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             Tourism in THe exTremes

did you think about going for some adven-
ture tour with your kids and did not know how
to do it? What about the insurance of your
extreme holiday – is it useful? What risks do
adventure tourists take? even better – you
are founding an outdoor tour company and
look for some marketing tips. Come and read
about these and other questions of adventure
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                                       a DV e N t U r e : Tour i sm in the E xtre me s

maKiNg moNeY iN tHe
oUtDoor iNDUstrY
                                                                          understand the rigors, responsibilities, dangers and level of
                                                                             2) Exceed Expectations – Under promise and over deliver
                                                                          on a consistent basis with exception service. Blow them away
                                                                          with the unexpected. This is what they’ll remember and tell their
                                                                          friends about.
                                                                             3) Practice Safety – Guests want to know the activities they
                                                                          are about to do or surroundings they are in, are safe and their
                                                                          welfare is always being monitored. They will feel more at ease
                                                                          during real or perceived risks if they have been educated about
                                                                          their new activity or environment in advance. Advise on plant,
                                                                          animal and natural resource cautions. Let them know that there
                                                                          is generally nothing to worry about if they respect the environ-
                                                                          ment and heed your advice. Brief guests on your safety proce-
                                                                          dures for any excursions without staff away from home base.
H      ave you ever wondered, «How effective is all my market-
       ing?» Are you spending money to get «the word out» and
yet your sales aren’t what you would like? I will show you the
                                                                             4) Provide Great Food – Guests must eat well, never be hun-
                                                                          gry and have adequate water and drinks. Fresh food with ample
most effective and easy path to increase your sales without               portions served at a scheduled time can make any adventure
spending additional money.                                                more memorable and satisfying. Whenever possible, serve ap-
                                                                          petizers, happy hour eats and beverages.
  Many in our industry overlook the foundation of what busi-
ness we are in. This is a service business. We are selling and               5) Everyone Needs Sleep – Guest need and want comfortable
providing an invisible experience. This emphasis on getting pro-          and peaceful sleep. Make sure everyone is comfortable with
motions «outside», causes you to overlook the «inside» and the            their bedding. Cater to individual needs (snoring, light sleeper,
foundation of marketing a service: the service itself.                    frequent bathroom needs) by offering single accommodations,
                                                                          charging an extra cost is OK. Provide easy access to bathroom
  Our participants and guests should go home with increased
                                                                          with safety procedures for night time use. Separate late evening
skills, fond memories, unique experiences, and rejuvenated.
                                                                          social areas from sleep areas by distance and/or trees or a hill.
This will lead them to enthusiastically share with family and as-
                                                                          Handout earplugs if necessary.
sociates the magic of how wonderful your company is. Word of
mouth and repeat business is the most cost effective, easiest                6) Think Comfort – Provide high standards when possible.
avenue to continually make more money and grow your busi-                 Here’s a chance to over deliver! Bathroom breaks and bathing
ness. Harry Beckwith author of «Selling the Invisible» says it            are important on a regular basis. Give people every opportunity
best, «First before you write an ad, rent a list, dash off a press        for comfort: hammocks, beach chair, portable toilets, etc. Make
release – fix your service».                                              sure everyone has adequate water, appropriate clothing and
  Careful research and analysis I’ve done over the years, of
many of my adventure travel clients around the globe, led to the             7) Be Sensitive to Capabilities – Never exceed physical or
creation of the following nine principles. They are the foundation        mental capacities of guests. Always ask group and individuals if
of customer service for our outdoor industry. Think about how             they are comfortable with activity and exertion level before and
your guests experience your operation. Focus on improving                 during activity. Be sensitive to the slowest as well as strongest
these principles and never compromise them.                               in group. Split the group into two smaller groups is a good an-
                                                                          swer. Rest as needed.
   Principles of Customer Service                                            8) Be Fun – That’s what our guests are paying money. Be
   1) Be a Good Listener – First and foremost, listen to their            friendly, helpful, courteous, and fun! Make sure your staff is there
concerns, complaints, as well as their praise. Discover what              for the guests and not for themselves first. Good story tellers,
it is they want. Your guests are your best source of infor-               jokesters and musicians can separate your staff and company
mation in assessing your services and performance. Help                   from others companies. Be sensitive with humor and families
them qualify themselves before signing up. Make sure they                 with kids. If you cater to kids, employ staff that loves kids. Guest

