Head injury is recognized as a major public health problem and those due to road traffic accidents account for the great majority world wide. According to a WHO research published in 1996, road accidents which were the 9th leading cause of years lost to death and disability would become the 3rd most major cause by 2020.

Developing countries bear the brunt of the fatalities and disabilities form road traffic accidents, accounting for more than 85% of the worlds road accident fatalities and about 90% of the total disability adjusted life years (DALY) lost to road traffic injuries. The problem is increasing in these countries at a fast rate, while it is declining in all industrialized nations. Road traffic accidents have become the most serious problem faced in this century whether measured in costs, hospital admissions, deaths or loss of productive years of life.

The same applies for India which is undergoing a major economic and demographic transition coupled with increasing urbanization and motorization. Among the top causes of mortality in the country, road traffic accidents was the tenth cause two decades back, but with increasing urban expanse and life style changes, it is projected that road traffic accidents will occupy the fifth position in the list of major killers and third position among the causes of disease burden in 2020.

Road traffic accidents constitute the major cause of head injuries. This incidence of head injuries and the road traffic accidents as a major cause are considered low when we know that many patients with mild head injuries may not attend the hospitals and those of severe head injuries associated with death at the scene of accident or during transportation to the hospital are not accounted in data collection for epidemiological studies of head injuries. Male to female ratio of head injured patients is found to be 6:1. The peak percentage of head injuries among patients of road traffic accidents is found in patients aged from 20 30 (35.8%) which is the most vulnerable group. This highlights the importance of measures for containing the wastage of these young potential of our society. Two wheeler riders represent the majority of victims of road traffic accidents (72.6%).

Road traffic accidents have become the first public hazard in the world, which results in one of the largest threats against human lives and safety. Some of the factors that increase the risk of road crashes in India are

• Unsafe traffic environment
• Poor road infrastructure and encroachments that restrict safe areas for pedestrians
• Lack of safety engineering measures
• Traffic mix and an increasing number of motorized vehicles
• Unsafe driving behavior, including drunken and rash driving and lack of valid driving licenses

The last factor is the one where as responsible citizens we can make a huge impact. Having understood the magnitude of the problem some of the suggestions for improvement are

• Compulsory use of helmets for all two wheel users including pillion rider
  Seat belts for four wheel passengers especially children
• Auto rickshaw passengers are at great hazard due to the inherent instability and insecurity of the vehicle. Suitable measures including seat belts or head gears or speed restrictions have to be implemented to ensure safety of these passengers and driver.
• Strict adherence and enforcement of traffic rules with separate bike and bus lanes and heavy punishment to discourage drunken driving. (For example a doctor caught for drunken driving in U.K. looses his license to practice).
• Pedestrian passages respected by both pedestrians as well as vehicles.

In addition to all of these the responsibility for ensuring the safety of self and others has to be remembered by each of us, the safety of self especially by the pedestrians, two wheelers and auto rickshaws and the safety of others by the drivers of cars, buses and lorries.

The trauma that a head injury from road traffic accident is not only devastating to the patient himself but also to the immediate family and the close society around him as has been observed by this author in several cases. Though accidents will always happen let us pledge not to contribute to the incidence through our negligence, carelessness and lack of awareness, for the gift of life is too precious to loose in a moment of carelessness.