VIEWS: 291 PAGES: 40

                     International SOS Worldwide Journal


                                                            04 A PASSION FOR QUALITY
                                                                CARE AND SERVICE
                                                                International SOS founders, Dr Pascal
                        ELCOME to this special edition of
        W               Hotline. To mark the 20th
        anniversary of International SOS, this
                                                                Rey-Herme and Arnaud Vaissié,
                                                                talk about the genesis of the company
                                                                and the changes they have seen over
                                                                20 years.

                                                            07 A DOUBLE SUCCESS
                                                                Dr Rey-Herme remembers a day in 1985,
        issue is devoted to a review of just some               which stretched International SOS
                                                                resources to the limit.
        of the milestones in the company’s
                                                            08 A 20-YEAR PARTNERSHIP
        history. It looks back at a few of the more             A focus on BP, with whom International
                                                                SOS has been working for 20 years to
        dramatic events from the past 20 years.                 provide a duty of care to its employees,
                                                                their families and local communities
                                                                throughout the world.
        There are memories of International SOS
                                                            10 HOSPITALS IN THE AIR
        in the early days, of individual clients and            A look at the vital work played by
                                                                International SOS’s global fleet of
        members, and recollections from                         air ambulances around the world.

        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.

                                                              04                                             08                                                 10
                                                             12 PIONEERING A NEW                            22 THE WORLD AT YOUR FINGERTIPS                    34 WIDENING THE NET
                                                                 SERVICE CULTURE                                A close-up of how International SOS’s              A spotlight on SPIN - the tool for
                                                                 Personal memories from Dr Inggriani            clients can harness the power of                   accessing International SOS’s 24-hour
                                                                 Gandha of the opening of the very first         technology to provide a global duty                network of medical and other providers.
                                                                 International SOS clinic.                      of care.
                                                                                                                                                               35 SAFETY IN THE SKIES
                                                             14 ALL HANDS ON DECK                           24 A VITAL 20 HOURS                                    The story of how one Lufthansa passenger
                                                                 Recollections of the early days at             International SOS medic Patrick Deroose            received vital medical care on a long-
                                                                 International SOS’s first alarm center,         recalls a mass medical evacuation from Bali.       distance flight.
                                                                 and the rapid response they provide
                                                                 today.                                     26 ANYWHERE IN THE WORLD                           36 SUPPORTING PATIENTS
                                                                                                                How International SOS is delivering                IN A NEW WAY
                                                             17 STRAIGHT FROM THE TOP                           healthcare services in some of the                 A look at the new service provided to
                                                                 How International SOS’s most senior            remotest regions on earth.                         patients who need to take prescribed
                                                                 medical team is involved in delivering                                                            medication long term.
                                                                 front-line care.                           30 A CHANGE OF GEAR IN
                                                                                                                OCCUPATIONAL HEALTH                            38 ADDING VALUE
                                                             18 EVERYBODY OUT                                   A conversation with Dr David Cook about            How International SOS’s logistics
                                                                 The dramatic events that unfolded during       the importance of occupational health              expertise is helping clients to deliver
                                                                 Indonesia’s civil unrest in 1998.              services and how they have changed over            premium services to their customers.
                                                                                                                the years.
                                                             21 MORE THAN AN                                                                                   39 KNOWLEDGE IS POWER
                                                                 EMERGENCY SERVICE                          32 WHERE OTHERS FEAR TO TREAD                          Innovations in technology mean that
                                                                 How one International SOS doctor views         An insight into the work undertaken by             patients can now be monitored in real
                                                                 the importance of membership.                  International SOS for governments and              time, irrespective of where they are in
                                                                                                                NGO’s in some of the world’s hotspots.             the world.
Designed by Andrew Kellard Associates +44 (0) 1483 549095.

                                                              26                                             38                                                                  HOTLINE - ANNIVERSARY EDITION   3

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?                              open-pit coal mine in Kalimantan, Borneo, and
     Pascal: I was working in Jakarta as Medical             our remote site services began. Today we run over
     Attaché for the French Embassy and observed how         200 such operations, with hospitals and clinics,
     medical care in Asia was very much based around         taking care of tens of thousands of people
     the hospital. I felt that there was a big opportunity   including both employees and the local population.
     to bring in a European model of ‘pre-hospital care’,
     including a medical rescue service. Arnaud was          Arnaud: We were very small at first, with just two
     based in San Francisco at the time and I persuaded      small clinics in Singapore and Indonesia, and 14
     him to join me in setting up this new venture.          staff. But we saw tremendous growth from day
                                                             one. Although at first we only had small pieces of
     Arnaud: I was told that you should never go into        business, they were with large clients such as BP,
     business with your friends – but we’ve proved that      Schlumberger and Alstom, with the potential to
     it can work! We gave each other support and             grow. I’m delighted to say that all our clients from
     fortunately our styles are complementary.               our early days are still with us today, as are many
     Naturally we have our differences but when it           of our original employees.
     comes to the major decisions, we have always
     been in agreement. Essentially our early vision         Pascal: Our first plane was a small Beechcraft
     was the same as it is now – to offer complete           that we had to convert ourselves by ripping out
     healthcare solutions to organizations and               seats. On one of our first evacuations out of
     institutions – firstly in Asia and now globally. And     Dacca, we had to stop in Rangoon without
     from day one we have both been passionately             permission and were promptly arrested! Our nurse
     committed to quality service – something that will      was actually on her first ever flight and must have
     never change.                                           wondered what she was getting into. We now have
                                                             a fleet of ten state-of-the-art air ambulances, and
     How did the business develop in the                     at any point in time at least one of our planes will
     early days?                                             be in the air.
     Pascal: We started with medical evacuations and
     clinic services, with most of our patients being        Arnaud: Having clinics wasn’t part of our original
     expatriates working in Indonesia and Vietnam.           idea, but we soon realized that this gave us a base
     However, as many of these people were working in        to employ and train specialists, which is now one
     remote locations and employing large local              of our core strengths. Now we have 24 clinics
     populations, it was a natural progression to move       around the world, but they all stay true to the initial
     into broader healthcare consulting services. Then       concept of 24/7 pre-hospital and emergency
     Rio Tinto told us it was building an enormous           services.

                                                                                      HOTLINE - ANNIVERSARY EDITION   5

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.
                                                  Arnaud and Pascal relaxing on the Great Wall   year, this speeds up our service and radically
Pascal: Our online services really proved         having obtained the right to open an           improves the quality of our decision-making.
their value during the SARS epidemic,             International SOS clinic in Beijing in 1989
where there was a huge need for accurate,                                                        Pascal: It also allows us to stay true to our
practical information on a daily basis. Our                                                      initial ideas – where a customer will always
general attitude is: “if it needs to be done,                                                    reach a trained professional who can
we’ll find a way to do it”. This was amply                                                       understand his or her situation and quickly
demonstrated during the recent SARS                                                              pass the caller onto a medical or security
epidemic. We were told that we couldn’t                                                          professional.
evacuate patients due to the risk of infection,
so our team lead by Dr Roger Farrow,                                                             Arnaud: To achieve the global reach that our
quickly developed a Portable Medical                                                             clients demand, we have had to expand
Isolation Unit (PMIU).                                                                           quickly, and acquisitions have played a big
                                                                                                 part in achieving this. Of course the biggest
What are the main challenges now                                                                 single addition was the purchase of
that the company has grown so large?                                                             International SOS Assistance in 1998, which
Pascal: We have to sustain the same culture       Laurent Sabourin speaking at the inaugural     meant we became a global rather than a
and values that have driven us from the start:    ceremony of the office in Taipei                predominantly Asian company, with a far
a medical heritage and a passion for patient                                                     bigger US presence.
care. Now that there are over 4000 people,
we have to work harder to achieve this, and                                                      What about the future?
recruitment and training have a very big role                                                    Pascal: My main aim is to ensure that we
to play to ensure we maintain quality control.                                                   continue to offer the highest quality service

Arnaud: Logistics is a key development area,      “40% of our                                    to our clients. To achieve this we need to
                                                                                                 attract a new generation of dedicated
as we serve more and more clients and                                                            professionals. Arnaud and I were 30 when
individuals, and IT plays a central role. We
have recently invested millions of dollars and
                                                  existing business                              we started the business and we want to bring
                                                                                                 in talented 30 year olds to keep driving the
thousands of man-hours into a new global
case management system called Magellan.
                                                  is with services                               organization forward.

