Bengaluru Road Safety & Injury Prevention Programme: Injury snapshots and activity profile - 2009
Item
- Title
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Bengaluru Road Safety &
Injury Prevention Programme:
Injury snapshots and activity
profile - 2009 - extracted text
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Bengaluru Road Safety &
Injury Prevention Programme:
Injury snapshots and activity
profile - 2009
■ r
National Institute of Mental Health & Neuro Sciences
Department of Epidemiology
WHO Collaborating Centre for Injury Prevention
and Safety Promotion
Bengaluru-560 029, India
Bengaluru Road Safety
and
Injury Prevention Programme:
Injury snapshots and
Activity report 2009
NATIONAL INSTITUTE OF MENTAL HEALTH &
NEURO SCIENCES
Department of Epidemiology
WHO Collaborating Centre for Injury Prevention and Safety Promotion
Bengaluru - 560 029, India
Kempegowda Institute of Medical Sciences and Research Cent
M. S. Ramaiah Medical College and Hospitals
De Naresh Shetty, Medical Director, M S Rainaiah Memorial HospitalP
Dr. Mali Manjunath, Nodal officer
Mallige Medical Centre
Mallya Hospital
Casualty Medical Officer- Dr. Sunil Kumar
Manipal Hospital
Dr. Sudarshan Ballal, Medic I
Sagar Hospital
Medical Records Officer, Mr. W. Wellesly Stephen
Sanjay Gandhi Institute of Trauma Care and Orthopaedics
Dr. Prabhakar, Nodal Officer
Dr. Shlvalingaiah, Resident Medical Officer
St. John's Medical College & Hospital
Dr. Georgr D'souza, Medical Superintendent
Department of Community Medicine - Dr. Arvind K, Dr. Bobby Joseph, Dr. Shilpa R.
Surg.Cmde. A J Moraes, Medical Superintendent
Dr. Mallikarjun V Abdulpur, Nodal Officer
Dr. Shashikanth, Legal Medical Officer
St. Philomena’s Hospital
Casualty Medical Officer - Dr. Ramesh, Dr. Toby, Dr. Deepanjali, Dr. Subbalakshmi, Dr. Farah, Dr. Anusha,
Kathrine, Marcel
Victoria Hospital
Dr. A.Vishwanath, Dr. Vijayashree, Dr.Thyagaraj, Dr. Shivakumar, Dr. Varalakshmi, Dr. B. Ramesh, Dr. R.Ramesh’
Dr. Jagadish
Employee State Insurance Model Hospital (ESI), Rajajinagar
Dr. Padma Khokar, Dr. Malagi, Additional Medical Superintendents
Chinmaya Mission Hospital
Dr. Muralikumar, Nodal Officer
Medical Records Officer, Smt.Devaki,
Staff Nurses - Shashikala, Suja, Rekha.Sony, Berly, Bincy, Geethu
Suguna Hospital
Vydehi institute of medical science
Dr. D. V Chaiapathy, Medical Superintendent
Dr. Sathish Kumar, Nodal Officer
Rajarajeshwari Medical College and Hospital
Dr. SrividyaV NodalOfficer
Columbia Asia Hospital
Dr. Nina Laxmikanth, Nodal Officer
Ambedkar Medical College and Hospital
Dr. S.V Divakar, Medical Superintendent
Dr. Mohd. Irshad Ahmed, Nodal Officer
Command Hospital, Airforce, Bangalore
Chief Co-ordinating Officer, Air Cmdr. A.K. Patra
MVJ Medical College and Research Hospital, Bangalore
Dr. Vevai, Medical Superintendent
Dr. Anjan Reddy, Chief CMO
viii
BRSIPP 2009
RURAL CENTERES
Siddartha Academy of Higher Education (Deemed to be University)
District Hospital, Tumkur
Dr. Sreedhara Murthy, District Health and Family Welfare Officer
Co-ordinating Centre: National Institute of Mental Health and Neuro Sciences
I )r Ginsli N Rao, Dr. Kavita R
And all other staff working in emergency rooms - medical record divisions of hospitals, Bengaluru Metropolitan
Table of Contents
Table of Contents
List of Abbreviations
Foreword
Messages
Acknowledgements
Executive Summary
x
xi
xii
xiii-xviii
xix
xx
Section A: Understanding Injury & Programme description
Introduction
Understanding Injuries Is The Basis For Preventive Strategies
Injury In India
Injury In Karnataka
Underreporting Of Injuries
Information Requirements For Injury Prevention And Control
A Surveillance Approach
Bengaluru Road Safety And Injury Prevention Programme
A8. Goals, Purpose And Objectives
A9. Preparatory Phase (March - June 2007)
A10. Focus Of Surveillance
All. Surveillance Mechanisms
A12. Implementation Phase (June 2007 - June 2008)
A13. Review Phase (June 2008 - December 2008)
Al.
A 2.
A3.
A4
A5.
A6.
A7.
2
4
5
7
7
11
11
12
12
12
13
13
17
18
Section B: Data and Information
The City of Bengaluru
Bl. Injury deaths
B2. Urban injuries
B3. Rural Injuries
B4. RTIs and suicides are major injury causes
B5. Injuries affect young people
B6. Injury deaths are distributed in phases
B7. Road crashes, deaths and hospitalisations
B8. Risk factor information
B9. Solutions and strategies for road safety
B10 Falls
Bll. Suicides
B12. Bums and Fire Injuries
B13. Poisoning
B14. Animal Bites
B15. Assault / Violence
Bl6. Prehospital Care
B17. Nature Of Injuries
B18. Management And Outcome:
20
21
22
26
27
28
29
29
36
42
43
44
45
47
47
49
50
54
55
Section C: Profile of activities
Cl. Injury: Addressing the problem
C2. Activity Profile of 2009
Sustainability issues
The way forward
References
Annexure -1
Annexure - II
X
BRSIPP 2009
57
58
54
55
57
59
70
List of Abbreviations
BRSIPP
Bengaluru Road Safety and Injury Prevetion Programme
CMO
Casualty Medical Officer
CC
Co-ordinating Centre
CCRB
City Crime Records Bureau
CDs
Communicable Diseases
ER
Emergency Room
FIR
First Information Report
HICs
High Income Countries
ICD
International Classification of Diseases
ICECI
International Classification of External Causes of Injuries
ICMR
Indian Council of Medical Research
IPC
Indian Penal Code
LMICs
Low and Middle Income Countries
MCCD
Medical Certification of Cause of Death
MLC
Medico-Legal Case
NCRB
National Crime Records Bureau
NIMHANS
National Institute of Mental Health & Neuro Sciences
NCDs
Non-Communicable Diseases
NGO
Non-Governmental Organization
OTC
Over The Counter
RMO
Resident Medical Officer
RTI
Road Traffic Injury
WHO
World Health Organization
MESSAGE
R. ASHOKA
Minister for Transport
No: Tm/O/Sms/136/2010
Telephone: Off:
22253835 22033234
Room No. 317, 3rd Floor
Vidhana Soudha,
Bangalore
Dated: 26-02-2010
During the last two to three decades, India is going through a process of rapid motorisation. Bangalore city
with its 251akh two-wheeler population, contributing to nearly three-fourths of the total vehicular load, is
the highest compared to any other city in India. It is thus imperative that we need to make the roads safe
particularly to the Vulnerable Road Users. It is rather unfortunate that nearly 1000 people die due to road
traffic injuries in Bangalore and majority are either pedestrians or two wheeler users. Thousands more are
injured and become disabled.
A key solution to this human made disaster is making the public transportation systems more robust and
reliable. The transport department and the public sector transport corporations in Karnataka have launched
new initiatives in this regard. While we try to enhance and improve services there is a need to understand
and evaluate the impact of these measures. I am extremely happy that Bangalore Road safety and Injury
prevention programme is bringing out the report for the year 2009. I am sure the suggestions and
recommendations of the data analysed from hospitals, police and BMTC will be very resourceful.
1 would also like to take this occasion, when all the partners of the Bangalore Road Safety and Injury
surveillance programme are meeting, to convey my heartiest compliments for being involved in this very
important issue in the city of Bangalore. I am sure the daylong deliberations would be highly productive
and useful to plan and implement innovative solutions.
(R. Ashoka)
xiv
BRSIPP 2009
MESSAGE
Over the last few decades there have been fundamental changes in disease
patterns among the people of Member States of the WHO South-East Asia
Region due to rapid urbanization and economic growth. The pattern of
mortality and morbidity with regards to communicable and noncommunicable
diseases has changed. From being largely linked to infectious diseases earlier,
it is now mainly related to noncommunicable diseases as well as injuries and
violence. Road traffic injuries have emerged as one of the leading causes of
death and disability in most countries of the Region.
World Health Organization estimates predict that road traffic injury will increase from being the ninth
leading cause of death globally in 2004 to be the fifth leading cause of death by 2030.
Road traffic injuries are one of the fastest growing epidemics in the South-East Asia Region, and more than
285 000 people are dying on the roads every year. The trend in road traffic deaths has also been on an
upward spiral in recent years. Most of those killed on the roads in accidents are young and aged between 15
and 44 years, thus corresponding to the most economically productive segment of the population. Hence,
road traffic injuries lead to a colossal economic burden at both the family and community levels on Member
States of the Region.
Almost three quarters of all road traffic deaths in South-East Asia occur among the most vulnerable road
users, i.e., pedestrians, motorcyclists and cyclists. The rapid growth of motorized two-wheelers in the
Region is a major risk factor in road traffic injuries. These two critical issues should be prioritized during
policy decisions on road safety.
Although primary prevention is a far better option to address the huge toll from road traffic injuries than
other measures, only a few Member States in the Region have specific preventive measures on road traffic
injuries in place. Measures that will reduce injuries and contribute to a healthier future may include appropriate
land use planning, setting safety standards for vehicles, designing infrastructure keeping the protection of
pedestrians and motorcyclists in mind, promoting safe public transport, and campaigning for the improvement
of personal behaviour on roads. To realize this goal and implement these measures it is imperative to
develop and sustain strong intersectoral partnerships and collaboration.
To meet the challenge of the rapidly growing road traffic injuries, The WHO South East Asia Regional
Office has supported trainings in injury surveillance, injury epidemiology, prevention and care, and road
safety planning. This meeting is a very important effort to strengthen our workforce against RTI. The
meeting should focus on actions , based on data collected from different sources.
I look forward to the outcome of this meeting and assure you that WHO will continue assistance and
collaboration.
Dr Chamaiparn Santikarn
Regional Advisor, Disability,
Injury Prevention and Rehabilitation, WHO/SEARO
XV
MESSAGE
Urbanisation, motorisation, industrialisation, infrastructure development are
becoming hallmarks of our growth and development in recent years. Indian
cities are growing in a fast and unplanned manner and this is having a major
impact on people' lives. Bengaluru city is no exception to this change and
visible changes are occurring all around us. Amidst these changes, safety of
people has become an important issue for planners and policymakers. In all
our cities and in rural areas, road traffic accidents, stress related suicides and other injuries have become a
major public health problem and has been a matter of concern for all. Hundreds of people are killed and
injured on our roads, at homes and in workplaces of our cities on a daily basis. This human tragedy needs
to be addressed by all stakeholders in growth and development, on a regular and continuous basis.
Unfortunately, in majority of the cases, young people in their formative and productive years of life are the
victims. The untimely death or hospitalisation of young people brings huge suffering to their families.
Majority of these injuries can be prevented, if we aim at developing a proper understanding of injuiy profiles
and patterns in our society, we need to address gaps in our information systems, develop mechanisms for
prevention, trauma care and rehabilitation along with building robust policies and programmes for future.
All concerned departments of police, transport, urban and rural development, health, law, information and
broadcasting, and others need to develop joint and coordinated mechanisms to address the problem.
I am happy to note that the Bengaluru Road safety and Injury Prevention Programme initiated in 2008 has
been working towards road safety and injury prevention on a scientific and systematic approach with all
partners in the city. Bruhat Bengaluru Mahanagara Palike is the central agency for all development and
infrastructure activities in the city and needs to include safety of people on roads, at homes, in schools and
in work places.
The 2009 and 2010 programme reports, fact sheets, public health alerts, and strategy documents prepared
for the programme will help BBMf’ Police, Transport, Urban Development and other city agencies to give
due importance for road safety and injury prevention initiatives. We are making efforts to give importance
for safety in all our activities.
The Bengaluru Road Safety and Injury Prevention Programme has shown that it is possible to develop good
data and provide scientific basis for robust current and future interventions. I strongly hope that this
collaborative programme with involvement of BBMB police, transport, all major hospitals and other partners
will be able to develop scientific and systematic road safety and injury prevention programmes to save our
young people. I take this opportunity to wish the programme all success and will be happy to extend all
possible support in its future activities.
Govinda Raju K H
(LAS, Special Commissioner), BBMR Bangalore.
xvi
BRSIPP 2009
MESSAGE
India and China have the largest number of deaths and injuries related to
road traffic accidents. More than 1,00,000 people die and 10,00,000 Iget
injured on the roads every year in India. Unfortunately these incidents have
not attracted adequate amount of attention from policy makers and
enforcement agencies. Every time a person is dead or injured it leaves behind
pain and sufferings for the entire family. Unabated vehicular growth,
infrastructure enhancement and changing life styles have aggravated matters for the worse. Majority of
these deaths and injuries are preventable, if, road safety is given due importance in all our policies and
programmes. Also, the policies and programmes have to be based on scientifically collected data, evidence
and research.
Bangalore Road Safety and injury prevention programme initiated in 2008 an example of fruitful cooperation
between traffic police and medical fraternity.
This programme has two important elements; firstly, it uses information and data to plan and develop
activities. Secondly, it works with all stakeholders to develop and support interventions of all partners.
Bengaluru City Traffic Police are a major partner in this programme, by facilitating information development
and using information in all our activities. Year 2009 and 2010 programme reports, fact sheets, public
health alerts and strategy documents will help Police, Transport, Urban Development and other city agencies
to give importance for road safety and injury prevention. Fatalities on roads in Bangalore City have seen a
significant decline in past two years and we need to continue with this to reduce them further. A welcome
development would be a similar decline in number of injuries, primarily due to our interventions.
The Bangalore Road Safety and injury Prevention Programme has shown that it is possible to develop good
data and lay a good foundation for present and future activities. Despite limitations in resources and
manpower, we are giving major importance for road safety in both B-Trac 2010 and all other activities.
I hope this collaborative programme with involvement of traffic police and all major hospitals and other
stake holders will be able to develop scientific and systematic road safety and injury prevention programmes
to save young lives in the years to come. I also wish that similar programmes come up in other parts of
India. I wish the programme all success and will be happy to extend all possible support for the programme.
Mr. Praveen Sood, IPS,
Addl. Commissioner of Police,
Traffic Bangalore City
xvii
MESSAGE
TRANSPORT
PARTMEN
At the outset, I extend my warm greetings and it gives me great pleasure to share my views in the Road
safety and Injury Surveillance Report being brought out by N1MHANS.
An efficient transport system is the first step in the direction of building a stable and secure State contributing
towards economic and cultural ties. Roads and Transport System not only binds people but also plays a
crucial role in nation building process.
Road safety is a process and transport depar tment is a major partner in this process. The transport department
is building driving tracks in all its regional transport offices to ensure objectivity in testing driving licence
aspirants.
The Transport Department aims to establish the following:
G
Institute of Drivers Training & Research (IDTR) to impart scientific training especially to drivers
transporting hazardous goods to ensure Road Safety.
O
Automated vehicle testing centre for issue of fitness certificate to vehicles.
O
Electronic driving track for stringent testing before issue of driving licences.
O
Networking of emission testing centres to monitor air and noise pollution for cleaner and greener
environment.
These developments would yield the desired results if civil infrastructure, like wide Roads, multi-lane roads
with dividers, safe pedestrian crosses & improvement in public transport are also brought about by other
departments. We in the department, place road safety high on our agenda and wish to undertake all activities
for saving lives and prevent injuries.
We extend our whole hearted co-operation to the Bangalore Road safety and Injury Prevention Programme,
initiated by NIMHANS along with all other partners.
Bhaskar Rao, IPS,
Commissioner for Transport & Road Safety,
Government of Karnataka
xviii
BRSIPP 2009
Acknowledgements
The Bengaluru Road Safety and Injury Prevention Programme is a large collaborative and partnership
programme with the participation of Bengaluru city police, 30 leading hospitals, Bengaluru Metropolitan
Transport Corporation, Bruhat Bengaluru Mahanagara Palike and NGO's. Nearly 500 people from all these
organisations have taken keen interest and participated in several activities during 2008 and 2009. Listing
all individual names will run into several pages, but we would like to place our immense gratitude to all for
building this partnership programme. Specially, thanks to all heads of institutions and nodal officers for
taking leadership role in their respective organisations.
Thanks to Prof. D. Nagaraja, Former Director / Vice Chancellor and Prof.S.K.Shankar, Director/Vice
Chancellor of NIMHANS for extending all support and encouragement along with taking keen interest in
the programme.
Sincere thanks to World Health Organisation, India country office and Indian Council of Medical Research
(Department of Health Research, Ministry of Health and family welfare, Government of India) for facilitating
Phase 1 of the programme. We are thankful to Dr. Bela Shah, Deputy Director General, Indian Council of
Medical research and Dr. J S. Thakur, Cluster focal person for NCDs in WHO, India office, for all help and
support in developing the programme. Our sincere thanks to Dr.Margie Peden, Coordinator, Department of
Violence and Injury Prevention, World Health organisation, Geneva, and, Dr. Ann Dellinger of the
Epidemiology Division of Centre for Disease Control and prevention, Atlanta, USA for all support and
encouragement.
We are immensely thankful to Sri. Sanjay Sahay, IGP State Crime Records Bureau, Sri. Shankar Bidari,
Commissioner of Police; Sri Praveen Sood and Sri. M.R. Pujar - Additional Commissioners of Police,
Sri. Bhaskar Rao - Commissioner for Transport ; Sri Govinda Raju, Special Commissioner of BBMP; Sri.
Zameer pasha, Managing Director of BMTC for all help and support. We thank all their staff for taking
keen interest in all activities under the programme.
Special thanks to all our field coordinators (Sri. Manjunath and Sri. Lokesh) and all our field research
officers spending tireless hours in police stations and casualty departments of hospitals in facilitating data
collection. Sincere thanks to my colleagues Dr. Girish N Rao and Dr. G. Kavita Rajesh for all help from the
beginning of the programme. Thanks to Sri. Girish BG and Sri.Chandrashekar for efficient data management
and analysis.
xix
Executive Summary
The city of Bengaluru has changed phenomenally during the last decade. The "peaceful and cosy Bengaluru"
of 90's has changed to a "Bruhat Bengaluru” in 2010, embracing a population of more than 8 million into
its day to day activities. As a senior citizen remarked "the city is a living testimony to what technological
and socioeconomic changes can make for a one time peaceful city". The city takes pride in many positive
developments of education, information technology, raising living standards, vibrancy and hope for millions.
At the same time, the dark side of this growth and development are also serious issues for city planners and
administrators.
With marginal and gradual decline of communicable and infectious diseases, injuries, hitherto, referred to
as accidents, have emerged as a major public health problem in the country. Injuries have only moved from
fifth or third pages of our newspapers to the front page. All television channels continuously beam episode
after episode of violence and injury throughout the day; most of the times, the "Breaking news" is nothing
but deaths and injuries among people. Even though there is regular public outrage on these issues, injuries
are only increasing day after day. Commonly, these are considered as accidents, events due to bad times, or
simply act of fate. High Income Countries (HICs) of the world had similar understanding of injuries and
were doing, what we are doing today in 1960’s and 70’s. Research, knowledge, evidence and data changed
this understanding and resulted in significant changes in the way problems were addressed. Today, it is well
acknowledged that injuries are predictable and preventable.
This knowledge and information came from years of research that resulted in a better understanding of
injury phenomenon in terms of burden, characteristics, causes, risk factors, determinants, impact and
outcome. Surveillance is one such activity that will help in recognizing the burden of injuries, identifying
broad risk factors and causes, prioritizing activities, monitoring and evaluating interventions, capacity
development, and stimulating further research. Even though India has considerable experience in
Communicable Disease (CD) surveillance, Injury and Road Traffic Injury surveillance are new and its
importance is only recently gaining recognition.
Bengaluru Road Safety and Injury Prevention Programme is a collaborative programme between National
Institute of Mental Health & Neuro Sciences, Bengaluru City Police, 30 leading health care institutions,
Bengaluru Metropolitan Transport Corporation, Bruhat Bengaluru Mahanagara Palike and was facilitated
by Indian Council of Medical Research and WHO, India office in 2008. The programme aims at reducing /
preventing injuries, improving trauma care and strengthening rehabilitation services using a surveillance
approach.
The programme started in 2008 began on a surveillance basis, and has become an ongoing and a continuous
activity. In 2008, the major focus was on developing systematic mechanisms for uniform and standardised
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BRSIPP 2009
data collection from all partner institutions. This phase streamlined number of discrepancies and a systematic
approach was developed. Surveillance was developed with available resources and within existing systems
along with appropriate strengthening at different levels.
Information gathered during 2009 reveals that - nearly 4,500 individuals died and more than 100,000 were
hospitalised due to an injury in the city. Majority of those killed and injured were in younger age groups of
16 to 45 years and predominantly men. Road traffic injuries and suicides are two major injury problems in
the city of Bengaluru. Pedestrians, two wheeler riders and pillions, and pedal cyclists were involved in
greater nu mbers. Suicides were commonly due to consumption of organophosphorus compounds and drugs,
occurring at a time when the person was alone and at home. Burns, poisoning, falls were other major
injuries responsible for deaths and hospitalisations. Trauma care was found to be inadequate and poor
requiring immediate strengthening.
In 2009, the major emphasis was on application and utilisation of data to develop programmes, and to
provide inputs for policies and programmes. Systematic applications of data can always make a difference
to strengthen activities. Number of inputs has been provided for regulatory, engineering, educational and
other activities during 2009. Discussions with policymakers and professionals have indicated that the data
developed will be useful to develop new activities as well as monitor existing programmes.
It is hoped that 2010 will see a combination of data gathering and data application and also development
of focussed activities. Plans are already afoot in this direction. Using surveillance as the first level of
activity, additional research activities such as trauma registries, risk factors studies, and multidisciplinary
crash and injury investigations are being considered. Capacity development of all sectors related to road
safety and injury prevention along with other focussed interventions are planned for 2010 and the coming
years. Injury/RTI surveillance data will be a useful tool in the prioritisation process, resource allocation,
and monitoring ongoing activities. There are several opportunities to develop and use data to develop
scientific programmes for injury prevention and control. It is hoped that this experience and learning will
help professionals across the country to initiate activities for road safety and injury prevention on a scientific
basis using evidence based approaches. Recognition of the problem, administrative support, training of
personnel, monitoring and regular feedback, availability of resources and, most importantly, cooperation
of all partners will be the building blocks for our future activities.
Preventing road crashes, suicides and other injuries requires a "proactive approach" rather than a "reactive
approach". It requires action to be taken by police, transport, health, urban - rural development, land
development authorities, product and vehicle manufacturers, civic authorities, NGOs, public, media and
others to see that these injuries do not occur; even if it occurs, it should not lead to deaths and disabilities.
Information - data - and evidence is a powerful tool in this process to bring people together for collective
actions.
xxi
Section A
Understanding Injury & Programme description
Bengaluru Road Safety and Injury Prevention Programme is a collaborative
programme between 30 hospitals, Bengaluru City Police, Bengaluru
Metropolitan Transport Corporation, Bruhat Bengaluru Mahanagara Palike
and was facilitated by Indian Council of Medical Research and WHO, India
office in 2008. The programme is coordinated by the WHO Collaborating
Centre and the department of Epidemiology at NIMHANS. The programme
aims at reducing I preventing road traffic injuries, suicides and other
injuries, improving trauma care and strengthening rehabilitation services
using a surveillance approach.
1
Section A
Understanding Injury & Programme description
Bengaluru Road Safety and Injury Prevention Programme is a collaborative
programme between 30 hospitals, Bengaluru City Police, Bengaluru
Metropolitan Transport Corporation, Bruhat Bengaluru Mahanagara Palike
and was facilitated by Indian Council of Medical Research and WHO, India
office in 2008. The programme is coordinated by the WHO Collaborating
Centre and the department of Epidemiology at NIMHANS. The programme
aims at reducing / preventing road traffic injuries, suicides and other
injuries, improving trauma care and strengthening rehabilitation services
using a surveillance approach.
1
Introduction
The “Incredible India" is on the move and changing
at a fast pace. In recent years, we have witnessed an
increase in motorization, industrialization,
migration, urbanization and feeling the impact of
overall globalisation. The influence of print and
visual media is also much larger today, compared
to the past. Consequently, our life styles along with
habits and value systems are changing fast.
This change has seen a decline of some
communicable diseases, while Noncommunicable
diseases and injuries are on the increase. In this
changing scenario, Injury and violence is a leading
cause of death and disability'. This change is palpable
across the country and Bengaluru is no exception to
this change.
Everyday, we read, listen or witness, injuries in our
day to day lives. Over time, it has moved from 5,h to
3rd to 1“ page of our newspapers. Some days, it is
not uncommon to see the entire page of our
newspapers filled with news about injury and
violence. On television channels, even on prime time,
injury and violence has occupied the centre stage.
Many times, the “Breaking News” is only deaths due
to road crashes, suicides, mass burns and blood
loaded violence. It has become common to see blood
and broken limbs on our roads, at homes or in work
places. No single day passes in our lives without
injuries making a direct or indirect appearance.
Naturally so, because, Injuries are common and affect
all people, more so the productive age groups and
sections of our society. Road traffic injuries, falls,
burns, poisoning, occupational / work related
injuries, suicides, violence / assault and animal bites
are all common injuries. Individuals in 5-44 years
and men are affected most. Greater vulnerability is
seen among people in middle and lower income
strata of society and injuries make them poorer
further due to its economic impact and lack of access
to quality care. The maximum brunt of injuries is
felt by the health sector as it has to provide care for
affected individuals and families. As India is yet to
recognise injury and violence as a public health
problem, there are no visible policies and
programmes to effectively address this problem. Injury
prevention and control in India is publicly glaring,
2
BRSIPP 2009
politically invisible and professionally missing.
It is only recently, injuries are acknowledged as a
major killer in our society, more through media
and occasionally (now becoming frequent) in
professional circles. Systematic and scientific efforts
in injury prevention and control are yet to begin.
Among several injuries, Road traffic Injuries (RTIs)
and suicides have been recognised as major injury
problems. As injuries are linked to number of
sociocultural issues and happen at individual and
family level, they are treated as individual issues.
As police and judiciary are involved, they are
considered as police and legal problems. Since
everyone uses roads and vehicles, they have become
road and transport problems. With its relation to
infrastructure development and expansion, they are
urban problems. Despite the health sector bearing
the maximum impact due to policies and
programmes of other sectors, they are still not
considered as public health problems.
While injuries have declined in many developed parts
of the world, it has been steadily rising in India. The
need to adopt and suitably modify lessons from HICs
is crucial for injury prevention and control in India to
avoid repetition of mistakes and to make appropriate
decisions by recognition of principles. The last four
decades of research and policy developments across
the world have shown that injuries are predictable,
preventable, and needs a systems approach. Due to
non-recognition of the problem and absence of
coordinated, integrated and intersectoral approaches,
injury prevention and control is at cross roads and
without direction in India.
