| Abstract|| |
A study was conducted in Karnataka Institute of Medical Sciences to study the epidemiology of Road Traffic Accidents (RTA) . It was a time bound study and the data was collected using a pre-structured questionnaire. India has one of the largest road networks in the world, second only to USA. And, though India has only 1% of world's vehicle population, about 6% of RTAs occur in India 1 .
The study included 82 RTA cases admitted to the hospital. The cases were studied with respect to the various medico-socio-demographic parameters. Almost 80% people were educated and 68% came from a rural background. Less than 40% people had a license while they were driving, with negligible number using helmets and car belts. On the brighter side, extremely few people were under the influence of alcohol (less than 8%) . Most commonly observed injuries were fractures (71%) and crush injuries (21%) with around 2% of the people ultimately losing their limbs. 43% of the people did not receive treatment before three hours while, only 23% received first aid. Most importantly, only 21% of the cases were brought to the hospital by the highway or state police, with more than half of the patients being brought by co-passengers or passers-by. The study concluded highlighting the poor state of infrastructure, contributing to a high rate of accidents, complicated by a deficient trauma response medical service.
Keywords: fracture, disability, road accident
|How to cite this article:|
Kaul V, Bant DD, Bendigeri N D, Bhatija G. A brief medico-socio-demographic profile of non-fatal road traffic accident cases admitted to Karnataka Institute of Medical Sciences. Scho Res J 2011;1:32-6
|How to cite this URL:|
Kaul V, Bant DD, Bendigeri N D, Bhatija G. A brief medico-socio-demographic profile of non-fatal road traffic accident cases admitted to Karnataka Institute of Medical Sciences. Scho Res J [serial online] 2011 [cited 2014 Oct 31];1:32-6. Available from: http://www.scholarsjournal.in/text.asp?2011/1/1/32/82327
′Originally Published in 2010 in electronic version, through Open Journal Systems and this is republication of the same′
| Introduction|| |
As the WHO slogan for the year 2004 goes, "ROAD SAFETY IS NO ACCIDENT", accidents are logically, not often due to ignorance but due to carelessness, thoughtlessness and over-confidence in one's capabilities.
An accident is an event independent of human will, caused by a sufficiently strong external force or energy acting rapidly on an individual and causing him or her, a bodily and/or a mental injury  . It constitutes an important cause of preventable morbidity, mortality and disability.
Worldwide, the number of people killed in road traffic accidents each year is estimated to be almost 1.2 million, while the number injured, could be as high as 50 million  . Road accidents cause 1 death every 9 minutes (160 everyday and 60,000 every year) and 4 ½ times as many non-fatal accidents  . Road traffic accident injures are currently ranked 9 th globally amongst the leading causes of DALY (Disability Adjusted Life Years) and the ranking is projected to rise to 3 rd by 2020  .
Accidents constitute the first leading cause of death in the age group 5-45 years, in both developing as well as developed countries. Developing countries bear large share of burden, accounting for 85% of annual deaths and 90% of DALYs lost because of road traffic injuries. This burden is creating enormous economic hardship and swamping the already inadequate resources.
As one of largest highway and road networks, India contributes 6% of world's RTA share while having only 1% of world's vehicle population. Road traffic accidents are essentially caused by:-
- Rapid increase in personalized modes of transports. (Agent)
- A lack of road discipline. (Host)
- Improper roadway features. (Environment)
The situation that leads to improper interactions could be the result of complex interplay of a number of factors such as, road characteristics, traffic characteristics, road-users behavior, vehicle design, driver's characteristics and environmental aspects, so on and so forth. Thus, the occurrence of accidents is a complex phenomenon.
RTAs are predictable and preventable, but good data is required to understand the ways in which road safety interventions and technology can be successfully transferred from developed countries, where they have proven effective.
