Death and injury on roads
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7558.53 (Published 06 July 2006) Cite this as: BMJ 2006;333:53All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
The problem of traffic causing death by accidents is dwarfed by the
increase in mortality caused by air pollution. In the UK there are 32,000
deaths per year caused by air pollution, the vast majority of which comes
from traffic fumes.
Transport also contributes to over a quarter of our CO2 emissions, and we
can expect climate change to cause massive increases in morbidity and
mortality through a range of mechanisms.
Reducing traffic through encouraging walknig and cycling and better public
transport is the obvious solution.
Competing interests:
I am involved in campaigning against road schemes
Competing interests: No competing interests
‘Cars and Horses’ (1) by Dr. Loudon gives a historical glimpse of
transport about hundred years ago in London and other cities in England in
a very amusing manner. Animal driven transportation is still in vogue in
several countries in Asia. Bullock carts, horse bandy, camels and even
elephants are still in use. Donkeys are still used by dhobis to carry
clothes for washing in some cities in India.
The vivid description of the dung problem on the roads in earlier
days by Dr Loudon is still a problem in such places, even though it has
been greatly reduced in these places owing to the advent of automobiles.
Two years ago, when visiting Delhi, India our seven year-old daughter
stepped on cow dung accidentally. Since she was wearing only slippers and
since the dung was soft it nestled pretty well between her toes. She threw
a real fit until it was all washed away. Later in a small town in India,
she stepped on elephant dung. This time she had a milder fit, since the
elephant dung was much harder than the cow dung.
Reference
1) Cars and horses
Irvine Stewart Lees Loudon (8 July 2006)
Competing interests:
None declared
Competing interests: No competing interests
Traffic crashes result in one million fatalities worldwide. Another
20–30 million people suffer injuries. Motor vehicle injury prevention
offers one of the most promising ways of reducing deaths, hospitalizations
and related health care costs. However evidence based policies and
countermeasures needed to control the epidemic of road traffic crashes
remain neglected in most motorized countries. The first step of prevention
of traffic crashes should be start with implementation of evidence based
policies that have international validity (1, 2) Systematic reviews of
scientific literature provide number of following evidence based
strategies:
• Enforcement of laws against driving under the influence of
alcohol (highly publicized Sobriety checkpoints-random breath testing)
• Setting minimum age for the consumption of alcohol
• Setting lower legal BAC limits
• The alcohol interlock program
• Interventions for problem drinking appear to reduce injuries and
their antecedents (e.g. motor vehicle crashes, falls, suicide attempts)
• The meta-analysis established that DUI remediation generally has a
positive effect on alcohol-related traffic crashes
• Graduated driver licensing (GDL) is effective in reducing the crash
rates of young drivers
• Helmets reduce bicycle-related head and facial injuries for
bicyclists of all ages involved in all types of crashes, including those
involving motor vehicles.
• Free helmets alongside an educational component increase observed
helmet wearing in the areas in which they are set.
• Global efforts to reduce road traffic injuries can be facilitated
by increasing helmet use by motorcyclists.
• Interventions to increase use of child restraint safety seats and
booster seats are effective.
• Primary seat belt enforcement laws are likely to be more effective
than secondary seat belt enforcement laws.
• Red-light cameras are effective in reducing total casualty crashes.
• Speed cameras are effective in reducing casualty crashes.
• Pedestrian safety education can change road crossing behavior
• Daytime use of headlights reduces the number of multiparty daytime
crashes
• Traffic-calming reduces the number of crashes and pedestrian
crashes
• Roundabouts and pedestrian and cycle facilities provide significant
safety benefits
• Reduction in average speeds is accompanied by reduction in crashes.
Many motor vehicle related countermeasures have been effective in
reducing crashes. Effective public health policy must be based on evidence
based approach and implementation of this evidence based strategies will
reduce burden of motor vehicle crashes in the world.
However, older unscientific strategies still exist, and these
measures aimed at change of road user behavior. (1, 2) Unfortunately
researchers in highly motorized and motorizing countries continue to
advocate strategies that have not been shown to be effective (2) :
• There is no reliable evidence that interventions in the alcohol
server setting are effective in reducing injury.
• There is no evidence that post-license driver education is
effective in preventing road traffic injuries or crashes.
REFERENCES:
(1) O'Neill B, Mohan D., Reducing motor vehicle crash deaths and
injuries in newly motorizing countries. BMJ. 2002:11; 324(7346):1142-5.
(2) Mohan, D., Road traffic injuries--a neglected pandemic. Bull
World Health Organ. 2003; 81(9):684-5.
(3) Task force on Community Preventive Services: Recommendations to
reduce injuries to motor vehicle occupants: increasing child safety seat
use, increasing safety belt use, and reducing alcohol impaired driving.
American Journal of Preventive Medicine 2001:21(4s) 16-20
(4) Cochrane injuries group- http://www.cochrane-
injuries.lshtm.ac.uk/ (accessed 12th July, 2006)
Competing interests:
None declared
Competing interests: No competing interests
I agree entirely. It is alarming to see the number of people nowadays
who drive in fog/ rain/ near-darkness with no headlights on. As you
correctly point out, it's not as if it costs anything. This mirrors the
general deterioration in driving standards, in particular not using
indicators. I assume that the driving test has been dumbed down along with
school exams.
