Thailand’s Report
Situation of Severe Injuries
Year 2005-2010
Data from Injury Surveillance (IS), Thailand
2
Thailand’s Report on
Situation of Severe Injuries
2005-2010
Data from Injury Surveillance (IS) ,Thailand
Supported by World Health Organization
3
Thailand’s Report on Situation of Severe Injuries 2005-2010
Editor
Siriwan Santijiarakul Child safety promotion and injury prevention research center
Ramathibodi hospital
Working Group
Pimpa Techakamolsuk Bureau of Epidemiology, Department of Disease Control
Ministry of Public Health
Arattha Rangpeung Bureau of Epidemiology, Department of Disease Control
Ministry of Public Health
Anong Saengjanthip
Bureau of Epidemiology, Department of Disease Control
Ministry of Public Health
Consultant committee
Wittaya Chadbunchachai Senior Deputy. Director, Khon Kaen Regional Hospital
Director of Trauma and Critical Care Centre , Khon Kaen
and President of Road traffic injury prevention technical
program for provincial level ,Thailand
Vorasith Sornsrivichai Deputy Director of Institute of Research and Development for
Health of Southern
4
Contents
Foreword…………………………………………………………………… 5
Executive summary…………………………………………………………6
Acknowledgements………………………………………………………….8
1.Introduction……………………………………………………………….9
2.External Causes of Severe Injuries and deaths in Thailand
Overview………………………………………………………………….11
3.Transport Injuries……………………………………………………….17
3.1 INJURY SURVEILLANCE ( IS) For Road Safety ………………18
3.2 Severe Injuries due to Transport Accident…………………………..20
3.3 Severe injuries related to motorcycle accident………………………29
3.4 Important Risk Behaviors …………………………………………..53
3.4.1 Alcohol use……………………………………………………53
3.4.2 Seatbelt……………………………………………………......54
4. Accidental Falls………………………………………………………….60
5. Assaults…………………………………………………………………..71
Appendix
Development of the provincial injury surveillance ( IS) in Thailand……82
National Injury Surveillance record form ………………………………...95
Name of sentinel sites : Data for report………………………………… 97
IS sentinel sites of National Injury Surveillance System in 2012…………98
5
Foreward
Over the last few decades there have been fundamental changes in disease patterns among the
people of Thailand due to rapid urbanization and economic growth. The pattern of mortality and
morbidity with regard to communicable and non communicable diseases in these largely linked to
infectious diseases earlier, it is now mainly related to non communicable diseases as well as injuries
and violence. This report is for studying trends of morbidity and mortality from severe injuries that
always in the top five of Thailand including the behavior risk factors which effect to the injury in 6
years since 2005-2010. Data for report was the secondary data which has been selected from injury
surveillance(IS)2005-2010.This Surveillance System is controlled by Bureau of Epidemiology
,Department of Disease Control, Ministry of Public Health. This report provide the Overview of
injury morbidity and mortality, the situation of Road Traffic Injuries, motorcycle problem in our
country also behavior risk factors and other injuries that we pay attention for the report in Falls
and assaults. So far we further look for more knowledge of injury based on injury surveillance data
and other information to achieve on proposing the intervention and policy in the issue of injury’s
prevention and control and we hope that it is possible to use the baseline of injury information and
some knowledge from this report to develop the tool on Thailand’s injury forecasting in the future as
well.
Team of IS Analyzers and report writers
April 1 ,2012
6
Executive summary
Injury is a serious public health issue with a major impact on the lives of people. It is the leading
cause of death among children and young adults and also a major cause of long and short term
disability in many countries. Effective prevention and control of injuries requires as system of
surveillance that monitors the incidence of injuries, their causes, treatment and outcomes. The
provincial injury surveillance was established by Bureau of Epidemiology since 1996. Now there are
33 hospitals for the sentinel sites collecting the data of injury surveillance to planning and evaluating
the policies, programs and services in Thailand especially on problem of road traffic accident , others
such as assault , falls etc. still are the problems too . So far we further look for more knowledge of
injury based on injury surveillance data and other injury information to achieve on proposing the
intervention and policy in the issue of injury’s prevention and control and we hope that it is possible
to use the baseline of injury information and some knowledge from the information from this report
could be use for tool development on Thailand’s injury forecasting in the future as well.
Objectives of the report :
1. To analyze the injury surveillance data ( IS 6 years) that would facilitate injury prevention and
control at national level.
