Co-authors: Gayatri Nair Lobo and Varad Pande*
It is one of the sad realities of our country that not even four minutes pass without a death from a road accident. Road accidents kill 435 times more people than terrorism in India—there were 1,46,133 fatalities from road accidents in 2015 versus 336 from terrorism-related incidents (civilians and security force personnel)
India has the highest toll for road accident fatalities in the world, according to a 2016 news report. A whopping 72% of fatalities occur among the economically active age group of 15-44 years. According to SaveLife Foundation estimates road accidents cause India an annual economic loss amounting to 3% of our GDP i.e. a massive sum of ₹4 lakh crores.
Providing good-quality trauma care can play a critical role in reducing the existing mortality and morbidity rate of road accidents.
The Road Safety Week (11-17 January) initiated by The National Safety Council of India (NSC) in 2011, along with the Ministry of Road Transport and Highways and regional governments, recognises the urgent need for action. The event has successfully garnered the right kind of attention from stakeholders such as the government, corporates, NGOs and media. The week-long campaign creates awareness on safety measures (seatbelts, helmets, road rules etc.) and preventive actions such as fines and penalties to curb road mishaps.
Also, while prevention may be better than cure, are we adequately prepared with a plan for those injured that have a chance of survival?
Post-accident care is a key component of road safety analysis. There are wide disparities in the outcome of post-accident care among high, middle and low income countries, owing to the quality and availability of trauma care facilities. Take for example the section of survivors who make it to the hospital: there is a six-fold increase in mortality of patients with moderately severe injuries between a high-income country and a rural area of a low-income country. Providing good-quality trauma care can play a critical role in reducing the existing mortality and morbidity rate of road accidents.
The concept of trauma care involves a four-step chain of actions that must take place beginning with first response, swiftly moving to transit, then treatment, and ending with rehabilitation. First response and transit are the building blocks of the trauma care chain; these two steps alone can help reduce accident deaths by 50% if the patient is attended to in the first "golden hour" following the accident.
Icons sourced from Noun Project
However, first response and transit are currently absent/negligible in the trauma care value chain in India. For starters, we do not have enough trained first responders. Further we do not have a system that connects a road accident-prone site to the closest first responder. The extremely time sensitive transit stage, in which the patient is stabilised and transported to the trauma care facility, is also lacking in efficiency. Ideal response time for ambulances, which should be within 10 minutes but currently varies between 20 to 35 minutes.
First response and transit are currently absent/negligible in the trauma care value chain in India... Technological innovations can play an important role in addressing the gaps.
Technological innovations have been harbingers of change and can play an important role in addressing the gaps in first response and transit. Three interventions using existing cost-effective technology, proposed in a study conducted by Dalberg Global Development Advisors, could dramatically change the landscape of trauma care by smoothening out kinks in first response and transit stages.
The first intervention involves citizens, through a crowdsourced program, Road Angel Coalition. The program creates a first responder network and trains volunteers as first responders in basic life support through a mobile application. When a road accident takes place the application uses the network to alert the nearest first responders and also provides details on ambulances and treatment facilities in the vicinity of the accident spot. Proof of concept exists in Israel where the United Hatzalah app has managed a response time of less than three minutes and saved 207,000 lives (2012).
The quality and efficiency of ambulances play a key role in improve response time in the transit stage. The second intervention proposes a Big Data-based ambulance positioning system to minimise time taken to reach the accident site. This system will algorithmically identify areas that are accident prone and update ambulance placement in real-time accordingly. A pilot study on this has been conducted in a district in Turkey, where real- time ambulance placement has helped reach 77.6% of the demand areas within the first 5 minutes of an accident.
The effective use of technological interventions and citizen engagement approach to trauma care can potentially impact 3,00,000 lives annually...
The third intervention addresses the quality of care given during transit through an ambulance checklist, which is a critical aspect for reducing mortality rates. An automated inventory management system for rapid replenishment will ensure that ambulances are equipped with the standard equipment and consumables, thus eliminating the scope for human error from manual checking. Similar checklists have been used during surgery and a pilot study conducted in hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, The Philippines; Ifakara, Tanzania; London, UK; and Seattle, USA) with diverse healthcare settings. The checklists have helped reduce the rate of major complications from 11% to 7%, and the death rate post major operations has fallen from 1.5% to 0.8%.
The effective use of technological interventions and citizen engagement approach to trauma care can potentially impact 3,00,000 lives annually (reducing deaths and extent of disability caused by accidents). The cost per life impacted could range from US$22-42 if these ideas were implemented which is negligible when compared to the potential for impact. Leveraging technological advancements can help us achieve our national target of reducing accidents by 50% by 2020 well ahead of time. However, we need to act fast: we must not lose momentum by spending too much time creating the "perfect roadmap". Instead, ideas should be rapidly tested in the field and accordingly refined for full scale national implementation. Strengthening our trauma care response system will reinforce our capacity to reduce the fatality rate from road accidents.
* Gayatri Nair Lobo is a Senior Project Manager at Dalberg, a global strategy and policy advisory firm focused on social impact.
Varad Pande is a partner at Dalberg, a global strategy and policy advisory firm focused on social impact.