Des Conway has over 20 years' experience in police and commercial security. He uses his additional research and commercial security experience to ensure his own and his family's safety while planning and taking holiday and business trips. Through this and his other security handbooks he is committed to helping people keep themselves and their loved ones safe, wherever they are.
When abroad, no matter where you are, you should be particularly careful with your health for a number of reasons.
- UK citizens are becoming increasingly adventurous, arranging to travel to ever more exotic and remote locations.
- Around the world there are any number of deadly diseases and conditions that can easily kill you or make you very ill.
- You can pick up infections that you can carry and pass on at home.
- There is a potential lack of decent, effective and available medical care at your holiday destination.
- Local medical costs can be exorbitant.
- Treatment may be refused unless you agree to pay medical fees in advance in cash, or unless you can prove that you have insurance that will cover those potentially huge medical fees.
About 50% of UK citizens have now abandoned the traditional package tour to a Spanish beach, preferring to arrange personalised holidays to increasingly exotic locations. UK tourists are now likely to be on a trek through the Himalayas, or on a jungle safari in search of rare orchids or animals. The following advice on holiday health will educate you and prepare you for the new health challenges that foreign holidays can bring.
This advice is designed to bring risks to your attention and to highlight hidden health dangers associated with travelling off the beaten track (or on that Mediterranean beach). I have included descriptions of common symptoms, to help you recognise the possible onset of a potentially fatal disease. I have also included potential countermeasures you might use to avoid contracting those diseases or to apply emergency treatment if necessary. Whatever you do, as soon as possible seek expert medical advice and treatment.
Water and Food
Many people suffer food poisoning while abroad. The problem isn’t the water and food, it’s the bugs and germs that are swimming in it, or climbing and breeding on it. Local people have usually built up a natural immunity to the infections, so they easily shrug off any bacteria and virus. A tourist can arrive in the country, take one sip of water and then be so ill from an infection that they spend the rest of their holiday in bed.
Holiday ailments like the infamous ‘Delhi Belly’ and ‘Montezuma’s Revenge’ are not inevitable If you follow some simple rules on hygiene, food and drink, you can greatly reduce the risk of suffering from these infections.
Be warned that apparently simple infections that cause diarrhoea and vomiting can lead to dehydration and ultimately to fatal complications. Young children and the elderly are particularly susceptible to dehydration.
You should be able to avoid the usual stomach upsets by taking some simple precautions.
For most people in the UK their biggest medical worry is whether they will catch a particularly debilitating dose of the flu each winter.
Washing your hands and maintaining standard domestic and kitchen cleanliness will reduce the chance of picking up a UK winter virus. If you are infected, you’ll feel rough for a few days and then you will be back to normal, so the risks associated with becoming infected by most UK viruses are minimal.
Abroad, things are very different. Even just across the channel there are diseases that can easily kill. Tropical climates are particularly hazardous when discussing possible infections, but what are those infections?
To us, foreign diseases are just words you hear on the television news. We may vaguely recognise them as diseases but they aren’t of any concern to us, until we go abroad.
Researching foreign diseases can be worrying, but I want you to worry! I want you to worry just enough to tear down your complacency and see how serious a threat these diseases could be to you and your family. Abroad you risk infection with some really serious and highly contagious diseases. I want you to be motivated to take steps to avoid infection. The diseases you may find in many holiday destinations include:
- Dengue fever (mosquito bite)
- Hepatitis (contaminated food or drink)
- Cholera (contaminated food or water)
- AIDS/HIV (sexual contact or bodily fluid transfer)
- Diphtheria (contact with infected person)
- Yellow Fever (mosquito bite)
You don’t have to be a doctor to recognise most of them, but not knowing about them can lead to complacency. So the news says that ‘Viral Hemorrhagic Fever’ has broken out at my destination. I never heard of it, so should I worry? It’s rare, isn’t it? Something they catch in dirty villages – nothing for me to worry about. right?
You should worry about it because that term covers a range of similar conditions that you probably have heard of, including the more familiar Lassa fever. Marburg disease, and Rift Valley fever, and anyone can be infected.
At the same time the names of other infectious diseases scare us, but they may no longer be a threat. Smallpox is a killer, isn’t it? Well it was. The World Health Organisation declared that smallpox has been eradicated.
But the plot thickens. The WHO now advises people not to take the smallpox vaccine. Apparently the minute risk of developing smallpox from the vaccination now presents a greater risk than not being vaccinated and risking contracting the disease (if it still exists).
Having warned you of the range of deadly tropical diseases that exist, I want to finally destroy any possible complacency that you may have about European diseases. Don’t assume that all the really bad diseases only exist in tropical climates. Here are just two examples of European diseases.
Rabies is almost always transmitted by an animal bite (unless the virus is somehow introduced into an open wound). The incubation period is between one and three months, but it can take several years for the virus to reach the brain and spinal cord, when symptoms appear.
All mammals are susceptible. The dog is the main carrier of the disease. There are two common types of rabies.
Furious rabies. These animals/victims are hostile to anything and everything, including inanimate objects. Infected animals usually produce lots of saliva. The movies show them foaming at the mouth. They don’t, but they do dribble.
Dumb rabies. These animals/victims appear to be quiet, timid and shy. They often reject food and their lower jaw seems to be paralysed.
