Policy Tag: Injury

Adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992
Revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016

 

INTRODUCTION

Deaths and injuries resulting from road crashes and collisions are a major public health problem. The World Health Organization’s 2015 Global status report on road safety indicates that the total number of road traffic deaths per year has reached 1.25 million worldwide, with the highest road traffic fatality rates in low-income countries.

Driving while under the influence of alcohol has caused a large number of the deaths and injuries resulting from road crashes. The prevalence of drinking and driving is increasing worldwide each year.

A change in the behaviour of road users with regard to alcohol consumption would appear to be the most promising approach to preventing traffic deaths and injuries. Measures forbidding driving while under the influence of alcohol will lead to a considerable improvement in road safety and an appreciable reduction in the number of dead and injured.

CONSEQUENCES OF DRINKING AND DRIVING

Driving a vehicle implies the acceptance of a certain number of risks. The careful driver will always be aware of the risks but also ensure that the level of risk never rises to an unacceptable level. Alcohol not only impairs one’s ability to drive, but it also alters a driver’s subjective assessment of risk so that he or she drives more recklessly.

Irrespective of the amount of alcohol consumed, the maximum concentration of alcohol in the body is reached:After half an hour when taken

  • on an empty stomach;
  • After an hour when taken with a meal.

On the other hand, it takes the body a long time to eliminate alcohol. An individual in good health eliminates alcohol at a rate that reduces blood alcohol concentration by 0.1 to 0.15 gram/litre/hour. Thus, one’s driving ability remains impaired long after he or she has stopped drinking.

Alcohol abuse has both short- and long-term neurological and psychiatric consequences that can endanger road safety.

Certain drugs interact negatively with alcohol, and in particular some combinations are known to reduce alertness. When drugs, whether legal or illegal, are taken with alcohol, the effect of the latter is intensified. This mixture can trigger mental dysfunctions that are extremely dangerous for road users. Physicians should be educated and informed about these pharmacological facts.

RECOMMENDATIONS 

1. The WMA reaffirms its commitments to work for reducing excessive alcohol consumption and for fostering harm-reduction policies and other measures (WMA Declaration on Alcohol, October 2015.)

2. Physicians and National Medical Associations should play an active role in promoting and advocating for the development of evidence-based government policies to reduce alcohol use and driving:

Policy interventions

3. At the present time, permitted blood alcohol levels while driving vary from country to country. Even small amounts of alcohol have a direct effect on the brain, with disturbances noted at levels as low as 0.3 grams per litre. Therefore, it would be desirable to lower the maximum permissible level of blood alcohol to a minimum, but not above 0.5 grams per litre, which is low enough to allow the average driver to retain the ability to assess risk.

4. The especially high prevalence in certain countries of driving while under the influence of alcohol may justify more coercive policies, which physicians and National Medical Associations should play an active role in supporting. For example, the driver may be declared unfit to drive for a period of time sufficient to ensure he or she will no longer be a threat to road safety in the future.

5. Government officials should consider implementing restrictions on the sale or affordability of alcohol, perhaps through taxation, licensing systems, and/or limits on the days and hours of sale. Restrictions on the promotion of alcoholic beverages, including advertising and event sponsorship, should also be considered.

6. A minimum legal age for alcohol purchase and consumption should be adopted in each country. Government officials should consider implementing a separate, lower or zero blood alcohol content law for young drivers.

7. There should be strict consequences to selling alcoholic beverages to individuals under the age to purchase and consume alcohol. These laws should be properly enforced.

8. Any driver who has been in a road traffic crash must undergo a blood alcohol concentration test or a breath test.

9. The practice of random driver testing for breath alcohol levels should become more widespread, and there should be further research into other ways to test urine, breath and saliva to identify impaired drivers and prevent subsequent operation of motor vehicles.

10. Devices that prevent individuals with an unauthorised level of blood alcohol from starting the engine of or operating the vehicle should be developed and experimented with.

Educational interventions

12. Educational interventions should promote moderation and responsibility in the consumption of alcohol and seek to reduce the likelihood that someone will consume alcohol and drive afterwards.

13. The information dispensed by physicians and other health professionals should be aimed at making everyone aware of the dangers of driving under the influence of alcohol. When physicians and other health professionals issue fitness-to-drive certificates, they can use this opportunity to educate road users and pass on a message of prevention and personal responsibility.

