International Tourists, Motor Vehicles and Road Safety: A Review of the Literature Leading Up to the Sydney 2000 Olympics

International Tourists, Motor Vehicles and Road Safety: A Review of the Literature Leading Up to the Sydney 2000 Olympics

Jeflre y Wilks

The number of international visitors to Australia is forecast to rise to 4.6 million in the year 2000, the main attraction being the Olympic Games in Sydney.’ While the Olympic Games are expected to directly attract 132,000 international visitors as athletes, officials, judges, journalists and spectators, a hrther 1.49 million visitors will be attracted to Australia because of the global spotlight on the country in the years leading up to and during the staging of the event.2 Pre- and post-Games travel will also involve large numbers of tourists mov- ing about in other Australian states and territories. For example, 50% of the extra tourists are expected to visit Queensland, 25% Victoria, 13% Western Australia and 9% the NorthernTerritory.’ In order to provide the best possible experience for alI of these visitors, it is essential that potential causes of travel-related illness and/or injury are anticipated, and that procedures are established in each state to minimize harm and to deliver appropriate health care if it is r e q ~ i r e d . ~ Ideally, procedures and resources should be coordinated to achieve maxi- mum effectiveness.

Overall,Austrdia has a good reputation in terms of tourist health and safety, though recent reviews show that very little empirical research has been conducted to direct national policy and program^.^*^ Further research is needed, for as Behrens and his colleagues note,“A cru- cial prerequisite for giving balanced advice and assessing health risks is accurate epidemiological data on travel morbidity and mortality, preferably related to geographical risk.”6 One area of concern that consistently emerges in the travel medicine literature is that of tourists being injured or killed in motor vehicle crashes.The purpose of this paper is to:

Jeffrey Wilks, LLB IHonsl, PbD: Consultant Psychologist and Principal Research Fellow with the Centre for Accident Research and Road Safety-Queensland (CARRS-Q).

Reprint requests: Dr. Jeffrey Wilks, CARRS-Q, School of Psychology, Queensland University of Technology, Beams Road, Carseldine, Queensland 4034, Australia.

J TravelMed1999; 6: 115-121.

1. Review the existing literature on international tourists and road safety in the lead up to the Sydney 2000 Olympic Games.

2. Suggest road safety issues that travel medicine practitioners should include in pretravel advice for travelers visiting Australia.

3. Iden@ areas where hrther research is needed to form the foundation for applied road safety initiatives.

Review Methods Employed

In order to identify international research in this area, two approaches were adopted. First, on-line computer searches were conducted with MEDLINE Express,WIL- SON discs,AUSTROM, CINAHL, ERIC and PsycLit. The reference lists of articles identified by the computer search were then examined to trace papers not appear- ing on the main databases. Second, telephone and e-mad contact was made with academics as well as transport, medical and allied health professionals known to be working in the field.Word-of-mouth referrals generated a large network, all o f whom were contacted about research that might be included in this review.

International Research Findings

Motor vehicle crashes consistently emerge as the most common cause of injury death for tourists.Table 1 presents the main empirical on tourist injuries and fatalities in motor vehicle crashes identified from extensive on-line computer searches.

While studies like that of Picot and his colleaguesI6 indxate that many tourists may be generally aware of the risk of a road crash on their vacation, they may also underestimate the magnitude of the risk in comparison to other travel-related health issues. Differences in methodology and geography prevent direct compar- isons across the studies in Table 1 ; however the clear mes- sage is that tourists are probably a t greater risk of injury from a motor vehicle crash than local residents,’’ largely due to driving in unfamiliar surroundings, especially on the opposite side of the road to which they are accustomed.I4 Contributing to an unfamiliar environment is

the challenge of driving or riding an unfadiar vehicle.

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1 1 6 J o u r n a l o f T r a v e l M e d i c i n e , Volume 6, Number 2

Table 1 Tourist Injuries and Fatalities in Motor Vehicle Crashes: International Research findings

Year Author(s) Sample Findings

1985 Hargarten and Baker’ 185 Peace Corps volunteers who died during the period 1968 to 1983

Motor vehicle crashes (n = 67) were the single most common cause of death of Peace Corps Volunteers (PCVs).They accounted for more than one third of all deaths and more than half of all unintentional injury deaths. Motor vehicle death rates were slightly higher for men than for women, accounting for 67% of the motor vehcle deaths. Half of the motor vehicle fatalities occurred in the Afkican region. Motorcycles accounted for 12% of all PCV fatalities and 33% of all motor vehicle deaths.