When abroad, you should play safe and avoid all animals. Anyone who thinks they have been exposed to rabies must:
- Remove any clothing that may still be contaminated with saliva from the biting animal, remembering to protect any wound from other infections such as flies and dirt.
- Immediately clean the wound and the surrounding area very thoroughly with soapy water. The more you wash the wound the smaller your chance of infection. Wipe outwards away from the wound – don’t grind any saliva, infection and dirt into the wound.
- Apply a povidone-iodine solution if it is available.
- After thoroughly washing the wound with clean water, seek medical attention as soon as possible. Go to the nearest doctor or hospital immediately.
- Report all bites to the local authorities so that they can deal with the animal.
- As soon as you get back to the UK see your own doctor and report the circumstances of the incident, plus any treatment you had, then ask them to check you over.
Warning signs of rabies in animals. Animals with rabies may appear to act differently to normal healthy animals, and will behave differently depending on whether they have dumb or furious rabies. Some changes you may notice:
- Animals suffer behavioural changes when infected.
- Wild animals may be seen to be moving slowly or acting tame, or seem to be ‘uninterested’ in things and people around them.
- Infected animals may display signs of general sickness before other symptoms appear.
- A pet that is usually friendly may become aggressive and try to bite people or anything nearby.
- Infected animals often have problems swallowing.
- Depending on the type of infection they may produce a lot of saliva or can suffer partial paralysis.
- When an animal or human is infected and showing signs of the disease, it is too late – the result is always death.
Early symptoms of rabies in humans. The symptoms vary but they could include:
- Sore throat
- Feeling tired.
All of which could just be the early signs of flu – which is why it is important to seek medical advice and treatment after any bite or wound caused by an animal abroad.
Other symptoms of rabies in humans include:
- When the virus reaches the brain, the victim can become nervous, confused and upset.
- Pain or tingling at the site of the bite.
- Possible hallucinations.
- Hydrophobia – a fear of water.
- Paralysis in parts of the body.
As the disease advances, an infected person finally goes into a coma and dies.
There are vaccines, but the victim has to be treated as soon as possible. Without treatment, all victims will die.
Lyme disease is found in temperate forested regions. It is not found in tropical climates.
Lyme disease is transmitted to humans through the bite of infected ticks, which are found in grass, bracken and bushes. The ticks jump onto people walking through the undergrowth and then work their way to a warm moist area. Once there they bite and treat you like a mobile snack bar. Actually the ticks don’t just bite, they hold on to suck your blood over extended periods. By doing so they inject ‘spirochetes’ into you.
Anyone infected with Lyme disease can usually be cured by an appropriate course of antibiotic treatment. If in doubt, seek advice from your doctor or local hospital.
Warning signs of Lyme disease. Infected people display:
- A characteristic expanding rash at the site of the tick bite
- Neurological symptoms, for example facial paralysis.
Mosquitoes and Malaria
Malaria is a highly debilitating and sometimes fatal parasitic disease, which is spread through the bite of an infected mosquito. Malaria is present in all tropical countries (and is creeping north into new areas). It comes in different forms. some of which are a lot more dangerous than others.
Local people often have a natural immunity to the effects of malaria, but tourists don’t. About 2.000 UK residents contract malaria each year, and some of them die. If you are going to a tropical destination, ask your doctor for advice about anti-malaria treatments and measures.
If you are going to a high-risk area, your doctor can prescribe a course of the most appropriate medication, which has to be started at least a week before your trip.
Anyone making a last-minute booking is at greatest risk, because they may not have had time to see their doctor, or obtain the correct medication.
If you are interested in researching any specific diseases, you may find the World Health Organisation website interesting at www.who.int/health_topics
Avoiding mosquito bites
First the bad news. You might just be unlucky, because some experts claim that mosquitoes are attracted by smell. If you are really unlucky your natural body odour might smell like a Sunday lunch to any passing mosquito.
Now the good news. More often than not it is a combination of the smell of your soap, aftershave, perfume, deodorant or skin cream that is attracting them.
Injuries and Illness
When abroad, be very wary of disease and injury. In extreme climatic conditions, a small scratch that you wouldn’t give a second thought to in the UK could very quickly deteriorate to a state where it needs urgent medical attention and could even become life-threatening if left untreated.
If you do seek local advice, make a note of what they say when they treat you. Though they have treated you there may be complications or the treatment may be wrong or need to be continued at home. Get whoever treats you to write down what caused the injury, the diagnosis, the recommended treatment and any treatment given.
If you need to see your doctor back home, this should be enough information for him to understand what has been done, and decide what he should do. Just the name of the species of plant, snake or insect that caused the problem can be 60 a great help.
Other Health Threats
Earthquakes are more common than most people think. When I was in San Francisco I was surprised to see that the daily newspaper carried a tally of the number of small shocks that had been recorded each day, and there were usually several.
Geological movements can include major earthquakes, volcanic eruptions and tidal waves.
The more remote your location the more advice you should get. In the UK bad weather means you risk getting a little cold or wet. Abroad, bad weather can easily kill you, through extremes of heat and cold, avalanche, flood, mud slide. tornado, storm, and hailstones the size of tennis balls!
