A study of road accident deaths in Andhra Pradesh

Transcription

1 A study of road accident deaths in Andhra Pradesh D. Raja Reddy Introduction: A recent ghastly private bus accident in October of 2013 on a national highway in Andhra Pradesh leading to the death of 45 passengers illustrated the state of affairs on our roads. The following table lists the numbers of accidents, numbers of injured and dead on our roads in the state (table-i). No. Accidents Table-I No Injured No. Dead Year The road accident statistics of India are listed in table-ii. Table-II Year No accidents No injured No dead It is obvious from the tables that India and Andhra Pradesh have witnessed an enormous increase in the amount of traffic on the roads resulting in increased numbers of injuries and deaths. World

2 Health Organization has reported that in the year 2010 that there were 1.24 million deaths in the world due to traffic accidents. This represents an average of 3242 persons dying every day around the world and million people are injured or disabled every year. Road fatalities per 100,000 inhabitants per year in the WHO report were 18 and road fatalities per 100,000 motor vehicles were 93.3.There were deaths due to traffic injuries in India during that year and the numbers of injured per 100,000 inhabitants and vehicles were 18.9 and 100 respectively. It is obvious that road fatalities are higher in India as compared to other countries. Earlier studies also confirmed this observation. For example India accounts for as high as 6% of world traffic accidents, although it has only 1% of world s vehicles. The same report stressed that the Road Traffic Accident rate of 35 per vehicles in India is one of the highest in the world and so is the RTA fatality rate of 25.3 per 10,000 vehicles (Fitzerald et al 2006). Kelkar-Khambete of the Sir Ratan Tata Trust studied the epidemiology of road traffic accidents in India and reviewed the literature on the subject in Some excerpts from this study are mentioned below. India has the highest proportion of deaths due to road traffic accidents in South East Asia. Recent statistics indicate that the incidence of accidental deaths have increased by 32.5% during the ten years from in India. The road accidents are on the rise and are the forth important cause of death globally leading to significant proportion of injuries, deaths and disabilities of the population. Following is an analysis of road traffic accidents in Andhra Pradesh. Road traffic accidents in Andhra Pradesh: Road traffic accidents and the resultant injuries and deaths are increasing at an alarming rate in Andhra Pradesh in recent years. An analysis of the road accidents during the first six months of 2007 by the Andhra Pradesh road safety authority revealed that there were on an average of 129 accidents daily with 40 deaths and 186 injured. During the year 2001 there were 79 accidents per day with 22 deaths and 103 injured and now in 2012 there were 107 accidents per day and the number of daily dead were 41. The number of dead does not include those admitted to hospitals and succumb later due to various complications during treatment. Andhra has kilometers of roads out of which 4472kms are national and 8271 kilometers are state roads and the rests are other roads. Andhra Pradesh has 2% of the total road network in the country (65714 as against 3.32 million kms), 6.7% of national highways (4472 vs kms) and 7.9% of registered motor vehicles in the country (57.2 lakhs as against total of 727 lakhs). But Andhra is contributing to 11.6% of total deaths in road accidents, which is highest in the country. Another statistic to be noted is that Maharashtra (89.69lakhs), Tamilnadu (85.75 lakhs), Gujarat (70.87 lakhs) and Uttar Pradesh (64.60 lakhs) have more motor vehicles than Andhra Pradesh but it has very high rate of accidental deaths per 1000 vehicles in the country which is 2.2.The figures for other four states are 1.3, 1.7, 0.8 and 1.7.All these prove that Andhra has the dubious distinction of having highest road traffic accidents and related deaths in the country. It is important to analyze the causes of accidents and measures to be undertaken to lessen the mortality and morbidity on our roads.

