20 TH Anniversary Hotline

hotline
International SOS Worldwide Journal
20 ANNIVERSARY OF INTERNATIONAL SOS

TH
1985-2005
Contents
04 A PASSION FOR QUALITY
ELCOME to this special edition of

Hotline. To mark the 20th
anniversary of International SOS, this

issue is devoted to a review of just some
of the milestones in the companys
history. It looks back at a few of the more
dramatic events from the past 20 years.
There are memories of International SOS
in the early days, of individual clients and
members, and recollections from
CARE AND SERVICE

International SOS founders, Dr Pascal
Rey-Herme and Arnaud Vaissi,
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,
which stretched International SOS
resources to the limit.
08 A 20-YEAR PARTNERSHIP
A focus on BP, with whom International
SOS has been working for 20 years to
provide a duty of care to its employees,
their families and local communities
throughout the world.
10 HOSPITALS IN THE AIR

A look at the vital work played by
International SOSs global fleet of
air ambulances around the world.
International SOS people who have played

a key role in the companys 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.
2
INTERNATIONAL SOS
18
04
12 PIONEERING A NEW
SERVICE CULTURE
Personal memories from Dr Inggriani
Gandha of the opening of the very first
International SOS clinic.
08
22 THE WORLD AT YOUR FINGERTIPS
A close-up of how International SOSs
clients can harness the power of
technology to provide a global duty
of care.
10
34 WIDENING THE NET
A spotlight on SPIN - the tool for
accessing International SOSs 24-hour
network of medical and other providers.
35 SAFETY IN THE SKIES

14 ALL HANDS ON DECK
Recollections of the early days at
International SOSs first alarm center,
and the rapid response they provide
today.
17 STRAIGHT FROM THE TOP

How International SOSs most senior
medical team is involved in delivering
front-line care.
18 EVERYBODY OUT
The dramatic events that unfolded during
Indonesias civil unrest in 1998.
24 A VITAL 20 HOURS
International SOS medic Patrick Deroose
recalls a mass medical evacuation from Bali.
26 ANYWHERE IN THE WORLD

How International SOS is delivering
healthcare services in some of the
remotest regions on earth.
Designed by Andrew Kellard Associates +44 (0) 1483 549095.
26
36 SUPPORTING PATIENTS
IN A NEW WAY
A look at the new service provided to
patients who need to take prescribed
medication long term.
30 A CHANGE OF GEAR IN
OCCUPATIONAL HEALTH
A conversation with Dr David Cook about
the importance of occupational health
services and how they have changed over
the years.
21 MORE THAN AN
EMERGENCY SERVICE
How one International SOS doctor views
the importance of membership.
The story of how one Lufthansa passenger

received vital medical care on a longdistance flight.
38 ADDING VALUE
How International SOSs logistics
expertise is helping clients to deliver
premium services to their customers.
39 KNOWLEDGE IS POWER
32 WHERE OTHERS FEAR TO TREAD
An insight into the work undertaken by
International SOS for governments and
NGOs in some of the worlds hotspots.
Innovations in technology mean that

patients can now be monitored in real
time, irrespective of where they are in
the world.
38
HOTLINE - ANNIVERSARY EDITION
INTRODUCTION
INTERNATIONAL SOS
A passion for quality

care and service
Since they founded the company in 1985, Dr Pascal
Rey-Herme and his childhood friend Arnaud Vaissi have
seen the company rise from humble beginnings to become
the worlds leading provider of medical assistance,
international healthcare and security services.
How did the company begin?
Pascal: I was working in Jakarta as Medical
Attach for the French Embassy and observed how
medical care in Asia was very much based around
the hospital. I felt that there was a big opportunity
to bring in a European model of pre-hospital care,
including a medical rescue service. Arnaud was
based in San Francisco at the time and I persuaded
him to join me in setting up this new venture.
Arnaud: I was told that you should never go into
business with your friends but weve proved that
it can work! We gave each other support and
fortunately our styles are complementary.
Naturally we have our differences but when it
comes to the major decisions, we have always
been in agreement. Essentially our early vision
was the same as it is now to offer complete
healthcare solutions to organizations and
institutions firstly in Asia and now globally. And
from day one we have both been passionately
committed to quality service something that will
never change.
open-pit coal mine in Kalimantan, Borneo, and

our remote site services began. Today we run over
200 such operations, with hospitals and clinics,
taking care of tens of thousands of people
including both employees and the local population.
Arnaud: We were very small at first, with just two
small clinics in Singapore and Indonesia, and 14
staff. But we saw tremendous growth from day
one. Although at first we only had small pieces of
business, they were with large clients such as BP,
Schlumberger and Alstom, with the potential to
grow. Im delighted to say that all our clients from
our early days are still with us today, as are many
of our original employees.
How did the business develop in the

early days?
Pascal: Our first plane was a small Beechcraft

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

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

idea, but we soon realized that this gave us a base
to employ and train specialists, which is now one
of our core strengths. Now we have 24 clinics
around the world, but they all stay true to the initial
concept of 24/7 pre-hospital and emergency
services.
INTRODUCTION
Tell us about some other key milestones

Arnaud: In many cases weve 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 werent 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
weve now rolled it out worldwide.
Pascal: Our online services really proved
their value during the SARS epidemic,
where there was a huge need for accurate,
practical information on a daily basis. Our
general attitude is: if it needs to be done,
well find a way to do it. This was amply
demonstrated during the recent SARS
epidemic. We were told that we couldnt
evacuate patients due to the risk of infection,
so our team lead by Dr Roger Farrow,
quickly developed a Portable Medical
Isolation Unit (PMIU).
Arnaud and Pascal relaxing on the Great Wall

having obtained the right to open an
International SOS clinic in Beijing in 1989
Pascal: It also allows us to stay true to our

initial ideas where a customer will always
reach a trained professional who can
understand his or her situation and quickly
pass the caller onto a medical or security
professional.
What are the main challenges now

that the company has grown so large?
Pascal: We have to sustain the same culture
and values that have driven us from the start:
a medical heritage and a passion for patient
care. Now that there are over 4000 people,
we have to work harder to achieve this, and
recruitment and training have a very big role
to play to ensure we maintain quality control.
Arnaud: Logistics is a key development area,
as we serve more and more clients and
individuals, and IT plays a central role. We
have recently invested millions of dollars and
thousands of man-hours into a new global
case management system called Magellan.
This means that anyone dealing with a
patients case from an alarm center will see
the same details in real time, enabling us to
create virtual coordinating teams with
doctors from around the world. When you
consider that we handle over 600,000 cases a
INTERNATIONAL SOS
year, this speeds up our service and radically

improves the quality of our decision-making.
Laurent Sabourin speaking at the inaugural

ceremony of the office in Taipei
Arnaud: To achieve the global reach that our

clients demand, we have had to expand
quickly, and acquisitions have played a big
part in achieving this. Of course the biggest
single addition was the purchase of
International SOS Assistance in 1998, which
meant we became a global rather than a
predominantly Asian company, with a far
bigger US presence.
What about the future?
40% of our
existing business
is with services
developed in the
past five years
ARNAUD VAISSI
Pascal: My main aim is to ensure that we

continue to offer the highest quality service
to our clients. To achieve this we need to
attract a new generation of dedicated
professionals. Arnaud and I were 30 when
we started the business and we want to bring
in talented 30 year olds to keep driving the
organization forward.
Arnaud: Innovation is the key: providing
unique new services and as Pascal said,
attracting the best talent in the world. I
spend a lot of time interviewing, and see this
as my number one responsibility to ensure
we all get the very best people to join us.
FIRST EVACUATION
A challenging flight
A double
success
We asked Dr Pascal Rey-Herme to tell us about some
of the first medical evacuations he was involved with
for International SOS. Here he remembers one
afternoon in 1985 when his team received two
simultaneous calls for help.
JAKARTA-BASED church which ran a

