Ten interviews were carried out with three commissioning stakeholders, 4 service providers and three community representatives. All participants were male except one, with age ranges between 27 and 58 years old (see Table 1).
Five themes emerged from the analysis of the interview findings: participants’ knowledge of RTCs in their city, state and/or country; impact of RTCs; current preventative strategies; barriers to prevention; perceived recommendations for improving prevention. The summary of the themes with categories and descriptors can be found in Additional file 1.
Participants’ knowledge of RTCs in their city, state and country
The nature and extent of the problem
Participants recognised that RTCs are a major problem in their city, state and country where most collisions occur among adolescents and young adults, and involve pedestrians and two-wheeler users:
“India has the highest road traffic victims, and moreover this year Andhra Pradesh has a 10% increase in road accidents compared with last year, and 70 to 80 percent are pedestrians and two-wheelers.. At present there are 97 accident prone areas in Visakhapatnam. The collisions are in those between 18 and 40, youth people [sic].”.(Key Informant 2)
Most participants were also very clear about the role of RTCs in neurotrauma causation and felt that RTCs are the leading cause of neurotrauma and that most victims of RTCs will sustain injuries to the head injuries. However, one participant presented a different view:
“In Road traffic Accidents head injuries are less than other injuries like leg and hand fractures which are more and head injuries are very less [sic].” (Key Informant 10)
Factors and risk factors leading to RTCs and RTC-related neurotrauma
Participants identified various human factors that led to RTCs and RTC-related neurotrauma, the most common being drink driving and speeding. Many also discussed the lack of or improper use of personal safety equipment, namely helmets:
‘Most of the traffic accidents and brain injuries are caused in two wheeler bike riding[sic].. Most of the riders do not wear helmet or they do not wear it properly.” (Key Informant 8)
“… people carry the helmet on the bike without wearing it; it is safe if they wear it. “(Key Informant 3)
Other frequently observed traffic rules violations included wrong-way driving and using mobile phones when driving. Another issue that was raised was underage driving.
“Nowadays more accidents are happening because of minors riding vehicles. People should not give their vehicle to others who do not have license[sic]” (Key Informant 5)
Poor road infrastructure and design was cited as the most common environmental factor that contributed to this problem.
“Roads everywhere have pot holes, unfinished works of sanitary, water and other departments after they dig for various repairs and renovations, making it risky for the bike riders.. and increasing the chances of skidding and falls. When riders fall the first impact would be on head leading to head injury.” (Key Informant 9)
“..This (highway) stretch it is totally in the center of the city where all types of people are moving -pedestrians, old, children, this, that. If you have lorries going, say, 70 kilometres per hour, we have to use stoppers (to prevent collisions) and all this will cause more damage than the open highway where there is no village or no public there, and the lorry driver can go 70 to 80 kilometres per hour- nothing will happen.” (Key Informant 6)
Bad weather conditions were reported to also contribute to poor road infrastructure, in addition to causing poor visibility, especially for those on two-wheelers.
Other environmental factors that resulted in RTCs included being hit by the opposite driver or by moving obstacles that suddenly emerge onto the road. One participant narrated:
“Obstacles like dogs, pigs and children on the road are also causing accidents. I am a bus mechanic. That day one bus is in repair[sic], so I had gone to the workshop on that morning 5 am. From the side of the depo, one forest pig came in at high speed and hit my two- wheeler, then I fell down unconscious[sic]. After that I was admitted in hospital.” (Key Informant 10)
Vehicle and equipment factors were brought up by some participants when discussing RTC and neurotrauma causation. Overloaded vehicles were commonly seen on roads and highways, as reported by the following participant:
“Auto, lorry and even buses when they were over loaded above the capacity of the vehicle and it will automatically give more pressure to the driver. The vehicles will be uncontrolled and the vehicle will fall down from bridges or fall down into rivers, hit the road dividers and so on[sic].” (Key Informant 1)
Another participant talked about the rampant use of substandard safety equipment that did nothing to protect from RTC-related neurotrauma, but was simply to appease law enforcement officials:
“..even if they (two-wheeler riders) use helmet, they use a sub-standard helmet as it is cheap and can escape the fines imposed for not using helmet by police[sic]. These cheap and low quality helmets break easily causing severe damage to their heads leading to skull fractures, brain injury and internal bleed[sic].” (Key Informant 9)
Impact of RTCs
Participants agreed that RTCs can lead to death and result in injuries. Of all the injuries sustained in RTCs, neurotrauma was the most common and devastating, where this was illustrated in its health impact on victims.
