Accident prevention

Accidents

Accidents kill more travellers to developing countries than tropical diseases and are a major cause of health problems for holidaymakers wherever they go.

Obviously no one gets involved in an accident on purpose, but reckless or careless behaviour increases the risks. Conversely, there are some precautions that can reduce danger to a certain extent.

• Do not drive when you’re tired or after alcohol
• Do not drive or be driven on unlit roads at night in developing countries
• Check the condition of a hire car and the insurance agreement
• Use seat belts and put children in child restraints
• Hire a larger size of vehicle when possible
• Do not ride a moped, motorbike or even a cycle without a helmet
• Do not ride in the back of trucks or on the roof of trains
• As a pedestrian note from which direction the traffic comes
• Find safe places to cross the road
• Never leave children unattended near water
• Check the depth of water before diving in
• Check locally about sea currents or dangerous marine creatures
• Check the safety record of ferries and airlines if possible
• Piracy is a danger in some tropical sailing waters
• Remember that alcohol or drugs may affect your judgement.

There may be some potential hazards that you can’t prevent completely, but at least if you’re aware of them, you may be able to reduce the element of risk. Try to ascertain which areas of a town or country are safe to visit, but be prepared to hand over your valuables without a fight if attacked. Advice on political unrest/safety may be obtained from the Foreign and Commonwealth Office (FCO) before travel (see ‘Useful information’); this includes updated advice on international terrorist threats and any areas that the FCO advises against visiting.

Hotels and self-catering accommodation may have unsafe balconies, lifts, or electrical or gas appliances. Fire exits may be inadequately marked, so find out for yourself where they are and work out your route to them in advance. Camp sites may have poor security and be vulnerable to extremes of weather such as floods or sandstorms.

Sports risks may be increased by poorly maintained equipment – if in doubt, don’t use them. It’s probably best to steer clear of new and potentially dangerous sports unless you’re sure that the instructors are properly trained and that there is adequate supervision and planning. Think about your own level of fitness before undertaking anything strenuous or physically demanding.

In safe waters?

Water sports are becoming increasingly popular, especially on the specialised activity holidays. As well as swimming, you can go water-skiing, canoeing, snorkelling, windsurfing, sailing and scuba diving. Sadly, this also means that more people are being affected by all kinds of water-borne infections, which can include tummy upsets, sore throats, and skin, ear and eye infections. Occasionally hepatitis A (liver infection) or shigella dysentery can be transmitted in this way.

The rate of infection varies enormously but it can happen in all countries.

There has been much publicity about safe and unsafe beaches and whether bathing water is potentially hazardous to health. There is a ‘blue flag’ programme. The Blue Flag is awarded to over 3,300 beaches and marinas in 36 countries across Europe, South Africa, Morocco, New Zealand, Canada and the Caribbean. It compares those that meet high standards of cleanliness and management, promote coastal environmental care and have attained the higher guideline standard of water quality. It refers only to the busier ‘resort’ beaches.

The Blue Flag Programme is owned and run by the independent non-profit organisation Foundation for Environmental Education (FEE). The bathing water quality at all Blue Flag Award beaches meet the legislation’s guideline standards, based on the Bathing Water Directive 76/160/EEC. In the UK the water quality is tested every week during the bathing season and the main results displayed at award beaches, along with summary details for previous years. However, it must be understood that even at the best sites water quality fluctuates. A change in the current or weather can change a test result within hours so that natural organisms in the water, or very occasionally diluted sewage from a distant coastal area, can be found. Conversely, even where no faecal organisms have been detected, bathers may develop mild sore throats, or ear or skin infections. However, not all beaches may be listed, so ask if in doubt. You might also want to know whether there are any sewage outlets nearby. The local council environmental health department usually has this information.

No beach can be entirely safe because of its intrinsic nature and proximity to water, rocks and sand dunes. However, Blue Flag Award beaches could be expected to be relatively safe because they should have assessed the risks, identified any potential hazards and provided appropriate lifesaving equipment.

River water, swimming pools and whirlpool baths have all been blamed for causing infection at times. Very rarely a more serious infection such as meningitis may develop.

In a study of a gastroenteritis (tummy upset) outbreak associated with a busy swimming pool, it was shown that how long a person spent in the water and how much water they inadvertently swallowed were important risk factors.

A few organisms are resistant to chlorination although proper chlorination and filtration prevent most infections.

