War on the roads: two years on
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7444.845 (Published 08 April 2004) Cite this as: BMJ 2004;328:845All rapid responses
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Tragic and wasteful though death as the result of road traffic
accident (RTA) is, the opportunity for solid organ donation and
procurement arises (liver, kidneys, heart, and lungs). 1
Whilst it is incumbent upon governments and institutions such as the
Medical Research Council to demand and develop strategies for reduction of
deaths from RTA, it is not unreasonable to believe that the same groups
should promote every effort to support and sustain organ donation from
deceased persons in such circumstances. Thus, some good might arise from
an otherwise hopeless and seemingly futile situation.
It is not stated among data on the European Liver Transplant Registry
website, 2 nor in the recent paper on behalf of the same group what
proportion of patients undergoing orthotopic liver transplantation (OLT)
did so with an allograft from a deceased donor (DD) who died as the result
of a RTA. 3 Of 5183 patients undergoing OLT from a DD in the USA between
1st July 2002 and 30th June 2003, 22.9% of recipients gained their
allograft as the consequence of motor vehicle accident. 4
However, these figures give no indication as to the numbers of
patients whose death as the result of RTA led to successful organ
procurement for transplantation. Furthermore, so long as disparity in the
laws regarding the status of deceased persons with respect to consent for
organ donation exists between countries, e.g. Spain and the UK, then the
opportunity for organ procurement and the gift of life for otherwise dying
people will remain unfulfilled.
References:
1. Roberts I, Abbasi K. War on the roads: two years on. BMJ 2004;328:845.
2. European Liver Transplant Registry. Available at: http:// www.eltr.org.
(accessed 8th May 2004).
3. Adam R, McMaster P, O’Grady JG, Castaing D, Klempnauer JL, Jamieson N
et al. Evolution of liver transplantation in Europe: report of the
European liver transplant registry. Liver Transpl 2003; 9: 1231-43.
4. Scientific Registry of Transplant Recipients. Transplant statistics:
national reports. Available at: http:// www.ustransplant.org (accessed 7th
May 2004).
Competing interests:
None declared
Competing interests: No competing interests
If you enter somehow a ‘No entry’ zone,
To the fellow from the other side, you’re not known.
Your move is full of consequences unknown,
Avoid this dangerous move, be you novice or well known.
You’re a great man; you’ve a love of the thrill,
You love to talk with the winds, cross speeds with a shrill.
Your machine may give way without notice or drill,
Speeding is a dangerous move, it may disable or kill.
You’re a funny guy, love to chat on the wheel,
You get lost in the chat; lose your hand on the wheel.
Or you lose your focus; shift your eyes from the road,
Dangerous to lose control of the wheel & thus lose the road.
You great guy, you think yours is the road,
Why other users, why pedestrians cross the road?
But know better; roads are for everyone’s sensible use,
Being oblivious of others is a dangerous move.
‘Drinking and driving don’t mix’ they say;
Inebriated you feel great but you may sway.
You may drive but you misjudge at every step,
Make not this dangerous move, you better give up.
“I wear no helmet; I love no seat belt,
Don’t curb my freedom, I’m a free bird.”
To stay free dear, you must be safe at first,
Make no dangerous moves, follow safety rules with trust.
Didn’t sleep well or took drugs to fall asleep?
You want to drive with droopy eyes and the falling lids?
If not fully awake don’t take to the road or leave homestead,
It’s a dangerous move you better be rested instead.
AND THANK YOU EVERYONE FOR LISTENING TO GOOD SENSE.
Competing interests:
None declared
Competing interests: No competing interests
Editor -- Roberts and Abbassi (1) are right to highlight
disproportionately low spending on preventing road injuries compared to
more popular investment areas. Perel et al.(2) address the gaps in road
safety in developing countries. The risks in developing countries are high
since protective clothing, road rules, driver training and speed limits
are often absent.
It may come as a surprise to some that the annual rate of injuries
and mortality from road traffic accidents overtook those related to UXOs
(unexploded objects - bombs) and landmines in Cambodia in 1998. Traffic
accidents have continued to rise in number and severity since. Keep in
mind that Cambodia, with Angola, has been at the top of the list of
landmines per capita.
