Safety in New Zealand's adventure tourism industry: the client accident experience of adventure tourism operators

BACKGROUND: Injuries and fatalities among participants of adventure tourism activities have the potential to seriously impact on New Zealand's tourism industry. However, the absence of statistics for tourist accidents in New Zealand, and the lack of detailed academic research into adventure tourism safety, means the extent of the problem is unknown. The aims of the present study were to determine the incidence of client injuries across a range of adventure tourism activity sectors, and to identify common accident events and contributory risk factors. METHOD: A postal questionnaire survey of New Zealand adventure tourism operators was used. Operators were asked to provide information related to their business; the number of recorded client injuries during the preceding 12 month period, January to December 1998; common accident and injury events associated with their activity; and perceived risk factors for accidents in their sector of the adventure tourism industry. RESULTS: The survey was responded to by 142 New Zealand adventure tourism operators. The operators' reported client injury experience suggests the incidence of serious client injuries is very low. Highest client injury incidence rates were found for activities that involved the risk of falling from a moving vehicle or animal (e.g., cycle tours, quad biking, horse riding, and white-water rafting). Slips, trips, and falls on the level were common accident events across most sectors of the industry. Perceived accident/incident causes were most commonly related to the client, and in particular, failure to attend to and follow instructions. CONCLUSIONS: The prevalence of client injuries in activity sectors not presently covered by government regulation, suggests policy makers should look again at extending codes of practice to a wider range of adventure tourism activities. Further research considering adventure tourism involvement in overseas visitor hospitalized injuries in New Zealand, is currently in progress. This will provide supporting evidence for the risk associated with participation in a range of commercial and independently undertaken adventure activities.     

The work-related fatal injury study: numbers, rates and trends of work-related fatal injuries in New Zealand 1985-1994

AIMS: To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994. METHODS: Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness. RESULTS: The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths. CONCLUSIONS: This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.     

Psychotropic medication use and accidents, injuries and cognitive failures

BACKGROUND: Psychotropic medication has the potential to impair psychomotor and cognitive function, and several medications have well documented links to increased accident and injury susceptibility. Those developed more recently have many fewer side effects. However, there is little work examining any association between psychotropic medication use and safety within the context of other demographic, health and lifestyle factors. AIMS: To examine and compare any associations between psychotropic medication use (including benzodiazepines, tricyclics and SSRIs) and accidents, injuries and cognitive failures in a community sample. METHODS: A postal questionnaire survey was conducted among people selected at random from the electoral registers of Cardiff and Merthyr Tydfil. RESULTS: Psychotropic medication use was associated with accidents, injuries and cognitive failures, particularly among those who already had higher levels of other risk factors and/or continuing mental health problems. CONCLUSIONS: The well established associations between accidents and injuries and older psychotropic medications were replicated. SSRIs, however, were relatively safer. The study also highlighted the need to consider any effect of psychotropic medication within the context of both mental health status and other factors.     

How well do we monitor patient satisfaction? Problems with the nation-wide patient survey

AIM: To outline and assess the accuracy and usefulness of the quarterly nation-wide patient survey of all New Zealand hospitals. METHOD: Data generated by an improved patient survey at South Auckland Health (SAH) was used to examine some of the problems and issues pertaining to this survey: i.e. the format of the questionnaire; unintended consequences of the specific methodology employed and the usefulness of the obtained information. RESULTS: Evidence is provided to show that the inpatient sample is not representative of the SAH patient population and that patients across different socio-demographic groups have different satisfaction rates. Additional research projects undertaken by the authors at SAH suggest that different methods of completing the questionnaire can significantly influence the results. CONCLUSION: The nation-wide patient survey is in need of revision, if it is to be used as an effective management tool within hospitals and for the sector as a whole.     

Acute stroke services in New Zealand

AIMS: To obtain an overall picture of the organisation of acute stroke management in hospitals throughout New Zealand. METHODS: A questionnaire was sent to all New Zealand hospitals. The survey included questions about access to organised stroke care, the presence of designated areas for stroke patient management, guidelines for stroke management and audit. RESULTS: Responses were received from all hospitals surveyed, with 41 admitting stroke patients acutely. Five hospitals (four regional and one large urban) had organised inpatient care. Five hospitals (three regional and two large urban) had stroke physicians. Only 40-60% of the New Zealand population had access to hospitals with guidelines for the management of complications following stroke or secondary prevention. Only fifteen of 41 hospitals had audited local stroke care. There were few differences in the management of stroke patients between urban and regional centres, but care in some regional hospitals was 'better' than that in most large urban hospitals. CONCLUSIONS: The development of an organised approach to inpatient stroke care in New Zealand and the training of general physcians, geriatricans and neurologists in stroke medicine must be seen as a priority.     

