Editorial
Head injury due to vehicular accidents V. P. Singh, A. K. Banerji Department of Neurosurgery, Indraprastha Apollo Hospital, New Delhi, India Address for correspondence: Dr. V. P. Singh, Indraprastha Apollo Hospital, New Delhi ‑ 110 076, India. E‑mail: [email protected] Received : 25‑12‑2014 Review completed : 27‑12‑2014 Accepted : 27‑12‑2014
India has acquired the dubious distinction of having the largest number of road traffic accidents in the world. In our country, the population driving a motorized vehicle is growing much faster than the rate of growth of the related infrastructure. The data compiled by the Ministry of Road Transport and Highways revealed that there were 4.97 lakh accidents in 2011 or one accident every minute.[1] This resulted in 1,42,485 deaths annually or one death every 3.7 minutes. Of the fatalities, 37.1% deaths took place on national highways, 27.4% on state highways, and 35.5% on other roads. Two‑thirds of the deaths on the highways involved vulnerable road users—32% pedestrians, 24% two‑wheeler riders, and 11% cyclists.[2] The data from a busy metro like Delhi reveals that 83% fatalities were vulnerable road users—52% pedestrians, 21% motorized two‑wheelers, and 10% cyclists.[2] Road traffic accidents most commonly affect young males in the age‑group of 15–29 years—people in the most productive phase of life. There is a tremendous economic loss both in terms of direct medical costs and indirectly in lost wages and productivity. Accidents account for a financial loss estimated at Rs. 55,000 crores per year for our country. A paper published in this issue of Neurology India is an excellent prospective study on a large number of patients (1545 patients) by Tripathi et al.[3] This study Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.149356
Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
evaluates the profile of head injured patients vis a vis safety measures undertaken by road users. It very convincingly proves the benefits of the use of crash helmets for two‑wheeler drivers and pillion riders. It also emphasizes the importance of using a good quality, full‑coverage helmet with the chin‑strap properly fastened. Surprisingly, the study did not find any benefit in the usage of seat belts or for avoiding alcohol immediately prior to driving. This is likely due to the small numbers recruited for these particular subsets of population in this study. The paper also does not discuss the most vulnerable road user in vehicular accidents, namely, the pedestrian and non‑motorized vehicles users. Besides the mentioned factors for road safety in this paper, a multi‑pronged national road safety plan is required to stem this epidemic. Road safety management There is a need to promote non–motorized transport systems like walking and cycling. This not only reduces traffic congestion but also has ancillary benefits of reducing air pollution and improving the standards of health through regular exercise. This strategy can be effective and safe only by separating these road users from motorized traffic. Thus, there is an essential need for enough pavements and cycle lanes. Jaywalking and the use of music earphones while walking needs to be discouraged. Another strategy is to reduce the number of vehicles on the roads by encouraging usage of public transport. This can only work if the public transport is safe, comfortable, accessible, and affordable. Safe roads Good metaled roads with adequate lighting and properly working traffic signals are essential to avoid accidents. 585
Singh and Banerji: Head injury due to vehicular accidents
The design, construction, and maintenance of roads have to be optimized. Meticulous monitoring of traffic patterns and accidents is necessary to institute remedial measures. Safe vehicles Safety features of vehicles go a long way in protecting the occupants in the event of an accident. Airbags have been proven to reduce the risk of serious injury. Even bonnet airbags are becoming available to save pedestrians from serious injury. Automatic emergency braking systems are available in cars (even in India) through continuous radar monitoring to prevent collision in the event that the driver is momentarily distracted. Systems are also available to monitor the alertness of the driver. Safe road users Safe driving practices are essential if mortality from accidents is to be reduced. Issuance of driving license should be only after a series of stringent tests. •
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•
•
• 586
