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Sixty seconds on . . . road traffic crashes

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3833 (Published 12 July 2016) Cite this as: BMJ 2016;354:i3833

Re: Sixty seconds on . . . road traffic crashes

We are pleased that successful accident prevention approaches in the UK are now being recognised.(1) Considerable effort over decades by dedicated doctors, nurses, engineers, public health specialists and many others is now coming to fruition. However, much more could be achieved.(2-5) Our roads and homes could be made far safer.

A range of effective strategies for preventing many types of accidents now exist based on the approaches of education, environmental modification and enforcement.(6) In addition, the seminal work of Dr Haddon, a physician and engineer who is considered to be the father of modern injury epidemiology, can also guide us. He developed the Haddon Matrix and Ten Countermeasures.(7,8) They are both excellent tools for generating ideas about possible new public health interventions.

A growing number of national organisations including CAPT, NICE, the Institute of Health Promotion and Education, PHE and RoSPA have all now looked at the evidence base for the prevention of accidents in homes and on the roads and have recommended priorities for action.(3,4,9-13) Crucially they state that the actions will have an important impact in reducing injuries and deaths.

The nature of accident prevention is complex, with multiple causes, multiple injury types and a range of approaches to prevention are often needed.(6) Addressing injury effectively requires collaboration with agencies outside the medical and public health communities. In some parts of the country formal accident prevention groups exist. However many struggle to survive in the long term. Examples of those involved in such alliances include: doctors, health visitors, police, road safety and trading standards. Often key to coordinating and facilitating such groups are those working in public health.

In the past these groups have achieved much and supported successful projects such as home safety equipment schemes and a variety of schools projects. The Injury Minimization Programme for Schools (IMPS) is an example of an innovative health education programme delivered in some parts of the country jointly, in schools and local hospital emergency departments (6)

Over the last few decades, the policy response to accidents in England has suffered from lack of national co-ordination.(14,15) Greater national government leadership on accident prevention is needed. For example, a national injury prevention strategy with specific targets and timelines is required. Also, national action is required to improve the data situation.(14-16) Both of these would greatly assist local accident prevention groups and ensure that evidence based practice is facilitated.

Given the considerable cost of injuries and death to peoples’ lives, the NHS and the economy, we strongly believe that more can be and must be done to prevent accidents.

References
1) Gulland A. Sixty seconds on ………road traffic crashes. BMJ 2016;354:i3833
2) Peden M, Oyegbite K, Ozanne-Smith J, et al. World report on child injury prevention. Geneva: World Health Organization, 2008.
3) Public Health England Reducing unintentional injuries on the roads among children and young people under 25 years. London: Public Health England, 2014.
4) Public Health England. Reducing unintentional injuries in and around the home among children under five years. London: PHE, 2014
5) World Health Organization Global status report on road safety 2015. Geneva: World Health Organization, 2015.
6) Watson M C and Errington G, 2016. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health. 2016; 26(5):194–199.
7) Haddon W. The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. American Journal of Public Health 1968;58:1431-1438
8) Haddon, W. Energy Damage and the Ten Countermeasure Strategies. Journal of Trauma 1973;13:321-31.
9) Child Accident Prevention Trust. Preventing Childhood Accidents: Guidance on Effective Action. London: CAPT, 2003.
10) NICE. Strategies to prevent unintentional injuries among children and young people aged under 15. NICE public health guidance 29. London: NICE, 2010.
11) NICE. Preventing unintentional injuries in the home among children and young people aged under 15: home safety assessments and providing safety equipment. NICE public health guidance 30. London: NICE, 2010.
12) RoSPA. The Big Book of Accident Prevention. Birmingham: RoSPA, 2012.
13) Lloyd J, Baillie M, Evans I, James A, Bennetts J, Watson M C, Safety Education: Priorities for children and young people – A Manifesto for Action. Welwyn: Institute of Health Promotion and Education, May 2015.
14) British Medical Association. Injury Prevention London: BMA, 2001.
15) Audit Commission/Health Care Commission. Better Safe than Sorry: Preventing Unintentional Injury to Children. London: Audit Commission, 2007.
16) Watson M. and White J. Accident prevention activities: a national survey of health authorities. Health Education Journal. 2001; 60 (3), 275–283.

Competing interests: No competing interests

14 July 2016
Michael Craig Watson
Associate Professor of Public Health.
Dr John Lloyd (Vice President Institute of Health Promotion and Education, Institute of Health Promotion and Education, http://ihpe.org.uk/).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA
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