Medical, Social, and Economic Aspects of Road Traffic Trauma in Moscow

The dissertation is devoted to a comprehensive analysis of road traffic trauma in Moscow from medical, social, and economic perspectives, as well as to the development of directions for improving the organization of first medical aid at the pre-hospital stage. The study covers the period 1999–2003 and includes a retrospective analysis of accident rates, an examination of the nature and structure of traumatic injuries, the determination of the causes of mortality and disability, and an assessment of the economic damage from irretrievable and sanitary losses of the population.

The research is based on materials from driver questionnaires and internet-based surveys, an analysis of literary sources, and road traffic accident statistics. Special attention is given to the problem of the failure to provide first medical aid to victims at the scene of the incident, the role of self-aid and mutual aid, and organizational measures for improving the effectiveness of driver and traffic police officer (GIBDD) training in the provision of first aid. Recommendations are proposed for improving the training of medical personnel and for introducing amendments to the legislative framework concerning the criminal liability of drivers who have rendered first aid to victims.

According to world statistics, up to 300 thousand people are killed on the roads annually and over 8 million sustain injuries. The annual growth rate of injuries with a fatal outcome is 5% [17]. From Appendix No. 16 to Order No. 100 of the Ministry of Health of the Russian Federation dated 26.03.99: "Competent and timely first medical aid provided by medical personnel before the arrival at the scene of an accident may, in most cases, be the principal factor in saving a person's life."

At present, this provision is becoming increasingly relevant and is associated with the annually growing need for the provision of first medical aid at the pre-hospital stage in connection with the increasing number of road traffic accidents, which is attributable to the growing traffic volume, non-compliance by drivers with traffic regulations, the increase in speed limits in Moscow, and the frequent obstruction of traffic in the form of "traffic jams," which in turn impedes the prompt arrival of emergency medical service brigades to the scene of accidents.

Mortality resulting from road traffic accidents, according to domestic and foreign statistics [29, 75], amounts to 5–12%. At the scene of the accident and during transportation, 28–47% of all those who die in road traffic accidents perish [13]. The volume and quality of first aid provided to victims at the scene of the accident largely determine the consequences of traumatic illness. At the pre-hospital stage, many victims die not from injuries incompatible with life, but due to the absence of timely and adequate medical care. As a result of the deaths of accident victims, as well as their acquisition of disability or temporary incapacity, society incurs direct economic losses determined by the reduction in labor productivity, the decrease in national income, expenditures on medical care, compensation for temporary incapacity, social insurance payments, and funeral expenses. The increase in the number of children injured in road traffic accidents, the high mortality rate among men of working age, and the resulting increase in the burden on labor resources and the national economy, combined with the regressionary character of the demographic pyramid, further exacerbate the situation.

Under conditions of severe financial deficit, the most efficient use of resources acquires particular significance. This consists primarily in the prudent allocation of financial priorities, with a focus on the implementation of a package of programs for primary medical and social assistance and prevention, that is, mass, population-level measures.

In light of the above, one of the most urgent tasks at the current stage for mitigating the consequences of road traffic accidents is the provision of timely and adequate first medical aid (including, in the form of self-aid and mutual aid), which will undoubtedly contribute to improving the effectiveness of subsequent treatment and reducing the economic costs arising from the consequences of road traffic accidents.

An analysis of literary sources indicates that there are isolated works addressing the medico-social problems of road traffic trauma (Farhatov A.Z., 2000; Ponomarev M.F., 2002), the optimization of medico-social and psychological assistance to victims of automobile accidents (Bakieva A.M., 2001), and the reduction of its medical and socio-economic consequences in a specific region of the country (Osipov V.V., 2004). However, a comprehensive study of road traffic trauma and directions for improving first medical aid to victims of such accidents in a metropolitan setting has not been conducted to date.

The goal of the research is to substantiate directions for improving the organization of first medical aid at the pre-hospital stage for victims of road traffic accidents.

To achieve the stated goal, the following research tasks were set:

1. Conduct a retrospective analysis of the timeliness of first medical aid provided to victims of road traffic accidents at the pre-hospital stage.

