Summer, Travel, and Injuries
Summer, Travel, and Injuries
ABSTRACTS & COMMENTARY
Synopsis: Pre-travel counsel about injury prevention should focus particularly on motor vehicle accidents and water activities. Careful implementation of injury avoidance behaviors during foreign travel can prevent many unnecessary deaths.
Sources: Petridou E, et al. Car restraints and seating position for prevention of motor vehicle injuries in Greece. Arch Dis Child 1998;78:335-339; Lauriola P, et al. Avoidable deaths from vehicle accidents in Modena, Italy. Lancet 1998;351:1180; Centers for Disease Control and Prevention. Boat-propeller-related injuries-Texas, 1997. MMWR Morb Mortal Wkly Rep 1998;47(17):354-356.
"Common sense" would probably lead to the prevention of many travel-related injuries, but such common sense is too rarely applied. Clients expecting "shots" and a bit of discussion about diarrhea during pre-travel visits might well benefit from clear reminders about the importance of careful injury avoidance behaviors.
Petridou and colleagues performed a case-control study involving 129 children (age range, 0-11 years) injured as car passengers in motor vehicle accidents in Athens. Risk for injury was 3.3 times higher for unrestrained children. Unrestrained children were 5.0 times more likely to be injured if in the front rather than a back seat. It was estimated that two-thirds of all motor vehicle accident injuries in children in Greece could be avoided by the regular use of a proper child restraint.
Retrospectively, Lauriola and associates evaluated care following motor vehicle accidents for all fatal cases in Modena, Italy, in 1994. Four of 102 deaths (3.9%) were determined to have been due to faulty care, and another 18 (17.8%) were probably due to inadequate care. Avoidable factors related to fatal outcomes were inadequate first-aid training of ambulance staff and inappropriate transport of severely injured patients to inadequately equipped hospitals.
The 78 million individuals who engage in recreational boating each year in the United States put themselves at risk of several sorts of injury. Boat propeller injuries are typically multiple, deep, and associated with serious long-term morbidity. To better characterize the occurrence of these injuries in Texas, an investigation was conducted at four Texas lakes during the summer season of 1997. Thirteen individuals sustained boat propeller-related injuries, and three of them died. None of the individuals who died was wearing a personal flotation device. Injuries were usually related to boarding or disembarking the boat (n = 5), participating in water activity such as skiing (n = 4), and falling or being thrown from the boat (n = 4, including the adult and both children who had fatal injuries). Most boat propeller-related injuries result from operator error, and many are preventable.
COMMENT BY PHILIP R. FISCHER, MD
Injuries are 10-20 times more likely to cause death in international travelers than are infectious diseases. In addition, motor vehicle accidents account for more injury deaths in travelers than does any other sort of injury. Injury prevention must be a major concern of health care providers preparing individuals for overseas travel. Injuries, Hargarten and Gursu remind us, are not accidents. (See Suggested Reading section.) They are predictable events. Planned preventive behaviors can help reduce both the risk and the severity of injuries in travelers.
Travelers driving or riding motorcycles should be reminded to take or find an appropriately fitting helmet for use at their destination. Helmets should also be worn by all bicyclers, even those "just out for a short, scenic ride." Trip planning should include consideration of how to ensure that seatbelts and child safety restraints will be available and used, particularly when traveling with children less than 5 years of age. In those unfortunate situations in which seat belts are not available, the Greek report reminds us of the relative safety of back seats compared to front seats. Newer vehicles might be less likely to suffer mechanical breakdown, and larger vehicles, when in an accident, might protect passengers from some personal injury. Nighttime road travel should be avoided in some areas of East Africa. Taxis should be chosen carefully. (In Mexican cities, for example, taxis called for by hotel personnel are safer than many of the "taxis" offering rides in front of the hotels.) The Italian report reminds us that injured passengers and their companions might be wise to assist in selecting the site to which they are transported for emergent care.
Water activities rank second to motor vehicle accidents as a cause of injury-related deaths in travelers. As noted in Texas, careful entry into and exit from boats can prevent many of the injuries. Skillful piloting of watercraft can help prevent some of the injuries associated with the ejection of passengers. Sitting only in seats would prevent deaths associated with falling from seat backs, gunwales, transoms, and bows. Personal flotation devices should be worn by every boat passenger. As with any motorized vehicle, boat drivers should be well-trained, prudent, and free from the influence of alcohol. Swimmers should similarly be free from the influence of alcohol. Swimmers should always be with a "buddy," and they should only enter water when they are familiar with its depths and currents.
More travelers die of injury than of malaria, hepatitis, and diarrhea combined. Pre-travel counsel about injury prevention should particularly focus on motor vehicle accidents and water activities. Careful implementation of injury avoidance behaviors during foreign travel can prevent many unnecessary deaths.
Suggested Reading
1. Reid D, Keystone JS. Health risks abroad: General considerations. In: DuPont HL, Steffan R, eds. Textbook of Travel Medicine and Health. Hamilton, Ontario: BC Decker; 1997:3-9.
2. Hargarten SW, Gursu KG. Travel-related injuries, epidemiology, and prevention. In: DuPont HL, Steffan R, eds. Textbook of Travel Medicine and Health. Hamilton, Ontario: BC Decker; 1997:258-261.
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