Experiences of injury treatment abroad?

A snowHead

Intended to post this anyway as a result of my recent experiences, then saw a comment on another post about someone suffering severe complications after mis-treatment of a fracture whilst abroad. It gets me to worrying and wondering... (I'm thinking here particularly of injuries which result in hobbling wounded: ligament/tendon problems, fractures etc - but other experienes are also invited.)
In my case, whilst the tests (x rays and mri) and diagnosis was swift, and the basic treatment seemed adequate, I felt that after I was sent away I was very alone, unsupported, didn't really know what had happened to me or what to do if I felt ill or worried again. No follow up advice given, no real advice as to what to do or not do in terms of movement, activity, alcohol, injury protection, RICE, etc. No information about what signs and symptoms were to be expectd (e.g. swelling, pain, 'funny' feelings - or no feelings at all) or what was abnormal and needed urgent re-checking, no follow-up appointment, no emergency number. No information given about heparin-like anti-coagulants which I had to self-inject, nor even how to self-inject them, although they did say that there was extensive internal joint bleeding and DVT risk (joy!); nor, more worryingly, did I receive any English translation of the normal drug warning, information, interactions and side-effects leaflet which came with them (and I did ask, but no-one was prepared to or could translate the leaflet for me). And, worrying to me, no vital signs ever checked, no medical or medication history taken at all before injury assessment, nor before anti-clotting drugs prescribed and pain-killer types recommended. They gave me a fit to fly certificate there and then without checking anything at all. No advice as to whether I should see my GP at home, except to get more anti-coagulants (which as soon as I was back in the UK they told me to stop). Thank goodness for wi-fi and Google is all that I can say.
Accordingly, I wanted to get back to the UK asap, and fortunately my insurers got me an early flight home (though that still took until the Wednesday, the injury happeneing on Sunday). It was still a very worrying and at times scary wait whilst I had all sorts of weird things happeneing and generally wasn't feeling very well at all (whether that was the drugs, interactions, natural shock or what I don't know.)
I know various people who have had fractures and complications in the UK with limb-threatening swelling afterwards; it scares me as to what might happen if this happened abroad. It scares me generally if I had to have surgery abroad - and especially now.
I had thought that medical and inury care in the main EU countries would be very good, and obviously ski- and boarding-related injurines are terribly commonplace to them. But in the case of holidaymakers, is it really just a case of do the basic patching-up and then leave them to it? Is it therefore adviseable if you have an injury to insist on getting yourself back to the UK urgently (fitness to fly permitting)? Was my experience unusual or perhaps related to the fact that I attended a private medical sports injury clinic rather than a hospital or doctor's clinic per se?

A snowHead

@Grizzler, I've had 3 injuries which needed treatment abroad over the years. here's the story of one of them.

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My hubby broke his neck in France. I have no complaints about the treatment he received there. It was excellent 12/10. Team treating him was the same team that looked after Michael Schumacher. At no point, apart from at the surgery at the bottom of the slopes in Monetier were we asked to pay anything up front. It is normal there to pay the GP for a consultations (<30€). The insurers (Direct Travel) dealt directly with the ambulance that transferred him to the trauma centre in Grenoble (the weather was too bad for a helicopter). I took his EHIC card to the office for foreign patients the following day, and gave them our insurance details as well. After that, we had nothing to do with any medical claims, other than a bill a few weeks later for the scans at A&E in Briancon . But these were state hospitals, as is normal in France for major injuries. It is normal to get anticoagulants , especially if you are then needing a flight. Knee injuries, leg fractures, and immobility are major cause of DVT. It also depends on your insurer. If they agree to surgery taking place, or it is essential to your survival, it takes place in the country where your injury occured. It does depend on the injury though. Horses for courses.

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I broke three fingers on a chair lift in Orelle. It wasn't detachable and the kids were small, so we had a system where I would grab the chair to stop it for a fraction of a second and they would jump on. Mis-timed the grab and got a good whack. Went to medical centre in VT where they checked it and said it was bruising. Skiied on for 10 days with drink and drugs to numb the pain. It still hurt after a few months, so went to local A&E. x ray confirmed 3 broken metacarpals, two had healed well and one was slightly displaced. They offered to break it again and straighten it out, but it wasn't really THAT sore. Ring finger on my right hand is now as wonky as my pinky, which got a fair auld battering playing hurling in the olden days.

