Road safety: A call for action.

To The Editor: We would like to thank both Dr. A. Ali [1] and Dr. A. Salamat [2] for highlighting the issue of road traffic accidents in Libya.

Road traffic accidents and their consequences have become a huge burden on societies all over the world; this is especially true for Libya in recent years where it has reached epidemic proportions.

Each year over a million people are killed worldwide in road traffic accidents and about 10 million people are injured, 85% of these deaths occurring in developing countries [3]

The Global Burden of Disease study, undertaken by the World Health Organization (WHO), Harvard University and the World Bank, showed that in 1990, traffic crashes were assessed to be the world's ninth most important health problem. The study forecasts that, by the year 2020, road crashes would move up to third place in the table of leading causes of death and disability facing the world community [4].

In Libya the picture is very grim; each year over 2000 people die as a result of road traffic accidents, and the number is steadily and surely rising. Last year alone 2138 people died on the roads in Libya (approximately 35 deaths per 100 000), which is the second highest death rate within the Arab world [5]. Compare this figure to the UK where the death rate is 5.9 per 100 000 [6]. This year, the number of road deaths in Libya is already in the hundreds. Only recently two traffic accidents occurred within weeks of each other, the first resulting in the death of 36 people and the other in 9 people, both accidents involved forms of public transport, and as with most of the accidents, these 45 deaths could have been prevented.

There is no doubt that the issue of road safety is of paramount importance in Libya, but, unfortunately, despite the tragic figures there is little tangible evidence of any measure to combat this serious issue. Policymakers in Libya have neglected the issue of road safety and its burden, barring few and far in between exceptions. This neglect is also replicated within our own medical community.

There is literally a wealth of available research and evidenced based guidance from around the world, all pointing towards implementing a scientific and systemic approach to the problem of road traffic accidents, a process which leads to marked reductions in deaths and injuries.

As an example of this, in developed countries, road traffic death rates have decreased since the 1960s because of successful interventions such as seat belt safety laws, enforcement of speed limits, anti-drunk driving law enforcement and safer design and use of roads and vehicles. For example, road traffic fatalities declined by 27 percent in the United States and by 63 percent in Canada from 1975 to 1988 [7].

There is hardly any effort expended on prevention and research, a sad fact and in keeping with a pattern known throughout the developing world.

The main reasons why death rates are so high and increasing in Libya have not been accurately studied, but one can reasonably infer from what is known the following major causes:

Poor enforcement of traffic safety regulations. A huge problem, the departments responsible are archaic in nature, lack of proper resources and training at all levels. The main issue in the responsible departments is, unfortunately, corruption, which could and does result in terrible consequences. Many drivers and vehicles on the roads should not be allowed to be so; this is plain to see and requires no scientific probing! Many deaths have occurred due to improper and often illegal licensing both of drivers and cars.

Aging and poorly designed roads. This is further aggravated by an exponential increase in the number of cars.

Poor trauma-related health care. Trauma and emergency care is below standard. There are enormous short falls in this area. There is a lack of trained staff in all areas of the “rescue chain”, starting from the road side ending in the bedside. Trauma care is still archaic and the lack of development in this area is tragic, and like road safety, it has not shown any improvement at all.

Most of the trauma departments are run by medical staff who has not received any formal trauma or emergency training such as ATLS/ACLS. Basic trauma guidelines are not practiced nor are there the basic resources to implement them.

ATLS/ACLS would be a huge step in the right direction, but who would fund or introduce it to those departments? The scientific evidence is clear, better trained doctors will reduce morbidity and mortality of trauma patients.

Most trauma department resources are inadequate and aging and they are in need of modernizing in keeping with today's standards.

We have to be honest and forthright at pointing out the problems facing trauma care in Libya. Furthermore we need to encourage appropriate resource channeling and use for this important facet of care. Many people in health care management are either unaware and if not, are ignoring the importance of modernizing and implementing evidence based practice in trauma care. This attitude- if continued- will unfortunately lead to more suffering and loss of lives.

The responsibility to implement changes not only lies with doctors on the front lines in our hospitals in Libya, but also lies collectively with all of us wherever we may be. We have a moral and scientific responsibility to contribute to improve the situation on our roads and hospitals.

The question we all have to ask is: What can we do? The answer is that we all can do something, through raising awareness, using our scientific and managerial influence to try to encourage research and implement a modern effective evidence based approach to the issue of road safety in Libya. Dr. Ali and Dr. Salamat kindly gave excellent suggestions on what can be done, and we need to explore all of these suggestions and expand upon them but the most important thing is to implement them.

Many of our surgical and emergency care colleagues can contribute by arranging and participating in training courses, seminars and workshops on the issue of trauma care. This would be an enormous step in the right direction.

Further to this issue, we recommend to the editors of the Libyan Journal of Medicine to dedicate a full issue of the LJM to road safety in Libya and to invite contributions on this subject. This will not only encourage awareness but also stimulate much needed research and debate and hopefully a positive influence which can lead to the reduction in the number of deaths on our roads. As we all know any procrastination on dealing with this issue will sadly lead towards more death and injury.