Post on 01-Aug-2020
ROAD TRAFFIC InjuRY AnD TRAuMA CARE: InnOVATIOnS
FOR POLICY (ROAD TRIP)
Report of the Road Traffic Injury and Trauma Care Working Group
Professor Adnan A Hyder with Dr Prasanthi Puvanachandra
and Katharine A Allen
ROAD TRAFFIC InjuRY
3 WISH Road Traffic Injury Report 2013
WISH Road Traffic Injury Report 2013
ROAD TRAFFIC InjuRY AnD TRAuMA CARE: InnOVATIOnS
FOR POLICY (ROAD TRIP)
Report of the Road Traffic Injury and Trauma Care Working Group
Professor Adnan A Hyder with Dr Prasanthi Puvanachandra
and Katharine A Allen
ROAD TRAFFIC InjuRY
5 WISH Road Traffic Injury Report 2013
COnTEnTS
1 Foreword2 Executive Summary4 Background7 JustificationforthisReport10 GoalofthisReport11 Methodology11 FrameworkforRoadSafetyInnovations15 SummaryoftheLiteratureReview16 InnovationsinRoadSafetyandTraumaCare37 TheDevelopmentChallenge38 PolicyRecommendations43 Acknowledgments44 References
ProfessorTheLordDarzi
Professor Adnan A Hyder
1WISH Road Traffic Injury Report 2013
FOREWORDOveramillionpeopledieeachyear–theequivalentofajumbojetcrashingeveryday–fromroadtrafficinjuriesaroundtheworld.Millionsofpeoplebecomeinjuredordisabledasaresultoftheseinjuries,whilemanymoresuffertheimpoverishingeconomicandsocialimpactbothintheshortandthelongterm.Alargemajorityofthesedeathsanddisabilitiesoccurinlow-andmiddle-incomecountriesorintherapidlydevelopingeconomiesoftheMiddleEast.Andyettheworldhasnotgivenenough attention, policy support, and dedicated investment for stemming andcontrollingthis“epidemic.”
Roadtrafficinjuriesarebothpredictableandpreventable,andthatmakesthecasefor urgent attention. The science of injury prevention has identified specific riskfactors–suchasspeed,alcohol,andlackofhelmetsandseatbelts–thatincreasetheriskofacrashorinjury.Effectiveinterventionsareavailableformanyoftheserisks,buttheyneedtobeimplemented.Therearenewriskstoo–suchastheuseofcellphonesandtexting–thatchallengeustodevelopnew,appropriateinterventions.
Atthesametime,medicalbreakthroughsandclinicaladvanceshaveenabledustocarefortheinjuredanddisabled.Traumacareisacriticalelementinmanagingroadinjuries,andemergencymedicalsystemsplayakeyroleinsavinglives.However,manyhealthsystemshave ignored thedevelopmentofacutecareservices,andinmanypartsoftheworld,pre-hospitalcareiseithernon-existentorembryonic.Clearly, there is a serious need for innovation and change in developing healthsystemsforthefuture.
TheWorldInnovationSummitforHealth(WISH)hasprovidedamajoropportunityforprofilingthehealth,social,andeconomicimpactofroadinjuries,andtheinnovationsthatcanhelpineasingthisburden.Creativethinkingandevidence-basedsolutionsarethekeytothefuture,andouramazinggroupof thought leaders intheWISHForumforRoadTrafficInjuryandTraumaCarehavecollatedafantasticresourceinthispaper.Wehopethatitwillstimulatetheglobalhealthcommunity–policy-makers,funders,andactivists–toadopttheavailableinnovationsinaddressingthechallengeofroadtrafficinjuries.Itistimetomakeinnovationswork.
Professor The Lord Darzi, PC, KBE, FRSExecutiveChairofWISH,QatarFoundationDirectorofInstituteofGlobalHealthInnovation,ImperialCollegeLondon
Adnan A Hyder, MD MPH PhDChairoftheForumProfessor,DepartmentofInternationalHealth,JohnsHopkinsBloombergSchoolofPublicHealth
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ExECuTIVE SuMMARY Roadtrafficinjuries(RTIs)aretheeighthleadingcauseofdeathglobally,andtheleadingcauseofdeathforyoungpeopleaged15-29.Theglobalcostofdealingwiththeconsequencesofthesecrashes–includingtraumacare–runsintobillionsofdollars.1Whilemuchhasbeendone,therealityremainsthatoveramillionpeopledieeachyearfromroadtrafficcrashes,whilemanymoreareinjured.Thisunacceptablesituationrepresentsamajorcalltoactionfortheglobalhealthcommunity.
The overall goal of this report is to identify the best available evidence, goodpractices,andpromising innovations thatareemergingaroundtheworldonRTIpreventionandtraumacare,andtosynthesizethisknowledgeintopracticalpolicyrecommendationsfordecision-makers.WeproposeauniqueanalyticalframeworktoassessthecurrentspectrumofavailableinnovationstoaddressRTIsandtraumacare,andtocontextualizetheworkthatneedstobeundertakentomovethefieldforward.
In identifying the relevant key innovations, by highlighting best practices andpresentingarangeofcasestudiesfromaroundtheworld,thisreporttakesaglobalandmulti-sectoralperspective,withsensitivitytothoseregionsoftheworldthatfacespecificsocial,economic,andfinancialchallenges.Theintentisnotonlytobeconciseandpracticalbutalsotobeboldandprovocative,especiallyinthoseareasrequiringimmediateactionorurgentre-toolingofapproaches.
ItisclearthatthefieldofRTIpreventionandtraumacareisripeforabreakthrough.Suchachangeisneedednotonlytodrive,butalsotosustainthedevelopmentofinnovationsthatcansuccessfullyreducetheheavyburdenofRTIsandroaddeaths.Webelievethatallstakeholdersinroadsafetyandtraumacareacrosshealthandalliedsectorshaveakeyroletoplayindevelopinganddiffusinginnovativesolutionsand supporting their effective implementation. This report concludes by puttingforwardtenrecommendationsthatwehopewillbetakenupbydecision-makers.
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KEY RECOMMEnDATIOnS OF ThE REPORT1. Weurgepolicy-makersandnon-governmentalorganizationsto
understand and use road safety data and disseminate it to their populations.
2. Weurgedonors,governments,andtheprivatesectortoinvest inresearchanddevelopmentforroadsafetyandtraumacare.
3. Weurgegovernmentstoensurethattheyadoptandimplementtherecommendationsofthe2004WorldReportonRoadTrafficInjuriesPrevention.
4. Weurgeallstakeholderstoadopttheprincipleofpromotingandusingevidence-basedinnovationsforroadsafetyandtraumacaresystems.
5. Weurgeallsectors,especiallynon-governmentalorganizations,academia,andcivilsociety,topromoteglobaldiffusionofroadsafetyandtraumacareinnovationsusingtraditionalandnewtechnologies.
6. WeurgegovernmentstoadoptandimplementthestrategiesintheUNDecadeofAction’sGlobalPlanfor2011-2020.
7. WeurgeglobalhealthleadersandtheUNagenciestoensure theincorporationofroadsafetyandtraumacareasakeyconcern forsustainableglobalhealthanddevelopmentgoals.
8. Weurgecivilsociety,victimgroups,andnon-governmentalorganizationstobeeffectiveadvocates,andengenderastrongdemandforroadsafetyandtraumacareinpopulationsaround theworld.
9. Weurgeallstakeholders,especiallyacademiaandresearchers,towidelyshareevidence-basedsuccessesandmodelsforbestpracticesinroadsafetyandtraumacare.
10.Weurgeallstakeholders,especiallygovernmentsanddonors, toensurethatcapacitydevelopmentisintegratedinallroadsafetyandtraumacareefforts.
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22%5%
23%
BACKgROunDGLoBAL BuRDEn oF RoAD TRAFFIC InjuRIES AnD ovERvIEW oF RISK FACToRS
Currently,more than1.2millionpeople each year are killed in road traffic crashesaroundtheworld,whileanadditional20to50millionareinjuredbythem.2 According totheGlobalBurdenofDiseaseStudy2010,roadtrafficinjuries(RTIs)wereresponsibleforoverathirdoftheworldinjuryburden,andresultedinthelossof76millionDisability-AdjustedLifeYears(DALYs).3ThatrepresentedasubstantialincreaseintheburdenofRTIssince1990,whenRTIswereresponsiblefor57millionDALYs.3 IfnosignificantactionistakentocurbRTIs,thisburdenispredictedtorise,andby2020anestimated1.9millionpeoplewilllosetheirlivesannuallytoroadtrafficcrashes.4
Figure 1: Road traffic deaths and registered motorized vehicles by country income status Source:WHOGlobalStatusReport2013
This growing burden falls disproportionately on developing countries, on theyoung,andonvulnerableroadusers.Low-andmiddle-incomecountries(LMICs)experience80percentofallroadtrafficfatalities,thoughtheyhaveonly52percentoftheworld’sregisteredvehicles(seeFigure1).2Over75percentofallthosekilledinroadtrafficcrashesaremale.2About59percentareyoungadultsaged15-44.2 Andabout50percentarevulnerableroadusers–notably,pedestrians,cyclists,andmotorcyclists(Figure2).2OwinginparttothisburdenofRTIsoneconomically-activeyoungindividuals,roadtrafficcrashesandRTIsareestimatedtocostmostcountries1-3percentoftheirgrossnationalproducts.4
Figure 2: Road traffic deaths in vulnerable road users Source:2013GlobalStatusReportonRoadSafety
Deaths
Middle 80%
High 8%
Low 12%
High 47%
Middle 52%
Low 1%
vehicles
of all road traffic deaths are among pedestrians, cyclists, and motorcyclists.50%
5WISH Road Traffic Injury Report 2013
RISK FACToRS ASSoCIATED WITH RTIs
ThemajorityofRTIsandroadtrafficdeathsarepreventable.Speedingremainsamajorriskforcrashes:studieshavefoundthatwithevery1km/hdecreaseinspeed,theriskofacrashdecreasesby2–3percent.5Accordingly,thesettingandenforcingofsafespeedlimitshasprovedtobeahighlyeffectiveroadsafetyintervention.5Theuseofseatbeltsreducestheriskofdeathforfront-seatpassengersbyanestimated50percent,whileproperlyusedchildrestraintscanreducedeathsamonginfantsbyanestimated70percent.6Formotorcyclists,theuseofhelmetsreducestheriskofdeathbyabout40percent,andofsevereinjurybyover70percent.7Toreducealcohol-related crashes, laws specifying a blood alcohol concentration (BAC) of 0.05g/dlorbelowhaveprovedeffective.8
So,bymandatingandenforcingseatbelts, child restraints,andhelmets,andbylimiting speed and alcohol levels, governments can dramatically reduce RTIs. Yetonly28countries,representing7percentof theworld’spopulation,currentlyhavelawsthatcoverallfiveoftheseriskfactors(Figure3).9
Figure 3: “Comprehensive” legislation on five key road safety risk factors since 2008Source:GlobalStatusReport2013,WHO
Therearefurtherriskfactorstoo–poorroadinfrastructure,lackoftraumacare,complex changes in transportation patterns, lack of enforcement, and rapidmotorizationamongothers–thatcreateahigh-incidenceenvironmentforRTIs.ThisshortfallhighlightstheneedforfurtheractiontocombatthegrowingepidemicofRTIsanddeaths.
DECADE FoR ACTIon
In2004,theWorldReportonRoadTrafficInjuryPreventionwaspublished,presentingvaluable informationabout thecauses, risks,and interventions related toRTIs.10 ItwasahallmarkreportandgreatlyincreasedawarenessofRTIsasamajorhealth
Speed Drink-driving
Helmets Seatbelts Childrestraints
Allfive risk factors
Percentage(%
)ofw
orld’spopulation
40
10
50
20
60
80
30
70
90
0
2008 2011
6 WISH Road Traffic Injury Report 2013
burdenontheglobalcommunity.Sincethen,thepoliticalmomentumforroadsafetyhasgatheredstrength,with theUNGeneralAssemblyproclaiming2011-2020astheDecadeofActionforRoadSafety.4, 11TheoverallgoaloftheDecadeofActionis tostabilizeand thenhalve the levelof road traffic fatalitiesaround theworld. Ifsuccessful,anestimated50percentreductioncouldavoidfivemillionfatalitiesand50millionnon-fatalinjuries,andsaveUS$3trillioninsocialcosts(Figure4).