“Road accidents majorly lead to head injury. (Other injuries) all are generally curable, treatable and small. The head injury cases are mostly unable to cure completely[sic].” (Key Informant 3)
One participant explained how the increase in RTCs meant an increase in neurotrauma cases, which in turn was overwhelming the current healthcare system, to the detriment of the victims.
“Mostly these major injuries (from collisions) are head and spine. So now we can see the figure is so huge so the need of centres, the need of hospitals, trauma care, emergency care are most important. We are having only (few) beds that are available so most (neurotrauma cases) are without any sort of rehabilitation[sic].” (Key Informant 2)
RTCs also had an economic or financial impact particularly on families as most of the victims would be the only earning member of the family. Participants described not only the loss of income, but the fact there was no system in place to provide support or assistance for households who have lost their sole breadwinner.
“The Impact is more on their families because most of the times victims of RTA (road traffic accidents) are the bread winner of the family and leading to financial crisis. There is a Telugu saying that goes ‘if an accident happens it is not the individual that is affected, it is the family on the road (hopeless) [sic]’ “(Key Informant 9)
Some participants mentioned the economic impact RTCs would have on the country:
“A lot of good professionals we are losing in the city[sic]. They are very good in work and different professionals. We are losing such a great people in the city due to these accidents.” (Key Informant 6)
“As per the statistics of government of India these accidents are affecting around 3 % of our GDP (Gross Domestic Product)” (Key Informant 4)
One participant discussed the social impact of RTCs, bringing up an interesting point:
“(These accidents) bring a bad name to the city, that this is very accident- prone city in this area. So for that lot of work has to be done to control such type of accidents.” (Key Informant 6)
Current preventative strategies
The role of the government and related organisations
Participants identified the various rules and laws that were in place to address the issues of drink driving, speeding and unauthorised use of motor vehicles. Many mentioned regulations relating to helmet use and how it was also compulsory to purchase a helmet when purchasing a new motorcycle.
Participants felt that enforcement of this legislation was in place where police would carry out checks for drink driving using breath analysers, and spot checks for valid licenses. The police were also carrying out speed enforcement, not only through road-side patrolling but also using technology:
“We are taking lot of steps like regularly we are keeping our (police) to keep watch and check the over-speeding[sic]. We have laser guns in the city, 10 more we are going to procure, so everywhere we are keeping these laser guns and we are monitoring the movements of those people[sic].” (Key Informant 6)
This enforcement also allowed for offenders to be booked and issued with penalties and high fines or imprisoned, if their offense was serious enough. An example of this was seen in relation to those who violated the helmet laws:
“We have many helmet cases, those persons who are not wearing, we are taking photographs and sending chalans (citations), and all then now these people will start wearing helmets and start following the traffic rules[sic].” (Key Informant 6)
Many participants brought up how the police were involved in prevention not only by taking action against rule breakers but also through educational and awareness efforts:
“Definitely to prevent road traffic accidents traffic police are organizing so many awareness campaigns to prevent all these things.[sic].” (Key Informant 7)
“(The police) have started awareness programmes in the colleges and educational institutions.. (They) are going and creating awareness among the students, that you should follow the traffic rules, and that time (they) are showing some incidents where people died.” (Key Informant 6)
Another law that was brought up by many participants was the Good Samaritan Law which ensured that members of the public who assisted RTC victims were given the necessary legal protection from harassment by the police, judiciary system or the healthcare system.
