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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 1-3

Pedestrian fatality: Price paid for zero individual travel carbon footprint!!


1 Specialist Consultant, Department of Surgery, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry, India
2 Medical Superintendent, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry, India
3 Director of Medical Services, Government of Puducherry, Puducherry, India

Date of Submission18-Apr-2022
Date of Acceptance13-Jun-2022
Date of Web Publication8-Jul-2022

Correspondence Address:
Angeline Neetha Radjou
Specialist Consultant, Department of Surgery, Indira Gandhi Government General Hospital and Postgraduate Institute, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3069.350137

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How to cite this article:
Radjou AN, Uthrapathy M, Sevel S, Sriramulu G. Pedestrian fatality: Price paid for zero individual travel carbon footprint!!. J Curr Res Sci Med 2022;8:1-3

How to cite this URL:
Radjou AN, Uthrapathy M, Sevel S, Sriramulu G. Pedestrian fatality: Price paid for zero individual travel carbon footprint!!. J Curr Res Sci Med [serial online] 2022 [cited 2022 Sep 25];8:1-3. Available from: https://www.jcrsmed.org/text.asp?2022/8/1/1/350137



In 1896, the coroner who examined the first reported pedestrian death of Ms. Bridget Driscoll in the United Kingdom is quoted to have hoped that “such a thing would never happen again.” According to the European Transport Safety Council, the death risk per 100 million person km traveled is 6.4 for pedestrians as against 13.6 for motorized two-wheeler, 0.7 for car users, and 0.07 for bus users. At the end of the day, we are all pedestrians; every trip begins and ends with walking even when using motorized transport.[1] Pedestrians form a mixed group of people with respect to age, gender, and socioeconomic status.

Globally, pedestrians constitute 5%–60% of all road deaths, and India has a share of 10%. Pedestrian deaths in India have increased by 80% in the last 5 years. Pedestrian collisions occur more in urban areas in high-income countries; in low- and middle-income countries (LMICs), pedestrian crashes are more in rural areas. The crash occurs mostly while crossing the road, standing by the side of the road, or hawking. A study from Pondicherry reported pedestrians accounted for 40% of the fatal road crashes in 2018. This is much higher than 30.4% in Bengaluru and 35.6% in Mumbai. However, recent reports indicate that pedestrians in Bangalore face a daunting task in using roads and footpaths, and the pedestrian safety index is 0.63, way below other metros.[2]

Factors and their mitigation efforts will be discussed in tandem for the sake of clarity and brevity. Pedestrian safety is a multidimensional problem and hence needs a holistic approach to analyze predisposing factors, pedestrian injuries, and solutions. However, neglect of walkers in transport planning and decision-making occurs at several levels from planning to execution to the audit phase [Figure 1].[1]
Figure 1: Vehicle pedestrian conflict. PC Dr Angeline


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Engineering, Enforcement, Education, and Economics, the pillars of prevention of road crashes will be appraised here, regarding pedestrian safety. Road designs should be specific to the traffic mix. Some progress in addressing the neglect of pedestrians in road design has been observed in China and India and deployed in some metros, and partial auditing is being done. Most collisions occurred during evenings and early nights since illumination levels are independent risk factors for road traffic accidents (RTC) with maximum impact on pedestrians.[3] However, studies have reported significant fatal crashes during the daytime, as different road users would be competing for the same limited space during peak traffic hours. Road improvements may, in fact, increase road traffic injuries. For road engineering interventions, the results were uncertain in reducing the number of road traffic injuries and deaths. Infrastructure changes are very expensive and hence have to be evidence-informed and be seen from the perspective of the larger scenario, which also includes the four-wheeler and other larger vehicles. Traffic calming measures with the use of transverse rumble strips and speed bumps could reduce the incidence of crashes by 25%. Without a detailed explanation of crash dynamics, suffice to say that vehicle speed up to 30 km/h is safe where there is high pedestrian density.[4] A 60%–90% reduction in pedestrian fatalities was observed in 10 high-risk locations after installing traffic signals and rumble strips and pedestrian-holding areas (vendors also share this) in 2011 in New Delhi.[5] Contrary to popular belief, widening roads encourages an increase in motor vehicle traffic speed, resulting in higher pedestrian risk. Motor vehicle design has become increasingly safer for occupants only…However, recently, there is an increasing effort to include design elements that reduce the likelihood of pedestrian collision. Brake assist improves emergency braking ability and reduces the chance of a collision by 10%. Autonomous emergency braking is a more recent development. Pedestrian-friendly road design is necessary but not sufficient to ensure pedestrian safety.[1]

Legislative interventions provided the best outcomes when combined with strong enforcement initiatives. Increased police surveillance, penalization for noncompliance, advocacy campaigns, and automated-enforcement systems were more effective in changing drivers/pedestrian behaviors when compared to standalone road engineering interventions. Pedestrian behavior and enforcement are entangled in most situations. Since there was no police surveillance or a financial penalization for using roads to cross or any attempts to channel pedestrian traffic to the overpass, most of the pedestrians crossed by creating their own path at “convenient” points through traffic while risking life. In both Mexico and South Africa, for example, reasons for avoiding the use of crossing facilities included lack of lighting at night and the perceived risk of assault at deserted overpasses or subways. Pedestrians' waiting (30 s) and crossing times (20 s) are the two most significant constraints influencing crossing behavior in India. Understanding people's perceptions of security in the walking environment is an important element for improving pedestrian safety. People may choose to avoid walking altogether if they perceive too great a risk of traffic injury or other threats to personal security. The issue of alcohol and pedestrian fatality is significant. 20% of pedestrian fatality was attributed to alcohol.[5] Pedestrian light reflector or light-colored clothing (engineering factor) has a reasonable benefit. However, again, it should be tagged with a change in pedestrian behavior. Focusing solely on pedestrian behavior as the key factor influencing pedestrian safety may be cheaper and easier, but attention to infrastructure for pedestrians as well as for vehicles is also essential. Optimizing road designs itself can change pedestrian behavior.