Figure 4: Goal of the Decade of Action for Road Safety 2011-2020 Source:CommissionforGlobalRoadSafety
TheUNRoadSafety Collaboration (UNRSC) developed the ‘Plan for theDecade’,whichhasfivemainpillarsofaction:buildingroadsafetymanagementcapacity,improving the safety of road infrastructure and broader transport networks,further developing the safety of vehicles, enhancing the behavior of road users,and improvingpost-crashcare. Inconsultationwithkeystakeholdersaroundtheworld,thePlanidentifieskeycapacity-buildingandinjury-preventionmeasuresforeachofthefivepillars.Fordetailsofalltherecommendedactivities,seethereportby theCommission forGlobalRoadSafety, “Make Roads Safe – Time for Action.”12 www.makeroadssafe.org/publications/Documents/mrs_iii_report_lr.pdf
Thefivepillarsarebasedonthe‘SafeSystems’approachtoroadinjuryprevention–anapproachthattreatstheuser,vehicle,androadasaninteractivesystem.Thekeyideaisthathumanerrorshouldbetoleratedinaforgivingsystemthathasbeendesignedtopreventcrashesandreducetheriskofinjury.Thisrepresentsanewperformancefrontierinroadsafetymanagement,andrequiresthedevelopingandstrengtheningofacountry’sinstitutionalmanagementcapacityinordertoachievetheambitioustargetofzerodeathsandseriousinjuries.
BuildingonthemomentumoftheDecadeofAction,the2012‘Rio+20UNConferenceonSustainableDevelopment’ recognized thewider impacts that roadsafetyhas ontheenvironmentalanddevelopmentalobjectivesoftheSustainableDevelopmentGoals (SDGs). A recent report by the Commission for Global Road Safety, Safe Roads for All: a post-2015 agenda for health and development, calls for road safety
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Numbero
fdeaths(millions)
0.8
0.2
1.0
0.4
1.2
1.6
0.6
1.4
2.0
1.8
0
5 million lives saved
Projectedreductionifactiontaken
Projectedincreasewithoutaction
7WISH Road Traffic Injury Report 2013
tobeincludedinthepost-2015SDGsframework,alongsideinternationaleffortstoimproveglobalhealth,combatclimatechange,andtackle inequalityandpoverty.Specifically,theframeworkpromotesa50percentreductioninroadtrafficfatalitiesby2030,asmeasuredbytheGlobalStatusReportcompiledbytheWorldHealthOrganization(WHO).2
juSTIFICATIOn FOR ThIS REPORTTheneedforaglobalreportsuchasthisisbasedoneightkeychallengesdescribedbelow:
1. ConFRonTInG THE PERSISTEnT BuRDEn oF RoAD InjuRIES
TheWHOGlobalStatusReportreveals that88countriesmanagedtoreduce thenumberofdeathsontheirroadsbetween2007and2010.However,87countriessawanincreaseinroaddeathsoverthesameperiod.2ForLMICs,thechallengeistoavoidthesamehighfatalityandinjuryratesthathigh-incomecountries(HICs)experienced,andtoshifttowardsaSafeSystemsapproach–onethatrefusestoaccept that RTIs are an inevitable consequence of economic advancement.13,14 ForHICs, thechallenge is toshift towardsa “VisionZero,”wherenoroad trafficdeathsareaccepted.Thisshiftwillrequireinnovativethinking,goingbeyondknowneffectiveinterventionsinordertoachievethehighestsafetystandardspossible.
2. RoLE oF THE HEALTH SECToR
In2004,theWorldReportonRoadTrafficInjuryPreventionproposedthatthehealthsectorshould takeonanewandbroader role inpreventingRTIs.10 Traditionally, thehealthsectorhasfocusedonpost-crashcarealongwithinjurysurveillanceandresearch,whileadvocatingforimplementationofevidence-basedinterventionsintraumacareandrehabilitation.Itsroleneedstobeexpanded.ByshiftingtowardstheSafeSystemsapproach,andadvocatingforzerotoleranceofroadtrafficfatalities,thehealthsectorcanpursueitsmandateofprotectingthefundamentalhumanrighttohealth. Inmanysettings,particularlywithinLMICs,medicalprofessionalshave averypowerfuladvocacyvoice:theycangreatlyadvancethecauseofroadsafety,sothatitbecomesabuilt-inkeyperformanceindicatorofroadtransportsystems.15 Theycanalsoleveragethetraditionaldoctor-patientrelationship,builtontrustandrespect, to promote enforcement of behavior changes in high-risk road users –avoidingdrink-driving,encouragingseatbeltusage,andsoon.
3. unACCEPTABLE InEquITy
A challenge that remainswithin road safety and trauma is the disproportionateburdenthatvulnerableroadusersface.Ithindersthepursuitofequityinhealthamongpopulations.InDelhi,India,morethan80percentofthosekilledinroadtrafficcrashesarevulnerableroadusers,withpedestriansbeingthelargestgroup.InThailand,70percentofroadfatalitiesrelatetomotorcycles.Infact,only79countrieshavereportedpoliciesinplacetoprotectvulnerableroadusersbyphysicallyseparatingthemfrom high-speedroadusers(Figure5).Thisinequityisunacceptableforthehealthsector.
8 WISH Road Traffic Injury Report 2013
4. GovERnAnCE AnD LEADERSHIP CHALLEnGES
TheWHOGlobalStatusReporthighlightsinterventionsthathavedemonstrablyreducedtheburden.However,bringingaboutthisreductionrequiresstrongpoliticalwillandincreased financial investments. Strengthening of national lead agencies is critical,particularly in developing countries where there is weaker institutional capacity,insufficientfunding,andoftenlimitedpoliticalwill.Thoughmanycountriesaretakingtherightsteps,progressisslow:89percentofthecountriessurveyedhadestablished aleadagencyforroadsafety,yetonly28countriescovering7percentoftheworld’spopulationhadbeenabletoenactlegislationacrossallthemajorriskfactors.
Figure 5: Proportion of countries with policies to encourage non-motorized modes of transport, by WHo regionSource:GlobalStatusReport2013,WHO
5. ADDRESSInG EConoMIC GRoWTH
Thecurrentdecadeisseeinganunprecedentedgrowthinpassengercaruse,withnumbersalmostdoublingtoreach1.5billionby2020.In2010,forthefirsttime,salesof light-dutyvehiclesinLMICsexceededthoseinHICs.Theworldisfacingmajorsocial and environmental issues – and safety issues, particularly in LMICs. ThechallengewillbetopromotevehiclesafetyregulationsinLMICsasattentivelyastheindustrializedWesthasbeendoinginitsownroadsystems.
African Region
Regionof the Americas
South-EastAsiaRegion
EuropeanRegion
WesternPacificRegion
Percentage(%
)ofcountrie
s
40
10
50
20
60
80
30
70
90
Eastern Mediterranean Region
0
Policytopromotewalking and cycling
Policytopromoteinvestmentinpublictransport
Policytoseparatevulnerableroadusers fromhigh-speedtraffic
9WISH Road Traffic Injury Report 2013
6. DRIvER DISTRACTIon
Another issue relates to the increasing reliance on technology that is emerging globally. Use of the car as a mobile office is becoming increasingly viable.16 MoreandmoreevidencepointstodriverdistractionasanimportantcauseofRTIs.InNewZealand,researchsuggeststhatdistractioncontributestoatleast10percentoffatalcrashes,withanestimatedsocialcostofNZ$413millionin2008.17InsurancecompaniesinColombiareportedthat9percentofallroadtrafficcrashesin2006werecausedbydistracteddrivers,andofallcaseswherepedestrianswerehitbycars,21percentwerecausedbydistracteddrivers.18
7. LACK oF FunDInG
Lackoffinancialinvestmentinroadsafetyisanotherkeyissuetoaddressintheefforttoreduceroadtrafficfatalityandinjuryrates.Withoutstablefunding,manyeffective interventionsfail,sosustainableresourcesarecrucial.Traditionally, thefiscalresponsibilityhasfallenongovernmentsandinparticulartheroadauthorities.However, given themulti-sectoralnatureofRTIprevention, responsibility shouldbesharedbetweenvariousgovernmentalsectorsandtheprivatesector.Forthatto happen a strongbusiness case should bemade for road safety investments; that requires cost-effectiveness and cost-benefit studies, which are at presentnoticeablylackingwithinthefield.
8. IMPRovInG THE EvIDEnCE BASE
Oneofthemostimportantcontributionsthatthehealthsectorcanmaketoroadsafetyistheprovisionofevidence-basedinformation.ThehealthsectorhasaleadingroleinmonitoringandreportingRTIsanddeathandalsoriskfactors–datathatcanthenbeusedbyothersectorstoinformtransportsystemsandtheirperformance.Notonlycanthehealthsectordevelopastrongevidencebaseforeffectiveinterventions;itcanalsopromotetheuseofinjurysurveillancesystems,developgood-practiceguidelinesfortraumaandpre-hospitalcareservices,andprovidecostdataofRTIs.
Insummary,whilemuchhasbeendone,therealityremainsthatoveramillionpeopledieeachyearfromroadtrafficcrashes.Thisunacceptablesituationrepresentsamajorcalltoactionfortheglobalhealthcommunity–towhichthisreporthopestocontribute.
10 WISH Road Traffic Injury Report 2013
gOAL OF ThIS REPORT ThisreporthasbeenspeciallycompiledfortheWorldInnovationSummitforHealth2013(WISH2013).Theoverall goalofthereportistoidentifythebestevidence,goodpractices,andpromisinginnovationsthatareemergingfromaroundtheworldonRTIpreventionand traumacare, and tosynthesize thisknowledge intopracticalpolicyrecommendationsfordecision-makers.
Thespecific objectivesofthisreportareto:
1. Identify global innovations that have the potential to address key challenges inRTIsandtraumacare.
2. Synthesizeavailableevidenceabouttheseinnovationsandotherbestpracticesforaglobalaudience.
3. Identifypracticalrecommendationsandactionsforgovernments, internationalorganizations, non-profit organizations, private organizations, and other keydecision-makers.
4. Helptospurthe internationalexchangeofknowledgeandcatalyzetheuptake ofhealthinnovations,inordertoreducetheburdenofRTIs.
5. FormthebasisofapaneldiscussionofveryseniorleadersatWISH2013.
In identifying the relevant key innovations and best practices, the report takes aglobalandmulti-sectoralperspective,withsensitivitytothoseregionsoftheworldthat face social, economic, and financial challenges. The intent is not only to beconciseandpracticalbutalsotobeboldandprovocative,especiallyinthoseareasrequiringimmediateactionorurgentre-toolingofapproaches.
Inviewoftheabove,thefollowingtypesofcriteriainfluencedthisreportasitreviewedevidence,tools,andsolutionsforRTIs:
• Innovation-related: Newideas,newimplementationmodels,newapplications.
• Evidence-based: Science-drivenapproachesthatbuildondata.
• Practical:Operationalapproachesthatpolicy-makerscansupport.
• Sustainable: Long-termsocialandfinancialapproachesthatworkatscale.
Theprimaryaudienceforthereportconsistsofgovernmentministers,secretaries,technocrats, and other senior policy-makers. In addition, the report is aimed atbusinessleaders,civil-societyleaders,andotherhealthleaderswiththeabilitytomakedecisionsthataffectpeople’shealthandwell-being.Ourkeyconcernisthatthereport,andassociatedthinkinganddiscussionsatWISH2013,shouldleadtoactioninthecauseofreducingthegrowingglobalburdenofRTIs.
11WISH Road Traffic Injury Report 2013
METhODOLOgYIn compiling this report, we used a systematic method to explore innovations. Inordertogainadeeperinsightintowaysofimprovingroadsafetyandtraumacare,wetookfourapproaches:
1. Athoroughreview of the literature,bothpublishedandgray,lookingatwhathasemergedfromthefieldinthelast25yearsasbestpracticesinroadsafetyandtraumacare.
2. Recommendationsofapanel of experts inthefieldthroughforumdiscussions.
3. Anonline survey,whichhelpedtostimulatedialogueaboutcurrentchallenges inroadsafetyandpotentialwaysforward.
4. Aseriesofin-depth semi-structuredinterviewswithabroadrangeofexperts, todrawontheiryearsofexperienceinthefieldandtosolicitawiderperspectiveinthesearchfornewthinkinginroadsafety.
