The burden of road crashes on the health system in Asia Pacific Professor Peter F.M. Choong Sir Hugh Devine Professor of Surgery, University of Melbourne Department of Surgery Director of Orthopaedics, St. Vincent s Hospital Melbourne President, Australian Orthopaedic Association
Lower infant mortality, healthy aging, better healthcare
Life expectancy - Australia 90 80 70 60 50 40 Males Females 30 20 10 0 1901-1910 1960-1962 2010-2012 Sources: ABS 2008; ABS 2013a
Leading cause of death 15-29 years Energy of impact = 1/2 mv 2 Road deaths Australia : 2008 statistical summary. Department of Infrastructure, Transport, Regional Development and Local Government May 2009 Rapid motorization and road traffic accidents in China. Shengchuan Zhao, Dalian University of Technology, Dalian, China 116024
The vulnerable road users
Mode of transport for serious injury Australia 2008 09 Injured Person Count Percent % Rate per 100000 Car occupant 17937 32.5 81.5 Motorcyclist 14493 26.3 67.4 Pedal Cyclist 9577 17.4 45.3 Pedestrian 3686 6.7 16.8 Total 53406 96.9 246.5 AIHW: Henley G and Harrison JE 2012. Serious injury due to land transport, Australia 2008 09. Injury research and statistics series no. 67. Cat. no. INJCAT 143. Canberra: AIHW.
Key Indicators for Land Transport Injuries Australia 2008 09 Indicator Persons admitted to hospital 53406 % of all admissions due to injury 9.8% Mean length of stay in hospital 4.4 (days) Total patient days 233882 (incl same day) Crude rate / 100000 245.8 AIHW: Henley G and Harrison JE 2012. Serious injury due to land transport, Australia 2008 09. Injury research and statistics series no. 67. Cat. no. INJCAT 143. Canberra: AIHW.
Location of Injuries Car Occupant Motorcyclist Pedal cyclist Pedestrian 23.7% 10.8% 23.3% 30.7% 19.3% 7.8% 4.7% 4.3% 13.5% 35% 44.5% 15.2% 13.7% 7.4% 6.9% 8.8% 11.4% 35.3% 17.2% 36.2%
Head Injuries Death, Vegetative state, Cognitive deficit, Motor deficit, Epilepsy
Lower limb injuries Loss of mobility Soft tissue defects Nerve/Vessel injury Non-union Deformity Contractures Shortening Amputation
Upper limb injuries Loss of independence Nerve injuries Loss of function Poor healing Stiffness and contractures
Cost of Road Traffic Accidents 1-3% GDP 5-20% Health Expenditure Australia $27 Billion ($140 Billion) USA $518 Billion ($2.6 Trillion)
Challenges
Societal Cost - Life years lost through disability Road Traffic Injuries 20-50x > than fatalities Asia - 1 Fatality, 20 Hospital admissions, 50 ER visits, 100 minor injuries Road Traffic Accidents 16268 (x thousands) Diabetes 20758 Heart disease 21985 HIV/TB/Malaria 15187 Cancer 4483 Force of Nature/War 2289 Global Burden of Disease Study, Lancet 2012; 380: 2163 96
Impact of RTA in Asia 645000 road fatalities each year 3.5 million deaths last 5 years 18 million permanently disabled last 5 years 60% of global deaths and injuries By 2030-2x > HIV/AIDS, 4x > TB New Zealand 4.4 Million Latvia 2.29 Million Mauritius 1.29 Million Luxemberg 502 Thousand Iceland 317 Thousand
Road Death rate per 100,000 population - Asia Region Rank Rate World Rank Region Rank Rate World Rank 1 Thailand 42.94 6 19 South Korea 13.67 109 2 Malaysia 34.53 20 20 Uzbekistan 12.28 120 3 Mongolia 31.64 26 21 Myanmar 11.60 124 4 Vietnam 26.01 44 22 Sri Lanka 11.46 125 5 Afghanistan 25.07 48 23 Nepal 11.44 127 6 Kyrgyzstan 23.42 51 24 Georgia 11.40 129 7 Indonesia 6322 54 25 Philippines 10.61 133 8 Laos 21.98 58 26 Turkmenistan 10.48 135 9 Russia 21.91 60 27 Timor-Leste 10.29 138 10 Kazakhstan 21.58 64 28 North Korea 10.24 139 11 China 20.75 67 29 Azerbaijan 8.53 149 12 India 18.65 77 30 Singapore 5.28 175 13 Bhutan 18.60 78 31 Tajikistan 3.86 186 14 Cambodia 16.70 87 32 Japan 3.81 189 15 Bangladesh 16.40 90 33 Maldives 2.42 192 16 Pakistan 15.55 94 Australia 6.75 162 17 Brunei 14.16 103 UK 4.77 180 18 Armenia 14.12 105 USA 13.88 107
Health and Wealth: Poverty impact 22 million: number of families that have experienced a family member being killed or permanently disabled by road accidents in the last 5 years. R. Silcock. 2003. Guidelines for Estimating the Cost of Road Crashes in Developing Countries. London: Department for International Development; WHO. 2009. 7 out of 10: number of victims' families that suffer decreased income due to road accidents. Source: R. Silcock. 2003. Guidelines for Estimating the Cost of Road Crashes in Developing Countries. London: Department for International Development; WHO. 2009. Two-thirds: proportion of victims' families who end up taking loans to cover income loss. Road Safety in the Western Pacific Region: Call for Action. Geneva. WHO. $15 billion: estimated cost of road accidents in ASEAN countries ADB Transport $96 billion: amount lost annually to road accidents in ADB member countries. Road Safety in the Western Pacific Region: Call for Action. Geneva. WHO.
Road Traffic Fatalities in Australia Seat belts Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
Trinca GW, Dooley BJ. The effects of seat belt legislation on road traffic injuries. Aust N Z J Surg. 1977 Apr;47(2):150-5. Dooley BJ. Medical significance of occupant restraint on road-crash victims and the role of the medical profession. Can J Surg. 1987 Nov;30(6):400-2. Trinca GW, Dooley BJ. The pattern of motor cycle injuries sustained by motor cyclists in Victoria in 1974 and 1975. Aust N Z J Surg. 1979 Apr;49(2):203-7.
Seat Belt Wearing vs Fatality Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
Road Traffic Fatalities in Australia Drink Driving Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
Random breath testing
Road Traffic Fatalities in Australia Speed camera Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
Impact speed in dry conditions 50 km/h 55 km/h 60 km/h 65 km/h 70 km/h 75 km/h 80 km/h Metres Reaction Braking Stops in time Stops in time Touches Hits at 32 km/h Hits at 46 km/h Hits at 57 km/h Hits at 66 km/h 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Road Traffic Fatalities vs Road Traffic Injuries Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
Actual vs Predicted Australian Road Deaths Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
Actual vs Predicted Australian Road Injuries Bureau of Infrastructure,Transport and Regional Economics (BITRE), 2014, Road Safety Modelling a Global Phenomenon, Report 141, Canberra ACT.
What lessons have we to share? Education Road culture Specific groups Legislation Car seat belts Motor cycle and pedal cycle head protection Alcohol restriction Speed limits Road rules Car safety features