Not an altogether unfamiliar headline, quite routine in fact. Every day we hear of other incidents such as "garbage disposal truck on the rampage after losing its brakes" and "provincial bus loses steering and ends up in a deep mountain ravine". It's all part of a global phenomena which is reaching epidemic proportions. The chilling truth is however, that whilst the trend in developed countries is towards a reduction in road accident mortality and morbidity, the opposite can be said for poor and developing countries such as the Philippines, which account for more than 85% of the deaths and 90% of disability-adjusted life years � the "war on the roads' has truly started and is wreaking havoc.

T-Bone doesn't begin to describe this.

Unfortunately the driver didn't survive.

The World Health Organization (WHO) global estimates show that there are more than 3,000 people killed on the roads daily, with at least 30,000 others seriously injured and disabled. The global annual cost of Motor vehicle accidents (MVA's) is quoted at somewhere in the region of $518 billion US dollars. At present, motor vehicle accidents are the ninth leading cause of mortality worldwide, but it is predicted that by the year 2020 it will be the third highest cause of mortality and morbidity.

MVA's can be attributed to many factors including poor roadway design and maintenance, hazardous weather conditions, failure to use safety devices, poorly constructed and poorly maintained motor vehicles, poor standards of driving tuition, driver testing and courtesy towards other road users, inattention to pedestrians and cyclists, alcohol and drug use, excessive hours behind the wheel resulting in fatigue, poor traffic regulation and / or poor enforcement of traffic regulations - unfortunately a great many of these factors are all too common here in the Philippines.

In addition to belonging to the group which account for more than 85% of the deaths and 90% of disability-adjusted life years, the Philippines has yet another very serious drawback and that is, a very poorly developed Emergency Medical Services System (EMSS). We see a drastic shortages of well trained Emergency Medical Technicians (EMT's), Trauma Nurses, Trauma Physicians and very little in the way of available funding or the political will to make essential improvements.

Reducing traffic mortality and morbidity is an enormous challenge and will require both the political will and a multidisciplinary approach to succeed. In the first place reducing the burden on already overstretched medical resources can be achieved by eliminating as many of the risk factors as possible. Tightening up standards of driving instruction and testing will directly improve driver performance, introducing annual or bi-annual vehicle testing will not only keep dangerous vehicles off the road, but help unclog our already overcrowded road system and enforcing traffic laws and regulations will result in a more disciplined approach to driving.

Priority must be given to collecting local data on MVA's, only then will we appreciate the enormity of the problem and find the real will to do something about it. Once this data is collected, we will then be able to decide on measures such as skills and resources development, road safety enforcement and provision for essential trauma care. Lip-service is quite simply not enough, as medical professionals, we must learn to be much more pro-active and go the extra mile. The predictions for 2020 are not by any means final, this gloomy forecast can and must be averted and by so doing many, many lives will be saved along the way. We simply cannot afford to waste any more time � ACT NOW.

References:

1. Nantula VM, Reich MR. The Neglected Epidemic: Road Traffic Accidents in Developing Countries. BMJ. 2002; 324:1139-1141
2. War on the Roads. BMJ Theme Issue No. 7346, Vol 324. (I. Roberts, K Abbasi and G Cotton, EDs 11 May 2002.
3. Peden MM, Krug E, Mohan D, et al. A five year WHO strategy for road traffic accident prevention. Geneva: WHOP, Ref: WHO/NMH/VIP/01.03
4. Holder Y, Peden M, Krug E, et al. (Eds). Injury Surveillance Guidelines. Injury control and Safety Promotion 2003; 10:105-108.
5. Holder Y. Peden M, Krug E, et al. Injury Surveillance Guidelines. Geneva: WHO, 2001, Ref WHO/NHM/VIP/01.02
6. Forjuoh S. Traffic related injury prevention interventions for low income countries. Injury Control and Safety Promotion 2003;10:77-81.