Travel Medicine and Infectious Disease (2009) 7, 257e261

available at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/tmid

Geotourism and volcanoes: Health hazards facing

tourists at volcanic and geothermal destinations
Travis W. Heggie a,b,*

a
University of North Dakota, Recreation & Tourism Studies Program, University Mail Stop # 7116,
Grand Forks, ND 58202, USA
b
University of North Dakota, Great Plains Injury Prevention Research Initiative, Grand Forks, ND 58202, USA

Received 4 June 2009; accepted 10 June 2009

Available online 5 July 2009

KEYWORDS Summary Volcano tourism and tourism to geothermal destinations is increasingly popular. If
Geotourism; such endeavors are to be a sustainable sector of the tourism industry, tourists must be made
Volcano tourism; aware of the potential health hazards facing them in volcanic environments. With the aim of
Geothermal; creating awareness amongst the tourism industry and practitioners of travel medicine, this
Health; paper reviews the potential influences and effects of volcanic gases such as carbon dioxide
Hazard (CO2), hydrogen sulfide (H2S), sulfur dioxide (SO2), and hydrogen chloride/hydrochloric acid
(HCl). It also reviews the negative health impacts of tephra and ash, lava flows, landslides,
and mudflows. Finally, future research striving to quantify the health risks facing volcano tour-
ists is recommended.
ª 2009 Elsevier Ltd. All rights reserved.

Introduction incorporates the concept of sustainable tourism in that

Geotourism is a relatively new concept in the tourism industry
that has emerged as a rapidly growing form of tourism.1 In
response to the need for a more encompassing concept than
ecotourism or sustainable tourism, the concept of geotourism
was introduced by the Travel Industry of America and National
Geographic Traveler Magazine in 2002.2e4 Through this
introduction, geotourism was defined as tourism that sustains
or enhances the geographical character of a place, its envi-
ronment, culture, aesthetics, heritage, and the well being of
its residents.2 Moreover, much like ecotourism, geotourism
* Tel.: þ1 701 777 2978; fax: þ1 701 777 3845.
E-mail address: travis.heggie@und.edu
destinations should remain unspoiled for future generations.2
It also embraces the principle that tourism revenue should
promote conservation while allowing for ways to protect
a tourist destinations character.2
Volcano tourism and travel to geothermal destinations
figures prominently under the umbrella of geotourism. In
2008, 1.2 million tourists visited the active volcanic features
in Hawaii Volcanoes National Park, 1.1 million visited Hawaii’s
Haleakala Volcano, 3 million visited the geysers and hot
springs of Yellowstone National Park, 1.2 million visited Hot
Springs National Park in Arkansas, and 415,000 visited Ore-
gon’s Crater Lake National Park.5 The geothermal and
volcanic activity at Rotorua, New Zealand, Mount Etna in Italy,
Japan’s Mount Fuji, Mount Tungurahua in Ecuador, Villarrica
Volcano in Chile, and Iceland’s active volcanoes are other

