Epidemiology of Road Traffic Accidents

Epidemiology of Road Traffic Accidents

Framework1.Introduction2.Magnitude of Problem 3.Risk Factors4.Social Impact5.Haddon Matrix6.Interventions7.Recent Road safety initiatives by Government of India8.Current status9. Success stories10. Conclusion11. ReferencesIntroduction RTAs is major public health and development crisis, and are predicted to increase if road safety is not addressed adequately by countries.

Amongst the leading causes of deaths, disabilities and hospitalizations with severe socioeconomic costs across the world, however more so in developing countries like India.

In the year 2011, there was one road accident every minute, and one road accident death in less than four minutes, many of these victims are young people, those who are economically active.

Road traffic accidents are amenable to remedial action.

Many countries have witnessed drop in road accidents and fatalities by adopting multipronged approach to road safety, The challenge for India is to adapt and evaluate these approaches to suit our needs.

Magnitude

MagnitudeApprox 1.24 mill people die every yr on the worlds roads, and another 20 to 50 million sustain nonfatal injuries as a result of road trafc crashes.

In most regions of the world this epidemic of road trafc injuries is still increasing.

80% of road traffic deaths occur in middle-income countries, which account for 72% of the worlds population, but only 52% of the worlds registered vehicles.

In India Between 1970 and 2011, the number of accidents increased by 4.4 times, with 9.8 times increase in fatalities and 7.3 times increase in the number of persons injured

Growth in Accident related parameters CAGR (%) in IndiaPeriodNumber of AccidentsNumber of DeathsNumber of Injured persons2001/19913.23.74.72011/20012.15.82.4

Risk Factors

Factors influencing exposure to riskFactors influencing crash involvementFactors inuencing injury severityFactors inuencing post-crash injury outcomeFactors influencing exposure to risk

Rapid motorization Motor vehiclesMain contributing factors for the increase in global road crash injury

Buses and trucks are a major mode of travel

In New Delhi, buses and trucks are involved in almost two thirds of crashes involving vulnerable road users, and these people make up over 75% of all road trafc deaths.

Motorized two-wheeled vehicles Non motorized Traffic

Factors influencing exposure to riskDemographic Factors-Fluctuations in the relative sizes of different population groups physical vulnerability

Transport, land use and road network planning

The degree of physical exercise undertaken by individuals, and the volume of road trafc crashes and injuries

Increased need for travelChoice of less safe forms of travel

Risk factors inuencing crash involvementSpeedCore of the road injury problemInuences both crash risk and crash consequence

Pedestrians and cyclists-The absence of separate pedestrian and cyclist facilities, such as footpaths or cycle tracks, creates a high risk for these road users.If separation is not possible, road management and vehicle speed management are essential.At speeds of less than 30 km/h, pedestrians and cyclists can mix with motor vehicles in relative safetyYoung drivers and riders-Young men in their rst few years of driving, have higher rates of crash involvement than women.Thrill seeking behaviourover-condence less tolerance of alcohol excess inappropriate speedAlcoholAge of drivers- Teenagers with BAC of 0.03 g/dl carrying two or more passengers were 34 times more at risk of a crash than drivers aged 30 years. Severity of crashes- - each 0.02% increase in BAC doubled the risk of involvement in a fatal crash.

Medicinal and recreational drugsDriver fatigue

Crash Risk

Probability of a crash involving an injury is proportional to the square of the speed. The probability of a serious crash is proportional to the cube of the speed. The probability of a fatal crash is related to the fourth power of the speed. Increase of 1 km/h in mean trafc speed results in a 3% increase in the incidence of injury crashes. At levels above 50 km/h, a decrease of 2% in the number of crashes for every 1 km/h reduction in the average speedBlood alcohol concentration (BAC)-

Severity of crash injuries-As V from increases about 20 to 100 km/h, the probability of fatal injuries increases from 0 to almost 100%Serious injury for belted front-seat occupants is three times at 30 miles/h and four times as great at 40 miles/h compared with the risk at 20 miles/.

Risk factors inuencing injury severity

Risk factors inuencing injury severity

Lack of in-vehicle crash protection-Most accidents occur outside the car, with those affected being pedestrians, cyclists, motorized two-wheeled vehicle riders

Non-use of crash helmets by two-wheeled vehicle usersreduce fatal and serious head injuries by between 20% and 45% Non-use of seat-belts and child restraints in motor vehicles

27Risk factors inuencing post-crash injury outcome50% of deaths from road collisions occurred before reaching to hospitals.

Pre Hospital FactorsNo access to basic form of emergency medical service. Many victims do not possess social security, health cover or life insurance therefore lack access to hospital care.

Hospital care factors-Lack of trained expertise in trauma care, equipment- essential low-cost and reusable equipment poor organization rather than the cost.

Road safety as a social equity issue High impact on the poor and vulnerable in society. costs of prolonged medical care loss of the family breadwinner cost of a funeral loss of income due to disability can push families into poverty.

Haddons Matrix

Road transport as an ill-designed, man-machine system needing comprehensive systemic treatment

three phases of the time sequence of a crash event pre-crash, crash and post-crash

epidemiological triad of human, machine and environment

nine-cell Haddon Matrix models a dynamic system

each cell of the matrix allowing opportunities for intervention to reduce road crash injury.

