One of the most important but neglected cause of morbidity and mortality among young population.

1. Epidemiology of Road Traffic
Accidents
Dr. Vikash R Keshri

2. Road Traffic Accidents
Definitions
Introduction & Problem Statements
Agent factor
Host factor
Environmental Factor
Impact of RTA
Prevention of RTA
Specific Intervention for

3. Definitions:
“ An unexpected Unplanned Occurrence
which may involve injury”
“ An unpredictable event resulting in
recognizable damage”
“ Occurrence in a sequence of events
which usually produces unintended
Injury, death or Property damage”

4. Some Key Facts…….
• A Global Problem
– Over 90% of the deaths on the roads occur in low-income
and middle-income countries,.
– Constitutes only 48% of the world’s registered vehicles.
• High proportion of vulnerable road users
– Pedestrians, cyclists, and riders of motorized two-
wheelers and their passengers (collectively known as
"vulnerable road users") account around 46% of global
road traffic deaths. Greater in low-income countries.
• Speed
– Speed Control an important way to reduce road traffic
injuries.

5. Some Key Facts……
• Drinking and Driving
– Drinking and driving increases the risk of a crash,.
– WHO recommends a blood alcohol concentration limit of
0.05 gram per deciliter (g/dl) for adult drivers.
– Less than half of countries worldwide have drink–driving
laws set at this limit.
• Helmet use
– Wearing good-quality helmet can reduce the risk of death
from a road crash by almost 40% and the risk of severe
injury by over 70%.
– Only 40% of countries have motorcycle helmet laws that
cover both riders and passengers, and mandate quality
standards for helmets.

6. Some Key Facts………
• Seat-belt use
– Reduces the risk of death among front-seat
passengers by 40-65%
– can reduce deaths among rear-seat car
occupants by 25-75%.
• Child restraint use
– The use of child restraints (infant seats, child
seats and booster seats) can reduce deaths of
children by between 54% and 80% in the event
of a crash.

7. Some Key Facts
• Pre-hospital care
– Prompt, good-quality pre-hospital care can save
many people.
– About 76% of countries have pre-hospital care
systems.
• The potential for progress
– Road traffic injuries can be prevented. A number of
countries, mainly high-income countries, have
made significant progress over the last few
decades in reducing their road traffic death rates.
But more can be done to reduce these rates
further.
• Now is the time to act:

8. The leading cause of death
of young people aged
15-29 years
Some More Facts

9. Leading cause of death by age

10. Leading cause of death 2004 and 2030

11. Leading cause of Burden of Disease:
2004 and 2030

12. Indian Scenario:
Source: Govt. of India, Ministry of Road Transport, Road Accidents
in India 2010.

13. Govt. of India, Ministry of Road Transport, Road Accidents in India 2010.

14. India: Injury & Death due to RTA

15. India: Situation in Indian states

16. No. of persons killed in Indian states (2010)

17. RTA Injury by type of vehicles
Govt. of India, Ministry of Road Transport, Road Accidents in India 2010.

18. RTA Deaths by type of Vehicles

19. RTA: Epidemiological Triad
Agent:
Vehicles
Environment:
Physical
status of
Road
Social context
Host:
Individual at
Risk

20. Causative factors:
Human Factors:
Over speeding
Over taking
Not wearing Helmet
Drunken Driving
Sudden Road Crossing
Vehicular Factors
Poor safety features
Faulty Design
Poor condition
Poor Visibility
Loss of Balance
Brake Failure
Problem with Head or Tail
Light
Overloaded Vehicles
Environmental Factors
Absence of reliable
public transport system
Poorly designed Roads
Poor Lighting
Obstacles on Road
Absence of traffic
system
Lack of pedestrian
footpath

21. Other Risk factors:
• 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
• Risk factors influencing crash
involvement:
– Speed
– Pedestrians and cyclists
– Young drivers and riders
– Alcohol
– Medicinal and recreational drugs
– Driver fatigue
– Hand-held mobile telephones

22. Other Risk Factors:
• 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
• Risk factors influencing post-crash
injury outcome:
– Pre-hospital factors
– Hospital care factors

23. When , Who & Where are affected ?

24. Who ?

25. Where ?

26. Pattern of Death due to trauma
•Road Deaths Occur in 3 Peaks :
• Early death (within Minutes) - Primary Prevention
• Intermediate Deaths (within 1 or 2 Days) –
Secondary
Prevention
• Late Death ( Over Days or Weeks) – Tertiary
Prevention

27. Prevention:
Primary
Prevention:
Road
Vehicle
People
System
Secondary
Prevention:
Pre trauma
care
Acute
emergency
trauma care
system
Tertiary
Prevention:
Hospital Care
Rehabilitation

