Journal of Local and Global Health Science - Proceedings of the 24th World International Traffic Medicine Association Congress, Qatar 2015, November 2015

Injury contributes approximately 12% of the world’s burden of injury and there is increasing evidence that injury results in the new onset of a range of psychiatric disorders. Posttraumatic stress disorder (PTSD) is one of the more common psychiatric disorders after injury due to road crashes and other forms of traumatic injury. The incidence of PTSD in a number of well controlled studies has been reported at 10-25% but it has been reported to be less than 10% in other studies. In one large longitudinal study, where patients were followed up to 12 months after injury, 31% of patients had developed a psychiatric diagnosis at 12 months and 22% had a new psychiatric diagnosis. PTSD can occur in combination with other psychiatric disorders or as a single diagnosis. The most common new psychiatric disorders in the above study were depression, generalised anxiety disorder, PTSD and agoraphobia. Many patients with psychiatric symptoms after injury did not seek professional assistance and only a minority of patients (33%) sought mental health treatment at 12 months. Functional impairment (physical, psychological, social and environmental impairment) at 3 months has also been shown increase the risk of the development of a psychiatric disorder at 12 months. PTSD symptoms (intrusive thoughts, avoidance behaviour and hyper-arousal symptoms) may persist or become worse if not diagnosed and treated within the first 12 months. These symptoms can be extremely debilitating and lead to social isolation, relationship breakdown and ongoing psychological dysfunction. The presence of head injury, substance abuse, depression and other psychiatric disorders may further complicate the diagnosis and treatment of PTSD and other psychiatric disorders. The presence of mild Traumatic Brain Injury increases the risk of subsequent development of PTSD, panic disorders, agoraphobia and social phobia. A biological model of anxiety disorder suggests that fear is mediated by impaired regulation of the amygdala by the ventral medial prefrontal cortex and damage to this area may lead to increased vulnerability of the patient to develop anxiety and depression due to impaired neural regulation. The main issue associated with the diagnosis and treatment of patients with PTSD and other psychiatric disorders depends on appropriate presentation and available treatment options including cognitive behavioural therapy, desensitisation or drug treatment. It appears that up to 33% of patients may develop a psychiatric illness after a traumatic injury and this may lead to significant functional impairment and social dysfunction. Public health initiatives are required to address the mental health burden caused by these disorders. I will address some of the newer approaches to both the early identification and diagnosis of these disorders and suggest some early interventions for both the treatment and prevention of these debilitating psychiatric disorders.

Most of the world's population and economic growth is occurring in the cities. Essential as the movements of people and goods are to the economic and social aspects of urban life, they present people and their surrounding with the ever-increasing problems. As a consequence, world's cities face traffic congestion associated with imbalance of the available road space and operation vehicles, slow traffic flow, poor access to main activity centers, high transport cost, waste of time, psychological effects, decline productivity and increase discomfort. Vehicle emissions have their economic and health effects. Road accidents and their fatalities and injuries, pedestrian movements, socioeconomic impacts, inefficient road infrastructure, and unsafe design are also critical issues. To overcome urban transport problems, the UN Habitat has stressed that the conventional solutions of transport planning have proven their inefficiency during the past decades. The pattern and cost of land use, urban structure, population distribution, tight budget, stand-alone projects, lack of expertise, and other factors restrict the impose of successful road facility. Besides, maximizing road network capacity is not the only solution to tackle transport problems, due to the facts of high demand for urban road space and less supply, transport problems are accelerating at higher rate than population and economic growth, and building new road infrastructure requires long period due to complex project cycles. Introduction of the traditional traffic management measures to control vehicle operations is also proved partial solution. Transfer from private vehicles to public transport use is not fully acceptable solution by majority of the community in some countries beside lack of current public transport services. Another serious obstacle is institutional, due to involvement of several organizations in the transport sector, lack of interagency coordination, insufficient enforcement, unavailability of common policy and performance indicators, and insufficient information. Community concern about transport efficiency and the negative drawbacks has increased. Politician and government agencies face increasing pressure to protect the quality of urban environment, create livable cities, maintain the right access and run efficient and integrated transport system. At present, Transport Demand Management (TDM) is emerging as a fashionable concept among planners and decision-makers for sustainable urban development and minimizing transport drawbacks, since traditional transport techniques have reached their effective limits in most cities. The paper addressee merits of the TDM which aim to modify trip makers behavior and habits, reduce use of private vehicles (drive-alone transport), influence mode choice, minimize travel time, alleviate congestion and enhance road safety. Assessment is presented into the practical techniques of the TDM such as congestion charging, public transport priorities, sustainable road network development, ridesharing schemes, service centers, transport-land use planning, communications, restricting use of road space and vehicles, private sector programs, school programs, working hour schemes, and traffic monitoring centers. The paper also explores development conditions, programs and performance of the TDM systems in different parts of the world such as London, Singapore, Stockholm, Dubai and Victoria (Australia) which alleviated congestion, enhanced road safety, and promoted equity in transport accessibility for passengers, pedestrians, freight, community and economic viability. The paper stresses that TDM is the only sustainable approach to accommodate the ever-increasing demand for travel and tackle transport problems, as part of a comprehensive and balanced policy for today and future cities. TDM should be associated with shift in behavior, involvement of private sector, community groups and government organizations, efficient institutional capacity, action plan, and lead agency. TDM program should be linked with the national vision, transport system, development plan, and community benefits and expectations through short term and long-term strategy. Government leadership is crucial.

