Skyborn: in-flight emergency births on commercial airlines.

BACKGROUND: This study reports the global occurrence of in-flight emergency births on commercial airlines. To date, no existing research investigating in-flight emergency births has been published. METHODS: A retrospective study was conducted of all known in-flight births on commercial airlines between 1929 and 2018. RESULTS: Between 1929 and 2018, there were 74 infants born on 73 commercial flights. Seventy-one of the infants survived delivery, two died shortly after delivery and the status of one is unknown. Seventy-seven percent of the flights were designated international flights, and 26% of all flights were diverted due to the in-flight emergency births. The gestational age at delivery ranged from 25 to 38 weeks with 10% of the infants born at 37-38 weeks, 16% born at 34-36 weeks, 19% born at 31-33 weeks and 12% born prior to 32 weeks. Physicians, nurses, the flight crew and other medical personnel provided medical assistance in 45% of the births. CONCLUSION: In-flight emergency births are infrequent but not trivial. Commercial airlines are dependent on physicians and other medically trained passengers to help with in-flight deliveries.Despite US Federal Aviation Authority and Joint Aviation Authority standards, on-board medical and first aid kits are depleted and inadequate for in-flight deliveries.

Pediatric and adolescent injury in wilderness and extreme environments.

The participation of children and adolescents in wilderness and extreme environment sports is increasing. Engaging in these activities is not without risk of injury, illness, or death. To date, there is limited research investigating pediatric and adolescent injuries in wilderness and extreme environments. With the intent of creating awareness within the sports medicine field, this review begins by examining the growth in popularity of outdoor sports in wilderness and extreme environments and the injury impact they are registering. The review then examines reported pediatric and adolescent injuries in multiple wilderness and extreme environments. Close examination is paid to youth adventuring on global expeditions and entering high altitude environments. Future studies acquiring denominator data to help establish injury rates while keeping pace with the rapidly diversifying outdoor and extreme wilderness sport trends are necessary.

Lake tourism fatalities: a 46-year history of death at Lake Powell.

Background: This study investigates tourist mortality at Lake Powell over a 46-year period. To date no comprehensive long-term investigation examining the relationship between the lake environment and tourist mortality exists. Methods: A retrospective study was conducted of all tourist fatalities between 1959 and 2005. Results: There were 351 fatal incidents resulting in 386 deaths between 1959 and 2005. Over the 46-year period, the average number of fatalities was 8.4 (±5.26) per year. Out of all fatalities, 282 were classified as accidental, 80 were classified as natural deaths, 13 were suicides and 5 were classified as homicides. Males accounted for 80% of fatalities and tourists aged 20-29 years and 10-19 years accounted for 36% of all fatalities. The highest number of fatalities was recorded in July (74), May (64), August (63) and June (59). Out of all accidental deaths, boating (29%) and swimming (22%) were the most common pre-death activities. High winds capsizing boats and carbon monoxide poisoning from boat engines were common factors contributing to 31 boating fatalities. Fatigue and exhaustion contributed to 22 swimming deaths. Conclusions: Recreational boating and swimming account for over half of all accidental deaths. Tourists visiting Lake Powell for recreational purposes should be informed of the risks associated with the lake environment.

Surviving Naegleria fowleri infections: A successful case report and novel therapeutic approach.

Naegleria fowleri is a deadly human pathogen recognized as the causative agent of Primary Amoebic Meningitis (PAM). N. fowleri is commonly found in warm freshwater environments such as natural or man-made lakes, hot springs, and resort spas frequented by tourists. PAM infections have a mortality rate between 95 and 99% with minimal progress being made toward a successful treatment therapy. We report the case of a 12-year old American female who survived a PAM infection and propose a new drug therapy which includes the antimicrobial drug Miltefosine.

Sand hazards on tourist beaches.