1477-8939/$ - see front matter ª 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.tmaid.2009.06.002
258
popular destinations for volcano tourists.6e8 However, as
popular as these and other volcano destinations are, the
potential health hazards presenting at these destinations
cannot be ignored. In fact, if volcano tourism is to be
a successful tourism sector, the potential health hazards
facing tourists at volcanic destinations must be recognized
and mitigated. Thus, the purpose of this paper is to review the
health hazards associated with volcanoes and geothermal
destinations with the intent of creating awareness amongst
the tourism industry and practitioners of travel medicine.
Volcanic hazards
Many tourist destinations in hazardous locations are popular
because of their high scenic value.7,9e11 In fact, volcanoes
in particular have been described as a powerful tourist
attraction because of their aesthetic value.12 From
a geologic perspective, volcanoes are generally described
as being explosive or effusive with the quantity and
behavior of volatiles contained in their magma being a key
determinant on the eruption style of a volcano.13e15 For
example, effusive volcanoes such as those in the Hawaiian
Islands are known for their hot, less viscous magmas that
allow gas to separate more efficiently.13,16 This in turn
limits the explosiveness of eruptions.13,16 In contrast, more
explosive volcanoes such as those in Indonesia have cooler,
more viscous magmas, that are more likely to fragment in
an explosive eruption.16 It is important to note, however,
that regardless of their eruption style volcanoes pose
a range of health hazards for tourists during and between
eruptions. These hazards range from acid rain to tephra and
ash falls, earthquakes, volcanic gas emissions, landslides
and mudflows, lava flows, and volcanic laze (Table 1).
Volcanic gases
Volcanoes and geothermal areas are regularly associated with
a variety of gas emissions. These gases include carbon dioxide
(CO2), sulfur dioxide (SO2), hydrogen chloride (HCl), hydrogen
sulfide (H2S), hydrogen fluoride (HF), carbon monoxide (CO),
nitrogen (N2), hydrogen (H2), helium (He), methane (CH4),
radon (Rn), and heavy metals such lead and mercury.17e19
Carbon dioxide
Carbon dioxide (CO2) is abundant in volcanic gases and is
particularly dangerous because it is odorless, denser than air,
and emitted during volcanic eruptions and in geothermal
areas.17,20 Like most gases, CO2 poses the risk of asphyxia-
tion. Lower to moderate concentrations of CO2 (7e10%)
causes vomiting, dizziness, visual disturbances, headaches,
sweating, rapid breathing, tachycardia, mental depression,
and tremors.19,20 Moreover, exposure to CO2 concentrations
> 100 000 ppm (or concentrations of 10e30%) can rapidly
produce unconsciousness in 1e10 min and may result in
seizures followed by death.17,19,21e23
Exposure to CO2 in volcanic areas is generally the result of
exposure to CO2 clouds or CO2 accumulations in low-lying
topographic areas where the denser CO2 concentrations
accumulate below the air.17,20 Such exposure often occurs
T.W. Heggie
near preferential pathways such as faults and fractures along
which concentrations of CO2 are able to migrate towards the
surface.17 Hence, the threat from CO2 is most acute in loca-
tions such as health spas/thermal springs, near surface areas,
poorly vented vacation homes or hotels in high seepage areas,
or poorly ventilated vacation homes or hotels with ground-
floor bedrooms, basement suites, and wooden or cracked
floors that permit high seepage.24,25 Small children may be
particularly vulnerable because of their limited height and
near surface patterns of play.25 Likewise, those sleeping or
lying near the floor may be vulnerable.25 CO2 related deaths in
volcanic environments have been well documented.
However, literature documenting CO2 concerns directly
effecting tourists have only been identified for tourists visiting
Vulcano, a popular volcanic island off Sicily, tourists owning
vacation homes in the Azores, tourists visiting Hawaii Volca-
noes National Park, and tourists visiting Mammoth Mountain,
a dormant volcano and popular recreation destination in the
United States.19,24e29
Hydrogen sulfide
In addition to CO2, Hydrogen sulfide (H2S) is historically
associated with volcanic emissions and degassing events.
Hydrogen sulfide is a colorless gas with a sewer or rotten egg
smell that is primarily found in destinations with high
geothermal activity.17,30 At low concentrations, H2S can irri-
tate eyes and act as a depressant. At higher concentrations,
H2S can cause upper respiratory irritation and pulmonary
edema.30 Hydrogen sulfide is known to have resulted in tourist
fatalities in various parts of Japan and the geothermal field in
Rotorua, New Zealand.31 Moreover, it is calculated that
exposure to 500 ppm of H2S for 30 minutes can result in
headache, dizziness, an unsteady gait, and diarrhea.30 It can
also be followed by the development of bronchitis and bron-
chopneumonia.30 Acute exposures to >700 ppm of H2S can
result in unconsciousness within a matter of minutes and
eventual death from H2S poisoning.17,20,32
Sulfur dioxide
Following water and carbon dioxide, SO2 is one of the more
common gases in volcanic emissions and is a hazard to humans
as a gas or a sulphate aerosol.31 Sulfur dioxide is irritating to
the eyes, throat, and respiratory tract and induces coughing,
burning of the eyes, and difficulty breathing.31 While these
reactions are considered relatively short-term effects, tour-
ists with pre-existing asthmatic conditions can be sensitive to
SO2 at low concentrations and suffer more severe conse-
quences.17,24 In fact, SO2 is known to have played a significant
role in the death of several tourists at Aso, Japan, and in
Hawaii Volcanoes National Park28,31 In these situations, half of
the fatalities involved asthmatic tourists.28,31 The World
Health Organization (WHO) air quality guidelines have set
a maximum exposure limit for SO2 at 175 ppb for 10 minutes
and 44 ppb over a single day.33 In contrast, the United States
Geologic Survey (USGS) Volcanic Hazards Program notes that
a concentration of 6e12 ppm of SO2 can result in the imme-
diate irritation of the nose and throat, 20 ppm can cause
immediate eye irritation, and 10,000 ppm will irritate moist
skin within minutes.30
Geotourism and volcanoes 259

Table 1 Potential hazards threatening volcano tourists.