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

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

was too short for the HS 748, so we arranged
for a light aircraft belonging to the
missionaries to meet our incoming team at
Banjarmasin and take them and whatever
equipment they could fit into the small
aircraft on to the mission.
From Jakarta we contacted the Indonesian
authorities to get landing clearances at
Banjarmasin airport at sunrise (the airport
had no facilities for night-time take-offs or
landings).
The pediatrician, the mother and her
premature baby were squeezed into the light
aircraft and taken to Banjarmasin, then
transferred to the HS 748. The head of
immigration was waiting at the aircraft with
the necessary travel documents, and the
mother and baby were rushed to Singapore.
Weighing just 1.9kg, the baby was taken
straight to hospital where Im pleased to say
both mother and baby recovered well from
their ordeal.
Another emergency
At the same time as we were harnessing our
resources to save the baby, another request
came in, this time from Malaysia. An
American oil worker had been transferred
from an offshore platform to his company
clinic in Kerteh. Suffering from a heart
condition, he needed urgent transfer to
hospital in Singapore. As the HS 748 was
already being used to transport the baby, the
only aircraft available to us was a much
smaller plane called a Queen Air.
With our Singapore escort team already
flying to Indonesia to care for the baby, I went
on the journey to Kerteh to escort the patient
to Singapore. On arrival I discovered that he
was 1.95m tall and weighed over 140 kg.
(These days its standard procedure to check
this type of information before a flight.) With
considerable difficulty we got the patient, the
pilot and me on board. We then flew back to
Singapore where we landed at the same time
as the baby. I will always remember one of
our Singaporean nurses exclaiming at the
time: So, you put the big patient in the small
plane and the small patient in the big plane!
After carefully extracting the patient from
the small plane, we transferred him safely to
hospital. Facing many challenges, we had
successfully completed two evacuations at the
same time.
FIRST CLIENT
A 20-year
partnership
International SOS has been working with BP for 20
years. Sandy Johnson who joined the company in 1985
recalls that right from the start, she saw the
importance of combining international standards with
local knowledge and experience.
WAS BASED in Singapore in 1985 and

met two charming French gentlemen
through a friend of mine who was a nurse and
had done medical evacuation work for them.
They were looking for somebody to
communicate with American and Western
clients operating in Singapore and Jakarta.
Having grown up in Texas and with the oil
industry, I was very aware of the importance
of medical evacuations and was fascinated by
the work that Pascal and Arnaud were doing.
I joined as Director of Marketing in July
1985. At that time there were many European
and North American companies operating in
Indonesia who were drilling for oil and gas in
the area, as well as organizations providing
support services to them. It was natural for us
to work with these companies because they
had a specific need we could help them with.
We also worked extensively with
embassies, insurance companies and private
citizens who were looking for real-time local,
medical support. Unlike the European
assistance companies at the time, who had no
physical presence in Asia, we had people on
the ground and had developed very strong
relationships with doctors and hospitals in the
region.
Our first client was BP. They had
operations in Sumatra and at the time had a
problem with malaria on one of their remote
sites. Pascal heard about this through one of
INTERNATIONAL SOS
PARTNERING WITH BP
Our relationship with International SOS
has been successful because they
understand our business needs and our
culture. International SOS teams can
work seamlessly with our staff in the
field and provide specialist skills, advice
and experience where needed.
International SOS has the global reach
we need combined with vital local
knowledge. Its network of alarm centers
and family-based clinics is a very useful
resource for BP worldwide.
Dr Alison Martin, Health Director,
Exploration & Production, BP
The security of our employees across the
globe is of paramount importance. In
order to assure ourselves of our ability to
relocate any of them in times of crisis,
we have contracted on a long-term basis
with International SOS to take advantage
of their expertise and capability to effect
such emergency relocations, and have
tested that capability in a real situation
with great success.
Nigel Carpenter, Deputy Head, Group
Security, BP
the managers who was using our clinic. He

was invited to visit the site, undertake a
survey and set up protocols for malaria. He
also arranged an evacuation service using our
clinics and alarm centers in Jakarta and
Singapore.
The relationship with BP is ongoing. I
think the reason why weve been successful is
because we have common goals: we were
able to provide them with locally based
services. Local knowledge is so important. If
you break your leg in Singapore, theres no
big problem because medical services are
available. If on the other hand, youre with a
geo-thermal crew in Sumatra and you break
your leg, its a completely different situation.
Its not possible to undertake night flights on
helicopters. We had to develop detailed plans
for BP to evacuate people by road ambulance
to a point where the aeromedical evacuations
could be done by fixed wing.
Over the years weve maintained an
unwavering, uncompromising commitment to
quality. Ive always been absolutely sure that
we would get the job done. Arnaud and
Pascal lead from the front and there is
accountability through every layer of the
organization. I call the company a diamond
it has many facets, with a core integrity.
Assistance in partnership
International SOS has been working with BP
for 20 years, helping to ensure the well-being
of employees, their families and local
communities throughout the world.
As one of the worlds major energy
companies, BP is committed to meeting its
corporate responsibilities to the environment,
to its people, and to the communities in
which it operates. Its an ethos that
International SOS readily understands and the
two companies have worked closely together
at a global and local level.
Work on projects
International SOSs relationship with BP
started in 1985, when Dr Pascal Rey-Herme
was asked to assist with a malaria outbreak at
one of BPs remote sites. International SOSs
involvement with BPs anti-malaria programs
still continues today.
Since then International SOS has been
involved with many of BPs largest projects.
International SOS is often there right from
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 BPs own security divisions.
24-hour security advice and evacuation
assistance is available to BP employees
abroad, and International SOS experts work
on BPs projects providing advice and support
on security and risk management.
In just one example, an International SOS
team provided security consultancy to BPs
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 BPs 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.
Picture courtesy of BP
Medical services support
care services to workers on site. As each

project develops, employees families join
them and local people are hired. So
International SOS broadens its service to
include the full spectrum of healthcare in the
community, including family and
occupational health services.
ASSESSING THE HEALTH OF

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

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

some of the largest energy and exploration
projects in the world today. International
SOS is currently providing a full suite of
project-based medical services to a number
of BP projects across the globe including the:
Namconson Liquefied Natural Gas (LNG)
project in Vietnam, Tangguh LNG project in
the Papua region of Indonesia, various BP
projects in the Caspian region and new
ventures in Russia, including Sakhalin Island
in far east Russia.
Growth and evolution

The partnership between BP and
International SOS has grown from the close
involvement of one doctor to the fully
structured corporate response service it is
today. Martin Dennett is Business
Development Director for Energy, Mining
and Infrastructure at International SOS: By
aligning ourselves closely with BPs
business, we can deliver comprehensive
solutions to help provide a duty of care to its
employees and their families. BP takes its
corporate responsibilities seriously, and in
partnership with them we can help to ensure
that medical and security risks to employees,
their families and local communities are
managed effectively.
Hospitals in the
International SOSs air ambulances are a vital
link in providing bed-to-bed care for patients.
SIX-YEAR-OLD child was lying in a

hospital bed in Abidjan in the Ivory
Coast following a snake bite. International
SOS doctors in Johannesburg were
monitoring his condition, but one vital piece
of information was missing: what kind of
snake had bitten him? They decided it was
too risky to wait.
It was June 2000 and the newly
commissioned Falcon 10 air ambulance was
about to make its first medical evacuation.
Within hours the boy had been picked up and
flown, with the unidentified snake in tow, to a
modern hospital in Johannesburg, where he
was placed in intensive care.
It turned out that the bite came from the
potentially deadly West African Carpet Viper
and would probably have proved fatal in this
child. The boy was given the appropriate
serum but also needed to be on a ventilator.
He made a full recovery and was able to
return home a few weeks later.
With its high quality of medical facilities,
South Africa and Johannesburg in particular
is very strategically placed in relation to
10
INTERNATIONAL SOS
the rest of Africa, explains Dr Fraser

Lamond, Regional Medical Director Southern
Africa. Logistically our jet air ambulances
can access anyone up to fifteen degrees north
of the equator. We are also supported by our
air ambulances based in Europe which can
also overlap this area into sub-Saharan Africa
thereby allowing us to efficiently cover the
entire continent.
And the demand for evacuations to South
Africa has spiraled in recent years: With
three dedicated aircraft, we make over 100

medical transports a month between our
resources based in South Africa, Botswana
and Namibia. We have been as far afield as
the Maldives, Ascension Islands, Canary
Islands and Diego Garcia. Overall, more than
two thirds of all the patients brought into
South Africa for medical care are handled by
International SOS.
A growing fleet worldwide