This means that anyone dealing with a
patient’s case from an alarm center will see      developed in the                               Arnaud: Innovation is the key: providing
                                                                                                 unique new services and as Pascal said,
the same details in real time, enabling us to                                                    attracting the best talent in the world. I
create virtual coordinating teams with
doctors from around the world. When you
                                                  past five years”                                spend a lot of time interviewing, and see this
                                                                                                 as my number one responsibility – to ensure
consider that we handle over 600,000 cases a      ARNAUD VAISSIÉ                                 we all get the very best people to join us. s

                                                                                                          FIRST EVACUATION

                                                                                                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
                                                                                                   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

A double
                                                                                                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
We asked Dr Pascal Rey-Herme to tell us about some                                              condition, he needed urgent transfer to
                                                                                                hospital in Singapore. As the HS 748 was
of the first medical evacuations he was involved with                                            already being used to transport the baby, the
for International SOS. Here he remembers one                                                    only aircraft available to us was a much
                                                                                                smaller plane called a Queen Air.
afternoon in 1985 when his team received two                                                       With our Singapore escort team already
                                                                                                flying to Indonesia to care for the baby, I went
simultaneous calls for help.                                                                    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
                                                Vital help and support
A    JAKARTA-BASED church which ran a
     small remote mission in Kalimantan,
Indonesia, heard that the wife of a foreigner
                                                Through the night an obstetrician and
                                                pediatrician in Singapore gave vital help and
                                                                                                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
working in the area had arrived at the          support to the mission’s health officer by      Singapore where we landed at the same time
mission’s medical center in premature labor.    phone while the baby was delivered and then     as the baby. I will always remember one of
   At that time, the only way to communicate    resuscitated. At the same time, we were         our Singaporean nurses exclaiming at the
with the mission was by radio. We already       assembling a pediatric team from Singapore      time: “So, you put the big patient in the small
had an arrangement with Singapore Radio         and equipping an HS 748 aircraft to fly out     plane and the small patient in the big plane!”
(which supported shipping fleets in that part    to Kalimantan as soon as possible.                 After carefully extracting the patient from
of the world) whereby we could patch our           Our team in Jakarta managed to contact       the small plane, we transferred him safely to
telephone with their radio. In this way, we     the head of immigration in Banjarmasin at       hospital. Facing many challenges, we had
were able to establish a radio link with the    home that night to convince him to issue a      successfully completed two evacuations at the
mission.                                        travel document for the new-born baby.          same time. s

                                                                                                                   HOTLINE - ANNIVERSARY EDITION   7

A 20-year                                                                                       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
                                                                                                    “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
International SOS has been working with BP for 20                                               services. Local knowledge is so important. If
                                                                                                you break your leg in Singapore, there’s no
years. Sandy Johnson who joined the company in 1985                                             big problem because medical services are
                                                                                                available. If on the other hand, you’re with a
recalls that right from the start, she saw the                                                  geo-thermal crew in Sumatra and you break
                                                                                                your leg, it’s a completely different situation.
importance of combining international standards with                                            It’s not possible to undertake night flights on
                                                                                                helicopters. We had to develop detailed plans
local knowledge and experience.                                                                 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

“I    WAS BASED in Singapore in 1985 and
      met two charming French gentlemen
through a friend of mine who was a nurse and
                                                  PARTNERING WITH BP
                                                                                                quality. I’ve always been absolutely sure that
                                                                                                we would get the job done. Arnaud and
                                                                                                Pascal lead from the front and there is
had done medical evacuation work for them.                                                      accountability through every layer of the
They were looking for somebody to                 “Our relationship with International SOS      organization. I call the company a diamond –
communicate with American and Western             has been successful because they              it has many facets, with a core integrity.”
clients operating in Singapore and Jakarta.       understand our business needs and our
Having grown up in Texas and with the oil         culture. International SOS teams can          Assistance in partnership
industry, I was very aware of the importance      work seamlessly with our staff in the         International SOS has been working with BP
of medical evacuations and was fascinated by      field and provide specialist skills, advice    for 20 years, helping to ensure the well-being
the work that Pascal and Arnaud were doing.       and experience where needed.                  of employees, their families and local
   “I joined as Director of Marketing in July     International SOS has the global reach        communities throughout the world.
1985. At that time there were many European       we need combined with vital local                As one of the world’s major energy
and North American companies operating in         knowledge. Its network of alarm centers       companies, BP is committed to meeting its
Indonesia who were drilling for oil and gas in    and family-based clinics is a very useful     corporate responsibilities to the environment,
the area, as well as organizations providing      resource for BP worldwide.”                   to its people, and to the communities in
support services to them. It was natural for us   Dr Alison Martin, Health Director,            which it operates. It’s an ethos that
to work with these companies because they         Exploration & Production, BP                  International SOS readily understands and the
had a specific need we could help them with.                                                     two companies have worked closely together
   “We also worked extensively with               “The security of our employees across the     at a global and local level.
embassies, insurance companies and private        globe is of paramount importance. In
citizens who were looking for real-time local,    order to assure ourselves of our ability to   Work on projects
medical support. Unlike the European              relocate any of them in times of crisis,      International SOS’s relationship with BP
assistance companies at the time, who had no      we have contracted on a long-term basis       started in 1985, when Dr Pascal Rey-Herme
physical presence in Asia, we had people on       with International SOS to take advantage      was asked to assist with a malaria outbreak at
the ground and had developed very strong          of their expertise and capability to effect   one of BP’s remote sites. International SOS’s
relationships with doctors and hospitals in the   such emergency relocations, and have          involvement with BP’s anti-malaria programs
region.                                           tested that capability in a real situation    still continues today.
   “Our first client was BP. They had              with great success.”                              Since then International SOS has been
operations in Sumatra and at the time had a       Nigel Carpenter, Deputy Head, Group           involved with many of BP’s largest projects.
problem with malaria on one of their remote       Security, BP                                  International SOS is often there right from
sites. Pascal heard about this through one of                                                   the start – delivering primary and emergency

                                                                                                                                          FIRST CLIENT

                                                                                                                     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
Picture courtesy of BP

                                                                                                                     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:
                         care services to workers on site. As each                                                   Namconson Liquefied Natural Gas (LNG)
                         project develops, employees’ families join                                                  project in Vietnam, Tangguh LNG project in
                         them and local people are hired. So                                                         the Papua region of Indonesia, various BP
                         International SOS broadens its service to                                                   projects in the Caspian region and new
                         include the full spectrum of healthcare in the   ASSESSING THE HEALTH OF                    ventures in Russia, including Sakhalin Island
                         community, including family and                                                             in far east Russia.
                                                                          THE LOCAL COMMUNITY IN
                         occupational health services.
                                                                          TANGGUH, INDONESIA                         Growth and evolution
                         Global agreement                                                                            The partnership between BP and
                         In 1999, after a number of highly successful     Among the many projects International      International SOS has grown from the close
                         projects, BP and International SOS               SOS has been involved in, is one for BP    involvement of one doctor to the fully
                         recognized that a more strategic approach was    in Tangguh - the development of a          structured corporate response service it is
                         needed. They developed a Global                  large liquefied natural gas (LNG)          today. Martin Dennett is Business
                         Membership Agreement which put in place          facility.                                  Development Director for Energy, Mining
                         consistent mechanisms for looking after the         As part of BP’s environmental           and Infrastructure at International SOS: “By
                         health of all BP’s personnel when they were      impact assessment, International SOS       aligning ourselves closely with BP’s
                         outside their home countries.                    developed and carried out a baseline       business, we can deliver comprehensive
                            The agreement means that International        health survey in the local area, Bintuni   solutions to help provide a duty of care to its
                         SOS can work closely with BP in a consistent     Bay. This work assessed the state of       employees and their families. BP takes its
                         and structured way. International SOS’s          health of the community, so that BP        corporate responsibilities seriously, and in
                         medical teams are aligned with BP’s own          could review the potential impact on       partnership with them we can help to ensure
                         medical divisions, and its global network of     the health of its employees and the        that medical and security risks to employees,
                         alarm centers and clinics are accessible to BP   project overall.                           their families and local communities are
                         employees when they’re working abroad.                                                      managed effectively.” s

                                                                                                                                        HOTLINE - ANNIVERSARY EDITION   9
Hospitals in the
International SOS’s air ambulances are a vital                                                      three dedicated aircraft, we make over 100
                                                                                                    medical transports a month between our
link in providing ‘bed-to-bed’ care for patients.                                                   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

A     SIX-YEAR-OLD child was lying in a
      hospital bed in Abidjan in the Ivory
Coast following a snake bite. International
                                                   the rest of Africa,” explains Dr Fraser
                                                   Lamond, Regional Medical Director Southern
                                                   Africa. “Logistically our jet air ambulances
                                                                                                    two thirds of all the patients brought into
                                                                                                    South Africa for medical care are handled by
                                                                                                    International SOS.”
SOS doctors in Johannesburg were                   can access anyone up to fifteen degrees north
monitoring his condition, but one vital piece      of the equator. We are also supported by our     A growing fleet worldwide
of information was missing: what kind of           air ambulances based in Europe which can         From the early days it was a real challenge
snake had bitten him? They decided it was          also overlap this area into sub-Saharan Africa   getting quick access to suitable aircraft for
too risky to wait.                                 thereby allowing us to efficiently cover the      the medical teams operating out of Jakarta
   It was June 2000 and the newly                  entire continent.”                               and Singapore. This prompted the company to
commissioned Falcon 10 air ambulance was              And the demand for evacuations to South       think seriously about investing in its own jets.
about to make its first medical evacuation.         Africa has spiraled in recent years: “With          Since the Falcon 200’s maiden air
Within hours the boy had been picked up and                                                         ambulance flight from Singapore in 1997,
flown, with the unidentified snake in tow, to a                                                       International SOS has expanded its fleet to
modern hospital in Johannesburg, where he                                                           ten, making it one of the world’s largest air
was placed in intensive care.                                                                       ambulance service providers. With bases in
   It turned out that the bite came from the                                                        Germany, Russia, South Africa, Namibia,
potentially deadly West African Carpet Viper                                                        Botswana, Singapore, China and Papua New
and would probably have proved fatal in this                                                        Guinea. The speed and range of the aircraft
child. The boy was given the appropriate                                                            enables International SOS to reach patients
serum but also needed to be on a ventilator.                                                        virtually anywhere in the world. There are a
He made a full recovery and was able to                                                             variety of aircraft including Learjet, Falcon,
return home a few weeks later.                                                                      Hawker and even turbo props that can land in
   “With its high quality of medical facilities,                                                    particularly difficult terrain where there may
South Africa – and Johannesburg in particular                                                       be no proper airstrip.
– is very strategically placed in relation to                                                          The aircraft are quite literally ‘intensive

