Presentation By :
dr param preet GHuman
mBBs, pGdHa, mBa
senior medical officer
employee state insurance corporation
“Health of the Nation is more important
than the wealth of the Nation”
n Road safety is a major public health concern.
n Indian road network is second longest in the world covering
more than 3 million Kilometers.
n 80% of road length consists of village and other roads and
12% constitutes major districts roads.
n 85% of passenger loads and 70% of freight load is carried by
n As per 2004 data there were 72.7 million vehicles on roads and
vehicle fleets are doubling after every 6 to 7 years.
n Financial outlay for road transport sector during 10th plan i.e.
2002-2007 was 9416.90 crores.
Types of vehicles plying on
Indian roads along with their
wrong usage according to their
capacity is a matter of great
concern for road safety. These
vehicles create traffic chaos and
are a cause of road crashes.
Few examples are :--
A mini shop on a cycle
Carriage of goods on Horse carts
Wrong loading of Jeep
Wrong sitting posture of a man in a goods carrier
Load volume larger than the vehicle
Labourer carrying a special ladder
(Gohri) and his material on cycle
Carrying animal on a motor cycle
Jeep with over capacity of passengers
Road Accidents in India (In Thousands)
Year Road Persons Killed Persons
1970 114.1 14.5 70.1
1980 153.2 24.6 109.1
1990 282.6 54.1 244.1
2000 391.4 78.9 399.3
2005 439.2 94.9 465.2
n India has only 1 % of world vehicle population, but
accounts for 6 % of the accidents and 10 % fatalities
due to road traffic injuries.
n Total economic loss to society on account of road
accidents is estimated to be Rs. 55000 crores per
n In India 11 % of deaths due to non communicable
diseases are due to injuries and 78 % of these injury
deaths are due to road traffic crashes. Hence road
safety becomes important responsibility of the
Factors affecting Road Traffic
n Types of roads and road users.
n Colliding vehicles.
n Environment and road related factors like road
geometry, design, visibility, diversions etc.
n Vehicle related causing traffic mix.
n Composition and flow of road traffic.
n Adherence / enforcement of road safety regulations.
n Unsafe driving behavior.
n Traffic congestion caused by increased use of private
mode of transport and less practice of vehicle pooling.
n Highway capacity shortages (National Highways
constitute less than 2 % of the road length of the
country but carry 40 % of road based traffic).
n Lack of valid and fake driving licenses
n Nature of traffic management.
•Over loading of vehicles particularly trucks and tractor
Improper and overloading
Improper and overloading
Bottle necks in Road Safety:-
n Drivers especially of heavy vehicles operate under
inhospitable conditions which induces high levels of
stress and possibility of accidents.
n No organized wayside amenities, maintenance and
n Coverage of extra long distances by drivers leading to
fatigue and long spells of absence from home leading
to emotional and sexual deprivation causing increased
n Concessions given to drivers by wayside eateries also
known as “Dhabas” in the form of free food and
alcohol for their own profit.
n Lack of parking space alongside highways leading
to parking on roads.
n Inexperienced, untrained and underage,
cyclists and rickshaw pullers on the road with
no separate path for them.
n Presence of beggars on busy road junctions
and traffic lights.
n Use of mobile phones while driving.
n Drug addiction.
n Presence of wine outlets near the roads.
n Sale of lotteries, helmets etc near roadside.
Presence of slums near the roads.
n Selling of fruits on road side.
n Sale of Jaggery near the road.
n Sale of small items like tissue papers, agarbatis,
Christmas caps, car shades, balloons,
newspapers, magazines etc on traffic light.
n Roads used as dumping place for
Dangers to Road safety due to religious reasons :--
n Astrologers, palmists, tarot card readers etc. advise people to do certain
rituals known as “Upaayays” which cause traffic chaos. eg. throwing
something in flowing rivers, placing certain things on centre of the road or
at cross junctions etc.
n Practice of donating money on certain specific days of the week in the
name of religion and presence of these donation seekers on busy roads and
traffic lights eg people on Saturday worship Saturday God known as
“Shani Devta” and there are special persons known as “Dandaut” who
dress up specially and hold a utensil in hand containing mustard oil and a
iron casting of Saturday God.
n Partial encroachment of roads in the name of religion by building religious
structures which may be small or big.
n Creating indigenous road blocks for organizing religious community
kitchens also known as “Langars” .
n Organizing religious community kitchens on road and participation by
overenthusiastic devotees on road.
