road accidents - preventable disasters
Making his presidential address
to the Sri Lanka Medical Association last month, Professor A.H.
Sheriffdeen FRCS, FRCSE drew attention to a new study on the rising
rate of motor accidents and outlined the need for urgent action
to curb the problem. We publish here extracts from his address
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 and industrial and home accidents.
accidents including motor accidents are another disaster group.
In spite of early warning systems there is very little we can 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.
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 on national policy 4. Small
units in different departments working in consensus to improve safety.
Sri Lanka, however, newspapers continue to report sensational accidents
and horrendous deaths daily. The dead include foreigners, doctors,
businessmen, children, adults and families. Even traffic policemen
have been affected on what has been dubbed "the killer roads
of Sri Lanka".
there are over 3,000 deaths daily at a cost of 2% of GNP in most
countries. Eighty-five percent of these accidents occur in low and
middle-income countries such as India, Pakistan, 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 recognized
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 7, 2004. Several articles were written
in newspapers and journals. Other media campaigns were organized,
books written and activities conducted at enormous cost, but what
effect has it had in Sri Lanka?
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 nine months) the death rates, grievous injuries and total
accidents are showing a steady increase. In 2002, there were 2,038
fatal accidents, and 16,011 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 Rs. 220
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
unprotected road-user (motorcycle, bicycle and pedestrian) is the
most affected while the largest number killed formed pedestrians
(815 in 2002 and 747 in 2003). The culprit usually escapes since
the recorded number of drivers killed in such fatal accidents is
comparatively the smallest (205).
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 2,000 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
leading causes of death totalling over 8,000 deaths per year.
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 and Dr. W. Gunathunga who did the statistics.
I coordinated the study.
Of those admitted to the Accident Services over this six-month
period, there were 2,158 who could respond. Fatalities and patients
receiving outpatient treatment were not included.
highest number of injured was in the 20-40 age group, 82% were male
and 72% had an education below Grade 10. (Worldwide mortality figures
for accidents show that the commonest cause of deaths in this 20
to 40 age group is Motor Traffic Injuries.)
was no seasonal variation although accidents were lowest on Fridays
with a rise in numbers on Saturdays, 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, faulty clutch, poor
condition of tyres, defective lights and malfunctioning brake lights.
this study, 14.5% of three-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 another study, found that 24 out of 29 three-wheelers
that had met with such accidents had handle locks that had been
tampered with. It may be that his advocacy has had some effect.
travelling in unprotected vehicles like motorcycles, three-wheelers
and push bicycles were at a higher risk of suffering injuries. 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
vehicles that the accident occurred against were predictably the
protected and heavy vehicles of which vans, lorries, buses and cars
came highest, with three-wheelers ranging next in frequency. Twenty-nine
percent of the injured were pedestrians and constituted the largest
group (as we earlier mentioned this was the largest group killed)
and again the group that was least liable to injury was the drivers.
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 on after
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.
It may be surprising news that accidents were commoner
in roads of normal or narrow width (over 55%) 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 which set the scenario for higher accident rates and
injuries to the subjects in the study. The above conditions appear
to be a temptation for drivers to drive fast on the unfavourable
road width giving the driver less room for error. Making the road
surface a disincentive for fast driving seems a logical answer.
significant percentage of pedestrian victims who met with 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
While 19.67% were after alcohol and 9.8% admitted to being
under its influence, only four of the subjects had been tested with
a breathalyzer. It has been shown that the risk of crashing is four
times higher if the driver is using a mobile phone while driving.
Six used mobile phones during the accident. One was a pedestrian
whose mobile phone rang while he was crossing the road and he was
run over when he paused on the middle of the road to take his phone
out of his pocket!
4.7% were wearing seat belts. There is no legislation and thus no
compulsion for wearing seatbelts even though every car and van imported
to Sri Lanka is fitted with them. While 78.9% were self-taught some
had registered with a driving school so as to only facilitate the
obtaining of the driving licence. The former is a significant statistic.
and micro sleep (where drivers fall asleep momentarily for a fraction
of a second and wake up almost immediately) are significant driver-related
causes of accidents. Twenty-three percent of drivers had driven
continuously for over five hours during the preceding 24 hours.
A majority admitted to feeling sleepy prior to the accident.
percent of motorcycle riders and 35.8% pillion riders were not wearing
helmets at the time of the accident. However, only 5% had had accidents
within the last two years. One should not be complacent and take
risks just because one has not met with an accident. Very significantly,
12.2% of car drivers and 26.8 % motorcycle riders did not possess
driving licences. This appears to add weight to the argument that
more spot checks are necessary.
of the drivers who sustained injuries after accidents had a major
illness. This included severe visual impairment, a cerebrovascular
event resulting in a stroke and a myocardial infarct leading to
loss of consciousness.
to avoid potholes or oncoming vehicles resulted in accidents and
injury in15%, half these were in trying to avoid an oncoming vehicle.
Careless driving need not necessarily result in an accident to that
person but it certainly is a source of risk to others. There is
no law to prosecute such irresponsible drivers.
from work and from parties is statistically a significant health
hazard as accidents and injury are commoner than when proceeding
to work or to parties. Seventy-eight percent who were returning
from parties admitted to being under the influence of alcohol.
of the vehicles, according to the injured party estimation, were
driven at excessive speed, 68% were fast to medium and 29.3% were
definitely fast. Forty-three percent of the injured were either
travelling in or knocked down by a speeding bus.
The study showed that 32.8% were jay walking outside the
pedestrian crossings. Ten percent were getting on or off a bus indicating
the scant respect the bus driver has for his passengers. Those trying
to board a bus fell when the bus suddenly pulled away and they were
either run over by the rear wheel of the bus or by the vehicle behind
the bus. Darting across the road after emerging from behind a parked
vehicle contributed to 3.8% injuries. Pedestrian crossings placed
in front of a bus are a hazard especially to schoolchildren. About
5.3% of injured pedestrians were under the influence of alcohol,
while 62.8% of the injured pedestrians wore dark clothes after dusk.
(Next week: What we can do about it)