CHAPTER INTRODUCTION

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1 CHAPTER INTRODUCTION 1.1 Background According to the World Bank (2002), every year more than 1.17 million people die in road crashes around the world. The majority of these deaths, about 70 percent occur in developing countries. Sixty-five percent (65%) of deaths involve pedestrians and 35 percent of pedestrian deaths are children. Over 10 million are crippled or injured each year. It has been estimated that at least 6 million more will die and 60 million will be injured during the next 10 years in developing countries unless urgent action is taken. The majority of road crash victims (injuries and fatalities) in developing countries are not the motorised vehicle occupants, but pedestrians, motorcyclists, bicyclists and non-motorised vehicles (NMV) occupants. In response to these staggering statistics, the World Health Organisation (2010) works with partners - governmental and nongovernmental - around the world to raise the profile of the preventability of road traffic injuries and promote good practices related to helmet and seat-belt wearing, not drinking and driving, not speeding and being visible in traffic According to Global Road Safety Partnership, Ghana, road crashes kill an average of four persons daily in Ghana. In 2005, the number of road crashes increased by 16% relative to The regions Ashanti, Eastern, Greater. Accra, Central and Brong Ahafo Regions account for more than 70% of the total number of crash fatalities. Some 70% of crashes occur on flat and straight roads. Speeding is a major cause of crashes, accounting for over 50% of reported crashes. Buses and mini-buses cause 35% of fatal crashes while cars are responsible for 32%. Road users between years are the most vulnerable group and account for 58% of total road crash fatalities from % of persons killed in road crashes are males. The age 1

2 groups from 0-5, and over 65 years also accounted for a 20.8%, 16.7% and 4.6% respectively of the total fatalities during the same period. According to the National Road Safety Commission, an annual distribution of fatalities by road user class 3.5% of motorcyclist were I involved in fatalities. These fatalities were reportedly mostly due to head injuries which could have be preventable if motorcyclist were wearing crash helmets. Afukaar et al. (2009) indicated that Northern region accounts for the most (20%) motorcycle fatalities in Ghana followed by the Upper West region with 14.7% motorcyclist. In the November 10 th 2009, edition of the Daily Graphic, Wear helmets for protection was a major concern when Tamale was brought into focus on the Metro news column. In this article it mentioned that there had been occasions on which the Northern Regional Director of the NRSC and the Deputy Superintendent of Police and the Commander of the MTTU had to go on the streets of the metropolis sensitizing riders on the need to wear helmets. However the sensitization seemed to have fallen on deaf ears. Reports in the metropolis indicate that, at least an unhelmeted motorcycle rider is killed every fortnight and the number of motorcycle injuries has reportedly increased in recent times. The majority of those involved are reportedly young males. In Ghana where motorcycle taxis are now becoming common although they are not an authorized means of public transportation, it is common to find both the riders and the pillion riders (passenger) riding without wearing helmets. In the event of an accident the risk of obtaining head injuries are high whereas the risk could be reduced if they wear crash helmets. Road safety campaigns should encourage pillion riders who patronize motorcycle taxis to insist on being provided with helmets. Many studies conducted elsewhere have demonstrated higher incidence of head and cervical injuries and mortality in unhelmeted patients (Solagberu et al, 2006). 2

3 The idea that it is possible to engage the public at a personal level in road safety has led to the development of the driver Voluntary Code of Conduct (VCoC). In countries where there are scarce and competing resources, the most effective way to achieve casualty reductions may be to target the public and elicit personal commitment to being a responsible and respectful road user. This project is the result of a partnership between Shell Ghana Limited the Global Road Safety Partnership (Ghana) and the National Road Safety Commission. Historical research into the causes of crashes suggested that road user errors were the predominant cause. The more recent approach of considering the road/vehicle/user system as a whole focuses more on the interactions between users and the physical elements of the system. Behavioural issues and human choices however remain critical, particularly with respect to aspects such as wearing seat belts and helmets, drinking and driving, and speed (GPRS Ghana, n. d). 1.2 Justification for the study In many low-income and middle-income countries, where motorcycles and bicycles are an increasingly common means of transport, users of these two-wheelers make up a large proportion of those injured or killed on the roads. Motorcycle and bicycle riders are at an increased risk of being involved in a crash because they often share the traffic space with fastmoving cars, buses and trucks. In addition, their lack of physical protection makes them particularly vulnerable to being injured if they are involved in a collision. In most high-income countries, motorcycle fatalities typically comprise around 5% to 18% of overall traffic fatalities. This proportion reflects the combined effect of several important factors including the relatively low ownership and use of motorcycles in many developed countries, and the relatively high risk of these motorcycles being involved in crashes involving fatalities. Typically, these risks are much higher for motorcycle than for vehicle travel. In low-income and middle-income countries, car ownership and use rates are generally much lower than in high-income countries. In developing countries motorcycles are frequently the most common form of motor transport (WHO, 2006). 3

