India: Road Safety & Spinal Cord Injuries

Deaths in Road Accidents Much Higher Than the Wars

• India has the highest number of road accidents in the world as well as the highest number of deaths due to it.
• Road safety for spinal injuries is like a ‘RELATIONSHIP’ You can’t cheat and expect it to work.
•  India, which has one of the largest road networks across the world, spanning over a total of 5.5 million km.
• In 2015, there were about five lakh road accidents in India, which killed about 1.5 lakh people and injured about five lakh people.
• Over 1,37,000 people were killed in road accidents in 2013, that is more than the number of people killed in all our wars put together.

By Kanishka Singh

New Delhi, Oct 14, 2018: India, which has one of the largest road networks across the world, spanning over a total of 5.5 million km, is experiencing increasing road traffic injuries amidst increasing motorization and infrastructure growth in recent years. Every day, nearly 400 road deaths occur on Indian roads and several thousand are hospitalized due to road crashes. WHO estimates the incidence of road deaths to be 16.6 per 100000 population in India. With nearly 3% of all deaths being due to road accidents, and especially with high rates among young people and males, the issue calls for serious and coordinated action from the government and all other stakeholders.

In 2015, there were about five lakh road accidents in India, which killed about 1.5 lakh people and injured about five lakh people. That’s about 400 fatalities a day and far higher than developed auto markets like the US, which in 2016 logged about 40,000. According to reports available, since 2000, while road length has increased by 39 per cent, numbers of motor vehicles have increased by 158 per cent. This is important to note that Indian National Highways comprise 2 per cent of the total road network, but witness 28 per cent of the road accidents.

Roads contribute to a very large extent in our day-to-day lives for commuting, travelling and transportation. The Indian roads carry almost 90 per cent of the country’s passenger traffic. In India sales of automobiles and movement of freight by roads is growing at a rapid rate. India’s road network transports 64.5 per cent of all goods in the country. Road transportation has gradually increased over the years with the improvement in connectivity between cities, towns and villages in the country.

Due to continuous increasing population, highly increasing purchase of automobiles, poor road development & their maintenance, hectic & rushed lifestyle, poor sense of road safety and traffic rules and last but not the least poor maintenance of vehicles… all these causes one of the leading yet on a day-to-day basis a majorly ignored health problem i.e. SPINAL INJURIES.

Road traffic accidents (RTA’s) is one of the major preventable public health problems in India & is highly increasing now-a-days everywhere. Injuries due to RTA as one of the prime causes of “Global Burden of Diseases” was on the 10th position in year 2002, but according to the reports in 2013 the place had been shifted to 8th position and as expected, by 2030 this position is going to be at 5th place if the injuries trend due to lack of road safety continues at the same speed.

According to the WHO reports, every year, between 250 000 and 500 000 people suffer a spinal cord injury (SCI). The majority of SCI’s are due to preventable causes such as Road Traffic Crashes, Fall or Violence; And people with an SCI are 2-5 times more likely to die prematurely than those without SCI’s, with worse survival rates in developing countries. According to the latest reports, males are more susceptible to SCI than females, and about half of the RTA victims were of 25-65 years & around 30.3% victims were of the age 15-24 years, which is a productive human age of an individual.

Symptoms of SCI depends on the severity of injury and its location on the spinal cord, which may include symptoms like partial or complete loss of sensory function or motor control of arms, legs and/or body; and the most severe injury affects GI system, urinary system, breathing, heart rate and blood pressure.

The most leading causes of SCI are road traffic crashes, falls and violence (which may include attempted suicide). Human, Vehicular and environmental factors play a major role for SCI due to RTA (Road Traffic Accidents). India is a country where road & traffic safety is one of the most ignored sections in preventive health care and even by govt. According to recent reports, ‘India has the highest number of road accidents in the world, as well as the highest number of deaths due to it.’

          Road Traffic Accidents (RTA’s) occur due to the following:

1.         The poor condition of roads

2.         Highly growing number of vehicles, which are making heavy traffic flow and creating a rapidly increasing jamming problem.

3.         Inadequate road & traffic infrastructure, which includes non-availability of footpaths, inappropriate road markings, poorly maintained signals, inappropriate road designs & layout

4.         Ignorance of the driver/rider of the vehicle

5.         The poor condition of vehicles

6.         People’s behaviour on the roads

7.         Speed riding/driving unnecessarily made and technically wrongly made speed breakers

8.         Suddenly putting breaks of speedy vehicles

9.         Poor traffic & road safety sense

10.       Distractions while driving/riding, like usage of phone while driving, loud sounds, etc.

11.       Poor usage of safety devices likes helmets, seat belts, anti-glare glasses/goggles, etc.

12.       Drunken driving/riding and drugs

13.       Overloading of vehicles

14.       Driving/riding time of the day, i.e. driving/riding during the night is comparatively riskier than the day which can be attributed to fatigue, and/or alcohol consumption

15.       Mode of transport i.e. 2-wheeler or 4-wheeler. 2-wheelers more tend to be the victim of SCI than 4-wheelers.

       Causative Effects of RTA on SCI’s & Other Health Effects:

1.         Spinal Cord Compression

2.         Spinal Cord Nerve Compressions

3.         Bone/ Spinal Cord Dislocations

4.         The damaged/Retarded shape of Spinal Cord

5.         Muscle Spasms

6.         Cauda Equina Syndrome (CES)

7.         Monoplegia (Paralysis on one limb)

8.         Hemiplegia (Paralysis on one arm & one leg on one side)

9.         Paraplegia (Paralysis in both legs, sometimes the pelvis & lower body as well)

10.       Tetraplegia (Paralysis of both arms & legs, it is a permanent condition)

11.       Accumulation of fluids in and around the spinal cord

12.       Slip Disc & other disc injuries

13.       Bleeding & swelling

14.       Osteoporosis

15.       Deep Vein Thrombosis

16.       Pressure Ulcers

17.       Chronic Pain

18.       Fistula

19.       Respiratory Complications

20.       Urinary Tract Infections

21.       Poor Mobility/ Restricted Movements

22.       Muscular Atrophy

23.       Incontinence

24.       Partial or Complete Loss of Muscle Function

Road & traffic accidents & poor road behaviour costs a lot on our health grounds, especially in terms of the spinal cord which is the backbone of body and provides posture to the human body. In order to prevent spinal injuries & muscular traumas, this in turn leads to mental, emotional & social traumas, drive and ride safely, give proper & regular maintenance to vehicle, follow traffic & road safety rules, do not speed, do not honk unnecessarily, always wear safety wears and do not avoid minor symptomatic conditions of injuries.

Now, Prime Minister Narendra Modi’s government is attempting to curb the carnage on Indian roads caused by everything from speeding two-wheelers to cars not equipped with India, as a signatory to the Brasilia declaration, intends to reduce road accidents and traffic fatalities by 50% by 2022. The Motor Vehicles (Amendment) Bill, 2016 has been listed for consideration and passage in the current Budget Session of Parliament. It seeks to address issues related to road accidents, third party insurance and road safety measures. In this context, we present some data on road accidents, causes of accidents, and motor vehicle third party insurance. airbags.

The Motor Vehicles (Amendment) Bill stuck in Parliament can have the revolutionary impact on your life on the road. The Motor Vehicles (Amendment) Bill, which has to be passed by the Rajya Sabha and is being opposed by various opposition parties for curtailing powers of state governments and favouring corporates, contains provisions that will make Indian roads safer. The Bill has already been passed in the Lok Sabha.

The MV Bill was introduced in August 2016 - proposing harsher penalties for traffic offences and requiring that automakers add safety features - has passed the lower house of parliament and is expected to go through the upper house in 2018.

The MV bill is being opposed by various opposition parties for curtailing powers of state governments and favouring corporatesthousand contains provisions that will make Indian roads safer.

The MV Bill proposes huge increases in various penalties for traffic violations, protection to Good Samaritans, recall of defective vehicle parts by auto companies, holding builders accountable for the poor quality of infrastructure and making vehicle owners criminally liable for violations committed by juvenile drivers.

The MV Bill has provisions which open up the public transport sector for the private players and also control and regulate permits and taxation. It also aims to create National Transportation Policy within the ambit of a national Act giving power to the Centre.

Public Transportation System at present is a state subject and is operated by State Transport Undertakings (STUs) under the direct control of the State Government. These State Transport Undertakings offer travelling facilities at low rates as compared to private buses. The transport sector workers fear if the private sector is allowed to interfere in this sector, it will create more difficulty to the public and will be a threat to the job security of the employees working under STUs Transport / Tourism / Urban development.

Highlights of The Motor Vehicles (Amendment) Bill, 2016

•      The Bill amends the Motor Vehicles Act, 1988 to address issues such as third party insurance, regulation of taxi aggregators, and road safety.

•        Under the Act, the liability of the third party insurer for motor vehicle accidents is unlimited.  The Bill caps the maximum liability for third party insurance in case of a motor accident at Rs 10 lakh in case of death and at five lakh rupees in case of grievous injury.

•        The Bill provides for a Motor Vehicle Accident Fund which would provide compulsory insurance cover to all road users in India for certain types of accidents.

•        The Bill defines taxi aggregators, guidelines for which will be determined by the central government.

•        The Bill also provides for: (i) amending the existing categories of driver licensing, (ii) recall of vehicles in case of defects, (iii) protection of good samaritans from any civil or criminal action, and (iv) increase of penalties for several offences under the 1988 Act.

Key Issues and Analysis

•        The Bill caps the maximum liability for third party insurance, but does not cap the compensation amount that courts can award.  In cases where courts award compensation higher than the maximum liability amount, it is unclear who will pay the remaining amount.

•        Under the Act, compensation for hit and run victims comes from a Solatium Fund.  The Bill creates a new Motor Vehicle Accident Fund in addition.  With a Fund already existing to provide compensation for hit and run accidents, the purpose of the new Accident Fund is unclear.

•        State governments will issue licenses to taxi aggregators as per central government guidelines.  Currently, state governments determine guidelines for plying of taxis.  There could be cases where state taxi guidelines are at variance with the central guidelines on aggregators.

•        While the penalties for contravening provisions of the proposed scheme on interim relief to accident victims are specified in the Bill, the offences that would warrant such penalties have not been specified.  It may be argued that imposing penalties without knowing the nature of the offences is unreasonable.

•        The Bill does not address several issues around road safety that have been highlighted by other committees such as (i) creating road safety agencies, and (ii) improving road design and engineering. (The above Highlights are compiled by http://www.prsindia.org)

 (The author is a well-known Nutritionist, Professor, National Secretary (Traffic & Road Safety Foundation) and National Coordinator & State President (UP Chapter) of Nutrition & Natural Sciences Association.)