Thunderclouds are up to 10 miles high, and very cold at the top, allowing ice to form. In the turbulent airflow within those clouds, ice particles collide. separating their electrical charges. Positively charged ice crystals rise to the top of the cloud while negatively charged ice particles and hailstones drop to the middle and lower parts of the cloud. Because of that separation, a huge electrical differential develops inside thunderclouds.
The storm gathers a huge pool of positively charged particles as it moves over the ground. As the differences in charge continue to increase, positively charged particles rise up from taller objects on the ground, such as trees, houses and telephone poles, forming small upward-reaching electrical ‘fingers’ of charge. That means that electricity is forming in taller ground-based objects and reaching up towards the base of the thunderclouds. Those upward-reaching, invisible fingers of charge streaming off a tree, a chimney or your head if you are standing in a field are called ‘leaders’.
A negatively charged area in the storm sends out a charge towards the ground, which is attracted to one of those ‘leaders’. If they connect and make a circuit, the resulting discharge is what we see and call a lightning strike.
(In a storm, if your hair stands on end that is a sign of an imminent lightning strike on and then through you – so get down as flat as you can and hope a stronger and taller ‘leader’ will take any lightning strike that is coming.)
As the lightning channel heats quickly to 30,000 degrees, the expansion of heated air produces the noise we identify as thunder.
As light travels faster than sound, we see the flash first then hear the sound.
There are different types of lightning too! Negative lightning, from the base of the cloud, or positively charged lightning from the top of the cloud. Positive lightning is thought to be more dangerous, because it can strike as much as 5 or 10 miles away from the storm, in an area where people think they are safe. Positive lightning discharges also last longer, which means that they are more likely to cause fires.
- If lightning hits your car when you are inside it you will survive.
- If lightning hits you, even if you survive you will never fully recover.
- Consider the power, risk and danger of lightning, and think about what you would do if caught in a thunderstorm, on foot in an exposed place.
- Each bolt of lightning can be over 5 miles long.
- A lightning bolt can reach approximately 50,000 degrees Fahrenheit, and contain 100 million volts.
- There are about 2,000 thunderstorms in progress around the world at any given time. In those storms around 100 lightning bolts are discharged every second, which adds up to about eight million lightning bolts a day around the world.
- On average that lightning kills over 1,000 people each year, leaving thousands more injured and permanently disabled.
- On average, 20% of lightning strike victims die when the lightning strikes.
- At least 70% of survivors suffer serious long-term effects.
- There are up to 20 million thunderstorms each year, so you should be aware of the dangers and know how to protect yourself from a thunderstorm. wherever you are.
- American research has recorded 25 million lightning strikes (from the cloud to ground) every year in the USA. With that figure as a guide. the UK must have at least a quarter of a million lightning strikes each year.
Moving water and vehicles
Another danger that is unfamiliar to most UK residents is mixing vehicles with moving water, particularly streams and rivers that cross roads and floodwaters on roads.
Moving water has immense power. It can destroy houses, rip down bridges and move huge boulders. Don’t make the mistake of assuming that it is safe to walk or drive through a few inches of moving water.
- Because floods are uncommon in the UK, we are unfamiliar with the dangers of moving water. A few inches of fast-flowing water can kill you.
- Off-road-driving instructors say that before driving into any water, in even the biggest and meanest four-wheel-drive vehicle, the driver should check for depth, flow and obstructions by prodding with a long stick. (They also need to see if there is somewhere to drive out of the water on the far bank.)
- Any water may be deeper than it appears.
- Water may be flowing faster than it appears.
- The power of flowing water is immense. Less than two feet of water can wash away almost any vehicle. If the circumstances are right, a small family car can be washed off the road by just six inches of moving water.
- If you or you and your car are washed into deeper water, you are at the mercy of cold, fast currents and floating debris. DON’T RISK IT.
- If faced with flowing water and floods, get out and get to dry land and high ground as soon as you can. Don’t try to save the vehicle. Don’t risk your life for a metal box with a wheel on each corner.
- STAY OUT OF MOVING WATER.
Some countries can be so hot and humid that it can affect your well-being, comfort and health in several ways. Obviously the energy sapping heat and humidity of tropical jungles will shock your system so you need a few days to acclimatise.
Even the moderate heat and humidity of a Caribbean island can shock the system of UK citizens more used to chilly winds and drizzle.
Our UK skin is generally not used to coping with a 12-hour daily dose of extremely high UV rating sunshine.
What is the UV rating that people talk about when discussing sunburn and the strength of the sun?
The sun emits three different types of ultraviolet (UV) radiation, which all damage the skin and can damage the eyes too. The three types are:
UVA radiation penetrates deep into your skin, and causes damage such as apparent ageing, wrinkles and discoloration.
UVB causes what is commonly known as sunburn. Surface blood vessels expand and leak fluids, producing the identifiable redness and pain of sunburn. Any sunburn can cause permanent and irreversible skin damage. UVB is associated with the most harmful effects of UV radiation, including ageing, wrinkles, cancer, cataracts, snow blindness, etc.
UVC should be absorbed and blocked by the ozone layer in the atmosphere. Global pollution and the depletion of the ozone layer have reduced the filtering effect of the atmosphere, so we are in ever-greater danger of exposure to UVC radiation.
In most people, when their skin is exposed to sunshine (UV radiation) their skin reacts to protect itself by producing melanin pigmentation, which darkens and protects the skin. That darkening is often called a ‘suntan’.
