Editor—Increasingly, tour operators are offering adventure holidays in remote mountainous regions of the world (often at high altitude) where local medical facilities are scarce to inexperienced travellers. Some companies provide their own medically trained staff, but they may rely on doctors on holiday with the group to provide help.
Acute mountain sickness is common and when inappropriately treated potentially fatal. Twice in the past year, while on holiday, I have treated other group members with moderate to severe acute mountain sickness. In both cases the group leaders had exceeded the recommended rates of ascent.1 In one case basic rules of mountaineering had been ignored, and in the other a considerable delay occurred until the correct treatment of acute mountain sickness—descent—was started; this delay was for fear of disrupting the group's itinerary. In both cases the people concerned were unaware of the severity of the risks of travel to high altitude.
I believe that this raises two concerns—namely, the lack of information given to tourists before departure about the health risks of certain destinations, and the standard of medical care and safety provided by the tour operators at the destination. Neither Air Travel Organisers' Licensing (ATOL) nor the Association of British Travel Agents provides guidance for this (personal communication). With respect to information before departure, government trading standards regulations state that “information about health formalities required for the journey and the stay” should be provided.2 ATOL tells me that this is usually interpreted as meaning that information relating to recommended vaccinations should be given.
Tourists may arrive at these destinations with no knowledge of the risks of the environment and lack of medical facilities if they have not been informed by their travel company. Local guides may be more focused on ensuring that clients enjoy their holiday than on carrying out the best safety measures or giving medical intervention.
In this age of informed consent the public should be properly informed of potential risks to their health and safety. We, as a profession, should take a leading role in persuading travel companies to give their clients detailed information of the potential health risks of travel so that they can make informed decisions about whether to visit these destinations. Adherence to standards of best medical and safety practice to prevent acute mountain sickness and other conditions should be mandatory for tour operators.
References
- 1.Hackett PH, Roach RC. Current concepts. High altitude illness. NEJM. 2001;345:107–114. doi: 10.1056/NEJM200107123450206. [DOI] [PubMed] [Google Scholar]
- 2.The package travel, package holiday and package tours regulations. London: HMSO; 1992. . (No 3288, para 7.2b.) [Google Scholar]