                                                                                                                      AIR AMBULANCES

air                                                    MAKING A DIFFERENCE
                                                       ”FROM the moment we arrive on the scene,
                                                       we’ve upgraded the quality of care”, says
                                                                                                        woman in Mozambique with 60% burns. We
                                                                                                        had a very bumpy ride due to bad weather
                                                       Dr Tyrone Richards, Deputy Medical Director,     and we had to use a tube to get oxygen into
care units in the sky’, carrying everything            International SOS, South Africa. “Medical        her lungs.
necessary to cope with a medical emergency,            facilities are virtually non-existent in many        “On landing in Johannesburg we rushed her
including resuscitation equipment, oxygen,             parts of Africa, so we can offer real hope for   to a preferred hospital. It was touch and go
infusion pumps and a full range of drugs,              the patient.                                     but fortunately she pulled through and three
fluid and supplies.                                        “Each day is a new adventure; you never       months later was back home, working again.
   “All our medical staff is fully trained in          know where you may end up. One of our most       It’s so satisfying to know that you’ve made a
aviation and emergency medicine and has                dramatic rescues involved a fifty-year-old        difference.”
extensive medical evacuation experience,”
says Dr Arnaud Derossi, International SOS’s
Regional Aviation Medical Director for the          alarm centers manage all the logistical              helicopters, and communication with staff at
EMEA region. “They can manage adults,               aspects of an evacuation. The nerve centers          clinics and hospitals to prepare them for the
neonatal and pediatric cases, with the most         are the four regional aviation units in              patient’s arrival.
common conditions being cardiac conditions,         Frankfurt, Johannesburg, Singapore and
traumas, infectious disease, head and spinal        Philadelphia.                                        Bed-to-bed care
injuries.                                              Dr Derossi explains some of the key               “It’s capability, continuity and quality of care
   “Medical missions need to be flown by             challenges in creating an integrated support         that distinguishes our service,” Dr Fraser
pilots who are expert in air ambulance              structure: “Access and landing permits are           Lamond tells us. “We offer a high standard of
processes and knowledgeable about the               critical to the success of a mission and our         medical care and attention throughout the
medical team’s requirements. They also need         centers can obtain landing clearances and            transportation process. And every detail
to have the experience of dealing with the          coordinate the complex set of activities             counts: we deliver a safe reliable service to
logistics of flying in and out of remote sites       required at destination airports”.                   those who need it.
where conditions may be rudimentary.                   And when every minute can literally mean             “The integrated nature of International
   “Although the vast majority of flights are        the difference between life and death, local         SOS’s local, regional and international
on our own jets, we also have access where          knowledge and contacts can help get you              network means that from the very first call,
necessary to a range of other aircraft              through customs and immigration quickly.             we can manage just about any logistical
including executive jets, helicopters and even      “We recently evacuated a seriously ill patient       challenge and deliver medically appropriate
military aircraft or wide-body aircrafts.”          from Tajikistan to London, which required            services and support.
                                                    clearance across seven different countries’ air         There are many decisions to make during
Sophisticated logistics                             space.”                                              an emergency: finding the quickest and best
Whilst the pilots and paramedics on board are          The coordination activities also involve the      transportation should not have to be among
at the sharp end, the aviation specialists in the   utilization of ground ambulances and                 them.” s

                                                                                                                           HOTLINE - ANNIVERSARY EDITION   11

                                                                                                    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

a new service culture                                                                               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.”

                          Dr Inggriani Gandha joined AEA                                            Growth and change
                                                                                                    As the years passed, the number of clients
                          International, now International SOS, in                                  and members visiting the clinic grew
                                                                                                    steadily. “At the first clinic we saw around
                          1985. She was part of the team that                                       900 expatriate patients and the numbers just
                                                                                                    went up. By 1991 we needed new premises
                          opened the first clinic in Jakarta.                                        to accommodate our growing client base and
                                                                                                    we opened our second clinic – where we’re
                                                                                                    still based today.”
                                                                                                        Increasingly the client base grew to
     R INGGRIANI Gandha (known locally               As well as delivering primary healthcare       include local people as well as expatriates
D    as Dr Inge) trained as a doctor in
Indonesia. She spent 11 years in Germany,
                                                  services to expatriates and their families, the
                                                  clinic pioneered emergency care to patients
                                                                                                    and eventually the balance tipped. “These
                                                                                                    days we see around 6,500-7,000 patients
studying in Aachen and specializing in            before they were evacuated, often to hospitals    every month”, says Dr Inge, “With around
gynecology. In 1983, she returned to              in Singapore. “We have always been strong         60% of them coming from the local
Indonesia and joined AEA International (now       on our emergency response capabilities. Back      population”.
International SOS). In 1985 she was part of       when we first started, the type of service we
the team that opened the first clinic, in          offered was virtually unheard of in               The clinic today
Jakarta.                                          Indonesia.”                                       Today’s busy clinic has around 300 staff,
                                                                                                    including 40 doctors on site. “We see patients
First beginnings                                  Changing the culture                              of all ages, and many of the children at the
“We set up the first clinic in 1985 in Jakarta     As well as pioneering new services, the           International School in Jakarta come to us”,
because we needed a place where patients          clinic was forging a new, more service-           says Dr Inge. The range of services has
could be stabilized before being evacuated”,      oriented culture among healthcare                 expanded over time to include a dental
Dr Inge explains. “At that time, there were       professionals. Dr Pascal Rey-Herme                practice, a pediatric practice, a diabetic clinic,
24-hour clinics in the city, but they were        recruited and trained a team of local doctors     a well-woman clinic and a weight-control
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.”

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
   “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.”

                                                                                                                           FIRST CLINIC

                                                                                                     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
Reception of the International SOS clinic in Jakarta                                                 and occupational health programs. Clinics
                                                                                                     are well equipped with the facilities
                                                                                                     needed to stabilize a critically ill or injured
clinic. “We also do a lot of medical check-ups     healthcare services on every continent. She       person before evacuation. Many clinics
for companies as part of their employee            speaks six different languages and                have international-standard pharmacies,
healthcare programs. Of course the percentage      understands cultural differences in the           laboratory services and diagnostic services.
of emergency cases is small – but we provide       delivery of healthcare around the world.          Many are also equipped to offer x-ray and
dedicated intensive care,” she says.                  “My time in Germany was instructive in         ultrasound tests, dentistry, physical
   “Our clients today still value international    terms of getting experience of international      therapy and counseling.
medical training and standards. While              standards”, she says. “I’ve learned about the         There are 24 International SOS clinics
English language capabilities are critical, the    differences in emphasis and expectation in        worldwide in the following locations:
spectrum of nationalities among our staff is       different countries. And of course sometimes
wide, including Australian, South African,         you have to adjust your approach to your             Angola:          Gamek
American, Malaysian, Philippine, French,           environment. But international standards of                           Ilha
German and British.”                               medical care are essentially the same                Azerbaijan:      Baku
                                                   everywhere – and that’s what we are here to
                                                                                                        Cambodia:        Phnom Penh
International standards                            provide. Whether you’re in Moscow or
During her career, Dr Inge has traveled            Beijing, the standard of care you’ll receive is      Chad:            N’Djamena
extensively and gained experience of               the same.” s                                         China:           Beijing
“Dr Rey-Herme                                                                                           Indonesia:       Jakarta (2)
emphasized right                                                                                        Kazakhstan:      Almaty
from the start that                                                                                     Mongolia:        Ulaanbaatar
                                                                                                        Myanmar:         Yangon
the patient was at                                                                                      Nigeria:         Lagos
                                                                                                                         Port Harcourt
the center of                                                                                                            Warri
                                                                                                        Russia:          Moscow
any decision that                                                                                       Vietnam:
was made”                                                                                                                Ho Chi Minh City
                                                                                                                         Vung Tau

                                                                                                                      HOTLINE - ANNIVERSARY EDITION   13
       hands on alarm center
Allfirst International SOSdeck
at the
                          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.
                                                mobile phone. It was huge, and the networks
                                                weren’t great, but even then we were leading
                                                edge in terms of telecoms and technology.”
                                                                                                they are today, but we were doing frequent
                                                                                                medical evacuations so the level of expertise
                                                                                                was high and the process very efficient. We
Here he looks back at the early days, at what                                                   learnt right from the start about the
has changed – and what has stayed the same.     Early days                                      importance of harnessing the
   “Back when we first started, it was all       Sharing and swapping apartments and             complementary skills of both expatriate and
hands on deck”, he says. “Arnaud [Vaissié]      traveling between Jakarta and Singapore, Dr     national staff – just as we continue to do
and Pascal [Rey-Herme] were involved with       Farrow and Dr Rey-Herme were on constant        globally today. This mix of expertise has
every case, with Pascal and I always on call    call at the Singapore and Jakarta alarm         been a key element in the company’s
to give medical assistance to clients and       centers when in 1989 the Hong Kong alarm        success.”
undertake medical evacuations. This was in      center opened and additional medical staff         Zaleha Hassan also worked at the
the days before mobile phones, when we          came on board. “There were a lot of mining      Singapore alarm center in the early days.
each carried pagers and bags of 10-cent coins   and infrastructure companies in Asia, and a     “Back then we did everything ourselves”, she
ready to rush to the nearest public phone. I    large population of expatriates and families.   remembers. “We rushed to embassies to apply
remember sharing our very first Ericsson         Medical facilities were certainly not what      for visas, picked up medication, filled up

