Adventure Travel

Introduction

Adventure travel is unique because trips revolve around active human locomotion and usually involve challenging terrain, extreme weather, longer durations, and remote locales. Adventure travel includes activities like hiking, trekking, backpacking, cycling, diving, mountaineering, river rafting, skiing, and surfing. Adventure travelers might conduct scientific research, drive overland, or provide humanitarian relief as part of an expedition. Popular trips include climbing Mount Kilimanjaro, exploring the North and South Poles, hiking the Inca Trail, sailing the South Pacific, diving the Galápagos, and trekking to Everest Base Camp.

Compared to other travel, risk for illness and injury is much greater during adventure for several reasons (Box 8.7.1). Risk may be viewed as a function of 3 variables: probability, consequence, and cognitive bias. The probability of a mishap occurring is based on the duration, frequency, and severity of the hazards encountered. Objective hazards include difficult environmental conditions, such as terrain and weather. Dehydration, insufficient sleep, and poor nutrition are examples of subjective or human-controlled hazards.

Box 8.7.1

Consequence, the second variable, is the result or effect of an illness or injury. In adventure travel, where conditions are often austere and access to definitive care is remote, even if the probability of a mishap occurring is low or the injury is minor, the consequences are nearly always magnified.

Cognitive bias, the third variable, is the human factor of interpreting events, facts, and other data based on a set of emotions, experiences, and personal beliefs that may not be correct, but which may influence decisions and judgment. Many types of bias exist. Familiarity and consistency are biases when someone is familiar with a particular environment or when the environment rarely changes, causing the adventure traveler to miss important warning signs. Expert halo is when a highly skilled adventure traveler, such as a guide, thinks they cannot make a mistake. Scarcity is when someone does not want to miss a rare event, like summiting a mountain, and exceeds safety limits. Social facility is when peer pressure impacts one's decisions.

Travelers should be vigilant about the probability, consequence, and cognitive bias of risk and try to make good decisions both before and during their trip.

Pre-travel considerations

During the pre-travel consultation, in addition to providing routine travel medicine advice, gather extra information and discuss precautions for adventure travel. Several excellent wilderness medicine resources exist, including resources available through the Wilderness Medical Society.

Trip type

Obtain details about the type, length, and remoteness of the trip. Guided trips could eliminate some of the need for complex logistical planning on the part of the traveler. Even with guided trips, though, encourage participants to ask trip organizers about: contingency plans for emergencies; guide experience and medical training; recommendations for medications and medical supplies to be carried by participants; types of medical kits (see Travel Health Kits chapter) and safety equipment carried by guides; and types of recommended insurance (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter). In a few cases, such as Mount Everest expeditions and polar cruises, a formal medical officer with a comprehensive medical kit might accompany the participants.

Confirm that the experience, fitness, and skill level of the participant matches the trip type. Novices at diving, mountaineering, sailing, or skiing should participate in instructional trips. Encourage people with less experience or who are visiting a location for the first time to go on a guided trip.

Personal health requirements

Travelers might need medical clearance to participate in a trip. For travelers with chronic diseases, healthcare professionals should carefully consider medical clearance and provide prescriptions for regular medications (see Travelers with Chronic Illnesses chapter).

Screen travelers for conditions that can be exacerbated by environmental hazards or exertion. Check for a history of anaphylaxis-level allergies (see Severely Allergic Travelers chapter), asthma, cardiac disease, deep vein thrombosis and pulmonary embolism (see Deep Vein Thrombosis and Pulmonary Embolism chapter), diabetes, joint replacement, opioid-dependent pain (see Traveling with Prohibited or Restricted Medications chapter), oxygen-dependent emphysema, recent surgery, sleep apnea, or stroke. Any of these conditions could indicate that a traveler is at risk for adverse outcomes under physiological stressful conditions. Travelers with a previous history of environmental illness (e.g., altitude illness, anaphylaxis, frostbite, heat exhaustion, hypothermia) could be at risk for recurrence.

Counsel travelers to carry electronic copies of their most recent electrocardiogram and chest x-ray, their medical and surgical history, and a medication list. Blood type may be useful to know for trips in extremely remote locations or long expeditions. Caution travelers who rely on battery-operated devices (e.g., continuous positive airway pressure machine, insulin pump) about the possibility of device failure or lack of electricity and discuss the need for a backup plan or the possibility that they should avoid adventure travel altogether. Some people with chronic illnesses, especially those who are medically dependent on electronic devices, who have difficulty ambulating, or who are medically frail, likely are not good candidates for adventure travel.

Adequate hydration, nutrition, and sleep could be in short supply, especially with increased demands due to exertion, terrain, and weather. During the planning stages, travelers should pay attention to how they will obtain food, rest, and water on their journey.

Insurance

Insurance comes in many forms and is widely variable; having insurance does not guarantee rescue (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter). Warn travelers that they might need to pay in advance for rescue, evacuation, and repatriation, especially for aeromedical transport from remote locations, so they should bring a credit card with a high credit limit and emergency cash.

Insurance coverage can be contingent on deductibles, maximum expenditures, medical control approval, and preexisting conditions. Insurers also might not authorize aeromedical transport. Insurance companies might deny claims involving acts of war or civil unrest, alcohol or drugs, chronic illness, mental health, and pregnancy. Travelers should read policies carefully before purchasing insurance and departing on their trip.