4 The ownership and use of motorcycles and other two-wheelers is generally relatively high for example, in India 69% of the total number of motor vehicles are motorized two-wheelers, considerably higher than in high-income countries Reflecting this difference, the levels of motorcycle rider fatalities as a proportion of those injured on the roads are typically higher in low-income and middle-income countries than in high-income countries. For instance, 27% of road deaths in India are among users of motorized two-wheelers, while this figure is between 70 90% in Thailand, and about 60% in Malaysia. In China, motorcycle ownership between 1987 and 2001 grew rapidly from 23% to 63%, with a corresponding increase in the proportion of traffic fatalities sustained by motorcyclists increasing from 7.5% to 19% over the same period (WHO, 2006). Motorcycle and bicycle taxis are emerging as important means of public transportation in many African cities - but their operation is characterized by non-helmet use. In Ghana and most African countries, the use of motorcycles as a means of transportation is becoming increasingly popular. This is because the cost of a motorcycle is relatively lower compared with the cost of an automobile. Motorcycles can traverse and maneuver over all types of roads, thus the cost for infrastructure is rather low as compared to automobiles. In congested urban Ghana, a significant number of people prefer the use of motorcycles since one could maneuver and weave through all types of traffic; however the safety of riders leaves much to be desired, in that most of them ride without wearing helmets, especially when riding within the cities and towns. Research indicates that wearing a helmet lowers a motorcycle rider's risk of fatalities by 29% and reduces the risk of traumatic brain injury by 67 %.( NHTSA, 2002). Here in Ghana the National Road Safety Commission s Arrive Alive campaign has laid on the wearing of crash helmets and how it can reduce head injuries. Coupled with this, there is a Mandatory crash helmet law in Ghana requiring that all Motorcyclists should wear helmets when riding. Despite these laws, campaigns and the scientific evidence showing that helmets reduce deaths and injuries to motorcycle riders, many riders choose not to wear helmets. In Ghana, statistics show that 4

5 between 2004 and 2006, 303 motorcycle riders were involved in fatalities and these fatalities were due to head injuries. Available data indicates that Northern Ghana accounts for a high proportion of fatalities However, in Ghana, gap in existing data due to under reporting of crashes means that precise levels of motorcycle rider fatalities are still not known. Knowledge of the numbers of motorcyclists complying with helmet laws or levels of non compliance alongside the associated reasons will help the NRSC to shape its educational strategy or have a more focused road safety activity on helmet use. 1.3 Objectives of the Study The objectives of the study are: 1. To establish the prevalence of motorcycle helmet usage for both the rider and the pillion rider and factors determining use or non use of the helmet 2. To establish the level of awareness among motorcyclists of the benefits of using crash helmet. 3. To establish the perception of motorcyclists on the usage of crash helmets and the enabling legislature or regulation. 5