Health and safety standards in New Zealand mortuaries.

AIM: To establish the degree of compliance with health and safety standards in New Zealand mortuaries. METHOD: A mortuary audit tool was developed based mainly on British mortuary health and safety standards. This was tested and then applied to all identified mortuaries. RESULTS: Less than 50% (seven out of 15 institutions) met the standards required to carry out "basic" autopsies. Only one institution had mortuary facilities that were deemed suitable for "high risk" procedures. Where necessary, recommendations for improvements were made. CONCLUSIONS: New Zealand (and preferably Australasian-wide) standards need to be established and adopted for mortuaries. Some rationalisation of mortuary services so as to isolate risk (and improve quality control?) is necessary. People working in mortuaries need to adhere to stricter work practices while working in purpose-designed environments that minimise their risk.     

A decade of intensive care unit trauma admissions in Auckland

AIMS: To describe the demographics, nature and severity of injury of trauma admissions to a New Zealand urban Intensive Care Unit (ICU) over a ten year period; to determine differences in injury characteristics between patients received from inside and outside the local trauma catchment area; and to calculate incidence rates in the local population served, to identify high risk groups of patients. METHODS: We carried out a cross-sectional analysis of a prospective ICU patient registry. Data on all trauma admissions from 1988 to 1997 to the ICU of a large New Zealand urban hospital were studied with respect to age, gender, ethnicity, injury type and severity, and referral status. National Census data for the ICU catchment area were used to calculate incidence rates for local admissions. RESULTS: A total of 2305 trauma patients were admitted over the period of the study, accounting for 25% of all ICU admissions. The median age was 28 years and 75% were males. Blunt trauma, mostly due to motor vehicle crashes, accounted for 95% of admissions and penetrating trauma was very rare. The median Injury Severity Score (ISS) was 26 and most life threatening injuries occurred in the head region. Referred admissions were more severely injured and had a higher prevalence of severe head injury than local admissions. The ICU trauma admission rate for local patients was 34.6 per 100,000 person-years. Males had a higher rate than females in all age groups. New Zealand Europeans made up the majority of admissions, but Maori and Pacific Island males had the highest incidence rates. CONCLUSIONS: This study identified trauma as a major component of the ICU population. ICU trauma admissions were characterised by young males with head injuries resulting from motor vehicle crashes. Referred admissions were more severely injured than local admissions and would thus distort the estimated incidence of trauma in the local geographic region served. Calculation of incidence rates highlighted a significantly higher risk of ICU trauma admission amongst Maori and Pacific Islands people than New Zealand Europeans.     

A community based investigation of the association between cannabis use, injuries and accidents

There are well documented acute and chronic effects of cannabis use. However, less is known about any effects on safety within the context of work and everyday life. The aim of the study was to examine any association between cannabis use and injuries and accidents. A postal questionnaire survey was conducted among people selected at random from the electoral registers of Cardiff and Merthyr Tydfil. Cannabis use was associated with both minor injuries and accidents, particularly among those with high levels of other associated risk factors. Cannabis use was associated with a significant detrimental impact on safety. It is possible that this is linked to an amplification of other risk factors associated with accidents and injuries. This has potentially wide reaching implications particularly in the context of other work and lifestyle characteristics.     

Hazards associated with the boat building industry in New Zealand: an OSH audit.

AIM: To randomly audit the boat building industry in New Zealand to assess the occupational health status and level of knowledge of employees. METHODS: A survey was conducted using a nurse and inspector administered questionnaire. 151 workers from 120 randomly selected firms participated in the survey. RESULTS: 31.5% respondents thought they had had some sort of work related health problem since working in that job. 22% reported wheezing during the last twelve months. 14-16% met criteria for occupational causation, and 4% met a measure of severe wheezing related to work. 25.6% of workers had dermatitis. Only a quarter of these met criteria for occupational causation. No respondents reported symptoms suggestive of chronic solvent neurotoxicity. Solvents and epoxy resins comprised the majority of chemicals with which there was contact. Observation suggested little use of Material Safety Data Sheets as a source of knowledge about toxicity of the chemicals used. Although 94.3% reported wearing gloves, this did not correlate with numbers reporting dermatitis suggesting non-compliance or glove failure. CONCLUSION: New Zealand boat builders and their employees remain at risk for occupational health problems by virtue of their employment.     