Safe automobile driving requires sufficient vision, cognition, and physical capability that, in turn, depend on the relative integrity of cerebral functioning. Fairly common medical conditions such as dementia, stroke, and seizures affect the brain, and may therefore compromise safe driving. Evidence of unsafe or impaired driving in these diagnostic groups has been presented, but has also been subject to debate. Furthermore, legislation regarding license holding for people with different medical conditions varies widely across countries and states. Nonetheless, it is important, in the clinical context, to determine whether patients should drive, when their medical conditions may put them or other road-users at risk. When patients with dementia and post-stroke conditions are not evidently either fit or unfit to drive, assessments should ideally be carried out by multi-professional teams comprising physicians, neuropsychologists, and/or occupational therapists. Areas addressed should be visual functioning, cognition (with an examination of domains such as attention, speed, and visuospatial ability), and the ability to handle the vehicle. It is also necessary to consider additional factors such as medication use, the presence of co-morbidities and risk of recurrence of stroke, and the risk or speed of progression that makes it necessary to reexamine the patient at suitable intervals (in cases of dementia, at least on a yearly basis). Professionals should be aware of the fact that there is no perfect ‘golden standard’ against which to compare the outcome of the clinical examinations and that factors such as the occurrence of adverse traffic events or the compensatory potential of the individual patient, based on insight and/or premorbid driving skill, should be taken into consideration. Losing consciousness while driving constitutes a considerable traffic hazard, but there is no clear-cut evidence that drivers with epilepsy or seizures are over-represented in motor vehicle crashes. Legislators in different countries have differing approaches to the granting of driving privileges to patients who have had seizures and the required duration of a seizure-free period before driving can be resumed can vary considerably on grounds that do not appear to be scientifically based.

Traffic fatality data for four continents, namely Asia, Africa, Europe and North America, are analysed and modelled here. The analysis is based on gathered traffic death frequencies and rates for over three decades considering 176 countries within the four continents. The predicted values for the coming decade, based on best regression fits, are also analysed. The data sums to over 28,000 records. Official publications, well-known databases, journal papers, official web-sites and personal correspondance were manily employed in collecting the necessary data. While fatlity and vehicular data for the developed countries and few other less developed countries take no time to compile; those for most of the other countries are highly time consuming and distracting, due to the presence of conflicting data, to be processed. It took over three years to gather such data. Such large gathered data for such long period of time are yet not observed in the literature using the common means. Moreover, while future trends of traffic fatalities in Europe and North America are very common and widely presented; that in Asia and Africa are very scarce and lack accuracy due to lack of long-term data. The results indicate that traffic fatalities in Asia and Africa raised from 153 thousands and 46 thousands during 1980 to 384 thousands and 90 thousands deaths during 2011, in respective order; that in Europe and North America dropped from 97 thousands and 57 thousands deaths to 39 thousands and 33 thousands, respectively. It is also intresting to mention that the traffic fatalities in the Arab world sharply increased from 22,145 during 1980 to 37,736 during 2011. It is expected to pass 45 thousands deaths during 2021. The traffic fatalities in the four continents will add up to just 790 thousands considering a flat rate of adjustment factor for underreporting. This however raises serious question regarding underreporting of the official records. Nevertheless, while the roadway deaths in Europe and North America is expected to drop by around 40 and 20%, respectively by the year 2025, according to the models developed here, that in Asia and Africa is expected to increase by around 15 and 70%, respectively. The fatality rates per population followed a very similar pattern, but steeper, of the fatality frequency. There are many contributory factors leading to such high traffic deaths in Asia and Africa. These include, among many other factors, lack of measurable long term safety plans on real ground, inconsistent handling of traffic safety strategies, poor involvement of NGO’s, poor coordination between various stake holders, poor research involvement in the traffic safety crises and limited post-accident rehabilitation centres. Selected References 1. World Health Organization, Eastern Mediterranean Status Report on Road Safety Call for Action, Regional office for the Eastern Mediterranean, 2010. 2. UNECE Transport Division, Handbook of Transport Statistics in the UNECE region 2006, Geneva, Switzerland, 2007. 3. Jacobs, G., Aeron-Thomas, A. and Astrop, A., Estimating Global Road Fatalities, Transport Research Laboratory and Department for International Development, TRL Report 445, UK, 2000. 4. Al-Madani, H., Crash Deaths in the Arab World During Three Decades: Challenges and Opportunities, Session on UN Decade of Action for Road Safety: Progress Report, IRF 17th World Meeting, Reyadh, Saudi Arabia, 2013. 5. Kopits, E. and Cropper, M., Traffic Fatalities and Economic Growth, University of Maryland and Resources for the Future, Policy Research Working Paper 3035, World Bank.

