Road Safety Best Practices

Examples and Recommendations

Authors: Peter Elsenaar, GRSP senior advisor Samar Abouraad, GRSP advisor

November 2005

Global Road Safety Partnership P.O. Box 372 17, chemin des Crts CH-1211 Genve 19 Switzerland

Phone: + 41 22 730 42 49 Fax: + 41 22 733 03 95 E-mail: GRSP@ifrc.org

TABLE OF CONTENT

Pages

INTRODUCTION..................................................................................................................... 2 PRESENTATION OF GRSP .................................................................................................... 3 Chapter 1: CAMPAIGN AND ENFORCEMENT.................................................................... 5 Chapter 2: AWARENESS AND PARTNERSHIP ................................................................... 9 Chapter 3: CRASH DATABASES ......................................................................................... 15 Chapter 4: BLACK SPOT TREATMENT.............................................................................. 26 Chapter 5: ROAD DESIGN AND SPEED MANAGEMENT................................................ 31 Chapter 6: HEALTH AND ROAD SAFETY, PREHOSPITAL CARE ................................. 36 APPENDICES......................................................................................................................... 40 Appendix 1: Molasses Databases ............................................................................................ 41 Appendix 2: ROSPA; Road Safety Engineering Cost Effective Local Safety Schemes...... 52 Appendix 3: Extracts from the Urban Safety Management Guidelines for Developing Countries. ................................................................................................................................ 55

INTRODUCTION The Problem Worldwide With more than 1 million people killed and over 20 million injured in road accidents each year, road safety is an issue of immense human proportions. Over 75 percent of these casualties occur in developing and transition countries, though they account for only 32 percent of motor vehicles. These accidents will continue, and very likely increase as motorization increases, unless all stakeholders act together. Likewise, the global economic impact is huge economic losses caused by road accident amount to US$ 500 billion worldwide. For the countries in development and transition, their share of this economic loss is estimated to be close to 2% of GDP, nearly US$ 100 billion, i.e., nearly equivalent to double all overseas development assistance. These huge economic losses inhibit economic development and perpetuate poverty. Apart from releasing pressure on medical facilities, reductions in deaths and injuries will produce savings that can be spent on other aspects of health care, or can be invested to deliver better public services.

Objectives of the Manual The present manual has been produced by the Global Road Safety Partnership for its participation in the Workshop on the Implementation of Good Practices in Road Traffic Safety organized by the UN-ESCWA in Muscat, Oman on 28 and 29 November 2005. This workshop strives to introduce through lectures and manual presentations the most recognized worldwide good practices in road safety and will address those who are directly involved and responsible for planning or implementing road safety policies and programmes in their respective countries. The manual presents six chapters each one focusing on a road safety theme where experience has proved that specific measures and actions could lead to positive outcome in the reduction of crashes and victims of road accidents. Each chapter starts with an introduction followed by an analysis of the effectiveness of actions in road safety, and then an example in countries around the world where some good results have been achieved is briefly described. Recommendations are given on how to proceed with the best implementation. The following subjects are being tackled in the six chapters: Campaign and Enforcement, Awareness and Partnership, Crash Databases, Treatment of Black Spots, Road Design and Speed Management, Heath and Road Safety: Prehospital Care. In the appendices some extracts from various manuals and reports are given as additional references and examples of best practices.

PRESENTATION OF GRSP Organization The Global Road Safety Partnership (GRSP) is a global partnership between business, civil society and governmental organizations collaborating to improve road safety conditions around the world. Initiated by the World Bank Group in February 1999, GRSP stakeholders have been identifying ways in which they could work together to improve road safety globally. The International Federation of Red Cross and Red Crescent Societies hosts the GRSP Secretariat at its headquarters in Geneva, Switzerland. The GRSP is governed by a Steering Committee and assisted by a small Secretariat. Over 200 organizations have taken an active role in establishing the GRSP and it is now active in over 10 countries. GRSP is one of four Business Partners for Development (BPD) programs initiated by the World Bank. BPD is a project-based initiative that studies, supports and promotes strategic examples of partnerships for the development of communities around the world. The underlying concept of BPD is build on the premise that partnerships benefit the long-term interests of the business sector while meeting the social objectives of communities by helping to create stable social and financial environments. Road safety offers an opportunity for a wide range of stakeholders to actively engage in addressing the global problem of road accidents, deaths and injuries. Previous efforts by governments and donors to try to improve road safety in developing and transitional countries have had limited success and many interventions simply have not been financially or institutionally sustainable. The Global Road Safety Partnership aims to identify innovative ways to improve road safety by applying the business partnership approach. It hopes to produce solid evidence that partnerships offer win-win benefits for all parties and that this approach can be widely used throughout the world. The GRSP is not a funding agency and does not finance road safety interventions of the type normally financed by governments, bilateral and multi-lateral donors.

GRSP Secretariat The GRSP Secretariat is accommodated at the headquarters of the International Federation of Red Cross and Red Crescent Societies (IFRC) in Geneva. It consists of a manager, a program officer and part-time consultants / advisors who animate the GRSP focus country activities. Both the manager and program officer are full time employees. The Secretariat handles the day-to-day management of the program and is assisted and guided by the Chairman and Vice-Chairmen. This management team meets several times per year. The broad policies followed by the management team are laid down by the Steering Committee and the smaller Executive Committee. GRSP Advisors The work in each GRSP focus country is coordinated by an Advisor. As a conscious matter of policy, Advisors work part-time for the program. This has enabled the program to recruit senior staff and provides a degree of flexibility. Finally, part-time advisors bring added skills and experience to the program from the work they do for other clients.

Role of Advisors The main task of an Advisor is to bring a wide range of people together to:

advocate for road safety in the focus countries; forge partnerships between relevant government officials, business interests and civil society organizations committed to improving road safety; seek agreement on the kind of interventions the partnership is willing to support; seek commitment of the time and money needed to implement the chosen partnership program; monitor implementation of the program against agreed targets ensure that all parties continue to support the program they have committed themselves to.

Global Road Safety Partnership P.O. Box 372 17, chemin des Crts CH-1211 Genve 19 Switzerland Phone: + 41 22 730 42 49 Fax: + 41 22 733 03 95 E-mail: GRSP@ifrc.org

Chapter 1: CAMPAIGN AND ENFORCEMENT

1. Introduction A road safety publicity campaign is part of a set of activities that aim to promote safe road use. Mass media advertising is often the most visible component of a campaign; however to be effective, this must be combined with visible government and/or community support, particularly law enforcement. Campaigns target people and generally aim to change behaviour, either directly, or by providing information to influence attitudes and thus have an impact on behaviour.

2. Are campaigns effective? Research in motorised countries shows that a publicity campaign by itself has only modest impact on attitudes and behaviour. Campaigns work best when combined with other interventions, such as enforcement of traffic laws and regulations, or provision of other safety services and products, or public relations. The effectiveness of publicity campaigns when they are backed up by enforcement is shown by substantial reductions in the frequency and severity of casualty crashes in Australia, New Zealand, North America and Europe. The link with law enforcement is essential. The fear of being caught and penalised for traffic offences appears to be a more powerful motive for reducing speed than the fear of being involved in a crash. For instance, a campaign is important to lift the profile of speeding as an issue that is legitimate for the police to pursue, and to make drivers aware of the risk of prosecution. A driver who has regularly exceeded the speed limit and has yet to be involved in a crash does not accept that the statistical evidence linking speed and risk applies to him. This illustrates why it is important to link most publicity campaigns with law enforcement in order to achieve the desired change behaviour.

3. Presentation of an Australian case study: Some of the best case studies that illustrate the effectiveness of Campaigns and Enforcement have been discussed and analysed in a report issued by the Monash University Accident Research Centre (MUARC) in Victoria, Australia. The report investigates the effectiveness of road safety public information campaigns conducted through the mass media. Case studies from Europe, North America, Australia, and New Zealand were evaluated. The type of appeal used (rational/emotional/fear), the use of supporting activities (enforcement or incentive) and the duration, intensity, timing and exposure of media placement are identified as key variables in the effectiveness of mass media campaign. One of the case studies in the report is about the Victorian Transport Accident Commission (TAC) road safety programme that has been instrumental in the development of road safety advertising in Victoria, Australia. The programme commencing in the late 80s, represented a fundamental shift away from the existing road safety advertising programmes towards a more systematic approach. Funding for the programme was dramatically increased, which in turn led to a greater public profile, improved quality of advertisements and an increasing role as a support mechanism for enforcement operations. The TACs aim was to develop a style of advertising that had the potential to provoke all drivers to actively rethink their attitude toward drink-driving and speeding, regardless of age or sex. In addition, the campaign had to launch and communicate two new Police initiatives, the Random Breath Test and Speed Cameras. Television was the major component of the TACs media budget. For two years, the

advertising agency acting for TAC continued to develop additional road safety themes (fatigue, seatbelts, motorcycles, learners, etc.). There were over 65 road safety campaigns covering the various themes. The television advertisements have been classified into different styles, based on the perceptions of road safety researchers or marketing professionals: Emotive; Emotive-instructive; Enforcement-related (an informative style); Instructive (generally learner driver messages); Emotive and Enforcement (both emotive and informative styles components).