1990 Purlass’

1991

1991

1991

1993

1996

1996

Hargarten, Baker and Guptill’

Guptill, Hargarten and Baker”

Sniezek and Smi th ”

Hargarten and Bowl2

Carey and Aitken”

Page and Meyer’‘

926 patients attending a hospital emergency department in Bermuda with an injury following a motorcycle or moped accident

2,463 deaths ofAmerican travelers in 1975 and 1984

396 deaths of American travelers to Mexico in 1975 and 1984

17,988 deaths among non-US residents in the United States between 1979 and 1984

796 cases of American tourists transported back to the US by emergency medical air transport services over a 3 year period

538 cases of road trauma involving motorbikes in Bermuda between July and September 1993

Data on road-based accidents collated by the Land Transport Safety Authority in New Zealand

Tourists were involved in 48.3% of the accidents.The average monthly incidence for the tourist population over the 6 month study period was 1.57 accidents per thousand people.There were 16 moderate or severe injuries to tourists, requiring inpatient hospital care.The average age for tourist admissions was 37 years, and their mean hospital stay was 7.3 days.

There were 601 deaths due to injuries in the study period. Motor vehcle crashes were the most common cause of injury deaths (26.8%). followed by drownings (16.1%).

The leading cause of death to all US travelers to Mexico was injuries (51%), with 18% of deaths resulting from motor vehicle crashes.

Injuries (n = 4,078) accounted for 23% of a l l deaths. The most frequent causes of injury deaths were motor vehicle d c crashes (37%). drownings (15%). and homicides (11%). From the 1,525 injuries related to motor vehicles, a risk indicator of 11.7 per one million tourist arrivals was calculated.

Injury accounted for 44% (n = 351) of the total cases, with motor vehicle crashes (n = 157) being the most common cause of injury. Almost half of all fights (41%) h m Mexico were for multiple vehicle collisions (n = 82). Motor vehicle crashes were also the leading cause of transports h m the Caribbean, and South and Central America.

The tourist rate of motorbike-related injury was 94.1/1,000 person-years at risk, whereas that of the local population was 16.6/1,000.The injury rate among residents was highest for young males, whereas among tourists it was highest among older persons.Tourists also had an increased risk of fiacture.The study concluded that tourists visiting Bermuda are at high risk of injury &om motorbike use, with rates of injury much higher than the local population.

Some 52 foreign drivers were involved in fatalities on New Zealand roads for the period 1988-93, with nearly 20% due to drivers not keeping to the left, a major problem for some overseas visitors.There were 1,386 non- fatal accidents involving foreign drivers for the period 1988-91.The foreign driver w a s considered by the New Zealand police to have been a causative factor in 232 non- fatal injury crashes in the period 1988-91, with not keeping to the left a significant factor. Foreign drivers were also identified as a major problem in terms of rental car crashes.

(continued on pate 1 17)

Wilks, Motor Vehicles a n d Road Safe ty : Sydney 2000 Olympics 1 1 7

Table 1 Tourist Injuries and Fatalities in Motor Vehicle Crashes: International Research Findings (continued)

Year Author(s) Sample Findings

1997 Petridou et al.I5 730 road traffic injury victims who contacted any of the three hospitals of the Heraklion owing to injuries of any type for every 18 Greeks.The District in the island of Crete during the 6-month study period

On the basis of Greek hospital discharge statistics in Heraklion District, one foreign visitor was discharged

correspondmg ratio for road tratfic accidents is close to 1:3, underlying the importance of road traffic accidents as the major health hazard during pleasure traveling. Lefi-side driving country nationals were at an increased risk for a traffic accident when they drove a rented rather than an owned vehcle (p = .02), possibly on account of maladapnon during the adjustment period in the country of visit. Moreover, road traffic victims from left-side driving countries compared with foreigners tiom right-side driving countries were involved 2.5 times more kequently in accidents in which overpassing or other driving maneuvers require reflexes conditioned on reverse directionality (p = .02).Alcohol abuse was reported as a primary cause of accident in a sigdicandy higher proportion of foreign nationals, reflecting the fact that the latter group was on vacation.The study concluded that road traffic accidents are a major hazard during pleasure traveling and victims of such accidents among travelers have a distinct epidemiological profile compared with accidents of a simdar nature among locals.

