A road traffic accident (RTA) is any injury due to crashes originating from, terminating with or involving a vehicle partially or fully on a public road. It is projected that road traffic injuries will move up to the third position by the year 2020 among leading causes of the global disease burden. They are considerable economic losses to victims, their families, and to countries as a whole.
The Global status report on road safety 2013 indicates that worldwide the total number of road traffic deaths remain unacceptably high at 1.24 million per year. Road traffic injuries are the leading cause of death among young people, aged 15–29 years. Children, pedestrians, cyclists and older people are among the most vulnerable of road users constituting half of those dying on the world’s roads. Majority of the world's fatalities on the roads occur in low-income and middle-income countries, even though these countries have approximately half of the world's vehicles.
India is no exception and data showed that more than 1.3 lakh people died on Indian roads, giving India the dubious honour of topping the global list of fatalities from road crashes. Rapid urbanization, motorization, lack of appropriate road engineering, poor awareness levels, nonexistent injury prevention programmes, and poor enforcement of traffic laws has exacerbated the situation.
2. Risk Factors
Rather than mechanical, its human factor that contribute significantly to increasing number of road accidents in India. Drunken driving, over speeding, refusal to follow traffic rules, and reckless driving are main reasons for road accidents.
Drunken driving is one of the major causes of road traffic accidents especially among commercial vehicle drivers on highways. Data shows drunken driving to be responsible for 70% of road fatalities in Delhi and Mumbai. The risk of being involved in a crash increases significantly above a blood alcohol concentration (BAC) of 0.04 g/dl.
Over speeding increases the probability of fatal injuries for car occupants from near zero to almost 100% as the change of speed during the impact increases from 20 kilometers per hour to 100 kilometers per hour. Pedestrians have a 90% chance of surviving car crashes at 30 kilometers per hour or below, but a less than 50% chance of surviving impacts at 45 kilometers per hour or above.
Reckless driving like use of mobile phones during driving, non-use of helmets, non-use of seat-belts are significant contributing factors for road traffic accidents and should be avoided. Driver fatigue and sleepiness also contribute to crashes. Improper designing of roads and lack of pedestrian pavement are other contributing factors. Only 28 countries have comprehensive road safety laws on major key risk factors like drunken driving, speeding, and failing to use helmets, seat-belts, and child restraints. This is a major cause of concern and both society and government should work together to reduce this preventable cause of death.
3. Preventive Measures
RTAs are amenable to prevention strategies.
Helmets for two-wheeler riders: Setting and enforcing mandatory helmet use is an effective intervention for reducing injuries and fatalities among two-wheeler users. Wearing a helmet decreases the risk and severity of injuries by about 72% and likelihood of death by 39% as per WHO road safety manual on use of helmets.
Seat-belts and child restraints: It should be mandatory to wear seatbelts both for the front and rear occupants of the car. Wearing a seat-belt reduces the risk of a fatality among front-seat passengers by 40–50% and of rear-seat passengers by between 25–75%. Children of any age should not be seated in the front seat and should have child restraints. The latter is also effective in reducing injuries that can occur during non-crash events, such as a sudden stop, a swerving evasive manoeuvre or a door opening during vehicle movement.
Setting and enforcing speed limits: Pedestrians have a 90% chance of survival if hit by a car travelling at a speed of 30km/h or below, but less than a 50% chance of surviving an impact of 45km/h or above. Speed-monitoring cameras and radars and speed-limiting governors in vehicles are useful devices in enforcing the speed limit.
Setting and enforcing alcohol limits: Drinking and driving is one of the main causes of road crashes worldwide. Laws that establish blood alcohol concentration (BAC) of 0.05g/dl or below are effective at reducing the number of alcohol-related crashes.
Banning drivers from using hand-held mobile phones: Drivers using a mobile phone are approximately four times more likely to be involved in a crash than when a driver does not use a phone.
Road Safety: The central and the state governments have been implementing measures to make our roads safer. But the magnitude and gravity of the problem is such that these alone will not suffice. There is a need for the society at large to take cognizance of the issue and to join hands to make road safety a social movement. To give all the stakeholders an opportunity to take part in concerted action for the cause, “Road Safety Week” is observed throughout the country every year in the month of January. The theme of Road Safety Week in the year 2014 was “When on the road, always say, “Pehle Aap”. The theme of Road Safety Week for 2015 is “ Build a safety culture for sustainable supply chain” The link of National Road Safety Policy is given below.
Road Safety and Transport Bill, 2014: The Government has proposed a new Road Safety and Transport Bill, 2014, making the penalties more stringent, with an obvious aim to curb traffic violations. Its vision is to provide a framework for safer, faster, cost effective and inclusive movement of passengers and freight in the country. A draft for the proposed new Act to replace the existing road safety legislative framework is placed on the official website of the Ministry of Road Transport and Highways seeking feedback from the public and stakeholders.
4. Management of Accident Victims
The term "golden hour" is commonly used to characterize the urgent need for the care of trauma patients. This term implies that morbidity and mortality are affected if care is not instituted within the first hour after injury. If proper first aid is given, road accident victims have a greater chance of survival and a reduction in the severity of their injuries.
There is a relative ignorance on part of public to come forward to help the road crash victims, for the apparent fear that they might be involved in police case. The Hon’ble Supreme Court in the case of Pt. Parmanand Katara vs. Union of India has also stressed that the victims of road crashes need to be provided medical aid in the first instance and thereafter, the procedural laws could operate.
“Every injured citizen brought for medical treatment should instantaneously be given medical aid to preserve life and thereafter the procedural criminal law should be allowed to operate in order to avoid negligent death. There is no legal impediment for a medical professional when he is called upon or requested to attend to an injured person needing his medical assistance immediately. The effort to save the person should be the top priority not only of the medical professional but even of the police or any other citizen who happens to be connected with that matter or who happens to notice such an incident or a situation.
“There are no provisions in the Indian Penal Code, Criminal Procedure Code, Motor Vehicles Act, which prevents doctors from promptly attending to serious injured persons and accident cases before arrival of the police and their taking into cognizance of such cases, preparation of F.I.R. and other formalities by Police.”
Following the Supreme Court order in 1989, the Motor Vehicles Act was amended in 1994, to make it mandatory on both the driver/owner of the vehicle to take the accident victim to the nearest doctor, and the doctor to treat the victim without waiting for any formalities. This makes the duty of the driver mandatory by law and failure to comply is punishable under Section 187 of the Motor Vehicles Act 1988.
Every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. No law or State action can intervene to avoid / delay the discharge of the paramount obligation cast upon members of the medical profession. The obligation being total, absolute and paramount, laws of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way.
The treatment of the patient should not wait for the arrival of the police or completion of legal formalities. All hospitals and doctors are required to provide immediate medical aid to all the cases, whether medico-legal or not.
Police authorities in Delhi have instructed that the members of the public, who rendered voluntary help to persons injured in accidents, should not unnecessarily be questioned and detained at police stations. Those who bring accident victims to hospitals are to be treated with utmost courtesy and should not be harassed in any way. Even if they are unwilling to give their particulars, the same should not be insisted upon. Delhi Administration circular also instructs that the local police should pay the transportation expenses (upto Rs 100) to the public man who brings the victim to the hospital. Government of India has instructed all the Director General of Police of all States/UT to follow action on Delhi Police lines.
The content of this module has been validated by Dr Satendra Singh, University College of Medical Sciences, Shahdara, Delhi on 15/10/2014