INJURIES, ACCIDENTS, SAFETY & SECURITY

TRAVEL MEDICINE
KEYPOINTS

 Injuries are the leading cause of travel-related

mortality with motor vehicle trauma.
 Drowning being the most important.
 Fractures, lacerations, dislocations and
sprains ~ the most common injuries
experienced by tourists.
KEYPOINTS

 When driving in a foreign

country, travelers should
avoid alcohol, fatigue,
jetlag, all night driving and
familiarize themselves with
local driving customs.
 Never drive or ride on a
moped or motorbike in a
foreign country.
KEYPOINTS

 Avoid overcrowded public transport.

 Never swim at an unmarked or unguarded
beach.
INTRODUCTION

 An Accident is an event that is without

apparent cause, or is unexpected; an
unfortunate event, especially one causing
physical harm or damage. (Concise Oxford Dictionary)
 The challenge is to use available information
effectively in the design and implementation
of risk management and injury prevention
programs.
RISK PROFILE

 In 2011 ≈ one billion international travelers.

 ≈ 50% travelling to low and middle income
countries (LMICs).
 Infectious Diseases (ID)
 <2% all deaths during travel
 US citizens abroad are 10 x more likely to die from
injuries than ID.

(*Wadhwaniya S, Hyder AA. JTM. 2013;20(4):217-20.)

RISK PROFILE

 Injuries ~
 leading cause of travel-related mortality worldwide.
 Up to 25 x (>ID)
 A significant burden to hospital and health-care
systems.

(*Wilks J. Travel Medicine.2004;48:455-59.)

FATALITIES

 Tourists are most often killed in motor vehicle

crashes and by drowning.
 Less common :
 Homicides, Suicides, Airplane crashes, animal and
marine bites/stings.
 If injuries are the main form of harm travelers
are likely to experience at a particular
destination, then pre travel advice and
preparation should adequately address the
potential injury risks.
INJURIES

 Intentional  Un-Intentional
 Muggings  Road Traffic Injuries (Cars & Motorbike)
 Homicides  Drowning
 Natural Disasters
 Suicides
 Aviation Accidents
 Drugs/Alcohol
 Terrorism
 Poisoning
 Falls
 Burns
WHY SO MANY ACCIDENTS AND
DEATHS ?
 RTI:
 Traveler unfamiliar
 Language/Signage
 Different road rules
 Driving on opposite side of the road
 Environment more risky
 Poor signage
 Lack of road rules/enforcement
 Crowded roads
 Poor road surface
 Share the road with many users
 Bicycles, pedestrians, animals
ROAD RULES
WHY SO MANY ACCIDENTS AND
DEATHS ?
 RTI:
 Lower safety standards
 Especially motor vehicles
 Traveler taking more risks
 No choice
 In “holiday mode”
 Influenced by alcohol and drugs
 And if DO have an accident
 Access to local medical care may be delayed
 Once accessed may be of poor quality
 TRAVEL-RELATED INJURY DEATHS

(*Wilks J. Travel Medicine.2004;48:455-59.)

LEADING CAUSES OF INJURY DEATH (US
CITIZEN) IN FOREIGN COUNTRIES 2009-2011
ROAD TRAFFIC INJURIES (RTIs)

 World wide: 8th leading causes of death

 LMICs account for 90% fatal RTIs (but 50%
of all vehicles)
 RTIs leading cause of both fatal and non-fatal
severe injuries in travelers
 Europe: fatal RTI 12/100000 vs
Africa:28/100000

(*Wadhwaniya S, Hyder AA. JTM.2013;20(4):217-20.)

ROAD TRAFFIC INJURIES (RTIs)

 RTI fatality rates higher in tourists than locals

 Risk factors in travelers
 Male
 Business travelers

(*Wadhwaniya S, Hyder AA. JTM. 2013;20(4):217-20.)

ROAD FATALITIES
NEW ZEALAND
WHO
ROAD TRAFFIC INJURIES (RTIs)
ROAD TRAFFIC INJURIES (RTIs)

 2011
ROAD DEATH TOTAL POPULATION

BALI 601 4M

NEW ZEALAND 285 4.4 M

MOTOR VEHICLE CRASHES

 International visitor crashes were less likely to

involve high risk driving behaviors (alcohol
use and speeding);
 International visitors crashes more likely to
involve disorientation, particularly driver
fatigue, failure to keep to the left (correct)
side of the road, head on crashes and
overturning their vehicle;
MOTOR VEHICLE CRASHES

 International visitors who drive on the right

side of the road at home were more likely
than left side of the road visitor drivers to be
involved in a head on crash;
 German, English, American and Japanese
tourists were identified as possible ‘at risk’
groups on Australian roads.
KEY RECOMMENDATIONS TOURIST
ROAD SAFETY
 Be mindful of the effects of medication, alcohol
and jetlag when they reach their destination
 Take a rest after long distance flight, especially
before taking charge of a motor vehicle
 Familiarize themselves with road rules and
traffic signs
 Request a full familiarization of their rental
vehicles and briefing on their travel route from
staff of the hire company before leaving the
airport or car depot
KEY RECOMMENDATIONS TOURIST
ROAD SAFETY
 Always wear a seat belt
 Drive a rental vehicle around the car park
before heading onto a public road for the first
time
 Plan to drive only in daylight hours
 Build in rest stops every 2 h to counter driver
fatigue
(*Wadhwaniya S, Hyder AA. JTM.
2013;20(4):217-20.)
THANK YOU