AMA Speech - Australasian Road Safety Conference
SPEECH TO AUSTRALASIAN ROAD SAFETY CONFERENCE
FRIDAY 16 OCOBER 2015
AMA PRESIDENT PROFESSOR BRIAN OWLER
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The Human Tragedy of Road Trauma
I acknowledge the traditional owners of the land on which we meet, and pay my respects to elders past and present.
It is a great pleasure to represent the AMA at this forum.
I thank the organisers of the Australasian Road Safety Conference for the opportunity to share a platform with the many experts committed to road safety.
We are here today because we all share a commitment to improving driver behaviour, improving road safety, and reducing road trauma.
We all want to save lives. We all want to stop horrific avoidable injuries. We all want to stop families being shattered by recklessness, tiredness, carelessness, or error on our roads.
Australia’s doctors have had a proud history when it comes to road safety.
Many of the pivotal changes in road safety were changes advocated for by the medical profession – particularly surgeons.
The reason for that is simple. Doctors, and other health care workers, see the tragic results when road safety is ignored or when terrible avoidable accidents occur.
Today I am here as Federal AMA President, but also as an adult and paediatric neurosurgeon.
As a professional organisation, the AMA is an organisation that is committed to public health advocacy.
I am going to spend some time talking about road safety advocacy issues and the opportunities that are before us. But I am also going to talk about some personal experiences – the sort of experiences that drive me, that drive my colleagues and that drive many of you here.
As a neurosurgeon, I have too often witnessed first-hand the tragic consequences of road accidents.
My personal commitment to driver safety came from seeing the aftermath of vehicle accidents and road trauma. I will share with you now a personal story I have shared on other occasions. It helps explain why road safety is important to me.
As a neurosurgeon you see a lot of trauma, but one experience, within the space of less than 24 hours, changed my approach to medicine and indeed my life.
Essentially, it was a long weekend. I was on call for both the adults’ hospital at Westmead and the Children’s Hospital at Westmead.
I was sitting at home in my study doing my dictation on a Friday night. The sort of exciting life that you lead as a neurosurgeon. It was raining. The phone rang and it was my registrar at the Children’s Hospital.
There had been a motor vehicle accident on a notorious stretch of road in the Blue Mountains west of Sydney. A child from the accident had been flown to the Children’s Hospital at Westmead with a severe head injury and they had just had a CT scan.
Shortly after the scan, the child had arrested. While I spoke to the registrar, they were doing CPR. I asked her to send through images from the scan. The images showed that the skull had been shattered. It was not a survivable injury, and I suggested they stop. She died.
About five minutes later, the phone rang again, and this time it was the registrar at the adults’ hospital. A young lady with severe head and facial injuries was in the scanner. She needed surgery that night.
When I arrived, I learnt that she had been the driver in that accident that had not only killed the child from the Children’s Hospital, but also had killed another adult and another child.
All because she decided to overtake in the wet. A split second decision with fatal consequences - but also a life with a brain injury and, no doubt, a lifetime of guilt.
The next day I had another call. This time from the Children’s Hospital, and this time there were two children. So I went in to find a situation of what seemed to be chaos. They were brothers, aged 6 and 8. One had a CT scan. He had a bleed on the brain, and we were about to take him to theatres. The other was in the scanner when I arrived.
The child was having CPR. There were about 20 people in the room, working frantically. The mother and the father were in the room.
The current wisdom is that, in these circumstances, parents cope better with loss if they are present. I am not sure that is true. They knew what was happening.
I looked at the scan and I could see the reason why. The spine had separated from the skull. In medical terms, an atlanto occipital dislocation. In lay terms, an internal decapitation.
The child was not going to survive, and I suggested they stop. The team took the child back to the ED so that the parents could be with him in his final moments.
I have, unfortunately, witnessed a lot of grief, but perhaps never seen quite the same anguish from parents as this. I suspect one of the reasons was that the driver that caused the accident was the father. A split second decision – again, fatal consequences for some; lifelong disability and anguish for others.