Recognition of the problem requires good quality,
reliable and representative information; and this is
vital to formulate injury prevention programmes. Injury
prevention and control should be evidence based and
data driven. However, in India, comprehensive
information is often lacking or, at best, patchy. Though
police data on injuries are available to a limited
extent, health sector information has been totally
missing. Further, even the collected information is
not systematically and scientifically analysed to
develop a better understanding of injury pattern,
profile and determinants. The available data are not
aptly utilized in policy and programme development.
Nevertheless, the scenario has begun to change and
time is appropriate to give a major push and direction
for this area.
There have been several initiatives at different levels
in India to address the growing problem, and some
of this is happening in the area of road safety.
International and national developments have paved
the way for this change. The World report on Road
Traffic Injury Prevention (1), World report on
Violence & Health (2) and few national reports
(3, 4, 5) have brought to light a number of activities
to be undertaken for control of injuries. Road Traffic
injury surveillance initiatives in 2007 / 08 in select
cities of India on a pilot basis by the Indian Council
of Medical Research (6), activities in suicide and
violence prevention, an active judiciary and NGO
network, report of the National Commission on
Farmers (http://krishakayog.gov.in/) and Prevention
of Domestic Violence Act (http://ncw.nic.in/
DomesticViolenceBill2005.pdf) are some examples.
Although road safety has been acknowledged as an
important issue in many states and cities, other safety
issues like home safety, work safety, safety aspects
at public places etc. have not been given due
importance and also need to be addressed.
With this in view, the present Bengaluru Road safety
and Injury Prevention programme was initiated in
2008 to develop systematic activities in prevention,
trauma care and rehabilitation programme for RTIs
and other injuries based on data and evidence.
A 1.1 Injuries are biomechanical in
nature and not accidents
Historically, injuries have always been referred to as
accidents and the term “accident” implies the
inevitable nature of the event and connotes that
nothing can be done about it. ‘Injury’ by definition
means that there is a body lesion due to an external
cause, either intentional or unintentional, resulting
from a sudden exposure to energy (mechanical,
electrical, thermal, chemical or radiant) generated
by agent - host and environmental interaction (9).
When this generated energy is transferred and exceeds
the physiological tolerance of an individual it leads
to tissue damage. Apart from this, injury can also
occur due to the sudden withdrawal of a vital
requirement of the body like oxygen in case of
drowning, asphyxiation etc. In short, injury is the
damage caused to the body due to a rapid and sudden
exposure to energy beyond his / her tolerance levels.
It is an acute event, occurs in varying severities and
with chances of repeated occurrence. Prevention of
injuries is possible by acting on one or all three areas
of this interaction and thus can be modified,
predicted, and prevented.
A 1.2 Injuries can be classified
Firstly, injuries are classified as intentional,
unintentional and undetermined injuries, based on
intent of injury occurrence. Unintentional injuries
are also referred to as accidental injuries though not
really accidental in nature, while intentional injuries
are self-inflicted or caused by others. The latter
include suicides, homicides, injuries due to violence
against women, children and elderly, those due to
wars, riots and conflicts, etc.,
A second common method of classifying injuries is
according to the mechanism which caused the injury,
like road traffic crashes, poisoning, falls, fires/bums,
drowning, fall of external objects and others.
A third method of classifying injuries is according to
place of occurrence like road injuries, home injuries,
sports injuries and work related injuries based on
place of occurrence of injury.
The fourth method is based on anatomical types and
location of injuries depending on body organs injured
like head injuries, facial injuries, injury to long bones
etc. The nature and type of injuries are documented
as fractures, contusions, haemorrhage for care and
management.
International Classification of Diseases (11) and
International Classification of External Causes of Injuries
(12) are commonly used for systematic and scientific
classification of injuries all over the world. A particular
classification chosen is primarily determined by the
purpose of a (or more) programme(s), research focus
and availability of resources. Commonly, the first three
methods (viz., intent, mechanism, and place) are
preferred for prevention, as changes can be made in
products and environment, and injury occurrence can
be prevented for future.
3
Some of the professional concerns that have been raised about lay beliefs in the field of modern injury
control have not held up to scientific scrutiny. One example has to do with the word “accident”. For the
last few decades of the twentieth century, national and international safety advocates lamented the public’s
persistent use of that term.
The magnitude of the automotive injury problem in the pediatric population remains as great as it is
largely because of the perpetuation of a societal ethic that automotive injuries are accidents. The word
accident suggests that the injury event was determined by fate and, therefore, was unpredictable and
unavoidable [Rosenberg, Rodriguez, & Chobra 1990, p.1086].
The most important reason for this delay in the use of science to control injuries, and one which persists
to some degree even today, is the sense of fatalism towards trauma. Injuries are still called accidents....
[Rivara, 2001, p.3].
The term accident has been banned by the U.S. National Highway Traffic Safety Administration
(National Highway Traffic safety Administration, 1997), as well as the British Medical Journal (Davis
& Pless, 2001). At meetings of injury control professionals, audiences have been known to hiss, if an
invited speaker from another field inadvertently included the word in his or her remarks. In 1996,1
addressed this issue by fielding a national random-digit-dialled telephone survey that assessed adult in
interpretation of the word accident.Eighty-three percent of respondents associated preventability with
the term (Girasek, 1999). Scores of studies have now established that most adults believe a majority of
accidents and injuries are preventable (Chiappone & Kroes, 1979; Colver, Hutchinson, & Judson, 1982;
Duan, 2004; Green, 1997; Hooper, Coggan, & Adams, 2003; Hu, Wesson, Parkin, & Rootman, 1996;
Roberts, Smith, & Bryce, 1995).
Reproduced from JO.
Understanding injuries is the basis for
preventive strategies
Historically, in 1970, William Haddon Jr., proposed
a matrix for consideration of all factors involved in
injury causation at different time periods and at
various levels (13). This involved identifying what
can be done for people, products and the environment
before injury, during an injury and after its occurrence
(Table 1). This concept has revolutionized injury'
prevention since 1970s all over the world, and can
be used to analyze any type of injury, identify
interventions that might prevent such an event from
happening again or reducing the harm done.
Injuries occur due to a combination of agent, host,
vector and environment factors. The epidemiological
triad of agent, host and environment has been used
in our understanding of communicable diseases
earlier, and injuries too have similar dimensions like
any other public health problem. There is a clear
need to understand injury mechanisms to develop
intervention programmes.
4
BRSIPP 2009
Figure 1: Epidemiological model of an injury
caused by a motorcycle collision
Table 1 shows the case of an injury to a motorcycle
rider involved in a motorcycle collision. Here, the
host is the rider, vector is a motorcycle, agent is the
mechanical force or energy and environment is the
road. Similarly, in an act of interpersonal domestic
violence in which a man causes injury to his wife,
the host is the injured person, the agent is the energy
(physical assault), the vector is also the person
inflicting injury and, the environment include
domestic situation and societal norms and values
that allow for such behaviours to occur.
Using a model of this type helps in identifying factors
involved in an injury. This would help policymakers,
professionals, product manufacturers and others to
identify situations and target interventions to prevent
such injuries from happening in the future or reduce
the harm done when they happen. For instance, in
die first example, there may be factors about the rider,
the motorcycle or the road that contributed to the
crash. One or more of these can be changed in order
to prevent such incidents in the future. Interventions
that might be done by thinking about these elements.
These can include implementing helmet & drink drive
laws, reducing speeds, increasing visibility of twowheelers and/or riders, strengthening brake & light
systems, improving pre hospital & emergency care
and overall safety improvement of roads and others.
Table 1: Example of Haddon’s matrix as
applied to two wheeler road traffic injury
Vehicle
Environment
Pre-event Increase
Increase
awareness
visibility of
about helmet
vehicle
wearing, drink
driving, safe
driving, etc.
Implement
safety features
on roads
Human
Event
Early transfer
to hospital
and required
care
Better braking Crash
systems of two protective
wheelers
road side
stationary
objects
Post
event
Rehabilitate
and improve
health care
services
Improve safety
technologies
and compo
nents
Facilities for
early rescue
of injured
persons
Use of injury spectrum is another useful method to
understand injuries. This method (figure 2) maps an
injury over time, starting with its exposure, followed
by the event, through the occurrence of injury time
finally resulting in disability or death. Understanding
this time spectrum can help in developing
interventions that can either prevent injury or lessen
the impact of injury.
Figure 2: The injury spectrum
■o
EXPOSURE
EVENT
INJURY
DISABILITY
DEATH
Based on this understanding, injury prevention and
control is broadly classified as primary prevention,
secondary prevention and tertiary prevention. Primary
prevention involves preventing the event from
occurring or preventing it from leading to injuries.
This involves taking all necessary steps to see that
injuries do not happen and includes all activities
that are done to make people, products and their
environment safer. Secondary prevention involves
early diagnosis and appropriate management of an
injury. Most of the times health professionals are
involved in providing care and services for injured
people. This includes ail activities right from
application of basic first aid at the place of injury
to stopping an injury from having serious
consequences. Tertiary prevention aims at improving
the final outcome and involves preventing
further complications through rehabilitation
programmes.
Injury in India
The National Crime Records Bureau (NCRB) at
national level (15), state crime records bureau at
the state level, district and city bureaus at district
and city levels, respectively, are designated official
agencies in India for collecting, compiling and
disseminating injury data in India. Since majority of
injuries and injury deaths are considered as medico
legal events, they are commonly reported to police.
A 3.1 National reports
As per NCRB 2008 nearly 485,008 injury deaths and
2.4 million injuries were reported in India in 2008.
RTIs and suicides, being 2 major injuries, accounted
for 118,239 and 125,017 deaths, respectively.
Southern Indian states reported higher number of
deaths, reasons for which can be several varying
from increased occurrence to better reporting systems
and reasons are not clearly delineated.
A 3.2 Million Death study
The million death study report based on the special
survey of deaths carried out under Sample
Registration System (SRS) provides comprehensive
details of deaths in India (16). The causes, based on
5
Figure 3: State wise distribution of RTIs in India, 2008
(Rate / 100,000 population; National average 10.8/ population)
State
Goa
Haryana
Tamil Nadu
Andhra Pradesh
Karnataka
Chandigarh
Chhattisgarh
Sikkim
Rajasthan
Delhi
Himachal Pradesh
Maharashtra
Kerala
Gujarat
Uttaranchal
Rate 1 ■ State
20.3
Madhya Pradesh
19.6
Arunachal Pradesh
Mizoram
19.2
17.2
Jammu & Kashmir
15.3
Orissa
13.6
Punjab
13.6
Uttar Pradesh
13.2
Tripura
12.9
Meghalaya
12.2
Assam
12.1
West Bengal
12.1
Nagaland
11.5
Jharkhand
11.3
Manipur
11.2
Bihar
Rate
10.8
10.4
8.0
7.8
7.8
7.7
6.3
6.3
5.8
5.7
5.4
5.3
5.2
5.0
3.7
Figure 4: State wise distribution of Suicides in India, 2008
National Average - 10.8/100,000 population
State
Sikkim
Kerala
Tamil Nadu
Tripura
Karnataka
Chhattisgarh
Goa
Andhra Pradesh
West Bengal
Maharashtra
Orissa
Haryana
Gujarat
Madhya Pradesh
Assam
Verbal autopsy techniques referred to as “RHIME” or
Representative, Re-sampled, Routine Household
Interview of Mortality with Medical Evaluation
method adapted a well defined and established
methodology. The assignment of cause of death was
done through a process of medical evaluation by
two independent trained physicians.
In total, NCDs were the leading causes of death in
the country for 42% of all deaths. Communicable
diseases, maternal, perinatal and nutritional
constituted 38% of the deaths. Injuries, of both
intentional and unintentional types, contribute
for a total of 10 % of deaths. Several ill-defined
causes for which causes were difficult to determine
account for 10% of deaths. Injuries are one among
the top ten leading causes of death, with similar
6
BRSIPP 2009
Rate/100,0001I State
48.2 Himachal Pradesh
25 Arunachal Pradesh
21.7 Rajasthan
21.3 Chandigarh
21.2 Delhi
20.8 Mizoram
17.5 Meghalaya
17.4 Punjab
16.8 Jharkhand
13.4 Jammu & Kashmir
12.2 Uttar Pradesh
11.1 Uttaranchal
10.9 Nagaland
10.9 Manipur
9.9 Bihar
Rate/100,000
9.6
9.1
7.9
7.7
7.6
4.2
3.3
3.3
3
2.5
2.1
2
1.9
1.3
1.1
number of deaths in both urban and rural areas,
even though specific conditions vary.
An interesting finding from the study is the high
deaths due to injuries in the younger age group of
15-24 years. Deaths in this age group are due to
road traffic injuries, intentional self-harm and other
un-intentional injuries. Every 3rd death in this age
group is due to an injury. Motor vehicle crashes were
high among men, while suicides were more among
women.
A 3.3 WHO estimates
As per the Global Burden of Disease study report,
there were 1,117,000 deaths due to injuries in India
contributing for an estimated 10.8% of deaths in
2005 ( 17 ). It is estimated that RTIs and suicides
contributed for 202000 and 188000 deaths,
respectively. Nearly 66.7% of deaths occurred in
younger age groups, predominantly among men.
A 3.4 Independent studies
A recent national review (17) has estimated that a
million injury deaths and 30 million hospitalizations
occur every year. The review highlighted and
estimated that in 2005, 8, 50,000 (nearly a million)
persons lost their lives and 17,000,000 hospitalized
(Figure 5). If unchecked, numbers are likely to
increase to 1,200,000 deaths and 24,000,000
hospitalizations of serious injuries by 2015. Road
traffic Injuries, suicides, burns, poisoning, violence
are all major causes of deaths and disabilities. Recent
studies (18,19,20) using verbal autopsy methods have
shown that injury deaths contribute for 13-18% of
total deaths varying from place to place.
Figure 5: India Injury Pyramid, 2005
Limited studies have been undertaken in recent year's
by individual researchers. A summary of Indian
studies is available in the report entitled “Injuries in
India: A National Perspective” (17). In Bengaluru,
few studies have been undertaken by NIMHANS on
epidemiological, preventive and public health aspects
of road traffic injuries, brain injuries, suicides and
violence (www.nimhans.kar.nic.in/epidem/WHO).
In New Delhi, TRIPP at IIT has made significant
contributions in road safety and transport
management (http://web.iitd.ac.inZrctrippZ). Few
medical colleges and engineering and transport
departments have also undertaken studies in their
respective areas of interest. Individual researchers
have also undertaken studies on Road traffic Injuries
(20, 21), suicides (23) and violence (24). A few
national studies and surveys have been carried out
by Ministries (25). Studies and reports available from
independent agencies like WHO, World Bank,
IndiaClen, NGO’s and other agencies have added
substantial information. However, these have been
stand alone - one time studies and provided useful
information for policy making process and to
recommend interventions. Regular, continuous and
timely information has not been available for any
Indian city or for the country. The Bangalore Road
safety and Injury Prevention Programme is the
first of its kind being undertaken in India . Details
of the programme are available at http://
www.nimltans.kar.nic.in/epidemiolQgyZbispZs_rl.pdf
and in the recently published report from Indian
Council of Medical Research (6).
A4o Injury in Karnataka
As per data from NCRB, a total of 12,222 suicides and 8,814 RTI deaths followed by 1,844 homicidal deaths
were reported for the year 2008 in Karnataka. In the same year, 184,226 persons were injured as per police
reports with a ratio of nearly 1:6.
A5. Underreporting of Injuries
Injuries are underreported in all parts of the world
(26) due to several reasons. In India, while official
statistics are able to capture large majority of deaths,
non-fatal injuries of various severities are highly
underreported. For each death from injury, there are
many more injures that result in hospitalization,
treatment in emergency departments or treatment
by practitioners in formal and/or informal health
sectors. Data from HICs & studies from India
indicate that for every person killed by injury;
approximately 30 persons are hospitalized and
roughly 50 - 100 more are treated in hospital emer
gency rooms (1, 17). Studies in Bengaluru and
Haryana have shown that injury problems are much
higher in the community than officially reported
figures (26, 27). Thus, it is essential to realise that
in the country, number of deaths due to injuries could
be much higher than official figures.
7
00
BRSIPP 2009
Table 2: Top 10 causes of death by Age Groups in India: Male
Rank
<1
1-4
0-4
5-14
15-24
25-69
70+
All Ages
1
Perinatal
conditions (49.2)
Diarrheal
diseases (22.0)
Perinatal
conditions (36.9)
Unintentional
injuries: Other
(19.4)
Unintentional
injuries: Other
(14.7)
Cardiovascular
diseases (26.3)
Cardiovascular
diseases (26.5)
Cardiovascular
diseases (20.3)
2
Respiratory
infection (20.5)
Respirator)'
Infections 21.4)
Respiratory
infections (20.7)
Diarrheal diseases
(15.2)
Intentional
self-harm (14.3)
Tuberculosis
(11.4)
3
Diarrheal diseases
(9.0)
Other infectious and
parasitic diseases
(15.5)
Diarrheal
diseases (12.3)
Other infectious and
parasitic diseases
(13.5)
Motor vehicle
accidents :;
(12.4)
COPD, asthma, other
respiratory diseases
(10.1)
Senility (13.1)
Tuberculosis (7.1)
4
Other infectious and
parasitic diseases
(7.9)
Unintentional
injuries: Other (9.3)
Other infectious and
parasitic diseases
(9.8)
Respiratory
infections (8.4)
Ill-defined
conditions (7.2)
Malignant and other
neoplasms (7.8)
Diarrheal diseases
(7.3)
Diarrheal diseases
(6.7)
5
Congenital
anomalies (3.4)
Malaria (6.6)
Ill-defined
conditions (3.5)
Malaria (8.1)
Cardiovascular
diseases (6.3)
Digestive diseases
(6.1)
Malignant and other
neoplasms (4.6)
Perinatal conditions
(6.4)
6
III defined
conditions (2.9)
HI defined
conditions (5.3)
Unintentional
injuries: Other (3.4)
Ill-defined
conditions (5.4)
Tuberculosis
(6.0)
Unintentional
injuries: Other (5.0)
Tuberculosis (4.5)
Respiratory
infections (5.4)
7
Nutritional
deficiencies (1.8)
Nutritional
deficiencies (4.3)
Congenital
anomalies (3.0)
Motor vehicle
accidents (5.3)
Other infectious and
parasitic diseases
(5.2)
Ill-defined
conditions (4.8)
Ill-defined
conditions (4.4)
Malignant and other
neoplasms (5.4)
8
Unintentional
injuries: Other (1.5)
Fever of Unknown
Origin (3.1)
Nutritional
deficiencies (2.4)
Malignant and other
neoplasms (3.8)
Diarrheal diseases
(5.1)
Diarrheal
diseases (4.0)
Unintentional
injuries: Other (3.7)
Unintentional
injuries: Other (5.2)
9
Malaria (0.9)
Congenital
Anomalies (1.9)
Malaria (2.4)
Digestive diseases
(2.9)
Malaria (4.8)
Intentional
self-harm (3.3)
Respiratory
infections (3.4)
Ill-defined
conditions (4.6)
10
Fever of unknown
origin (0.9)
Digestive
Diseases (1.6)
Fever of unknown
origin (1.5)
Fever of unknown
origin (2.5)
Maternal
conditions (■)
Malaria (2.4)
Fever of unknown
origin (2.8)
Senility (4.0)
COPD, asthma, other COPD, asthma, other
respiratory diseases
respiratoiy diseases
(15.7)
(9.3)
Ref: http://cghr.org/publications/FlNAL°/o20REPORT-Millon% 20Death%20study%202001-2003%20-phase%201 .pdf
Table 3:Top 10 causes of death by Age Groups in India: Female
Rank
<1
1-4
0-4
5-14
15-24
25-69
70+
All Ages
1
Perinatal
conditions (43.1)
Diarrheal
diseases (25.2)
Perinatal
conditions (29.2)
Diarrheal diseases
(19.6)
Intentional
self-harm (16.9)
Cardiovascular
diseases (22.5)
Cardiovascular
diseases (24.8)
Cardiovascular
diseases (16.9)
2
Respiratory
infection (23.3)
Respiratory
Infections (23.3)
Respiratory
infections (23.3)
Other infectious and
parasitic diseases
(16.7)
Maternal
conditions (12.6)
Malignant and other
neoplasms (11.8)
Senility (18.4)
Diarrheal diseases
(9.9)
3
Diarrheal
Diseases (10.6)
Other infectious and
parasitic diseases
(16.2)
Diarrheal diseases
(15.3)
Unintentional
injuries:
Other (12.0)
Unintentional
injuries: Other (9.1)
COPD, asthma, other COPD, asthma, other COPD, asthma, other
respiratory diseases
respiratory diseases
respiratory diseases
(8.0)
(12.4)
(10.4)
4
Other infectious and
parasitic diseases
(8.8)
Malaria (6.6)
Other infectious and
parasitic diseases
(11.2)
Respiratory
infections (11.1)
Tuberculosis (7.5)
Riberculosis (8.3)
Diarrheal diseases
(9.8)
Respiratory
infections (7.1)
5
III defined
conditions (3.2)
Unintentional
injuries: Other (6.2)
Ill-defined
conditions (3.4)
Malaria (10.7)
Ill-defined conditions
(7.2)
Diarrheal diseases
(6.6)
Unintentional
injuries: Other (4.6)
Senility (6.5)
6
Congenital
anomalies (2.8)
Nutritional
deficiencies (5.1)
Nutritional
deficiencies (3.2)
Ill-defined
conditions (4.6)
Diarrheal diseases
(7.2)
Ill-defined
conditions (6.0)
Ill-defined
conditions (4.5)
Perinatal conditions
(6.2)
7
Nutritional
deficiencies (2.3)
III defined
conditions (3.9)
Malaria (3.0)
Fever of unknown
origin (3.3)
Cardiovascular
diseases (6.3)
Unintentional
injuries: Other (4.1)
Fever of unknown
origin (3.9)
Malignant and other
neoplasms (6.0)
8
Unintentional
injuries: Other (1.3)
Fever of Unknown
Origin (3.1)
Unintentional
injuries: Other (2.9)
Digestive diseases
(2.8)
Malaria (4.6)
Digestive diseases
(3.5)
Malignant and other
neoplasms (3.5)
Ill-defined
conditions (5.0)
9
Malaria (1.3)
Digestive diseases
(1.8)
Congenital
anomalies (2.3)
Motor vehicle
accidents (2.1)
Other infectious and
parasitic diseases
(4.4)
Malaria (3.4)
Respiratory
infections (3.4)
Riberculosis (4.7)
10
Fever of unknown
origin (0.9)
Congenital
anomalies (1.3)
Fever of unknown
origin (1.6)
Malignant and other
neoplasms (2.0)
Motor vehicle
accidents (1.7)
Intentional
self-harm (2.6)
Riberculosis (2.6)
Unintentional
injuries: Other (4.5)
Ref: http://cghr.org/publications/FINAL%20REPORT-Millon%20Death%20study%202001-2003%20-phase%201.pdf
Table 4: Top 10 causes of death by Age Groups in India; Person
Rank
<1
1-4
0-4
5-14
15-24
25-69
70+
All Ages
1
Perinatal
conditions (46.3)
Diarrheal
diseases (23.8)
Perinatal
conditions (33.1)
Diarrheal
diseases (17.4)
Intentional
self-harm (15.6)
Cardiovascular
diseases (24.8)
Cardiovascular
diseases (25.7)
Cardiovascular
diseases (18.8)
Respiratory
infections (22.0)
Unintentional
injuries: Other
(15.7)
Unintentional
injuries: Other
(11- 8)
COPD, asthma, other
respiratory diseases
(10.2)
Senility (15.7)
COPD, asthma, other
respiratory diseases
(8.7)
Respiratory
Respiratory
infection (21.8)
Infections (22.5)
Diarrheal
diseases (9.7)
Other infectious and
parasitic diseases
(15.9)
Diarrheal
diseases (13.8)
Other infectious and
parasitic diseases
(15.1)
Ill-defined
conditions (7.2)
Tuberculosis (10.1)
COPD, asthma, other
respiratory diseases
(14.1)
Diarrheal diseases
(8.1)
Other infectious and
parasitic diseases
(8.3)
Unintentional
injuries: Other (7.5)
Other infectious and
parasitic diseases
(10.5)
Respiratory
infections (9.7)
Motor vehicle
accidents (6.9)
Malignant and other
neoplasms (9.4)
Diarrheal diseases
(8.5)
Perinatal
conditions (6.3)
5
Congenital
anomalies (3.1)
Malaria (6.6)
Ill-defined
conditions (3.4)
Malaria (9.4)
Tuberculosis (6.8)
Ill-defined
conditions (5.3)
Ill-defined
conditions (4.4)
Respiratory
infections (6.2)
6
III defined
conditions (3.0)
Nutritional
Deficiencies (4.8)
Unintentional
injuries: Other (3.2)
Ill-defined
conditions (5.0)
Maternal
conditions (6.5)
Digestive diseases;
(5’1 >
Malignant and other
neoplasms (4.1)
Tuberculosis (6.0)
7
Nutritional
deficiencies (2.0)
Ill defined
conditions (4.5)
Nutritional
deficiencies (2.8)
Motor vehicle
accidents (3.7)
Cardiovascular
diseases (6.3)
Diarrheal diseases
(5.0)
Unintentional
injuries: Other (4.1)
Malignant and other
neoplasms (5.7)
8
Unintentional
injuries: Other (1.4)
Fever of Unknown
origin (3.1)
Malaria (2.7)
Malignant and other
neoplasms (2.9)
Diarrheal
diseases (6.2)
Unintentional
injuries: Other (4.6)
Tuberculosis (3.6)
Senility (5.1)
9
Malaria (1.1)
Digestive diseases
(1.7)
Congenital
anomalies (2.7)
Digestive diseases
(2.9)
Other infectious
and parasitic
diseases (4.8)
Intentional
self-harm ' (3.0)
Respiratory
infections (3.4)
Unintentional
injuries: Other (4.9)
10
Fever of unknown
origin (0.9)
Congenital
anomalies (1.5)
Fever of unknown
origin (1.5)
Fever of unknown
origin (2.9)
Malaria (4.7)
Malaria (2.8)
Fever of unknown
origin (3.3)
Ill-defined
conditions (4.8)
f
(
3
u
Ref: http://cghr.org/publications/FINAL°/o20REPORT-Millon% 20Death%20study%202001-2003%20-phase%201.pdf
A6. Information requirements for injury
prevention and control
Information available through national reports
indicates the number of fatal and nonfatal injuries,
age - sex profiles, state and city wise distribution,
education and occupation levels, road user categories
for RTIs and a vague distribution of causes.
Information reported is based on information
received from different places. Detailed examination
into some of this data reveals that much of the
required information (especially with causes or risk
factors) is unavailable or remains unclassified.
In India, as RTIs and other injuries are medico legal
events, a lot of information is collected in detail as
part of routine police investigation. However, the
collected information is not used for prevention and
control, but more for administrative and legal
purposes. Numbers are also collected by different
agencies like transport department, City Corporation
and others for their own use. In addition, total
information is not available in the public domain
for researchers and policy analysts. Thus, information
is piecemeal, fragmented and not integrated.
To formulate effective injury prevention and control
(IPC) programmes, information is required on what
types of injuries are occurring? Who are the affected
people? What are their characteristics? Where are
injuries occurring? How are injuries occurring? What
are the risk factors and causes? What are the agent
- host - environment factors that can be modified?
and other detailed information. This is a similar
understanding developed for many other public
health problems like malaria, tuberculosis, HIV/Aids
and others. This will facilitate designing programmes
for prevention, improving trauma care and
rehabilitation in IPC activities.