Visiting the beach is a popular tourist activity worldwide. Unfortunately, the beach environment is abundant with hazards and potential danger to the unsuspecting tourist. While the traditional focus of beach safety has been water safety oriented, there is growing concern about the risks posed by the sand environment on beaches. This study reports on the death and near death experience of eight tourists in the collapse of sand holes, sand dunes, and sand tunnels. Each incident occurred suddenly and the complete burial in sand directly contributed to the victims injury or death in each case report.

The epidemiology of extreme hiking injuries in volcanic environments.

The objective of this review was to summarize the epidemiological literature for extreme hikers in volcanic environments and describe the incidence, nature and severity of injuries, the factors contributing to the injuries, and strategies for preventing injuries. Due to the relative newness of extreme hiking in volcanic environments, there are only a small handful of studies addressing the topic. Moreover, these studies are primarily focused on extreme hikers in Hawaii Volcanoes National Park. These studies found that the majority of extreme hikers in volcanic environments are inexperienced and unfamiliar with the potential hazards present in volcanic environments. The studies found that upper respiratory irritation resulting from exposure to volcanic gases and dehydration and scrapes, abrasions, lacerations, and thermal burns to the extremities were common injuries. The severity of the injuries ranged from simple on-site treat-and-release incidents to more severe incidents and even death. This review reveals a need for well-designed epidemiologic research from volcanic destinations outside of Hawaii that identify the nature and severity of injuries along with the factors contributing to injury incidents. There is also a demonstrated need for studies identifying preventive measures that reduce both the occurrence and severity of extreme hiking incidents in volcanic environments.

Swimming with death: Naegleria fowleri infections in recreational waters.

Naegleria fowleri is a free-living amoeba commonly found in warm freshwater environments such as hot springs, lakes, natural mineral water, and resort spas frequented by tourists. N. fowleri is the etiologic agent of primary amoebic meningoencephalitis (PAM), an acute fatal disease of the central nervous system that results in death in approximately seven days. Previously thought to be a rare condition, the number of reported PAM cases is increasing each year. PAM is difficult to diagnose because the clinical signs of the disease are similar to bacterial meningitis. Thus, the key to diagnosis is physician awareness and clinical suspicion. With the intent of creating awareness among travel medicine practitioners and the tourism industry, this review focuses on the presenting features of N. fowleri and PAM and offers insight into the prevention and treatment of the disease.

Traveling to Canada for the Vancouver 2010 Winter Olympic and Paralympic Games.

The 21st Winter Olympic Games will be held in Vancouver, British Columbia, Canada from February 12 to 28, 2010. Following the Winter Olympic Games, the Winter Paralympic Games will be held from March 12 to 21, 2010. There will be 86 winter sporting events hosted in Vancouver with 5500 athletes staying in two Olympic Villages. Another 2800 members of the media, 25,000 volunteers, and 1 million spectators are expected in attendance. This paper reviews health and safety issues for all travelers to Canada for the 2010 Vancouver Winter Olympic Games with a specific focus on pre-travel planning, road and transportation safety in British Columbia, natural and environmental hazards, Olympic medical facilities, safety and security, and infectious disease.

Geotourism and volcanoes: health hazards facing tourists at volcanic and geothermal destinations.

Volcano tourism and tourism to geothermal destinations is increasingly popular. If such endeavors are to be a sustainable sector of the tourism industry, tourists must be made aware of the potential health hazards facing them in volcanic environments. With the aim of creating awareness amongst the tourism industry and practitioners of travel medicine, this paper reviews the potential influences and effects of volcanic gases such as carbon dioxide (CO(2)), hydrogen sulfide (H(2)S), sulfur dioxide (SO(2)), and hydrogen chloride/hydrochloric acid (HCl). It also reviews the negative health impacts of tephra and ash, lava flows, landslides, and mudflows. Finally, future research striving to quantify the health risks facing volcano tourists is recommended.

Dead men walking: search and rescue in US National Parks.