Analysis of injury and death from burning upholstered furniture.

AIMS: Upholstered furniture is considered by governments in the United Kingdom, United States of America, Canada and New Zealand to be a potentially hazardous product. Use of polyurethane foam in upholstered furniture in the United Kingdom was banned in 1989 so as to reduce the risk of injuries and deaths from fire. This study assessed the situation in New Zealand. METHODS: Burn related deaths (1977-86) and injuries (1986) from the Health Statistics Services hospitalisation records were examined to identify cases in which upholstered furniture and bedding were implicated and analysed to describe the situation. Coroners files where relevant were examined. Detail on all fires and domestic fires for 1987 obtained from the New Zealand Fire Service were also examined. Characteristics of upholstered furniture available in New Zealand during the 1987 production year were identified through responses to a questionnaire sent to manufacturers, wholesalers and importers of this type of furniture. RESULTS: Examination of burn related deaths in which upholstered furniture and bedding were implicated (28.3% of all burn related deaths) showed the average annual death rate was at least 0.16 per 100,000 population and that the change in rate over ten years was not significant. Bedding and mattresses appeared to be the first textile items to ignite in 25.1% of those deaths occurring in the bedroom and furniture in 7.2% of those in the lounge. At risk groups were males (1.9 per 100,000 compared with 1.3 per 100,000 for females), those over 55 years (males 5.3, females 4.8 per 100,000) and those who may live alone (separated 4.5, single 5.4, divorced 11.4, widowed 13.4 per 100,000). The mix of alcohol consumption, smoking, then falling asleep created a situation of risk. Sufficient information was not always available to identify with certainty that upholstered furniture and/or bedding was the item to first ignite those fires which subsequently caused burn related injuries and deaths. Manufacturers, wholesalers and importers of upholstered furniture in New Zealand reported that of the total units, at least 38.5% had covers of wool/wool rich or leather and other materials which generally do not ignite readily. Polyurethane and polyester hollow-fill were commonly used as fillings. CONCLUSIONS: The death rate attributable to burning of upholstered furniture and bedding was not found to be especially high. Bedding, mattresses and bedroom furniture were reported more frequently than upholstered furniture.     

Maternity care providers' attitudes and practices concerning HIV testing during pregnancy; results of a survey of the Canterbury and upper South Island region.

AIMS: To assess current attitudes and practice toward antenatal human immunodeficiency virus (HIV) risk assessment, HIV testing and barriers towards implementation of these among midwives, general practitioners (GPs) and obstetricians in the upper South Island METHODS: A survey was conducted among maternity care providers by anonymous self-administered questionnaire. Most questions were dichotomous, forced choice or Likert scale format but there were four open- ended questions asking for a written response. RESULTS: The response rate was 57% overall. The main finding was that 275 (66%) of respondents assessed risk of HIV in less than 10% of patients, and 328 (midwives 93, 85%; GP's 226,77%; obstetricians 9,64%) respondents had performed less than three HIV tests in the past twelve months. Most respondents strongly agreed that detection of HIV during pregnancy is beneficial to mother 318 (83%) and to baby 367 (96%) and to mother prior to pregnancy 353 (92%). 202 (52%) supported and 44 (11%) were opposed to an antenatal screening programme in New Zealand. Most knew how to assess risk for HIV saw themselves as having an important role in antenatal HIV testing, and were comfortable performing risk assessment. Multiple reasons for current practices were offered, including perceived reluctance by women to be tested, lack of time, skills, knowledge and support services, and low rates of HIV in the community. CONCLUSIONS: The current policy of routine HIV risk assessment is not working among respondents. A systematic reassessment and implementation of a workable strategy needs to be undertaken in New Zealand.     