14. In most countries, road crashes linked to alcohol consumption affect adolescents and young adults to a disproportionately high degree, and every available resource should be mobilised to reduce their consumption of alcohol. The problem of alcohol consumption in adolescents and young adults and its relation to road safety should be addressed in the school curricula so that a responsible attitude becomes the norm.

Clinical and rehabilitative interventions

15. Physicians should also be involved in reducing the likelihood of impaired driving by participating in the detoxification and rehabilitation of drunk drivers. These initiatives should be based on a detailed analysis of the problem as it manifests itself within each country or culture. Generally speaking, however, alcoholism is a medical condition with concomitant psychological or social and interpersonal difficulties that affect the family, work or social environment.

16. Alcoholic subjects should be given access to rehabilitation services. When drivers are found to have excess alcohol in their blood (or their breath), other factors linked to their excessive drinking should be examined and included in a rehabilitation programme. These rehabilitation programmes should be publicly funded.

17. Road crashes linked to the consumption of alcohol can be considered as possible predictors of other addictive and violent behaviours. This should be taken into consideration in the medical treatment of the patient.

Community interventions

18. Strategies should be developed by relevant stakeholders to ensure safe transportation home in situations where alcohol consumption occurs.

19. Eliminating alcohol from the workplace and in situations where consumers must drive should be a goal of organizational policies. The promotion of non-alcoholic drinks is an important tool to facilitate these policies.

Adopted by the 42nd World Medical Assembly, Rancho Mirage, CA., USA, October 1990
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

 

PREAMBLE

Serious injuries and mortality in road collisions are a public health problem with consequences similar to those of major diseases such as cancer and cardiovascular disease. Worldwide, about 1.2 million persons are killed each year on the roads, and an additional 20-50 million are injured. By 2020, road traffic injuries are expected to be the third largest contributor to the global burden of disease and injury.

In addition to the immeasurable personal and social price paid by road crash victims and their relatives, traffic injury has a significant economic impact. The economic costs of traffic injury and disability, including emergency and rehabilitative health care, costs of disability and disability adjusted life years (DALYs), amount to 1% of the GDP of poorer countries and 1.5-2% of wealthier countries. Much of this burden is borne by the health sector.

Road injuries continue to increase in many countries, particularly in low- and middle-income nations which currently account for 85% of all road traffic deaths, and are the second leading cause of death among youth worldwide.

Most traffic injuries could be prevented by better countermeasures. Combating traffic injury is the shared responsibility of groups and individuals at the international, national, and community levels, including governments, NGOs, industry, public health professionals, engineers and law enforcement personnel.

Speed is widely recognized as the most important determinant of road safety, affecting both the likelihood that a crash will occur and the severity of a crash. On average, an increase in speed of 1 km/h is associated with a 3% higher risk of a crash involving injury and a 5% higher risk of serious or fatal injury.

However, efforts to decrease road crashes and injury also require a “systems approach” that recognizes and addresses the many factors that contribute to the risk of traffic crashes and resulting injury, including human, vehicle and road design variables.

Preventing traffic injury requires addressing the social determinants of health—the social, economic, environmental, and political factors in society that influence a population’s health. Low- and middle-income countries, where there is less safe infrastructure, fewer minimum standards on vehicle safety, and poorer quality emergency care, experience the greatest number of traffic injuries. In this way, human, vehicular and environmental factors interact before, during and after a collision. Intervention at each of these stages will help reduce crashes and injury. Effective intervention requires public education as well as professional involvement in the fields of engineering, law enforcement and medical care.

Pre-collision intervention is aimed at preventing crashes and reducing risk factors. Examples include preventing drivers from driving when fatigued (especially drivers of heavy vehicles), distracted or under the influence of drugs or alcohol. Necessary policies may include prohibiting the use of hand-held cellular phones and night curfews or graduated licensing for young drivers. Pre-collision intervention also includes setting vehicle design standards that ensure that vehicles are roadworthy and cannot be driven at excessive speeds. Other interventions include setting and enforcing appropriate speed limits, installing speed cameras, and optimizing road design and layout to prevent crashes.

A second level of intervention is aimed at preventing or reducing injury during the crash. Such interventions include: enforcing the use of seat belts and child restraints; requiring helmets for cyclists; manufacturing vehicles equipped with safety devices and crash-protective design; lowering and enforcing speed limits; and removing heavy, rigid objects such as concrete or metal dividers, light posts and abutments from the sides of roads.

