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Wilderness Medical Society - snowmass 2005 (Page 131)

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Wilderness Medical Society - snowmass 2005
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In the past, Public Announcements have been issued to deal with short-term coups, bomb threats to airlines,
violence by terrorists and anniversary dates of specific terrorist events.
Consular Information Sheets are available for every country of the world. They include such information
as location of the U.S. Embassy or Consulate in the subject country, unusual immigration practices, health
conditions, minor political disturbances, unusual currency and entry regulations, crime and security
information, and drug penalties. If an unstable condition exists in a country that is not severe enough to
warrant a Travel Warning, a description of the condition(s) may be included under an optional section
entitled "Safety/Security." On limited occasions, we also restate in this section any U.S. Embassy advice
given to official employees. Consular Information Sheets generally do not include advice, but present
information in a factual manner so the traveler can make his or her own decisions concerning travel to a
particular country.
General information on countries with regard to social and economic issues can be found
at the CIA website
http://www.cia.gov/cia/publications/factbook/

Even with this wealth of information at your fingertips, it is still difficult to access and
interpret much of it in a meaningful manner for your consulting patients. Much of this is
due to the level of risk that they are willing to assume. There is also a lack of
convenience in trying to access the websites and in printing out and reading through this
information.

Also there is a matter of political filtering of data. It is very likely that risk material is
suppressed if the country in question takes offense to remarks made (this has happened
with regard to areas of banditry in Mexico which appeared briefly and were removed due
to political pressure) and, conversely, travel may be discouraged to an area in response to
U.S governmental displeasure with a country. Check out the Islamic country of your
choice and note the vast differences in travel alerts provided citizens, which seems to
follow more of a political line than a true travel risk line. For example, compare Syria
with Egypt. Islamic terrorists in Egypt have killed many more tourists than in Syria, but
this would be hard to tell from the warning system.

Geographic location of travel death, when adjusted for the number of travelers, provides
a surprising result. Per capita is appears to be riskiest to travel to the Carribean and to
Central America and Mexico. This would provide some correlation to the death statistics
from drowning and alcohol related deaths due to the number of sea front and water
related activities in those locations.

Risk of harm to travelers has been shown to be greater than that of local people engaging
in the same activity. Carey and Atkin in the Annals of Emergency Medicine
(1996;28:424-429) looked at 657 cases of road trauma in Bermuda and found that 82%
involved motorbike. When the rates of injuries of tourists and locals were compared rate
in 1000/p-y for tourists was 93 as compared to 17 for locals. The peak age for the
accident for tourists was 50-59 as compared to 20-29 for locals. Being older does not
make the traveler wiser.

Comparing trauma and cardiovascular death rates for travelers vs age adjusted rates of
US non-travelers, we see what is probably a selection process that sends healthier people

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