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By-Ramray Tudu

4th Year M.B.B.S,


S.C.B MCH,Cuttack
Global Scinerio Of Accident

Leading cause among 5.1 million global deaths due to injuries


and violence,2012 (source:park 24th edition)
Recent Scienerio:2018
Key Facts:-
• Approximately 1.35 millions people die in road traffic accident each
year worldwide.
• Road traffic accidents cost 3% of Gross Domestic Product of most of
countries.
• More than half of road traffic deaths are among vulnerable road
users-pedestrains,cyclists and motorcyclists.
• 93% of world’s fatalities occur in low and middle income
countries,even though they have 60% of world’s vehicles.
• Road traffic accidents are more amoung children and adults aged 5-
29.
Indian Scienario:-
• Reported road traffic fatalities (2016) -150 785 (85% M, 15% F)
• WHO estimated road traffic fatalities (2016)-299 091
• WHO estimated rate per 100 000 population (2016)-22.6
Who are at risk?
• Socioeconomic Status-low and middle
• Age-5-29yrs
• Sex-M>F::3:1(within age limit of 25 yrs)
• Medical Conditions-sudden illness,heart attack,impaired vision
• Fatigue
• Psycho-social factors-lack of experience,risk taking
behaviour,impulsiveness,defective and delay in judgement,agressiveness,poor
perception,family dysfunction
• Lack of body protection-helmets and seat belts
Risk Facters:-
Speed-
• Speed directly related to accident rate.Speed of vehicles should be
reduced below 30km/hr in residential and school zones.
• Pedestrains have 90% chance of surviving a car crush at a speed of
30km/hr,but <50% at a speed >= 45km/hr.
• Excess speed increases car emissions which ll lead to resp. problems.
Drink-driving-
• Driving under the influence of alcohol and psychoactive drugs
increases the accidents and case fatalities.
Continued...
• Risk of crash increases significantly above a BAC of 0.04g/dl
• Drugs like barbiturates,amphitamines and cannabis increases chance
of RTAs.
Non use of motorcycle helmets,seat belts and child
restrains:-
• Wearing a motorcycle helmet correctly can reduce risk of death by
almost 40% and risk of severe injury by over 70%.
• Helmet can effectively reduce head on collision in a crash.
• Seat belt wearing reduce risk of fatalities amoung front seat
passangers by 40-50% and of rear seat passangers by 25-75%.
Continued....
• Children remain seated in back seats of a vehicle to avoid
fatalites.Therefore some countries have introduced laws which
require that children of under 12-15 yrs in cars to be in the rear seats
only.
Distracted driving:-
• Mobile phone using while driving
• Text messaging
Unsafe road infrastuctures:-
Unsafe vehicles:-old and poorly maintaind vehicle.
Continued....
Inadequate post-crash care:-
• Delay in detecting and proving care
Inadequate law enforecement of traffic
• * Developing countries have a different environment anf mix of vehicles in
traffic stream
• Mixed traffic
• Old vehicles
• Low driving standards
• Overloaded buses
• Large no. of buses,motorcycles,scooters.
• Defective roads,poor street light,defective lay-out cross roads and speed breakers.
Prevention:-
1. Data collection-
• Basic reporting system of all accidents
• Integration of police records for preventive purposes
2. Safety education-
• Safety education must begin with school children.
• Drivers trained in proper maintenance of vehicles and safe driving.
• Young people need to be educated regarding risk factors,traffic rules and
safety precautions.
• They should be trained in first-aid.
3. Promotion of safety measures-
• Use of seat belts
Continued....
• Safety helmets use
• Children restrains
• Use of door lock,proper vehicle design,use of laminated high penitration
resistance wiindscreen
4. Alchol and other drugs
5. Primary care
• Planning,organisation and management of trauma treatment and emergency
care
• Emergency care should begin at accident site ,continued during
transportation and conclude in hospital emergency room.
(“Timeline Concept”)
Continued....
• Organisation of a trauma team consisting of doctors of emergency
department,anaesthetics,orthopedics and general
surgeons(nowadays hematologist and radiologists assist in primary
dignosis)
• Work according to”Code red trauma calls”
• Simultaneous and effective Advanced Trauma Life Support(ATLS)
should be started to avoid life threatening complications.
• Damage control orthopedics should be started as-
• Resuscitation
• Hemorrage control
Continued....
• Decompression
• Decontamination
• Fracture splintage
• Elimination of causative factors-
• Improvement of roads
• Imposition of speed limits
• Marking of danger points
• Enforcement of laws
• Rehabilitation services
• Medical
• Social
• Occupational
A WHO iniciative with SDG 3.6 and 11.2.(Save LIVES)

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