                                                                                                       FIRST ALARM CENTER

oxygen tanks locally, and went to the airport
to check in patients ahead of repatriation.”        “The soul of the                              sophisticated medical equipment available
                                                                                                  today, we had to take the utmost care to
                                                                                                  monitor the patient to make sure he remained
Pioneering evacuations
Modern aviation has made the medical
                                                    company, its                                  stable through each stage of the flight.”
                                                                                                     On another occasion, a Singaporean boy
transportation of patients faster and less
stressful. Roger Farrow continues: “I
                                                    humanity and                                  had to be flown back urgently from Kota
                                                                                                  Kinabalu, where the airport was already
remember in 1988 we completed a
pioneering evacuation of an extremely sick          compassion, have                              closed. Dr Pascal Rey-Herme asked Lisa Tan,
                                                                                                  who was the only Malaysian in the company
patient by air ambulance from Singapore to a                                                      at that time, to talk to the Malaysian
hospital in London. This was before the
advent of the non-stop long haul 747 400
                                                    been preserved”                               authorities to convince them to open the
                                                                                                  airport especially for the mercy flight. The
aircraft and when there were few air                ROGER FARROW, INTERNATIONAL SOS               airport authorities readily agreed to do so
ambulance aircraft available. We used a Lear                                                      once the urgency of the situation was
36 to make the transcontinental flight,                                                            explained.
stopping at Madras, Abu Dhabi and then
Lanaka in Cyprus before finally landing at                                                         Soul of the company
Heathrow. Stopping in the middle of the                                                           The years since have seen the rapid growth
night, while the aircraft was being refueled                                                      of International SOS, with hundreds of new
needed careful planning. With little of the                                                       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,
SERVING INTERNATIONAL SOS’S                                                                       today’s alarm centers are incredibly efficient
JAPANESE CLIENTS AND MEMBERS                                                                      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.
INTERNATIONAL SOS delivers services              Jakarta, Hong Kong and Brisbane to audit our     The soul of the company, its humanity and
specifically designed and tailored for its        operations. We were able to demonstrate our      compassion, have been preserved.
Japanese clients and members.                    consistency of approach. More importantly,          “I always liken Pascal and Arnaud to the
    Lisa Tan joined International SOS in 1988.   we demonstrated our understanding of Asia        queen bee in a bee hive. Just as the queen
She spent two years setting up and               and the Japanese market, and showed              bee affects and directs the behavior of the
upgrading International SOS's alarm center       intimate local and cultural knowledge. The       whole hive, so in the same way Pascal and
operations in Seoul and Hong Kong. In 1991       key win for us was our geographically            Arnaud’s strong medical and personal ethics
she returned to the Singapore alarm center       balanced network, which met the                  and their passion for excellence have shaped
as Operations Manager. She remembers how         expectations and requirements of Tokio           this company and the people who work in it.
the International SOS Japanese Desk first        Marine in Asia Pacific at that time. Today, we    I’ve been strongly influenced by them both
came about.                                      provide services to Tokio Marine on a global     since the day I first met them. And in turn
    "Our Japanese clients and members have       basis.                                           those longer serving members of the
always been important to us. They were the          "In 1993, we set up the Japanese desk at      company are passing onto those who joined
first clients in Asia willing to invest in our   the Singapore alarm center, dealing              later, the same values and standards.
services despite medical assistance being        exclusively with assistance to our Japanese
almost unknown in this region in the late        clients and members. This was the start of       A hands-on approach
1980's", she explains. "Both AIU Insurance       the fully-fledged Japanese service department     “What is so important and so unusual for a
Company and former Mitsui Marine & Fire          that has continued till this day in Tokyo,       large company like ours, is that Pascal and
Insurance Company, now known as Mitsui           serving more than 90% of Japanese non-life       Arnaud are still directly involved in medical
Sumitomo Insurance Company, were the first       insurers and all our global members from         and operational decision making. There is no
Japanese insurance companies to show a           Japan.                                           serious medical case which senior
keen interest in including medical services         "International SOS has always believed in     management are unaware of. What we all
to give added value to their insurance           the importance of providing services to          value – and the reason so many of us stay
products. Both companies have grown to           customers in their own language and in           with International SOS – is the opportunity
become key clients and our business              accordance with their own customs and            to work for a compassionate, medically
partners in many ways.                           traditions, even when they're overseas. The      driven, ethical company.
    "In 1992 we reached another milestone        attention to detail and commitment we               “In another 20 years we’ll probably look
when Tokio Marine chose us as their              demonstrated to our Japanese clients in the      back at 2005 and say that what we’re doing
appointed assistance company for Asia            early days is still fundamental to the service   now was pioneering. It’s all a question of
Pacific. Before choosing International SOS,       we offer today, even though we have grown        perspective. But it is extraordinary to see
Tokio Marine sent teams to Singapore,            such a lot in the past 20 years."                just how far we’ve come in such a relatively
                                                                                                  short time.” s

                                                                                                                   HOTLINE - ANNIVERSARY EDITION   15


                                     Patient calls International SOS                              An Australian lady, Sue Williams, lives in Inner
                                              and speaks to                                       Mongolia, China, with her husband, who is
                                         Operations Coordinator                                   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
                                    Patient speaks to Intl. SOS doctor                            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
                                         Doctor calls Beijing AC                                  center in Sydney.

                                                                                                  Expert response
                                                                                                  After talking at length with Mrs Williams, an
                                         Beijing AC recommends                                    International SOS doctor determines that she
                                               admittance                                         needs neurological investigations and treatment.
                                        to hospital in Hong Kong                                  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
                                                                         Intl. SOS doctor calls
               International SOS            Intl. SOS arranges                                    International SOS doctor recommends that she
                                                                            patient to make
                 calls insurers              flight and escort                                     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
               Intl. SOS stays in                                                                 and Hong Kong work together to arrange all
                 contact with                                            Intl. SOS stays in       logistical aspects of the transportation, including
                     insurers                                              contact with           her medical escort and Mrs Williams’ admission
                                                                               patient            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.
                                                                         Patient discharged          On being discharged from hospital, Mrs
                                                                         from hospital and        Williams asks International SOS for help to make
                                                                         contacts Intl. SOS       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.
                                                                         Intl. SOS arranges       A safe conclusion
                                                                           hotel and taxis
                                                                                                  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
                                                                           Patient arrives
                                                                                                  Sydney, to the staff in Beijing and Hong Kong.
                                                                             home safe
                                                                                                  Everyone was concerned and professional. I
                                                                              and well
                                                                                                  cannot praise your organization too much.”

                                                                  CORPORATE ASSISTANCE DEPARTMENT

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
                                                                                  • the condition of a patient deteriorates
                                                                                    while they are being evacuated
                                                                                  • a major medical or security incident
International SOS service delivery model                                            requires a crisis response
puts the best people with the right expertise
at the front end. That’s why we have full-time                                       “Ever since the company started, senior
medical teams – not medical consultants – on                                      medical staffs have provided round-the-clock
duty in all our alarm centers. They provide                                       support to members of assistance teams,”
real-time medical advice, direction and                                           explains Dr Nerwich. “But as the
reassurance to our members and patients.                                          organization grew, we realized we needed a
Their skill is to listen to what’s being said,                                    more formalized approach, and in 2000 the
assess and interpret in the context of the                                        Corporate Assistance Department was
individual’s situation, and then to respond                                       formed. The Department ensures there is
appropriately.”                                                                   total transparency and that any element of
   “The decisions taken will depend as much                                       medical or security risk is dealt with
on the condition of the patient as on the                                         proactively. This is particularly important in a
implications posed by the local environment.                                      crisis situation.”
In consultation with our other medical teams                                         In response to the most recent Bali
around the world who are experts in their                                         bombing in October 2005, Dr Philippe
region, we decide on the best local solution,                                     Barrault, a fellow CAD member, poignantly
or alternatively evacuate them if local                                           commented that International SOS had
resources are insufficient.                                                        learned so many lessons from previous
   “And when a situation is particularly                                          bombings that this time the decision was
challenging, all our staff know they have the                                     taken to proactively launch mercy medical
Corporate Assistance Department to call on.”      “Ever since the                 evacuation flights. “One of the lessons was to
                                                                                  mobilize as quickly as possible,” says Dr
Expert advice and opinion
The Corporate Assistance Department
                                                  company started,                Barrault. “As soon as we realized that help
                                                                                  was needed, our largest air ambulance left
(CAD) comprises a global roster of senior
medical directors with the knowledge and          senior medical                  Singapore in the early hours of Sunday
experience to deal with the most complex or                                          “Our processes ensure that clinical need is
challenging cases. On call 24 hours a day,
seven days a week, they make decisions on a
                                                  staffs have provided            put first,” continues Dr Nerwich. “Patients
                                                                                  are in direct communication with medical
real-time basis in the best interests of the
patient and the client. A strict set of
                                                  round-the-clock                 staff right from the outset, so their access to
                                                                                  a doctor is in real time. The ethos of
operating procedures ensures that they are
always contacted in scenarios where:              support to members              International SOS comes from the very top.
                                                                                  Through the Corporate Assistance
                                                                                  Department we make sure that our collective
• there is a complex case involving
  evacuation across continents or where
                                                  of assistance teams”            experience is applied where it matters most –
                                                                                  responding to our members when they need
  technical difficulties need to be resolved       DR NERWICH, INTERNATIONAL SOS   our help.” s

                                                                                                   HOTLINE - ANNIVERSARY EDITION   17
Indonesians demanding
the resignation of
President Suharto
                                                   SECURITY EVACUATIONS


                            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.

