1. Public Health, Trauma & Road Safety:
A Holistic Approach to Partnership Working
Matt Staton
Road Safety Education Team Leader, Cambridgeshire County Council
Rod Mackenzie
Clinical Director, East of England Major Trauma Centre,
Cambridge University Hospitals
RSGB Conference 16 November 2016

2. Overview Road trauma from the health perspective
Redeveloping the Road Safety Partnership
Targeting Road Injury Prevention (TRIP)

3. East of England Trauma Network
Trauma System
East of England Trauma Network

4. East of England Trauma Network
Trauma System
East of England Trauma Network

5. Trauma
Fatal injuries
Injuries requiring hospitalisation or resulting in disability
Injuries treated in emergency department setting
Injuries treated in primary care setting
Injuries that do not receive attention in a healthcare setting

6. Epidemiology
Engineering
Education (ETP)
Enforcement
Epidemiology

7. Trauma System Epidemiology All Trauma Network Hospitals
Consistent injury severity scoring
Case-mix analysis
Comparative outcomes
Injury severity score
Survival rates
Patient reported outcomes
Hospital performance
System performance

8. Trauma System Epidemiology Population based
Multi-agency Injury Research Register (5 years)
100% case ascertainment
Complete epidemiological description
Mechanism
Injury patterns
Pre-hospital care
Emergency care
Outcomes (pre-hospital and in-hospital)
Socio-demographic profile
Cambridgeshire Trauma Audit
and Research Project

9. Epidemiology Burden of Disease (Count of patients, 95% CI)1
Pre-hospital System
Survive to hospital
Admitted with significant injury
(meeting UK TARN entry criteria) 2
Age-standardised population rate per 100,000 (95% CI) 3
999
Call
2623 4
Serious injury 55
(53-57)
Survival to hospital 46
(42-48)
Serious
Injury 34
(32-36)
Severe Injury
(ISS >8) 22
(20-23)
Major Trauma
(ISS > 15) 12
(11-13)
Cambridgeshire Trauma and Research Project
See
Directly age-standardised rate per 100,000 resident population with 95% confidence interval
Based on estimate from Ambulance Service related to 999 call burden for trauma related AMPDS codes (150000/year)

10. Epidemiology 12 (11 to 13 ) 22 (20 to 23 ) 34 (32 to 36)
EoE ITSPB
20 April 2010
Epidemiology
Major Trauma ISS > 15
‘Severe’ Injury ISS > 8
TARN entry criteria
12 (11 to 13 )
22 (20 to 23 )
34 (32 to 36)
Age-standardised population rate per 100,000 (95% CI)
R Mackenzie 10

11. Epidemiology
Road traffic collisions remain the commonest cause of severe injury or life threatening major trauma

12. Do not meet entry criteria
CTARP Data
39,763
STATS 19
Persons
‘injured’
2,850
ONS
Registered
deaths
3,307
PHEMS
Attended
patients
3,383
TARN
Submitted
cases
254
Pre-hospital
deaths
983
Survivors to hospital
38,526
Do not meet entry criteria
1,237
Meet entry criteria
2,020
1,363
2,682
625
186
439
2,464
261
123
384
329
1,685
150
In-hospital
deaths
Entry criteria: Kinetic injury event within the geographical County of Cambridgeshire between 2000 and 2004 and resulting in a pre-hospital trauma death (with injuries which would have met TARN injury criteria) or survival to hospital with admission that met TARN 07 entry criteria
Cambridgeshire Trauma Audit
and Research Project

13. CTARP Data Pre-hospital Deaths - 329 ONS STATS19 PHEMS
(261)
STATS19
(254)
PHEMS
(186)
Entry criteria: Kinetic injury event within the geographical County of Cambridgeshire between 2000 and 2004 and resulting in a pre-hospital trauma death (with injuries which would have met TARN injury criteria) or survival to hospital with admission that met TARN 07 entry criteria
Cambridgeshire Trauma Audit
and Research Project

14. CTARP Data Survivors to hospital - 1685 Cambridgeshire Trauma Audit
ONS
(123) 35 21 1 2 20
PHEMS
(439) 21
TARN
(1363) 15 8 1
592 50
271
386 85
177
STATS 19
(983)
Entry criteria: Kinetic injury event within the geographical County of Cambridgeshire between 2000 and 2004 and resulting in a pre-hospital trauma death (with injuries which would have met TARN injury criteria) or survival to hospital with admission that met TARN 07 entry criteria
Cambridgeshire Trauma Audit
and Research Project

15. CTARP ‘KSI’ Data 39,763 persons STATS19 persons
(from 17,256 incidents)
STATS19 persons
Five years to 2004 inclusive
15,897 uninjured and 1 unborn child excluded
23,865 persons
334 ‘killed’
2924 ‘serious’
20,594 ‘slight’
1064 discharged from ED
254 STATS19 pre-hospital deaths
(172 resident, 82 non-resident)
80 STATS19
in-hospital deaths (<30 days)
(64 resident, 16 non-resident)
1860
1019 with LoS < 72 hrs and/or injuries which do not meet CTARP/TARN entry criteria
841 ‘serious’
+ 2 in-hospital STATS19 death initially coded as serious and slight
(both resident)
62 met TARN entry criteria, 1 of which was an in-hospital death
+ 61 patients coded as slight
-1 of which is in-hospital death
336 ‘killed’
(238 resident / 98 non-resident)```````
901 ‘severe’
TARN entry criteria
(697 resident / 286 non-resident)
Cambridgeshire Trauma Audit
and Research Project
2083 ‘serious’
(1548 resident /
536 non-resident)
20,532
‘slight’

