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Road accident rates: strategies and programmes for improving road traffic
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Eur J Trauma Emerg Surg
DOI 10.1007/s00068-015-0544-6
REVIEW ARTICLE
Road accident rates: strategies and programmes for improving
road traffic safety
K. Goniewicz1   · M. Goniewicz2 · W. Pawłowski1 · P. Fiedor3 
Received: 4 February 2015 / Accepted: 31 May 2015
© Springer-Verlag Berlin Heidelberg 2015
Abstract  through applying an integrated approach to safety on roads.
Introduction  Nowadays, the problem of road accident
rates is one of the most important health and social pol-
icy issues concerning the countries in all continents. Each
year, nearly 1.3 million people worldwide lose their life on
roads, and 20–50 million sustain severe injuries, the major-
ity of which require long-term treatment.
Discussion  The objective of the study was to identify the
most frequent, constantly occurring causes of road acci-
dents, as well as outline actions constituting a basis for
the strategies and programmes aiming at improving traffic
safety on local and global levels. Comparative analysis of
literature concerning road safety was performed, confirm-
ing that although road accidents had a varied and frequently
complex background, their causes have changed only to
a small degree over the years. The causes include: lack
of control and enforcement concerning implementation
of traffic regulation (primarily driving at excessive speed,
driving under the influence of alcohol, and not respect-
ing the rights of other road users (mainly pedestrians and
cyclists), lack of appropriate infrastructure and unroadwor-
thy vehicles.
Conclusions  The number of fatal accidents and severe
injuries, resulting from road accidents, may be reduced
* K. Goniewicz
krzysztof.goniewicz@wum.edu.pl
1 safety. The WHO predicts that without undertaking appro-
Department of Disaster Medicine, Medical University
of Warsaw, ul. Zwirki i Wigury 81 A, 02‑091 Warszawa,
Poland
2
Emergency Medicine Unit, Medical University of Lublin,
Lublin, Poland
3
Department of General and Transplantation Surgery, Medical
University of Warsaw, Warszawa, Poland
The strategies and programmes for improving road traffic
should include the following measures: reducing the risk
of exposure to an accident, prevention of accidents, reduc-
tion in bodily injuries sustained in accidents, and reduction
of the effects of injuries by improvement of post-accident
medical care.
Keywords  Road accidents · Road traffic safety ·
Haddon’s matrix · Public health
Introduction
The problems of road accident rates currently belong to
the most important issues of health and social policy of
the countries in all continents. Nowadays, a fatal road traf-
fic incident occurs on average every 50 s, and road traffic
injuries are sustained every 2 s [1]. According to the WHO,
every year, nearly 1.3 million people lose their life on roads
worldwide, whereas 20–50 million sustain severe trauma,
the majority of them require long-term and costly treat-
ment. Road accidents, apart from grief and suffering, cause
tremendous social and economic loss, absorbing 1–3 % of
the gross domestic product of most countries [2]. Numer-
ous consequences of road accidents may be effectively pre-
vented; however, this requires continuous efforts for new
methods and programmes aimed at improving road traffic
priate measures, road accidents will result in the death of
approximately 1.9 million people annually before the year
2020 [2].
The objective of the study was to identify the most fre-
quent, reoccurring causes of road accidents, as well as to
present actions which should be a basis for strategies and
13