Forfulldetailsofallthemethodsused,seethetechnicalappendix(AppendixA1–ReviewofMethodswww.wish-qatar.org/reports/2013-reports).Therichdatafromeachoftheapproachesabovewasanalyzedforchallenges,innovations,andnewideastoaddressthehealthburdenofRTIs.Inaddition,thecombineddatafrompaneldiscussions,theonlinesurveyandthe in-depth interviewsunderwentathematicanalysis,usingtheframeworkpresentedbelow.
FRAMEWORK FOR ROAD SAFETY InnOVATIOnSWhiletherehavebeensomepositivegainsinthefield,substantialworkremainstobedonetomoveroadsafetyforward.Thisreportusesabroadanalyticframeworktoidentifyandcontextualizethatwork.
SPREAD oF InnovATIonS
As is widely known, the rate of diffusion of innovations can vary according to thepopulationinquestion.Thereisalonghistoryoftryingtounderstandthevariationand themechanismsbywhich thespreadoccurswithinsocial systems.19 Threefactorsappeartoinfluencethedisseminationofaninnovation:
1. Perceptions of the innovation (based on five attributes: benefit, compatibility,simplicity,trialability,andobservability).
2. Characteristicsoftheindividualwhomay(ormaynot)adoptthechange.
3. Contextual factors (including communication, incentives, leadership, andmanagement).20
12 WISH Road Traffic Injury Report 2013
Althoughthefieldofroadsafetyhasmanyevidence-basedinterventions,knowledgeandpracticedisseminateslowly,ifatall.Forexample,eventhoughthevalueofseatbeltsinreducingRTIsanddeathshasbeenwelldocumentedforover40years,only69percentoftheworld’spopulationisfullyprotectedbyaseatbeltlawforallcaroccupants(Figure6). Figure 6: Seat belt law by country/area Source:GlobalStatusReport2013,WHO
Forinterventionstobetakenup,individuals,institutions,andcommunitieshavetochangetheirbehavior,existingpolicies,andnorms.Sincesuchchangesareoftenresisted,theinterventionsthemselvesfacetheprospectofresistanceandrejection.WhenLMICs,inparticular,trytodisseminateresearchevidence,theyarehinderedbyweakhealthsystems,lackofprofessionalregulation,andlimitedaccesstotheevidence.21, 22Thereisaneedtostrengtheninstitutionsandsystematicallypromoteinteractionsbetweenresearchers,governments,policy-makers,andhealthworkers–onlyinthatway,cancountriesbridgethisgapandinfluencethedissemination,implementationandpromotionofevidence-basedinnovationsinroadsafety.23
Inviewofthisunderstanding,thispaperusedaframeworktoreviewandanalyzeinnovations for RTI prevention and trauma care. This is elaborated in the two sectionsbelow.
APPRoACH To InnovATIonS
Ourreportadoptsabroad-baseddefinitionofinnovation–onethatincludesnotonlynewideasorsolutionswithinthefielditself,butalsoideasfromotherfieldsthatcouldberelevant toroadsafety,andalsonewmodelsofprogramming, implementing, andfinancingroadsafetyinterventionsthatalreadyexist(Table1).
13WISH Road Traffic Injury Report 2013
The framework also favors solutions that are grounded in scientific evidence.Evidencederivedfromthesystematiccollectionandinterpretationofdataiscrucial–suchevidenceconstitutesastrongfoundationonwhichtobuildnewthinking.Theliteraturereviewinthisreportprovidesthebasisforour listofbestpractices inroadsafetyandtraumacare,andenablesexistinginterventionsandmodelsofinjurypreventiontobeprioritizedbythescientificlevelsofeffectiveness(seeAppendixA2www.wish-qatar.org/reports/2013-reports).
Interventionsbasedmainlyon theoreticalapproacheswillall toooften failwhentranslatedintoreality.Soanothercriterionforourframework,particularlyrelevantgiventhelimitedresourcesofmanyLMICs,isthatthesolutionsmustbeoperational and transferable,ie,thattheycanbeputintopracticeintherealworld.
Finally, thereport isbasedon thebelief that innovationmustbesustainable and scalable. RTIs do not just affect small sub-populations; they have far-reachingconsequences,sothebestsolutionsarethosethatcanbesuccessfullyscaleduptocaterforthevastnumbersofvictimsandtheirfamiliesandcommunities.Ofcourse,thesolutionshavetobeacceptabletothepublicaswell. In addition to the best practice examples included in the report, there are alsoinnovativepracticeslistedwhichasyetonlyhaveanemergingevidencebase.Allinterventionsdescribedarecategorizedbytype:Legislationandpolicy,Behavioral,Infrastructure,andTechnology.Table1presentsonepartoftheframeworkusedinthispaper.
Table 1: Domains and types of Innovations for Road Safety and Trauma Care
InTERvEnTIon CATEGoRy
InnovATIvE SoLuTIon
InnovATIvE uSE/uTILITy oF ExISTInG non-RTI SoLuTIonS
InnovATIvE IMPLEMEnTATIon oF ExISTInG RTI InTERvEnTIonS
Legislation and Policy
Behavioral
Infrastructure
Technology (IT/ICT/m-health/ e-health)
SCoPE oF AnALySIS
Weconsideredbroadthemesofroadsafety, inordertoexploreaswidearangeaspossibleofinterventionsandpracticalsolutionstoroadsafetyandtraumacare(Table2).
14 WISH Road Traffic Injury Report 2013
The spectrum of time:WhileprimarypreventionofRTIhasbeenthetraditionalpublichealthapproachtoroadsafety,thisreportlooksatthefullspectrum,fromprimarypreventionthroughtoacutetraumacareandlong-termmanagementofdisabilitiesresultingfromRTI.Examplesofinnovationswithinthisthemeinclude:
• Primaryprevention(eg,alcohol-detectionsystemsincars).24
• Acutetraumacare(eg,theuseoftranexamicacidtocontrolbleedinginacutetrauma).25
• Long-termmanagement of disability (eg,mindfulness-based stress reduction forlong-termfatiguefollowingtraumaticbraininjury).26
The inequity of RTIs:RTIsdisproportionatelyaffectthemostvulnerablepopulationswithinsociety–groupsthatuptonowhavebeenthemostneglectedintransport andplanningpolicy.Innovationsmayaddressthefollowing,amongothers:
• Dependents(eg,foamhead-protectivedevicesinchildseats).27
• Risk-takers,suchasadolescents(eg,abanontextingwhiledriving).• Vulnerablegroups(eg,low-speedzonesinresidentialareas).28, 29
The life cycle of RTIs:RTIsaffectbothgendersandallages.Roadinjuriesdonotdiscriminate;theyimpactonallpeopleacrossthelifecycle–fromyoungchildren toseniorcitizens.
Levels of society: Road safety is commonly considered from the point of view of the individual – the personal risk, the personal-injury protection measures, andtheindividualtreatmentplansforthosesufferingRTI.Thisreportgoesbeyondthe individual level, and explores interventions at the institutional, population, andsystem-widelevels.
Table2presentsthesecondpartofourframework,capturingtheelementoftimeandthelevelofapplicationofinterventions.
Table 2: Levels of Application for Innovations
LEvELS oF APPLICATIon
Individuals Institutional System
Time Horizon
General population
Vulnerablegroups
Youngdependants/adolescents
Pre-event
Event
Post-event Sub-acute
Long-termmanagement
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SuMMARY OF ThE LITERATuRE REVIEWTable3presentsa summaryof the typesof roadsafety interventions thathavebeenimplementedoverthepast30years.Pleaserefertothetechnicalappendix(Appendix A2 www.wish-qatar.org/reports/2013-reports) for the full literaturereview,includingreferences.
Table 3: Summary of Road Safety Practices
GooD PRACTICES
PRoMISInG PRACTICES
EMERGInG PRACTICES
InEFFECTIvE PRACTICES
Thesepracticeshaveshown consistent evidence of reduced vehiclecrashes,RTIsorfatalities.
Thesepracticesmayshowbeneficialoutcomes such asimprovedroadsafety knowledge orbehavior,butnoevidenceisavailableas to whether this translates into reduced vehicle crashes,RTIs andfatalities.
Thesepracticesarebackedbyanextremely limited bodyofevidence,often with no evaluationstudies.Theyarenewandpossibleapproachestoroadsafety,andrequireevaluationto assess their effectiveness.
Thispracticehasshown no evidence ofimprovedroadsafety knowledge orbehavior,orofreduced vehicle crashes,RTIsandfatalities.Ithasbeenassociated with an increased risk of vehiclecrashes.
• Graduated driver licensingprograms
•Roadsafetycampaignswithenforcement
•Improvedlightingfor roadways and vehicles
• Guardrails and crash cushions
•Continuingeducationcourses for trauma care
•Firstresponders•VehicleDataRecorders
•Redlightcameras•Speedingcameras•Traffic-calming
measures
•Pedestrianbehaviorprograms
•Improvedpedestrian/cyclistVisibility
• Pedestrian safety measures
• Political advocacy approaches
• Booster seat Programs
•Incentiveprograms•Policepatrols• Alcohol ignition locks
•AutomaticCrashNotification(ACN)systems
•Built-inGeographicInformationSystems(GIS)
•Non-vehicle-dependenttravelsystems
• Driver education programs
16 WISH Road Traffic Injury Report 2013
InnOVATIOnS In ROAD SAFETY AnD TRAuMA CARETheonlineandin-persondiscussionsenabledanin-depthanalysisofthechallengesfacing road safety and trauma care. These challenges have been categorized by typeandsector.Thechallengesfall intothebroaddomainsofKnowledge,Attitude,Engagement,Management,Capacity,andInfrastructure.TheyarepresentedinTable4.
Innovationsidentifiedorrefinedbytheonlinesurveyandthein-depthinterviewswere categorized according to thematrix presented in the previous section on“FrameworkforRoadSafetyInnovations”(seeTable5).Thefollowingpageshighlightsomeof the interventionswithineachof theeightdomains.For fulldetails,casestudiesandsupportingreferences,pleaseseeAppendixA3–InnovativePracticesinRoadSafetywww.wish-qatar.org/reports/2013-reports.
17WISH Road Traffic Injury Report 2013
KnoW
LEDG
EAT
TITu
DEEn
GAGE
MEn
TM
AnAG
EMEn
TCA
PACI
TyIn
FRAS
TRuC
TuRE
GovERnMEnT (ALL SECToRS)
Lim
ited
know
ledg
e of
road
sa
fety
inte
rven
tions
Unaw
are
that
road
saf
ety
isagovernm
entproblem
Lackofpoliticalw
ill
Corrup
tion
Absenceofleadagency
Investmentinineffective
campaigns
Inadequatefinances
Under-fund
edpoliceforces
Lack
of s
yste
mat
ic
planningoftransport
syst
ems
HEALTH
Uncl
ear e
stim
ates
of
burdenoftraum
aon
heal
th s
ecto
r
Roadsafetynotperceived
as a
hea
lth s
ecto
r iss
ueHe
althisnotapartner
inlargertransport
and
infra
stru
ctur
e developm
entprogram
s
Nosystemsapproachto
road
saf
ety
and
trau
ma
care
Silo
man
agem
ent o
f activitiesbydiffe
rent
sect
ors
Inadequatepost-c
rash
care
Grow
ing
cost
s of
trau
ma
care
Under-fund
ed
rehabilitationservices
Lackofn
ationalpolicies
andprogramsontrauma
care
Lack
of i
nteg
rate
d tr
aum
a fa
cilit
ies
No E
MS
syst
em
CoMMunITy
Lim
ited
know
ledg
e offirstaid
Fata
listic
atti
tude
sNe
edforC
SOs/NG
Osto
takeownershipofro
ad
safe
ty in
itiat
ives
FewCSO
sfocusedon
road
saf
ety
LackoftrainingforC
SOs/
NGOs
inRTIprevention
andpost-crashca
re
Rapidurbanization
in
crea
sed
dem
and
on
infra
stru
ctur
e an
d ca
r depend
ency
ACADEMIA
Lack
of t
rans
latio
nal a
nd
cost
dat
aRe
sistance/barrie
rs
to e
ngag
ing
with
policy-makersand
gove
rnm
ent
Roadsafetyresearch
poorlyfund
ed
PRIvATE SECToR
Focusonbusinesscase
for e
ngag
emen
tLackofcorporatesocial
responsibilitytoim
prove
road
saf
ety
Non-standardizationof
safe
ty re
gula
tions
Weaklocalsafety
stan
dard
s
Indu
strycom
petition
de-specificationofsafety
feat
ures
Surg
e in
dem
and
for c
ars
Tabl
e 4:
Iden
tified
chal
leng
es a
nd b
arrie
rs to
road
saf
ety a
nd tr
aum
a ca
re
CSO:civilso
cietyorganiza
tion,EMS:emergencym
edicalse
rvice,NGO
:non-governm
entalorganiza
tion
18 WISH Road Traffic Injury Report 2013
1. LEgISLATIVEComprehensive legislation – incorporating strict and appropriate penalties, andbackedbyconsistentenforcement–hasbeenshowntobeeffective inchangingbehavior,normsandpublicperceptionsaboutroadsafety.30, 31
SPEED EnFoRCEMEnT
Speedenforcementaimstodiscouragedriversfromexceedingthespeedlimitbypenalizingthosewhodo.Fixedandcovertcamerassendoutastrongmessagethatspeedingwillnotbetoleratedandthatcontrolsareinplace.
