Brussels, 19 March 2013
Towards a Strategy on Serious Road Traffic Injuries – Frequently asked questions
Road safety work in the EU has to date been highly successful. During the last strategy period, 2001-2010, the number of fatalities on EU roads was reduced by a total of 43%, coming close to but not completely achieving the strategic objective of ‘halving road deaths by 2010’. However, for every person killed on the road, an estimated ten are seriously injured. Moreover, for serious injuries, the reported improvements are not as impressive. The data reported by Member States showed only a 36% decrease between 2001 and 2010. Apart from the human suffering caused by these injuries, the socio-economic costs incurred are estimated at around 2% of annual EU GDP.
Towards an injuries strategy
For these reasons, the European Commission has today published a document on serious road traffic injuries outlining the next steps towards a comprehensive EU strategy on serious road injuries, notably:
A common definition of serious road traffic injury,
A way forward for Member States to improve data collection on serious road accidents, and
The principle of adopting an EU-level target for the reduction of serious road traffic injuries.
Tackling serious injuries – what is the current situation?
Some 250 000 people are estimated to be seriously injured in road accidents every year - compared to the 28 000 road fatalities in 2012.
The most common serious road traffic injuries are head and brain injuries, followed by injuries to legs and spine. Many serious injuries lead to life-long suffering or permanent disabilities. Vulnerable road users, for example pedestrians, cyclists, motorcyclists or users in certain age groups – notably the elderly – are especially affected by serious road injuries. Serious road traffic injuries more often occur in urban areas than on rural roads.
What can be done?
A key factor contributing to success in tackling road fatalities has been the results-based approach adopted in two consecutive ten-year EU road safety strategies. It is clear that, based on the experience of the successful targeted work on road fatalities, much could be gained by applying a similar focus to serious but non-fatal road injuries. To do that however, requires clear and accurate data to assess the scale, nature and complex causation of serious injuries, as well as to allow for the monitoring of the impact of subsequent actions.
What is the problem with injuries data?
A lack of common definitions and wide-spread underreporting and misreporting mean that the information on the scale and nature of serious injuries is insufficient, lacking in detail and incomplete. It is likely that the total number of people seriously injured in road traffic is substantially higher than currently reported.
Currently, Member States use different, often non-medical, definitions of serious injury, as well as different data gathering methods. For example, some Member States defined a seriously injured person as someone needing hospital treatment; others as someone having to stay at the hospital for more than 24 hours; and some Member States had national definitions based on lists of diagnoses.
At the moment, there is also substantial misreporting and under-reporting of serious injuries. Misreporting occurs as "on the spot" assessments by police have commonly been the only method used for determining the injury severity grade that is entered into road safety databases. In many cases there is no appropriate follow up with hospital records of assessments. A large proportion of non-fatal accidents are not reported at all (for example, under-reporting occurs as police are not always alerted to accidents). Some injuries are reported as serious although they are not. Studies have indicated that only about 70% of serious injuries are actually reported.
This knowledge gap must be closed. Only with a better understanding of the situation can actions and policies be efficiently designed to reduce the number of serious injuries and minimise their long-term consequences. A better understanding of crash injury trends is also needed for making international comparisons.
What are we proposing?
The Commission today has outlined 3 steps to allow the development of a comprehensive EU Injuries Strategy.
1. A common definition for road injuries
A common definition of serious injuries is a prerequisite for effective intervention. Without a harmonised definition of serious injuries the magnitude and true nature of the problem of serious injuries cannot be fully understood. Nor can any meaningful comparisons be made.
To move this issue forwards, the Commission proposed that Member States discuss the options for a common definition at a meeting of the High Level Group on Road Safety, composed of road safety experts representing the EU Member States, in June 2012. The already existing trauma scale ‘Maximum Abbreviated Injury Score’ (MAIS1) was seen as the preferable option for a common definition. This choice was confirmed by the High Level Group at its meeting in January 2013.
What is the MAIS trauma scale?
The MAIS is a globally accepted trauma scale used by medical professionals. It provides an objective and reliable basis for data collection. The injury score is determined at the hospital with the help of a detailed classification key. The score ranges from 1 to 6, with levels 3 to 6 considered as serious injuries. The MAIS system also allows for detailed sub-classifications.
The benefit of using this specific classification system is that it has high validity and reliability. The use of a detailed classification key reduces the risk of arbitrary diagnosis and also the risk of misreporting would be substantially reduced. Moreover, it is also internationally comparable. Some Member States have already started to use this method to classify road injuries. The system is well established and widely used by medical staff, so new systems do not have to be developed.
