Healthy Travelling

General issues

• Have you checked the country-specific entry requirements, such as visa, mandatory insurance requirements, COVID-testing, vaccines?
  
• Do you have adequate travel-health insurance?
  
• Do you have a copy of your passport and tickets?
  
• Do you have medical contact details and important phone numbers, such as family, family doctor, health insurance, travel insurance, credit card company?
  
• Have you packed appropriate clothing for the country of destination? Have you considered cultural, religious, climatic and geographic (e.g. altitude) aspects?
  
• If you travel with your own car - or plan on using a rented car - make sure that you have appropriate insurance, international driver’s license and car equipment according to local regulations.
  

Health Prevention

• Book an appointment to see a travel doctor at least 6-8 weeks before you leave.
  
• Get a COVID-19 certificate if requested by any of the countries where you are travelling.
  
• Are you aware of frequent diseases, health problems and recommended or mandatory vaccinations in your country of destination?
  
• Have you thought of insect bite prevention (e.g. bed nets, repellents)?
  
• Do you know about common poisonous animals in the country of destination?
  
• Do you have an adequate sun block, sun glasses, and head cover?
  
• Get a medical check-up with your general practitioner if you suffer from a chronic condition.
  
• If you suffer from a chronic condition, obtain local contact details in case of illness (e.g. hospitals).
  
• Think about safe sex and carry condoms with you, as they might be difficult to obtain or of bad quality in the country of destination.
  
• Get a dental check if you travel for a prolonged period.
  

Medication and drugs

• Do you have enough of your personal medication (preferably in a waterproof container) with you?
  
• Do you have an emergency kit with essential drugs and first aid material?
• If necessary, get a medical certificate for drugs and needle material that you carry with you.

Vaccinations ensure that you are well protected against many infectious diseases. You can be vaccinated by your family doctor, a tropical doctor or at a vaccination center. Only the yellow fever vaccination is only carried out in vaccination centers and by certain vaccinators. 

The indications for vaccinations when travelling abroad depend on:     

• The entry regulations (e.g. COVID-19, yellow fever, polio and meningococcal meningitis vaccination)
• Travel and environment-specific aspects: Destination, the epidemiological situation at the destinations, length of stay, travel style (trekking, overnight stays with locals or five-star hotel), city or country stay and the time available until departure (planned or last-minute trip).
• Personal criteria: Vaccination history (intolerances, etc.), age, pregnancy, allergies, state of health, chronic illnesses, current medication, immunodeficiency, etc.
  

Vaccinate up to time
Certain vaccinations require several doses to provide sufficient protection. It is best to schedule them 6 to 8 weeks before departure. 
But even if you decide to travel at the last minute, you should consult a doctor beforehand. A booster vaccination provides sufficient protection very quickly and there are accelerated vaccination schedules. You can have several vaccinations at the same time. 
In addition to your vaccination card, you should also bring a list of the medication you regularly take.

Inform your doctor if you have the following problems:

• Allergies
• Severe reaction to a vaccination
• Pregnancy
• Chronic illnesses, cancer
• Long-term treatment with blood thinners§ Treatments that have an effect on the immune system, Cortisone, chemotherapy, etc.
• HIV infection
  

If you have any of the above problems, certain vaccinations may be contraindicated or used with caution.
Vaccinations should be postponed if you have a fever.
 
For further information:

• The Federal Office of Public Health (FOPH): Information on vaccination
• Infovac: www.infovac.ch

The size and composition of your first-aid kit depends on a number of factors: destination, duration of the trip, travelling style and the size of your travel group. Once you have packed your first-aid kit correctly, it is important to store it properly: childproof, protected from breakage and in a cool place. Before using any medication, please read the package leaflet carefully to rule out possible intolerances or contraindications. Observe the expiry dates stated on the medication packs. Special care should be taken when taking medication during pregnancy. Your doctor will recommend and prescribe the medication that is most suitable for you. Please note: certain medications (painkillers, codeine and morphine derivatives, narcotics, sleeping pills, steroids, etc.) may be banned in certain countries or require a medical certificate.

Existing illnesses: take a sufficient supply of medication required regularly or occasionally at home in separate luggage (hand luggage).

Malaria prophylaxis

• Medicationen when travelling to a malaria area
  
• Repellents for the skin (e.g. Exopic®, Anti-Brumm®, Nobite®; children: Anti-Brumm sensitive®, Nobite Haut- Sensitive® from 2 years)
  
• Insecticide for textiles (Nobite cloths®)

Allergic reactions (e.g. insect bites): Always carry the emergency medication prescribed by your doctor!

Disinfect hands: hydro alcoholic solution (at least 70% ethanol)

Injury

• Disinfectant (e.g. ethanol 75%, Merfen®, Betadine®)
  
• Dressing material: quick bandage, adhesive plasters, elastic bandage, sterile gauze,
  
• bandage clips, safety pins
  

Instruments

• Clinical thermometer in unbreakable case
  
• Small scissors
  
• Foreign body tweezers
  

Fever, cold, pain: paracetamol (Dafalgan®, Panadol®)

Stomach and intestines

• Anti-diarrheal medication for watery diarrhea without fever (e.g. Imodium®)
  
• In case of diarrhea with high fever and bloody stools: see a doctor!
  
