M ost seasoned travelers take simple precautions against falling sick overseas and carry medical insurance, a handful of basic over-the-counter medicines and the numbers of local hospitals. But if you become seriously ill - what then?

Meet the medical escorts, anything but your average general practitioners. These specially trained medical professionals spend their working lives getting into tense situations. Their job description includes traveling to remote locales on a moment's notice, first-aid on the fly, reassuring panicking patients far from home and dealing diplomatically with egotistical local doctors and officials.

Dr Ahmed Fahmy is one of three in- house doctors at the Hong Kong office of International SOS (ISOS), the largest global organization specializing in medical evacuations. Fahmy traded in his life as a Parisian GP to join the company in 1995. But describing a "typical day on the job" is impossible, Fahmy says.

"A typical day does not exist for a medical escort," he says, flashing a grin "Every day hands me a new, often unique set of challenges. It's just one of the things that makes the job so interesting."

For Fahmy, most days begin around eight o'clock with a call into the company's Causeway Bay office where a multilingual staff of 30 deals with the compl icated logistics of handling the medical emergencies of clients - communicating with hospitals, insurance companies and other ISOS offices all over the world. If a client from anywhere in the world needs assistance in southern China, a team from the Hong Kong office is usually called in. Once the location of a patient needing assistance or evacuation is pinpointed, a medical escort team is assembled and sent into the field.

One recent ISOS case involved a Brazilian traveler who wound up in a Guangzhou hospital after lapsing into a coma after a drinking spree. The Brazilian's friend called his parents, the parents called the insurance company who then called ISOS. Fahmy was sent immediately.

"First I went to the hospital in Guangzhou. The patient was in a serious condition, and I suspected that there was more than alcohol involved (this proved to be the case). I brought him back to Hong Kong, and after his condition had stabilized I was able to take him back to his family in Brazil."

For medical escorts, the main concern after stabilizing the patient is to ensure they are taken to, in professional parlance, a center of medical excellence. For travelers in Southeast Asia, this usually means Hong Kong or Singapore.

"For reasons to do with language and quality of care, we want to bring any patient who cannot be repatriated immediately into Hong Kong or Singapore first," Fahmy says.

In most cases patients are brought out on commercial airlines, the company arranging either a row of economy seats to be used as a stretcher or, for less serious cases, seats in business or first class. But in cases where the patients are too ill or potentially infectious to travel commercially, the company employs its own air ambulances. The one used in the China region is a specially designed Lear Jet tricked out with all the latest medical gear.

"Our air ambulance can function as a fully mobile emergency room and intensive care unit," Fahmy says. "We believe in being equipped to handle almost any medical emergency that might arise."

While ISOS employs a small number of in-house doctors in Hong Kong, it also keeps on retainer a number who work on a part-time basis.

Dr John Wedderburn runs a small clinic on Lamma Island and has been a medical escort for more than a decade. Unlike many GPs, Wedderburn discourages regular patients from making appointments too far in advance.

"At any point during the day I can get a call from the company asking me to fly somewhere to evacuate a patient, or to repatriate a patient from Hong Kong back home. One Sunday last month I woke up expecting to spend the day on Lamma doing housecleaning, and instead wound up escorting a gentleman who'd had a stroke in Hong Kong back to his home in Memphis."

Wedderburn admits that working as a medical escort makes regular practice seem a bit dull by comparison. Flexibility, patience, and the ability to deal diplomatically with ever-changing situations, he says, are the keys to being a successful medical escort.

"It's not uncommon for the description of the problem and the problem itself to be quite different," Wedderburn says. "In one case I had to fly out to help a European woman who'd been in a car accident in China. The local doctors had determined that her injuries were not life threatening, but that she had tachychardia (a condition where the heart beats too rapidly), which they were dealing with through medication and withholding of fluids.

"As soon as I arrived I could tell the accident had been worse than we'd been told, and that the patient was suffering from severe blood loss. The issue then became dealing with the original doctor's misdiagnosis and getting fluids into the patient as quickly as possible without causing the local doctor to lose face."

According to Wedderburn, the problem was managed diplomatically, and the patient was soon on both the road home and to recovery. Fahmy concurs that cases like these do happen, and that a good medical escort must maintain as unobtrusive a posture as possible while doing everything they can to assist the patient.

"Even in cases where we do not agree with the local diagnosis, we need to maintain a good rapport with the local doctors and be as culturally sensitive as possible," Fahmy says. "We must never forget that we are on their turf."

The majority of day-to-day cases handled by medical escorts involve physical illness or injury; however, expatriate life can be stressful, and evacuations due to mental or emotional issues aren't uncommon. A basic understanding of how to keep a mentally volatile patient stable enough to be brought on an airplane is another key skill they must have.

"One of my more memorable cases involved escorting a European gentleman home from Indonesia," Fahmy says. "The fellow had suffered a breakdown and committed acts that were offensive by local standards. Through the application of a great deal of diplomacy, the Indonesian government agreed to drop the charges on condition that the man be taken out of Indonesia with no delay."

But commercial airlines are notoriously reluctant to allow people displaying obvious signs of mental illness to board airplanes; in cases like these the escort acts not merely in a medical capacity, but as a buffer between patient and flight crew.

"The patient was in the midst of a severe paranoid episode, and the potential for him to freak out on the plane was real. Though I had a syringe with anti- psychotic medication on me, I wanted to keep that option as a last resort."

Wedderburn concurs with his colleague on the challenge of escorting psychiatric patients.

"I once escorted a Scandinavian man who was both large and out of control. He became rather agitated changing planes at Heathrow, though I was able to calm him down with the assistance of sedatives and an extremely patient nurse."

Wedderburn was able to get the patient back home, though not without incident: The patient took off his pants while lining up for immigration in the home stretch, resulting in a police escort.

So if escorting the ill, injured and occasionally deranged across the globe is a medical escort's workload during normal times, what happens when a large- crisis occurs? The recent bus crash tragedy in Egypt provided a textbook example of a medium-scale medical evacuation operation as doctors from seven ISOS offices converged on Cairo to treat - and eventually repatriate - 30 injured Hong Kong tourists. Things get more complicated during a disaster of global proportions.

"During SARS, our phones rang constantly," Fahmy says of the 2003 crisis. "Though it didn't become the pandemic that we feared, we remained at heightened alert."

More recently, he was on the ground in Thailand within 24 hours of the Boxing Day tsunami, along with medical escorts and doctors from all over the world.

It's important to note that while medical escorts can often be found at the scenes of great disasters, services such as ISOS are businesses and not humanitarian organizations. ISOS is not, for example, Medecins Sans Frontieres, though according to Fahmy a lot of humanitarian organizations are their clients. "If any of their people needs to be medivac'd, we are the ones who go in and get them."

He adds: "When you travel, you really need to be insured. Our company has assisted uninsured patients on several occasions, but we are still a business. Very often the only help available to the uninsured traveler injured in a foreign country comes from either their families or embassies, never a certain proposition."

Despite the demands of the work, Fahmy says he's never looked back.

"Being a doctor in Paris was a good life, but working in the field of medical assistance is far more challenging."

Though Wedderburn maintains his private practice, he admits the encounters of his part-time job are alluring.

"It's rare that I return from a trip without something interesting having happened. After delivering my patient to Memphis I had an hour to kill and visited Graceland. How many other doctors in Hong Kong get to do that during office hours?"

For more information about International SOS, www.internationalsos.com