Inadequate guidelines about the dangers of kidney stones could be putting travellers’ lives – and their medical insurance – at risk, according to the March issue of the urology journal BJU International.
Urologists have called for transport companies to put stringent staff guidelines in place to tackle the condition, which can cause sudden, severe and debilitating pain.
And they’re urging family doctors to ensure that kidney stone sufferers who are planning to travel overseas are aware of the risks and that they inform their insurance company to avoid costly unpaid medical bills.
Patients should also inform their employers if a sudden kidney stone attack could put them, or others, at risk.
"Kidney stones affect about one in ten people and the pain can be notoriously severe, with up to 40 per cent of attacks needing hospital admission" says urologist Nigel Borley, a specialist registrar from St George’s Hospital, London.
"The pain is so disabling, that even with intravenous morphine, pain relief only averages 36 per cent."
"If transport workers, such as pilots and train drivers, are suddenly incapacitated by kidney stone pain it can pose a real safety risk to them and their passengers" adds co-author Commodore David Rainsford, a consultant physician to the UK Civil Aviation Authority and consultant in renal disease to the Royal Air Force.
The authors contacted major UK supervising and professional bodies and asked them if they issued any formal or informal guidelines for transport staff who could be affected by kidney stone attacks.
The UK Civil Aviation Authority was the only civilian body they talked to that had formalised guidelines for managing kidney stones. Although the guidelines only covered pilots, most of the major airlines surveyed also adopted the guidelines for cabin crew.
Very strict guidelines are also in place for the Royal Air Force, with pilots being immediately grounded and referred for investigation if they suffer from renal colic or are found to have kidney stones.
Royal Navy and British Army personnel are also screened before entry and a positive kidney stone result would mean a medical downgrade and restricted duties.
The Rail Safety and Standards Board, which is responsible for the safety of Britain’s railways, has no specific guidelines for train drivers with kidney stones, but there are general guidelines covering conditions that could cause sudden incapacity.
The UK’s Drivers Vehicle Licensing Agency (DVLA), which is responsible for the safety of private and public service drivers, has a "surprisingly large" list of conditions that could be hazardous to road safety, say the authors. But kidney stones are not specifically listed.
However DVLA does provide general guidance that it should be notified of any medical conditions "likely to affect ability to safely control a vehicle."
Travel insurance companies the authors spoke to provided more categorical responses. They said that if they knew that a person had a kidney stone they would not be covered for treatment abroad.
And if the person didn’t declare their condition, and then claimed for treatment abroad, their insurance would be invalid.
"It is clear that there are few guidelines for workers in charge of other people’s safety and for patients with stone disease waiting to travel" says Nigel Borley.
The authors have devised their own guidelines for family doctors and urology colleagues, which are published in the journal. But they stress that it’s essential for governing bodies to develop formal guidelines for the protection of their own staff and the travelling public.
Notes to editors
- What activities are safe with kidney stones? A review of occupational and travel advice in the UK. Borley et al. BJU International. 99.3, 494-496 (March 2007).
- Established in 1929, BJU International is published 12 times a year by Blackwell Publishing and edited by Professor John Fitzpatrick from University College Dublin, Ireland. It provides its international readership with invaluable practical information on all aspects of urology, including original and investigative articles and illustrated surgery. www.bjui.org
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