OBJECTIVE: To identify search and rescue (SAR) trends in US National Park Service (NPS) units. METHODS: A retrospective review of the US National Park Service Annual Search and Rescue Reports from 1992 to 2007 and the SAR statistics for all NPS units in 2005. RESULTS: From 1992 to 2007 there were 78,488 individuals involved in 65,439 SAR incidents. These incidents ended with 2659 fatalities, 24,288 ill or injured individuals, and 13,212 saves. On average there were 11.2 SAR incidents each day at an average cost of $895 per operation. Total SAR costs from 1992 to 2007 were $58,572 164. In 2005, 50% of the 2430 SAR operations occurred in just 5 NPS units. Grand Canyon National Park (307) and Gateway National Recreation Area (293) reported the most SAR operations. Yosemite National Park accounted for 25% of the total NPS SAR costs ($1.2 million); Wrangell-St. Elias National Park and Preserve ($29,310) and Denali National Park and Preserve ($18,345) had the highest average SAR costs. Hiking (48%) and boating (21%) were the most common activities requiring SAR assistance. Hiking (22.8%), suicides (12.1%), swimming (10.1%), and boating (10.1%) activities were the most common activities resulting in fatalities. CONCLUSIONS: Without the presence of NPS personnel responding to SAR incidents, 1 in 5 (20%) of those requesting SAR assistance would be a fatality. Future research and the development of any prevention efforts should focus on the 5 NPS units where 50% of all SAR incidents are occurring.

Search and rescue trends associated with recreational travel in US national parks.

BACKGROUND: National parks are popular travel destinations worldwide. Unfortunately, negative health experiences can and do occur during travel in national parks. This study investigated search and rescue (SAR) trends associated with recreational travel in US National Park Service (NPS) units. METHODS: A retrospective study was conducted of the Annual US National Park Service Search and Rescue Report for the years 2003 to 2006. RESULTS: From 2003 to 2006, there were 12,337 SAR operations involving 15,537 visitors. The total operational costs were US$16,552,053. The operations ended with 522 fatalities, 4,860 ill or injured visitors, and 2,855 saves. Almost half (40%) of the operations occurred on Saturday and Sunday, and visitors aged 20 to 29 years were involved in 23% of the incidents. Males accounted for 66.3% of the visitors requiring SAR assistance. Day hiking, motorized boating, swimming, overnight hiking, and nonmotorized boating were the participant activities resulting in the most SAR operations. The vast majority of visitors requiring SAR assistance were located within a 24-hour period, and the most common rescue environments were mountain areas between 1,524 and 4,572 m, lakes, rivers, oceans, and coastal areas. An error in judgment, fatigue and physical conditions, and insufficient equipment, clothing, and experience were the most common contributing factors. CONCLUSIONS: SAR incidents can be expensive and end with severe health consequences. NPS management should develop education and preventive efforts focused on hikers, boaters, and swimmers who are males and aged 20 to 29 years, addressing issues of adequate judgment, preparation, and experience.

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.

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.

Search and rescue in Alaska's national parks.

BACKGROUND: Recreational travel to wilderness destinations such as national parks is increasing. The inherent risks present in such destinations can result in injury and illness, have a significant impact on local medical resources, and end with expensive search and rescue operations. In order to increase our understanding of the activities and situations which lead to wilderness search and rescue incidents, this study examines search and rescue operations from National Park Service units in Alaska. METHODS: A retrospective review of all search and rescue incident reports filed by National Park Service units in Alaska during 2002. RESULTS: During 2002 there were 25 reported search and rescue incidents involving 38 individuals. The majority of incidents (19 of 25) occurred at Denali National Park and Preserve. Thirteen fatalities were reported in six incidents, nine incidents involved traumatic injuries, eight involved illnesses, and two involved both injuries and an illness. Mountain climbing (20) and hiking (8) were the most common subject activities at the time search and rescue assistance was required. Climbing solo (4), uneven and wet terrain (4), falls into crevasses (3), and a lack of experience or ability (3) were the factors most commonly contributing to search and rescue incidents. Nineteen helicopters were utilized in 15 operations and fixed-wing aircraft were utilized in seven operations. Males accounted for 33 of the 38 individuals involved in all search and rescue incidents and United States citizens accounted for 74% of the individuals involved. The mountain environment higher than 4500m was the most common search and rescue environment (11). The average cost was USD $6253. CONCLUSIONS: Search and rescue operations in Alaska can be expensive and end with severe health consequences. Preventive education efforts at park visitor centers and at the lower and upper base camps on Mt. McKinley should be continued. In addition, pre-departure travel education efforts via the internet should be expanded for all park units and match the detail provided on the Denali National Park and Preserve website.

