Untapped potential of commercial drivers in providing post-crash care to road traffic accident victims: A cross-sectional study from fast urbanizing city of Jodhpur, India

Key Messages

• Commercial drivers commonly witness and provide post-crash care to RTA victims irrespective of their poor understanding regarding it.

• Capacity building of commercial drivers with supportive engagement of legal and health-care authorities is warranted for their effective contribution as first responders at an accident site.

INTRODUCTION

Road traffic accidents (RTAs) kill approximately 1.2 million people worldwide annually.^[1] The majority of trauma deaths in low- and middle-income countries occur in pre-hospital period, of which a third may be preventable with treatment typically aimed at airway preservation, promoting oxygenation, and rapid transfer to hospital.^[2]

The World Health Organization recommends training of lay people in providing pre-hospital care for RTAs.^[3] Systematic review found training of bystanders including commercial drivers is feasible and may reduce mortality rates.^[4,5] Studies describing training interventions were mainly reported from African countries, often in urban settings with the recommendation that training be targeted at taxi drivers.^[4] In India, though some local training initiatives are previously reported for commercial drivers, there is no national level strategy.^[6-8]

This study aims to determine the role of professional drivers as post-crash care providers for RTA victims in fast urbanizing Jodhpur district of Rajasthan and to assess their knowledge and practices in this regard.

MATERIALS AND METHODS

Sampling technique

Investigator approached the taxi and auto stands for the inclusion of the study participants. The drivers who volunteered for the study were included one after another till the required sample size was reached [Figure 1]. The time given for data collection was 2 h/day, 5 days a week. Interviewing no more than 10–12 drivers in a single day was the predetermined cap.

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Figure 1:

Density of three-wheeler and four-wheeler passenger vehicles in the Jodhpur city, Rajasthan.

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RESULTS

A total of 200 professional drivers (100 each auto and cab drivers) were interviewed for the study. GIS map shows that the auto-rickshaw and cab driver waiting posts are overlapping with accident hotspots as per traffic police records of the past 2 years [Figures 1 and 2a]. Widespread presence of health facilities and ambulance can be appreciated in same geographic area [Figure 2b].

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Figure 2:

(a) Accident hotspots areas in the Jodhpur city (blue dots). (b) Health facilities (red signs) and ambulance location in urban Jodhpur.

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All the drivers were male participants; their mean age was 37.74 ± 8.96 year and ranged between 18 and 68 years. The majority (65.0%) of participants had education of at least 8^th standard or more. Out of 200 participants, only few (3.5%) reported attending a training course on post-crash care of accident victims. The majority of the participants were sufficiently experienced – working for more than 10 years as drivers. Mean age and professional work experience were significantly higher among cab drivers (P < 0.05).

DISCUSSION

All respondents in our study were male, which is consistent with our observations of taxi drivers throughout Rajasthan. The wide range of respondents’ age (18–60 years) supports the findings not being limited to a specific age group.

Our study revealed that only a few drivers (3.5%) have ever received any training in providing first aid and knowledge of providing post-crash care to RTA victims was limited in most. Further, the majority of drivers had witnessed (70.5%) road accidents during their professional experience. This is substantial proportion to emphasize the importance of training among commercial drivers in Jodhpur and other fast urbanizing districts of India. Furthermore, reporting of involvement in support to crash victims supports the hypothesis of commercial cab and auto-rickshaw drivers being of assistance to injured RTA victims.

A large number of auto-rickshaw drivers reported contributing as care providers to RTA victims, but ironically, the post-crash care knowledge and practices score for majority of the components was significantly lower among them. Auto-rickshaw drivers are mainly confined to premises of urban municipal cooperation for providing their services in contrast to cab-drivers who provide services both in and outside of urban Jodhpur. Thus, the auto-rickshaw drivers generally travel familiar routes compared to cab drivers who are required to travel long distances and frequently unfamiliar routes. This is an essential area to intervene as auto-rickshaw drivers possibly has a good understanding of health-care facilities in the city limits and may own up the responsibility of providing care to road accident victims in their vicinity in contrast to cab drivers who provide services both in and outside of urban Jodhpur probably resulting in low familiarity regarding health-care facilities in area. Poor scores among auto-rickshaw drivers highlights the neglect of road safety agencies recognizing their role as effective post-crash care providers which needs to be investigated further in future studies from India. To our knowledge, previously no other studies have exclusively investigated the role of auto-rickshaw drivers in scenarios of RTAs.

Shotland and Heinold discussed the type of bystander’s response at the site of accident and reported that indirect help responses (calling for help or an ambulance) were more frequent among untrained bystanders while trained bystanders responded with prescribed method of responses in a simulated situation of arterial bleeding.^[10] Our study provides the essential evidence for investing resources in training commercial drivers, especially auto-rickshaw drivers to administer post-crash care in urban areas. Workplaces were previously recognized as most common place of first aid training by Bakke et al.^[11] In India, training of commercial drivers especially auto-rickshaw drivers must be coupled with the engagement of legal authority/health facilities/ ambulance personnel and employers of commercial drivers as emphasized by Sangowawa and Owoaje.^[12]

Besides, integration of first aid training in schools is previously emphasized and evidence exists that children and adolescents from 5 to 18-years-old are able to learn certain first aid techniques.^[13] Mean years of education of commercial drivers in our study is 8 years and drivers with education of 8 years and more years of education had higher scores for post-crash care related knowledge, also observed previously.^[14] Implementation of first aid training program in schools in low- and middle-income countries encountering high burden of accidents and injuries can ensure community engagement and maximize participation in providing post-crash care. Further increasing the minimum level of education required for obtaining driver’s permit and strictly enforcing it can help in having cohort of commercial drivers with better knowledge of post-crash care.

The intended practices/behaviors of drivers were found to be significantly affected by the previous training in these skills. This emphasizes the importance of training in post-crash care to have enabled first responders. The implementation of training programs has shown to be tricky due to variable literacy, variability in the availability of first aid supplies, role played by legal authorities (police), and bystanders. Further, these programs are operational in only some districts with most commercial drivers on national level being still untrained.^[15,16]

Our study has several limitations such as limited generalizability as all the study participants were representative of single district selected through purposive sampling. Considering the different geographic location s and route s ferried upon by cab and auto drivers, the use of disproportionate sampling in our study led to satisfactory representation of both subgroups. Keeping precision as 10% rather than convention 5% was decided considering the exploratory nature of research, only few published studies in this area from India, and feasibility to reach out required number of study participants. The potential for social desirability bias was reduced by assuring the anonymity of respondents and the administration of questionnaire to individual drivers keeping enough distance from other drivers. The study results might be influenced by self-selection bias as drivers with a strong interest in post-crash care may have been more likely to understand the importance of topic and show interest in being part of this study.

Further studies in India are required to explore the implantation of training in first aid care for commercial drivers. Furthermore, the diffusion of knowledge among drivers from those who ever got trained in first-aid or helped an accident victim is possible and must be explored.

CONCLUSION

The current study establishes the role of commercial drivers as first responder s at accident sites in fast urbanizing city of Jodhpur, Rajasthan. Bridging the existing gaps by investing resources in their training and building an enabling environment by engaging legal and health authorities to salvage RTA victims has potential to strengthen pre-hospital trauma care continuum.