Reduced speed of driving is an important contributor in saving lives. Highways with a central divider and provisions for segregation of motorized and non‑motorized traffic would allow for higher speed limits. Rural roads need lesser speed limits. Urban roads with a high concentration of pedestrians and cyclists should have limits not exceeding 50 km/hour. Introducing a 30 km/hour speed zone in residential areas in UK resulted in a 67% reduction in crashes.[4] Reducing drinking and driving: Driving after drinking increases the risk of a crash as well as the severity of injuries. Most adults have a definite impairment of their driving abilities with blood alcohol concentration (BAC) reaching 0.05 g/dl; and, at BAC of 0.1 g/dl, the chances of a crash increase five times.[4] India has a permissible BAC of 0.03 g/dl. The effect of drinking is augmented if there is a super‑added element of fatigue. Increasing helmet usage: This is a proven method of reducing injuries from crashes for motorcyclists who constitute an extremely vulnerable segment of road users. Use of an helmet reduces deaths from accidents by 40% and reduces serious injury by 70%.[5] Just wearing a helmet is not enough; it should be of a good quality (Indian Standards Institute approved), full face helmet with the chin strapped tightly to give optimal protection. Increasing seat belt usage: Serious injury can be mitigated with the usage of a seat belt for both front and back seat passengers. Wearing a seat belt reduces the risk of a fatal injury by up to 40–50% for a front seat passenger and upto 25–75% for a rear seat passenger.[6] Increasing child restraint usage: Child restraint systems protect infants from fatal injury by up to
•
•
70% and young children by more than 50%. They do not, however, come in standard sizes and, therefore, require customization. Reducing mobile phone usage: Using a mobile phone while driving increases by four‑folds, the chances of an accident.[7] The risk is the same for hand‑held and hands‑free phone usage. Texting messages are even more dangerous. Road rage: This phenomenon, seen increasingly in the metros, impairs judgment and contributes to accidents.
After crash care Good pre‑hospital care and early transportation to a hospital can help save lives. A good ambulance service is extremely beneficial. Health‑care providers, both in the pre‑hospital and in the emergency room setting, should be trained in basic and advanced life support systems. This is especially applicable to police control room (PCR) and public ambulance drivers and para‑medical personnel who are often the first to reach the site of the accident, carry out the preliminary triage, and help in transporting the victim. The development of multidisciplinary trauma centers all over the country will also help in improving outcomes. The government has initiated several programs to promote road safety practices in India. The multitude of agencies looking after various aspects of road safety are compounding the problem due to lack of co‑ordination among them. This is preventing proper implementation of the policies advocated by them. A National Road Safety Policy has been approved and a National Road Safety Council is being constituted. Tamil Nadu has taken the lead in starting a Road Accident Data Management System and this model has been accepted for replication throughout the country. Several laws are notified for road safety measures. The problem lies in their inadequate implementation and enforcement. Penal provisions for breaking the law should be stiff and rigorously enforced. The will to implement existing laws and educating the citizens about various measures to promote road safety are the needs of the hour. The Neurological Society of India has taken on itself the mandate to promote these activities as part of its social responsibilities.
References 1. Road Accidents in India: Issues and Dimensions. Ministry of Road Transport and Highways, Government of India. Available from: http:// www.unescap.org/sites/default/files/2.12.India_.pdf. 2. Murad B. Safety is no accident. The Auto Magazine 2004;05:44‑6. Available from: http://tripp.iitd.ernet.in/media/automagzine/no_ accident.pdf. 3. Tripathi M, Tewari MK, Mukherjee KK, Mathuriya SN. Profile of patients with head injury among vehicular accidents: An experience from a tertiary care centre of India. Neurology India– in print. 4. Global Status Report on Road Safety 2013: Supporting a decade of action. Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
Singh and Banerji: Head injury due to vehicular accidents
ISBN 978 92 4 156456 4 WHO Press, World Health Organisation, Switzerland 2013. Available from: http://www.who.int/violence_injury_ prevention/road_safety_status/2013/en/. 5. Liu B, Ivers R, Norton R, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2005. 6. Elvik R, Vaa T, editors. The Handbook of Road Safety Measures. Amsterdam: Elsevier Science; 2004. 7. Road traffic injuries: Fact sheet World Health Organization March
Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
2013. Available from: http://www.who.int/mediacentre/factsheets/ fs358/en/. How to cite this article: Singh V P, Banerji A K. Head injury due to vehicular accidents. Neurol India 2014;62:585-7. Source of Support: Nil, Conflict of Interest: None declared.
