Trauma care key to cut accident deaths

Delhi reported the highest number of fatal road crashes during 2017 with 1,584 deaths, according to the latest available data from the ministry of road transport and highways. In the same year, 6,673 accidents were reported from the city.

“The number of traffic deaths in Delhi is high because of the high number of road accidents. And, the infrastructure and the enforcement of traffic rules, along with the pre-hospital care systems, are to blame,” said Dr Sanjeev Bhoi, professor of emergency medicine at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences.

The AIIMS trauma centre, one of the two level 1 trauma centres in Delhi, receives around 200 to 250 cases daily, the highest in the city. Of these, over 70% are victims of road crash.

And, the numbers might be under-reported.

“These numbers are gathered from the police cases registered and are likely to be under-reported. Sometimes patients die days after the case is registered and this may not get updated in the records,” said Dr Rakhi Dandona, who heads the Global Burden of Disease –Road Injuries group for the State-level Disease Burden initiative.

At country level, the World Health Organisation’s Global Status Report on Road Safety 2018 estimated the number of traffic deaths to be 2,99,091 in 2016, which is nearly double the 1,50, 785 deaths reported in that year.

Most accident victims suffer from poly-trauma — injuries to more than one system of the body. But it is the head injury that leads to the highest mortality and disability.

“Of all the accident cases, almost 40% come in with severe head injuries. And, in such cases, even if the patient reaches hospital on time and receives the best care, 35% die within 48 hours.

Of those that survive, half are left in a vegetative state and the rest experience some sort of cognitive deficit depending on what part of the brain is affected. No one is left unscathed. Wearing a simple helmet can reduce the number of head injuries,” Dr Bhoi said.

Apart from head trauma, the second most fatal is excessive bleeding. “Around 30% accident victims come in a haemorrhagic shock caused by excessive bleeding. This can be prevented by using a tourniquet. Tying a piece of cloth tightly above the area that is bleeding can reduce the blood flow,” Dr Bhoi said.

The best way to reduce mortality is to reduce the number of accidents, the experts say. For this, there is a need to plan cities better and to improve road infrastructure.

“The first step is to ensure that there are no potholes, and there are appropriate speed breakers and signage. And, the authorities should be on the lookout for and fix black spots or areas where a lot of accidents are reported. The pavements need to be improved and the roads have to be made keeping in mind the pedestrians,” said Dr Nutan Mehta, head of the new emergency and trauma wing of Dr Ram Manohar Lohia hospital.

Then comes following speed limits taking safety measures such as wearing helmets and putting on seat belts.

A study at the AIIMS trauma centre found that only half of the two-wheeler users were wearing helmets, only 45% had fastened it properly, and only 38.5% were wearing a helmet approved as “crash proof” by the Bureau of Indian Standards.

Only 32.4% people used seat belts, showed another study from AIIMS. This is because of lax enforcement, which is the key to ensure safe driving practices.

“World over, there is enough evidence to suggest that awareness alone cannot ensure safe driving practices. There is a need for strict enforcement so that people face real consequences like licences being cancelled and actually not being able to drive after the licence is cancelled. But, we do not have enough manpower to ensure that all violators get punished,” Dr Dandona said.

Poor vehicular standards are also to blame. “Most of the commonly used cars in India do not adhere to the international safety standards. The New Car Assessment Programme (NCAP), which looks at how likely a driver or passenger is of surviving a crash, shows that there are only two or three cars that have a four-star rating, a norm strictly followed in the West,” Dr Bhoi said. And, even if there is a crash, to ensure that a person survives there is a need for a strong pre-hospital and hospital care.

“Currently, there aren’t enough trauma care hospitals in the country, which means valuable time is lost and the patient does not get appropriate care within the first “golden” hour of the crash when the chances of survival and minimum disability is the highest. The roads are such that it is also difficult for ambulance to reach an accident site and then take the patient to the hospital in time,” said Dr Dandona.

People walking on the roads and those driving two-wheelers have the highest risk of severe injury in road crashes. In India, 40% of all road crash deaths were reported in motorised two and three-wheeler riders and 10% in pedestrians.

“In India as in any developing countries, higher number of injuries and deaths are reported in two wheeler riders and pedestrians because of the traffic mix. We have high speed cars moving along with bikes, cycles and pedestrians on the roads. This is because missing or occupied pavements and cycles lanes and the attitude of the people as well,” Dr Dandona said.

Also, men outnumber women when it comes to road crashes.

A study of demographics of the victims of road crash in Delhi showed that 84% were men and just 16% were women. Besides, almost 50% of the victims belonged to the 16-30 age group.

“These are the groups that are more likely to travel for work. The way we have developed the infrastructure of the city, people have to travel long distances to get to work. There are commercial hubs and residential hubs in Delhi. Ideally, people should be working in their neighbourhood. If that were the case, 90% of the people would be off roads in the city,” said Dr Mehta of RML hospital.

People in a hurry also lead to a higher number of crashes. Of the 900 accident victims interviewed for a 2017 study, 54.2% reported that they were in a hurry to reach somewhere. The same study reported that 26.1% were having a
conversation with co-rider or on a cell phone. Drivers using mobile phones are 4 times more likely to be involved in a crash, according to the World Health Organisation.

First Published: Feb 25, 2019 01:26 IST