28. The Haddon matrix for RTA
Phase Nature of
Interventio
n
Factors
Human Vehicles &
Equipment
Environment
Pre –
Crash
Crash
Prevention
Information
Attitude
Impairment
Police
Enforcement
Road Worthiness
Lighting
Braking
Handling
Speed
Management
Road Design
Road Layout
Speed limit
Pedestrian
Facility
Crash
Injury
Prevention
during crash
Use of
Restraint
Impairment
Occupant
Restraints
Other Safety
devices
Crash protective
Design
Forgiving
Roadsides
( i.e. Crash
Barriers)
Post Crash Life Sustaining First Aid
Skills
Access to
Ease of Access
Fire Risk
Rescue
Facilities

29. System Approach:

30. Specific Interventions for Road Safety
• Education
• Drinking & Driving
• Helmet
• Seat Belt
• Speed Management
• Trauma Care

31. Education:
• Principles
– Informed People will take necessary action to reduce the
risk.
– Educating people decreases the activity that result in
injuries, and
– The educator has the means available to provide
information and build skills and bring changes related to
emotions and values
• Approaches:
– Banner, Posters and Slogans
– General Education Programmes
– Training programmes
– Campaign
– Driver Education Programme
– School Health Education

32. Drinking and Driving:
Source 1: Crompton RP et al. Crash risk of alcohol-impaired driving.

33. Indian Law:
• Central Motor Vehicle Act 1988 Section 185:
Driving by a drunken person or by a person under the
influence of drugs. Whoever, while driving, or attempting to
drive, a motor vehicle,-
a) Has, in his blood, alcohol exceeding 30 mg. per 100
ml. of blood detected in a test by a breathalyzer, or
b) Is under this influence of a drug to such an extent as
to be incapable of exercising proper control over the
vehicle,
• Punishment for the first offence:
– Imprisonment for a term up to to six months, or with
– fine up to two 2000 Rs., or with both;
• for a second or subsequent offence, if committed
within three years of the commission of the previous
similar offence:

34. Focus Target for drink drive laws:
– Males in 18 - 45 years,
– Teenage drivers,
– Two wheeler - car - heavy vehicle drivers,
– Those driving during 8 p.m. - 12 midnight, and in
– Peripheral, outer city areas and on highways.
But the enforcement has to
be:
• People friendly,
• Non harassing
• Uniform across geographical areas,
• Visible in nature ,
• Random
• Sustained continuously and
• Scientific in implementation.

35. Helmets:
• As per WHO,
"wearing a helmet is the single most effective way
of reducing head injuries and fatalities resulting
from motorcycle crashes”.
• Helmet primarily reduces the impact of the
collision and consequent injury to the brain
– Act as mechanical barrier between skull and
the impacting object.
– Reduces deceleration of the skull and brain
movement.
– Providing cushioning effect.
– Spreading the force of the impact to a larger
area.

36. Helmet: Some practical Tips
• Tips for proper helmet usage:
 Comfortable and standard helmet
 Always use a helmet while riding
 Encourage your pillion to use a helmet
 A bright colored helmet increases your
visibility on the road
 Always strap the helmet to keep it on the
head in the event of a crash
 Use a full-face helmet for maximum
protection

37. Legislation and Enforcement
• Indian Motor Vehicles Act has included
compulsory use of helmets under its legal
provisions.
• Make clear and strong Legislation uniformly
• Educate people about the existing law
• Involve peer groups for enforcement of
legislation.
• Enforce law practically

38. Seat Belt:
• According to the National Highway Traffic
Safety Administration (NHTSA),
– Seat belts reduce the risk of fatal injury to
front-seat passenger car occupants by
45% and the risk of injury by 50%.
– For light truck occupants, seat belts
reduce the risk of fatal injury by 60% and
injury by 65%
• Car population increasing
• Important to make car occupants safer.
• The Central Motor Vehicles rules, 1989 as
amended by The Central Motor Vehicles
(first amendment) rules 2003 deals with
seat belt use
• Enforcement has equal importance.
• Increase usage of seatbelts by enforcing
the law along with public education

39. Speed Management:
• Excessive and inappropriate speed has been recognized
as one of the major contributing factors for increasing
road crashes.

40. Trauma Care
• Place of Death for RTA:
• Only 28% of deaths and 48% of injured received
some first aid. Hospital was the first center for
provision of first aid.
• 1% of road traffic injuries were provided care at
injury site

41. Conclusion:
Road safety; shared Societal Responsibility
GOVERNMENT, PUBLIC
HEALTH, PUBLIC
WORKS & LEGISLATIVE
BODIES
MEDIA
PROFESSIONALS
NGOs, SPECIAL
INTEREST GROUPSPOLICE
INDUSTRY
USERS / CITIZENS
ROAD INJURY
PREVENTION
POLICY

42. Road Traffic Accidents: Public Health Issue
Public
Health
Injury Surveillance
Research
Prevention &
Control
Evaluation
Policy
Services
Advocacy