Road Trauma, a socially accepted horror movie

Ihave the incredible good fortune to have been born in a rich, peaceful country. I know nothing of war or terrorism, apart from the images I see on the television news. But if television wars have any “justification,” then what of the war that I have to attend to—a war that kills every day? Absurdly, in my country, Belgium, a total of 1500 people die each year, with a cortège of thousands mentally or physically disabled. Worldwide, my war kills millions.

I cannot count the number of dead or disabled people that I have dealt with over the past 20 years in the mobile intensive care unit or in the emergency room.

Our hospital invests large amounts of money in staffing and equipment in order to improve the immediate on-site care of those injured in road traffic crashes. The hope is to minimise the consequences of major trauma. I know that this is not enough. For years our hospital has taken part in national and international scientific studies that aim to improve trauma care. Our efforts leave us with the taste of ashes. Whatever care we offer, at best we only glue together the pieces in the hope of some small benefits.

The numbers of those killed in road crashes rises inexorably in an absurd way, adding deaths to deaths

The numbers of those killed in road crashes rises inexorably in an absurd way, adding deaths to deaths. I know the only rational solution is prevention. But what can a small group of trauma doctors do? Perhaps share with you some of our stories and memories. Please don't think this is post-traumatic stress disorder or burnout. We continue to live and work with energy, despite the horrors that have been burnt so indelibly on our memories and that we can recount so clearly and so effortlessly as if replaying a road horror movie: a broken skull, open and emptied of its brain; human parts scattered so wide from the crash scene that it is difficult to reconstitute the bodies; a mother nearby screaming her despair; the shredded bodies of pedestrians thrown by a car over a hedge in a village street; the body of a man who has melted into the asphalt after his car burst into flames; a body without a head, the head later found inside the crash helmet which is inside the thorax. And implicated in so many of these kinds of incidents are speed and alcohol.

How to explain to a mother that I failed to resuscitate her daughter who was reversed over by a car?

There are two types of horror. The most striking is the visual, the sight of the lesions and the physical suffering; the other, the most intolerable, is the suffering of the families. How to explain to a mother that I failed to resuscitate her daughter who was reversed over by a car? What should I say to the children whose drunk father has just killed their mother? He had already had his driving licence revoked for drink driving.

After 17 years of working in a mobile intensive care unit, I have many such stories in my memory. Why do we accept such horror? Is it a reflection of our society, our wanting everything and immediately? A key factor is speed, but speed itself means nothing, it depends on the road conditions and the road environment. Speed limits must be set according to the road hierarchy, and people must understand why it has to be so. And alcohol? We took part in the Belgian trauma toxicology study. Because of individual rights, we could not take blood for blood alcohol measurements on every injured driver but only those hospitalised for 24 hours. Despite the bias, we found that over 40% of injured drivers were drunk, and, taking into account other drugs and treatments, over 70% of injured drivers were intoxicated in some way.

Statistics also tell a story. In Scandinavia no alcohol is permitted when driving but in Belgium we pay for our more liberal approach with 1000 lives a year. Drink driving is like firing a shotgun in a crowded place, but not in the eyes of Belgian law. In hospital, we work hard, but, with all our efforts, at best we will only minimise the consequences. For, as long as the war on the roads is sanctioned, there is no hope. So my job must be to work hard on trauma care but also to tell my stories. I'm angry and sometimes I'm a little desperate. Help me to end the war on the roads.