PHILADELPHIA -- In the middle of the Pacific, several days out of the Galapagos Islands on a Class Afloat semester on the tall ship Concordia, a 17-year-old Connecticut youth felt a pain in his right side.

The ship's doctor diagnosed appendicitis, put Chris Feffer on morphine and intravenous antibiotics to try to prevent a burst appendix. He was strapped in a bunk so he wouldn't roll out as the 188-foot Concordia raced under heavy sail through 16-foot seas to the next port, Easter Island.

In Chester, Conn., Chris' father, David Feffer, got a call. "I looked up Easter Island. It is one of the most remote places in the world," he said. "I immediately started thinking of what things had to happen, one of which was get in touch with International SOS right away."

 For the next six days, he said, "We must have talked to the SOS people six to 10 times a day, up until late at night."

 International SOS' Americas office in Philadelphia arranged medical consultations with the ship's doctor, checked on the positions of other ships, and contacted officials on Easter Island, a triangle of volcanic rock in the South Pacific more than 2,000 miles from Chile to the east and Tahiti to the west.

 The crisis for the Feffers was business as usual for International SOS. "On the average worldwide we are performing one medical evacuation per hour," said Arnaud Vaissie, president and chief executive officer.

 International SOS has headquarters in London, offices in Philadelphia and Singapore, 24-hour alarm centers in 25 locations and 19 international clinics, a network coordinating services from on-the-phone medical advice to air ambulance evacuations for corporate and individual travelers.

 "We started with the oil industry, with clients like Exxon and BP and Shell," Vaissie said. "We focused in the beginning exclusively on medical needs."

 Now clients include more than 360 of the Fortune 500 companies as well as individual travelers. The company has added security services for travelers who run into personal emergencies or political turmoil, and a Web site posting security alerts and full reports on the top 80 countries business travelers visit.

 Recent alerts warned members to avoid Sri Lanka, where 4,000 tourists were stranded at the airport; keep a low profile in Cuba, where massive protests were planned; and avoid nonessential travel to Jakarta, though a political crisis there "has been resolved somewhat."

 The advice comes from experts like Serena Jerinsky, who joined the company in March as regional security manager for the Americas after experience as an FBI agent and working with the Defense Intelligence Agency assisting anti-drug operations in South America.

 "I know how the drug dealers operate," said Jerinsky, who got interested in the company while on a traveling security detail for FBI Director Louis Freeh.

 "In Uzbekistan a State Department woman was in a car collision with a trolley and was severely burned, and we found this company called International SOS had evacked her out of the country," she said. "I like helping people. I liked that it is a private organization and I wouldn't be tied down by bureaucratic red tape."

 Customers include multinational companies like General Motors, Ford, Motorola, AT&T, Bristol-Myers, Cisco Systems and Coca-Cola. Coca-Cola, for example, has 8,400 employees in overseas offices in 200 countries, and 600 a year making international trips from its Atlanta headquarters. "I think it's our duty to provide a means of getting care," said Lynne Harper, manager of the company's medical services department.

 Some employees call for routine things like referrals to a local clinic or dentist, but some must be evacuated, such as a Coca-Cola employee with a high-risk pregnancy who was flown from Russia to Switzerland for treatment, Harper said.

 International SOS handled more than 350,000 assistance cases last year, including more than 11,000 medical evacuations.

 On the Net: http://www.internationalsos.com/