Whirlpool baths have been implicated in bacterial skin infections (an organism known as Pseudomonas species). River water in a British rural setting may occasionally be dangerous because urine from animals (cattle or rats) can transmit a bacterium causing Weil’s disease (leptospirosis). It enters the body through skin abrasions or nasal mucosa and, as it can be serious, it often causes concern to canoeists and windsurfers who have fallen into the water. Some people are more susceptible than others. Symptoms occur after about 10 days with a fever, chills, aching, vomiting and diarrhoea. It is usually treatable with antibiotics but there is a one per cent mortality rate. Approximately 50 cases a year are reported in England and Wales, but it must be said that only a relatively small proportion of victims can be shown to have been exposed to water beforehand. It is more common in most tropical areas, including the Caribbean and Hawaii, and is probably under-diagnosed in the USA.

Preventing infection

• Ask about the recent safety record of a beach (but remember that testing may not have been carried out and, even if it has, it has limitations)
• Less crowded swimming facilities away from built-up areas and sewage outlets are likely to be cleaner
• Keep your head out of the water and avoid swallowing it if possible
• Try to teach children to do the same
• Don’t let children swim or play in the water when they have tummy upsets and anyone with respiratory symptoms should avoid enclosed swimming pools. On hot days, especially when crowded, they can be the ideal environment for organisms to multiply
• Plastic shoes may reduce the incidence of plantar warts (verrucas) at swimming pools and infected cuts from outdoor swimming
• Avoid shallow natural pools with visible algae
• Whirlpools and swimming pools should be properly chlorinated
• Showering after swimming and drying thoroughly, including your ears and between your toes, reduces fungal and bacterial skin infections
• Ideally, avoid immersion in fresh water near fields of cattle or where banks are inhabited by wild rodents, because of the risk of Weil’s disease.

Although it’s worth following these commonsense precautions, don’t forget that the risk of infection must be kept in proportion; THE GREATEST RISK TO LIFE FROM WATER IS FROM DROWNING.

Water-skiing boats should always have a lookout as well as a driver to watch that those in the water are not in danger from speeding propellers. Life jackets or buoyancy aids are appropriate for most water sports. For this reason there should be designated areas for swimmers that speedboats and jet skis are not allowed to enter.

Windsurfers should also have warm suits (wet or dry) because learners can become exhausted if continually in and out of cold water. In the tropics, clothes to protect you from sunburn may be necessary. Beginners should not go windsurfing in an offshore wind unless a rescue boat is at hand because there is a risk of being blown out to sea.

Teaching children (and adults) to swim and to respect the possible dangers of water sports must be the first priority.

Parasailing with a parachute behind a motorboat over tropical water looks spectacular, but it can be hazardous. Often the operators on the beach are disowned by the reputable hotels because they may have no insurance and accidents have sometimes occurred. Try to check on the level of care taken and remember your travel insurance may not cover such activities.

Before you go scuba diving

Many people are tempted to learn scuba diving in resorts with crystal-clear turquoise water teeming with colourful and exotic fish. Increasing demand from travellers has put pressure on even small island resorts to offer this facility, but there may not be enough experienced teachers to meet this rapid increase in demand.

‘Scuba’ stands for self-contained underwater breathing apparatus. Less responsible hiring outlets will not check the ability of those wishing to hire and may offer only rudimentary tuition for novices. Don’t dive unless you’ve had proper training (usually in a pool), the equipment is well maintained and you know that there are no medical reasons why you shouldn’t. These may include chronic ear or sinus disease, asthma, bronchitis, heart disease, epilepsy and diabetes. In any case of doubt check with your doctor before you go.

Obtain local advice about any dangers from tropical fish, sea snakes or jellyfish.

Remember that snorkelling with a mask in clear water will often give you a wonderful view and, if used sensibly, will be much safer.

Fresh water hazards

In tropical areas do not wade or swim in freshwater lakes or slow-flowing rivers or drink water from them, however clean or clear they may look, because of the risk of infection with bilharzia (schistosomiasis). Don’t go wind-surfing, water-skiing or canoeing on fresh water in an area where bilharzia is endemic unless you are certain that there is no risk. The infection is spread by the larvae of worms, which burrow under your skin and can cause severe illness. Even if symptom free, you should get a blood test 10 to 12 weeks after a possible exposure to bilharzia-infected water because the disease is usually readily treatable.