Search and rescue trends and the emergency medical service workload in Utah's National Parks.

OBJECTIVE: To identify the emergency medical service (EMS) workload and trends associated with search and rescue (SAR) operations in Utah's National Park Service (NPS) units. METHODS: Data for this study were collected from the Annual Emergency Medical Services Report and the Annual Search and Rescue Report for National Park Service units in Utah from 2001-2005. RESULTS: There were 4762 EMS incidents reported between 2001 and 2005, including 79 fatalities (50 traumatic; 29 nontraumatic). The most common EMS transportation method was ground (1505) and helicopter (553) transport. The heaviest trauma, medical, and cardiac workload was at Glen Canyon National Recreation Area (GLCA) and the heaviest first aid workload was at Zion National Park (ZION). There were 1190 SAR operations between 2001 and 2005 involving 67 fatalities, 623 ill or injured visitors, 1813 non-ill or non-injured visitors, and 92 saves. GLCA and ZION accounted for 47% and 21% of all SAR operations. The total cost of SAR operations was $1 363 920. SAR operations most commonly occurred on weekends, involved male visitors (59%), visitors aged 20-29 years (23%), and 40-49 years (20%), and visitors participating in day hiking (221), motorized boating (196), and canyoneering (98) activities. Most SAR operations were in lake (226), desert (147), and canyon (140) environments and were resolved within 24 hours. CONCLUSIONS: GLCA and ZION experienced heavy use of EMS resources that should be noted by EMS administrators and planners. GLCA and ZION also reported the most SAR operations. The development of techniques to prevent the need for SAR at GLCA and ZION would likely have the most potential to reduce the financial impact of SAR incidents and morbidity and mortality to visitors.

Reported fatal and non-fatal incidents involving tourists in Hawaii Volcanoes National Park, 1992-2002.

Objectives. To examine fatal and non-fatal incidents involving tourists in Hawaii Volcanoes National Park. Methods. Official press releases from the public relations office at Hawaii Volcanoes National Park were examined for reports of fatal and non-fatal incidents involving tourists. Results. Between 1992 and 2002 there were 65 press releases reporting 40 fatalities, 45 serious injuries, 53 minor injuries, and 25 no injury events. Severity information was unavailable for four additional tourists. Aircraft and backcountry incidents each accounted for 30% of all incidents followed by road incidents (22%) and frontcountry incidents (17%). Aircraft incidents reported 17 fatalities, backcountry incidents accounted for 10 fatalities, frontcountry incidents reported seven fatalities, and road incidents totaled six fatalities. One fatality was classified as a suicide. Backcountry (23) and road (10) incidents had the highest number of serious incidents. Male tourists (62) were more frequently involved in incidents than female tourists (41) and tourists aged 20-29 years and 40-49 years accounted for the highest number of fatalities and total incidents. Conclusions. Helicopter tours, hiking in areas with active lava flows, falls into steam vents and earthcracks, and driving unfamiliar rental cars in unfamiliar locations are the major activities resulting in death and serious injury. Additional factors such as tourists ignoring warning signs, wandering off-trail or hiking at night, tourists misinformed by guidebooks and other tourists, and tourists with pre-existing heart and asthma conditions are contributing causes in many incidents. The findings of this study provide information that allows prospective tourists, tourism managers, and travel health providers make informed decisions that promote safe tourism and can aid future efforts in developing preventative strategies at tourist destinations with similar environments and activities. However, in order for preventative strategies to be most effective, future research using medical or emergency response records and employing an injury epidemiology framework that identifies the cause of fatal and non-fatal injuries is recommended.