• Cite worldwide research & statistics on motor vehicle collisions (number of deaths, injuries and primary cause of road incidences). • Explain the concepts of defensive driving (which was pioneered and developed by the National Safety Council in 1964) • Discuss distracted driving (e.g., use of cell phones or texting while driving) which has joined speeding and alcohol as one of the 3 leading factors in fatal and serious injury crashes • Benefits of managing work-related road safety and the need to promote safe driving practices and a positive safety culture at work. • Explain why the adoption and enforcement of traffic laws appears inadequate in many countries (subtopics include excessive speed, seat-belt use, drinking and driving, use of motorcycle helmets, and use of child restraints in a vehicle).

A research team from Texas A&M University at Qatar (TAMUQ) and Texas A&M Transportation Institute (TTI) conducted during the past three years a study that focused on traffic safety situation in Qatar, tyre properties, and the influence of tyre properties on driving safety. The presentation will compare and contrast the specifications of the Gulf Standardization Organization (GSO) and other specifications used in Europe and United States. Consequently, the presentation will discuss recommendation for changes in GSO tyre specifications in order to better reflect climatic conditions in the region. One of the road safety issues in Qatar is the routine use of some drivers of off-road tyres on paved roads. The research team conducted comprehensive testing of off-road tyres and standard tyres that are used in a typical large SUV. In addition, the team developed computer models and conducted finite element analysis to simulate the driving and manoeuvring conditions of the different types of tyres. The experimental measurements and computer simulations revealed valuable information about performance of off-road tyres and risks associated of using them on roads in Qatar. The results will be very useful for the policy makers and the driving public regarding the development of regulations that control the use of off-road tyres.

Road traffic injuries found to be the second rank of Years of Life Lost (YLL) and third rank of Disability Adjusted Life Years (DALY) in Iran based on Global Burden of Disease 2010. The number of annual fatalities, which had been on the rise for several decades, reached to the maximum number of over 27500 deaths in 2005. The number decreased to 23000 in 2010 and less than 18000 in 2013. The reduction in number of deaths happened despite a four-fold increase in number of motor vehicles. Some of the interventions that might be contributing to this achievement include the following: a) the new traffic law passed in 2010 that replaced the previous one dating back to 1968. Heavier penalties for major offences like: speeding, driving under the influence and dangerous driving are considered in the new law; b) stricter law enforcement by traffic polices(1); c) mass media campaign for traffic injury prevention (1); d) using fixed speed camera systems and laser speed guns; e) universal coverage of hospital treatment costs for all traffic injuries by Ministry of Health and Medical Education(2); and f) graduated driving license. On the other side, there are areas that need to be improved, including: a) driving behavior of both public and private drivers; b) driving under influence of drugs specially among public vehicle drivers (3,4) c) motorcycle riding behavior with special emphasis on helmet use (5); d) medical and psychological fitness to drive examinations; e) vehicle safety specifically for cars manufactured within the country; f) transportation engineering with emphasis on expansion of railroads and safe highways. References: 1) Soori H1, Royanian M, Zali AR, Movahedinejad A. Road traffic injuries in Iran: the role of interventions implemented by traffic police. Traffic Injury Prevention. 2009 Aug; 10(4):375-8. 2) Karim H, Mohammadi M, Bazargan-Hejazi S, Ahmadi A. Removing the economic burden of road traffic injuries from patients: a successful model. Journal of Injury and Violence Research. 2015 Jul; 7(2): 95-96. 3) Motevalian SA, Jahani M, Mahmoodi M. Driving under influence of opiates in heavy vehicle drivers of Iran in 2001. Hakim; 2004, 7(1): 1-8. 4) Majdzadeh R, Feiz-Zadeh A, Rajabpour Z, Motevalian A, Hosseini M, Abdollahi M, Ghadirian P. Opium consumption and the risk of traffic injuries in regular users: a case-crossover study in an emergency department. Traffic Injury Prevention. 2009 Aug;10(4):325-329. 5) Motevalian SA, Asadi-Lari M, Rahimi H, Eftekhar M. Validation of a Persian Version of Motorcycle Rider Behavior Questionnaire. Annals of Advances in Automotive Medicine. 2011 Oct:91-98.