2. Analyze drivers' attitudes toward the provision of first medical aid to victims of road traffic accidents through self-aid and mutual aid.

3. Study the nature and structure of traumatic injuries in victims of road traffic accidents.

4. Determine the primary causes of death resulting from road traffic accidents across various age groups.

5. Determine the structure of primary disability among individuals of various age groups who were victims of road traffic accidents.

6. Assess the economic damage from irretrievable population losses (lost GDP due to loss of life) and the economic damage from sanitary losses of the population (the cost of social transfers — disability pension payments).

7. Develop organizational directions for improving the provision of first medical aid.

The scientific novelty of the research lies in the fact that, for the first time:

• The attitude of "at-fault" road traffic accident perpetrators toward the problem of their failure to provide first medical aid has been identified through driver questionnaire surveys and internet-based questionnaires.

• Changes in the system of driver training regarding rules for providing first aid have been substantiated, and analogous courses have been proposed for traffic police officers (GIBDD).

• The economic damage from road traffic trauma in Moscow (from irretrievable population losses and social transfer payments) has been assessed.

• The attitude of accident participants toward criminal punishment for drivers whose fault resulted in harm to a person's health has been identified, and the possibility of mitigating the criminal liability of drivers who caused a road traffic accident, provided they rendered first aid to the victims, has been demonstrated.

The scientific and practical significance of the work lies in the development of scientifically grounded approaches and recommendations for improving the quality of training and retraining of drivers and traffic police officers (GIBDD) to enable them to provide timely and adequate first medical aid to victims at the scene of road traffic accidents, with the aim of preserving the population's lives and, consequently, reducing the economic losses from the consequences of road traffic accidents.

Implementation in practice. The results of the conducted research have been implemented in pedagogical practice at the Department of Public Health and Healthcare of the Moscow State Medical and Dental University, at the Department of Disaster Medicine and the Regional Branch of the Russian Society of Disaster Medicine and Military Medicine of the Russian State Medical University, and at the Department of Medical Insurance, Management, and Marketing of the Krasnoyarsk Medical Academy's Advanced Training Faculty, and have been incorporated into the training programs of three driving schools in Moscow. Proposals regarding the possibility of introducing amendments to the legislative framework (on mitigating the criminal liability of drivers who caused a road traffic accident resulting in medium-severity or grave bodily harm to a person, if the driver provides first medical aid to the victims) have been submitted for consideration by the Moscow City Duma.

Main provisions for defense:

1. Under conditions of an increasing number of road traffic accidents, with a high indicator of the severity of consequences and a high risk of death among accident participants, there is an increase in the mortality of victims at the pre-hospital stage (before the arrival of emergency medical service brigades).

2. The results of studies on the severity of the consequences of road traffic accidents and the timeliness of providing first medical aid to victims in Moscow in dynamics over five years (1999–2003).

3. The primary reasons for the failure of victims and witnesses of road traffic accidents to provide timely and adequate first medical aid.

4. Directions for increasing the effectiveness and quality of first medical aid provided to victims of road traffic accidents.

Verification of the work. The materials and main provisions of the dissertation were reported at an inter-institute scientific and theoretical conference (Moscow, 2000), at a conference of the Department of Public Health and Healthcare of the Moscow State Medical and Dental University (Moscow, 2005), at a conference of the Department of Automobile Transport of the Moscow State Automobile and Road Technical University named after V.P. Gorchakov (Moscow, 2003), and at a conference of the Department of Disaster Medicine and the Regional Branch of Disaster Medicine and Military Medicine of the Russian State Medical University (Moscow, 2005).

Publications. Four printed works on the topic of the dissertation have been published, including two in peer-reviewed journals.

Volume and structure of the dissertation. The dissertation is set out on 139 pages of computer typesetting and consists of an introduction, a literature review, a chapter on the organization, materials, and methods of the study, three chapters of original research, conclusions, findings, practical recommendations, and a reference list. The work is illustrated with 33 tables and 14 figures. The reference list contains 161 sources, of which 109 are by domestic authors and 52 by foreign authors.