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.

Saving tourists: the status of emergency medical services in California's National Parks

BACKGROUND

Providing emergency medical services (EMS) in popular tourist destinations such as National Parks requires an understanding of the availability and demand for EMS. This study examines the EMS workload, EMS transportation methods, EMS funding, and EMS provider status in California's National Park Service units.

METHODS

A retrospective review of data from the 2005 Annual Emergency Medical Services Report for National Park Service (NPS) units in California.

RESULTS

Sixteen NPS units in California reported EMS activity. EMS program funding and training costs totaled USD $1,071,022. During 2005 there were 84 reported fatalities, 910 trauma incidents, 663 non-cardiac medicals, 129 cardiac incidents, and 447 first aid incidents. Sequoia and Kings Canyon National Parks, Yosemite National Park, Golden Gate National Recreation Area, and Death Valley National Park accounted for 83% of the total EMS case workload. Ground transports accounted for 85% of all EMS transports and Emergency Medical Technicians with EMT-basic (EMT-B) training made up 76% of the total 373 EMS providers.

CONCLUSIONS

Providing EMS for tourists can be a challenging task. As tourist endeavors increase globally and move into more remote environments, the level of EMS operations in California's NPS units can serve as a model for developing EMS operations serving tourist populations.

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.

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.

The compromised traveler

Compromised travelers represent a diverse and challenging group of individuals. They include HIV-infected patients who are at risk for potentially adverse reactions to immunizations, and new exposures to enteric water-borne opportunistic pathogens associated with chronic infections. Such travelers may encounter unfamiliar opportunistic fungi and classical tropical infections, such as leishmaniasis, whose pathogenesis can be enhanced by the presence of prior HIV infection. Other immunocompromised groups include those who are functionally or anatomically asplenic, and patients who are iatrogenically immunosuppressed from medications utilized for solid organ transplantation, chemotherapy, or treatment of malignancies. This population of travelers also includes those with diabetes mellitus who may require adjustments in their dosing, administration, and possibly even the types of insulin used on their trips. These patients are also at greater risk for acquisition of tuberculosis, severe community-acquired pneumonia, urinary tract infections, and pyomyositis. Older travelers present both the infectious disease and travel medicine specialist with issues such events, malignancy-related infections, myocardial infarction, and other forms of cardiopulmonary compromise, which the authors address in this article.

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.