Fulfilling of myth…A Traffic hazard
Collecting donation in the name of religion
Person donating alms in name of “Saturday God”
Creating road blocks for religious functions
Devotees stopping vehicles for serving food etc.
Devotees stopping vehicles for serving food etc.
Other Threats to Road Safety :-
n Movement of animals on busy roads -
n Flouting of rules by road users.
n No separate pathway for the non motorized transport and
n Poor visibility due to fog.
n Parking of any type of vehicle at own convenience.
n Playing mischief on road (specially with women drivers) while
n Seeking attention on road by playing gimmicks like leaving
the handle while driving, standing while driving etc.
n Use of pressure horns or horns with loud and funny noises.
n Listening to loud music etc.
Animals roaming on roads
Animals roaming on roads
Animals roaming on roads
Poor visibility and no separate pathway for pedestrians
Playing mischief on road
Person carrying helmet in hand during riding
Where is the helmet ?
Cause for chaos on Road
Road Traffic Injuries cause:--
n High Social and economic costs which include medical costs,
cost related to administration, Legal and police expenditure,
collateral damage in terms of damage to property and motor
vehicles, loss due to income forgone rising out of absence
from work or disability.
n In 2005, there were 4.4 Lakh road accidents leading to death
of 94,968 persons i.e. there was one road accident every
minute and one road accident death every 6 minutes.
n Quality of life of accident survivors becomes poor as they live
with pain and suffering.
Multisectorial Involvement in Road Traffic Crash
Road Designers Transport Sector
Road Traffic Health Sector
Legal Sectors Insurance Sector
Complete co-ordination in all these sectors is needed for the
rescue, transportation, trauma care and relief, investigation and
compilation of data to achieve total road safety in the interest
of road users.
Flow of information in case of road traffic crash:
Road Traffic crash
Police Control Room
Removes injured to the
hospital after giving first
PCR Van or Ambulance
aid and pre-hospital care
where ever possible.
Sign board for emergency help
Sign board for emergency help
Existing Health care setup:-
n Sub Centres at village level
n Primary Health Centres
n Community Health Centres
n Civil Hospitals
n District Civil Hospitals and Trauma Centres
n Tertiary Care / Referral Hospitals and Medical Colleges with
Super specialist set up.
n All through the chain of setup private practitioners are present,
who also treat road traffic crash victims and form a very
important link in treating and providing data for road traffic
n Data regarding road traffic crashes and the treatment of crash
victims can be collected from all these health set ups.
Post Road Traffic Crash Care:--
n Aim is speedy and effective trauma care and management to save life.
n Assistance by bystanders. People are reluctant for the fear that they may be
involved in police case. Awareness is now being spread that any body who
shifts the traffic crash victims to hospital will not be harassed as per law.
n For any vehicle involved in accident that has caused injury to the person it
is the duty of the driver to shift the accident victim to the nearest doctor
and report the accident to the nearest police station with in 24 hours and the
n Any vehicle government or private without any jurisdictional formality
should shift the accident victim to the hospital at the earliest to save life
even in cases of fatal accidents rather than declaring the victim dead on the
spot. There might be hope for him.
n Courteous behavior by police and health staff towards the person who has
shifted the crash victim to the hospital.
n Help the crash victim promptly and to the best of your ability. Remember
some time it could be you or your near and dear one. Think and act
empathetically and try to save life of the victim.
