ROAD INJURIES: CAUSES, SAFETY AND PREVENTION, LATEST IN TRAUMA CARE, AND MORE

Road injuries are a major public health problem that affects millions of people around the world every year. As per the World Health Organization (WHO), road traffic injuries rank as the primary cause of death for individuals aged 5-29 years and eighth in terms of fatalities across all age demographics. Annually, an estimated 1.19 million people succumb to road traffic crashes, and another 20-50 million people suffer non-fatal injuries, many of whom incur long-term disabilities. Road injuries also have significant social and economic impacts, costing an estimated 3% of the gross domestic product (GDP) in most countries.^[1]

The purpose of this blog is to provide an overview of the causes of road injuries, recommended safety measures, as well as the latest developments in trauma care, which is specialized medical care for people with severe and life-threatening injuries.

Road Accident Types and Risk

Driving is not a simple or easy task. It requires a lot of skill, attention, and an accurate sense of judgment. There are many factors to deal with while on the road, including the traffic and other road users, weather conditions, pedestrians, animals, and other distractions. You have to follow the rules, respect the signs, and anticipate hazards almost before they happen. It is also challenging to be alert all the time.

Even when you do everything right, you can still get into a road accident due to some unforeseen factor. According to statistics, an average of 0.25-0.62% of the global population is involved in a road accident at any given time. On the low end, it can be estimated that a driver has a 1 in 366 chance of getting injured for every 1000 miles driven (1609 km).

More than 70% of road traffic deaths are attributable to young men under the age of 25. Men of this age are three times as likely to be killed in a road accident than young women. Up to 90% of all accidents occur in low and middle-income countries.

Road accidents are unpredictable and undesirable. Some of the most common types of road accidents that people get into are:

• Collisions: Two or more vehicles or objects that hit each other. Collisions can occur in different ways, such as head-on, rear-end, side-impact, or involve multiple vehicles.
• Rollovers: When a vehicle turns over on its side or roof. Rollovers can happen because of sharp turns, high speeds, uneven surfaces, or collisions.
• Run-offs: The vehicle leaves the road and hits a fixed object, such as a tree, wall, guardrail, or pole. Run-offs happen due to loss of control, distraction, fatigue, or poor road conditions.

No matter what type of road accident you get into, you or the other passengers can end up with serious injuries, vehicle or property damage, and possible fatality. That is why you should always drive safely and carefully and be prepared for any situation.

One of the factors that can influence the severity and outcome of road accidents are safety devices, such as seat belts, airbags, helmets, or child restraints. Such devices are designed to safeguard the occupants from the impact of a crash by reducing the force, distributing the load, or absorbing the energy. The use of safety devices can reduce the risk of injury or death by 40-80%, depending on the type and severity of the crash.

Road Injury Causes

Road injuries are the result of a complex interaction of factors involving the road user, the vehicle, the road, and the environment. Some of the main causes of road injuries are:

• Human error: Mistakes on the road are the most common cause of accidents, accounting for more than 90% of road crashes, and are responsible for about 1.2 million deaths and 50 million injuries every year.
• Speeding: Speeding elevates the risk of road injuries by reducing the available reaction time and the distance required to stop, while increasing the collision force and the likelihood of losing control of the vehicle. According to the WHO, for every 1 km/h increase in speed, the risk of a crash increases by 3%, and the risk of a fatal crash increases by 4-5%. 
• Driving under the influence: Alcohol is a major factor in about 20% of road fatalities in high-income countries and up to 69% in some low and middle-income countries.
• Nonuse of motorcycle helmets, seatbelts, and child restraints: Safety devices like these reduce the risk of injury or death by 40-80%. According to the WHO, only 57% of countries have laws that require the use of all these devices for all road users. Nonuse of these devices is a factor in about 50% of road fatalities in low and middle-income countries.
• Distracted driving: According to the WHO, drivers using a mobile phone are four times more prone to crashing, and the risk is similar for hands-free and handheld devices. 

All the above causes are mostly due to human error or deliberate disregard for safety. You can lower the likelihood of being involved in a motor vehicle accident by actively applying safety measures, such as seatbelts, and by ensuring the driver is able to focus on the road.

Other factors that contribute to the global burden of traffic injuries include poor road infrastructure (5% of accidents), unsafe vehicles (2%), a lack of laws and regulations regarding vehicles and traffic (10%), as well as inadequate post-crash care.