587
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Head injury due to vehicular accidents V. P. Singh, A. K. Banerji Department of Neurosurgery, Indraprastha Apollo Hospital, New Delhi, India Address for correspondence: Dr. V. P. Singh, Indraprastha Apollo Hospital, New Delhi ‑ 110 076, India. E‑mail: [email protected] Received : 25‑12‑2014 Review completed : 27‑12‑2014 Accepted : 27‑12‑2014
India has acquired the dubious distinction of having the largest number of road traffic accidents in the world. In our country, the population driving a motorized vehicle is growing much faster than the rate of growth of the related infrastructure. The data compiled by the Ministry of Road Transport and Highways revealed that there were 4.97 lakh accidents in 2011 or one accident every minute.[1] This resulted in 1,42,485 deaths annually or one death every 3.7 minutes. Of the fatalities, 37.1% deaths took place on national highways, 27.4% on state highways, and 35.5% on other roads. Two‑thirds of the deaths on the highways involved vulnerable road users—32% pedestrians, 24% two‑wheeler riders, and 11% cyclists.[2] The data from a busy metro like Delhi reveals that 83% fatalities were vulnerable road users—52% pedestrians, 21% motorized two‑wheelers, and 10% cyclists.[2] Road traffic accidents most commonly affect young males in the age‑group of 15–29 years—people in the most productive phase of life. There is a tremendous economic loss both in terms of direct medical costs and indirectly in lost wages and productivity. Accidents account for a financial loss estimated at Rs. 55,000 crores per year for our country. A paper published in this issue of Neurology India is an excellent prospective study on a large number of patients (1545 patients) by Tripathi et al.[3] This study Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.149356
Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
evaluates the profile of head injured patients vis a vis safety measures undertaken by road users. It very convincingly proves the benefits of the use of crash helmets for two‑wheeler drivers and pillion riders. It also emphasizes the importance of using a good quality, full‑coverage helmet with the chin‑strap properly fastened. Surprisingly, the study did not find any benefit in the usage of seat belts or for avoiding alcohol immediately prior to driving. This is likely due to the small numbers recruited for these particular subsets of population in this study. The paper also does not discuss the most vulnerable road user in vehicular accidents, namely, the pedestrian and non‑motorized vehicles users. Besides the mentioned factors for road safety in this paper, a multi‑pronged national road safety plan is required to stem this epidemic. Road safety management There is a need to promote non–motorized transport systems like walking and cycling. This not only reduces traffic congestion but also has ancillary benefits of reducing air pollution and improving the standards of health through regular exercise. This strategy can be effective and safe only by separating these road users from motorized traffic. Thus, there is an essential need for enough pavements and cycle lanes. Jaywalking and the use of music earphones while walking needs to be discouraged. Another strategy is to reduce the number of vehicles on the roads by encouraging usage of public transport. This can only work if the public transport is safe, comfortable, accessible, and affordable. Safe roads Good metaled roads with adequate lighting and properly working traffic signals are essential to avoid accidents. 585
Singh and Banerji: Head injury due to vehicular accidents
The design, construction, and maintenance of roads have to be optimized. Meticulous monitoring of traffic patterns and accidents is necessary to institute remedial measures. Safe vehicles Safety features of vehicles go a long way in protecting the occupants in the event of an accident. Airbags have been proven to reduce the risk of serious injury. Even bonnet airbags are becoming available to save pedestrians from serious injury. Automatic emergency braking systems are available in cars (even in India) through continuous radar monitoring to prevent collision in the event that the driver is momentarily distracted. Systems are also available to monitor the alertness of the driver. Safe road users Safe driving practices are essential if mortality from accidents is to be reduced. Issuance of driving license should be only after a series of stringent tests. •
•
•
•
• 586