This particular problem is highlighted with tourists injured while riding motorbikes in Bermuda,I3 since motorbikes are the main form of transport available to visitors because of the restriction on the number of cars on the island.

Hargarten and Bouc’‘ note that environmental factors such as inadequate roadways or increased exposure (i.e., tourists spending more time in cars than they do at home because they are driving from destination to destination) were two possible contributing factors to the greater number of motor vehicle crashes they reported originating from Mexico. Across the international literature variable road design, poor maintenance, poor adher- ence to traffic rules, and lack of safety devices such as guardrails are acknowledged as problems for the international driver, especially in less-developed countries.’”’’ What is not clear from the literature is the relative importance ofvarious factors contributing to road safety problems among tourists, and the ex ten t to which environmental, social and cultural factors vary in importance according to the background of the driver and the characteristics of the destination.

The report by Petridou and her colleague^'^ is a par- ticularly valuable contribution to our understanding of tourism and road safety. Their study provides empirical support for the proposition that visitors to a right-side driving country such as Greece, who are accustomed to driving on the left-hand side of the road at home, may be at increased risk of motor vehicle injuries. Situations

such as entering the opposite lane; overpassing from the right, and priority (right of way) violations were more problematic for visitors from lefi-side driving countries. In addition, alcohol abuse was reported as a primary cause of accident in 55 out of 244 foreign nationals (22%); a propomon sigmficantly higher than that of Greek Nation- als (3%). Finally, the study tentatively concluded that, for the study area “it appears that the likelihood of hospital contact during a pleasure trip is six times more frequent on account of a traffic accident than it is on account of injuries of any type or indeed any other cause.”

Australian Research Findings

The Austrahan empirical presented in Table 2 tend to confirm findings in the international literature.

For -. example, Prociv’s study’ of 421 recorded deaths ofAustralian travelers overseas revealed that motor vehcle or road accidents were the leading cause of injury death. Proportionately, more short-term travelers were killed in road accidents (9%) than were Australians per- manently resident in other countries (3%). Motor vehicle accidents were also the leading external cause of injury among overseas visitors adrmtted to seven Queens- land coastal hospitals over a 12 month period,” which supports the conclusion made by Petridou and her col- leaguest5 that international tourists are more likely to be admitted to hospital as a result of a motor vehicle crash

1 1 8 Journal of Travel Medicine, Volume 6. N u m b e r 2

Table 2 Tourist Injuries and Fatalities in Motor Vehicle Crashes: Australian Research Findings

Year Author(s) Sumple Findings

A u s d a n s Traveling Overseas 1995 ProciV'O 421 recorded deaths of

Australian travelers overseas

Domestic and InternationalVisitors within Australia 1994 Salib and Brimacombe2' 255 patients presenting to the

Ayers Rock Medical Centre over 18 months with a serious incident (defined as life threatening or requiring more than 1.5 hours of emergency m e d d treatment) 695 overseas and 3,479 interstate tourists admitted to seven Queensland hospitals over a 1 year period

1996 Nicol, Wilks and Wood"

A total of 31 travelers (7% of the sample) died in motor vehicle or road accidents. Most of the fatalities (n = 26) involved short term travelers, defined as those going overseas for less than 12 months. A further nine non-specified deaths were possibly related to road crashes. Of the 40 traffic and non-specified accident victims, 25 were men and 15 women; 34 (85%). including 12 women, were below the age of 50.

There were 33 incidents associated with car accidents, of which two think involved tourists (no distinction was made between domestic and international tourists).

