Background
• What are key informants’ views and/or experiences of RTCs and RTC-related neurotrauma? | |
• What are current approaches to preventing RTCs and related neurotrauma? | |
• What affects the successful implementation of these approaches? | |
• What is the best practice (or other measures) applicable to the local context that would improve the prevention of RTCs and related neurotrauma? |
Methods
Study design and setting
Participants and recruitment
Data collection
Data management and analysis
Results
Key informant | Designation and Group | Age (in years) | No. of years involved in RTCs prevention |
---|---|---|---|
1 | Neurosurgeon (Service provider) | 44 | 12 years |
2 | Director of Non-governmental organisation (Community representative) | 52 | 13 years |
3 | Nurse (Service provider) | 30 | 4 years |
4 | Local government official (Commissioning stakeholder) | 43 | 13 years |
5 | Ambulance service staff (Service provider) | 27 | 2.5 years |
6 | Law enforcement official (Commissioning stakeholder) | 55 | 25 years |
7 | Rehabilitation service staff (Service provider) | 34 | 8 years |
8 | Law enforcement official (Commissioning stakeholder) | 58 | 10 years |
9 | Former patient and patient advocate (Community representative | 44 | 2 years |
10 | Former patient (Community representative) | 40 | 2 years |
Participants’ knowledge of RTCs in their city, state and/or country
The nature and extent of the problem
“India has the highest road traffic victims, and moreover this year Andhra Pradesh has a 10% increase in road accidents compared with last year, and 70 to 80 percent are pedestrians and two-wheelers.. At present there are 97 accident prone areas in Visakhapatnam. The collisions are in those between 18 and 40, youth people [sic].”.(Key Informant 2)
“In Road traffic Accidents head injuries are less than other injuries like leg and hand fractures which are more and head injuries are very less [sic].” (Key Informant 10)
Factors and risk factors leading to RTCs and RTC-related neurotrauma
‘Most of the traffic accidents and brain injuries are caused in two wheeler bike riding [sic].. Most of the riders do not wear helmet or they do not wear it properly [sic].” (Key Informant 8)
“ … people carry the helmet on the bike without wearing it; it is safe if they wear it. “(Key Informant 3)
“Nowadays more accidents are happening because of minors riding vehicles. People should not give their vehicle to others who do not have license [sic]” (Key Informant 5)
“Roads everywhere have pot holes, unfinished works of sanitary, water and other departments after they dig for various repairs and renovations, making it risky for the bike riders.. and increasing the chances of skidding and falls. When riders fall the first impact would be on head leading to head injury [sic].” (Key Informant 9)
“..This (highway) stretch it is totally in the center of the city where all types of people are moving -pedestrians, old, children, this, that [sic]. If you have lorries going, say, 70 kilometres per hour, we have to use stoppers (to prevent collisions) and all this will cause more damage than the open highway where there is no village or no public there, and the lorry driver can go 70 to 80 kilometres per hour- nothing will happen.” (Key Informant 6)
“Obstacles like dogs, pigs and children on the road are also causing accidents. I am a bus mechanic. That day one bus is in repair, so I had gone to the workshop on that morning 5 am [sic]. From the side of the depo, one forest pig came in at high speed and hit my two- wheeler, then I fell down unconscious [sic]. After that I was admitted in hospital.” (Key Informant 10)
“Auto, lorry and even buses when they were over loaded above the capacity of the vehicle and it will automatically give more pressure to the driver [sic]. The vehicles will be uncontrolled and the vehicle will fall down from bridges or fall down into rivers, hit the road dividers and so on [sic].” (Key Informant 1)
“..even if they (two-wheeler riders) use helmet, they use a sub-standard helmet as it is cheap and can escape the fines imposed for not using helmet by police [sic]. These cheap and low quality helmets break easily causing severe damage to their heads leading to skull fractures, brain injury and internal bleed [sic].” (Key Informant 9)
Impact of RTCs
“Road accidents majorly lead to head injury [sic]. (Other injuries) all are generally curable, treatable and small. The head injury cases are mostly unable to cure completely [sic].” (Key Informant 3)
“Mostly these major injuries (from collisions) are head and spine [sic]. So now we can see the figure is so huge so the need of centres, the need of hospitals, trauma care, emergency care are most important. We are having only (few) beds that are available so most (neurotrauma cases) are without any sort of rehabilitation [sic].” (Key Informant 2)
“The Impact is more on their families because most of the times victims of RTA (road traffic accidents) are the bread winner of the family and leading to financial crisis [sic]. There is a Telugu saying that goes ‘if an accident happens it is not the individual that is affected, it is the family on the road (hopeless) [sic]’ “(Key Informant 9)
“A lot of good professionals we are losing in the city [sic]. They are very good in work and different professionals. We are losing such a great people in the city due to these accidents [sic].” (Key Informant 6)
“As per the statistics of government of India these accidents are affecting around 3 % of our GDP (Gross Domestic Product)” (Key Informant 4)
“(These accidents) bring a bad name to the city, that this is very accident- prone city in this area. So for that lot of work has to be done to control such type of accidents.” (Key Informant 6)
Current preventative strategies
The role of the government and related organisations
“We are taking lot of steps like regularly we are keeping our (police) to keep watch and check the over-speeding [sic]. We have laser guns in the city, 10 more we are going to procure, so everywhere we are keeping these laser guns and we are monitoring the movements of those people [sic].” (Key Informant 6)
“We have many helmet cases, those persons who are not wearing, we are taking photographs and sending chalans (citations), and all then now these people will start wearing helmets and start following the traffic rules [sic].” (Key Informant 6)
“Definitely to prevent road traffic accidents traffic police are organizing so many awareness campaigns to prevent all these things.[sic].” (Key Informant 7)
“(The police) have started awareness programmes in the colleges and educational institutions.. (They) are going and creating awareness among the students, that you should follow the traffic rules, and that time (they) are showing some incidents where people died.” (Key Informant 6)
“(The police) are launching tomorrow one programme called “road safety friendly”. We are starting where we have trained almost 50 volunteers especially shop keepers and the workers all over the high way. Every one kilometer we have trained them and 150 of our traffic constables and local police who are working on the highway if any accidents happens they work like first responders immediately. They will provide first aid for them (victims). We are providing them (volunteers) first aid kit and immediately they will inform to 108 (ambulance)[sic]. They will take local assistance [sic] and shift the fellow to the nearest hospital and we will make them aware which are nearby hospitals, whom to contact, how to contact, how to shift the fellow because in accident multiple fractures are there, spine fracture are there. How to tackle such situation, we have trained them [sic].” (Key Informant 6)
“The DMHO (District Medical and Health Officer), District collector, KGH (King George Hospital), have taken it into consideration and we have put the posters (about the Good Samaritan guidelines)- to help the crash victims without any fear [sic].” (Key Informant 2)
“Government is constituting ‘district road safety committee’ in every district. District collector is the chairman of this committee and deputy transport commissioner is the convener, along with them DMHO/DCHS (District Medical and Health Officer/District Child Health Services), superintendent of district hospital, officers from R and D (Research and Development unit), Panchayati Raj (Rural development) department are coordinating with each other and identifying the causes of road traffic accidents and remedies [sic]. The committee meetings happen periodically and discuss the strategies to reduce the road traffic accidents, to prevent neurotrauma injuries.” (Key Informant 4)
“We have gone to attend the meeting of state road safety committee and we have raised so many issues so now they are empowering the enforcing the law [sic]..” (Key Informant 2)
The role of individuals and communities
“I personally go weekly thrice [sic] for counselling the drunken drivers and for my way we also counsel the employees of IT (Information Technology) and ITES ( Information Technology Enabled Services) companies. So try to educate them.. I have started another banner called project ‘Bhavishya’. This Project ‘ Bhavishya’ is three ‘R’s. First ‘R’ is road safety awareness. Second ‘R’ is right to emergency care of the crash victim. Third R is for rehabilitation of the crash victim.” (Key informant 2)
“I have conducted several awareness programs in my college and near- by schools and colleges..with collaboration from [..] police, I conducted several campaigns about prevention on [sic] road traffic accidents. “(Key Informant 9)
“As a surgeon when a patient arrives with traumatic injury I try to understand, first of all what is the cause of the accident. After knowing that what is the reason, like is it due to drinking of alcohol or over speed driving or due to the fault of other driver, I try to motivate the patient to avoid same mistake again [sic]. “(Key Informant 1)
“My role is to make my friends, family members and all known people aware of these head injuries, and the possibilities of head injuries if they go over bike without helmet the chances of head injuries are more. And I always inform to people to make journey safer with enough speed [sic].” (Key Informant 5)
The role of research
“Some research is going on at New Delhi. Because we will come to know whether it is severe road accident or moderate or simple injuries and how many people died, how many people have memory loss, how many people suffering with disabilities, what is the effect on the family etc.[sic] Because of this research we are getting the information about how many people dying in the road accidents, how many people and families are suffering due to road accidents and what steps we should be taking in order to prevent this [sic].” (Key Informant 1)
“I am involved in few researches [sic] in Traumatic Brain Injury. We work on psychosomatic problems of the patient after Traumatic Brain Injury and we work on involvement of transcranial magnetic stimulation, transcranial direct current stimulation which help in outcome of the motor control issues and use of the role of neuro plasticity in traumatic brain injury recovery, we work on few researches [sic]. Whatever research is going behind the system [sic], (we) will always give the information in accurate way so that we can assess the severity of the problem, so according to that we can take the preventive measures.” (Key Informant 7)
Effectiveness of current strategies
“Government of India is also doing a lot of work and spending money on road safety by involving all the state governments. Even the Supreme Court committee in road safety is also reviewing the situation with state governments to reduce RTA’ s (road traffic accidents). These steps are helping to reduce accidents.” (Key Informant 4)
Challenges to prevention
“In India 80% of the roads are with heavy traffic and to control this rush of vehicles it is very difficult for police authorities [sic].” (Key Informant 9)
“You can see this city has more than 30 lakhs (more than 3 million) population where we have only 3400 police man, in that only 500-600 working in the traffic (division). Remaining are busy in some other duties [sic]. We can say it is totally disproportionate..hardly 600 people can’t control the 30 lakhs and more than 8 lakhs vehicles are in the city [sic].” (Key Informant 6)
“Generally what happened we are creating awareness only in the educational institutions, limited areas where public is less, but large numbers of people are dying on the rural areas and illiterate people, so they are not getting this type of counseling or training..[sic] Conducting one day, two days rally will not make much difference [sic]. Of course people will come to know that these are the rules. It should be like a part of a habit [sic].” (Key Informant 6)
“Trauma care facilities are available at very few locations now. Our facilities are concentrated in certain centralised locations only. Due to present centralised systems, it's difficult for reaching the centre from out skirts in Golden hour [sic].” (Key Informant 4)
“Police people also not enforcing the law at all the places in same way [sic]. In some places they are using strict rules and where in some places they are not serious about the issues, then people are not taking these things seriously [sic]. They are taking very easily about rules and regulations of the traffic [sic].” (Key Informant 9)
“Nowadays the fines are hiked [sic], but the people who are having political background and not following rules are not being fined.” (Key Informant 3)
“If accident happens between car and bike, immediately people blame the car vehicle people only [sic]. Even sometimes if two-wheeler hits the stopped car also people blame on car vehicle people only [sic]. Police people do this wrong [sic]. Generally, whenever accidents occur root cause for the accident is not sought, rather they blame the big vehicle and find fault always without properly investigating the case to find the proper cause [sic].” (Key informant 9)
“Here there is another issue happened after meeting accident [sic]. Immediately people shift (the victim) to PHC (Primary Health Care facility) or some small hospital. There they take a lot of time. They (the hospital) don't have scans and all these things … I will give example. Two to three days back there was an accident. Simple external injuries were not there, but he got brain haemorrhage and he was simply sent to some hospital [sic]. They gave some first aid, put some ointment and all [sic]. They have not done scan and all these things. After 2 days he developed complications and died.” (Key Informant 6)
“Here at my place 6 lanes widening of highway road construction work is going on [sic], and the construction material is unloaded in an inappropriate manner and safety precautions are not taken, which is increasing the chances of road accidents.” (Key Informant 10)
“Due to rains [sic] the holes are coming on the road, and these holes causes the accidents but they (the government) are not attempting the repair works on time [sic].” (Key Informant 5)
“The biggest barrier to this type of research is that people will not give proper information. For example, I had an accident and supposedly I was amputated of hand and leg, and when people enquire about the accident and the reason how it happened, general tendency is to avoid giving appropriate answers to these questions [sic]. If we are unable to get correct data we cannot come to a proper conclusion about any research [sic].” (Key Informant 9)
“The corruption by police is another barrier and they collect fine charges from the areas which are crowded … Corruption is the one in the present law system [sic].” (Key Informant 3)
“(Police) are threatening bikers and taking bribes, and leaving them (offenders) unpunished.” (Key Informant 10)
“Another important thing is parents, they are purchasing new vehicles and giving the vehicles to minors, is also big problem [sic].” (Key Informant 9)
“Children are playing on the roads and their parents are not caring about them is also causing more accidents [sic].” (Key Informant 10)
“The motor vehicle manufactures in their advertisements and in the movies and TV channels promote their vehicle’s high speeding capacity and entice with thrilling and action promos, causing a huge impact on youth [sic].” (Key Informant 9)
“These police people [sic] should be like a role models to the society. Police people [sic] are not using helmets. They are using cell phones while driving. With these all [sic], people are not following rules. First, police people [sic] should follow these rules and regulations properly then they can ask others to follow.” (Key Informant 10)
“Education level is very low. People are not aware regarding the traffic rules.. they are not aware what are the changed rules [sic].” (Key Informant 6)
Perceived recommendations for improving prevention
Enhancing current strategies
“Most important thing is that to create an awareness we should select the targeted persons who are more probable to get such type of accidents, like students because they are young [sic]. They don’t know traffic rules and regulations. We should create awareness more on the targeted groups like I found here in that most of the deaths are on two wheelers [sic]. We should target on these two -wheeler drivers, whether they are students or some of the employees, so we should target them [sic].” (Key Informant 6)
“There must be road safety syllabus for school and college students. It should be implemented in schools and colleges. If school and college children are properly educated in this awareness programme, they will be the primary step in their family to avoid accidents [sic].” (Key Informant 2)
“In any society the first responder is the public. They can’t depend on the police. If something happens also people should respond immediately [sic]. They should behave like a first responder, providing first aid, give the injured person comfortable position and call the nearest police station, ambulance [sic].” (Key Informant 6)
“If we train the RTC (Real Time Clock)* drivers and the auto drivers how to helpcrash victims, it may be CPR (Cardio-Pulmonary Resuscitation), it may be BLS (Basic Life Support), I believe that will be our strategy because auto rickshawwalas (auto drivers) and RTC drivers, lorry drivers, if given proper education in this, they can easily handle the patient [sic].” (Key Informant 2)
*A real time clock or RTC driver is a bus driver
“Decentralisation is important. If we decentralised them we can also save many lives. Providing trauma care facilities in the outskirts of the city. Trauma centres should be established in industrial corridors, and upcoming urban centres, highways and peripherals of the city [sic] which will help treat neurotrauma immediately and can save lives.” (Key Informant 4)
“Additional efforts will be like taking strict action against drunken driving [sic] by eliminating liquor shops near the highways.” (Key Informant 4)
“I believe that (accidents) can be prevented if .. the good Samaritan guidelines which are given by the honourable Supreme Court can be implemented in the grass root level [sic].” (Key Informant 2)
“Change of police system and genuine implementation of the existing rules and regulations should be done, everything will fall in place..there is no need of new rules and regulations in this manner [sic]. New regulations will give some more headaches and problems to the society.” (Key Informant 10)
Establishing collaborations and partnerships
“I feel strongly the main stakeholders are four: one is police department i.e traffic, second is health department i.e. DMHO, third which is very important aspect is the transport department where they have logistics how to implement strategies and fourth one is volunteers who are NGOs (non-governmental organisations)[sic]. They should come forward to coordinate with all these three departments then only (preventative strategies) will be successful.” (Key Informant 2)
“First thing that we should take the help of the public [sic]...they should also keep watch, they should also come forward and assist the police. Whenever such things are happening, they should bring to our notice. If they found some other people, if they notice that people are violating the traffic rules, immediately they should call we have 100 number and 109 like that [sic]. If they take assistance [sic] definitely it will be reduced.” (Key Informant 6)
Changing mindset and behaviour
“Rather than depending upon the Government, we ourselves should do something from our side, then only (prevention) can be improved a lot.” (Key Informant 2)
“These police people [sic] should be like role models to the society.. first police people [sic] should follow these rules and regulations properly, then they can ask others to follow.” (Key Informant 10)
“If all the government institutions whether semi government, Central government or State government, if they all follow good Samaritan guidelines there will be huge impact]sic].” (Key Informant 2)
Discussion
Limitations
Recommendations
Education | |
• More regular, consistent educational efforts focusing on groups, populations and areas that are densely populated and prone to RTCs | |
• Regular education and training of government officials and entities involved in prevention | |
• Introducing road safety education as part of the school syllabus for primary and secondary schools | |
• Involving former casualties and their families to spread awareness messages and educate the community | |
• Utilising the media in education and awareness | |
• Opportunistic education i.e. roadside events and road safety education during vehicle purchase | |
• Ensuring education and awareness messages are understood by all layers of society | |
Enforcement and Legislation | |
• Stricter enforcement of laws and penalties for traffic offenses | |
• Establishing an audit system to ensure enforcement is carried out consistently and correctly | |
• Carrying out targeted enforcement by developing a programme to identify accident-prone areas | |
• Eliminating liquor shops near the highways to curb RTCs from drink driving | |
Road Engineering | |
• Ensuring good quality roads are built with adequate width which are multi-lane | |
• Establishing a road maintenance system | |
• Ensuring speed reduction through road engineering measures such as speed breakers | |
Pre-hospital and Trauma System (Emergency Care) | |
• Organising training programmes for lay first responders which would encourage the public to be involved in providing first aid to RTC casualties | |
• Establishing a network for all ambulance services and ensuring staff are adequately trained and ambulances equipped in order to deliver pre-hospital care to casualties | |
• Building small first aid centres in villages to assist casualties in rural areas | |
• Building more trauma centres which are equipped with neurosurgical expertise in areas where RTCs tend to frequently occur | |
• Initiating a system where casualties are transported to the appropriate healthcare centre and not just to the nearest facility | |
Collaborations and Partnerships | |
Developing and maintaining good inter and intra-agency relationships, including non-governmental organisations and the wider community | |
Research | |
• Disseminating research findings through social media or formal reports | |
• Scientific conduct of research in more centres by dedicated groups of people | |
• Regular audits and reviews of research methods and findings | |
• Involving former casualties in research | |
• Focusing on the epidemiology of RTCs and secondary neurotrauma prevention |