Don't Forget to Plan for Emergencies

A few weeks ago, we discovered in rather dramatic fashion, that the Little Lady has a very severe allergy to cashew (and pistachio) nuts, as well as a milder reaction to several other tree nuts. This happened while we were in Florida, and I confess we really hadn't made an emergency plan. Fortunately, things worked out and we were in a context where we basically knew what to do. But when traveling internationally, it's important to have a plan in place before you go. And for us, that has gotten even more important. I'll tell you what happened and how we've planned for the worst when we go to Peru for field work this summer.

We were visiting Jana's parents in Florida for spring break. On a Sunday after a morning at the beach, we came home for lunch. At the end of the meal, the LL asked for some cashews, so sure, why not.

Well, within about 90 seconds she was starting to have some problems. Choking and gagging mostly. She has a sensitive gag reflex, so not necessarily anything to worry about. Within just a few more minutes it was clear something was wrong. The choking had gotten worse. She was starting to vomit. She was not talking much and was getting lethargic. Her face was starting to swell. Hives were appearing. And it was clear she was starting to have a tough time breathing. As things progressed, we realized she was having an anaphylactic reaction.

We were not completely unfamiliar with this. She has had an allergy to eggs that she is growing out of. So we had been through the signs of a severe reaction with her allergist. And he had given us epinephrine injectors just in case she ever had a really bad reaction to eggs. She never has. He told us to use the epi if in doubt, but we knew that using it would mean a trip to the ER. And I did not want to go down that road unless it was really necessary. We gave her an appropriate dose of Benadryl as soon as we realized she was having an allergic reaction. As it got worse, we realized we needed to inject her with the epi pen. She was clearly very scared, as were we. Our first inclination was to drive to the hospital. But we quickly realized we needed more help. We called for an ambulance and the St. Lucie County fire rescue got there pretty quickly. And it is good they did. Even after the epinephrine, the LL kept reacting, and they had to pump her full of medicine to stop the reaction on the ride to the hospital. We clearly would not have been able to do that. In the end, she was treated at the ER for several hours, the reaction was controlled, and we've been following up with specialists to pinpoint exactly what she was reacting to and take steps to avoid exposure in the future.

This was a very scary situation, and it could have turned out much, much worse without the availability of the epinephrine and a quick response time by EMS. And this experience really highlights the importance of having an emergency plan when you travel. No matter where you go, it's important to know what services are available in an emergency. And it's become even more important for us now that we know the LL has a potentially life-threatening medical condition.

For our trip to Peru, I've focused mostly on medical emergency services. You don't dial 911 in Peru if you need help. 116 is the number to dial for medical or fire emergency. Apparently the volunteer fire department in Lima provides pretty good service for medical emergencies. I've also identified a handful of hospitals nearby our apartment if we have a problem, and have a sheet of other information related to companies that we have access to that can provide help and guidance in an emergency situation (provided through work since this is a business trip).

It's also important to be at least minimally prepared for other types of emergencies. We will figure out the best way to evacuate our apartment in case of fire. It's a high-rise, so fires can be dangerous if not extinguished quickly. The number for help from the police is 105, and there are specialized branches of the police who can deal in particular with issues that foreign visitors are more likely to have in non-emergency situations. The embassy provides a lot of this information, and can also be a resource in an emergency.

That covers the basics. Medical. Fire. Police. It is also useful to think about any particular local hazards as well. In Peru, probably the big one is earthquake. A strong earthquake can have devastating consequences. If a major earthquake strikes, we will be as ready as we can be. If phone service is still working, the embassy and, even better, the emergency response companies mentioned above should be helpful. But we'll probably keep a bit of extra water and food around in case the worst might happen. We are in a modern building that should be as earthquake proof as possible. But it's hard to predict what the broader context would be in a major and widespread natural disaster. So, we have done a little thinking about this ahead of time.

Here's hoping that our trip to Lima will be less eventful than our trip to Florida. No ambulance rides, no trips to the ER. Even avoiding a trip to the pediatrician would be nice, but I won't hold my breath on that one with a two year old in a new childcare setting. The bottom line is that thinking through emergency procedures ahead of time makes it easier to respond if the unexpected happens and makes for a more enjoyable and stress-free trip.