Dr. Parvez Mohi Ud Din Dar
Road safety week brings attention to the rising number of accidents and injuries that result in death and disability worldwide and the importance of preventing them.Road Safety Week is observed from 11th to 17th January and the theme for this year is – SADAK SURAKSHA JEEVAN RAKSHA.
Trauma may be caused by various factors, including traffic accidents, firearm injuries, burns, falls, violent actions, and crimes against the vulnerable population. Road accidents are the leading cause among allabove-mentioned causes.
In India, the prevalence of trauma-related illnesses has reached epidemic levels. Trauma is a major cause of death and disability worldwide. It is the fifth leading cause of death regardless of age and the first leading cause of death in the young population below 44 years of age. It has a peak incidence between 14 to 30 years of age. Globally traumatic injuries cause 6-10% of all deaths and are expected to increase over time. As per the world health organisation 2011 report, nearly 1.3 million people die and more than 50 million are injured every year because of trauma due to road traffic injuries. In low and middle-income countries, which make up 85% of the world, 11% of all disability-adjusted life years are due to trauma. Ninety per cent of trauma mortalities globally occur in low and middle-income countries.
India ranks 1st in the number of road accident deaths across the 199 countries reported in the World Road Statistics, 2018 followed by China and the US. As per the WHO Global Report on Road Safety 2018, India accounts for almost 11% of the accident-related deaths in the World. In India, the number of people killed in vehicle accidents is steadily increasing, both in absolute terms and per thousand population. India has the largest number of road deaths in the world. As per the Road Accident Report for 2020, a total number of 4,67,171 accidents took place in the country during the calendar year 2019 and 3,68,828 accidents during the year 2020, leading to 1,81,113 and 1,46,354 deaths respectively. The working-age group of 18 – 60 years accounted for a share of 84 per cent of the total road accident deaths. These young people are breadwinners for their families and contribute to society. We spend 2.5% to 3% of our GDP on Trauma Care whether we wanted it or not, whether we liked it or do not like it.
Risk factors
Socioeconomic status: More than 90% of deaths due to road traffic crashes occur in low- and middle-income countries like India. Road traffic injury death rates are highest in these regions and lowest in developed countries. These people from lower socioeconomic backgrounds are more likely to be involved in road traffic crashes even within high-income countries.
Over Speeding:The risk of a crash happening as well as the severity of the outcomes of the incident are strongly correlated with an increase in average speed. For every 1% increase in the mean speed of a vehicle, the chance of a fatal collision rises by 4% and the risk of a major crash rises by 3% The death risk for pedestrians hit by car fronts rises rapidly (4.5 times from 50 km/h to 65 km/h).In the side impact of car-to-car,the fatality risk for car occupants is 85% at 65 km/h.
Non-use of seatbelts, and child restraints: Wearing a seatbelt reduces the risk of death among drivers and front seat occupants by 45 – 50%, and the risk of death and serious injuries among rear seat occupants by 25%. The use of child restraints can lead to a 60% reduction in deaths.
Non-use of Helmets: About 90% of the risk of suffering a severe brain injury may be prevented by wearing basic safety gear like a “HELMET” of appropriate quality and being correctly placed. The majority of states have not made it compulsory that two-wheeler drivers and pillion riders wear helmets, which has led to an exponential increase in head injuries all across the country. The use of a helmet needs to be made compulsory for both the driver as well as the pillion rider of the two-wheeler, regardless of gender, i.e., men or women.
Distracted driving (Use of mobile): There are many types of distractions that can affect safe driving. The distraction caused by mobile phones is a growing concern for road safety. Drivers using mobile phones are approximately 4 times more likely to be involved in a crash than drivers not using a mobile phone. Using a phone while driving slows reaction times and makes it difficult to keep in the correct lane, and to keep the correct following distances. Hands-free phones are not much safer than hand-held phone sets, and texting considerably increases the risk of a crash.
Driving under the influence of alcohol: When a driver is drunk while driving a vehicle, the probability of a car collision rises gradually at low blood alcohol concentrations (BAC) and rapidly when the BAC is more than 0.04 g/dl. In the case of drug-driving, the risk of incurring a road traffic crash depends on the psychoactive drug used.
Unsafe vehicles: Safe vehicles play a critical role in averting crashes and reducing the likelihood of serious injury. There are several regulations on vehicle safety from National road safety Council, Ministry of Road Transport and Highways that if applied would potentially save many lives. These include requiring vehicle manufacturers to meet front and side impact regulations, to include electronic stability control (to prevent over-steering) and to ensure airbags and seatbelts are fitted in all vehicles. Without these basic standards, the risk of traffic injuries – both to those in the vehicle and those out of it – is considerably increased.
Unsafe road infrastructure: The safety of roads may be strongly influenced by their design. Ensuring that there are appropriate facilities for motorcyclists, cyclists, and pedestrians. Measures such as traffic lights, safe crossing points, footpaths, cycling lanes, and other traffic uplifting measures can be critical to reducing the risk of injury among these road users.
Road traffic injuries can be preventedand timely treated. For that general public awareness plays an important role. To reduce the burden of trauma-related death and disability, a wide range of actions must be taken, from monitoring and fundamental research to preventative programmes and trauma management. Multiple sectors such as transport, police, health, and education should be involved. Large improvements may be achieved through focusing on prevention and timely treatments; hence a strong focus should be placed on this strategy. Essential Trauma Care Projects need to be developed and promoted.
Our Central Government as well as the state governments are very ambitious and making policies regularly so that all persons involved in any type of trauma benefit from speedy and effective trauma care and health management. The essential functions of such a service would include the provision of the rescue operation and administration of first aid at the site of an accident, and the transport of the victim from the accident site to the trauma care hospital.? This project would be a crucial stage toward achieving the desired goal of reducing preventable deaths due to trauma.
(The author is Assistant Professor Trauma and Emergency Medicine All India Institute of Medical Sciences, Vijaypur, Jammu)
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