It’s a very good idea to avoid walking barefoot on tropical beaches, especially if they are fouled by dog faeces, and on damp earth in rural areas. You might otherwise risk infection with hookworm which can produce very unpleasant itchy rashes and sometimes more serious symptoms.

Winter sports

Unless you’re already seriously fit, you can reduce the risk of accidents by getting some training in before you go. Exercises to strengthen rarely used leg muscles will be particularly beneficial. Invest in the proper clothes – you’ll need a hat or helmet, mittens or gloves, warm socks and undergarments as well as the obvious ski suit. Good sunglasses, ideally with side protection, or goggles, will be necessary too. If you don’t own ski boots, it is worth spending time on arrival to find comfortable ones that allow some toe movement. Adjustment of ski bindings must be done by an expert so as to protect against serious injury, and beginners will need advice on length of skis and poles.

You may feel that you could do with some inner warmth, but remember that alcohol dilates the blood vessels of the skin so, while temporarily giving a warm feeling, it actually will cause cooling. And as with all sports, drinking alcohol increases the chance of accidents. Finally, before you are tempted to try your hand at tobogganing, you might like to know that it is responsible for even more injuries than skiing!

Mountain sickness

There is less oxygen in the air at high altitudes. If you are suddenly moved from a low to a high altitude, you may feel unwell because less oxygen reaches your body’s tissues every time that you take a breath. These symptoms are called mountain sickness.

The symptoms can be prevented by going up slowly to allow the body to adapt to the lower oxygen pressure (by changes in respiration, fluid balance and the blood). So mountain sickness is basically caused by too rapid an ascent.

Mountain sickness can be unpredictable and strike those who have not previously had problems at altitude. Fitness does not guarantee protection and may even encourage a too rapid rate of ascent. However, some exercise and training before all active holidays are recommended for enjoyment and safety.

Symptoms of mountain sickness

• Headache
• Fatigue
• Shortness of breath
• Dizziness
• Nausea
• Loss of appetite

In the past when people had to climb up slowly there was more time for acclimatisation, but now holidays are offered with flights straight into airports at high altitude. For example, in South America, there are many organised trips that fly into La Paz at 3,577 metres (11,736 feet), Quito at 2,819 metres (9,249 feet) or Lima at sea level but with rapid travel to Cuzco at 3,399 metres (11,152 feet).

Holidaymakers to East Africa may want to ascend Mount Kilimanjaro (5,895 metres, 19,340 feet) in only a few days. This summit is slightly higher than Everest Base Camp, which is reached by serious trekkers but usually by more gradual means. Mountaineers obviously go higher, but such expeditions plan proper ascent rates.

Altitude chart

The height at which symptoms begin varies from person to person. It is rare below 2,450 metres (8,000 feet) and most commonly occurs above 3,650 metres (12,000 feet). Trekkers, climbers and occasionally skiers can be affected.

Planning an itinerary with a slow ascent is recommended because it allows the body to acclimatise naturally and will avoid problems for many people. Rest days should be built into high altitude treks, and the Himalayas Rescue Association in Kathmandu advises on safe schedules for Nepal.

When flying into any high altitude destination such as Mexico City (2,300 metres/7,546 feet) or La Paz (3,577 metres/11,736 feet) you should avoid physical exertion for the first day. Drink plenty of water or juice to maintain hydration (remember that strong coffee and alcohol dehydrate), and don’t smoke if at all possible.

Many people will feel a little light-headed or tired at first, but more severe symptoms can develop with headache, shortness of breath and/or nausea, and must be carefully observed. Mountain sickness can kill and it is vital that those in danger obtain a professional opinion or, if in doubt, descend to a lower altitude.

Some itineraries don’t allow proper time for acclimatisation and the question arises of whether to use a medicine to help. Acetazolamide (Diamox) does help many people and your GP may

agree to provide a private prescription (although the drug is not licensed for this purpose in the UK). It is important to understand that you can develop symptoms despite taking the tablets and, if so, you must still go down.

Key points

• Accidents kill more travellers than tropical diseases

   

• Holiday freedom and euphoria must be tempered by sensible precautions

   

• Alcohol has been implicated in a wide variety of holiday accidents

   

• Sports opportunities on holiday are increasing - avoid poorly maintained equipment and try to ensure expert tuition