He was no doubt a good person. A good person making a bad decision.
I can clearly remember driving home that weekend – exhausted – but thinking – there has to be something that I could do.
For me, that was the moment that it became not just about the patient in front of me, but about making it better for the patient that will come afterwards – and, of course, preventing people from becoming patients at all.
But this is not just about road deaths. We know that there are tens of thousands of significant injuries that occur through road accidents.
Indeed, the brother that I did operate on, and whose life we saved, ended up with a severe traumatic brain injury.
I see the brain injuries, the spinal injuries that also devastate the lives of people of all ages. But there is much more. Injuries such as whiplash can devastate people's lives too.
A few months ago, I reviewed the case of a young man. He once had the dream job travelling the world as a professional photographer. He mainly photographed ski resorts and exotic locations.
Then a simple accident. Rear-ended. He ended up with whiplash. He lost his business, his career, his girlfriend, his social circle, and, in his words, his life - all because of someone else's failure to stop.
Six years on, he is still trying to pick up the pieces. It's an all too common story, but one that is rarely told.
So when I decided to act as a result of my experiences, it was these human factors that we decided to focus on. I took my ideas to the NSW Government and the result was the Don’t Rush road safety campaign in NSW.
The campaign worked because it came through my experience as a doctor and, similarly, other doctors are motivated by their experiences.
Our personal experiences as doctors is what motivates many of us within the AMA. It is why the AMA is so active and passionate about public health advocacy.
Prevention is not only better than the cure, when it comes to road trauma, there is often no cure. And while we save lives, many people live with devastating consequences.
We are all well aware of the horrific statistics of road deaths and accidents, but they need to be repeated over and over so the public understands the extent the tragedy.
According to the research, since they began keeping data on the road toll in1925, there have been more than 185,000 deaths on Australia’s roads.
We have managed to substantially reduce road trauma, especially in the past few decades with the introduction of preventive measures such as random breath tests, seat belts, and improved automobile technology.
And yet, on average, three people die on Australia's roads every day, and 90 are seriously injured. That represents about 33,900 adults and children every year.
We know the numbers of people that are killed on our roads. We have some estimates of the number of injuries as well, but do we really know how many serious injuries are occurring and why?
No, we don’t, and I know that this a matter of some discussion at this conference.
I am not sure that anyone really has all of the answers to how we collect this information or even what information to collect.
Hospital admission data is one way, but I would suggest to you that not all serious injuries result in admission to hospital - and whiplash is the perfect example. In fact, it may be best to determine how we define serious injury first.
The Australian Trauma Registry (ATR) provides research and reporting on the work of designated trauma centres. It reports on major traumas, including road trauma cases.
Major trauma is different from serious injury. As such, it won’t identify every injury but will provide more detailed information on the more serious trauma cases.
The total number of major trauma cases as a result of road transport over the three years from 2010 to 2012 was 7,315, or 36 per cent of major trauma cases.
Of these, there were 554 fatalities, which is 27 per cent of major trauma fatalities.
I know that there are lots of other suggestions floating around as well.
I don’t think that any of them is going to be perfect but, at some point soon, consensus on an approach to this issue, working together, will be needed.
This argument to eliminate road trauma is not only a humanitarian argument, this is an economic imperative as well.
The cost of road trauma to the Australian community is enormous - conservatively estimated at $27 billion per annum, or $70 million a day.
Traumatic Brain Injury (TBI) is a brain injury that is the result of a traumatic event, such as a car accident or a blow to the head
According to Brain Injury Australia, over 22,000 Australians were hospitalised as a result of a traumatic brain injury in 2004-2005 - nearly one in three was due to a motor vehicle accident.
The average lifetime cost of new cases of TBI in Australia is estimated to be $2.5 million (moderate TBI) to $4.8 million (severe TBI).
These are costs we carry as a community, and in this country we support people who can't look after themselves through the often random nature of road trauma - perhaps not well enough, but we do it.
