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Mobility & Transport - Road Safety

Introduction | PDF

Diagram & Summary

The chain of help

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Post-impact care is a strategy which aims to reduce the severity of injury consequences once a road traffic crash has occurred. Minor injury patients will often need the help of a general practitioner and optimal medical and psychological follow up care is important to alleviate pain and distress. For major injuries, clinical experts define the post-impact care needed as the chain of help starting with action taken by the victims themselves or more commonly by lay bystanders at the scene of the crash, emergency rescue, access to the pre-hospital medical care system, and trauma care and helping road crash victims who have suffered debilitating injury re-integrate into work and family life. The effectiveness of such a chain depends upon the strength of each of its links [7].

Despite the fact that the cost of years of life lost from road trauma is larger than from cancer or cardio-vascular diseases, the attention paid by health policymakers, by the medical community and by the road safety field to trauma-related care and research has been disproportionately small so far. The European Commission has stated that several thousands of lives could be saved in the EU by improving the response times of the emergency services and other elements of post- impact care in the event of road traffic accidents [12].

Nevertheless, over the last 30-40 years improvements have been seen in post-impact care in several countries ranging from improvements in emergency medical response systems to advanced trauma care procedures to specific surgical intervention techniques [16][43]. While studies analysing the relationship between the performance of the trauma management system and road crash outcomes are not frequent, research indicates that various improvements have contributed to better injury outcomes [43][46][44]. In a review of 1970-1996 data in several OECD countries it is suggested that between 5% and 25% of the reductions in road crash fatalities may have been due to improvements in medical care and technology (including trauma and emergency response systems) [43].

The main sources of information for this outline comprise: in particular, a review of post impact care by medical experts from across the European Union [7] ; a review of studies by Elvik and Vaa [16]; the World Health Organization's pre-hospital care guidelines [50], essential care guidelines [36] and World Report on Road Traffic Injury Prevention [48] and a recent unpublished overview of research produced within the SafetyNet project.