Hazard Potential health effects
Acid rain Irritant to eyes and skin. Also a potential threat to safe drinking water.
Forms when rain falls through volcanic gas and acid particle emissions.
Also forms where lava enters ocean water.
Earthquakes Impact injuries from damage to tourist facilities and other structures.
Earthquakes are common with volcanic activity. A tsunami may occur
if water is displaced by underwater volcanoes.
Lava flows Thermal injuries. Methane explosions can occur as active lava flows
over vegetation. Lacerations, scrapes and abrasions, muscle strains and
sprains, and other fall injuries when inactive lava flows used for
recreational purposes.
Landslides/mudflows Burial, drowning, and impact injuries. May create a localized tsunami if
either flow into an ocean or lake.
Laze Irritant to eyes, skin, mucous membranes, and throat. Exposure to high
concentrations can cause laryngeal spasms and pulmonary edema.
Pyroclastic density Thermal and impact injuries. Forms when a mixture of hot currents
ash, rocks, and gas is pulled down a volcano by gravity.
Tephra and Ash Impact injuries, skin and eye abrasions, and respiratory irritation.
Long term exposure can result in silicosis and chronic obstructive
pulmonary disease. Hazardous to aircraft and the structural capability
of tourist facilities. Lightning is common in ash clouds.
Volcanic gases Asphyxiation, vomiting, headache, dizziness, visual disturbances,
tachycardia, respiratory irritation, bronchitis, bronchopneumonia,
eye irritation and throat irritation.
Source: Adapted from Table 1, Hansell, Horwell and Oppenheimer.13

Hydrogen chloride/hydrochloric acid Tephra and ash

Another volcanic gas posing potential health hazards for
tourists is chlorine. Chlorine gas is emitted from volcanoes
in the form of hydrogen chloride and hydrochloric acid
(HCl).30 Exposure to HCl can irritate eyes, mucous
membranes, and the skin. It can further induce coughing,
burning of the throat, and a choking sensation.34 Exposure
to concentrations over 35 ppm will irritate the nose, throat,
and larynx after short exposure. However, exposure to
concentrations > 100 ppm can result in acute laryngeal
spasm or pulmonary edema.34 Recently it has been noted
that when active lava in coastal regions flows into
seawater, the results produce a dense HCl mist that is
referred to as volcanic laze.35 This process occurs when the
lava entering the ocean rapidly boils, vaporizes seawater,
and produces a white plume containing a mixture of HCl
and concentrated seawater that is a brine with a salinity
about 2.3 times that of seawater and a pH of 1.5e2.0.35
Table 2 displays the seawater chloride reactions that
produce HCl. Exposure to this dense volcanic laze is known
to have caused the death of tourists in Hawaii.35
Tephra is a general term describing fragments of volcanic
rock and lava that are blasted into the air by explosions or
carried upward by hot gases and lava fountains.30 Tephra
fragments are classified by size with fragments < 2 mm in
diameter labeled as ash. Tephra fragments that are between
2 and 64 mm in diameter are called volcanic cinders or lapilli
and tephra > 64 mm in diameter is called volcanic bombs or
volcanic blocks. Tourist fatalities resulting from tephra have
been documented on Mount Semeru in Indonesia and on
Galeras Volcano in Colombia.36,37
In the incident on Galeras, three tourists and six volca-
nologists were killed while visiting the caldera of the
volcano when a small eruption occurred without warning.
The victims were pelted with volcanic bombs > 1 m in
diameter for approximately 15 minutes and sustained
devastating head and chest injuries along with other impact
injuries.37 Volcanic bombs from this small eruption were
found 1 km beyond the rim of the caldera.37
Aside from impact injuries, tephra can cause health
problems through inhalation and contact with the skin and

Table 2 Seawater chloride reactions that produce HCl.