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sometimes needs encouragement or guidance to try an activity.
You are the guide and activity director combined. Communicate
activities or mini-class in advance so guests know what and
when activities are happening.
    9) Provide Information – An informed guest is safer, more re-
laxed and has more fun. Our guests are educated and want to
learn about their new environment. Assume guest know little or
nothing about their surroundings. Look for opportunities to pro-
vide a minimum of three details about each type of surrounding
element during any outing. For example: names and informa-
tion of plants, animals and habitats, birds, trees, rocks, geologi-
cal formations, fish, marine mammals and shells. Information
on local culture, economy, and history too. The more we can
share the more value we are providing our guests.
    Like business I know and have worked with, you too will ex-
perience more repeat clients and referrals by applying these
little details of great customer service. Your business, in time
will prosper like never before!

By Tim Warren (Adventure Business Consultants)

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      aDVeNtUre toUr gUiDes:
      WHat KiND oF Job is tHat?
                                                                                   and women serve as educators and all-around experts in the
                                                                                   history, geography, and culture of the vacation destination. Ad-
                                                                                   venture tour guides will travel with the group, as an active mem-
                                                                                   ber, so that they are able to contribute firsthand and make the
                                                                                   entire journey more enjoyable.
                                                                                      There is a great deal of work that an adventure tour guide
                                                                                   undertakes before the journey even begins. As a guide, you’ll
                                                                                   be responsible for organizing the tours, making all the travel ar-
                                                                                   rangements, arranging for visas, planning meals, making lodg-
                                                                                   ing reservations, scheduling activities and educating your group
                                                                                   on the cultural customs. Once your voyage begins, your du-
                                                                                   ties will also include organizing and leading the group to exotic
                                                                                   places, and coaching participants on the basics of each activity.
                                                                                   When required, you may need to give lessons in mountain bik-
                                                                                   ing, kayaking, hiking, skiing, horseback riding, diving, sailing,
                                                                                   cave explorations, white-water rafting and whatever other activ-
                                                                                   ity your adventure might entail. Part entertainer, part trouble-
                                                                                   shooter, you will be an indispensable guide serving as a profes-
                                                                                   sional ambassador for the tour company you represent.
                                                                                      Adventure tour guides must have effective people skills. This
                                                                                   is extremely important, as you’ll be spending many days with
                                                                                   your group and must be able to communicate clearly and ef-
                                                                                   fectively. While friendliness is important, you also have to com-

                                                                                   mand the respect of those in your group. Dealing with different
              lanning on setting off the see the world? Want to get paid
                                                                                   personality types and people of varying cultures is not easy, and
              for it? Then you should consider a career working as an
                                                                                   you may find it a struggle to please everyone in the group. Last,
       adventure tour guide. If you have what it takes, your job may
                                                                                   but definitely not least, as an adventure tour guide you must
       actually be the adventure of a lifetime.
                                                                                   possess contagious enthusiasm, and have a wealth of experi-
         When travelers take an escorted tour, they’re hiring the ser-             ence in a variety of adventurous disciplines.
       vices of a professional who is not only familiar with the specific
       geography of the area traveled, but is also well-versed in the
       customs and traditions of the people living there. These guides
       are also experts in organizing and implementing all of the de-
       tails required with group travel packages. Leading tours that run
                                                for a week or two involves
    WHat is a toUr gUiDe?
   before seeking a job in this field           quite a bit of work, and as
   should have a clear understand , you        an adventure tour guide
   the job and its requirements. ing of        you need to be prepared
  guide is not merely someona tour
  leads a group of people aro e who
                                               to take your responsibili-
  particular site. They are highly at a       ties very seriously.
  at what they do. They underst skilled
 to communicate and work with howand
                                                 Adventure tour guides
 ple. They know the rules and peo-
 the group to follow those rule    expect     meet people arriving from
guides study hard to learn all s. tour        other countries, and often
about the site or attraction so they can     play the role of «unoffi-
answer questions along the way   they can
understand the importance
                                   . They    cial spokesperson» for the
and are trained to handle eme safety         travel company. In addition,
when they arise.                rgencies
                                            these knowledgeable men