From the early days it was a real challenge
getting quick access to suitable aircraft for
the medical teams operating out of Jakarta
and Singapore. This prompted the company to
think seriously about investing in its own jets.
Since the Falcon 200s maiden air
ambulance flight from Singapore in 1997,
International SOS has expanded its fleet to
ten, making it one of the worlds largest air
ambulance service providers. With bases in
Germany, Russia, South Africa, Namibia,
Botswana, Singapore, China and Papua New
Guinea. The speed and range of the aircraft
enables International SOS to reach patients
virtually anywhere in the world. There are a
variety of aircraft including Learjet, Falcon,
Hawker and even turbo props that can land in
particularly difficult terrain where there may
be no proper airstrip.
The aircraft are quite literally intensive
AIR AMBULANCES
air
care units in the sky, carrying everything
necessary to cope with a medical emergency,
including resuscitation equipment, oxygen,
infusion pumps and a full range of drugs,
fluid and supplies.
All our medical staff is fully trained in
aviation and emergency medicine and has
extensive medical evacuation experience,
says Dr Arnaud Derossi, International SOSs
Regional Aviation Medical Director for the
EMEA region. They can manage adults,
neonatal and pediatric cases, with the most
common conditions being cardiac conditions,
traumas, infectious disease, head and spinal
injuries.
Medical missions need to be flown by
pilots who are expert in air ambulance
processes and knowledgeable about the
medical teams requirements. They also need
to have the experience of dealing with the
logistics of flying in and out of remote sites
where conditions may be rudimentary.
Although the vast majority of flights are
on our own jets, we also have access where
necessary to a range of other aircraft
including executive jets, helicopters and even
military aircraft or wide-body aircrafts.
Sophisticated logistics
Whilst the pilots and paramedics on board are
at the sharp end, the aviation specialists in the
MAKING A DIFFERENCE
FROM the moment we arrive on the scene,
weve upgraded the quality of care, says
Dr Tyrone Richards, Deputy Medical Director,
International SOS, South Africa. Medical
facilities are virtually non-existent in many
parts of Africa, so we can offer real hope for
the patient.
Each day is a new adventure; you never
know where you may end up. One of our most
dramatic rescues involved a fifty-year-old
alarm centers manage all the logistical

aspects of an evacuation. The nerve centers
are the four regional aviation units in
Frankfurt, Johannesburg, Singapore and
Philadelphia.
Dr Derossi explains some of the key
challenges in creating an integrated support
structure: Access and landing permits are
critical to the success of a mission and our
centers can obtain landing clearances and
coordinate the complex set of activities
required at destination airports.
And when every minute can literally mean
the difference between life and death, local
knowledge and contacts can help get you
through customs and immigration quickly.
We recently evacuated a seriously ill patient
from Tajikistan to London, which required
clearance across seven different countries air
space.
The coordination activities also involve the
utilization of ground ambulances and
woman in Mozambique with 60% burns. We

had a very bumpy ride due to bad weather
and we had to use a tube to get oxygen into
her lungs.
On landing in Johannesburg we rushed her
to a preferred hospital. It was touch and go
but fortunately she pulled through and three
months later was back home, working again.
Its so satisfying to know that youve made a
difference.
helicopters, and communication with staff at

clinics and hospitals to prepare them for the
patients arrival.
Bed-to-bed care
Its capability, continuity and quality of care
that distinguishes our service, Dr Fraser
Lamond tells us. We offer a high standard of
medical care and attention throughout the
transportation process. And every detail
counts: we deliver a safe reliable service to
those who need it.
The integrated nature of International
SOSs local, regional and international
network means that from the very first call,
we can manage just about any logistical
challenge and deliver medically appropriate
services and support.
There are many decisions to make during
an emergency: finding the quickest and best
transportation should not have to be among
them.
11
FIRST CLINIC
Pioneering
a new service culture
Dr Inggriani Gandha joined AEA
International, now International SOS, in
1985. She was part of the team that
opened the first clinic in Jakarta.
R INGGRIANI Gandha (known locally
as Dr Inge) trained as a doctor in
Indonesia. She spent 11 years in Germany,
studying in Aachen and specializing in
gynecology. In 1983, she returned to
Indonesia and joined AEA International (now
International SOS). In 1985 she was part of
the team that opened the first clinic, in
Jakarta.
As well as delivering primary healthcare

services to expatriates and their families, the
clinic pioneered emergency care to patients
before they were evacuated, often to hospitals
in Singapore. We have always been strong
on our emergency response capabilities. Back
when we first started, the type of service we
offered was virtually unheard of in
Indonesia.
First beginnings
Changing the culture
We set up the first clinic in 1985 in Jakarta

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

clinic was forging a new, more serviceoriented culture among healthcare
professionals. Dr Pascal Rey-Herme
recruited and trained a team of local doctors
Establishing services
Opening the new clinic was fraught with
practical difficulties and challenges. We
struggled even to get a telephone line
installed, she remembers. After just a few
months, and with a small medical and
operations team in place, the clinic opened its
doors.
In the early days, a large proportion of
our clients were international oil and mining
companies, says Dr Inge. They came to us
because they knew their people would get
access to international standards and
procedures they recognized.
12
INTERNATIONAL SOS
to work at the clinic.

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

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

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

clinic. We also do a lot of medical check-ups
for companies as part of their employee
healthcare programs. Of course the percentage
of emergency cases is small but we provide
dedicated intensive care, she says.
Our clients today still value international
medical training and standards. While
English language capabilities are critical, the
spectrum of nationalities among our staff is
wide, including Australian, South African,
American, Malaysian, Philippine, French,
German and British.
International standards
During her career, Dr Inge has traveled
extensively and gained experience of
Dr Rey-Herme
emphasized right
from the start that
the patient was at
the center of
any decision that
was made
healthcare services on every continent. She

speaks six different languages and
understands cultural differences in the
delivery of healthcare around the world.
My time in Germany was instructive in
terms of getting experience of international
standards, she says. Ive learned about the
differences in emphasis and expectation in
different countries. And of course sometimes
you have to adjust your approach to your
environment. But international standards of
medical care are essentially the same
everywhere and thats what we are here to
provide. Whether youre in Moscow or
Beijing, the standard of care youll receive is
the same.
INTERNATIONAL SOS clinics operate in

countries where medical care of an
international standard is unavailable, or
where cultural and language barriers make
it difficult to receive appropriate care.
Each clinic offers primary care,
diagnostic care and 24/7 emergency care.
Services include family practice
consultations, pediatrics, ophthalmology
and occupational health programs. Clinics
are well equipped with the facilities
needed to stabilize a critically ill or injured
person before evacuation. Many clinics
have international-standard pharmacies,
laboratory services and diagnostic services.
Many are also equipped to offer x-ray and
ultrasound tests, dentistry, physical
therapy and counseling.
There are 24 International SOS clinics
worldwide in the following locations:
Angola:
Azerbaijan:
Cambodia:
Chad:
China:
Indonesia:
Kazakhstan:
Mongolia:
Myanmar:
Nigeria:
Russia:
Vietnam:
Gamek
Ilha
Baku
Phnom Penh
NDjamena
Beijing
Nanjing
Shekou
Tianjin
Jakarta (2)
Bali
Almaty
Atyrau
Ulaanbaatar
Yangon
Lagos
Port Harcourt
Warri
Moscow
Yuzhno-Sakhalin
Hanoi
Ho Chi Minh City
Vung Tau
DR INGE, INTERNATIONAL SOS

13
All
hands
on
deck
at the first International SOS alarm center
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.
OR 18 YEARS, Dr Farrow has been

closely involved with the development of
the International SOS alarm center network.
Here he looks back at the early days, at what
has changed and what has stayed the same.
Back when we first started, it was all
hands on deck, he says. Arnaud [Vaissi]
and Pascal [Rey-Herme] were involved with
every case, with Pascal and I always on call
to give medical assistance to clients and
undertake medical evacuations. This was in
the days before mobile phones, when we
each carried pagers and bags of 10-cent coins
ready to rush to the nearest public phone. I
remember sharing our very first Ericsson
14
INTERNATIONAL SOS
mobile phone. It was huge, and the networks

werent great, but even then we were leading
edge in terms of telecoms and technology.
Early days
Sharing and swapping apartments and
traveling between Jakarta and Singapore, Dr
Farrow and Dr Rey-Herme were on constant
call at the Singapore and Jakarta alarm
centers when in 1989 the Hong Kong alarm
center opened and additional medical staff
came on board. There were a lot of mining
and infrastructure companies in Asia, and a
large population of expatriates and families.
Medical facilities were certainly not what
they are today, but we were doing frequent

medical evacuations so the level of expertise
was high and the process very efficient. We
learnt right from the start about the
importance of harnessing the
complementary skills of both expatriate and
national staff just as we continue to do
globally today. This mix of expertise has
been a key element in the companys
success.
Zaleha Hassan also worked at the
Singapore alarm center in the early days.
Back then we did everything ourselves, she
remembers. We rushed to embassies to apply
for visas, picked up medication, filled up
FIRST ALARM CENTER
oxygen tanks locally, and went to the airport

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

company, its
humanity and
compassion, have
been preserved
ROGER FARROW, INTERNATIONAL SOS
Soul of the company
SERVING INTERNATIONAL SOSS

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

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

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

of International SOS, with hundreds of new
staff joining and new alarm centers and
clinics opening throughout the world. This
might have meant a lot of change
particularly for longer-serving members of
the team. Dr Farrow doesnt agree. Yes,
todays alarm centers are incredibly efficient
operations, with systems and technology that
we wouldnt have recognized even 10 years
ago. But the heart of what we do is the same.
The soul of the company, its humanity and
compassion, have been preserved.
I always liken Pascal and Arnaud to the
queen bee in a bee hive. Just as the queen
bee affects and directs the behavior of the
whole hive, so in the same way Pascal and
Arnauds strong medical and personal ethics
and their passion for excellence have shaped
this company and the people who work in it.
Ive been strongly influenced by them both
since the day I first met them. And in turn
those longer serving members of the
company are passing onto those who joined
later, the same values and standards.
A hands-on approach
What is so important and so unusual for a
large company like ours, is that Pascal and
Arnaud are still directly involved in medical
and operational decision making. There is no
serious medical case which senior
management are unaware of. What we all
value and the reason so many of us stay
with International SOS is the opportunity
to work for a compassionate, medically
driven, ethical company.
In another 20 years well probably look
back at 2005 and say that what were doing
now was pioneering. Its all a question of
perspective. But it is extraordinary to see
just how far weve come in such a relatively
short time.
15
FIRST ALARM CENTER
A TYPICAL CASE FOR THE ALARM CENTER TEAM

