Journal of Public Health and Development Vol. 15 No. 1 January-April 2017 GENERAL ARTICLE Response to road traffic injuries: a survey of Royal Thai Traffic Police in a Northeastern Province of Thailand Bijaya Shrestha1, Oranut Pacheun2, Chaweewon Boonshuyar3 and Manash Shrestha1 1 MPH, Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand 73170 2 Dr.PH, Faculty of Public Health, Thammasat University, Rangsit Campus, Klong 1, Klong Luang District, Prathumthani, Thailand 12121 3 MSPH, Faculty of Public Health, Thammasat University, Rangsit Campus, Klong 1, Klong Luang District, Prathumthani, Thailand 12121 Corresponding author: Manash Shrestha Email address: [email protected] Received: 24 March 2017 Revised: 17 April 2017 Accepted: 30 April 2017 Available online: April 2017 Abstract Shrestha B, Pacheun O, Boonshuyar C. and Shrestha M. Response to road traffic injuries: a survey of Royal Thai traffic police in a Northeastern Province of Thailand. J Pub Health Dev.2017;15(1):101-112 Timely and appropriate response to road traffic accidents can reduce the mortality and severe morbidity associated with it. Traffic police are one of the first responders, and could play a vital role in pre-hospital care of road traffic injuries (RTI). A cross-sectional survey was conducted to assess knowledge, experience, and practice of Royal Thai traffic police in responding to RTI, and the association between respondent characteristics and their practice of responding to RTI. Self-administered questionnaires were employed among 123 traffic policemen of Nakhon Ratchasima Province. Descriptive statistics and chi square tests were utilized to analyze the data. A majority of traffic police reported dealing with RTI cases in the previous year (76%), having prior experience of post-crash rescuing (76%) and responding within 10 minutes of being informed about accidents (78%). There were 65 respondents (56%), who had received training on handling RTI cases and they were more likely to respond within 10 minutes to RTI than those who had not received such training (85% versus 69%, p-value 0.04). This study demonstrates a positive link between training on management of RTI to the traffic police and their responding ability. Providing proper training and encouraging traffic police to respond quickly and effectively to road traffic accidents, in coordination with emergency medical services, may help reduce the burden of RTI in Thailand. Keywords: Pre-hospital care, Response, Road traffic injuries, Royal Thai traffic police, Thailand 101 วารสารสาธารณสุขและการพัฒนา ปีที่ 15 ฉบับที่ 1 มกราคม-เมษายน 2560 Introduction utilizing first responders for pre-hospital care after a Road Traffic Injury (RTI) exerts a global public traffic accident.2 Traffic police have been identified health burden, with around 1.24 million people as one of such first responders,2,9,10 along with dying on the road, and another 20-50 million community volunteers, laypeople and taxi drivers, sustaining non-fatal injuries due to it every year.1 RTI whose prompt response might increase the victim’s has emerged as one of the leading causes of death, chances of survival and lessening severe morbidi- especially among young people aged 15-29 years.1,2 ties.3,4,11-14 Therefore, increasing general awareness of Despite having similar number of vehicles, deaths first responders with first aid training and practical due to RTI occur twice as much in low and middle demonstrations to improve the quality of their income countries than the high income countries.1 responses when called upon, can be beneficial in The gross disparities in mortality rates between the low and middle income countries.11,15-18 Due to their countries of different socioeconomic statuses can be significant role in pre-hospital care, first responders attributed to the level of care received immediately are often considered as important members of the post-crash and later in a health care facility. responding team at the accident site.19,20 Time is of critical importance in road traf- Thailand is a middle income country which has fic trauma injuries. Proper and timely pre-hospital seen a dramatic increase in level of motorization, care can reduce RTI mortality.3,4 In potentially fatal spurred by economic growth, leading to an adverse accidents, survival of victims often depend on the time road traffic situation.21 In 2015, WHO estimated in of starting an intravenous drip (IV) or receipt of basic excess of 24,000 fatalities due to road traffic accidents life support.5,6 Many trauma experts consider “golden in Thailand, with more than 70% of deaths occurring hour” - the first 60 minutes after injury occurrence - among motorbike users.2 The estimated mortality rate as the most effective for saving lives, beyond which, in Thailand due to RTI (36.2 per 100,000 people) is the risk of death or injury severity rises significantly.7 the second highest in the world,2 and creates a huge This “golden hour” consists of various time