Motor vehcle accidents were the leading external cause of injury among overseas tourists (57 cases), and the second most kequent for interstate tourists (97).

than any other type of injury. Moreover, treating overseas visitors in public hospitals after serious motor vehicle accidents is very resource intensive,= and a significant financial burden for Australian hospitals if costs cannot be recovered from the patient.24

The most detailed Australian work on road crashes and international drivers to date is presented in a 1995 report produced by the Federal Office of Road Safety.= The report notes that fatal crashes involving international tourists are given considerable prominence in the media; a fact confirmed by independent research.26 Yet such crashes are actually rare, accounting for only 1.5% of all fatal crashes. Based on the outcome of coroner's inves- tigations into fatal crashes for the years 1988, 1990 and 1992 the report found that there are about 30 crashes involving foreign drivers in Australia each year.

Approximately 32 people are killed in these crashes and a hr ther three international tourists are lulled as pedestrians each year.

Figure 1 dustrates the distribution of fatal crashes involving international drivers.

The map shows that over half the crashes occur in New South Wales (25%) and Queensland (26%), which are the two most popular state destinations for international visitor^.^' However, when a comparison is made against each state's share of all fatal crashes,WesternAus- traha and the Northern Territory are over-represented for tourist crashes.

The Federal Office of Road Safety repor? also notes that international drivers involved in fatal crashes are driving a four-wheel drive vehicle, minibus or util-

ity in 32% of cases, compared with 20% for Australian drivers. The choice of vehicle is consistent with the leisure travel of international tourists, with 64% of their fatal crashes occurring on country roads (45% for Aus- tralian drivers).

Table 3 shows that excessive speed and alcohol can be important factors in all fatal crashes, though the available Australian data suggests that international drivers are somewhat more cautious in relation to alcohol and

Bold Figure = State share of fatal crashes involving international drivers (Bracket) figure = State share of all fatal crashes

Figure 1 Fatal Crashes in Australia Involving International Drivers. (Map reproduced from reference 25, with permission.)

Wilks, Motor V e h i c l e s a n d R o a d Safe ty : Sydney 2000 Olympics 119

speed, a finding for alcohol which runs counter to that of Petridou and her colleague^'^ from their Greek study.

Table 3 also shows that international drivers are far more likely to overturn their vehicles, with the injury con- sequences of an overturn being heightened by a failure to wear seat belts. International drivers were also more involved in fatigue-related crashes.

Non-Fatal Injuries

Not all motor vehicle crashes involving international tourists result in a fatality. Data from QueenslandTrans- p o r P for the 10 year period 1986-1995 shows that half of the international drivers and riders involved in a crash received only minor injuries. At the same time,Table 4 reveals that 43% of road crashes with international drivers resulted in hospitalization, and there were 191 deaths during the period.

These road crash outcomes represent only a relatively small proportion of all Queensland crashes (1.9%),which may partly explain why international tourists have not been specifically targetted as a group for road safety campaigns or initiative^.'^

Unfamiliar Surroundings

According to the Bureau oflourism Research,z7 43% of all international visitors drive a private or company car while in Australia, 15% rent a car, 2% drive a motor- home or camper van, and 3% use a four-wheel drive vehicle. One of the most difficult concepts to convey to an international visitor is the vastness of the Australian countryside. Fatigue is a major consideration in long-dis- tance trips,= and this may be compounded by being tired before starting to drive. For example, a visitor arriving fi-om overseas may be jet-lagged and dehydrated &om an international flight and in no condition to take control of a motor vehicle. Since travel agents are the main source of information for international visitors to Aus- tralia,*’ it is important that they are made aware of fatigue

Table 3 A Comparison of Australian and International Drivers on Factors Contributing to Fatal Crashes

International drivers do better: Australian International

Excessive speed Alcohol over .05

15% 9% 18% 11%

International drivers do worse:

Fatigue 9% 13% Not wearing seat belt 11% 19% Overturned vehcle 16% 30% ~

(Table reproduced from reference 25, with permission.)

Table 4 Overseas Drivers and Riders Involved in Road Crashes in Queensland 19861995

Percentage of all Severity L$ Crash Number Queensland Crashes

~~

Minor Injury 1358 (1.5%) Hospital 1173 (2.5%)

Total 2722 (1.9%)

(Table based on data from reference 28.)