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

and speaks to
Operations Coordinator
Patient speaks to Intl. SOS doctor
Doctor calls Beijing AC
Beijing AC recommends
admittance
to hospital in Hong Kong
International SOS
calls insurers
Intl. SOS stays in

contact with
insurers
Intl. SOS arranges

flight and escort
Intl. SOS doctor calls

patient to make
recommendation
Intl. SOS stays in

contact with
patient
Patient discharged
from hospital and
contacts Intl. SOS
Intl. SOS arranges

hotel and taxis
Patient arrives
home safe
and well
16
INTERNATIONAL SOS
Expert response
After talking at length with Mrs Williams, an
International SOS doctor determines that she
needs neurological investigations and treatment.
He contacts his medical colleagues at the Beijing
alarm center to discuss suitable medical
facilities. Having completed their research, they
identify Hong Kong as the nearest center of
excellence in this field.
Because of her medical condition, the
International SOS doctor recommends that she
travels on commercial flights from Yinchuan to
Hong Kong with a medical escort. This
recommendation and a quotation is provided to,
and approved by, Mrs Williams insurer.
The International SOS alarm centers in Beijing
and Hong Kong work together to arrange all
logistical aspects of the transportation, including
her medical escort and Mrs Williams admission
to hospital in Hong Kong.
Throughout, International SOS staff keep in
constant contact with Mrs Williams to keep her
fully informed and reassured. They also maintain
communications with the underwriter.
On being discharged from hospital, Mrs
Williams asks International SOS for help to make
her hotel arrangements before flying back home
to Inner Mongolia. International SOS not only
arranges and pays for the hotel, but also
arranges taxis within Hong Kong.
A safe conclusion
On her safe return, Mrs Williams contacted
International SOS to express her gratitude for
the service provided.
I wish to commend all the staff I had contact
with, from my initial telephone contact in
Sydney, to the staff in Beijing and Hong Kong.
Everyone was concerned and professional. I
cannot praise your organization too much.
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 Farrows comments.
UR OVERRIDING aim is to
consistently provide medical duty of
care at the very highest levels, he says. The
International SOS service delivery model
puts the best people with the right expertise
at the front end. Thats why we have full-time
medical teams not medical consultants on
duty in all our alarm centers. They provide
real-time medical advice, direction and
reassurance to our members and patients.
Their skill is to listen to whats being said,
assess and interpret in the context of the
individuals situation, and then to respond
appropriately.
The decisions taken will depend as much
on the condition of the patient as on the
implications posed by the local environment.
In consultation with our other medical teams
around the world who are experts in their
region, we decide on the best local solution,
or alternatively evacuate them if local
resources are insufficient.
And when a situation is particularly
challenging, all our staff know they have the
Corporate Assistance Department to call on.
Expert advice and opinion

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

while they are being evacuated
a major medical or security incident
requires a crisis response
Ever since the

company started,
senior medical
staffs have provided
round-the-clock
support to members
of assistance teams
DR NERWICH, INTERNATIONAL SOS
Ever since the company started, senior

medical staffs have provided round-the-clock
support to members of assistance teams,
explains Dr Nerwich. But as the
organization grew, we realized we needed a
more formalized approach, and in 2000 the
Corporate Assistance Department was
formed. The Department ensures there is
total transparency and that any element of
medical or security risk is dealt with
proactively. This is particularly important in a
crisis situation.
In response to the most recent Bali
bombing in October 2005, Dr Philippe
Barrault, a fellow CAD member, poignantly
commented that International SOS had
learned so many lessons from previous
bombings that this time the decision was
taken to proactively launch mercy medical
evacuation flights. One of the lessons was to
mobilize as quickly as possible, says Dr
Barrault. As soon as we realized that help
was needed, our largest air ambulance left
Singapore in the early hours of Sunday
morning.
Our processes ensure that clinical need is
put first, continues Dr Nerwich. Patients
are in direct communication with medical
staff right from the outset, so their access to
a doctor is in real time. The ethos of
International SOS comes from the very top.
Through the Corporate Assistance
Department we make sure that our collective
experience is applied where it matters most
responding to our members when they need
our help.
17
Indonesians demanding
the resignation of
President Suharto
SECURITY EVACUATIONS
Out
Everybody
International SOS evacuated 4000

members from Indonesia during the civil
unrest that followed President Suhartos
resignation in May 1998. Jim Williams
was at the center of the drama.
Y EARLY 1998, President

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

hearing of people driving their cars to the
airport and abandoning them or selling them
on the spot, recalls Jim Williams, who was in
charge of International SOSs Indonesian
19
SECURITY EVACUATIONS
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 passengers flight
needed to be covered. Our staff had to do
everything from schedule the aircraft and
crews to assign passenger seats, deal with
immigration paperwork and help them pay the
exit tax. At the airport most people were
waiting eight hours in a government line to
pay the exit tax. We took the situation into our
own hands and agreed to a new procedure
with officials to help with the paperwork
ourselves. This enabled our members to go

through the system in a fraction of the time,
explained Jim. The Singapore operations
provided all of the reception services. They
were tasked with arranging ground
transportation, travel arrangements and hotels
TOWARDS RISK MANAGEMENT

INTERNATIONAL SOS is no longer just
helping organizations respond to events,
says Richard Culver, Senior Director, Security
Services, EMEA/CIS. In an uncertain world,
were increasingly being asked to look at
the complete security infrastructure to help
reduce the risks of terrorism or crime. We
also help clients manage the consequence
of crisis, not just the incidents themselves,
through the provision of holistic crisis
management services.
We can evaluate site security, travel
policies and the quality of security firms
used. We can also provide a full-time or
seconded security manager to oversee all a
clients activities and prepare crisis
management and emergency evacuation
plans.
Clients can access our comprehensive
web services, giving security updates and
other useful information. They can also call
into our alarm centers 24/7 and receive
immediate advice and assistance from our
on-call security specialists. Our security
specialists typically have a military
background with further experience in
consulting and corporate security. Theyre
all accustomed to working in war zones
and other hostile regions.

Its all about knowing the risks you
face, managing those risks and making
informed decisions. In 2004 a construction
client needed to establish business
operations in Afghanistan. We embedded a
security consultant with their project team,
and as an integral part of the client
structure assisted in the management and
reduction of risk to enable the business. We
supervised security provider selection, and
deployed with the client advance party to
ensure that their security management incountry was up to the standards required.
That client is still successfully operating in
Afghanistan, and our
plans and procedures
have assisted in the
prevention of death
and injury to their staff
on a number of
occasions.
Richard Culver,
Security Services,
EMEA/CIS
for the members we evacuated.

Organizing the evacuation of so many
people in such a short time was an enormous
logistical operation. In spite of this we
managed to launch several medical
evacuations with our own air ambulance. One
of these was a neonatal case.
During an intense three-day period, over
four thousand people were successfully
airlifted out of the country. Overall many of
us in Jakarta and Singapore didnt sleep for 56
hours. When members are in trouble, they
immediately call International SOS. Our job is
to help them, whatever their needs.
I remember
hearing of people
driving their cars to
the airport and
abandoning them
or selling them on
the spot
JIM WILLIAMS, INTERNATIONAL SOS
20
INTERNATIONAL SOS
MEMBERSHIP
More than an
emergency service
Dr Rene de Jongh has worked for
International SOS since 1992. Hes a
passionate believer in the importance of
membership and hes at the end of the
phone when members call for help.
INCE he started working for

International SOS back in 1992,
Regional Medical Director for Assistance,
Dr Rene de Jongh has seen the benefits of
membership time and time again. People
aren't always clear what membership really
gives them, he says. I think the value of
membership is two-fold: Members have
access to myself or any of my physician
colleagues day or night should they have a
medical concern, and as medical
professionals, we have the opportunity to get
to know a little more about them. Knowing
our members' background and situation
helps us to deal more effectively with issues
or emergencies when they arise. Whats
more, membership ensures that
administration and payment is already
sorted. When youre dealing with someone
whos had a serious accident, the last thing
you want to talk about is whos going to foot
the bill.
Sometimes International SOS helps
members with problems that they didnt even
know they had. I remember one lady who
had been a member for some time, says
Rene. I was delighted to get a call from her
telling me that she and her husband were
expecting a baby I knew theyd wanted a
family. But during our conversation, she told
me shed been experiencing nasty headaches.
She presumed these were a normal symptom
of her condition and had been suffering
bravely because she didnt want to take any
painkillers. As she was talking I realized that
these headaches werent just another side
effect of pregnancy. They sounded much
more serious. Speed was important, so we
got her examined at the nearest International