6 CHAPTER LITERATURE REVIEW 2.1 Studies Comparing Injury of Riders by Helmet Use Over the past three decades the use of motorcycle safety helmets has become more common in many Countries throughout the world. Research, mostly conducted in the United States of America, has repeatedly found that motorcycle helmets are effective in reducing head and neck injuries and deaths from motorcycle crashes. Studies indicate that wearing helmets reduces fatalities by more than 25% (Baker et al. (1992), Offner et al. (1992), Rutledge et al. (1993)). A study by Braddock et al. (1992) found non-helmeted motorcyclists involved in crashes were 3.4-fold more likely to die than were helmeted riders. The National Highway Traffic Safety Administration (NHTSA) estimates that wearing a helmet reduces a motorcyclists overall risk of death in a crash by 29 percent and the risk of brain injury by 67 percent (NHTSA, 2002). Bachulis et al. (1988) studied the records of all motorcyclists admitted to hospital and found a much higher percentage of deaths in non-helmeted riders than in helmeted riders. They found 23 deaths (9.7%) in the 235 non-helmeted patients compared to 7 deaths (5.3%) in the 132 helmeted riders. They also reported that almost half of the non-helmeted motorcyclists had brain injuries compared with nearly a fourth of the helmeted patients. Severe brain injuries were three times as high in non-helmeted patients as in helmeted patients (30% versus 9.3%). The study also shows that deaths from causes other than brain injury were 3.8% in both helmeted and non-helmeted patients. Gabella et al. (1995) reported on the relationship between helmet use and head injuries among motorcycle crash victims in El Paso County, Colorado, from 1989 to They reported head injuries for 7.6% of motorcycle riders with helmets versus 25.4% of head injuries for motorcycle riders without helmets. May et al. (1989) reviewed 225 victims of motorcycle crashes during a 24-month period from 1987 to The source of the data was 6

7 the Bay Area Trauma Registry which show that 1 of 60 (1.7%) patients who used helmets died while 7 out of 153 (4.6%) patients who did not use helmets died. The study by Wagle et al (1993) includes 81 motorcyclists involved in crashes and flown to the trauma center of Hartford Hospital, Connecticut. They reported that one out of the 23 helmeted motorcyclists died (4.3%), while 9 of the 58 (15.5%) non-helmeted riders died. Heilman et al. (1982) study motorcycle-related trauma and helmet usage in North Dakota. The study which includes four years of data from 1977 to 1980 concludes that 2.5% of motorcycle riders without helmets in crashes died while 0.8% of motorcycle riders with helmets in crashes died (H Schneider, 2006). 2.2 Effectiveness of Motorcycle Helmet Legislation to Increase Helmet Use There is strong evidence that laws requiring the use of helmets increases their use (Braddock et al. 1992; McSwain et al. 1990; Chenier et al. 1987), thus reducing injury, death and medical costs. Less than 50% of motorcyclists wear helmets when they are not required by law, while compliance approaches 100% when the laws are in effect and are enforced (Champion et al.1991). Motorcycle injuries and fatalities are a growing problem in developing countries (Ding et al. 1993; Supramaniam et al. 1982; Sood 1988; Sidharta et al. 1989; Buro Pusat Statistik 1988). Relatively few developing countries have enacted and are enforced motorcycle helmet laws (Falope 1991). Ghana is one of the few developing countries that have a mandatory helmet law. This law was passed in Although many risk factors for crashes have been identified, such as alcohol use, driver fault, speeding, vehicle design, there has been little reported success in reducing motorcycle crash rates. The most successful injury prevention approach has been secondary that is, reduction of the severity of injury after the crash and the secondary countermeasure most employed worldwide for this purpose has been motorcycle helmets. 7

