Characteristics of shock-producing injuries in victims of traffic accidents on federal, regional and local highways in the Arctic zone of the Arkhangelsk region

Relevance. Motor vehicles are a highly traumatic type of transportation and the cause of traffic accidents with medical consequences, including large numbers of severe shock-associated injuries. Federal, regional and local highways differ significantly by the type and quality of pavement, technical maintenance and upkeep, which affects the safety conditions for drivers and pedestrians.

The objective is to analyze shock-producing injuries in victims of road accidents on federal, regional and local roads in the Arctic zone of the Arkhangelsk region to characterize the incidence, type and severity of traumatic injuries.

Methodology. A set of criteria for case series description was used to analyze medical records of 72 victims presented with shock-producing injuries as a result of road accidents on federal, regional and local roads of the Arkhangelsk region who were admitted to a level 1 trauma center of the Arkhangelsk Regional Clinical Hospital. The injury type was characterized according to A.V. Kaplan et al. classification. We identified the following types of injuries: isolated (single lesion), multiple (several foci in a single body area), and combined (several foci in different body areas) injuries. Combined injuries were split in 3 categories according to the criteria developed by E.K. Gumanenko et al.: severe combined injuries, multiple injuries, and extremely severe multiple injuries. The injury severity was assessed by the Injury Severity Score. The STATA version 12 software was used for statistical analysis of the results.

Results and discussion. In the Arkhangelsk region, 70 % of the road accidents resulting in shock-causing injuries occurred on the M-8 ‘Kholmogory’ federal highway. These accidents are largely represented by car-to-car collisions (65 %), where regional and local roads are typically characterized by car collisions with pedestrians (52 %). In case of the federal highway accidents, the overwhelming majority of victims with shock-causing injuries have combined injuries (90 %); this rate decreases to 65 % (p < 0.001) for regional and local roads. On the M-8 ‘Kholmogory’ federal highway, accidents are show a 1.4 times higher risk of the most severe mechanical injuries – multiple injuries – than accidents occurring on regional and local roads. Thus, in the Arkhangelsk region, medical treatment organizations require stronger workforce and logistics support; mobile highway safety points should be set-up along the M-8 ‘Kholmogory’ federal highway to ensure prompt emergency medicacare, both on federal and regional or local roads.

 Conclusion. By incorporating the public status of a road into the analysis of occurrence, type and severity of shock injuries in victims of road accidents in the Arkhangelsk region, we were able to substantiate proposals to pursue reduction in the injury rates. The M-8 ‘Kholmogory’ federal road requires drivers to unconditionally observe and comply with traffic rules regarding over taking and speeding through extensive deployment of both stationary and portable video recording devices, as well as quadcopters. As for regional and local roads, special attention should be granted to pedestrians’ behavior, such as walking along the hard shoulders of highways, crossing the road at night time, as well as impaired visibility conditions. Intoxicated pedestrians constitute a very specific category. The basics of safe behavior on roads and highways should be nurtured in the preschool and school age.

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