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@Grizzler, what is it that you're worried about? Going on holiday in a European country again in case you get ill/have an injury?

Is it advisable to insist you get back to the UK asap in those circumstances rather than having surgery performed by an EU doctor? Err, no, I don't think so. I would advise doing what the medical professionals tell you to do, unless you are a medical professional yourself and know what you're talking about. Can you 100% guarantee they won't make a mistake? No, but you couldn't with the UK medical profession either. Is it your responsibility to ensure you're either staying in a hotel/chalet where someone can call the doctor for you or make sure you know the medical emergency number if not? Yes, personally, I think it is. When you were feeling very unwell in between seeing the doctor and flying home, did you call the doctor to tell them you were feeling unwell? Because they had decided (correctly) that you were fit to be released and to fly home. If you had told them you were feeling unwell, a doctor would have come to you to check your vital signs etc. and your insurance would have paid for it.

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I do know if hubby had been repatriated to the UK by air ambulance after his accident to be operated on in the UK, it was likely that he would have been immobilised in bed for several days before surgery could take place. Most of the spinal surgeons were probably in Courchevel or Val Despair for New Year.
Instead he was operated on in France the following morning. Surgery happens if it is urgent and the need is immediate, fractures pinned and stabilised etc etc. You will be sent home only if it is safe to do so, after providing the necessary immediate care you need to travel.
I do find it odd that you weren't told how to inject yourself, I know several people who have needed the heparin injections, all have been shown how to use them. It may be a requirement of that fit to fly certificate that you are using them before you fly for leg injuries. Leg injuries are particularly at risk of DVT, as you are naturally less mobile and sitting around a lot. Hubby didn't have them for his neck injury, as he was out of bed and walking around within 24 hours of surgery. Patient information leaflets are readily available online in any language you desire, but it is unlikely they will be available in a clinic in Austria. I wouldn't know where to find an equivalent leaflet in German in the UK, other than by using Google myself (I'm a UK pharmacist).
There are a few diseases and long-term conditions where heparin should be avoided, but if you suffered from them, you should have told the medical staff. You have to take some responsibility as a patient for your own well-being, which would include letting them know you were feeling unwell after being discharged from the clinic.
Knee injuries are very common in a mountain resort. Most have no complications.

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@Hand Wringer, what it is that worries me, fundamentally, is that it is potentially considered normal to treat a patient for any form of injury without checking that there is no other injury (didn't even ask what happened, if had hit head, worn helmet etc), without some basic monitoring, and without taking any form of medical history or checking whether there are any contraindications or interactions with other medication being taken when further medications are prescribed. Ditto enquiring of drug or excipient allergies. When I attended a minor injuries unit in the UK on my return they asked all this before even adressing the injury at all. When I or others whom I know have had injuries in the UK treated as outpatients, they have also been given leaflets or advice as to what they should look out for as warning signs of any potential problems. That also didn't happen. From a clinical perspective, this concerns me.

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@Grizzler, it should be standard practice to take such details anywhere. I don't remember hubby being asked, but I wasn't with him at the initial stages of his treatment.

@Grizzler, Maybe EU medical professionals just aren't as good as UK ones, so what are you going to do? Never go on holiday in the EU again? You didn't require surgery. If you did, they would have of course asked you all sorts of stuff. I don't think the medical centre asked me a lot of questions about what happened either when I ruptured my ACL (and, no, I wasn't wearing a helmet), though the poor pisteur who had to controlled snowplough the entire length of the mountain with my bodyweight behind him did. But if you're worried you weren't really fit enough to be discharged, I highly doubt insisting on being discharged and trying to get on an immediate flight to the UK is the way forward Confused

But I'm far from being a medical expert so maybe I'm wrong about that.

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I had two visits to medical services this season, one to a big hospital in Austria (concern about broken pelvis and/or internal injuries, fortunately OK) the other to a resort clinic in France (ACL & MCL, fortunately sprained not torn). I was impressed with the treatment on both occasions - the hospital was much more thorough in terms of asking about medical history, contraindications, and conducting a full series of tests including blood work, but they were administering morphine shots and IV paracetamol in addition to the x-rays and scans I had so I guess the medical history was important. The hospital would only release me with a fit to fly certificate when I assured them that I was travelling back to the UK with people who would assist and look out for me. I was given all the test results and told to book an appointment with my GP on return to the UK to discuss a couple of issues, as well as staying off skis for a few weeks because of a concussion.

