Road traffic accidents

epidemiological determinants, prevention

1. Road Traffic Accidents Dr.S.Sujatha MD.,DPH., Assistant Professor, Department of Community Medicine Chengalpattu Medical College

2. What is an Accident 1.An unexpected, unplanned occurrence that may involve injury . 2. Unpremeditated event resulting in recognizable damage (WHO Advisory Group) 3. Occurrence in a sequence of events, which usually produces unintended injury,death or property damage. 1 April 2018 2 Chengalpattu Medical College

3. Classification of Accidents Road Traffic Accidents Domestic Accidents- Drowning,Burns,Falls,Poisoning,Injuries from sharp ,Bites and other injuries from animals Industrial Accidents Railway Accidents Aircraft crash Maritime accidents Violence 1 April 2018 Chengalpattu Medical College 3

4. Measurement of Problems 1. Mortality Proportional mortality rate Number of deaths per million population Death rate per 1000 (or 1 lakh ) registered vehicles per year. Number of accidents or fatalities as a ratio of number of vehicles per km or passengers per km. Deaths of vehicles occupants per thousand vehicles per year. 1 April 2018 4 Chengalpattu Medical College

5. Cont…. 2.Morbidity Based on Abbreviated injury scale Serious injuries Slight injuries 3.Disability - temporary or permanent ,partial/total International Classification of Functioning,Disability and Health (ICF) by WHO 1 April 2018 5 Chengalpattu Medical College

6. Road Accidents : A Snapshot Road Accidents - a leading cause of Injuries, Deaths & Disabilities. India : 2016 Accidents – 4,80,652 Deaths – 1,50,785 Person Injured – 4,94,624 In Every Day : 1,317 Accidents /day and 413 Persons killed/day In Every Hour: 55 Accidents /hr and 17 Persons killed /hr Source: Government Of India Ministry Of Road Transport & Highways Transport Research Wing , www.morth.nic.in 1 April 2018 6 Chengalpattu Medical College

7. www.morth.nic.in 1 April 2018 7 Chengalpattu Medical College

8. www.morth.nic.in Source: www.morth.nic.in 1 April 2018 Chengalpattu Medical College 8

9. Source: Government Of India Ministry Of Road Transport & Highways Transport Research Wing , www.morth.nic.in 1 April 2018 9 Chengalpattu Medical College

10. Source: Government Of India Ministry Of Road Transport & Highways Transport Research Wing , www.morth.nic.in 1 April 2018 10 Chengalpattu Medical College

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12. Risk Factors 1.Speed: Pedestrians has 90% chance of surviving a car crash at 30Km/h or below. Reducing respiratory problems associated with car emissions 2.Drink – Driving: Blood Alcohol Concentration(BAC)of 0.05g/dl or below reducing the alcohol related crashes. Enforcing Sobriety Check points & Random breath testing can reduce 20%of alcohol related crashes. 1 April 2018 12 Chengalpattu Medical College

13. Risk Factors Cont… 3. Motor cycle Helmets: Reduce the risk of death by 40% and risk of severe injury by 70% Strict Laws should be enforced 4.Seat –Belts and Child Restriants : Reduces risk of fatality among Front seat passengers by 40-50% Rear –seat passengers by 25-75% 5. Mobile Phone usage - 4 times the risk of crash increases 1 April 2018 13 Chengalpattu Medical College

14. Risk Factors – cont.... 6.Factors influencing exposure to risk: Rapid motorization Demographic factors Transport, land use and road network planning Increased need for travel Choice of less safe forms of travel 7.Risk factors influencing crash involvement: Speed Pedestrians and cyclists Young drivers and riders Alcohol Medicinal and recreational drugs Driver fatigue Hand-held mobile telephones 1 April 2018 14 Chengalpattu Medical College

15. Othe Risk Factors – cont.... r Risk Factors: 8. Risk factors influencing injury severity: Lack of in-vehicle crash protection Non-use of crash helmets by two-wheeled vehicle users Non-use of seat-belts and child restraints in motor vehicles Roadside objects 9. Risk factors influencing post-crash injury outcome: Pre-hospital factors Hospital care factors 1 April 2018 15 Chengalpattu Medical College

