Recommendations for water safety and drowning prevention for travelers

Lifejackets or just jackets? Seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda

Objectives. Upon immersion in water, a cascade of human physiological responses is evoked, which may result in drowning death. Although lifejackets are over 80% effective in preventing drowning, many people in lakeside fishing communities in Uganda shy away from wearing them because of active distrust in the quality of the lifejackets on the local market. No study has determined the veracity of these claims. This study determined the seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda. Methods. Using a within-person repeated assessment design, we tested 22 new lifejacket samples obtained from landing sites of Lake Albert, Uganda. We conducted water entry, righting, floatation stability and minimum buoyancy performance tests. Results. All the lifejacket samples failed the minimum buoyancy functional requirements test; the average buoyancy was 80 N (SD 13). Only 4% of the lifejackets passed the righting test within 5 s. For floatation stability, 45% of the lifejackets sank earlier than 48 h of placement in water and also failed water entry tests by getting dislodged from the wearer. Conclusion. The lifejackets sold at the landing sites of Lake Albert do not meet minimum seaworthiness functional requirements. The government should regulate the quality of lifejackets on the local market.

Injuries and medical emergencies among international travellers

BACKGROUND

Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings.

METHODS

We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled).

RESULTS

All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur.

CONCLUSIONS

Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.

Rip current knowledge: do people really know its danger? do lifeguards know more than the general public?

Introduction

Drowning is a global problem. This so-called "silent killer" claims hundreds of thousands of lives every year around the world. Despite this, beaches are a fundamental space in the lives of many people throughout the world. The scant knowledge regarding aspects of safety, accident prevention and the identification of risks in these natural aquatic environments, all contribute to the number of aquatic accidents that happen. The objective of this study was to establish the reality about the Spain population's knowledge of risks on the beaches.

Methods

A study was carried out using a questionnaire, generated through Google Forms©. The questionnaire was available for 7 days, from May 12 to 19, 2022. 289 responses were selected. The Chi-square statistic was used to analyze the associations while Cramér's V statistics and the Odds Ratio were applied to analyze their strength. The significance level was p < 0.05 for the entire study.

Results

50.5% of the participants knew how to correctly identify a rip current. In terms of definition, identification and response to a current, those who were lifeguards were more likely than the general population to answer correctly.

Conclusions

Sex, age or place of residence do not seem to explain knowledge about rip currents in an active population group. Finally, as a factor in avoiding possible accidents related to currents, the importance of having professional lifeguards in natural aquatic environments is confirmed.

The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran

The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran is necessary. We dealt with drownings on three levels of prevention including before, during, and after the injury in northern Iran (Guilan province). This study aimed to investigate the use of Haddon's matrix in preventing three-level drowning cases before, during, and after the accident in the north of Iran. This qualitative study consisted of 9 focus groups with a sample size of 78 people including 48 nursing staff, 21 emergency medicine specialists, and 30 people from non-medical personnel (local community leaders, executive officials of relevant organizations, lifeguards, staff working in health centers, and families of victims). All group discussions were recorded and the questions were based on the focus group table. According to Haddon's table of results, the major risk group was the young and adolescent boys and more in the area of neglect in culture-building and education. In this study, the role of factors was investigated separately and the necessary solutions were presented that can be used as a scientific and practical basis to achieve the main goal of drowning prevention. These strategies require cross-sectoral collaboration, which seems to be a strong interaction with a greater focus on major risk groups to address deficiencies and prevent the recurrence of potential accidents. The study aimed to investigate the use of Haddon's matrix in the prevention of three-level drowning cases before the event, during the event, and after the event in northern Iran.

