Road Safety

M K Mam
Bone and Joint Day is celebrated all over India by the Indian Orthopaedic Association (IOA) on 4th of August every year since 2012. It was on this day in 2012 the President of IOA asked members to have at least one free surgery for poor patient and that activity is taken care of every year on that day . We also have other public awareness programs at state chapters to sensitize the society about the increasing impact of bone and joint conditions, how to prevent and treat them. People are educated about the importance of maintaining a sound bone health and what all can be done to have a sound bone health. This year IOA is celebrating 1st.to 7th of August as Bone and Joint week.
This year the theme of observing the day is ‘Road Safety’. It is a fact that  the incidents of road accidents is on the rise in our country. Deaths and injuries resulting from road traffic accidents certainly is a major and growing public health problem in our country. It has been reported that in India there are around 5 lakhs victims of traffic accidents every year and out of that more than 150,000 people are killed and this is much higher than many of the countries. It has been observed that most productive age group i.e. 30-44 years is mostly involved in deaths in the road accidents and males are most often involved  in comparison to females. Many lose their limbs and many are left with permanent disabilities of various degrees. Deaths, injuries and long-term disabilities caused by road accidents certainly have lot of physical, social and emotional and economic implications. There are several factors responsible for road accidents and related fatalities, however it has been reported that most of accidents occur because of human error. Driver’s fault is the most important factor and accounts for 78% of total accidents and  main issue has been the speed of motor vehicles. Lot many accidents are occurring due to potholes on roads and in one of the studies defective roads has been attributed to as the second most common cause next to driving fault. However, a recent report by central Ministry of Transport and Highway is  encouraging as the road accidents have dropped by 3 % and fatalities have dropped by 4.75 % in first half of 2017.
Road traffic fatalities and injuries can be prevented , yes  this can be prevented to a large extent. We can certainly reduce number of fatalities and injuries . Most important is that people have to be educated and made aware of road safety norms and this has to be started in schools and colleges as there lies the future of the country.  People have to be explained about the importance of strictly following  these norms.  It has  been reported that strict enforcement of traffic laws and severe penalties for violation help a lot to  influence the behaviour of road users. All the stake holders i.e. public, regulatory  and enforcement agencies, driving licence issuing authorities, vehicle makers and transporters, road making agencies  have to strictly adhere to and  observe road safety norms. Road safety is  certainly  a major social concern in the country and  somehow or the other it has not received the attention from the governments, it should have received. Over the years some steps have taken to tackle this crucial issue, but they have been somehow  insufficient. As such, lot more needs to be done towards road safety The serious issue of road safety has also been raised by the highest court in our country i.e. Supreme Court of India. Certainly ,lot many things can be done to decrease road accidents, causalities and fatalities caused thereby with a proactive involvement of all the stake holders. The Road Transport and Safety Bill 2015 is a step in right direction as it should  provide a framework for safer, faster, cost-effective and inclusive movement of passengers and freight in India.
This year’s Indian Orthopaedic Association is focussing on road safety and as such various public awareness programs are being arranged by various state chapters and orthopaedic fraternity all over the country  for education of public about importance of road safety norms and prevention of road accidents. The activities to increase the awareness of road safety amongst the general public include having road safety rallies, run/walkathon, distribution of pamphlets and posters on road safety to general public, having lectures on road safety in schools and public forums. Other activities  include Basic Life Support courses for paramedics, drivers, students and general public ,free medical camps, free surgeries and free BMD camps for awareness about Osteoporosis. Looking at the extent of the morbidity, mortality and long term disabilities, it is very appropriate that general public is also made aware of the importance of prehospital care –  Basic Life Support.
Basic Life Support (BLS): It has been reported that a  third of prehospital deaths can be prevented with an excellent prehospital care- appropriate BLS at the accident site. Before we discuss about  BLS, it is essential that we know about ‘The Golden Hour’, the most crucial hour. It  is the time following an injury during which prompt medical and surgical treatment prevents death and morbidity to a large extent. Morbidity and mortality increases significantly after that time, even though there have  been conflicting evidences about golden hour dictum. Chances of survival of a person are  certainly greatest if the person receives care within a short period of time after a severe injury. Treatment  has to start with BLS, which consists of emergency medical care to restore or sustain vital functions i.e. airway, respiration and circulation. Main aim is to maintain an airway, support breathing and the circulation without specialized medical equipment and  thus try to limit further damage till the victim reaches to a specialized emergency medical care centre.  BLS skill training certainly is a must for doctors and paramedics, but it should also be an essential skill for every person. People in general especially teachers, students and drivers should be trained in BLS skills, as it is the common man who is usually the first to be present at  the accident site. This can certainly help a lot in reducing the mortality, morbidity and long term disability following road side accidents.
This has to be followed by Advanced Life Support  where medical care is given by doctors and nurses trained in critical care medicine with all specialized equipment and facilities , and  aim is to stabilize or restore vital functions. It is very well known that an organized prehospital care after a road accident, as well as a prompt medical attention reduces the morbidity and mortality among the accident victims. In this context, building of Trauma Hospitals on highways is a nice concept provided we have the necessary personnel and facilities to take care of the accident victims, unfortunately this has been one of the main challenges faced by most of the hospitals in general especially in public sector.
(The author is formerly, Vice Principal, Prof. & Head of Orthopaedics, CMC , Ludhiana)
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