             Y EARLY 1998, President                  “It was absolute mayhem. I remember
             Suharto’s thirty-year grip on power   hearing of people driving their cars to the
             in Indonesia was loosening. With      airport and abandoning them or selling them
             the economy in crisis,                on the spot”, recalls Jim Williams, who was in
demonstrations, violent clashes and riots          charge of International SOS’s Indonesian
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

                                                                    HOTLINE - ANNIVERSARY EDITION   19

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          ourselves. This enabled our members to go
exit tax. “At the airport most people were           through the system in a fraction of the time,”
waiting eight hours in a government line to          explained Jim. The Singapore operations
pay the exit tax. We took the situation into our     provided all of the reception services. They
own hands and agreed to a new procedure              were tasked with arranging ground
with officials to help with the paperwork             transportation, travel arrangements and hotels

                                                                                                      for the members we evacuated.
                                                                                                         Organizing the evacuation of so many
   TOWARDS RISK MANAGEMENT                                                                            people in such a short time was an enormous
                                                                                                      logistical operation. In spite of this we
   “INTERNATIONAL SOS is no longer just             and other hostile regions.                        managed to launch several medical
   helping organizations respond to events,”           “It’s all about knowing the risks you          evacuations with our own air ambulance. One
   says Richard Culver, Senior Director, Security   face, managing those risks and making             of these was a neonatal case.
   Services, EMEA/CIS. “In an uncertain world,      informed decisions. In 2004 a construction           During an intense three-day period, over
   we’re increasingly being asked to look at        client needed to establish business               four thousand people were successfully
   the complete security infrastructure to help     operations in Afghanistan. We embedded a          airlifted out of the country. “Overall many of
   reduce the risks of terrorism or crime. We       security consultant with their project team,      us in Jakarta and Singapore didn’t sleep for 56
   also help clients manage the consequence         and as an integral part of the client             hours. When members are in trouble, they
   of crisis, not just the incidents themselves,    structure assisted in the management and          immediately call International SOS. Our job is
   through the provision of holistic crisis         reduction of risk to enable the business. We      to help them, whatever their needs.” s
   management services.”                            supervised security provider selection, and
       “We can evaluate site security, travel       deployed with the client advance party to
   policies and the quality of security firms
   used. We can also provide a full-time or
                                                    ensure that their security management in-
                                                    country was up to the standards required.
                                                                                                      “I remember
   seconded security manager to oversee all a
   client’s activities and prepare crisis
                                                    That client is still successfully operating in
                                                    Afghanistan, and our
                                                                                                      hearing of people
   management and emergency evacuation
                                                    plans and procedures
                                                    have assisted in the                              driving their cars to
       Clients can access our comprehensive         prevention of death
   web services, giving security updates and
   other useful information. They can also call
                                                    and injury to their staff
                                                    on a number of
                                                                                                      the airport and
   into our alarm centers 24/7 and receive
   immediate advice and assistance from our
                                                    occasions.”                                       abandoning them
   on-call security specialists. “Our security
   specialists typically have a military
                                                    Richard Culver,
                                                    Security Services,                                or selling them on
   background with further experience in            EMEA/CIS
   consulting and corporate security. They’re
   all accustomed to working in war zones
                                                                                                      the spot”
                                                                                                      JIM WILLIAMS, INTERNATIONAL SOS


More than an
emergency service
                    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,
                                                  got her examined at the nearest International
                                                  SOS clinic. She had in fact a significant
                                                  previously undiagnosed neurological
                                                                                                    International SOS in an emergency. “I’m not
                                                                                                    interested in just sticking to the bare facts,”
                                                                                                    says Rene. “I want to give people proper,
Dr Rene de Jongh has seen the benefits of         problem, so we arranged to evacuate her by        detailed advice on how to manage
membership time and time again. “People           commercial flight to London so that she           themselves while they’re traveling. If
aren't always clear what membership really        could immediately receive the care she            someone is a diabetic planning a trip to
gives them,” he says. “I think the value of       needed to make a recovery.”                       China, they’ll want to know where they can
membership is two-fold: Members have                                                                buy needles, where they can keep their
access to myself or any of my physician           Managing risk                                     insulin cold during flights, and whether they
colleagues day or night should they have a        Of course membership isn’t just there for         can get their needles through customs. We
medical concern, and as medical                   emergencies. Members have access to travel        give them the whole nine yards.”
professionals, we have the opportunity to get     and security advice to help keep themselves
to know a little more about them. Knowing         and their families safe while abroad. “It’s       Clinical need
our members' background and situation             human nature to get excited when you’re           For Rene, membership is about much more
helps us to deal more effectively with issues     going on a trip. People tend not to think         than just a fast service. “The first person
or emergencies when they arise. What’s            about what might go wrong,” says Rene. “I         you’ll speak to when you call is a trained
more, membership ensures that                     don’t want to take the fun out of traveling; I    customer service executive. The second will
administration and payment is already             just want to help people manage the risks.”       be a medical professional who will already
sorted. When you’re dealing with someone             One International SOS member was               have an idea of who you are, what your
who’s had a serious accident, the last thing      starting a mine site survey trip to Africa and    problem is, and at least a partial solution
you want to talk about is who’s going to foot     called Rene on the suggestion of a                already in place.”
the bill.”                                        colleague. He outlined his plans and the             This reflects a principle that attracted
   Sometimes International SOS helps              vaccinations he’d been given on the advice        Rene to International SOS in the first place.
members with problems that they didn’t even       of his GP. It soon became clear that he           “The service we give our members when
know they had. “I remember one lady who           would pass through countries where it is a        they travel is unique,” he says. “Every
had been a member for some time,” says            requirement to have been vaccinated against       decision is based first and foremost on
Rene. “I was delighted to get a call from her     yellow fever. “If you’re not covered, quite       clinical need – even before they’ve stepped
telling me that she and her husband were          apart from the risk of the disease to you         off the plane.” s
expecting a baby – I knew they’d wanted a         personally, you may either be deported or be
family. But during our conversation, she told     given a jab there and then at the airport,        Dr de Jongh is a New Zealand citizen who
me she’d been experiencing nasty headaches.       which won’t always be safe,” explains Rene.       joined International SOS in 1992 and is now
She presumed these were a normal symptom          During their phone conversation Rene              Area Medical Director for SOS’s operations
of her condition and had been suffering           advised his client to re-route in order to have   in the South Asia Region. His specialty is in
bravely because she didn’t want to take any       the yellow fever vaccination, take time to        hospital-based emergency and intensive care
painkillers. As she was talking I realized that   develop immunity and collect documented           medicine. He is also qualified in pre-
these headaches weren’t just another side         proof to take with him.                           hospital emergency care, advanced cardiac,
effect of pregnancy. They sounded much               Getting this kind of advice reduces the        pediatric and trauma life support and was
more serious. Speed was important, so we          likelihood of ever having to call on              awarded a MSc in Travel Medicine.

                                                                                                                     HOTLINE - ANNIVERSARY EDITION   21

                                                                                              pages each, available in English, French,

The world at your                                                                             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
Hi-tech online solutions help mitigate the risks of                                           wanted a system that could track every
                                                                                              traveling member of staff anywhere in the
international travel.                                                                         world.
                                                                                                 “Traveler Locator takes data from travel
                                                                                              management systems and travel agencies to
                                                                                              give an instant snapshot of the movements of

O    NE OF THE downsides of living in the
     ‘Information Age’ is data overload.
This is particularly true for international
                                                International SOS’s website and associated
                                                online services the only places you would
                                                ever need to look,” says Tim Daniel, Chief
                                                                                              employees. You can track individuals by
                                                                                              region, by country, by flight number or hotel
                                                                                              booking. It also lets you assess the risks
companies with hundreds or thousands of         Operating Officer, International SOS Online.   facing these people and gives automatic
employees traveling or working abroad.             From humble beginnings in 1997, the main   medical and security alerts if they’re likely to
With so many sources of information, it’s       International SOS members’ website has        face dangers or hazards.
virtually impossible to access the specific     developed into a comprehensive guide to          “The service is web-based and accessible
details they need to help keep staff safe and   traveling and working around the world, as    from anywhere in the world, yet also highly
secure.                                         Tim explains: “We now have more than two      secure with restricted users. As you would
   “The aim from the start was to make          hundred country guides of around 25-30        expect, the amount of data processed is


                       enormous, with 120,000 travel itineraries        management, it asked International SOS to
                       entered every day.”                              create a dedicated portal. This contains action
                          Over the past few years a number of other     plans and procedures, relevant local
                       online services have emerged, such as            information such as fire, police and
                       ‘Automated Travel Advisories and ‘Travel         ambulance services, and details on all
                       Ready’. These help travelers prepare for the     employees, including scanned copies of
                       next trip, giving up-to-date information on      passports.
                       destinations through email alerts, making sure      If there is a crisis, management can act
                       they have the right vaccinations and even        quickly, contact all relevant parties and make
                       letting them know the status of visa             evacuations or close facilities. There are even
                       applications.                                    detailed maps helping to locate expatriate
                       Customized services                                 Renault in France has chosen to provide a
                       As with many International SOS offerings,        similar service to its employees and decided
                       the client is often the trigger for              to incorporate a customized medical section
                       improvements. For example, when IKEA             into the site. Daniel Mahé, General Manager
                       wanted to improve its global crisis              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
“This new online tool contributes to our                                our employees’ awareness of the importance
                                                                        of maintaining their health and of the services
employees’ awareness of the importance of                               our company provides in this field.”
                                                                           “The future of online services is all about

maintaining their health and of the services                            getting the right information to the right
                                                                        people in real time,” says Tim, “Whether it’s
                                                                        epidemics, natural disasters or political
our company provides in this field”                                      unrest, the use of email alerts, websites and
                                                                        portals will give clients the tools they need to
DANIEL MAHÉ, RENAULT                                                    take important decisions and mitigate risk.” s

                                                                                         HOTLINE - ANNIVERSARY EDITION   23
A vital
20 hours
Memories of the first International SOS mass evacuation.