In the light of this, participants discussed programmes where volunteers were trained to respond to RTCs:
“(The police) are launching tomorrow one programme called “road safety friendly”. We are starting where we have trained almost 50 volunteers especially shop keepers and the workers all over the high way. Every one kilometer we have trained them and 150 of our traffic constables and local police who are working on the highway if any accidents happens they work like first responders immediately. They will provide first aid for them (victims). We are providing them(volunteers) first aid kit [sic] and immediately they will inform to 108 (ambulance). They will take local assistance [sic] and shift the fellow to the nearest hospital and we will make them aware which are nearby hospitals, whom to contact, how to contact, how to shift the fellow because in accident multiple fractures are there, spine fracture are there. How to tackle such situation, we have trained them[sic].” (Key Informant 6)
Further on the Good Samaritan Law, the government and healthcare organisations also have taken it upon themselves to educate and create awareness among the public about this law:
“The DMHO (District Medical and Health Officer), District collector, KGH (King George Hospital), have taken it into consideration and we have put the posters (about the Good Samaritan guidelines)- to help the crash victims without any fear[sic].” (Key Informant 2)
Strategies relating to vehicle engineering were mentioned by a few participants, where these were the compulsory installation of in-vehicle speed management devices in new vehicles and commercial vehicles including school buses. The road engineering strategy identified by participants was speed breakers on roads.
Some participants mentioned road safety committees and felt that these are an instrumental component of prevention:
“Government is constituting ‘district road safety committee’ in every district. District collector is the chairman of this committee and deputy transport commissioner is the convener, along with them DMHO/DCHS (District Medical and Health Officer/District Child Health Services), superintendent of district hospital, officers from R and D (Research and Development unit), Panchayati Raj (Rural development) department are coordinating with each other and identifying the causes of road traffic accidents and remedies. The committee meetings happen periodically and discuss the strategies to reduce the road traffic accidents, to prevent neurotrauma injuries.” (Key Informant 4)
“We have gone to attend the meeting of state road safety committee and we have raised so many issues so now they are empowering the enforcing the law [sic]..” (Key Informant 2)
The role of individuals and communities
One issue that emerged was how preventative strategies were developed and implemented not only by the government, but also by individuals and communities. An area where this was identified was through education and awareness efforts:
“I personally go weekly thrice[sic] for counselling the drunken drivers and for my way we also counsel the employees of IT(Information Technology) and ITES ( Information Technology Enabled Services) companies. So try to educate them.. I have started another banner called project ‘Bhavishya’. This Project ‘ Bhavishya’ is three ‘R’s. First ‘R’ is road safety awareness. Second ‘R’ is right to emergency care of the crash victim. Third R is for rehabilitation of the crash victim.” (Key informant 2)
Some of these measures were carried out in collaboration with government entities:
“I have conducted several awareness programs in my college and near- by schools and colleges..with collaboration from [..] police, I conducted several campaigns about prevention on [sic] Road Traffic Accidents. “(Key Informant 9)
Aside from these formal programmes, many participants brought up how education and awareness could be delivered informally through communicating with the people they crossed paths with in their jobs and daily lives:
“As a surgeon when a patient arrives with traumatic injury I try to understand, first of all what is the cause of the accident. After knowing that what is the reason, like is it due to drinking of alcohol or over speed driving or due to the fault of other driver, I try to motivate the patient to avoid same mistake again[sic]. “(Key Informant 1)
“My role is to make my friends, family members and all known people aware of these head injuries, and the possibilities of head injuries if they go over bike without helmet the chances of head injuries are more. And I always inform to people to make journey safer with enough speed[sic].” (Key Informant 5)
Another area where there appeared to be community involvement was in the area of tertiary prevention of neurotrauma where one participant mentioned a rehabilitation centre that was built by a community-based organisation which offers free services for RTC victims with neurotrauma.