A Surveillance approach
“Surveillance” is a public health activity, referring
to ongoing, continuous and systematic collection,
analysis, interpretation and dissemination of health
information (14). Injury surveillance, in a similar
context refers to collection, analysis, interpretation
and dissemination of injury data with the overall
aim of developing policies and programmes for
effective prevention and control of injuries. It includes
gathering information on individual cases or
assembling information from records, analyzing and
interpreting information, reporting and providing
feedback into programmes. Surveillance is a
continuous activity with an inbuilt feedback
mechanism and an action component. It helps in
recognising existing and changing burden and
pattern of injuries, identifying new / emerging
problems, prioritising and selecting interventions and
measuring the impact of interventions in a timely
manner. Surveillance data can be a meaningful input
to several programmes and activities of various
ministries, government departments, health
professionals, transport, police, NGOs, and all others
interested in injuty prevention.
Importance of injury surveillance
Reliable information on the burden, pattern, trends
and causes of injuries are required to develop
systematic policies, programmes and interventions.
In India, lack of reliable information on injury burden
& impact has been one of the major barriers for
absence of systematic programmes for injury
prevention and control. Consequently, ad hoc, and
at times, unscientific interventions are proposed and
implemented, and so far, these have not made any
significant change. Injury problem has not been
defined due to absence of systematic information.
Systematic activities like allocation of resources,
human resource and capacity development,
systematic efforts for care and management, injury
prevention interventions, and others have not received
much importance. Hence, injuries have been a
clearly neglected problem and a hidden epidemic
for many decades, even though evidence exists that
the burden is huge (17).
Surveillance generates data that helps in
understanding the:
O
Magnitude of the problem and its
characteristics
11
O
O
O
O
Changing trends
Populations at risk
General and select risk factors, and
Impact of interventions
Local, regional and national injury surveillance
systems can provide data required for planning and
delivering effective injury prevention programmes
to communities and to the country at large. It will
help planners and administrators to take appropriate
action on a continuous and regular basis. Further, it
helps societies to advocate for positive changes that
are required for safety’ of everyone.
♦
Often, it is thought that RTI / Injury surveillance
requires building entirely new systems involving
huge resources. This is not true. Alternatively,
it can be built within existing systems using
available resources. The existing systems
and methods can be improved, strengthened
and utilized to develop information that is
required for injury prevention and control
programmes.
Any surveillance programme has to be operational
and sustainable, and hence, should be
o Simple
O Acceptable
O Sensitive
O Reliable
O Representative
O Sustainable
O Timely
o Cost effective and, most importantly,
O Useful
►
It is crucial to highlight that injuiy surveillance
provides broad and specific information
(depending on the extent and depth of
surveillance) and should be supplemented widi
data from focussed, targeted and specific
studies (like trauma registries, risk factor
studies etc.) to obtain further insights. Thus,
injury surveillance is often the first step in the
larger information systems.
►
The essence of surveillance is to collect small
quantities of good, reliable and useful
information (by well defined methods) and
apply it to develop policies, programmes and
interventions.
Bengaluru Road safety and Injury
Prevention Programme . .................... .
Details of the surveillance programme undertaken in 2007 - 08 have been reported earlier and are available
at http://www.nimhans.kar.nic.in/epidemiology/bisp/srl.pdf and only salient points are highlighted below.
A8. Goals, purpose and objectives
The overall goal of BRSIPP is to achieve a reduction
in injury (RTI and others) deaths, hospitalisations
and disabilities in Bengaluru.
O
The purpose and objectives of Bengaluru Injury /
Road traffic Injury Surveillance Programme are to:
O
Collect and analyse data from selected
participating health care institutions, police
sources and transport sector on specific aspects
of RTIs, sucides and other injuries.
Facilitate application and utilization of data
for planning and implementing inteivention
programmes through various policies and
programmes.
A9. Preparatory Phase (March - June 2007)
Stake holder’s involvement
All stakeholders in injury prevention and control
including ministries of health, police, transport,
urban and rural development, social welfare,
12
BRSIPP 2009
education, industries and commerce, media, NGOs
and others need to be involved in surveillance,
prevention and control activities. In Bengaluru,
stakeholders from - Police (Traffic, Crime and Law
and Order), Health (Directorate of Health Services,
Directorate of Medical Education, officials from
Integrated Disease Surveillance Programme and all
hospital administrators), Heads of major hospitals
(Directors, Chief Executive Officers, Senior
administrators), Transport (transport department
and Bengaluru Metropolitan Transport
Corporation), Bruhat Bengaluru Mahanagara
Palike, social welfare, urban development, National
Highway Authority and Non-Governmental
Organizations working with injury issues were
contacted, sensitised and involved in the
programme.
As it is an inter-sectoral and coordinated activity,
stake holders contribution in terms of need for data,
what type of data is required, how will it be collected
, steps involved in the development and mechanisms
of data collection and utilisation - application were
discussed in preliminary discussions during the
meeting. The roles and responsibilities were specified
and agreed upon by all stake holders.
9. Focus of surveillance
Under the present programme, data is being collected
on Road traffic injuries, falls, burns, poisoning,
suicides and assault/violence. While the focus is on
all injury causes, the major thrust is on road traffic
injuries and suicides as identified by stakeholders. It
was decided to include occupational and other
injuries in later stages of the programme.
Surveillance cameras & Blackberry
Pbe year witnessed massive
I induction of technology in
traffic management with 160
surveillance earner.is being in
stalled at unportant junctions.
These cameras helped the po
lice In deciding on remedial
measures fast wherever there
were traffic woes. The police
A1
kept utilising Blackberry and vanahalli and Chikkajala.
decided to phase out paper no
tice for traffic violations.
Stem action
These initiatives brought re 'rhe police adopted zero toler
maria bl e improvement tn road ance in handling traffic viola
users’ behaviour. Says Prawn tions. There was positive re
Sood: “People changed for two sponse from BMTC as the police
reasons fear of being caught by recovered Rs 2S lakh in form of
the police and imposition of fine. fine amount from it Moreover,
Things will change if the im the BMTC drivers visited traffic
provement comes from within.” management centre to learn
Bangalore C ity is a t least one more on safe driving.
year ahead of Mumbai, Kolkaita. Dciha. Hyderabad and Chen Staff not enough?
nai in terms of usage of technol The staff strength to handle
ogy in traffic management. complex Bangalore traffic prob
ciaims Sood
lems seems to be insufficient
Presently, the department has a
Drop In fatal accidents
strength of 2500 of all ranks.
The dip in the number of road besides assistance of250 home
accident-related deaths has guards. But Sood views it differ
been apparent this year. Com ently. "It is not a question of
pared to the previous years, the adding more men. but that of
number of accidents and dca tits utilising technology effectively.
If we are able to utilise technol
came down.
Last year. 892 deaths were ogy effectively, we can yield re
reported, while the figure for sults within existing staff. The
this year so far is 740. The num department spent 15,000 man
ber was 981 in 2007. This de days to train 3.000 policemen
spite inclusion of areas upto De- for fhv days, he added.
Surveillance Mechanisms
The different agencies collecting injury related
information in the city of Bengaluru are police,
hospitals, transport, city corporation vital registry
division, and NGOs. Accordingly, these sources are
strengthened and are being used to collect data on a
regular basis. The sources of data under the present
programme include police records for RTI and other
injury mortality information - BMTC data for fatal
bus crashes - vital division records for deaths in the
city for injury mortality information - and hospital
data for nonfatal injuries.
Figure 6: Sources of information for injury
13
A11.1. Data on fatal injuries
Data on injury mortality is collected from police
sources as previous studies had shown that majority
of deaths are reported to police. Bengaluru City Police
collect information on various aspects of RTIs and
other injuries (any unnatural death) under the
“medico-legal” rubric. All deaths due to road crashes,
suicides, homicides and other unnatural (suspicious)
deaths are considered medico-legal and police are
entrusted with the primary responsibility of
documenting information. Information is based on
the formats provided by NCRB. A review of the road
crash death and other injury death records revealed
that large body of information is collected on every
case and processed as per administrative and legal
requirements.
The review of police information system revealed:
G
Lack of a uniform reporting format for injuries
Q
Information systems are piecemeal and
fragmentary
Q
Different types of records received from casualty
rooms of hospitals for reporting injuries to
police (along with duplication of work)
O
Manual handling of data
O
Frequent transfer of Officials and personnel
G
Lack of analysis of data
O
Absence of linkage of records between police
and health
O
Absence of a centralized agency to process,
analyse and utilize data
O
Absence of systematic reporting to concerned
stakeholders, society at large and others, and
O
Medico legal problems of a continuous
nature.
A major limitation of this approach has been that
information on preventive aspects that can be helpful
for planners and policymakers are not clearly
available. Secondly, the collected data is not
compiled and analyzed systematically at the city or
state level. Thirdly, information is distributed across
the 39 traffic and 106 law and order police stations
of the city and is not available in any systematic
format in a central place for examination. Fourthly,
information is not brought to the attention of all
stakeholders and is not applied for programmes. A
specified format was developed based on review of
records, piloted in few stations, and has been widely
adapted in the programme.
14
BRSIPP 2009
A11.2. Data on nonfatal injuries from
hospitals
Since hospitals and health professionals (doctors,
nurses, specialists, technicians, medical record
staff, etc.,) provide care for injured persons across
the city and round-the-clock, information is
gathered in medical records as per the practices
followed by individual hospitals. An inventory of
few hospitals prior to the beginning of the
surveillance programme revealed that the
methods, practices and procedures varied from
hospital to hospital. The way information is
recorded is often dependant on practice of the
doctor and huge variations and discrepancies are
seen. A review of the system indicated that
information is not collected on injury nature,
causes, situation, circumstances, and use of
protective equipments or pre-hospital care details,
except the source of referral. The diagnostic and
management details are written in detail to
document care for patients. There is no central
agency or organization within the health sector
that collects information from all the hospitals,
analyses and processes data and brings it on a
common format to develop intervention
programmes. As there was no uniformity, it was
decided in the stakeholders meeting that all
hospitals will adopt a system of documenting
information in a uniform manner using a common
format of “Emergency Trauma Care Record”,
supplemented by training and sensitisation
programmes.
A11.3. Selection of surveillance sites
As per the decision in the stakeholders review
meeting it was decided that injury death information
will be extracted from 39 traffic as all RTI deaths
are reported to police authorities on a regular basis
soon after the occurrence of an event. In addition,
data from BBMP and BMTC crashes are collected
separately and pooled together to make final
conclusions. For nonfatal injuries, data is being
collected from 30 urban hospitals and 1 rural hospital
and it was estimated that these hospitals would cover
nearly 60-70% of injury registrations and
hospitalisations. The hospitals were chosen based
on the criteria of geographical coverage, availability
of round the clock trauma care, location of the
hospitals and willingness to participate. Participation
is purely voluntary in the programme (Fig. 7).
Limitations of Health Sector Information
o Rudimentary information systems on RTIs and other injuries
o No uniform data formats in the hospitals
O The death certificate does not mention injury as associate or antecedent condition, even
when injury has been cause of death; injury deaths are reported to police separately
o Information on injury patterns, profile and causes not available
o Data on pre-hospital care factors not elicited
o Data on injury care and disability details are not available, analyzed or reported
o Hospitals do not use ICD-10 classification or the ICECI classificatory systems
o Overburdened and overstretched emergency staff in hospitals (more so in public sector
hospitals)
O Injury surveillance system is absent in the country
o No information system with in the health sector
O Lack of resources (money, manpower, time and other facilities)
o Very few hospital based studies
Figure 7: Map of Bengaluru showing the location of various partner hospitals and
Traffic Police Stations
A11.4
Inventory of hospitals and
scoping study
To identify the caseload in emergency rooms,
type and nature of personnel available, type of
documents maintained, information flow and other
aspects, a scoping study was undertaken in the
beginning. The study highlighted that various
categories of personnel were available in institutions
depending on the type of organization. Commonly,
in medical college teaching hospitals - casualty
medical officers, nurses, residents, postgraduate
students, interns and medical record personnel work
round the clock to provide care for patients. In other
hospitals, primarily of a private nature, casualty
medical officers and nurses are the only routine
personnel.
A11.5 Time of data collection
For injury deaths, the point of information collection
was the individual police stations (35 traffic and
103 law and order) and the first information report,
summary sheet and available extracts were chosen
as the source of information. At present, no
documents are being reviewed by the central
team.
In the hospitals, data was collected from casualty
departments, as it is the first point of contact for
15
injury patients. Data is collected in the form of an
“Emergency Trauma Care Record". It was also agreed
that data would be collected uniformly in a standard
format along with training of all involved personnel.
Information was collected as part of the history taking
process or soon after treatment procedures were
completed.
The review of the existing hospital information
system revealed that:
O Information collected in detail on patient care
and management
O Information collection depends on attending
physician
O Different types of records maintained in
casualty rooms with duplication of work
( number of records maintained for injuries
varied from 1-15 across hospitals)
O No central processing of data even in hospitals
o Absence of systematic reporting to any agency,
as there is no designated agency
O Lack of a uniform reporting format for
injuries
o Transfer and turnover of staff at repeat, regular
and frequent intervals
O Medico legal problems of a continuous
nature
o Reluctance on the part of some hospitals to
undertake shared responsibility'. Information
is piecemeal and fragmentary
O No information on preventive aspects
A11.6 Focus of information collection
Any injury surveillance programme should outline
core data for the programme and include optional
items depending on the need. The focus of
information gathering was on
O
Basic identification and brief socio
demographic details
G
Information on Injury and death (place, type,
activity, intent)
BRSIPP 2009
G
O
Q
G
Details of road traffic deaths (where, who, how
and selected risk factors)
Details of other types of injury and deaths
(intent, place, type),
Pre-hospital care (first aid, transport, referral)
Management and outcome
It was decided to focus on core data elements with
scope for expansion in due course of time. The
responsibility of identifying personnel to complete
the surveillance form was left to individual
hospitals. An operation-training manual (available
on request) was developed for training of all
involved personnel from police and health. The
manual included description of purpose of
collecting information, various variables - brief
description - coding patterns - methods of filling
up of the forms. The collected and analyzed
information should be able to unravel injury
characteristics and dimensions and, help in
developing intervention programmes.
A11.7 Pilot study
A pilot study was undertaken in both police stations
and hospitals over a one month period to examine
feasibility, identify problems, find remedial solutions
and develop logistics for future work. The pilot study
showed that it is possible and feasible to transfer
and collect data in a uniform format. Trained staff
from NIMHANS did data collection during this
phase. On an average, it took 3 - 5 minutes to
complete a form depending on the experience of the
person filling up the proforma.
Following the pilot phase, the findings were discussed
with stakeholders and nodal officers. The proforma
was revised accordingly. The revised police and
hospital format was accepted as the core data element
form with provision for addition of information at
later stages of the programme.
Implementation Phase
(June 2007 - June 2008)
Information was collected from Police, transport,
city corporation and hospital sources from January
- December 2007 (police and transport) and April
2007- 2008 (hospitals), respectively, by combination
of different methods. Overall mortality information
(all cause deaths) was also collected from the vital
statistics division of Bengaluru Mahanagara Palike
for the year 2005 (latest year for which data was
available). Injury mortality information was collected
from police sources. Since the transport department
collects data from most of the fatal and serious nonfatal road traffic injuries and since the focus is
different, it was collected separately, even though
some of it is captured in police records. Morbidity
data was captured from emergency rooms of 25
participating hospitals. During the 1 year period data
was collected from 4334 injury deaths and 68498
non-fatal injuries. Details are available at httpjZZ
www.nimhans.kar.nic.inZepidemiologyZbispZsrl.pdf
and in the report (28). The type and volume of data
that was collected has been discussed in our previous
report (28).
A12.1. Training of Police and health
personnel
In the beginning, the field officers from N1MHANS
were trained in data collection. These people had
basic qualifications in sociology, social work, rural
development, or in other areas and had prior research
experience in health. Gradually, the CC staffs were
withdrawn encouraging institutions to take up the
activity on their own.
In the police department, the writers of police
stations were invited for training programmes.
Since capacity development is a systematic activity,
repeat programmes were done to improve contents
and quality of data. The training focussed on
understanding contents of proforma, definitions used,
method of entering and coding, checking for
completeness and other aspects.
In the hospitals, training of casualty staff (casualty
medical officers, nursing personnel and medical
records staff) was crucial to ensure completeness,
coverage and uniformity in data collection. It was
essential to do this in a phased manner, as there
were large numbers of people to be trained (due to
frequent change of personnel). The training focussed
on purpose of the programme, persons responsible
for data collection, nature of information being
collected, coding patterns, and ensuring safety of
completed forms to be collected. Training was also
offered to different personnel depending on roles
and responsibilities of the personnel. In the rural
areas, staffs from district hospital and Siddhartha
Medical College hospital were trained on the
various aspects of the programme in a similar
manner. Series of training programmes have been
conducted under the programme for both police and
hospital staff.
Consensus was reached on many of the items and
methodology of data collection - pooling - transfer analysis - reporting and feedback of the programme.
The training was held in the local language and in
a simple way using local examples and colloquial
terms. Several questions that came up were answered
and changes incorporated.
A12.2. Data collection logistics
With continuation of activities, all hospitals have
printed their own forms with their names and logo
in duplicate carbon copy formats (essential to note
that ER departments have not been computerised in
any hospital). With the evolution of the programme,
it is proposed to shift from paper-based forms to
online transmission depending upon the availability
of computer facilities. In the hospitals, information
is being collected from injury patients in emergency
rooms. It was agreed that data would be collected
in casualty departments soon after completing
treatment procedures or as part of history' taking
process. Different modalities of operations were
evolved in different situations.
From the police records and primarily from FIRs,
the station staff completed the forms soon after
investigations were completed or during the course
of investigation. These trained staff send the
completed forms to the nodal officer in police
17
Section B:
Data and Information
--------------------times cm
"3
Good news! Fatal accidents come down
Road Dividers And Strict Law Enforcement Contributed To Streamlining Of Traffic
■rember <cd expired to fill jW» death' Alw ttr.ee euforccxeo: cf
Rj 77 a crore. Traffic pollciMythjt nfinby the traffic police haa hXped
ictal fine cclteocd la likely to tcricii to a grau exJrsl.” b« aaya.
PjHcicre ter ICO trace th? D«cra
ter firarea ara tabulated.
FOCUMD DffOSCaOXT
•lifted rtclng from 7»5. with TH ttoo. traffic police bad focuaod on
All three violation a»i hare la-
WKT JUXtDtXn AH LBS
up The raciber of caus bxkcd un
der MV Act. KP Act ar.d WatUtt cat alcwtf pdice(lndnclPrT«n$ood. ahichintwocccddbeorarftherca2W7 Traffic <-.fI’.clili M7 csrn ifirr
crcd.t Ibr the redaction must co Io the atria behind acc-.dmu ccralap down.
addict Dc-reratcr Cnrei, ih« total lltelf raspirod to tail jtai'i Lilly cf
fitxl accllcnu fcr XO3 uwJd be7 M
hai raw.Lured a W to aneamilntni acraMMainS three bust
I) lakh rcccrdsd In Son.
Enn the fine reltectcd ur.d«
The data collected from different sources in 2009 has been presented in
this section. The purpose of this section is not to describe the epidemiology
of RTIs and other injuries, but to highlight the type of data that will be
available in a surveillance programme. The data description highlights
the current profile and patterns of RTIs and other injuries, and provides
directions for linking number of other activities. I his approacn should
help in deciding usefulness of surveillance activities. The natuie and
depth of analysis can be decided based on specific inputs ano requirements
for programmes.
19
The City of Bengaluru
The city of Bengaluru is a recognizable landmark
on the national and global map for its technological,
educational and economic growth. The city of
Bengaluru, as per tire boundaries delineated by BBMP
was identified for the programme and a brief profile
of the city is given in Table 5.
O
G
What changed in Bengaluru in 2009
The city of Bengaluru moved ahead in several areas.
Some important changes that are of relevance to
injuries are highlighted below as illustrative
examples.
O
In the year 2009, the city added 348,707
vehicles onto its roads. Among them, 233,699
were two wheelers, 122,910 were cars and odter
vehicles like buses, trucks etc., accounted for
the rest.
The BMTC added 571 new buses, increasing
its total fleet strength to 5344. Correspondingly,
the trips and schedules increased by 9%. The
system transports approximately 40, 00,000
people every day, an increase of 2% compared
with 2008.
A few infrastructure projects were completed
and opened for public. Important among them
Table 5: Bengaluru City - A Socio Demographic Profile - update in select areas and
show 2008 and 2009 together
SI. No
1
2
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Parameters
Area
Population
Density
Contribution to Karnataka state population
Sex Ratio (Females/1000 males)
Life expectancy at birth
Crude birth rate/1000
Crude death rate/1000
Decennial growth rate
Total number of slums
Total population in slums
Slum population%
Socially disadvantaged population (%)
Literacy rate%
Total number of schools and colleges
Total number of factories
Total number of police stations
Total number of hospitals (including public, private hospitals & nursing homes)
Total number of Drug stores
Total number of General practitioners
Total length of roads
Total number of police personnel (traffic)
Total number of police personnel (law and order)
Total number of registered vehicles
Number of alcohol selling oudets (CL-2, 4, 5, 6, 6A, 7, 9, 14 & 15) Licensees
Indian Made Liquor sold for the year 2007 - 2008
Total revenue from IML & Beer
2009
800 sq. kms
7 million
2980/sq.km
11%
915
64.2 years
19.1
7.2
1.3%
733
4,30,501
10
40
83.91
7674
6024
142
572
4445
H” 5000
1500 kms
3,102
11,908
3.4 million
H” 2400
325.48 lakh CBs
Rs.3478cr
Source
1
2
3
4
5
6
7
20
http://www.bmponline.org
www.bangaloreit.com
http://www.experiencefesrival.com/slum
http://www.hindu.com/2007/04/28/stories/
2007042802250200.htm
www.censusindia.com
www.des.kar.nic.in
Karnataka Education Departments
BRSIPP 2009
8
9
10
11
12
13
Small. Medium and Large scale industries Corporation
BCP Bengaluru City Police
KSPCB Karnataka Stare Pollution Control Board
Karnataka state Drugs control General
www.rto.kar.nic.in/bng-veh-stat.htm
Karnataka State Beverages Corporation Limited
I
1
2
3
2
2
4
5
2
6
7
8
9
10
11
10
1
12
13
13
13
O
O
O
O
O
were the Yeshwantpur flyover, 11 pedestrian
subways, 60 bus bays and 74.28 km of concrete
roads.
The city also witnessed construction of several
concerete-rigid medians on some of its roads.
It took little time to realise that these could
have been designed better.
The metro work continued in the city and is
expected to be completed in 2010 with the
opening of sector 1. However, the ongoing
metro work was a major impediment and
bottleneck for the traffic flow. It also created a
few major injuries during the year and many
of them night have gone unnoticed.
Environmentalists, NGOs and public were up
in arms for the felling of hundred’s of tress and
loss of green belts in the city (which was
considered essential for metro works).
Probably, thousands of people would have
migrated to the city, taking the total population
of the city to 7 million in an area of 800 sq
kms with a population density of 2980 / sq.
km.
New alcohol outlets were also opened in the
city, taking the total number of alcohol selling
outlets to approximately 2400. There was a
O
O
change in the timings of alcohol selling outlets
with an extension from 10.30 pm to 11.30 pm.
The economic recessions that became
prominent since middle of 2008 had an effect
on Bengalureans and many business sectors
were affected considerably. During the year,
employment, travel, hotel, entertainment and
others were affected most and were in a
depressed phase, even though the last 3 months
have seen a slow recovery. Due to this, the travel
exposure might have come down (the total
km travelled data is not available)
considerably.
Year 2009 turned out to be a very tragic
year for at least 4489 families with the
sudden and unexpected loss of their family
members due to an injury. These 4500
families will take many years to recover or
may not recover at all. The effect of these
deaths alone will be felt for many years to
come by their families and is just the
beginning of turbulent life for them.
The deaths and injuries of these young
ones will be an immense loss for their
families, employers, friends and society at
large.
B1. Injury deaths
Data on all deaths, including injury deaths, was
collected from the vital statistics division of BBMP
In 2008, there were 31,811 deaths, which increased
to 43,648 deaths in 2009. There was an addition of
11837 deaths in the intervening 365 days period.
Since computerisation and analysis of 2009 data is
still in progress, 2008 data has been used for
discussion in this report.
In summary, it is estimated that nearly 4000 persons
would have died due to an injury in 2008. The total
number of injury deaths from police sources for the
same period was 4497. Among total deaths of 2008,
20,117 were males and 11,694 were females,
respectively. The age - sex distribution is shown in
Figure 8, and it can be seen that highest deaths
for all cause mortality was in the age group of
70+ years.
Figure 8: Age Sex distribution of deaths, 2008
(BBMP data)
Communicable diseases accounted for 15 % (4601)
of deaths, while NCDs and injuries contributed for
74 % (24,237) and 11 % (2973) of total deaths. The
proportions of injuries might probably be an
underestimate due to well known reasons like
misclassification, nonreporting of injuries as
underlying causes of death, undefined categories.
non-availability of information in late post hospital
deaths and other causes.
21
Figure 9: Major causes of death, 2008
Specific analysis of injury deaths revealed that
more than two thirds of injury deaths (64.4 %)
occurred in 15 - 44 years, with variation as
per causes. Proportionately, more injury deaths
occurred among women in the 15-34 yrs age
group, with preponderance of males in later age
groups.
Figure 10: Age sex distribution of
injury deaths, 2008
The top 10 conditions that lead to death in 2008 are
given in Table 6. Examination of contribution of
injury causes for deaths revealed that injuries
occupied the 3rd leading condition for deaths.
Disaggregated data showed that traffic accident,
bums, suicides and other injury causes occupied 10'",
12th, 15th and 17,h rank, respectively. In total, RTIs
and suicides accounted for 2.9% and 2 % of total
deaths, respectively.
Table 6: Top 10 causes of death in Bengaluru
Sr.
No
1
2
3
4
5
6
7
8
9
10
11
Cause of Death
Ischemic Heart Disease
Neoplasm
Injury
Diabetes mellitus
Respiratory Diseases
Hypertensive disease
Liver Diseases
Cerebrovascular diseases
Tuberculosis
Pulmonary heart Disease
Other causes
Number of
Deaths
5015
3270 .
2973
2483
2320
1972
1608
1603
1329
1238
8000
Detailed analysis was performed to identify top 15
leading causes of death in different age groups and
both sexes. Tables 7,8,9 indicate that
O
Injuries are leading cause of death in younger
age groups of 15-44 years.
O
Traffic crashes are the leading cause of death
in 25-34 yrs age groups.
O
Burns are the foremost cause among women
in 15-34 yrs age groups.
O
Intentional self harm accounted for 9.35%
deaths in 25-34yrs.
Comparison of injury causes between police and vital
statistics division data showed major differences,
reflecting information gathering practices. Transport
accidents were higher in BBMP data (based on death
certificates), while suicides were more in police data.
Our previous research in suicides has shown that
suicidal deaths are not properly documented in
hospital deaths for medico legal reasons. Similarly,
some unspecified and unclassified deaths are included
in police sources as suicides. If RTIs are the
underlying cause of death, they are not documented
in death certificates. This shows that there is
considerable scope for improving vital statistics data
based on death registration systems.
82. Urban injuries
After intense data gathering activities in 2008, 2009
was devoted primarily for review, streamlining and
consolidation of activities in all institutions. After
the stake holder’s consultation meeting on Jan 28,
2009, all partners were encouraged to discuss with
their heads of institutions and colleagues to improve
and strengthen mechanisms for data collection.
Consequently, data collection continued at different
22
BRSIPP 2009
points of time and data on nonfatal injuries is not
available from all institutions uniformly for the
entire T2 month period in a uniform manner. In
2010, the mechanisms have been strengthened in
all partner hospitals and 8 new partner institutions
have joined the programme. Hence, the data on
nonfatal injuries indicates only the broad trends
and patterns.