How much cheaper is prevention compared to these costs? But also what is the opportunity cost of doing this? How much more could we be investing in health or other areas if we eliminated road trauma?
Seeing far too many injuries and deaths is why the AMA is committed to improving the way we drive, the cars we drive, and the roads we drive on.
As I said, my public foray into road safety began when I became the face of the Don't Rush campaign.
As a surgeon representing the AMA, I wanted to make the public aware of the consequences of driver behaviour – in particular speeding and fatigue.
I wanted the public to understand the impact of road trauma not just on those in the vehicle, but how road accidents impact throughout the community.
The general public isn’t necessarily aware of the aftermath of road trauma.
They don’t see the surgery, blood transfusions, the lengthy recovery and the rehabilitation; the permanent impairment, and disability.
They don’t see the neurological damage.
The general public doesn’t always see the Post Traumatic Stress Disorder that affects survivors and others who are involved in an accident – the innocent people who witness or arrive at a crash, the emergency workers and tow-truck operators, and the many others who are traumatised by road accidents.
They don’t see the grief on the faces of family and friends in the waiting room or the weeks spent bedside at a hospital.
The Don’t Rush message is simple.
Yes, it is about reducing speed, but it is also about the decisions that people make on the road - whether it be speeding, not taking a break, or overtaking and taking a risk. It asks drivers to choose wisely.
There was another message in the Don’t Rush campaign, and that was to encourage everyone to speak out against others who break the road rules and change the cultural acceptance of risky behaviour.
There are cultural issues and even rites of passage that make some young people – mostly young men, but increasingly young women, too – think that speeding and disobeying the road rules is something tough, something cool, or something to be admired.
There are no survivors of road trauma who think this way. There are only physically and mentally scarred victims and their families who live with the consequences of these actions.
But unless people speak up - and that applies particularly to passengers - then those speeding drivers may never get a chance to change their ways.
I’m proud of the Don’t Rush campaign.
It played a very important role in trying to change driver behaviour in NSW and also made others aware that speeding and fatigue are the leading causes of road trauma.
The evaluation of this campaign has shown it was successful in imparting the important message about the dangers and consequences of speeding.
As a result, many drivers were motivated to change their driving behaviour and take more care to stay below the speed limit.
Speed-related injury and death is preventable.
Changing driver behaviour, and indeed culture, is very difficult. It is slow and needs a combination of education, awareness, and enforcement.
We know the systems approach. Safer roads, safer cars, safer drivers.
But it is that human factor, the unpredictable nature of people, particularly children, that is the most difficult element to control.
There are behaviours and cultures that can be changed, albeit slowly. A combination of education, awareness and enforcement are essential, but people being people will make mistakes.
Of course, you or your family shouldn’t die or be seriously injured for a split second mistake. Having other measures to protect people is therefore so important.
That is why, in August this year, the AMA and ANCAP joined forces to launch the Avoid the crash, Avoid the Trauma campaign.
Our two organisations are lobbying governments and car industry leaders to embrace new technologies.
Reducing road trauma on our roads can be achieved through the introduction of new vehicle technologies in all new cars.
We want to see the introduction of Autonomous Emergency Braking, or AEB, in all new cars sold in Australia.
As you all know, AEB is a proven advanced driver technology that reduces the severity of car accidents and road trauma.
This type of advanced automatic breaking technology must be adopted because it makes cars safer and it reduces accidents.
AEB systems have been shown to reduce rear-end crashes by more than 38 per cent.
It is simply common sense, not to mention basic health prevention, to apply new technologies that reduce death and trauma.
We use this approach in operating theatres and hospitals, and we should do the same for motor vehicles.
Technology is a driver of health prevention.
Improving vehicle safety will improve driver (and passenger) safety.
Because 90 per cent of crashes involve some form of human error, the more we can alleviate driver mistakes the more we reduce road accidents.
In workplaces, building sites, construction and mining – in fact, in almost every activity that involves a public health risk - governments and industry are rapid adopters of technologies that prevent injury and save lives.
This is the approach we must apply to road safety.
