Laypeople roles at road traffic crash scenes: a systematic review

This study aimed to identify the roles of laypeople at road traffic injuries (RTIs). A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of ‘laypeople’, ‘layman’, ‘layperson’, ‘bystander’, ‘first responder’, ‘lay first responder’, ‘road traffic’, ‘road traffic injury’, ‘crash injury’, ‘crash scene’, ‘emergency’, ‘trauma care’, and ‘prehospital trauma care’ were used in combination with the Boolean operators OR and AND. We did electronic search on Google Scholar, PubMed, ISI Web of Science, CINAHL, Science Direct, Scopus, ProQuest. Based on the reviewed studies, some factors such as cultural conditions, knowledge, relief agencies, and demographic factors affect the interventions of laypeople at the crash scene in functional areas. Regarding the permanent presence of people at the crash scene, the present study can provide an opportunity to reduce different side effects of RTIs imposed on the society.     

Prehospital trauma care evolution,practice and controversies: need for a review

Abstract

Modern medicine and surgery is historically very recent, and most interventions that are so commonly done in a hospital now are only 60 to 70?years old. Understanding of emergency care of the injured is more recent; however, for the sake of temporal convenience trauma care has become compartmentalized into phases: first aid, bystander care, prehospital care, emergency care, definitive levels of care and rehabilitation. The injured patient’s body physiology is changing continuously from the time of the impact at the injury site.. The outcome of trauma is dependent not only on what is done in the prehospital phase but also on hospital care and rehabilitation. Our understanding of the changes and the response to interventions in a trauma patient has been evolving over the years. This paper discusses the need to review recent advances in our understanding of the care process and how we need to improve it and how there is a pressing need to generate valid evidence on what we do in emergency care.     

Global collaboration on road traffic injury prevention

Worldwide, nearly 1.2 million people are killed in road traffic crashes every year and 20 million to 50 million more are injured or disabled. These injuries account for 2.1% of global mortality and 2.6% of all disability-adjusted life years (DALYs) lost. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate action, by 2020, road traffic injuries are predicted to be the third leading contributor to the global burden of disease. The economic cost of road traffic crashes is enormous. Globally it is estimated that US$518 billion is spent on road traffic crashes with low- and middle-income countries accounting for US$65 billion--more than these countries receive in development assistance. But these costs are just the tip of the iceberg. For everyone killed, injured or disabled by a road traffic crash there are countless others deeply affected. Many families are driven into poverty by the expenses of prolonged medical care, loss of a family breadwinner or the added burden of caring for the disabled. There is an urgent need for global collaboration on road traffic injury prevention. Since 2000, WHO has stepped up its response to the road safety crisis by firstly developing a 5-year strategy for road traffic injury prevention and following this by dedicating World Health Day 2004 to road safety and launching the WHO/World Bank World Report on Road Traffic Injury Prevention at the global World Health Day event in Paris, France. This short article highlights the main messages from the World Report and the six recommendations for action on road safety at a national and international level. It goes on to briefly discuss other international achievements since World Health Day and calls for countries to take up the challenge of implementing the recommendations of the World Report.     

How much would low- and middle-income countries benefit from addressing the key risk factors of road traffic injuries?

Abstract

Despite strong advocacy, the UN Decade of Action for Road Safety (2011–2020) is ending with most low- and middle-income countries (LMICs) no closer to the Sustainable Development Goals target of reducing traffic mortality by half. In contrast, most high-income countries (HICs) have seen large benefits in recent decades from large-scale safety interventions. We aimed to assess how much LMICs would benefit from interventions that address six key risk factors related to helmet use, seatbelt use, speed control, drink driving, and vehicle design for safety of occupants and pedestrians. We use a comparative risk assessment framework to estimate mortality and health loss (disability adjusted life years lost, DALYs) that would be averted if these risks were reduced through intervention. We estimate effects for six countries that span all developing regions: China, Colombia, Ethiopia, India, Iran, and Russia. We find relatively large benefits (27% reductions in road traffic deaths and DALYs) from speed control in all countries, and about 5%-20% reductions due to other interventions depending on who is at risk in each country. To achieve larger gains, LMICs would need to move beyond simply learning from HICs and undertake new research to address risk factors particularly relevant to their context.     