Table 7: Top 15 Leading Causes of Death in Bengaluru City : Persons
SI No.
0-4 yrs
5 - 14 yrs
15 - 24 yrs
25 - 34 yrs
35 - 44yrs
45 - 54yrs
55 - 64 yrs
Above 65 yrs
Total
1
Perinatal
deaths
Neoplasms
Burns
Burns
Liver diseases
Neoplasms
' Ischaemic heart
diseases
Ischaemic heart
diseases
Ischaemic heart
diseases
2
Congenital
malformations
Viral Infections
Suicide
Transport
Crashes
Neoplasms
Ischemic heart
disease
Neoplasms
Diabetes Mellitus
Neoplasms
3
CNS Infections
Bums
Transport
Crashes
Suicide
Ischemic Heart
Disease
Liver diseases
Diabetes Mellitus
Hypertensive
diseases
Diabetes Mellitus
4
Diarrhoeal
diseases
Transport
Crashes
Tuberculosis
Tuberculosis
Tuberculosis
Diabetes Mellitus
Hypertensive
diseases
Neoplasms
Respiratory
disorders
5
Viral diseases
Respiratory
disorders
Neoplasm
Neoplasms
Respiratory
disorders
Tuberculosis
Respiratory
disorders
Respiratory
disorders
Liver diseases
6
Neoplasms
Digestive Sytem
disorders
Digestive Sytem
disorders
Liver Diseases
Transport
Crashes
Respiratory
disorders
Liver Diseases
Cerebrovascular
diseases
Hypertensive
diseases
7
Respiratory
disorders
CNS infections
Other injury
causes
Respiratory
disorders
Cerebrovascular
diseases
Cerebrovascular
diseases
Cerebrovascular
diseases
Pulmonary heart
diseases
Cerebrovascular
diseases
8
Burns
Rheumatic
heart disease
Respiratory
Infections
Ischemic Heart
Disease
Bums
Hypertensive
diseases
Pulmonary
heart diseases
Urinary System
disorders
Thberculosis
9
Transport
Crashes
Congenital
malformations
Pregnancy &
Childbirth
Other injury
causes
Diabetes Mellitus
Pulmonary
heart diseases
Diseases of
urinary system
Liver diseases
Pulmonary heart
diseases
10
Tuberculosis
Tuberculosis
Rheumatic
heart disease
CNS infections
Suicide
Transport
Crashes
"Riberculosis
Tuberculosis
Urinary System
disorders
11
Rheumatic
heart disease
Bacterial
diseases
CNS infetions
Urinary System
disorders
Hypertensive
diseases
Urinary System
disorders
Transport
crashes
Diseases of the
Nervous System
Transport
Crashes
12
Other injury
causes
Other injury
causes
Viral diseases
Cerebrovascular
diseases
Pulmonary
heart diseases
CNS infections
CNS disorders
Intestinal
infectious diseases
Perinatal deaths
13
Malnutrition
Haemopoeitic
disorders
Urinary System
disorders
Viral diseases
Urinary' System
disorders
Suicide
Other bacteria!
diseases
Other bacterial
diseases
Burns
14
llaemopoeitic
disorders
Cardiovascular
diseases
Bacterial diseases
CNS infections
Viral diseases
Viral diseases
Other diseases of
the circulatory
system
Transport
crashes
CNS disorders
15
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Total
1382
348
1285
2128
2829
4200
5323
12390
31811
Miscellaneous includes all other conditions with smaller numbers after the first 14 causes
BRSIPP 2009
Table 8: Top 15 Leading Causes of Death in Bengaluru City : Males
SI No.
0-4 yrs
5 - 14 yrs
1
Perinatal
deaths
Neoplasms
Transport
crashes
2
Congenital
malformations
Viral diseases
3
Diarrhoeal
diseases
4
35 - 44yrs
45 - 54yrs
55 - 64 yrs
Above 65 yrs
Total
Transport
crashes
Liver
Diseases
Ischaemic heart
diseases
Ischaemic heart
diseases
Ischaemic heart
diseases
Ischaemic heart
diseases
Suicide
Suicide
Ischaemic heart
diseases
Liver Diseases
Neoplasms
Diabetes Mellitus
Neoplasms
CNS Infections
Bums
Tuberculosis
Tuberculosis
Neoplasms
Diabetes Mellitus
Neoplasms
Diabetes Mellitus
Neoplasms
Bums
Tuberculosis
Liver Diseases
Transport crashes
Tuberculosis
Liver Diseases
Hypertensive
diseases
Liver Diseases
5
Viral diseases
Transport crashes
Neoplasms
Burns
Neoplasms
Diabetes Mcllitus
Hypertensive
diseases
Cerebrovascular
diseases
Hypertensive
diseases
6
CNS infections
Respiratory
diseases
Other Injury
Causes
Ischaemic heart
diseases
Cerebrovascular
diseases
Cerebrovascular
diseases
Cerebrovascular
diseases
Lower respiratory
diseases
Cerebrovascular
diseases
7
Respiratory
Diseases
Other CNS
diseases
Digestive System
Disorders
Neoplasms
Diabetes Mcllitus
Transport crashes
Pulmonary
Heart Disease
Pulmonary Heart
Disease
Tuberculosis
8
Burns
Congenital
malformations
Rheumatic
Heart Disease
Other Injury
causes
Suicide
Hypertensive
diseases
Tuberculosis
Urinary System
Disorders
Pulmonary
Heart Disease
9
Other diseases of
the nervous
system
Bacterial diseases
Respiratory
Diseases
Urinary System
diorders
Hypertensive
diseases
Pulmonary
Heart Disease
Lower respiratory
diseases
Liver Diseases
Transport crashes
10
Hiberculosis
Other Injury
causes
Viral diseases
Cerebrovascular
diseases
Other Injury
Causes
Urinary System
Disorders
Urinary system
disorders
Pneumonia
Lower respiratory
diseases
11
Transport crashes
Rheumatic
Heart Disease
Diseases of
urinary system
CNS Infections
Pulmonary Heart
Disease
Lower respiratory
diseases
Transport crashes
Tuberculosis
Urinary System
Disorders
12
Rheumatic Heart
Disease
Tuberculosis
CNS infections
Pneumonia
Urinary System
Disorders
Suicide
Pneumonia
Other CNS
diseases
Perinatal Deaths
13
Haemopoeitic
Disorders
Digestive
disorders
Other bacterial
diseases
Viral diseases
Bums
Other Injury
causes
Other diseases of Transport crashes
the nervous system
14
Other injury
causes
Haemopoeitic
disorders
Other CNS
diseases
Other CNS
diseases
Viral diseases
Pneumonia
Other bacterial
diseases
Other bacterial
diseases
Other injury
causes
Miscellaneous
Miscellaneous
Miscelaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
182
676
1348
1995
2886
3181
7305
20117
15
Total
|
861
15-24 yrs
25 - 34 yrs
Suicide
Table 9: Top 15 Leading Causes of Death in Bengaluru City : Females
NJ
un
SI No.
0-4 yrs
5 - 14 yrs
15 - 24 yrs
25 - 34 yrs
35 - 44yrs
45 - 54yrs
55 - 64 yrs
Above 65 yrs
Total
1
Perinatal deaths
Viral diseases
Bums
Bums
Neoplasms
Neoplasms
Neoplasms
Ischaemic heart
diseases
Ischaemic heart
diseases
2
Congenital
malformations
Bums
Suicide
Suicide
Bums
Ischaemic heart
diseases
Ischaemic heart
diseases
Diabetes Mellitus
Neoplasms
3
Diarrhoeal
Diseases
Neoplasms
Maternal Deaths
Neoplasm
Tuberculosis
Diabetes Mellitus
Diabetes Mellitus
Hypertensive
diseases
Diabetes mellitus
4
CNS infections
Transport crashes
Tuberculosis
Tuberculosis
Ischemic heart
diseases
Hypertensive
diseases
Hypertensive
diseases
Neoplasms
Hypertensive
diseases
5
Viral diseases
Diarrhoeal
Diseases
Respiratory
Diseases
Respiratory
Diseases
Liver Diseases
Liver Diseases
Cerebrovascular
diseases
Cerebrovascular
diseases
Bums
6
Bums
Rheumatic
Heart Disease
Neoplasms
Maternal Deaths
Diabetes Mellitus
Htberculosis
Urinary System
Disorders
Lower respiratory
diseases
Cerebrovascular
diseases
7
Neoplasms
Tuberculosis
Liver Diseases
Ischaemic heart
diseases
Viral diseases
Cerebrovascular
diseases
Malignant
neoplasms of
genitourinary
organs
Pulmonary Heart
Disease
Pulmonary heart
Disease
8
Other CNS
diseases
Other CNS
Diseases
Rheumatic
Heart Disease
Rheumatic
heart Disease
Pneumonia
Pulmonary
Heart Disease
Pulmonary heart
Disease
Urinary System
Disorders
Urinary System
Disorders
9
Pneumonia
Pneumonia
Transport crashes
Pneumonia
Other bacterial
diseases
Urinary Sytem
Disorders
Tuberculosis
Pneumonia
Tuberculosis
10
Transport crashes
Haemopoeitic
Disorders
Urinary System
Disorders
Diabetes Mellitus
Cerebrovascular
diseases
Lower respirator}'
diseases
Lower respiratory
diseases
Other CNS
Diseases
Lower respiratory'
diseases
11
Other Injury
causes
Congenital
malformations
Haemopoeitic
Disorders
Cerebrovascular
diseases
Hypertensive
diseases
Viral diseases
Liver Diseases
Liver Diseases
Perinatal Deaths
12
Tuberculosis
Other bacterial
diseases
Viral diseases
Liver Diseases
Pulmonary Heart
Disease
Bums
Pneumonia
Tuberculosis
Liver Diseases
13
Malnutrition
CNS infections
Other Injury
Causes
Viral diseases
Rheumatic Heart
Disease
Other bacterial
diseases
Other bacterial
diseases
Diarrhoeal
Diseases
Suicide
14
Rheumatic Heart
Disease
Malaria
Other bacterial
diseases
Haemopoeitic
Disorders
Urinary System
disorders
Other CNS
Diseases
Other Circulatory
disorders
Haemopoeitic
Disorders
Pneumonia
15
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Total
521
609
780
727
1314
1663
5085
11694
Figure 11: Comparison of injury deaths using different information sources, 2008
Police data
BBMP data
In 2009, there were 4489 injury deaths registered
with police and 34225 persons were registered in
study centres. With an underreporting of 10 % for
injury deaths, it can be concluded that nearly 5000
injury deaths would have occurred in the city during
2009. Usingi conservative figures of 1:20:5.0, for
deaths to serious injuries to mild injuries in 2009,
there were estimated 5000 injury deaths (police
data), nearly 1,00,000 serious and 2,50,000 mild
injuries.
Figure 12: Bengaluru Injury Pyramid, 2009
Rural Injuries
Brief profile of Tumkur
Tumkur is one of the 27 administrative districts of
Karnataka state, located North-west of Bangalore
at a distance of about 70 kms. The district is bounded
by Mandya District in the South; Chitradurga and
Hassan districts in the West; Chikkamangalore in
the Northeast and Ananthapura District of Andhra
Pradesh state in the Southeast direction. Tumkur town
is the administrative head quarter of the district and
is a centre for commercial, business and educational
activities. It is home to Tumkur University, four
Engineering and a Medical college and other
institutions of importance. The district is famous
for its iron ores. It has a population of 2.5
million.
the district. Injuries are one of the top leading causes
of death in this district with a population of
approximately 2.6 million. Males and females
accounted for 770 and 539 deaths, respectively, and
once again, highest number of deaths occurred in
15- 44 yrs age group.
In the same period, the medical college hospital
registered 2165 injured persons in the ER. Using
conservative estimates as reported in earlier sections,
it is estimated that there would be 1500 deaths
(police data), 30,000 hospitalisations (26180) and
75000 minor injuries in 2009. Further details on
profile and pattern of injuries in rural area are
provided in different sections of the report and in
the fact sheet.
The rural component of Road safety and Injury
prevention programme is being carried out in
Tumkur with the participation of District police,
District hospital and Sree Siddhartha Medical
College. In 2009, the district police registered a total
of 1309 Injury deaths. Among them, 435 deaths were
due to road crashes, 366 were suicidal deaths and
371 were due to other unnatural causes. With a 10
% underreporting as seen from earlier studies, it is
estimated that there will be 1500 injury deaths in
26
BR5IPP 2009
Figure 13: Rural Injury pyramid, 2009
RTIs and suicides are major injury causes
Among the various causes of injuries, RTIs are a
leading cause of deaths and hospitalisations. RTIs
accounted for 31% of deaths as per data of vital
statistics division, 20% as per police records and
62.7% of hospitalisations in Bangalore. In the rural
area the contribution was 34.4% and 51.5 %,
respectively (Fig. 14).
Suicides or Deliberate self harm was the second
leading cause with 1325 deaths (CCRB data) and
1509 hospital contacts. The intent is the
differentiating factor between natural, suicidal and
homicidal deaths and requires skills with
investigative agencies and systematic documentation
and review of events prior toldeath.
Burns can be accidental, suicidal or homicidal and
once again requires a careful scrutiny of intent. As
per delta in table 9, burns were the leading cause of
mortality among women in 15- 24yrs and 25 - 34
yrs age groups (BBMP data).
Poisoning due to a variety of substances (common
ones being Organophosphorus compounds and
drugs) is a common contributor for ?uicides. It is
important to differentiate the intent here to separate
suicidal and accidental (occasional homicidal
ones);
:
Even though work related / occupational injuries
are quite common, their contributions for deaths were
not exactly available in the official reports.
1
1
There were no major disasters that contributed
for deaths and injuries during the year 2009 in the
city.
Figure 14: Comparison of the distribution of causes of injury deaths in urban and rural areas 2009
B5. Injuries affect young people
In comparison to communicable diseases which
primarily affect children, and NCDs affecting late
middle aged and elderly people, injuries are a problem
of young people. Sixty five percent of deaths (BBMP)
and 66.9 % of hospitalisations occurred in the age
group of 15-44 years. Men accounted for 64.17% of
deaths and 79.9 % of hospitalisations, while women
contributed for 35.83% deaths and 20.1.% of
hospitalisations, respectively. In rural areas, the
distribution was almost similar with increased
occurrence among men and in younger age groups.
There are several reasons for preponderance of injuries
among young people and in men and are linked to
social, cultural, psychological, biological,
environmental, product / vehicle related reasons. The
risk taking nature of young people coupled with type
of products and vehicles and the environment they
are use add for their injury predilection.
Irrespective of data sources, nature of injuries, or injury
causes, the data highlight that young people in 15 44 years are affected most in injuries (
Fig. 15). This is a major difference in comparison
with causes of deaths and hospitalisations. This is
also a specific reason as to why road safety and injuiy
prevention should be given importance as young
people are most vital for any family and any society.
Figure 15: Age -sex distribution of injuries (%)
28
BRSIPP 2009
B6. Injury deaths are distributed in phases
Usually, injuries follow a trimodal distribution, with
(Heaths occurring soon after a crash or an injury, few
dluring transfer to hospital and others after admission
t o the hospital. Some deaths occur as late
complications of injury after discharge from the
Inospital. The precise proportion of these deaths vary
ans per cause and are influenced by many factors like
ange , sex, nature and type of injury, availability of
care, level of safety policies and a number of other
factors.
Data from rural part of surveillance programme in
Tumkur revealed that almost half of the deaths
occurred at the injury/crash site.
Among RTI deaths in Bengaluru, 38 % of victims died
at the crash site, 11 % during transport to hospital and
51 % in the hospital. Less than a °/o died soon after
discharge. Among BMTC crashes, nearly half (45.4%)
died at the spot, 7.4% before reaching hospital and
47.2% in the hospital. In rural areas, nearly half died
at site soon after injury (Fig. 16).
Figure 16: Place of Death (%)
RTI deaths in Bengaluru
Injury Deaths in Himkur
BMTC crashes
B7. Road crashes, deaths and hospitalisations
Iln 2009, there were 754 road deaths as reported by
[police sources. Discrepancies in deaths between police
sources and BBMP vital statistics division sources
could probably be due to different data sources and
[methods of reporting. Attempts will be made towards
[reconciliation of these differences in the year 2010. It
iiis known that late deaths that occur due to
(complications of RTIs are neither reported in police
cor vital statistics reports as the associated or underlying
(causes of injury deaths are not mentioned in both.
"These deaths would have occurred beyond tire 30 day
[reporting time required for RTIs as per legal
(definitions. A study undertaken by NIMHANS on
"Traumatic Brain Injuries in 2005 revealed that 13%
oof brain injuries (mostly due to RTIs) had died within
12 months of hospital discharge (based on domiciliary
ifollow up visits) (29). Applying these figures for the
[year 2009, it is estimated that the city would have an
collection from 3 large hospitals was limited in 2009
due to administrative and resource contacts and the
same 3 hospitals contributed nearly 18,000 RTI
patients in 2008. With the assumption that probably
same number of patients would have sought care in
2009 ( with variations, of course), the estimated
numbers would be in the range of40,000 RTI patients
in 2009 due to RTIs in the city of Bengaluru.
The situation in rural areas could be far more
different due to poor documentation of events. In
Tumkur district, there were 435 reported deaths due
Figure 17 : Trend of Road deaths in Bengaluru
•estimated 852 deaths due to RTIs.
"With regard to nonfatal injuries, data was available
ifrom 21207 hospital contact RTI patients. The data
29
to RTIs in 2009. Using similar methods of estimation,
it is estimated that the district would have witnessed
nearly 500 deaths and 10,000 hospital contacts due
to road crashes in 2009.
For the 2nd consecutive year, the city recorded a
decline in registered RTI deaths from 961 in 2007 to
754 in 2009. Reasons for this could be several and
identifying them would be guesswork as relative
contributions are difficult to establish. Some
contributing factors could be increasing enforcement
from city police, increasing traffic congestion due
to addition of 348,707 vehicles, separation of traffic
in roads with new medians (however, there were
not many crashes in these areas earlier also), ongoing
infrastructure expansion and traffic blocks due to
metro works in many parts of city ,or could simply
be a partial effect of economic recession (it is
acknowledged that economic recession reduces risk
of exposure as people travel less during these times.
Apart from increasing enforcement (greater
commitment and training of all police personnel),
there were no other visible interventions in the city
in the year. The trends need to be observed for the
coming years to make clear conclusions.
B7.1. Crashes had a pattern as per
locations
The city has 39 police station subdivisions spread
over an area of 800 sq. km. Data revealed that
highest number of fatal crashes occurred in 10 areas,
accounting for 48% of total fatal RTIs. The
distribution was similar across months and, in all
12 months, these top 10 areas remained high in the
ranking (Fig. 18 and Table 10).
Further analysis revealed that within each of these
areas, specific roads which are connecting to
national or state highways accounted for 54% of
fatal crashes. In the case of Madivala with 55 deaths,
Hosur road had recorded 32 deaths. Similarly, in
Byatarayanapura, of the 53 deaths, 28 deaths were
on Mysore road. In Yelahanka, 23 of the 39 deaths
were on Bellary road. All these roads in the above
examples are entry and exit stretches of national
and state highways with greater movement of goods
vehicles, traffic and people. In all other areas, RTIs
were spread out in different locations, moving from
place to place in a non-random method (Fig. 18).
30
BRSIPP 2009
The surveillance data using epidemiological analysis
has identified geographical areas with high fatal
crashes. Further analysis is required to see any
specific clustering of crashes on these roads as the
average length of each road in city boundary limits
is 20 ( +/- 5) kms. Most of the people killed on
these roads were pedestrians and two wheeler drivers
and were hit by buses or trucks. Microanalysis of
crash patterns will be taken up in these 10 areas
during 2010 on a prospective basis.
While accident black spots are generally known
to shift from location to location over time, area
wide traffic calming measures need to be
considered by authorities. In general, it needs to
be seen whether a combination of engineering /
traffic calming measures, increased enforcement,
stationing of ambulance at strategic locations,
combined with greater road safety awareness in
these areas will help reducing crashes. Some
possible options include traffic separation, safer
footpaths and crossing facilities, increasing road
and vehicle visibility, speed control, augmented
programmes on drink drive - helmets and
seatbelts, placement of ambulances at strategic
locations and others. All these can be included
and developed as “Area wise traffic and road safety
programmes “with integration of activities.
B7.2. Vulnerable road
affected most
users
are
Findings from different studies in India have indicated
that pedestrians, two wheeler drivers and pillions
and bicyclists are involved in large number of crashes
in India (3,4,5). Data from BRSIPP once again
confirm this finding for Bengaluru. In 2009, 350
pedestrians, 198 two wheeler riders, 92 two wheeler
pillions and 36 bicyclists lost their lives in crashes.
These 3 groups, in total, contributed for
76 % of total road deaths. Figure 19 shows the
relative contributions of different road user categories
in urban and rural areas for both fatal and non-
fatal RTIs.
Among nonfatal injuries, the distribution remained
similar with the vulnerable road users accounting
for 81.3% of total hospital registrations due to R f's-
The distribution across hospitals was different
depending on the total volume of trauma patients.
Iin the nearby rural area of Tumkur, crashes though
leesser in numbers, resulted in greater number of
deaths among VRUs. Nearly, 121 pedestrians, 110
t’wo wheeler drivers, 36 pillions and 16 bicyclists
were killed in crashes. The hospital data also showed
similar distribution with a preponderance of deaths
and injuries among VRUs.
Integrated strategies for reducing deaths and
injuries among VRUs need to be considered by
authorities.
Figure 18a: Fatal crashes in different traffic police station limits, 2009
Figure 18b: Distribution of Fatal RTIs along with approximate speed limits
31
BRSIPP 2009
Table 10 : Location of crashes in high risk areas of Bangalore
Area
SI No
Total
Deaths
2008
Total
Deaths
2009
1
Byatarayanapura
48
56
2
Madivala
56
55
3
K.R. Puram
98
40
4
Yelahanka
45
39
5
Electronic City
6
Yeshwantapura
7
Devanahalli
8
Peenya
50
25
9
Banasawadi
32
24
10
Mico Layout
26
24
L
37
49
30
28
Total
Pedestrians
Major Roads
Mysore Road
Kengeri Ring Road
Nice Road
80Feet Road
Others
Hosur Road
Ring Road
Others
Old Madras Road
Ring Road
ITPL Road
Others
Bellary Road
Doddaballapur Road
Others
Hosur Road
Konena Agrahara gate
Others
Tlimkur Road
Jalahalli
HMT Main Road
Others
Bellary Road
Others
Tumkur Road
Hesaraghatta Road
Others
Ring Road
Old Madras Road
Others
Bannerghatta Road
BTM Layout
Hosur Road
Others
28
5
6
4
13
32
13
10
12
11
3
14
23
9
Two
Wheelers
Cyclists
Car
Drivers
Lorry
Drivers
Others
23
24
1
0
4
4
28
23
3
1
0
0
12
24
1
2
0
1
20
12
2
2
0
3
19
12
2
2
0
2
15
13
0
0
15
10
0
1
1
1
7
11
3
0
0
4
13
8
1
0
0
2
11
9
2
1
0
1
7
18
6
13
11
7
5
7
19
9
12
3
10
7
4
2
13
8
5
3
8
Figure 19: Road User categories in RT1 deaths and injuries (%), 2009
Urban
Fatal
Non-fatal
Others
Car occupant l—J
Two wheeler rider
10
20
30
40
30
40
Rural
Fatal
Non-fatal
Bas Orrsor p
Unknown U
Bus/Truc* 6rr.tr []
F
Others 0
Car dnver O
Other 4 wheeler occupant |
|
Pedal cyclist
Pedal cyclist czu
Pedestnan
5
20
25
30
35
10
METRO / STATE
20
50
Thursday. January 29. 2009
Disturbing facts
Drunken driving on the rise
Pedestrians
are not safe
Killer two-wheelers
H •*»
■ Ml 430
»i»
W1J00
■ ”»
33
B6. Injury deaths are distributed in phases
Usually, injuries follow a trimodal distribution, with
deaths occurring soon after a crash or an injury, few
during transfer to hospital and others after admission
t0 the hospital. Some deaths occur as late
complications of injury after discharge from the
hospital. The precise proportion of these deaths vary
as per cause and are influenced by many factors like
age , sex, nature and type of injury, availability of
care, level of safety policies and a number of other
factors.
Data from rural part of surveillance programme in
Tumkur revealed that almost half of the deaths
occurred at the injury/crash site.
Among RTI deaths in Bengaluru, 38 % of victims died
at the crash site, 11 % during transport to hospital and
51 % in the hospital. Less than a % died soon after
discharge. Among BMTC crashes, nearly half (45.4%)
died at die spot, 7.4% before reaching hospital and
47.2% in the hospital. In rural areas, nearly half died
at site soon after injury (Fig. 16).
Figure 16: Place of Death (%)
B7. Road crashes, deaths and hospitalisations
In 2009, there were 754 road deaths as reported by
police sources. Discrepancies in deadts between police
sources and BBMP vital statistics division sources
could probably be due to different data sources and
methods of reporting. Attempts will be made towards
reconciliation of these differences in the year 2010. It
is known that late deaths that occur due to
complications of RTIs are neither reported in police
or vital statistics reports as die associated or underlying
causes of injury deaths are not mentioned in both.
These deaths would have occurred beyond the 30 day
’eporting time required for RTIs as per legal
definitions. A study undertaken by NIMHANS on
Traumatic Brain Injuries in 2005 revealed that 13%
of brain injuries (mostly due to RTIs) had died within
12 months of hospital discharge (based on domiciliary
follow up visits) (29). Applying these figures for the
collection from 3 large hospitals was limited in 2009
due to administrative and resource contacts and the
same 3 hospitals contributed nearly 18,000 RTI
patients in 2008. With the assumption that probably
same number of patients would have sought care in
2009 ( with variations, of course), the estimated
numbers would be in the range of40,000 RTI patients
in 2009 due to RTIs in the city of Bengaluru.
The situation in rural areas could be far more
different due to poor documentation of events. In
Tumkur district, there were 435 reported deaths due
Figure 17 : Trend of Road deaths in Bengaluru
year 2009, it is estimated that the city would have an
estimated 852 deaths due to RTIs.
W‘th regard to nonfata! injuries, data was available
ft°m 21207 hospital contact RTI patients. The data
29
These observations clearly indicate that safety of
VRUs should be given importance on Indian roads.
Even as the proportion of car users continues to
increase, two wheelers are still going to occupy the
top slot in MV registrations for many more years to
come with the current rate of economic growth.
Walking and cycling will remain important and
essential modes of travel and safety and health of
these groups needs to be ensured. The safety of these
groups should be seen as vital in urban roads, on
highways and in rural parts of India. Road / vehicle
safety aspects and enforcement of road safety
regulations need to be given high importance apart
from targeted education of these groups.
B7.4. Safety of Public Transport systems
Amidst a large number of vehicles on the streets of
Bengaluru, Public and private buses play a crucial
role in transport of people and goods both within
and outside the city. The Bangalore Metropolitan
Transport Corporation plays a central role and
transports millions of people every day.
Based on the findings of the study, a preliminary
report was submitted along with recommendations
for improving safety scenario.
In 2009, data collection mechanisms were
strengthened and improved. The data collection was
undertaken comprehensively for the period
2007 - 09 and a total of 293 records were analysed.