Treatment of the Road Crash Victim:--
n Thrust is on saving life by providing prompt and best medical care right from the
site of accident, during transportation, in hospital and post hospital care period,
which may be in form of medication, counseling, rehabilitation and compensation.
n As soon as crash victim is received in emergency prompt treatment is started for
resuscitation and maintenance of vital parameters and then according to severity
and type of injury treatment / surgical intervention by specialists is done
immediately in emergency operation theatres itself and the patient is kept under
emergency care post operatively until he stabilizes and is then shifted to respective
ward where he is fully treated and then discharged.
n Medico legal work is done only after initial treatment.
n In case of serious patients treatment even surgical intervention is started without
waiting for any relative to come for consent in the interest of saving life of the
accident victim. All legal formalities are done at later stage.
n When ever accident victim is shifted to tertiary care hospitals a referral form
containing full detail of the injury and physical status of the patient along with
treatment given is filled but if patient is very serious he is immediately shifted and
emergency of tertiary care hospital is informed telephonically by referring doctor so
that every thing is ready there to receive and treat the patient.
n As per law any body accompanying the road crash victim is not to be unduly
questioned or harassed to encourage public participation in shifting the road crash
victims to hospitals to save life.
Health Records on Road Traffic Crashes:--
n Health records are inadequate in detail as they lack information on:--
n Pre Hospital care.
n On the spot deaths.
n Transportation details from accident site to the hospital.
n Data about intoxicated and unconscious states.
n Injury details.
n Details of road accident.
n Use of variable forms in various health institutes in accident cases leading
to problems in data compiling.
n Lack of specific Nodal Officers for collection and compilation of road
traffic injury treatment cases.
n Lack of collection of data on treatment of road crash victims from private
n Lack of matching of data of police and health records.
n Inadequate data makes it difficult to improve Rapid Evaluation Techniques
for having authentic information on road traffic crashes and the treatment
of accident victims there after, but the process to improve the data
collection, compilation and analysis has now begun as road safety has
become a public health concern.
Factors Affecting Quality Care of Road Crash Victims:-
Lack of awareness in general public about the legal procedures.
n Crowd of onlookers at the accident site without serving any purpose.
n Chaos in emergencies of public hospitals due to overcrowding of patients.
n Political interference.
n Lack of adequate spiritual and moral training workshops for casualty
doctors and nurses.
n In adequate data on road traffic injuries and their treatment records.
n Incomplete registration of road traffic crashes. Mostly compromise is
reached between the crash causing vehicle owner and crash victim and
accident case is not reported.
n Due to low awareness level lack of trust by relatives of crash victims in
health care facilities being provided leading to frequent shifting of patient
and thus affecting his treatment.
n Inadequate link between all health institutions for trauma care and
compilation of data.
Employee State Insurance Scheme:--
n It is participative health and social insurance scheme to
provide protection to workers in the organized sector and their
dependants in contingencies such as sickness, maternity or
death and disablement due to an employment injury or
occupational disease. This scheme is administered by
corporate body called Employee State Insurance Corporation
which has its central headquarters at New Delhi.
n ESI Health infrastructure has :--
n 1422 ESI Dispensaries.
n 2000 Panel Clinics.
n 307 Diagnostic Centres.
n 144 ESI Hospitals
n 42 Hospital Annexes.
n 28000 Hospital Beds.
n For Super Specialty Treatment, there is tie up with advanced medical
institutions in country both private as well as public.
n 825 Branch Offices for payment of cash and other ESI related works.
n Role of ESI in treating road crash victims:--
n It provides all types of care to road crash victims even if
the person is not a insured person (IP) with the ESI in order
to save life.
n In case of insured person meeting with road accident
complete treatment along with sickness benefit for 91 days
and extended sickness benefit for 2 years with 50 % and 70
% of wages respectively is given after authentication by
n Any expenditure by the IP in his treatment after road crash
is reimbursed by ESI in case he has been treated elsewhere
in emergency outside the ESI health network.
n Free supply of physical aids and appliances such as
crutches, wheel chairs, dentures, spectacles etc.
n Funeral expenses on death of an IP subject to a maximum
of Rs 2500/- payable at branch office.