Safety education and training is one of the four basic injury prevention strategies, although there are concerns about its effectiveness. In this study, we aimed to summarize the scientific evidence on effectiveness of education and training for different road user groups. Cochrane Injuries Group, Pubmed, Campbell Systematic Reviews and TRID databases were searched for the relevant literature. Only systematic reviews or meta-analyses were recruited for this study. Pedestrian safety education can increase the knowledge of children and improve their road crossing behavior, but its effectiveness on road traffic injuries remained unknown. More evidence for adult pedestrians, especially elderly people is needed. Bicycle skill training for children and youth may increase their safety knowledge, but not necessarily improve their behavior or decrease their injury rates. Non-legislative interventions were found effective for increasing observed helmet use among bicyclists. Education only interventions were less effective than those providing free helmet. School based programs were less effective than community based. Motorcycle rider training has not found to be effective in reducing injuries. Mandatory pre-license rider training is an obstacle in motorcycle licensing process, so it indirectly reduces crashes through reduction in exposure. Quality research is needed to evaluate the effectiveness of rider training on crashes and injuries. Graduated Driving License (GDL) are designed to gradually introduce novice drivers to higher risk driving situations. GDL is effective in reducing crash rates among young drivers. Stronger GDL programs achieve greater fatality reduction. A systematic review on the effects of post-license driver education, provides no evidence of its effects on preventing road traffic crashes or injuries. Because of the large sample size included in the meta-analysis, the possibility of even modest benefits is rejected. School-based driver education can lead to early licensing, but there is no evidence that it reduces road crash involvement. The findings suggest that driver education may even lead to a modest but potentially important increase in the proportion of teenage drivers involved in road traffic crashes. There is strong evidence that education in combination with on-road training is effective on improving driving performance. There is moderate evidence that only educational intervention is not effective in reducing road traffic crashes. The evidence supports the effectiveness of interventions aimed at retraining older drivers. Review of the systematic reviews show that education only interventions are rarely effective on prevention of road traffic crashes. Except for some interventions like post-license driver education which has strong evidence based on large number of participants, in most of the subject interventions more rigorous investigation is needed especially in low- and middle- income countries.

Three thousand people, including 500 children, are killed every day on the world’s roads. These amounts to 1.2 million deaths a year .In addition more than 50 million people are seriously injured; many are disabled for life. According to WHO reports, the number of road crashes fatalities will increase worldwide by 60% by 2020. Road crashes represent a major social cost to most societies, and their management has thus been a high priority. Efforts in management have been at the levels of both prevention (via education, enforcement and engineering) and cure (via the hospital and insurance systems). A large proportion of road traffic crashes are as a result of road-user behavior and more specifically, crashes occur because of the decisions taken by road users to disobey or break the road rules, commonly referred to as human error. Crashes rates and compliance are inversely related. Law enforcement agencies like the traffic police come up with strategies including use of penalties to ensure road rules are obeyed and compliance improves. Good traffic law enforcement is essential for road safety .The main objective of law enforcement is road safety – achieved by deterring road users from committing offences, which are related to road crashes and injuries. Police activities should primarily serve as deterrence for drivers inclined to commit traffic offences through increasing road users’ perception of the risk of being caught. Consistent deterrence strategies, which typically comprise highly visible police or camera activity can bring about lasting changes in road user behavior and, as a consequence, changes in road users’ attitudes which reinforce these behavioral changes. It is generally accepted that enforcement influences driving behavior through two processes: general deterrence and specific deterrence. Enforcement of road rules should be aimed primarily at causing general deterrence because then it is not necessary for police to catch and punish road users for them to be encouraged to obey the rules. To result in general deterrence, enforcement should be: accompanied by publicity, unpredictable and difficult to avoid, a mix of highly visible and less visible activities, and continued over a long period of time. Targeted and appropriate legislation that is consistently enforced and well understood by the public is a critical component of successful enforcement. An appropriate penalty system also needs to be in place. In many cases road users do not obey traffic laws and regulations because they do not know them .yet, even when people know the rules they do not obey them .while public education programs are important in informing the general public – especially if new laws and regulations are introduced – enforcement is important if some level of compliance is to be achieved. It should be recognized that not all enforcement should involve punishment. Some enforcement activity can be aimed at offering positive feedback, or reward, or offering education and courses in improved driving, rather than a fine. To maximize the road safety benefit, enforcement should be aimed at road rule violations that have been proven to increase the likelihood or severity of crashes. Safety benefits can be further increased through intelligence led policing. In road rule enforcement, intelligence led policing involves the use of data (for example, data on when and where crashes are occurring, data on severity factors such as not using seatbelts or helmets, or data on causal factors such as speeding or drink driving) to focus enforcement on the times and places that present the greatest risk.