8 2.3 Head injuries; a leading cause of death and disability Injuries to the head and neck are the main cause of death, severe injury and disability among users of motorcycles and bicycles. In European countries, head injuries contribute to around 75% of deaths among motorized two-wheeler users; in some low-income and middle-income countries head injuries are estimated to account for up to 88% of such fatalities (WHO et al, 2006). The social costs of head injuries for survivors, their families and communities are high, in part because they frequently require specialized or long term care. Head injuries also result in much higher medical costs than any other type of injury (WHO et al, 2006), such that these injuries exert a high toll on a country s health care costs and its economy. Globally, there is an upward trend in the number and use of motorcycles and bicycles, both for transport and recreational purposes. Indeed, most of the growth in the number of vehicles on the world s roads comes from an increasing use of motorized two-wheelers. Asian countries, in particular, are expected to experience a considerable rise in the number of motorized two-wheeler vehicles on their roads. This rapid growth in the use of motorcycles in many low income and middleincome countries is already being accompanied by a considerable increase in the number of head injuries and fatalities that will only continue to increase if present trends continue. In Ghana, Road Traffic Act 2004, Act 683 ensures the mandatory use of standard crash helmet, the sale of standard protective crash helmet and the extensive education campaign on helmet use by the National Road Safety Commission. Thus the National Road Safety Commission s ARRIVE ALIVE campaign lays emphasis on the wearing of crash helmet and despite the documented effectiveness of helmets, many motorcycle riders choose not to wear them. It has been observed that when enforcement by the police is strong, some cyclists wear helmets and some go to the extent of improvising just to avert the attention of the police. In some communities in the North, Upper East and Upper West regions, some riders go to the extent of painting huge calabashes to look like helmets. Studies show that countries where the use of helmet is not mandatory or if this rule was repealed the number of fatal injuries or death due to motorcycle crashes increased many fold. In Pakistan the use of helmet is a mandatory for 8

9 motorcycle riders however poor compliance is a major problem and failure to enforce on the part of the traffic police. 2.4: What is a Helmet? A motorcycle helmet is a type of protective headgear used by motorcycle riders. The primary goal of a motorcycle helmet is motorcycle safety - to protect the rider's head during impact, thus preventing or reducing head injury or saving the rider's life. Some helmets provide additional conveniences, such as ventilation, face shields, ear protection, intercom etc. [Wikipedia, 2010] 2.5 Types of Helmets Full-face helmets (Figure 3.1a) These helmets offer facial protection in addition to impact protection. Their principal feature is a chin bar that extends outwards, wrapping around the chin and jaw area. Extending above the jaw, there is a vision port that allows the wearer maximum range of sight, in line with the requirements for peripheral and vertical vision. Open-face helmets (Figure 2.1b) Open-face helmets give standard protection from impact with their hard outer shell and crushable inner liner. Compared to the full-face type, they offer only limited protection for the jaw and chin area. They may or may not have retractable visors to protect the eyes. Half-head helmets (Figure 2.1c) These helmets provide protection by means of a hard outer shell and a crushable inner liner. They do not offer protection for the chin or jaw area and are rarely equipped with visors. The half-head helmet may or may not have ear flaps attached to the retention system. 9

10 Helmets for tropical use (Figure 2.1d) These are helmets specifically designed for South Asian and South-East Asian countries with extremely hot and humid climates. They are actually half-head helmets with ventilation holes to provide a maximum flow of air so as to reduce the heat. Their extreme lightness of weight is achieved by using semi-rigid vacuum-forming PVC material. Fig. 2.1: Helmet Types (Source: WHO et al, 2006) 2.6 Laws and standards Motorcycle helmets greatly reduce injuries and fatalities in motorcycle accidents, thus many countries have laws requiring acceptable helmets to be worn by motorcycle riders. These laws vary considerably, often exempting mopeds and other small-displacement bikes. In some countries, most notably the USA and India, there is some opposition to compulsory helmet use thus not all the States in the United Sates of America have a compulsory helmet law (wikipedia.org, 2010). Worldwide, many countries have defined their own sets of standards that are used to judge the effectiveness of a motorcycle helmet in an accident, and define the minimal acceptable standard thereof. Among them are: 10

