• Especially on coordinating helpline services and providing basic first aid 
• Challenges including resource-related constraints, communication and coordination issues, and policy issues prominent

The training of laypersons for better coordination with helpline services and the provision of basic first aid in the context of road-based motor traffic accidents can make post-accident/crash management more effective. 

This would make post-accident/crash care more cost-effective as they can activate the emergency care system and facilitate the safe transportation of road traffic accident victims to hospitals. 

These observations were made in an original paper on ‘Awakening community resilience: Strengthening post-crash support for road traffic accident victims through Sarvodaya's community based initiatives (A case study)’ which was authored by H. Attanayake, and V. Ariyaratne (both attached to the Health Ministry), and published in the Sri Lankan Journal of Medical Administration's 25th Volume's First Issue, in November 2024.

Road traffic accidents cause nearly 1.3 million deaths and 50 million injuries in the world each year. This situation particularly affects low- and middle-income countries which is unacceptable both in absolute and relative terms. However, it has remained unchanged for the past 20 years, despite targeted global efforts to arrest it (Global plan for road safety).

Sri Lanka records an annual average of 38,000 road accidents, resulting in 3,000 fatalities and 8,000 cases of severe injuries, posing a public health challenge for the nation (Delivering road safety in Sri Lanka).

A broad and integrated approach to support road traffic accident victims, enabling them to mitigate both the immediate and long-term effects of an accident, will facilitate their return to functionality and independence. Such an effective post-accident/crash response necessitates the harmonious integration of trauma-related care, mental health services, legal support, and legislative measures.

Post-accident/crash response

The post-accident/crash response refers to a coordinated set of actions and procedures undertaken immediately after an accident to address the needs of those involved, minimise further harm, and provide appropriate medical, rescue, and support services. It encompasses various activities, including emergency medical care, the extrication of the trapped individuals, securing the accident scene, and notifying the relevant authorities. The post-accident/crash response aims to save lives, prevent injuries, and mitigate the impact of the accident on individuals and the community at large, thereby enhancing the survivability of the accident/crash victims (Y. Domenech’s ‘Post-crash response’). Post-accident/crash care consists of several components. 

Support groups, including non-governmental organisations, play a pivotal role in providing immediate post-accident/crash care for road traffic accidents, addressing both the victims and the broader impact of these incidents. Their function extends beyond immediate medical attention to encompass its wider influence on road safety. 

Attanayake et al.’s study sought to explore potential community-based initiatives to enhance post-accident/crash support for road traffic accident victims by Sarvodaya. The Sarvodaya Disaster Management Centre is dedicated to community-based disaster responses and provides extensive training to Sarvodaya volunteers and community groups, ensuring that they are equipped for an effective disaster response. During emergencies, the centre mobilises trained volunteers through the Sarvodaya network to mitigate disaster-related risks at the community level.

The study was conducted at the Sarvodaya Headquarters in Moratuwa. This research employed a mixed-method approach, incorporating quantitative and qualitative components. Data collection methods included the distribution of questionnaires and conducting key informant interviews. The study targeted officers in managerial roles at the Sarvodaya Headquarters, volunteers, and district-level coordinators. Data were collected from 17 March 2024, to 6 April 2024. Purposive sampling was utilised. The sample size was 37. 

Results

The questionnaire survey predominantly included district-level coordinators, who collectively accounted for 88% of Sri Lanka’s administrative regions (25). The districts not represented in the survey were Matara (Southern Province), Batticaloa (Eastern Province), and Mannar (Northern Province). Officers in the Sarvodaya Headquarters and volunteers were also represented. 

Over 60% of the participants (23) reported having worked with Sarvodaya for more than 10 years.

Over half of the respondents have asserted that behavioural issues among both drivers and pedestrians are the primary contributors to road traffic accidents. These issues include reckless driving, irresponsible pedestrian behaviour, distractions, and aggressive driving.

Over 50% of the respondents have stated that legal, transportation, and financial challenges represent significant hurdles for road traffic accident victims in accessing post-accident/crash care.

Of respondents, 81% assert that Sarvodaya currently lacks initiatives to support victims of road traffic accidents. However, the remaining participants (seven/19%) contend that initiatives like the community lifesaver project REACT, road safety programmes, and community awareness programmes are already operational. Furthermore, there are youth-based first aid teams established across the 25 districts.

A total of 68% of the respondents are confident that the existing ‘REACT – Community Life Saver’ initiative has the potential to address the needs of road traffic accident victims.

The majority of the participants claimed that the community is not well engaged in supporting road traffic accident victims, indicating the need to drive community awareness programmes.

The participants claim that community lifesaver programmes, the Red Cross organisation, the 1990 Suwa seriya ambulance service, interested individuals in the communities, the Civil Defence committee, and district-level disaster management committees are the potential resources that can be collaborated with when driving community-based initiatives in support of accident/crash victims.

Awareness campaigns, first aid training, enhanced emergency response systems, community engagement and empowerment, and victim advocacy and legal support have been prioritised by respondents as areas to be paid more attention to.

First aid training, awareness campaigns, enhanced emergency response systems, and community engagement and empowerment have been endorsed as the most feasible initiatives by Sarvodaya in terms of resources, community involvement, and sustainability.

Challenges

Participants identified the following challenges in implementing the initiatives in support of road traffic accident victims.

Resource-related constraints include inadequate training for first responders, the absence of trained counsellors for road traffic accident victims, and the lack of vehicles in reaching the accident/crash site at a given time.