4. Evaluation of results in Australia Impacts of TAC advertising on crashes: Scientific evaluations conducted by MUARC have shown substantial reductions in road trauma in Victoria associated with increased random breath testing and the new speed camera programme, each supported by TAC advertising. High levels of awareness of TAC speed-related publicity with emotive styles produced casualty crash reductions in Melbourne during the months in which it occurred. Casualty crashes were reduced by 12-13% when awareness of publicity campaign was at the higher level. There was no evidence of an effect of the emotive-style speed-related publicity on the injury severity outcome of the casualty crashes. The fatality risk was reduced following months with very high levels of speeding tickets and increased following months with very low level of speeding tickets. Perception of TAC advertising: The likelihood of an advertising resulting in a behaviour change was associated with its originality or information content and its ability to evoke uncomfortable emotions. The advertisements included in the emotive group were generally perceived to be more serious, less pleasant, and more emotional than those in the enforcement group. They were also perceived to be more effective (in terms of self-reported behaviour change) and were generally more relevant and credible.

5. Best Practices and Recommendations in the used case From the evaluations conducted in the above studies, it is apparent that the extent to which any individual mass media campaign affects crash frequency is determined by the characteristics of the individual campaign. It is suggested that the following characteristics are of a particular importance: The use of an underlying theoretical model; The consideration of prior quantitative or qualitative research on the issue(s) addressed in the campaign; The use of campaign supports such as legislation, enforcement and public relations or associated publicity; The type of appeal approach adopted in the campaign and the media mix used to transmit the message; and The intensity, duration, timing and exposure of the campaign.

Furthermore, guidelines for effective campaign management include recommending a responsible key agency, a limited number of messages, development decisions based on research and community support.

6. European campaigning organisations In Europe road safety campaigns are organised by several institutions: - UN Working Party 1 of the , most of the time focussing at a European Traffic week every 4 or 5 years concentrating on one area in which member governments are asked to work out this campaign on a national level. The next one is planned for April 2007, - European Commission, Directorate General for Energy and Transport, examples are: Think 10 seconds before you start (safety belts, headrests, children seats and luggage storage); Speed Kills, Effective Campaign examples, Bonn 2000, workshop organised by Deutsche Vekehrs Sicherheitsrat with the High Level Committee on Road safety, - PRI members. Prvention Routire Internationale is an organisation of all national advocacy, education and campaigning organisations. Their members have broad experience in campaigns and campaigning material on many items. With assistance of the EC now a website is set up with campaign TV spots, that might be a source of inspiration and spots might be used after agreement with the producing organisation. More info on PRI, its national members and activities can be found on www.lapri.org

7. Other case studies UK department of Transport THINK The THINK campaign is a component of the UK departments for Transports road safety strategy. THINK! Is a year round road safety banner for all campaigns, aiming to create a greater public awareness of road safety issues. Underpinned by a year round calendar of publicity, the campaign is heavily supported at local level by police, local authorities, voluntary, and private sector organisations. www.think.dft.gov.uk ASIPHEPE Let us be safe (Zulu) This South African project in KwaZulu Natal Province addressed drink driving and speeding. It combined publicity based on dramatic television advertising (adapted from the Australian emotional advertisements) with strong enforcement and new technologies. It resulted in improved compliance and less public criticisms of police revenue raising. In the 2-year period following the campaign, there was a 35% reduction in road fatalities in the province compared with 17% for the rest of the country. 8. Recommendations Based on experiences of organisations mentioned before the following recommendations for planning and execution of campaigns can be given: a. Use an underlying theoretical model or evidence from crash databases, b. Plan an evaluation to measure the effect of the campaign for future improvements, c. Define the problem and a well-chosen motto and message. For instanced: reduce your speed and keep distance during fog is too general, A message like: During fog: halve your speed and double the distance is much more effective.

d. Define your target group and find means of communication to reach them, (TV spot, handouts, radio interviews, school activities, disco activities for teenagers, fuel stations, school areas etc depending on your target group) e. Involve all stakeholders in the campaign activities, of which the police and other enforcement agencies are crucial, f. After an information period of for instance 2 weeks, it is crucial that enforcement on the campaign item is executed. g. Most countries with a campaign tradition have a year program, with 4 or 6 messages per year and an enforcement planning inclusive, h. As government has many messages to the public a large number of countries have chosen for an independent campaigning organisation that is financially supported by government (example Morocco, see also the PRI website). i. Some countries have national road victim organisations; these organisations have members with specific experience that can illustrate stories in a campaign. j. It is recommended to organise a try out, also to test if cultural elements are addressed appropriately.

9. Publications (see also www.lapri.org) Delhomme, P. (1999) Evaluation of Road Safety Media Campaigns. Deliverable 4, GADGET Projects European Commission. Inrets. France. This report reviews 265 campaign evaluations in 21 countries (but none are developing countries). It shows the importance of the link with enforcement. Epstein, T.S (editor) (1999) A Manual for Culturally-Adapted Social Marketing. Sage: New Delhi. A good reference for ensuring campaigns are planned and implemented in ways that are culturally appropriate. GRSP focus note: Road safety publicity campaigns A good brochure that gives information on implementation of campaigns and good practices. www.GRSProadsafety.org

Chapter 2: AWARENESS AND PARTNERSHIP

1. Introduction As a combined public health, economic, and infrastructure challenge, road safety is an issue that effects, and is affected by, a wide array of stakeholders ranging from governments to business, civil society, and the general public. These sectors work individually and collectively to accomplish the tri-partite goal of creating safer roads, safer road users, and safer vehicles. Historically, road injury and death have been viewed as an issue for governments-particularly those parts of governments overseeing transportation infrastructure issues and health. Sadly, in many low income countries, governments often lack the political will as well as being short of financial and professional resources to tackle road safety issues effectively on their own. The business community relies heavily on the basic road infrastructure for delivery of materials and products. This sector also includes transport operators, providing services to carry people as well as goods. They are responsible for the standards of their vehicles and drivers. The quality of service offered includes the safety of their operations and their image can be adversely affected by poor safety systems. NGOs with interests in road safety are primarily of two types: those representing or caring for the victims of road crashes, such as a Red Cross or Red Crescent Society; and those representing road user groups, such as motor clubs or pedestrian associations. Both groups have an interest in preventing road crashes and may well have substantial membership made up of individual citizens or families.

2. Is partnership effective for promoting road safety? Many sectors, both inside and outside government, can make valuable contribution to road safety. Partnerships are vital, especially partnerships that encourage community participation, thus promoting awareness. They should bring together: Transport, health, and other involved government agencies at all levels; National, regional, and local levels; Government, the private sector, and civil society. Each sector has different core competencies which, when brought together in partnership, can result in the achievement of community development objectives in a more efficient and effective manner. Society-at-large plays an important role by adopting safer behaviours and demanding safer conditions while business works individually and collectively to produce safe vehicles, safety products, engage communities, and take part in policy dialogues. Engagement by different actors along different parts of the road safety system may create the best results by leveraging the full range of expertise and resources along a continuum. In some countries, there are different balances of weight between public-private and civil organisations. Partnership can build more stable and powerful organisations. Every partner has its own strength, government in policy development, NGO's in involving public and the private sector in marketing. Partnerships combine the strong points of each. The Knowledge Resource Group of the Business Partners for Development programme, in its publication Endearing Myths, Enduring Truths suggests that successful partnerships are those shaped around common or shared activities that first and foremost deliver against the individual aims of each partner, particularly where these have been legitimised within the partnership. However it should not be thought that partnership is appropriate for every issue

in every place. Partnerships take time and energy to build. The trust needed between the partners is not always present and self-interest can prevent it from developing.

3. Presentation of a case study: A simple partnership between public sector and an NGO is illustrated in the example of the Yemen Red Crescent Society (YRCS). In 2001, the YRCS conducted a vulnerability and capacity assessment study in Hajjah and Hodeidah governorates. The study showed that traffic accidents are a major hazard and the YRCS decided to initiate a pilot road safety project in the two governorates. The YRCS local branches carried out the project that aimed to: Reduce the number of the traffic accidents; Increase the level of the local communities awareness of the hazard; Change the behaviour of students towards traffic; and Decrease the number of casualties among students. In collaboration with the Ministry of Education and the Ministry of Interior (Police Traffic Directorate), the YRCS Disaster Management Unit collected information related to road safety activities and programmes from the Egyptian Red Crescent Society and other sources worldwide. The target population is students of elementary schools as they are the most affected by road accidents. Students were trained by the police department to organize the traffic in front of their schools. All students were trained in first aid. The YRCS and school administration organized a meeting with students parents to get their approval. Among students, team leaders were selected to be in charge of their daily interventions.

4. Issues At the beginning of the project, some female students parents were reluctant as for the involvement of their daughters in such project. This issue was overcome after the YRCS, the school and the police introduced the project and assured families that their daughters were in safe hands and the project was under control of three institutions. Same issue was raised at the beginning of the projects when Yemeni drivers were not accustomed to see students and especially young girls organizing traffic. As the project developed, female students - with support from traffic police, their schoolteachers and the YCRS- became more accepted by drivers.

5. Evaluation of results So far results of such interventions were highly positive and qualitatively evaluated. Some of the impacts on students, schools, and YCRS are listed below: Students behaviour towards both traffic rules and policemen changed in a positive way. More parents are asking to enrol their children in the programme; and more schools asked to be involved in the programme. All children involved in the programme as well as all teachers in the involved schools were trained in first aid. The number of students playing in the streets decreased, which showed that they were putting the rules they learned into practice. The relationship between these schools and the traffic police were strengthened.