MgCl2 (sea salt) þ H2O (steam) Z MgO (periclase) þ 2 HCl (HCl gas)
2 NaCl (sea salt) þ H2O (steam) Z Na2O (sodium oxide) þ 2 HCl
CaCl2 (sea salt) þ H2O (steam) Z CaO (lime) þ 2 HCL (HCl gas)
Source: United States Geological Survey.30
260
eyes. For example, newly fallen volcanic ash can have acid
coatings and be very abrasive to the skin.13 If inhaled, fine
ash particles can cause respiratory irritation and chest
discomfort as well as corneal abrasions and conjunctivitis.
Moreover, acute short-term conditions such as nasal irrita-
tion and dry coughing can occur. For tourists with asthma or
other respiratory conditions, ash can cause the lining of the
airways to produce more secretions which can easily result
in more severe concerns. The severity of any such incident
will naturally be influenced by duration of exposure and the
presence of crystalline silica and any volcanic gases mixed
with the ash. Long term exposure to crystalline silica can
result in silicosis and conditions such as chronic obstructive
pulmonary disease (COPD).13
Heavy or frequent amounts of volcanic ash pose an
additional threat to the structural capabilities of tourist
facilities such as hotels and ski lodges. Such conditions from
volcanoes like Japan’s Mount Usu has had considerable
impact on the hot-spring resort town of Toyako-Onsen on the
island of Hokkaido.38 Moreover, another major concern
about volcanic ash is the threat it poses to aviation and
tourist transport operations. For example, visibility is
greatly reduced during ash falls and roads, highways, and
airport runways become slippery or impassable when ground
ash becomes wet. Moreover, volcanic ash particles can
remain in the atmosphere for years and be spread globally by
high-altitude winds. More than 80 commercial aircraft have
unexpectedly encountered volcanic ash during flight and at
airports over the past 15 years causing considerable damage
to jet engines and infiltrating the air-filter systems of plane
cabins.39,40 Incidentally, even volcanic fumes with the
absence of tephra and ash are known to be immediately
corrosive to the engines of tour helicopters and aircraft in
Hawaii resulting in a restriction of engine air intake and
a high number of crashes and emergency landings.28
Lava flows
Lava flows consist of molten rock expelled by volcanoes.
Lava flows are extremely hot (700e1200  C when first
expelled) and can flow long distances before cooling. Lava
flows also destroy everything in their path.41,42 For
example, lava flows are known to have destroyed or caused
serious damage to international airports and tourist facili-
ties in Africa and Italy.42e44 Deaths caused directly by lava
flows are uncommon because most lava flows move slowly.
However, tourist fatalities from direct contact with lava
flows have been recorded in Hawaii.28,29 Most of these
fatalities were the result of tourists falling into active lava
and falling on cooling lava.28 Another threat related to lava
flows exists when cooled lava flows are utilized for recre-
ational purposes such as hiking or when tourists trek over
cooled lava flows in an attempt to view active lava flows.
Severe burns, lacerations, scrapes and abrasions, and
muscle strains and sprains from hiking the difficult terrain
have been documented.29,45
Volcanic landslides and mudflows
Volcanic landslides, mudflows, and pyroclastic flows are
among some of the most potentially hazardous volcanic
T.W. Heggie
processes threatening tourists. A volcanic landslide, also
called a debris avalanche, refers to the rapid downslope
movement of rock, snow, or ice. Volcanic landslides are
often caused by the gravitational collapse of volcanic
features on the slopes and near summit areas of volca-
noes.46 However, it is important to note that rainfall or
earthquakes can also trigger landslides. Moreover, volcanic
landslides often evolve into mudflows.13 Mudflows, also
known as lahars, describe a hot or cold mixture of water
and rock fragments flowing down the slopes of a volcano
that can travel in excess of 60 km at speeds over 30 km.13
Mudflows form in a number of ways such as the rapid
melting of snow and ice by volcanic events, rainfall on loose
volcanic deposits, and the breakout of crater lakes.13,47
Physical injuries related to burial, penetrating wounds and
fractures, and eyes lesions are documented results of
landslides and mudflows.13 Destinations such as the ski hills
of Mount Ruapehu in New Zealand and the recreational
areas on and around Mount Rainier in the United States are
thought to pose the greatest hazards to tourists.48
Conclusion
Volcano tourism and tourism to geothermal destinations is
becoming increasingly popular in many regions of the world.
It is hoped that the present study has brought attention to the
possible health hazards associated with tourism to volcanoes
and geothermal fields. Geotourism and volcano tourism
dictates that tourists will place themselves at some degree of
risk by visiting volcanoes and geothermal areas. While it is
recognized that the dynamics of these locations are not
necessarily seasonal or periodic, if geotourism is to be an
important source of income tourists must be made fully
aware of the potential health hazards facing them. It is
strongly recommended that future research efforts strive to
quantify the health risks facing volcano tourists. This will
help develop evidence based tourism policy and improve
emergency medical planning.
Conflict of interest
None declared.
Funding
None declared.
Ethical approval
None required.
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