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                                            a DV e N t U r e : Tour i sm in the E xtre me s
  While an exotic tour may seem luxurious, playing the part of
an adventure tour guide is not always glamorous. These es-
corts are responsible for leading a group of twenty or more in-
dividuals. They must look after the needs of every person in the
group, answer questions and deal with emergencies. As a group
leader you must be reliable and trustworthy, and able to build
the group confidence to the degree necessary for successful
completion of potentially dangerous activities. Without this level
of confidence, the entire tour will fail; and to an adventure tour
guide, failure is not an option. It’s your job to ensure success in
every activity in the tour. That’s why it’s so important that you’re
able to use good judgment under pressure and be resourceful
when dealing with any emergency situations that may
arise.                                                               g                       y ou r
                                                       e traiNiN                 el job of
  Acting as an adventure tour to           Ur gUiD p in finding the trav e. training is
                                               rt rst ste            ining cou
guide is not an easy profes- a smas isfito take a tour tratour directors, andining,          e ven
                                           a m                   es,                  r tra
sion, but if you crave excite- dre ilable for tour munagement. With r vu rious trav-
                                                            g id
ment it could be the perfect job                  nal tour fety procedures fo o learn about
                                        professio about sa               You’ll als encies, doc-
for you. Not only will you get to       you’ll learn and destinations.dling emerg
                                                   s                                            an d
                                        el method ith suppliers, han rmative narration,ector
meet different people and travel                 gw                  fo
                                         workin n, delivering in ing and tour d ople,       ir
to exotic places, every day will         umentatioth tour guide train to work with pe able
                                         more. bo ill help you prepa organized, and be re is
really be a new adventure.               training w      t speaker, g
                                                                               cies arise.
                                                      grea               ergen           ,300
                                           become a ediately when em red through over 1 ave
                                           to act imm ur training offe n’t even have to le
                                                      e to                  o               also onlin orldwide. so, you wable skills.
                                            colleges we to learn these valu               your hom

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                                       a DV e N t U r e : Tour i sm in the E xtre me s

aDVeNtUre traVel
iNsUraNce: eNJoY WitH risK
                                                                          proportion of those people wrongly believe that their European
                                                                          Health Card will provide full cover should they have an accident.
                                                                          This is not the case and an accident whilst skiing could cost you
                                                                          dearly in the long term. The health card system aims to provide
                                                                          cover for the initial emergency treatment required but beyond
                                                                          this you are left to foot the bill.
                                                                             If you are airlifted in a helicopter to hospital, a service that
                                                                          could easily cost you £1,500, this could be classed as an ex-
                                                                          tra. Add to this any daily charges for your hospital bed or room
                                                                          and you could easily be looking at tens of thousands of pounds
                                                                          in total costs. This type of event can easily bankrupt the aver-
                                                                          age person and it is clearly worth purchasing a travel insurance
                                                                          policy to cover against this eventuality.
                                                                             It is essential you check a prospective or existing policy be-
                                                                          fore you travel to ensure you have winter sports cover. You will
                                                                          find with some policies that this is excluded, although it can
                                                                          sometimes be added as a bolt-on to the policy, whereby you
                                                                          pay an optional charge for this cover.
                                                                             There are many companies who offer a winter sports holiday
                                                                          insurance policy as a standalone package. Other companies will
                                                                          provide this cover within their standard policies. It is important
                                                                          to compare features during the quoting process to see exactly
                                                                          what you are getting for your money.

                                                                                tr aVel iNs orY                         t for brit-
                                                                                be oblig
                                                                                         at                   quiremen ggested.
                                                                                              shou ld be a re      e en su
                                                                                               rance                , it has b              said
                                                                                travel insuthey leave the UK for insureandgo, un-
                                                                                ons befo son, spokespers l insurance is often any
                                                                                           re                   on
                                                                                Perr y Wil portance of trave re going abroad. m our
                                                                                that the im d by people who asurance is «about y
                                                                                 derestima think that travel inmarked.