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One of the private schools proposed to integrate the road safety in its curriculum. The authorities now accept the YCRS as an auxiliary in implementing projects. The YCRS produced road safety guidelines for use in schools. Donors decided to continue to support the project after visiting Hajjah and Hodeidah. The project will be expanded to Sanaa and Dhamar governorates.

6. Lessons learned / Best Practices Local programs and community participation are essential to ensure that measures are tailored to the needs of communities, especially the needs of poor and vulnerable people, and encourage local ownership and acceptance of the improvements. Community participation also encourages intersectoral approaches. NGOs are often good at brokering partnerships and representing the underrepresented. On the other hand, it is particularly important that business partners work with government and others to meet the road safety challenge. Transport services and vehicle manufacturers are major business sectors that are directly affected and involved. They can and should contribute significantly to the improvement of road safety practices and raising of safety standards. Ten key lessons on partnership are proposed based on the experience of the Global Road Safety Partnership: 1. Take a systems approach to systemic challenges. 2. Good data and rigorous science are crucial at the outset to establish effective programs and baselines, and to measure performance / create impact metrics. 3. Get technical experts on board early. 4. Establish communications systems to share lessons across program early on. 5. Establish clear reporting, measurement and cooperation systems within the partnership. 6. Understand the challenges, expectations and motivations facing each of the sectors involved in partnership and try to work effectively within these constraints. 7. Identify leaders / champions in the field and in the political arena to advocate, help focus attention, and underscore the issues importance. 8. Underscore that the social issues around which these partnerships emerge are largely ones for government to solve-engage in cross-sector-thinking about how to enable government to more effectively address these issues in the long term, thereby building sustainability into the system. 9. Focus on the contextual need and create programs that can provide the best benefit-cost ratio. Do not assume that the most convenient program is the best one to establish. 10. Engage and build the capacity of local experts and establish relationships; try to avoid engaging roving consultants.

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7. Recommendations Partnerships Involving Government Road safety is rarely a high priority for governments in developing and transition countries. Typically resources are underprovided and responsibility is dispersed among a number of government agencies. This can attract public bodies to a partnership approach as they see possibilities of attracting additional resources both professional and financial to address the issue. However there are difficulties when involving government agencies in partnerships. Partnerships require real relationships between real people and as politicians and government officials come and go (with alarming frequency in some countries) there is a constant need to reinforce, or recreate the trust needed for a partnership to function. There are devices that can help. Governments can and do enter into contractual relationships and a pseudo-contract, for example a Memorandum of Understanding, can provide a framework within which the members of a partnership, including government, can work and acknowledge what each will deliver and expect. In its recommendations for developing country governments drawn from experience of its programme, Business Partners for Development (BPD, 2002) identify the following opportunities for governments:

Ability to gain political credibility and to improve relationships with communities; Greater transparency; Learn of more appropriate and replicable technical, social and institutional solutions; Leverage funding; Turn lessons into legislation; and Disseminate knowledge and new skills.

The BPD report also makes a number of recommendations for governments involved with partnerships. Particularly relevant to road safety are:

Build internal capacity there may be public sector capacity issues for staff involved, both in terms of technical aspects of partnership development and with respect to resources. Developing country governments may look for support from donors to build such capacity. Create enabling environments governments have a key role to play in creating an enabling environment that allows for and rewards partners. These include: ensuring that national standards, with legislation where necessary, are in place; and stimulating local and national dialogue on partnering, especially the relationship between public sector responsibilities and those of private and civil societies; Scale up the positive outcomes of demonstration projects. This may involve getting other regions or local governments to take up the results and apply them on a more comprehensive basis, or a national government rolling out a successful approach

8. Other case studies The Global Road Safety Partnership (GRSP): GRSP is a global partnership between business, civil society and governmental organizations collaborating to improve road safety conditions around the world. Initiated by the World Bank Group in February 1999, GRSP stakeholders have been identifying ways in which they could work together to improve road safety globally. The International Federation of Red Cross and Red Crescent Societies hosts the GRSP Secretariat at its headquarters in Geneva, Switzerland.

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The GRSP is governed by a Steering Committee and assisted by a small Secretariat. Over 200 organizations have taken an active role in establishing the GRSP and it is now active in over 10 countries. GRSP is one of four Business Partners for Development (BPD) programs initiated by the World Bank. BPD is a project-based initiative that studies, supports and promotes strategic examples of partnerships for the development of communities around the world. The underlying concept of BPD is build on the premise that partnerships benefit the long-term interests of the business sector while meeting the social objectives of communities by helping to create stable social and financial environments. Road safety offers an opportunity for a wide range of stakeholders to actively engage in addressing the global problem of road accidents, deaths and injuries. Previous efforts by governments and donors to try to improve road safety in developing and transitional countries have had limited success and many interventions simply have not been financially or institutionally sustainable. The Global Road Safety Partnership aims to identify innovative ways to improve road safety by applying the business partnership approach. It hopes to produce solid evidence that partnerships offer win-win benefits for all parties and that this approach can be widely used throughout the world. Through a comprehensive approach to road safety, GRSP partners collaborate and coordinate road safety activities. This approach aims to build the capacities of local institutions and by enhancing the ability of professionals and communities to pro-actively tackle safety problems. This concept underlies the Global Road Safety Partnership: a new paradigm for dealing with road safety in these countries. The partnership is an informal network of businesses, civil society organizations and relevant government departments working together to realize common goals. The expectation is that partnerships between these three sectors will result in more effective and sustainable development activities than if any of these partners acted on their own. Global Road Safety Strategy (GRSP) strategy embodies the following key elements: Forging a partnership between all the key groups in society with a strong vested interest in improving road safety - the business community, civil society, government and donor agencies. This coalition becomes the focal point for interest in road safety interventions. Partners collaborate on road safety projects and press government to deliver on those interventions which only government mandate and accomplish (e.g., research, major infrastructure improvements, road safety database analysis, etc.). Undertaking-with finance provided by the business members of the coalition-small-scale interventions and demonstration projects that show that road safety can be improved in achievable and cost-effective ways. In a typical donor intervention, the concerned government agency tends to focus unduly on only minor infrastructure improvements (e.g., black spot improvements and road safety audits). The local GRSP partners emphasize a collaborative and holistic approach to road safety with all stakeholders contributing resources by actually financing and implementing the required interventions. Sharing lessons learned from ongoing projects already being implemented or involving the business sector and demonstrating that partnerships can be increase development impact.

A number of specific case studies and countries activities as well as links to major organizations dealing with road safety can be found on the GRSP website: www.GRSProadsafety.org

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9. Publications Business Partners for Development (2002) Putting Partnering to Work. BPD, Washington Global Road Safety Partnership (2001) Moving ahead: emerging lessons. GRSP, Geneva, Switzerland. www.GRSProadsafety.org Knowledge Resource Group, Business Partners for Development (undated). Endearing Myths, Enduring Truths. BPD, Washington PriceWaterhouseCoopers (2002) Evaluation of Business Partners for Development for the World Bank and DFID. PriceWaterhouseCoopers, London, UK Runciman, D (2003) Partnering the State, in Partnership Futures, Issue 1, 2003. The Copenhagen Centre. TRL and Babtie Ross Silcock (2002) Review of Road Safety Management Practice TRL Report PR/INT/216/2002 for DFID. TRL, Crowthorne, UK Zadek, S (2003) Partnership Futures, Issue 1, 2003. The Copenhagen

Centre.

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Chapter 3: CRASH DATABASES

1. Introduction The need for a road crash and injury database. Crash databases are an indispensable tool for: - Drafting a road safety action plan and a strategy. One needs to know: What is the problem, what are accident root courses; than one can design countermeasures, - Evaluation of road safety countermeasures, like campaigns, new legislation, etc - Formulation of enforcement plans - Road improvements, for which location information is evident Numerous groups are interested in road safety and need to use road crash data. They include road safety professionals, highway engineers, the police, lawyers, research groups, politicians, teachers, statisticians, motor manufacturing companies, vehicle fleet operators, insurance companies and even members of the public. Some of the key reasons for collecting crash and injury data are to: overview the problem, monitor trends, identify high risk/problem groups, identify high risk, hazardous locations, enable objective planning and resource management, evaluate effectiveness and monitor achievement of targets, make international comparisons, and provide evidence for prosecution.

Potential sources of data include:

police crash data hospital and medical data insurance data vehicle operators special surveys Most countries have made it a legal requirement that road crashes, at least those involving casualties, be reported to the police. This requirement is often reinforced by law, as especially in severe crashes juridical follow up should be supported by accident reports. Also insurance companies require claimants to follow this law. However, in many countries a significant number of road crashes are not reported to the police. The level of so called under-reporting varies considerably from country to country, but even where there is a legal requirement to report crashes involving personal injury, studies of hospital data have demonstrated considerable under-reporting (as high as 97 per cent missing for some categories - AeronThomas, 2000). Hospital data are an important source of information, especially about injury and treatment, but information relating to the scene of the crash is often missing in medical data. Also, in poorer countries, hospitals cannot yet cope with the burden of collecting accurate data on road crash victims. Nevertheless a minimum requirement should be the collection of reliable data about causes of death. For trend analyses and overviews of the scale of road death and injury it is recommended that both health and transport (usually police) records be examined. Whilst direct matching of these two sources is difficult, comparisons of aggregate data from both sources can help to confirm trends or identify problems with the data where there are differences between the two sources. The other data sources such as insurance have more limitations and it is usually the police who provide the main source of crash information for national systems.