Community awareness, behavioural and attitudinal challenges include the non-compliance of drivers and pedestrians with traffic rules and regulations, the lack of interest in the community on road safety and post-accident/crash assistance, the reluctance to be informed and to participate actively, the fear of being videoed instead of receiving assistance from the people who gather around the victim/s, the lack of awareness within the community regarding post-accident/crash care, decreased community participation due to hardships created by the economic crisis, the fear of confrontation with litigation issues in the event of a crime, and the lack of community understanding of legal matters related to post-accident/crash care.

Communication and coordination-related issues include the absence of a communication loop between the hospitals and the community support group, the lack of access to a real-time road traffic accident information management system, and the lack of a mechanism for the direct coordination of the services provided by insurance companies.

Government intervention and policy-related issues include the lack of active involvement of the State to facilitate community involvement to enhance post-accident/crash care, and the difficulties encountered in utilising Government resources required for the training.

The situation analysis on the potential community-based initiatives to enhance post-accident/crash support for road traffic accident victims by Sarvodaya will be as follows.

Strengths: A competent and experienced workforce, potential initiatives already in operation, existing community awareness programmes on road safety, existing youth-based first aid teams across 25 districts, and the wide representativeness of the workforce across all districts.

Weaknesses: Resource-related constraints, having no access to a real-time road traffic accident database, and having no link to the road traffic accident alert system.

Opportunities: Potential collaborations with community lifesaver programmes, the Red Cross, the Suwa seriya ambulance service, local individuals, and District Disaster Management committees, possible collaborations with the National Trauma Secretariat, the National Council for Road Safety, and the Police, increasing State and media attention on preventing road traffic accident fatalities, and broader international collaboration with resourceful development partners as reducing road traffic accident fatalities is a Sustainable Development Goal. 

Threats: The negative attitudes of the community towards post-accident/crash assistance, decreased community participation due to economic challenges, confrontations being expected when protecting casualties without causing additional harm from untrained individuals or inappropriate actions, and the lack of immunity from unnecessary legal confrontation in judicial procedures.

Discussion

An Indian study (Urfi [note to the editor: this is the given name of the first author of this research study paper], N. Khalique and A. Ahmad’s ‘Facilitators and barriers influencing the post-crash emergency care of road traffic injuries in the Aligarh District of Uttar Pradesh’) reveals that nearly all respondents (98.58%) recognised laypersons as crucial facilitators in post-accident/crash care, along with the police and roadside shopkeepers. Laypersons were notably effective in calling for help, identifying nearby health facilities, and facilitating victim transport. This conclusion underscores the significance of community-based initiatives to enhance post-accident/crash care. 

This study confirms the capacity of Sarvodaya to spearhead such initiatives at the community level while identifying potential areas of intervention that are within the reach and grasp of Sarvodaya.

The unlawful conduct of drivers and pedestrians act as a significant contributor to road traffic accidents. It emphasises the need for comprehensive strategies addressing both drivers’ and pedestrians’ conduct. T.P. Klassen, J.M. MacKay, D. Moher, A. Walker, and A.L. Jones’s ‘Community based injury prevention interventions’ focuses on altering behaviour, promoting environmental changes, and implementing legislation to shift social norms regarding safety-related behaviours.

Despite some ongoing initiatives by Sarvodaya, there is a perceived lack of support for road traffic accident victims by Sarvodaya at present. However, as perceived by a significant portion of participants, the REACT initiative has the potential for impactful interventions to address the needs of road traffic accident victims.

Community engagement emerges as a critical aspect, with participants expressing concerns about the limited involvement in supporting road traffic accident victims. Collaborative efforts with existing resources like community lifesaver programmes and the Red Cross could strengthen community-based initiatives.

The identified needs and priorities, including awareness campaigns, first aid training, and enhanced emergency response systems, align with the feasibility of interventions. However, several implementation-related challenges need to be addressed, including resource-related constraints, communication gaps, and policy-legal concerns (these findings are consistent with the stakeholders interviewed in D. Khorasani-Zavareh, R. Mohammadi, H.R. Khankeh, L. Laflamme, A. Bikmoradi and B.J. Haglund’s ‘The requirements and challenges in the prevention of road traffic injury in Iran. A qualitative study’).

Barriers included the involvement of laypeople, the lack of coordination, inadequate pre-hospital services, and infrastructure-related deficiencies. Recommendations for improving laypeople’s involvement included public education campaigns in first aid and emergency services, and targeted training for professional drivers, Police officers, and volunteers. An integrated trauma-related system and infrastructure improvements were also deemed crucial. The involvement of laypeople is vital for effective post-accident/crash management, systemic improvements such as integrating trauma systems and enhancing the human and physical resources.

A volunteer first responder network in Bangladesh (J. Moussally, A.C. Saha and S. Madden’s ‘TraumaLink: A community-based first-responder system for traffic injury victims in Bangladesh’) utilises an emergency hotline and a 24/7 call centre to dispatch trained responders via text based notifications. In six years, TraumaLink expanded from one highway section to three, covering 135 kilometres and aiding 3,119 patients from 1,544 accident crashes. With a 100% response rate, responders reached scenes within five minutes in 88% of the cases. Most patients, mainly young men, were transported to hospitals within 30 minutes, with accurate triage decisions. TraumaLink effectively addresses barriers in rapid response, triage-related accuracy, first aid, and timely transport, with high community acceptance and volunteer dedication. Policymakers could integrate this model with existing emergency services to manage traffic injuries efficiently.

The ‘REACT – Community Life Saver’ initiative, coupled with the youth first aid teams of Sarvodaya, show promise in executing such operations.

Sarvodaya has the potential to launch community-based initiatives to enhance post-accident/crash support for road traffic accident victims provided that the identified constraints are duly addressed.