Tourists as inpatients in Queensland regional hospitals

Travel-weary to travel-worry: the epidemiology of injury-related traveller deaths in Australia, 2006-2017

OBJECTIVE

To explore injury deaths in international and domestic interstate travellers, together with those newly arrived to Australia.

METHODS

A population-based cohort study of all injury-related deaths between 1January 2006 and 31 December 2017 registered with Births Death and Marriages in Australia was conducted using Australian Bureau of Statistics' (ABS) Cause of Death information. Population data on travellers were obtained from Tourism Research Australia.

RESULTS

There were 4,503 injury-related traveller deaths (domestic interstate:3,055; international:934; new arrivals:514). The average annual age-standardised mortality rates in domestic interstate travellers was 0.75 per 100,000, compared with 2.22 per 100,000 in international travellers. Leading causes of injury-related death were land transport incidents (n=1495, 33.2%), self-harm (n=786, 17.5%) and falls (n=513, 11.4%), with differences in mechanism by state/territory, traveller type and age group. Intentional self-harm was common amongst all visitor types, however, it was the primary cause of death in new arrivals Conclusion: Age-standardised mortality rates were almost three-fold higher in international than domestic travellers. New arrivals, international and domestic travellers have different injury profiles, and each require specific prevention strategies.

IMPLICATIONS FOR PUBLIC HEALTH

While COVID has restricted travel to and within Australia, this has provided an opportunity for exploration, reflection, and consideration of risk factors for travellers, and to develop targeted injury prevention strategies for visitor types, so travel experience can be optimised and the magnitude of harm can be reduced.

Critical care resource use associated with tourism in Central Australia

OBJECTIVE

Tourism to regional and remote Australia is increasing. Its impact on regional critical care services is incompletely understood. We describe tourist admissions and their impact on critical care resources relative to the local population.

DESIGN

Single-centre retrospective study using prospectively collected data from January 2009 to December 2018.

SETTING

Australian regional intensive care unit.

PARTICIPANTS

All critical care admissions for patients aged over 18 years for whom postcode data were available were included.

OUTCOME MEASURES

Primary outcome was hospital mortality. Secondary outcomes examined resource use (intensive care unit and hospital length of stay, mechanical ventilation, interhospital transfer) and admission diagnosis.

RESULTS

Tourists comprise 6.1% of critical care admissions, occupying 5.7% of intensive care unit bed days. They were less likely to be Indigenous (6.3% vs 72.7%), but older (61.5 vs 49.2 years) and male (65.4% vs 52.6%). They were more frequently admitted following acute myocardial infarction (14.2% vs 8.9%) or trauma (20.0% vs 5.0%). There was no difference in hospital mortality (2.9% vs 4.0%) or intensive care unit mortality (2.4% vs 1.8%); however, tourists were more than twice as likely to require interhospital transfer (31.7% vs 14.0%). These findings persisted after adjustment for illness severity.

CONCLUSION

Tourists are an appreciable caseload of this regional intensive care unit and are more likely to require interhospital transfer. There was no difference in mortality. Further research is required across regional and rural Australia to better understand the epidemiology and impact of tourism on critical care resources, and the economic implications of becoming unwell in a regional area.

Comparison of injuries experienced by international tourists visiting Australia and Australian residents

This article compares the epidemiological profile of injury-related hospitalized morbidity of international tourists in New South Wales (NSW) with the hospitalized injury profile of NSW residents. Injury-related hospitalizations were identified from the NSW Admitted Patients Data Collection during 1 July 2000 to 30 June 2009. Injuries were identified using a principal diagnosis code of injury (ie, ICD-10-AM range S00-T98) and the presence of an external cause code (ie, ICD-10-AM range V00-Y98). Overseas tourists were more likely to be hospitalized for an injury following air and water transport, near-drowning, and pedestrian-related injuries. Sport or leisure-related activities were the most common activity conducted at the time of the incident. International tourists are at a higher risk of experiencing injuries particularly following recreational pursuits, while as a pedestrian, in vehicle crashes for older age groups, as a result of interpersonal violence for young males, and following a poisoning or cut/pierce injury for young females. Prevention measures should be undertaken to limit the incidence of injury among international tourists, particularly during active recreational activities and while using the roadways.

Overseas visitor deaths in Australia, 2001 to 2003

BACKGROUND

The health and safety of international visitors remain an important issue for Australia and other tourist destinations. The death of visitors remains an important indicator of safety. The aim of this study was to provide updated figures on deaths of overseas travelers in Australia.

METHODS

Data were sourced from the Australian Bureau of Statistics concerning deaths of overseas visitors for the years 2001 to 2003.

RESULTS

There were 1,068 overseas visitor deaths (701 males, 66%) during the study period 2001 to 2003. Death by natural causes increased with age, while deaths associated with accidents were more frequent among younger age groups. The majority of deaths were from natural causes (782, 73%), particularly ischemic heart diseases (26%). There were a total of 247 accidental deaths (23% of all deaths) with the main causes being transportation accidents (14% of all deaths) and accidental drowning/submersion (5% of all deaths). The countries contributing the most deaths were the UK (247, 23%), New Zealand (108, 10%) Melanesia/Micronesia (95, 9%), and the United States (57, 5%).