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2. How can a Crash Database be effective? Road accidents are rare events with extreme outcomes that statistically represent a small proportion of real-life interactions between drivers and the road environment or between drivers themselves. Even though accidents are rare, all information that can be derived from such events is of a great value to road safety engineers when tracing the possible causes of an accident. Accident data thus are a crucial element of a safety diagnosis. They are the basis for any road safety action plan and a major tool for the decision-making process when priorities have to be defined and immediate actions to be taken. The types of accidents on which efforts should be focused or the sections of a network requiring immediate remedial actions need to be determined. With systematic monitoring, the formation of black spots can be observed so that the location and time of future problems can be anticipated. This knowledge greatly facilitates budget planning and should have a strong impact on the strategic elements, such as the determination of the main accident reduction target and the development of the road safety action plan target. An efficient road safety program must be based on these data since realistic targets can only be established by using accident-related information. Some finetuning will also be required at local levels, where politicians and civil organizations may have their own goals.

3. Presentation of a case study

The case study illustrated below is from Fiji where a typical utilisation of a good crash database has lead to an improvement of the road design with a positive consequence in reduction of crashes and casualties. This example is taken from TRL reports.
The accident data collection form is shown below:

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The following Accident Location Map is generated by the MAAP software: Source TRL

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A Stick Diagram summarizes accidents properties: Source TRL

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The following photos show the before and after treatment of a road section Before Treatment: Source TRL

After Treatment: Source TRL

Crashes before and after improvements in 1996-97, Fiji Source TRL

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Kings Road Laqere Bridge-Wainibuku

4. Evaluation of results and quality checks 16
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Accidents

Fatal+Hospitalised Non-Hospitalised

10 8 6 4 2 0 1994 1995 1996 1997 1998 1999

5. Lessons learned / Best Practices Good examples are numerous. In the ESCWA region the Jordan annual accident report is a good example, also to show progress made in accident reduction and vulnerable road users. It is essential to produce annual reports on crashes with various analyses and data. These reports will give automatically an evaluation and comparison with previous years. As the whole system depends on the quality of data input by the police organisation, which has also other priorities, periodic checks on quality, accuracy and time gaps are needed.

6. Recommendations Software packages for database management and Analysis Crash databases are complex in structure but powerful and easy-to-use software is available. The packages chosen should be simple to use, with easy data entry, full editing and back-up facilities, and logical internal checking routines to ensure that the data is as accurate as possible when entered. Validation of data should be done as close to the data entry as possible, to enable rapid follow up and correction of errors in the data records. Key software facilities usually include: Data entry, data management and validation checks: enable electronic file management and provides standard logical checks within fields and between fields which are usually automatically applied on data entry. Content of the database The police have limited time to spend on recording crash information. Therefore they need to strike the right balance between the amount of detail required by all stakeholders and the ease with which they can collect the data according to their expertise and the tools and support available. Ideally the police should not have to record the same information twice and therefore the data required for evidence and

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for the database should be made as compatible as possible. This can be done by making the form used for data entry acceptable as evidence in the courts. For the road safety professionals, the database should at least be able to answer the following questions: Where did crashes occur: When did crashes occur: location by map coordinates, road name and km post, class by year, month, day of month, week, time of day

Who was involved and who People in relation to vehicles, vehicles, was injured: animals, roadside objects What was result of the worst severity of injury or property crashes: damage What conditions: environmental poor light, weather, road surface condition

How or why did the crashes collision type, driver fault type occur: The exact details to be collected for the database are usually decided by a multisectoral committee to ensure that all stakeholders are consulted and that a reasonable spread of data are collected within the capacity of the police. Ideally, the required information should be completed at the scene on a user-friendly form, or booklet. This form should be easy to use and be acceptable as evidence in the courts. The form is usually structured for easy data entry which means grouping information by: general details, vehicle and driver details, casualty details, location information and sketch map, and simple summary description. Outcome of the database Tabulations: provide cross tabulations of fields by crash frequencies, or casualties, or the vehicles involved. Tables can be set up as standard for regular and automatic output. Presentation graphics: display figures and tabular results graphically in the form of bar charts or pie charts. Hazardous location identification and investigation: provides the user with a list of the worst sites, however defined, in any area of interest. Now usually uses electronic maps and powerful onscreen tools for selecting sites and areas and carrying out on line analysis. Therefore GIS (Geographic Information System) related crash data are recommended. As well for the roads department, as well for enforcement at place these maps give a direct insight in location related crashes. Stick diagrams: provide engineers with a simple visual tool for searching for crash patterns at selected sites and areas. Key features of a crash (e.g. type of collision, hour of day, vehicle types) can be selected and these are shown using symbols where each column represents one crash.

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Collision diagrams: is another tool for engineers. These show in a simple way all the types of crash and related road user movements over a period of time. Performance indicators: are important for assessing risk and monitoring changes. This facility requires traffic, demographic and geographic data to be linked to the crash database. The system should enable the production of a number of useful outputs. These should include regular reports varying from simple 24-hour reports often required by the police to comprehensive annual reports available as a public document. The system also needs to provide widespread access and it is important that local road safety teams can analyse their own data. Where there is strong decentralisation of the data collection and entry and road safety responsibility, then the national system should meet the local needs but also have a standard and simple system for collating the data at the national level. Countries should also consider participating in regional systems such as the OECD International Road Traffic and Accident Database (IRTAD) (http://www.bast.de/htdocs/fachthemen/irtad/) or the Asia - Pacific Road Accident Database (APRAD) run by the UN-ESCAP (http://www.unescap.org/tctd/pubs/files/aprad_usermanual.pdf). This will encourage international harmonisation of the databases and ideally countries, which are revising their systems, should take into account the data required at the international level.

7. Publications AERON-THOMAS A (2000). Under reporting of road traffic casualties in lowincome countries. TRL Report PR/INT/199/00. TRL Ltd, Crowthorne. Asian Development Bank (1999). Road Safety Guidelines. ADB, Manila, Philippines. Moon J (2003). APRAD and road safety in ASEAN. Proceedings of the 3rd GRSP ASEAN Seminar, UNESCAP, Bangkok, Thailand. OECD: Annual reports of the International Road Traffic and Accident Database (IRTAD) (http://www.bast.de/htdocs/fachthemen/irtad/)

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Chapter 4: BLACK SPOT TREATMENT

1. Introduction The origin of a black spot is a monitoring map maintained by the police in which a fatal accident was represented by a black pin. Many pins formed a black spot. So a black spot is a place in the road network with a high accident frequency, also called a hazardous location. Most of the time these are intersections, pedestrian crossings, bends etc. The terms hazardous location and high accident location are often used as a synonym. As the effect of a crash can be of a fatale nature or severe injury, some countries have a definition of a black spot based on weighing fatal-injury- and only material damage crashes. The gravity of a black spot can thus be defined and prioritised. The effectiveness of countermeasures can be rated with a cost benefit analyses. Accident costs and prevention by countermeasures can be expressed in a pay back period, which is an indicator for cost effectiveness. Design of countermeasures is the first step, evaluation of the countermeasures applied is another crucial part.

2. Is Black Spot Treatment an effective measure? Black spot correction is usually seen as a highly profitable action in terms of accident reduction and cost-effectiveness. As such, it is often the focus of a road authority, particularly during the first years of interventions.

3. Presentation of a case study: A case study that illustrates a black spot treatment is taken from the GRSP Hungary activities. At a GRSP committee meeting in May 2000, the participants agreed to launch a project aiming to improve the safety of three selected black spots by replacing the traffic signs with new ones. 3M Hungary decided to support the project with highly reflective traffic signs while the Hungarian Institute for Transport Science was contracted to select the sites with the help of the local road maintenance company and the police. On the basis of the conflict technique study, the traffic survey and the discussions with local experts, a 60km/h speed reduction was introduced on the main road and the traffic signs were replaced by new ones. Yellow cross stripes were also applied on the pavement to slow down the traffic flow approaching the hazardous intersection. An application approval was needed to place the traffic signs on a 3M ScotchliteTM diamond grade background. The signs were placed in April 2001 while the markings in October 2001.

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4. Evaluation of results First Site Before studies: Example of the conflict technique study and speed surveys that were conducted on each branch (a whole day before study took place on October the 20th 2000.). Main direction-main direction conflicts Number of conflicts by type: "D": 3 F "E": 2 hard braking, 4 near E fel impact conflicts yr t G "F": 2 83.
fe l
OP ST OP ST

pa fel 83. t P

D
ET M RO

After studies: After studies show that the number of the conflicts did not drop but their severity reduced. The speed survey is shown before (2001/02/09 and 2001/04/27) and after the pavement markings (2001/12/01). The 60 km/h speed limit signs performed no significant effect on the distribution of speeds. The cross stripes however managed to reduce the speed by 4-6 km/h in both direction (2001/12/01). Between 1996 and 2002, 18 personal injury accidents were reported of which the majority were caused by cross direction impacts, mainly due to failing to give way. From the reduction of accidents and the speeds performed by the motorists, one may qualify the treatment as successful, though the number of conflicts between vehicles has not changed significantly. The crossing remained hazardous. The reason is the unfavourable horizontal alignment and the potential hazard that a crossing of a motorway ramp and a main road holds not to mention the traffic generated by the store at one of the legs of the crossing.

fe l

5 4 3 2 1 0

light serious fatal

1996 1997 1998 1999 2000 2001 2002

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Second Site A hazardous section of 500m was also treated. Most of the accidents recorded are single vehicle accidents due to excessive speeds. One of the reasons may be the late recognition of the road curvature.