Fatal 191 (3.4%)

as one ofseveral factors that may impact on their clients’ road safety.

The second issue emerging from the Federal Office of Road Safety Report? is that of seat belts. International drivers and their passengers must be informed of the legal requirements in Australia to wear seat belts, and be hr - ther counseled on the increased safety that seat belts provide. In contrast to car rental agencies overseas,30 availability of seat belts is not an issue in Australia since seat belts are a mandatory item in rental vehicles.

The final issue identified in the Federal Office of Road Safety Report” concerns choice of vehicle, especially for country driving.The report suggests that efforts should be made to ensure that international drivers are aware of the road-handling properties of vehicles such as four-wheel drives and minibuses, especially on rural roads. Like motorbikes in Bermuda,” many international visitors will find it difficult driving an unfamiliar vehicle such as a four-wheel drive in the outback. In one study, Black and Rutledge)’ asked 11 1 overseas tourists about their ‘worst’ experience in the Australian outback. The most frequent response was ‘heat’ (28% mentioned), followed by vehicle problems (25%).A number of respon- dents also included worry about vehicle problems within the generic category of‘safety’ (12.5%).

Tourist Road Safety Issues in Australia

Advice for driving in Australia, includmg issues such as those presented inTable 5 , is sometimes mentioned in the medical literature as part of general advice for trav- e l e r ~ ~ ~ and is usually available in brochures or booklets from motoring organizations and local government agencies.3s35 Whether tourists heed the available advice is seldom investigated, and where survey evidence is presented it tends to be with small, non-representative samples.36

However, there is a growing awareness within Aus- tralian government^^'-^^ and the tourism industry“ that road safety is an issue that must be addressed for overseas visitors. Anecdotal evidence suggests that the lead-

1 2 0 J o u r n a l of Travel Medic ine , Volume 6, N u m b e r 2

Table 5 Advice for Driving in Australia

General lssues

Ensure you have an appropriate driver’s licence Drive on the left-hand side of the road Always wear a seat belt Don’t drink and drive Avoid night driving Don’t drive if tired Don’t speed Beware of animals Wear a helmet when riding a motorbike or bicycle Be aware of local weather conditions

Dnving in Regional or Remore Locations

Advise someone of your travel plan, including estimated

Ensure vehcle is well maintained Carry drinlng water Carry extra gasoline Beware of anirnals Avoid night driving Carry independent means of telecommunication In the event of a breakdown, remain with the vehicle.

time of arrival

ing six issues for medical practitioners to include in advice for patients traveling to Australia are:

1.

2. 3. 4. 5. 6 .

Be conscious of driving on the left-hand side of the road. Always wear a seat belt. Don’t drink alcohol and drive. Don’t exceed the local speed limits. Don’t drive if you are tired. Be aware ofthe distances involved when planning each day of travel.

This list is not presented in any order of priority; nor should it be considered exhaustive.

In order for these issues to be prioritized and rel- evant educational material developed for overseas drivers, further research is needed to determine the relative contributions of host, environment and vehicle factors In actual crash situations. As noted by Hargarten4’ “knowledge of the variable in-country risks of motor vehicle crash mortahty and morbidity is essential for the international traveler to develop strategies to prevent injuries.”

Directions for Research

In 1996. just over half of the international arrivak to Australia were people visiting for the first time.27 In addition to the possible distractions of beaunful scenery, alcohol US^'^^^^ and inexperience with a particular type of motor vehicle’ identified in other studies, Australian research needs to quantifjl the unique contributions of driving on the lefi-hand side of the road“.’’ and fatigues

as particular problems of an unfamiliar environment for international drivers. Given the diversity of international groups visiting Australia,” a related issue is that of lan- guage, especially the abhty to read and understand road signs. Currently, international visitors need only produce a domestic licence from their home country in order to obtain a rental car in Ausmha.

The Queensland Parliamentary Travelsafe Com- m i ~ x e e ~ ~ has recently called for further investigation to identify best practice policies and procedures for the management of short-term overseas drivers. Such best practice initiatives d only be successful if they are based on sound empirical research. Some directions for t h s work are suggested from the literature reviewed here, though it is interesting to note that overall very little in-depth study has been made of international tourists and road safety to date.

A new research program at the Centre for Accident Research and Road Safety in Brisbane, Australia has recently been established to address this neglected area. Crash data fiom state transport authorities, details of overseas visitor hospital admissions, and information on insurance claims are being gathered to provide a com- posite picture of road safety problems encountered by international to~rists.~’ Educational material and prevention strategies will then be developed &om detailed empirical analyses of these data sets.

Conclusions

There is s t i l l very little known about the driving habits and road safety problems experienced by international visitors in Australia. Given that a large number of additional tourists will visit Australia for the Sydney 2000 Olympic Games, it is important that policy and pro- grams be in place to assist with road safety. In order to do this effectively, further research is urgently needed to identify and prioritize risk factors when driving in an unfamiliar environment.

Acknowledgments

Permission from the Federal Office of Road Safety to reproduce material 6 o m their 1995 report on international drivers is gratefully acknowledged. This review was supported by funds fiom the MotorAccident Insur- ance Commission (Queensland).The author would like to thank Anna Johnson for assistance with gathering the international literature.

References

1, Australian Tourism Forecasting Council. International visitor arrival forecasts. Canberra: Australian Tourism Forecast- ing Council, 1998. Federal government says Olympics will bring extra 1.6 mil-

lion tourisn to Ausualia. Me& Release by The Hon.Andrew Thomson MP, Minister for Sport andTourism, 1 July 1998.

2.

Wilks , Motor Vehicles a n d Road Safe ty : Sydney 2000 Olympics 1 2 1

3.

4.

5.

6.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

Wilks J, Oldenburg B.Tourist health: the silent factor in cus- tomer senice.Aust J Hosp Manage 1995; 213-23. Wilks J, Atherton T. Health and safety in A u s d a n marine tourism: a social, m e d d and legal appraisal. J Tourism Stud 1994; 5:2-.16. Wilks J, Grenfell R.Travel and health research in Australia. J Travel Med 1997; 4 3 3 8 9 . Behrens RH, Steffen R, h o k e DFM.Travel medicine. 1. Before departure. Med JAust 1994; 160:143147. Hargarten SW, Baker SP. Fatalities in the Peace Corps: a ret- rospective study, 1962 through 1983. JAMA 1985; 254: 1326-1329. Purkiss SE Motorcycle injuries in Bermuda. Injury 1990; 21: 228-230. Hargarten SW, Baker T, G u p d K. Overseas fatalities of United States citizen travellers: an analysis of deaths related to international t r a v e 1 . h Emerg Med 1991; 20:622426. Guptill K, Hargarten SW, BakerT.American travel deaths in Mexico: causes and prevention strategies.West J Med 1991;

Sniezek JE, Smith SM. Injury mortality among non-US m- idents in the United States 1979-1984. IntJ Epidemiol 1991; 20:225-229. Hargarten SW,Bouc GT. Emergency air medical transport of US-citizen tourists: 1988 to 1990. Air Med J 1993; 12: 398402. Carey MJ, Aitken ME. Motorbike injuries in Bermuda: a risk for tourists. Ann Emerg Med 1996; 28(4):424-429. Page SJ, Meyer D. Tourist accidents: an exploratory analysis. Ann Tourism Res 1996; 23(3):666-690. Petridou E, Askitopoulou H,Vourvahakis D, et al. Epidemi- ology of road traffic accidents during pleasure travelling: the evidence h m the Island of Crete. Accid Anal Prev 1997; 29(5): 687-693. Picot N, Goujon C, Sylvestre EArmengaud M.What risks are aavelen in fear of? In: Fourth international conference on travel medicine: program and abstracts. Zurich: International Soci- ety ofTravel Medicine, 1995. Heraty MJ. Tourism transport-implications for developing countries. Tourism Manage 1989; 10(4):288-292. Bewes PC.Trauma and accidents: practical aspects of the prevention and management of trauma associated with travel. Br Med BuU 1993; 49(2):454-464. Hargarten SW Injury prevention: a critical aspect of travel medicine. J Travel Med 1994; 1(1):4&50. Prociv F! Deaths ofAustralian travellers overseas. Med J Aust 1995; 163:27-30. Salib MW, Brimacombe JR.A survey of emergency memcal care at Uluru (Ayers Rock) Med J Aust 1994; 161:69%694. Nicol J , W i J, Wood M. Tourists as inpatients in Queens- land regional hospitals.Aust Health Rev 1996; 19:55-72. Walker S, Wilks J, Ring I, et al. Use of Queensland hospital services by interstate and overseas &tors. Health Inform Manage ! 995;25:12-15. Barraclough S, McBain C.The use of Australian health care services by overseas visitors: some data-related problems for policy makers.Aust Med Rec J 1992; 22(2):51-55.