The main goal of this presentation is to describe the current state of research in regards to in-vehicle feedback technology aimed at young drivers. Young drivers have a higher crash risk worldwide than other age groups, and the first months after licensing are the most dangerous. Several countries have achieved important crash reductions over the past years that are associated with the implementation of graduated driver licensing programs. Provisions of these primary and secondary prevention programs includes older age at licensing and driving privileges provided gradually to young drivers, such as driving at night and with young passengers. Development of in-vehicle technology, such as feedback devices, now allows easier implementation of secondary and tertiary interventions aimed at young drivers. A number of randomized controlled trials have been published and results suggest the efficacy of in-vehicle feedback devices in reducing some indices of risky behavior, such as g-force events. Research has also identified several obstacles to deployment of these devices, including acceptance by both young drivers and their parents. Results of recent studies by our research group on efficacy (N = 160) and acceptance (N = 380) of in-vehicle devices in 18-24 year old drivers, and individual factors that influence these dimensions, will be presented in light of the current research. The main discussion will address the efficacy of in-vehicle feedback technology to reduce young drivers’ risk, its strengths, limitations, and obstacles to implementation in primary, secondary, and tertiary prevention programs.

Road traffic injuries [RTI’s] are known to be a global leading cause of death and disability. In Latin America, they have been shown in disproportionately affect young males, vulnerable road users and low-income populations. Some of the world’s highest death rates from RTI’s are found in this region and this lecture will describe the efforts to improve road safety in the Dominican Republic [DR]. Temporal trends in RTI incidence and mortality rates have been on the rise and these have been heightened by the changing demographics, increasing numbers of vulnerable road users and the influx of immigrant populations. In response, government and non-governmental agencies have been implementing a wide array of public education programs, targeted enforcement campaigns, road improvement and quality improvements in the delivery of post-crash care. An evaluation of the multi-sectorial programs to reduce the health burden from RTI’s in the DR will be presented and recommendations made for specific elements that must be retained and continued will be made.

In place of Germany as a whole, the situation of traffic medicine in Hamburg is described. As a metropolis in the north of Europe and hub for the land traffic, maritime transport and air traffic – Hamburg is a good location for the topic of traffic safety. In particular the maritime medicine as well as the production of traffic airplanes define our city. Furthermore Hamburg and the University Medical Center of Hamburg-Eppendorf (UKE), as a science location, have made a name for itself especially in the area of forensic medicine. The legal medicine and traffic medicine are key aspects in research and teaching of the UKE. The traffic medicine/road safety under the perspective of forensic medicine focuses on the following main-areas: •Determination and prognosis of fitness to drive with respect to age, illness and substance abuse/dependence •Driving under the influence of alcohol, drugs and medicaments. •Chemical-toxicological analyses, methodology, accreditation of laboratories, drug recognition training, breath alcohol analyses •Demographic change, drivers licence and old age medical condition •Accident reconstruction, with special respect to the investigation of drivers (dead or alive) Germanwings Flight 9525 (4U9525/GWI18G) is a central point of discussion. It was a scheduled international passenger flight from Barcelona in Spain to Düsseldorf Airport in Germany. On 24 March 2015, the aircraft, an Airbus A320-200, crashed in the French Alps. All 144 passengers and six crew members were killed; this was deliberately planned by the co-pilot. Having previously been treated for suicidal tendencies and been declared “unfit to work”, he caused the aircraft to crash into the mountains. Consequences? In response to the incident and the circumstances the public, experts, and authorities discussed recommendations for new policies in traffic safety.