2. To review the former knowledge in each issues and gathering with the IS information,Thailand
3. To summarise the report and recommendation for prevention and control of the serious injuries in
Thailand
Result :
The result of analysis of data collected from 28 participating hospitals in National Injury
Surveillance System during 2005-2010 revealed that transport accident, which accounted for 47.31%
(444,555 cases) was the most important cause of severe injuries and deaths .Drinking habit directly
related to occurrence of severe injuries, particularly assaults. Most of assault cases (49.01% 57.74%) were drunk .For transport injuries, the most important vehicle of severe injuries and deaths
7
is motorcycle . Each year, there were 54,000-61,000 severe injury cases related to motorcycle
accident who were admitted into 28 sentinel hospitals. Among them, 3,000-4,000 died. The number
of severe injury cases under 15 years old was 5,000-6,000 and 200 died.
Recommendations:

Law enforcement should be done, especially on helmet use and drunk driving. Check points on
roads should be set up more frequently. Since 2007, the punishment of drunk driving is a repeal
of driving license with 10 year imprisonment and 200,000 Baht fine.

The rule for motorcycle licensing should be revised in accordance with WHO recommendations
(World Health Organization-Regional Office for South-East Asia, Recommendation of the
Expert Group on Preventing Motorcycle Injuries in Children 2010), which also include the rule
of transportation by and the merchandizing motorcycles. 3
- age of legal motorcycle drivers should be over 18 years old, which equal to car drivers.
motorcycle passengers should be more than 5 years old.
market price of motorcycle should cover 2 helmets, one of which is for children.

Principals of elementary schools should not allow school children to drive motorcycles to
schools, because the maximum age of elementary school children is only 12 years old, and
he/she should be encouraged to provide school bus for children.

Serious concern of alcohol drinking risk on severe injuries, law enforcement in alcohol control
( Alcohol Control Act B.E. 2551 (2008)) should be continuously done cause of the most risk
group is age 15-19 years old while the legal drinking age is 20 years old .(The Alcoholic
Beverage Control Act of 2008 increased the drinking age in Thailand from 18 to 20. Alcohol sale
is banned between 2pm to 5pm and between midnight to 11am and also on election days and
some religious holidays but there ‘s still poor law enforcement in those issues with poor
communication) .
8
Acknowledgements
The process of compilation and analysis of this report based on data from 28 sentinel
hospitals of Injury Surveillance System, Thailand which was established in 1995 by Bureau of
Epidemiology, Ministry of Public Health. We are grateful to the following professionals for
supporting this activity by providing the valuable suggestion :Dr. Chamaiparn Santikarn, Dr. Vitaya
Chadbunchachai, Dr. Anuchar Setasatian and Dr. Vorasith Sornsrivichai
Our sincere thanks to the staff and personnel of the 28 sentinel hospitals participating in the
National Injury Surveillance System, for their kind cooperation in data collection and analysis, also
the central IS staff who need to work for the quality control. Thanks to the directors of sentinel
hospitals, provincial health offices and 12 offices of disease of prevention and control who support
the work inside their hospitals, provinces and regions.
This document has also benefited from the contribution of several staffs of Epidemiology
Bureau , in particular, Dr. Pasakorn Akarasewi who support the IS system in line of management.
9
Introduction
With the phenomena of globalization ,industrialization and media expansion , Thailand has
been pass through a major and significant social, economic and technological transition . Injuries
are emerging as an established public health problem . Transport injury is the main issue of injury
problem for Thailand since 1969 ,but there are some trends of severity and loss seem to grow up
for the other injuries such as falls and intention self harm with the increasing of alcohol risk in
recent years. In 1991, the Ministry of Public Health announced the accident prevention and control
as a major policy. The lack of good and systematic epidemiological data is one obstacle for setting
the guidelines and evaluation for prevention and control program. In 1992, the non-communicable
disease section of Epidemiology Division was assigned to develop injury surveillance (IS) system
in order to obtain essential and sufficient epidemiological data. A pilot of injury surveillance at the
provincial level was developed using trauma registry at Khonkaen hospital as a primary model.
Provincial injury surveillance system was piloted in five big provincial hospitals in different
regions of the country and from January 1995. Analysis of surveillance data was done by using IS
Software. Sentinel hospitals were expand gradually every year and at present in 2012 there are 33
sentinel hospitals contributing to the injury surveillance.The system is coordinated by Bureau of
Epidemiology under the Department of Disease Control. The analysis of IS data for this report will
be the information which is useful to clearify the problems , magnitude and trend , moreover data
using for initial program evaluation and update useful information for injury prevention and control.
