Health Information Sheets
Personal Safety During Travel
Recent events, including a coach accident in Egypt (May 2008), another in Ecuador (April 2008) and a minibus accident in South Africa (August 2008), all involving British travellers, serve as reminders that the greatest life threatening risks amongst travellers, are not caused by tropical disease, but by accidents and injuries. Road traffic accidents (RTAs) are an important cause of injury and death in international travellers and young travellers are at greatest risk [1,2]. The World Health Organization estimates that 1.2 million people are killed and 20-50 million people are injured worldwide every year as a result of RTAs [3,4]. Most of these deaths and injuries occur in low- and middle-income countries [3,4].
Travellers may believe that they are safe because they do not intend to drive whilst overseas. However, they can be injured as passengers, as pedestrians, or as cyclists. Of the estimated 1.2 million road traffic fatalities each year, about 65% involve pedestrians . Poor road construction and maintenance, failure to adhere to traffic rules, excessive speed, vehicles that are inadequately maintained, absence of safety belts, and drivers that may not be properly trained or under the influence of alcohol, all increase accident rates in many regions of the world .
The lack of ready emergency rescue and first class medical facilities may adversely affect the outcome of an accident or of other injuries , and mortality following road traffic accidents is higher in resource poor countries. Of road fatalities, about 70% occur in resource poor regions of the world. Countries in South East Asia account for more than a third of all road traffic injuries, and Africa has the highest death rate of 28 deaths per 100,000 persons [5,8].
Even in resource rich countries, such as New Zealand, foreign drivers have been identified as a major problem in terms of rental car crashes . In this case many hire car drivers were not used to driving on the left side of the road. Lack of familiarity with driving on the right hand side of the road can pose dangers for British drivers in other countries. In the US, tourists were found to be at greater risk of injury from a motor vehicle crash than local residents .
Public transport via rail, air and large cruise ships is usually safe, however, overcrowding and poor maintenance may lead to unsafe conditions on many local buses and ferries.
Drowning is a risk that travellers may associate with holiday travel, and in one study it was second to road traffic accidents as a cause of death . Many accidents and injuries will be prevented by exercising prudent behaviour. Alcohol is a frequent factor in injuries as well as promoting risky behaviour, such as having unprotected sex, and should be drunk only in moderation.
Other deaths that are not caused by infectious diseases may be affected by a traveller’s age and underlying health conditions. A Scottish study showed that in older travellers, cardiovascular deaths [69% of deaths] are higher than deaths from vehicle accidents [21%]; the highest cardiovascular mortality was in the 60-69 age range . An American study of overseas fatalities has shown a similar increase in cardiovascular deaths in the older age groups . All travellers should be sure that any chronic medical conditions are evaluated and stable prior to their trip.
When the overseas deaths of British nationals are analysed, the same trends are seen: deaths from natural causes are most common (73% to 82% of deaths from 1998 through 2001), with those from accidents and injuries second most common (14% to 17%) (Figure 1). Figure 2 indicates the types of accidents that are seen; road accidents account for 53% to 72% of deaths from accidents each year (data from the Foreign and Commonwealth Office (FCO) annual consular reviews).
Assault, murder, kidnapping, riots and terrorism can occur in any destination and FCO advice on specific risks should always be consulted before travel. The traveller should know that their travel insurance is likely to be invalidated if they visit a country contrary to FCO advice.
Travellers and those who advise them should be aware of these risks and exercise the usually straight-forward and common sense measures outlined below to provide the best chance of a safe and healthy trip.
Figure 1. Number of deaths overseas in repatriated UK nationals, all causes 1998 - 2002*
* Deaths from natural causes for 2002 are not currently available
Figure 2. Number of deaths overseas in repatriated UK nationals caused by accidents, 1998 - 2002
Traveller Safety Do's and Don'ts
- Consider safety in your choice of destination, bearing in mind that all travel involves some risk.
- Consult the current FCO security advice about your destination countries
- Take out comprehensive travel insurance, check the details of the cover, and be aware that pre-existing health conditions may be excluded unless they have been specifically mentioned to the insurance company
- Check the tyres, brakes, lights and safety belts on any hire vehicle
- Be aware of local traffic patterns even if walking or cycling
- Consult with a reputable source (e.g. airport or hotel information, restaurant) for a reliable taxi service
- Use vehicle safety belts where available
- Use child safety restraints when possible
- Wear a helmet if riding a horse, bicycle or motorbike
- Consider obtaining safety statistics for your airline, cruise ship, or for driving in your destination country. (Safety information concerning airlines may be found on the Aviation Safety Network website; information about health during cruise ship travel may be found at the U.S. Centers for Disease Control website; road safety information may be found on the US Department of State website; WHO website, International Road Traffic and Accident Data website, and Association for Safe International Road Travel website.
- Be aware that local transport including ferries, especially in resource poor area may be poorly maintained and endangered by overcrowding
- Check fire exits in discos, clubs and hotels
- Seek local advice on avoidance of marine or land animal hazards, safe places to swim.
- Use the hotel safe to store valuables
- Check depth of water before diving
- Supervise children at all times when near water
- Dress modestly and avoid wearing jewellery or clothing that brings attention to yourself
- Be aware that when you stop on the street to take a picture, purchase a postcard, or look at commotion in front of you, that you become a potential target for pickpockets or robbery
- Drink alcohol only in moderation
- Advise someone of your travel plans
- Drive, or be driven, at night on poor roads
- Drive after drinking alcohol or when tired
- Exceed local speed limits
- Travel on overcrowded, poorly maintained ferries, trains, buses, or minivans
- Travel alone at night unless you are sure of the area
- Strike up a conversation with a stranger who approaches you on the street
- Agree to use illegal drugs or carry them for others
- Swim after drinking alcohol
- Display expensive jewellery and watches
- Attempt to resist a mugger
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2. 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;20:622-626.
3. Prociv P. Deaths of Australian travellers overseas. Med J Aust 1995;163:27-30.
4. Sniezek JE, Smith SM. Injury mortality among non-US residents in the United States 1979-1984. Int J Epidemiol 1991;20:225-9.
5. Hargarten SW, Bouc GT. Emergency air medical transport of U.S.-citizen tourists: 1988 to 1990. Air Med J 1993;12:398-402.
6. World Health Organization. Global road safety crisis. Report of the Secretary-General 2003, Geneva. p. 1-11. Available at www.who.int/world-health-day/2004/en/, accessed 25 January 2004.
7. U.S. Department of State, Bureau of Consular Affairs, American Citizens Services. Road Safety Overseas:
8. Heraty MJ. Tourism transport - implications for developing countries. Tourism Manage 1989;10:288-292.
9. Bewes PC. Trauma and accidents. Practical aspects of the prevention and management of trauma associated with travel. Br Med Bull 1993;49:454-64.
10. Odero W, Garner P, Zwi A. Road traffic injuries in developing countries: a comprehensive review of epidemiological studies. Trop Med Int Health 1997;2:445-460.
11. Page SJ, Meyer D. Tourist accidents: an exploratory analysis. Ann Tourism Res 1996;23:666-690.
12. Paixao MLTDA, Dewar RD, Cossar JH, Covell RG, Reid D. What do Scots die of when abroad? Scot Med J 1991;36:114-116.
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