Injuries and fatalities occur in all forms of transportation. Numerically, road traffic accidents account for the great majority worldwide. Special questions (especially from the forensic medical point of view) are associated with maritime and flight crashes, when bodies are heavily mutilated and severely decomposed (concerning i. e. identification). – Post mortem radiological investigations are of special value (especially body scanning, pm CT, so called virtual autopsy). The pattern of injuries, toxicological findings, and trace evidence vary considerably and the whole scale of forensic medical analyses is required. This concerns for example: Pattern of injury of vehicle occupants, effect of seatbelts, vulnerability of children in vehicles, injuries to motorcyclists, pedal cyclists and pedestrians, cause of death, suicide and homicide, railway injuries and the special dynamics of other motorized transports. Concerning fitness to drive/pilot/navigate/work careful medical (i.e. concerning epilepsy), psychological (concerning psychiatric illness, substance abuse) and toxicological screenings and investigations are required. For example chronic alcoholism and drug dependence have to be evaluated (i.e. by segmented hair analysis). Such drivers are responsible for very severe crashes. According to the German law these persons are banned from driving motorized vehicles.

Pregnancy causes diverse physiologic and lifestyle changes that may contribute to increased driving and driver error. We compared a woman’s risk of a serious motor vehicle crash during her second trimester to her own baseline risk before pregnancy. We conducted a population-based self-matched exposure-crossover longitudinal cohort analysis of women who gave birth in Ontario, Canada, between April 1, 2006 and March 31, 2011 (5 years). We excluded women less than age 18 years, individuals living outside Ontario, those who lacked a valid identifier number under universal insurance, and cases managed by a midwife. The primary outcome was a motor vehicle crash resulting in a hospital emergency department visit. A total of 507,262 women gave birth during the study (mean age = 30 years, middle-low socioeconomic status = 64%, cesarean section rate = 30%). The women accounted for a total of 6,922 motor vehicle crashes as drivers during the three-year baseline interval (177 per month) and 757 motor vehicle crashes as drivers during their second trimester (252 per month). The elevated risk during the middle of pregnancy equaled a 42% increase in crash risk (95% confidence interval 32 to 53, p < 0.001). The increased risk included diverse populations, varied obstetrical cases, and different crash characteristics. The increased risk was largest in the early second trimester and compensated during the third trimester. No increase was observed in incidents involved as passengers or pedestrians, cases of intentional injury or inadvertent falls, or self-reported risky behaviors. The absolute risk amounted to an estimated 1-in-50 women experiencing a motor vehicle crash at some point during an average pregnancy, taking into account all nine months and the full spectrum of severity (fatal, injury, and vehicle damage combined). We suggest that pregnancy is associated with an increased risk of a serious motor vehicle crash during the second trimester that may merit attention in prenatal care guidelines.

Canada is a country of about 35 million people located about 11,000 kilometers away from Qatar. The purpose of this talk is to provide six informal insights from the Canadian experience that may inform traffic risks in Qatar. A greater awareness of these points, we suggest, might help lessen the losses from traffic crashes in both countries.