SOS clinic. She had in fact a significant
previously undiagnosed neurological
problem, so we arranged to evacuate her by
commercial flight to London so that she
could immediately receive the care she
needed to make a recovery.
Managing risk
Of course membership isnt just there for
emergencies. Members have access to travel
and security advice to help keep themselves
and their families safe while abroad. Its
human nature to get excited when youre
going on a trip. People tend not to think
about what might go wrong, says Rene. I
dont want to take the fun out of traveling; I
just want to help people manage the risks.
One International SOS member was
starting a mine site survey trip to Africa and
called Rene on the suggestion of a
colleague. He outlined his plans and the
vaccinations hed been given on the advice
of his GP. It soon became clear that he
would pass through countries where it is a
requirement to have been vaccinated against
yellow fever. If youre not covered, quite
apart from the risk of the disease to you
personally, you may either be deported or be
given a jab there and then at the airport,
which wont always be safe, explains Rene.
During their phone conversation Rene
advised his client to re-route in order to have
the yellow fever vaccination, take time to
develop immunity and collect documented
proof to take with him.
Getting this kind of advice reduces the
likelihood of ever having to call on
International SOS in an emergency. Im not

interested in just sticking to the bare facts,
says Rene. I want to give people proper,
detailed advice on how to manage
themselves while theyre traveling. If
someone is a diabetic planning a trip to
China, theyll want to know where they can
buy needles, where they can keep their
insulin cold during flights, and whether they
can get their needles through customs. We
give them the whole nine yards.
Clinical need
For Rene, membership is about much more
than just a fast service. The first person
youll speak to when you call is a trained
customer service executive. The second will
be a medical professional who will already
have an idea of who you are, what your
problem is, and at least a partial solution
already in place.
This reflects a principle that attracted
Rene to International SOS in the first place.
The service we give our members when
they travel is unique, he says. Every
decision is based first and foremost on
clinical need even before theyve stepped
off the plane.
Dr de Jongh is a New Zealand citizen who
joined International SOS in 1992 and is now
Area Medical Director for SOSs operations
in the South Asia Region. His specialty is in
hospital-based emergency and intensive care
medicine. He is also qualified in prehospital emergency care, advanced cardiac,
pediatric and trauma life support and was
awarded a MSc in Travel Medicine.
21
ONLINE
The world at your
fingertips
Hi-tech online solutions help mitigate the risks of
international travel.
NE OF THE downsides of living in the

Information Age is data overload.
This is particularly true for international
companies with hundreds or thousands of
employees traveling or working abroad.
With so many sources of information, its
virtually impossible to access the specific
details they need to help keep staff safe and
secure.
The aim from the start was to make
22
INTERNATIONAL SOS
International SOSs website and associated

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

Spanish, Japanese and Chinese. You can find
out all you need to know about health,
security, climate, culture and customs. And
information is constantly updated 24/7 to
keep users fully informed.
Towards full interactivity

Customers are always searching for ways to
help manage risk more effectively: The idea
for our Traveler Locator Service came
following a client discussion shortly after
9/11. Tragically, the company had had
employees on one of the hijacked planes, and
wanted a system that could track every
traveling member of staff anywhere in the
world.
Traveler Locator takes data from travel
management systems and travel agencies to
give an instant snapshot of the movements of
employees. You can track individuals by
region, by country, by flight number or hotel
booking. It also lets you assess the risks
facing these people and gives automatic
medical and security alerts if theyre likely to
face dangers or hazards.
The service is web-based and accessible
from anywhere in the world, yet also highly
secure with restricted users. As you would
expect, the amount of data processed is
ONLINE
enormous, with 120,000 travel itineraries

entered every day.
Over the past few years a number of other
online services have emerged, such as
Automated Travel Advisories and Travel
Ready. These help travelers prepare for the
next trip, giving up-to-date information on
destinations through email alerts, making sure
they have the right vaccinations and even
letting them know the status of visa
applications.
Customized services
As with many International SOS offerings,
the client is often the trigger for
improvements. For example, when IKEA
wanted to improve its global crisis
This new online tool contributes to our

employees awareness of the importance of
maintaining their health and of the services
our company provides in this field
DANIEL MAH, RENAULT
management, it asked International SOS to

create a dedicated portal. This contains action
plans and procedures, relevant local
information such as fire, police and
ambulance services, and details on all
employees, including scanned copies of
passports.
If there is a crisis, management can act
quickly, contact all relevant parties and make
evacuations or close facilities. There are even
detailed maps helping to locate expatriate
workers.
Renault in France has chosen to provide a
similar service to its employees and decided
to incorporate a customized medical section
into the site. Daniel Mah, General Manager
of the International Mobility Department
succinctly summarises the benefits: This is
an additional risk prevention tool for our
company. This new online tool contributes to
our employees awareness of the importance
of maintaining their health and of the services
our company provides in this field.
The future of online services is all about
getting the right information to the right
people in real time, says Tim, Whether its
epidemics, natural disasters or political
unrest, the use of email alerts, websites and
portals will give clients the tools they need to
take important decisions and mitigate risk.
23
A vital
20 hours
Memories of the first International SOS mass evacuation.
ATRICK Deroose is General Manager at

International SOSs Corporate Assistance
Department. A trained nurse, he has been
with International SOS since 1993.
Soon after he joined, Patrick was part of a
team sent to care for the victims of a serious
road accident on Bali. Here he remembers
how events unfolded.
A couple of weeks after I started work
with International SOS there was a terrible
crash on Bali. A group of elderly French and
Belgian tourists were traveling in a
mountainous area when their coach tumbled
into a ravine.
Many of the passengers were injured, some
24
INTERNATIONAL SOS
seriously, and several people were killed.

Local services arrived at the scene as quickly
as possible and took the injured passengers to
the local hospital.
As soon as they were informed of what
had happened, the French insurance company
contacted International SOS and the
Singapore alarm center was immediately
alerted.
Knowing that local medical facilities
would not be sufficient to deal with the
situation, our mandate was to bring the
patients to major trauma centers in Singapore
for treatment and repatriation.
Combining resources
The operations team at Singapore quickly put
together a plan that combined the resources of
three International SOS alarm centers:
Singapore, Jakarta and Bali. The Singapore
and Bali teams would triage the patients (that
is, determine their injuries in order to decide
the order and urgency of treatment) ready for
repatriation. The Jakarta team would provide
the necessary equipment and personnel for
the aircraft.
One of our Bali-based doctors was
immediately sent to the hospital in Bali to
assess the situation. Understandably,
conditions at the busy emergency room of
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

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

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

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

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

easier because there were 14 ambulances
waiting to transport them to the casualty
departments of Singapore General Hospital,
the National University Hospital and other
private hospitals in the city. Allocations were
made by the Singapore alarm center to ensure
that each patient received the treatment they
needed.
20 hours from the time of the first call to
International SOS, the patients had arrived
safely in hospital in Singapore where the 15
most seriously injured remained until being
repatriated for treatment or rehabilitation.
Out of the five people with more minor
injuries, three went home and the two others
stayed in Singapore to be with their loved
ones who were being treated in hospital. All
the uninjured were flown home within 24
hours.
25
Any
REMOTE SITE SERVICES
where
IN THE WORLD
Taking healthcare to some of the worlds most remote regions.
RGANIZATIONS working in oil, gas,

mining and construction operate in
some of the harshest, hostile and most
inaccessible environments, with
employees carrying out dangerous work, often in
extreme weather conditions. Whole communities
can spring up around these sites, and keeping
employees and their families healthy is a major
challenge.
International SOS first became involved in
this field in 1988, when a French airport
construction company was commissioned by the
Indonesian government to build Jakartas new
international airport. The company was eager to
offer a high standard of care to their construction
teams at a site that was three hours drive from
the city. After consultation, Dr Pascal Rey-Herme
recommended creating a field clinic offering the
same emergency and primary care services as his
city center operation. The doctor not only
designed and equipped the clinic, he also
supplied and supervised local medical staff.
Some time later a senior mining company
executive asked International SOS whether it
could help develop medical services for a huge
coal mine that was being built in Kalimantan in
Borneo. With the mine employing 300
expatriates and 2000 local Indonesian workers
and their families, the company needed to be able
to make medical evacuations and manage day-to-
day healthcare, as well as provide preventative