7 6 5 4 3 2 1 0 1996 1997 1998 1999 2000

light serious fatal

2001

2002

The effect of the treatment was measured by speed surveys and the survey of lane keepings. It is well demonstrated that the curve is safe enough even at the speed 100 km/h. After the new signs were introduced average speed went down by 2-3 km/h and even the fastest car drove at a lower speed. The traffic signs were placed in February 2002. Only one serious accident occurred at this location since then (report published early 2003).

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Third Site At this site there is a sharp curve right after a hill that is difficult to notice at high speed. The new traffic signs were installed in March 2001. The average speed is over 80 km/h. At this speed the curve that is unrecognisable from behind the hill can only be taken with a hard brake. After the new signs were placed speeds went slightly down. The road was repaved in November 1997. One week after the opening a personal injury accident occurred here. The main types of accidents here are roll-over and roll off the road due to excessive speeds. After the treatment (April 2002), no personal injury accident was recorded at this site.

7 6 5 4 3 2 1 0

light serious fatal

1995 1996 1997 1998 1999 2000 2001 2002

Summary The positive effects of the treatment at all three sites are reduced speeds, better lane keeping and somewhat calmer traffic flow. The success is shown in accident statistics; however the real effect can only be verified after a 2-3 years.

5. Lessons learned / Best Practices Sites identified as Hazardous may differ depending on which identification criterion is used. For instance, the accident frequency tends to detect more sites with higher traffic flows, while the accident rate detects more sites with lower traffic flows and accident severity detects more sites in rural environments. Each of them highlights problems from a different perspective and it appears as a good practice to analyse the safety performance of a road network from more than one angle: a high concentration of accidents at the same location is in itself a strong indicator of a road related problem that should warrant safety diagnosis; the accident rate measures the level of risk faced by road users. When road users travelling at a specific location face an abnormally high risk, corrective actions should be taken; reducing road fatalities and injuries should be the ultimate objective of any road safety action and accordingly, it is sensible to give special attention to those sites where more severe accidents occur.

6. Recommendations The development of safety treatments requires very good knowledge of the accident mechanisms and, more particularly, a good understanding of hazardous traffic features. Expertise and experience, which allow the development of sound engineering judgment, are key elements in road safety engineering (road safety is often achieved from details).

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Two levels of road infrastructure improvements, with differing budgetary impacts, can be identified: network modernization: development of new infrastructures that are safer in design, based on findings from black spot evaluations introduced in new design guidelines. This systematic approach requires substantial investments; improvement of the existing network through safety studies conducted at hazardous sites. Remedial measures are local in this case, such as improvement of an intersection, correction of a horizontal curve, removal of a roadside obstacle, etc. investments requirements are less significant. But if they are to be fully effective, they must sometimes be supplemented or accompanied by measures applied elsewhere on the treated road (to prevent accident migration). This type of action is highly effective. It might be combined with road safety inspections of the existing road network.

7. Publications Road Safety Manual PIARC Technical Committee on Road Safety (C13) Urban Safety Management: Guidelines for Developing Countries: by A Quimby, B Hills, C Baguley and J Fletcher TRL / DFID

Case study from Hungary: The site selection, the before-after studies and the evaluation were performed by Tibor Mocsri (Kzlekedstudomnyi Intzet Rt.). The traffic signs were produced and installed by 3M HUNGARY (Jzsef Bekes) with the assistance of the county experts: Zsolt Zentai (Gyr-Sopron Megyei Kztkezel Kht.), rpd Palots (Pest Megyei Kztkezel Kht.) and Pter Monics (Fejr Megyei Kztkezel Kht.)

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Chapter 5: ROAD DESIGN AND SPEED MANAGEMENT

An example from The Netherlands

Summary In the Netherlands, traffic calming started in the sixties when the woonerf was created. Based on evaluations, the strategy Sustainable Safety was developed in which the capacity of the human being was taken as a basis. Speed management is one of the main elements in this strategy. Starting in 1998 about 15% of all potential living zones had a 30 km/h regime. In the framework of Sustainable Safety, a broader program has been agreed upon in which the percentage of 30 km/h roads will be enlarged to 50% in 3 years time. In a contract made up by municipalities, provinces and the Ministry of Public Works in total 400 million guilders was planned for 3 years from 1998 as a start program for Sustainable Safety. The program has as an aim to reduce traffic victims by avoiding conflicts or reducing the severity of a collision by a new hierarchy of roads and speed management. This program should contribute to a reduction target of 25% in 2000 and 50% (casualties 40%) in 2010 in comparison with 1986. The goals have been achieved in 2004. This approach has been copied in some Middle East countries.

Ambitions on traffic safety In the Netherlands, like everywhere in the motorised world, the roads are unsafe, although the situation is not as bad as in many other countries. Together with the United Kingdom and some Scandinavian countries, the Netherlands is in the top-ten of traffic safety. Nevertheless, the country is not satisfied with its relatively favourable position. In 1998 on every million inhabitants, 80 people are killed and 1300 are hospitalised because of traffic accidents. The financial consequences of traffic accidents are estimated at an amount of US$ 1.000 per motor vehicle each year. In comparison: Many groups in the society find the financial losses resulting from traffic jams unacceptable. These are estimated at an amount of US$ 150 per motor vehicle each year. An increase of traffic together with a decrease of victims Since the 60s, the Netherlands has witnessed a tremendous growth of car traffic. In the same period, a lot of effort has been put into road safety. From 1970 - 1990 car mileage has grown by a factor 2.5 and in the same period the number of fatalities has dropped also by a factor 2.5. This means that the society as a whole succeeded in bringing down the risk (number of fatalities per billion motor vehiclekm.) from an index of 100 to only 15, in twenty years time. On the other hand, it is quite ambitious to aim at the same reduction in road victims in the next period. For instance, as in all fields of policy, the Netherlands started by taking the measures that were relatively 'easy' (low-cost, no great opposition). Succession of safety-measures During the past decades, there was a succession of safety-measures. Each group shows an S-curve in effect. At first, while the concept is elaborated, the effect is small. Then follows a period of rich harvest. After that, the phase of diminishing returns (more effort, less effect) is reached. In the 50's the emphasis lay on: legislation and regulation (speed limits); In the 60's on: road building (by building motorways, urban arteries and networks of bicycle-paths and on the other hand by a more friendly lay-out of roads like the 'woonerf', a residential street designed for all kinds of activities, commanding very low speed); In the 70's on:

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passive safety (protective devices like seatbelts, deformation zones, soft edges and air-bags in cars, helmets on motorcycles and mopeds, reflection on bicycle-wheels);

In the 80's on: improving the behaviour of the road-user (by combinations of education, enforcement, and campaigns in the media). Differences in risk Now, in the 90's, a new approach is taken, which is called 'Sustainable Road Safety'. It is based on the observation that there are large differences in risk (the chance to get involved in a serious traffic accident per million motor vehicle-km). The risk not only differs between one type of road and another type, but also within each type of road. Apparently road conditions and road lay-out (design) do have a lot of influence. The observation that some situations take the limitations of man better into account than others, is not new. We all know about the existence of 'black spots', traffic situations with an excessive number of serious accidents. And, in the course of time, learning from international experience, guidelines for motorways were developed resulting in a kind of road with a risk that is (at least relatively) very low. Below are some averages on the number of serious accidents per billion motor vehicle km on different types of roads, with different speed limits: Road type Within built-up areas: 1. 'woonerf' and residential streets 2. residential roads 3. urban arteries Outside the built-up areas: 4. local rural roads 5. rural arteries 6. motor roads 7. motorways Speed limit 30 km/h 50 km/h 50 km/h, sometimes 70 km/h 80 km/h 80 km/h 100 km/h 100 or 120 km/h serious accidents/ billion mvh.km 200 750 1330 640 300 110 70

. Based on this scheme, all Dutch roads have been categorised and will be fitted according to the speed regime, starting with the lowest categories the residential zones and a new category of local rural roads with 60 km/h regime.

