Complacency about road safety hiding a public health crisis

“96 vehicles involved in collision after ‘wall of snow’ hits Highway 400”

Highway 17 Crash Leaves Five Men Dead

Huge multi-vehicle pile-up injures 100 people near Edmonton.”

Every winter, we’re snowed under by headlines like these, on stories of car crashes that seem as inevitable as the season. But it’s not just Old Man Winter that’s to blame.

Even the word accident is misleading, say some researchers, who think car crashes should be seen as preventable causes of death and disability.

Changes to legislation, enforcement and driver education – like seatbelt laws, graduated licencing and divided highways – have helped Canada reduce the number of car crashes and deaths from accidents over the past four decades. But we still have further to go. Motor vehicle collisions caused nearly 1,800 deaths and 122,100 injuries in 2012. And those collisions are the leading cause of death for Canadians under 25.

Fatalities are just the beginning of the problem: For every person who dies in a motor vehicle collision, 68 are injured. They can be left with lasting repercussions, including chronic pain and post-traumatic stress disorder. Many will take over a year to go back to work, or not return at all. “It becomes like a chronic illness,” says Avery Nathens, chief of Sunnybrook Hospital’s department of surgery.

Patients are often overwhelmed with regret after a car accident, thinking “if only I had done things slightly differently, this could have been avoided altogether,” says Donald Redelmeier, who researches traffic accidents at the Institute for Clinical Evaluative Sciences and a staff physician who treats complex trauma patients at Sunnybrook.

He shares their sentiment. “I look after patients suffering from multiple myeloma, or Crohn’s disease as well,” he says. “I don’t really know what to do about preventing those. Whereas with a road crash, I know. We could be doing a lot more to prevent them.”

Edmonton’s experiment

In 2004, Bill Smith witnessed the aftermath of a traffic accident. The sight shook Smith, then mayor of Edmonton, so badly that he called for a Mayor’s Task Force on Traffic Safety. That led to the Office of Traffic Safety, a group that has used evidence-based policies to try and reduce accidents since it was created in 2006. And they’re succeeding.

The number of injuries has been cut almost in half, from 8,221 in 2006 to 4,123 in 2013. The number of collisions has also declined, from 26,066 to 24,803 in 2013. Meanwhile, Alberta’s car accidents have dropped, from 575 per 10,000 licenced drivers in 2009 to 477 in 2013. And the province’s injuries rate has dropped, though less dramatically than Edmonton’s, from 70 per 10,000 licenced drivers in 2009 to 63 in 2012.

The group has a focus on big data, which helped reveal the city’s most dangerous locations. Since 2009, the city has modified many of the intersections, changing the angles of right-turn lanes and adding left-hand turn signals. In one intersection, where there were 150 collisions over five years, they removed the separate turn lane, so drivers now have to stop, then turn. Since that change in 2010, there’s been only one collision. Across all modified intersections, crashes have dropped by 75%.

“We’re applying science to [crash prevention],” says Gerry Shimko, executive director of the Office of Traffic Safety. “I have half a dozen PhDs working in my office on everything from traffic safety culture to speed management to weather prediction.” His team also works with a research chair in urban traffic safety at the University of Alberta that was created by city council.

The Office of Traffic Safety has also beefed up enforcement, using digital feedback signs and photo radar on the ring road around the city. That’s lowered the number of people who go more than 30 km over the speed limit – which increases fatalities and serious injuries – from 30% to under 5%. And the group has proposed even more innovative approaches, including variable speed limits.

Lifesaving changes

The World Health Organization has declared this the Decade of Action for Road Safety, calling 2010’s 1.24-million global death toll from road traffic “unacceptably high.” It drew particular attention to middle-income countries, where the number of people with vehicles is rapidly increasing.