The melanin absorbs UV radiation, protecting skin cells from UV damage – for a while!
Experts say that fair-skinned people should gradually expose their skin to sunshine in stages for up to 7 days before their melanin production has reached a maximum. Unfortunately very fair-skinned people take longer, while darker-skinned people take a shorter time, so no fixed rule can be given.
Cumulative Danger. UV radiation has a cumulative effect. The more often you burn the worse the damage. If you burn often enough and badly enough, especially during childhood, your chances of developing skin cancer increase significantly.
The strength of the sun varies according to a number of factors. They are:
- Latitude. Equatorial regions have stronger sunshine.
- Altitude. The higher you arc, the less ozone and atmosphere there is to protect you from solar radiation.
- Season. Days are longer in summer so you are exposed to more sunshine.
- Time of day. The sun is stronger from 10am to 2pm, when it is at its height.
- Reflection. Sun reflects off water, glass, white surfaces and hard surfaces, possibly concentrating radiation on you – even if you are sitting under an umbrella.
The best way to protect yourself from the sun is to move into the shade, remembering that you will still be susceptible to reflected radiation unless you go into a building with walls all around you.
The shade from balconies, umbrellas and porches offers some protection, but beware. Don’t become complacent. You are still susceptible to solar radiation unless there are walls all around you.
Just like a burn from scalding water or fire, sunburn can be serious, though it develops gradually. It can range from slightly coloured skin to severe pain with blisters and swelling. Treating sunburn is common sense, with a golden rule of ‘seek medical assistance if at all in doubt’.
The UV scale indicates the expected level of UV radiation. The scale runs from 1 to 20. Television, radio and newspaper weather forecasts include the expected level ot UV radiation for that day.
Tables attempting to indicate the level of danger from UV radiation offer only a rough guide, because so many factors can affect the level of damage that UV radiation can do to your skin.
For example, altitude, cloud cover, level of previous exposure, wet or dry skin, and whether or not a sunscreen product is being used can all affect you.
For that reason treat tables as a rough guideline, issued with a strong health warning. Anyone can suffer sunburn in under 30 minutes, depending on skin type, UV rating, activities, locations, etc.
When there is a forecast UV Scale of 10 or above, everyone should avoid exposure to the sun where they can. See table on page 72.
Hundreds ot people in the UK die each year from sun-related cancer. If you have a ‘mole’ that is
- of irregular shape
- has a dark centre
- is growing in size
- is changing shape
or in any way causes you concern, sec your doctor immediately.
Sunstroke and heat stroke
Sunstroke and heat stroke can kill. They occur when the natural body temperature regulating system fails because of extended exposure to high environmental temperatures.
Heat stroke is often combined with periods of high physical exertion. The patient experiences a sharp increase in body temperature and an associated fever. which can cause permanent damage to internal organs, resulting in death if not treated immediately.
Heat stroke is often seen when somebody who is not acclimatised enters a particularly hot or humid environment, or performs strenuous physical activity in a hot and humid environment. Young children and the elderly are at most risk, though in the right circumstances anyone can become a victim.
These are the symptoms to look out for:
- The skin seems red, feels dry and very hot.
- The patient doesn’t seem to be able to sweat.
- Their pulse is strong and fast.
- Possible hyperventilation.
- Check the eyes. Do the pupils appear small?
- The patient seems to be developing a very high fever.
- The patient may appear disoriented or mentally confused.
- In advanced stages – unconsciousness with possible convulsions.
- Ultimately – death.
If you suspect that somebody is suffering from sunstroke or heat stroke, you should take steps to offer immediate first aid, but your main aim should be to seek professional medical help as soon as possible.
Initial treatment should include:
- Take the patient out of the sun to a cooler place as soon as possible.
- Loosen their clothing or take it off for maximum cooling out of the sunlight.
- If possible, immerse the patient in cool water, a bath, a shower, or even a nearby stream or lake as long as it is safe. Don’t risk drowning them, or risk the victim being washed downstream on a strong current.
- If you can’t immerse them in water, cool them by spraying them with water and consider turning on any electric fans that may be available for maximum evaporation and cooling.
- If available, use cold compresses, such as ice wrapped in a tea towel applied to the head and neck area, as well as the armpits and groin for maximum cooling effect – but don’t overdo it.
- While doing this, summon professional medical assistance. Carry on with the above treatment until the ambulance or doctor arrives.
- Do NOT give any medication to lower a fever. It will not be effective and may cause further harm and complications.
- Avoid giving the patient water or anything else by mouth until the condition has been stabilised or until medical staff instruct you to give something to the patient.
Dehydration is a real threat, which is more common than people realise. It can accompany heat-related illnesses such as sunstroke or heat stroke, as well as being a complication of prolonged attacks of diarrhoea, vomiting or fever Young children and people over the age of 60 are particularly susceptible to dehydration.
Everybody loses bodily water during the day, through sweat, tears and using the toilet. Normally that water is replaced by eating and drinking. If anyone has to work hard, hike, climb or play sports in a very hot or humid place they can easily upset the balance between water intake and water losses.
As you lose water you also lose essential body salts such as sodium, potassium, calcium bicarbonate and phosphate. Losing that water and those salts will upset your body chemistry, which results in a condition that is commonly called dehydration.