Saudi Arabia is a vast country of 2,149,690 km2, and is the largest Arab state in Western Asia. The Kingdom has been categorized as a high-income nation, and is part of the “Group of Twenty” (G-20) of major economies. It has a total population of approximately 27 million, one-fourth of whom are expatriates, with the highest population density (per km2) of 101 in Jizan, and 38 in Makkah, and the lowest of 2.8 in Najran, and 3.6 in Al Jawf. In KSA, motor vehicles are the main means of transportation within, and in-between cities. According to a recent estimate, more than 6 million cars are found on the roads of KSA. According to the morbidity and mortality records in the Ministry of Health (MOH) hospitals, 20% of beds are occupied by RTA victims, and 81% of deaths in the hospitals are due to RTIs. Over the past 2 decades, KSA has recorded 86,000 deaths, and 611,000 injuries in RTAs with 7% resulting in permanent disabilities. Road traffic accidents are a major health hazard with 19 killed daily, and 4 injured every hour in KSA. Al Naami et al, in his article mentioned the common reasons behind the soaring numbers of road traffic accidents in Saudi Arabia, which included the human factor, the vehicle, and the road/environment (2). Among the human factor, Driver errors account for about 80% of all RTAs in Saudi Arabia. Overspeeding is responsible for 65% of all traffic accidents (3.5 times the incidence in the USA). Violation of traffic signals at urban intersections is responsible for about 50% of accidents (4.5 times more common than in the USA). Vehicles and road layouts contribute to accidents and account for 20% of RTAs in Saudi Arabia, Tire blowouts and poor roads are very “hot” safety issues in Saudi Arabia, particularly in rural areas. Environmental factors such as rain, fog, and dust have minimal effects on RTAs in Saudi Arabia. However, extreme heat is responsible for 39% of all accidents due to tire blowouts. Heat also contributes to driver stress levels, leading to reduced mental capacity. Traffic medicine in Saudi Arabia has focused more on the prevention approach rather than the rehabilitation, The evidence sufficiently supports that the action plans in KSA so far have mostly focused on the prevention of RTIs rather than RTAs, including seat belt laws, Saher system, emergency medical rescue services, and the role of the police in the documentation of RTAs. While the international recommendations emphasize on developing institutional framework, safer roads and vehicles, proper surveillance or data system, safer road users, and post-crash care. The MOH in collaboration with the Ministry of Interior launched a road safety program called Saher in 2009. It is an automated system that was developed to manage traffic via electronic systems in major cities in Saudi Arabia, this newly established system uses a digital camera network connected to the national information center to track any violations and to control traffic. However, data on its long term effects on accidents and death are not yet available(3). Another important aspect of traffic medicine is the implementation of Trauma Registry as part of the national trauma system project, trauma registries can provide information on injury pattern and allow statistical modeling of trauma related variables to identify public health threats and prioritize interventions. Additionally registries can help monitor the epidemiology of serious injuries, track hospital performance overtime, and benchmark outcomes between hospitals and regions(4). Education and training of Trauma Human resources is another important aspect, King Abdulaziz Medical City has took the lead in a lot of medical fields disciplinary including medical education and has given trauma a major importance were KAMC has the largest ER outside North America and the 4th largest in the world. KAMC has the lead nationally if not in the region in regard to trauma courses where the main office to those courses is in King Abdulaziz Medical City.

If every driver in Sweden were to obey the speed limits there would be more than 100 lives spared each year. Every reduction of 1 km/h on average speed in the country saves approximately 20 lives per year (SRA 2015). One of many important measures in the later road safety work in Sweden is a project attempting to reduce speed, namely the implementation of speed cameras. Without a comprehensive increase in traffic surveillance it is difficult to achieve traffic safety (VTI 2005). The Swedish Road Administration together with the National Police Board put up the first speed cameras, or road safety cameras, in the late 1990’s and at the end of 2014 there were 1200 cameras monitoring 3000 kilometer of road stretches in Sweden. Before deciding where to install the road safety cameras the Swedish road traffic crash- and injury surveillance system, STRADA, was used to spot where accidents happened most frequently. STRADA is also a tool in the follow up work when evaluating the effects of the road safety cameras. The road safety camera project has been and still is a successful road safety work. When looking at data from STRADA from three examples (road 222, 225 and 268) of the approximately 120 roads with speed cameras one can see, when comparing a four year period before and after speed cameras, fatal accidents was reduced from a total of 8 to 3, and accidents with serious injuries as an outcome was reduced from 65 to 28. The road safety cameras have reduced the average speed on roads with cameras with 5% and are now appreciated to save up 20 lives and up to 50 persons from being seriously injured per year in Sweden. Speed monitoring with road safety cameras has shown to be a successful way of reducing speed and save lives on Swedish roads. Every year the cameras prevent 20 people from being killed in traffic and 50 persons are prevented from being seriously injured. In order to evaluate road safety work such as speed cameras there has to be measurements made before and after the intervention. Using data from STRADA has both been contributing to the foundation of the road safety camera project and also one of the important tools for follow up. References: Swedish Transport Administration: Trafiksäkerhetskameror (Road Safety Cameras) (in Swedish) website http://www.trafikverket.se/Privat/Resan-och-trafiken/Trafiksakerhetskameror/2015-07-22. Swedish Transport Administration: Road Safety Made in Sweden, Order no 10097 2nd Edition, http://online4.ineko.se/online/download.aspx?id=43885 2013. Jörgen Larsson, Susanne Gustafsson: Vad är en effektiv trafikövervakning? En litteraturstudie, (in Swedish) VTI notat 42-2005, Swedish National Road and Transport Research Institute 2005.