A Review of Interventions for Drowning Prevention Among Adults

Adult drowning is a complex and multifactorial public health challenge requiring community, national and global efforts to mitigate impacts. This study updates the evidence base for public health interventions that address adult fatal and non-fatal drowning. A systematic review was undertaken of the peer-reviewed literature for English-language primary studies published between 2011 and 2021describing a drowning intervention with adults. Twenty-two studies were included. Most studies (n = 16) were conducted in high-income countries. Yearly trends in drowning prevention intervention publications were analysed with 2015 (n = 6) the peak publishing year. Over half of the study designs were pre-post (n = 15). Intervention duration ranged from 4 hours to 11 years. Ten studies described either behaviour change theory or formative evaluation to inform design. Thirteen studies targeted interventions at a population level, seven at a group level and two at individual level. Studies identified a range of prevention strategies, categorised as behavioural (n = 9) (e.g., swimming lessons), socio-ecological (n = 8) (e.g., mandatory personal flotation devices) and mixed (n = 5) (e.g., awareness campaign and barriers to prevent access to water). A range of outcomes were described including changes in awareness, water safety knowledge, attitudes, water safety behaviours and skills, environmental, policy and regulation changes and drowning rates. Findings indicate a small but important increase in the evaluation and publication of effective interventions to prevent adult drowning. The complexity of the issues surrounding drowning requires multi-strategy and context -specific adult focused prevention interventions. Contemporary evidence that identifies effective interventions that contribute to prevention efforts is an essential first step in addressing the challenge.

Lake tourism fatalities: a 46-year history of death at Lake Powell

BACKGROUND

This study investigates tourist mortality at Lake Powell over a 46-year period. To date no comprehensive long-term investigation examining the relationship between the lake environment and tourist mortality exists.

METHODS

A retrospective study was conducted of all tourist fatalities between 1959 and 2005.

RESULTS

There were 351 fatal incidents resulting in 386 deaths between 1959 and 2005. Over the 46-year period, the average number of fatalities was 8.4 (±5.26) per year. Out of all fatalities, 282 were classified as accidental, 80 were classified as natural deaths, 13 were suicides and 5 were classified as homicides. Males accounted for 80% of fatalities and tourists aged 20-29 years and 10-19 years accounted for 36% of all fatalities. The highest number of fatalities was recorded in July (74), May (64), August (63) and June (59). Out of all accidental deaths, boating (29%) and swimming (22%) were the most common pre-death activities. High winds capsizing boats and carbon monoxide poisoning from boat engines were common factors contributing to 31 boating fatalities. Fatigue and exhaustion contributed to 22 swimming deaths.

CONCLUSIONS

Recreational boating and swimming account for over half of all accidental deaths. Tourists visiting Lake Powell for recreational purposes should be informed of the risks associated with the lake environment.

Protecting the health of medical students on international electives in low-resource settings

BACKGROUND

Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure.

METHODS

The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material.

RESULTS

This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours.

CONCLUSION

This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.

Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries

Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life-years annually, making up 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries. Given this burden, it is not unexpected that injuries are the leading cause of death among travelers to low- and middle-income countries, namely, from road traffic crashes and drowning. Therefore, pretravel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as wearing seatbelts, helmets, and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children.

International travelers and unintentional fatal drowning in Australia--a 10 year review 2002-12

INTRODUCTION

. Drowning deaths of travelers are commonly reported in the media, creating a perception that they are at a higher risk of drowning than residents. This may be true, due in part to unfamiliarity with the risks posed by the hazard, however there is limited information about drowning deaths of travelers in Australia. This study aims to identify the incidence of drowning among international travelers in Australia and examine the risk factors to inform prevention strategies.

METHODS

. Data on unintentional fatal drowning in Australian waterways of victims with a residential postcode from outside Australia were extracted from the Royal Life Saving Society-Australia National Fatal Drowning Database.

RESULTS

. Between 1 July 2002 and 30 June 2012 drowning deaths among people known to be international travelers accounted for 4.3% (N = 123) of the 2870 drowning deaths reported in Australian waterways. Key locations for drowning deaths included beaches (39.0%), ocean/harbour (22.0%) and swimming pools (12.2%). Leading activities prior to drowning included swimming (52.0%), diving (17.9%) and watercraft incidents (13.0%).

DISCUSSION

. International travelers pose a unique challenge from a drowning prevention perspective. The ability to exchange information on water safety is complicated due to potential language barriers, possible differences in swimming ability, different attitudes to safety in the traveler's home country and culture, a lack of opportunities to discuss safety, a relaxed attitude to safety which may result in an increase in risk taking behaviour and alcohol consumption.

CONCLUSION

. Prevention is vital both to reduce loss of life in the aquatic environment and promote Australia as a safe and enjoyable holiday destination for international travelers.