programmes aimed at improving road traffic safety on the
local and global levels.
First publications concerning road traffic safety
The problem of accident rates has been analyzed from the
very beginning of the development of motorization. In 1902,
the first scientific report was published regarding an accident
that involved a vehicle with a power engine [3]. In 1903,
Dittrich published the first medical-judicial report pertain-
ing to injuries, resulting from being run over by a mechanical
vehicle [4]. In 1908, Zimmer presented one of the first statis-
tical analyses regarding accident rates. That analysis included
accident events that took place during the period 1904–1907
in Germany [5]. Moreover, Butrym presented one of the first
reports in Poland concerning that problem in 1924 [6]. In the
following years, further researches were published concern-
ing the increase in road accidents rates. These publications
pertained not only to the epidemiology of the phenomenon,
but additionally described the characteristic injuries found in
the victims of road events, as well as the mechanisms of their
occurrence [3]. In 1937, Straith published a report in which he
suggested, as one of the first, the possibility of reducing inju-
ries in the victims of road accidents by implementing suitable
construction of vehicles [7]. Moreover, Nader wrote about
the road safety, and in his publications, the researcher criti-
cized the American motor industry. Nader claimed that many
American cars were poorly designed and dangerous while
being operated, that could be a cause of road accidents (e.g.,
car steering and instrument panels inside cars were decorated
with chrome and glittering enamel which reflected sunshine
and the headlights of oncoming vehicles, causing the daz-
zling of the driver). Furthermore, Nader considered that the
excessive external ornamentation of cars was dangerous for
pedestrians (increased injuries in victims of road accidents).
In addition, the author stated that many inventions improving
active and passive safety of vehicles were, to a great extent,
ignored by the American motor industry. Nader suggested
that the motor industry should be compelled by the govern-
ment to pay greater attention to the safety of vehicles [8, 9].
A rapid development of motorization, observed since
the second half of the 20th century, accompanied by a con-
stant growth in the number of victims of road accidents,
enforced wider interest in the scope of problems connected
with road safety.
Modern strategies and programmes for improving
road traffic safety
At the turn of the 1960s and 1970s, William Had-
don designed an analytical instrument to facilitate the
13
K. Goniewicz et al.
identification of factors related to road accidents. This
model, called ‘Haddon’s Matrix’ (Table 1) illustrates the
interaction between three factors, such as: human factors,
vehicles and equipment factors, and environmental factors,
by phases in time of the event, i.e., pre-event, event, and
post-event [10].
Due to the Haddon’s model, at each phase, it is possible
to undertake proper interventions to decrease injury rates
related to road accidents. In pre-event phase, there are vari-
ous types of actions preventing the occurrence of a road
accident. At the event phase, there are interventions aimed
at prevention of the occurrence of injuries, or in the case of
occurrence of injuries, a reduction of their intensity in vic-
tims. The post-event phase covers all actions decreasing the
negative effects of a road accident [11].
The application of the Haddon’s model in practice led
to progress in the understanding of human behaviours
connected to road traffic, as well as the recognition of the
factors that exert an effect on the number and severity of
bodily injuries. In the studies of road accident rates, three
factors have been distinguished having a decisive effect on
the safety of road traffic. These factors are: human factor,
road environment, and vehicle. The human factor occupies
a prominent position among the causes of accidents. The
behaviour of individual groups of road users (protected
and unprotected participants of road traffic) to the high-
est degree affects the occurrence of accident events. The
remaining factors are of considerably lesser importance
[11–16]. According to the European Road Assessment Pro-
gramme, the human factor contributes to the occurrence of
90–95 % of road accidents; road and its environment—to
28–35 % of events, and vehicle—to 8–10 %. These factors,
individually or interacting may affect the risk of occurrence
of a road accident event [17].
The analysis of many reports concerning the scope of
problems of road accidents illustrates that although traffic
events most often have a varied, and frequently complex
background, over the years, their causes have changed
only to a small extent [1, 12–16]. The lack of control and
enforcement concerning implementation of traffic regula-
tion is considered as the most frequent, constantly present
causes of road accidents (primarily driving at an excessive
speed, driving under the influence of alcohol, and lack of
respecting the rights of other road traffic users mainly dis-
regarding the rights of pedestrians and cyclists), poor skills
of drivers in combination with an incorrect evaluation of
the situation on the road, lack of an adequate road infra-
structure and poor technical state of vehicles [1–3, 13–16,
18–23].
The number of fatalities and casualties resulting from
road accident events may be reduced by the application of
an integrated approach to road safety. Studies conducted
in many developed countries confirmed that such systemic
 Road accident rates: strategies and programmes…

solutions enabled the recognition and elimination of the

Safety zones, road side embankments/guard rails in the

accessibility of emergency equipment, place of reha-

major mistakes contributing to the occurrence of accidents

atmospheric conditions, speed limits, facilities for

Road design, state of road infrastructure, lighting,

response, co-operation between rescue services,

and bodily injuries, and also resulted in a clear decrease in

Notification system, emergency medical service

the number of fatal victims and those injured among the
participants of road traffic [24–28]. The policy of the safety
of road traffic should cover a wide range of participants
representing various groups of interests (state and self-
government administration, scientific-research institutes,
non-government institutions, medical and fire rescue ser-

bilitation and treatment

vices, police, industry, media, road users). The engagement
road infrastructure of many participants contributes to the development of new
methods, which are helpful in the creation of the system of
pedestrians
Environment

road traffic safety [29–32].

Based on Haddon’s experiences, many strategies and
programmes were created to improve the safety of road
traffic. They covered primarily the following actions: a
decrease in exposure to danger, prevention of road accident
the part of the vehicle (fire, explo-
speed, performance of MOT tests

Skill of providing first aid by witnesses or participants Access to the victims, hazards on
Degree of training, observance of regulations (speed, Method of exploitation, technical

events, reduction of accident-related injuries, and reduction

Modern devices for passive and
status, lighting, breaks, tyres,

of the extent of bodily injuries by the improvement of post-

active safety, vehicle size

accident medical care [2, 24, 33–35].

