The major causes of serious disability or loss of life are not infectious. Trauma caused by injuries, principally that suffered in motor vehicle crashes, is the leading cause of death and disability in both developed and developing countries worldwide. The risk of motor vehicle related death may be from 7 to 13 times higher in developing countries than the United States. Motor vehicle crashes result from a variety of factors, including inadequate roadway design, hazardous conditions, lack of appropriate vehicles and vehicle maintenance, unskilled or inexperienced drivers, inattention to pedestrians and pedalcyclists, or impairment due to alcohol or drug use; all these factors are preventable or can be abated. Defensive driving is an important preventive measure. When driving or riding, insist on a vehicle equipped with safety belts, and where available, use them. Cars should be carefully inspected to assure that tires and brakes are in good condition and that all lights are in good working order. Where available, also request a vehicle equipped with airbags and when renting a large truck, request a vehicle equipped with anti-lock brakes. As a high proportion of crashes occur at night when returning from “social events,” avoid non-essential night driving, alcohol, and riding with persons who are under the influence of alcohol or drugs. Pedestrian, bicycle, and motorcycle travel are often dangerous, and helmet use is imperative for bicycle and motorcycle travel.

Fire injuries are also a significant cause of injuries and death—do not smoke in bed, and inquire about whether hotels have smoke detectors and sprinkler systems. Travelers may wish to bring their own smoke detectors with them. Always look for a primary and alternate escape route from rooms in which you are meeting or staying. Look for improperly vented heating devices which may cause carbon monoxide poisoning. Remem-ber to escape a fire by crawling low under smoke.

Other major causes of injury trauma include drowning (see swimming precautions p. 196) and injuries to water skiers and divers due to boat propellers. Boats equipped with propeller guards should be used whenever possible. Protection against potentially hazardous drugs is nonexistent in some countries increasing the risk of adverse reactions. Do not buy medications “over the counter” unless you are familiar with the product.

Travelers should also be aware of the potential for violence-related injuries. Risk for assault or terrorist attack varies from country to country; heed advice from residents and tour guides about areas to be avoided, going out at night, and going out alone. Do not fight attackers. If confronted, give up your valuables. For more information, contact the U.S. Department of State, Overseas Citizens Emergency Center, at (202) 647-5225.