Managing foreseeable risks

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1 Managing foreseeable risks Which factors should be considered when determining the needs of business travellers and short term assignees? What is risk tolerance and how do you provide the right care for business travellers, students and expats? Paul Hedman, Risk Advisor February 20 th 2014

What is risk tolerance and how do you provide the right care for

2 Falck a global assistance company Falck core services Emergency Assistance Healthcare Safety Services Fire Services Ambulance Services Public fire fighting Industrial fire Fire fighting Services Consultancy and training Ambulance Medical Clinics Ambulance Elderly care Services Assistance Employee Assistance Assistance Assistance Programs (EAP) Psychological crisis aid and counseling Staffing Risk Management 24/7 Emergency Response Center Evacuation Repatriation Travel risks & security Sea Survival Fire Fighting Other Safety enclosures Crisis management Falck Global Assistance Onsite Medical Services Assistance & Evacuation Travel Risk Mgt Training Crisis Management Fire Provision Services of onsite medical staff, clinics, and emergency care services Fire 24/7 Services Emergency assistance and evacuation from site to relevant care unit Provision of risk advisory, risk rapports, security training and travel tracking Provision of on-site training general as well as specialized training services Provision of crisis plans, crisis mgt. teams, equipment and rescue operations

Risk Management 24/7 Emergency Response Center Evacuation Repatriation Travel risks & security Sea Survival Fire Fighting Other Safety enclosures Crisis management Falck Global Assistance Onsite

3 A global travel, medical, and security assistance structure with regional alarm centres 30,000 employees worldwide

4 There are many issues to consider when an organization is responsible for guaranteeing the safety of its international employees Road traffic deaths in

Medical Evacuation in a Hostile Environment: Bangui, Central African Republic December, 2013 Location: Bangui, Central African Republic Seleka Militia Service: Medical Evacuation in Hostile

5 Medical Evacuation in a Hostile Environment: Bangui, Central African Republic December, 2013 Location: Bangui, Central African Republic Seleka Militia Service: Medical Evacuation in Hostile Environment Patient : Employee collapsed at hotel due to undetermined diagnosis. No medical treatment available locally. Case Outcome: Successful air ambulance medevac to Nairobi with help of heavy security support on ground in Bangui. French troops at the airport gates Situation in Bangui - Dec 6 Chaos and violence as deadly clashes erupted between rivals Seleka and Antibalaka armed groups At least 400 casualties civilians indiscriminately targeted Complete shut down of government and hospitals people sought refuge at Bangui M Poko International Airport, controlled by French troops Most westerners gathered at the same hotel for protection.

Case Outcome: Successful air ambulance medevac to Nairobi with help of heavy security support on ground in Bangui.

What we are up against Risk mapping Risk Appetite and Risk Tolerance Risk doesn't always make sense and despite the fact that many people have a hard time managing the uncertainty that

6 What we are up against Risk mapping Risk Appetite and Risk Tolerance Risk doesn't always make sense and despite the fact that many people have a hard time managing the uncertainty that comes with risk-taking; 1 Risks make life more interesting More engaging More exciting LeVan, Angie. Happiness Is Risky Business, 5 Best Practices of Happy Risk-Takers, Pshycology today 6

comes with risk-taking; 1 Risks make life more interesting More engaging More exciting 1 2012

7 Determining what measurements to take to fulfil your duty of care obligations starts with a risk assessment DESTINATION CHARACTERISTICS Medical: Health risks Infrastructural health risk Health care system Medical evacuation Security: Political stability Civil unrest Crime Terrorism TRAVELLER CHARACTERISTICS Gender Age Pre-existing conditions Physics Assignment (short term/long tern) Psychosocial characteristics Experience 7

system Medical evacuation Security: Political stability Civil unrest Crime Terrorism TRAVELLER

8 Destination specific risks: Duty of Care strategy and medical risks Solid decision on an informed ground Risk matrix Health risks Hygiene Environment Natural disasters Crime, urban related Infrastructural health risks Culture and religion Language skills Resources Infrastructure/transportation Psychological Health care system Centres of excellence Specialties, diagnostics, equipment Regional variation Blood, medications and consumables Medical evacuation Mobilization time Local air ambulance and HEMS Ground ambulance Road conditions

Infrastructure/transportation Psychological Health care system Centres of excellence Specialties, diagnostics, equipment Regional

9 Destination specific risks: Duty of Care strategy and security risks Solid decision on an informed ground Risk matrix Political stability Political conflicts Strikes, riots, demonstrations Religious protests/riots Violent Unrest Traffic Civil unrest Strikes Demonstrations Public tension Violence and lack of control from the government Civil war Crime Petty crime/violent crime Organized crime/gangs Curfews Kidnapping Corruption Terrorism Domestic groups Daily risk of terror Political terrorism Religious terrorism International terrorism