11 ACU (Auto-Cycle Union) Gold or Silver badge AS/NZS 1698:2006 (Australia and New Zealand) BSI (British Standards Institute) 6658 DOT FMVSS 218 (USA)[4] NBR 7471 (Brazil) IS 4151 (India) JIS T 8133:2000 (Japan) Snell M 2005 "2005 Helmet Standard For Use in Motorcycling" SNI (Indonesia) ECE (Europe)[5] The Snell Memorial Foundation has developed stricter requirements and testing procedures for motorcycle helmets with racing in mind, as well as helmets for other activities (e.g. drag racing, bicycling, horseback riding), and many riders in North America consider Snell certification a benefit when considering buying a helmet while others note that its standards allow for more force to be transferred to a rider's head than the U.S. Department of Transportation (DOT) standard. However, the DOT standard does not test the chin bar of helmets with them, while the Snell (and ECE) standards do. In the United Kingdom, the Auto-Cycle Union (ACU) defines a stricter standard for racing than the legal minimum ECE specification. Only helmets with an ACU Gold sticker are allowed to be worn in competition, or at track days. Many riders in the UK choose helmets with an ACU Gold sticker for their regular on-road use (wikipedia.org, 2010). 2.7 The Mechanism of Head Injuries An appreciation of the anatomy of the head is important in understanding the mechanism of injuries to the head and brain (Figure 2.1). Briefly, the important anatomical information about the head to note is the following: The brain is enclosed within a rigid skull. The brain sits on bones that make up the base of the skull. 11

12 The spinal cord passes through a hole in the underside of the brain. Under the skull, adhering to the bones is a tough tissue called the dura that surrounds the brain. Between the brain and the dura is a space containing cerebrospinal fluid that protects the brain tissue from mechanical shock. The brain floats in the cerebrospinal fluid but it can only move about 1 millimeter in any direction. The skull is covered by the scalp, which provides some additional protection. Fig. 2.2: Structure of the head and brain (Source: WHO, 2006) During a motorcycle or bicycle crash there are two principal mechanisms of injury to the brain: through direct contact and through acceleration deceleration. Each mechanism causes different types of injuries. When a motorcycle or bicycle is involved in a collision, the rider is often thrown from the cycle. If the rider s head hits an object, such as the ground, the head s forward motion is stopped, but the brain, having its own mass, continues to move forward until it strikes the inside of the skull. It then rebounds, striking the opposite side of the skull. This type of injury can result in anything from a minor head injury, such as concussion, to a fatal head injury. Head injuries that 12

13 result from either contact or acceleration deceleration injuries are themselves divided into two categories: open or closed head injuries. Most traumatic brain injuries are the result of closed head injuries that is, there is no open wound to the brain. ` Motorcycle riders who do not wear a helmet run a much higher risk of sustaining any of these head and traumatic brain injuries, or a combination of them. Helmets create an additional layer for the head and thus protect the wearer from some of the more severe forms of traumatic brain injury. 2.8 How a Helmet Works A helmet aims to reduce the risk of serious head and brain injuries by reducing the impact of a force or collision to the head. A helmet works in three ways: It reduces the deceleration of the skull, and hence the brain movement, by managing the impact. The soft material incorporated in the helmet absorbs some of the impact and therefore the head comes to a halt more slowly. This means that the brain does not hit the skull with such great force. It spreads the forces of the impact over a greater surface area so that they are not concentrated on particular areas of the skull. It prevents direct contact between the skull and the impacting object by acting as a mechanical barrier between the head and the object. These three functions are achieved by combining the properties of four basic components of the helmet that are described below (Figure 2.3). Fig. 2.3: Components of a helmet (Source: WHO, 2006) 13

14 The shell This is the strong outer surface of the helmet that distributes the impact over a large surface area, and therefore lessens the force before it reaches the head. Although the shell is tough, it is designed to compress when it hits anything hard. It provides protection against penetration by small, sharp and high speed objects and it also protects the padding inside the helmet from abrasions and knocks during daily use. These requirements mean that the shell must be hard, usually with a smooth exterior finish. The impact-absorbing liner This is made of a soft, crushable padded material usually expanded polystyrene, commonly called styrofoam. This dense layer cushions and absorbs the shock as the helmet stops and the head tries to continue moving. The comfort padding This is the soft foam-and-cloth layer that sits next to the head. It helps keep the head comfortable and the helmet fitting snugly. The retention system, or chin strap This is the mechanism that keeps the helmet on the head in a crash. A strap is connected to each side of the shell. Chin and neck straps, which are specifically designed to keep the helmet on during an impact, must be correctly used for the helmet to function as it is designed to. A study in Malaysia examined the compliance of helmet use in a typical Malaysian town. Of the 5000 motorcyclists studied, only 54% used helmets properly, 21% used them improperly, and 24% did not wear them at all. Younger people, men and those with less formal education were more likely to not wear helmets properly. 14