For       many, travel insurance is a valuable commodity: it of-                 travellers g cancelled», he re                art of it is
                                                                                 flig  ht bein             but th e biggest plf and also per-
          fers protection against eventualities that could prove                               part of it,             yourse                 lse,»
                                                                                  «That is a ental damage to mage to someone e por-
costly, such as personal injury, baggage loss or theft and can-                   c al – accid              cause da               t it is im
                                                                                               ility if you             added tha              ture
cellation cover. Of course, as with most things in life, there are                 sonal liab d mr. Wilson. He take part in adven sure
                                                                                              te                                              n
                                                                                   commen eople who plan            to
                                                                                                                         wboard  ing – to eor in-
some who won’t commit to something without seeing clear proof                      tant for p ch as skiing or sno ey go. even min ou-
of the benefit it will give them. Unfortunately, to experience the                  sport  – su             db  efore th kle, can cost «th e
                                                                                                 are covere              r an                   rag
                                                                                    that they as a broken leg odding that «the ave
benefit you will need to encounter an eventuality for which your                    ju          ch
                                                                                       ries, su unds», he said, a .
                                                                                                  o                       0»
insurance policy covers you. Without a policy you will learn that                    sands of p in excess of £2,00
                                                                                     ski cl aim is
benefit the hard way – by being left out of pocket.
  As you increase the risk factor on your holiday, the need for
some kind of protection becomes ever more apparent. One holi-
day for which cover should definitely be seen as a necessity is a           A winter sports insurance package will usually cover areas
winter sports or skiing trip.                                             such as ski equipment, ski hire and lack of services due to clo-
  According to statistics released by the insurer esure, one in           sure or avalanches. Quite often basic cover will be improved to
four Brits takes to the slopes without any form of cover. A large         offer higher levels of protection in terms of monetary value.

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                                           a DV e N t U r e : Tour i sm in the E xtre me s
  It is important to remember when searching for that all-impor-
tant cheap travel insurance policy to not base your decision on
price alone. Saving £10 or 20 is fantastic but is it worth it if it costs
you hundreds in the long run, due to lack of the right cover?
  Purchasing a travel insurance policy should be deemed a ne-
cessity in the case of a winter sports holiday. Without any form
of holiday insurance medical bills can be huge should you have
an accident. Remember when looking for cheap travel insur-
ance to weigh up the features of potential policies.
By Chris Rowlands

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                                       a DV e N t U r e : Tour i sm in the E xtre me s

tHe triP oF a liFetime –
aDVeNtUre WitH KiDs?

   «In this fast paced world I never get the time to spend with my        what makes family rafting vacations and adventure holidays so
teenagers. This is an excellent way to stop the clock and have            rewarding. What a great feeling it is to face a challenge and do
fun with them!»                                                           well! And, when you do this as a member of a group or team, ev-
   «My goal was to have a special time with my granddaughter              eryone celebrates! When was the last time your family worked
and we did. She does not stop talking about all the things she            and played together to overcome a common challenge? Simply
accomplished! I cannot think of anything I would have liked dif-          put, the teamwork required in most adventure activities brings
ferently.»                                                                people together, friends, strangers, and families alike.
   Wonderful comments like these are regularly heard by ad-                 Of course, it is very important to be as prepared as possible
venture travel outfitters from their clients. Whether it is on a          for any adventure travel vacation. Correctly preparing yourself
family rafting vacation, at a dude ranch, or participating in a           and your family is the first step towards a successful outdoor
wildlife expedition, family adventure holidays seem to be some            adventure. The following suggestions may work for your family
of the most satisfying and rewarding vacations available. What            as you consider and plan your next adventure vacation:
is it about these vacations that make them so memorable and
enjoyable? And what planning steps are suggested to families                Choose the Correct Adventure Vacation for
considering an outdoor adventure for their next family vaca-              your Family
tion to help make that trip extraordinary as those described                Perhaps the most important decision you can make regard-
above?                                                                    ing an adventure travel family vacation is which adventure to
   Family adventure holidays are successful in large part be-             choose. As seen in this guidebook alone, there are myriads of
cause of the challenges they provide and the camaraderie that             choices. Trips range from one-day river trips near your home-
results from successfully meeting those challenges. There is              town to multi-day wildlife safaris in the distant corners of the
nothing like climbing up on a horse for the first time and pulling        earth. So how do you choose? Consider asking yourself the
on the reins to get it to gallop through a mountain meadow, or            following questions to help you decide:
paddling a bouncing raft through eight-foot waves. Successfully             Is my family or are most members of my family adventurous?
steering your horse or helping paddle a raft through a rapid are          In other words, is our family one that enjoys or would enjoy