16. Reasons for more Accidents in Developing countries Large numbers of pedestrians and animals share the common roadway Large number of old , poorly maintained vehicles Large numbers of buses often overloaded Large number of motor cycles, scooters and mopeds Low driving standards Widespread disregard of traffic rules Defective roads, poor street lighting, defective layout of cross roads and speed breakers Unusual behaviour of men and animals 1 April 2018 Chengalpattu Medical College 16

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18. RTA : E pidemiological Triad Triad 1 April 2018 Chengalpattu Medical College 18 Agent : V e h icles En v ironment: Physical status of Road Social context Host: Individual at Risk

19. Age Sex Education Medical Conditions - Sudden illness - Heart attack - Impaired vision Psychosocial factors - lack of experience - risk-taking - impulsiveness - defective judgements - aggressiveness - poor perception - family dysfunction Lack of body protection - helmets - safety belts Relating to road defective , narrow roads defective lay out of cross roads and speed breakers poor lighting lack of familiarity Relating to vehicle over speeding bad maintenance large numbers overloading low driving standards Bad weather Mixed traffic HUMAN FACTORS ENVIRONMENTAL FACTORS 1 April 2018 19 Chengalpattu Medical College

20. Increased vulnerability and/or risk factors Precipitating factors Emotional tension Alcohol and drugs Precipitating factors Special traffic conditions Social pressure Stolen vehicles ACCIDENT 1 April 2018 20 Chengalpattu Medical College

21. Prevention of RTA Human factors Vehicle factors Environmental factors Pre-crash Driver experience, fitness to drive, driver behavior Vehicle maintenance & features( electronic stability control) Transport systems, road engineering, visibility Crash Use of protective equipment (helmets, seat belts, child restraints) Vehicle design for impact protection Fixed objects at roadside, safely barriers Post-crash Preexisting conditions, emergency response care, rehabilitation Entrapment, fire Location, speed of emergency response, access to trauma care The Haddon matrix 1 April 2018 21 Chengalpattu Medical College

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25. Prevention Data collection Safety education Promotion of safety measures Alcohol and other drugs Primary care Elimination of causative factors Law enforcement Rehabilitation Accident research 1 April 2018 25 Chengalpattu Medical College

26. 1.Data collection Basic reporting of all cases Supplementation by national surveys Eliciting the data about conditions and environmental factors leading to accidents Making Police investigation of an accident mandatory 1 April 2018 26 Chengalpattu Medical College

27. 2.Safety education ‘ If Accident is a disease, Education is its vaccine ’ Initiated at the school level Educate regarding risk factors, traffic rules, safety precautions and first aid. 1 April 2018 27 Chengalpattu Medical College

28. 3.Promotion of safety measures Seat belts Safety helmets Safety measures for children Others like door locks, proper vehicle design ,air bags and so on 1 April 2018 28 Chengalpattu Medical College

29. 4.Alcohol and other drugs Abstinence from alcohol and depressant drugs before and during driving Barbiturates , amphetemines and Cannabis –impairs driving ability Education Law enforcement 1 April 2018 29 Chengalpattu Medical College

30. 5.Primary care Planning, organization and management of trauma and emergency care services improved At accident site -- Transportation-Hospital Skill of the Health Care Provider Accident Services Organization and one fully equipped specialised trauma care hospital in all major cities 1 April 2018 30 Chengalpattu Medical College

31. 6.Elimination of Causative factors Improve roads Impose speed limits Mixed Traffic Bad weather Mark danger zones Improve the Vehicle Conditions Drunk and drive Lack of body protection 1 April 2018 31 Chengalpattu Medical College

32. 7.Enforcement of laws Driving tests Medical fitness to drive Speed limits Compulsory wearing of seat belts Compulsory wearing of helmets Checking for blood alcohol concentration Road side breath analyzer, Regular and periodic inspection of vehicles, Periodic examination of drivers above the age of 55 yrs . 1 April 2018 32 Chengalpattu Medical College

33. 8.Rehabilitation services Medical rehabilitation Social rehabilitation Occupational rehabilitation 1 April 2018 33 Chengalpattu Medical College

34. 9.Accident research New field called Accidentology 1.Gathering information about Type, extent & characteristics of accident 2.Corelating accidents with personal and environmental factors 3.Devising measures to alter human behaviour make environment safe accident control measures 1 April 2018 34 Chengalpattu Medical College

35. Government Initiatives Multi-pronged road safety programmes and initiatives Mass awareness / education programmes , Engineering measures (both road and vehicle ), Enforcement of safety laws Emergency care to road accident victims . 1 April 2018 35 Chengalpattu Medical College

