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VACATION
INJURIES
Vacation Injury Prevention
David A. Sleet, David J. Ederer, Michael F. Ballesteros
Center for Disease Control
According to the World Health Organization (WHO), injuries
are among the leading causes of death and disability in the world,
and they are the leading cause of preventable death in travelers.
Among travelers, data show that injuries are one of the leading
causes for consulting a physician, hospitalization, repatriation, and
death. Worldwide, injuries are the leading cause of death for young
people aged 15–29 years. Estimates have reported that 18%–24%
of deaths among travelers in foreign countries are caused by injuries.
Infectious diseases accounted for only 2% of deaths to travelers
abroad. Contributing to the injury toll while traveling are exposure
to unfamiliar and perhaps risky environments, differences in lan-
guage and communications, less stringent product safety and vehicle
standards, unfamiliar rules and regulations, a carefree holiday or va-
cation spirit leading to more risk-taking behavior, and overreliance
on travel and tour operators to protect one’s safety and security.
From 2011 through 2013, an estimated 2,466 US citizens died
from non-natural causes, such as injuries and violence, while in for-
eign countries (excluding deaths occurring in the wars in Iraq and
Afghanistan). Motor vehicle crashes—not crime or terrorism—are
the number 1 killer of healthy US citizens living, working, or trav-
eling in foreign countries. From 2011 through 2013, 621 Americans
died in road traffic crashes abroad (25% of all non-natural deaths
to US citizens abroad). Another 555 were victims of homicide
(23%), 392 committed suicide (16%), and 309 were victims of
drowning (13%) (Figure 2-02). Other less common but serious in-
juries are related to natural disasters, aviation accidents, drugs, ter- ulation, and the rate is highest in people aged 50–59 years. Motor
rorism, falls, burns, and poisoning.
If a traveler is seriously injured, emergency care may not be avail-
able or acceptable by US standards. Trauma centers capable of pro-
viding optimal care for serious injuries are uncommon outside urban
areas in many foreign destinations. Travelers should be aware of the
increased risk of certain injuries while traveling or residing abroad,
particularly in developing countries, and be prepared to take pre-
ventive steps.
ROAD TRAFFIC INJURIES
Globally, an estimated 3,300 people are killed each day, including
720 children, in road traffic crashes involving cars, buses, motorcy-
cles, bicycles, trucks, and pedestrians. Annually, 1.24 million are
killed and 20–50 million are injured in traffic crashes—a number
likely to double by 2030. Although only 53% of the world’s vehicles
14 San Antonio Medicine • May 2016
are in developing countries, >90% of road traffic casualties occur in
these countries.
International efforts to combat road deaths command a tiny frac-
tion of the resources deployed to fight diseases such as malaria and
tuberculosis, yet the burden of road traffic injuries is comparable. In
response to this crisis, in March 2010 the 64th General Assembly of
the United Nations described the global road safety crisis as “a major
public health problem” and proclaimed 2011–2020 as “The Decade
of Action for Road Safety.” On April 19, 2012, the United Nations
General Assembly adopted a new resolution (A/66/PV.106) to im-
prove global road safety by implementing plans for the decade, setting
ambitious targets, and monitoring global road traffic fatalities.
According to Department of State data, road traffic crashes are
the leading cause of injury deaths to US citizens while abroad (Fig-
ure 2-02). Of the 621 US citizens killed in road traffic crashes from
2011 through 2013, approximately 110 (18%) deaths involved mo-
torcycles. Unlike in the United States, in many countries, 2- and 3-
wheeled vehicles outnumber cars, and travelers unfamiliar with
driving or riding motorcycles may be at higher risk of crashing. Most
non-natural American deaths in Thailand and Vietnam, popular
travel destinations, were related to motorcycle use. Motorcycle use
is also dangerous for travelers in countries where motorcycles are not
the primary mode of transportation. The reported rate of motorbike
injuries in Bermuda is much higher in tourists than in the local pop-
vehicle rentals in Bermuda and some other small Caribbean islands
are typically limited to motorbikes for tourists, possibly contributing
to the higher rates of motorbike injuries. Loss of vehicular control,
unfamiliar equipment, and inexperience with motorized 2-wheelers
contributed to crashes and injuries, even at speeds <30 miles
per hour.
Road traffic crashes are common among foreign travelers for a
number of reasons: lack of familiarity with the roads, driving on the
opposite side of the road, lack of seat belt use, the influence of alco-
hol, poorly made or maintained vehicles, travel fatigue, poor road
surfaces without shoulders, unprotected curves and cliffs, and poor
visibility due to lack of adequate lighting. In many developing coun-
tries, unsafe roads and vehicles and an inadequate transportation in-
frastructure contribute to the traffic injury problem. In many of
these countries, motor vehicles often share the road with vulnerable
road users, such as pedestrians, bicyclists, and motorcycle users. The