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                                                                         challenging in their own right, as cultural and schedule differ-
    aDVeNtUre triPs For KiDs                                             ences can cause difficulties. When considering an overseas
     Prices are for a family of four, not including international        adventure vacation it is important to know that your family will
     flights.                                                            be able to deal with the cultural and amenities differences of
     Hi k ing mount Ki limanjaro: estimated price: $21,600               another country, as well as the challenges that adventure activi-
     for 16-day climb and safari. What you’ll do: expedition
     company alpine ascents says it’s seeing nearly 30 % more            ties can provide.
     family trips than five years ago, including this one to the
     highest peak in africa. The tour company says kids as                  Do the outfitters we are considering have experience running
     young as 12 are reaching the surnmit. What to watch for:            trips with families who have never participated on an adventure
     Kids may not recognize signs of altitude sickness so adults         travel vacation? This is a very important question to ask the
     must stay alert
     c amel s af ari in Kenya: estimated Price $31,400 for l2            companies you are considering for your adventure vacation.
    days. What you’ll do: Uncharted outposts safari & travel             Outfitters with experience have likely developed an approach
    company is offering a new camel trip over the lalkipia               to guiding trips that help first-timers with all aspects of their ad-
    highlands, a three-day excursion that’s included in its lon-
    ger Kenyan safari. The travel company is advertising the             venture, from helping with tent set-up to having extra activities
    trip for children’s birthday parties – kids get a gag «birth-        available for children.
     day cake» made out of frosted elephant dung. What to
     watch for: tour operator recommends immunizations for                  What type of elements do we most enjoy or would we most
    typhoid, hepatitis a and b, meningitis, yellow fever, and            enjoy? In other words, is mine a family of water-loving swim-
    urges guests to take malaria pills.
    me e ting mayan Fami li es in b eliz e: estimated price:             mers, land-loving hikers, or…? This question ultimately decides
    $8,000 for 8 days. What you’ll do: The Wildland adven-               what type of adventure vacation may be best suited for your
    tures tour, which includes snorkeling and hiking to water-           family. If you have a family that loves to hike, then consider a
    falls, is now offering a day with a mayan family. Kids can
    watch a craftsman make a harp, listen to traditional music,          backpacking or hiking with pack animals trip. If your family loves
    walk through a cacao plantation and make tortillas from              water then rafting down a wilderness river may be best. With all
    scratch. What to watch far: children under age 12 are not
    allowed on the trip because of more risky activities such as         of the options now available to families looking for adventure
    caving and kayaking.                                                 travel, it is a safe bet that you will find many vacations that will
    e aster isl and statu e tour : estimated price $5,188 for            prove to be as satisfying and rewarding to you as they were to
    4 days. What you’ll do: Families hike to the giant statues,
    known as «moal,» hear island lore from locals and swim               the folks who were quoted above!
    in natural pools along the coast in a tour package from                 Once you have narrowed down the choices or have selected
    the chilean travel company explora. What to watch for:
    it takes more than 10 hours to get to santiago from most             the adventure vacation that is well suited to your family, con-
    U. s. cities, and another five hours to reach the island–a           sider the following suggestions as a way to best prepare you
    rough trip for restless kids.
                                                                         and your child (ren) for the big adventure.
                                                                           Involve Your Kids in Planning
facing exciting challenges? If you answered no to this,                    Getting your child (ren) excited about specific aspects of
then perhaps adventure travel vacations are not right                    the trip will help engage them during the trip itself. If you are
for you and your family. If you answered yes, then the                      so inclined, take some time before you travel to show them
following questions should further assist you in decid-                      maps, list animals that may be encountered on your trip,
ing which adventure travel offerings are best for your                         and discuss what type of activities will be included on the
family.                                                                         trip, etc. Above all else, consider each child’s abilities and
                                                                                   personality to ensure they have a fun and rewarding
   Do we or would we like to camp and spend time
                                                                                    adventure without getting in over their heads.
outdoors? Since most adventure travel holidays
involve spending time outdoors and camping, it is                                        Plan a Trip-Long Project
important to at least feel comfortable with the idea                                     A trip-long project may help your child (ren) en-
of sleeping in a tent, being out in the sun all day,                                  joy the trip even more, and can provide a valuable
etc.                                                                                   record for lifelong memories. One popular option
   What experience do we have with the activities we are                                  is to buy your child a disposable camera and
considering? If you have haven’t participated in the activ-                                    have them create a photo essay of pictures
ity or activities that are the feature of the vacation you                                      they’ve taken. Another good idea is to cre-
are considering (rafting, backpacking, horseback riding,                                         ate a journal for your children to write in
four-wheel driving, etc.), it might be best try the activity                                     each evening at camp. They can write,
on a local and shorter term basis. For example, a one-day                                         draw pictures, press flowers and go
raft trip should indicate to you whether or not your family                                     home with a running record of the trip.
would enjoy a longer wilderness river trip.
   Have we ever traveled overseas as a family on a more                                      Watch the Weather
typical vacation? Vacations that include comforts (such as                                   Once on the trip, watch the weather and
hotels and restaurants) in a foreign country can often be                         heed advice from your guides in order to assure your