• In small children and the elderly, prepare a fluid substitute (e.g. Oralpädon®, ELOTRANS®); in adults, increased fluid and salt intake is sufficient.
  

Nausea, vomiting, travel sickness: e.g.Motilium®, Trawell®

Skin protection

• Sun cream (recommendation: protection factor > 30, the choice depends on your skin type, the intensity of the sun's rays and your activities).
  
• Insect bite reactions: (Fenistil®, Tavegyl Gel®)
  

Eye protection

• Sunglasses, lens cleaner
  
• Conjunctivitis: non-purulent: eye drops (e.g. Oculosan®); purulent: (e.g. Ciloxan®)
  

Cold: nasal drops, spray before the flight (Nasivine ®, Triofan ®)

Allergies: personal medication (antihistamines, asthma medication, etc.)

AIDS/sexually transmitted diseases: Condoms or Femidom®

Water disinfection: sterilization tablets (e.g. Aquatabs®, Micropur forte®)

Sauerstoffmangel im Flugzeug ist heutzutage kein Thema mehr. Auch auf 12 000 m ü.M. entspricht das Sauerstoffangebot im Flugzeug etwa der Höhe von 2000 m ü.M. Die Luftdruckveränderung im Flugzeug ist kaum wahrzunehmen. Es sei denn, Sie sind erkältet, dann kann sich durch das Anschwellen der Schleimhäute die Verbindung von Rachen und Mittelohr verschliessen.

Der zunehmende Aussendruck beim Landen würde Sie dann im Ohr schmerzen. Am besten Sie sorgen vor: mit Nasentropfen, -sprays oder -salben; auch Kauen und Gähnen hilft, den Druck zu lindern. Die trockene Kabinenluft bewirkt zudem ein Austrocknen der Nasenschleimhäute, dagegen hilft eine Nasensalbe.

Thrombosen: Mit ein paar einfachen Vorkehrungen verhindern Sie Durchblutungsstörungen Ihrer Beine durch das lange Sitzen. Schränken Sie Ihre Beinfreiheit nicht durch Gepäckstücke ein, lockern Sie Ihre Muskeln durch ein paar Übungen im Sitzen oder stehen Sie auf und gehen ein paar Schritte. Trinken Sie reichlich (alkoholische Getränke mit Mass!) und Sie werden vor allem lange Interkontinentalflüge besser überstehen. Gut angepasste Kompressionsstrümpfe helfen Ihnen bei Venenleiden.

Der «Jet lag» trifft Sie nach dem Überfliegen mehrerer Zeitzonen mit Erschöpfung und Schlaflosigkeit, denn Ihre innere Uhr stimmt nicht mehr mit der Ortszeit überein. Kleine Nickerchen im Flugzeug, nach der Ankunft, so schnell wie möglich den neuen Lebensrhythmus übernehmen (inkl. Licht- und Sonnenexposition tagsüber) und Sie haben das Übel am schnellsten überwunden. Medikamente können Ihnen dabei helfen, erkundigen Sie sich bei Ihrem Arzt.

Alle Medikamente für die Reise führen Sie am besten im Handgepäck mit. Ist deren Einnahme zeitlich streng vorgeschrieben (z.B.Insulin, Antibabypillen), besprechen Sie vor Ihrer Abreise mit dem Arzt, wie die Anwendung bei grossen zeitlichen Verschiebungen erfolgen soll.

Sind Sie krank oder behindert, ist das Flugzeug Ihr Transportmittel: Sie erhalten Unterstützung, einen Rollstuhl oder die Möglichkeit zu liegen, wenn Sie die Fluglinie rechtzeitig informieren. Liegendtransporte werden stets begleitet. In Notfällen ist mit dem Flugzeug meistens eine rasche Rückkehr nach Hause möglich (s.u." Vorbereitungen und Versicherungen: Medizinische Notfälle im Ausland" ).

General Safety

DOs

• Be aware of traffic accidents and wear a seatbelt and a helmet.
• Inform your family and friends if you travel to an isolated or risky area.
• Carry emergency numbers with you.

DONT's

• Do not accept money changing in the street; go to a bank or an official money changer.
• Do not consider that anyone, including yourself, is at zero risk of carrying one or more sexually transmitted infection(s).
• Do not stop your regular medication, or your malaria prophylaxis if you are in a high malaria risk area.

Food and water safety

DOs

• Remember food and water safety measures.
• Practice regular hand hygiene.
• Eat what you can peel, boil or cook.
• Drink bottled, sealed or disinfected water.

DONT's

• Do not eat undercooked or raw food.
• Do not drink water from the tap.
• Do not drink beverages with locally made ice-cubes.
• Do not eat non-commercial ice creams, especially from street vendors.