Post-crash intervention is aimed at maximizing life-saving and injury-reducing treatment and includes improved pre-hospital and emergency trauma care and rehabilitation.

RECOMMENDATIONS

  1. The WMA supports the findings and key recommendations of the WHO’s 2015 Report on road traffic injury prevention and calls for their implementation by its member National Medical Associations and their governments and relevant bodies.
  2. Physicians must view traffic injury as a public health problem and recognize their responsibility in fighting this global problem.
  3. National Medical Associations and their member physicians should work to persuade governments and policy makers of the importance of this issue and should assist in adapting empirical and scientific information into workable policies.
  4. National Medical Associations and physicians should be key players in public education and should include road safety in health promotion activities.
  5. Physicians should be involved in the collection and analysis of data regarding road crashes and concomitant injuries, including injury surveillance systems.
  6. Physicians should work toward changing the public attitude of road travel, including pressing for improved public transportation, bicycle paths and proper sidewalks to encourage less car use and the adoption of healthier options such as walking and cycling.
  7. Physicians should address the human factor and medical reasons for road crashes, including, but not limited to, the use of prescription drugs or medical conditions that may impair driving ability, and explore ways to prevent and reduce the severity of injuries.
  8. Physicians should lobby for the implementation and enforcement of the measures listed above, which have been shown to decrease the risk and severity of vehicle crashes, and the evaluation of their impact.
  9. National Medical Associations and their member physicians should encourage the research and development of improved training systems and medical care at all stages, including effective communication and transport systems to locate and evacuate the victims, emergency medical care systems to provide life-saving first aid services, and expert trauma and rehabilitative care, and should lobby for increased resources to help provide these services.

Adopted by the 42nd World Medical Assembly, Rancho Mirage, CA., USA, October 1990
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

 

Injuries are the leading cause of death and disability in children and young adults, destroying the health, livelihoods and lives of millions of people each year. Causes of injury include, among others, acts of violence against oneself or others, traffic crashes, falls, poisonings, drowning, and burns. Yet many injuries are preventable. Injury control should be recognized as a public health priority requiring coordination among health, transportation and social service agencies in each country. Physician participation and leadership through medicine, education and advocacy is necessary to ensure the success of such injury control programmes.

As the World Health Organization states in Injuries and Violence: The Facts, the rate of injury is far from uniform around the world. Indeed, about 90% of injury-related deaths occur in low- and middle-income countries. Within countries, injury rates vary by social class as well. The impoverished face more dangerous living and working conditions than the more affluent. For example, buildings in poorer communities are more likely to be older and in need of repair. Poor communities are also plagued by much higher rates of homicide. What’s more, people living in poverty also have less access to quality emergency care and rehabilitation services. Greater attention must be given to these root causes of injuries.

The World Medical Association urges National Medical Associations to work with appropriate public and private agencies to develop and implement programmes to prevent and treat injuries. Included in the programmes must be efforts to improve medical treatment and rehabilitation of injured patients. Research and education on injury control must be increased, and international cooperation is a vital and necessary component of successful programmes.

National Medical Associations should recommend that the following basic elements be incorporated in their countries’ programmes:

EPIDEMIOLOGY

The initial activity of such programmes must be the acquisition of more adequate data on which to base priorities, interventions and research. An effective injury surveillance system should be implemented in each country to gather and integrate information. A consistent and accurate system for coding injuries must be implemented by hospitals and health agencies. There should also be international uniformity in the coding of injury severity.

PREVENTION

Injury prevention requires education and training to teach and persuade people to alter their behaviour in order to reduce their risk of injury. Laws and regulations based on scientifically sound methods of preventing injuries may be appropriate for effecting changes in behaviour (for example, the use of seatbelts and protective helmets). These laws must in turn be strictly enforced. An effective injury surveillance system as mentioned above will help determine how to target further preventive efforts. Urban and traffic planning should support safe environments for the residents.

BIOMECHANICS

A better understanding of the biomechanics of injury and disability could inform the development of improved safety standards and regulations of products and their designs.

TREATMENT

Injury management at the scene of the occurrence must be enhanced by an effective system of communication between first responders and health professionals at hospitals to facilitate decision-making. Rapid and safe transportation to the hospital should be provided. An experienced team of trauma practitioners should be available at the hospital. There should also be adequate equipment and supplies available for the care of the injured patient, including immediate access to a blood bank. Education and training of medical practitioners in trauma care must be encouraged to assure optimal technique by an adequate number of physicians at all times.