Core elements of epilepsy diagnosis and management: expert consensus from the Leadership in Epilepsy,Advocacy, and Development (LEAD) faculty

ABSTRACT

Background: Although epilepsy is relatively common, only a limited number of specialized epilepsy centers exist in the United States. Therefore, epilepsy diagnosis and management frequently occur in the community setting. This can complicate patient management and suboptimal care is a potential concern. Delayed recognition and inadequate treatment increase the risk of subsequent seizures, brain damage, disability, and death from seizure-related injuries. To identify core elements of epilepsy management that should be offered to all patients, the Leadership in Epilepsy, Advocacy, and Development (LEAD) faculty assessed current practical issues and identified practices to improve patient care and outcomes.

Scope: This paper presents a consensus opinion formed from a survey of 26 current LEAD faculty members, who answered 105 questions about epilepsy diagnosis and patient evaluation, treatment decisions, lifelong monitoring, and the management of special patient subgroups. Consensus agreement was concluded when ≥50% of the faculty provided the same answer. The results were compiled and areas of consensus are included in this report. The recommendations provided in this commentary are limited by the scope of the survey.

Findings: Consensus was reached on several minimum standard patient management practices. Primary among these minimum standards of care is the need for diagnosis including a detailed medical history, neurological examination, discussions with caregivers, and diagnostic tests including electroencephalograms and magnetic resonance imaging. As the overall goals of therapy include seizure freedom, minimizing side effects, and improving quality of life and long-term safety, therapy decisions should consider parameters that affect these goals, including potential adverse effects of therapy. Antiepileptic drug selection should consider coexisting conditions for possible exacerbation of disease and potential drug–drug interactions.

Conclusions: The core elements of epilepsy management identified here suggest minimum standards that can be used across all settings to improve consistency and quality of epilepsy diagnosis and care.     

Quality of care indicators for population-based primary care in New Zealand

AIM: To develop a set of non-invasive, evidence-based, population-based quality of care indicators for primary care in New Zealand and to test their feasibility. METHODS: New Zealand, British and Australian publications were reviewed and a set of quality of care indicators was constructed. These were trialed on data collected from seventeen fully computerised practices from the FirstHealth network of general practices. RESULTS: 28 indicators are proposed in five categories: smoking cessation, preventive health activities, prescribing quality, chronic disease management and data quality. We were able to calculate ten indicators from data already collected routinely, a further twelve could be calculated now with more sophisticated data queries and six would require the trial practices to collect further data. CONCLUSIONS: While any set of indicators is arbitrary there are sufficient research data to support a set of evidence-based, population-focused, quality of care indicators in New Zealand primary health care. In computerised practices these indicators can be calculated from routinely collected data.     

Critical injuries in paediatric pedestrians

Data are presented on all sixty-four children who were injured as pedestrians and admitted to the department of critical care medicine, Auckland Hospital over a four year period. Median age was six years, with a male:female ratio of 1.6:1.0. Admission rates were 3.1 and 3.0 times higher for Maori and Pacific Island children, respectively, than for children of European origin. Fifty-two percent of injuries occurred between 3 pm and 7 pm. Median injury severity score (ISS) was 29, and 95% of patients had an ISS of 16 or more. Life threatening injuries were most commonly to the head, whilst less severe injuries, commonly fractures, were to the limbs. The combination of head and lower limb injury was seen in 53% of patients. Twenty-nine patients had 34 operative procedures: 16 orthopaedic, six neurosurgical, four laparotomies and eight wound debridement and closure. Eighty-one percent of the patients received ventilatory support and nine patients (14%) died, all from brain injuries. Pedestrian injury is an important child health problem in New Zealand and studies aimed at the identification of factors that place children at risk for these injuries are needed.     

Dunedin sports injuries, 1974-1976.

An analysis of 3894 sports injuries presented to the Dunedin accident and emergency centre between 1 April 1974 and 30 March 1976 is reported. An outline of the general age, sex, sport, site and type of injury trends follows, and comparisons with published New Zealand and overseas studies are made. The paper concludes with comments on problem areas and suggests some safety measures.     