Inadequate Post-Crash Care as a Major Contributor to Road Fatalities

Post-crash care refers to pre-hospital trauma care (emergency care) for road injuries. A lack or delay of emergency medical care for people with severe and life-threatening injuries can increase the risk of death or disability.

Trauma care experts refer to the 60 minutes directly after a car crash as the ‘golden hour,’ as this is the most critical window for saving lives^[2]. Inadequate post-crash care is a major contributing factor. Approximately 15% of road injury-related deaths occur within the 4 hours after an accident, and 35% occur after^[3]. Recent surveys conducted in Africa, South America, and other low-middle income regions found that many of them lacked structured prehospital care systems^[4]. Responses were often slow, uncoordinated, and lacking in skilled personnel.  

As many road accidents cannot be avoided even with proper safety measures, adequate pre-hospital trauma care is a top priority to reduce road-related mortality rates, especially in countries that lack sufficient emergency services.

The Latest in Trauma Care

The goal of trauma care is to provide the right care at the right place, at the right time, for the right patient to minimize fatality or permanent disability. This involves seamless coordination between traffic systems that monitor for accidents, emergency hotlines, and trauma care facilities or hospitals, as well as adequate pre-hospital equipment and sufficiently trained personnel. All of these aspects of trauma care are constantly being refined in an attempt to save more lives on the road.

With improvements in technology and the applications of robotics, artificial intelligence, and biotechnology, trauma care is expected to save many more lives over the next decade. Some emerging advances in trauma care are reviewed below.

Telemedicine

Telemedicine refers to health care services that are provided over a distance through the use of digital technology. Long-distance medicine can enhance trauma care by improving access, efficiency, and quality of care, especially when an accident has occurred in a remote or rural area that might take several hours for paramedics to reach. For example, telemedicine can let a trauma expert in a big city help and guide a local person in a small town who may not have the same skills or tools to perform a life-saving procedure on a road injury patient.

Telemedicine can also be used to streamline and improve the services offered by emergency personnel. Feedback between medical experts at a hospital and paramedics can improve pre-hospital services, particularly where staff are overburdened or where there is a lack of trained personnel requiring guidance. It can also help to streamline the process, allowing emergency departments to be better prepared by receiving extra insight, footage, and biometric information before the crash victim arrives.^[5]

Electronic health records coupled with telemedicine can allow emergency personnel to access someone’s health records from any location and to better assess their needs. This includes administering medications that do not cross-react with the patient’s prescriptions or cause allergic reactions, as well as providing information on the victim’s surgical history or pre-existing orthopedic conditions that might otherwise be confused for an injury.^[6]

Portable Pre-Hospital ICU

Overcrowding is one of the greatest issues faced by trauma wards in many middle to lower-income countries. Pre-hospital services help to stabilize patients before they arrive at an emergency ward to receive adequate treatment. Outdated technologies currently leave some crash victims waiting in the emergency ward before they can receive adequate care, lowering survival odds.

Improving pre-hospital equipment and portable Intensive Care Units (ICU) is one possible solution to these problems. Medical technologists are currently working on improving the medical equipment available in ambulances to reduce the trauma care burden and help streamline the process.

Some recent technological advances in pre-hospital ICU equipment include:

• Portable ultrasound devices: These are handheld or smartphone-based devices that can perform point-of-care ultrasound examinations in the field, such as assessing cardiac function, detecting internal bleeding, or guiding vascular access. Portable ultrasound devices can improve the diagnosis, treatment, and triage of critically ill or injured patients, as well as the training and feedback of pre-hospital providers. Portable ultrasound devices are becoming more accessible, affordable, and user-friendly and have shown promising results in various pre-hospital settings.
• Video laryngoscopes: These are devices that use a camera and a screen to visualize the airway and facilitate endotracheal intubation, which is a procedure that involves inserting a tube into the trachea to secure the airway and provide ventilation. Video laryngoscopes can improve the success rate, safety, and quality of endotracheal intubation, especially in difficult or challenging cases, such as patients with limited mouth opening, cervical spine immobilization, or obesity. Video laryngoscopes are becoming more available, portable, and affordable and have shown beneficial effects in various pre-hospital settings.
• Negative pressure helmets: These are new inventions that may provide portable, non-invasive ventilation to trauma victims before getting to the hospital. Negative pressure helmets cover and seal the head and neck of a patient and provide continuous negative pressure ventilation, which means pressure is lowered inside the helmet to create a vacuum that draws air into the lungs. Compared to old-fashioned intubation (inserting a tube into the airways), negative pressure helmets are a far more comfortable and safe alternative for patients with respiratory failure. They also offer improved protection against the spread of infectious agents, such as COVID-19. Negative pressure helmets are relatively simple, inexpensive, and adaptable and have shown potential advantages in various pre-hospital settings.