Clinical Overview of Causes of Road
Traffic Crashes among industrial
Stress due to :--
n Employer behavior.
n Interpersonal Stress among employees.
n Domestic stresses.
n Professional Stress.
n Fatigue caused by :--
n Long working hours.
n Rigid and odd working hours.
n Practice of overtime irrespective of health status of workers.
n Haphazard and unhealthy working environment.
n Time bound irrational target oriented work approach.
n Inadequate flexible leave for recreation or for doing personal work.
n Employment at mercy of employer.
n Lack of counselors to de-stress workers.
n Lack of sincere efforts to check working environment.
n Lack of awareness among workers regarding various
n Drug addiction, improper and unhealthy diet intake
from factory canteens leading to physical ailments in
n Maximum use of non-motorized transport by
These workers who are either physically weak or
fatigued or under mental stress often become a cause
or a victim of road crash as even while driving /
walking on the road their mind is occupied.
Road Safety ---- A Responsibility:---
n Department of Road Transport and Highways with its head
office at New Delhi is responsible for :--
n Formulation / Implementation of policies for road transport
n Maintenance of National Highways.
n Transport Research.
n Updating of norms for road safety.
n Ensure safe mobility of the road transport system in the country.
n Administration of Motor Vehicle Act 1988, which lays downs
principles and procedures and makes authorities responsible for issue
of driving licenses, issue of permits, grant of fitness certificates for
vehicles on roads, prescription of emission and safety related norms for
motor vehicles, norms for type approval in production of new motor
vehicles, issues relating to compensation in case of motor vehicle
accidents and compilation of data.
n Checking of vehicles plying on the road.
n National Highway Accident Relief Service
n Under this scheme crash victim is shifted to
nearest hospital, medical assistance is provided,
damaged vehicle is removed from site, cranes and
ambulances are given to NGOs and state
Fire Engine and Ambulance parked on the road
Recovery Van parked on the road
Ambulance parked on the road
n Proposal to setup National Road Safety and
Traffic Management Board to provide a co-
ordinated approach in the area of road
n Proposal to build and re-strengthen existing
public private partnerships to enhance road
n Adherence to National Road Transport Policy.
Road Safety – A Challenge:--
n Thrust of road safety is 4 E’s i.e. education,
enforcement, engineering and environment.
n 80 % of road accidents are due to driver negligence
and fault, so there is a need to monitor driver training
school regarding their infrastructure, equipment,
quality control, qualified driver training instructors,
strict code for issue of driving licenses, regular and
random health checkups of drivers along with
counseling sessions, checking for any drug and
alcohol addiction, overloading, over speeding and
refresher training for existing drivers.
n Need for parking spaces and truck terminals out side
the cities to reduce traffic crashes.
n Need to avoid using mobiles while driving.
n Need to use helmets and seat belts while driving.
n Need to inculcate road safety culture.
n Need to count traveling time for reaching the
n Need to design roads in a way that even if a person is
wrong the system does not permit him to do that
n Need to strictly enforce yellow colour code for school
buses and to regulate their speed.
n Need to stop the ringing up a e person while he is
n Need for stress free driving, avoid driving while
Road Safety Awareness Measures:--
n Organization of road safety weeks, seminars and
exhibitions. This year road safety week was observed
throughout the country from 1st to 7th January 2009
and theme was “Carefully Drive Reach Alive”.
n Display of banners and distribution of pamphlets on
n Telecasting and broadcasting of TV spots / Radio
n Organizing Essay Competitions, Declamation
Contests on Road Safety.
n Printing of calendars, stickers, posters containing
road safety measures.
n Display of road safety slides in cinema halls.
n Organizing street plays on road safety.
n Organizing workshop cum training programs on road
safety management, road transport regulation and
n Display of road signs and Do’s and Don’ts regarding
road safety at important locations / traffic junctions to
inculcate road discipline.
n Special training for school and college students for
sensitization to traffic rules.
n Involvement of NGOs, print, audio and audio visual
media in all the above activities.
n Organizing rallies to create awareness on road safety
“Your Life is Precious and so is the
Life of Others. Drive Safely and Live
and Let Others Live”
Happy and Safe Driving