The role of research
Many participants described the different types of ongoing research that was being carried out by different entities and how these had a role in prevention of RTCs and neurotrauma:
“Some research is going on at New Delhi. Because we will come to know whether it is severe road accident or moderate or simple injuries and how many people died, how many people have memory loss, how many people suffering with disabilities, what is the effect on the family etc. Because of this research we are getting the information about how many people dying in the road accidents, how many people and families are suffering due to road accidents and what steps we should be taking in order to prevent this[sic].” (Key Informant 1)
Some discussed the research that they are involved in:
“I am involved in few researches [sic] in Traumatic Brain Injury. We work on psychosomatic problems of the patient after Traumatic Brain Injury and we work on involvement of transcranial magnetic stimulation, transcranial direct current stimulation which help in outcome of the motor control issues and use of the role of neuroplasticity intraumatic brain injury recovery, we work on few researches[sic].Whatever research is going behind the system[sic], (we) will always give the information in accurate way so that we can assess the severity of the problem, so according to that we can take the preventive measures.” (Key Informant 7)
Effectiveness of current strategies
A few participants brought up how they felt that the current strategies were effective in reducing RTCs and related neurotrauma as the government appeared to consider this an important issue:
“Government of India is also doing a lot of work and spending money on road safety by involving all the state governments. Even the Supreme Court committee in road safety is also reviewing the situation with state governments to reduce RTA’ s. These steps are helping to reduce accidents.” (Key Informant 4)
However, one participant felt that the strategies were useful to some extent but there were still areas that were lacking.
Challenges to prevention
Participants raised many factors that appeared to affect the prevention of RTCs and neurotrauma. Some brought up physical factors such as overpopulation and overcrowding and its impact on road use.
“In India 80% of the roads are with heavy traffic and to control this rush of vehicles it is very difficult for police authorities[sic].” (Key Informant 9)
Others discussed the lack of funds and manpower for carrying out preventative strategies. This was particularly relevant in the area of research and the trauma system, and especially in the area of law enforcement:
“You can see this city has more than 30 lakhs (more than 3 million) population where we have only 3400 police man, in that only 500-600 working in the traffic (division). Remaining are busy in some other duties. We can say it is totally disproportionate..hardly 600 people can’t control the 30 lakhs and more than 8 lakhs vehicles are in the city[sic].” (Key Informant 6)
One participant also felt that the police had a lot of other responsibilities, especially during certain times of the year, and that there was not enough time for traffic law enforcement.
This lack of resources was felt to be one of the contributing factors which led to gaps in the current preventative strategies. However, participants also felt that there were other flaws, particularly inconsistent implementation:
“Generally what happened we are creating awareness only in the educational institutions, limited areas where public is less, but large numbers of people are dying on the rural areas and illiterate people, so they are not getting this type of counseling or training..[sic] Conducting one day, two days rally will not make much difference. Of course people will come to know that these are the rules. It should be like a part of a habit[sic].” (Key Informant 6)
“Trauma care facilities are available at very few locations now. Our facilities are concentrated in certain centralized locations only. Due to present centralized systems, it's difficult for reaching the centre from out skirts in Golden hour[sic].” (Key Informant 4)
Building on the issue of inconsistent implementation, one participant explained how laws were not being enforced consistently or equally:
“Police people also not enforcing the law at all the places in same way[sic]. In some places they are using strict rules and where in some places they are not serious about the issues ,then people are not taking these things seriously. They are taking very easily about rules and regulations of the traffic[sic].” (Key Informant 9)
“Nowadays the fines are hiked[sic], but the people who are having political background and not following rules are not being fined.” (Key Informant 3)
A lack of appropriate action was cited as another factor that was a barrier to the prevention of RTCs and neurotrauma despite there being strategies in place. Participants felt there were insufficient awareness programmes and lack of enforcement or implementation of laws. The lack of root cause analysis was an example mentioned by some participants:
“If accident happens between car and bike, immediately people blame the car vehicle people only[sic]. Even sometimes if two-wheeler hits the stopped car also people blame on car vehicle people only. Police people do this wrong. Generally, whenever accidents occur root cause for the accident is not sought, rather they blame the big vehicle and find fault always without properly investigating the case to find the proper cause[sic].” (Key informant 9)
One participant narrated how this lack of appropriate action was also seen in the current trauma system:
“Here there is another issue happened after meeting accident. Immediately people shift (the victim) to PHC (Primary Health Care facility) or some small hospital. There they take a lot of time. They (the hospital) don't have scans and all these things …I will give example. Two to three days back there was an accident. Simple external injuries were not there, but he got brain haemorrhage and he was simply sent to some hospital. They gave some first aid, put some ointment and all. They have not done scan and all these things. After 2 days he developed complications and died.” (Key Informant 6)
Other participants found this was also true in relation to the implementation of road engineering interventions:
“Here at my place 6 lanes widening of highway road construction work is going on[sic], and the construction material is unloaded in an appropriate manner and safety precautions are not taken, which is increasing the chances of road accidents.” (Key Informant 10)
“Due to rains[sic] the holes are coming on the road, and these holes causes the accidents but they (the government) are not attempting the repair works on time[sic].” (Key Informant 5)
In the area of research, the participants identified a lack of timely data collection, data sharing and overall scientific research. In addition, they felt that research participants tended to provide incorrect data, as explained by one participant:
“The biggest barrier to this type of research is that people will not give proper information. For example, I had an accident and supposedly I was amputated of hand and leg, and when people enquire about the accident and the reason how it happened, general tendency is to avoid giving appropriate answers to these questions. If we are unable to get correct data we cannot come to a proper conclusion about any research[sic].” (Key Informant 9)
Poor governance was also cited as a factor that had a negative impact on the success of current preventative strategies where many participants reported the issue of corruption:
“The corruption by police is another barrier and they collect fine charges from the areas which are crowded… Corruption is the one in the present law system[sic].” (Key Informant 3)
“(Police) are threatening bikers and taking bribes, and leaving them (offenders) unpunished.” (Key Informant 10)
Aside from this, participants felt that there was a lack of political will which resulted in poor procedures and infrastructure, and the lack of coordinated efforts between government agencies. There was also the problem of obstacles from opposing political parties.
Another area which participants felt challenged successful prevention of RTCs and neurotrauma was the mindset and behaviour of the people. Road users tended to disregard traffic rules due to a general lack of concern for road safety or thinking that nothing will happen to them. Even if they did follow the rules, it was done simply to avoid fines and not for safety and avoidance of injury. This indifference was also seen when people would forget to use personal protective equipment like seat belts or helmets, or consider it unnecessary when travelling short distances.
Some participants brought up how the mindset and behaviour of parents affected the safety of their children:
“Another important thing is parents, they are purchasing new vehicles and giving the vehicles to minors, is also big problem[sic].” (Key Informant 9)
“Children are playing on the roads and their parents are not caring about them is also causing more accidents[sic].” (Key Informant 10)
The participants felt that complacency was also evident in the way vehicles were portrayed in the media:
“The motor vehicle manufactures in their advertisements and in the movies and TV channels promote their vehicle’s high speeding capacity and entice with thrilling and action promos, causing a huge impact on youth.” (Key Informant 9)
Participants felt that even the entities involved in prevention did not have the right mindset and behaviour and that this would have an influence on the general public, as narrated by the following participant:
“These police people should be like a role models to the society. Police people [sic] are not using helmets. They are using cell phones while driving. With these all [sic], people are not following rules. First, police people should follow these rules and regulations properly then they can ask others to follow.” (Key Informant 10)
Lack of education and awareness among the public were identified as factors that not only influenced mindset and behaviour but also affected the success of preventative strategies, especially newly implemented ones:
“Education level is very low. People are not aware regarding the traffic rules.. they are not aware what are the changed rules[sic].” (Key Informant 6)
Perceived recommendations for improving prevention
Participants provided suggestions on how to improve the prevention of RTCs and neurotrauma. These appeared to be linked to changes in policy and behaviour.