Drones and Unmanned Aerial Vehicles

Instead of deploying manned aircraft or road vehicles to help out during an emergency, unmanned vehicles and drones are currently being explored as better, more cost-effective alternatives. Drones can quickly scan a crash scene and alert emergency personnel^[7], helping them to streamline their processes and arrive nearly 100% prepared every time. Unmanned aerial vehicles may also aid the delivery of valuable resources that bypass traffic or even help to rescue victims trapped in the wreckage in the future.

Next-Generation Hemostatic Agents

Hemostatic agents are strong blood-clotting agents applied to open wounds to stop bleeding. While hemostatics are not new, biotechnology breakthroughs have vastly improved hemostatic materials and effects. Current cutting-edge hemostatic agents work at every level of wound repair, consisting of chitosan, fibrin, or collagen, which activate the body's natural blood clotting responses as well as skin and tissue repair. These can minimize scarring and speed up recovery times.

Self-Assembling Nanofibers: Further refinements to this technology include the use of nanomaterials that are capable of self-assembly.^[8] Self-assembling nanofiber hemostatic agents can control bleeding by rapidly forming a physical barrier and by activating the clotting cascade. They are composed of short peptides that can self-assemble into nanofibers under physiological conditions, such as contact with blood or electrolytes. These have the potential to revolutionize pre-hospital care by providing rapid and efficient wound sealing, being biocompatible and non-toxic.^[9] They might eventually replace trauma care equipment, such as sutures, staples, or clips, and dramatically improve the survival outcomes of trauma patients with severe blood loss.

These are some of the examples of how technology, science, and medicine are transforming trauma care and creating new opportunities and challenges for trauma patients and providers.

Dealing with a Road Incident

If you are involved in a road accident, you or someone able should follow these steps to ensure your safety and that of others, as well as to comply with the legal and ethical obligations:

• Stop: Stop your vehicle as soon as possible and turn on the hazard lights. Do not leave the scene of the accident unless it is unsafe to stay or you are instructed to do so by the authorities.
• Check: Check yourself and others for any injuries, and call for medical help immediately if needed. It is also important to assess the extent of any other damages.
• Call: Call the relevant emergency services, such as the police, ambulance, or fire brigade, and report the accident. Provide the following information: your name, location, number of vehicles and people involved, type and extent of injuries and damage, and any other relevant details. Follow the operator’s instructions and stay on the line until they tell you to hang up.
• Exchange: Exchange the following details with the individuals involved in the accident: names, addresses, phone numbers, license numbers, registration numbers, insurance company information, and policy numbers. Obtain the names and contact information of any witnesses or bystanders, and refrain from accepting blame, apologizing, or engaging in arguments with anyone present at the scene.
• Report: Report the accident to your insurance company as soon as possible and provide them with the information and evidence you have collected. Also, report the accident to any other relevant authorities, such as the road transport department, if required by law. Keep a copy of the report and the receipts for any expenses or repairs.
• Seek: Seek medical attention if you have any injuries, even if they seem minor or delayed. Legal advice may also be helpful if you have any questions or concerns about your rights or liabilities or if you are involved in a dispute or a lawsuit.

By following these steps, you can ensure your safety and the safety of others, as well as protect your interests and comply with your duties.

Conclusion

Road injuries are a major public health problem that affects millions of people around the world every year, especially in low to middle-income countries. Road injuries can be prevented or reduced by addressing key risk factors and through adopting safe and responsible road behaviors. It is important to know what to do if involved in a road accident and who to call for emergency trauma care. Inadequate post-crash care is one of the leading causes of road fatalities, second to human error. Recent breakthroughs in trauma care are bound to reduce mortality rates and improve outcomes for those with road injuries. These include superior communication between trauma care teams, improved portable ICU equipment, implementation of less invasive wound repair techniques, and drones that can seamlessly assess a crash for damages and emergency requirements.

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