DRInK-DRIvInG
TherecommendationisthatcountriessetthelegallimitforBACat0.05g/dlforthegeneralpopulation,andat0.02g/dl fornovicedriversandothergroupssuchascommercialdriversanddriverscarryinghazardousgoods.
Randombreath-testing(RBT)isanotherwell-knownmeasurethatcountriesshouldincorporate into theirroadsafety legislation.Drivers, regardlessofwhether they are suspected of drink-driving, are randomly stopped and tested to assess whether theirBAC isabove the legal limit.RBT is twiceaseffectiveasselectivetesting,ie,testingonlythoseundersuspicion.32
InnovATIvE PRACTICE ExAMPLE:ARRIvE-ALIvE! – vICToRIA STATE, AuSTRALIA
InNovember2001,theVictoriagovernment in Australia started the Arrive-Alive!Roadsafetystrategywith the aim of reducing road traumaby20percentby2007.Inthisprogram,speedenforcementeffortswereincreased,withmoreactivemobilespeedcameras,newfixedspeedcameralocations,and
increasedenforcement.Thestrategyisconductedbya‘roadsafetypartnership’,comprisingVicRoads,VictoriaPolice,andtheDepartmentofJusticeandtheTransportAccidentCommission(TAC).Theyallhavetheirownspecificenforcementresponsibilities,buttheyoftenactinconsultationwithoneanotherandwithotherroadsafetypartners,includingNGOs.EvaluationbytheAuditorGeneralofAustraliashowedfavorableresults,witha16percentreductioninfatalitiesbetween2002and2005.Manyfactorscouldhavecontributedtothisdecline,butitissignificantthatthemostimpressivetraumareductionswereexperiencedinMelbourne’slow-speedzones,wherefatalitiesdecreasedby40percent.33
19WISH Road Traffic Injury Report 2013
SEAT BELTS
Wearingseatbeltsshouldberequiredbylawforallseatingpositionsineverymotorvehicle.Inaddition,toenhancetheeffectivenessofseatbeltlaws,legislationshouldbe introduced for primary enforcement laws that allowa police officer to stop avehiclesolelyfortheobservedviolationofnotwearingaseatbelt.
LEvIES on InSuRAnCE AnD LICEnSE FEES
Severalcountrieshaveattemptedtofinanceroadsafetyinterventionsbysuchmeansasroadtolls,licensingfees,compulsoryvehicleinsurancefees,surchargesonmotorfuel, and weight-distance transportation charges. Other examples of innovations toraiseroadsafetyfundsarethefollowing:personalizedlicensingplatestofinancethe road safety trust (eg, New Zealand), a levy on tire manufacturers’ profits (eg, Korea), and traffic fines from red light and speeding violations (eg,WesternAustralia,Vietnam).
BEST PRACTICE ExAMPLE: GLoBAL nEW CAR ASSESSMEnT PRoGRAMME
Giventhechallengesposedbyemergingtrendsinvehicleuse,particularlyinLMICs,innovativeandmarket-basedapproachestovehiclesafetyarerequired.OnesuchapproachisconsumerinformationprovidedbyNewCarAssessmentPrograms(NCAPs),whichisprovingtobeeffectiveincreatingamarketforsafety.Byempoweringtheconsumer,NCAPsalsohelpcivilsocietypartnerships–involvingconsumergroups,automobileclubs,fleetmanagers,andNGOs–toraiseawarenessofthesafetychoicesweallcanmakewhenbuyinganautomobile.
TheGlobalNewCarAssessmentProgramme(GNCAP)isanewlyestablishednon-profitorganizationregisteredintheUKthataimstoencouragetheworldwideavailabilityofindependentconsumerinformationaboutthesafetyofmotorvehicles.ItservesasaplatformtopromotethedevelopmentofNCAPsandsimilarorganizationsworldwide,particularlyinLMICs.GNCAPalsosupportscross-learning,andpromotesthesharingofbestpracticestoencouragethemanufactureofsafercarsacrosstheglobalautomotivemarket.GNCAPcarriesoutresearchoninnovationsinvehiclesafetytechnologiesandtheirapplicationsinglobalmarkets.Additionally,GNCAPstudiestherangeofpoliciesthatacceleratetheuseofthesetechnologies,andmonitorstheprogressofvehiclesafetyimprovementsacrosstheglobe.
20 WISH Road Traffic Injury Report 2013
BEST PRACTICE ExAMPLE:BLooMBERG GLoBAL RoAD SAFETy PRoGRAM –RoAD SAFETy In THE RuSSIAn FEDERATIon
TheBloombergGlobalRoadSafetyProgramwaslaunchedinFebruary2010inMoscowbeforealargeaudienceofstakeholders.Initiativesrelatingtoseatbeltratesandspeedcommencedintwooblasts(LipetskayaandIvanovskaya)inSeptember2010.Followingobservationalstudiesandfocusgroupdiscussions,alargesocialmarketingcampaignwaslaunchedinLipetskayaOblastinNovember2010andtheninIvanovskayaOblastinMay2011.Themotto
was“Donotbreakthelineoflife”.Thecampaign,developedandconductedwiththesupportoflocalpolice,waspublicizedthroughTV,radio,outdooradvertising,andpublicrelationsactivities.
Theinitiative‘DvaSh:shokolade/shtraf’receivedconsiderableattentionfromregionalandfederalmedia.Inthisinitiative,driversandpassengerswhowerebuckledupreceivedabarofchocolatewiththelogoofthecampaign,whereasthosewhowerenotreceivedafine,inkeepingwiththelegislationcurrentlyinforce.Duringtheperiodofthecampaign,policeofficersstrengthenedenforcementactivitiesuptotentimestothelevelofpre-campaignmeasures.
Thesocialmarketingcampaignandotherawareness-buildingefforts,followedbystrongpoliceenforcement,havesignificantlyincreasedseatbeltuse.Observationstudiesconductedatbaselineandthroughouttheinterventionphasehaveshownpositiveresultsinbothoblasts.InLipetskayaOblast,useofrestraintsforalloccupantsincreasedfrom52percentinOctober2010to75percentinMarch2012,andhasremainedstablesincethen.InIvanovskayaOblast,restraintuseforalloccupantsincreasedsteadilyfrom48percentinApril2011to93percentinMay2013.
overall seat-belt use in Ivanovo & Lipetsk, Russian Federation, 2010-2012Source:JohnHopkinsInternationalInjuryResearchUnit,IvanovoStateTechnicalUniversity:unpublisheddata
Tacklingseatbeltunder-utilizationrequiresacoordinatedeffortfrommultiplesectors.Thiscampaignshowsthesuccessthatispossiblewhenexpertsandstakeholdersintransport,health,business,andpublicsectorsaremobilizedandworktogether.
Oct‘10
Nov‘10
Dec‘10
Jan‘11
Feb‘11
Mar‘11
Apr‘11
May‘11
Jun‘11
Jul‘11
Aug‘11
Sep‘11
Oct‘11
Nov‘11
Dec‘11
Jan‘12
Feb‘12
Mar‘12
Apr‘12
Percentagewearin
gseat-belt(%)
80.0
42.5
55.0
67.5
Lipetsk Ivanovo
21WISH Road Traffic Injury Report 2013
2. BEhAVIORALTHE RoLE oF THE MEDIA
Withitswidetargetpopulation,themediahastheabilitytoincreaseawarenessandeducatethepublicinawaythatmanyprogrammaticapproachesfailtodo.Traininghasbeencarriedoutsuccessfully,aspartof theBloombergRoadSafetyGrantsProgram, inRussia, Turkey,Egypt,Kenya, andCambodia.Widespreaduseof themediacanhelp tocreatea“theaterofpolicing,”which in turn leadstoageneralperception thatpoliceenforcement isbeing increased throughoutacityorstate, leadingtoacorrespondingreductioninriskydriverbehavior.
InnovATIvE PRACTICE ExAMPLE:DRIvER InCEnTIvES FoR SAFE DRIvInG – vITALITyDRIvE, SouTH AFRICA
Discoverywasestablishedasasmallspecialisthealthinsurertwodecadesago,withagoalofimprovingpeople’shealth.Ithassubsequentlygrownintoamultifaceted,integratedfinancialservicesorganizationthatspansoverfourcontinents.DiscoveryInsureinSouthAfrica
encourages safe driving through its Vitalitydrivedrivingprogram,whichrewardsitsclientsforimprovingtheirdriving.Theprogramusesaninnovativemotorvehicletelematicstechnologytodevelopascientificmeasureofdriverbehavior.Withafocusonaddressingmodifiabledriverbehaviors,DiscoveryInsurerewardsitsmembersfordrivingwell,improvingtheirknowledgeandawareness,andmakingsurethattheirvehicleissafetodrive.
Driving well:Driverscanearnpointsthroughreducingtheiruseofharshbraking,riskyaccelerationandcornering,speeding,anddrivinglateatnight.Improving knowledge:Driverscanearnpointsbycompletinganannualdriversafetyreviewandquarterlyonlinequizzes.Accrediteddrivingcoursesarealsoavailabletoencourageskillfuldrivingandhelptopromotesaferoaduse.Safe vehicles: Drivers are rewarded for taking their car in for annual checks andkeepingtheircarservicehistoryup-to-date.
Inaddition,DiscoveryInsureteamsupwithtwoinnovativetransportcompaniesinSouthAfricathatprovideachauffeur-basedservicetoitsmembersinordertoreducedrink-drivinganddrivinglateatnight. TheDiscoveryInsureprogramdatabaserecordsapositivechangeindriverbehavior:
Percentage change in number of drivers per risk category from month 1 to month 12
*Resultsbasedondrivingstatusof12,000clientsoveraconsecutive12monthperiod
Poor and average
Good drivers
Excellent Drivers
-29%
36%
137%
22 WISH Road Traffic Injury Report 2013
InnovATIvE PRACTICE ExAMPLE:PRoACTIvE PARTnERSHIP STRATEGy (PPS) To IMPRovE RoAD SAFETy AT THE CoMMunITy LEvEL
In2002,theGlobalRoadSafetyPartnership(GRSP)introducedtheProactivePartnershipStrategy(PPS)asamodeltoaddressroadsafetyatthecommunitylevel.PPSisaprocessmethodologyusedforfosteringpartnershipsbetweencommunities,government,localbusinesses,andcivilsociety.Inturn,thesesustainablepartnershipsaimtoimprovelocalroadsafetyconditionsthrough
thecreationofmeasurabletargetsandtheimplementationofastructuredactionplan.Theprocessispredicatedonsixsteps:partnershipbuilding,datacollectionandanalysis,integratedroadsafetyactionsystems,monitoringandevaluation,programreview,andprogramrenewalandexpansion.
PPShasbeensuccessfullyimplementedinBrazilandCambodiawiththeassistanceofGRSP.InthecityofSãoJosédosCampos(Brazil),PPSwasintroducedin2010,andbroughttogetheractorsfromtheprivateandpublicsectorsalongwithcivilsocietygroups.Numerousroadsafetymeasureswereimplemented,includinglarge-scalepublicawarenesscampaigns,roadengineeringprojects,andaheavyenforcementarea.Between2010and2011,fatalcrashesdeclinedby41percent,eventhoughthecity’svehiclefleetgrewby9percent.
