Interview: Dr Simon Worrell of Crisis24

In addition to International Assistance work, we have a strong medical services capability. For instance, we have been in pandemic planning throughout the last epidemics of MERS, Zika, Ebola and of course Covid-19; advising governments, banks and the oil and gas industry on how to keep their employees safe and operations ongoing. Our in-field operations include clinic set-up and staffing for major events (such as the Olympics) and throughout Covid-19, where we successfully lobbied the UK government to allow airport PCR testing to aid travel and trade. Within Crisis24, we now augment security details with acute medical capability, further reducing risk for companies and their VIPs.

Looking back at the past decade, major outbreaks have occurred every two or three years

What are the biggest challenges facing the international medical assistance industry?

Demand for quality international medical assistance has never been greater. We have all seen first-hand the dangers of unbridled infections, and for many companies, the difficulties managing employees abroad in the midst of a pandemic. Added to this is the increased awareness that employees have of their vulnerability when travelling: wanting to be more involved with arrangements and supported by an assistance company that is genuinely knowledgeable and effective. We need assistance teams that are experienced, caring for clients in the most remote and problematic locations.

For assistance companies, the addition of chargeable medical services to their range of services is essential if the ‘race to the bottom’ insurance pricing continues unabated. It will be a challenge for clients to separate the wheat from the chaff: those that have proven experience in medical services, and those who would like the cash and are winging it.

How has Crisis24 used new technology to assist clients, and what plans are there to develop these kinds of services in the future?

We have invested in artificial intelligence (AI) capabilities that can mine data from the full breadth of what is available on the web, in multiple languages – making connections between the entries where they exist and highlighting them for our human intelligence teams to vet, further investigate and action. This ‘human and machine’ approach produces verified medical and security intelligence comprehensively, quickly and dependably. We are very proud of this groundbreaking facility. The intelligence is fed directly to clients as required and to our portal, Horizon, where they are mapped and viewed directly. The medical and security teams then apply the information to our individual clients. For example, for medical, if an employee is travelling to a location that has received intelligence about an outbreak, and has a relevant past medical history – on certain medications, or might need routine medical attention abroad – we assess the risk and make arrangements, where possible, to facilitate the trip safely.

How has the industry improved since you began your career?

I started as a repatriation doctor in 2002. We had mobiles and the net, but the former was expensive and mostly avoided abroad if possible, and the latter was little utilised. We still had paper airline tickets, and many was the time I stood at the British Airways counter to pick them up, trying to remember which part of the world I was due to visit on that particular day! As the web developed, visa applications became simpler. No longer did I need to queue in packed halls for hours, hoping that my multitude of paperwork wasn’t found wanting and that I was grimacing sufficiently in the photos, but the process became entirely digital. Later, the advent of platforms, such as LinkedIn, meant that we could easily publish articles that I’d produced on epidemics such as Ebola and MERS, allaying fears where possible and charting the likely course of the outbreaks.

Do you feel like travellers have forgotten about Covid-19 in general now that travel restrictions have eased, and is this a fair attitude – or should they still be aware of heightened health risks?

I’m really pleased that most are able to move on from Covid-19; to capitalise on the triumphs afforded us by the vaccine development and rollout. I think there is still a heightened awareness of disease, but we are very fatigued by the subject. In fact, this is the best time to prepare for the next epidemic, as it is inevitably just around the corner. Looking back at the past decade, major outbreaks have occurred every two or three years – most affecting hotter parts of the world. As such, tropical locations are often important to many multinational companies, so ensuring that epidemic plans and training are in place is essential.

How can travel assistance programmes help corporate and leisure travellers be more aware of the risks they face, so they cope more effectively when an adverse event occurs?

Much of what we do at Crisis24 is to prepare the traveller for their trips abroad. The correct immunisations are of clear importance, but so is receiving clear pre-travel briefings, giving a fuller picture of what to expect. If itineraries are complex, involving remote locations, we often prepare a medical evacuation response plan (MERP), which identifies available clinics in an emergency, the nearest airstrips, trusted air ambulance providers, and the location of the most appropriate place of medical safety. With our Human and Machine approach, it is our aim to equip the traveller with all the information they could need, then detail how the intelligence affects them personally, given their history, and plan to reduce any identified risk – be it security or medically related.

How has the Ukraine crisis challenged companies to predict and react more effectively to geopolitical tensions in what were previously stable regions?

The invasion illustrated the challenge of when to issue advice around restricting travel or evacuating during times of looming – but not yet ongoing – crises. Western governments, for example, are typically anxious not to act prematurely when mandating evacuation. However, as with Ukraine, such advice can go from ‘premature’ to ‘too late’ with little to no warning. The watchword is ‘preparation’ – as crises are developing, it is important for companies to be considering and making necessary preparations already. They should not wait for an evacuation mandate before acting.

With Ukraine, there was also the sense of a Russian invasion being unthinkable; we’d seen high tensions in the region before, so there was a temptation among some people to wait for it all to blow over. But when governments are advising withdrawal, and Crisis24’s threat indicators are being crossed one by one, organisations and people should take heed – no matter how safe or familiar the area appears to be.

In a sense, the best way of keeping people safe is to enter into a partnership with them

Of course, the impact of Ukraine isn’t just in that country. There have been consequent security and disruptive impacts elsewhere, with rising fuel prices and grain shortages exacerbating the global cost of living crisis. The consequence – as is typical during times of economic hardship – is inevitably higher crime rates, increased violent or disruptive civil unrest, as well as a rise in extremist militancy, even in stable countries.

How has the rise in political extremism affected travel risks for globally mobile employees, and what mitigation measures can ensure employees are protected and prepared?

In many areas, the polarisation of discourse – partly due to social media, partly due to mass communications, and partly due to economic strife – has had a detrimental effect on the security environment in some locations. At the less dramatic end of the scale, a traveller could face low-level harassment or rudeness in a country, due to their actual, or perceived, background. At the extreme end, they could be subject to a targeted attack.

However, either of these scenarios is still a rare occurrence and perspective is important. The more likely impacts of political polarisation stem from the resultant increase in adversarial industrial action, or protests. If, for example, an extreme political party holds a demonstration, there is more likely to be a counterdemonstration; the nature of such events means they are more likely to turn violent. Therefore, disruptive security measures are often put in place, which is the most likely impact on the travelling workforce.

To protect employees, organisations should continually monitor and reassess the local threat environment and – where possible – work to alter individuals’ risk profiles to reduce their exposure to local threats. So, make sure they don’t attract attention by advertising their political, national or religious affiliation. Advise them on online security and potentially contentious social media content. If you are sending an employee to an unfamiliar location, inform them of potential threats. Other risk mitigation measures include adequate travel insurance and medical assistance, making sure you maintain communications if there is an incident – and that they know who they should contact in an emergency. Organisations should also establish escalation, movement and evacuation triggers and formulate ‘what if/in the event of’ contingency plans. These plans should be reviewed and tested regularly.

How can pre-travel health checks empower business travellers to look after themselves more effectively?

In a sense, the best way of keeping people safe is to enter into a partnership with them: the assistance company gives the employee all they need to keep safe, while the traveller does their bit to follow advice and mitigate their risk. It’s probably true that all the briefings on gastroenteritis and its causes that we can deliver become somewhat redundant when the first mouthfuls of street food are swallowed. Of course, we’ll be there to help with any consequences!

If you could change one thing about the international medical assistance industry, what would it be?

I suspect the single measure that would produce the greatest improvement is to reverse the race to the bottom pricing.