"Curbing" Road Traffic Deaths in Developing Countries with Emergency Care

This Sunday is one of those international awareness days you don't hear much about. Football teams won't wear a particular color, Google won't change its logo and newspapers probably won't devote their front page to the cause. But its importance and relevance are nonetheless profound.
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This Sunday is one of those international awareness days you don't hear much about. Football teams won't wear a particular color, Google won't change its logo and newspapers probably won't devote their front page to the cause. But its importance and relevance are nonetheless profound.

Sunday is the World Day of Remembrance for Road Traffic Victims. For most of us, this topic needs no introduction: we've all likely had a brush with a traffic accident at some point in our lives; and worse, we all likely know someone who's been seriously injured, if not killed, in an accident. The impact of these severe injuries and deaths can reverberate across families and communities - their pain immediate yet long-lasting, their shock hard-to-imagine yet overwhelmingly real.

Fortunately, in places like the U.S. and Europe, road traffic deaths are on the decline - and have been for many years. Much of this progress is attributable to the strides that wealthy countries have made in preventing road accidents - namely by addressing the five major risk factors (speed, drunk driving, helmets, seatbelts and child restraints) and emphasizing safer vehicles and roads. But we also know that these countries have emergency response systems in place to treat victims of road accidents when they occur, which can save lives and mitigate the severity of injuries, averting a lifetime of disability.

It's a much different story in the developing world.

Globally, road accidents represent the eighth leading cause of death, killing more than a million people every year - on par with more well-known health issues like HIV/AIDS, malaria or tuberculosis. Nine in 10 road deaths occur in low- and middle-income countries, and in many, the numbers are rising. In fact, the African region has the highest road traffic fatality rate in the world (with the majority of deaths among pedestrians, cyclists and motorcyclists), while, in absolute terms, India and China have nearly half of all the world's road deaths combined.

Of course, much more can be done in these countries to prevent life-threatening accidents in the first place - including public policies and investments to improve vehicle safety, road conditions and driver behavior - but there is also an opportunity to improve how we respond to these accidents. According to Global Status Report on Road Safety released last month by the WHO and Bloomberg Philanthropies, "if trauma care systems for seriously injured patients in low- and middle-income countries could be brought up to the levels of high-performing countries, an estimated half a million lives could be saved each year."

The first step is pre-hospital care. Most people who die on the road do so before they get to the hospital, so it's imperative that countries have an emergency phone number to report an accident (like 911 in the U.S.). This number must also be connected to a functioning ambulance service and referral system to transport patients to a health facility that can provide quality, timely care. A good example of a model that offers these linkages is Ziqitza Healthcare in India. Its Dial 108 service is a public option supported by state governments and tailored to poor, often hard-to-reach patients, whereas its Dial 1298 service is a private model for wealthier patients. Together, they've served more than 4 million Indians to date.

The next step involves trained health providers. In high-income countries, doctors, nurses and emergency medical technicians go through extensive training to prepare them for treating trauma patients. But only half the countries in the African region and less than half in Southeast Asia offer emergency medical training to doctors (even fewer for nurses). That's one reason Medical Teams International has established training programs to ensure that first responders, nurses and physicians in developing countries have the knowledge and skills to deliver emergency medical care.

However, knowledge and skills only go so far if hospitals don't have the equipment and infrastructure to offer appropriate emergency care, which often involves surgery. This is a continuous challenge in the developing world. Sometimes hospitals lack adequate supplies of anaesthetic drugs to operate; other times, the electricity abruptly shuts down, rendering surgery nearly impossible. Compounding these problems is the fact that medical equipment is often broken down or abandoned in these settings - leaving up to 80% of it unusable. My company, Gradian Health Systems, is one of many organizations setting out to make safe surgery possible in hospitals throughout the developing world - both to save lives and, importantly, to ensure that safe surgical treatment is available to reduce the likelihood of long-term disability.

Emergency response is just one piece of a complicated, systemic puzzle when it comes to preventing road traffic deaths. But the fact is, death and disability from road traffic accidents are as pressing a global health problem as any. It's time we gave this preventable and surmountable challenge the attention it deserves by strengthening emergency response systems so that when an accident does occur, the pieces are in place to keep it from becoming fatal or disabling.

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