16. CTARP ‘KSI’ Data
Cambridgeshire Trauma Audit
and Research Project

17. CTARP Responsibility Data
All
persons
Cambridgeshire Trauma Audit
and Research Project

18. CTARP Responsibility Data
Responsible
persons
Cambridgeshire Trauma Audit
and Research Project

19. CTARP Responsibility Data
To blame (n=123)
Whole group (n= 281)
Significance (p)
Median age (IQR)
35 (22-49)
34 (22-49)
p=0.9
Mean Age (SD)
38 (20-58)
38 (19-57)
Modal Age 30 18
P=0.02
Proportion male (%) 76 47
P=0.005
43% of those with ISS>15 following road traffic collisions were not responsible for the injury event
Injury prevention strategies targeted according to the epidemiology of the injured may not effectively target those who cause injury events
Cambridgeshire Trauma Audit
and Research Project

20. Trauma System Lessons Learned
Multi-agency data sharing improves understanding
‘Serious injury’ in STATS19 terms doesn’t necessarily constitute a ‘severe injury’ in trauma care or injury prevention terms
Linking TARN and STATS19 data will provide the cheapest, quickest and most comprehensive understanding of road traffic related injury.
Geo-demographic profiling, combined with culpability and injury severity analysis, might improve the targeting of ETP strategies.
Cambridgeshire Trauma Audit
and Research Project

21. Road Safety and Public Health
KSIs per 100,000 population is a Public Health Outcomes Framework Indicator (1.10)
NICE guidelines –
PH29 strategies to prevent unintentional injuries among the under-15s
PH8 Physical activity and the environment
Road Safety is often a (perceived or actual) barrier to active travel
Drug and alcohol safety
Expertise in behaviour change interventions

22. Victim Support
64% of people bereaved by fatal road collisions suffer from depression
58% have general health problems
49% have sleeping problems
46% have anxiety attacks
41% have distressing nightmares
37% experience suicidal feelings
24% never work again

23. Redeveloping the Partnership
LAs (CCC & PCC)
Police
Fire & Rescue
Highways England
East of England Trauma Network
Road Victims Trust
Cambridge University Hospitals
Public Health
The Cambridgeshire and Peterborough Road Safety Partnership (CPRSP) is a mature strategic
partnership covering the geographical County of Cambridgeshire and the Unitary Authority of
Peterborough. In addition to local authority, emergency services and Highways England
representation, the partnership includes the East of England Trauma Network, the Road Victim’s
Trust and the East of England Major Trauma Centre at Cambridge University Hospitals.

24. Redeveloping the Partnership
“Our vision is to prevent all road deaths across Cambridgeshire and Peterborough and to significantly reduce the severity of injuries and the subsequent costs and social impacts from road traffic collisions.”
Every death and life changing injury on Cambridgeshire and Peterborough’s roads or to a Cambridgeshire or Peterborough resident is one too many, and the social and economic burden of road casualties is felt much wider than just those immediately involved in the collision.

25. A new strategy

26. Trauma System Looking forward
CTARP identified significant differences, in terms of demographics and marketing preferences, between profiles for injured road users and profiles for those who were uninjured but considered culpable for crashes.
Existing prevention strategies, if targeted on injured road user profiles, may not be effectively targeted at high-risk or culpable road users.

27. Targeting Road Injury Prevention
TRIP Project
Targeting Road Injury Prevention
Change the focus from those who are ‘KSI’ to those who are ‘at risk’ of causing death or serious injury, regardless of whether they themselves are harmed or not.
PhD studentship hosted by Loughborough University in partnership with Addenbrookes Charitable Trust
Grant funding from the Road Safety Trust
£150k 3-5 year project
£100k from Road Safety Trust
Other funding from PCC and potentially other sources e.g. ADEPT

28. Targeting Road Injury Prevention
TRIP Project
Targeting Road Injury Prevention
Question: Will prevention strategies based on the marketing preferences of culpable persons and high-risk road user profiles be more effective at reducing the number of road traffic related injuries and deaths than strategies based on casualty based data alone?
£150k 3-5 year project
£100k from Road Safety Trust
Other funding from PCC and potentially other sources e.g. ADEPT

29. TRIP Project
Utilise STATS19 and Police data, together with culpability analysis techniques, to identify:
The severely injured
Culpable persons (whether injured or uninjured)
‘High-risk’ road users who have not been involved in a crash (such as speeding, drink-driving, failure to wear a seatbelt and mobile phone use)
£150k 3-5 year project
£100k from Road Safety Trust
Other funding from PCC and potentially other sources e.g. ADEPT

30. TRIP Project
Undertake detailed epidemiological analysis to further define the geo-demographic profile (Mosaic Public Sector) and dominant marketing preferences of each of these groups.
Identify postcode areas which match the over-represented geo-demographic profiles – these are people with similar geo-demographic profiles to the severely injured, culpable and high-risk road user groups.
Develop and test a targeted ETP prevention strategy, designed around marketing preferences, for defined geographically bounded sub-sets of these groups.
£150k 3-5 year project
£100k from Road Safety Trust
Other funding from PCC and potentially other sources e.g. ADEPT

31. Contact matt.staton@cambridgeshire.gov.uk