Traumatic Travels – A Review of Accidental Death and Injury in International Travellers

Document Type : Review Article

Authors

1 School of Medicine, National University of Ireland Galway, Ireland

2 School of Medicine, International Medical University, Kuala Lumpur, Malaysia

Abstract

Insufficient attention has been paid to physical trauma as a cause of morbidity and mortality in international travellers, despite travellers themselves ranking it among their most important pre-travel health concerns. Road traffic collisions (RTCs) are the most common cause of death in younger travellers. One of the significant factors contributing to motorist accidents is tourists’ disorientation in a foreign environment. This is compounded by jet lag and travel fatigue, unfamiliarity with a hired vehicle, local road rules, weather, terrain, distracting scenery and driving on the wrong side of the road, the last factor accounting for the highest percentage of road crash-related injuries. Many of the traumatic risks of travel can be anticipated by performing a careful risk assessment. Travellers should receive targeted advice in relation to prevention of RTCs, adventure sports injuries, large mammal attacks, stampedes and breaches to their personal safety and security. This narrative review article draws attention to these risks and offers practical advice for mitigating the risk to travellers.

Keywords

References

  1. UNWTO. UNWTO Tourism Highlights 2016 edition. http://www.e-unwto.org/doi/pdf/10.18111/9789284418145. Accessed November 29, 2017. Published 2016.
  2. Connolly R, Prendiville R, Cusack D, Flaherty G. Repatriation of human remains following death in international travellers. J Travel Med. 2017;24(2). doi:10.1093/jtm/taw082.
  3. Flaherty GT, Lim Yap K. Bibliometric analysis and curriculum mapping of travel medicine research. J Travel Med. 2017;24(5). doi:10.1093/jtm/tax024.
  4. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-2128. doi:10.1016/S0140-6736(12)61728-0.
  5. Tonellato DJ, Guse CE, Hargarten SW. Injury deaths of US citizens abroad: new data source, old travel problem. J Travel Med. 2009;16(5):304-310. doi:10.1111/j.1708-8305.2009.00318.x.
  6. Hargarten SW, Baker TD, Guptill K. Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel. Ann Emerg Med. 1991;20(6):622-626. doi:10.1016/S0196-0644(05)82379-0.
  7. Paixao ML, Dewar RD, Cossar JH, Covell RG, Reid D. What do Scots die of when abroad? Scott Med J. 1991;36(4):114-116. doi:10.1177/003693309103600406.
  8. Prociv P. Deaths of Australian travellers overseas. Med J Aust. 1995;163(1):27-30.
  9. Stewart BT, Yankson IK, Afukaar F, Medina MC, Cuong PV, Mock C. Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries. Med Clin North Am. 2016;100(2):331- 343. doi:10.1016/j.mcna.2015.07.011.
  10. Carey MJ, Aitken ME. Motorbike injuries in Bermuda: a risk for tourists. Ann Emerg Med. 1996;28(4):424-429. doi:10.1016/S0196-0644(96)70009-4.
  11. Leggat PA, Fischer PR. Accidents and repatriation. Travel Med Infect Dis. 2006;4(3-4):135-146. doi:10.1016/j.tmaid.2005.06.008.
  12. Spira AM. Preventive guidance for travel: trauma avoidance and medical evacuation. Dis Mon. 2006;52(7):261-288. doi:10.1016/j.disamonth.2006.08.002.
  13. McInnes RJ, Williamson LM, Morrison A. Unintentional injury during foreign travel: a review. J Travel Med. 2002;9(6):297-307. doi:10.2310/7060.2002.30168.
  14. MacPherson DW, Guerillot F, Streiner DL, Ahmed K, Gushulak BD, Pardy G. Death and dying abroad: the Canadian experience. J Travel Med. 2000;7(5):227-233. doi:10.2310/7060.2000.00070.
  15. Petridou E, Askitopoulou H, Vourvahakis D, Skalkidis Y, Trichopoulos D. Epidemiology of road traffic accidents during pleasure travelling: the evidence from the Island of Crete. Accid Anal Prev. 1997;29(5):687-693. doi:10.1016/S0001-4575(97)00038-9.
  16. World Health Organization. Road safety: Estimated number of road traffic deaths, 2013. http://gamapserver.who.int/gho/interactive_charts/road_safety/road_traffic_deaths/atlas.html. Accessed November 29, 2017. Published 2016.