Changing the attitudes and behavior of drivers and pedestrians is a complex, long-term undertaking. Other aspects related to perceived risk and road use behavior must be considered and addressed, such as making streets more esthetically pleasing, widening sidewalks, separating pedestrians from motor vehicles, providing street lighting, lowering vehicle speeds, and making streets safer from interpersonal violence. Given the expense involved in developing infrastructure solutions, it is essential that decisions are evidence-informed and that more possibilities be extracted from education and enforcement perspectives.

The Safe System Approach by the WHO provides a basis for LMICs to avoid mistakes made by a number of high-income countries that designed roads mainly with motor vehicles in mind. Of all the factors discussed, the proportion of vehicles interacting with pedestrians is the highest risk factor. This is a looming problem in fast-motorizing nations such as India and China.

India has taken up pedestrian safety as evidenced by a few initiatives. Pedestrian Safety Score Index model has been developed for some metros in India. Preinjury factors have been captured from studies from IITs and NIMHANS. There is a paucity of postinjury studies in India, which is equally important information for decision-makers. Clinical outcome of trauma patients is available only in 40% of cases. This severe paucity of information is the main stumbling block during the planning of a policy on trauma care. The most common cause of death was isolated traumatic brain injury (up to 80%), irrespective of age, and 50% of the patients died within 24 h of the incident. There was a peak again after 48 h (25%) between 48 h and 1 week (10%), and late deaths (>1 week) was 15%, hence a call to strengthen trauma services.[3],[6],[7] The health sector armed with evidence should also give impetus to prevention efforts in addition to strengthening postcrash trauma care.

Transport planning vulnerability is a pervasive phenomenon that is situated not only in transport planning decision-making but also in the overall interaction of several economic, social, technological, and political factors that contribute to automobile-dependent transport planning. As we continue to reflect on where the real vulnerability lies, let us remember the words of Juliet to Romeo, “That which we call a rose, by any other name would smell as sweet.”

Before I conclude, there is a flip side to this pedestrian issue. Pedestrians are a threat to other road users! 3% of fatality in motorized road users is due to maneuvers to avoid sudden pedestrian intrusion into the roads, as reported in one of the largest prospective studies on road traffic mortality in India.[3]

To conclude, a comprehensive understanding of the local pedestrian safety situation is essential to effective action. Core components of the action plan include a well-defined problem, clear objectives, realistic targets, performance indicators, timeline and milestones, adequate resources, monitoring and evaluation, and sustainability options. Effectiveness of the measures is assessed by the reduction of fatalities and injuries, as well as changes in behavior, attitudes, and knowledge. As regards hard evidence, speed limit is proven, and traffic calming measures are promising, but improvement in vehicle design has very poor strength of evidence as of now.



 
  References Top

1.
WHO: Pedestrian Safety: A Road Safety Manual for Decision-Makers and Practitioners. Available from: https://www.who.int/publications-detail- redirect/pedestrian-safety-a-road -safety-manual-for-decision-makers -and-practitioners. [Last accessed on 2022 Apr 17].  Back to cited text no. 1
    
2.
National Crime Record Bureau. Available from: https://ncrb.gov.in/en/accidental-deaths-suicides-india-2019. [Last accessed on 2022 Apr 17].  Back to cited text no. 2
    
3.
Radjou AN, Kumar SM. Epidemiological and clinical profile of fatality in vulnerable road users at a high volume trauma center. J Emerg Trauma Shock 2018;11:282-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Ministry of Urban Development; 2008. Study of Traffic and Transportation Policies and Strategies in Urban Areas in India, Final Report. Available from: https://mohua.gov.in/upload/uploadfiles/files/traffic_transportation(1).pdf. [Last accessed on 2022 Apr 17].  Back to cited text no. 4
    
5.
Gupta M, Bandyopadhyay S. Regulatory and road engineering interventions for preventing road traffic injuries and fatalities among vulnerable road users in low- and middle-income countries: A systematic review. Front Sustain Cities 2020;2:1-26. Avaialble from: htpps://www.frontiersin.org. [Last accesse on 2022 Apr 17].  Back to cited text no. 5
    
6.
Radjou AN, Mahajan P, Baliga DK. Where do I go? A trauma victim's plea in an informal trauma system. J Emerg Trauma Shock 2013;6:164-70.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Radjou AN, Balliga DK, Pal R, Mahajan P. Injury-related mortality audit in a regional trauma center at Puducherry, India. J Emerg Trauma Shock 2012;5:42-8.  Back to cited text no. 7
[PUBMED]  [Full text]  


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