3 Prevention: Deaths from Road trauma were studied extensively in the west and they are listed so that preventive measures can be introduced: Very early or almost immediate deaths occur in about 24-40% of the injured and these are non-preventable. Rests of the deaths are preventable and among these early deaths within 4 hours occur in about 20% of the cases. These cases need immediate care and rapid transport. Hospital deaths within 24 hours occur in about 20% of cases. Hospital deaths after days or weeks result in about 20% of cases dying from trauma and some of them are due to noso-comial infections acquired in the intensive care units and multi-organ failures due to extensive injuries. It is worth recalling that almost three quarters to 85% of road traffic accidents are preventable and 75% of deaths following road trauma are preventable. Majority of trauma accidents are due to human error such as over speeding, drunk driving, not wearing protective gears such as seat belts and helmets and fatigue factor. The road factors and the machine failures account for the rest of the accidents. A stringent test before giving driving license is also important. Appropriate legislation and checks will reduce the number of accidents. It may be noted that the speed limit of vehicles in different roads has not been identified yet. It is important to reiterate the observations of World Health Organization studies on trauma: A non-helmet wearing person driving a motorized two wheeler is 20 times more likely to die than those who did wear a helmet. Seat belts reduce the risk of fatal injuries in car crashes by 40-60%.Compared with a person in a car motorized two wheel rider is 20 times more likely to die. A pedestrian is 9 times more likely to die than a passenger in a car. A person on a bicycle is 8 times more likely to die than a passenger in a car. A person in a car is 10 times more likely to die than a passenger in a bus and 20 times more likely to be killed than a passenger in a train. Air travel is safer than train and train is safer than road travel. Early transport: Once an accident occurs early transport of the injured to an appropriate hospital will not only save lives but also will lessen the morbidity in the injured. Apathbandu was conceived during 1980 s to provide the emergency medical care of the injured in the Andhra Pradesh. The government started this without spending any money and given this to an organization which was given permission to run a lottery. The money raised from lottery was used to buy ambulances etc but the great disadvantage faced by Apathbandu was shortage of funds and lack of IT support and simple phone number for people to contact. Hence this effort was not very successful. In its place government permitted 108, which was funded 95% by the government and rest 55 by Satyam computers in the beginning and by GVK in recent years. It may be noted that 108 answers all kinds of emergency calls including trauma cases. Care of the injured in the western countries has improved after the training of the medical personnel in basic and advanced trauma support courses. These courses are also provided now in India and Gandhi Medical College conducts them periodically. A specialty of emergency medicine developed in recent years but such facilities are only available in corporate hospitals in our state at present and there is a need to develop such degree courses in the government medical colleges. Selection of the hospitals which can handle major trauma is also important and this has not been planned in

4 our state. Not all hospitals can handle major trauma and some may not have facilities to handle emergencies which requires immediate availability of a neurosurgeon, orthopedic surgeon, anesthetist, general surgeon etc. Ready availability of blood is also important and lack of adequate blood has been a problem in government hospitals. Such kind of set up is only available in some corporate hospitals and only in some government hospitals. But the patients who are taken to corporate set up may not be able to afford such care and the governments need to pay so that good emergency care is available to all irrespective of their capacity to pay. Emergency medical care including trauma should be included in Arogyasri scheme. Let us look at the fate of road accident victims during the past few years since 108 services were made available in the state from 2005 onwards. There were 30 deaths a day on our roads in 2005 which increased to 41 a day in It is apparent that number of injured and dead has gone up which crossed 40 a day. It is obvious that 108 has not made any impact so far on the fatality rate of the injured is concerned. It is not only early transport but transfer to the right hospitals is very important which has not been followed. Another factor to be noted is that daily fatal road accidents in Hyderabad commissionerate are only 1 out of 40 odd dying daily. Most of the injured are dying on the national and state highways where the concentrations of 108 ambulances seem to be thin or lacking. Hence it is necessary that defects of the past have to be rectified if the trauma care has to improve. The marked increase in the number vehicles on the roads alone cannot explain the rise in the number of fatalities on our roads. In Andhra number of vehicles on the roads increased from in 2001 to in 2006 and it is true of other states also. For example Maharashtra (89.69 lakhs), Tamilnadu (85.75 Lakhs), Gujarat (70.87 Lakhs) and U.P. (64.60Lakhs) have more motor vehicles but they have relatively lesser number of fatalities on their roads as compared to Andhra Pradesh. Reasons for the failure of 108 and the remedies to rectify them: The reasons for the failure of 108 programme with regard to road accident victims are easy to comprehend. 1. All calls to 108 are not real emergencies: 108 have excellent communication facilities but they respond to all types of calls and not all of these are real emergencies. Road traffic victims need priority since taking them to a proper hospital in the golden hour only will save many lives. Average time of admission of 29 injured to NIMS in a five-day period was 8 hours, which is shocking. Only 3 out of these 29 were brought during the first hour. Only other ailments, which can be called as emergencies, are heart attacks, strokes and a lady in labor. It was given to understand that only one call out five received by 108 is such an emergency. If all calls need to be answered promptly by 108 it will require many times more number of ambulances and staff. 2. Coverage of national and state highways: Andhra has kilometers of roads and they are as follows: 1.National highways kilometers. 2. State highways-8271 kilometers

