Pillion Riders in New Delhi: Helmet Use and Patterns of InjuryFrom: Road Accidents in India 2011; Government of India Ministry of Road Transport and Highways. Transport Research Wing,

Pillion Riders in New Delhi: Helmet Use and Patterns of Injury

Selma Siddiqui MD, Amit Gupta MBBS, MC Mishra MBBS FRCS, Sushma Sagar MBBS MS, Marie Crandall MD MPH FACS

Northwestern University Feinberg School of Medicineand

All India Institute of Medical Sciences

Field Work funded by the Northwestern University Center for Global Health

Mamta Swaroop, MD FACSAssociate Professor of Surgery

Division of Trauma and Critical Care SurgeryNorthwestern University

Feinberg School of Medicine

www.ntsinitiative.org @mamtaswa [email protected]


From: Road Accidents in India 2011; Government of India Ministry of Road Transport and Highways. Transport Research Wing, New Delhi

0

100,000

200,000

300,000

400,000

500,000

600,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Total No Accidents No. Persons Killed No. Persons Injured

Total No. Road Accidents, Persons Killed and Persons Injured: 2002-2011

Road Traffic Accidents (RTAs) in India


ACCIDENT CAPITAL OF THE WORLD 2012

The Motorized Two-Wheeler Problem

• Multi-passenger vehicles

• 70-75% of registered vehicles

• 1/3 of vehicular traffic in Delhi

• 22% of responsible vehicles in RTIs and 20-25% of fatalities/injuries


Helmet History in India


Study Design

• Survey Element: Identify attitudes towards helmet usage and contributing factors/influences among Sikh, Hindu and Muslim women

• How does the exempted population feel about helmets?• Observational Element: Identify actual rates of helmet usage among

pillion riders in New Delhi• Did helmet compliance change after the Motor Vehicle Act?• Chart Review Element: Identify injuries among male and female pillion

riders, helmeted and non helmeted in RTAs• Does gender or helmet use affect outcomes?


Surveying New Delhi’s Women

• Hypotheses: – Women oppose mandatory helmet

laws– Helmet non-use is most commonly

due to conflict with religious practice

– Inaccurate understanding of role of helmets in RTAs

– Media can influence helmet use


Survey Methods


0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

90% 67% 75% 88%

Hindu Muslim Sikh Other

Support for Mandatory Helmet Use by Religious Affiliation


• Majority of women DO NOT support helmet law exemptions for themselves

• Support for mandatory helmets is similar among MTW Users and Non-users

Who Women Exempt from Helmet Law

77%

12%

4%

Women

Sikhs

No one


Perception of Outcomes in Head Injury


Reported reasons Women who use MTWs do not use Helmets

Total MTW Users

46%

17%16%

0.9%

Discomfort/ Appearance

No Legal Mandate

Ineffective/ Cost Prohibitive

Religion


Which Media Outlets are Influential

78.0%12.1%

3.5%4.6%

TV News andAdvertisements

Movies

Government/Schools

Religion


Helmet Use Observation

• 1984 helmet use rate among all pillion riders: 0.6%

• Hypothesis: Male pillions will have a higher helmet use rate now than in 1984. Female pillions will not demonstrate any change.


Patterns of Helmet Use Methods

• 8 hours of video

• 4 intersections

• Data extraction with 2 reviewers


Actual Helmet Use Rates

• 1984: 3774 pillions, 0.6% helmeted

• 2011: 3868 adult pillions, 58.7% helmeted– Males: 2560 pillions, 88.4%

helmeted– Females: 1308 pillions, 0.6%

helmeted


Pattern of Injury Assessment


Pillion Riders in RTAs

MTW Pillion Type Number Percent of totalHelmeted Male 108 23.1%

Un-helmeted Male 142 30.3%

Helmeted Female 3 0.6%

Un-helmeted Female 165 35.3%

NR Helmet Use Male 20 4.3%

NR Helmet Use Female 29 6.2%

Total 467 100%


Injury Patterns Among Pillions

System Total (of all injuries)

Male Pillions (proportion of

injuries by system)

Female Pillions(proportion of

injuries by system)

Head and Neck 45.9% (246)47.1% (116) 52.8% (130)

Face 6.3% (34)70.5% (24) 29.5% (10)

Thoracic 3.5% (19)68.4% (13) 31.5% (6)

Abdominal 5.4% (29)72.4% (21) 27.5% (8)

Extremity/MSK 38.8% (208)67.3% (140) 32.7% (68)

Total 100% (536) 58.5% (314) 31.5% (222)


Head and Neck Injuries

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Helmeted Pillions Unhelmeted Pillions

28.8%

61.2%

Frequency of Head & Neck Injury by Helmet Use

p < 0.0001

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Unhelmeted Males Unhelmeted Females

53.5%67.9%

Frequency of Head & Neck Injury among Unhelmeted Pillions by Gender

p = 0.015


Injuries Requiring Surgery

0

50

100

150

200

TotalHelmeted Males

Unhelmeted MalesUnhelmeted

Females

81

8 32 41

181

3868 75

Neurosurgical Procedure Any Surgical Procedure


Injuries Resulting in Death

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Helmeted PillionsUnhelmeted Pillions

6.3%

16.9%

Frequency of Death by Helmet Status

p = 0.006

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

6.5%

15.5%

Male Helmeted Male Unhelmeted

Frequency of Death among Male Pillions by Helmet Status

p= 0.03

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

0.0%

18.2%

Female Helmeted Female Unhelmeted

Frequency of Death among Female Pillions by Helmet Status

Frequency of Death by Helmet Status among Gender Groups

*Tests of significance were limited due the low no. of helmeted females

*

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

15.5%

18.2%

Male Unhelmeted Female Unhelmeted

Frequency of Death among Unhelmeted Pillions by Gender

p = 0.55


Length of Stay

Helmeted Males

UnhelmetedFemales

Length of Stay in days

8.32 10.47

t= 0.27


Conclusions• There is a mortality benefit of helmet usage in MTW RTAs,

along with fewer surgical interventions utilized.

• Female pillions are more vulnerable to injury, including head and neck injuries

• Helmet use among women would prevent a significant number of injuries and death.

• Helmet use among all pillions has increased significantly

• Unhelmeted pillions are significantly more likely to be female

• TV media based forms of encouraging helmet use should be utilized.


Future Directions

• In 2014, the Delhi Supreme Court repealed the helmet law exemption for women.– We are reevaluating rates of helmet use compliance and injury

patterns since this law change • Establish Public service and education campaigns on helmet

use and efficacy (given awareness difference among education/income levels)

• Engage media outlets in promoting helmet compliance• Modified protective headgear suitable for women’s needs and

India’s climate



Documents

Pillion Riders in New Delhi: Helmet Use and Patterns of InjuryFrom: Road Accidents in India 2011; Government of India Ministry of Road Transport and Highways. Transport Research Wing,