Reduced speed of driving is an important contributor in saving lives. Highways with a central divider and provisions for segregation of motorized and non‑motorized traffic would allow for higher speed limits. Rural roads need lesser speed limits. Urban roads with a high concentration of pedestrians and cyclists should have limits not exceeding 50 km/hour. Introducing a 30 km/hour speed zone in residential areas in UK resulted in a 67% reduction in crashes.[4] Reducing drinking and driving: Driving after drinking increases the risk of a crash as well as the severity of injuries. Most adults have a definite impairment of their driving abilities with blood alcohol concentration (BAC) reaching 0.05 g/dl; and, at BAC of 0.1 g/dl, the chances of a crash increase five times.[4] India has a permissible BAC of 0.03 g/dl. The effect of drinking is augmented if there is a super‑added element of fatigue. Increasing helmet usage: This is a proven method of reducing injuries from crashes for motorcyclists who constitute an extremely vulnerable segment of road users. Use of an helmet reduces deaths from accidents by 40% and reduces serious injury by 70%.[5] Just wearing a helmet is not enough; it should be of a good quality (Indian Standards Institute approved), full face helmet with the chin strapped tightly to give optimal protection. Increasing seat belt usage: Serious injury can be mitigated with the usage of a seat belt for both front and back seat passengers. Wearing a seat belt reduces the risk of a fatal injury by up to 40–50% for a front seat passenger and upto 25–75% for a rear seat passenger.[6] Increasing child restraint usage: Child restraint systems protect infants from fatal injury by up to
•
•
70% and young children by more than 50%. They do not, however, come in standard sizes and, therefore, require customization. Reducing mobile phone usage: Using a mobile phone while driving increases by four‑folds, the chances of an accident.[7] The risk is the same for hand‑held and hands‑free phone usage. Texting messages are even more dangerous. Road rage: This phenomenon, seen increasingly in the metros, impairs judgment and contributes to accidents.
After crash care Good pre‑hospital care and early transportation to a hospital can help save lives. A good ambulance service is extremely beneficial. Health‑care providers, both in the pre‑hospital and in the emergency room setting, should be trained in basic and advanced life support systems. This is especially applicable to police control room (PCR) and public ambulance drivers and para‑medical personnel who are often the first to reach the site of the accident, carry out the preliminary triage, and help in transporting the victim. The development of multidisciplinary trauma centers all over the country will also help in improving outcomes. The government has initiated several programs to promote road safety practices in India. The multitude of agencies looking after various aspects of road safety are compounding the problem due to lack of co‑ordination among them. This is preventing proper implementation of the policies advocated by them. A National Road Safety Policy has been approved and a National Road Safety Council is being constituted. Tamil Nadu has taken the lead in starting a Road Accident Data Management System and this model has been accepted for replication throughout the country. Several laws are notified for road safety measures. The problem lies in their inadequate implementation and enforcement. Penal provisions for breaking the law should be stiff and rigorously enforced. The will to implement existing laws and educating the citizens about various measures to promote road safety are the needs of the hour. The Neurological Society of India has taken on itself the mandate to promote these activities as part of its social responsibilities.
References 1. Road Accidents in India: Issues and Dimensions. Ministry of Road Transport and Highways, Government of India. Available from: http:// www.unescap.org/sites/default/files/2.12.India_.pdf. 2. Murad B. Safety is no accident. The Auto Magazine 2004;05:44‑6. Available from: http://tripp.iitd.ernet.in/media/automagzine/no_ accident.pdf. 3. Tripathi M, Tewari MK, Mukherjee KK, Mathuriya SN. Profile of patients with head injury among vehicular accidents: An experience from a tertiary care centre of India. Neurology India– in print. 4. Global Status Report on Road Safety 2013: Supporting a decade of action. Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
Singh and Banerji: Head injury due to vehicular accidents
ISBN 978 92 4 156456 4 WHO Press, World Health Organisation, Switzerland 2013. Available from: http://www.who.int/violence_injury_ prevention/road_safety_status/2013/en/. 5. Liu B, Ivers R, Norton R, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2005. 6. Elvik R, Vaa T, editors. The Handbook of Road Safety Measures. Amsterdam: Elsevier Science; 2004. 7. Road traffic injuries: Fact sheet World Health Organization March
Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
2013. Available from: http://www.who.int/mediacentre/factsheets/ fs358/en/. How to cite this article: Singh V P, Banerji A K. Head injury due to vehicular accidents. Neurol India 2014;62:585-7. Source of Support: Nil, Conflict of Interest: None declared.
587
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
