Thursday, February 7, 2019

National Road Safety Week: HCFI Harm Reduction Conference Consensus recommendations

The country is observing the National Road Safety Week from 4th February (Monday) to 10th February (Sunday). The aim is to increase public awareness about traffic rules including the importance of wearing helmets and seat belts. 

A Harm Reduction conference was organized by Heart Care Foundation of India (HCFI) at Maple Hall, India Habitat Centre, New Delhi on January 30, 2019. Harm reduction strategies for important public health issues were discussed, including helmets and seat belts.

A consensus statement was also released. The recommendations with regard to helmets and seat belts are as follows:

Helmets and harm reduction

Preventing head injuries by wearing a bicycle helmet reduces the risk of brain injury. A 2009 systematic review of five case-control studies found that helmets provide a 63 to 88 percent reduction in the risk of head, brain, and severe brain injuries and a 65 percent reduction of injuries to the upper and mid-face for bicyclists of all ages.  Helmets provide similar protection for crashes involving motor vehicles and other causes (70 percent). In children (<15 years of age), wearing a helmet reduces the risk of head injury by 63 percent and of loss of consciousness by 86 percent.

Pregnancy Belt

Pregnant women should wear three-point seat belts during pregnancy. The lap belt is placed across the hips and below the uterus; the shoulder belt goes between the breasts and lateral to the uterus. Although there are case reports of maternal and foetal injuries resulting from seat belt use, the overall effect is that seat belts provide significantly more benefit than risk to the mother and foetus in the event of collision.


·         Zero tolerance for not wearing helmets and seat belts.
·         Govt should be asked to bring in laws for mandatory cycle helmets, seat belts for back seat passengers, seat belt for bus drivers.
·         Awareness should be created about quality of helmets.
·         Children below < 5 years old should not be allowed to sit in the front seat of a car. Car seats for children to be mandatory.
·         In the back seat of a car, the middle seat should always have a seat belt as the person seated in the middle is most at risk.
·         The importance of helmets and seat belts should be taught in schools.
·         Children from schools in high risk areas should be made to wear helmets while crossing the roads.

Suggested Reading

1.    Attewell RG, et al. Bicycle helmet efficacy: a meta-analysis. Accid Anal Prev 2001; 33:345.
2.    Maimaris C, et al. Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers. BMJ 1994; 308:1537.
3.    Thompson RS, et al. A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med 1989; 320:1361.
4.    Thompson DC, et al. Effectiveness of bicycle safety helmets in preventing head injuries. A case-control study. JAMA 1996; 276:1968.
5.    Thomas S, et al. Effectiveness of bicycle helmets in preventing head injury in children: case-control study. BMJ 1994; 308:173.
6.    Spaite DW, et al. A prospective analysis of injury severity among helmeted and non-helmeted bicyclists involved in collisions with motor vehicles. J Trauma 1991; 31:1510.
7.    McDermott FT, et al. The effectiveness of bicyclist helmets: a study of 1710 casualties. J Trauma 1993; 34:834.
8.    Persaud N, et al. Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case-control study. CMAJ 2012; 184:E921.
9.    Thompson DC, et al. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev 2009; :CD001855.
10. Kaushik R, et al. Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law. Inj Epidemiol 2015; 2:16.
11. Schieber RA, et al. Effect of a state law on reported bicycle helmet ownership and use. Arch Pediatr Adolesc Med 1996; 150:707.
12. Klinich KD, et al. Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint. Am J Obstet Gynecol 2008; 198:450.e1.
13. Motozawa Y, et al. Effects of seat belts worn by pregnant drivers during low-impact collisions. Am J Obstet Gynecol 2010; 203:62.e1.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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