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Abstract
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In urban India, cycle rickshaws are a significant mode of transport. Exact numbers are hard to obtain, but it is estimated that there are 2 million or more rickshaws on the road. Taken together, cycle rickshaws account for 6-8 billion passenger kilometer/year. Recent research analyzed the workload of cycle rickshaw pullers. The investigators concluded that pulling the cycle rickshaw is heavy to very heavy, which also corresponds to the subjective assessment of the participants. As known from other countries, pedestrians, cyclists, and other (motorized) two wheeled vehicle users are the most endangered road users to sustain accidents and corresponding serious injuries and death. Said this, rickshaw pullers as well as rickshaw users have to be categorized into this "high-risk" group. So far, little is known about injury pattern and characteristics of cycle rickshaw pullers or users.
The study at hand presents new data of 84 patients, which were involved in a road traffic accident related to cycle rickshaws. A predominance of young men was evident with a peak between 20 years and 30 years of age. Crash characteristics were differentiated between single and multiple vehicle crashes. Interestingly, overturned vehicles were predominant in this group. The authors found an overload of the rickshaw in 28.5% which most likely contributes to that type of accidents with cycle rickshaws. In case of multiple vehicle crashes, the majority involved crashes with big vehicles like trucks. During hospital stay, three patients died from traumatic brain injury.
Another study dealing with injuries from cycle rickshaw accidents was performed by Jaiswal et al. In their study, the majority of the participants were children or young adults. The majority of the injuries were soft-tissue injuries mostly due to the chain and the rear sprocket, but a number of fractures were also described. In summary, the authors described injuries related to rickshaws comparable to those of bicycles. The majority of patients travelled on rickshaws in a dangerous way, which also included overloaded rickshaws. The authors concluded that most of the rickshaw related injuries are preventable by restricting the number of persons travelling on cycle rickshaws and application of chain covers on new rickshaws.
Another form of transport, which is popular in Asia including India, is the motorized rickshaw. Although, these vehicles reach higher traffic speeds, motorized rickshaws may serve to compare injury patterns and characteristics to those of cycle rickshaws. A study of Schmucker et al. analyzed these items in a prospective trial. In total, 60% of the reported accidents led to injuries of the rickshaw occupant. Of these the investigators were able to recruit a total of 139 patients including 82 injured motorized rickshaw occupants. Of these patients, 50% had multiple injuries and there was an alarming mortality of 12.2% in that group. This data demonstrates the need of further research to improve traffic safety in these road traffic users.
To compare data of the mentioned studies to other countries, further studies are required, which also include the preclinical management. Particularly, the organization preclinical emergency medicine has to be described and should be analyzed. Based on these data including multivariate analyses, an international comparison to bicycle or motorcycle accidents might be supposable. Possibly, some implemented safety features out of the research performed in accident research units world-wide are transferable to cycle rickshaws in order to improve the safety of this mode of transport.
Language: en |