The baseline knowledge of injury would be carried out and possible to be as the issue for tool
development on injury forecasting.
Objective
1. To study trend of injury and death from road traffic injury , falls and assault during
2005-2010
2. To study epidemiological descriptive
3. To study risk factor behavior which related with the important injuries
4. To gathering the useful information and knowledge from IS data as the key issues
for developing forecasting model on injury in the future
10
Methodology
1. Study design :Descriptive study
2. Data collecting from Secondary data from Injury Surveillance ( IS) , Bureau of
Epidemiology , Ministry of Public Health . Time period between January 2005 and
December 2010.
3. Analysis cause of mortality and morbidity determination , trends within the significant
variables.
4. Conclusion and discussion of study
5. Report and recommendation
11
External Causes of Severe Injuries and deaths in Thailand
National Injury Surveillance, Thailand 2005-2010
Overview
During the past decade, the most important cause of severe injuries and deaths which is one of major
health problems in Thailand is transport accident. Apart from that, accidental drowning and submersion is an
important cause of death in children under 5 years of age. Severe injuries and deaths due to assaults are on the
increasing trend and have major impact on health, economy and the society. Bureau of Epidemiology, Ministry of
Public Health, had developed Hospital-based Injury Surveillance, in 2004. At that time, there were 26 hospitals which
volunteered to be Sentinel sites, both in Bangkok Metropolis and regional areas. In 2011, there were 33 sentinel
sites all over the country. At the national level, there are annual reports which summarize information on
magnitude of Dead before arrival, Dead at ER and severe injury cases which were admitted/observed in sentinel
hospitals.
During 2005-2010, Bureau of Epidemiology has issued a report based on Injury Surveillance data from
28 hospitals. The total number of severe injury cases was 939,585, which included 45,092 deaths, giving case
fatality rate of 4.79%. Injuries among male were 2.6 times higher than female. Majority of severe injury cases
were 15-29 years of age (34.2%) and under 15 years of age (14.5%). Unskilled laborer accounted for 36.62% of
injury cases, followed by student and agriculturist (19.83% and 12.96% respectively). The highest percentage
was found during 15.00-21.00 hr. The number of injury cases distributed evenly during a week, except 1-2%
higher on Friday, Saturday and Sunday. High numbers of injury cases were found in January, March, April and
December. All other months had no significant increment. (Table 1)
Causes of severe injuries and deaths
Transport accident, which accounted for 47.31% (444,555 cases) was the most important cause of severe
injuries and deaths, followed by accidental falls (155,172 cases,. 16.51%); exposure to inanimate mechanical
forces (137,579 cases, 14.64%), assaults (89,592 cases, 9.54%) and intentional self-harm (37,820 cases, 4.03%)
(Table 2)
Regards to deaths by cause, it was found that the highest number of deaths were from transport accident
(27,783 cases, 61.61%), followed by assaults (4,538 cases, 10.06%), accidental falls (4,439 cases, 9.84%),
intentional self-harm (3,095 cases, 6.86%) and accidental drowning and submersion (1,739 cases, 3.86%).
Accidental drowning and submersion has the highest case fatality rate (42.19% - 49 %) (Table 3)
Epidemiologic characteristics of some important causes of severe injuries and deaths
Regarding severe sex ratio by causes, it was found that male has higher proportion of 1.3 – 8.5 times
more than female, except for intentional self-harm, which showed the female : male ratio of 1.2 : 1 to 1.4 : 1.
12
Age of severe injuries by transport accident and assaults was similar (mostly were in 15-29 year agegroup). Three-fourth of assaults occurred in victim’s home. More than half of accidental falls cases were over 60
years of age. Majority of severe injuries from exposure to inanimate mechanical forces were between 35-49 years
of age, except in 2005 in which most of cases were between 25-44 years old. Most of intentional self-harm cases
were between 15-24 and 20-29 years of age. However, in 2010, intentional self-harm injuries were found between
15-44 years of age, and highest in 20-24, followed by 15-19 year age-groups.
