ROAD TRAFFIC Inju RY AnD TRAuMA CARE: I nnOVATIO nS FOR … · 2019-03-08 · Figure 2: Road...

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


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


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.


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.


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%


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


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

http://www.makeroadssafe.org/publications/Documents/mrs_iii_report_lr.pdf


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.


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


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.


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.


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

http://www.wish-qatar.org/reports/2013-reports


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).


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).



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


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



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.



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


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


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.


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


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%


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.


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.


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


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


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


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

http://www.upc.gov.ae/template/upc/pdf/Street%20Design%20Manual%20English%20(small)%20FINAL.pdf


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.

http://www.drivingforbetterbusiness.com

http://www.fleetsafetybenchmarking.net


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.


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.


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.


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.


InnovATIvE SoLuTIonSInnovATIvE uSE/uTILITy oF ExISTInG non-RTI SoLuTIonS


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


InnovATIvE SoLuTIonS InnovATIvE uSE/uTILITy oF ExISTInG non-RTI SoLuTIonS


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


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


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)


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?


• 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.


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.


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.


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.


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.


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.


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