The resort clinic was much more straightforward with just an x-ray and ultrasound, so you could say that it was less thorough but I thought that was dictated by my injury rather than a lack of care. The Doc did ask about any allergy to ibuprofen before he issued me with a prescription and advice to RICE it. My only frustration was the the clinic did not issue medication, and for that I had to visit the nearby pharmacist, which fortunately was open but still an uncomfortable hobble in ski boots with a very sore leg.

I was very confident that the care I got on both occasions was appropriate, and would have no concerns about future visits (although hoping not to have to test my confidence levels).

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@Grizzler, my treatment in austria was excellent in every way. I couldn't say it would be the same for everyone as everyone's insurance is different, also individual's sophistication on how to deal with such matters.

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I genuinely believe you are worrying excessively about this (I run a chalet in the French Alps with quite a large guest capacity, and have done so for 8 winters and 7 summers... so you can imagine we have had a few guests over that time who've had ski/cycling injuries, as well as going through the process myself, and nothing has given me the slightest reason to fear that I am in peril should I or my husband injure ourselves again, nor our staff, nor our guests). Put it this way... they all come back again once they are recovered! My husband's cycling accident was actually in Italy and not France and, again, absolutely no worries.

@Grizzler, Sorry I missed it, but what did the resort medical centre say when you went back with your developments?

You know it makes sense.

Glad that all who had major problems and/or hospital visits feel that they received good treatment and care, and that surgery in as safe as it can be in the UK. I had never wanted to believe otherwise.

@johnE, didn't go back, wasn't told to go back. Didn't have any "developments" which I considered needed emergency advice, else I would have phoned 112 (all that I knew or was advised by TO to do if worried). Self-monitored.

@Hand Wringer, apologies if I've made this sound like I'm per se overly worried and quivering under the bedclothes at ever setting foot outside the UK. With the aid of Goggle and a few well-trusted resource sites (including BNF and professional and layman drug information ones) I can check things and make my own decisions and judgments - even if the thought of feeling oddly unwell with previously-unexperienced symptoms, medications and injuries is not the most pleasant one to have in the UK, never mind in a foreign country where you don't fully understand how things work, don't speak the language well and don't have access to a health information helpline (memo - try to get an insurer who provides one). And I won't make apologes if I find this situation rather scary. It was; and it was to Mr G too.
I also have under-and post-grad training in matters medical and pharmacuetical, and a fair bit of experience behind me, plus I was with someone with good experience of fractures and soft tissue damage who was able to keep a close eye on me and advise me as to what they thought was OK (and had anything not seemed so).
I wasn't worried that I was discharged early; although I was dis-satisfied that I was sent away with no explanation as to what I should expect to happen and what might be the sign of something more troublesome, and if the latter whether I should return to them or somewhere else or summon an ambulance. I wasn't advised to take any precaustions and I wasn't advised not to take any precautions. I was offered an operation that afternoon, and when I declined they didn't seem to want to know further. Likelihood was that I was going to be perfectly OK: and I was, shock and a few probable minorish drug side effects aside.
My worry is more for those who are rather more blithe about things than I am, or those more vulnerable and those without knowlege or the drive of self-responsibility. I always carry a copy of my prescription and I am very keen to make people aware of all of my medication, allergies, intolerances and the like; and the underlying conditions. But then again that is in my nature and training. Many people do simply trust medical or allied professionals to do what's right and to treat them properly and with due care. Most people, in my experience, don't read drug information leaflets anyway, in any language, nor think to look anything up.
But, for instance, would you personally have concerns if the anti-coagulant drug which I was administed with, and given to self administer, was prescribed to anyone taking Warfarin (or a thrombolytic or other anti-coagulant or a whole host of other haemostatic and related drugs)? What about if they were taking Ibuprofen or Aspirin or Naproxen or Indomethacin? What about if they had kidney or liver dysfunction? Peptic ulcers? Is it safe to take alcohol with it, or paracteamol? Just a few examples; there are many more. You may or may not know; I may or may not know unless I/we look it up (though at least 2 of these are on the major contraindications list for Enoxaparin, I know that, and more on the moderate/do not take concurrently/advisory). A doctor should know, but will only know if they ask a patient before they administer and prescribe the stuff - and I would have expected them to have asked me, especially given my mature age. As it was I had to stop them just injecting it into me willy nilly, and they seemed rather put out when I asked what it was; ditto creams and gels applied.
No offence to you or your clients, or to European medical systems in general. I just found that mine raised some concerns, and in my experience those concerns are justified. By the sounds of things, others do not seem to have experienced it in the hospital system. In my case I was seen at a private clinic who specialise in sports injuries. To them it was a very run of the mill, production line case. But, as @Hells Bells said, I would still expect there to be a basic standard of practice, and I was really surprised (I won't say worried) that it wasn't followed. I do hope that this was an isolated case.