  17. Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804-812. doi:10.1097/00005373-199805000-00011.
  18. Toroyan T, Iaych K, Peden M. Global Status Report on Road Safety. Geneva (Switzerland): World Health Organization, Department of Violence and Injury Prevention and Disability; 2013.
  19. Mock C, Asiamah G, Amegashie J. A Random, Roadside Breathalyzer Survey of Alcohol Impaired Driving in Ghana. J Crash Prev Inj Control. 2001;2(3):193-202. doi:10.1080/10286580108902564.
  20. Ross HL. Prevalence of alcohol-impaired driving: an international comparison. Accid Anal Prev. 1993;25(6):777-779. doi:10.1016/0001-4575(93)90042-U.
  21. World Health Organization. Road safety: Estimated road traffic death rate (per 100,000 population) 2013. 2016. Available at: http://gamapserver.who.int/gho/interactive_charts/road_safety/road_traffic_deaths2/atlas.html. Accessed January 29, 2017.
  22. Tang JZM, Flaherty GT. An Eye on Travel: An Overview of Travel- Related Ocular Complications. Int J Travel Med Glob Health. 2017;5(3):74-76. doi:10.15171/ijtmgh.2017.16.
  23. Guptill KS, Hargarten SW, Baker TD. American travel deaths in Mexico. Causes and prevention strategies. West J Med. 1991;154(2):169-171.
  24. Leggat PA, Leggat FW. Reported fatal and non-fatal incidents involving tourists in Thailand, July 1997-June 1999. Travel Med Infect Dis. 2003;1(2):107-113. doi:10.1016/S1477-8939(03)00040-1.
  25. Westhoff JL, Koepsell TD, Littell CT. Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study. BMJ. 2012;344:e3782. doi:10.1136/bmj.e3782.
  26. Marsigny B, Lecoq-Jammes F, Cauchy E. Medical mountain rescue in the Mont-Blanc massif. Wilderness Environ Med. 1999;10(3):152- 156. doi:10.1580/1080-6032(1999)010[0152:MMRITM]2.3.CO;2.
  27. Burtscher M. Climbing the Himalayas more safely. BMJ. 2012;344:e3778. doi:10.1136/bmj.e3778.
  28. Flaherty GT, Kennedy KM. Preparing patients for travel to high altitude: advice on travel health and chemoprophylaxis. Br J Gen Pract. 2016;66(642):e62-64. doi:10.3399/bjgp16X683377.
  29. Leggat PA, Durrheim DN, Braack L. Traveling in wildlife reserves in South Africa. J Travel Med. 2001;8(1):41-45. doi:10.2310/7060.2001.1232.
  30. Durrheim DN, Leggat PA. Risk to tourists posed by wild mammals in South Africa. J Travel Med. 1999;6(3):172-179. doi:10.1111/j.1708-8305.1999.tb00856.x.
  31. Uzun I, Celbis O, Baydar CL, Alkan N, Arslan MN. Foreigners dying in Istanbul. J Forensic Sci. 2009;54(5):1101-1104. doi:10.1111/j.1556-4029.2009.01120.x.
  32. Kennedy KM, Flaherty GT. The Risk of Sexual Assault and Rape During International Travel: Implications for the Practice of Travel Medicine. J Travel Med. 2015;22(4):282-284. doi:10.1111/jtm.12201.
  33. British Foreign and Commonwealth Office. Foreign travel advice. https://www.gov.uk/foreign-travel-advice. Accessed January 23, 2018. Published 2018.
  34. Manoochehry S, Rasouli HR. Recurrent human tragedy during Hajj. Int J Travel Medicine Glob Health. 2017;5(1):36-37. doi:10.15171/ijtmgh.2017.07.
  35. Flaherty GT, Chen B, Avalos G. Individual traveller health priorities and the pre-travel health consultation. J Travel Med. 2017;24(6). doi:10.1093/jtm/tax059.
  36. Wadhwaniya S, Hyder AA. Pre-travel consultation without injury prevention is incomplete. J Travel Med. 2013;20(4):217-220. doi:10.1111/jtm.12041.
  37. Flaherty G, Md Nor MN. Travel itinerary uncertainty and the pre-travel consultation--a pilot study. J Travel Med. 2016;23(1). doi:10.1093/jtm/tav010.
  38. Flaherty GT, Choi J. The ‘selfie’ phenomenon: reducing the risk of harm while using smartphones during international travel. J Travel Med. 2016;23(2):tav026. doi:10.1093/jtm/tav026.

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History

  • Receive Date: 30 November 2017
  • Accept Date: 13 February 2018
  • First Publish Date: 01 May 2018

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