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                                         a DV e N t U r e : Tour i sm in the E xtre me s
comfort. As you know, children (especially small ones) are more
susceptible to the elements than most adults. Bring lots of wa-
terproof sunscreen and have your child apply it several times a
day. However, do not apply sunscreen to your or their forehead.
If it drips in your eyes from splashing or perspiration it can sting.
Also, have your child wear a hat with a bill. Also, make sure that
you have closely followed the gear and clothing requirements
before the trip, in order for you and your children to be as com-
fortable as possible.
  Drink Lots of Water
  Dehydration may be the biggest hazard on any adventure trip,
and the first sign is often a bad mood. Bring water bottles and
have your whole family drink lots of fresh water. This is probably
the most important thing you can do to ensure everyone has a
good time.                                                                   tures that you too feel that your holiday was «the most incred-
                                                                             ible vacation we have ever had!”
  Share Activities
  Most adventure travel outfitters encourage everyone to do as
                                                                             By Ken Streater
much or as little as they want to in camp and at other times
while on the trip. If your children like to participate and lend   
hands, most outfitters welcome it! When deciding on a trip, find   
out from potential outfitters exactly how much hands-on partici-
pation there can be!
  Hopefully, these suggestions inspire you and your family to
participate in adventure travel vacations. And, we hope that
should your next family vacation be filled with outdoor adven-