List of Reviewers 2013

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. The rate of road traffic accidents caused by four-wheeled vehicles is the highest globally reported road traffic accidents statistic. In Saudi Arabia, the motor vehicle is the main means of transportation with one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Road traffic injuries cause considerable economic losses to victims, their families, and to nations as a whole. Strategic prevention plans should be implemented soon by various sectors (health, police, transport, and education) to decrease the mortality and morbidity among adolescent and young age group. Strong and effective coordination between ministry of health and other ministries together with World Health Organization and other related organisations will be an important step towards implementing the international Decade of Action for Road Safety (2011–2020). The aim of this review article is to highlight some aspects of the health impacts of road traffic accidents.     

Cumulative Table of Contents

Objective. To assess acute alcohol intoxication among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.

Design. Cross-sectional surveys were conducted during a four-week period in each of the above sites in 1999, 2000 and 2001. The concept of an ‘idealised week’ was used to render representative samples. Breath-alcohol concentrations were assessed in a total of 1900 patients using a Lion SD2 alcolmeter.

Results. Over half of all the patients experienced violent injuries. Across sites and for each respective year of the survey, between 35.8% and 78.9% of patients tested positive for alcohol. Between 16.5% and 67.0% had a breath-alcohol concentration greater than or equal to 0.05g/100ml. Port Elizabeth consistently had the highest proportion of patients testing positive for alcohol. Patients injured as a result of violence were more likely to test positive for alcohol than patient who sustained road traffic or other unintentional injuries.

Conclusions. Alcohol involvement among trauma patients remained consistently high for each of the three study periods. Efforts to combat the abuse of alcohol would appear to paramount in reducing the burden of injuries on health care services.     

Utilization of health services by the injured residents in Kumasi, Ghana

The objective was to determine the pattern of health service utilization by the injured in Kumasi, Ghana and thus to gain information useful for the strengthening of trauma care in that environment. A household survey was utilized as it was anticipated that many injured might not receive formal medical care and a total of 11,663 persons living in 264 clusters in Kumasi were surveyed. One-third of all injured did not receive any formal medical care, mainly due to financial constraints. Altogether, 37% of the injured attended a hospital and 34% attended a clinic. Among the severely injured (> or =1 month disability) attending a clinic, most (76%) used it as the sole source of care. Most (54%) of these clinics were private. Efforts to strengthen trauma care in urban Africa need to address financial barriers to care and need to consider clinics, as well as the main hospitals.     

Utilization of health services by the injured residents in Kumasi,Ghana

The objective was to determine the pattern of health service utilization by the injured in Kumasi, Ghana and thus to gain information useful for the strengthening of trauma care in that environment. A household survey was utilized as it was anticipated that many injured might not receive formal medical care and a total of 11 663 persons living in 264 clusters in Kumasi were surveyed. One-third of all injured did not receive any formal medical care, mainly due to financial constraints. Altogether, 37% of the injured attended a hospital and 34% attended a clinic. Among the severely injured (≥1 month disability) attending a clinic, most (76%) used it as the sole source of care. Most (54%) of these clinics were private. Efforts to strengthen trauma care in urban Africa need to address financial barriers to care and need to consider clinics, as well as the main hospitals.     

Multinational investment and host country development: Location efficiencies for services offshoring

Services offshoring has become an important source of investment and development in many emerging economies. While much attention has been paid to companies’ use of services offshoring to lower costs, not all of these offshoring activities have yielded the anticipated results. Thus, the choice of where to locate offshore facilities is an important yet complex one that has substantial implications for both the investing firm and host country. In this paper, we adopt the perspectives of service firms located in the U.S. and empirically examine the attractiveness of host countries for offshoring of services. Using data envelopment analysis (DEA), we examine which countries use their resources or inputs most efficiently in order to produce outputs that make them attractive for services offshoring. We find that China, India, Ireland, the Netherlands, Pakistan, Slovakia, Spain, and the U.K. are particularly attractive locations for services offshoring. All of these countries have at least one core efficiency-creating competency among the key inputs of wages, education, and infrastructure. We discuss implications for firms and government policy makers and offer recommendations for future research.     

Social inequalities in injury risk in Wales,U.K.