Types of travel insurance important for adventure travel

• Comprehensive expedition policies can include travel, medical, rescue, repatriation, and security services.
• Domestic health insurance might or might not be effective outside a home country. Often, travelers need to pay up front for medical care and get reimbursed from health insurance providers once they return home.
• Short-term rescue insurance is available in some destination countries through local helicopter rescue companies, mountaineering clubs, and ski resorts.
• Travel insurance, which often includes medical, trip cancellation, evacuation, and repatriation benefits, might exclude coverage for wilderness rescue and adventure sports like diving, mountaineering, and skiing. An adventure sports rider is available with some travel insurance policies.
• Wilderness rescue insurance policies are available through specialty clubs, outdoor and professional associations, and organizations (e.g., the American Alpine Club, Divers Alert Network).

First aid and safety training

If travelers have time, they should consider completing basic life support and first aid courses before departure. These can be particularly helpful for regular adventure travelers. Such courses can be found through local community colleges and fire departments, the American Heart Association and the American Red Cross.

Emergency resources

Travelers should always keep their credit cards, immunization records (including COVID-19 vaccine), money, passport, and other documents on their person because they might need to seek medical care or evacuate urgently without their luggage. Travelers also can store backup copies as a PDF or JPG format on a mobile phone.

Before leaving on their adventure, travelers should know embassy contacts, emergency escape routes, local medical facilities, and local rescue resources. Travel medicine practitioners willing to accept emails, phone calls, and text messages from travelers abroad should make sure that travelers understand this is not a substitute for local emergency care (see What to Do When Sick Abroad chapter). In a pre-travel medicine encounter, physicians might have only a few minutes to educate travelers. Depending on the type, duration, and location of trip, a few key adventure travel health and safety tips (Box 8.7.2) might be worth discussing.

Box 8.7.2

Communication and route-finding equipment

Travelers should carry a smart phone equipped with a global positioning system (GPS). Phones can be used to store electronic versions of documents (e.g., embassy and hospital contact information, insurance policies, medical data, passport copies, plane tickets) in email, JPG, or PDF format. Because not all North American mobile phones and service plans are compatible with international networks, travelers should check with their local (i.e., domestic) carrier before departing.

Alternatively, an unlocked (not restricted to any carrier) global-compatible mobile phone can be used with a local SIM card in the country of travel. Inexpensive phones and SIM cards are usually available at stores in airports and major cities. In some countries, registration to obtain a local SIM card requires fingerprinting and a passport.

Adventure travelers should download and learn how to use several apps. These include airline, hotel, and rideshare apps to help with booking. Communication apps for texting are used widely by travelers, hotels, guides, and outfitters. Navigation apps are essential for route-finding; the local maps should be downloaded beforehand to be used offline. In a given country or region, specific apps have more detailed and up-to-date maps. Weather apps are useful as well. Customs and passport control apps from the U.S. government can help speed up re-entry into the United States.

An emergency satellite communication messenger is an excellent tool to carry. This device can sync with a mobile phone to send routine and emergency messages, usually via text using satellites. In areas where cellular phone service is not available, travelers might consider an unlocked (i.e., no frequency restrictions) VHF/UHF radio or a satellite phone. Several countries require users of handheld radios or satellite phones to have permits.

Remind travelers that electronics are not foolproof; often they are limited by battery power, deep canyons, dense cloud cover, government restrictions, and physical damage caused by extreme temperatures, impact, or water exposure. A backup external battery and external power source (e.g., a solar or dynamo charger) are useful. Maps and other data should be downloaded. A paper map and compass should be considered in case electronics fail.

Emergency kits

Adventure travelers often require a comprehensive, yet compact, personal emergency kit for medical care, survival, and equipment repair. Beyond a basic travel health kit (see Travel Health Kits chapter), adventure travelers should consider packing additional items due to the remote nature of their travel. Standard kits might need to be augmented for specific types of travel (e.g., high elevation, jungle, open ocean, polar, undersea).

If travelers are on guided trips, they might only need a small personal medical kit. Before they depart, travelers should determine whether guides provide group emergency equipment (e.g., automatic external defibrillator, comprehensive medical kit, portable hyperbaric chamber and oxygen, portable stretcher). Be cautious if asked to prescribe medications for guides to stock in the expedition medical kit intended for clients' use. Third-party use of prescription medication is unlawful in most jurisdictions and is best left for the guide company medical director.

Medications

In addition to routine travel medications (e.g., analgesics, antibiotics for travelers' diarrhea, antiemetics, or motion sickness medication), consider prescribing altitude illness medicines, non-sedating antihistamines, an ophthalmologic antibiotic, and/or an oral antibiotic for skin and soft tissue infections. For situations where medical help may be inaccessible, consider added medications with adequate training. Instruct travelers on self-treatment of anaphylaxis with an epinephrine auto-injector because this can be lifesaving. People with diabetes traveling in remote locations with limited access to help should consider carrying glucagon or glucose gel for hypoglycemia.

Safety supplies

In addition to items typically included in a general travel health kit, adventure travelers should consider packing safety equipment that can help in an emergency (Box 8.7.3).

Box 8.7.3