Data collection was done by a trained research
officer from the CC as staff was not available within
BMTC for this activity. A redesigned and validated
proforma was finalised in consultation with BMTC
staff. Data was collected from available records and
each record was totally reviewed in a systematic
way and specific information was transferred to the
forms. The collected data was analysed using
EPI - INFO. The trend of BMTC fatal bus crashes is
shown in Figure 26.
A comprehensive report highlighting the crash
patterns of BMTC buses has been completed and is
pending acceptance and approval by the authorities
(available on request). The report has several
recommendations aimed at improving safety
performance of buses.
In 2008, the available data was collected from BMTC
records and a preliminary survey was completed.
Figure 26: Fatal and non-fatal crashes (resulting in serious injuries) invloving BMTC buses, 2000-2009
Fatal
Non-fatal
Year
B8. Risk factor information
B8.1
Helmets
Two wheelers have increased significantly on the
roads of Bengaluru in the last decade (Fig. 27).
Increase in two wheeler vehicles are primarily due
to its ease of driving, easy availability, greater income
levels of people, media promotion and inability to
afford cars. Among two wheeler riders, injury to
head and face was seen in 79% and 28% of deaths
respectively, while 80% and 26 % of pillions had
similar injuries. Injuries to brain and facial organs
36
BRSIPP 2009
are a common cause of deaths within this group.
Figure 27: Growth of Two-wheelers in Bengaluru
Use of helmets is an established method for reducing
brain injury related deaths and injuries. A helmet
primarily reduces the impact of the collision and
thereby consequent injury to the brain by (30)
G
Acting as a mechanical barrier between the
skull and the impacting object.
G
Reducing the deceleration of the skull, and
hence the brain movement.
O
Providing a cushioning effect through the
padding thermocole lining which absorbs the
impact and brings the head to a halt slowly.
O
Spreading the force of the impact to a larger
area so that energy is distributed through the
outer shell of a helmet.
O
The shell also protects against penetration of
the skull by any sharp pointed objects.
O
Keeping the helmet on the head in a crash
through chinstraps.
Figure 28 : Two-wheeler deaths in
Bangalore (1996-2009)
IKarnataka introduced partial helmet legislation (in
tselect cities and only for riders) on November 6,
22006. The Karnataka Motor Vehicles rules, 1989
IRule: 230 stipulates that every person while driving
oor riding a motor cycle of any type, that is to say,
unotor-cycles, scooters and mopeds shall wear
[protective headgear of such quality which will reduce
lhead injuries to riders of two-wheeler resulting from
lhead impacts. In addition, it also highlights that
lhelmets should confirm to standards and should also
ccarry reflective tapes of 2 x 13cms to increase
visibility.
peripheral parts of city ( on ring roads, residential
areas, on highways ), during weekends, at night times
are low compared to central - business areas due to
varying levels of enforcement (Fig. 29).
Figure 29: Helmet usage among fatal and
non-fatal RTIs
Examining helmet use rates among dead and injured
people, though not a good measure, still indicates
and helps in establishing the efficacy and
effectiveness of helmets among those with different
levels of injury severity. Data showed that among
the killed and hospitalised, only 44% and 51% had
worn helmets at the time of crash. Among the fatal
RTIs in Tumkur district, only 8 % of the two wheeler
riders had used helmets. More data is required on
type, nature and wearing pattern to clearly
understand people’s practices and helps in education
programmes. Recently, an independent study on
“prevalence of non-standard helmet use “has been
completed and data analysis is in progress.
Enforcement by police for violator’s not using helmets
has been stepped up in the last 2 years as indicated
by the number of people booked for violations (Fig.
30). The number of people booked for not wearing
helmets has remained around 2,00,000 cases per
year along with an increase in fine amount in recent
days from Rs. 100 to Rs.500 in the same period.
Figure 30: Cases Booked by the Bangalore city
police for not using helmets
iDur data show that the current use of helmets within
“he city has gone up from less than 10 %
zprelegislation to between 60 - 70 % post legislation.
TThe usage rates vary in different parts of the city
sand also according to day and time and are subject
“o levels of enforcement. The usage rates in
37
There is need to strengthen helmet legislation and
enforcement for all riders in the city and state to
derive good protection from helmets. Targeted
education of road users with increased enforcement
will strengthen the helmet usage practice. Research
is underway to make helmets more convenient and
easy to use at Indian Institute of Technology in New
Delhi.
roads, and thus affects driving performance. Alcohol
brings in a pseudo euphoric effect malting the person
less inhibitive, consequently resulting in higher
speeds and non-adherence to safe behaviour on
roads. Studies have shown that the severity and
impact of injuries are higher, deaths are more, and
disabilities are greater when alcohol is involved in
crashes (31)
B8.2 Drinking and driving
As per the Central Motor Vehicles Act, 1988 Sec 185:
Whoever, while driving, or attempting to drive, a
motor vehicle, has in his blood, alcohol exceeding
30 mg. per 100 ml. of blood detected in a test by a
breathalyser, or is under this influence of a drug to
such an extent as to be incapable of exercising proper
control over the vehicle, shall be punishable for the
first offence with imprisonment for a term which
may extend to six months, or with fine which may
extend to Rs.2000, or with both; and for a second or
Alcohol consumption, even in relatively small
amounts, increases the risk of being involved in
crashes. People under alcohol influence not only injure
themselves, but are likely to injure and kill others.
Alcohol is also a major risk factor for falls, suicides,
violence, child abuse, and others. Consumption of
alcohol leads to poor judgment, slow reaction,
delayed reflexes, poor visual attention, improper
coordination, difficulties in identifying dangers on
Figure 31: Alcohol use among Fatal and Non-fatal RTIs, 2009
Figure 32: Alcohol from previous studies
38
BRSIPP 2009
Figure 33: Trend of Drunken Driving cases booked
by the Bangalore City Police
subsequent offence, if committed within three years
of the commission of the previous similar offence,
with imprisonment for a term which may extend to
two years, or with fine which may extend to Rs.3000,
or with both.
Data from BRSIPP show that, among road deaths
that occurred in 2009,4% of road crashes were linked
to alcohol use among the dead person. In 5 % of
cases alcohol involvement was found in the driver
of the colliding vehicle (Fig. 31). There could be a
gross underreporting of alcohol involvement in road
deaths as alcohol levels are not measured in each
and every case. Similarly, among hospitalised
individuals, alcohol was seen in 22 % of injured
persons. This is an improvement from nil recording
in 2008 to selective documentation (probably due to
training of people in police and hospitals). However,
this data is still inaccurate as previous studies have
shown that nearly a third ofcrashes occur during 8
pm - 6 am, and a third of these are linked to alcohol
(Fig. 32) (32). The presence of alcohol in both police
and medical records are underreported due to several
reasons, with prominent ones being medico legal
barriers and issues linked to compensation. If alcohol
is involved in crashes, and if police and doctors
document the same, the courts often ask for evidence
as physical certification is not accepted as evidence.
As blood and breath alcohol tests are not routinely
done in both, police and doctors cannot provide
evidence and hence, do not document the same.
Further, families do not receive any compensation if
there is alcohol involvement. Thus, in order to help
families of injured and killed, alcohol is not routinely
entered into records. This calls for changes in legal
system to allow documentation and to delink the
same from legal issues and to encourage mandatory
documentation in records. In the rural area the
alcohol use among those fatally injured was nearly
2% but the alcohol use in the driver of the colliding
vehicle was 17%.
The implementation of drink driving laws has been
stepped up since 2007 as seen by increasing number
of convictions in this period (Fig. 33). The number
of convictions has gone up from 27644 in 2007 to
33241 in 2009. Despite the increase in enforcement,
it is well acknowledged that drinking and driving
still remains a major problem.
Recommendations of 2008 National Consultation on
reducing drinking & driving in India
O
Capacity strengthening of policy makers
O
Strengthening data collection systems
O
Up scaling enforcement activities
O
Revision of existing laws
O
Guidelines for drivers and service industry
O
Uniform guidelines on age, timing and location
O
Screening for alcohol in emergency rooms of
hospitals
O
Mandatory testing in fatal crashes
O
Co-ordinated activities
O
Formulating policies and programmes
It is important to target implementation and
enforcement of drink drive laws at
O
males in 18 - 45 years,
O
teenage drivers,
O
two wheeler - car - heavy vehicle drivers and
O
those driving during 8 p.m. -12 midnight
O
peripheral, outer city areas and on highways.
B8.3 Seat belt use
Car drivers and passengers can get injured in crashes
as the driver may collide with vehicle in front, may
hit a stationary object, may be hit by vehicles from
back or may suddenly apply brakes in traffic. In all
these crashes, the driver and passengers are thrown
forwards or in other directions and can sustain
injuries to head, chest and abdominal organs. A seat
belt is a safety harness designed to keep the occupant
of a vehicle inside the vehicle and in place by
reducing / minimizing rapid movements that occur
soon after a crash. Seat belts reduce injuries by
stopping the driver from hitting interior objects and
passengers in the cars and by preventing the driver/
passenger from being thrown out of the vehicle. Seat
belts also distribute the forces of rapid deceleration
over larger and stronger parts of the body, such as
the chest, hips, and shoulders. The seat belt slow
down the body movement by stretching slightly and
holds the occupant in the same position by keeping
Figure 34: Growth of Motorcars in Bengaluru
39
him / her in their seat and hence, will not be thrown
around during a crash (33).
Figure 35: Seat Belt Use among Fatal and
stricter enforcements and systematic education
programmes to increase seat belt use.
B8.4 Speed
Non-fatal RTIS in Bengaluru
Figure 37: Effect of Speed
Figure 36: Trend of Seat belt cases
booked by the Bangalore city police
Excessive speed and associated behaviours like
The Central Motor Vehicles rules, 1989 as amended
by The Central Motor Vehicles (first amendment) rules
2003 stipulates that all cars manufactured after 1998
shall be fitted with seatbelt and should be in conformity
with AIS:005-2000 and AIS:015_2000 specifications.
However, as in other areas, enforcement is left with
states and enforcement has been far from satisfactory.
The status of implementation of seat belt law reveals
that only few have been penalized for not wearing
seat belts and the fine is just Rs. 100.
Despite the availability of seat belts in India for some
time, the usage has been abysmally low. There are
no population based surveys done till date to see the
use, but is estimated to be less than 10 %. No efforts
have been made for education of car drivers, even
when seat belts are available. Data from BRSIPP
reveal that among the fatal RTIs, none of the car
drivers were wearing seat belts at the time ofcrash.
Among those hospitalised, 21.9% of car drivers and
11.7% of the car occupants were wearing the seat
belt.
The enforcement of seat belt laws has recendy gained
momentum in Bangalore. The number of cases
booked for not wearing seatbelts has increased from
636 In 2007 to 780 by 2009. There is a need for
40
BRSIPP 2009
overtaking (from wrong direction) are key risk
factors in road crashes. Generally crashes occurring
at higher speeds, result in greater generation and
transfer of mechanical energy to the affected person;
when this exceeds the physiological tolerance of the
individual, it results in damage to body organs. The
level of damage to the body is influenced by the
shape and rigidity of the colliding object along with
velocity of the impact. Every increase in mean speed
levels by 5% leads to approximately a 10% increase
in all injury crashes and a 20% increase in fatal
crashes (Fig. 37) (34).
Some common reasons for increasing speeds are covering the required distance in shorter period of
time, increasing productivity and greater returns,
fun and pleasure seeking, good condition of roads,
availability of fast moving vehicles, false perceptions
on safety, traffic conditions, enforcement practices
on speed limits and knowledge and practice of road
users. Young drivers are more likely to speed and
end up in crashes, resulting in more deaths and
hospitalisations.
The BRSIPP data has not included measurement of
speeds and linkage to crashes, as it is only a
surveillance programme and not a crash analysis
study. Our efforts to identify this in police records
have had limited success. However, a few data
pointers indicate the presence and association of
speed as a major factor.
O
O
O
O
O
Anecdotal reports and media news items
covered soon after a crash indicate that
majority of crashes occurred when moving
vehicles were in high speed.
Most of the deaths occurred in peripheral parts
of city, ring roads and on highways, where roads
are in good condition and high speeds are
common.
91% ofcrashes occurred on straight roads and
majority of these were separated roads.
89% of deaths occurred when visibility was
good.
8% were head on collisions and 19% were rear
end collisions.
The condition of vehicles was not known as
this data comes from motor vehicle inspections
after crash.
O
The 1MV act has stipulations on speed management
and implementation of these has been poor due to
lack of resources and technology with enforcement
agencies.
Experience of many countries indicate that mobility
and safety needs to go together to save lives of people.
Classifying roads based on purpose and fixing
appropriate speed limits, appropriate and visible
signage’s, staggering traffic flow, speed warning
THE MOTOR VEHICLES ACT, 1988
NOTIFICATION
No. TRD 16 TDK 2005, Bangalore, dated 10th May, 2005
Karnataka Gazette, Extraordinary No. 1042, dated 28-5-2005
In exercise of the powers conferred by sub-section (2) of Section 112 of the Motor Vehicles Act, 1988
(Central Act 59 of 1988), the Government of Karnataka - is satisfied that it is necessary to restrict
the speed of motor vehicles specified in column (2), of the table below in the interest of public safety
or convenience or because of the nature of the road or bridge hereby fixes the maximum and
minimum speed limits specified in column (3) thereof.
SI. No.
(1)
1.
Maximum speed per hour in km.
(3)
Class of Motor Vehicle
(2)
Near
Educational
Institutions
Ghat
Roads
In the city
All other
limits of
places
Bangalore,
Mysore,
Mangalore,
Hubli-Dharwad,
Belgaum and
Gulbarga
If all the wheels of the
vehicles are fitted with
pneumatic tyres and the
Vehicle is not drawing a
(a) Motor-car
25
40
40
70 to 90 on
National
Highways
(b) Motor-cycle
25
40
40
50
(c) Autorickshaw
25
30
30
40
(d) Light Motor Vehicle other
than a transport vehicle
25
40
40
60
(e) Light Motor Vehicle arid,
a transport vehicle
25
40
40
60
(f) Medium or Heavy
Passenger Motor Vehicle
15
35
35
60
(g) Medium or Heavy Goods
vehicles
15
35
35
60
41
improving compliance towards speed restrictions is
an important activity, requiring education to public
through campaigns and public education
programmes on speed reduction.
signs, speed controlled elevated pedestrian crossing
facilities, speed humps at strategic locations,
restricting speeds at entrance and exit to heavy traffic
generators, developing roundabouts, separation of
vulnerable road users through fencing, medians,
footpath etc., monitoring speeds through speed
cameras are some examples in managing speeds.
Several intelligent transport systems incorporating
elements of speed control and adaptation in different
settings have been seen in many parts of world.
Combined with enforcement strategies like
formulating road rules and speed limitations, use of
speed cameras, automated enforcement systems,
appropriate penalties for violations and others are
highly effective. Increasing public awareness and
Despite limitations of resources, the city police have
stepped up enforcement as seen by an increase in
booking violators in different places. With the help
of interceptors and speed surveillance cameras in
certain locations, 2009 saw an increase in catching
violators to the tune of 55189 Offences. Many
engineering technologies in both vehicles and
roads can pay greater dividend bringing
automatic compliance from the road users (Figs. 38
and 39).
Figure 38: Trend of Overspeeding cases booked by
the Bangalore City police
Figure 39: Fine collected Under the Indian Motor
Vehicle Act by the Bangalore City Police
60000
50000
40000
30000
20000
10000
0
Year
39. Solutions and strategies for road safety
For a long time, it was believed that road crashes
and injuries are accidents and hence, cannot be
reduced. Years of research and implementation of
safety programmes demonstrated that it is possible
to reduce road crashes. With improvements in
understanding human behaviour and the way people
behave on roads and in vehicles, a safe systems
approach has evolved in recent years. Several
countermeasures in road engineering, safe design of
roads and highways, vehicle safety, increased
enforcement of helmet - drink drive - seat belts- child
restraints laws , effective speed management
strategies, adequate trauma care and others have
played a key role in road crashes. These have been
put in place through engineering, legislation and
enforcement, education and timely trauma care
strategies in different ways. The past few years have
also shown what works and what does not work in
road safety.
42
BRSIPP 2009
Need for revision of IMV Act.
Under the Indian Motor Vehicles Act of 1988, several
road safety laws have been formulated and are
implemented at the local levels by police and
transport authorities. These were formulated several
years back, when transport scenario was different.
With increase in road crashes and addition of huge
number of vehicles, there is need for revision.
Recognising this need, recently the Ministry of Road
transport and highways is in the process of revising
these laws and the process has been set in motion.
There is need to modify / amend regulations in the
areas of driver licensing systems, age of driving,
speeding, use of helmets, dangerous driving, racing
on roads, drinking and driving, Use of drugs and
driving, use of seat belts, use of cell phones while
driving, child restraints, visibility, obeying traffic
rules, carrying excess people on vehicles, disabilities
and driving, health status of drivers, fatigue and
sleeplessness, emergency care, safety rights of
pedestrians and crash (accident) reporting and
investigation systems.
Specifically with regard to road safety, there is an
urgent need to revise laws in conformity with national
requirements and based on international experiences.
These revisions need to keep in mind the possible
changes likely to occur in the coming years with inbuilt
With the data available from BRSIPP and other
national studies, inputs have been provided for the
expert committee to facilitate required changes. The
set of recommendations and the proposal submitted
is given in annexures 2.
Most importantly, since the laws and revisions are
intended to make people safe and reduce road deaths
and injuries, it is essential to monitor and evaluate
the impact of these laws in the coming days.
provisions for periodical amendments.
FaHs
Estimated deaths: 500; serious injuries:
10,000
Falls commonly occur in homes, schools, construction
sites, roads, public places, and are an important
cause of deaths and disabilities. A “fall at a
construction site” can result in instantaneous death
for the worker, while a “simple fall from a chair”
can turn out to be a life long disabling condition for
the injured person.
O
In 2008, there were 147 fall deaths as per
mortality data from the vital statistics division
of BBMR Many of these deaths occurred in
15-34 yrs age group and males predominated
females. Actual numbers could be higher as
only smaller number of institutions could have
reported precise cause of deaths.
O
The number of fall deaths as per CCRB reports
for the year 2009 was 93. Once again, these
numbers could be much higher as only
unnatural and medico legal cases are reported
to CCRB. In the same year, there were 5837
patients brought to hospitals due to fall injury.
In both fatal and non-fatal injuries, males accounted
for 80% of falls (ratio of 4:1 between men and
women). In the non-fatal injuries, women in younger
(< 15 yrs) and elderly age groups were represented
in higher numbers compared to men. Nearly 24.3%
and 10.5%of the hospitalisations were in children
and elderly respectively (Fig 40).
The data from hospitals indicate that home (44%)
was the commonest place of occurrence of falls
followed by roads (23%). Almost half (51%) of the
patients who sustained falls had a moderate to severe
type of injury. Majority of these patients (87%) were
either admitted for medical and surgical care or
referred to another centre for treatment.
Figure 40 : Age Sex distribution of Falls -Non-fatal
Dr. Pallavi Sarji, in her M.D., thesis at the M.S.
Ramaiah Medical college, observed that falls were
the highest among the very young (<4yrs and very
old (.>75yrs). 25% of the child hood injuries were
falls, with the common place of occurrence being
home followed by schools. (35)
In another study on domestic injuries by Dr. Ashok
for his M.D., in community Medicine, observed that
falls (39.5%) were the most common cause of
domestic injuries followed by burns. The age group
of 15 - 44 yrs was involved in maximum number of
domestic injuries. Slippery floors were found more
in households reporting these accidents. (36)
Prevention of falls requires in-depth analytical
research to clearly delineate individual environmental and responsible product role in
understanding risk factors. Improving awareness
levels among household members, eliminating
slippery floors and improving health of elderly can
reduce falls among elderly, while better supervision
of children by parents can help children.
43
Suicides
Estimated deaths: 2,500; attempted
suicides: 25,000
O
Information on Intentional self harm or suicides data
was collected from BBMP vital statistics division,
office of the city crime records bureau and from
participating hospitals.
G
In 2007, there were 2429 completed suicides as
registered by police and 5328 attempted suicides
registered in 21 hospitals. After excluding undefined
categories the ratio of completed to attempted
suicides was found to be 1: 6.
In 2009, there were 2374 completed suicides as per
CCR.B data and included hanging and poisoning.
Even though data is received from CCRB, the
classification based on intent and mechanisms are
not scientifically done and there are some observed
discrepancies in total numbers. Detailed data on
suicidal deaths was not available from police records
due to administrative and procedural difficulties.
G
O
O
G
Nearly 85 % of attempted suicides were first
recognised by family members and were
brought to hospitals.
More than 90 % of suicides were among
residents of the city.
Using education and occupation as proxy
indicators, it was observed that 2 / 3rd of
suicides occurred in poor and middle income
households.
One out of 2 suicidal attempts occurred during
6 pm - 6 am in the city.
Students, housewives, manual labourers,
business employees and professional groups
were seen in 15.9%, 4.9%, 30 %, 10 % and
12 % of the categories.
Every alternate attempt occurred among
married households and one in three were in
unmarried groups.
Figure 42 : Place of attempted suicides (%)
Using figures from previous population based surveys,
it is estimated that the city has on an average 2500
completed suicides and 25,000 attempted suicides.
Number of persons harbouring suicidal ideations is
likely to be much larger and can only be guesrimates.
The available data provided from 1703 attempted
suicides is a reflection of profile and patterns and
caution has to be exercised in extrapolating these
figures to the larger population.
O
Nearly 78% of attempted suicides occured in
younger age groups of 15-39 years. Women
outnumbered men in early age groups of
15-29 years (Fig 41).
Figure 41 : Age Sex distribution of attempted
O
O
G
suicides
O
Home was the commonest place of suicides
and % of the suicides were attempted at home.
The next common place was roads (Fig. 42).
The intent, though difficult to establish in a
busy casualty setting revealed that 80 % of
attempts were clearly intentional in nature.
Commonest method of suicidal attempt was
consumption of organophosphorus compounds
and over the counter drugs, as they were within
easy reach of individual. Our previous studies
have indicated that they were purchased by the
individual earlier.
A history of alcohol consumption in the
individual or among spouses / parents was
present in 9% of the attempted suicides
(definitely much higher).
44
BRSIPP 2009
O
G
Information on precipitating factors, causes or
mechanisms was not available clearly and has
not been included in this analysis.
In all, 2/3rd reached hospital directly and
l/3rd were referred from 1st contact hospitals.
Nearby government or private hospitals were
the first point of contact among l/3rd of
attempts and the treating doctor was the first
person to provide care. The mode of
transportation was predominantly auto
O
rickshaws (25 %) and private vehicles (40 %),
with ambulance transfer seen in 27 % of
attempted suicides.
Nearly a third (32%) of the patients were
unconscious or semiconscious at the time of
hospital entry. One third were admitted straight
to medical wards and more than half were
treated in casualty departments for more than
6 hours, while 10 % were treated and sent
home. Three % had died by the time they
reached hospitals.
Suicides are complex phenomena and occur due to
combined, cumulative, progressive and interactive
factors operating in social, cultural, psychological
and health domains of an individual or his family.
Larger societal factors and policies and programmes
play an important role by acting as precipitating or
triggering factors. Prevention of suicides requires a
careful understanding and interplay of factors and
identification of larger modifiable risk factors. This
requires regular good quality information
supplemented by focussed and well designed
research. To build this process, it requires total
cooperation and participation of health
professionals, police officials, law makers and policy
makers along with several other sectors contribution.
Surveillance of suicides and strengthening of research
are crucial to formulate programmes and policies.
Some established and known strategies likely to
reduce suicides are
O
Recognition of individuals with warning signs
and symptoms
O
Crisis help for distressed individuals and
families
O
Mechanisms for crisis intervention
O
Life skills for coping with stress
Q
Expansion/ strengthening of mental health
care.
O
After care service for suicide attempters
O
Limiting availability of hazardous chemicals
and drugs
O
Parental education to keep toxic products away
from the reach of vulnerable members of family
O
Family support systems
O
Care for persons with physical / terminal
illness.
O
Legal changes in suicide laws.
O
Policy changes and reforms at macro levels,
and
O
Stigma reduction
B12. Bums and Fire injuries
Estimated deaths: 500; serious injuries:
5,000
Burn injuries are one of the commonest causes of
deaths, hospitalisations and disabilities and are
regularly reported in die media. A variety of products
ranging from electrical, thermal, mechanical and
radiant in nature contribute for burns. Burns can be
suicidal (which is very common in India among
women in 15-29 years), homicidal or accidental.
O
Nearly 360 persons (11%) lost their lives due
to bums injury in the city of Bengaluru in 2007
as per police reports. At the same time, 2,517
persons were hospitalized with a ratio of 1:7.
It is likely that numbers could be higher as
Q
O
many of those receiving care in other
institutions and those with minor injuries are
not included.
As per data from Vital statistics division of
BBMF> there were 875 deaths due to fires and
burns in 2008. In 2009, as per police reports,
there were 788 burn deaths in the city.
In 2009, hospital data was not totally available
as data was not collected from one of the
earlier participating institutions due to
procedural difficulties and resource constraints.
Nevertheless, using data available from earlier
sources, the actual numbers of deaths,
hospitalisations and minor burns could be in the
45
Figure 43: Age-sex distribution of Burn injuries (%)
Officials inspect the site of a
fire at a children's hostel in
Palin, Arunachal Pradesh, on
Thursday, ph
14 die in
Arunachal
hostel fire
ITANAGAR. PTI: At least 14students were burnt to death and
seven injured on Thursday in a
fire at a private hostel in
Arunachal Pradesh's Kurung
Kurney district, bordering Chi
na, official sources said.
The students of Holy Angel
Don Bosco School, both boys
and girls, were killed after a fire
swept through a hostel made
of bamboo at Palin area in the
district. Officer on Special Duty
to the chief minister Nob Tshering said. Prima fade, it appears
that a short drcuit could have
led to the blaze, he said.
“The fire broke out at 2:30
am. There were about 56-60
students in the hostel when the
mishap took place," Deputy Inspector General of Police
(Crime) Tashi Lama said.
Tshering said two platoons
of reinforcements were rushed
from the district headquarters
of Koloriang to Palin. A platoon
of Central Reserve Police Force
was rushed as tension prevailed
in the area following a clash be
tween locals and school author
ities after the inddent.
Dated 12,h Feb 2010 - DH
ratio of 1: 10: 30 with about 500 deaths, 5,000
hospitalisations and 15 - 20, 000 minor burns.
Victoria hospital, an exclusive bums management
centre with Bangalore Medical research Institute
Data from the previous report (28) indicated that
bum related deaths were
©
High in the younger age groups of 16-40 years,
with one fifth each occurring in 21-25 and 2630 years (Figure 36). Interestingly, ’/-» of burn
deaths occurred in less than 20 years age group.
Women were overrepresented in 15-25 years
in both fatal and non-fatal burn injuries. The
male to female distribution was 2:1 in the total
series, while it was 1:2 among those in younger
age groups. This phenomenon has been
©
©
reported by many Indian studies and causes
are primarily attributed to cultural issues.
Three fourths of burn deaths and injuries
occurred at home and remaining were seen in
industrial areas and other places.