Limited freedom of road use As per this scheme, the risks are relatively low on the top and on the bottom. These road-types have in common that the freedom of road use is strictly limited in one way or another. At one end are motorways where only high-standard motor vehicles with well trained drivers are allowed. These highways are designed according to well proven guidelines. A relatively high speed can be allowed because no interruption to the homogenous flow in each direction is possible. At the other end are residential streets with a lay-out that commands low speed. Although there may be chaos and little discipline, the problems are limited as long as speed is kept low. Incompatible functions On local and regional roads the situation is often just as chaotic. Unexpected encounters can happen all of a sudden, while a speed of 50 km/h or 80 km/h is allowed. On these roads the vast majority of unsafe situations are to be found. Consequently, it is found that these roads have too many functions. An example is the traditional main street: it acts as a residential street and shopping street, where cars are parked and busses stop, where people chat and children play. It is a walkway to school, a

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cycleway to the city centre, a route for public transport and a channel for heavy vehicles. In addition, it is intersecting the neighbourhood and disturbs local life and cultural heritage. On many rural roads a similar incompatible accumulation of functions is to be found. All makings must meet the measure of man's mind In this context, it is important to refer to the imperfection of man. Nobody acts perfectly all the time. Be it permanently or at least temporarily, everybody is disabled in one way or another. Some people are bodily disabled, too young to understand or too old to act quickly. All people are distracted from time to time, window-shopping, looking at other people or whatever. On the road everyone is making mistakes, all the time. Therefore, in Sustainable Road Safety the limitations and flaws of the common road user are the reference standard. Separation of incompatible functions, Each of the road functions presents its own demands. As long as we do not separate incompatible functions, the total demand on the human mind is too high. Regarding car traffic, three main functions should be distinguished: access function: car traffic going to/from buildings, grounds, woonerf and pedestrian precincts, with a constant interchange of traffic all over the length of the road; connecting function: car traffic to/from large urban districts, villages, rural areas, meant to relieve those areas of streams of car traffic, with an interchange of traffic at a limited number of crossings and intersections only; flow function: rapid through traffic, without interruption. These main functions must not be intermingled. A clear choice should be made. No road should get more than one of these functions for car traffic, if any. Channelling, to minimise hindrance and danger The need to make a clear choice does, of course, not mean that all streets with through traffic should be handed over to the flow function. Car traffic should be distributed and guided in such way that the total amount of hindrance and danger is minimised. Streams of car traffic should be channelled into a small number of well-designed arteries. Self-explaining roads, safe and friendly As a result from the above analysis, the first step is to make a comprehensive plan in which each road is given one single function for car traffic. Subsequently each road should be laid out to create the conditions to perform this single function as safely and as pleasantly as possible, taking in account the interests of people living and working in the neighbourhood and also the demands of other modes of traffic. The layout should be self-explaining. The ideal is that at every point any road user understands immediately what kind of behaviour is expected in that situation. Function, form, road-use in accordance with each other As for traffic planning and road engineering, the key to Sustainable Road Safety is bringing the following: * function = the intended situation on the road * form = the lay-out of the road * road-use = the actual behaviour in accordance with each other. Form is the instrument to make the use identical to the function.

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To achieve this, it is important to: 1. prevent unintended use; 2. keep speed very low, or prevent large discrepancies in speed, in direction and in mass; 3. prevent uncertainty amongst road-users. What does this mean for the layout of the different types of roads? Roads with an access function In towns and villages the access function brings about that pedestrians, playing children and cyclists use the road, that people are shopping and chatting, that cars are parked, heavy vehicles are loaded and the milkman makes his round. This prohibits speeds of over 30 km/h. In rural areas the access function brings about that cyclists, animals and agricultural machinery use the road where people are walking and lorries are turning. This prohibits speeds of over 40 km/h at crossings and entries, while between crossings and entries 60 km/h may be acceptable. Even when it is feasible to keep speeds within these limits, the possibility of conflicts still exists. However, low speeds do allow more time to see and anticipate one another. In addition, if anything might happen, the impact will be less serious. Roads with a connecting function To relieve residential and rural areas from streams of car traffic, roads with a connecting function should be made relatively attractive. This means that the speed limits must be higher than at roads with an access function. For this small number of roads we might stick to the speed limits that are applicable to all roads at present, which is 50 km/h inside built-up areas and 80 km/h outside. These speeds bring about that there should be separate paths or parallel-roads for pedestrians, cyclists, parking, and loading/unloading. In addition oncoming traffic should be avoided in many cases. At crossings either the speed must be brought down (like at round-abbots), or streams must be safely separated (which means high-standard traffic lights, if not flyovers) Roads with a flow function The flow function requires a design, which allows driving safely at relatively high speeds. In the Netherlands it is thought that 100 km/h in densely populated regions and 120 km/h in other regions is enough. However, whatever speed limit is chosen, complete separation of streams is a must. Two-phase implementation Many road-management authorities already act in the sprit of Sustainable Road Safety. For instance: municipalities have already made large sections of the built-up area into 30 km-zones; regional roadauthorities are improving road safety by constructing roundabouts, in some areas rural roads are transformed into 60 km-zones. Nevertheless, there is a need to speed up this process. A joint committee on Sustainable Road Safety was set up by the organisations of road-management authorities together with the Ministry of Transport and Public Works. Various problems were encountered. Road-management authorities endorse the concept but want support during implementation. While plans are to be further elaborated at the local level, the consequences are not always clear and work must be done to gain support for various measures. The main problem, however, is that integral implementation will be far-reaching and time-consuming. In light of these problems, conclusive agreements concerning the comprehensive and integral implementation of Sustainable Road Safety could not yet be made. Still a great deal can be achieved at this stage. Therefore, the committee decided to follow a two-phase implementation, guided by feasibility and practicability.

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Start-up programme Sustainable Road Safety 1997-2001 A joint Start-up programme for Sustainable Road Safety was signed by the Minister of Transport and Public Works, together with the organisations of road-management authorities. It comprises agreements, spanning from 1997 through 2002, on: 1. engineering and legislation; 2. additional enforcement; 3. education, information and communication; 4. transfer of knowledge; 5. making long-term plans. Integral implementation will be cost-effective Together with guidelines for road layout, overall categorisation of roads will be the basis to devise a joint national plan for the integral implementation of Sustainable Road Safety. Financing will be the hot issue. A lot of money is required for the realisation of all the necessary infrastructural measures, even when it is done in combination with other public works. But besides the prevention of sorrow, it will result in enormous financial benefits for the nation as a whole. A longterm policy is cost-effective. Economists have calculated a yearly return of 9% in the long run. The problem is to relate these investments to the future savings regarding material damages, health care, productivity-loss and support to dependant relatives. Conclusion A multidisciplinary approach based on a hierarchy of roads and its speed management, with transfer of technical knowledge, political support and stimulating budgets available together with support on all levels of Government can create a major step in achieving the traffic safety goals. Other Good Practices More Road Design interventions are shown in the Appendices. Extracts from the Chapter 6 (decisionmaking for solutions) of the Urban Safety Management: Guidelines for Developing Countries (TRL/DFID) show a list of various types of measures that could be implemented in road design and indicate many of their advantages and disadvantages.

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Chapter 6: HEALTH AND ROAD SAFETY, PREHOSPITAL CARE

1. Introduction Road crashes present a major and growing challenge to the health sector worldwide and in the MENA/EM region. Worldwide, 1.2 million people are killed and about 50 million are injured each year in road crashes, and the WHO predicts 2.3 million deaths from road accidents in 2020. In the MENA/EM region, more than 70,000 deaths from road crashes cost the region approximately $7.4 billion in 1999. Road crashes increased by 20% in the MENA/EM region from 1980 to 1995; and the trend has continued. However countries can reverse this trend without spending large sums of money. Several highly motorized countries have achieved notable successes in reducing deaths and injuries from road crashes. Activities and achievements in the MENA/EM region vary from country to country, but several have moved forward on road safety management, and the more motorized countries in the region, notably the Gulf states, have made considerable advances in their road infrastructure and supporting systems. However, the problem of pedestrian deaths and injuries remains extremely serious for the whole region. The World Health Organizations five-year strategy for preventing road traffic injuries highlights the need to focus on epidemiology, advocacy, and prevention (Peden and others 2001). The health sector has a key role to play in all three areas. An important additional area where health sector can and should take the lead is injury control.

2. Pre Hospital Care In a recent publication of the WHO on prehospital care systems (see www.who.org) 15 cases on this item from different parts of the world are given. In the systematic approach after a crash the life of a victim depends on care in three phases: Phase 1: From 0 20 minutes after the crash: The victim depends on volunteers, passing road users who assist in stop bleeding and support or restore respiration. For this it is recommended that professional road users, police and others get first aid training. An often made mistake is that untrained supporters move the victim and damage crucial injured body parts. Phase 2: From 20-60 minutes after the crash, trained ambulance staff prepares the victim for transport to the hospital, if they have enough expertise they can stabiles the patient. Sometimes the fire brigade needs to rescue the victim from the wreck with professional tools. Phase 3: After 60 minutes of the crash, when the victim is in the hands of specialized trauma doctors, all needed care that is locally available can be applied. Restoration of the victim depends very much on the speed of operation in which the golden hour (time between crash and stabilization of the victim) is crucial for the peed and level of recovery.

The total system of prehospital care and incident management at the road depends very much on incident management organization in which:

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a national emergency number speeds up the process and guarantees that all relevant agencies are warned and involved, well defined cooperation of health staff, police, fire brigade, roads authority and dispatch centre is organized and trained analyses of time for each phase and activities is evaluated frequently regional coverage of systems is monitored.

In such a systematic approach, first aid is often a neglected element, but when adapted properly, it can save many lives.

3. How is first aid effective? The application of First aid techniques, in particular the proper positioning of the victim prior to the arrival of the emergency team, can mean the difference between life and death in a road crash. There is wealth of medical evidence to suggest a golden hour exists for casualties after a road crash. Within this time, road crash victims stand a greater chance of survival and a reduction in the adverse consequences of their injuries, if life-saving measures are immediately applied and followed by quality health care assistance. Immediate on-the-scene rescue and assistance is vital, especially if emergency care response is absent or significantly delayed.