treatment for malaria and other tropical diseases.
What began with just one doctor in a single
clinic has now grown into a complete medical
infrastructure operation incorporating a small
hospital, outpatient and emergency facilities, and
satellite clinics with occupational health
programs and award winning public health
programs, explained Dr Myles Neri, Group
Medical Director for International SOSs Global
Medical Services.
A natural development
Fast forward to 2005 and International SOS now
manages around 200 remote sites across five
27
REMOTE SITE SERVICES
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 theyre looking to achieve a high
standard of medical service for all their
operations. These facilities may range from a
simple first aid station to 120-bed fully
managed hospitals.
Over the years, International SOS has
developed its services to encompass the full
spectrum of health care specialist services
from primary and emergency care to
occupational and public healthcare. And
having gained an intimate understanding of
remote site medical needs, it also offers
expert consulting advice and guidance to its
clients.
Dr Neri continues: Our first step
typically involves a site survey, looking at
everything from local living and working
conditions to the availability of medical care
and accessibility of emergency transport.
From here we work with the client, the local
health authorities and local resources to
define the appropriate scale of medical
services.
The oil and gas fields on the island of
Sakhalin, off the easternmost coast of
Russia, present a different challenge
altogether. There are 16 field sites scattered
around the island, where the severe winters
can last for up to 7 months. International
SOS provides doctors and paramedical staff
for all these sites and has nine permanent
clinics on the larger work sites, plus a
doctor, medic and health and safety adviser
28
INTERNATIONAL SOS
Water sampling as part of

a malaria control program
Large, remote sites

not only create their
own communities,
they also impact
upon the wider
local population.
on the huge offshore platform that supports

a crew of 132 people.
Helping the wider community

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

site. The dual aim is workers health
protection as well as health promotion.
In recent times governments and aid
agencies have called upon International SOS
to provide similar services to them in areas
of reconstruction, following conflict
(Iraq/Afghanistan) or devastation
(Aceh/Pakistan). The emphasis is on rapid
deployment, quality medical services,
medical evacuation capacity and local
staffing, training and development.
Companies, governments and aid
organizations will continue to operate in
remote areas, to respectively extract raw
material and energy, develop the
infrastructure or to help the local population.
And in extreme heat or arctic cold, in deserts
or offshore, International SOS will be there
with them, helping keep the workforce and
their families healthy.
HAIR-RAISING SURGERY
DR Patrick ONeill, who worked as Chief
Medical Officer at the Kaltim Prima coal mine
in Indonesia when International SOS first set
up its on-site operation, remembers the many
challenges of those early days.
In addition to carrying emergency
operations out in remote jungle clinics, and
riding 90 minutes by boat to transport
patients to the nearest local hospital (before
a hospital was built on site), he also had to
handle patients of a hairier variety!
One day an orang-utan managed to find
its way into the site and severed its thumb in
a conveyor belt. The unfortunate animal was
sedated with tranquillizers and then taken
into the site clinic, where visiting plastic

surgeons involved in a company public health
surgical program for cleft lip repair, were on
hand to sew it back on. After a difficult
period of readjustment the orang-utan was
finally released back into the wild with both
hands fully intact.
29
D SPENT YEARS delivering general

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

health mean?
A change of gear
in occupational
health
Dr David Cook was originally Chief Medical Officer
in Burma for International SOS between 1996 and
1997, working in Jakarta, Singapore and Papua
New Guinea. After 10 years working abroad he
returned to the UK to pursue occupational health
as his specialty in 2003.
30
INTERNATIONAL SOS
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 theres occupational health in
emerging countries where there is little
medical infrastructure, where medical
training can be variable and resources scarce.
Classic industrial diseases like lead
poisoning, dust induced lung diseases and
hearing loss may prevail and public health
problems are far more prevalent, for example
HIV, tuberculosis, under-vaccination, and so
on. Services are often delivered at remote
sites and include employment screening and
health and safety management, with disease
management an inevitable component.
What occupational services does

International SOS offer?
International SOS offers services across the
whole occupational health spectrum. Were
second to none in terms of resources
medical, intellectual, transport,
communications, and security.
Remote sites are usually in emerging
countries, where International SOS delivers
occupational health services along with
general medical services in places where
employees dont 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 companys

needs. We can deliver fully managed
occupational health services on behalf of
clients.
We are the only company in the world
that can offer consistent levels of care
globally. And thats a capability thats
becoming increasingly important for many
of our clients.
How has occupational health

changed over the years?
Occupational health has always been in
place. More recently the emphasis has
changed towards preventative medicine and
public health, not just general medical
health. Companies recognize that
occupational health directly affects safety
and productivity.
We are also moving towards evidencebased occupational health. Companies are
keen to meet their corporate responsibilities,
to improve the health, safety and
environment of local employees and to make
a positive contribution to communities.
What is evidence-based
occupational health?
Its about developing management and
reporting systems that enable organizations
to manage risk proactively and coherently.
Specific initiatives can be designed to
combat particular issues that are identified
based on evidence. Its also about
implementing coordinated systems and
processes to ensure that employees are
treated consistently, wherever they work.
International SOS delivers a thoroughly
researched, evidence-based medically driven
service, comprehensively thought through
and comprehensively delivered.
How is evidence generated?

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

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

call it quality, quality, quality. That was our
mantra back in the 1990s and it hasnt
changed today.
What new developments are there in

occupational health?
International SOS is continuing to develop
new occupational health services. At the
moment, were working on an evidencebased service to manage sickness absence
for our clients in Europe. Believe it or not,
LOOKING AFTER THE WELL-BEING

OF WORKERS AT TOYOTA AUSTRALIA
TOYOTA Motor Corporation is one of
Australias leading car manufacturers. It has
over 4,500 employees in Australia, spread
over six locations with 90% based at its two
main sites in Port Melbourne and Altona.
Objectives for Toyota Australia
Toyotas key objective is to ensure that every
employee is treated as an elite athlete and
the best treatment possible is rapidly sourced
so that they can be returned to their
workplace as soon as possible.
Back in 2003, with concerns about costs
spiraling, its own health services not widely
used, and work injuries (particularly
musculoskeletal injuries) increasing, Toyota
Australia needed a more proactive approach
to managing the health of its employees. It
wanted its Health Centers to be the first port
of call for any employee with a health
concern, whether work-related or not.
Toyota Australia needed an expert partner
who understood its business and had the
capability to deliver a full range of healthcare
services. It asked International SOS to work in
partnership with its occupational health and
safety team to design, deliver and monitor a
comprehensive occupational health
management program.
How International SOS has helped
Philippe Arnaud, Group General Manager
GMS Development explains International
SOSs approach: We have delivered a fully
integrated occupational health program in
partnership with Toyota Australia.
Our medical teams run Health Centers at
Toyota Australias two main sites. They offer a
full range of services to promote employees
return to work after ill health, including

primary first aid, diagnosis, support,
treatment planning, active support and
advice. Staff assess and advise on a wide
range of health issues, and provide stability
and familiarity for workers visiting the
centers.
We also carry out pre-employment and
employment assessments, monitoring,
reporting and education. Recent health
education initiatives have included healthy
eating and keeping hearts healthy.
To raise awareness of healthy practices in
the workplace, we are working closely with
Toyota Australia to identify workplace
concerns and put in programs to minimize
risk of injury.
Measuring progress
International SOS carries out detailed
monthly reporting against key performance
indicators agreed with Toyota Australia. Data
is used to target healthcare and education
initiatives. Key measures this year include a
fall in the number of musculoskeletal injuries,
and a reduction in the cost of third-party
medical providers.
Paul Furtado is Health Support Advisor on
Toyota Australias Occupational Health and
Safety Team. The Toyota/International SOS
relationship is now over 12 months old. In
this time a strong relationship has been
established and quality health outcomes are
being delivered.
Toyota looks forward to continuing to
work with International SOS in the important
area of employee health to ensure that we
retain our competitive advantage both locally
and globally.
31
OCCUPATIONAL HEALTH
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.
NEW GLOBAL PUBLIC