                                                                                                  Combining resources
P   ATRICK Deroose is General Manager at
    International SOS’s Corporate Assistance
Department. A trained nurse, he has been
                                                 seriously, and several people were killed.
                                                 Local services arrived at the scene as quickly
                                                 as possible and took the injured passengers to
                                                                                                  The operations team at Singapore quickly put
                                                                                                  together a plan that combined the resources of
with International SOS since 1993.               the local hospital.                              three International SOS alarm centers:
   Soon after he joined, Patrick was part of a      As soon as they were informed of what         Singapore, Jakarta and Bali. The Singapore
team sent to care for the victims of a serious   had happened, the French insurance company       and Bali teams would triage the patients (that
road accident on Bali. Here he remembers         contacted International SOS and the              is, determine their injuries in order to decide
how events unfolded.                             Singapore alarm center was immediately           the order and urgency of treatment) ready for
   “A couple of weeks after I started work       alerted.                                         repatriation. The Jakarta team would provide
with International SOS there was a terrible         Knowing that local medical facilities         the necessary equipment and personnel for
crash on Bali. A group of elderly French and     would not be sufficient to deal with the          the aircraft.
Belgian tourists were traveling in a             situation, our mandate was to bring the              One of our Bali-based doctors was
mountainous area when their coach tumbled        patients to major trauma centers in Singapore    immediately sent to the hospital in Bali to
into a ravine.                                   for treatment and repatriation.                  assess the situation. Understandably,
   Many of the passengers were injured, some                                                      conditions at the busy emergency room of

                                                                                                  FIRST MASS EVACUATION

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

this Government hospital were crowded, with      to us. We quickly organized for the least           Offloading the patients in Singapore was
staff struggling to cope. The doctor carefully   injured patients to go first, with the most       easier because there were 14 ambulances
and sensitively explained the plan that          critical patients following last so that they    waiting to transport them to the casualty
International SOS had put in place.              would spend as little time as possible out of    departments of Singapore General Hospital,
   Meanwhile a medical team was sent from        hospital.                                        the National University Hospital and other
Singapore to Bali, comprising myself, Dr            Meanwhile, our logistics team were sorting    private hospitals in the city. Allocations were
Roger Farrow and Dr Peter Heron. With the        out passports and the necessary papers in        made by the Singapore alarm center to ensure
necessary language capabilities between us,      collaboration with the insurance company and     that each patient received the treatment they
we took with us the medical equipment we         the relevant consul on Bali.                     needed.
would need, including 15 stretchers.                                                                 20 hours from the time of the first call to
                                                 Safe arrival in Singapore                        International SOS, the patients had arrived
Directing triage                                 The patients were flown out of Bali on a          safely in hospital in Singapore where the 15
One of our Bali team met us at the airport       Fokker aircraft, which had been prepared by      most seriously injured remained until being
and took us to the hospital. Dr Farrow           the Jakarta team, including medical staff,       repatriated for treatment or rehabilitation.
directed the triage and we prepared the          monitoring equipment and enough food and         Out of the five people with more minor
patients for transport out of Bali to            drink for the patients.                          injuries, three went home and the two others
Singapore. 15 were seriously injured and            Once the aircraft was loaded, we called the   stayed in Singapore to be with their loved
another five had more minor injuries.             Singapore alarm center with our arrival time     ones who were being treated in hospital. All
   A lack of ground transport in Bali meant      so that ambulances would be waiting on the       the uninjured were flown home within 24
that there were only five ambulances available    tarmac at Singapore airport.                     hours.” s

                                                                                                                   HOTLINE - ANNIVERSARY EDITION   25
                                                             REMOTE SITE SERVICES

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

              RGANIZATIONS working in oil, gas,        day healthcare, as well as provide preventative
              mining and construction operate in       treatment for malaria and other tropical diseases.
              some of the harshest, hostile and most      “What began with just one doctor in a single
              inaccessible environments, with          clinic has now grown into a complete medical
 employees carrying out dangerous work, often in       infrastructure operation incorporating a small
 extreme weather conditions. Whole communities         hospital, outpatient and emergency facilities, and
 can spring up around these sites, and keeping         satellite clinics with occupational health
 employees and their families healthy is a major       programs and award winning public health
 challenge.                                            programs,” explained Dr Myles Neri, Group
    International SOS first became involved in         Medical Director for International SOS’s Global
 this field in 1988, when a French airport             Medical Services.
 construction company was commissioned by the
 Indonesian government to build Jakarta’s new          A natural development
 international airport. The company was eager to       Fast forward to 2005 and International SOS now
 offer a high standard of care to their construction   manages around 200 remote sites across five
 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-

                                                                            HOTLINE - ANNIVERSARY EDITION   27

                                                     “The occupational health
                                                  program aims at prevention,
                                                 detection and surveillance of
                                                    occupational illnesses and
                                                          injuries on the site”
                                                        DR DAVE KNIGHT, INTERNATIONAL SOS

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
   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
   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

                                                 Water sampling as part of
                                                 a malaria control program

                                                 Large, remote sites                                of occupational illnesses and injuries on the
                                                                                                    site. The dual aim is workers’ health
                                                                                                    protection as well as health promotion.”
                                                 not only create their                                 In recent times governments and aid
                                                                                                    agencies have called upon International SOS
                                                 own communities,                                   to provide similar services to them in areas
                                                                                                    of reconstruction, following conflict

                                                 they also impact                                   (Iraq/Afghanistan) or devastation
                                                                                                    (Aceh/Pakistan). The emphasis is on rapid
                                                                                                    deployment, quality medical services,
                                                 upon the wider                                     medical evacuation capacity and local
                                                                                                    staffing, training and development.
                                                 local population.                                     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. s

on the huge offshore platform that supports         HAIR-RAISING SURGERY
a crew of 132 people.
                                                   DR Patrick O’Neill, who worked as Chief          into the site clinic, where visiting plastic
Helping the wider community                        Medical Officer at the Kaltim Prima coal mine     surgeons involved in a company public health
Large, remote sites not only create their own      in Indonesia when International SOS first set     surgical program for cleft lip repair, were on
communities, they also impact upon the             up its on-site operation, remembers the many     hand to sew it back on. After a difficult
wider local population. International SOS is       challenges of those early days.                  period of readjustment the orang-utan was
active in helping clients build health                 In addition to carrying emergency            finally released back into the wild with both
capacity with their neighbouring                   operations out in remote jungle clinics, and     hands fully intact.
communities by providing programs to               riding 90 minutes by boat to transport
monitor, treat and prevent diseases, improve       patients to the nearest local hospital (before
sanitation and manage and counter sexually         a hospital was built on site), he also had to
transmitted diseases (including HIV), TB           handle patients of a hairier variety!
and malaria.                                           One day an orang-utan managed to find
   Dr Dave Knight, International SOS               its way into the site and severed its thumb in
Medical Director at Batu Hijau, Indonesia          a conveyor belt. The unfortunate animal was
told us: “The occupational health program          sedated with tranquillizers and then taken
aims at prevention, detection and surveillance

                                                                                                                      HOTLINE - ANNIVERSARY EDITION   29
                                                          ’D SPENT YEARS delivering general
                                                    “I    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

                                                    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

A change of gear                                    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

in occupational                                     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

health                                              sites and include employment screening and
                                                    health and safety management, with disease
                                                    management an inevitable component.

                                                    What occupational services does
                                                    International SOS offer?
Dr David Cook was originally Chief Medical Officer   International SOS offers services across the
                                                    whole occupational health spectrum. We’re
in Burma for International SOS between 1996 and     second to none in terms of resources –
                                                    medical, intellectual, transport,
1997, working in Jakarta, Singapore and Papua       communications, and security.
                                                       Remote sites are usually in emerging
New Guinea. After 10 years working abroad he        countries, where International SOS delivers
returned to the UK to pursue occupational health    occupational health services along with
                                                    general medical services in places where
as his specialty in 2003.                           employees don’t have ready access to a GP
                                                    or a local A&E. We also develop
                                                    comprehensive occupational health programs

                                                                                                          OCCUPATIONAL HEALTH

designed to suit a particular company’s          Can clients access GO-Care?                            – a quality system and a quality service. We
needs. We can deliver fully managed              A very important component of GO-Care is               call it quality, quality, quality. That was our
occupational health services on behalf of        the online statistics and reports that it can          mantra back in the 1990s and it hasn’t
clients.                                         generate. As GO-Care is web-based, some of             changed today.
   We are the only company in the world          our clients can access it to generate and
that can offer consistent levels of care –       download their own reports. So it’s a tailored         What new developments are there in
globally. And that’s a capability that’s         service, with tailored data recording and              occupational health?
becoming increasingly important for many         reporting. And employees with some of our              International SOS is continuing to develop
of our clients.                                  clients can download their own paperwork               new occupational health services. At the
                                                 (while individual medical records remain               moment, we’re working on an evidence-
How has occupational health                      confidential).                                         based service to manage sickness absence
changed over the years?                             GO-Care is all about quality management             for our clients in Europe. Believe it or not,
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                    LOOKING AFTER THE WELL-BEING
occupational health directly affects safety
and productivity.                                   OF WORKERS AT TOYOTA AUSTRALIA
   We are also moving towards evidence-
based occupational health. Companies are            TOYOTA Motor Corporation is one of                 return to work after ill health, including
keen to meet their corporate responsibilities,      Australia’s leading car manufacturers. It has      primary first aid, diagnosis, support,
to improve the health, safety and                   over 4,500 employees in Australia, spread          treatment planning, active support and
environment of local employees and to make          over six locations with 90% based at its two       advice. Staff assess and advise on a wide
a positive contribution to communities.             main sites in Port Melbourne and Altona.           range of health issues, and provide stability
                                                                                                       and familiarity for workers visiting the
What is evidence-based                              Objectives for Toyota Australia                    centers.
occupational health?                                Toyota’s key objective is to ensure that ‘every        We also carry out pre-employment and
It’s about developing management and                employee is treated as an elite athlete and        employment assessments, monitoring,
reporting systems that enable organizations         the best treatment possible is rapidly sourced     reporting and education. Recent health
to manage risk proactively and coherently.          so that they can be returned to their              education initiatives have included healthy
Specific initiatives can be designed to             workplace as soon as possible.’                    eating and keeping hearts healthy.
combat particular issues that are identified           Back in 2003, with concerns about costs             To raise awareness of healthy practices in
based on evidence. It’s also about                  spiraling, its own health services not widely      the workplace, we are working closely with
implementing coordinated systems and                used, and work injuries (particularly              Toyota Australia to identify workplace
processes to ensure that employees are              musculoskeletal injuries) increasing, Toyota       concerns and put in programs to minimize
treated consistently, wherever they work.           Australia needed a more proactive approach         risk of injury.”
    International SOS delivers a thoroughly         to managing the health of its employees. It
researched, evidence-based medically driven         wanted its Health Centers to be the first port      Measuring progress
service, comprehensively thought through            of call for any employee with a health             International SOS carries out detailed
and comprehensively delivered.                      concern, whether work-related or not.              monthly reporting against key performance
                                                       Toyota Australia needed an expert partner       indicators agreed with Toyota Australia. Data
How is evidence generated?                          who understood its business and had the            is used to target healthcare and education
Data reporting and measurement is critical          capability to deliver a full range of healthcare   initiatives. Key measures this year include a
to effective occupational health                    services. It asked International SOS to work in    fall in the number of musculoskeletal injuries,
management.                                         partnership with its occupational health and       and a reduction in the cost of third-party
   At International SOS we have developed           safety team to design, deliver and monitor a       medical providers.
our own occupational health tool called GO-         comprehensive occupational health                      Paul Furtado is Health Support Advisor on
Care (Global Occupational Care). Its                management program.                                Toyota Australia’s Occupational Health and
backbone is a bespoke piece of software,                                                               Safety Team. “The Toyota/International SOS
which is fully integrated with the other            How International SOS has helped                   relationship is now over 12 months old. In
International SOS systems. We use GO-Care           Philippe Arnaud, Group General Manager             this time a strong relationship has been
to manage a complete suite of occupational          GMS Development explains International             established and quality health outcomes are
health services for our clients.                    SOS’s approach: “We have delivered a fully         being delivered.
   These include comprehensive fit-for-             integrated occupational health program in              Toyota looks forward to continuing to
work programs and vaccination programs.             partnership with Toyota Australia.                 work with International SOS in the important
We also use GO-Care to manage and                      Our medical teams run Health Centers at         area of employee health to ensure that we
support our occupational health consulting          Toyota Australia’s two main sites. They offer a    retain our competitive advantage both locally
services and our occupational health staff          full range of services to promote employees’       and globally.”