PPSisaviableoptionforcommunitieswhererobustgovernmentalentitieshavethemotivationtoaddressroadsafety,andcitizensarebothempoweredandeagertoimprovetheirroads.
GRADuATED DRIvER LICEnSInG
Graduateddriverslicense(GDL)programsareemergingasameansofcontrollingcrashratesamongyoungdrivers.Thebasicpremiseisthatnovicedriversshouldbegindrivingunderrelativelysafeconditions,andbeexposedonlygraduallytomorecomplexscenarios.
3. COMMunITY EMPOWERMEnTCommunityprogramsareapracticalandsuccessfulmeansofpromotingroadsafetyinatargetedandsustainableway.Theyareparticularlyhelpfulinruralandsuburbanareas,wherecommunityfeelingmaybestrongerandwhereregularenforcementishardertoimplementowingtolimitedpoliceresources.
23WISH Road Traffic Injury Report 2013
SoCIAL ACCounTABILITy
In Kenya, an initiative to influence bus drivers has used posters to encouragepassengersto“heckleandchide”thedriversiftheyaredrivingtoofastorrecklessly.The initiative is proving successful in reducing the level of RTIs. According topreliminarydata,socialaccountabilityinnovationsresultinasignificantreduction(25-50percent)ininsuranceclaims.
EnFoRCEMEnT
Localcommunitiescanhelpenforcementbyprovidingtrafficpolicewithinformationon the location and circumstances of unreported crashes, aswell as identifying“black-spots,”whereoffensessuchasillegalturnsorspeedingareaproblem.
ADvoCACy
Civil society groups and the local community play an important advocacy role.Advocacycanbeused tostrengthenpoliticalwill, correctpublicmisconceptionsaboutthecausesandpreventabilityofRTIs,promotechangesinnationalpolicies,build effective partnerships and coalitions, and increase funding for road safetyprograms.
4. ROAD SAFETY MAnAgEMEnTEnsuring effective road safety management systems is a strong indicator for success intacklingroadsafety,andunderpinsthefirstpillaroftheDecadeforAction.TheWorldBankGlobalRoadSafetyFacilityispromotinggoodroadsafetymanagementaskeytoproducinggeneralimprovementsinroadsafety.
MuLTI-SECToRAL WoRK
Toreversetherise inglobalRTIsanddeaths, theBloombergGlobalRoadSafetyProgramcommittedUS$125millionoverfiveyears(2010-2014)tosupportprovenand effective interventions in ten LMICs. The Program works with six partnerorganizationstoimplementroadsafetyactivitiesandco-ordinatewithin-countrygovernmental and non-governmental stakeholders. The Program’s overall goal istosupportthetengovernmentsinimplementinggoodpracticesinroadsafety, inlinewiththeirnationalroadsafetystrategies.
24 WISH Road Traffic Injury Report 2013
InnovATIvE PRACTICE ExAMPLE: vICTIMAS DE vIoLEnCIA vIAL (vIvIAC) ADvoCATES FoR DRInK-DRIvInG LEGISLATIvE CHAnGE In MExICo
VIVIACisanNGOconsistingpredominantlyofvictimsofRTIs,operatinginthestateofJaliscoinMexico.Byfacilitatingopportunitiesfor victims and their families to share theirstorieswithinfluentialgroups,VIVIAChavebeeninstrumentalinbringingaboutstatelegislativechangeondrink-driving.
Underthebanner“LegislandoparalaVida”or“LegislatingforLife,”VIVIACregularlyorganizesinterviewswithvictims,theirfamilies,andrepresentativesofthestate’sbroadcastandprintmedia.TheiremotivestoriesreachthousandsofpeoplethroughTVbroadcastsandradiotalkshows,whichhelpstoincreaseroadsafetyawarenessandeducatethepublicabouttheneedforstricterlawsandenforcement.InSeptember2010,withthebackingofthreemainpoliticalparties,thestateofJaliscoreviseditsdrink-drivinglegislation,settinganupperlimitforBACof0.05g/dlforthegeneralpublic.Thiscontrastswiththepreviouslimitof0.15g/dl,whichwasthreetimeshigher.Additionally,astrictBAClimitof0.00g/dlwasimplementedfordriversofpublictransportvehicles.
OwinginparttotheadvocacyeffortsofVIVIACandothernon-governmentalorganizationswithinthe“ColectivoCiudadano”or“Citizens’Collective,”thestatehasseenadeclineindrink-drivingfatalitiessincethelawwasenacted.Withsupportfromsomekeygovernmentministries,VIVIACanditspartnersarecurrentlyorganizingadvocacyforotherissues,suchasseatbelts,childrestraints,andhelmetsformotorcyclists.
Source:Advocatingforroadsafetyandroadtrafficinjuryvictims:aguidefornongovernmentalorganizations34
25WISH Road Traffic Injury Report 2013
BEST PRACTICE ExAMPLE: THE qATAR nATIonAL RoAD SAFETy STRATEGy 2013-2022 – “SAFE RoAD uSERS, SAFE vEHICLE, SAFE RoADS, SAFE SPEEDS”
Between2000and2006,Qatarexperiencedasteadilyincreasingnumberofroadcrashfatalitiesasitspopulationrapidlyexpanded.Withtheintroductionofaninitialseriesofroadtrafficreformsin2007,thenumberoffatalitiesandseriousinjuriesdeclined.
However,evenwiththisreduction,roadfatalityratesinQatarremainexcessivewhencomparedtootherHICs.Forexample,in2010therewere13deathsper100,000populationinQatar,comparedwitharound3per100,000populationincountriesliketheNetherlands,theUKandSweden.
InresponsetothisburdenofRTIs,theQatarNationalRoadSafetyStrategyhasbeendeveloped.Thisten-yearstrategy(2013-2022)setsouttoreduceroadcrashfatalitiesfromabout13to6per100,000people,andseriousinjuriesfrom33to15per100,000people.Thiswillbeaccomplishedbypursuingavarietyoftactics,includingincreasedpoliceenforcementmeasures,massmediacampaigns,concentratingon“high-riskdriversandriders”suchasmalesaged18-30,improvedstreetandinfrastructuredesign,police-backeddata-collectionefforts,andenhancedvehiclesafetystandards.
Thismulti-prongedstrategyconformstothefivepillarsdesignatedbytheGlobalRoadSafety“DecadeofAction”,andillustratestheneedfornationalroadsafetystrategiestobecomprehensiveandambitiousindesign.Qatar’sexperiencewillprovidevaluablelessonsfortheglobalcommunityinthefieldofroadsafety.
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
NumberofCasualtiesper10
0,000population
40
10
50
20
60
30
70
Seriousinjuriesper100,000populationFatalitiesper100,000population
80
0
26 WISH Road Traffic Injury Report 2013
5. InFRASTRuCTuREIncreasingattentionisbeingdirectedatstructuralchangestothebuiltenvironment.Suchchangescanhelptoprotectroadusersfrominjuries,eitherbyreducingtheirexposuretovehicleuseorbytransformingtheenvironmentintoasaferoneforroadtravel.Onebroadapproachistoseparatepedestriansfromvehiclesmorethoroughly,bymeansofbettersidewalks,raisedcrossings,orwiderefugeislands.Theseandotherapproaches,usedjointlyorsingly,cangreatlyimprovepedestriansafety.
RuMBLE STRIPS
Rumble strips, also known as audible lanes, are low-cost road safety devicesinstalledonroadways.Consistingofaseriesofraisedstrips,theyalterthenoiseofavehicle’stiresonaroadway,andtherebyprovideanaudiblewarningfordrivers.35 Giventheirlowcostandeffectiveness,rumblestripsareaverysuitableinterventionforLMICs.36
CABLE MEDIAn BARRIERS
Cablebarriersaremediandividersmadeupof3-4steelcableshungalongaseriesofcentralposts,andaredesignedtopreventlane-departurecrasheswithopposingtraffic.37Incontrasttosolidmedians,cablebarriersallowforflexionduringcrashes,andsotendtoproducelessseverecrashoutcomesthanguardrailsandconcretebarriersdo.38, 39
DynAMIC SPEED LIMITS
Incontrasttopermanentspeedlimits,dynamicspeedlimitsarevariable,changinginaccordancewithavarietyoffactors.Theyarebasedonthereal-timeexpectationsofmotorists,andrespondtochangesinweather,trafficflow,roadconditionsandtrafficincidents.40Dynamicspeed limitsystemsareoptions forcountries thathavethetechnologycapacitytoimplementthemandapublicthatactivelyadherestopostedspeedlimits.
TRIP REDuCTIon MEASuRES
Tripreductionmeasuresincludearangeoftechniquestoreduceormodifytheamountofvehicletravel.41Themeasuresinclude:telecommutingforworkers;greateruseofelectroniccommunicationmethods;improvedmanagementformasstransportationsystems;bansonfreighttransportation;andurbandesignadjustmentstorestrictvehicleparkingandroaduse.10, 42
27WISH Road Traffic Injury Report 2013
InnovATIvE PRACTICE ExAMPLE:PEDESTRIAn SAFETy – ABu DHABI uRBAn STREET DESIGn MAnuAL
TheAbuDhabiUrbanStreetDesignManual(USDM)wascommissionedin2009bytheAbuDhabiUrbanPlanningCouncil(UPC)toaddresstheneedsofthegrowingpopulation,andtoimprovepedestrianfacilitiesinordertocreatemorewalkableandlivablecommunities.TheUSDM’smainobjectiveis
tore-balancetheprioritiesofstreetdesigntosuitallroadusers,inparticularthemostvulnerable.Inotherwords,theUSDMaimstoshiftthesystemofstreetdesigntoanintegratedprocessthatservestheneedsofpedestrians,transitridersandcyclists,aswellasmotorists.
Onthebasisoftherecommendationsinthemanual,asegmentofamajorstreetinAbuDhabi,SalamStreet,wasredesignedin2011.Priortotheredesign,thisstreetwascharacterizedbymanholes,utilitypoles,signs,andill-placedstreetfurniture,whichposedhazardstopedestrians.Therewasverylimitedseparationbetweenvehiclesandpedestrians,withnoformalsidewalksorcurbs.Theredesignedroadnowhasmuch-improvedpedestrianfacilities,includingrefugeislands,medianbarriers,raisedcrossingsandtrafficcontrol.Thishasresultedinimprovedwalkingconditionsforpedestrians,andareductioninvehiclespeedof4-10km/hrrelativetonearbystreets.Streetredesignhasbeenaccompaniedbyincreasedenforcementatpedestriancrossings,raisedawarenessandimplementationofeducationcampaigns,andimplementationofotherdesignmeasuressuchasbollardsandredirectivecurbs.
Themanualisthefirstofitskindtobetailoredtothelocalclimateandculture,andaimstoguideAbuDhabi’stransitionfromamotor-vehicle-orientedcitytoamulti-modalone.Themanualhasgainedinternationalrecognition,andtheUrbanPlanningCouncilwasrecentlyawardedthe2013InstituteofTransportationEngineers(ITE)AwardforBestProgram.
www.upc.gov.ae/template/upc/pdf/StreetDesignManualEnglish(small)FINAL.pdf
28 WISH Road Traffic Injury Report 2013
PRIvATE SECToR
Theprivatesectorcanplayakeyroleinroadsafety,particularlyinconjunctionwiththegovernmentandcivilserviceorganizations.Asmanufacturers,theprivatesectorcanensurethatvehiclesmeetsafetystandards,suchasthoserelatingtoseatbeltsandothersafetyequipment.
CREATInG A RoAD SAFETy WoRK ETHIC
Promotion of effective work-related road safety policies can benefit business, inadditiontoalleviatingsomeoftheRTIburden.Campaignssuchas‘Drivingforbetterbusiness’(www.drivingforbetterbusiness.com)caneffectivelyraiseawarenessoftheimportanceofwork-relatedroadsafetyinthebusinesscommunity.Theprivatesectorcanalsopromotebenchmarkingofroadsafety,aswiththeglobalprogram‘Fleetsafetybenchmarking’(www.fleetsafetybenchmarking.net).