Majority of the burns were reported as stove
bursts, and accidental burns and had occurred
inside the house. Kerosene stoves, gas cylinders,
oil lamps, cooking materials and hot liquids
were the primary agents responsible for burn
injuries. The causes of burns were not clearly
known in majority of the instances.
be accidental in nature. Two thirds of injured and
killed persons were brought or reported by family
Once again, understanding the epidemiological
characteristics of bums injuries is crucial to identify
what needs to be addressed for prevention. In 2010,
it is proposed to set up a Burns Registry in one of the
leading centres. Improving socioeconomic conditions
of households, making available safer stoves, safe
electricity connections and electrical products, family
education programmes are likely to help burns
members.
injuries.
registered 815 Deaths, 1566 hospitalisations and
1911 minor injuries during Jan 1 - Dec 31, 2009
( personal communication). Among the total, l/3rd
were suicidal, 6% homicidal and 60% reported it to
BRSIPP 2009
B13. Poisoning
Estimated deaths: 500; serious injuries:
10,000
Poisoning is one of the commonest injury causes for
deaths and hospitalisations. Many cases of accidental
poisoning due to food, alcohol and others are
frequently reported in the media. As a variety of
organophosphorus compounds, Over The Counter
(OTC) medicines, household products and other
dangerous chemicals are easily available, a
vulnerable person can easily commit acts of
poisoning; important to note that poisoning can be
suicidal, accidental and homicidal in nature. Causes
of poisoning are unclear even at national level as
there are no large scale studies.
Figure 44: Age-sex distribution of Fatal & Non-fatal poisoning
O
In Bengaluru, nearly 300 people (9% of total
deaths) lost their lives due to a poisoning act
during 2007, while 10% of those hospitalized
due to an injury were due to poisoning. Among
them, 75% were men and 25% were women.
Highest number of poisoning deaths was seen
in 21-30 years (36%), while poisoning among
teenagers in 16-20 years was 13%. Among the
non-fatal poisoning cases 60% were in the age
group of 16-34 years. In similarity to burns,
in both fatal and non-fatal poisoning injuries,
there were more women in the younger age
groups (16-34 years) as seen in Figure 44.
O
O
Summary data available from CCRB sources
in the city, indicate that there were 349
poisoning deaths and most of these were
suicidal (80%) with homicidal and accidental
poisoning being about 1-2% and 18-19%
respectively.
Hospital data was available in 1406 (4.2%)
instances of poisoning and indicates that
among 82% of these cases, these were
consumed with suicidal intent. Only 11.4% of
them were unintentional and most of these were
among children (<14yrs).
B14. Animal Bites
(contributed by Dr.Ashwath Narayana from one of the partner
institutions, KIMS)
Animal bites are a common problem and all hospitals
provide care for injured persons. Among them, Rabies
is 100 % fatal but is preventable by timely post
exposure rabies prophylaxis (local treatment of
wounds, administration of anti rabies vaccines and
vaccines and local infiltration of rabies
immunoglobulin in WHO category III exposures).
An estimated 20,000 human rabies deaths and 17.4
million animal bite cases occur in India every year.
Dogs continue to be a major source (96 %) of
47
infection in India. The dog census in Bangalore city
revealed that there were 320,000 dogs (180,000 stray
and 140,000 pet dogs) in BBMP area. During the
current year, nearly 17,000 victims sought treatment
for animal bite in different health care settings under
BBMP (Table 12). Majority of animal bite victims
visiting BBMP hospitals for post exposure prophylaxis
were children and belonged to lower socio-economic
class.
There is apparent reduction in number of human
rabies deaths reported at Epidemic diseases hospital
(EDH) in Bangalore (Fig. 45). This may be due to
availability of modern rabies immunobiologicals,
both in Government & private sector for treatment of
animal bites. BBMP is providing rabies vaccines by
intradermal route and Equine rabies Immunoglobulins
free of cost to bite victims. In addition, BBMP is
implementing animal birth control (ABC) programme
for controlling the dog population.
(Table 13). The centre undertakes epidemiological
studies, clinical trials and is also the registered office
of Association for Prevention & control of Rabies in
India (APCRI) & The Rabies in Asia (RIA) Foundation
Table 13: Animal bite cases reported at the
Anti-rabies clinic, KIMS Hospital
TOTAL
YEAR
2005
15.85
2006
1212
2007
1996
2008
1976
2009
1979
Source: Anti rabies clinic, KIMS hospital, Bangalore.
Figure 46: Age Sex distribution of the
Animal bites cases
Table 12: Animal bite cases reported at Bruhat
Bangalore Mahanagara Palike Hospitals
Year
No. of animal bite cases
reported at BBMP hospitals
2003-04
22,912
2004-05
32,967
2005-06
28,006
2006-07
17,798
2007-08
21,121
2008-09
13,833
2009-10 (up to Dec. 09
16,584
Figure 47: Place of Occurrence of Animal bite cases
Others. 6.7%
Source: Pilot project office, BBMR Bangalore.
Figure 45: Trend of Rabies cases in
Bangalore
The anti rabies clinic, run by Department of
Community Medicine, Kempegowda Institute of
Medical Sciences (KIMS) is a referral centre for
management of animal bite cases in the city of
Bangalore. Nearly 2000 cases are seen annually
48
BRSIPP 2009
Children <15 years (37.4 %), and within them in
5 - 9 year years (15.2 %) were bitten by dogs to a
greater extent. The overall male to female ratio was
3: 1. While nearly one fourth of the cases (72.6%)
were from within Bangalore, nearly two thirds of
them were bitten (62.0%) on the road (Fig. 47).
More than half of the bites occurred when die person
was either walking (47.9%) or standing (4.8%) on
the road and one fifth (20.0%) were playing when
the bite occurred. Bites were frequently on Lower
limbs (51.7%) and Upper limbs (27%) (Fig 48).
Figure 48: Animal bites and body parts involved
Majority (84.7%) of the bite victims had received
first aid, with one fourth (24.6%) receiving it at the
place of injury; of the remaining, 45.5% received
first aid in a government hospital and 25.8% in a
private hospital / nursing home or medical college.
Only 16.6% of the bite victims did wound toileting
by themselves. Three fourths of the patients (74.8%)
had already visited one other hospital before coming
to KIMS hospital and were commonly referred from
a government hospital (49.7%) or private hospital /
nursing home (21.1%). More than two thirds
(64.9%) had used a private vehicle to transport the
patient and less than 15% had severe type of injury.
The Government of India / National Centre for
Disease Control (previously National institute of
Communicable Diseases, NICD) has initiated a
2 year pilot project on “Prevention of human rabies”
from 2009 to be implemented in 5 cities of India
viz. Delhi, Ahmedabad, Pune, Bangalore and
Madurai. The important component of this pilot
project include 1) Provision of post-exposure rabies
prophylaxis to all bite victims 2) Strengthening of
laboratory surveillance of rabies in animals 3)
Training of health professionals about rabies and
animal bite management 4) Creating awareness
about timely and adequate post exposure treatment
to all animal bite victims in the community and dog
population management 5) Sensitizing veterinarians
regarding vaccination of the owned and stray animals
with potent vaccine at regular intervals through
active community participation, controlling their
habitat, movement and population 6) Involvement
of NGOs and Community. The BBMP is the nodal
project implementing agency in city of Bangalore.
Assault / violence
Estimated deaths: 200; serious injuries:
25,000
Violence is a commonly used term and includes
homicides, assault, rape, injuries due to riots and
wars, abuse of elderly-women-children, custodial
related injuries, etc. The precise magnitude of the
problem and its causes are difficult to establish in a
surveillance programme and requires focused
investigation.
O
In 2009, there were nearly 207 deaths due to
assault / homicide/violence in the city and
nearly 3000 were provided care in 10 select
institutions.
O
The ratio of fatal to non-fatal injuries was
1: 300 based on data of 2008 under BRSIPR
Non-fatal injuries registered were primarily due
to interpersonal violence and domestic violence
but also included other types of violence.
Majority were brought to hospitals in a state
of acute injury by family members or friends /
acquaintance.
Figure 49: Place of assault / violence
49
Assault /Violence was most commonly observed in
the 20 - 34 yrs age group. Beyond the age of 30,
violence was committed more against women as the
injury cases were more among women as compared
to men. Majority of the assault cases brought to the
partner institutions were conscious (89%). Less than
5% of the cases were unconscious and only less than
1% were brought dead to the casualty. Almost half
of the patients (58%) had mild injuries and 42%
had moderate to severe injuries. Almost % of the
assault cases were either admitted for further care
or referred to other institutions.
Vanitha Sahaya vani is an exclusive helpline run
by Bangalore City Police to help women in
distress. The agency can be contacted at
"22943225" from any telephone and people also
have direct access. The centre is run by
professional staff offering services to needy
women in crisis situations. During April 2008 March 2009, the centre received 1135 calls and
more than half (770) were provided support on
telephone helplines. Based on the nature of calls,
the callers are also referred to Family Counselling
centre (1066), police help, legal counseling and
short stay homes. Majority of the calls are related
to Marital disharmony, dowry harassment,
alcoholic problem in spouses, financial issues and
other issues.
Source.; Personal communication : "Vanitha
Sahaya Vani"
"Makkala Sahaya vani" is a telephone service for
helping children in crisis and distress, with
support provided by trained staff. The helpline
can be contacted at "22943224", 24 x 7. During
Jan-Dec 2009, the centre received 11,094 calls
from children/ parents for a number of reasons.
Nearly 156 children were rescued, 131 missing
children were traced, 200 were provided
emotional support and 374 were referred for
shelter, school and hostel facilities. Direct
telephone interventions were provided for 207
children. About one - fourth of callers had
contacted the centre after the first call.
Source: Personal communication, "Makkala
Sahaya vani"
"Hiriyara Sahaya vani" is a telephone service for helping the elderly population in distress. The Service
is provided by trained counselors. In the year 2009, the helpline had received 9823 calls from Elders in
Distress. About 372 complaints were registered, 238 complaints resolved. Many of the calls were from
elderly people to seek information (5881) which was provided to them satisfactorily.
Source; Personal communication, "Hiriyara Sahaya vani"
Bl6. Prehospital Care
Good surveillance programmes can often reflect the
status of trauma care services and identify areas of
strengthening. Previous studies in Bengaluru have
been limited and examined the pre hospital care in
road traffic injuries, traumatic Brain injuries and
suicides (37,38). However, these studies have been
isolated, stand alone and not continuous in nature.
In a surveillance programme, examination of these
factors can reveal the changing patterns and identify
critical elements, helping in prioritization and policy
setting process.
Trauma care issues included under surveillance were
50
BRSIPP 2009
- availability of first aid, mode of transportation,
time interval between injury occurrence to reaching
one of the study hospitals, referral patterns and
number of hospital contacts before reaching a
definitive hospital. While these formed a set of vital
factors contributing for availability, accessibility and
affordability of emergency and pre-hospital care, tire
quality of care neither received nor provided were
included. It is also essential to highlight that this is
an examination of pooled data and variations might
occur with data of individual hospitals depending
on the nature (public-private; apex - primary, etc.,)
of institutions.
B16.1. First aid services
The provision of first aid to an injured person depends
on place of injury, nature and severity of injury along
with availability of first aid facilities. As there are
no specified first responders, people in the vicinity
are the first responders, who often make the decision
of what should be done. Secondly, it depends on the
knowledge and practice of these responders and what
they do. Commonly, in a road crash, the scenario is
more of confusion, altercation and fights among
people rather than shifting the person to the nearest
site of care (In India, it is common to see people
fighting, beating up the driver, setting the vehicle
on fire, etc.,). Thirdly, it also rests with the existing
medico legal practices in the society as it is common
to see people lying unattended for fear of later legal
complications or police enquiries among public (The
hon. Supreme court has ruled that people attending
to road crash victim need not be involved at later
stages).
The definition of first aid varies in the local context
and in the present study even care in a first contact
hospital was considered as first aid as this was the
first available care. In totality, nearly one fifth (20%)
of fatal and non-fatally injured persons received some
type of first aid. However, the number of persons
receiving first aid soon after a fatal injury varied
from 10-50% depending on the type of injury. In
non-fatal injuries, the numbers were slightly higher
ranging from 24% to 65%.
The place of delivery of first aid is crucial as it
depends on the practice of “save and stabilize” or
“scoop and run”. People generally do not wait for an
ambulance even if it is a severe or fatal injury. Less
than 2% of non-fatal injuries received first aid at
injury site. This was quite high in case of burns going
upto 25% patients receiving some first aid at the
injury site. This indicates the presence of a “scoop
and run” practice as injured were taken to nearby
hospitals by those present at the site of injury. Nearby
Government / public hospitals was the most common
place of providing first aid in nearly 50% of injuries
(Table 15). This was closely followed by Private
health care institutions like private hospitals and
nursing homes. The involvement of general
practitioners and common responders like police was
less than 1% in the series.
Who delivers first aid is an important aspect as what
is delivered depends on the knowledge and skills of
the person and the extent he/she goes in translating
that knowledge to action. In the present study, as
many people received their first aid in public or
private hospitals, it was commonly the doctor or
nurse involved in delivery of first aid care. More
than 90% of first aid deliverers were doctors,
followed closely by nurses.
B16.2. Mode of transportation
Mode of transportation of an injured person is critical
as the aim is to reach the nearest health care centre
in the safest possible way within a short period of
time. In the rural areas, data from non-fatal injuries
revealed that the commonest transportation vehicle
was private means of transport through private
vehicles (cars or taxis) or a 3 wheeled auto rickshaw
in 66% and 14% of cases, respectively. Government
and Police vehicles extended support by transporting
about 4% of injured persons in urban areas. Transfer
was predominantly through Auto rickshaw and
Table 15: Place of first aid for injured persons (%)
Injury
Cause
At injured
site
Nearby
Govt.
hospital
Nearby Pvt.
hospital /
Nursing
home
Medical
college
Pvt. clinic
Police
General
Practitioner
Others
Road traffic
injury
0.93
56.25
39.09
2.73
0.93
0.02
0.01
0.03
Fall
0.60
47.39
47.50
3.01
1.41
0.05
0.00
0.05
Poisoning
1.11
26.00
66.44
3.56
2.67
0.00
0.22
0.00
Burns
25.00
0.00
75.00
0.00
0.00
0.00
0.00
0.00
Hanging
0.00
38.46
61.54
0.00
0.00
0.00
0.00
0.00
51
private vehicles for nearly three fourth of injured
patients. Ambulances were mainly seen in
interhospital referrals.
Figure 51: Time interval between time of injury and
registration, (all injuries)
Figure 50: Mode of Transportation (2009)
B16.4. Source of referal
B16.3. Time interval
The time of death among fatal injuries depends on
severity of impact and availability of care. In both
urban and rural areas, nearly 50% of fatal injuries
were brought to hospitals is less than I hour; however,
this also included those who had died on the spot/at
injury site and those dying on the way to hospital.
Among the rest, 13% of urban and 10% of rural
patients reached in less than 3 hours. The remaining
40% of those who died in urban areas and 35% of
rural cases died in the hospital and were brought
beyond 3 hours. Interesting to note that Wh of those
who died in urban and 16% in rural had reached a
hospital beyond 24 hours after injury. Many of these
deaths occurred after the patient had contacted other
hospitals, prior to reaching a definitive study
hospital. Data was to be interpreted cautiously as
quality of care has not been included in the present
analysis.
52
BRSIPP 2009
The source of referral indicates the place of first
contact highlighting the possibility of strengthening
services across different institutions. Among fatal
injuries, the referral to the final hospital was mainly
from Government (54%) and private hospitals (22%).
In contrast, overall 53% of injured persons reached a
hospital on their own and this was the most common
practice in assault / violence (72%), attempted
suicides (60%), and accidental poisoning (62%);
nearly half (47%) of injured persons in a RTI also
reached direcdy on their own. Government hospitals
and private hospitals referred 22% and 18% of injured
persons, respectively. The referral from private
teaching hospitals was less as the available facilities
are comparatively better in these hospitals.
It is a common practice in Bengaluru to see patients
being referred from one hospital to another for a
number of reasons. Some of the common reasons
are type - nature - severity of injuries (polytrauma
patients and those seriously injured are referred
depending on availability of specialties), nature of
hospital (public or private), availability of facilities
in health care institutions and affordability of care
(expenses depend on nature of hospital, injury
management practices and ability of patients and
their families to pay along with availability of
insurance with people). In the present programme,
it was observed that among fatal injuries, 70% of
patients visited more than 1 hospital. Among those
visiting more than 1 hospital it varied from 50% for
fall related injuries to 13% in bum injuries. In nonfatal injuries, more than 90% visited at least 1 other
hospital. The smaller number in burn injuries is
primarily because exclusive burns care and
management is available in one of the larger public
sector hospital. Among non-fatal injuries, since the
first contact hospital was chosen the numbers were
around 10%, but majority were referred from these
hospitals to other hospitals.
5.
Basic first aid training should be provided for
possible first aid responders like police, health,
drivers, and teachers who can respond to
emergencies any time. These personnel should
be able to assess scene and patient, provide
first aid, call for help and arrange safe
transportation.
6.
All casualty medical officers and nurses should
be trained in Basic Trauma Care and should
receive periodical training in management of
complex injuries connected with brain, chest
abdominal organs, burns and poisoning.
The fact that two thirds of injury deaths occurred in
hospitals and that poor services in terms of first aid,
frequent referrals, delayed time intervals and
transportation problems highlight the need for
improving trauma care services in the city. This
requires a set of combined activities and has been
7.
A single system number for ambulance service
should be available for the entire city which is
easy to recall. Ambulances should be available
at free of cost to all individuals in need of care.
8.
discussed in the accompanying series on emergency
and trauma care. Some activities likely to benefit
towards improving trauma care services.
Trauma registries should be established in all
medical college hospitals.
9.
CME programmes on trauma care and related
aspects can be undertaken by medical college
teaching hospitals or professional bodies or
Indian medical Association at periodical
intervals with its availability to all interested
professionals.
10.
Public awareness programmes for immediate
and early transfer of patients to nearest hospital
should be encouraged.
1.
2.
At the city level, a working group should be
established by the Ministry of Health and
Directorate of Health services to coordinate guide - supervise - and monitor all trauma
related activities. The group should include
policy makers, public health specialists, trauma
professionals and clinical specialists.
All hospital Directors and administrators in the
city should be sensitized on the need for
building effective trauma care systems and
improving quality of care at reasonable costs
with a focus on essential components.
3.
In rural areas, all medical and supportive
personnel working in district and Taluka level
hospitals should be trained in basic aspects of
trauma care along with managing less
complicated injuries.
4.
A hospital inventory of all public and private
hospitals needs to be undertaken to assess the
existing facilities and resources in individual
institutions. Areas of strengthening have to be
identified for improving facilities, wherever
required.
In summary, emergency and trauma care needs
serious attention of planners , policy makers and
professionals. The current efforts are fragmented and
require clear direction through policies and
programmes addressing several areas in totality. The
need of the hour is to develop mechanisms for
availability of care to all, irrespective of their ability
to pay. Simple and effective prehospital care and
trauma systems that are available to every injured
person and to all sections of society will be far more
effective in the long run than high tech sendees
required for few. Minimum standards and guidelines
for care of the injured needs to be developed across
the country. What is required In Indian cities and
villages should be driven by data and evidence and
pilot demonstration programmes and not just by
individual experiences alone.
53
Nature of injuries
Organization and delivery of trauma care services
depends on number of factors like nature - type severity of injury, availability of facilities and
resources and ability of people to pay for care. Head
injury was the commonest cause of death in 80% of
road crashes, while injury to chest and abdominal
regions were documented in 1.8% of deaths. Among
non-fatal injuries, injuries to head/face, upper limb
and lower limb were present in 82%, 17% and 25%
of crashes, respectively (Figure 52a,b 8c c). Neither
detailed anatomical injury nor clinical diagnosis or
autopsy findings was included in the programme.
The present programme adapted a vety common and
simple method of classification to assess injury
severity. Being a surveillance programme, it was
decided to include this practical method as trauma
care physicians in some hospitals were not familiar
with scientific methods of injury severity assessment
Figure 52 a: Body Parts injured in RTIs
Figure 52 b: Body Parts injured in Assault/violence
Figure 52c: Body Parts injured in Falls
Head-73.2
Face-12.6
Neck ■ 2.9
Chest - 1.7
Upper limb-8.10
Abdomen - 0.7
Spine - 5.7
Lower limb - 9.5
like AIS, IIS, GCS, GOS, TRISS or other methods. In
addition, detailed documentation and severity
ascertainment of each injury was not done; for
medico-legal purposes, detailed description of
injuries was done separately.
The injury severity was considered mild (only ER
care), moderate (requiring hospital stay up to 6 hours
and needed X-rays, blood or IV transfusion, expert
consultation etc.,) and severe (direct admission from
54
BRSIPP 2009
casualty and intensive management) based on this
operational definition. It was observed that 40 % of
injuries were mild in nature. One third of RTIs and
less than 10% of burns, poisoning and attempted
suicides were considered mild injuries. Most of the
RTIs, burn injuries, drowning, attempted suicides
and falls were moderate to severe in nature (Table),
indicating the need for comprehensive and integrated
management approaches. The proportion of severe
injuries was more in rural areas, probably due to
delays in reaching hospitals. This also reflects that
minor injuries can be provided care in nearby health
centres or general practitioners.
Table 16: Severity of injuries in ER facilities (2009) (%)
Mild
INJURYCAUSE
Moderate
Severe
Urban
Rural
Urban
Rural
Urban
Rural
57.8
56.1
26.7
34.2
40.5
53.3
7.3
54.6
3.5
18.2
34.9
27.3
38.8
50.1
46.2
35.5
46.1
12.4
26.6
12.8
30.3
26.7
13.4
37.3
Assault
Burns
Fall
48.8
Poisoning
23.4
Road traffic injury
41.0
18.4
42.6
Suicide
Total
23.7
41.6
16.7
42.0
49.5
44.9
39
46.0
40.3
20
35.5
18.5
17.7
B18. Management and Outcome
The status of injured person at the time of reaching
hospital reflects severity of injuiy and the need for
hospital preparedness to manage such patients. The
number of patients brought dead was less than 1%
in the series. Every tenth patient with a poisoning drowning - attempted suicide was in an unconscious
state at hospital entry time. Although the proportion
of brought dead cases was less than 0.5% , nearly
10% of the cases were brought in an unconscious or
semiconscious state. Overall, 83% were conscious
at the time of hospital entry. Among road traffic
injuries, one out of 8-10 patients were in
semiconscious or unconscious state, necessitating the
need for intense management and tine need to deliver
efficient care.
Information on the managerial practices of injuries
revealed that nearly one fourth were provided care
and discharged home with advice on follow-up, while
more than half were admitted for further medical
and or surgical lines of management. The admission
rates were highest for burns, falls, RTIs and
attempted suicides. Those treated in ER and further
referral was high for RTIs and falls. Sixteen percent
of patients were referred to another hospital for
number of reasons like patient choices, lack of
facilities (bed, investigation, manpower, etc.,),
affordability, and at times included medico legal
reasons as well.
Figure 53: Mode of management
Urban
Rural
The outcome of injuries was assessed at the end of
ER stay and may not be truly indicative of real
outcome as those admitted and intervened were not
followed-up in the programme. However, it sheds
light on issues like care patterns and limitations.
Majority improved in their vital status and got
stabilized after reaching casualty, but required further
care and management. Nearly 2% of patients died
in ER and combined with those brought dead, the
total number of deaths at ER was 3%. Highest
number of deaths was seen among those with bums
and drowning, while the status of nearly 40% with
poisoning, attempted suicides deteriorated indicating
need for aggressive management.
55
Section C:
Profile of activities
Feedback and action are two essential components of any surveillance
programme. This section broadly highlights the process of data
application and utilisation for number of activities under the
programme. Surveillance may or may not exactly pinpoint the precise
interventions to be implemented, but provides directions for capacity
strengthening,
strengthening policies and
programmes
,
implementation of general or specific activities and continued
research for developing interventions. At present, there is no defined
agency or a mechanism for road safety and injury prevention and
control activities in Bengaluru or India; however, opportunities exist
(and needs to be developed) for strengthening existing activities and
developing new programmes.
56
BRSIPP 2009
I
C
Injury: Addressing the problem
C1.1 Injuries are a neglected issue and
needs systematic approaches
Even though injuries are a major public health
problem, efforts to address it through an intersectoral
and evidence based approach are yet to begin. Some
developments have begun in road safety in recent
years and others are yet to be recognized. Even
though suicides have been recognised, systematic
integrated efforts are not in place to address
the problem. Other injury problems like burns,
poisoning, occupational injuries, violence and others
have not received any attention. This hidden and
unanswered epidemic needs to be given importance
at all levels of policy making and implementation.
Nearly a million people die of injuries in India every
year. Data from BRSIPP has revealed that nearly
4500 persons die every year, more than 1,00,000
are hospitalized and the impact is huge in a city like
Bengaluru. Today, knowledge and experience exists
to address the problem.
C1.2. Injuries are a public health
problem
The present programme is the first systematic effort
to build a surveillance activity with existing data
sources to recognise and understand the problem.
The health sector bears the maximum impact in
terms of providing care and services for injured
persons. Apart from huge costs, the impact on young
minds and bodies are phenomenal. The psychosocial
and economic consequences have not been measured.
In a “do nothing" scenario or if the present scenario
continues, Injuries will result in an estimated loss of
10,000 lives, 2,00,000 hospitalizations and 50,000
persons with disabilities every year by 2015 in
Bengaluru(17). These numbers are conservative
estimates and are likely to be influenced by many
factors.Despite the enormity of die problem, there has
been a glaring absence of institutional mechanisms
and injury prevention policies at the ground level.
C1.3. Young people should not die due
to preventable injuries
Data presented in this report as well as in 2009
clearly indicate that 70 - 80 % of injuries occur
among young people, majority being men. This
pattern remains similar across injuries. With
changing patterns, women will be affected more as
changes in life styles will increase the problem. The
age of 15 - 35 years is the most crucial age of an
individual with children and parents building their
dreams, aspirations and ambitions. Loss of lives,
broken skulls and fractured limbs at this stage can
entirely pull back families and result in life long
negative life styles. In few of our earlier studies (39)
it is seen that people develop many negative life styles
(alcohol, depression, violence, etc.,) following the
loss of their near and dear ones. The loss of young
lives due to an injury should be a wake-up call for
all concerned and realistic programmes should be
in place. This human tragedy due to a human disaster
needs to be stopped.
C1.4. Injuries have huge economic
impact
With guestimates in operation, considering that a
Rs. 1,00,000 compensation is given to all deaths
(Whether it reaches all those affected is to be seen
to be believed), and minimum Rs.25,000 for injured,
the economic losses per year are equivalent to
Rs. 2,950,000,000 in just Bengaluru alone. This apart
from the huge losses, families and individuals incur
for direct and indirect medical costs. Many families
sell their assets, make loans, pawn their property
and make emergency arrangements. At the national
level, it is estimated that Rs.55,000 crores are the
annual economic losses due to Road Traffic Injuries
alone. If all injuries and both direct and indirect
economic losses are considered, the losses will be
around 3 - 5 % of GDR
C.1.5. Information systems and existing
gaps
Any prevention and control programme needs a
good foundation to work through policies and
programmes; such programmes obviously need
good quality and reliable information. The injury
information system till date in the country and in
Bengaluru has been fragmented and patchy with
different systems operating in their individual ways
as per their administrative and legal requirements.
Four common sources of injury information are
police, corporation vital registration sources,
57
transport and health. Police data is the only source
of injury information and even this is of limited value
for policies and programmes. The data is not
comprehensive, quality is moderate, not analysed
and disseminated, and utilized by all stake holders
at local levels (city or state). Even though health
sector provides care for number of patients in
individual hospitals, there has been no injury
information system in health sector. Further, each
hospital follows its own individual practices. In the
absence of timely and scientific information, it has
not been possible to develop - implement - monitor
and evaluate any systematic policies and
programmes. There is need for building proper
information systems, research, and surveillance
Activity Profile of 2009
The Bangalore Road traffic injury/injury surveillance
programme was started in April 2007 and formal
activities began in 2008. The details of the
programme are provided in the present report and
also in the earlier report entitled “Bangalore Road
Traffic injury/injury surveillance programme: a
feasibility study” published in January 2009. The
data collection activities during the period Jan 2009
- December 2009 are presented in earlier sections
of this report. In 2009, the major emphasis was on
inputs for policies and programmes along with
continuation of data gathering and pooling. The
following sections provide various activities
undertaken by the partners in the programme during
the year 2009 using data from the programme.
1.
January - Stake holders Consultation:
The year started with a stake holder’s consultation
meeting on 28 January 2009 under the Bangalore
Road safety and injuiy Prevention Programme with
the participation of more than 250 members from
all partner agencies. During the meeting, the
feasibility report, set of 10 fact sheets and 5 public
health alerts were released. Various activities
undertaken in 2008 were reviewed and steps to be
taken for further improvement were identified. The
burden and impact of road traffic injuries, suicides
and other injuries, presentation on current initiatives
by different sectors and need for scientific approaches
to prevention and control were discussed. Following
this, discussions by the CC with individual
stakeholders continued at periodical intervals.
Several areas have been strengthened in the
intervening period.
2.
O
O
O
Data Collection Activities
In 2009, data collection continued with die City
traffic police department to on road deaths in
the city. The earlier data collection format was
modified to make it more specific and focused.
The form remains uniform for all the 39 police
stations of the City and is completed by writers
and assistant writers in all stations. The
completed forms are sent to the nodal officer
before 10Ih of every month and transferred to
coordinating centres for data entry and
computerization activities. Data collection was
not continuous with the law and order division
of city police due to procedural issues.
The Bangalore Metropolitan Transport
Corporation extended all support for data
collection on involvement of public transport
BMTC buses in road crashes. The format of
data collection was revised and finalized in
consultation with the organisation. Data
collection was undertaken by the CC Staff on a
regular basis once a month in the revised format
and computerized.
Data collection continued in all the partner
hospitals on a regular day to day basis. The
forms are printed by the Institutions with their
name and logo, completed by existing staff and
collected once a month by the CC staff for
computerization. Based on review and feed
back, the format was revised and data
58
BRSIPP 2009
collection is done by the team of causality
medical officers and nurses soon after
completing treatment procedures. To examine
the possibility of the system running on its own,
data collection by CC staff was withdrawn and
hospitals were encouraged to continue on their
own. However, regular monthly monitoring
continued with feedback to hospital
administrators and doctors.
Due to administrative procedures and other
unanticipated problems, data collection could not
be undertaken without supervision for in- between
periods in Victoria hospital, Bowring hospital,
Jayanagar General Hospital, St. John Medical
College Hospital, Manipal Hospital, Malya Hospital
and two other small hospitals. However, efforts were
continued to develop mechanisms for data collection
activities.
3.
the hospital were discussed, including
improving emergency care and teaching of
medical students.
O
June: The writers and assistant writers of all
39 police stations were trained in data
collection activities on 8,h June 2009. The
importance of timely data collection and the
need for focussing on completeness, coverage
and quality was highlighted.
Training and Capacity building activities
Series of Capacity building activities were conducted
on a regular basis throughout the year. These
programmes focussed on sensitisation of participants,
review of activities, problems in data collection and
management, opportunities for improvement and
strengthening, feed back on completed forms and
monitoring mechanisms. Apart from focussing on
data collection, it also included developing evidence
based approaches for road safety and injury
prevention by identifying new activities that could
be undertaken.
O
O
March: Discussions were held with Staff of
BMTC personnel and data collection for the
year 2008 was initiated in a systematic way in
March 2008.It was also planned to undertake
a survey on attitude and practices of drivers
working with BMTC in the city. The role of
managements and drivers in road safety was
highlighted.
O
June 2009: The nodal officer meeting was
held on 12 June 2009 at NIMHANS to discuss
various aspects of programmes which was
attended by 20 members. Data of last 6 months
was reviewed and priority' areas of action were
identified.
June: An orientation cum training programme
was held for medical officers, nurses and
medical records officers of Kempegowda
Institute of Medical Sciences on 18,h June 2009.
The data collected from the Institute was shared
with the members and their role and
contribution was highlighted. Specific activities
that could be undertaken and advantages to
59
O
salient findings from the first phase of the
programme based on data collected from police
and hospitals, existing laws related to road
safety (provisions under the Indian Motor
Vehicle Act, 2002, other relevant Indian Penal
Code provisions for road safety, Judicial
pronouncements), importance of systematic
enforcement and aspects related to pre-hospital
care (principles and appropriate practices of
first aid, safe transportation of the crash
victim). The crucial role of the traffic police in
implementation of road safety measures
particularly for prevention of road deaths and
injuries was highlighted. The need for a
uniform, visible, random, continuous, ongoing
enforcement / implementation programme was
emphasized.
October: An orientation programme for the
administrators of newly introduced hospitals
was held on 31 October 2009 at N1MHANS.
O
November: The training programme for the
nodal officers from all the 8 new hospitals was
undertaken on 26'h November 2009. The
programme highlighted the need for
involvement of institutions in road safety and
injury prevention and importance of data
collection to formulate scientific programmes.
The various steps and procedures involved in
the programme were highlighted for
participants. All new hospitals have printed
their own forms and activities are in progress.
©
G
A review meeting of the programme was held
at MS Ramaiah Institute of Medical Sciences
with around 40 participating members and the
administration. Data collected from the
hospital was provided as feedback and new
areas of activities were identified.
June - December 2009: The Bangalore City
Police in a unique approach organized a
continuous training programme for all middle
and junior level officers on integrated approach
to traffic management and road safety from
June 2009. A total of 52 sessions were held,
and each programme was over 2 days for a
batch of 60 - 70 officers. The trainees included
Police Sub Inspectors (240), Assistant Sub
inspectors (325), Head constables and police
constables (2100) of the Traffic Wing of the
Bangalore City Police. The road safety sessions
focused on overview of the Bengaluru Injury
surveillance programme, importance and
burden of RTIs as a public health problem,
60
BRSIPP 2009
O
December 2009: Similarly, a 3 day
orientation cum training programme for road
engineers working in BBMP was conducted
during 14,h to 16,h December 2009 highlighting
the engineering approaches on Road Safety. The
objectives of the deliberations were to sensitize
the staff regarding concerns, concepts and
principles of road safety and identify possible
mechanisms for making roads safe. The scope
of BBMP engineering department was
identified to be to ensure safety of people on
road, at home, all public places and in work
places through safe design, maintenance
and operation of roads, ensuring strict
implementation of regulations in all places,
developing mechanisms for monitoring of
ongoing activities, evaluating safety in terms
of reduction in deaths and injuries, undertaking
joint analysis and interpretation, and supporting
interventions to be implemented by police,
transport, health and others.
disaster mitigation of management, road safety
was not included in the same. Efforts were
made by the CC to integrate road safety with
other disasters as the principles of management,
through policies and programmes remain
equally important. Need to ensure safety of
children through comprehensive school safety
programme has been highlighted.
httpjZZndma.gay.inZ
©
Considering the inadequacies in road crash and
suicide information, technical report was
submitted to National Crime Records Bureau
and State Crime Records Bureau to strengthen
data collection mechanisms for fatal road
crashes. Since , the FIR format and summary
format are used for online data transmission,
opportunities exist for data strengthening
activities.
©
Considering the significant hardships
experienced by trauma patients in terms of their
ability to pay in hospitals, the data related to
trauma care and outcome was provided to the
4.
Inputs to policies and programmes:
During the year the data collected under the
programme was shared with several stake holders
at National, State and City levels to strengthen road
safety components.
©
August 2009: Inputs were provided for the
road safety programme organized by Shell
India and GRSP to strengthen fleet safety
programme in Bangalore. Specific data on
involvement of fleets as available from the
BRSIPP was developed under this activity.
hrtpjZZw_w_w.,_g.r_spr.o_adsa±e_t_y_,_o_LgZ
?pageid_^27#projecL9_3
O
August 2009: Inputs were provided to “Abide
Bangalore” for consideration, recognition and
inclusion of road safety in all development and
infrastructure expansion activities in the city
of Bangalore w_ww.abidebengaluru.in
©
August 2009: Inputs were provided for the
technical team of the National High Way
authority of India to strengthen road safety on
National and State Highways. The NHAI in
its attempt to strengthen road safety is in the
process of constituting a road safety cell and
information collection was identified as a key
activity. The methodology and data from the
programme was provided to identify specific
factors of road safety on high ways. It was
suggested to include pilot studies collecting
minimal data from all fatal crashes occurring
on National Highways in 2010.
-.www.nhai.org
O
November 2009: Even though the National
Disaster Management Authority of India has
developed number of measures aimed at
5o.».
__
Z>.
Trauma care needs
to be upgraded
ir.jFMixuiM.n
PH Ntw$ Strnnct
Bangalore:
Road traffic
accidents and suicides an?
two major causes of 5.000
deaths and 1.00,000 hospital
isations that take place in
the City annually To sur
vive injuries from road traf
fic injuries (RTI). falls.
burns, poisoning, disaster
related injuries, suicides.
violence, occupational in
juries, the individual requi
res trauma care services.
A study released by
NIMHANS publishing data
from Bengaluru Injury' Sur
veillance programme high
lighted the current state of
trauma care facilities - pre
hospital and emergency
care. Injury patterns as well
as suggested strategies for
strengthening trauma care.
The data showed that the
highest percentage of in
jury deaths (53 per cent) oc
cur in hospitals, injury
sites (36 per cent) on the
way to hospital (11 per
cent). In RTls. 29 per cent
died at the crash site, 22 per
cent on the way to hospital
and 49 per cent after enter
ing the hospital.
Pre-hospital care
To survey pre-hospital
care, availability and pat
tern of first aid. transporta
tion methods, referral pat
terns. time interval be
tween occurrence of Injury
and reaching a partnering
hospital and number of
medical contacts were ex
amined.
It was found that 2R p«T
cent of deaths and -13 per
■ Head (77 per cent in
fatal and 42 per cent in
non fatal)
■ Face (19 per cent in
fatal and 27 per cent in
non fatal)
■ Upper limbs (25 per
cent in fatal and 35 per
cent in non fatal)
■ Lower limbs (37 per
cent in fatal and 46 per
cent in non fatal)
■ Chest and abdominal
organs (23 per cent of all
patients)
cent of the injured received
some first aid before reach
ing the partnering hospital.
Only three per cent of all in
juries and one per cent of
road traffic injuries were
provided care at the injury
site.
The study states that
doctors and nurses wen? the
ones to provide basic first
aid and common first aid re
sponders like police, driv
ers and volunteers were not
available at the injury site.
Private vehicles and autorickshaws were the pri
mary mode of transport of
the injured. The time inter
val between occurrence of
the injury and reaching the
definitive hospital which is
crucial. Only' 30 per cent
and 47 per cent of Injury pa
tients and 32 and -15 per cent
of RTI patients reached
hospitals in less than one
hour and three hours re
spectively About 47 per cent
of all injury patients and 53
per cent of RTI patients
were referred from one hos
pital to another due to non
availability of facilities, in
vestigation and inability to
pay
Strengthening means
Among the strategies
put forward in the study in
clude establishing of a lead
organisation within the
Ministry of Health to coor
dinate implement, monitor
and evaluate all trauma
care activities in state and
city level and mechanisms
for integrated emergency
can? programmes covering
all types of emergencies.
All pre-hospital and trauma
care facilities to be made
available in all hospitals
with a bed strength of over
10) also found mention.
61
expert committee constituted to develop
mechanisms for free treatment of injured
persons.
o
In a significant development, the Ministry of
Road Transport and Highways, established an
expert committee under the chairmanship of
Ms.S. Sundar to suggest revisions for Indian
Motor Vehicles Act of 1988. Even though this
issue was discussed in our nodal officers meting
and was identified as a critical need, this
provided an opportunity for providing inputs
to strengthen the legislative aspects of road
safety. The data available under the
programme was analysed in different ways and
list of recommendations were submitted to the
Chairman and members of the expert
committee. (Annexure 2) details the
recommendations submitted on behalf of the
programme. Further, some members of the
committee were met individually to highlight
importance of revisions and doing it based on
data and evidence. - http:ZZmonh.nkJnZ
index2.asp2sublinkiji^46Q&langid = 2
was provided and discussed. The programme
is likely to get expanded in the City and the
entire state. The comprehensive school safety
programme is under development in
consultation with the Department of
community medicine at MS Ramaiah Medical
College and initial activities are under progress.
5. Campaigns and awareness programmes
Under the programme,inputs were provided for
number of ongoing initiatives that were aimed at
increasing awareness and importance for road safety
in the City of Bangalore by other agencies. In all
these activities, detailed discussions have been held
to identify need, type of data required, areas of focus,
target audience and duration. It only made these
campaigns more specific, targeted and focussed.
O
safety by the Indian Institute of Journalism and
Media, and Indian Institute of Management,
data on pedestrian’s deaths and injuries in
Bangalore was provided to the production
team. The necessary steps that can be taken by
various stake holders and the people have been
highlighted in the documentary which is in the
final stages of development.
September 2009: In a significant programme,
the transport department of Government of
Karnataka in collaboration with MS Ramaiah
Institute of Medical Sciences, initiated the
programme on “Adolescents and Road safety”
in Bangalore on September 7, 2009. The data
available in the programme specifically for
young children in 10-20 years of age group
August 2009: In a documentaty on pedestrian
O
December 2009: In a documentary under
development by Terravista Films by Sree Amith
Mithra, entitled “ Lives : Lost and Saved”, data
on two wheelers deaths and injuries has been
provided to highlight the specific issues of two
wheeler drivers and measures for improving
road safety aspects. The documentary is in final
stages of production ( done at very less cost)
G
ADOLESCENTS AND ROAD SAFETY
December 2009: In a campaign developed
by www.smilngdrivers.org, specific inputs on
helmet usage, seat belt use and early trauma
care have been highlighted with data from the
programme.
G
Reach home safe, Someone is waiting for you
Contact ui
In a series of day to day news related
programmes by the print media, data inputs
on number of issues have been provided on
number of occasions. The print media from
different news paper agencies covered road
safety aspects in the City with the data available
in the programme. All partners were also
encnuraged tn write articles in the press.-------
62
BRSIPP 2009
METHO/ STATE
conference of the Indian Public Health
Association, Jan 22 to 24,h 2010, Andhra
Medical College, Vishakapatnam
MsMiy, »<tx-j4zy 2. 2009
Deaths by poisonous substances soar
5)
6.
Academic Activities
The partners in programme also used the data from
their respective Institutions and from the programme
(that was made available by the CC) to present papers
in various conferences and scientific meetings. New
activities from academic institutions also were
encouraged and are in progress.
Scientific paper presentations
1)
Suryanarayana S I’ Gautham M S, Manjunath
M, Pruthvish S: Surveillance of injuries in a
tertiary care hospital; presented at the 21s1
Annual conference of the Karnataka
Association of Community Health, 10-11th
October 2009, J S S Medical College, Mysore
2)
3)
4)
Giriyanna Gowda, Ashwath Narayana D H,
Girish N Rao, Gururaj G. Road Traffic Injury
Surveillance Programme at KIMS Hospital,
Bangalore. Presented at the 21s' Annual
conference of the Karnataka Association of
Community Health, 10-1 1th October 2009, J S
S Medical College, Mysore
Giriyanna Gowda, Ashwath Narayana D H,
Girish N Rao, Gururaj G. Road Traffic Injury
surveillance programme in a Tertiary Care
Hospital in Bangalore City. Presented at the
Annual conference of the Indian Public Health
Association, Jan 22 to 2411’ 2010, Andhra
Medical College, Vishakapatnam
Venkatesh B Ashok J, Girish N, Gururaj G.
Profile of rural injuries. Presented at the Annual
Anita et al. Injury surveillance programme in
tertiary care centre. Poster presentation at
INDUS 2009, Coimbatore, Oct 30 to Nov 01,
2009
Technical assistance provided to Dissertation
and research projects
6)
Dr Pallavi Sarji, Postgraduate in Community
Medicine under the guidance of Dr S P
Suryanaraya, Professor of Community
Medicine, M S Ramaiah Medical College,
Bangalore - 560 054 titled “Study of gaps
between precepts and practices of preventive
measures and pre-hospital care among injury
cases” admitted to M S Ramaiah Teaching
Hospital.
7)
Dr Sreedhara, Postgraduate student of masters
in Hospital Administartion, Padmashree
Institute of Management initiated a study
entitled “processing of medico legal cases in
selected hospitals in Bangalore”.
8)
Dr. Shilpa R, Post graduate in Community
Medicine under the guidance of Dr. Bobby
Joseph, Department of Community' Medicine,
St. John’s Medical College started her M.D.,
thesis on “Incidence and Profile of Occupational
Injuries among residents of villages under the
Sarjapur PHC area, Bangalore”.
9)
In July 2009, BMTC took keen interest to
understand drivers knowledge and practices
and initiated a survey among BMTC bus drivers.
Nearly 4200 interviews have been completed
and data analysis is in progress.
10)
In addition, information pertaining to data
from Department of Plastic Surgery' and Burns
ward, Victoria Hospital was utilised for display
during Suvarna Arogya Seva Trust, a health
insurance initiative by Government of
Karnataka for Below Poverty' Line, at Gulbarga
on January Is* 2010.
63
7.
O
O
Expansion of activities
Din ing the year, 8 new hospitals were enrolled
into the programme and these are
Rajarajeshwari Medical College, (Mysore
Road), Vydehi Medical College, (ITPL Road),
ESI Hospital, Rajajinagar, (for occupational
injuries). Suguna Hospital (Private Hospital),
ESI Hospital, Indiranagar, (for occupational
injuries), Ambedkar Medical College Hospital,
Rajiv Gandhi Institute for Chest Diseases, and
Colombia Asia Hebbal and Yeshwanthapur
Hospitals. We warmly welcome our new
partners. The nodal officers meeting was held
on 31 October 2009 and the Casualty Medical
Officers/ Nurses training programme was held
on 26lh November 2009. All the hospitals have
printed their own forms and activities are in
progress.
Discussions have been held with Bangalore city
police and with the Centre for product design
and development at Indian Institute of science
to initiate a centre for crash analysis to
O
specifically examine vehicle and road related
features for prevention and control of road
traffic injuries.
Preparations are in progress to develop
electronic transmission of data from all
39 police stations in the city. The
computerization process and related training
has been initiated in consultation with the
Additional Commissioner for Traffic Safety in
Bangalore.
In summary, the activities can be summed up as strengthening of data collection, data led
programmes, and beginning of new activities. Most
importantly, linkages were established, partnerships
strengthened and new ideas were discussed during
the year.
Sustainability issues
Administrative support through a programmatic
approach - motivated and committed staff - resource
availability - necessary back up services - continuous
feedback - and data utilization / application for
policies and programmes are crucial for Road safety
and injury prevention and surveillance programmes
to be effective. Injury surveillance, especially for
Road traffic injuries and suicides, should become an
inbuilt component of injury prevention and control,
road safety and suicide prevention programmes,
respectively. Feasibility, sustainability and cost
effectiveness should be addressed from the beginning.
These aspects and possible mechanisms have been
discussed in our previous report and some salient
points are provided below.
G
There is need for a dedicated agency in the
city that can drive these programmes on a
continuous basis. This agency has to be
identified, supported and nurtured to undertake
these activities with resource allocation and
capacity strengthening at appropriate levels.
O
64
As injuries are a health problem, the
Directorate of Health Services should take a
leadership role and inform all major hospitals
BRSIPP 2009
O
O
for introduction of Emergency trauma care
record on a regular basis. Necessary
administrative notifications should be sent to
all partnering health institutions. Apart from
surveillance, number of other activities like
advocacy, capacity building, monitoring and
evaluation should be initiated.
Capacity strengthening programmes for senior
and mid level policy makers and training
programmes for other staff from police and
health sector should be held at periodical
intervals. Injury surveillance will ensure
monitoring of activities along with data inputs
for other activities at different levels.
All professionals involved in data gathering,
treatment and care of injured persons in
all participating institutions (police at mid
and junior levels + ER staff of selected participating hospitals-medical record
divisions) should be trained (at least twice in
a year) to improve data collection, trauma care
and to obtain better cooperation. The required
training modules and training course contents
should be developed jointly for ensuring
uniformity in training.
O
O
Variety of communication channels like reports,
fact sheets, websites and other channels should
be utilised for sensitisation, awareness building
and use of data. The local decision making
bodies and respective departments at higher
levels should utilize and apply data for
development - implementation of interventions
and for larger decision making process as well.
The programme should be monitored
continuously and evaluated at periodical
intervals for further modifications and
improvements.
A programme of this nature will require
cooperation - participation - support of stake
holders, police and transport officials, hospital
administrators, nodal officers and teams in
casualty departments. Inputs to strengthen this
O
component through training programmes,
information sharing, continuous feedback,
using data at individual and hospital levels,
and joint collaborative programmes needs to
be promoted.
Resources are required in the long run for
continuous running of the surveillance
programme and this should be part of the larger
road safety and injury prevention programme
; not an isolated activity on its own. An initial
investment is very much required till the
programme gets established. The local
government or Directorate of health services
or state health division or city police or BBMP
should take ownership of the programme. Injury
and RTI surveillance is a part of larger injury
prevention and control and road safety
activities.
The way forward
With existing police, transport and health systems
reporting systems being patchy and fr agmented and,
research in all these sectors being extremely limited
in India, the obvious questions is “ how can we
improve data availability to formulate - implement
- monitor and evaluate road safety and other injury
prevention and control programmes”. One of the
possible methods is to implement a surveillance
programme in sentinel institutions across the country
on selected injuries (RTIs and suicides) with a focus
on moderate and severe injuries. The scope and
ambit of surveillance can be expanded to the level
of trauma registries or kept to a simple level
depending on the technical expertise available in
institutions and mechanisms that would evolve to
address road safety and other IPC issues. The need
for evidence-based programmes, which would
result in a noticeable reduction in deaths and
hospitalizations, has been acutely felt. It is hoped
this joint partnership programme with leading
institutions and organizations in the city of
Bengaluru would pave the way to formulate effective
injury prevention policies and programmes in
the coming years. Injury surveillance should be a
part of larger road safety and injury prevention
activities.
65
If only, he had got the right care
Mr 'V' is a 50 year old male coming from Chikkanayakanahalli in Tumkur district. He is a farmer
and has completed middle school. The injury happened when he was traveling in his scooter near
to his agricultural fields. The scooter toppled after slipping on the mud road leading to the tank
bund area. V sustained minor injuries on face and back, but had some bleeding from his nose, and
there were lacerated wounds on his scalp.. Immediately after the accident, the patient was rushed
to the nearby government hospital. First aid was given by the doctor. After stitching the scalp
wound, the doctor noticed continued bleeding from the nose. Suspecting traumatic brain injury,
the patient was informed to go to Bangalore for further management. Till such time, V did not
have vomiting and suddenly started complaining of giddiness and could not speak. Worried after
his condition, the family members hired a taxi and started off to Bangalore. Halfway through, as
the vomiting became worse, they took him to a nearby nursing home. After giving him some
injection to stop vomiting, the doctors asked them to rush to Bangalore. On reaching Bangalore,
on suggestion by one of their friends, they took V to a private hospital on the outer ring road. The
Duw doctor refused to see the patient and asked them to take the patient to the government
hospital. It was a delay of almost 18 hours before the patient reached the right hospital. By that
time, his conditioned had worsened. A CT scan revealed a big Subdural hematoma. After the
emergency surgery, V was shifted to the head injury ward for observation and has still not recov
ered totally.
11
jiSgSSLHow can we survive?
Mr "S" is a 40 year old male residing at Hosakere in rural Bengaluru. He could not complete his
education beyond 6th standard and is now working as a daily wage laborer. In the evening at
about 6.20 pm, when walking back to home, he was hit by a two wheeler from behind at the bus
stand on the Devanahalli - Hosakote main road. He was standing on the road and was about to
cross the road, when the speeding two wheeler hit him and speeded without stopping. The
injuries were serious: apart from abrasions over face and upper limbs, he complained of pain in
the sides of tire abdomen and said he could not move his legs. Seeing drat he had no bleeding from
his ears or nose and not suspecting head injury, the government hospital doctor referred him to the
Government hospital in Bangalore as he was still not conscious. Nearly 4 to 5 hours were spent in
getting an ambulance transfer organized. On arrival at the hospital in Bangalore, the CMO sus
pected internal injury and was shifted to the surgical unit for emergency surgery. S had no money
with him, and his wife and young son who accompanied him also did not have any money, and
desperately tried requesting everyone for some help. They had not had any meal since afternoon.
Fortunately, investigations revealed that there was no major damage to internal organs and he
was shifted to the ward within 24 hours. Meanwhile, his wife had gone back to their village and
had come back with a loan, which they would need to repay over the next 1 to 2 years. Because of
the surgery S would not be able to go to work for almost one month.
66
BRSIPP 2009
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Joshi R, Cardona M, Iyengar S, Sukumar A,
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AB, Subbakrishna DK, Krous JF, Traumatic
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BRSIPP 2009
Annexure - 1
The cases of Injured and Killed in India for various causes, 2008
Karnataka
Bengaluru
SI. No
A
I
II
1
2
3
4
5
III
1
2
IV
V
1
2
VI
1
2
VII
1
2
VIII
1
2
3
4
IX
X
XII
1
2
3
4
5
XIII
XIV
1
2
3
XV
XVI
B
XVII
1
2
3
XVIII
1
2
3
4
5
6
7
8
Causes
India
Killed
Injured | Killed
Injured
Killed
Injured
0
16
0
7
0
0
9
7
0
7
3
4
4
0
10
10
0
0
0
0
19
1
0
18
0
0
0
119
0
0
0
3
116
0
6180
6180
0
0
65
0
6430
0
6
0
3
0
0
3
102
0
102
49
0
0
0
85
80
5
0
0
0
314
0
4
50
260
0
0
30
8
10
1
1
10
0
865
865
0
0
600
199
2524
0
29
3
7
0
0
18
15
0
15
11
4
4
0
12
12
0
0
0
0
27
1
1
18
7
0
3
132
0
0
0
9
123
0
63314
63281
33
0
65
0
63620
0
149
37
14
6
0
92
2173
29
2144
388
11
0
11
462
439
23
29
26
3
1587
29
102
260
1196
7
62
1838
107
188
32
658
856
6
10232
8814
0
1418
1117
1074
20129
1
19
991
2833
261
1173
107
249
2]
66
22
93
1252
599
582
27206
58
979
524
26227
400
8067
1719
792
490
1588
302
131
10637
1778
744
8757
1034
1880
506
1229
461
858
45
371
2987
22454
194
342
202
1098
316
3628
2275
17386
734
1639
134
827
4405
24261
2098
7829
181
1358
6
247
1703
7825
417
7002
92
434
473562 144587
469156 118239
2222
124
4282
24126
4387
35135
1493
13962
498124 318316
0
0
0
253
54
2396
1593
251
12222
35962
8093
125017
Unintentional injuries
Air-Crash
Collapse of Structure (Total)
House
Building
Dam
Bridge
Others
Drowning (Total)
Boat Capsize
Other Cases
Electrocution
Explosion (Total)
Bomb Explosion
Others (Boilers, Gas Cyld. etc.)
Fall (Total)
From Height
Into Pit/Manhole
Factory
Machine Accidents
Mines or Quarry Disaster
Fire (Total)
Fireworks/Crackers
Short-Circuit
Cooking Gas Cylinder/Stove Burst
Other Fire Accidents
Fire-Arms
Killed by Animals
Poisoning (Total)
Food/Accidental intake of Insect, etc.