Enhancing current strategies
i. Education and awareness
An important area that was felt needed improvement was in educating the public in RTC and neurotrauma awareness, identifying a need to target RTC-prone groups or areas where RTCs were high, and carried out more consistently:
“Most important thing is that to create an awareness we should select the targeted persons who are more probable to get such type of accidents, like students because they are young. They don’t know traffic rules and regulations. We should create awareness more on the targeted groups like I found here in that most of the deaths are on two wheelers[sic]. We should target on these two -wheeler drivers, whether they are students or some of the employees, so we should target them[sic].” (Key Informant 6)
Many felt that education should be started from an early age where road safety should be introduced as part of the school syllabus for primary schools, and continued in secondary schools and colleges. In addition to creating awareness amongst the children and adolescents, this would also create opportunities for education and awareness of households in general:
“There must be road safety syllabus for school and college students. It should be implemented in schools and colleges. If school and college children are properly educated in this awareness programme, they will be the primary step in their family to avoid accidents[sic].” (Key Informant 2)
Participants also discussed different ways these efforts could be made more effective and far-reaching, for example through road-side events, getting former victims or their families to share experiences, and through the media. One participant also highlighted how the education or awareness sessions should be carried out in a way that is understood by the people, especially in villages amongst those with low educational attainment.
Aside from the public, many participants also felt that education was also a necessity among government bodies and other entities involved in prevention through regular and relevant training programmes.
ii. Research
Aside from being educated about road safety and neurotrauma, participants felt there needed to be more awareness about previous and ongoing research amongst the government and any agencies involved in prevention as well as the public. Research findings should be disseminated to all these groups either formally or through social media, depending on the target audience. One participant talked about the role of celebrities in the dissemination of research findings.
Participants felt that increasing awareness on research could attract other researchers to work on this issue and enable innovative solutions to be developed with policy-makers.
When discussing the practical aspects of how current research could be improved, participants felt that research into the causes of RTCs and the number of victims, as well as on pre-hospital care should be prioritised. Research should also be conducted in more centres in both cities and peripheral areas, and should involve former victims. It should also be carried out consistently by a dedicated group of qualified people and should be regularly reviewed or audited to ensure accuracy of procedures and findings.
iii. Pre-hospital and trauma system
Many participants felt there was a need to improve the current first responder system where there was a need for more layperson involvement:
“In any society the first responder is the public. They can’t depend on the police. If something happens also people should respond immediately. They should behave like a first responder, providing first aid, give the injured person comfortable position and call the nearest police station, ambulance.” (Key Informant 6)
“If we train the RTC (Real Time Clock) drivers and the auto drivers how to help
crash victims, it may be CPR (Cardio-Pulmonary Resuscitation), it may be BLS (Basic Life Support), I believe that will be our strategy because auto rickshawwalas (auto drivers) and RTC drivers, lorry drivers, if given proper education in this, they can easily handle the patient[sic].” (Key Informant 2)
One participant mentioned the possibility of building small first aid centres in villages so victims in rural areas would have an immediate and dedicated space where they can receive care while waiting for transport to hospital.
There was also a need to improve ambulance services through proper training of staff and ensuring availability of appropriate medical equipment within the ambulance. The response time should also be reduced to under 10 minutes, where this could be achieved if all the ambulances were part of a network.
Some participants discussed the need for more trauma centres particularly with expertise in neurotrauma. This not only improved access to care but also mitigated the issue of victims being transported to the nearest healthcare facility which may not have the necessary expertise to deal with their injuries. There should be coordination between the hospitals and ambulance services so that the ambulance staff would be aware of centres which provide different facilities, such as neurotrauma care, so that victims could be transported to a healthcare centre where they could receive appropriate management regardless of whether it is private or government institution.