Many of its top recommendations – such as legislation around speeding, drunk driving, seat belts and child restraints, and motorcycle helmets – are already in place in Canada. Thanks to a gradual tightening of driving rules, from the introduction of seatbelt laws in 1976 to restrictions on adolescent drivers and tougher impaired-driving penalties, Canadian drivers across the country are much safer than they used to be. There has been a 58% drop in road fatalities across the country since the 1970s. In Ontario, the number of deaths per 10,000 licensed drivers dropped from 5.3 in 1964 to 0.6 in 2010; the number of injuries per 1,000 also dropped, from 202.5 to 69.8 over the same period.

Tougher speeding and seatbelt enforcement has also been credited with lowering fatalities. “Enforcement always works. The problem is, it’s not a public relations winner,” says Redelmeier. At the same time, new threats have arisen. While the number of collisions involving alcohol and drugs is still a priority, it is dropping, and distracted driving, including from smartphones, is on the rise.

Despite Canada’s overall success in curbing accident rates, there are still vulnerable populations more likely to be injured or killed in a car crash. Aboriginal people are more affected, with rates of death and injury from motor vehicle crashes that are twice as high as that of the general population. The risk of death in collisions is also more than twice as high in rural areas than in large urban areas. And our roads are especially dangerous to pedestrians, cyclists and those on motorcycles and scooters, who make up 23% of all traffic deaths.

There’s been a focus on improving car safety and driver habits through initiatives like impaired driving penalties. “But no one really focuses on the road safety components… those environmental things haven’t been sorted out,” says Nathens. A sub-committee of the Council of Ontario Medical Officers of Health is currently looking into how to lower traffic fatalities, reviewing the literature to see what policies might be most influential.

Part of the job of educating the public also falls to individual doctors. In seven provinces, including Ontario, it’s mandatory for doctors to report people who might be dangerous drivers, such as those who have epilepsy, poorly controlled diabetes, or Parkinson’s, to the Registrar of Motor Vehicles. (Alberta doesn’t mandate this.) In Ontario, physicians can even bill for these warnings. And they work, reducing the risk of a subsequent crash by 45%. But physicians may be overly reluctant to issue them. Only 1% of Canadians get a medical warning – lower than expected based on rates of chronic illness.

Spinning their wheels

Dozens of multidisciplinary teams that include communities, the OPP and the province have been created to improve road safety in Ontario. They’re looking at injury and collision hot spots and trying to modify driver behavior, roadway design or enforcement to reduce accidents.

But some still face roadblocks, like Renfrew County, home to part of Highway 17, one of the deadliest roads in the province and part of the Trans-Canada Highway. The provincial fatality rate from motor vehicle collisions in 2011 was 4.2 per 100,000, with rural rates rising to about 8.8. In Renfrew County, it’s 10.4 per 100,000.

The stretch faces two issues: It’s an undivided two-lane highway, unlike much of the Trans-Canada Highway, which has four lanes and a divider. It’s also a route for heavy traffic, including military traffic and commercial trucks. Trucks and commercial vehicles are involved in 20% of fatal crashes in Canada. That issue was exacerbated when CP Rail and CN Rail stopped serving Renfrew County, leaving trucks as the only option for commercial freight.

“The highway’s not unsafe, but it is unforgiving,” says Peter Emon, mayor of the county. Because it’s a two-lane highway, “the margin for error isn’t there if you’re a driver.” In response to these issues, a group called Team Highway 17 brings together the province, the OPP and the county to work on the road’s safety. The county contributes manpower, but the province and federal governments cover the costs of all roadway changes.

The group has made progress on smaller fixes, such as adding centre line and side lane rumble strips and looking at putting in traffic lights to right-hand turn lanes and cat’s eye reflectors to the outside turns. But the pace of expansion to a four-lane road – which began 40 years ago – has been frustratingly slow to residents.

The zero-deaths goal

Sweden has addressed collisions head-on, with a goal to eliminate traffic fatalities and serious injuries by 2020. As part of that, they’ve created low speed limits within cities, built pedestrian bridges, and added three-lane roads that include a middle lane that alternately offers drivers on each side the chance to pass. Plus, they’ve been stricter about enforcing alcohol limits. The country has seen the number of traffic fatalities drop in half since 1997, and the national traffic fatality rate is the lowest in the world.