Safety with animals

DOs

• Seek medical help after bite of poisonous animals (including scorpion, snakes, stingray, jellyfish).
• Seek medical help immediately after any animal bite or scratch wound (CAVE rabies risk!), after proper washing and disinfection of the wound.
• Get immunized immediately against rabies if bitten or scratched by any mammal in a rabies-endemic country.

DONT's

• Do not cut open wounds after bites of poisonous animals or apply a tourniquet.
• Do not let children play with animals or pet them.
• Do not touch animals, including pets that may not be vaccinated against rabies.

Environmental safety

DOs

• Keep yourself cool and protected in the sun.
• Practice insect bite prevention during day and night, also in the cities.

DONT's

• Do not bathe or swim in ponds, lakes or rivers in schistosomiasis endemic countries.
• Do not perform intense physical exercise outside if there is high air pollution or extreme heat.

If you are ill

DOs

• Get tested immediately for malaria if you have a fever >37,5° C while - or after - being in a malaria endemic region.
• Seek medical help if you have severe (e.g. bloody) diarrhea.

DONT's

• Do not wait days until consulting a doctor in case of fever during or after a stay in the tropics.

Pay attention to personal hygiene and be cautious when eating and drinking, especially in unfamiliar surroundings. Watch out for poor hygiene conditions. Diseases are transmitted through dirty hands, drinks or food.

• Before eating: Don't forget to wash your hands!
• Play by the classic rule "boil it, cook it, peel it, or forget it" (boil, cook, peel or forget it). Food or drink contaminated with fecal residue is the main cause of diarrhea, the most common health problem among travelers abroad; 10 to 40% contract it in developing countries.
• The following also applies: well cooked, served at a temperature of 60° and eaten quickly! If food stands around for a long time, flies, for example, can quickly reintroduce pathogens. If you have been the victim of diarrhea yourself, do not prepare any food or drink for other people during this time!
• Clean water can be obtained quickly and easily using certain water sterilization products, special ceramic water filters or simply boiling water for 5 minutes.

It is best to avoid them:

• Uncooked or undercooked foods, such as seafood (especially oysters), fish and meat (beefsteak tartare)
• Salads and raw vegetables
• Fruit that you have not peeled yourself
• Milk and dairy products
• Ice cream and puddings
• Cold buffets
• Tap water for drinking, ice cubes or brushing your teeth (generally safe are water or soft drinks from sealed bottles, freshly made tea or coffee, filtered and boiled water, beer and wine)
• Communal towels (but still wash your hands before every meal)

The amount of the sun's UV radiation that reaches us is dependent on time of day, season, latitude, and altitude. It increases with reflection (water surface, sand, and snow/ice) and can even be relevant under cloudy conditions. UV exposure in the tropics is generally higher due to latitude.

Sunburn is especially harmful to children and people with sensitive skin. In general, everyone is affected, even dark-skinned people (e.g. sun-induced eye damage!).

Repetitive UVB / UVA exposure damages skin, eyes, and the immune system (e.g., recurrent Herpes simplex triggered by UV-light) and in the long-term it can lead to premature skin aging, skin cancer and cataract.

Well-known short-term effects are sunburn, sunstroke and sun allergy:

• Sunburn:  redness, swelling, pain and blistering of skin
  
• Sunstroke: headache, nausea, dehydration (sunstroke affects your body’s ability to cool down to normal temperature). See also the factsheet “heat associated conditions”
  
• Sun allergy: itchy pimples 24 to 48 hours after exposure
  

Sun-induced skin lesions can be enhanced or triggered by the application of - or contact with - natural or chemical substances on the skin (e.g., lemon oil, certain plants) or medications, including antibiotics (e.g. doxycycline).

Prevention

• Avoid the sun especially during 10 a.m. to 4 p.m., look out for shade!
  
• Clothing: long-sleeved shirts and pants, UV protection clothing (e.g., swimsuits), brimmed hats (to include neck, nose, and ears)
  
• Wear sunglasses with UV-protectant lenses
  
• Wear sunscreen labelled “broad - spectrum”, “sun blocks” or “UVA/UVB with sun protection factor (SPF) of 30 or higher”. Apply sunscreen before exposure and repeat regularly during the day to maintain protection, particularly if sweating or after swimming.
  
• Self-tanning products and pre-travel tanning are not recommended. They provide no or minimal sun protection and can even do harm.
  

Treatment

• Sunburn treatment: symptom control, priority towards limiting further exposure!
  
• Mild sunburn: cool compresses, topical aloe-based gels, and topical calamine.
  
• Severe sunburn and heat related symptoms: rehydration + see Factsheet “Heat associated conditions”.

Under hot conditions your body must be able to keep its temperature within the normal range by cooling. One of these cooling mechanisms is sweating.

Factors that lower the capacity of cooling are

• inadequate exposure to high temperatures over time
  
• increased humidity (ability to cool through sweating is reduced!)
  
• excessive loss of fluid through sweating, febrile diseases or diarrhea
  
• drug and alcohol intake (direct effect of the drug, loss of fluid, level of alertness)
  
• increased physical activity (increase in body temperature!)
  