ThePrivateSectorRoadSafetyCollaboration(PSRSC)isanestablishedroadsafetynetworkthataimstopromoteandstrengtheninternationalcollaborationsamongprivate-sectorcompaniesinmattersofroadsafety,inordertoreduceRTIsanddeathsamongstaff, thefleetworkers theycontract,andthecommunities inwhichtheyoperate.GroupssuchastheNetworkofEmployersforRoadSafety(NETS)isanon-profitorganizationdedicatedtoimprovingthehealthandsafetyofemployers,theirfamilies,andthecommunity,bypreventingtrafficcrashesatworkandelsewhere.
THE PRIvATE SECToR AS DonoRS
Bymakingroadsafetyoutcomesadevelopmentpriority,andbyinvestinginroadsafetygrantsforhealth,transport,environment,andeducation,theprivatesectorcansignificantlyimprovetheresearchanddevelopment(R&D)relatingtointerventionsinroadsafetyglobally.
PuBLIC-PRIvATE PARTnERSHIPS
CollaborativemechanismssuchastheGlobalRoadSafetyPartnership(GRSP),whichbringtogetherbusiness,civilsociety,andgovernmentalorganizationstoaddressroadsafetyworldwide,canexertconsiderableleverageinthefield.CompaniesworkcloselywithGRSPinHICsandLMICstopromoteroadsafetythroughactivitiessuchas: supplying reflectivematerial for integrating into clothing and safety devices;improvingroadsignsandmarkings;creatingroadsafetyzones,particularlyoutsideschools;andimprovingfleetsafetystandards.
29WISH Road Traffic Injury Report 2013
6. POST-CRASh CAREHowevermuchRTIsmightdecreaseasaresultofpreventiveroadsafetyefforts,thereality is thatcrashesaregoingtooccur,andemergencycare isgoingtobeneeded.TheWHOhasnotonlycalledonmemberstatestoimproveexistingsystemsfortraumacare,butalsodevelopedguidelinesforthecreationofessentialtraumacaresystems.43,44Thesesystemsshouldbeuniversal,well-designed,andlocallyappropriate,andcallforinnovativethinking,planning,andadaptation,particularlyin LMICs. This section will not cover strategies for basic trauma management,pre-hospital clinical care, or basic rehabilitation techniques (such as breathingmanagementandbleedingcontrol),whichareobviouslyessentialforanypost-crashcareinitiative.Whatthissectionwillfocusonistheissueofinnovationsinthefieldoftraumacare.
quALITy IMPRovEMEnT PRoGRAMS FoR TRAuMA CARE SySTEMS
Effortstoimprovetraumacaresystems–measuressuchasstreamliningpatientflowsandenhancingthecareofinjuredpatients–havebeenshowntoreducethemortalityof traumapatientsby15-20percent.45, 46Amongmedicallypreventabledeaths,suchimprovementscouldevenreducemortalityby50percent.45, 46 Not only dothesequality-improvementprogramsdecreasedeaths,buttheyalsodecreaseoverallcoststhroughimprovingtheprocessofcare.47, 48Suchprogramshavetheadvantageofbeingapplicableinavarietyofsettings,includinglow-incomeones.
FIRST RESPonDERS
Wherenopre-hospitaltraumacaresystemexists,onepotentialapproachistoteachcommunitymembersbasicfirstaidtechniques.Such“firstresponders,”astheyareknown,wouldthenbeabletorecognizeemergencies,callforhelp,andprovidebasictreatmentuntilformallytrainedhealthpersonnelarrive,oruntilthevictimcanbetransportedtohospitalbywhatevermeansavailable.
AuToMATIC CRASH noTIFICATIon
RecentresearchhashighlightedthepotentialofAutomaticCrashNotification(ACN)systemsincarstoreducetransit timestotraumacenters.49 An Australian study estimatedthatsuchanotificationsystemcouldreducecrash-to-hospitaltimesby3-6minutes,andwouldresultin104fewerfatalitiesinAustraliaeveryyear.49
mHEALTH: eCall 112
This systemhasbeen installed in someEUcountries. The in-vehicle eCall is anemergencycallgeneratedeithermanuallybyvehicleoccupantsorautomaticallyviaactivationofin-vehiclesensors.Whenactivated,thein-vehiclesystemwillestablishavoiceconnectiondirectlywiththe112emergencyservicesprovider.Thissystemhasthepotentialtochangecommunicationprotocolsfortraumacare.
30 WISH Road Traffic Injury Report 2013
AMBuLAnCE REDESIGn
Improvedmobilehealthcaresystemspermitambulanceservicestogivedefinitivetreatmentforurgentconditionsatthesceneofaroadcrash,therebyimprovingtheirquality, efficiency and cost-effectiveness. Redesign features include: 360-degreeaccesstothepatient,whichnotonlyincreasesclinicalefficiencybutalsoenhancespatientsafety;aneasy-toclean-interior;specialequipmentpacks;andnewdigitaldiagnosticsandcommunicationssystems.50
InnovATIvE SoLuTIonS In PoST-CRASH CARE – TRAnExAMIC ACID: FRoM RESEARCH To PRACTICE
Anestimated5.8millionpeopledieeachyearasaresultoftraumaofallkinds,manyafterreachinghospital.51 One of the most common causesofdeathisbleeding,accountingfor40percentofin-hospitaltraumadeaths.52
Tranexamicacid(TXA)hasbeenusedtocontrolbleedingduringelectivesurgeries.Researchersinvestigatedwhetherthisdrugcouldbeusedtotreatuncontrolledbleedingintraumapatients.TheCRASH-2trial,alargeinternationalrandomizedcontroltrialcarriedoutin40countries,showedthatadministrationofTranexamicacid(TXA)–ifcompletedwithinthreehoursofinjury–couldindeedleadtoastatisticallysignificantreductioninmortalityoftraumapatientswithbleeding.53Fromthesestudies,ithasbeenestimatedthatmorethan100,000livescouldbesavedgloballyeachyearifTXAwereinwidespreaduse.54
Global distribution of deaths likely averted by means of TxA administration within three hours of injury54
AtlessthanUS$10pertreatment,TXAadministrationhasbeenshowntobehighlycost-effectiveinLMICsorHICs.55Itismorecost-effectivethanantiretroviraltreatmentforHIV,andnearlyascost-effectiveasbednetsformalariaprevention.OnthebasisoftheevidenceofTXA’seffectiveness,thedrughasbeenincorporatedbytheBritishArmyintocombatcaretreatmentprotocols,andisnowincludedintheWHOlistofessentialmedicines.
31WISH Road Traffic Injury Report 2013
7. TEChnOLOgYAwidevarietyofe-Safetytechnologiesareinusetoday,someofwhicharefittedtovehiclesasstandardequipment.
ALCoLoCKS
“Alcolocks”areemergingasaninnovativemechanismforseparatingdrinkinganddrivingwithoutrelyingonhumanbehavior.Thealcolockisanalcoholignitionlock,anelectronicdevicethatpreventsthevehiclefrombeingstartedifthedriverhasdrunktoomuch.Thedriverhastobreatheintotheapparatusbeforestartingtheengine,andalsoatrandomtimeswhiledriving.
InTELLIGEnT SPEED ADAPTATIon (ISA)
ISAisasystemthatpreventsordiscouragesthedriverfromexceedingthestatutorylocalspeedlimit.Thein-vehiclespeedlimitissetautomaticallyasafunctionofthespeedlimitsindicatedonaroad.GPSallowsISAtechnologytocontinuouslyupdateandadjustthevehiclespeedlimittotheroadspeedlimit.
SuMMARy
TheinnovationsdescribedabovearesummarizedandclassifiedinTable5,accordingto the typeof innovationand intervention they represent. Table6 indicates theirapplicabilityattheindividual,institutionalandsystemslevels,andinrelationtothetimeofinjuryevent(pre,intra,post).Thesematricesallowacomprehensiveanalysisofinnovationtypesandtheiroperationalcharacteristics.
Bearinmindthattheseinnovationsaretheproductofaprocess–theprocessofinquiryanddiscoverythatleadstoasolution.Theprocessoftenbeginsbyidentifyingchallenges(suchasthehighburdenofRTIs),andthenmovesontoidentifyingspecificneeds (suchas those inLMICs), then to research thatsuggestsseveralpotentialsolutions,thentopilottestingtoidentifywhichoneswork,andthentolarge-scaletestingandquality-assurancestudiestocheckforbotheffectivenessandsafety,andfinallytoimplementationandcontinuousmonitoringandevaluation.Thatisageneric,andperhapssomewhatsimplistic,definitionofaninnovationcycleorprocess,butitdoesgivesomeindicationoftheamountandcomplexityoftheworkthathastobedoneinordertorealizeinnovationsthatwillactuallybringaboutchangeintherealworld.
Note too that this report has not concerned itself with the specific sources ofinnovations.Innovationsmayemergefromanypartoftheworld–high-,middle-orlow-income–astheinnovationsinroadsafetyandtraumacareclearlyshow.Whilethe lessonspassedfromHICstoLMICsarewell-known, the“reverse innovation”fromLMICstotheworldislesswidelydiscussed.56 WISH2013offersanopportunitytocelebrateallcreativityirrespectiveoflocation.
32 WISH Road Traffic Injury Report 2013
Tohighlightsomeoftheinnovations,wehavecompiledamixedselectionofcasestudies illustrating innovative and best practices from around the world. Theinnovations and approaches described have been successfully employed in avarietyofsettings.Areminderofsomeexamples: inSouthAfrica, the insurancecompanyDiscoverydevelopedanincentiveprogramfordriversthathassignificantlyincreasedtheproportionof“good”and“excellent”driversontheroad.InMexico,theNGOVIVIACusedagrassrootsadvocacyapproachtoreviseregionaldrink-drivinglegislation.AndintheUnitedArabEmirates,AbuDhabi’sUrbanPlanningCouncilcommissioned a street design manual and successfully used its recommendations toredesignamajorroadway,makingitsaferforpedestrians.Thesehearteningreal-worldsuccessesfitperfectlywithWISH2013’semphasisoninnovativepracticesthathaveemergedfromaroundtheglobe.