                                                                                                                          HOTLINE - ANNIVERSARY EDITION   31

£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. s

  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
                                                        Where others
  potential influenza pandemic and to
  develop pandemic preparedness plans.
     The concern is that if the current virus
                                                 Non-governmental organizations (NGO’s) often arrive
  mutates and gains the ability to spread
  easily from person to person, it may
                                                 in a country when everyone else is leaving. So who can
  emerge as the cause of the next                they turn to in time of need?
  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
                                                 N     ON-GOVERNMENTAL organizations
                                                       (NGO’s) often arrive in a country when
                                                 everyone else is leaving. So who can they turn
  monitoring the situation 24/7 and              to in time of need?
  making the latest information available           Whenever there is a war, famine or
  through our dedicated website, we              environmental disaster, most people’s first
  wanted to give our members practical           reaction is to get out of the area as quickly as
  guidance so that they could put                possible. But for organizations like the UN,
  contingency plans into place for their         Red Cross, WHO, Oxfam, Save the Children
  businesses,” he says.                          and Medecin sans Frontières, this is typically
     “After extensive research, we have          where their work is just beginning.
  developed nine chapters of protocols              Like any large international concern, NGO’s
  and over 120 pages of information to           and indeed government agencies also need to
  ensure employers have the key                  safeguard the health of their employees.
  documentation they need to develop a           Emmanuel Chevron, head of Sales and
  company- and employer-specific                  Marketing in International SOS’s Geneva office
                                                                                                    Banda Aceh – chaos and destruction caused
  Pandemic Preparedness Plan.”                   explains: “With the ever-present threats
                                                                                                    by the Tsunami
                                                 surrounding them, our clients need to be able to

                                                                                                            GOVERNMENTS & NGO

                                                      AGAINST ALL ODDS
                                                      DR Jean-Bernard Carbonnel, who has been         landing permit 2 hours before arrival in
                                                      with International SOS since 1992, recalls an   Kinshasa.
                                                      urgent medical case that he coordinated for        On reaching Geneva a large ambulance
                                                      the Red Cross:                                  was waiting to take the patient to the
                                                         “In March 2002 we received a call in our     intensive care unit in the Cantonal Hospital,
                                                      Geneva alarm center about a four year old       where a successful operation was followed
                                                      girl with severe hepatitis in Kinshasa,         by a full recovery. This project was a triumph
                                                      Democratic Republic of Congo. She was the       of logistics, with our team arranging visas,
                                                      daughter of a Red Cross delegate in the         landing clearance, ambulances and hospital
                                                      country and needed an urgent liver              facilities.”
                                                         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

fear to tread
get medical assistance at a moment’s notice,       employees are essentially no different to those     out over 100 evacuations.
anywhere in the world. Thanks to our global        of a commercial corporation.”                          Mike Penrose was also seconded to the
coverage, we have been able to help a number          Having previously worked in a number of          WHO for six weeks to help set up disaster aid:
of government bodies provide high levels of        NGO’s in war and disaster zones around the          “In an environment with so much suffering and
primary medical care to employees in different     world, Mike is only too aware of the dangers.       a totally traumatized population, it’s very
parts of the world.”                               Indeed, he was once kidnapped by Chechen            difficult to coordinate the aid effort.
                                                   rebels for two months. “When planning their         International SOS’s experience in similar
Security climbs up the agenda                      security, NGO’s must be very conscious about        situations helped us put together appropriate
With the breakdown of former political             how they are perceived. Surrounding yourself        strategies and assist the Indonesian Ministry of
structures and the rise in religious               with bodyguards may be counter-productive           Health to re-establish its own structure.” s
fundamentalism, security is also an issue.         and only serve to alienate local groups; it’s
NGO’s are not always seen as neutral               more important to project an image of absolute
organizations and may get labeled as ‘tools of     neutrality.”
the west’, leaving them increasingly vulnerable.                                                          TSUNAMI AID APPEAL
Security has consequently become a far higher      Tsunami: helping when disaster strikes
priority and a number are turning to               With its global infrastructure and experienced         THANKS to the generosity of customers
International SOS for advice on protecting staff   staff, International SOS can offer much-needed         and staff, International SOS has been able
and facilities and minimizing the risk of          advice and on-the-ground support to both               to raise over $330,000 dollars to help
terrorism, kidnapping and crime.                   governments and NGO’s. Following the 2004              victims of the disaster in Banda Aceh.
   “Where NGO’s may once have been seen as         Tsunami that devastated Sri Lanka, Indonesia,          These funds are being used to sponsor 80
a group of well-meaning amateurs they are now      Thailand, Maldives and Malaysia, it gave               young Indonesians from Aceh over the
large, established, professional organizations     valuable logistical aid to the UN and AUSAID           next four years to become nurses, so that
with full time staff,” explains Mike Penrose,      (the development wing of the Australian                they can actively participate in the
Regional Security Manager, International SOS.      Government), providing a team of 20 medics             rebuilding of their community.
“The security and medical needs of their           on the ground in North Sumatra, and carrying

                                                                                                                         HOTLINE - ANNIVERSARY EDITION   33

Widening the net
                          Thierry Watrin, Corporate Director, Global                               automatically. It is also integrated with our
                                                                                                   case management system, to ensure that the
                          Assistance Network, joined International                                 process of dealing with each individual case is
                                                                                                   as smooth and efficient as possible.
                          SOS in 1998. He has been responsible for                                    For a small number of our largest clients,
                                                                                                   we’ve developed tailor-made provider
                          developing the global network of medical                                 networks, available via the Internet. In
                                                                                                   particular, we can make details of key
                          and other providers that International SOS                               providers available to members through our
                                                                                                   online country guides.
                          can call on anywhere and at any time.
                                                                                                   Into the future
                                                                                                   The Global Assistance Network, which now

“W         HEN I joined International SOS
           there was already a strong network
of providers established in Asia, with more
                                                   tool used daily by our GAN managers and
                                                   coordinating doctors for managing the quality
                                                   of service delivered by our worldwide
                                                                                                   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
informal networks in place in other regions.       network, from assessing and credentialing       providers and preferred providers growing, but
   Years previously, the company had               providers, to ensuring smooth payment and       with the depth and quality of information
sometimes relied on the co-operation and           administration when help is needed.             continuing to improve. Key areas, like China,
resources of our correspondents to record             When someone from International SOS          are expanding quickly, and new parts of SPIN,
information about medical providers in             visits a provider, they use SPIN to record      for example a whole new function for provider
different parts of the world. All cases were       details about its organization and services.    credentials, is being released.
handwritten or typewritten, and to search for      This helps us make the right choices on            Thanks to the energy and dedication of the
individual cases required a trawl through          behalf of our clients and means we can          Global Assistance Network team, we have
stacks of physical files.                           develop a set of preferred providers. SPIN      managed to formalize our network rapidly
   The big change came when an important           also holds comprehensive records about          while continuing to meet the urgent needs we
client, the insurance company Tokio Marine,        providers, including licenses to practice,      deal with every day.
asked us to establish a cashless network of        medical qualifications, terms and conditions,       The network is the backbone of
medical providers for its clients worldwide.       and site audits.                                International SOS and a vital part of the way
Timothy Yee and Dr Doug Quarry at our                                                              we deliver services to our clients. There is still
Singapore alarm center established a system        Widening access                                 much to do, but the last three years have seen
to document assessments and details of             As a web-based tool, SPIN is accessible         a lot of progress in our development of such
medical providers onto a database and to set       worldwide and updates are available             an unique resource.” s
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

                                                                                                        IN-FLIGHT SERVICES

Safety in the skies
                                                                                                 emergency medical treatment procedures,
When a Lufthansa passenger suffered a heart attack                                               which includes simulation exercises.
on a long distance flight, he was in the safe hands –                                             Serving the aviation industry
of a doctor hundreds of miles away.                                                              “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,