All these factors facilitate a decompensation with a rise in body temperature and risk of damage to vital organs including the brain. We call the resulting condition heat exhaustion, respectively heat stroke. This health condition can also appear gradually. It is a medical emergency and can lead to shock and death, if left untreated.

Who is at risk
Basically everyone, even the young and healthy!

• especially children and the older population
  
• especially people with chronic or acute diseases, on various medication
  

Typical signs
Thirst, dry mouth, darkened urine, muscle cramps, headache, dizziness, nausea, sleepiness, faint, confusion, body temperature >40°C.

Prevention: Cooling and Rehydration

• Acclimatisation: consider extra time to get used to heat with enough rest.
  
• Plan outdoor activities early in the morning or in the late afternoon.
  
• Try to stay in cool indoor spaces (e.g., shopping malls or other public air-conditioned localities), take a cold shower, avoid direct sun exposure, and look out for shade and ventilation (e.g. fan).
  
• Appropriate clothing: wear loose fitting, light-weight, light-colored, and absorbing material (e.g. cotton), wear a brimmed hat, do not forget sunscreen.
  
• Physical activity: If you are not used to exercise in hot environment, start slowly and pick up the pace gradually.
  
• Regardless of how thirsty or active you are, drink plenty of fluids and avoid hot and heavy meals. Heavy sweating deprives the body of salt and minerals. For replacement, electrolyte containing sport drinks can be used.
  
• Avoid drinking alcohol.
  
• If you have fever, diarrhea or vomiting, correction of fluid and minerals is additionally advisable.
  
• If you are on a low-salt diet, have diabetes, high blood pressure, or other chronic conditions, do not forget to take pre – travel advice from your doctor regarding fluid management and adaption of medication.
• Never leave children or pets in a parked car, even if the windows are partly open!

Walking barefoot harbours the risk of injury and infection. With closed shoes and sandals for the beach, you don't give animals, broken glass and nails a chance.

Parasites (such as sand fleas or worm larvae) can enter the body through intact skin.
Poisonous animals can cause painful and dangerous injuries.
Taking a sunbath, lie down on a deckchair, a raffia mat or a bath towel, but preferably not on the bare ground.

To minimize the risk of sexual transmitted disease including HIV infection, follow the following rules:
With a new sexual partner:

• ALWAYS use a condom or femidom during sexual intercourse
• Do not put semen in your mouth, do not swallow semen
• Do not practice oral sex during your period (avoid menstrual blood in your mouth)

Carry condoms in your luggage (they are not always readily available locally and their quality is sometimes dubious). Avoid sex without this protection when under the influence of alcohol, out of shyness or because you do not have it with you!

Other sexually transmitted infections
There are sexually transmitted infections that can be spread during oral sex or by sharing sex toys. If symptoms occur (discharge, burning during urination, localized pimples/ulcers, pain during sexual intercourse), you must consult a doctor immediately. Detailed information on sexually transmitted diseases can be found at LINK.

Further precautions:
Injectable medication: only use sterile disposable syringes and needles
Always ask for unused disposable material for medical or naturopathic (acupuncture) treatments, tattoos or piercings.
Do not use other people's razors or toothbrushes.

For further information

https://lovelife.ch

https://aids.ch 

It is important to be aware of air pollution levels when travelling, especially if you have a chronic heart or lung condition (asthma, emphysema, obstructive diseases) or if you are travelling with children. Even healthy adults can be affected by very high levels of air pollution. The size of cities, climate, season, winds and time of day can all play a role. On days when pollution is very high, it is best to stay indoors as much as possible and reduce your physical activity. Do not forget to take your usual medication (asthmatics: always carry your bronchodilator with you!). Consult a doctor immediately if your health deteriorates or new symptoms appear. You may want to consider avoiding certain destinations during critical seasons.

Main causes of air pollution

Air pollution affects all countries, both industrialised and developing. A large number of molecules produced by road traffic, combustion (firewood, coal), industry and agriculture are present in the air and can be harmful to health: fine particles, carbon monoxide, ozone, nitrogen dioxide, sulphur dioxide, chemicals, radioactive particles, volatile organic compounds (benzene, halogens) and heavy metals.

Health effects
The WHO estimates that urban air pollution is responsible for 2 million deaths worldwide each year. The main risk comes from fine particles and ozone. Air pollution can cause or aggravate cardiovascular and respiratory diseases (asthma, acute or chronic bronchitis, bronchiolitis, etc.) and can cause cancer (chronic exposure). Children are particularly sensitive to this. In addition to the lungs and heart, various pollutants can also affect the blood, nervous system and kidneys.

Symptoms
Reactions to air pollution vary from person to person. Common symptoms include burning eyes or throat, coughing, chest tightness, difficulty breathing, wheezing (asthma attack), sputum production and fatigue.

Influence of weather and time of day
Significant fluctuations in air pollutant concentrations are observed depending on weather conditions (wind disperses them and reduces their concentration) and the time of day (rush hour). Ozone formation increases with solar radiation during very hot, windless summers (smog) and in winter when winter fog causes the air to stagnate (pollution accumulates under the clouds due to a temperature inversion phenomenon).