Otherwise you'll just go on seeing the one name:

A snowHead

After breaking my leg i was flown to Aosta to the hospital there, the treatment was fairly good, although no wifi or tv or anything in the room, plus the food was disgusting. The operation for the traction unit went well but the inut was dated, the operation was about 15 years behind uk techniques, but it was done well, i was well looked after though on the whole, getting out of the hospital was difficult though, not support on my leg for the transfer. Would hate to go back

A snowHead

I really think it's hard to generalise about the standard of care in even one country, given the different sectors (public and private clinics can give very different experiences) and different locations (complicated problems may well be more successfully treated at a university hospital if you happen to be close to one).

I certainly don't have the impression that people I know in FR, AT, IT, CH and ES have had significantly worse care overall than people in the UK. There is certainly problems when you are unfamiliar with the country's system and/or language, where you miss out on the best path through the system. For example, in many countries there are "polyclinics"/"permanences" which are efficient and practised in treating things which fall in the UK's awkward gap between GPs and A&E. On the other hand, most non-UK citizens wouldn't ever think of calling 111 for advice.

There were obvious problems with your care and follow-up, but I'm not sure they are systematic problems. I'm not so surprised, however, that a specialist sports injury clinic may have missed things which should have been picked up on by a generalist. If possible, they are best avoided until it's clear the issue lies entirely in their field of expertise.

Well, the person's real but it's just a made up name, see?

One observation I have had from skiing friends and acquaintances and also from my parents' experience in an EU summer destination with a broken ankle is that private clinics seem to be quite keen to operate - my father's broken ankle was apparently a we'll operate and put pins etc in urgent job which was all quite frightening and intimidating, they went with just a cast and usual rest etc and confirmed with local fracture clinic on return who said no we'd never pin or plate a non complex fracture like that.

Do wonder whether there is a bit of a profit motive operating (and of course conversely whether NHS advice tends to be a bit cost adverse)?
I suspect many of us have experience of being prescribed a whole bucket of stuff when we've seen a French doctor and been told simply to come back in 2 weeks if it doesn't get better by a UK GP so maybe there is just a degree of national expectation at play too.

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@Dave of the Marmottes,

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I'd add:
1) outcomes in UK are also better for people who know what the BNF is. Even here, you need to help yourself a bit.
2) no two clinicians will ever agree, so if you start treatment in one place, another place will always suggest a different approach.
3) 1 experience this season of taking a mate to ER in Whistler. 100% professional, no waits.

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I have experience with dealing with 5 accidents in La Plagne over the years including one helicopter evacuation. All I can add is make sure you have an EHIC and travel insurance Medical care in France is broadly similar to the UK including hospital staff apologising for beds in corridors. One subtle difference is the half bottle of wine with dinner in the ward Very Happy

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@Sourgraping, no wine in Grenoble hopsital. Hubby had to lay of the booze for a whole week. Apart from the whisky in the coffee cup on New Years Day from the hip flask.

@Hells Bells, Yep, but your Hubby was in for a little more than a broken wrist....

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@Sourgraping, that is true, but he wasn't taking any drugs once surgery was over (idiot). Others with less serious injuries didn't get any either.

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If you damage a lower limb I would rather it was treated in a French ski resort hospital than a NHS one.

If you have a heart attack you want to be treated in Phoenix Arizona, the wrinkly capital of the US with lots of customers. I speak from personal experience on the latter. They were great. Heli transfer from the satellite hospital, landing on the roof and the first stent going in about an hour later even though it was Sunday.

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Experiences of injury treatment abroad?

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