The strategies for road traffic safety aimed at the reduc-
tion of exposure to the risk were manifested by the fol-
lowing actions: decrease in the intensity of motor vehicles
traffic, provision of effective communication networks,
Vehicle

an increase in safety in the area of planning new roads,

sion)

encouraging people to use safer means of transportation,

reduction of exposure to the situations at high risk of inju-
alcohol), prophylactic examinations, current state of

of injuries, skills and knowledge of paramedics and

ries, introduction of limitations for vehicle users, and the

health (fatigue, sleep), execution of regulations by

of the accident, state of health of victims, severity

performance of changes in the road infrastructure [2, 24].

Age, gender, state of health (chronic diseases),

The prevention of accidents and counteracting the occur-

rence of injuries, or in the case of diagnosing injuries—
the reduction of their intensity in cases of victims, covers
mainly the following actions: application of new technolo-
gies in the construction of vehicles, development of safety
systems in the road infrastructure, education in the area of
road traffic safety, implementation and exercising of legal
mechanism of injury

regulations concerning various aspects of safety on the

roads [2, 24].
Human factor

physicians

The development of new technologies leads to design-

the police

ing safer cars (passive and active car safety systems), and
Factors

numerous safety systems concerning the road infrastructure

(effective and economic engineering solutions on roads at
high level of risk) improving the safety of drivers and pas-
 Sustaining life and decreasing dis-
 Injury prevention during accidents

sengers, as well as other participants of road traffic (pedes-

trians, cyclists, motorcyclists). New technologies also
enable elimination of the participants of road traffic who
Table 1  Haddon’s matrix

violate the regulations (cameras registering speed, sensors

 Accident prevention

registering cars running the red light, ignition disabler with

breathalyzer) [2, 36, 37].
A reduction of mistakes committed by road users
Post-event