Prevention: reduce exposure

• Heart disease, respiratory disease, children: limit outdoor activity when daily concentrations are moderate to high.
  
• Very high concentrations: even healthy adults should stay indoors.
  
• Avoid going outside during peak pollution times and limit physical exertion.
  
• Take a taxi; if travelling by car, close the windows and use the ‘recirculation’ function (air conditioning).
  
• Summer smog: limit your outdoor physical activity in the afternoon (preferably do it early in the morning or after sunset), while in winter, as long as there is no temperature inversion, ozone levels are already high in the morning.
  
• Avoid walking/cycling along busy roads; opt for green spaces and pedestrian areas instead.
  
• Chronic illnesses: take your usual medication (don't forget to pack it in your luggage).
  
• Asthmatics: always carry your bronchodilator with you!
  
• Wearing a mask is not very effective and uncomfortable in hot weather.

Measures and pollutant limit values
Different countries measure different pollutants and do not all use the same indices. The concentration of highly harmful fine particles such as PM10 (less than 10 µm in diameter) and PM 2.5 (less than 2.5 µm in diameter) is an important indicator of urban air pollution in terms of health.

According to WHO guidelines (2015), the values not to be exceeded are:

• Particulate matter: PM2.5: 25 µg/m3 average over 24 hours (and 10 µg/m3 annual average)
  
• PM10: 50 µg/m3 average over 24 hours (and 20 µg/m3 annual average)
  
• Ozone (O3): 100 µg/m3 average over 8 hours

Air Quality Index (AQI)

Air pollution by region

European Environment Agency: European air quality index website
PREVAIR.org: air quality forecasts and maps for Europe and the rest of the world
AIRNow: air quality index for the USA and the rest of the world

For more information
World Health Organisation: "Air quality and health"

Recreational diving combines experiencing nature with athletic performance, but it also requires personal responsibility and teamwork. Experience and physical fitness are essential factors for a successful, low-risk dive. The vast majority of diving accidents are caused by diver error. However, following safety instructions and making a sensible assessment of your own abilities and limitations significantly reduce the risks associated with this sport and make it a leisure activity that can be enjoyed by a wide audience.


Before travelling

Fitness is a prerequisite
Illnesses or limitations in physical performance that may not cause any problems on land can have fatal consequences underwater. Have your health checked by your doctor and clarify any health issues before your diving holiday. Also discuss with your doctor whether any long-term medication or occasional medication is compatible with diving.

Contraindications for diving

• Pregnancy
  
• Physical limitations: severe obesity, heart disease or other illnesses
  
• Children under the age of 14
  
• Lung diseases (such as exercise-induced asthma, emphysema, fibrosis, history of spontaneous pneumothorax, etc.)
  
• Unstable conditions (e.g. asthma, diabetes, etc.)
  
• Ear, nose or throat problems: such as a perforated eardrum, middle ear infection, severe cold, sinusitis
  
• Dizziness and illnesses that can lead to disturbances of consciousness (such as epilepsy, multiple sclerosis, inner ear damage, etc.)
  
• Psychiatric disorders (depression, behavioral disorders)
  

Medication and diving
Regular use of malaria prophylaxis is compatible with diving, provided that the medication in question does not cause any problematic side effects. However, sedatives, sleeping pills, strong painkillers and medications that can slow down your reaction time are not compatible with diving.

Diving fitness certificate
Virtually every reputable diving centre requires a diving fitness certificate. This can usually be issued by your family doctor. A thorough medical examination is mandatory for every prospective diver before their first dive (especially lung function, circulation, eyes, ears, nose and throat).

Find out about:
Evacuation options, centres with hyperbaric chambers and oxygen therapy (100%) options at the dive site. Always have emergency numbers and oxygen sources to hand during every dive.

Diving training
Training dives are essential for beginners. Even those returning to diving must familiarise themselves with local conditions such as tidal changes, currents, and special fauna and flora with a locally experienced diving instructor. Thanks to such accompanied dives, you can get used to the special conditions underwater in a calm and stress-free manner. Contact a good diving school with high-quality equipment in good condition. Make sure that your diving instructors have an internationally recognised certificate.


During the dive

Avoid hypothermia
Water is a very good heat conductor. Even in warm waters, severe hypothermia can occur. A diving suit helps to insulate heat and offers some protection from poisonous plants, animals or sharp objects (coral reefs, etc.).

Pressure equalisation
Even at a diving depth of ten metres, the ambient pressure is around twice as high as at the surface. This pressure increases continuously with increasing diving depth (1 bar per 10 metres). Although divers do not directly perceive the pressure exerted on them by the weight of the water, the pressure differences have a particular effect on the air-filled cavities in the body. Constant pressure equalisation is therefore essential during descent and ascent (increase and decrease in pressure).