Competing interests:
None declared
Competing interests: No competing interests
None of your articles this week on road traffic accidents mentions
the use of daytime running lights (DRL).
DRL (or the use of dipped headlights all day regardless of lighting
conditions) are compulsory in a number of European countries and have been
shown to result in a significant reduction in accidents. A helpful review
in Bandolier
http://www.jr2.ox.ac.uk/bandolier/band59/b59-3.html
suggests a reduction of up to 15% from a number of different studies.
Surely this warrants further research, and if the results are
confirmed we should be advocating compulsory dipped headlights all day.
This would cost nothing and should save significant numbers of lives.
Competing interests:
None declared
Competing interests: No competing interests
The use of motor cars has reduced the occurrence of popliteal
aneurysms
"Popliteal aneurysms......used to occur with unnatural frequency amongst
coach drivers, postilions and others working in equestrian occupations in
Georgian London. The problem may have been exacerbated by the wearing of
high leather riding boots which rubbed the back of the knee (1).
It suggests that changing your means of transport or job related
equestrian dress may have quite unintentional health benefits.
1. The Knife man. Moore W.
Competing interests:
None declared
Competing interests: No competing interests
It is easy to imagine that a hundred years ago, when cars were first
appearing on our roads, they replaced previously peaceful, gentle and safe
forms of travel. In fact, motor vehicles were welcomed as the answer to a
desperate state of affairs. In 1900 it was calculated that in England and
Wales there were around 100,000 horse drawn public passenger vehicles,
half a million trade vehicles and about half a million private carriages.
Towns in England had to cope with over 100 million tons of horse droppings
a year (much of it was dumped at night in the slums) and countless gallons
of urine. Men wore spats and women favoured outdoor ankle-length coats
not out of a sense of fashion but because of the splash of liquified
manure; and it was so noisy that straw had to be put down outside
hospitals to muffle the clatter of horses’ hooves. Worst of all, with
horses and carriages locked in immovable traffic jams, transport was
grinding to a halt in London and other cities.
Moreover, horse-drawn transport was not safe. Road traffic deaths
from horse-drawn vehicles in England and Wales between 1901 and 1905 were
about 2,500 a year. This works out as about 70 road traffic deaths per
million population per year which is close to the annual rate of 80 to 100
deaths per million for road traffic accidents in the 1980s and 1990s,
although we must not forget that many people who died from injuries
sustained in road accidents in 1900 would probably have survived today
thanks to our A&E departments.
Motor vehicles were welcomed because they were faster, safer,
unlikely to swerve or bolt, better able brake in an emergency, and took up
less room: a single large lorry could pull a load that would take several
teams of horses and wagons – and do so without producing any dung. By
World War One industry had become dependent on lorries, traffic cruised
freely down Oxford Street and Piccadilly, specialists parked their
expensive cars ouside their houses in Harley and Wimpole Street, and the
lives of general practitioners were transformed. By using even the
cheapest of cars doctors no longer had to wake the stable lad and harness
the horse to attend a night call. Instead it was ‘one pull of the handle
and they were off’. Further, general practitioners could visit nearly
twice as many patients in a day than they could in the days of the horse
and trap. (1)
1. Loudon I ‘Doctors and their transport 1750-1914’, Medical History:
2001; 45185-206
Irvine Loudon, Medical Historian. (irvine.loudon@green.ox.ac.uk)
Competing interests:
None declared
Competing interests: No competing interests
Death on roads and solid organ procurement for transplantation
The editorial,1 and another recent publication 2 are both correct in
stating that the burden of road-traffic deaths, injuries and their
associated costs falls disproportionately upon those countries and
societies least able to afford them. Nevertheless, such circumstances may
permit the opportunity for solid organ donation and procurement for
transplantation (heart, intestine, kidney, liver, lung and pancreas).
Thus, some good might arise from the wreckage of hopelessness and seeming
futility that pervades the aftermath of road-traffic deaths.
It is disappointing to find no mention of this potential intervention
in the either of these publications. One accepts that in many of the
countries so affected solid organ transplantation services may not exist
at all, e.g. Latvia 3 or be very limited at best. Although it is incumbent
on organizations such as the WHO, the UN, FIA Foundation and national
governments to demand and develop strategies for reducing deaths from road
-traffic crashes, it is also not unreasonable to believe that those same
bodies should be responsible for promoting every effort to support and
sustain organ donation from people dying in such circumstances.
Between 1 July 2004 and 30 June 2005 the total number of solid organ
transplant recipients in the USA was 20,813.4 The median proportion of
patients who received an allograft from a donor killed in a motor vehicle
accident was 25.1% (range 20.7 – 35.0). However, these data give no
indication as to the number of patients whose death as the result of a
road-traffic accident might have resulted in successful organ procurement
for solid organ transplantation, but did not. This is a more meaningful
statistic.
References
1. Ameratunga S, Jackson R, Norton R. Death and injury on roads.
(Editorial) BMJ 2006;333:53-4.
2. Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting
disparities to address a global-health problem (Review; 118 references).
Lancet 2006;367:1533-40.
3. European Liver Transplant Registry. Transplant Statistics. Available
at: http://www.eltr.org/publi/centers.php3 (accessed July 2006).
4. Scientific Registry of Transplant Recipients. Transplant statistics:
national reports. Available at: www.ustransplant.org (accessed July 2006).
Competing interests:
None declared
Competing interests: No competing interests