One aid donor, Japan, contributes a good deal to bridges/roads. Many
Cambodian bridges were destroyed by fighting or else by torrential rain
and lack of maintenance with the collapse of public infrastructure. In
recent years Cambodian roads have become more efficient and faster while
public transport systems (trains) have decayed. Roads, rather than
becoming safer with the removal of potholes, have become more efficient at
killing. Highways carry plaques announcing donor country assistance in the
building of bridges and roads while the tell-tale chalk marks made by
police show the outlines on roads of bicycles and bodies in Agatha
Christie style. Japan holds a virtual monopoly in automobile sales in
Cambodia, so the integration of aid and investment is convenient. Many of
these sales are of powerful 4-wheel drive vehicles which are never
intended to go off road but instead are status symbols for the rich. Socio
-economic inequality in road deaths does not require research.
Some non-governmental organisations leading on disability issues,
along with the Red Cross, have worked towards increasing safety for the
most vulnerably (motorcycle taxi riders) – employing fluorescent jackets,
defensive driving training courses and helmets. This is valuable work
which should be built upon and expanded to include government agencies.
However, donor countries which inadvertently contribute to deaths on such
a massive scale should, one could argue, take a more direct approach to
protecting those they purport to help.
Development, including enforced road rules, the finance for safety
equipment and training, and designs to protect slower road users (child
and elderly pedestrians, bicycle and motorcycle riders) should be a
condition of investment for donor countries. This would involve a tiny
fraction of their profits. UXOs and landmines and infectious diseases are
a more attractive option to donors especially when the cost of their
investments is so seldom understood.
1. Roberts I, Abbassi K. War on the roads: two years on. BMJ 2004;
328: 845 (10 April)
2. Perel P, McGuire M, Eapen K, Ferraro A. Research on preventing
road traffic injuries in developing countries is needed. BMJ 2004; 328:
895 (10 April)
Competing interests:
None declared
Competing interests: No competing interests
Moving trauma care on from the Prima Donna mentality.
Almost 20 years ago, Spencer asked why we did not make use of the
concept of trauma teams (1). Many hospitals in the UK followed this
advice, and now deploy such teams. Are they actually functioning as teams,
though?
I sometimes have the opportunity to escort seriously traumatised
patients into other units, and did so again recently. Not for the first
time, I found it profoundly depressing to watch. No trauma team had been
assembled to meet us, but a pleasant young SHO did arrive. I gave him the
story. He listened attentively, and appropriately started to examine the
area of my major concern. A passing Resuscitation Officer ably assisted. A
nurse then arrived and asked if he wanted a trauma team. He paused and
said yes, he‘d better have one.
From that promising start, it all went downhill. Five doctors of
varying ages and seniorities arrived, and in sequence went up to the
patient, barked the same questions at him and then started giving each
other, the nurse and the poor SHO orders. The paramedics and I were
ignored, and a power struggle ensued over the subsequent 23 minutes while
one drip was put up on the patient. Voices gradually rose as each doctor
attempted to assert team leadership. The oxygen mask he was wearing on
arrival disappeared. His physical handling was rough and empathy
nonexistent. The SHO timidly mentioned my clinical concern, which was
dismissed after a desultory examination. I left at this stage, just as the
patient radiographer was finally taking the first Xray.
I am an ATLS instructor, and ATLS courses still start with the little
fairy tale about the surgeon crashing his plane near a hospital with one
seemingly clueless doctor. The plane-crasher then saves the day by
treating his own family.
Arguably, ATLS has done more to improve trauma care world wide than
any other intervention, but the command and control system of ATLS is very
different from other treatment in the UK, based on collaborative decision
making. We need to accept that trauma care 20 years on is no longer given
in the developed world by a single doctor but a team. We may have reached
the stage where ATLS produces prima donnas intent on claiming their 15
minutes of fame as team leader, and is not turning out team members
looking to give best care to the patient collectively. We need to change
the focus of the ATLS philosophy (now that we have most of the medicine
right) and look to produce team members who do not spend their time
telling each other what to do. A separate course should be created to
teach team leadership.
1. Spencer JD. Why do our hospitals not make more use of the concept
of a trauma team? BMJ 1985;290:136-8.
Competing interests:
None declared
Competing interests: No competing interests