Injuries

In a review of death certificates of U.S. citizens who died abroad in 1997, injuries were responsible for 40% of all preventable deaths. Injuries, especially those associated with motor vehicles, pose a great risk of serious disability or loss of life to international travelers. The risk of motor vehicle-related death is generally many times higher in developing countries than in the United States. In 1996, more than 500 U.S. travelers died in other countries from motor vehicle-related incidents, according to the U.S. State Department. Motor vehicle crashes result from a variety of factors, including inadequate roadway design, hazardous conditions, lack of appropriate vehicles and vehicle maintenance, unskilled or inexperienced drivers, inattention to pedestrians and cyclists, or impairment due to alcohol or drug use; all these factors are preventable or can be abated. Defensive driving is an important preventive measure. When driving or riding, travelers should be advised to request a vehicle equipped with safety belts and, where available, to use them. If accompanied by young children, travelers should carry and use appropriate safety or booster seats that are adaptable for airline travel, and if possible, they should choose vehicles in which safety seats can be properly secured. Travelers should carefully inspect vehicles to ensure that tires, windshield wipers, and brakes are in good condition and that all lights are in good working order. Travelers should also request a vehicle equipped with air bags, where available. Because a high proportion of crashes occur at night when drivers are returning from social events, travelers should avoid nonessential night driving, alcohol, and riding with people who are under the influence of alcohol or drugs. Night driving outside urban areas in developing countries is particularly risky. The risk of death in a motor vehicle crash is greater for people sitting in the front seat than for those in the rear seat. Travelers should ride in the rear seats of motor vehicles, where possible. In addition, travelers should be strongly urged to be familiar with local recommendations about what to do if their vehicle is involved in a crash, especially one involving injuries. Such situations can quickly become dangerous for drivers and passengers.

Pedestrian, bicycle, and motorcycle travel are often dangerous as well, and helmet use is imperative for bicycle and motorcycle travel. In developing countries where helmets will likely not be available, travelers should be advised to bring their own with them if they plan to ride bicycles or motorcycles.

Fire injuries are also a significant cause of injuries and death. Travelers should be reminded not to smoke in bed, and to inquire about whether hotels have smoke or carbon monoxide detectors and sprinkler systems. Travelers may wish to bring their own smoke detectors with them. Travelers should always locate primary and alternate escape routes from rooms in which they are meeting or staying. Travelers should also be advised to look for improperly vented heating devices that might cause carbon monoxide poisoning. Travelers should be reminded to escape a fire by crawling low under smoke.

Other major causes of injury trauma include drowning (see "Swimming and Recreational Water Precautions," this chapter) and injuries to water skiers and divers from boat propellers. Travelers should use boats equipped with propeller guards whenever possible, and wear a personal flotation device (life jacket) whenever riding in a boat.

Travelers should also be aware of the potential for violence-related injuries. Risk for assault or terrorist attack varies from country to country; travelers should heed advice from residents and tour guides about areas to be avoided, going out at night, and going out alone. Travelers should be advised not to fight attackers and, if confronted, to give up their valuables. For more information, travelers may be advised to contact the U.S. Department of State, Overseas Citizens Emergency Center at 1-202-647-5225 or the website, http://www.travel.state.gov, for specific country travel warnings and information.

— Timothy Davis, David Sleet, Richard Waxweiler