HEALTH CHALLENGES
AS anxieties increase over the spread of
the avian influenza virus, International
SOSs most senior medical staff has been
working over the last 18 months to
thoroughly research the implications of a
potential influenza pandemic and to
develop pandemic preparedness plans.
The concern is that if the current virus
mutates and gains the ability to spread
easily from person to person, it may
emerge as the cause of the next
influenza pandemic.
Dr Doug Quarry, Medical Director,
International SOS Online, is a member of
the International SOS Avian Flu and
Pandemic Preparedness team. As well as
monitoring the situation 24/7 and
making the latest information available
through our dedicated website, we
wanted to give our members practical
guidance so that they could put
contingency plans into place for their
businesses, he says.
After extensive research, we have
developed nine chapters of protocols
and over 120 pages of information to
ensure employers have the key
documentation they need to develop a
company- and employer-specific
Pandemic Preparedness Plan.
32
INTERNATIONAL SOS
Where others
Non-governmental organizations (NGOs) often arrive
in a country when everyone else is leaving. So who can
they turn to in time of need?
ON-GOVERNMENTAL organizations
(NGOs) often arrive in a country when
everyone else is leaving. So who can they turn
to in time of need?
Whenever there is a war, famine or
environmental disaster, most peoples first
reaction is to get out of the area as quickly as
possible. But for organizations like the UN,
Red Cross, WHO, Oxfam, Save the Children
and Medecin sans Frontires, this is typically
where their work is just beginning.
Like any large international concern, NGOs
and indeed government agencies also need to
safeguard the health of their employees.
Emmanuel Chevron, head of Sales and
Marketing in International SOSs Geneva office
explains: With the ever-present threats
surrounding them, our clients need to be able to
Banda Aceh chaos and destruction caused

by the Tsunami
GOVERNMENTS & NGO
AGAINST ALL ODDS

DR Jean-Bernard Carbonnel, who has been
with International SOS since 1992, recalls an
urgent medical case that he coordinated for
the Red Cross:
In March 2002 we received a call in our
Geneva alarm center about a four year old
girl with severe hepatitis in Kinshasa,
Democratic Republic of Congo. She was the
daughter of a Red Cross delegate in the
country and needed an urgent liver
transplant.
We decided that the best place to get a
quick operation was Geneva, despite it being
11 hours away, and commissioned a long
distance jet. We took a chance in sending
the plane immediately and only received a
landing permit 2 hours before arrival in

Kinshasa.
On reaching Geneva a large ambulance
was waiting to take the patient to the
intensive care unit in the Cantonal Hospital,
where a successful operation was followed
by a full recovery. This project was a triumph
of logistics, with our team arranging visas,
landing clearance, ambulances and hospital
facilities.
fear to tread
get medical assistance at a moments notice,
anywhere in the world. Thanks to our global
coverage, we have been able to help a number
of government bodies provide high levels of
primary medical care to employees in different
parts of the world.
Security climbs up the agenda

With the breakdown of former political
structures and the rise in religious
fundamentalism, security is also an issue.
NGOs are not always seen as neutral
organizations and may get labeled as tools of
the west, leaving them increasingly vulnerable.
Security has consequently become a far higher
priority and a number are turning to
International SOS for advice on protecting staff
and facilities and minimizing the risk of
terrorism, kidnapping and crime.
Where NGOs may once have been seen as
a group of well-meaning amateurs they are now
large, established, professional organizations
with full time staff, explains Mike Penrose,
Regional Security Manager, International SOS.
The security and medical needs of their
employees are essentially no different to those

of a commercial corporation.
Having previously worked in a number of
NGOs in war and disaster zones around the
world, Mike is only too aware of the dangers.
Indeed, he was once kidnapped by Chechen
rebels for two months. When planning their
security, NGOs must be very conscious about
how they are perceived. Surrounding yourself
with bodyguards may be counter-productive
and only serve to alienate local groups; its
more important to project an image of absolute
neutrality.
out over 100 evacuations.

Mike Penrose was also seconded to the
WHO for six weeks to help set up disaster aid:
In an environment with so much suffering and
a totally traumatized population, its very
difficult to coordinate the aid effort.
International SOSs experience in similar
situations helped us put together appropriate
strategies and assist the Indonesian Ministry of
Health to re-establish its own structure.
TSUNAMI AID APPEAL
Tsunami: helping when disaster strikes

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

and staff, International SOS has been able
to raise over $330,000 dollars to help
victims of the disaster in Banda Aceh.
These funds are being used to sponsor 80
young Indonesians from Aceh over the
next four years to become nurses, so that
they can actively participate in the
rebuilding of their community.
33
GLOBAL ASSISTANCE NETWORK
Widening the net

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

case management system, to ensure that the
process of dealing with each individual case is
as smooth and efficient as possible.
For a small number of our largest clients,
weve developed tailor-made provider
networks, available via the Internet. In
particular, we can make details of key
providers available to members through our
online country guides.
Into the future
HEN I joined International SOS

there was already a strong network
of providers established in Asia, with more
informal networks in place in other regions.
Years previously, the company had
sometimes relied on the co-operation and
resources of our correspondents to record
information about medical providers in
different parts of the world. All cases were
handwritten or typewritten, and to search for
individual cases required a trawl through
stacks of physical files.
The big change came when an important
client, the insurance company Tokio Marine,
asked us to establish a cashless network of
medical providers for its clients worldwide.
Timothy Yee and Dr Doug Quarry at our
Singapore alarm center established a system
to document assessments and details of
medical providers onto a database and to set
up guarantees of payment with providers as
part of our service. This was the genesis of the
vast Global Assistance Network (GAN) that
we have today. The other strong building
block was to develop a whole team of Global
Assistance Network managers able to develop
our network anywhere we have a case.
About SPIN
Launched in November 2002, the Service
Provider Information Network or SPIN is
the key means of accessing our Global
Assistance Network and spans every country
in the world.
SPIN is a powerful on-line database and
search tool that pinpoints a particular
provider according to the criteria that our
staff choose, for example by location, medical
specialty or type of agreement.
But its much more than that. SPIN is a
34
INTERNATIONAL SOS
tool used daily by our GAN managers and

coordinating doctors for managing the quality
of service delivered by our worldwide
network, from assessing and credentialing
providers, to ensuring smooth payment and
administration when help is needed.
When someone from International SOS
visits a provider, they use SPIN to record
details about its organization and services.
This helps us make the right choices on
behalf of our clients and means we can
develop a set of preferred providers. SPIN
also holds comprehensive records about
providers, including licenses to practice,
medical qualifications, terms and conditions,
and site audits.
Widening access
As a web-based tool, SPIN is accessible
worldwide and updates are available
The Global Assistance Network, which now

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

When a Lufthansa passenger suffered a heart attack
on a long distance flight, he was in the safe hands
of a doctor hundreds of miles away.
N FEBRUARY 2003 a middle-aged man

suffered a myocardial infarction whilst his
Lufthansa flight was passing over Siberia.
This was cause for serious concern.
Fortunately the pilot was able to contact a
German-speaking International SOS doctor
by satellite phone at the Frankfurt alarm
center. The doctor assessed the patients
symptoms and concluded that it was
imperative to get him to a hospital as soon as
possible. Having checked the database, he
confirmed that the nearest appropriate
facilities were in Almaty. The pilot agreed to
land at the local airport and the patient was
rushed in for emergency treatment.
In-flight medical assistance is a highly
specialized service requiring an in-depth
knowledge of emergency treatment and an
understanding of how patients react when at
35,000 feet, says Dr Michael Weinlich,
Medical Director International SOS Germany.
You have to know the nature of on-board
conditions and be familiar with flight
procedures. Our doctors will calm everyone

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

thing to having a
doctor next to you
MR YAP KIM WAH, SIA SENIOR
VICE-PRESIDENT MARKETING
SERVICES, TALKING ABOUT THE
TELE-MEDICAL SERVICE
emergency medical treatment procedures,

which includes simulation exercises.
Serving the aviation industry

The development of our services to the
aviation industry can be traced back to the
1980s, when we provided medical assistance
to members of SIAs frequent flyer program,
Priority Passenger Services (PPS), Kasey
Khaw, Regional Director, Global Accounts
Asia, explains. The airline was impressed
with International SOSs ability to provide
remote medical care and assistance. We had
successfully carried out some medical
evacuations for individual customers whilst
on business and personal trips. Offering inflight services was just a natural progression,
where we combined our on-board medical
experience with our geographical knowledge
of appropriate medical providers and
facilities. Our in-flight medical assistance
teams are all aero-medical specialists trained
in aviation medicine.
Today, International SOS is also working
with airlines medical departments to help
reduce the risk of medical incidents by
providing pre-flight screening for both
passengers and crew. Whilst youll never be
able to guarantee that theres a doctor on
every flight, a virtual medical team is the
next best thing.
35
PATIENT SUPPORT
Supporting
patients in a
new way
With help from International SOS nurses and specialists,
patients on prescribed medication are benefiting from a
new service provided by International SOS.
36
INTERNATIONAL SOS
the treatment and make necessary behavioral

changes.
Holding their hands

Were there to provide ongoing support to the
patient, holding their hands through the
journey, says Ben Connor, International SOS
Operations Manager, Pharma Services. Our
aim is to give patients a better understanding
of the medication and what effects it may
have. We talk to them about their lifestyle and

for certain treatments, the importance of a
healthy diet. Many people expect a quick fix,
so we also have to manage their expectations
and educate them on the long term nature of
the benefits.
Patients enrol voluntarily, usually after
hearing about the program from their doctor
or pharmacist. International SOS will then
work to a contact plan, calling at critical
Reasons given by patients for ceasing antidepressant therapy
Ad
ve
rse
Ev
en
Fe
ar
ts
of
De
Un
pe
co
nd
m
en
fo
rta
ce
bl
e
wi
th
Dr
ug
La
s
ck
M
o
fE
us
tS
ffi
ca
ol
ve
cy
W
ith
ou
tD
ru
gs
GP
In
str
uc
tio
ns
60
50
40
30
20
10
0
Be
tte
r
HE PROBLEM of non-compliance has