4. Presentation of a case study: A large proportion of trauma patients in developing countries do not have access to formal Emergency Medical Services. This case study was conducted to assess the efficacy of a program that builds on the existing, although informal, system of prehospital transport in Ghana. In this country, the majority of injured persons are transported to the hospital by some type of commercial vehicle, such as a taxi or bus. A total of 335 commercial drivers were trained using a 6-hour basic first aid course.

5. Evaluation of results The efficacy of this course was assessed by comparing the process of prehospital trauma care provided before versus after the course, as determined by self-report from the drivers. Follow-up interviews were conducted on 71 of the drivers a mean of 10.6 months after the course. Sixty-one percent indicated that they had provided first aid since taking the course. There was considerable improvement in the provision of the components of first aid in comparison to what was reported before the course: crash scene management (7% before vs. 35% after), airway management (2% vs. 35%), external bleeding control (4% vs. 42%), and splinting of injured extremities (1 vs. 16%).

6. Lessons learned / Best Practices Even in the absence of formal Emergency Medical Services, improvements in the process of prehospital trauma care are possible by building on existing, although informal, patterns of prehospital transport.

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First Aid Training for drivers According to the EU directive 2000/56/EC, all EU countries must have taken the necessary measures to ensure that applicants for driving license must know how to behave in the event of an accident, and the measures that they can take to assist road accident victims; including emergency action such as evacuation of passengers and basic knowledge of first aid. The directive points also the requirement of first aid training and refresher courses for professional drives. First aid training can also target other population categories, for example children, cyclists, or public transport drivers. First Aid posts on roads Most countries operate first aid posts along roads and highways. In Iran and Viet Nam permanent posts are staffed year-round. In Togo, 90 posts are open during the summer. In Tunisia, Saudi Arabia, Bolivia, and Philippines special posts are set up along roads during religious events. In some countries, a network of petrol stations is used for the posts.

7. Recommendations Education in the protection and saving of lives shares universal foundations, being practical and giving confidence to act. This education is gained through awareness and refreshment initiatives such as media campaigns, training courses either in a classroom environment, CD-ROM or through an internet based e-learning system. It can also take place through involvement in community or group activities. It is essential that first aid education shows consideration for and pays respect to local conditions, culture and capacities. Furthermore, training people to cope with road injuries should include information related to reducing both risk of a crash by wearing reflective materials and the severity of injury by wearing a helmet when riding a motorcycle or scooter.

8. Other case studies In the ESCWA region, the Red Cross and Red Crescent Societies are implementing a new module on "Road Accidents and Road Safety" that has been added to the Regional Standardized Community Based First Aid (CBFA) Training Manual for Volunteers. A special session on road safety is included in the agenda of ToT CBFA Courses. Three sub-regional CBFA courses were held during the year 2005 and road safety was one of the main subjects/topics. On the national level: many National Societies have awareness activities on the issue of road safety and first aid, usually in coordination and correlation with related governmental offices. In Lebanon: the Lebanese Red Cross Youth distributed brochures and traffic stickers. The Lebanese Red Cross held special courses for their ambulance drivers.

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Tunisian Red Crescent has conducted an awareness program targeting kinder garden, school children and university students. Also, they have been facilitating first aid courses for truck driver, driving school staff. Morocco Red Crescent is participating in a pilot project with Civil Defence and the National Road Safety Association. In UAE, QATAR, Jordan, Yemen and others, the Red Crescent is giving awareness lectures to different public groups.

9. Publications Anyone can save a life, Road Accidents and First Aid, British Red Cross, 2001. This publication gives an overview of state-of-the-art knowledge of first aid in relation to road crashes. Report is available by contacting: Firstaid@redcross.org.uk Capacity of National Societies with regard to Road Safety. International Federation of Red Cross and Red Crescent Societies. 1999. This report gives an overview of the Red Cross and Red Crescents road safety and first aid initiatives. Report can be obtained by contacting the Federation at: secretariat@ifrc.org WHO report on Road Traffic Injury Prevention, 2004. This report is the first major report on the topic produced and issued by the WHO in collaboration with the World Bank. WHO Report on Prehospital Trauma Care Systems , Geneva, 2005 http://www.hsph.harvard.edu/traffic/papers/trauma.pdf http://emj.bmjjournals.com/cgi/content/full/21/2/237 http://depts.washington.edu/surgery/research/2003/mock.pdf

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APPENDICES

Appendix 1: Molasses Databases

THE MOLASSES DATBASE, UK. Extracts from the website

MOLASSES is a database that contains information about Local Road Safety Schemes installed by Local Authorities in the United Kingdom. The acronym MOLASSES stands for "Monitoring Of Local Authority Safety SchemES". The database has been active since 1991. What is a Local Safety Scheme? A Local Safety Scheme is a road scheme implemented by a Local Authority on local roads to address identified road safety problems. A Local Safety Scheme may involve simple things like adding a new sign or road markings, or more complex things like changing the layout or geometry of the road. Local Safety Schemes can be applied at a specify site (for example, at a junction), along a route or over an area. The purpose of a Local Safety Scheme is to reduce the number of road accidents and casualties. Although it may have other benefits link improving the road environment. Please note: MOLASSES now also covers schemes carried out by the Highways Agency. Who started the MOLASSES database? The MOLASSES project was initiated by the County Surveyors' Society (CSS) Accident Reduction Working Group (ARWG) in 1991. It was initially managed by Professor Chris Wright at Middlesex University. In 1993 TRL Limited agreed to take it over and they have been in charge of the database, and its operation, since that time. What is it used for? The objectives of the database are to - assess the effectiveness of different treatments in relation to specific accident problems, - give a better idea of the effectiveness of different types of Local Safety Schemes, - wherever possible, to produce reports and provide information in response to specific enquiries. How does MOLASSES work? When a Local Authority in the United Kingdom or the Highways Agency installs a Local Safety Scheme it is strongly encouraged to send details of that scheme to TRL Limited (details of the procedure are presented on the Submit Info page). The information is then entered into the MOLASSES database by staff at TRL. MOLASSES asks for such information as what type of Local Safety Scheme it is, where and when it was installed and very importantly the number of personal injury road accidents which have occurred at the site 3 years or more before it was installed. Three years after the Local Safety Scheme was installed, TRL send another form back to the same Local Authority or Highways Agency Area Agency and ask for details of the personal injury accidents that have occurred after the installation of the Local Safety Scheme. This information is then also added to the MOLASSES database.

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The effectiveness of the Local Safety Scheme can be assess by comparing the number of personal injury accidents before its installation with the number of personal injury accidents which have occurred in the same period after its installation. By comparing these figures we can workout how effective the Local Safety Scheme has been at reducing personal injury accidents. By comparing these figures with the cost of installing the scheme, we can work out how cost effective it is. Using the database we can compare the effectiveness of different types of treatment and measure how the effectiveness has changed over time.

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Table 1: Cost and effectiveness of treatment types Whole database to 31/12/1999

Treatment Type No. of schemes No. of Schemes with "after" data Average % Change in accidents per annum Average cost () of scheme (1999 prices) 59155 Average Annual Accidents Saved Expenditure per accident saved per annum 1999 prices () Average First Year Rate of Return (%) (1999)

Cycle scheme

30

12 (12)

-65 (-65) -31

3.79 (3.79)

15607

444

Area-wide

45

12 (10)

79312

1.86 (2.58)

30720

225

Route

283

77 (69)

-43 (-46) -48 (-49) -37 (-37) -48 (-54) -33 (-35) -32 (-32) -25 (-32) -26 (-29)

22419

1.51 (1.68)

13331

520

Link-calming

321

78 (63)

39612

1.48 (1.48)

26764

260

Signalised junction

299

195 (159)

35206

1.43 (1.35)

26128

266

Bend

471

304 (265)

10753

1.14 (1.12)

8958

722

Roundabout

320

188 (164)

40502

1.09 (1.03)

39415

176

Pedestrian facility

579

317 (250)

27296

1.02 (0.97)

28036

246

Link (overall)

1368

674 (435)

28391

1.00 (1.13)

25072

276

Link-general

1157

636 (398)

27333

0.90 (1.05)

26262

266

Priority junction

830

519 (468)

-34 (-37)

11930

0.87 (0.90)

13231

523

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Totals

4225

2298 (1832)

-38

23409

1.08 (1.13)

20726

372

Notes: The figures in round brackets () indicate the number of schemes for each treatment type where the cost of the scheme has been provided by the relevant Local Authority. The "before" and "after" period is typically 3 years. When the periods are not equal, the annual average number of accidents for "before" and "after" are compared. The cost of each scheme has been adjusted to 1999 prices using adjustment factors presented in Table 2.1 of Economic Trends 2000 (Office of National Statistics, 2000). The first year rate of return (1999) is calculated as follows: Cost of Personal Injury Accident * Average Annual Accidents Saved * 100 / Cost of scheme (adjusted to 1999). The Cost of Personal Injury Accident is taken as being 69390. This figure is taken from DETR's Highways Economics Note (HEN) No.1 and includes an element for damage only accidents.

