---

Road Traffic Accidents (RTA) - Park's PSM Summary

---

Definition

• "An unexpected, unplanned occurrence which may involve injury" (General definition)
• WHO (1956): "An unpremeditated event resulting in recognizable damage"
• Broader: "An occurrence in a sequence of events which usually produces unintended injury, death or property damage"

---

Nature of the Problem

• Accidents represent a major epidemic of non-communicable disease - they are no longer considered truly "accidental"
• They follow the same epidemiological triad (agent-host-environment) as communicable diseases
• A majority of accidents are preventable
• Susceptibility is increased by: alcohol, drugs, fatigue, and physiological state

---

Measurement of the Problem

a. Mortality Indices

1. Proportional mortality rate - deaths due to accidents per 100/1000 total deaths
2. Deaths per million population
3. Death rate per 1,000 (or 100,000) registered vehicles per year
4. Accidents/fatalities as ratio of vehicles per km or passengers per km
5. Deaths of vehicle occupants per 1,000 vehicles per year

b. Morbidity

• Measured as "serious injuries" and "slight injuries"
• Seriousness assessed by the Abbreviated Injury Scale (AIS)
• Morbidity rates are less reliable due to under-reporting and mis-reporting

c. Disability

• May be temporary/permanent, partial/total
• Measured using ICF (International Classification of Functioning, Disability and Health) by WHO

---

Global Epidemiology

• Nearly 1.25 million people die annually from road accidents worldwide
• For every death: 20-50 non-fatal injuries and 10-20 serious injuries
• Road traffic injury is the leading cause of injury deaths globally, followed by suicide, falls, and interpersonal violence
• 48% of those dying on roads are vulnerable road users (pedestrians, cyclists, motorcyclists)
• 90%+ of RTA deaths occur in low- and middle-income countries
• Males under 25 years are ~3 times more likely to die in crashes than young females
• Children and youth under 25 account for over 30% of those killed/injured

---

India-Specific Data (2017)

• Road injury = leading cause of death in males aged 15-39 years
• Deaths increased by 58.7% from 1990 to 2017
• India is unlikely to achieve SDG 2020 road safety target even by 2030

---

Risk Factors (WHO Classification)

1. Speed

• Directly related to both crash likelihood and crash severity
• A 1% increase in mean speed = ~4% increase in fatal crash risk; ~3% increase in serious crashes

2. Drinking and Driving

• Alcohol raises crash risk; risk increases sharply above 0.04 g/dL BAC
• Young people, motorcyclists, and drivers with prior traffic violations are at highest risk

3. Non-use of Helmets

• Helmets reduce head injury risk by 30% on average
• Reduce fatality risk by 40%
• Full-face integral helmets are preferred

4. Non-use of Seat Belts

• Seat belts reduce fatalities and non-fatal injuries by approximately 50% each
• Should be compulsory for cars, light trucks, and similar vehicles

5. Distracted Driving

• Mobile phone use while driving increases crash risk ~4 times
• Hands-free and hand-held phones are equally dangerous

6. Non-use of Child Restraints

• Child car seats reduce deaths in infants by ~71% and toddlers by ~54%

7. Road and Environmental Factors

• Defective roads, poor street lighting
• Defective crossroad/speed breaker layout
• Unusual behavior of men and animals
• In South-East Asia, semi-urban and rural areas contribute 60-80% of road accident injuries

---

Multiple Causation

• Human factors (up to 90% of accidents attributed to human failure)
• Environmental factors

---

Prevention Strategies

1. Data Collection

• Basic mandatory reporting system for all accidents
• Supplemented by special surveys and in-depth studies
• Police records as the starting point (statutory duty in most countries)
• Collect environmental data: road, vehicle, weather conditions

2. Safety Education

• "If accident is a disease, education is its vaccine"
• Begin with school children
• Driver training in vehicle maintenance and safe driving
• Education on risk factors, traffic rules, and first aid

3. Promotion of Safety Measures

4. Legislative Measures

• Enforce speed limits, drunk-driving laws, helmet and seatbelt laws
• Vehicle roadworthiness checks
• Driver licensing with fitness criteria (age, vision, medical history)

5. Environmental Engineering (Haddon Matrix Approach)

• Pre-event/Pre-crash: Improve roads, enforce speed limits, vehicle safety design
• Event/Crash: Seat belts, airbags, helmets - reduce injury severity
• Post-event/Post-crash: Emergency medical care, rehabilitation

6. Emergency Medical Services

• Prompt first aid and transport to hospital
• Golden Hour principle: critical care within the first hour
• Training lay public in first aid ("Good Samaritan" concept)

7. Rehabilitation

• Physical, psychological, and social rehabilitation
• Addresses permanent disabilities from RTAs

---

Haddon Matrix (Agent-Host-Environment Framework)

---

Key Facts to Remember (Exam Points)

• "Killed" in RTA = death within 30 days
• Morbidity assessed by Abbreviated Injury Scale (AIS)
• Seat belt reduces death/injury by ~50%
• Helmet reduces head injury by 30%, fatality by 40%
• 90% RTA deaths in low/middle-income countries
• Up to 90% of accidents due to human failure
• Vulnerable road users = 48% of road deaths globally
• India: pedestrians = 35.1%, motorcyclists = 30.9% of deaths
• "Accident is a disease, education is its vaccine" - classic PSM quote
• SDG target: Halve global road traffic deaths and injuries by 2020/2030

---