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traVel meDiciNe For
tHe extreme traVeler
                                                                             additional insurance for sports or adventure coverage is the
                                                                             single most important concept. In addition, health care provid-
                                                                             ers should be aware of the special medical problems that can
                                                                             arise in the growing area of extreme travel.
                                                                                Although there are no comprehensive demographic data
                                                                             characterizing this group of travelers, there are some relevant
                                                                             data that can be extrapolated to obtain a profile of extreme trav-
                                                                             elers. Among studies of backpackers to wilderness and interna-
                                                                             tional destinations, the average age of 32 years is younger than
                                                                             that of United States international travelers as a whole, which
                                                                             is 44 years. Illness rates among general international travelers
                                                                             between the ages of 20 and 40 years are almost double that of
                                                                             older international travelers.
                                                                                General Risks
                                                                                In reviewing a topic such as extreme travel, the goal is not to
                                                                             provide an all-encompassing tome giving advice for every pos-
                                                                             sible exotic destination and all manner of extreme recreational
                                                                             activity. Instead, there are common generalizable risks for ex-
                                                                             treme travelers as a group that health care providers should be-
                                                                             come familiar with. Principal among theses risks is longer dura-
                                                                             tion and more remote travel. Common factors in this cohort that
                                                                             have been independently associated with either not seeking or
                                                                             noncompliance of pre-travel advice are: younger age, longer
                                                                             duration of travel, and individual travel. The highest single risk is
                                                                             trauma related to local transportation or the activity itself. Statis-
                                                                             tically, local transportation in a developing country in rural areas
                                                                             is the highest risk for all travelers. Tourists driving themselves
                                                                             have a 6-fold higher likelihood of a motor vehicle collision than
                                                                             a local citizen, with an additional 2.5-fold higher risk if driving

E     xtreme travel is defined as journeying to remote destina-
      tions or participating in unusual high-risk activities during
travel, generally far off the beaten path. These destinations may
                                                                                  tYPical traVel iNsUraNce exclUsioNs
                                                                                  athletic activities, professional events, or contact amateur
be in developing countries or in the wilderness of a developed                    amateur athletic activities engaged in other than solely for
country. Activities may be unusual in nature (e. g. EcoChal-                      leisure, recreational, entertainment, or fitness
lenge) or a typical activity in an exotic location (e. g. bird watch-             mountaineering where ropes or guides are normally used
                                                                                  or above 4500m
ing in remote Guiana).
                                                                                  aviation (except as a passenger in a commercial aircraft)
   Encompassed within this concept of extreme travel are areas                    Hang gliding, sky diving, parachuting, or bungee jump-
of traditional travel medicine and wilderness medicine. Neither                  ing
travel nor wilderness medicine alone encompass the realm of                      snow skiing or snowboarding, except for recreational
                                                                                 downhill or cross-country
potential problems that might be encountered by an extreme                       racing by any animal or motorized vehicle
traveler. The activities that are typically excluded from travel                 spelunking (caving), scuba diving, jet skiing
insurance evacuation policies are perhaps the best reference                     any other sport or athletic activity that is undertaken for
as to what constitutes extreme travel. Recognizing that these                    thrill seeking and exposes one to abnormal or extraordi-
                                                                                 nary risk of injury
exclusions exist and that extreme travelers need to purchase