Haddons MatrixFactorsPhaseHumanVehicle/ EquipmentEnvironmentPre-crashCrash preventionInformation,Attitude,Police enforcementRoadworthinessSpeed m/m, LightingRoad design & layout, speed limit, pedestrian facilityCrashInjury prevention during crashUse of restraintsOccupant restraints, crash protective designCrash protective roadside objectsPost-crashLife sustainingFirst aid skill, Access to medicsEase of accessFire riskRescue facilities6. Road Traffic Accidents, Prevention and ControlRTA deaths and serious injuries are to a great extent preventable, since the risk of incurring injury in a crash is largely predictable.The strategies address the three prime elements of the trafc system Vehiclesroad users road infrastructureManaging exposure to risk through transport and land-use policiesReducing motor vehicle trafc Efcient land use-spatial distribution of origins and destinations of road journeyspatterns of urban growth size of residential areas.

Safety impact assessments of transport and land-use plans- improving mobilityreducing congestion improving the environmentProviding shorter, safer routes,Trip reduction measures.

Encouraging use of safer modes of travelImproved mass transit systemsbetter coordination between different modes of travel shelters for bicycle allowing bicycles to be carried on board trains, ferries and busesdiscourage private car use in favour of public transport

Minimizing exposure to high-risk scenariosPreventing traffic mixingGiving priority to higher occupancy vehiclesRestrictions on speed and engine performance of motorized two-wheelersIncreasing the legal age for use of motorized two-wheelersStrict driver licensing systems

Incorporating safety features into road designSegregation of traffic Trafc-calming measures, Safety audits, Crash-protective roadsides, Crash cushions, Remedial action at high-risk crash sitesProviding visible, crash-protective, smart vehiclesDaytime running lights for cars(20%), High-mounted stop lamps in cars(15% and 50% crashe reduction in Norway and United States), Crash-protective vehicle designSetting and securing compliance with road safety rulesSetting and enforcing speed limits

Setting and enforcing alcohol impairment lawsThe risk of crash starts to increase signicantly at BAC levels of 0.04 g/dlIn India legal BAC level is 0.03gm/dl.

Minimum drinking-age lawsDrivers hours of work in commercial and public transport2030% of crashes in Europe & US involving commercial road vehicles.60% of the overall costs of trafc crashes are borne by societyBAC level 0.08- crash involvement double, 0.1 triple37Setting and enforcing seat-belt and child restraint useMandatory seat-belt useMandatory seat-belt use has been one of road injury preventions greatest success stories and has saved many lives38Child restraintsBicycle helmetsReduce the risk of head/brain injury by 63-88%

Motorcycle helmetsIn Malaysia, legislation(1973)- reduction of 30% in motorcycle deaths In Thailand -head injuries decreased by 41.4% and deaths by 20.8%The role of education, information and publicityalways featured as the mainstay of prevention. Delivering post-crash care

Chain of help for patients injured in road crashes No Golden Hour

Pre-hospital care-Role of lay bystanderscontacting the emergency serviceput off firesecure the scenefirst aid, external haemorrhage could be avoided

Access to the emergency medical system Improvement of hospital settings by human resource, physical resource, organization of trauma care. Rehabilitation

Recent Road safety initiatives by Government of IndiaThe Government has already approved a National Road Safety Policy.

The Government has constituted National Road Safety Council as the apex body to take policy decisions in matters of road safety

The Ministry has adopted a multi pronged strategy to address the issue of road safety based on four Es of Road Safety.

Road Safety Framework plan has been praposed for the Twelfth Five Year Plan

Multi-Pronged Strategy to improve road safety

4 es edu, enforcement, engineering, env & emergency services41Present StatusNHAI has identified eleven locations for establishing, operating and maintaining Wayside Amenities with various entrepreneurs and out of which 4 are functional.

NHAI is identifying more Potential Sites along East West Corridor between Porbandar to Lucknow and North South Corridor between Kanyakumari to Hyderabad to develop Wayside Amenities to facilitate the Road Users. Call CentreNo. of Ambulances in place 223 No. of Tow away cranes 198 No. of Route Patrol vehicles 229

Success StoryVision Zero- trafc safety policy, Sweden, in the late 1990s. It is based on four elements: ethics, responsibility, a philosophy of safety, and creating mechanisms for changesystem should be able to take account of human failings and absorb errors in such a way as to avoid deaths and serious injurieslimiting factor of this system is the human tolerance to mechanical forcechain of events leading to death/serious injury can be broken at any point.

A tool for allRelevant to any countries that aims to create a sustainable road transport system.basic principles can be applied to any type of road transport system, at any stage of development.Adopting Vision Zero means avoiding the usual costly process of trial and error,

ReferencesWorld report on road traffic injury prevention. Geneva: World Health Organization, 2004.Global Status Report on Road Safety, Time for Action. Geneva: World Health Organization, 2009.Road Accidents in India. New Delhi: Transport Research Wing, Ministry of Road Transport and Highways, 2011.Road Accidents in India. New Delhi: Transport Research Wing, Ministry of Road Transport and Highways, 2009.