Spurious/Poisonous liquor
Leakage of gases etc.
Snake Bite/Animal Bite
Other
Stampede
Traffic Accidents (Total)
Road Accidents
Rail-Road Accidents
Other Railway Accidents
Other Causes
Causes Not Known
Total of unintentional injuries
Intentional Injuries
Intentional Injury Deaths
Homicides*
Dowry deaths’’
Suicides
Other Intentional Injuries*
Attempt to commit murder
Rape
Kidnapping and abduction
Molestation
Sexual harassment
Cruelty by husband and relatives
Other 1PC crimes
Others
Total of intentional injuries
Grand Total (A+B)
• Data from Crime in India Report, 2007
264
62
119
187
2
290
10969
15156
27049
33479
2736
5260
1251
436
680
1828
28
2507
60853
53023
120606
184226
14148
34277
27401
20737
27561
38734
10950
75930
829206
959154
1989673
2487797
166692
485008
Source: NCRB Report 2008
69
Annexure - 2
Extracts of the report submitted to the expert
committee set up for revisions of Indian
Motor Vehicles Act
psychology' and limitations of human behavior
(In the present act, in many places it is
mentioned as life imprisonment and other
punishments which are never followed) to deter
people from taking risky behaviors.
General Observations
1.
With increase of road deaths and injuries in
India due to combination of several factors,
the decision to revise the I MV act is timely and
appropriate. The proposed revision after 20
years has to keep changes that are likely to
occur in the coming years and possible future
developments.
2.
All road safety' laws need to be framed for safety
and health of people and the expected outcomes
and impact of the act need to be measured
by reduction of deaths, hospitalizations,
disabilities and socioeconomic losses.
3.
The revised IMV ACT should have individual
and separate sections with regard to Transport
vehicles, Roads and environment, Road safety,
insurance procedures and compensations. The
present Act is a mix up of all issues and needs
to be broken up into different sections. The
recommendations provided here are with
reference to road safety aspects.
4.
All revisions are to be based on data and
evidence available in the past few years from
the Indian region and should also consider
international developments and experiences.
5.
The act should have specific sections that are
mandatory for different groups and should be
based on consensus in the early stages to avoid
delays in implementation.
6.
The entire system should be made simple and
easy to follow, thereby giving less room for
misinterpretations by different groups. The law
should be strong enough to achieve the desired
goal.
7.
Penalties should be strong enough and realistic
based on an understanding of human
70
BRSIPP 2009
8.
The committee can consider uniform penalty
levels with regard to road safety laws as it
becomes easier for people to understand and
remember ( Ex: the fine could be Rs.2000 for
not wearing helmets, drinking and driving, over
speeding , driver license etc.,.) and these can
be grouped together in some areas. Higher
level penalties can be considered for serious
offenses. Areas that are of high importance
should be kept uniform with moderately high
penalty levels.
9.
The implementation of laws should be uniform
across the country' with no provision for change
or manipulation by states. With the
development of national databases for vehicle
registration and driver licensing systems this
should be easy to implement.
10.
Implementation mechanisms also need to be
specified and in some areas require
coordination with related ministries of health,
NHAI, police, law and others to develop
implementation mechanisms. These should be
discussed with concerned professionals and
sectors in the early stages to develop
comprehensive
mechanisms
for
implementation.
11.
The revised laws should be monitored seriously
to see the impact of changes and overall
reduction of road deaths and fatalities. It would
be helpful to establish centers for monitoring
of laws and to build road safety information
systems in select centers across the country.
The impact of all laws needs to be measured in terms
of reductions in deaths, hospitalisations and
disabilities due to road crashes. This requires
promoting and strengthening crash investigation and
analysis as an independent area.
Specific observations
A.
The Indian Penal code sections that are
relevant to road safety:
1.
Section 279. Rash driving or riding on a public
way. “Whoever drives any vehicle, or rides, on
any public way in a manner so rash or
negligent as to endanger human life, or to be
likely to cause hurt or injury to any other person,
shall be punished with imprisonment of either
description for a term which may extend to six
months, or with fine which may extend to one
thousand rupees, or with both.”
2.
3.
Section 304A. Causing death by negligence
“Whoever causes the death of any person by
doing any rash or negligent act not amounting
to culpable homicide, shall be punished with
imprisonment of either description for a term
which may extend to two years, or with fine,
or with both.”
Section 336. Act endangering life or personal
safety of others “Whoever does any act so rashly
or negligently as to endanger human life or
the personal safety of others, shall be punished
with imprisonment of either description for a
term which may extend to three months, or
with fine which may extend to two hundred
and fifty rupees, or with both.”
4.
Section 337. Causing hurt by act endangering
life or personal safety of others. “Whoever
causes hurt to any person by doing any act so
rashly or negligently as to endanger human
life, or the personal safety of others, shall be
punished with imprisonment of either
description for a term which may extend to six
months, or with fine which may extend to five
hundred rupees, or with both.”
5.
Section 338. Causing grievous hurt by act
endangering life or personal safety of others
“Whoever causes grievous hurt to any person
by doing any act so rashly or negligently as to
endanger human life, or the personal safety of
others, shall be punished with imprisonment
of either description for a term which may
extend to two years, or with fine which
may extend to one thousand rupees, or with
both.”
71
BRSIPP 2009
Specific recommendations for modifications of existing act in select areas of relevance to road safety
Sr.
No
Domain
1
Driver Licensing Systems
Existing Provision
Justification for revision
Proposed changes
The existing act stipulates that No Studies have found that nearly 1. Mandatory driving schools certification with permission to run
person shall drive a motor vehicle in 30 % of drivers drive without a valid
driving schools should be established. The New act should specify
any public place unless he holds an driving license. In addition, it is well
criteria's and guidelines for running driving schools.
effective driving license issued to known that anyone can obtain a
2. The Act should come out with one set of instructions for public
him authorizing him to drive the driving license in any state or city
on procedures and tests to be completed for obtaining a license.
vehicle.
without going through any formal
As national data bases of drivers are being set up, the system
procedures
should be uniform throughout the country. This information
Requirements include
should be available in all state languages and should be displayed
a. Proof of age
in all public schools.
b. Self declaration of physical
fitness and medical certificate
from a physician required
3. A national core curriculum should be developed for all driver
tests incorporating health, safety, awareness and rules of road
issues.
c. In case of drivers of goods
carriages carrying dangerous
and hazardous goods, mention
of minimum educational
qualifications.
4.
The licensing authority also has
powers to revoke rhe license in
certain situations
5. The system of suspending/canceling licenses should be
introduced and list of offences for which these can be done
should be notified for public information.
Driving tests should be made stricter. The online procedures
that are being established are helpful more from an
administrative point of view and do not really test driving
knowledge and skills. Minimum guidelines should be established
in this regard.
6. The fine of Rs.500 should be increased.
7. Renewal of driver license of individuals above 50 years should
be based on health status and previous health records.
8. Graduated driver license systems should be introduced and
made compulsory across the country, especially for drivers of
public transport vehicles and other heavy carriers.
2
Age of driving
No person under the age of eighteen
years shall drive a motor vehicle in
any public place provided that a
motor cycle with engine capacity not
exceeding 50 cc may be driven in a
Data from BRSIP has revealed that Graduated driver licensing systems should be introduced and
11 % of injured drivers were procedures need to be systematic. The transition from Learner’s
children less than 18 years. Young license to full license should be watched and there should be specific
children less than 18 years are also restrictions for learners. The final license should be available after
found to be drivers on the roads. No completion of 18 years and after completion of tests.
Sr.
No
Domain
Existing Provision
public place by a person after
attaining the age of sixteen years.
Justification for revision
Proposed changes
specific details on actual number of The penalty levels should be increased to Rs.1000 uniformly across
drivers less than 16 or 18 years are the country for those less than 16 years and for those below 18
available in the country.
years who drive a vehicle without a license.
The penalty is a fine of Rs.500 with
or without imprisonment. The latter
is not followed in any part of the
country.
3
Speeding and driving
Section 112 pertains to limits of
speed and prohibits driving of a
motor vehicle or it being allowed to
be driven in any public place at a
speed exceeding the maximum
permissible speed.
The Penalty for exceeding the
prescribed speed limit is up to Rs.
1000, abetment for over speeding,
Rs 300, for overtaking perilously, for
failing to confer way to sanction
overtaking and overtaking from
wrong side the fine is Rs 100.
Limited studies in India have shown The law should have clear specifications on speed in different urban
that excessive speed in urban areas - rural - highways - residential areas - near to schools / hospitals /
and on highways is a major other traffic generators.
contributor for crashes.
The penalty levels are not only low, and should be increased
Data from BRSIP has shown the substantially and linked to crash outcomes. For example, if crash
increasing occurrence of crashes on result in death, the penalty should be higher and to be modified for
the outskirts of the city and in other crashes with different outcomes.
peripheral areas, where speed
As it is difficult to establish evidence for courts, mechanisms should
exceeds 80 km per hour.
also be strengthened for monitoring of speeds, coordination
Studies done on highway using mechanisms along with high penalty levels.
speed cameras indicated that the
speed of heavy vehicles, public It should be made mandatory for all public transport vehicles and
transport buses and cars were in the heavy vehicles to be fitted with speed governors or tachometers to
range of 100 - 140 Ions , even in control speeds automatically.
places where highways pass All public transport vehicles must be fitted with closing doors
through villages and other traffic (automatic or manual) and should be strictly enforced to avoid people
generators.
falling from moving vehicles, especially in turns, when vehicles are
This is also substantiated by in high speeds.
increasing capture of violations by
Bangalore city police with the help
of interceptors.
4
Use of protective device
like helmets for two
wheeler drivers and
pillions.
Every person driving or riding
(otherwise than in a side car, on a
motor cycle of any class or
description) shall, while in a public
place; wear (protective head gear
conforming to the standards of
Bureau of Indian Standards).
At the national level, data from The Act should be more specific and comprehensive in all respects.
NCRB indicate that 19.08 % of
deaths were among two wheeler Helmet legislation should cover all motorcycle users above 18 years
and all classes of two wheeler vehicles.
riders
However,
all
independent The legislation should cover both riders and pillions.
epidemiological studies indicate that
BRSIPP 2009
Sr.
No
Domain
Existing Provision
At present the penalty for not
wearing a helmet is Rs. 100.
At present, many of the Indian states
do not have helmet legislation; and
in other states, there is only partial
legislation (for riders only and for
select class of two wheelers)
At present the law enforcement
agencies only look for the presence
of a helmet on the head and do not
look into whether it is a standard or
non-standard helmet
Justification for revision
Proposed changes
nearly 30 - 50 % of both fatal and The law should be uniform across the country and this should be a
nonfatal injuries are among two central law with no flexibility for states to modify as per convenience.
wheeler riders and pillions.
The penalty for not wearing helmet should be in the range of Rs.500
Specifically, data from BRSIP for - Rs.1000.
2008 indicate that 26 % of deaths
Helmets worn should meet standards as laid down by the Bureau of
and 42 % of hospitalised injuries
Indian Standards. Use of half head helmets, construction helmets,
were among two wheeler riders.
broken helmets and others should be totally banned.
Pillions accounted for 11 % of road
deaths and 10 % of hospitalised As there are no specified standards for child helmets in India, it
injuries.
should be considered separately after formulating necessary
guidelines.
The data also report that only 33 %
of riders and 38% of nonfataily Law should be applicable for all categories of motor vehicles,
injured had worn helmets at the irrespective of engine power.
time of crash.
Further, reports from all over the
world and from World Health
Organisation
in
particular
conclusively indicate that helmet
legislation and enforcement is one
of the proven and cost effective
method of reducing deaths and
injuries among two wheeler riders.
5
Dangerous driving
Dangerous driving is a commonly
used lay term and is nonspecific and
not focused. Since it is not defined,
Penalty shall be punishable for the
it will be difficult to link and relate
first offence with imprisonment for
this to crashes.
a term which may extend to six
months or with fine which may
extend to Rs.1000, and for any
second or subsequent offence, if
committed within three years of the
commission of a previous similar
offence, with imprisonment for a
term which may extend to two years,
or with fine which may extend to
Rs.2000, or with both.
Section
184
provides
for
punishment for dangerous driving
This section needs to be defined properly. What is dangerous driving
should be identified and defined and correspondingly, penalty levels
needs to be revised.
Even though life imprisonment is commonly seen in JMV act, it has
not been applied effectively due to legal barriers and other issues
Sr.
No
Domain
6
Racing on roads
Existing Provision
The existing act under Section 189
stipulates that Whoever without the
written consent of the state
government permits or takes part
in a race or trial of speed of any kind
between motor vehicles in any
public place.
Justification for revision
Proposed changes
No scientific data is available on this This should be strictly modified and enforced as it is becoming a
in India, but anecdotal media reports common practice.
indicate that this is a common
The penalty should be in the range of Rs.2500 - Rs.3000 and linked
occurrence
to speeding and driving.
This shall be punishable with
imprisonment for a term which may
extend to one month, or with a fine
which may extend to Rs.500 or with
both.
7
Drinking and driving
Whoever while driving or There is no national data on drinking Addressing drinking and driving requires a combination of
attempting to drive a motor vehicle and driving as reported in NCRB interventions. Some of these are
reports.
a. has in his/her blood alcohol
♦ Checking for alcohol among drivers in a random, visible and
exceeding 30 mg per 100 ml of However, several epidemiological
uniform manner in all urban areas, highways and districts.
blood detected in a test by a studies from Bangalore have
breath analyzer or
reported repeatedly that one third ♦ Screening for alcohol at the time of appointment of drivers of
public transport vehicles and heavy vehicles
of
crashes occur during night time.
b. is under the influence of a drug
to such an extent as to be Among these, the involvement of ♦ Ensuring that breath alcohol findings are accepted in all courts
alcohol varies from 20 % to 40 %,
of law and to be combined with blood and visceral tests for fatal
incapable of exercising proper
and is found to be a major risk factor.
crashes
control over the vehicle.
Studies
have
also
reported
the
♦ All fatal crashes to be investigated for alcohol involvement.
A police officer in Uniform or an
alcohol involvement in both the
officer of the Motor Vehicles
♦ Having a uniform policy with regard to location, timings and
injured and killed categories.
department can ask for breath tests
sale of alcohol.
to be done if they so suspect the Many times, people are injured
driver of the motor vehicle to be and killed by other drivers under ♦ Removing alcohol selling outlets from 200m on either side of
highways.
under the influence of alcohol.
alcohol influence, and it has not
been possible to trace them in ♦ All hospitals (medical colleges and district hospitals) to introduce
Penalty for drinking and driving
investigations.
screening for alcohol problems.
shall be punishable for the first
offence with imprisonment for a Since blood and breath alcohol levels ♦ If fatal crashes are linked to alcohol involvement, it should be
term which may extend to six are not estimated in nonfatal
considered under the category of nonbailable offense.
months, or with fine which may crashes and in majority of fatal
♦
Penalty levels to be increased to not less than Rs.2500 for first
extend to two thousand rupees or crashes, this is a major legal barrier
offence and Rs.3000 for repeat offences, including cancellation
in courts of law and for registering
with both and for a second or
BRSIPP 2009
Sr.
No
Domain
Existing Provision
Justification for revision
subsequent offence, if committed details in both police and hospital
within three years of the commission records.
of the previous similar offence with
imprisonment for a term which may
extend to two years or with fine
which may extend to three
thousand rupees, or with both.
8
Use of drugs and driving
The section is not clear and is There is no Indian data in this
imprecise with no definition of drugs regard and needs to be examined
(legal and illegal), level of offense, based on review of medical literature
penalty levels.
from India.
Proposed changes
of license. This should be uniform across the country and to be
revised once in 5 years.
♦
The penalty levels can also be based on breath alcohol levels like
o
Rs.2500 for those with 30 - 60 mg / 100ml
o
Rs.4000 for those with 60 - 120 mg / 100ml
o
Rs.5000 for those above 120mg / 100ml
The section of the act should clearly list out harmful and hazardous
drugs with severe penalty levels.
To be implemented effectively, mechanisms need to be established
for detection of drugs along with legal acceptance.
It will be helpful, if the Act can mention that manufacturers of
drugs need to inform the warning signs in big bold letters for those
legal drugs likely to cause drowsiness and decreased concentration
levels. This should be made a responsibility of drug manufacturers.
A list of such drugs can be obtained for MOH&FW.
9
Use of cell phones while
driving
10 Use of Seat belts
At present, the offence of usage of
mobiles will be punishable under the
category of dangerous driving vide
Section 184 Motor Vehicles Act.
Even though, precise numbers are A new section needs to be incorporated in the act.
not available from India, data from
The penally levels should be substantially high in the range of
other countries have clearly
Rs.2000 per offense and to be increased later.
established that cell phone use while
driving is a risk factor as it influences
attention and coordination.
Rule 125 A of Central Motor Vehicle
Rules, 1989 states that after the
year 1993, all manufacturers should
equip vehicles with a seat belt for
the driver and the front seat
occupant.
Studies have shown that seat belts The New act should make it mandatory that seat belt to be used by
are effective in reducing deaths and all front seat car occupants in all cars. Since this facility is already
available in all new cars it should become mandatory.
injuries among car occupants.
The current use of seat belts among
front seat passengers in India are
extremely low, less than 10 % levels
The existing act has a section on seat
belts and penalties are Rs. 100 for
not using seat belts.
11 Use of child restraints in
cars
There is no mention of this in the
existing act
No data is available from India.
The effectiveness of this inter
vention has been well established
In addition, the transport of children in front seat of cars should be
banned.
The penalty for not using seat belts should be in the range of Rs. 1000
- Rs.2000 for car drivers not using seat belts.
The specific provisions for implementation of this need to be included
in the new act.
Sr.
No
Domain
12 Visibility issues
Existing Provision
Proposed changes
Justification for revision
No clear directions in the existing Poor visibility is known to be a risk The New MVA should specify and include
act, except mention of glaring lights, factor for crashes. Several studies ♦ Compulsory running of daytime headlights by two wheeler
have pointed out this finding in
stickers for heavy vehicles
drivers.
studies.
♦ Uniform reflective stickers for all vehicles should be introduced
In a qualitative study of 1500 brain
and the dimensions shape and size of reflective materials for
injured RTI patients, it was self
different categories of vehicles has to be decided by the
reported that 22 % of patients
committee.
sustained a crash due to poor
visibility factors.
♦ All vehicle manufacturers should be encouraged to make their
vehicles in bright and reflective colours. The act can enprovision
incentives for vehicle manufacturers.
♦
All bicycles should be manufactured in yellow or orange colour.
♦
All wheels pf bullock carts to be painted in reflective paints.
13 Obeying traffic rules
Section 119 provides for the duty
to obey traffic signs.
14 Carrying excess people on
vehicles
Section 128: Safety measures for
drivers and pillion riders not to cany
more than one person excluding the
rider.
This is unspecific and act should specify this for different types of
vehicles.
15 Disabilities and driving
The existing act under Section 186 Even though no clear data exists on
stipulates that Whoever drives a this issue in India, it is easy to
vehicle in any public place when he understand the limitations of
is to his knowledge suffering from disabled persons in using road
any disease or disability calculated environment
to cause his driving of the vehicle to
be a source of danger to the public,
shall be punishable for the first
This section even though present for a long time has been difficult
to enforce due to definitions of what constitutes physically or
mentally unfit. Experts from different disciplines will have wide
ranging interpretations of the law.
Data on this can only be obtained This section is too vague and should specify list of things drivers are
from police challans and this is not not supposed to do and penalties to be severe enough cautioning
a specific indicator.
drivers not to take any risks.
Penalty of Rs 100 for disobeying
traffic
signals/
signboard,
disobeying traffic police officer in
uniform, disobeying manual traffic
signals, driving against police signal,
failing to give signal and jumping
signal.
All persons with a medically diagnosed condition need to carry a
card indicating their health problems and the type of medications
they are receiving.
00
BRSIPP 2009
Sr.
No
Domain
Existing Provision
Justification for revision
Proposed changes
offence with fine which may extend
to two hundred rupees and for a
second or subsequent offence with
fine which may extend to five
hundred rupees.
16 Health status of drivers
There is no clarity in the present act. There are no clear data available There is no specific mention of this in the current act and needs to
The existing act is very vague in from India on this issue and needs include issues of relevance.
mentioning that
to reviewed
All drivers of heavy and commercial vehicles can be made to carry a
card that informs of their health status, type of drugs they are on,
results of vision tests once in 3 years and any other important issues.
This should be applicable, especially to those above 50 years.
Specifically for Epilepsy, The Indian Epilepsy Association has filed
cases in courts with the argument that those drivers who are seizure
free for more than 1 year can be permitted to drive. They need to
carry a card indicating types of drugs they have been receiving.
17 Fatigue and sleeplessness
The existing act does not address With nearly one third of crashes
this issue in any way.
occurring during night times,
fatigue and sleeplessness is one of
the major contributing factors.
There have been difficulties in
measuring this risk factor.
The new act should specify the need for maintaining driving hours
in all public vehicles and private fleets. The need for making alternate
arrangements (like 2 drivers) in long distance carriers should be
incorporated.
Specially with heavy vehicles and
public transport buses, this has been
a major issue as it endangers the
life of many passengers on board
18 Emergency Care
The existing act under Section 134
mentions the duty of a person in case
of accident or injury to a person :
When any person is injured or any
property of a third party is damaged
as a result of an accident in which a
motor vehicle is involved, the driver
of the vehicle or other person in
charge of the vehicle shall -
The Hon. Supreme court of India The major barrier for this is the presence of medico legal issues in
has issued directives in this regard both hospitals and police. This should be removed and the presence
and the ministry of transport and of Supreme Court directives should be included in the act.
highways has given publicity for the
In addition, all hospitals have to provide mandatory free treatment
same.
till the patient is stabilized and referred, if required.
Despite these measures, the
Separate compensatory mechanisms have to be developed for initial
situation continues to be grim and
care of patients.
prehospital care has not been
strengthened
Provisions have to be made for movement of ambulances and right
of way has to be provided.
Sr.
No
Existing Provision
Domain
a.
unless it is not practicable to do
so on account of mob fury or any
other reason beyond his control,
take all reasonable steps to
secure medical attention for the
injured persons.
b.
Give on demand by a police
officer any information required
by him or if no police officer
is present,
report the
circumstances of occurrence,
etc...
Justification for revision
Proposed changes
Consequently, the injured do not
receive first aid, reach hospitals late,
referred from hospital to hospital
and there are no triaging systems.
Penalty:
punishable
with
imprisonment for a term which may
extend to three months or with fine
which may extend to five hundred
rupees or with both, or if having
been previously convicted of an
offence under this section, he is
again convicted of an offence under
this section, .with imprisonment, for
a term which may extend to six
months, or with fine which may
extend to one thousand rupees, or
with both.
of
Rule 11 deals with pedestrian rights As per BRSIP data and from several The act should mandatorily stipulate the provision of footpaths,
other reports in the country, nearly walking spaces, crossing facilities and speed reduction and control
50 % of deaths and 40 % of hospital in all areas , specially in traffic generators
registrations due to road crashes are
among pedestrians.
20 Crash (accident) reporting
and investigation systems
Reporting of all crashes to police by With increasing occurrence of road The new act should simplify number of things while promoting and
both injured people and by hospitals crashes (nearly 1, 50,000 deaths facilitating a scientific approach for reduction of road crashes. In
and 30 time this number for this regard
hospitalisations), the reporting
systems are inadequate and difficult ♦ A simple, essential, scientific reporting system has to be
established in both police (in coordination with NCRB) and
to manage.
hospital systems with the aim of identifying essential risk factors.
rights
19 Safety
Pedestrians
vO
00
o
BRSIPP 2009
Sr.
No
Domain
Existing Provision
Justification for revision
In addition, this complexity has also
been interfering in patient care and
spending time in documentation
and maintatinence of umpteen
number of registers in hospitals.
All police documentation has been
ongoing from an administrative,
criminal and legal perspective and
has not been of help for prevention
and control of road crashes.
Proposed changes
♦
Online transmission of information on crashes to national
agencies and designated centres (to be established) within the
country has to be promoted.
♦
This system should support transport and police departments
to take effective action at an early time.
♦
Mechanisms have to be delineated to report fatal and those
required by people (for compensation purposes only) to be
reported to police.
♦
Scientific research to be established for reduction of crashes
based on crash analysis by setting up of a crash investigation
and analysis in each state of India.
MENTOR-VIP is a global injury and violence prevention mentoring programme. It
has been developed through the efforts of WHO and a network of global injury prevention
experts. Mentoring allows for skills development through exchange of experience
between a more skilled or experienced person and a person seeking to develop those
skills. MENTOR-VIP offers an opportunity for individuals committed to the injury area
to further develop key skills. MENTOR-VIP is designed to match mentees wishing to
develop certain skills with mentors who have agreed to devote their time and efforts to
assist mentees develop those skills. Matching of individuals is made on the basis of the
profiles of mentee and mentor and the overall principles and objectives of MENTORVIP Once a mentorship is awarded the mentee and mentor jointly plan the activities
that will be undertaken during the mentorship. A principle of the programme is that it
provides a low cost model for mentoring. Mentoring takes place primarily through
electronic and telephonic forms of communication and interaction. Mentorships are
for a 12 month period and begin in September of each year.For further details visit:
httpjZZwww.whoJmtZyiolence^njurY^prevenXm^
enZindex.html
TEACH-VIP is a comprehensive injury prevention and control curriculum which has
been developed through the efforts of WHO and a network of global injury prevention
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erle.arningZ.enZixidex.html
81
How many more will be lost, before we act!
On ....... Jan 2009, Mr. C..., aged 34 years,
while travelling as a pillion, was hit by a. rfj....
bus and died immediately. He was travelling
with his son, when a supposedly speeding bus
collided with him and injured two others.
Following the crash, the driver and the
conductor fled the scene and crowd gathered.
Enquiry followed, compensation was
awarded, media reported the event and road
death statistics increased by another number.
Every one said such things will happen.
However, for his family, it was
the beginning of problems.
Loss of husband for the wife,
death of father for children,
financial problem in family,
and loss of a binding force i
followed in the next few ’
days and weeks. After 1 year,
the family has been tom
apart. This crash left an
unforgettable impact on the
family and they may or may
not recover from this tragedy.
As per official report, on any given day, nearly
350 persons die in India due to road crashes,
often those in younger age groups. About
1500 persons die due to injury causes like road
traffic injuries, falls, burns, poisoning,
drowning, suicide, assault and many others.
The real problem is much higher due to under
reporting and misclassification. Several
thousands reach our hospitals for care, and are
discharged with disabilities that will affect
them and their families for the rest of their life.
Each day, children and young adults saved
from Infectious and communicable diseases
die, get hospitalized and become disabled due
to injuries.
Each of these are considered as someone's
negligence, error, fault, wrong behaviour and
investigated from a criminal, legal
and administrative angle. Some get
compensation, many delayed. Does money
really make a difference for the bereaved
families?
In a country where road crashes and other
injuries are publicly glaring,
there are no systematic,
scientific and sustainable
programmes to address this
huge public health problem.
As long as we in this country
continue to accept road
deaths and other injuries
as unavoidable and
unpreventable events, and as
accidents, we cannot turn this
tide.
Road crashes and other injuries are
predictable and preventable. There are
solutions that work. Enforcement,
Engineering, Vehicle/Product Safety,
Education and Trauma Care can make a huge
difference to people like Mr. C .... and
thousands of others. We need to move from a
“reactive “to a “proactive approach”, and shift
from “concerns” to “actions”. Reduction in
road and injury deaths can only happen, if we
have the right policies, programmes,
resources and willingness to act by giving
road safety and injury prevention a higher
priority.
- Media
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