Reliability of the American Community Survey for unintentional drowning and submersion injury surveillance: a comprehensive assessment of 10 socioeconomic indicators derived from the 2006-2013 annual and multi-year data cycles

BACKGROUND

Our objective was to evaluate the reliability and predictability of ten socioeconomic indicators obtained from the 2006-2013 annual and multi-year ACS data cycles for unintentional drowning and submersion injury surveillance.

METHODS

Each indicator was evaluated using its margin of error and coefficient of variation. For the multi-year data cycles we calculated the frequency that estimates for the same geographic areas from consecutive surveys were statistically significantly different. Relative risk estimates of drowning-related deaths were constructed using the National Center for Health Statistics compressed mortality file. All analyses were derived using census counties.

RESULTS

Five of the ten socioeconomic indicators derived from the annual and multi-year data cycles produced high reliability CV estimates for at least 85 % of all US counties. On average, differences in socioeconomic characteristics for the same geographic areas for consecutive 3- and 5-year data cycles were unlikely to be caused by sampling error in only 17 % (5-89 %) and 21 % (5-93 %) of all counties. No indicator produced statistically significant relative risk estimates across all data cycles and survey years.

CONCLUSIONS

The reliability of the annual and multi-year county-level ACS data cycles varies by census indicator. More than 75 % of the differences in estimates between consecutive multi-year surveys are likely to have occurred as a result of sampling error, suggesting that researchers should be judicious when interpreting overlapping survey data as reflective of real changes in socioeconomic conditions. Although no indicator predicted disparities in drowning-related injury mortality across all data cycles and years, further studies are needed to determine if these associations remain consistent at different geographic scales and for injury morbidity.

Injury deaths among Finnish residents travelling abroad

The increasing international mobility raises the possibility of foreign nationals dying abroad. Here, a descriptive, retrospective and population-based study of deaths abroad among Finnish residents from 1969 to 2007 is presented. The data were collected from the Statistics Finland data based on certificates of cause of death issued after repatriation of the corpse and after review of medical documents or a medico-legal autopsy. The frequency of injury deaths, proportional mortality rates (PMRs) and mortality risk estimates (MREs) were measured. During the study period, 6894 Finnish residents died abroad. Spain, Sweden and Thailand were the top three destination countries for number of deaths, accounting together for 40.3% of all the deaths. Cardiovascular diseases were the most common cause of deaths. The overall injury deaths represented 26.7% of all deaths abroad and occurred at a higher proportion than in Finland (PMR: 3.3). The most common injury deaths were traffic accident and drowning, which together represented more than 50% of all unintentional injury deaths. High PMRs were found for traffic accidents in Russia, Germany and the US and for drowning in Spain, Portugal, Greece and Turkey. The MRE for injury deaths was 73.5 per 100,000 person-years of exposure. Finnish travellers abroad are a population subgroup with a high risk of injury death. Common travel health interventions must be backed by actions to prevent injuries abroad, particularly traffic accident and drowning.

Causes of death abroad: analysis of data on bodies returned for cremation to Scotland

BACKGROUND

The majority of travelers from the UK and Scotland visit Europe, particularly Spain and France, as well as North America, yet surveillance that aids in travel medicine guidance continues to focus on infectious diseases relating to developing countries. Here, we report on causes of death among all bodies returned to Scotland for cremation.

METHODS

Data collected by the Scottish Government on bodies being returned from abroad for cremation was collated for the period 2000 to 2004, and analyzed to identify the cause and location of death among travelers as well as to test the hypothesis that for death due to failure of the circulatory system among Scots there was a significant association between age at death and whether death occurred in Scotland or abroad.

RESULTS

Of the 572 deaths reported between 2000 and 2004, 73% occurred in the European region and 10% in the Americas. With respect to the cause, trauma accounted for 20.4%, infectious diseases 1.5%, and other non-infectious causes accounted for 75.5% of deaths. Among the latter, the major cause of death was due to failure of the circulatory system (77.0%). A significant association was observed between death abroad due to failure of the circulatory system and younger age at death for all (χ(2) = 26.9, df = 3, p < 0.001) and for males (χ(2) = 20.7, df = 3, p < 0.001) but not for females (χ(2) = 2.7, df = 1, p = 0.099).