Common symptoms of dehydration
Symptoms vary from patient to patient due to changes in body size, age, health. fitness, local temperature, local humidity and whatever the patient is doing at the time. Generally symptoms may include:
- Thirst – because your body knows it needs more water and is trying to make you drink some.
- Increased heart rate and breathing rate as the body works harder to recover.
- Dizziness and confusion. The patient may say they feel light-headed.
- The patient doesn’t want to urinate as frequently as they usually do, partly because the body is trying to preserve fluids and partly because the flow of fluids through their system is drying up.
- Dry mouth and nasal linings, because the body is pulling moisture back into the core to sustain life.
- The patient feels tired and their skin is dry.
Children and babies may display additional symptoms, mostly due to having smaller bodies and smaller reserves of water to use to maintain life. For example:
- An early symptom could be a dry mouth and tongue.
- If they cry but no tears are visible.
- Small babies stop wetting their nappy.
- The loss of moisture shows on the body and face of a baby or child. They have sunken eyes, cheeks and stomach.
- A child may appear to be unusually irritable, angry or tired and listless.
- A little test that parents can do on small children is to gently pinch the skin. When gently pinched, normal skin is moist and elastic, and when released it will flatten out and return to normal, showing no sign where it was pinched. Dehydrated skin will stay pinched and wrinkled like a bed sheet, plastic or paper, and it will be obvious that the skin is not as normal.
The dangers of being dazzled by the sun shouldn’t be overlooked. At home it we get sunshine for three days in a row it gets national news coverage!
Abroad the bright sun could dazzle you and cause an accident. When driving on unfamiliar roads or walking on cliff-top paths, climbing up and down steps in unfamiliar towns or negotiating boarding ramps onto ferries and docks you could have an accident. Expect bright sunshine and be prepared for it.
You may have selected a holiday destination at the other end of the climatic range where cold becomes a threat. In those conditions loss of body heat can lead to hypothermia.
Hypothermia is defined as a state where the core body temperature falls to below 35 degrees Celsius. If the body temperature drops another three degrees to 32 Celsius, the patient is in a state of reduced consciousness. At or below 30 degrees Celsius the heart stops and death occurs.
Be warned. The two-degree difference between 32 and 30 degrees Celsius is DEATH.
The body loses heat in several ways.
- Radiation. That is, the body acts like a radiator, a heat source trying to warm the area around it. Radiation heat loss is greater from exposed skin, the head, and anywhere that might be covered by wet clothes.
- Conduction. That is, through direct contact with something cold. If you touch a cold metal bench your body heat quickly transfers to the metal bench. NOTE: You lose up to 25 times more heat in water or wearing wet clothes than you would if you were dry.
- Convection. That is, where heat is lost to moving air or water. For example, riding a bike your skin heats the air in contact with your skin, then as you cycle the wind blows that warmed air away. Cold air takes its place and you warm that, until you stop cycling. There is a similar effect in flowing water.
- Evaporation. That is, where energy in the form of heat is lost when water evaporates. Sweat is a good example of this. When you are too hot you sweat, 78 the sweat evaporates and cools the skin.
- Respiration. That is, where you lose heat by breathing. Everybody has noticed their breath coming out as steam on a cold day. The steam is warm moist air coming out of your lungs and condensing, a clear indication that you are losing body heat by breathing.
Remember the five methods of body heat loss above. To survive in a cold environment, stop or reduce as many as you can.
Losing body heat by losing body fluids, in sweat or breathing will also affect the fluid levels, salts and electrolytes in the body, which can lead to dehydration even in a cold climate Dehydration is a dangerous and unwanted complication of hypothermia!
Who is at risk?
- Babies are at risk because they cannot do anything to protect themselves, or let anyone know that they are cold.
- Older people are possibly inactive, not able to seek shelter, or not able to participate in activities that would warm them.
- At home the elderly may also be possibly less well off. which means that they may not be able to afford to keep warm.
- Anyone who has a disability or is already suffering from an illness is also more susceptible to hypothermia.
- It has also been found that people who take some drugs are less able to regulate their own body temperature. Some prescription and illegal drugs have this effect.
Signs of hypothermia
- There will be a cold environment.
- Muscle stiffness noticeable in the neck, arms and legs.
- Possible gentle trembling that may be confined to one side of the body or one arm or leg.
- Shivering is the process the body uses to keep warm. If shivering stops, the patient may have warmed up, OR they may be even colder and in the early stages of hypothermia.
- Their face could appear to be puffy or swollen.
- The patient’s co-ordination may be deteriorating. They sometimes find it hard to walk and they easily lose their balance.
- Breathing and heart rate slow as hypothermia progresses.
- The skin looks pale (because all blood supplies have withdrawn from surface skin to protect vital organs), but there may be large pink or blue spots of skin. The skin feels very cold, even where it is not exposed to the air. (Check for this by touching under their clothing on the stomach, lower back, arms, legs, etc.).
- As the condition gets worse, the patient begins to lose consciousness. An indication of which is that they often lose the ability to reason and communicate – but that doesn’t always happen. Test this by asking simple questions, such as what is the date, what is twelve divided by four, etc.
- As hypothermia gets worse, the patient becomes more confused. They may forget the name of close family members and friends, or not be able to remember the town they live in.
- The patient can become listless, though some patients become aggressive or argumentative.
’Umbles’ is a simple term to remind you of these symptoms. The ‘umbles’ are stumbles, mumbles, fumbles and grumbles.
In very cold conditions, expect hypothermia to be a present and real risk and take steps to find shelter.
Frostbite is the name used to describe human skin and flesh when it freezes.
If the subject is careless about clothing and shelter, when the temperature hits freezing (zero degrees Celsius) human skin and flesh can freeze, especially if the subject is wet or wearing wet clothes. If the temperature falls below minus 5 degrees and wind chill is a factor, frostbite becomes a real problem. Below minus 10 with wind chill and/or wet clothes, frostbite is a major risk. Blood flow slows, ice crystals form within blood and tissues, then the ice expands and damages the tissues. When thawed, the tissue damage may get worse.
Frostbite makes the skin numb. It appears to be grey and waxy in colour, is cold to the touch and may feel stiff and ‘wooden’.
Frostbite is usually restricted to skin and surface tissue but it can reach deeper tissues. In severe cases it can even affect muscle and bone. In these cases permanent damage is almost inevitable.
Altitude sickness occurs at altitude, where ‘altitude’ is usually defined as anything higher than 2,500 metres (8,000 feet). Anyone who plans to travel to higher altitudes should understand the danger, symptoms and treatment of altitude sickness.
You don’t have to be a mountaineer to experience high altitudes.
- Jet aircraft always have a pressurised cabin, but though some light aircraft are capable of flying at over 8,000 feet, their cabins are not pressurised.
- A few roads approach or climb through altitudes where altitude sickness could be experienced.
- Hikers and walkers may well find themselves at dangerous altitudes when walking in some mountain ranges and through high passes.
- The highest mountain in Britain is Ben Nevis in Scotland, but that is only 1,344 metres tall (4,409 feet). Compare that to major cities in some countries which are at extreme altitude:
Most people assume that there is less oxygen at altitude, but at any altitude the proportion of oxygen in the air is quite constant at about 21%. The reduced air pressure at altitude means that the air is thinner, so when you take a ‘normal’ breath, each ‘lung full’ contains less oxygen. Over 8,000 feet you get significantly less oxygen per breath than you do when breathing the ‘thicker’ air at lower altitudes.
To compensate for the reduced air density and hence reduced oxygen, your breathing rate will automatically increase to take on an adequate supply of oxygen. In these conditions many people suffer from a potentially serious side effect of high altitude and low air pressure, which causes fluid to leak from the capillary blood vessels.
That fluid can then build up in the lungs or the brain causing complications as described below. If sufferers do not receive treatment immediately they will die.
Patients suffering from and having treatment for diseases such as congestive heart failure, angina, sickle cell disease, asthma, etc. should avoid higher altitudes. If in doubt, seek advice from your doctor before travelling to high altitudes. As a general rule, talk to your doctor before travelling anywhere off the beaten track.
Apart from low air pressure and reduced oxygen, other factors often contribute to the onset of altitude sickness. For example:
- Lack of acclimatisation.
- Over-exertion and rapid ascent.
- Possible dehydration.
- Possible hypothermia.
- Existing medical problems.
Statistically, few people have ventured to higher altitudes, but from the evidence available there appears to be no known group or factors that make a person susceptible to altitude sickness. Age, sex, and physical condition seem to matter less than acclimatisation.
Altitude sickness is usually described in three different forms. They are:
- AMS. Acute Mountain Sickness is the most common form of altitude sickness. It can be experienced at altitudes as low as 1,200 metres (4,000 feet) but is more common when patients quickly climb to altitudes of 2,700 metres (9,000 feet). Symptoms are noticed some hours after the ascent, and have been compared to a hangover.
- Loss of appetite
- Nausea and sometimes vomiting
- Mild symptoms that feel like hangover/not feeling well
- Fatigue and tiredness
- Shortness of breath
- Sleep disturbance
Severe cases may also suffer from breathlessness and chest tightness (which are signs of HAPE), or confusion, lethargy and unsteady walking (which are signs of HACE).
- HAPE. High Altitude Pulmonary Edema can be described in simple terms as water in the lungs. If the capillary blood vessels leak fluid, it can collect in the lungs and cause severe breathing problems. The symptoms may not be noticed until a day or two after a fast ascent. Symptoms include:
- Being very tired, reporting unusual levels of fatigue while walking
- Any exertion causing increased breathlessness
- Breathlessness does not subside with rest
- Increasingly short of breath even when resting
- Severe cough that may be dry or productive
- High pulse rate, i.e. 110
- Possible blueness of face, lip, fingernails, which is a sign of a failure to absorb oxygen and/or the failure of oxygen to circulate in the blood.
- HACE. High Altitude Cerebral Edema can be described in simple terms as water in the head or water on the brain. Symptoms include:
- Feeling very tired, reporting unusual fatigue while walking
- Severe headache
- The patient walks as though they are drunk
- The patient displays mental confusion
- The patient is often irritable and wants to be left alone
- Eventually – unconsciousness, coma and death.
Because the symptoms of altitude sickness develop gradually, a sensible traveller will be aware of the dangers and will be able to return to lower altitudes to reduce the impact and allow the patient to recover.
If you are at altitude and experience any of the above symptoms you should assume that it is altitude sickness and act accordingly by returning to lower 88 altitudes immediately.
- Descend. There is only one foolproof treatment, and that is to return to a lower altitude. If the patient has only just begun to experience the symptoms, recovery should be quite fast, usually within a few hours. Once symptoms begin, you should not climb to higher altitudes under any circumstances.
For AMS and HAPE descending 1,000 metres (3,280 feet) is usually effective in reducing symptoms and will allow the patient to recover. Patients with suspected HACE should descend at least 2,000 metres (6,561 feet). If the symptoms persist, descend even further and urgently seek medical advice.
- Gamow Bag. Some expeditions carry a Gamow Bag for the treatment of altitude sickness, and they are very effective. The patient is placed inside the bag, which is then sealed and inflated using a simple pump. It works by increasing the air pressure inside the bag, which simulates the atmosphere of a lower altitude – two pounds of pressure per square inch inside the bag (which is easily achieved with a hand pump) simulates a descent of 1.500 metres (6,000 feet).
- Oxygen. Giving the patient oxygen can give temporary relief to the effects of lack of oxygen but the underlying problem of the altitude and thin air is still present – avoid climbing any further, be sensible and go down.
- Medication. There are a range of medicines that can help with altitude sickness, by increasing your tolerance to high altitude and treating the symptoms. All of these medications are considered to be quite strong, so they should not be treated lightly, and should only be administered by somebody with medical training, or at least only administered on the radio or telephone advice of a doctor. I would suggest that if you are ill enough to need medication you have ignored the warning signs and should have turned back a couple of days before!
The human body is remarkably resilient. Within a few days we can acclimatise to most conditions. You may have noticed when you go on holiday that a destination that feels cold or hot on arrival quite quickly starts to feel ‘normal’. We can acclimatise to environmental changes but that acclimatisation usually takes from one to a more usual four days.
You must understand that acclimatisation is a progressive process, which has to be completed in stages. For example, if you walk to 3,048 metres (10,000 feet) then stay there several days you will have acclimatised to that height. If you now walk higher up the mountain and reach 3,658 metres (12,000 feet), you will have to stop to acclimatise to the new altitude and environment.
As you acclimatise to altitude, your body will naturally make changes to compensate for the changes around you so that you can function at reduced air pressure with reduced oxygen. The altitude changes are:
- You will breathe deeper, taking more air in with each breath. 90
- The blood pressure in your lungs will increase, making more efficient use of areas of your lungs that are not used normally.
- You will automatically produce more red blood cells, which carry oxygen around the body.
- Chemical changes take place within your body so that it can more efficiently release and use oxygen.
Motion sickness/travel sickness
Known as sea sickness, car sickness and air sickness, motion sickness is caused by a bodily reaction to a mismatch of sensory information.
Under normal conditions, your senses feed information to your brain, telling you what is happening to your body. At the same time your eyes are feeding your brain information about what is happening to the world around you. The design of the human senses has evolved over millions of years, and in all of that time the world has stood still. People, animals and clouds move, but the world just stands there!
Usually the information from your senses and your eyes matches. When sitting on a park bench you know you are stationary and there are trees and rubbish bins around you that are also stationary. The information matches, so your brain is happy and you feel well.
The problem comes when your brain receives conflicting information. For example, if you are sitting on a bench but that bench is on a ship, your senses tell your brain that you are sitting still on that bench. Unfortunately your eyes and balance mechanism are telling a different story. You can feel the movement as the ship rises and falls, rolls and pitches. Your eyes are deceived as well. As you steam past a cliff or lighthouse, your eyes are telling your brain that you are actually moving forward quite fast. Result, confused senses inducing sickness – ‘motion sickness’.
In short, the signs and symptoms of motion sickness occur when sensory information about your position in or movement through space is contradictory or contrary between different senses in relation to prior experience. Symptoms include:
- Yawning (early symptom)
- Clammy skin
- Cold sweats
- Possible cold hands and feet
Travel sickness is common among passengers in cars and ships, or on trains and aircraft. The common name is ‘sea sickness’ because it is most often experienced on water At least 90% of sea passengers initially feel the symptoms of ‘sea sickness’ but only about 45% of people experience ‘car sickness’.
We know that the human body is remarkably resilient and will usually adapt to any new circumstances within a few days, but the ‘within a few days’ causes us the problems.
We each have a quite sophisticated internal biological clock, which tells our bodies what they should be doing, for example getting ready to get up. eat or sleep.
When it is noon on one side of the earth, on the other side it is midnight, with a range of different time zones in between. If you travel slowly around the world, your body has time to adjust to the slightly different time zones, but when you travel by jet aircraft, your body has a shock. Your biological clock says it is 10am UK time, but when you get off the aircraft the world around you suddenly demands that you comply with the local timeframe!
The physical and mental affects of this confusion are called jetlag. The effects of jetlag vary for a variety of reasons:
- Some people are not susceptible to jetlag. Their body clock seems to be able to cope with being ‘re-set’ after flights to different time zones.
- Some people seem to be able to cope with travelling east better than they cope when travelling west, and vice versa.
- For some people the effects seem to be minimised if they depart and arrive in daylight or depart and arrive in darkness. The time doesn’t seem so relevant as long as the broad conditions of day and night are constant.
