ask for an emergency supply of tablets or injectables while away from home. 

12. It’s prudent to print out a copy of the emergency guidelines in the local language, and keep this with your injection kit. If you are travelling to a destination where there isn’t a medically-checked translation available online from ADSHG, then take the English-language version

13. Make sure you don’t get dehydrated, especially when out and about in hot weather or on a plane. Most people find it’s best to stick to plain or sparkling water. In hot climates, you are likely to need extra salt as well as plenty of water. Many people swear by a sprinkle of salt in a glass of lemonade or sparkling water. 

14. For temperatures over 30º, it’s usually recommended to increase the fludrocortisone dose by half. Your endocrinologist can give personalised advice if you are prone to high blood pressure.

15. Be prepared for gastric infections – diarrhoea and/or vomiting. You can read a personal experience blog here. These are more common when away from home and exposed to new local bugs. Follow the usual hygiene precautions and carry hand gels or sterile wipes with you. Avoid salads or unpeeled fruit where there is any question about water-borne infections such as rotavirus or Hepatitis.

16. Remember that vomiting in a steroid-dependent patient is always a medical emergency and you must act quickly if it happens. Follow the guidance from Prof Wass in the "When to inject" video; use your injection within 30 minutes of beginning to vomit. Then seek medical advice or phone the local emergency medical services (999 for UK, 112 for much of Europe and Turkey). 

Now relax and enjoy your holiday!

Author: Nikki Kieffer 

Nikki Kieffer is a senior endocrine nurse with Royal Leicester Infirmary and winner of the 2016 ADSHG nurse award, the Annette Louise Seal prize.

A former Chair of the Society for Endocrinology Nurse Committee and inaugural winner of the Society for Endocrinology Endocrine Nurse Award, she is also a great activist for nurses. Nikki led the development of the Society for Endocrinology Competency Framework for Adult Endocrine Nursing.

Tragically Nikki Kieffer died unexpectedly in October 2019. Everyone at the ADSHG sends Nikki’s loved ones our sincere condolences and thanks them for the legacy of Nikki’s work as a dedicated and compassionate endocrinology nurse.

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