                                                                                                                                   Febr u ar y, 2008
                                               a DV e N t U r e : Tour i sm in the E xtre me s
       on the opposite side of the road than their home country. One
       should especially avoid travel at night.
          Pre-travel advice should consist of more than the recommend-
       ed vaccinations; however, vaccinations are important. Hepatitis
       A is the most common vaccine-preventable illness, with rates
       of up to 1 % to 2 %. In many countries with nationalized health
                                                            systems, vac-
                                                            cinations are
 geNeral risKs oF extreme/aDVeNtUre                         free or inex-
 longer travel duration                                    pensive. Euro-
 High risk activities for trauma                           pean travelers
more risky food and beverage items                         tend to have
more contact with locals                                   greater levels
more austere accommodations (chagas, rats, fleas)         of pre-travel            sleeping under a bed net, ideally one pretreated with perme-
more brush exposure, thereby tick exposure                                         thrin. Second, pre-travel treatment of clothes with 0.5 % per-
                                                          health care visi-
mosquito exposure
                                                          tations and vac-         methrin, by soaking or spraying, is recommended. Permethrin
increased drowning risk
sexually transmitted diseases                            cinations than            binds to clothing and is effective through up to 10 washings.
crime/political instability/insurgency                   North Ameri-              Treatment of clothing or objects, such as tents, protects the in-
Psychological disorder unmasked by stress                can travelers.            dividual and also offers nearly 50 % protection to others in the
                                                         For example,              immediate vicinity. With the emergence of West Nile virus, the
                                                         among visitors            North American general population has more recognition of the
       to Cuzco, Peru, 85 % of Europeans versus 67 % of North Ameri-               dangers of mosquito-borne illness. Although mosquito avoid-
       cans had received pre-travel vaccinations. Nearly half of North             ance has traditionally been recommended in regions with ma-
       American travelers (48 %) did not visit a health care provider              laria, other mosquito – and tick-borne illnesses are worldwide in
       before travel. One encouraging prognostic among Europeans                   distribution. For example, Aedes aegypti, the vector for dengue
       travelers is the finding that those intending rural travel are three        fever, is an urban day-biting mosquito expanding in geographic
       times more likely to visit a health care provider. The health               range since the 1960s. In a prospective cohort study of Appa-
       preparation among young travelers is often less than optimal.               lachian Trail backpackers, nearly 5 % acquired a vector-borne
       Younger persons have been shown to seek pre-travel advice                   illness, principally Lyme disease.
       at substantially lower rates. A recent Japanese encephalitis in-
       vestigation reiterated this dilemma when it found that 40 % of                 Precautions
       American university students spending one month in Thailand                    One of humankind’s traits is the desire to explore. Within
       did not seek pre-travel advice.                                             the outdoor recreation and sporting communities, this trans-
          Traveler ’s Diarrhea                                                     lates into a never-ending search for more exotic locations
                                                                                   and more challenging endeavors. In many extreme travel
          Adventure travelers have been previously shown to have                   cases, this may mean taking traditional recreational activi-
       higher risk of traveler’s diarrhea as compared with those stay-             ties, such as skiing or scuba diving, and transporting the ac-
       ing at one hotel or as part of an organized tour. The incidence of          tivity to nontraditional locations–frequently without support
       traveler’s diarrhea is expected to be over 50 %. Instructions for           or medical backup. Here are some useful recommendations
       self-treatment of traveler’s diarrhea should be given (bismuth,             for adventure travelers:
       loperamide, ciprofloxacin). On longer or more rural trips, basic
       hygiene should be stressed. When soap, clean water, and clean               • Doxycycline prophylaxis daily for malaria, leptospirosis,
       towels are not available, alcohol-based hand sanitizer is an ef-               rickettsioses. Alternate combo: mefloquine + doxycycline
       fective alternative. Among United States backpackers, frequent                 weekly
       hand washing is the single most protective factor to prevent di-            • Permethrin pretreatment of clothes, mosquito bednet
       arrhea.                                                                     • Evacuation Insurance. Often «adventure activities» are ex-
                                                                                      cluded, and «Sports Rider Coverage» must be purchased,
          Mosquitoes                                                                  typically at an additional 20 % cost.
          Mosquito and tick precautions should be advised for nearly               • Medical first aid kit
       all destinations. In a plethora of studies that included American
       travelers to Africa, soldiers, aid workers, and Boy Scouts, anti-           • Use of licensed/certified guides
       mosquito measures were used by less than 50 % of travelers.                 • Advance planning. Word of mouth or via travel-related inter-
       Passive methods to reduce mosquito exposures are likely to be                  net chat rooms may be helpful to confirm the quality of tour
       consistently effective. Two primary examples exist. The first is               operators.

                                                                                        Febr u ar y, 2008
                                      a DV e N t U r e : Tour i sm in the E xtre me s
• Detailed cardiac evaluation for those with cardiovascular risk
   factors or age over 50 years with provision of baseline EKG
Among the recommendations for medical examination before
   extended travel is also:
• Detailed history and physical examination, especially cardio-
   vascular risks
• Dental examination
• Underlying illness, discussion of chronic medications
• Screening for age-specific guidelines
• Identifying cryptic psychiatric disease, substance abuse
• Identifying abnormal coping mechanisms for stress (self-
   awareness) and relationships
• Knowledge of trip duration, destination, activity, and local
   medical capacity affect the extent of evaluation.
   With international travel expecting to double by 2020 and with
the global population growing at near 2 % per year, probably
there will be increased demand for more exotic and remote
travel. Adventure travel is primarily a North American, Western
European, and Australian hegemony; however, this will presum-
ably change in the coming decade with increasing diversity of
travel originations and destinations.
By David R. Boulware, MD


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