I have heard the counter argument that mandating AEB and other technologies might increase the cost of new cars.
But we’re talking about life-saving technologies. You cannot argue about a small increase in cost – and it is a small cost - when lives are at stake.
In Europe, these new technologies are standard. In Australia, with our vast distances and long commutes, they should be too.
I have asked before why an Australian life shouldn’t be of the same value of a life in Europe or North America?
Australian’s should be driving the safest vehicles on our roads.
Pressure on automobile manufacturers to produce cars that are fitted with standard features such as AEB and reversing cameras is needed.
Consumer awareness and education about technology is needed so that they demand these features as standard.
Large companies purchasing fleets of new cars should also be demanding these features as standard in their vehicles.
The fastest way to have vehicles with these features as standard is through consumer demand.
There are many other examples of technology that save lives as well that are worthy of championing.
That is the future of road safety. It is the game changer that mitigates our human faults. It is the tool we have to truly move towards zero fatalities and serious injuries on our roads.
While technology improves and becomes standard, it doesn’t mean that we back off in the other important areas.
I am a very strong advocate for lower speed limits and greater community involvement in identifying black spots.
Some of you will be familiar with projects that have demonstrated significant reduction in road trauma, like the community road safety program in Millicent in South Australia.
This was a community-led initiative whereby the local community was able to make decisions about local traffic issues.
Through their direct input, there was a reduction in road fatalities and injuries.
There are other areas that need addressing too.
As doctors, we need to be firm with patients who take medication that might impair their driving. Doctors have a role here in managing patients who might be at risk behind a wheel.
In fact, I could go on with a long list of initiatives and strategies around fatigue, driver education, distraction of pedestrians and drivers, heavy vehicle safety, and how we better protect at risk users.
But I will leave that in your hands – the experts.
What I do want to do is make some observations about society and our Government, and the importance of prevention.
I made these points in a speech to the National Press Club in July, but they need repeating again and again.
Governments, at all levels, have a vital role to play in injury prevention - and perhaps no more so than in road safety.
The major reductions in road trauma have all come through government intervention, some of which were unpopular at the time.
The introduction of seat belts, speed limits, random breath testing, and other initiatives have all resulted in major reductions in road trauma.
They have saved thousands and thousands of lives.
But there are some in the community who have a different view about the role of government, and some of those people are in influential places in the media and in politics.
They rail against what they call the ‘Nanny State’. And it covers many areas of society.
I think it is a shame that these critics do not get to witness the human side of road trauma.
If they did, it may change their view of the world – and the need for governments to act in the interests of the people and communities they represent, not in a theoretical misguided personal ideology.
One of the great privileges of being a doctor and the AMA President is the extraordinary people you meet or come into contact with every day.
While interacting with them is a privilege, I wish with all of my heart that I had never met some of them or heard of them through my work as a doctor.
I wish instead that they were simply anonymous people going about their lives, worrying about ordinary things.
Instead, I know them or know of them because their lives have been touched by terrible tragedy, and they have made a decision to use that tragedy to try to ensure that tragedy does not touch another family.
I have paid tribute to some of these families and the extraordinary work they do.
They include Jo-ann and Michael Morris tragically lost their son, Samuel, in 2014.
Samuel suffered traumatic brain injury in 2006 following a near-drowning in his family pool.
Jo-Ann and Michael established the Samuel Morris Foundation to promote awareness of the risks of child drownings, and to advocate for better regulation and pool safety.
Toni and David McCaffery lost baby, Dana, to whooping cough in 2009. Catherine and Greg Hughes lost baby, Riley, in 2015 to the same terrible preventable illness.
Both families have worked tirelessly to improve awareness of the need for vaccination.
Ralph and Kathy Kelly lost their son, Thomas, as a result of drunken violence in Kings Cross in Sydney in 2012.
They established the Thomas Kelly Foundation to lobby for more appropriate alcohol controls and raise awareness of the harms of alcohol-related violence.
