• A Baldwin, T Harris, and G Davies.
• Brighton and Sussex Medical School, Audrey Emerton Building, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK. a.baldwin@doctors.org.uk
• Emerg Med J. 2008 Dec 1; 25 (12): 843-6.

IntroductionResearch within the European Union has shown international visitors to have a higher injury mortality than residents. Traffic accidents are the leading cause of injury-related death among overseas visitors and evidence suggests overseas visitors are at a greater risk of being involved in road traffic accidents than the resident population. Little information looks specifically at pedestrian injuries to overseas visitors. Pedestrian deaths account for 21% of all UK road deaths.MethodsA retrospective database review of London helicopter emergency medical service (HEMS) missions was undertaken to examine the number and type of missions to overseas visitors, specifically examining pedestrian incidents.ResultsOf 121 missions to overseas visitors, 74 (61%) involved the visitor as a pedestrian struck by a vehicle. Thirty-five pedestrians (47%) were struck by a bus and 20 by a car (27%). Fourteen patients (19%) had an initial Glasgow coma scale score of 3-8, suggesting severe head injury and half of all patients required prehospital intubation (38/74, 51%). Mortality was 16% (12/74%) and 62 patients (84%) survived to hospital discharge. Of 39 patients admitted to the Royal London Hospital, the average injury severity score (ISS%) was 23.0 (ISS >15 denotes severe trauma) with a mean inpatient stay of 17.9 days.ConclusionDuring the 7-year period studied, 61% of HEMS missions to overseas visitors involved a pedestrian being struck by a vehicle, compared with 16% of missions to UK residents. For HEMS missions, serious trauma to pedestrians is disproportionally more common among the visitor population to London.

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