Reliable high quality traffic safety data has been essential for monitoring, developing and evaluating strategies to reduce the burden of injuries from traffic injuries. Information is often available in many different sources including police reports, ambulance/emergency medical service (EMS) run data, emergency department(ED) and hospital data, and mortality data from death certificates or medical examiner/coroner systems. However while each of these data systems has their own strengths and weakness, none can provide a comprehensive picture of traffic related injuries. Hospital trauma center records for example have extensive information on injuries and related medical problems but lack details on the mechanism of injury and crash and roadway characteristics. Often medical data cannot even distinguish drivers from pedestrians. Police or insurance crash reports on the other hand have considerable detail on the crash and circumstances surrounding it but have very poor data on the actual injuries sustained or their severity. This impedes targeting of prevention strategies towards serious injuries and fatalities. This presentation will use examples from current work on data linkage to demonstrate the value of linking traffic record data and explore how this approach can greatly advance traffic medicine and road safety in fast developing countries. In the United States linkage of crash data and medical data has been important for many traffic safety programs. One example is Maryland’s Crash Outcome Data Evaluation System (CODES) that uses probabilistic methodology to link police crash records to injury outcome records. CODES was established in an effort to improve highway safety through the use of linked motor vehicle crash data collected from police, EMS, hospitals (emergency department or inpatient admissions), and death certificates. This linked data have been used for a variety of statewide studies such as of injured motorcyclists, effectiveness of seat belts at preventing injuries, studies of older drivers, an analysis of mismatch collisions, geographic analysis of pedestrian injuries, patterns of injury in frontal collisions, costs and consequences of lower extremity injuries, the safety of newer vehicles, and the impact of casino gambling on alcohol-related crashes. A new project seeks to overcome the serious lack of reliable routine data on drug involvement in fatal crashes by linking detailed toxicology data from medical examiners with the Fatality Analysis Reporting System (FARS) in a sentinel group of states. Similar data linkage is also used in other countries such as a New Zealand study estimating underreporting of serious injuries by police reports. An Australian study noted that workers compensation datasets can identify most serious cases of occupational traffic injuries but lack valuable information on the circumstances and risk factors contributing to work-related crashes. Through linkage to police crash reports the study was able to identify high risk groups such as heavy vehicle drivers and the role played by fatigue and speeding. Many fast developing countries also have useful crash reports either from police or insurance reports. However only through linkage with medical data can their full potential for reducing the burden of serous traffic injuries be realized?

The presentation will highlight the population health effects arising from land-use changes and public policy initiatives that lead to changes in transport mode share for six international cities namely, Melbourne, Beijing, Delhi, London, Copenhagen and New York. The findings demonstrate that policies encouraging optimal land-use for active transport combined with provision of infrastructure that reduces the risk of injury for vulnerable road users (in association with road safety interventions) can produce considerable population health benefits across both chronic disease and road trauma. Without such infrastructure, however, increases in road trauma are likely, especially within highly motorised cities.

The United Nations has declared the period from 2011 to 2020 as the Decade of Action for Traffic Safety. The World Health Organization indicates that in most Latin America countries, alcohol consumption is responsible for about 8% of all existing diseases. Worldwide 35% to 50% of all serious vehicule crashes are alcohol related (JORGE, ADURA, 2012-2013). Brazil has a practical system of control to catch drunk drivers, while the abuse of other substances while driving have passed unscathed. Legal and documentary research. Samples shall be taken from hair, or in cases of alopecia, fingernails to be used for screening the Radioimmunoassay and enzyme immunoassay. In Brazil, the National Traffic Council determined a wide toxicology system of detection for consumption of psychoactive substances in the occasion of the medical exam to the obtainment of the professional driver’s license. The medical expert should consider the candidate unfit temporarily for vehicular driving, in case the examination accuses abuse of the following substances: marijuana, cocaine, crack, heroin, opiates, ecstasy or other substances that impair the drivers performance.The Brazilian Association of Traffic Medicine is against this resolution. Through an extensive review of the scientific literature, they could not find any study to justify the need of mandatory substance abuse assessment for drivers or applicants when undergoing the medical exam. The adequacy of this resolution is controversial. Currently, toxicological analysis of substances that alter the performance of the driver are used worldwide in addition to other actions such as checking the medical condition of the driver. A stricter control of the traffic laws should provide greater effectiveness in reducing road accidents.