Trauma during travel

by Dr. Alan M. Spira, M.D., DTM&H, FRSTM

Trauma during travel is an underappreciated and, at times, even ignored health threat. There are many types of trauma, and the causes are surprisingly predictable and preventable, arising from a chain of events leading to the unwelcome conclusion.

Trauma may be divided into unintentional and intentional categories. Unintentional injury may arise from traffic collisions, falls, fires, drowning, envenomation or animal bites. Intentional injuries include those from crime, terrorism, war and self-inflicted causes.

It is estimated that over five million people die annually from injury or poisoning, which is approximately 10% of all deaths worldwide. Traffic collisions, violence, suicide, war, drowning and fire are the leading causes of injury-related mortality.

Risk factors

Aside from death, considerable morbidity, particularly long-term disability, may arise from trauma. Travelers are particularly vulnerable to this threat, and travel is an independent variable associated with an increased risk of injury.

World Tourism Organization data show a 10% annual growth in tourism worldwide, with an estimated increase of new international tourist arrivals of 58 million, the majority of these new arrivals visiting Asia and the Pacific region. In a recent U.K. survey, the number of those injured on vacation was found to have doubled in five years, and 5% of British travelers had some sort of injury. One study reported that up to 1% of British travelers needed hospitalization from serious injury.

Among travelers worldwide, trauma is responsible for 18% to 23% of deaths, although it is hard to be accurate due to a lack of consistent and widespread data. Few studies have calculated the incidence of nonfatal travel injuries. It is clear that there are higher injury mortality rates among those traveling through the developing world than in developed nations. Nonetheless, despite health risks being lower on standard tourist package tours to developed areas, the absolute numbers of those exposed to risk are higher on trips to nondeveloped nations.

Demographic factors associated with a higher rate of trauma include male gender, extremes of age, high-risk vehicles (motorcycles, pickup trucks, small aircraft), high-velocity driving, particular geographic areas and alcohol. In most scientific studies, injuries outnumber illness as causes of death in travelers.

Traffic collisions are a growing worldwide problem and are the single largest cause of all injury-related deaths worldwide, accounting for up to greater than 50% of all travel deaths and the most severe trauma occurring in travelers. For nonfatal injury, traffic collisions and falls are the main causes, followed by watersports.

Compounding hazards

A traveler does not just face danger from the actual trauma itself. If it’s serious enough that you need medical care, you may not be well enough or able to choose where or who takes care of you.

Most countries do not have 911 services. Organized emergency medical services often are lacking in the developing world, and most trauma victims have to make their way to medical care by private vehicle.

The local medical system then may pose an additional hazard. If the trauma is significant enough to warrant medical care, then there is a risk of blood and body fluid exposure as a confounding health risk to the injured traveler.

One study found that 17% of Americans who sought medical care abroad endured an injection. A study of Canadian travelers revealed that 10% suffered from illness or injury requiring medical attention; of these, 31.7% of travelers had an injection for a medication, intravenous therapy, blood transfusion, anesthetic or blood extraction.

Significantly, up to 75% of the equipment used in the developing world is presumed not to be sterile or safe. It has been estimated that in the developing world there are 6.7 billion “reuse” injections, accounting for approximately 39% of all injections worldwide.

Among the potential pathogens which may be transmitted by substandard medical care are HIV, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), malaria and viral hemorrhagic fevers. In addition there is a risk of abscess development and septicemia.

It is not fair to assume that this occurs only in the developing world. Large numbers of patients were infected with HIV from contaminated blood in France during the 1980s.

Despite the risk contained in unclean medical care, one can find highly competent health care practitioners throughout the world and often in surprising places. Just because the location is remote or unappealing, it does not mean the staff are not capable of first-class medical care, and the traveler should be cautious in judging the appearance of the treating facility — if able.

However, there may very well be the need for life-saving evacuation to better and safer medical facilities. Travelers should always seriously consider purchasing evacuation and supplemental health insurance prior to departure.

Injury is largely preventable. It takes individual responsibility. Furthermore, all travelers should travel with a quality first-aid kit which they know how to use — or else it is simply dead weight. First-aid kits should be compact and sensible, with appropriate amounts and types of supplies for realistic problems.

Dr. Spira is medical director of the Travel Medicine Center, 131 N. Robertson Blvd., Beverly Hills, CA 90211; visit www.healthytravel.com.