Inadequate pressure equalisation can lead to barotrauma (damage caused by negative pressure). When descending, pressure equalisation is particularly important for the ears. Otherwise, negative pressure can build up in the middle ear, pulling the eardrum inwards and possibly causing it to rupture. When ascending, it is important not to hold your breath, as the air in the airways and lungs expands during ascent, which can lead to tears in the tissue.

Ascent to the water surface in particular must not be uncontrolled. Depending on the duration and depth of the
dive, so-called decompression stops must be strictly observed. Failure to do so puts your life at risk. You can find the values for the decompression stops in dive tables or on your dive computer. This allows the gas dissolved in the tissue to be eliminated. Ascending too quickly can damage the tissue due to the formation of nitrogen bubbles and cause what is known as decompression sickness. This mainly affects the skin, joints, spinal cord and inner ear.

In case of problems underwater
Remain as calm as possible and try not to panic so that you do not ascend to the surface too quickly. Ask your diving companion for help and follow the advice of the diving instructors, who are most familiar with the local conditions.

Beware of risks associated with diving depth
Nitrogen has a narcotic effect when inhaled at high gas pressure, as is the case at great depths (raptures of the deep). This can lead to irrational and even dangerous behaviour. The risk of this complication increases significantly at diving depths of more than 30 metres.

Safety rules

• Never dive alone
  
• If you do not feel well, do not dive
  
• Do not dive after consuming alcohol or after taking sedatives, drugs and other mind-altering substances and medications.
  
• Only dive to a maximum depth of 30 metres (beginners only to 20 m)
  
• Do not dive more than twice in 24 hours
  
• After diving, wait at least 12 hours before ascending to > 200 m (e.g. mountain hiking)
  
• Fly no earlier than 24 hours after your last dive
  

In case of illness or accident
If you are unsure about your state of health, consult a doctor immediately, especially if the symptoms occurred as a result of diving. Earache can be a sign of barotrauma or middle ear infection. Both require medical treatment and a break from diving.

Ear infection (swimmer's ear; otitis externa)
Especially in tropical climates, with heavy sweating and prolonged exposure to water, the surface of the skin in the ear canal can become porous, allowing bacteria to penetrate deeper layers of skin and cause inflammation in the ear area.
Anti-inflammatory or antibiotic ear drops may be indicated for treatment. To prevent such infections, avoid cleaning your ears with cotton buds, which can cause minor injuries. Rinse your ear canals with clean water in the shower after each dive.

Prophylaxis is also recommended for divers who are particularly prone to such inflammation. Treatment with water and vinegar drops should be started one week before departure. You can make this solution yourself. A pipette bottle is available from the chemist. Fill it halfway with tap water and halfway with fruit vinegar (not wine or herb vinegar!). In the evening, three drops of this liquid are instilled into each ear canal. This prophylaxis is continued during the diving holiday.

When to assume a diving accident
The symptoms of a diving accident can occur during the dive or afterwards. Any change in health or behaviour within 24 hours of a dive must be considered a diving accident until proven otherwise. The main symptoms are:

• Joint or muscle pain, itchy skin, urticarial changes (usually reddened, itchy skin swellings)
  
• Neurological abnormalities: sensory disturbances or tingling, paralysis or weakness, difficulty walking and balance disorders, difficulty urinating or defecating, dizziness, nausea and vomiting, speech or vision disorders, confusion, convulsions, fainting or coma.
  
• Breathing difficulties: shortness of breath, coughing, bloody sputum, chest pain or a feeling of suffocation.
  
• Abdominal pain
  
  

First aid: Cardiopulmonary resuscitation if necessary. If possible, 100% oxygen to breathe. Referral to a hyperbaric chamber centre.

Before the return journey: Negative pressure in the aircraft
The cabin pressure set in passenger aeroplanes at cruising altitude corresponds to an altitude of approximately 2000 to 2500 metres above sea level and thus to a relative negative pressure in relation to the pressure at sea level. If the body's tissues are still saturated with gas after previous dives, this renewed decompression in the aeroplane can lead to a decompression accident. Therefore, the following must be strictly observed:
36 hours before the flight: no repetitive dives, no dives to great depths
24 hours before the flight: no more diving!

Further information
Professional Association of Diving Instructors (PADI): http://www.padi.com
Confédération Mondiale des Activités Subquatiques (CMAS) ): http://www.cmas.ch
National Association of Underwater Instructors (NAWI): http://www.naui.com
DAN (DIVERS ALERT NETWORK): http://www.daneurope.org

Telephone information for diving emergencies
International DAN ALARM centres (for emergencies ONLY)
Region (DAN) Institution Telephone
DAN America Duke University Medical Centre, NC, USA +1 919 684 4326 +1 919 684 8111
DAN Latin America DAN Latin America Hotline (Spanish and Portuguese) +1-919-684-9111
DAN South-East Asia-Pacific DES Australia, Royal Adelaide Hospital +61 (8) 8212 9242
DAN South-East Asia-Pacific DES New Zealand +64 (9) 445 8454
DAN South-East Asia-Pacific Singapore Naval Medicine & Hyperbaric Centre +65 750 55 46
DAN South-East Asia-Pacific DAN SEAP Philippines +02 815 99 11
DAN Europe DAN Europe 24-hour hotline +39 039 605 7858
DAN Japan Tokyo University Medical Centre +81 3 381 249 99
DAN Southern Africa Southern Africa 24-hour hotline +27 11 254 1112

Swimming and water sports are particularly popular holiday activities, but they can involve certain risks. The main dangers are accidents (collisions between boats, etc.), hypothermia and drowning. Find out about local conditions (water temperature, sea currents, poisonous animals, weather forecast). Heat loss in water is much faster than in air, and even good swimmers can quickly get into trouble in cold water. Be vigilant with children on the shore, especially if they are younger than 5 years old, as the risk of drowning accidents is particularly high at this age. Always take a lifebuoy and life jackets with you on boat trips.