intervals, burden on the country’s economy, accounting to as such as notification time, activation time, response much as 3% of its gross domestic product.1,2 Although time, on-scene time, and transport time.7,8 Shortening emergency care systems in Thai hospitals have been the response time – the time for emergency medical bolstered following quality improvement measures personnel to arrive at the accident scene site after in the hospital settings, lowering mortality rates by notification, is therefore crucial to ensure that the up to 50% in some regions,22,23 there exists a gap in patient receives prompt paramedical support on scene pre-hospital care and a need for multi-disciplinary and gets transported properly to hospital settings for approach to improve the quality of care in pre-hospital advanced care as soon as possible. setting has been recognized.1,24,25 A study based on In less resourced settings, in addition to a EMS database, estimated that a 1-minute improve- specialized emergency medical service (EMS), the ment in response time to traffic accidents in Thailand World Health Organization (WHO) recommends would save up to 23.2 lives and 145.4 severe inju- 102 Journal of Public Health and Development Vol. 15 No. 1 January-April 2017 ries per year, and a yearly cost-benefit of nearly 14 police in handling RTI cases, we assessed Royal Thai million USD.26 traffic police’s knowledge, experience, and practice of EMS service in Thailand is less mature in com- responding to RTI. We also examined the association parison to other Asian countries such as Japan, Korea of traffic police’s characteristics with their response and Singapore.27,28 In 1995, Narenthorn EMS was the time to RTI. first established EMS center in Thailand under the Ministry of Public Health.29 Only in 2008, a statutory Material and methods lead agency, Emergency Medical Institute of Thailand Study setting was established, which has helped in making some Nakhon Ratchasima is the largest province in gains in expanding coverage of pre-hospital care and Thailand. It has one of the most frequently used shortening response times.30 In Thailand, after a road highways in Thailand - National Highway No. 2, traffic accident occurs, pre-hospital care responses which is the main road heading towards Northeastern are sent out by an EMS radio control room which region of Thailand. The highway, 508 kilometers is located, depending on the province, either in the long, connects Thailand to Laos via the Thai-Lao provincial health office, police station or the provincial Friendship Bridge.34 The highway is highly vulnerable hospital. Although basic life support are carried out by for road traffic injuries with top causes being: over many foundations in pre-hospital settings, advanced speeding, drunk driving and dangerous lane changing life support are performed only in the hospitals.31 without signaling. Across Thailand, policemen are usually the first personnel to arrive at accident scenes.32 However, Study population traffic police play only a supporting role in treatment We conducted a cross-sectional survey in January of RTI victims: helping to remove the injured from 2014, using self-administered questionnaires among their vehicles and controlling traffic. Thai traffic all 140 traffic policemen employed at 12 different police receive some emergency medical training during police stations of Nakhon Ratchasima Province along police academy years.32 After they join the force, they the highway numbers 2 and 24. Traffic police who are equipped with emergency first aid kits, and some were voluntarily willing to participate in the study get trained in basic life support and patient transfer, were included, while those who did not give consent to handle post-crash rescue cases. This potentially or were unavailable on the day of data collection enables traffic police to play a bigger role in RTI were excluded from the study. management. Therefore, a multi-disciplinary approach with involvement of traffic police in pre-hospital care, Survey instrument might bring better outcomes on dealing with the road The survey questionnaire was divided into four traffic injuries cases.25,33 parts: Part 1 enquired about general characteristics, Part In light of the current scenario of road traffic 2 consisted of nine questions pertaining to knowledge accidents in Thailand and the potential role of traffic of post-crash, pre-hospital care in terms of detection 103 วารสารสาธารณสุขและการพัฒนา ปีที่ 15 ฉบับที่ 1 มกราคม-เมษายน 2560 of case types and severity, handling procedure, Ethical considerations communication guidelines and first aid information Respondents were clearly explained about based on the expectation and role of a first responder voluntary nature of participation and their rights to according to WHO road traffic injury prevention avoid answering uncomfortable questions. Written training manual,35 Part 3 asked participants about their informed consent was sought from the participants.