儿童医院医务人员锐器伤发生情况调查及管理对策

目的：了解儿童医院医务人员锐器伤发生的情况,分析锐器伤发生的原因,并提出管理对策。方法利用自制的调查问卷,对儿童医院225位医务人员进行调查,并对调查结果进行分析。结果225例调查对象中210例有锐器伤的经历,最少的被刺伤1次,最多的达到6次,锐器伤的发生率为93.3%,注射器针头导致的锐器伤人数最多,有73人,占35.0%,其次是玻璃头导致的锐器伤人数70人,占33.3%,161例初级职称中,有161人受到锐器伤,发生率为100%,37例中级职称中,有35人受到锐器伤,发生率为95.6%,27例高级职称中有14例受到锐器伤,发生率为51.9%。结论儿童医院锐器伤的发生率较高,初级职称的医务人员更容易遭受锐器伤害。应该采取积极的管理对策,减少锐器伤的发生,保障医务人员的人身安全。     

Injury to Maori. II: Serious injury

AIMS: To determine the significance of serious injury in Maori relative to other health problems, to describe the leading causes, and to determine age specific rates for major classes of injury. METHOD: We used New Zealand Health Information Services' public hospital inpatient data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates. RESULTS: On average, one in every eight admissions in Maori, was for injury. Injury was the leading reason for admission for those 5-44 years old. Unintentional injury accounted for 85% of injuries, with those ages 1-14 and 15-24 years having the highest numbers and rates. Falls, followed closely by motor vehicle traffic crashes, were the leading causes, accounting for 23% and 20% respectively. CONCLUSIONS: In order to address the priorities identified here, appropriate partnerships between crown agencies and social agencies, both Iwi and/or community based, must be established.     

Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire

This study investigated the health status of a representative sample of clients (35 Maori, 72 non-Maori) receiving methadone maintenance treatment in New Zealand, using the SF-36 health survey. The publication of New Zealand norms in 1999 enabled comparisons of the health of the Methadone Treatment Programme study participants with that of the New Zealand population. Although over 50% of participants rated their health as good, very good or excellent, 44% rated their health as fair or poor and compared with population norms, the health of the study participants was significantly poorer on all eight SF-36 scales. Male and female participants rated their health similarly to male and female clients attending another New Zealand Methadone Treatment Programme. Results highlighted the impact of a chronic disorder and co-existing health-related problems on the health and well-being and day-to-day functioning of this client group. Higher frequency of benzodiazepine use was associated with poorer social functioning, mental health and role functioning and higher frequency of cannabis use was associated with poorer role functioning due to emotional problems. Findings support routine monitoring of health status with clients receiving methadone maintenance treatment as a guide to preventative and treatment interventions and health maintenance strategies. [Deering DE, Frampton CMA, Horn J, Sellman JD, Adamson SJ, Potiki TL. Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire. Drug Alcohol Rev 2004;23:273-280]     

Injury to Maori. I: Fatalities

AIMS: Our aim was to determine the significance in Maori of injury in relation to other health problems, to describe the leading causes of injury, and to determine age specific rates for major classes of injury. METHODS: We used New Zealand Health Information Services mortality data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates. RESULTS: For more than three contiguous decades of life (1-34 yrs) injuries were the leading cause of death. For all age groups combined, unintentional injury accounted for 75% of injury deaths, suicide 17%, and assault 7%. The leading mechanism of death was motor vehicle traffic crashes (49%). Occupants of motor vehicles accounted for the majority of the victims. The occupant fatality rate remained relatively constant for all age groups from 15-24 years. The second most common mechanism of death was suffocation (13%), 76% of which were self-inflicted, all of these being hangings. CONCLUSIONS: There is a need for government agencies with a mandate for injury prevention to develop specific injury prevention goals for Maori.     

Alcohol advertising in the New Zealand university student press

University students drink more heavily than their non-student peers in New Zealand. The promotion of alcohol via advertising is a known contributor to heavy drinking. The aim of this paper was to determine the nature and extent of alcohol-related advertising and related policies at New Zealand universities. We sought to obtain all issues for 2005, of student newspapers at five New Zealand universities that had participated in an ongoing research project examining alcohol-related harm. The number of alcohol-related advertisements was determined and counts were weighted by the proportion of the page they took up. We surveyed senior university administrators to determine whether policies existed to regulate alcohol advertising on campus. The number of alcohol-related advertisements in student publications ranged from 1 to 129 across the academic year (median: 74 advertisements, 34 full-page equivalents). At three universities, most advertisements promoted bars, pubs and restaurants, while at the other two universities, most alcohol-related advertising was for events sponsored by a brewery, alcohol company or local pub. At one university with almost no advertising, a brewery sponsorship agreement with the student association forbade other parties from advertising alcohol and related events. Alcohol-related advertising is pervasive in the New Zealand university student press. Student associations should consider the ethics of alcohol industry sponsorship in light of the high prevalence of heavy drinking in this population group.