CONCLUSIONS

Australia remains a relatively safe destination for international travelers, at least in terms of fatalities, which appear to be declining. Most deaths of overseas tourists in Australia are due to natural causes with cardiovascular disease being the predominant cause of death in this group. Accidents remain the most common preventable cause of death of travelers, with road and water safety being the major issues. It is important that tourism and travel medicine groups continue to advocate for improved health and safety of international travelers visiting Australia.

Recreational travel fatalities in US national parks

BACKGROUND

Injuries are a public health problem affecting traveling populations such as tourists visiting National Parks. This study investigates the distribution of visitor fatalities in US National Park Service (NPS) units and identifies the predeath activities and contributing factors associated with them.

METHODS

A retrospective study was conducted of visitor fatalities from all NPS units during 2003 and 2004.

RESULTS

There were 356 reported fatalities during 2003 and 2004. Fatalities were most common during the summer months and on weekends. Males accounted for 75% of the reported fatalities, and visitors aged 20 to 29 and 50 to 59 years accounted for 51% of all deaths. Only 99 of 388 (26%) NPS units reported at least 1 fatality, and only 10 units reported 10 or more fatalities. However, these 10 units were responsible for 36% of all fatalities. Lake Mead National Recreation Area, Blue Ridge Parkway, Grand Canyon National Park, Great Smoky Mountains National Park, and Yosemite National Park reported the highest number of fatalities. Domestic visitors accounted for 73% of the fatalities, and European visitors accounted for 13%. Transportation and water-based activities recorded the highest number of fatalities. Motor vehicle crashes accounted for 20% of fatalities and was followed by suicide (17%), swimming (11%), hiking (10%), plane crashes (9%), climbing (6%), and boating (5%) incidents.

CONCLUSIONS

Fatalities in NPS units are not widespread and are related to more common events such as motor vehicle crashes, suicide, swimming, and hiking rather than exotic causes such as bears or other wildlife. It is recommended that preventive techniques first be developed in the 10 NPS units responsible for 36% of the total NPS-wide fatalities.

Environmental hazards in Nepal: altitude illness, environmental exposures, injuries, and bites in travelers and expatriates

BACKGROUND

Adventure travel necessarily places travelers at risk of environmental hazards. We assessed the burden of "environmental" hazards among a cohort of travelers and expatriates presenting to a large travel clinic in Nepal.

METHODS

Data on travelers and expatriates seen at the Canadian International Water and Energy Consultants (CIWEC) clinic in Kathmandu were prospectively collected and entered into the GeoSentinel Surveillance Network database. Data on individuals receiving predefined diagnoses related to environmental hazards were extracted and analyzed.

RESULTS

Of 10,499 travelers and 4,854 expatriates in the database, 2,160 were diagnosed with 2,533 environment-related illnesses. Injuries were common among both travelers and expatriates [N= 788 (6.1%) and 328 (4.9%), respectively], while altitude illness was seen almost exclusively in travelers [N= 611 (4.7%) vs N= 8 (0.1%)]. Factors independently associated with environmental diagnoses include male gender (p < 0.001), traveling for tourism (p < 0.001), and lack of pre-travel advice (p= 0.043). Three percent of travelers and 2% of expatriates presenting to CIWEC sustained a bite wound or required rabies postexposure prophylaxis. Injured travelers were less likely than others to have obtained pre-travel advice (p= 0.003), while those who sustained bite wounds were more likely to have received pre-travel advice (p < 0.001).

CONCLUSIONS

Environmental hazards are important causes of morbidity and potential mortality among adventure travelers and expatriates. Current pre-travel interventions are missing certain risk groups entirely and failing to have the desired educational impact in others.

Unintentional injury during foreign travel: a review

Unintentional injury is a global public health problem. In 1990, an estimated 5 million people worldwide died as a result of an injury or poisoning. This accounted for 10% of deaths from all causes that year, and over half of the estimated 900 million years of life lost in 1990 due to premature death. Although mortality rates for ischemic heart disease, cerebrovascular disease, and cancer are higher, the majority of people dying of these causes are elderly, with far fewer potential years of life to live. Reasons for the increasing public health importance of injury include the decline of infectious disease, the processes of urbanization, industrialization, motorization, and increased opportunities to travel.

How safe is adventure tourism in New Zealand? An exploratory analysis

The paper reports findings from a multidisciplinary programme of research, the major aims of which were to determine the nature and extent of the New Zealand adventure tourism injury problem. Analysis of hospital discharge and mortality data for a 15-year period identified adventure tourism-related activities as contributing to approximately 20% of overseas visitor injuries, and 22% of fatalities. Activities that commonly involve independent-unguided adventure tourism, notably mountaineering, skiing and tramping, contributed most to injury and fatality incidence. Horse riding and cycling activities were identified from hospital discharge data and adventure tourism operators' reported client injury-incidence, as the commercial adventure tourism activities most frequently involved in client injuries. Falls were the most common injury events, and a range of client, equipment, environmental and organisational risk factors were identified. Possible interventions to reduce injury risk among overseas and domestic adventure tourists are discussed.