I N FEBRUARY 2003 a middle-aged man
  suffered a myocardial infarction whilst his
Lufthansa flight was passing over Siberia.
                                                 procedures. Our doctors will calm everyone
                                                 down and help the captain decide whether a
                                                 diversion is necessary.”
                                                                                                 Priority Passenger Services (PPS),” Kasey
                                                                                                 Khaw, Regional Director, Global Accounts
                                                                                                 Asia, explains. “The airline was impressed
This was cause for serious concern.                 International SOS offers in-flight services   with International SOS’s ability to provide
   Fortunately the pilot was able to contact a   to Lufthansa, Singapore Airlines (SIA) and a    remote medical care and assistance. We had
German-speaking International SOS doctor         number of other carriers, as well as            successfully carried out some medical
by satellite phone at the Frankfurt alarm        supporting several fleets of private jets for    evacuations for individual customers whilst
center. The doctor assessed the patient’s        multinational corporations.Training is          on business and personal trips. Offering in-
symptoms and concluded that it was               provided for the airline flight crew in          flight services was just a natural progression,
imperative to get him to a hospital as soon as                                                   where we combined our on-board medical
possible. Having checked the database, he                                                        experience with our geographical knowledge
confirmed that the nearest appropriate
facilities were in Almaty. The pilot agreed to
                                                 “It’s the closest                               of appropriate medical providers and
                                                                                                 facilities. Our in-flight medical assistance
land at the local airport and the patient was
rushed in for emergency treatment.               thing to having a                               teams are all aero-medical specialists trained
                                                                                                 in aviation medicine.”
   “In-flight medical assistance is a highly                                                         Today, International SOS is also working
specialized service requiring an in-depth
knowledge of emergency treatment and an
                                                 doctor next to you”                             with airlines’ medical departments to help
                                                                                                 reduce the risk of medical incidents by
understanding of how patients react when at      MR YAP KIM WAH, SIA SENIOR                      providing pre-flight screening for both
35,000 feet,” says Dr Michael Weinlich,          VICE-PRESIDENT MARKETING                        passengers and crew. Whilst you’ll never be
Medical Director International SOS Germany.                                                      able to guarantee that there’s a doctor on
“You have to know the nature of on-board         SERVICES, TALKING ABOUT THE                     every flight, a ‘virtual’ medical team is the
conditions and be familiar with flight            TELE-MEDICAL SERVICE                            next best thing. s

                                                                                                                  HOTLINE - ANNIVERSARY EDITION   35

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.

T    HE PROBLEM of non-compliance has
     been plaguing the healthcare sector for
years. In some cases as many as 80% of
                                                   the treatment and make necessary behavioral
                                                                                                                  have. We talk to them about their lifestyle and
                                                                                                                  for certain treatments, the importance of a
                                                                                                                  healthy diet. Many people expect a quick fix,
patients fail to finish their course of treatment   Holding their hands                                            so we also have to manage their expectations
or take their medication correctly. This can       “We’re there to provide ongoing support to the                 and educate them on the long term nature of
have very serious consequences for the             patient, holding their hands through the                       the benefits.”
patient’s health, as well as costing the health    journey,” says Ben Connor, International SOS                      Patients enrol voluntarily, usually after
service the time and expense of re-admissions      Operations Manager, Pharma Services. “Our                      hearing about the program from their doctor
and further treatment.                             aim is to give patients a better understanding                 or pharmacist. International SOS will then
   There are many reasons why so many              of the medication and what effects it may                      work to a contact plan, calling at critical
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,               Reasons given by patients for ceasing antidepressant therapy
especially when the symptoms are hidden,
such as with high cholesterol. While poor                     60
compliance is often attributed to simple                      50
forgetfulness, in fact, the majority of patients              40
can articulate their reasons for ceasing                      30
therapy. In a bold move, doctors, pharmacists,                20
health managers and the pharmaceutical                        10
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               Ref: K. Demyttenaere et al. Compliance with antidepressants in a Primary Care Setting, 1:
receive a combination of information and               Beyond Lack of Efficacy and Adverse Events; J Clin Psychiatry 2001; 62
encouragement, helping them to understand

                                                                                                                          PATIENT SUPPORT

                                                                                                           “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

points, during a prescribed period. This can       patients, echoes Ben’s sentiments “We get so       approach: the patient improves his or her
vary between three and six months depending        much positive feedback from patients. One          condition; the health service saves time and
on the therapy.                                    woman recently told me she had just got out        money; and the pharmaceutical company
   The level of attention is a vital factor,       of her wheelchair and hung the washing up for      benefits from longer treatment regimes,
according to Maggie Butler, a registered           the first time in fourteen years, after             helping them establish their therapies.
nurse who works on one of the programs:            successfully losing weight. Whilst another            One client reported that the average
“Doctors just don’t have the time to talk to       improved her health and became pregnant, and       treatment duration has subsequently more than
patients at length, and sometimes it can take      rang to tell me that I had changed her life.”      doubled, with patient satisfaction with the
days to simply get an appointment. We’re on                                                           program running at over 85%. Importantly, the
the other end of the phone any time they want      Win-win                                            concept has the blessing of health
to call us.”                                       Patient Support is proving increasingly            organizations who realize the benefits of a
                                                   popular, with International SOS working with       healthier population. Indeed the UK
Highly rewarding                                   pharmaceutical companies across Europe,            Department of Health is so concerned with
Patient support is relevant for a wide range of    Asia and Australasia. It’s essentially a win-win   non-compliance that in 2002 it set up The
longer term or chronic conditions such as                                                             Medicines Partnership, a task force aimed at
cardiovascular conditions, diabetes, high                                                             helping patients get the maximum benefit
cholesterol, multiple sclerosis, osteoporosis,
obesity, rheumatoid arthritis and HIV Ben
                                                   “This is the most                                  from their medicines and therapies.

                                                                                                      Patient Support is an intrinsic
Connor continues: “We have nurses, exercise
physiologists, nutritionists and a range of        rewarding job I’ve                                 element of this initiative
other specialists who have developed an in-                                                           The last word goes to Ray Rowden1, an
depth understanding of the various treatments
we support. Most importantly, we can give
                                                   ever had, knowing                                  adviser to the UK Health Service, who
                                                                                                      believes we need: “...to create a generation of
patients all the time they need, whether they’re
concerned about side effects or merely want
                                                   that I can make a                                  patients who are empowered to take action,
                                                                                                      with the health professional caring for them.
some encouragement. In over twenty years of
working, this is the most rewarding job I’ve       real difference to                                 Patients will receive the support to take more
                                                                                                      control of their own health and treatment and
ever had, knowing that I can make a real                                                              to make more appropriate use of health and
difference to people’s lives.”
   And International SOS nurse Maggie
                                                   people’s lives”                                    social services.” s

Butler, who provides support to obese              BEN CONNOR, INTERNATIONAL SOS                      1.   Rowden R. The Expert Patient, Pharmaceutical Field, April 2002.

                                                                                                                                  HOTLINE - ANNIVERSARY EDITION              37

                                                                                                       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.”

Adding value
                                                                                                          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
International SOS is using its remote servicing skills                                                 to mobile phone users.
                                                                                                          Expectations are high, says John: “Our
and logistics expertise to help clients deliver premium                                                clients want comprehensive feedback on who
                                                                                                       is making the calls and how quickly and
services to their customers.                                                                           effectively their customers are dealt with. Our
                                                                                                       management information systems - initially
                                                                                                       developed to manage complex medical cases

E    VERY DAY a team of skilled car
     mechanics arrives at International SOS’s
alarm center in Sydney. But they’re not
                                                 premium services to help clients around the
                                                 world differentiate themselves from the
                                                 competition. “One of our core competencies
                                                                                                       - are able to give the kind of detailed reports
                                                                                                       they’re looking for. But above all, they have
                                                                                                       the confidence of knowing that International
wearing overalls and they won’t be getting       is highly skilled and trained specialists who         SOS is always fully committed to keeping the
their hands dirty. Their job is to take calls    are determined to solve any caller’s problem.”        customer happy - no matter what they’re
from worried motorists, talk them through        John Jessup continues: “Our sophisticated             demanding.” s
their concerns and if necessary arrange to
send a breakdown vehicle.
   This is part of a specialized service            “SUBARU has entrusted International SOS to        technicians as operators who have a real
provided for drivers of new Saabs, Ferraris,        provide Premium Assistance Service to our         understanding of the customer’s needs
Maseratis, Alfa Romeos, VW’s and other top          customers across Australia since February 2002.   together with a focused account
marques. “Because the mechanics really                 Customer interaction and high quality          management team.
understand the cars, one in three calls gets        service is a vital part of our business, and we      Subaru’s philosophy is based on doing the
resolved without having to send out a               have found International SOS to be a highly       common things uncommonly well and
breakdown truck,” explains John Jessup,             valuable and professional partner. From a flat     International SOS is a key part of that
Managing Director, International SOS,               tyre to an accident, International SOS            strategy.”
Australasia. “With our expertise, we can            provides assistance and peace of mind.
handle calls on behalf of our clients and help         They understand our business, our culture      Derek Ashby
offer something extra to their customers.”          and our customers. They have proven to be         Subaru National After-Sales Manager
   ‘Auto Assist’ is just one of a number of         flexible and provide skilled automotive            Subaru Australia
ways in which International SOS is providing

                                                                                       GLOBAL SYSTEMS

                                                   Knowledge is
        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.                                  Advanced technology lets International SOS globally
    “If a patient is moving between time
zones, then doctors in different alarm centers     monitor a patient’s condition in real time.
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.” s
Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom
Phone: +44 20 8762 8000
Fax:     +44 20 8762 8400

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