Road traffic accident data in Nigeria generally lack exact coordinate information. Accident analysis is, therefore, restricted to aggregate data on trends, magnitude and temporal dimensions. This article addresses the road accident problem in Jos between 1995 and 1999 through a road profiling approach. Results show that four gateway routes, seven multilane roadways (including two gateway routes) and seven road intersections accounted for 84% of all traffic accidents, 84% of injured casualties and 88% of fatalities. This approach allows for quantification of impacts of controlling for accidents by deliberate profiling of roads for close monitoring and policing. For example, reducing accident counts and fatalities by 50% each on gateway routes will amount to ～35 and 40% reduction in accident and fatality counts, respectively. Countermeasures must consider these roadways and intersections as important inputs in their accidents and casualty reduction targets.     

An analysis of risk factors associated with road crash severities in Namibia

Abstract

Road crash is a leading cause of death and disabilities in Namibia and other developing countries. Based on recent trends, the World Health Organization indicated that progress to realize Sustainable Development Goal (SDG) target 3.6 – which calls for a 50% reduction in the number of road traffic deaths by 2020 – remains far from sufficient. To contribute to efforts in reducing road fatalities in Namibia, this study examined risk factors associated with the severity of crashes recorded in the country. Mixed logit modelling methodology was adopted to address the problem of unobserved heterogeneity in injury severity analysis. Model estimation results reveal that collision with pedestrians, head-on collisions, ran-off road collisions and crashes involving high occupancy passenger vehicles were more likely to result in fatalities and severe injuries. The findings and recommendations of this study are expected to enhance countermeasure implementation to reduce road crashes in Namibia.     

Implications for research

We aimed to study the anatomical distribution, severity, and outcome of hospitalised trauma pedestrian patients in Al Ain, United Arab Emirates (UAE), so as to improve preventive measures. All pedestrian trauma patients who were involved with a road traffic collision and admitted to Al Ain Hospital for more than 24 hours or who died in the hospital were included in the study. Data were prospectively collected during March 2003–October 2007. Three hundred and eighteen patients were studied, 279 (87.7%) were males. Median (range) age was 31 (1–75) years. UAE nationals were significantly younger than non-nationals (median (range) age of 14 (2–75) years compared with 33 (1–75) years, p = 0.001, Mann–Whitney U-test). The lower limb (57.2%) was the most common injured region followed by the head (46.9%). The median (range) Injury Severity Score of patients was 5 (1–45). The median (range) total hospital stay was 11.3 (1–130) days. Thirty patients died (overall mortality 9.4%). In conclusion, mortality of pedestrian injured patients in the UAE is high. Severe head injury was the main cause of death. Measures to improve pedestrian safety should be adopted so as to reduce morbidity and mortality. These include educating drivers and pedestrians on road safety and enforcement of traffic safety laws.     

Speed control in developing countries: issues,challenges and opportunities in reducing road traffic injuries

Speed has been determined to be one of the most common contributing factors in vehicle crashes. This study explores vehicle speed as a factor in the causation of road traffic crashes, using the example of Ghana. It examines the effectiveness of various speed control measures, based on policereported traffic crashes in Ghana and published works on speed control measures in both industrialized and developing countries. In Ghana, pedestrians were the main victims of road traffic injuries. The dominant driver error assigned by traffic police was loss of control, with the underlying factor being excessive vehicle speeds. The ‘speed factor’ alone accounted for more than 50% of all Ghanaian road traffic crashes between 1998 and 2000. While the enforcement of speed limits by traffic police may not be affordable for most developing countries, rumble strips and speed humps were found to be effective on Ghanaian roads. Rumble strips installed on the main Accra-Kumasi highway reduced crashes by about 35% and fatalities by about 55%. Reducing vehicle speeds may be one of the most effective interventions to stem traffic crashes in low-income countries. However, setting lower speed limits is not an effective intervention without the traffic law enforcement resources to ensure that limits are followed. Developing countries must also look to other speed reduction measures such as speed bumps and rumble strips, roads that segregate high- and low-speed users, and technological solutions such as speed governors, as well as greater public awareness of the problem.     

Road safety determinants in low and middle income countries

The objective of this article is to summarize and review the literature on the determinants of road traffic injuries and fatalities, to identify the relevant research gaps in particular for low and middle income countries. We also present a cross-country analysis of the determinants of road traffic injuries and fatalities that take into account a wide range of potential environmental, economic and social factors. The present study focused on differences based on the level of development. The goal was to identify relevant commonalities that may assist in the creation of road safety policies common to countries at a similar level of development. The countries were divided according to the level of gross national income per capita, and these income-level groups were the primary units of interest. The results presented here focus on the differences by income level.     