been plaguing the healthcare sector for
years. In some cases as many as 80% of
patients fail to finish their course of treatment
or take their medication correctly. This can
have very serious consequences for the
patients health, as well as costing the health
service the time and expense of re-admissions
and further treatment.
There are many reasons why so many
patients seem unable to follow dosage regimes
or make lifestyle changes. For some its
simply a matter of poor motivation, whilst
others dont really believe theyre ill,
especially when the symptoms are hidden,
such as with high cholesterol. While poor
compliance is often attributed to simple
forgetfulness, in fact, the majority of patients
can articulate their reasons for ceasing
therapy. In a bold move, doctors, pharmacists,
health managers and the pharmaceutical
industry have joined forces to combat noncompliance, with the additional help of
International SOS.
The Patient Support program offers patients
on specific medications a support network of
healthcare professionals who can guide them
through the weeks and months of their
therapy. Primarily telephone-based, they
receive a combination of information and
encouragement, helping them to understand
Fe
eli
ng
Ref: K. Demyttenaere et al. Compliance with antidepressants in a Primary Care Setting, 1:

Beyond Lack of Efficacy and Adverse Events; J Clin Psychiatry 2001; 62
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 doesnt, for the
benefit of patients.
Geraldine Mynors, project manager for
Medicines Partnership
points, during a prescribed period. This can

vary between three and six months depending
on the therapy.
The level of attention is a vital factor,
according to Maggie Butler, a registered
nurse who works on one of the programs:
Doctors just dont have the time to talk to
patients at length, and sometimes it can take
days to simply get an appointment. Were on
the other end of the phone any time they want
to call us.
Highly rewarding
Patient support is relevant for a wide range of
longer term or chronic conditions such as
cardiovascular conditions, diabetes, high
cholesterol, multiple sclerosis, osteoporosis,
obesity, rheumatoid arthritis and HIV. Ben
Connor continues: We have nurses, exercise
physiologists, nutritionists and a range of
other specialists who have developed an indepth understanding of the various treatments
we support. Most importantly, we can give
patients all the time they need, whether theyre
concerned about side effects or merely want
some encouragement. In over twenty years of
working, this is the most rewarding job Ive
ever had, knowing that I can make a real
difference to peoples lives.
And International SOS nurse Maggie
Butler, who provides support to obese
patients, echoes Bens sentiments We get so

much positive feedback from patients. One
woman recently told me she had just got out
of her wheelchair and hung the washing up for
the first time in fourteen years, after
successfully losing weight. Whilst another
improved her health and became pregnant, and
rang to tell me that I had changed her life.
Win-win
Patient Support is proving increasingly
popular, with International SOS working with
pharmaceutical companies across Europe,
Asia and Australasia. Its essentially a win-win
This is the most

rewarding job Ive
ever had, knowing
that I can make a
real difference to
peoples lives
BEN CONNOR, INTERNATIONAL SOS
approach: the patient improves his or her

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

element of this initiative
The last word goes to Ray Rowden1, an
adviser to the UK Health Service, who
believes we need: ...to create a generation of
patients who are empowered to take action,
with the health professional caring for them.
Patients will receive the support to take more
control of their own health and treatment and
to make more appropriate use of health and
social services.
1.
Rowden R. The Expert Patient, Pharmaceutical Field, April 2002.
37
SPECIALTY SERVICES
technological infrastructure gives our team

the ability to search for solutions quickly.
Personal service
Adding value
International SOS is using its remote servicing skills
and logistics expertise to help clients deliver premium
services to their customers.
VERY DAY a team of skilled car

mechanics arrives at International SOSs
alarm center in Sydney. But theyre not
wearing overalls and they wont be getting
their hands dirty. Their job is to take calls
from worried motorists, talk them through
their concerns and if necessary arrange to
send a breakdown vehicle.
This is part of a specialized service
provided for drivers of new Saabs, Ferraris,
Maseratis, Alfa Romeos, VWs and other top
marques. Because the mechanics really
understand the cars, one in three calls gets
resolved without having to send out a
breakdown truck, explains John Jessup,
Managing Director, International SOS,
Australasia. With our expertise, we can
handle calls on behalf of our clients and help
offer something extra to their customers.
Auto Assist is just one of a number of
ways in which International SOS is providing
38
INTERNATIONAL SOS
premium services to help clients around the

world differentiate themselves from the
competition. One of our core competencies
is highly skilled and trained specialists who
are determined to solve any callers problem.
John Jessup continues: Our sophisticated
SUBARU has entrusted International SOS to

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

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

understanding of the customers needs
together with a focused account
management team.
Subarus philosophy is based on doing the
common things uncommonly well and
International SOS is a key part of that
strategy.
Derek Ashby
Subaru National After-Sales Manager
Subaru Australia
GLOBAL SYSTEMS
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 its vital to keep a constant
watch on the patients progress and have a
full medical history to hand.
A fully integrated system

International SOSs new global case
management system (codenamed Magellan)
which is currently being rolled out to all of
its 28 alarm centers, provides full, regularly
updated details for doctors monitoring cases
around the world.
If a patient is moving between time
zones, then doctors in different alarm centers
will all view the same information on
screen, letting them discuss the case more
efficiently. All details are entered directly on
to the paper-free system which already
contains the patients 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 patients 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 decisionmaking process.
Invisible life support

So, when a patient calls from Nigeria with
chest pains, the coordinating doctor, taking
the call from International SOSs alarm
center in Paris, is immediately able to access
the mans details, arrange transport to the
nearest approved hospital and automatically
generate a Letter of Guarantee to cover any
medical expenses. When the patient is
evacuated to South Africa, the case can be
simply and seamlessly taken up by the alarm
center in Johannesburg.
This whole system has been two years in
the making, involving millions of dollars of
investment and a tremendous effort by a
team of over 100 people. It is an invisible
life support system for our members. Our
doctors are delighted with this new
development as it helps them deliver a better
quality of care. Mark continues: This
software effectively lets us watch over a
patient twenty-four hours a day from
anywhere in the world.
Knowledge is
power
Advanced technology lets International SOS globally
monitor a patients condition in real time.
Hotline, International SOS, Landmark House, Hammersmith Bridge Road, London, W6 9DP, United Kingdom
Phone: +44 20 8762 8000
Fax:
+44 20 8762 8400

20 TH Anniversary Hotline

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hotline

International SOS Worldwide Journal

20 ANNIVERSARY OF INTERNATIONAL SOS

ELCOME to this special edition of

anniversary of International SOS, this

CARE AND SERVICE

10 HOSPITALS IN THE AIR

International SOS people who have played

35 SAFETY IN THE SKIES

17 STRAIGHT FROM THE TOP

26 ANYWHERE IN THE WORLD

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

The story of how one Lufthansa passenger

Innovations in technology mean that

A passion for quality

open-pit coal mine in Kalimantan, Borneo, and

How did the business develop in the

Pascal: Our first plane was a small Beechcraft

Pascal: We started with medical evacuations and

Arnaud: Having clinics wasnt part of our original

Tell us about some other key milestones

Arnaud and Pascal relaxing on the Great Wall

Pascal: It also allows us to stay true to our

What are the main challenges now

year, this speeds up our service and radically

Laurent Sabourin speaking at the inaugural

Arnaud: To achieve the global reach that our

What about the future?

Pascal: My main aim is to ensure that we

JAKARTA-BASED church which ran a

Vital help and support

Unfortunately the landing field at the mission

WAS BASED in Singapore in 1985 and

the managers who was using our clinic. He

Medical services support

care services to workers on site. As each

ASSESSING THE HEALTH OF

Among the many projects International

International SOSs medical services support

Growth and evolution

SIX-YEAR-OLD child was lying in a

the rest of Africa, explains Dr Fraser

three dedicated aircraft, we make over 100

A growing fleet worldwide

alarm centers manage all the logistical

woman in Mozambique with 60% burns. We

helicopters, and communication with staff at

As well as delivering primary healthcare

Changing the culture

We set up the first clinic in 1985 in Jakarta

As well as pioneering new services, the

to work at the clinic.

Growth and change

The clinic today

Reception of the International SOS clinic in Jakarta

healthcare services on every continent. She

INTERNATIONAL SOS clinics operate in

DR INGE, INTERNATIONAL SOS

OR 18 YEARS, Dr Farrow has been

mobile phone. It was huge, and the networks

they are today, but we were doing frequent

FIRST ALARM CENTER

oxygen tanks locally, and went to the airport