CONCLUSIONS

The data indicates a low rate of death among Scots traveling abroad, with trauma and other non-infectious causes being the most common cause of death; failure of the circulatory system was the most common cause of death in the latter group. Europe and the Americas were the most common locations of death. Although travel health services should continue to advise travelers to developing countries on infectious disease risks, it is also important that travel health acts as venue for providing key advice and preventative means to all travelers, including those to developed countries. Those agencies, organizations, and companies who deal with travelers along their journey should also engage with travel health experts and practitioners to reduce the risk of adverse outcomes, including death, to travelers.

Travel case scenarios as a demonstration of risk assessment of VFR travelers: introduction to criteria and evidence-based definition and framework

BACKGROUND

Travel-associated health risks need to be balanced against the positive opportunities associated with interregional travel. As the perceived and real spectrum of health risks related to international travel increase both quantitatively and qualitatively, the need for more discriminating tools in clinical assessment for the purpose of mitigation, public health management, and research are needed. One group of international travelers identified as having increased risk of poor travel-related health outcomes are those who travel with the specific intent of visiting friends or relatives (VFR travelers). Due to variations in defining VFR travel in the health context there are issues in applying this designation uniformly from multiple perspectives. This article supports the standardization of VFR traveler definitions based on objective criteria and provides illustrations of the application of this definition through an illustrated approach to risk assessment based on these criteria and the differentials in the determinants of health between source and destination regions.

METHODS

A working group was established by the Migration Health Sub-committee, International Society for Travel Medicine to assess the literature on VFR travel and health, review an evidence-based approach to managing health risk related to travel, and to propose criteria-based definition for VFR travel. The new definition of a VFR is a traveler whose primary purpose of travel is to visit friends or relatives where there is a gradient of epidemiological risk between home and destination.

RESULTS

A case scenario discussion of VFR travel defined by criteria and risk assessment based on differential determinants of health is presented in this article.

DISCUSSION

The goal of this article is to encourage discussion on travel health evaluation for the most "at risk" populations and to standardize the application of clinical, public health, and research approaches to defining VFR travelers in a risk management context.

GIS and injury prevention and control: history, challenges, and opportunities

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in industrialized countries around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. Recent evidence has shown that the analytical, data linkage, and mapping tools of geographic information systems (GIS) technology provide can further address these determinants and identify populations in need. This paper traces the history of injury prevention and discusses current and future challenges in furthering our understanding of the determinants of injury through the use of GIS.

Recreational travel fatalities in US national parks

BACKGROUND

Injuries are a public health problem affecting traveling populations such as tourists visiting National Parks. This study investigates the distribution of visitor fatalities in US National Park Service (NPS) units and identifies the predeath activities and contributing factors associated with them.

METHODS

A retrospective study was conducted of visitor fatalities from all NPS units during 2003 and 2004.

RESULTS

There were 356 reported fatalities during 2003 and 2004. Fatalities were most common during the summer months and on weekends. Males accounted for 75% of the reported fatalities, and visitors aged 20 to 29 and 50 to 59 years accounted for 51% of all deaths. Only 99 of 388 (26%) NPS units reported at least 1 fatality, and only 10 units reported 10 or more fatalities. However, these 10 units were responsible for 36% of all fatalities. Lake Mead National Recreation Area, Blue Ridge Parkway, Grand Canyon National Park, Great Smoky Mountains National Park, and Yosemite National Park reported the highest number of fatalities. Domestic visitors accounted for 73% of the fatalities, and European visitors accounted for 13%. Transportation and water-based activities recorded the highest number of fatalities. Motor vehicle crashes accounted for 20% of fatalities and was followed by suicide (17%), swimming (11%), hiking (10%), plane crashes (9%), climbing (6%), and boating (5%) incidents.

CONCLUSIONS

Fatalities in NPS units are not widespread and are related to more common events such as motor vehicle crashes, suicide, swimming, and hiking rather than exotic causes such as bears or other wildlife. It is recommended that preventive techniques first be developed in the 10 NPS units responsible for 36% of the total NPS-wide fatalities.

Fatal injuries of US citizens abroad

BACKGROUND

US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States.

METHODS

A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States.

RESULTS

Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6-1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad.

CONCLUSIONS

Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories.