A 60-year-old male sitting in the passenger seat fractured his humerus and the others had multiple contusions, cerebral concussions, and neck sprains. A 17-year-old girl presented to the ED in a semicoma due to severe head trauma after she fell off a bicycle. She was a high-school

student on a school trip to Jeju. She had rented a bicycle but had no protective gear such as a helmet. An acute subarachnoid hematoma and skull fracture were diagnosed. Drivers of tour buses or rental cars and visitors who rent motorcycles or bicycles are required to undergo safety instruction. Furthermore, protective gear including helmets and knee pads should be required for all motorcyclists and bicyclists. However, the proportion of bicyclists who use protective gear is low. Shin and colleagues analyzed 148 patients with bicycle-related injuries who visited a single tertiary hospital in an urban area of Korea. They reported that only Veliparib purchase 1.4% of patients were wearing a helmet when they were injured while riding a bicycle.9 A law designating the use of BGB324 mw protective gear for motorcyclists and bicyclists is needed. Visitors more often had penetrating and piercing trauma while in the countryside, recreational, or cultural areas. However, the severity of the penetrating trauma was not

significantly different between the groups (p = 0.173). Visitors had twice as many bites, stings, and invenomating injuries. This is because mountain climbers often suffer from hornet or wasp stings and are bitten by venomous snakes during outdoor activities. Here is one example case involving multiple victims suffering bee stings. Five tourists were admitted to our ED suffering from bee stings. They were climbing a mountain in the morning when the hornets attacked them.

One of them developed anaphylactic shock and the others had urticaria, dizziness, and nausea. They were treated with intravenous steroid and antihistamine and were rehydrated. Hawaii is one of the most visited places in many the world and the island size is similar to Jeju. According to a study by Ho and colleagues, the number of visitors per year is about 1 million more than that of Jeju.10 In Hawaii, 8,244 trauma patients were admitted to the island’s only trauma center from 2002 to 2007. Of these, 5.7% were visitors. The most common causes of injury were falls, water-related injuries, and motor vehicle crashes.10 In this study, falling, stumbling, jumping, and being pushed were the most common injuries, which was similar to Hawaii. In contrast, few water-related injuries, such as drowning or near-drowning, and more motorcycle and bicycle injuries occurred in Jeju when compared to those in Hawaii. Part of the reason may be that no major watersports industry exists in Jeju; tourists mostly enjoy mountaineering and hiking, and a popular activity for young people is to travel around the island by motorcycle and bicycle.