5 and 3.lastly other smaller roads kilometers. If one were to analyze the deaths of on these roads during 2006 year interesting facts came to light (36.1%), 3444 (27.8%) died on national and state highways and the rest died on large stretch of smaller roads, which accounted for 4475 deaths (36.1%). If effective patrolling and 108 facilities are provided on state and national highways lot of fatalities can be prevented. Smaller roads have less traffic flow and the deaths on them are fewer and their patrolling would be difficult. 3. Cities and towns: Most cities and towns do have good transport facilities including ambulance services. Most major corporate hospitals have their own ambulance networks with radiophone numbers. In the year 2007 forty people a day died on our roads but only one out of the forty died in cities while 39 died on highways. Hence concentration of 108 in cities and towns is not that useful and necessary. 4. Trauma centers are not listed: Not every hospital can handle major trauma cases. Our twin cities have grown enormously and distances are long. Police still transfer the injured to three major hospitals namely Osmania, Gandhi and NIMS unless injured wants to go to a private hospital. This is not an ideal situation. Average time elapsed between injury and treatment varies between 4-6 hours even in our city, which is not optimum. Hence we can follow what Bangalore accomplished in this record. Bangalore is divided the city into seven zones and each zone has a well equipped major and secondary hospitals. Injured person is guided to the nearest hospital, which can only handle such cases. Early deaths in traumatic injuries are due to excessive loss of blood leading to shock and most major government hospitals are short of adequate blood availability. Only hospitals which have good blood supplies are those corporate who do lot of heart surgeries where elective donation is mandatory. These facts got to be kept in mind and it is high time cities are divided into zones with hospitals listed on their ability to handle all kinds of injuries with immediate availability of all specialists. 5. Prevention of accidents by effective patrolling of national and state highways: It is worth recalling that 85% of road traffic accidents are preventable and 75% of deaths following road trauma are preventable. Majority of trauma accidents are due to human error such as over speeding, drunk driving, not wearing protective gears such as seat belts and helmets and fatigue factor. The road factors and the machine failures account for the rest of the accidents. A stringent test before giving driving license is also important. Appropriate legislation and checks will reduce the number of accidents. It may be noted that the speed limit of vehicles in different roads has not been identified yet. Hence it is necessary that the government provides patrolling of at least national and state highways, which would lessen the number of accidents, and also helps injured get an early medical help. As a trial government can take up a hundred kilometer stretch of an accident-prone highway such as Hyderabad- Vijayawada road and implement these measures.

6 Rehabilitation of the injured: The number of injured on our roads is large indeed. In 2007 there were injured who survived after the accidents. It is shocking to know that there are no rehabilitation facilities for those injured individuals in our state who survive the accidents. Rehabilitation is a long process and expensive if were to be undertaken in corporate hospitals. Since majority of those injured are younger people it is all the more important to provide rehab-counseling facilities in government hospitals Government earns enormous money from transport department and it is its duty to provide rapid transport of the injured as well as their rehabilitation. Summary: The management of road traffic injuries in Andhra Pradesh needs improvement and the present state of affairs is not acceptable. The efforts should start with prevention of accidents, effective and timely care of the injured on the roads and their prompt transport to the nearest but appropriate hospital. Rehabilitation of the injured is also important since in one decade more than a million people suffered injuries in the state. References 1. Fitzerald, M., Dewan, Y., O Reilly, G., Mathew, J. and McKenna, C.: India and the management of road crashes: towards a national trauma system. Indian journal of surgery, 68, , Kelkar-Khambete, A.: Epidemiology of road traffic accidents in India: a review of literature. Sir Ratan Tata Trust, Mumbai, 2011.