Accidental Tourist.

Be prepared to manage risk

Last April, more than 20 cruise ship passengers were injured in a jitney accident in Ocho Rios, Jamaica. While some received emergency treatment in a local hospital or at University Hospital in Kingston, seven passengers with head, back and eye injuries were airlifted to the University of Miami/Jackson Memorial Hospital's Ryder Trauma Center and Bascom Palmer Eye Institute.

"Some of the passengers wanted to come up here," said Dr. Enrique Ginzburg, a Ryder trauma surgeon. "Some of the hospitals down there don't have the capabilities to handle the major injuries."

Unexpected accidents or medical emergencies can happen to anyone traveling on business or for leisure in Latin America or the Caribbean. To reduce the risk, take several steps in advance of a trip:

* Talk to your primary care doctor if you have a chronic condition or are currently taking prescription medication.

* Familiarize yourself with local health care conditions and medical facilities.

* Review your insurance or HMO coverage.

* Consider a supplemental insurance or emergency medical transportation policy.

* Prepare a personal game plan for handling unexpected problems.

As with most aspects of medical care, prevention is the best strategy For example, put your medications in a carryon bag. On an extended trip, take an extra prescription with you, and know the generic terms for your medication in case a local pharmacy carries a different brand. Insulin users should bring a letter (in Spanish or Portuguese) from their physician that explains why they are carrying needles. And take along food supplements or vitamins if you have special dietary needs.

"If you plan to travel for an extended period, ask your doctor to recommend an associate in the region," advises Laura Weinsoff, a South Florida public relations specialist who travels frequently to Latin America "In an emergency it's a big help to have the name of a local physician."

Depending on your itinerary, it may be advisable to be vaccinated against diseases like hepatitis or to take anti-malaria drugs before leaving on your trip. Information is available through the U.S. Centers for Disease Control and Prevention's international travelers hotline (1-877-FYI-TRIP), or web site (www.cdc.gov).

The U.S. State Department posts medical advisories on many countries in Latin America on its web site (travel.state.gov). For example, the State Departments advisory on Paraguay says, "Facilities for medical care are limited. Doctors and hospitals often expect immediate cash payment for health services."

Study your insurance policy's international travel provisions. While most policies will cover life-threatening conditions, you may have to pay the costs of treating a broken leg, chipped tooth or sprained wrist. The federal Medicare/Medicaid program does not pay for medical services outside the United States.

If you're traveling on business, your company's insurance may offer additional medical coverage. Again, you should check the policy before you leave.

Even if your regular policy provides travel coverage, most doctors and hospitals in Latin America don't want to wait several months for payment from a distant insurance company In fact, many foreign hospitals will withhold your passport until they receive full payment.

The solution maybe purchasing a supplemental policy from an insurance company that deals directly with Latin American health care providers. Such a carrier maybe able to guarantee payment, saving you from financial jeopardy.

Finally, if you prefer to be treated for a serious condition in the United States, you should consider an emergency evacuation policy that covers air ambulance transport. While it's unlikely that you would need such a policy, medical emergencies like the Jamaican jitney accident can occur at any time or place. Follow the Boy Scout motto, and "be prepared."