At the inquest into the world’s first road traffic death in 1896, the coroner was reported to have said, “This must never happen again.” More than a century later, 1.2 million people are killed on roads every year and up to 50 million more are injured. Deaths from road traffic injuries (RTI) and, in particular, Motor Vehicle Traffic Accidents (MVTA) have been characterized worldwide as a hidden epidemic which affects all sectors of society. In Anguilla the number of casualties from road traffic accidents continue to increase and as we approach the August festivities we must take steps so that accidents are kept to a minimum.

Motor vehicle accidents
A motor vehicle is defined as any mechanically or electrically powered device not operated on rails, and includes cars, buses, trucks, vans, motorcycles and off-road vehicles. A traffic accident is defined as any vehicle accident occurring on a public road or highway and includes vehicle accidents where the place of occurrence is unspecified.

The economic costs of traffic accidents
The economic costs of traffic injuries are enormous. Some 50% of road traffic fatalities worldwide involve young adults aged 15-44 years coresponding to the most economic productive segments of the population.

The costs associated with providing health care and rehabilitation for road traffic accident victims are also very high in many countries including Anguilla.

Health costs
Road traffic accidents—the leading cause of death by injury and the tenth-leading cause of all deaths globally—now make up a surprisingly significant portion of the worldwide burden of ill health. The injuries associated with road traffic accidents are numerous and varied. Some injures can lead to numerous disabilities and in many countries, including Anguilla, there are limited resources to provide rehabilitation services. It is therefore vital that preventative measures are put in place to decrease road traffic accidents. In Anguilla, road traffic injuries place tremendous strain on the Accident and Emergency Department at our main hospital and also on our Ambulance Service. Road traffic injuries also often require the services of several doctors, nurses, laboratory staff and many other health workers. The cost of providing an effective and efficient service to deal with road traffic accidents can be very significant. If the injuries are very serious, victims might be transferred to a tertiary hospital overseas involving even more resources.
Are motor vehicle accidents preventable?
To a large degree, MVTA are preventable and can be influenced through national policy decisions, education and individual choices. As the number of cars increases in Anguilla, the roads have become more dangerous and the expected number of deaths and injuries will continue to rise relative to the number of vehicles on the road. The most important risk factors for motor vehicle injury identified are driving while impaired by alcohol or drugs, failing to use occupant protection (e.g., safety belts, child safety seats, and motorcycle helmets), speeding, poor road planning and road construction which does not plan for the interaction of different road users, especially pedestrians, unsafe vehicle design and inadequate implementation of road safety measures.

Role of Public Health agencies
Officials in Public Health must demonstrate the health and economic impact of road traffic injuries so that policy decisions can be made. Data should be collected on fatal and non-fatal injuries associated with road traffic accidents.

Public health should ensure appropriate care and rehabilitation for all injured persons, as well as promote road traffic education and safer driving behaviour. The recent media campaign on road safety is a step in the right direction and should be an ongoing programme.

Some vital information related to road traffic accidents
Speed - Speed contributes to at least 30% of road traffic accidents and deaths worldwide. For every 1km/hour increase in speed there is a 3% increase in the incidence of injury crashes and a 5% increase in the risk of a fatal crash. Pedestrians are eight times more likely to be killed by cars travelling at 50 km/hour than at 30 km/hour.

Alcohol - Any level of alcohol in the blood increases the risk of crashes. The risk of crashes increases significantly with blood alcohol concentration greater than 0.04g/dl. In Anguilla we need to set and enforce blood alcohol concentration limits and have breath testing. Tough and swift penalties for offenders are also needed.

Seatbelts - Seat belt usage has saved more lives than any other road safety intervention. Seatbelts reduce fatal or serious injury by 40-65%. Child restrains reduce infant deaths by 71% and deaths in young children by 54%. Although we do not have legislation to enforce the use of seatbelts and child restrains, all residents of Anguilla are encouraged to use seatbelts and use child restrains. Our opinion leaders in our community should lead by example!

Helmets - Head trauma is the main cause of deaths and disability in drivers of motorized two wheelers among children. Bicycle injuries are a leading cause of injuries as well.

Visibility - One third of people hit on the road report they have difficulty seeing the vehicle and almost half of drivers have difficulty in seeing the pedestrians. Reflectors on vehicles and reflective clothing for people especially at night will be beneficial. Improved street lighting is also needed in Anguilla.

What can be done?
Anguilla needs to designate a lead agency in government which can coordinate the national road safety efforts. We also need to assess the problem, prepare a national road safety strategy, allocate financial and human resources and implement specific interventions that are known to work. These include setting and enforcing laws on seat belts, child restrains, helmets and drunk driving; and improved visibility of all road users. Every sector is important - transport, education, health, law enforcement - in tackling the problem. Everyone can increase road safety in his or her private capacity, as well as drivers, passengers and pedestrians, and as members of the public who influence decision-makers. Road deaths and injuries are preventable.

Conclusion
More than 3000 people die on the world’s roads every day. Tens of millions of people are injured or disabled every year. The number of injuries from road traffic accidents continues to increase in Anguilla. Governmental and nongovernmental groups in Anguilla must do more to raise the profile of the preventability of road traffic injuries and promote good practices related to helmet and seatbelt wearing, not drinking and driving, and not speeding. We can prevent the vast majority of road traffic accidents in Anguilla. The loss and suffering associated with road traffic deaths and injuries are preventable. With firm political will and an integrated approach that addresses vehicles, the people who use roads, and the road infrastructure, our roads can be made safer.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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