154:169-171.

25. Federal Office of Road Safety. Driving in unfamiliar surroundings. Part 1: International drivers. Monograph 3. Can- berra: Federal O 5 c e of Road Safety, 1995. Wilki J, Pendergast D, Service M. Newspaper reporting of tourist health and safety issues.Aust Leisure 1996; 7(3):45-48. Bureau of Tourism Research. International visitor survey 1996. Canberra: Bureau offourism Research, 1996. Watson B, Fresta J,Whan H, et al. Enhancing driver management in Queensland. Brisbane: Queensland Transport, 1996. Wilks J,Watson B, Fa& I. International tourists and road Safety in Austraha: developing a national research and management programme.Tourisrn Manage 1999; 20:in press. Hargarten SW.Availabdity of safety devices in rental cars: an international survey.Travel Med Int 1992; 10:109-110. Black N, Rutledge J. Outback tourism: a survey perspective. In: Black N, Rutledge J, eds. Outback tourism: the authentic Australian adventure. Townsville: Department of Tourism, James Cook University, 1995:13-67. Mills D.Travelling well: the essential handbook for healthy mvel. Brisbane:Traveller's Medical &Vaccination Centre, 1995 Spencer R, Lloyd J, eds. Far north and far more healthy: a user's guide to life in the tropical north. Cairns:Tropical Public Health Unit, Queensland Health, 1995. N T Road Safety Council.TheTerritory by road: in seven lan- guages with maps included. Darwin: NT Road Safety Coun- cil, 1995. Queensland Transport. Welcome. Some handy hints on Queensland road rules and conditions. Brisbane: Queensland Transport, 1995. Ward J.The outback and the independent traveUer:with spe- cial focus on Lawn Hill National Park. In: Black N, Rutledge J, eds. Outback tourism: the authentic Australian adventure. Townsde: Department ofTourism, James Cook University, 1995: 147-1 57.

37. Joint Standing Committee on Road Safety. New road safety measures for the Northern Territory: notice of government intention. Ministerial statement by the Minister forTnnsport &Works, the Hon Barry Coulter MLA. Staysafe Report no. 38. Sydney: New South Wales Parliament, 1997:116-125.

38. Joint Standing Committee on Road Safety. Road safety and the Sydney 2000 Olympic Games. Staysafe Report no. 4 1. Syd- ney: New South Wales Parliament, 1997:55-56.

39. Joint Standing Committee on Road Safety Road safety for tourists. Staysafe Report no. 42. Sydney: New South Wales Par- liament, 1997:4546. Erickson D, Loan D, Dunstone J.Visitor road safety video fea- sibility study and'theTerritory by road'multi-lingual map &s-

tribution research. Report prepared for the Road Safety Council of the NorthernTerritory. Danvin: McGregor Mar- keting, 1997. Hargarten SW. International travel and motor vehcle crash deaths the problems, risks,and prevention.Tnve1 Med Int 1991; 9: 106-1 10. Colon LThe role of tourism in alcohol-related highway fatalities. IntJ Addict 1985; 20(4):577-582. Parliamentary Travelsafe Committee. Report on driver train- ing and licensing. Report no. 16. Brisbane: Legislaave Assem- bly of Queensland, 1996.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

40.

41.

42.

43.

Documents

International Tourists, Motor Vehicles and Road Safety: A Review of the Literature Leading Up to the Sydney 2000 Olympics