Although he travels abroad several times a year for work, Peter Young paid little attention last year when his company, the brokerage T. Rowe Price Associates, sent out an e-mail that it was contracting for travel assistance service.
Then, last summer, Young's son, Jamie, was injured on an overseas school trip. The 15-year-old slipped and fell 30 feet from a rocky cliff to a beach on Spain's northern coast. He was hospitalized in Gijon with a fractured pelvis.
Spanish doctors said Jamie should lie flat for six weeks. Young's family doctors in Baltimore suspected that the young patient should be walking around, but they needed more medical information to be sure. They recommended that he be flown back to the states, to the Maryland Shock Trauma Center in Baltimore.
Peter Young looked into air ambulance service, but it was prohibitively expensive: $35,000 to $50,000. When he called his company's benefits department, he learned that executives at his level were covered by the service described in the e-mail he hadn't paid much heed. The service was provided by MEDEX Global Group of Towson.
MEDEX offers travel insurance and helps tourists with problems as prosaic as lost luggage, but the heart of its service is medical assistance. Its 24-hour call center is poised to deal with a tumor in Mongolia or a sprain in Spain.
Its conference room is filled with framed, poster-size descriptions of other dramatic cases: a missionary hurt in a car accident in Siberia, an expatriate working in Indonesia diagnosed with leukemia, a vacationer in Jamaica who fell and injured his head. The growing company fielded 30,000 calls for help last year from travelers in 191 countries.
With a database of English-speaking doctors around the world, MEDEX is prepared to arrange care - or an airlift - for injured or sick travelers. In addition to assisting Americans traveling abroad, it offers coverage for foreigners visiting the United States.
Interest in travel services has grown with the increase in business and vacation trips. About a dozen companies offer medically oriented help line services like MEDEX, experts say.
Outbound trips from the United States grew by 31 percent from 1990 to 2000, according to the federal Bureau of Transportation Statistics. Moreover, a drop in travel costs and trends such as "ecotourism" have pushed Americans to locations beyond Western European cities. Travel to Eastern Europe, Asia, South America, the Middle East and Africa is increasing at a faster rate than to Western Europe, the federal figures show. Travel declined after the September 2001 terrorist attacks, but rebounded - albeit with new concerns about safety and health.
"People are looking for something a little more adventurous. They've been to France and Italy, and they want something more exotic," said Fran Lessans, president of another travel-related business, Passport Health of Baltimore. It offers travel inoculations from franchise locations in about 50 cities.
MEDEX began 25 years ago in England as a travel assistance company. Maryland investors bought it and moved it to Baltimore County, where it has remained through several changes in ownership. Within the past few years, it has added insurance to its travel assistance, making it more attractive to potential clients.
It has also done joint marketing with iJET Travel Risk Management, an Annapolis company that provides clients with information on risks around the world, from avian flu to political turmoil.
"Pre-9/11, people wanted a weather report" before they traveled, said Colleen LoPresto, chief of operations for MEDEX. "Now, they want a security report."
Beyond the corporate clients, who make up one-third of MEDEX calls, another 20 percent of the business comes from coverage "embedded" in insurance policies offered by companies as an added feature. Several Canadian insurers use MEDEX, so the assistance center gets a fair number of calls from Canadian "snowbirds" wintering in Florida or the U.S. Southwest.
MEDEX is also offered as part of the membership package by some travel clubs and associations. Schools buy the coverage for students who travel. And MEDEX does some direct-to-consumer marketing, through a Web site and advertisements in travel magazines.
In general, coverage costs about $4 a day, with a seven-day minimum. Exact cost varies with age and details of the coverage.
The privately owned company doesn't release financial figures, but Bruce Kirby, president and chief executive officer, said business has increased by 30 percent to 35 percent in his five years as CEO.
"There's an increase in awareness of the need for coverage," Kirby said. "We've grown over the past few years in our ability to handle situations all over."
The key to MEDEX's assistance, executives say, is a staff of "problem solvers" - about 30 call center employees, most speaking multiple languages, and a sort of super Rolodex. It keeps a file of about 70 "regional medical advisers" who are Western-trained and English-speaking, but familiar with treatment styles and facilities in different parts of the world.
MEDEX also checks up on medical facilities around the globe. Pascaline Rivera, director of provider relations, recently returned from Asia with data and a photo album with pictures of hospitals and clinics in Vietnam, Malaysia, Indonesia and Taiwan.
Once, Rivera recalled, MEDEX evacuated a patient from Tibet, but the insurance company questioned the bill. Looking at the Web site for the Tibet hospital, which touted its specialty care, the insurer opined that the patient could have gotten adequate, and less expensive, treatment there. MEDEX sent someone from Beijing to examine the facility: It turned out to lack such basics as disposable medical supplies - and windows.
Tim Bond, senior relocation specialist for Lockheed Martin, the defense giant headquartered in Bethesda, said his company reviewed six or eight potential travel assistance vendors in 2000 to replace its previous service. Lockheed Martin ultimately chose MEDEX because it felt it had an organized call center and a good track record with the U.S. Agency for International Development, Bond said.
About three weeks after the contract was signed with MEDEX, a Lockheed employee suffered a serious stomach ailment on Okinawa. MEDEX evacuated the patient to Singapore.
MEDEX has contacts with several "gateway facilities" - such as the hospital in Singapore where the Lockheed Martin employee was flown. MEDEX is familiar with the level of care at these hospitals, and because of its continuing relationship can facilitate admissions and guarantee payment.
After Peter Young, the T. Rowe Price executive, contacted MEDEX, the company requested doctors in Gijon to transmit medical records to Baltimore. MEDEX had a Spanish-speaking doctor talk with the doctors in Spain. They agreed that Young's son could, and should, be flown home.
MEDEX arranged ambulance transportation from Gijon to Madrid and a flight from there to Philadelphia (with Jamie, accompanied by a teacher, in a first-class seat so he could recline). An ambulance crew with a stretcher met him at Philadelphia International Airport and brought him to Shock Trauma. The night Jamie arrived at Shock Trauma, a MEDEX supervisor walked in to check up on him.
He's fine now, his father said.
"I couldn't have been more impressed from beginning to end," Peter Young said. "I couldn't imagine trying to coordinate something like this myself."