33WISH Road Traffic Injury Report 2013
InnovATIvE SoLuTIonSInnovATIvE uSE/uTILITy oF ExISTInG non-RTI SoLuTIonS
InnovATIvE IMPLEMEnTATIon oF ExISTInG RTI InTERvEnTIonS
1. L
egis
lativ
e/en
forc
emen
t •LoweredBAClimitfornovice drivers
•Useofautomaticspeedenforcementtoimprovecompliance
•TrainingnewandexistingMPsandpolicy-makersinroad safety issues
•Developingappropriatelegislation to deal with emerging road safety issues,eg,E-Bikes
•Companypoliciesthatfullybantheuseofcellphonesduringdriving
• Levies on licenses and insurance
•ImplementationofNCAPin all countries
•“Boozebuses”
•Promotingpoliciesoncorporatesocialresponsibilityandroadsafety
•Improvedspeed-enforcement technology along with training and mentoring
•Increaseduseofspeedcameras/radarstoimproveenforcement
•Finesfornon-useofseatbelts,eg,Click-itorTicket
•Randombreathtestsforalldrivers(notjustsuspects)andinmoreareas
•Bansoncellphoneusewhiledrivingforyoung/novice/fleet-car/schoolbusdrivers
•Implementationofhelmet laws
2. B
ehav
iora
l • Graduated driver licensingprograms
•Carinsuranceincentiveschemes
•Improvedmarketing/brandingofroadsafety
• Promoting a change of culture in road safety –unacceptabletodrink-drive or use cell phoneswhiledriving
•Useofhard-hittinggraphiccampaignsto create a theater ofpolicing
•Trainingmediaonroadsafety interventions
3. C
omm
unity
Em
pow
erm
ent •EmpoweringNGOsto
beenforcementofficerswherepoliceareunder-resourced
• Encouraging social accountability, eg,matatupassengers
•EncouragingCSOengagementinlobbying,eg,HIV/AIDS
•TrainingofNGOsandvolunteersinfirstaid
4. R
oad
Safe
ty
Man
agem
ent • Legislation to ensure that
there is a lead agency for road safety
•Shifttowardslocal/city-level management of road safety
•LobbyingtomakeroadsafetyapartoftheSDGs
•Promotionofnational/city-levelRoadSafetyCouncils
•Encouragingmulti-sectoralcollaborationacross all Decade of Actionpillars
Table 5: Matrix of Road Safety Innovations
34 WISH Road Traffic Injury Report 2013
InnovATIvE SoLuTIonS InnovATIvE uSE/uTILITy oF ExISTInG non-RTI SoLuTIonS
InnovATIvE IMPLEMEnTATIon oF ExISTInG RTI InTERvEnTIonS
5. In
fras
truc
ture •Dynamicspeedlimits
•Steelcablesinhighwaymedians
•Reducingdemandforcarusethroughurbandesign
•Linkingtrafficcalmingmeasureswithwell-fundedprograms, eg,streetresurfacing
•Rumblestrips•Separationofvulnerable
road users and vehicles
•Speedlimits•Speedrestrictionzones•Trafficcalmingmeasures, eg,roundabouts
•Separationofbikes from other vehicles
6. P
ost-c
rash
Car
e • Use of tranexamic acid in post-crashtreatment
• Promoting a systems approachtotraumacare
•eCallsystems• Building emergency lanes toproviderapidcareincongestion
•Automaticnotificationtoemergency services
•Psychologicalsupportforroad crash victims
•Traumaregistries•Qualityimprovementprogramsfortraumacare systems
•Mobile-phoneemergencyreportingsystems
•Identificationandreportingofhigh-riskdriversbyemergencydepartments
•Emergencydepartmentbriefinterventions
•EngagingRedCrossorRedCrescentsocieties inpost–crashcare, eg,Kenya
7. Te
chno
logy •AlcoholInterlocks
•Seatbeltreminders• Gearshift delay to promoteseatbeltuse
•IntelligentSpeedAdaptation
• Autonomous cars
•Speedgovernors•Cellphone-blocking
technology in cars
8. o
ther •Employingroadsafety
information systems (linkeddatabases:vehicles/drivers/crashes/violations)
•Hospitalstoclaimbacktreatment costs from health insurance
•LoweringimportdutiesinLMICsonsafety-relatedsparepartsforvehicles,suchasbrakecomponentsandtires
•Improvedresearchonintervention effectiveness
•Cost-effectivenessstudies
•Improvedmasstransportsystems,eg,rapidbussystem
•Involvingmoreprivatecompaniesinglobalroadsafety
Table 5: Matrix of Road Safety Innovations(continued)
NCAP:NewCarAssessmentProgram
35WISH Road Traffic Injury Report 2013
LEvE
LS o
F AP
PLIC
ATIo
n
InDI
vIDu
ALIn
STIT
uTIo
nAL
SyST
EM
TIM
E Ho
RIzo
nGE
nERA
L Po
PuLA
TIon
vuLn
ERAB
LE G
RouP
Syo
unG
DEPE
nDEn
TS/
ADoL
ESCE
nTS
PRE-
EvEn
T•“Bo
ozebu
ses”
• Alc
ohol
Interlo
cks
•Seatbelt
rem
inde
r• G
ears
hift
dela
y•Intelligent
Speed
Adaptation
•Cellphone
blocking
tech
nolo
gy
in ca
rs•Incentive
programs
• Enc
oura
ging
so
cial
accoun
tability,
eg,m
atatu
driv
ers
•Separationofbikesfrom
other
vehi
cles
•Separationofvulnerableroad
user
s an
d ve
hicl
es•Infrareddetectorsonca
rsto
detectvulnerableroadusers
• Ped
estr
ian
Beha
vior
Pro
gram
s•ImprovedPedestrian/Cyclist
Visibility
• Ped
estr
ian
safe
ty m
easu
res
• Gra
duat
ed d
river
lice
nsin
g programs
•Low
eredBAC
limitforn
ovice
driv
ers
•Bansoncellphoneusewhile
drivingfory
oung/novice/fle
et-
car/schoolbusdriv
ers
•Boosterseatprogram
s•S
peedgovernors
•VehicleDataRe
corders
•Trainingnewand
existingMPs
andpolicy-makersinro
adsafety
issu
es•D
evelopingappropria
telegislation
to d
eal w
ith e
mer
ging
road
saf
ety
issues,eg,E-Bikes
•Com
panypoliciesthatfullyban
theuseofcellphonesdu
ring
driv
ing
•Implem
entationofNCA
Pinall
coun
trie
s•P
romotingpoliciesoncorporate
socialre
sponsibilityandroad
safe
ty• L
egis
latio
n to
ens
ure
that
ther
e is
a le
ad a
genc
y fo
r roa
d sa
fety
co
unci
ls•S
hifttowardslocal/c
ity-le
vel
man
agem
ent o
f roa
d sa
fety
•Lobbyingtom
akeroadsafety
apartoftheSDG
s•P
romotionofnational/city-le
vel
RoadSafetyCo
uncils
•Encouragingm
ulti-sectoral
collaborationacrossallDe
cade
ofActionpillars
•Involvingm
oreprivatecompanies
inUNR
SC•P
oliticaladvocacyapproaches
•EncouragingCSO
engagem
entin
lobbying,eg,HIV/AIDS
•Improvedm
arketin
g/branding
of ro
ad s
afet
y• P
rom
otin
g a
chan
ge o
f cul
ture
inro
adsafety–un
acceptableto
drink-driveorusecellphones
whi
le d
rivin
g •U
seofh
ard-hittinggraph
ic
campaignstocreateatheater
ofpolicing
•Trainingmediaonroadsafety
inte
rven
tions
• Lev
ies
on li
cens
es a
nd in
sura
nce
•Improvedspeedenforcement
tech
nolo
gy a
long
with
trai
ning
an
d m
ento
ring
•Increaseduseofspeedca
meras/
radarstoim
proveenforcem
ent
•Finesforn
on-useofseatbelts,
eg,Click-itorTicket
•Implem
entin
grand
ombreath
testsonalldrivers(notjust
suspects)and
inm
oreareas
•Implem
entin
ghelm
etlaws
•Employingroadsafetyinform
ation
system
s(linkeddatabases:
vehicles/driv
ers/crashes/
violations)
•Low
eringim
portdutiesinLMICs
onsafety-relatedspareparts
forv
ehicles,suchasbrake
componentsandtires
•Improvedm
asstransport
system
s,eg,rapidbussystem
•Policepatrols
Tabl
e 6:
Lev
els o
f App
licat
ion
for I
nnov
atio
ns
36 WISH Road Traffic Injury Report 2013
LEvE
LS o
F AP
PLIC
ATIo
n
InDI
vIDu
ALIn
STIT
uTIo
nAL
SyST
EM
TIM
E Ho
RIzo
nGE
nERA
L Po
PuLA
TIon
vuLn
ERAB
LE G
RouP
Syo
unG
DEPE
nDAn
TS /
ADoL
ESCE
nTS
PRE-
EvEn
T•R
oadsafetyca
mpaigns
•Improvedlightin
gforroadw
ays
and
vehi
cles
•Red-lightcam
eras
•Speedingcameras
•Traffic-calm
ingmeasures
•GeographicInform
ationSystem
s(GIS)
•Non-vehicle-dependenttravel
EvEn
T•D
ynam
icspeedlimits
•Rum
blestrip
s•R
educingdemandforc
aruse
throughurbandesign
•Linkingtrafficca
lmingmeasures
with
well-fun
dedprograms,
eg,streetresurfacing
•Steelca
blesinhighw
aym
edians
PoST
-EvE
nT
SuB-
ACuT
E• U
se o
f tr
anex
amic
ac
id in
post-crash
trea
tmen
t
•Traum
aregistrie
s•C
ontin
uingEdu
cationCo
urses,
suchasATLS
,PTC,NTM
C•Q
ualityim
provem
entprogram
sfo
r tra
uma
care
sys
tem
s
•Promotingasystem
sapproach
to tr
aum
a ca
re•e
Callsystem
s•E
mergencylanesbu
ilttoprovide
rapidcareincongestion
• Aut
omat
ic e
mer
genc
y se
rvic
es
notifi
cation
•Cellphoneemergencyreporting
syst
ems
PoST
-EvE
nT
LonG
TER
M
MAn
AGE
MEn
T
•EngagingRe
dCrossorRed
Crescentsocietiesinpost–crash
care,eg,Kenya
•Emergencydepartmentbrie
fin
terv
entio
ns
•Psychologicalsup
portforroad
cras
h vi
ctim
s
Tabl
e 6:
Lev
els o
f App
licat
ion
for I
nnov
atio
ns (continued)
37WISH Road Traffic Injury Report 2013
ThE DEVELOPMEnT ChALLEngEThedesiretoreduceroadtrafficdeathsandinjuriesamidstrapideconomicgrowthandurbanizationnecessitatesanewwayofthinkinginthefieldofroadsafety.Theworldwideboominroadnetworksandthesoaringnumberofvehiclesonthemwillrequireinnovativemeasurestomoveroadsafetyforward,andtoensurethatRTIsaretakenintoaccountduringthistimeofrapideconomicdevelopmentandurbanization.
Theconsequencesofthiseconomicdevelopmentandurbanizationinclude:
• Massiveinvestmentsinroadbuilding,andtheneedtorefineroadsafety,bothforimmediateandforlong-termbenefits.Thisiscritical,giventhepathdependencyoftransportsystems.
• Expansionoftheglobalcarindustryandtheshiftofproductiontorapidlygrowingmiddle-incomecountries,andtheneedtobuildsafetymeasuresintothesenewcars.Inaddition,questionsoverhowasurgeinlow-costcarscanbeconsistentwithsafetyconcerns.
• Incorporation of large populations into the road transport networks,whetherasdriversorpedestrians,andtheneedforrapidchangesinroadsafetyculture.ThesechangestookalongtimeintheHICs,butweneedacceleratedstrategiesforchangeinLMICs.
• Rapidgrowthintheroadtransportindustry,andtheneedformeasurestoreduceriskaroundtheworld.
• Majorchangesinthepatternofhealthproblems,includingasoaringincidenceofRTIs,andtheinabilityofmanyhealthsystemstodeliveradequateacuteandtraumacare.
Theseconsequencesraiseseveralchallenges:
• Are mechanisms available to help incorporate road safety rapidly into themanagementofthesenewroadtransportsystems?
• Arethereexamplesofroad-systemexpansionschemesthatconsciouslyincludedroadsafetyintheirplanning?
• Cannewtechnologies,especiallythenewlyavailablelow-costtechnologies,helptomakedrivingsafer,evenwhereculturalchangehaslaggedbehindthechangeinroadtransportsystems?InHICs,suchpossibilitiesincludetheuseofdriverlesscars,ascurrentlybeingdevelopedbyGoogleintheUS.InLMICs,thechallengeremainsmorepronounced.
• Whatkindsofcoalitionscouldemergetodriveforwardreformsinsafetransport?Whatcontributionscouldbemadebycitygovernments,healthsystems,healthinsuranceschemes,highwayauthorities,andtheautomobileindustry?Couldnewtypesofinsuranceplayarole?
• Asmorecountriessetuniversalhealthcoverageasapoliticalaim,willthecoverageincludelow-costandeffectivetraumacare?Howcanbest-practicemodelsbespreadrapidly?Whoshouldpayforthistraumacare–governmentorhealthinsuranceschemes;orperhapsdrivers,throughtaxesorinsurance;orperhapsthepeoplewhoareinjured?
38 WISH Road Traffic Injury Report 2013
• Howcanministriesofhealthtaketheleadhere?Onekeyrolemightbetogenerateandpublicizestatistics;anotherwouldbetopromotethedevelopmentofatraumacaresystem.
• Isroadsafetyreallyamenabletotechnologicalinnovations,particularlyinrapidlygrowingLMICs?Assumingthatpeoplewilllargelyuselow-costvehicles,howcanthesebemadesaferfordriversandalsoforpedestrians?WhatrolemightICTinnovationsplay?
Thesequestionsreflectafundamentalfeatureofroadsafetyandtraumacare:theircomplexity.Todealwithsuchcomplexity,theglobalhealthcommunitywillhavetobeinnovativeandbold–anditisinthatspiritthatweofferoursetofsuggestionsinthefollowingsection.