• Avoid swimming or going on boat trips alone.

• Be careful of hypothermia. Only venture into cold water for a short time. You cool down very quickly in cold water, which can lead to cramps and loss of orientation. Such a state of hypothermia can also lead to loss of consciousness or cardiac arrest. Even good swimmers can drown quickly in very cold water. Always enter the water slowly and gradually to allow yourself to adjust to the temperature.
  
  

• Currents and tides: Find out about the local conditions and only swim in supervised areas. If you get caught in a current, do not try to swim against it: you risk exhausting yourself. When swimming in rivers, swim diagonally to reach the shore further downstream. In the sea, on the other hand, you should swim parallel to the shore to find a swimming lane without rip currents. Stay alert on air mattresses and inflatable boats so that you do not drift too far from the shore.

• Children: always supervise children in the water and on boats. If your children cannot swim, lock the doors of your hotel room that allow access to the beach or swimming pool. Inflatable water wings and swimwear with polystyrene floats offer a certain amount of protection, but are by no means a substitute for constant supervision. Supervise older children as well if there are no lifeguards or rescue swimmers present. They are at greater risk of accidents due to boisterous games (jumping on other children, submerging, water bombs, etc.).

• Be careful when diving, as moving water may conceal rocks or other swimmers and may be shallower than it appears.

• Wear a life jacket at sea, especially on small boats and when boating in cold water.

• Protect yourself from the sun at the seaside (increased radiation): Use sun cream with a high sun protection factor that is also waterproof.

• Be sensible after a large meal or prolonged sunbathing. Enter the water gradually and leave it immediately if you feel unwell or experience cramps. Avoid drinking alcohol before swimming.

• Dangerous marine creatures: Find out about the presence of dangerous animals/creatures in the region and the necessary precautions. Plastic sandals or flippers protect your feet from sea urchin spines, broken sharp-edged shells or broken glass. Swimming goggles or diving masks make it easier to avoid jellyfish and other poisonous marine creatures.

If you get into difficulty in the water
 
Falling into cold water:
Concentrate on getting to a boat or the shore as quickly as possible. Keep your clothes on at first, as they can retain a little warmth. However, be sure to remove your shoes and other heavy items such as bags. It is important to remain calm. If another swimmer tries to rescue you, do not cling to them if possible, so that you do not both drown. Turn onto your back and follow the instructions of your rescuer.

Try to attract attention by signaling: raise one arm and make sweeping movements from left to right. Do not tire yourself by shouting and gesticulating wildly.

To rescue someone: Do not heroically throw yourself into the water if there is another alternative. It is better to use a boat, rescue pole or rope for the rescue. If you have to swim, take a life jacket, lifebuoy, rescue rope or clothes line to secure the person in danger.

Cramps: Stop swimming, turn onto your back to float on the water and relax the affected limb. If you experience cramps in your calf or thigh, stretch your leg, pull your foot towards yourself and massage the painful muscle. Cramps occur more frequently in cold water during intense or prolonged exertion. They are a warning sign that should not be ignored.

First aid for drowning accidents
Always try to resuscitate drowning victims. Very cold water is often a factor in such accidents. However, it protects the heart and brain, giving the victim a good chance of survival. Send one of the bystanders to get professional help as quickly as possible. A first aid course where you learn resuscitation techniques can be very helpful, especially before a long journey or a boat trip at sea.

Sporting activities can lead to falls and injuries such as sprains or fractures, etc. Factors that contribute to such accidents include fatigue, lack of training, inadequate equipment or difficult environmental conditions, such as slippery paths, ice, heat, etc. If in doubt, it is always better to consult a doctor for possible treatment or further clarification (e.g. X-rays to rule out fractures, etc.). Here are some general recommendations.

Prevention

• Warm up your muscles before physical exertion and, if necessary, do stretching exercises (depending on the planned activity).
  
• Use suitable equipment that fits your body type; well-fitting, broken-in shoes are particularly important.
  
• Take breaks before you get really tired and be aware of your physical limits. Most accidents happen in the evening, towards the end of the activity (e.g. on the last ski run) or during an unfamiliar sporting activity.
  
• Make sure you drink enough, especially when it is hot or you are doing strenuous exercise. Protect yourself from the sun (with sun cream, sunglasses and a hat). Avoid the hottest times of the day (be careful, there is a risk of sunstroke).
  
