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| Sunday, 7 August 2005 |
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Features |  |
| News Business Features Editorial
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Road killer to claim 40,000 lives in 20 years : Motor traffic injury prevention Professor A. H. Sheriffdeen, FRCS, FRCSE President, Sri Lanka Medical Association
In spite of early warning systems there is very little we could do about natural disasters but, the one disaster we could possibly prevent is motor traffic injuries. In the UK, a sustained campaign resulted in a steady reduction of the "death index" from road traffic injuries, from 116 in 1965 to 90 in 1980. A steady decline annually thereafter has been recorded. There are similar graphs from Japan and Sweden. The strategies that these countries used were broadly similar. These included: 1. Identification of accident black spots at local level. 2. Cooperation between police and engineers. 3. Continuous research in national policy. 4. Small units in different departments working with consensus to improve safety. In Sri Lanka however, newspapers continue to report sensational accidents and horrendous deaths daily. The dead toll include foreigners, doctors, businessmen, children, adults, families. Even traffic policemen have been affected on what has been dubbed 'the killer roads of Sri Lanka'. Worldwide there are over 3000 deaths daily at a cost of 2% GNP in most countries. 85 per cent of these accidents occur in low and middle income countries such as India, Pakistan and Africa and Sri Lanka. The WHO predicts that the Disability Adjusted Life Year (an index of the disease burden) from Road Traffic Injuries in these countries will go up from 9th to 3rd place by the year 2020. The importance of motor traffic injuries is now recognised globally, so much so that the WHO dedicated World Health Day 2004, to road safety. A Worldwide campaign, the "Road Safety Week", was mounted globally on April 7th, 2004. Several articles were written in the daily newspapers and journals. Other media campaigns were organised, books written, and other activities were conducted at enormous cost, but what effect has it had in Sri Lanka? Whilst the figures in UK, Japan, and Sweden for mortality, following motor traffic accidents, are progressively falling, the figures in Sri Lanka keep rising. From 2002 to 2004 (figures available for the first 9 months) the death rates, grievous injuries and total accidents are showing a steady increase. eg. In year 2002 there were 2038 fatal accidents, and 16011 grievous injuries caused by a total of 54,911 accidents recorded. If the present trend is not halted, in the next 20 years there would be over 40,000 dead, over 320,000 injured and over 1 million vehicles damaged. The cost estimated at 11.6 billion rupees a year would add up to a phenomenal 220 billion rupees! The effect on human lives would be equivalent to the effect of a tsunami hitting Sri Lanka every 20 years. No outpourings of grief for those affected, no promise of international or local aid for those families affected, no psychosocial or mental health rehabilitation for those traumatized, no massive media coverage for this silent "creeping tsunami". The unprotected road user (motor bicycle, bicycle and pedestrian) is the most affected while the largest number killed were pedestrians (815 in 2002, 747 in 2003). The culprit to blame usually escapes since the recorded number of the drivers killed in such fatal accidents is comparatively the smallest (205). The Western Province accounts for the largest number of total accidents but they are spread throughout the country. The Epidemiology Unit of the Ministry of Health ranks Motor Traffic Injuries next to Cerebrovascular disease, Ischaemic heart disease and Cancer as the most common causes of death in Sri Lanka (each averaging over 2000 deaths a year). Deaths due to vector borne diseases (dengue, malaria etc) cost 162 lives, yet the GMOA wants a Director for vector borne diseases while there is only one Director for Non Communicable Diseases who is in charge of the first four 4 leading causes of death totalling over 8000 deaths per year. Results We therefore undertook a study of the injured following Motor Traffic Injuries admitted to the Accident Services of the National Hospital of Sri Lanka. The researchers included Dr. Thisara Samarawickrama, the principal investigator, Dr. Anil Jasinghe, Director Accident Services, Dr. N. Pinto, Consultant Orthopaedic surgeon in charge of the Accident Services, Dr. W. Gunathunga, who did the statistics. Professor A. H. Sheriffdeen, coordinated the study. There were 2158 who could respond of those admitted over this six month period. Fatalities and patients receiving outpatient treatment were not included. The highest number of injured were in the 20-40 age group, 82% were male and 72% were below grade 10 in education. (Worldwide mortality figures for accidents show that the commonest cause of deaths in this 20 to 40 age group is Motor Traffic Injuries). Vehicles There was no seasonal variation although accidents were lowest on Fridays with a rise in numbers on Saturdays and peaking on Sundays. The lesson is that weekend drivers must be especially careful. Vehicular defects contribute significantly to motor traffic injuries as shown up by the fact that 17.8% of the vehicles had serious defects which according to the drivers had contributed to the accident. These included faulty brakes and clutch plates and poor condition of tyres, defective lights and malfunctioning brake lights. 14.5% of 3 wheeler drivers had tampered with the handle lock to improve on their turning circle. This significantly shifts the centre of gravity of the vehicle, especially when this manoeuvre is effected at speed, causing the vehicle to topple. Prof. Mohan de Silva in a study found that 24 out of 29 three wheelers which had met with such accidents had tampered handle locks. It may be that his advocacy has had some effect. The vehicle, the injured person travelled in showed a higher incidence in unprotected vehicles like motor bicycles, 3 wheelers and push bicycles. Although these are a poor man's popular mode of transport, if we cannot reduce the numbers of such vehicles on the roads we must at least make a concerted effort to make such modes of transport safe for the user. The vehicle that the accident occurred against were predictably the protected and heavy vehicles of which vans, lorries, buses, cars came highest with 3 wheelers ranging next in frequency. 29 per cent of the injured were pedestrians and constituted the largest group (as we earlier mentioned this was the largest group killed) and again the group which was least liable to injury were the drivers. The vehicle colour was not significant although there is a popular belief that vehicles with lighter colours are less prone to accidents. A significant number 77.7% had not switched their lights after dark. The injury Severity Score (ISS) which is an index of the severity of the injury sustained was understandably highest in those who had sustained injury from or while in heavy vehicles. Environment It may be surprising news that accidents were commoner on roads of normal or narrow width (over 55 per cent) compared to those on major highways. Carpeted surfaces as opposed to rough roads, and light or no traffic on the roads (as opposed to heavy traffic) and also when vision and weather were clear were the environmental conditions. A significant percentage of pedestrian victims who met accidents after dusk wore dark clothes. There appears to be a case for advising such pedestrians to wear luminous arm bands when walking on the roads under such conditions. To be continued |
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| Produced by Lake House |
A tsunami killed around 40,000 and disadvantaged over a million people in
Sri Lanka. No disaster could possibly match it. Sri Lanka has also had its
share of human losses from wars, civilian conflicts, industrial and home
accidents. Travel accidents including motor accidents are another disaster
group. 