Australia is another leader in the field. It’s road deaths have dropped by 17% over the last five years. A countrywide 50 km urban speed limit, which the WHO describes as a best practice, has contributed, as have more photo radar and red light cameras. In addition, the country’s Black Spot Programme looks at dangerous intersections and roads and adds things such as traffic signals or roundabouts to make them safer. It’s estimated to prevent over 4,000 accidents a year.

That’s the kind of focus Redelmeir would like to see here. “For such a widespread cause of death and disability and economic loss, [motor vehicle collisions] receive a disproportionately low amount of attention,” he says. “It’s about 3,000 deaths a day worldwide – like one Japanese tsunami every day. Even if we could reduce that by 1/10th, it would make a huge difference.”

The comments section is closed.

  • Karen Woods says:

    What if we could significantly reduce the number of deaths and injuries by focusing more time and resources on reducing youth risk?

    In 2010, Transport Canada’s National Collision Database (NCDB) reported a rise in the number of vehicles on our roads with a noticeable decline in the total number of serious injuries and fatalities caused from motor vehicle collisions. Also noted, youth between the ages of 15-25 represented nearly one-fourth (23%) of these motor fatalities, a significant number for a group which makes up only 13% of Canada’s total population.

    Injury data across the Eastern region between 2007-2009 shows similar youth related motor vehicle related findings. During the reporting period, youth between the ages of 15-24 years represented slightly over 25% of the emergency room visits and 22% of reported hospital visits as the result of motor vehicle collisions. The same report indicates that between 2001 and 2005, 28% of all motor vehicle deaths involved youth between 15-24 years and in 2010, the majority of injury collisions occurred in urban areas (73%) with the majority of deaths (57%) taking place on rural roads.

    Of course, only a small part of the youth picture has been presented—but the numbers can speak for themselves. Youth are significant players in this issue so it only makes sense that they be respectfully included in the conversations that are focused on delivering effective solutions to address this problem in all communities.

    Data Sources:

  • Dr. Pooks says:

    A lot of the guidelines and best practices for reporting medical conditions to provincial ministries are very lacking in real world specifics, particularly here in Ontario.

    The CMA Driver’s Guide is an excellent resource, but it is silent on many conditions and subjects. Is has some very specific recommendations for some conditions like reporting and return to driving from heart disease, but is completely silent on some topics like chronic insomnia and incomplete on others such as obstructive sleep apnea.

    GPs are given little direction as to how to handle these safety concerns in the real world, with long waits for diagnostic tests, treatments and specialists.

    For example, the CMA guide has no recommendations for chronic insomnia. Sleep deprivation and sedatives/hypnotics are well known to greatly increase the risk of motor vehicle accidents. Yet when I searched for Canadian guidelines and international best practices, my extensive search came up empty. And when I had safety concerns regarding patients and their insomnia, I got chewed out both by patients and fellow colleagues for reporting my concerns to the Ministry.

    As well, in my experience, the recommendations for Sleep Apnea are incomplete. There really is no guidance in terms of timing and thresholds for reporting in the CMA guide. With long waits for Sleep Clinic assessments and testing, it leaves me and the patient in limbo. If I have clinical suspicion of Sleep Apnea, when do I report to the Ministry and when do I tell the patient to stop driving? Once I initially have suspicion of the diagnosis? When I order testing? What if the patient refuses testing? Do I wait until they get the test/see the specialist? What if it takes months? The guide is completely silent on what to do in the meantime.

    Untreated sleep apnea has been shown to be of equivalent increased risk of motor vehicle accidents as a blood alcohol level of >0.08.


Vanessa Milne


Vanessa is a freelance health journalist and a form staff writer with Healthy Debate

Michael Nolan


Michael Nolan has served Canadians through many facets of Paramedic Services.  He is currently the Director and Chief of the Paramedic Service for the County of Renfrew and strategic advisor to Healthy Debate

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