POLICY RECOMMEnDATIOnSThe fields of RTI prevention and trauma care are ripe for a breakthrough – amovementthatdrivesandsustainsinnovationstoreducetheheavyburdenofRTIsanddeaths.Webelievethatallstakeholdersinroadsafetyandtraumacareacrossthehealthsectorandalliedsectors–governments,NGOs,researchers,academics,victimgroups,theprivatesector,donors–haveakeyroletoplayindevelopinganddiffusinginnovativesolutionsandimplementation.Thatrolewillinvolvetakingupatleastsomeofthefollowingpolicyandactionrecommendations:
1. ADvoCATE FoR A GLoBAL unDERSTAnDInG oF THE BuRDEn oF RTIs
Moreeffectivecommunicationandadvocacyonroadsafetyisneeded,toelucidatethetrueburdenofRTIsinallitsdimensions(age,gender,inequities,andsoon).If thecurrentneglectof roadsafetycontinues, theprice is thecontinued loss ofmorethanamillionliveseachyear.Withmanymillionsdisabled,andthatis apricethatwecannotafford.
We urge policy-makers and non-governmental organizations to understand and use road safety data and disseminate it to their populations.
2. STIMuLATE A PIPELInE oF DISCovERy
R&DrelatingtoRTIsshouldbepromotedfromamulti-disciplinaryperspective,withcollaborationfromhealthprofessionals,engineers, thepolice, theprivatesector,andothers.Particularemphasisshouldbeplacedontranslationalresearchand cost-effectiveness data on new solutions, especially solutions for LMICs. A solid evidence base is the cornerstone of any public health action againstdiseaseandinjury.
We urge donors, governments, and the private sector to invest in R&D in road safety and trauma care.
39WISH Road Traffic Injury Report 2013
3. EnSuRE THAT PoLICy-MAKERS IMPLEMEnT THE RECoMMEnDATIonS oF THE 2004 WoRLD REPoRT on RoAD TRAFFIC InjuRy PREvEnTIon:
1. Identifyaleadagencyingovernmenttoguidethenationalroadtrafficsafetyeffort.
2. Assesstheproblem,policies,andinstitutionalsettingsrelatingtoroadtrafficinjuryandthecapacityforroadtrafficinjurypreventionineachcountry.
3. Prepareanationalroadsafetystrategyandplanofaction. 4. Allocatefinancialandhumanresourcestoaddresstheproblem. 5. Implementspecificactionstopreventroadtrafficcrashes,minimizeinjuries
andtheirconsequences,andevaluatetheimpactoftheseactions. 6. Supportthedevelopmentofnationalcapacityandinternationalco-operation.
We urge governments to ensure that they adopt and implement the recommendations of the 2004 World Report on Road Traffic Injuries Prevention.
4. EnABLE REAL-WoRLD TESTInG oF InnovATIonS
New roadsafetymeasuresand interventionsdevelopedby theprivatesectororacademicinstitutionsshouldnotonlyreachthepeopletheyaredesignedforbutshouldalsobeeffectiveandsafe.Systematicassessmentsofefficacyandeffectivenessshouldbeencouragedandfundedwithinthefieldofroadsafety.
We urge all stakeholders to adopt the principle of promoting and using evidence-based innovations for road safety and trauma care systems.
5. PRoMoTE THE DIFFuSIon oF EvIDEnCE-BASED InnovATIonS As discussed above, there are numerous interventions known to be effective,
yet theyhavenotbeentakenupona largerscale,andremainconfinedto fewlocations. Legislation and enforcement revolving around themajor risk factors(speed,seatbeltandchildrestraintuse,helmetuse,anddrink-driving)arestillnotpresentinmanycountries.Toremedythisshortcoming,effectiveinteractionsbetweenresearchers,governments,policy-makers,andhealthworkersneedtobestrengthened.Theuseoftrustedcommunicationchannelsandnewsocialmediawillenhancethedisseminationofevidence-basedinnovationsinroadsafety.
We urge all sectors, especially nGos, academia, and civil society, to promote global diffusion of road-safety and trauma-care innovations using traditional and new technologies.
40 WISH Road Traffic Injury Report 2013
6. uSE THE DECADE oF ACTIon on GLoBAL RoAD SAFETy 2011-2020 To PuSH FoR EFFECTIvE ACTIon
Wehavesevenyearsremaininginthedecade–anopportunitytocreateglobalmomentum for road safety and trauma care. Decision-makers should take up the challenge, andmake it their decade, to create a platform for change. Innovative actions of the kind in the table below and as discussed in this reportcanmakearealdifference.
Pillar1RoAD SAFETy MAnAGEMEnT
Pillar2RoAD InFRASTRuCTuRE
Pillar 3vEHICLE SAFETy
Pillar4SAFER RoAD uSERS
Pillar5PoST-CRASH CARE
Legislation to assign lead agencyforRoadSafetyCouncils
Lobbyingtomake road safetyapartofthe SDGs
Multi-sectoralcollaborationacross Decade of Action Pillars
Decreased demand for car use through urbandesign
Speedrestrictionzones
Separationofvulnerableroadusers and vehicles
ImplementingofNCAPinallcountries
Alcohol Interlocks
IntelligentSpeed Adaption
Speedgovernors
Cellphoneblockingtechnology
Graduated driver licensing
Carinsuranceincentive schemes
Automatic speedenforcement
Randombreathtests
Ban on cell phoneuse
Tranexamicacid
Promoting a systems approach
eCallsystems
Automatic emergency notification
Traumaregisters
Qualityimprovement
We urge governments to adopt and implement the strategies in the un Decade of Action’s Global Plan for 2011-2020.
7. InTEGRATE RoAD SAFETy InTo GLoBAL HEALTH AnD DEvELoPMEnT AGEnDAS
Theinterconnectionofroadsafetywithotherhealthandenvironmentalagendasisconsiderable,andcallsforincorporatingRTIreductionintodevelopmentpoliciesandprograms.PoliciesaimedatreducingRTIsmusttakeintoaccounttheotherhealtheffectsofroadtransport;andhealthpoliciesinotherareashavepositiveeffectsonroadsafety.Table7showsthelinkagesbetweenroadsafetyandfourotherhealthtopicscoveredintheWorldInnovationSummitforHealth2013.
41WISH Road Traffic Injury Report 2013
Table 7: Interconnection of Road Safety and other health agendas
HEALTH ToPIC ASSoCIATIon WITH RoAD SAFETy
obesity •Urbanplanningcanpromotehealthybehaviorandsafetythroughinvestmentinactivetransport,bydesigningareastopromotephysicalactivitywhilekeepingsaferoaddesignattheforefront.
•Thereisaknownlinkbetweenobesityandhigherratesofsevereinjuriessustainedafteraroadtrafficcrash.
Mental Health •AlcoholandsubstanceabusearemajorcontributorstoRTIs,astheyaretotheglobalmentalhealthburden.
• Dementia and other mental health issues associated with elderlypopulationsarenowrecognizedriskfactorsforcarcrashesandRTIs.
•Thereisaknownlinkbetweenepilepsyandriskofcarcrashes.Big Data •LocationtrackingforcarsyieldsBigData,andcouldbecome
increasinglyvaluableinRTIreductioneffortsinthenearfuture.•Projectionsofglobaltrafficpatternsoverthenext20-30yearsarepossibleviaBigData,andsoareprojectionsoftheeffectsonhumanhealth.
Patient Engagement •Engagementofvictimsupportgroupsandthecommunitycanbeapowerfuladvocacytoolforroadsafety.
Road safety needs to be an integral part of the post-2015 SDGs framework(whichreplacestheMillenniumDevelopmentGoals).Suchintegrationwillhelptomobilizethenecessarypoliticalandfinancialsupport for theUNDecadeofActionforRoadSafety.Thepost-2015frameworkprovidesauniqueopportunityforpolicy-makerstoputsafeandsustainabletransportprominentlyontheglobalhealthagenda.
We urge global health leaders and the un agencies to ensure the incorporation of road safety and trauma care as a key concern for sustainable global health and development goals.
8. CREATE CoMMunITy DEMAnD FoR EFFECTIvE SoLuTIonS
Community involvementcangreatlystrengthentheglobalmovement forroadsafety.Themorethatacommunityismobilized,throughNGOsandothervoluntarygroups,andthemorevocalitis,thelikelieritisthatofficialswillrespondtovaliddemands.Enablingcivilsocietytodemandinterventionsisanimportantstrategyforpromotingroadsafety.
We urge civil society, victim groups, and nGos to be effective advocates, and engender a strong demand for road safety and trauma care in populations around the world.
42 WISH Road Traffic Injury Report 2013
9. SHoWCASE REAL-WoRLD ExAMPLES oF EFFECTIvE CHAnGE
WhencountriestakepositivestepsandadoptmultipleinterventionstoreducetheirRTIburden,theireffortsshouldbepublicizedandshouldserveasmodelsforothercountries in theregion.Governmentsandotherroadsafetypolicy-makersoftenrespondtocomparativeexamplesandneighboringmodels,thusdocumentingsuccessesisimportantforlocalandnationalactiononroadsafety.
We urge all stakeholders, especially academia and researchers, to widely share evidence-based successes and models for best practices in road safety and trauma care.
10. EnSuRE CAPACITy DEvELoPMEnT AS A CoRE STRATEGy
Acriticalgapinroadsafetyinmanycountriesisthelackofhumantechnicalcapacity. Accordingly, countries and especially LMICs should invest in thetrainingandcapacitydevelopmentof their roadsafetyprofessionals.As thecountriesadoptinnovativeprograms,theywilldependonadvancedknowledgeandskillstodesign,implement,evaluate,andsustainsuchprogramsoverthecourseoftime.Continuousinvestmentsinindividualandinstitutionalcapacitydevelopmentareimportantforsustainability.
We urge all stakeholders, especially governments and donors, to ensure that capacity development is integrated in all road-safety and trauma-care efforts.
Wehopethatdecision-makerswilltakethesetoftenrecommendationsandstrivetoimplementthem.Weurgethedevelopmentofmodelplansandprograms,andhopethatthesesolutionscanbeappliedatscale.Thispaperurgesseveralhigh-levelactors(countries,states,cities)tovolunteertodevelopamodelroad-safetyandtrauma-careprogram,andreportitseffectivenessatanotherWISHinfiveyears’time.
Ourlistofsuggestionsindicateskeyrolesforallsections–government,NGOs,theprivatesector,academia,civilsociety–andeachsectioncanfindamissionamongthevariousstrategies.ItistimeforaglobalmovementtolightentheburdenofRTIsandtopromotetraumacare.WehopethatWISH2013canrenewthestrengthandmomentumoftheendeavor.
43WISH Road Traffic Injury Report 2013
ACKnOWLEDgMEnTSTheChair(ProfessorAdnanHyder)andtheresearchteamwishtothankthemembersoftheForumonRoadTrafficInjuryandTraumaCarewhohavecontributedtheirtimeandideastothedevelopmentofthisreport: • HassanAlThani,HeadofTrauma,HamadGeneralHospital,Qatar
• David Bishai, Professor, Department of Population, Family and ReproductiveHealth,JohnsHopkinsBloombergSchoolofPublicHealth,Baltimore,US
• GerryBloom,HealthEconomist,InstituteofDevelopmentStudies,Sussex,UK
• GayleDiPietro,Manager,GlobalRoadSafetyPartnership,Switzerland
• GopalkrishnaGururaj,ProfessorandHead,DepartmentofEpidemiology,NationalInstituteofMentalHealth&NeuroSciences,India
• MarthaHijar,Director,EntornosFoundation,Mexico
• OliveKobusingye,ResearchFellow,MakerereUniversity,Uganda
• KellyLarson,ProgramDirector,BloombergPhilanthropies,NewYork,US
• PatrickLeperc,CorporateVicePresidentPublicAffairs,Michelin,France
• Charlie Mock, Professor, Departments of Surgery, Epidemiology, and GlobalHealth,UniversityofWashington,US
• MargiePeden,Coordinator,UnintentionalInjuryPrevention,WHO,Switzerland
• JunaidRazzak,Chairman,EmergencyMedicine,AgaKhanUniversity,Pakistan
• MarkRosenberg,PresidentandCEO,TheTaskForceforGlobalHealth,US
• EndreSandvik,DirectoratOsloKommune,Oslo,Norway
• RochelleSobel,FounderandPresident,AssociationforSafeInternationalRoadTravel,US
• MarkWilson,HonoraryClinicalSeniorLecturer,ImperialCollegeLondon,UK
• DerekYach,SeniorVicePresident,VitalityGroup,US.
We also wish to thank the following people, who provided additional support: Matt Tagney, Kent Stevens, Neville Taylor, Alison Canning, and MeleckidzedeckKhayesi.
44 WISH Road Traffic Injury Report 2013
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