Overseas Injuries: Caution Your Traveling Patients

Phyllis Kozarsky, MD


April 15, 2013

Editorial Collaboration

Medscape &

This feature requires the newest version of Flash. You can download it here.

Editor's Note:
This commentary is part of the CDC Expert Commentary Series on Medscape.

Although many travelers and their healthcare providers focus on the risk for tropical diseases when traveling, injuries -- not infections -- are the leading cause of preventable death in travelers. However, advice on avoiding injury is often overlooked in the pretravel consultation.

I'm Dr. Phyllis Kozarsky, with the Travelers' Health Branch at the Centers for Disease Control and Prevention, with some advice on how to avoid injuries that should be incorporated into the pretravel consultation for people who will be traveling overseas.

Injuries cause nearly one fourth of deaths among US citizens traveling abroad, and the leading cause of injury death is traffic accidents. Traffic accidents are common in developing countries for several reasons. Roads and vehicles may be poorly maintained and unsafe, traffic regulations may be casually disregarded, and lighting may be inadequate for nighttime driving.

Furthermore, a variety of vehicles -- including cars, buses, rickshaws, large trucks, and even animals -- may share the same road, and the concept of a "road" may be defined very loosely in some areas.

Being on vacation often gives people license to do things they would never consider at home, such as riding in the back of an open truck or hanging onto the side of a moving bus. Drugs and alcohol also play a role in many injuries.

I tell my patients who are traveling overseas to relax and have fun, but that they need to adhere to the same common-sense guidelines that they follow at home: Always wear a seatbelt; wear a helmet when riding a motorcycle or bicycle; don't use a cell phone while driving; and never, ever ride with a driver who has been drinking.

Moreover, for travelers to developing countries, there are special precautions that should be emphasized:

  • Vehicles in developing countries may not have seatbelts; as much as possible, travelers should only ride in vehicles if they can be safely buckled in.

  • Travelers should avoid buses or vans that are overcrowded or appear top-heavy.

  • If travelers plan to drive, they should be familiar with the local traffic laws, and they should be experienced with the vehicle that they are operating -- vacation is a terrible time to learn to ride a motorcycle or all-terrain vehicle.

  • As much as possible, travelers should avoid driving or riding in a vehicle at night in rural areas of developing countries.

  • In addition to an increased risk for accidents in low-light conditions, carjackings are a risk in some areas.

  • Travelers with children should consider bringing safety seats from home, because they may not be available at the destination.

If a traveler is seriously injured in a developing country, emergency care may not be available or satisfactory by US standards. Medical evacuation from a remote area can cost more than $100,000, so travelers to developing countries should consider purchasing supplemental medical evacuation insurance. This is especially important for those at highest risk for injury, such as people who will be staying for an extended period of time in a rural area, or travelers who plan to engage in adventure activities, such as skydiving, whitewater rafting, or parasailing.

Travelers sometimes focus on the risk for infectious diseases that they may encounter overseas, but clinicians shouldn't end the pretravel encounter after administering vaccines. A pretravel visit is an excellent opportunity to counsel travelers on their risk for injury and what they can do to minimize it.

Best wishes for safe and healthy travels!

Web Resources

CDC Yellow Book. Injuries & Safety

CDC Yellow Book. Travel Health Insurance & Evacuation Insurance

Association for Safe International Road Travel

Make Roads Safe

Phyllis Kozarsky, MD, is an expert travel health consultant for CDC's Travelers' Health Branch. She is the chief medical editor of CDC's Health Information for the International Traveler, also known as the "Yellow Book."

Dr. Kozarsky began her CDC career in 2001. She is also medical co-director at TravelWell, an Emory Healthcare-affiliated program aimed at providing pre-and post-travel health services to international travelers, and at Grady Memorial Hospital's Immigrant and Refugee Clinic. Her current research efforts have primarily focused on issues in clinical tropical medicine and travelers' health, including the epidemiology of travel-related infections.

She received her bachelor's degree from Hobart and William Smith Colleges in Geneva, New York. She went to the Medical College of Pennsylvania in Philadelphia and received her medical degree from Albert Einstein College of Medicine in New York.

She is the author of many peer-reviewed articles and is a member of many professional organizations, including the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene.