prioritising vehicle and road safety injury …...foundation director, accident re search centre,...

Prioritising vehicle and road safety injury preventionPrioritising vehicle and road safety injury prevention countermeasures: the need for robust SCI incidence data

Dr Michael FitzharrisSenior Research Fellow Accident Research Centre Monash Injury Research Institute AustraliaSenior Research Fellow, Accident Research Centre, Monash Injury Research Institute, Australia.Foundation Director, Accident Research Centre, Monash South Africa, Johannesburg, South AfricaE: [email protected]

During the course of this 90 minute Prevention Session:• 222 people will be killed in a motor vehicle crash worldwide,

and

www.monash.edu.au/muarc

and• 3 people will have sustained a SCI and died


Overview of presentation

- The global agenda- SCI and road crashes

- Rollover crashes- Rollover crashes- In-depth case study- Economic evaluation

- Types of data and system gaps- Types of data and system gaps- An opportunity – SCI as an ‘index’ injury in developing countries- Injury data as a lever for policy decisions and action- Broader challenges impacting on road safety action- Broader challenges impacting on road safety action

Contention: Robust injury surveillance data and rigorous analysis is necessary for j y g y ypublic health policy and health service provision


The Global Burden of CrashesThe Global Burden of Crashes

• Global road toll: 1.2 million killed; injured ~20-50 million p.a. (WHO 2009, Global Status Report)Status Report)

• For every 1 fatality, 13 seriously injured & 135 minor injuries

• Impacts the economic & social development of countries (1 3% GDP)• Impacts the economic & social development of countries (1-3% GDP)

• Associated with rapid, and increasing, motorisation

M t d t d th i i i t f h i d t• Must understand the socio-economic impact of crashes in order to driver policy innovation


• Predicted global increase under ‘do nothing’ v goal ofunder do nothing v goal of 50% reduction

– South Asia: 68% ↑– Africa: 127% ↑– The Americas: 23% ↑– Europe: 36% ↓

• Change in the global mortality profile

• By 2030, 2.4 million killed & 5th leading cause of death

Source: GBD update, in Watkins The Missing Link: Road Traffic Injuries and the Millennium Development Goals. Make Roads Safe, 2010.


The global agenda: The UN General Assembly (March 2010)

‘...stabilize and then reduce the forecast level of road traffic fatalities around the e e o oad t a c ata t es a ou d t eworld by increasing activities conducted at the national, regional and global levels’

WHO A hit tWHO Architecture plan of action


The safe systems approachQ tifi bl & ifi bl• Quantifiable & verifiable targets

• Evidence-based intervention– problem identification– implementation of cost-effective

policy alternativesl ti– evaluation

– fine-tuning and re-evaluation

• Creating the evidence-baseCreating the evidence base requires a number of elements

– robust data– research capacityresearch capacity– policy implementation skill

WHO, Global Status Report on Road Safety, 2009


SCI and road crashes• The incidence of spinal cord injury (SCI) is in RTC low

– 0.3% of all non-fatal traffic injuries BUT possibly 50,000 people

T ffi h th l di f t ti SCI• Traffic crashes are the leading cause of traumatic SCI– Estimated 42-55% all incident cases a transport-related (70% occupants)– Approx. 60% Cervical, 30% Thoracic, 10% Lumbar– Victoria:

> 36 incident cases of paraplegia & 52 incident cases of quadriplegia per annum (83% male) per annum

i t l h lf t t l t d> approximately half transport-related

• SCI are costly:– to the individual, the family and to society , y y– $575 million p.a. (60% financial costs, 40% B.o.D (Victoria, Access Economics))– estimated $7.6 million per incident case of quadriplegia and $5 million

per incident case of paraplegia


Rollover crashes and SCI

• Vehicle rollover crashes are extremely violent

– Study of 3 SCI Centers in Victoria– Of the 44 vehicle occupants, 38

(86%) were injured in rollover crashes (Wigglesworth et al., 1991)

• Head impacts causing compression are associated with cervical spine fractureassociated with cervical spine fracture-dislocations (axial loading)

• High risk of C1/C2 #-dislocationg


Australian National Crash In-depth study (ANCIS) rollover case study(ANCIS) – rollover case study

• Crash occurred in daylight in wet weather conditions. SUV travelling along dirt road when driver lost control of vehicle, veered to left, overcorrected, veered to right and then mounted

b k t V hi l th ll d t d id dembankment. Vehicle then rolled toward passenger side and came to rest on roof. Speed limit 60 km/h

• 4 occupants of the vehicle


Ch t i ti / f t Vehicle factorsCharacteristics / factors• 33 year old male• (79kg/180cm; BMI = 24)

Vehicle factors• 1998, small SUV• No airbags, no pretensioners,

ABS/ESC i t l• Front seat passenger• Seat belt worn

no ABS/ESC, no cruise control• Roof crush (static): 22cm

Injuries• Complete cord injury with

fracture & dislocation of C5

Environment• clear, wet, day• dirt road, 60 km/hfracture & dislocation of C5

& C6• 6cm head laceration

L f i

dirt road, 60 km/h• public road

• Loss of consciousness• Multiple abrasions, upper

body


FactorsPhase Human Vehicles and Environment

Crash factors: prospects for prevention and injury mitigation

Phase Human Vehicles and Equipment

Environment

Pre -Crash

Crash Prevention

• Driver inexperience on

• Overloaded vehicle

• Wet, dirt road

Crash dirt road

• Distraction

• Speed

• Short-wheel base

• Over-corrected, loss of traction

• Rise, radius of corner

• Well maintainedSpeed

• Crashworthiness• No ESC

Crash Injury pre ention

• Seat-belt worn (medi m loading)

• No safety technologies in

• Speed limit 60 km/h appropriateprevention

during the crash

(medium loading) technologies in vehicle

km/h appropriate• Road alignment

posts

Post Life- • Transported to • Access / • Difficult location for Post crash sustaining

plocal hospital and HEMS request @40 minutes

• At MTC 180 min

extrication–trapped (35 min)

EMS


The power of data in evaluating ‘countermeasures’: the case for Electronic stability control (ESC) (Fitzharris et al 2011)case for Electronic stability control (ESC) (Fitzharris et al., 2011)

• ESC reduces risk of loss of control and rollover crashes ~35-70%, depending on region and type of road conditionsdepending on region and type of road conditions

• Estimated that by 2039 ESC will be in every ‘light commercial’ vehicle on the road in Australia

• Used extensive crash data estimated potential savings of ESC for ‘light commercial vehicles’ of

– 700 fatalities saved (range: 350 to 984)– 6934 fewer drivers seriously injured (range: 3467 to 9750).– community savings: $A3.1 billion (range: $A1.575 billion to y g ( g

$A4.429 billion) for cost of $1.3 billion– BCR of 2.3:1 (range: 1.2-3.3)


Data as a driver of policy

• Robust data is essential to drive health and road safety policy

• Forms the basis of evidence based and cost-effective policy

• Types of available data differs in its scope and completeness

• Data system development is a key challenge and development priorityData system development is a key challenge and development priority in the developing world


Levels of data to support road safety, health policy & services

Level of ‘data’

Data feature Victoria Sub-saharan Africa

Gl b l T t l b kill d ti tiGlobal Total number killed, estimation-based, adjusted for definitions; morbidity systems (GBD) WHO estimates

N i l C f li d d il dNational Core fatality data; detailed

State / region

Precise information: police, hospital, compensation system

Ability to disaggregate and define crash types, health outcomes

Injury ifi

SCI, TBI – detailed and precise i f ti ( ll h i )specific information (all mechanisms)

Mechanism specific

Constrained to a single injury mechanism, but detailed


An opportunity? SCI as an ‘index’ injurySCI i id d t d t i j i b i i i• SCI incidence data and post-injury care is basic in many regions

• SCI can act as a ‘sentinel’ injury due to treatment at limited number of facilitiesfacilities

– determine injury prevention priorities across all mechanisms

– implement and evaluate public health interventions

ti t t t t d fi i t ti– assess patient progress, set targets, define interventions

– captures a full range of information on health system performance from acute care to rehabilitation

Capitalise on the e pertise of ISCoS b the tilisation of Common• Capitalise on the expertise of ISCoS by the utilisation of Common Dataset Protocols

• More realistic approach with limited resources than a inclusive traumaMore realistic approach with limited resources than a inclusive trauma registry


The ‘data imperative’ & levers for health policy action

• High level global data is necessary to set the global agenda

• Robust data used well – including economic analysis, shows where investments in road safety can deliver the highest returns in terms of lives saved and injuries avoided

• Provides the basis for objective road safety and health policy• Provides the basis for objective road safety and health policy decisions

• Demonstrates the possibility to achieve rapid improvements

• High cost of SCI to the community and the individual must give pause to policy makers to act in prevention and treatment

• The unacceptably high cost of no data is an excuse for a lack of accountability and a lack of action in improving health systems


Broader challenges impacting on road safety action

• Cultural attitudes on risk and harm minimization personal freedoms• Cultural attitudes on risk and harm minimization, personal freedoms

• Political will to act– regulation for the common good not always attractiveg g y– short-term thinking vs. long-lag time for success

• Co-ordination issues & a whole-of-government approach

• Financial capacity and competing priorities– socio-economic (creating employment; education)

health– health– Infrastructure development

• The legitimacy of the road safety message - the imperative ofThe legitimacy of the road safety message the imperative of making the case with data driven evidence-based policy alternatives in vehicle safety technology and other countermeasures (seat belts, drink-driving, infrastructure)


Thank-you / Questions?Thank you / Questions?

Throughout the 5-day duration of the ISCOS event~18,000 people will have been killed in a motor vehicle

crash worldwide• 267 people will have sustained a SCI and

dieddied

Participate in road safety, see:Youth for Road Safety (YOURS) y ( )http://www.youthforroadsafety.org/

UN Decade of Action, 2011-2020UN: http://www roadsafetyfund org/index htmlUN: http://www.roadsafetyfund.org/index.html WHO: http://www.who.int/roadsafety/decade_of_action/en/index.htmlFIA Foundation: http://www.fiafoundation.org/Pages/homepage.aspx

prioritising vehicle and road safety injury …...foundation director, accident re search centre,...

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