through education in the area of road traffic safety (e.g. pro-

ability
Pre-event

motion campaigns, educational programmes, programmes

Phase

Event

training skills for pedestrians, motorcycles and cyclists,

13

improvement courses for older drivers) may contribute
to the change of behaviours and an increase in awareness
which, in consequence, should result in an improvement
in road safety, and a decrease in the number of deaths and
severe bodily injuries in victims of road accidents [24].
Education should cover the five main risk factors, which
contribute to road accidents, i.e. speed, alcohol, not fasten-
ing seatbelts, lack of using child care seats, not using pro-
tective helmets by cyclists and motorcyclists, and poor vis-
ibility of road traffic participants [2, 38, 39].
Legislation may also be an effective way of eliminating
risky behaviours among road users, and means for increas-
ing road safety. Legal means which limit the risk of occur-
rence of road accidents are, among others, the speed limit
in densely populated urban areas (reduces mortality rates
among all road users), the control of alcohol levels among
drivers (priority in prevention concerning fatal accidents
and severe bodily injuries), the obligation of wearing a pro-
tective helmet (protects the head against severe injuries),
the obligation to fasten safety seatbelts (the most effective
way of preventing bodily injuries in passengers seated at
both the front and rear seats of the car). Proper legal regula-
tions and an effective way of enforcing these regulations is
the key to the improvement of road traffic safety [2, 24].
The studies published by the WHO show that only 15 %
of countries possess the complete scope of legal regula-
tions concerning speed limits, driving under the influence
of alcohol, fastening seatbelts, and using child car seats and
protective helmets [40].
The limitation of speed is the priority when aiming at
decreasing the number of road accidents, especially among
pedestrians, cyclists and motorcyclists. Speed contributes
to at least 30 % of fatalities. Each increase in speed by
1 km/h causes a 3 % increase in the risk of an accident,
the participants of which will sustain bodily injuries, and
5 % increase in the risk of a fatal accident. Pedestrians are
eight times more likely to become a fatality when exposed
to a contact with a car moving at a speed of 50 km/h than
30 km/h. According to the WHO, only 29 % of countries
have undertaken essential measures limiting speed in cit-
ies to 50 km/h or below, and enable the local authorities to
further review speed limits on these roads [2]. The actions
which should be undertaken to reduce the risk of accidents
related to an excessive speed are, among others, the estab-
lishment and execution of speed limits, designing roads
according to their function (e.g., motorways, suburban
roads), the construction of elements of a road infrastructure
enforcing speed limits (e.g., roundabouts, traffic islands,
‘sleeping policemen’), educating and informing society [2,
41].
Driving a vehicle after the consumption of alco-
hol increases the risk of an accident resulting in death or
severe injuries. There is no ‘safe’ limit of alcohol in blood
13
K. Goniewicz et al.
concerning its effect on concentration and efficacy of a
driver. Accident risk considerably increases at the concen-
tration of alcohol in blood of over 0.04 g/dl. The WHO rec-
ommends an allowable level of alcohol in a driver’s blood
at the level of 0.05 g/dl. The WHO Report indicates that
less than a half of the countries worldwide have legally
established regulations at this limit. Actions which should
be undertaken to decrease the risk of accidents related with
alcohol are: establishing and enforcing the limits for the
concentration of alcohol in the blood, random tests for the
presence of alcohol among drivers, media campaigns pro-
moting the prohibition of driving a vehicle after the con-
sumption of alcohol, stringent and rapid punishment of
offenders, implementation of devices testing the driver’s
breath and blocking the ignition after diagnosing alcohol in
vehicles [2].
Furthermore, head injuries are the main cause of deaths
and disability among cyclists and motorcyclists participat-
ing in road accidents. Among children, ‘bicycle’ injuries
are the main cause of bodily injuries. Wearing good quality
protective helmets may decrease the risk of death in a road
accident by nearly 40 %, and the risk of severe injuries by
over 70 %. According to the WHO, only 40 % of coun-
tries possess legal regulations to use protective helmets by
cyclists, and motorcyclists (covering both the drivers and
passengers), as well as quality standards for motorcycle
protection helmets [2]. Actions which should be under-
taken to decrease the risk of an accident and reduce its con-
sequences for cyclists and motorcyclists are primarily the
establishment and execution of law to wear a protective
helmet, determining standards for motorcycle protection
helmets, specific sanctions for not using protective helmets,
and carrying out targeted information campaigns [2, 42,
43].
According to the WHO, the use of safety seatbelts has
saved more human lives than any other strategy for road
traffic safety. The use of safety seatbelts reduces the risk
of death among passengers in the front seat by 40–65 %,
and among passengers at the rear seat, by 25–75 %. Only
57 % of countries require the use of seatbelts in cars by
the passengers in both the front and rear seats. The use of
child safety features (baby car seats, children safety seats,
and special seat platforms) may decrease mortality among
children by 54–80 % (infants by more than 70 %, and small
children by 54 %) in the case of a road accident. The WHO
emphasizes that safety seatbelts and safety child seats save
children’s lives only when they are correctly used. Accord-
ing to the WHO, in less than a half of the countries there are
regulations, which require the use of special child restraints
while transporting them in vehicles. Actions related to
decreasing the consequences of road accidents are mainly
the establishment and execution of regulations concern-
ing the use of safety seatbelts and child restraints, carrying
Road accident rates: strategies and programmes…
out advertising campaigns emphasizing the effectiveness
of using safety seatbelts and child restraints, implementa-
tion in cars sound reminders concerning fastening seatbelts,
establishing loan programmes or other auxiliary strategies
for the purchase of child restraints [2].
Poor visibility is one of the risk factors, which contrib-
utes to the occurrence of road accidents [44]. The WHO
report shows that one-third of the respondents had prob-
lems with noticing a vehicle, and nearly a half of the driv-
ers had difficulties with spotting a pedestrian. Expected
measures related to limited visibility are: primarily the
establishment and execution of regulations concerning the
headlights for driving during daylight hours for single-track
vehicles and cars, promoting wearing reflective clothes and
various reflective materials by pedestrians (white, yellow)
protective helmets, and street lights [2].
The negative consequences of road accidents may be
reduced by first aid, specialist transport and emergency
treatment of the victims. An effective medical emergency
system based on the rescue chain, may save many victims
of road accidents [45]. According to the WHO, in many
countries with low or mediocre income such a system must
be constructed, whereas in other countries to improve post-
accident medical care, refresher courses in the provision
of first aid should be organized, the co-operation of rescue
services improved, as well as an accident notification sys-
tem. Various telephone numbers for emergency calls should
be harmonized into one global number or several regional
numbers [2].
Summary
In all parts of the world, despite the level of the develop-
ment of motorization, there is a need for improving the
road traffic safety, and reduce the number and severity of
injuries resulting from these accidents [46]. To achieve
this goal, it is necessary to consider the problem of acci-
dent rates as an urgent problem, requiring cooperation of
politicians, experts and professionals from research centres
and universities dealing with road traffic safety, road traf-
fic administration, rescue services, police and the media.
An indispensable instrument for the effective prevention
of accident-related injuries is the adoption of a systemic
approach, composed of the following elements: identifi-
cation of the problem, formulation of goals, preparation
of strategies and programmes, and monitoring undertaken
actions [24]. Strategies and programmes for improvement
of road traffic safety should cover primarily the following
actions: reduction of exposure to the danger of accidents,
prevention of accidents, reduction of injuries which are the
effect of accidents, decreasing the consequences of acci-
dents by improvement of post-accident medical care.
Conflict of interest  Krzysztof Goniewicz, Mariusz Goniewicz,
Witold Pawłowski and Piotr Fiedor declare that they have no conflict
of interest.
Compliance with ethics guidelines  This article does not contain
any studies with human or animal subjects performed by any of the
authors.
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