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Table 2: Treatments aimed at reducing child pedestrian casualties Whole database to 02/04/2001 Treatment Roundabout Priority Junction Pedestrian facility Treatment sub-group New Mini Geometric improvement Other New Zebra New Pelican Conspicuity refuge Promontory Number 5 1 1 1 2 1 3 2 Total Scheme Cost ( Average) 54719 104000 104000 23000 14240 42000 93600 4000

Link

Road humps Chicanes Tables Sheltered parking Throttle narrowing Carriageway Markings Surfacing Signing Publicity

5 1 1 1 2 1 1 1 1

21800 26000 50000 38595 42050 104000 104000 104000 104000

Route Calming

Not specified Road Humps Throttle Narrowing Other

1 1 1 1

26000 50000 50000 38595

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Area wide calming

Other Road Humps Tables Carriageway marking Surfacing Signing Signs and markings Traffic Regulation Orders Publicity Drainage Speed limits

2 3 1 2 1 2 2 1 2 2 2

67750 62333 42000 38500 35000 38500 38500 110000 38500 38500 38500

Every authority contributing data to MOLASSES is asked to indicate what particular problems their schemes are addressing. In this case, schemes that address child pedestrian casualties have been identified. The table indicates the treatments used within each scheme, the number of occasions they have been used and the total average scheme cost. It should be noted that the total average scheme cost does not equal the cost of implementing the treatment since there may be many treatments used in each scheme. Therefore the total average scheme cost is the average total cost of the schemes that contain the treatment indicated. The table is limited to schemes where the relevant Local Authority has indicated the cost of the scheme.
Every possible care has been taken to ensure that the information presented on this page is accurate. TRL Limited regret that they cannot accept any responsibility for loss caused by error or omission

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Table 3: Effectiveness ratings. Whole database to 02/04/2001 Effectiveness rating 1 2 3 4 5 Number of Schemes 145 133 134 64 84 Average Cost 76657 14845 24226 11338 11805

Following an evaluation period (typically 3 years) each Local Authority is asked to evaluate the effectiveness of the scheme. The effectiveness rating ranges from 1 (very effective) to 5 (not at all effective). The table above shows that most schemes are rated positively. The table is limited to schemes where the cost of the scheme is known.

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Table 4: Effectiveness ratings with treatment types used. Whole database to 02/04/2001

Treatment

Total Number
68 21 92 42 150 29 21 66 107 49 93 29 29

Effectiveness rating

1
20 9 29 13 28 12 5 3 27 6 14 7 1

Average 2 3 4 5 Effectiveness rating

2 2 4 2 2 8 3 9 6 9 1 6 2 1 1 1 2 3 5 6 2 9 3 2 4 1 5 8 1 9 4 2.47 2.38 2.45 2.45 2.79 2.24 2.29 3.23 2.65 2.82 3.04 2.90 3.41 2.00 2.49 1.68 4 2.76 2.43 2 2.53 2.00

1 Signalised Junction New signals 2 Roundabout New mini 3 Priority Junction Specified Other Geometric Improvement Signing 4 Bend Warning signs 5 Pedestrian Facility New Pelican Refuges 6 Cycle schemes 7 Link Road humps Carriageway marks

5 12 1 5

4 15 26 1 4 4 2 4 3 4 2 1 1 2 5 1

9 14 7 17 3 7

1 20 19 6 6 6 6 7 5 8

2 266 37 33 21 17 20 68 17 4 5 4 2

7 7 1 0 1 3 7 5 1 7

5 37 28 1 7 7 4 5 1 5 5 1 1 -

Signing
8 Route 9 Area wide

The table above covers all schemes where an effectiveness rating has been supplied. Here the treatment types within each scheme have been analysed. (It should be noted that there can be many treatment types within a scheme.) The table shows the effectiveness ratings for main treatment categories such as Pedestrian facilities, and treatment sub-groups such as new pelican and refuges. In the case of treatment sub-groups, the information has only been presented if there are at least 20 examples. Therefore, the sub-groups shown are the most popular types of treatment where an effectiveness rating has been given. The smaller the Average Effectiveness rating the better. Information was only available on 2 cycle schemes. These are included for completeness.

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Table 5: Annual Average Accidents Saved associated with different levels of Vehicle Flow and Pedestrian Flow Whole database to 02/04/2001 Vehicle flow (AADT) More than 19,999 Pedestrian flow Very light 0.97 (62) 10,000 19,999 0.60 (145) 5,000 - 9,999 0.70 (175) 0.63 Up to 5,000 (122) (41) (18) (3) The table above shows the Average Annual Accidents Saved associated with different levels of vehicle and pedestrian flow. The table only contains schemes where this information was supplied by the relevant Local Authority and "after" accident data has also been supplied. The numbers in round brackets () indicate the number of schemes within each category. For example, there were 62 schemes where the AADT vehicle flow was more than 19,999 and the pedestrian flow was considered very light. (AADT = Average Annual Daily Total, which equates to the average 24 hour vehicle flow.) The Average Annual Accidents Saved is defined as the average number of accidents per year "before" the scheme was implemented minus the average number of accidents per year "after" the scheme was implemented. The "before" and "after" periods are typically both 3 years long. Therefore, the larger the figure the more effective the scheme. Pedestrian flow Light 1.14 (33) 0.62 (105) 1.50 (85) 1.00 Pedestrian flow Medium 1.24 (46) 0.81 (102) 0.95 (48) 1.27 Pedestrian flow Heavy 0.00 (28) 1.07 (35) 0.48 (18) 1.24

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Table 6: Average Annual Accidents Saved associated with Urban and Rural Schemes. Whole database to 02/04/2001 Location Urban Rural Number of Schemes 1106 1203 Average Annual Accidents Saved 1.23 1.07

The table above indicates how many schemes within the database are either urban or rural. The table is limited to schemes where "after" accident data is available. The Average Annual Accidents Saved is defined as the average number of accidents per year "before" the scheme was implemented minus the average number of accidents per year "after" the scheme was implemented. The "before" and "after" periods are typically both 3 years long. Therefore, the larger the figure the more effective the scheme.

Table 7: Treatment types by Location Whole database to 02/04/2001

TREATMENT TYPE

URBAN OR RURAL

NUMBER OF SCHEMES

Average Annual Accidents Saved

TOTAL ACCS BEFORE

150 339 40 97 49 1721 599 189 48 161 49 608 44 808 18 107 526

TOTAL ACCS AFTER

TOTAL ACCS CHANGE

% CHANGE

Cycle Schemes Anti-skid surfaces

Combi Urban Rural

5 36 4 1 4 196 74 18 3 13 3 44 5 70 2 10 56

4.87 1.05 2.08 3.55 -0.50 0.83 0.88 1.27 3.67 1.76 2.01 1.30 0.22 1.10 1.88 2.88 0.95

52 231 15 89 55 1208 370 86 15 86 26 416 38 490 3 12 288

-98 -108 -25 -8 6 -513 -229 -103 -33 -75 -23 -192 -6 -318 -15 -95 -238

-58.00 -31.80 -62.50 -10.69 12.25 -29.63 -35.38 -46.91 -68.75 -46.16 -41.04 -30.90 -7.88 -36.01 -83.33 -88.46 -39.94

Speed cameras Red-light cameras Markings

Urban Urban Urban Rural

Chicanes/Narrowings Urban Gateways Guard-rail and pedestrian barriers Lighting Urban Urban Rural Urban Rural Pedestrian crossings Urban Rural Road humps New roundabouts Urban Urban

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and miniroundabouts New signals

Rural Urban Rural

15 26 8 80 10 222 136 5 2 2 40 11 40 15 9 1 1

2.62 1.80 1.93 1.28 1.96 0.66 0.70 0.73 1.83 1.17 1.23 3.11 1.56 1.31 2.46 6.67 0.00

216 323 93 1130 135 1536 879 38 15 19 644 151 535 128 153 23 1

45 144 20 697 66 1044 521 27 4 12 472 50 320 64 81 3 1

-171 -179 -73 -433 -69 -492 -358 -11 -11 -7 -172 -101 -215 -64 -72 -20 0

-76.15 -52.98 -75.03 -33.06 -47.96 -30.71 -37.37 -28.95 -73.33 -36.84 -25.07 -67.86 -39.78 -48.94 -45.1 -86.96 0.00

Modifications to signals Signing

Urban Rural Urban Rural

Splitter islands

Urban

Yellow bar markings Urban Rural Mass Action Schemes Route Action Schemes Area-wide schemes Urban Rural Urban Rural Urban Rural Speed tables Rural

The table above presents information for selected types of treatment for both urban and rural settings. The number of schemes refers to the number of schemes that contain the treatment type used. The treatment might be one of many applied at the same scheme. The Average Annual Accidents Saved, Total Accidents and % Change refer to the schemes and not the treatments. The table is limited to schemes within the database that have been positively identified as either urban or rural. The table is limited to schemes where "after" accident data is available.

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Appendix 2: ROSPA; Road Safety Engineering Cost Effective Local Safety Schemes

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Appendix 3: Extracts from the Urban Safety Management Guidelines for Developing Countries. This appendix presents extracts from the Chapter 6 (decision-making for solutions) of the Urban Safety Management: Guidelines for Developing Countries by A Quimby, B Hills, C Baguley and J Fletcher TRL / DFID The following tables show a list of various types of measures that could be implemented in road design and indicate many of their advantages and disadvantages.

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