Demonstrations Public tension Violence and lack of control from the government Civil war Crime Petty crime/violent crime Organized

10 Typical complications Characteristics Traveller specific risks related to type of traveller Based on case data and statistics Students Business travellers Expats Age: Length of stay: 4 months to 1 year First time traveller Age: Short travel periods Used to travelling not familiar with destination Age: Length of stay: Minimum half a year some are repositioned Travels with spouse and family Injuries caused by behaviour (limited illness) Age 16-19: Often alcohol related Sports and car accidents Psychosocial/mental Homesickness (root cause) Low risk, high cost countries <40 years travellers: Sports and STD >40 years travellers: Cardiac related Stress related diseases ex. stomach ache and headache (symptoms of stomach ulcer) Cardiac arrest and stressed heart Cold, sore throat and flu Gastroenteritis Psychosocial challenges due to adaption Lifestyle diseases related to way of life Pre-existing conditions not examined before travel Long term treatments Dependents often ill or worried Repeat expats experience more problems No obvious diseases (such as Malaria) High risk countries with no access to general physician 10

spouse and family Injuries caused by behaviour (limited illness) Age 16-19: Often alcohol related Sports and car accidents Psychosocial/mental Homesickness (root cause) Low risk, high cost countries

11 Traveller specific risks for students Based on case data and statistics Students Business travellers Expats Characteristics Typical complications Age: Lenght of stay: 4 months to 1 year First time traveller Injuries caused by behaviour (limited illness) Age 16-19: often alcohol related accidents Sports and car accidents Psychosocial/mental Homesickness (root cause) Low risk, high cost countries 11

traveller Injuries caused by behaviour (limited illness) Age 16-19: often alcohol related accidents

12 Traveller specific risks for business travellers Based on case data and statistics Students Business travellers Expats Characteristics Age: Short travel periods Typical complications <40 years travellers: Sports and STDs >40 years travellers: Cardiac related Used to travelling not familier with destination Stress related diseases ex. stomach ache and headache (symptoms of stomach ulcer) Cardiac arrest and stressed heart Cold, sore throat, and flu Gastroenteritis 12

travellers: Cardiac related Used to travelling not familier with destination Stress related diseases ex.

13 Traveller specific risks for expats Based on case data and statistics Students Business travellers Expats Characteristics Age: Length of stay: Minimum half a year some are repositioned Travels with spouse and family Typical complications Psychosocial challenges due to adaption Lifestyle diseases related to way of life Pre-existing conditions not examined before travel Long term treatments Dependents often ill or worried Repeat expats experience more problems No obvious diseases (such as Malaria) High risk countries with no access to general physician 13

adaption Lifestyle diseases related to way of life Pre-existing conditions not examined before travel Long term treatments Dependents often

14 Traveller specific advice to mitigate typical traveller related risks Students Business travellers Expats Training for University exchange students Define university risk appetite and choose exchange program accordingly Arrange homesickness hotline for students Robust driving policy Make sure clinics can handle sport related injuries Set-up for high & extreme countries Alcohol is and will be a problem Demand pre-ex Keep medical records of employees Develop travel training for age groups Regular medical check ups for 40+ Promote exercise Corporate risk appetite should be in the travellers DNA Have an open reporting system where travel experiences can be shared. Develop specific expat travel policy Training for dependents Follow up on dependents health regularly Rote domestic / abroad to avoid expats for life. Promote exercise Have clear alcohol policy Offer psychology hotline Do not dispatch expats on short notice. Give time to prepare. 14

problem Demand pre-ex Keep medical records of employees Develop travel training for age groups Regular medical check ups for 40+ Promote exercise Corporate risk appetite should be in the travellers

15 Practical advice Action Appoint one responsible point of contact for all travel related questions Mandatory training Reason Make sure your staff feel in safe hands More cost effective then re-active behaviour Be aware that conditions will change over time Political Security / medical Length of stay for expats Know you traveller Age / gender Risk appetite Pre ex. Destinations Fulfil your duty of care obligations Training, Policy, 24/7 call centre, risk assessment, response capacity Board / management to define corporate risk appetite correlating to company culture 15

medical Length of stay for expats Know you traveller Age / gender Risk appetite Pre ex.

Contact Paul Hedman Risk Advisor Mobile: +46 763 49 67 46

16 Contact Paul Hedman Risk Advisor Mobile: Mail:

ACE USA Travel Assistance Services

ACE American Insurance Company (A Stock Company) Philadelphia, PA ACE USA Travel Assistance Services ACE A&H Division offers worldwide travel assistance services to employees, students and their eligible