15 Fig. 2.4: Users do not secure their helmets (Source: WHO, 2006) Many helmet users do not secure their helmets properly and sometimes not at all thereby rendering the helmet of little if any value in the event of a collision 2.9 What Helmet Does Not Do Helmets are designed to reduce the chances of head, brain, and facial injuries occurring, but are not designed to prevent injuries to other parts of the body. To reduce the likelihood of injuries to other parts of the body, the following strategies can be employed: Appropriate clothing can be helpful to reduce other types of injuries (for example, jacket and trousers of particular materials which cover arms and legs the hands in the event of a crash) Obeying the laws of the road, including adhering to speed limits and not driving while drunk are behaviours that will reduce the chance of a motorcyclist being involved in a crash, and thus their likelihood of incurring any type of injury. 15

16 2.10 Motorcycle helmet design In addition to meeting the previously described functions and conforming to standards, a helmet needs to be designed to suit the local weather and traffic conditions. The following are some of the considerations usually addressed by helmet designers: Materials used in the construction of a helmet should not degrade over time, or through exposure to weather, nor should they be toxic or cause allergic reactions. Currently, the plastic materials commonly used are Expanded Poly-Styrene (EPS), Acrylonitrile Butadiene Styrene (ABS), Poly Carbon (PC) and Poly Propylene (PP). While the material of the helmet shell generally contains PC, PVC, ABS or fibre glass, the crushable liner inside the shell is often made out of EPS a material that can absorb shock and impact and is relatively inexpensive. However, helmets with EPS liners should be discarded after a crash, and in any case users should replace such helmets after 3 5 years of use. Standards often set the minimum coverage of a helmet (see Module 3). Half-head helmets offer minimal coverage. Full-face helmets should ensure that the wearer s peripheral vision and hearing are not compromised. To ensure that a helmet can absorb the shock of a crash, the crushable liner should be between 1.5 cm and 3.0 cm in thickness Helmet use is effective at reducing head injuries Wearing a helmet is the single most effective way of reducing head injuries and fatalities resulting from motorcycle and bicycle crashes. Motorcyclists who do not wear helmets are at a much higher risk of sustaining head injuries and from dying from these injuries. In addition, riders who do not wear helmets place additional costs on hospitals, while the disability that results from these head injuries incurs costs at an individual, family (or carer) and societal level. 16

17 2.12 Hospital Costs Are Reduced By Helmet Use Researchers in Michigan, USA, studied the impact of motorcycle helmet use on patient outcomes and cost of hospitalization. Despite Michigan s mandatory helmet law, 19% of the 216 patients included in the study were not using helmets when they crashed, allowing the researchers to compare costs among helmeted and unhelmeted riders. On average, helmet use led to average hospital costs that were about 20%, or US$ 6000, less than costs for those who did not wear helmets. For patients who were treated on an inpatient rehabilitation floor after leaving the trauma unit, average costs for unhelmeted riders were nearly twice those of helmeted riders, in part due to the fact they were kept in hospital longer. The results also confirmed earlier findings that riders without helmets were younger, suffered more head and neck injuries, and had higher overall injury severity scores. Failure to wear a helmet adds to the financial burden created by motorcycle-related injuries. The authors concluded that individuals who do not wear helmets should therefore be required to pay higher insurance premiums (Brandt M et al. 2002) Headwear Not Intended for Motorcycling There are other types of headwear - often called "beanies," "brain buckets", or "novelty helmets", a term which arose since they cannot legally be called motorcycle helmets. These helmets are not certified and are generally only used to provide the illusion of compliance with mandatory helmet laws. Such items are often smaller and lighter than helmets made to DOT standards, and are unsuitable for crash protection because they lack the energy-absorbing foam that protects the brain by allowing it to come to a gradual stop during an impact. A "novelty helmet" can protect the scalp against sunburn while riding and - if it stays on during a crash - might protect the scalp against abrasion, but it has no capability to protect the skull or brain from an impact. 17