The Institute of Health Sciences, Hyderabad, has taken up a similar study in the Hyderabad-Deccan area and it was a long term project to study in detail the factors affecting the rate of accident occurrence. A similar study was conducted by the NIMHANS under the WHO guidance to study prevention of RTAs in 2006  . But data regarding such an epidemiological study from Karnataka are sparse and that led to the initiation of this project.
| Aims and Objectives|| |
- To study the socio-demographic profile of Road Traffic Accident cases admitted to K.I.M.S emergency.
- To study the various types of injuries due to RTAs.
- To study the various factors (including medical and infrastructural) contributing to the occurrence of RTAs.
'Originally Published in 2010 in electronic version, through Open Journal Systems and this is republication of the same'
The project was a time bound study and the data was collected using a pre-structured questionnaire. The study was conducted under the Department of Community Medicine. Karnataka Institute of Medical Sciences, Hubli. The sample included 82 RTA cases admitted to the emergency ward in K.I.M.S hospital. The data was then tabulated, analyzed and conclusions were drawn.
Most of the RTA victims (56.98%), were males aged 20-40 years and least victims were seen in males aged >50. Similar age pattern was identified in a study conducted in JIPMER, Pondicherry where 55.3% males aged 20-40 years constituted the most affected group 5 . This can be attributed to factors such as the fact that, this group constitutes the maximum individuals using vehicles. Other factors such as lack of experience, risk taking behavior, impulsiveness and aggressiveness also come into play.[Table 1]
Out of the 82 cases, 79.28% people are educated. The study conducted at JIPMER, Pondicherry, reported a similar incidence of 84%. This is an alarming statistic, since it implies inadequate safety education and road traffic norm information provision during schooling and thereafter. This deficiency can be easily targeted to bring down the rate of RTAs, by providing quality information to students.[Table 2]
Around 57% of those admitted are laborers and servicemen, who are pedestrians or co-passengers most of the times and are involved in these accidents because they share roadway with fast and slow moving vehicles and in India the facilities for pedestrians' safety, such as foot-paths and dedicated walking tracks are inadequate. Also, these categories of victims were in a hurry to reach work or the market and thus were inattentive while on the road. In a study conducted by the WHO in Nepal, the laborers constituted the largest group (27.6%) involved in RTAs, followed by students (24.1%) . [Table 3]
Around 70% of the victims hail from rural areas. This signifies the lack of exposure to ideal driving conditions and poor information about traffic norms and etiquette. Also, due to a relative lack of roadway facilities in rural areas, these people are not used to driving in the city road conditions.[Table 4]
Out of 82 victims, only 10 were alcoholics and at the time of accident only 5(6.09%), were under the influence of alcohol. In the WHO supported study in Nepal, a much higher percentage (16.9%) drivers were found to have consumed alcohol 2-3 hours prior to the accident  .
Maximum accidents during the day time are seen on the state roadways and inside city limits (42.7%), signifying increased activities on road during daytime, such as commercial activities, activities like attending schools, colleges and offices etc. This increases the probability of the accidents in the daytime which could be due to poor traffic management, while maximum accidents in nighttime are observed on the highways (24.39%) which are attributable to the high speed transit and irresponsible night time driving by the buses and trucks as well as the effects of fatigue on distant driving. In a study done in Nagpur, when temporal distribution of the accidents was studied, it was observed that 225 (53.19%) accidents took place in the daytime . [Table 5]
Out of the 82 victims, only 32 were driving at the time of the accident. Out of 32 drivers, only 14 (43.75%) had license. This reflects the poor law and order situation besides disregard of the people for others' safety. Drivers who are qualified to drive, are not trained for driving under various conditions and are more prone to making errors while driving, leading to accidents.
35 of the total cases were using two wheelers. And out of these only 2 (5.72%) were using helmets. The victims using 4 wheelers accounted to 41 and out of these, NO ONE was wearing the seat belt. WHO observed that buses (31.4%), trucks (12.3%) and bicycles (11.3%) were the common vehicles involved in RTAs in Nepal  . This is a grave indicator of negligence on part of the motorists who don't follow recommended norms and laws, thus putting themselves and others into danger. THIS IS AN IMPORTANT AREA WHERE PREVENTIVE MEASURES CAN BE SUPREMELY EFFECTIVE.