REHABILITATION 

Trauma victims need continuity of care emphasizing not only survival but also the identification and preservation of residual functions. Rehabilitation to restore biological, psychological and social functions must be undertaken in an effort to allow the injured person to achieve maximal personal autonomy and an independent lifestyle. Where feasible, community integration is a desirable goal for people chronically disabled by injury. Rehabilitation may also require changes in the patient’s physical and social environment.

Adopted by the 48th WMA General Assembly, Somerset West, South Africa, October 1996
and editorially revised by the 174th WMA Council Session, Pilanesberg, South Africa, October 2006
and revised by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

 

PREAMBLE

Recalling its Declaration of Washington on Biological Weapons, its Resolution on the Prohibition of chemical weapons and its Statement on Nuclear Weapons, the World Medical Association condemns the use of any forms of weapons – conventional, biological, chemicals and nuclear weapons – which has the potential to bring immense human suffering and substantial death together with catastrophic effects on the earth’s ecosystem, a reduction of the world food supply and increased poverty. The use of such weapons against human beings is in opposition with physicians’ duties and responsibilities to preserve life.

When nations enter into warfare or into weapons development, they do not usually consider the effects of the use of weapons on the health of individual non-combatants and on public health in general, either in the short or in the longer term.

Nevertheless the medical profession is required to deal with both the immediate and long term health effects of warfare, and in particular with the effects of different forms of weaponry including the threat of nuclear, chemical and biological warfare.

The potential for scientific and medical knowledge to contribute to the development of new weapons systems, targeted against specific individuals, specific populations or against body systems, is considerable. This includes the development of weapons designed to target anatomical or physiological systems, including vision, or which use knowledge of human genetic similarities and differences to target weapons.

There are no current and commonly used criteria to measure weapons effects on health. International Humanitarian Law states that weapons that cause injuries, which would constitute “unnecessary suffering or superfluous injury”, are illegal. These terms are not defined and require interpretation against objective criteria for the law to be effective.

Physicians can aid in developing criteria for weapons that cause injury or suffering so extreme as to invoke the terms of International Humanitarian Law.

Such criteria could aid lawyers in the use of International Humanitarian Law, allow assessment of the legality of new weapons currently in development against an agreed, objective system of assessment of their medical effects, and identify breaches of the Law once it is developed.

Physician involvement in the delineation of such objective criteria is essential if it is to become part of the legal process. However, it must be recognised that physicians are firmly opposed to any use of weapons against human beings.

RECOMMENDATIONS

The WMA believes that the development, manufacture and sale of weapons for use against human beings are abhorrent. To support the prevention and reduction of weapons injuries, the WMA:

  • Supports international efforts to define objective criteria to measure the effects of current and future weapons, which could be used to stop the development, manufacture, sale and use of those weapons;
  • Calls on National Medical Associations to urge national governments to cooperate with the collection of such data as are necessary for establishing objective criteria;
  • Calls on National Medical Associations to support and encourage research into the global public health effects of weapons use, and to publicise the results of that research, both nationally and internationally. This will ensure that both governments and the public are aware of the long-term health consequences of weapons use on non-combatant individuals and populations.

Adopted by the 50th World Medical Assembly Ottawa, Canada, October 1998
and rescinded and archived by the 59th WMA General Assembly, Seoul, Korea, October 2008

RECOGNISING THAT:

In its Statement on Weapons and their Relation to Life and Health (17.130) the WMA supported efforts which would define “objective criteria which would measure the effects of current and future weapons, and which could be used to stop the development, manufacturing, sale and use of weapons”.

AND THAT:

A panel of experts working with the International Committee of the Red Cross (ICRC) has proposed such a set of criteria in the report “The SIrUS Project: Towards a definition of which weapons cause ‘superfluous injury or unnecessary suffering'”.

THE WORLD MEDICAL ASSOCIATION:

  1. congratulates the ICRC and the panel of experts on this work;
  2. calls on National Medical Associations formally to endorse The SIrUS Project in order to contribute medical knowledge for the practical enforcement of international conventions concerning the limitation of the effects of weapons; and
  3. insists that from a medical point of view neither “necessary injury” nor “necessary suffering” inflicted by weapons is acceptable.