Member States could therefore report data on both slight and serious injuries, indicating the level of severity according to the MAIS.
2. A reliable data collection for serious injuries
The priority is to arrive at a more accurate total number of people who are seriously injured in road accidents, as well as a better understanding of the specific injuries. It is vital that there must be a common definition of serious injury but different reporting systems can be used to effectively collect the data.
The High Level Group on Road Safety identified three main options for the Member States to improve reporting:
Hospital data: With the new definition of serious road traffic injury, the assessment will normally be done by the medical personnel at the hospital and reported from there to the road accident database. This option is easy to introduce and will provide accurate and reliable data on injuries, however it will not provide additional information on the causes and characteristics of accidents provided by police reports.
Combined police and hospital data: The method which would give the most complete picture would be to link the relevant data from police and hospitals. This is the Commission's preferred option as it provides the most complete set of information.
National coefficients: As an interim option, the most basic option is to continue current reporting based on police reports but to apply a national correction coefficient to get a "true" estimate of the total numbers.
Most importantly, this flexibility means that all Member States should be able to apply one of the three methods well in time for data gathering, using the common definition of serious injuries, during 2014, reporting the first data set during 2015.
3. Setting a target
A strategic and realistically ambitious reduction target with regard to serious injuries would complement the current EU road safety strategy, as envisaged in the Commission’s policy orientations 2011-2020. An EU-level target could be complemented by Member States adopting relevant targets at national level. Member States could also set themselves an even more ambitious objective or adopt sub-targets for example for specific road user groups, regions or traffic situations.
Based on the information received with the common definition and data gathering systems, the Commission will propose an EU-wide target to be adopted e.g. for the period 2015-2020. It will then also be possible to begin exploring areas for actions to reduce the severity of accidents, leading to a future adoption of concrete measures.
How much do road accidents cost?
It is very difficult to assess in detail all the costs linked to road traffic accidents. Costs include not only the expenses for the medical treatment, rehabilitation, disability adaptations, insurance and social support systems, but also the economic effects on society and employers from losing members of the workforce. The injured person’s family members may also be affected if they need to become carers. The most quoted estimate is that, for the EU, the total costs amount to around 2% of annual EU GDP.2 That would be equal to about 250 billion EUR for 2012.
What happens next?
Transport Ministers will discuss the Commission's approach towards a strategy for serious road traffic injuries in June 2013. Each Member State will decide which method suits them best for the data gathering and data reporting. They will be able to start applying the new common definition and data gathering procedures for the year 2014.
The Commission will be able to publish this data in 2015. With strong political support (from the Council and European Parliament) based on the information received, the Commission will propose an EU-wide target to be adopted e.g. for the period 2015-2020. It will then also be possible to begin exploring areas for actions to reduce the severity of accidents, leading to a future adoption of concrete measures.
What measures will be proposed?
It is too early to decide on any concrete measures. The first step is to gather reliable data and information on the scope and type of the problem. Using more and comparable data will help focus future actions in the most efficient way and on priority areas, however key areas could include:
Collision impact: complementing on-going work on accident prevention to focus on tools and techniques that could reduce the severity of injuries that cannot be avoided (both vehicle and infrastructure design).
First aid and emergency services: The aid received in the first hour after a crash is crucial for reducing the risk of severe consequences. It has been estimated that if the time between crash occurrence and arrival of emergency services is reduced from 25 to 15 minutes, the number of deaths will drop by one third3.
In-depth crash injury research to support the development of safety measures and better understand the complex causation. Actions and policies to reduce serious road injuries must be evidence based.
Will there be any legislative proposal on serious road injuries?
It should not be assumed that all areas of such a strategy require EU-level legislation. Rather, as with all road safety measures, the responsibility will be shared and requires buy-in from a multitude of stakeholders, in accordance with the principles of subsidiarity and proportionality. An appropriate mix of legislation, awareness-raising, enforcement, engineering, cooperation and knowledge transfer among relevant stakeholders, for example through the European Road Safety Observatory, plus research support will be needed.
The European Commission acknowledges that the AIS (in all its versions) is the property of the Association for the Advancement of Automotive Medicine (AAAM), owner of the Copyright. The so-called AIS (Abbreviated Injury Scale) is mentioned in this Commission staff working document for informational purposes only.
WHO, World report on road traffic injury preventions, 2004.
Rocío Sánchez-Mangas, Antonio García-Ferrrer, Aranzazu de Juan, Antonio Martín Arroyo, The probability of death in road traffic accidents. How important is a quick medical response?, 2010