What to do if you get sick on a layover

Pharmacy, clinic or emergency? How to handle illness overseas as crew: when to get help, insurance, telling your company before duty, and keeping receipts.

You wake up in another country with a duty in 18 hours and a stomach that has other plans. Two decisions come first: how bad this is, and who needs to hear about it. This guide covers both, along with the money side.

Pick the right level of care

Start with a pharmacist for mild stomach trouble or a minor ailment. The NHS says a pharmacist can advise on oral rehydration powder, and that you should ask one about signs of dehydration, such as dark, strong-smelling urine or passing less urine than usual. The CDC advises buying medicines from a trustworthy pharmacy and avoiding open markets, street vendors and suspicious-looking pharmacies. A price far below normal can mean a counterfeit.

See a doctor or clinic if the NHS list of warning signs applies:

There is blood in your diarrhoea, or bleeding from your bottom.
You keep vomiting and cannot keep fluids down.
Dehydration signs continue after you use rehydration sachets.
Diarrhoea has lasted more than 7 days, or vomiting more than 2 days.

Call the local emergency number for the NHS emergency signs: vomiting blood, a sudden severe tummy ache or headache, confusion, a stiff neck with pain from bright lights, blue, grey or pale skin, or severe trouble breathing. Our list of emergency numbers for crew cities has the numbers by country. In Japan, 119 reaches the ambulance, and the health ministry's Navii site searches for medical facilities and pharmacies in several languages. Tokyo also runs a medical information site for visitors in English, Chinese and Korean.

Tell your company before duty

Tell your company as soon as you know you might not be fit to operate, and follow its fitness-for-duty rules. A call from your room 18 hours out gives the company time to plan. A call at the aircraft door does not. Ask your company before you take any medicine, including one from a local pharmacy, because its rules on medication apply to you overseas as well.

Insurance and who pays

At most destinations you pay hospital and other medical costs yourself, the CDC says, and some providers want payment before care. You then send your bills to your insurer for reimbursement. Ask your company, before you fly, what cover it arranges for you and what it excludes. The CDC suggests checking these points on any policy:

Whether it reimburses what you pay out of pocket.
Which providers are in its network at your destination.
Its exclusions, such as high-risk activities, mental health emergencies and pre-existing conditions.
Whether it offers a 24-hour support line with a doctor behind it.

Keep your receipts

Insurers often deny claims because of poor documentation, the CDC warns. Ask for a receipt each time you buy a medicine, and ask for a record of any care you receive, including the medicines you were given. Keep the receipts with a summary of the charges, and photograph them on the spot in case your bag goes missing.

When you get home

If severe diarrhoea starts soon after you return, see a doctor and ask about stool tests, according to the CDC. Tell the doctor where you travelled and what you ate. Our guides on avoiding food poisoning and the crew bag medicine kit can cut the odds of a repeat.

Finding a pharmacy fast

On Chocks lets you search for a pharmacy and shows the ones crew recommend near you, with the Open now filter for the middle of the night.