While only 21% of the people were brought to the hospital by the traffic or the highway police, more than 47% victims were brought by passersby or co-passengers. This indicates a poor response time on behalf of the emergency services and the police. This has serious implications since the police and the EMS are trained to handle such situations and can handle the transport to the hospital and starting of immediate rescue attempts faster. With a deficient trained response, more patients are liable to be lost. [Table 6]
Fractures are the most common injuries observed (70.82%). Fractures are caused by a high kinetic force injury causing a break in the bone and this can be attributed to the high velocity traffic on present day roads. A study by the Department of Preventive and Social Medicine, Indira Gandhi Medical College, Nagpur, India noted that, fracture of the bones, was the common injury afflicted to the victims followed by multiple injuries like blunt injury, abrasions and lacerations  . [Table 7]
Nearly 80% of the victims did not receive first aid, starkly showing the lack of emergency medical infrastructure and thus, we lose the benefit of managing the person in the golden period. [Table 8]
More than 42% of the victims were brought to the hospital after a period of three hours, which is a significant delay with respect to management of trauma cases. The main reason is the inadequate infrastructure. [Table 9]
- The study was undertaken for a period of 15 days only.
- Only those who were admitted were included and thus the fatal RTAs and those who may have taken a transfer to another hospital were excluded.
- External factors such as road condition, vehicle condition or surroundings have not been considered.
- Long term implications and complications cannot be assessed.
- Education of people via mass media and campaigns to follow traffic rules and safety measures.
- Inclusion of detailed road etiquette in school syllabus with practical demonstrations.
- Implementation of driver's license as a compulsory requirement and issue of the same after thorough assessment by the Road Transport Authority. Strict action, against those found driving without license and against the parents of underage drivers.
- Education of people in basic first aid and life-support.
- Regulation of pedestrian traffic and flow.
- Limiting the number of passengers to the optimum in mass transport vehicles, to avoid mass triage.
- Construction of proper footpath and pedestrian bridges for pedestrians.
- Enforcement of strict speed limit and usage of helmets and seat belts.
- Improvement in the road conditions in city limits as well as highways.
- Improvement of vehicle conditions such as vehicle screens and doors.
- Banning wrong roadside parking.
- Enforcing use of low beam lights and prevention of use of mobiles.
- Formation of a dedicated Emergency Medical Services for prompt response to triage including ambulances with Advanced Life Support.
- Establishing Trauma Centers along the highways and in important medical colleges.
- Teaching police personnel regarding basic medical first aid and support.
| References|| |
|1.||Textbook of preventive medicine - Park and Park - Bhanot Publications. |
|2.||WHO world report on road traffic injury prevention in Geneva - WHO 2004:p3-29. |
|3.||Epidemiology of Road Traffic Accidents in Hyderabad-Deccan, Andhra Pradesh, India. Available from: (http://www.ihsnet.org.in/BurdenOfDisease/RoadTrafficAccidents.htm) |
|4.||Available from: http://www.nimhans.kar.nic.in/epidemiology/epidem_who6.htm |
|5.||Nilambar Jha, D.K. Srinivasa, Gautam Roy, S. Jagdish; Ind J of Com Medicine: Vol. 29, No. 1 (2004-01 - 2004-03). |
|6.||Epidemiological Study of Road Traffic Accident Cases: A Study from Eastern Nepal. Available from: (http://www.searo.who.int/en/Section1243/Section1310/Section1343/Section1344/Section1836/Se ction1837_8158.htm) |
|7.||Ganveer GB, Tiwari RR. Injury pattern among non-fatal road traffic accident cases: A cross-sectional study in Central India. Indian J Med Sci 2005;59:9-12 |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]