On Monday 28 May 2012 the (now former) Minister of Transport, Mr Sibusiso Ndebele in collaboration with Netcare911 and the South African National Taxi Council announced a new national programme to reduce mortality on South African roads. Taxi drivers would be trained in first aid and cardio pulmonary resuscitation (CPR). This programme “is an initiative in support of the United Nations Decade of Action for Road Safety 2011-2020”.
South Africa does have an unacceptably high mortality rate attributable to road traffic accidents. In 2011 there were 13 559 deaths on South African roads. South Africa’s death rate due to motor vehicle accidents is more than double the rate of most other middle income countries and just short of triple the average mortality rate of high income countries. (3) The morbidity and mortality resulting from these accidents significantly contributes to the high disease burden born by South Africans and consumes scarce health resources. The 2011 Road Traffic Report reported an average of 30 fatal crashes occurring on South African roads per day translating into 37 deaths daily. Minibuses, representing 3.2% of all registered vehicles in South Africa, were involved in almost 10% of fatal accidents and contributed to 13.2% of total number of fatal accidents and almost 20% of total passenger fatalities in 2011. The major factors contributing to accidents according to this report is speeding (40%); burst tires (54%); failing brakes (14.9%) and poor road conditions (28%). According to the CSIR more than 95% of traffic accidents in South Africa are as a result of a violation of one or more traffic offences.
Clearly there is a need to intervene, but we question whether the training of taxi drivers to provide healthcare in the form of first aid will be a reasonable intervention. Would this be a (cost) effective strategy?
From a public health perspective, and in general, the most effective means to deal with public health problems is to prevent them from occurring in the first place. Preventing road traffic accidents from occurring negates the need for expensive healthcare interventions.
Even though South Africa-specific evidence and data are scanty when it comes to quantifying the burden of traffic accidents or how best to deal with them, there are a number of interventions that have proven successful in other countries – none of which included the mass training of taxi drivers to provide first aid to their injured passengers. In the developing country context speed controls carries “…the greatest potential to save lives” but the effectiveness is heavily dependent on the driver’s perception of risk, not only of accidents, but also of being caught if they violate the law. Any regulation is doomed to failure in an environment of low enforcement; high levels of police bribery and corruption and low public awareness. (5) If the awareness of risk is low the driver perceives the benefit of traffic violation to be greater than the cost and thus an incentive to break regulation is created. This in conjunction with poor infrastructure creates an ideal environment for accidents. Strategies preventing road traffic accidents include better road design and lighting. It has been proved that lives can be saved by better enforcement of speed limits, stricter driving tests, reducing the level of drinking and driving, central barriers on highways, speed bumps in suburban areas etc.
Is the department of transport not in a better position to address these issues than to train taxi drivers to perform CPR?
Once road traffic accidents have occurred, minimizing death and serious injury can be achieved through the mandatory wearing of seat belts in the front and back of vehicles (including taxis) and improving access to appropriate and timely emergency services. In fact, studies have shown that reaching victims within the “golden hour” by trained paramedics contributes most to reducing mortality and serious morbidity.
Cardiac arrest requires CPR, but CPR does not treat the cause of the arrest and in the trauma patient the cause is usually due to bleeding or a collapsed lung – no amount of CPR regardless of how effectively it is done would save the life of a patient that requires fluid resuscitation. Is it likely or even desirable that lay-people could/should deal with these complex medical emergencies in extremely austere environments?
How effective would first aid and cardiopulmonary resuscitation (CPR) administered by a taxi driver be in the context of a motor vehicle accident involving multiple passengers? There is a good chance that the taxi-drivers themselves might require some treatment. Would we be saving any lives as the minister claims and how much would a programme like this cost, bearing in mind the need for subsequent refresher courses and first aid kits that require up-keep?
Training and maintaining the first aid skills of all taxi drivers in South Africa will no doubt be a very expensive undertaking and logistically challenging. It is not clear what skills taxi drivers will be taught, or at what cost. In the United Kingdom, all professional drivers are required to have a Certificate of Professional Competence (CPC). This requires 35 hours of training every five years and although this training includes some first aid, this is in the context of safe and efficient driving and health and safety of professional drivers.
Even if the taxi drivers come away as highly trained specialists in first aid with the appropriate equipment it is doubtful that a tangible impact would be made, even under ideal circumstances in the absence of competent and effective emergency services. If the goal is to save lives, then the training of taxi drivers in first aid to treat their injured passengers instead of having a multipronged approach to prevent users of public transport from sustaining injury in the first place, is misguided.
The Department of Transport surely should focus on interventions to ensure safety on the roads rather than engaging in a programme, with a private healthcare company, which is most unlikely to save anyone’s life.
Furthermore, any such intervention should be part of an overall strategy for improved road safety available in the public domain, which outlines the rationale, costs and implementation strategy for such a programme and a consideration of the cost effectiveness of such an intervention. It may well be that improving emergency services, especially in rural areas, and improving response times will be a more cost effective solution.
It seems the public is being taken for an expensive ride and we would suggest getting off at the next stop.
The views expressed are those of the authors and are not necessarily reflective of the views held by the Department of Community Medicine, the School of Public Health, the University of the Witwatersrand or PHASA.
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