• Be careful with medications that impair your reactions or cause drowsiness or dizziness.
  
  

Sprains, ligament or muscle strains: what to do?

• Rest the affected limb: do not put any weight on it, keep it still and relaxed, and elevate it slightly
  
• Cool the affected area as quickly as possible with ice, a cool pack (wrapped in a thin cloth or sock, for example) or cold water
  
• Apply light compression to the affected area with a tape bandage or a moderately tight elastic bandage that is neither too tight nor too loose.
• Consult a doctor
  
  

Signs of a more serious injury include: a cracking or crunching sensation, discomfort at the time of injury (especially vomiting), rapid swelling or discolouration.

If you have a known tendency to bleed or are taking blood-thinning medication such as Aspirin® or Marcoumar®, you should consult a doctor immediately to rule out any internal bleeding, which is not always immediately visible.

Stress fractures

During long walks, for example, so-called stress fractures can occur, which are caused by repeated impact on the heel or feet (more rarely on the legs). They should be considered if pain occurs during or after a long walk. These fractures are not necessarily treated with a plaster cast, but the limb should be rested and immobilised for 2-6 weeks, depending on the course of the injury. To prevent this, get used to longer walks slowly, wear shoes with good soles and avoid carrying a backpack that is too heavy.

Wounds and cuts

• Wash the wound thoroughly with soap and disinfect it
  
• Consult a doctor if the wound is deep, there is a risk of damage to ligaments or nerves, or the face is affected. The wound may need to be cleaned or stitched, and may require a final dressing or treatment with plasters, such as Steristrips®
  
• Ensure that your tetanus vaccinations are up to date (booster every 20 years in under 65 years of age/ every 10 years in over 65 years), even if it is only a graze.
  
• In the case of wounds on the feet, foreign bodies must be excluded or removed (glass, small stones or thorns)
  
  

Blisters
Blisters are caused by repeated friction on the skin (e.g. on the hands when playing tennis or on the feet when running) and can usually be avoided by wearing suitable equipment:

• Shoes without thick seams, short nails
  
• Comfortable, well-worn shoes in the right size (half a size larger than necessary)
  
• Plasters on vulnerable areas to protect the skin from friction and prevent blisters
  
• The diameter of the tennis racket handle should be adjusted to the size of the hand
  
• Adjust your rucksack to suit your individual needs
  

If the skin is intact, do not burst the blister! The skin is a natural barrier against infection. If it is more comfortable for you, you can pierce the blister with a sterile needle to drain it and then cover the skin with a sterile plaster. If the blister has already burst, you can remove the pieces of skin with small scissors and carefully disinfect the wound. A blister plaster made of colloidal gel provides greater relief than conventional plasters.

Be careful, vaccinations and medication cannot always prevent accidents or illness. If you find yourself in such a situation, seek help locally: from a doctor or hospital. If necessary, your doctor will continue your treatment at home after your return. If no one can help you locally, request assistance in Switzerland.

If you suddenly fall ill, especially if you suspect you have a tropical disease (diarrhoea, malaria, skin infection, etc.), you can contact a travel medicine clinic. In the event of accidents, acute illnesses or sudden deterioration of an existing condition abroad, if adequate treatment is not available locally, you can request assistance from Switzerland. (e.g. from the Swiss Air Rescue Service REGA).
You can obtain advice or assistance from REGA by calling the following telephone numbers:

Domestic: 14 14
Abroad: ++ 41 333 333 333
Fax: 0041 1 654 35 90
Website: http://www.rega.ch
Email: ops@rega.ch

Some insurance companies will give you a different emergency number to dial directly in case of an emergency. Based on the information you provide about the situation, the operations manager and the doctor will decide on the necessary measures, transport, the best time for this and the type of transport.

• Organisation of patient repatriation to a destination hospital in Switzerland.
  
• Transport and admission of the patient to the nearest specialist clinic abroad.
  
• Assistance with language problems and contacting the attending physician abroad.
  
• Advice on problems with medication and information on replacement medication.
• If necessary Ambulance aircraft equipped for intensive care of patients are available.

If the patient's condition allows, they will travel back to Switzerland on board a scheduled flight, where they will of course also be looked after by a medical team.

Not everyone needs a medical check-up after travelling.

See a doctor after travelling if you have the following symptoms:

• Fever >37.5°C after returning from a malaria endemic area (even months after your return!; main danger: malaria)
• have been bitten or scratched by a mammal (main danger: rabies!)
• Severe diarrhea or persistent/chronic gastrointestinal complaints
• chronic non-healing skin ulcer(s)/insect bite wound(s)
• if you have had unprotected sexual intercourse
• any worrying/unusual symptom occurring while travelling or shortly after return
• have had emergency self-treatment (NSB) for malaria or have been treated for malaria while travelling (if no symptoms occur, a check-up is only required within 7 days of treatment).

Make an appointment with a doctor who is experienced in travel and tropical medicine. A list of specialists in tropical and travel medicine (FMH) can be found under "Ask the specialists.