Injuries among Drivers in RTA

s: Background: Road Traffic Accidents (RTA) are responsible for the greatest number of injuries and fatalities worldwide by killing around 1.2 million people each year and injuring another 50 million. Objective: To evaluate the present situation of Road Traffic Accidents (RTA) in Dhaka and to find out the pattern of injuries present in the bodies of drivers who were victims of fatal RTA. Materials & Method: This cross sectional descriptive study was conducted at the Dhaka Medical College (DMC) Morgue during the period January 2008 to December 2008. Specific findings regarding injury of drivers were noted during post mortem examinations. Results: A total of 2714 post mortems were conducted during the study period and out of which 813 were cases of RTA (29.95%). Maximum RTA occurred at daytime 282 (34.68%). Greater number of accidents occurred during September 90 (11.07%), followed by January 85 (10.45%). Maximum accidents took place on highways 650 (79.95%) and buses were the most dangerous vehicle causing highest number of causalities 307 (37.76%). Among the victims, 545 (67.03%) were male. Out of all victims 39 (4.80%) were drivers. Highest incidence of fatality in RTA (30.38%) was observed among the age group 21 to 30 years. Among the deceased drivers, 36 (92.30%) were literate. Considering injuries of the drivers 100% victims had multiple abrasions and bruises, lacerations were present in 35 (89.74%), and intracranial injury in 36 (90.31%) cases. Specific injuries of drivers like injury to lower limbs due to break pedal/clutch was found in 27 (69.23%) cases, steering wheel injury was present in 24 (61.53%) cases and whiplash injury was found in 15 (38.46%) cases. However, no seat belt injury was observed in any deceased driver. Conclusion: Strict enforcement of traffic law, using seat belts, maintaining fitness of vehicles, driving licenses, improving public awareness etc. can reduce this economical burden and protect vulnerable groups of people of our country.


Introduction
Road traffic accidents (RTA) are responsible for the greatest number of injuries and fatalities worldwide by killing around 1.2 million people each year and injuring another 50 million.These victims occupy 30-70% of orthopedic beds in hospitals of developing countries 1 .The RTA is the most common causes of death below the age of 50 years in developed countries and predicted to be the third leading contributor to the global burden of disease, just behind clinical depression and heart disease by 2020 2 .In developing countries 90 percent of the disability-adjusted life years (DALYs) lost occur because of road traffic injury 3 .World Bank estimates that road traffic injuries cost 1 to 2 % of the gross national product (GNP) of developing countries, or twice the total amount of development aid received worldwide by developing countries 4 .

Materials and methods
The study was conducted among victims of Road Traffic Accidents (RTA) at the Dhaka Medical College (DMC) Morgue during the period January In developing countries, exposure to potential road traffic injury has increased largely because of rapid motorization, coupled with rapid population growth, lack of safety features in vehicles, crowded roads, and lack of law enforcement.For example, in Vietnam, the number of motorcycles grew by 29 percent in 2001, with an associated increase of 37 percent in the number of road traffic deaths 7 .In the present study among the victims, male female ratio was about 2:1 (67.03 %: 32.96 %) This ratio is in conformity with previous studies performed in India 8-12 .Men are at higher risk of injuries than women because in our country they are predominantly the earning member of the family.They also have greater exposure to traffic and more risky behavior than females such as running to catch a bus, hanging on the side of bus, impatience, lack of attention and drinking alcohol (in case of drivers) prior to driving etc 13-15 .Among the drivers all the victims (39) were male, which indicates males are predominantly engaged in the jobs of driving in our country.About the time of incidence, most accidents occurred during daytime 282 (34.68 %), which corresponds with increase traffic load on road at daytime due to rush of passengers towards offices, educational institutes and industries and the result coincides with similar studies in other countries 16

Types of Postmortem Examinations Number of victims Percentage
Fig-1: Time of RTAs ; (n=813) Fig-2 : Places of occurrences ; (n=813) among the age group 21 to 30 yrs (Table-IV).Among the drivers age group 30-40 years were more involved (Fig-4).Regarding literacy rate, 36 (92.30%) was literate.All the deceased drivers had multiple abrasions and bruises, lacerations were present in 35 (89.74 %), and intracranial injury in 36 (90.31 %) cases.Specific injuries of drivers like injury to lower limbs due to break pedal/ clutch was found in 27 ( 69.23%) cases, steering wheel injury was present in 24 (61.53%)cases and whiplash injury was found in 15 ( 38.46% ) cases (Table-V), However no seat belt injury was observed.DiscussionIn Bangladesh unplanned roads and highways, incompetent traffic system, violation of traffic laws by the drivers and pedestrians, overcrowding, reckless driving etc all are the possible explanations for highest figure of road traffic accidents in the city areas.The total number of accidents in Bangladesh 2000 was 3,419 and causalities were 3050 .The number injured was 1,988 in 1987, which rose to 2,653 in 2000, a rise of 33 %.The available data 5 .The estimated national cost of road accident is Tk.38 billion or US$ 644 million.This is said to be 1.5 percent of GDP and three times annual expenditure of the RHD 6.

Table - V
260][21][22][23][24]in deceased drivers ; (n=39) N.B: same victim had multiple types of injuries[20][21][22][23][24]Lower proportion of RTA in age group below 10 years and above 60 years could be explained by the fact that children are usually taken care of by elders during travel and lesser mobility of geriatric people.neurogenicshock26.This pattern of injury has similarity with other studies done before.In Mant's series of 100 driver fatalities.70%drivers had broken ribs, 50% had liver rupture, 36% had injury to spleen, 31 had injury to lower limbs, and 19% had arm injury.Both Mant and Eckert's study showed that drivers had more incidences of head injury than passengers.If the driver is ejected out from the vehicle there is five times more injury than remaining in seat 27-28 .This ndicates the importance of using seat belt, which is not regularly practiced in our countryConclusionStrict enforcement of traffic law, promoting efficient patterns of land use and providing shorter, safer routes for vulnerable pedestrians to reduce their exposure to high ways, using seat belts, maintaining fitness of vehicles, driving licenses, improving public awareness etc. can reduce this economical burden and protect vulnerable groups of people of our country.
. Sleeping tendency among drivers at night, poor visuality, lack of luminescence marking on road, over taking of vehicles, increase number of cargo vehicles on road are the possible explanations of accidents at night.Regarding various months of the year, most accidents occurred at September 90 (11.07 %).