Safety in New Zealand's adventure tourism industry: the client accident experience of adventure tourism operators

BACKGROUND

Injuries and fatalities among participants of adventure tourism activities have the potential to seriously impact on New Zealand's tourism industry. However, the absence of statistics for tourist accidents in New Zealand, and the lack of detailed academic research into adventure tourism safety, means the extent of the problem is unknown. The aims of the present study were to determine the incidence of client injuries across a range of adventure tourism activity sectors, and to identify common accident events and contributory risk factors.

METHOD

A postal questionnaire survey of New Zealand adventure tourism operators was used. Operators were asked to provide information related to their business; the number of recorded client injuries during the preceding 12 month period, January to December 1998; common accident and injury events associated with their activity; and perceived risk factors for accidents in their sector of the adventure tourism industry.

RESULTS

The survey was responded to by 142 New Zealand adventure tourism operators. The operators' reported client injury experience suggests the incidence of serious client injuries is very low. Highest client injury incidence rates were found for activities that involved the risk of falling from a moving vehicle or animal (e.g., cycle tours, quad biking, horse riding, and white-water rafting). Slips, trips, and falls on the level were common accident events across most sectors of the industry. Perceived accident/incident causes were most commonly related to the client, and in particular, failure to attend to and follow instructions.

CONCLUSIONS

The prevalence of client injuries in activity sectors not presently covered by government regulation, suggests policy makers should look again at extending codes of practice to a wider range of adventure tourism activities. Further research considering adventure tourism involvement in overseas visitor hospitalized injuries in New Zealand, is currently in progress. This will provide supporting evidence for the risk associated with participation in a range of commercial and independently undertaken adventure activities.

Overseas visitors admitted to Queensland hospitals for water-related injuries

OBJECTIVE

To determine the number of overseas visitors admitted to Queensland hospitals for water-related injuries over three years, the causes of their injuries, the resulting conditions treated, and the type of hospitals to which they were admitted.

DESIGN

Retrospective analysis of admissions of overseas visitors to Queensland hospitals over the three financial years 1995/96, 1996/97 and 1997/98.

PATIENTS

296 overseas visitors admitted for water-related injuries, identified from hospital records by their usual place of residence.

MAIN OUTCOME MEASURES

Number of admissions, causes of injuries, conditions treated, and bed days occupied by these patients at different types of hospitals (metropolitan, regional and rural public hospitals, and private hospitals).

RESULTS

The 296 overseas visitors accounted for a total of 596 separate admissions, many of these the result of patients with decompression illness being admitted several times to a regional hospital hyperbaric chamber for treatment as day patients. The largest number of injuries involved the use of diving equipment. The main conditions treated were decompression illness (54.7%), fractures and dislocations (15.5%), and drowning and non-fatal submersion (14.9%). Overall, overseas visitors admitted to hospital following a water-related incident occupied 1215 bed days; 90% of these admissions were to regional hospitals.

CONCLUSIONS

The main reason for admission of overseas visitors is for decompression illness, suggesting that the prevention of injuries among scuba divers requires further coordinated efforts by health and tourism authorities.

International tourists, motor vehicles and road safety: a review of the literature leading up to the Sydney 2000 Olympics

The number of international visitors to Australia is forecast to rise to 4.6 million in the year 2000, the main attraction being the Olympic Games in Sydney. While the Olympic Games are expected to directly attract 132,000 international visitors as athletes, officials, judges, journalists and spectators, a further 1.49 million visitors will be attracted to Australia because of the global spotlight on the country in the years leading up to and during the staging of the event. Pre- and post-Games travel will also involve large numbers of tourists moving about in other Australian states and territories. For example, 50% of the extra tourists are expected to visit Queensland, 25% Victoria, 13% Western Australia and 9% the Northern Territory. In order to provide the best possible experience for all of these visitors, it is essential that potential causes of travel-related illness and/or injury are anticipated, and that procedures are established in each state to minimize harm and to deliver appropriate health care if it is required. Ideally, procedures and resources should be coordinated to achieve maximum effectiveness.

Travel and Health Research in Australia

Travel and tourism is a major industry in Australia, employing 6.9% of the nation's workforce (535,600 persons) and generating AUS$46.9 billion in 1993-94.1 While economic and marketing analyses have traditionally dominated the field of tourism research in Australia, health and safety issues that impact on the business of tourism are now emerging.2 Travel medicine is still a small specialty area, though it has established a legitimate role within the tourism industry by providing services in prevention and treatment. To date, little attention has been given to empirical research, even though field studies are a critical component in the provision of accurate medical advice for patients. This paper reviews the Australian research that is available and identifies areas where further work should be conducted.