18 Fig: 2.5: Accident damaged helmet shows how the chain bar and face shield protected the user (Source: Wikipedia) Fig: 2.6: A Shoei helmet which has been involved in an accident (Source: Wikipedia) 2.14 Standards Testing Most motorcycle helmet standards use impacts at speeds between 4 7 m/s (9 16 mph). At first glance, this is confusing given that motorcyclists frequently ride at speeds higher than 20m/s (45mph). This confusion is relieved by understanding that the perpendicular impact speed of the helmet is usually not the same as the road speed of the motor cycle and that the severity of the impact is determined not only by the speed of the head but also by the nature of the surface it hits. For example, the surface of the road is almost parallel to the direction the motorcyclist moves in so only a small component of his velocity is directed perpendicular to the road while he is riding. Of course, other surfaces are perpendicular to the motorcyclist's 18

19 velocity, such as trees, walls and the sides of other vehicles. The other vital factor in determining the severity of an impact is the nature of the surface struck. The sheet metal wall of a car door may bend inwards to a depth of cm ( inch) during a helmeted head impact, meaning that it generates more stopping distance for the rider's head than the helmet itself. So a perpendicular impact against a flat steel anvil at 5m/s (11mph) might be about as severe as a 30m/s (67mph) oblique impact against a concrete surface or a 30m/s perpendicular impact against a sheet metal car door or windscreen. Overall, there is a very wide range of severity in the impacts that could conceivably happen in a motorcycle impact. Some of these are more severe than the impacts used in the standard tests and some are less so. (Wikipedia, 2010) 2.15 Public Awareness Campaign for Helmet Usage Wear A Helmet. There Are No Excuses. is the slogan of the Public Awareness Campaign (PAC) that strives to increase helmet-use rates and improve traffic safety knowledge throughout Vietnam, to decrease traffic accident fatalities and modify road safety behavior. The campaign is endorsed by many celebrities; including movie star Michelle Yeoh Formula 1 star Michael Schumacher, Football players Thanh Binh, Miss Vietnam Mai Phuong Thuy and many others. Fig. 2.7: Children playing in the street and wearing Protective Helmets Source: Asia Injury Prevention Foundation, ) 19

20 The (PAC) includes billboards, postcards, concerts, fashion shows, and television commercials, all designed to focus on unsafe behaviors. The PAC currently is in phase III. Phase III of the PAC rounded out the message of Phase I and II, and responded to the changing dynamics of the road traffic safety public health crisis in Vietnam. In Phase I, the Campaign displayed graphic images of road accident survivors that portrayed the consequences of a severe road accident. During Phase II, PAC messages focused on habitual helmet use with the message: Turn it on, put it on. During Phase III, messages focusing on habitual helmet use were reinforced with television and outdoor advertising slogans Wear a Helmet. There Are No Excuses. Contributions to the PAC can be arranged on an ad hoc basis and offers interesting opportunities for companies and other organizations to enhance and realize their corporate social responsibility. Helmets for Kids (HFK) is a non-profit program distributing free quality safety helmets to needy primary school children. Sadly, children in Vietnam bear the brunt of the traffic safety crisis because they do not have access to proper safety equipment. In a society where the motorbike is the primary mode of transportation, children have become the most vulnerable passengers while riding with their parents. In response, AIPF initiated Helmets for Kids. Launched in 2000, this innovative program was the catalyst for government, nonprofit organizations, and corporate sponsors to work together to develop one of the most successful public-private partnerships devoted to saving the lives of children in the developing world. The program has distributed more than 260,000 child helmets to primary schools throughout Vietnam, Thailand, Laos and Cambodia and is now being expanded into Africa [AIPF Wear-a-Helmet English Site AIPF.mht, Asia Injury Prevention Foundation Copyright All Rights Reserved] Fig. 2.8: Former U.S. President Bill Clinton at Helmets for Kids launch in 2000 in Hanoi. (Source: Asia Injury Foundation) Fig 2.9: King Norodon Shihamoni of Cambodia at the first Helmets for Kids ceremony in Phnom Penh in (Source: Asia Injury Foundation) 20

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