36. Recent Measures taken by MoRTH Road Engineering measures: 789 black spots identified of which 651 on NH and 138 on State roads. 140 spots already rectified. 283 under process. Road Safety Audits at different stages are integral part of BOT and EPC road projects. All road development projects have provision for essential road safety furniture: like road signs, markings, delineators etc. Crash barriers installed in hilly areas. 1 April 2018 36 Chengalpattu Medical College

37. Recent Measures taken by MoRTH (contd.) Vehicular safety standards and IT enabled safety measure Trucks prohibited from carrying protruding roads; Anti-locking Brake System (ABS) made mandatory on Heavy Vehicles. Cars to have provision for fitment of at-least one child seat. AHO (Automatic Headlight On) made mandatory for Two Wheelers. Bus and truck code for safe cabins for drivers and others. 1 April 2018 37 Chengalpattu Medical College

38. Recent Measures taken by MoRTH (contd.) Education and Awareness Ministry sanctioned 24 model institutes of drivers training and research (IDTR) for drivers. Of which 16 functional. Road Safety Week January 11 th to 17 th observed each year for mass awareness. To support traffic and transport rules. 1 April 2018 38 Chengalpattu Medical College

39. Recent Measures taken by MoRTH (contd.) Post-crash response and trauma care “Good Samaritans” guidelines accepted by Supreme Court – States/U.Ts requested to implement. NHAI provide ambulances at a distance of 50-60 kms on completed stretches of NH. MV Amemdment Bill 2017 provide stricter penalities for traffic offences for strengthening enforcement and ensuring compliance: 1 April 2018 39 Chengalpattu Medical College

40. The Motor Vehicles (Amendment) Bill 2017 Driving under the influence of alcohol  or drugs has been increased from ₹2,000 to ₹10,000 Rash driving , it has been increased from ₹1,000 to ₹5,000 . People found driving without a seat belt can be fined ₹1,000 Driving without a helmet is a fine of ₹1,000 along with a 3-month suspension of the offender’s driving licence. Cashless Treatment for Road Accident Victims within the first hour of its occurrence 1 April 2018 40 Chengalpattu Medical College

41. The Motor Vehicles (Amendment) Bill 2017 Talking with phone while driving – Rs.5000 Aadhar card made compulsary -for getting Driving license and vehicle registration Driving without a licence - Rs.5000 Over speeding – Rs.2000 Specially abled people- vehicle alteration mandatory 1 April 2018 41 Chengalpattu Medical College

42. The Motor Vehicles (Amendment) Bill 2017 Increased Compensation for The Family of the person died by - Hit and Run - ₹2 lakh or more    Inclusion of Good Samaritan Guidelines National Transportation Policy  Compulsory Insurance-  ₹10 lakh for deaths and ₹5 lakh for grevious injuries Recognition of Offences Committed by Juveniles 1 April 2018 42 Chengalpattu Medical College

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45. The Motor Vehicles (Amendment) Bill 2017 Automated Fitness Training for Vehicles - computer-monitored tests for PUC (pollution under control) certification, speedometer calibration, brake adjustment, suspension testing and wheel alignment. National Registry for Licenses and Registrations Electronic surveillance on national and state highways and urban roads.  1 April 2018 45 Chengalpattu Medical College

46. The Motor Vehicles (Amendment) Bill 2017 6 months time limit for application of compensation to the claims Time limit for renewal of driving liscence -1 month Manufacturers for sub standard components responsible Contractors, consultants and civic agencies responsibity in road accidents - faulty designs and poor maintainence 1 April 2018 46 Chengalpattu Medical College

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53. 4 E’s for Injury Prevention Education Envronmental modification Enforcement of Laws Engineering 1 April 2018 53 Chengalpattu Medical College

54. Seat Belt Importance 1 April 2018 54 Chengalpattu Medical College

55. I Pledge for Road Safety 1 April 2018 Chengalpattu Medical College 55

56. References 1.www.morth.nic.in 2.K.Park ,Park’s textbook of Preventive and Social Medicine, 24 th edition.Banarsidos Bhanot Publishers, (2017),423-427. 1 April 2018 Chengalpattu Medical College 56

57. Thank You 1 April 2018 57 Chengalpattu Medical College