- Some people seem to be able to maintain a steady body clock time, and ignore the local time around them. For example, I am told that some airline pilots stay on UK time for the duration of their trip, ignoring the fact that their body says it is noon but it is dark outside.
As explained above, the symptoms of jetlag vary but can include:
- General fatigue that may last for a few days after arrival
- A loss of the ability to concentrate
- A feeling that you have no energy, no drive
- An inability to sleep at night
- General feeling that you are not quite right
- In some cases you can become short-tempered and intolerant
- Dehydration and constipation
- Swollen legs and feet.
Drowning is a real risk. The statistics make it important enough to include a cautionary note.
Though it is difficult to collect accurate figures from third-world and communist countries, it is estimated that:
- Each year at least 150,000 people die from recreational drowning around the world.
- For every death from drowning there are 500 ‘non-fatal submersions’ – that is, people who nearly drown.
- In at least 50% of non-fatal submersions of children, those who require resuscitation suffer brain damage due to lack of oxygen.
- Lack of oxygen causes brain and tissue damage after about 4 minutes.
- Drowning is the second most common cause of death for children under 15.
- Nearly 20% of children who drown are in the presence of parents, lifeguards or other adults who are distracted at the time.
- Statistically, any given swimming pool is at least ten times more likely to be involved in the death of a child under four than any given car.
- The highest drowning rate per 1,000 population is shared by children under five and young people between the ages of 15 and 24.
- Of the children under six who drown, 70% will have been in the care of at least one parent and 75% will have only been missing for 5 minutes when they are found.
- 92% of children who get into difficulties survive if they are found and retrieved within 2 minutes of the incident.
- A child can drown in just 2 inches of water.
- 10% of all submersions occur in toilets, pools, buckets, baths and other domestic water containers.
- Contrary to popular belief, people don’t usually shout and scream when they are drowning – they are too busy fighting for breath. Most people drown quietly.
Water-based activities – threats
You don’t have to travel very far in any direction in any country to find water. Holiday destinations are often constructed on or near water, and also provide water as an amenity to attract guests. Holiday water attractions include:
- Lakes/Rivers/Streams/Reservoirs/Flooded Quarries/Oceans etc.
- On fresh water – Sailing/Speed boats/Canoes/Water Skiing/Rafting etc.
- In fresh water – Swimming/Diving/Fishing etc.
- On the sea – Jet Skis/Sailboards/Windsurfing/Surf Boards/Fishing etc.
- In the sea – Scuba Diving/Snorkelling/Spear Fishing etc.
- At purpose built water parks the whole point of their existence is to attract people to play in the water!
Why do people drown?
People drown for any number of reasons. More often than not children drown because they are exploring and don’t recognise or understand the danger associated with water. Reasons for drowning include:
- Not being able to swim, but still going into the water.
- Leg cramp or cramp after eating too much food or rich heavy food.
- Loss of consciousness due to injury, e.g. swimmers hit by boat or jet ski, diving into unknown and untested shallow water, hitting the bottom or an unknown underwater obstruction.
- Getting out of your depth, in water that is too deep or too rough.
- Medical condition such as a stroke or heart attack.
- Falling through ice and being trapped.
- Not wearing a life jacket for water sports.
- Drinking alcohol, which leads to risk-taking, bravado and possible death.
- Overloading boats with cargo or passengers, making them sink.
- Falling victim to unknown currents and rip tides.
- Being cut off by incoming tides.
- Water being colder than the swimmer thought – as found in deep quarries – leading to muscle cramps, hypothermia and death by drowning.
- Swimming where boats, jet skis and ships are manoeuvring, then being involved in a collision or injured by propellers.
- Disabling action of sea creatures such as jellyfish.
If you are taken ill abroad, be wary of medication. In many countries, powerful medication, which is only available on prescription in the UK, is available over the counter at popular holiday destinations.
The brand names often differ from the products that you may know, and the quality of the product and the strength and dosage can also vary. You cannot be sure of what you are getting, or what the effects may be.
Include health care in your plans
Having read this section, you are now more aware of the threats to your health, and how those threat levels usually increase significantly when on holiday.
If you didn’t previously know the range of holiday health threats that you face, you do now. Knowing what threats and risks you may encounter is one thing, doing something about them is another. You can quite easily wash your hands before eating and avoid risky foods and dirty restaurants. You can even wash and treat a mosquito bite when you know that the bite can become so infected that it will require medical treatment.
The big question is, when you or a member of your party needs urgent medical assistance and you are the first person at the scene, would you know what to do’
Forget holidays, what about everyday life? If your daughter. father, sister or a close friend collapsed in front of you, other than calling for an ambulance would you know what to do?
You may come up with some general health and safety questions relevant to your holiday. For example, you might now decide to check to see what safety and first-aid equipment has been installed on the canal boat you are thinking of hiring next summer, or you may want to ask about the presence of lifeguards at your holiday hotel pool. Make sure that you have asked your doctor about any proposed unusual activity such as bungee jumping and climbing to extreme altitudes.
When you are happy that you have made all the medical and health preparations that you can, pack this book. This may be the only guide to symptoms available to you in an emergency at a remote spot.
You should also remember that the locals probably know best. They live with the conditions all year, so they probably have more experience with local illnesses, bites, stings and diseases than most UK doctors.
Be safe, not sorry.