Safety and Ethics in the Global Workplace: Asymmetries in Culture and Infrastructure

This study described and analysed the circumstances surrounding a fatal car accident involving personnel of a multinational corporation in a developing country. For some companies, road accidents are the leading cause of work-related fatalities in developing countries. This reality highlights the ethical dilemmas encountered in a global workplace. Questions as to how a company addresses safety concerns outside the standard work environment, the ethics of operating in a risky environment and the requirements for international consistency in compensation standards for loss of life were addressed. The authors argued that multinational companies should localize health and safety practices to address the important asymmetries between different regions of the world regarding social, cultural and infrastructural issues. Furthermore, the authors analysed the leadership role that should be played by multinational companies to help and support national governments to reduce traffic fatalities in developing countries. From this perspective, the article represents a contribution for the body of knowledge dealing with the business–society relations. The authors used an action research approach to address these issues, both in response to the particular incident and to contribute to the body of research in this field.     

What can we learn from the historic road safety performance of high-income countries?

Abstract

Road traffic deaths in high-income countries (HICs) have been steadily declining for five decades, but are rising or stable in low- and middle-income countries (LMICs). We use time-series cross-sectional methods to assess how age- and sex- specific death rates evolved in 20 HICs during 1955–2015, controlling for income, population density and urbanization. Past work has attributed improvements in safety in HICs to income growth, suggesting that countries intervene when they become richer (Kuznets hypothesis). In contrast, we show that HICs had statistically significant declines in road traffic injuries starting in the late 1960s that persist after controlling for income effects, and inclusion of a lagged dependent variable. These findings are consistent for all age-sex groups but the effects are strongest for the elderly and young children. We argue that the reversal in the traffic injury trend did not occur because HICs reached an income threshold. Instead, the 1960s were a period of paradigmatic change in thinking about road safety. Subsequent, safety improvements occurred because countries at different income levels established regulatory institutions that had a legislative mandate and financial resources to conduct large-scale safety interventions.     

Prevalence of mortality in cannabis consumer motorcyclists: meta-analysis of international studies

Abstract

The purpose of this study was to estimate prevalence of mortality in cannabis consumer motorcyclists across the world. A systematic review was conducted from publications PubMed/Medline, ISI Web of Knowledge, EMBASE, Scopus, and Google Scholar from August 2010 to March2019. The variances of each study were calculated using the binomial distribution formula and the heterogeneity among the studies was analyzed by Q-Cochran test with a significant level less than 0.1 and the index of changes attributed to I² heterogeneity. The prevalence of mortality in cannabis consumer motorcyclists was estimated 0.15 (95% CI = 0.08–0.22). Subgroup analysis based on country type showed that the mortality rate of cannabis consumer motorcyclists in developed countries is 16% (0.08–0.24) and in developing countries is 8% (0.04–0.10). These findings have implications for developing interventions through presenting appropriate solution, educating people and raising awareness to address the changing nature of drug use among motorcyclists in the world.     

Preference Erosion,Government Revenues and Non‐tariff Trade Barriers

Developing countries benefiting from developed country unilateral trade preferences fear that Doha Round tariff cuts will erode the value of those preferences. That these programmes confer significant benefits, however, is not clear. Studies indicate that the impact of preference erosion would be minimal for most developing countries. But for a small subset of middle‐income and least‐developed countries, concern may be warranted. WTO members, should address affected countries’ concerns, perhaps by tailoring WTO tariff negotiations to lessen adjustment pressures and providing development assistance. Developing countries also are anxious that lower tariffs will reduce government revenues. Dependence on tariff revenue is diminishing and trade liberalisation need not result in lower total tax revenues or even lower customs revenues. Much depends on a country's current tariff and trade regime, its tax structure and its overall economic structure. At some point, a country does need to broaden its tax base and look to other revenue sources to offset declining tariff revenues. Tax reform, therefore, complements trade reform. A third area of developing country concern is non‐tariff barriers (NTBs), which may limit market access even after tariffs are reduced. Despite prior WTO work in this area, NTBs remain a thorny issue for all WTO members.