And, of course, our Australian of the Year, Rosie Batty, who lost her son, Luke, to domestic violence in February 2014.
The road safety community is no different.
Peter Frazer lost his daughter, Sarah, in 2013 in a motor vehicle accident. He established the SARAH Foundation to raise awareness of road safety.
Michelle McLaughlin who lost her little boy Tom to road trauma only last year.
She established the Little Blue Dinosaur Foundation to eliminate child pedestrian fatalities in holiday areas.
These families share many things in common.
However, their most common desire is to ensure that what has happened to their family never happens to any other family.
There are many other families like theirs, particularly those affected by road trauma, who have also found ways to use their tragedy to make a difference and help others. They are all an inspiration.
Doctors see the impact of tragedy every day. It is why we are unashamed champions for public health.
Every day, we see people whose lives have been changed by preventable illness or by trauma.
Sometimes the fault is their own, sometimes the fault is with others, but either way the harm is done. All of them say they wish there had been a different outcome.
I am dismayed by the current political narrative opposing the so-called ‘nanny state’.
A few years ago, I was watching one of the candidates for the Republican nomination for the United States Presidency talk about driving and the use of mobile phones.
His view was that people should be able to do whatever they wanted in the privacy of their own cars.
I found it fascinating that someone with such ridiculous views could be a serious candidate for Presidency, let alone be a U.S. Senator.
I thought how fortunate we were that our Australian politicians were more moderate. Well, it appears that that faith was misplaced.
In our very own Parliament, Senator David Leyonjhelm has been successful in forming a Senate Committee to investigate the ‘Nanny State’.
He wants to question the role of Government in controlling things like smoking or alcohol abuse, and enforcing the use of bicycle helmets – actions that save lives and prevent injury and illness.
I find it very concerning that there are clearly others in Parliament that share these views.
I agree that the Government should not be interfering with choices and behaviours of individuals without reason.
But, as individuals, we live in a society. As such, the choices and behaviours that we make as individuals affect those around us.
Libertarians would argue that laws against driving while using a mobile phone interfere with their rights as an individual in their private space.
However, if you drive while on a mobile phone, you are four times more likely to be involved in a motor vehicle accident, possibly killing or maiming someone else.
But what if they only injure themselves? It will be the rest of society that pays for their hospitalisation and treatment, their rehabilitation, and other costs as well.
Government does have a role to play in making this country a safer and healthier society.
It does have a role in regulating and modifying the behaviour of individuals so that the rest of us can be confident that we won't be run over by someone distracted by talking on their mobile phone, or run off the road by a drink driver.
That is why events like this are so important. It is why you are so important. To fight harmful ideology with common-sense, with evidence, with research, and with your professional knowledge and passion.
There are people in Government who do share you passion and commitment. Our State Roads Ministers are in that group.
What is pleasing at a Federal Government level is the appointment of the Hon Michael McCormack as Assistant Minister to the Deputy Prime Minister with responsibility for road safety.
He clearly understands the impact of road trauma from his time as a journalist and newspaper editor. Road safety needs a champion at the Federal Government level. It is with much enthusiasm that we greet this appointment.
The Assistant Minister’s attendance here yesterday during a sitting week of Parliament is very encouraging.
Earlier, I talked about eliminating serious road trauma. Reducing the number of road deaths to zero. Reducing the number serious injuries to zero.
I used the word ‘eliminate’ deliberately. As highlighted by the recent public campaign in Victoria, there is no acceptable number of deaths as there is no acceptable number of serious injuries.
Towards zero is not an aspirational target. Zero fatalities and zero serious injuries is the correct answer.
The difference now is that we have the ability to do this. You, in this room, have the answers. You, here now, have the technology.
I know that we have the will. Our challenge is to engender the same will in our leaders and have the public demand the technology, the standards and the systems that mean that they, their family or someone else, doesn't pay with their lives for a split second mistake.
For Australia, we must make zero the reality. I am grateful to have had the opportunity to talk to you, the people who will make this happen.
16 October 2015
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Published: 16 Oct 2015