Accidents abroad are an underestimated hazard. More travelers die from accidents than any other cause, and most accidents are avoidable.
Dr. Richard Fairhurst is the Chief Medical Officer of The Travellers’ Medical Services, the Chairman of the British Aeromedical Practitioners Association, and was formerly the Chief Medical Officer of Europ Assistance. He has supervised the medical assistance rendered to more than 60 000 ill or injured travelers abroad and has logged 5000 flying hours repatriating some of them.
Many travelers will regard exotic infections as the biggest danger to their health abroad, but in fact, these represent only a small proportion of medical problems involving travelers. Half of all medical incidents notified to travel insurance companies are accidental injuries, and 60 percent of these result from road traffic accidents. Such figures are hardly surprising when one considers that, in the UK, accidents are the main cause of death between the ages of two and forty-five.
Infectious diseases are important, of course. They are preventable, and a proper programme of vaccination, as well as the general precautions described elsewhere in this book, are vital. However, travelers should also employ a number of other strategies to protect themselves.
Risk and the traveler
Travellers fall into different categories of risk: many have paid out a great deal of money in the expectation of enjoyment for themselves and their families, and are under pressure to have a good time regardless of inconvenient safety rules and common sense. Others, alone perhaps, and traveling on business, are under pressure to complete the business deal at any cost, to press on regardless of itineraries, and to use dangerous shortcuts to achieve results.
Because of these pressures, and the absence of the usual constraints of home, family, and work, many people behave in a quite
reckless, uncharacteristic manner while abroad—exposing themselves to risks they would never dream of taking at home. Of course, a certain amount of risk-taking is all part of the excitement and enjoyment of being on holiday—but if you are to avoid accident and injury, you must examine the hazards to which you are exposing yourself and decide whether these are really justified.
First of all, travelers should realize that they face at least the same risk of everyday accidents abroad as they do at home. Travel does not suddenly remove these dangers; on the contrary, the enjoyment and carefree attitude that travel engenders can increase the hazards.
As a general rule, you should continue to apply your usual safety standards even if the legal requirements in the country you are visiting are lax. For example, most motorists in the UK comply with the seat-belt law in the knowledge that this markedly reduces the risk of serious injury; to stop wearing seat-belts abroad, just because there is no legal requirement to do so, is inviting trouble. The same applies to wearing helmets on motorcycles and mopeds and observing traffic regulations. If you believe that driving at more than 70 m.p.h. is dangerous (and UK accident statistics suggest that it is), then you should stick to 70 m.p.h. abroad, even in countries where there are no speed limits.
The same approach extends to safety in the home. In the UK in 1986 there were 5700 deaths and two million injuries in the home, from causes such as falls, misuse of electrical appliances, and domestic poisoning.
These dangers are no less common abroad. A room with an antiquated electric lighting system will require special precautions. Gas installations should also be treated with great respect—recent tragedies with gas water-heaters in Portugal were due to poor ventilation. Be alert and apply a strict safety code to any device you may use. This applies particularly in working environments where the temptation to cut corners is ever-present.
The possibility of robbery and assault is another danger that travelers all too easily forget. Tourists are prime targets for muggers, yet people who will not walk through their own city center for fear of attack are often happy to stroll unaccompanied through the more dangerous areas of New York, Miami, or Bangkok. Again, these risks are under your own control.
All forms of transport pose some danger to the traveller—with road transport at the top of the list. However, most hazards can be minimized with a little forethought and attention to detail.
Motoring is by far the most dangerous form of transport. In the UK in 1987,5125 people died as a result of road traffic accidents, and there were 64 300 serious injuries and 311 500 minor ones. On venturing abroad, motorists may find it difficult to keep their chances of injury down even to this appallingly high level.
The wisdom of wearing a seat-belt and observing reasonable speed limits has already been mentioned. Other obvious precautions are to avoid driving when you are tired, and above all not to drink and drive.
The risk of injury on a scheduled airline is very small. In 1987 there were no passenger deaths on British Airlines, either scheduled or charter. In 1988, however, 270 people died in a single incident, the sabotage of a Pan American Boeing 747 over Scot land. And in the first week of 1989,46 people died when a British Midland Airways Boeing 737 crash-landed on the Ml motorway after both its engines failed—though remarkably there were more than eighty survivors. Of course, certain airlines and airports have much worse safety records than others. ‘Flight International’ regularly publishes data on these risks and a little attention to such information can lead to a potentially safer routing for your trip.
Airlines are required by their regulating bodies to provide safety briefings on every flight. Listen carefully to the briefing, and read the safety instruction card. Even though you may have traveled by air hundreds of times before, this particular airliner might have a different configuration and different safety equipment. For example, not all oxygen masks fall out of the cabin roof on depressurization: on DC10 aircraft they are in the headrest of the seat in front of you. On flights with only short over- water sectors the crew may not brief you on the location of life- vests; make sure you know where they are.
Other more subtle strategies may also be important: a seat near the tail of the aircraft may give you a statistically greater likelihood of survival in a crash. Unfortunately, airlines have the strange habit of making the rear of their cabins the smoking section, so you have to balance the risks of being exposed to other people’s cigarette smoke against the chance of surviving in an accident!
Turbulence occasionally causes injury, so move around the cabin as carefully as possible, and keep your seat-belt fastened at all times. Be particularly careful when hot drinks and meals are being served, because sudden movement can spill scalding fluid into your lap.
Baggage poses an additional hazard—both on and off the plane. Avoid traveling with more baggage than you can carry comfortably and beware of other travelers who cannot keep their luggage trolleys under control—this is a frequent cause of injury.
On boarding the plane, try to restrict your hand luggage to one small item: the more the cabin is cluttered, the greater the risk of an accident. Overhead racks are getting larger and larger, but resist the temptation to put heavy items on these racks; in an accident, they may fall on top of you and may even prevent your escape.
Duty-free alcohol is a particular problem. A fully laden Boeing 747 may be carrying up to 350 liters of inflammable alcohol in its cabin: this not only creates an obstruction but also constitutes a considerable fire risk. The sooner Customs Authorities around the world rationalize the system and allow passengers to buy duty-free goods at the port of entry, the safer everyone will be.
Smoking on board aircraft is potentially hazardous—not only to your own health but also to the safety of the aircraft. If you must smoke during a flight, be very careful to extinguish cigarettes and matches properly. Use only the ashtrays provided. Above all, do not smoke when moving around on the aircraft and never smoke in the washrooms. There is a recent example of a serious cabin fire caused by an unextinguished cigarette left in a washroom.
Hijacking is still a problem, so co-operate with security procedures. If it happens to you stay calm, do not do anything to single yourself out as a specially useful hostage, and try to form a bond of friendship with your captors.
Once out of the realm of commercial airlines, the risks of accidents increase greatly. If you are thinking of traveling in a private aircraft, try to form an impression of whether the operation is being run professionally; if it is not, it is probably dangerous, and you should make excuses and find another way of getting to your destination.
Read Part II
Accidents – Part II – Environmental And Recreational Hazards