The WHO is tackling road traffic injury prevention head on through a wide ranging programme, co-funded by the FIA Foundation, for road traffic Injury prevention in low and middle income countries.
Road traffic safety prevention programmes have been implemented in a series of countries including Mexico, Ethiopia, Cambodia, Poland and Vietnam. In Mexico, for example, a campaign on various road safety messages including speed, alcohol, seatbelt use and pedestrian crossing has been promoted through radio advertising, posters and leaflets in the city of Cuernavaca. The messages have been tailored to address the specific road safety issues arising among young members of the community identified as the key target group. It is hoped that following the impetus given to the initiative by the WHO, the Mexican government will take on the project and disseminate its message across the whole country.
In Cambodia a helmet initiative involving a high profile media campaign, the introduction of new road safety legislation and work related helmet wearing policies were established to address the dangerously low percentage of motorcyclists wearing protective headgear.
Televised and radio broadcast advertisements spread the message of the importance of wearing helmets by both the drivers and passengers of motorcycles. A rise in the average wearing rate was recorded over the months that advertisements were broadcast.
Supporting this was the development of a national road safety plan which was formally adopted by the Cambodian Government. Crucially, draft road safety legislation, the first of its kind in Cambodia, contains a section on motorcycle helmets.
As a result of the initiative, UN agencies active in Cambodia, government and NGOs are being encouraged to adopt, enforce and monitor polices that require their employees to wear motorcycle helmets.
Alongside these initiatives, the WHO has produced a booklet, with the support of the FIA Foundation, intended as a guide for policymakers, which focuses on establishing pre hospital trauma care systems in middle and low income countries.
According to WHO estimates, every year approximately 5 million people worldwide die from injuries, with road traffic injuries the leading cause of death. Worryingly, the global burden of injury is rapidly growing prompting fears that if action is not taken, factors such as the rapid increase in the availability of motor vehicles in developing countries will dramatically increase the human toll of injuries during the next decade.
The booklet acts on the premise that most of the world’s population does not have access to prehospital trauma care yet research has shown that many injuries can be prevented or their severity reduced through the implementation of simple measures that can be carried out at the scene. All too often victims of injury needlessly die in the first few minutes following injury due to lack of treatment in those crucial moments or lack of transportation to get them to a hospital.
The central principle of pre hospital trauma care systems, according to the booklet’s authors, is that “community members and non-medical professionals can be trained to work collaboratively within a country’s existing healthcare infrastructure to provide a basic level of prehospital care to people who are seriously injured, and that it is possible to do this affordably.”
The booklet is unique in that it actually talks through the process of setting up such a system and how it can be developed in the context of locally available resources. It identifies the skills, supplies and equipment that will allow lay people and healthcare professionals to provide definitive care and provides advice on identifying a lead agency to promote prehospital trauma care.
WHO guidance also looks at the vital steps that should follow the initial first aid administered at the scene, such as, establishing an effective communications system to call for the help if the victim requires hospitalisation. Many countries have developed a nationwide telephone number that connects the caller to the nearest healthcare facility or ambulance despatch centre. Other measures include the adaptation of suitable vehicles to provide the transportation of victims to hospitals where ambulances cannot get to the scene quickly enough. Owners of such vehicles would receive training to carry out the necessary first aid and safely transport the victim to a hospital or appropriate healthcare facility.
Case studies in countries where WHO guidelines have been implemented indicate initial success. In Mures county in Romania, for example, a single county-level integrated emergency dispatch centre was created. A single emergency telephone number was established and county-level coordination and management of emergency vehicles and responses between different agencies achieved. All agencies in the county can now be alerted to a major event in less than one minute.
It is hoped that widespread adoption of WHO prehospital care recommendations will enable countries to implement cost-effective strategies that will increase the likelihood that injured victims survive to reach hospital and that they can also benefit from any subsequent treatment or surgery that they may undergo.