Decentralisation of trauma facilities was brought up as another way to improve access to care:
“Decentralisation is important. If we decentralized them we can also save many lives. Providing trauma care facilities in the outskirts of the city. Trauma centres should be established in industrial corridors, and upcoming urban centres, highways and peripherals of the city which will help treat neurotrauma immediately and can save lives[sic].” (Key Informant 4)
iv. Enforcement and legislation
Participants felt that there was a need for stricter enforcement of laws and that penalties should be implemented fairly and uniformly. An audit system was suggested as a way to ensure enforcement was carried out properly and consistently as well as a programme to identify accident-prone areas which would allow for a focus of enforcement in those areas.
A few participants felt that the penalties should be harsher and that even small faults should be punished with high fines or imprisonment to ensure people would not want to violate the traffic rules. Some suggested that traffic sign posts should also be increased at every junction to reduce RTCs.
Some participants discussed how legislation changes could influence the area of drink driving:
“Additional efforts will be like taking strict action against drunken driving by eliminating liquor shops near the highways.” (Key Informant 4)
Several participants also felt there should be proper implementation of the Good Samaritan Law:
“I believe that (accidents) can be prevented if .. the good Samaritan guidelines which are given by the honourable Supreme Court can be implemented in the grass root level[sic].” (Key Informant 2)
One participant talked about changing the police system without changing the rules. He explained:
“Change of police system and genuine implementation of the existing rules and regulations should be done, everything will fall in place..there is no need of new rules and regulations in this manner. New regulations will give some more headaches and problems to the society.” (Key Informant 10)
v. Road engineering
The participants felt that the current status of the roads needed to be improved not only by improving the quality and width of roads but by ensuring roads were constructed safely and with care. Roads should also have more than one lane to cater for vehicles with different speed capacities.
There should also be a system in place for the reporting and immediate rectification of any road defects.
Road engineering efforts should also focus on speed reduction, for example having more speed breakers at junctions between small roads and main roads.
Establishing collaborations and partnerships
Some participants mentioned the need for inter-and intra-agency collaborations and partnerships, as well as partnerships between the public and private sectors.
“I feel strongly the main stakeholders are four: one is police department i.e traffic, second is health department i.e. DMHO, third which is very important aspect is the transport department where they have logistics how to implement strategies and fourth one is volunteers who are NGOs (non-governmental organisations). They should come forward to coordinate with all these three departments then only (preventative strategies) will be successful.” (Key Informant 2)
Another important and necessary partnership was between the government and members of the public:
“First thing that we should take the help of the public[sic]...they should also keep watch, they should also come forward and assist the police. Whenever such things are happening, they should bring to our notice. If they found some other people, if they notice that people are violating the traffic rules, immediately they should call we have 100 number and 109 like that. If they take assistance definitely it will be reduced.” (Key Informant 6)
Changing mindset and behaviour
Participants believed that the prevention of RTCs and neurotrauma could be improved if the mindset and behaviour of the citizens were changed. All traffic rules needed to be followed with the understanding that it is for their own safety and not just avoidance of punishment. Abiding by the rules would also lead others around them to do the same. The public should also realise that they have a bigger role to play in the prevention of neurotrauma and RTCs, for example by organising awareness campaigns for their community and providing first aid to unknown RTC victims, as narrated by one participant:
“Rather than depending upon the Government, we ourselves should do something from our side, then only (prevention) can be improved a lot.” (Key Informant 2)
It was felt that there needs to be a strong political will with governmental support for all preventative efforts. Government officials and all those involved in prevention should also set good examples to be emulated by the public in order to have a bigger impact:
“These police people should be like role models to the society.. first police people should follow these rules and regulations properly, then they can ask others to follow.” (Key Informant 10)
“If all the government institutions whether semi government, Central government or State government, if they all follow good Samaritan guidelines there will be huge impact.” (Key Informant 2)