By occupation, most of severe injuries and deaths were among unskilled laborer in all five highest causes
found, followed by student. Time of event was somewhat different for different causes, say, transport accident
mostly occurred during 16.00-21.00 hr, with an increasing trend between 15.00-21.00 hr. In 2010, injuries due to
transport accident increased during 22.00-24.00 hr. Intentional self-harm mostly occurred during daytime to
nighttime (noon to midnight). Injuries due to exposure to inanimate and animate mechanical forces mostly
occurred during daytime (8.00-19.00 hr). Accidental falls mostly occurred in the evening (15.00-19.00 hr), and
assaults occurred at nighttime (21.00-02.00 hr).
Severe injuries due to all causes occurred more on weekend (1-2% higher) than weekdays. By months,
there was no difference in magnitude for all causes, except transport accident which occurred more in January,
March, April and December. Accidental drowning and submersion occurred more in April, 1.6-3.5 times higher
than other months.
Drinking habit directly related to occurrence of severe injuries, particularly assaults. Most of
assault cases (41.43% - 57.74%) were drunk. (Table 4)
13
Table 1 Descriptive data of severe injuries, classified by leading causes of injury, 2005-2010.
Year
2005
Descriptive
data
Sex ratio
Age group
Occupation
Time of
occurrence
Sex ratio
Age group
2006
Occupation
Time of
occurrence
Sex ratio
Age group
2007
Occupation
2009
04.00 PM 09.00 PM
Sex ratio
Age group
2:1
15-29
- Unskilled
laborer
- student
03.00 PM 09.00 PM
2.6 : 1
15-29
- Unskilled
laborer
- student
Time of
occurrence
Sex ratio
Age group
Occupation
Time of
occurrence
03.00 PM 09.00 PM
Sex ratio
Age group
2.6:1
15-29
- Unskilled
laborer
- student
03.00 PM 00.00 AM
Occupation
2010
3:1
15-24
- Unskilled
laborer
- student
04.00 PM 09.00 PM
2.8:1
15-29
- Unskilled
laborer
- student
Time of
occurrence
Occupation
2008
Transport
accidents
3:1
15-29
- Unskilled
laborer
- student
03.00 PM 09.00 PM
Time of
occurrence
Exposure to inanimate
mechanical injuries
4: 1
Falls
1. 6 : 1
>60
- Unskilled
laborer
- student
03.00PM 09.00PM
Intentional
self-harm
1 : 1.3
Assaults
laborer
- student
06.00 PM 09.00 PM
6:1
15-29
- Unskilled
laborer
- student
09.00 PM 02.00AM
- Unskilled laborer
- student
1. 6 : 1
>60
- Unskilled
laborer
- student
03.00PM 07.00PM
1. 6 : 1
>60
- Unskilled
laborer
- student
1 : 1.4
15-24
- Unskilled
laborer
- student
06.00 PM 09.00 AM
1 : 1.4
20-29
- Unskilled
laborer
- student
7:1
15-24
- Unskilled
laborer
- student
09.00 PM 02.00AM
6.1 : 1
15-29
- Unskilled
laborer
- student
08.00 AM 07.00 PM
03.00PM 07.00PM
06.00 PM 09.00 PM
09.00 PM 02.00AM
1. 3 : 1
>60
- Unskilled
laborer
- student
03.00PM 09.00PM
1. 5 : 1
>60
- Unskilled
laborer
- student
1 : 1.3
15-29
- Unskilled
laborer
- student
06.00 PM 09.00 PM
1 : 1.3
20-29
- Unskilled
laborer
- student
6.7 : 1
15-29
03.00PM 09.00PM
06.00 PM 00.00 AM
09.00 PM 03.00AM
1. 5 : 1
>60
- Unskilled
laborer
- student
03.00PM 09.00PM
1 : 1.2
15-44
- Unskilled
laborer
- student
12.00 PM 00.00 AM
8.5 : 1
15-29
- Unskilled
laborer
- student
08.00 PM 03.00AM
25-45
- Unskilled laborer
- student
09.00 AM 06.00 PM
4:1
35-49
- Unskilled laborer
- student
08.00 AM 07.00 PM
4:1
35-49
2.6: 1
35-49
- Unskilled laborer
- student
09.00 AM 06.00 PM
4 .2: 1
35-49
- Unskilled laborer
- student
09.00 AM 06.00 PM
4 .3: 1
15-49
- Unskilled laborer
- student
08.00 AM 08.00 PM
15-24
- Unskilled
- Unskilled laborer
- student
09.00 PM 03.00AM
6.2 : 1
15-29
- Unskilled
laborer
- student
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of
Disease Control, Ministry of Public Health, Thailand 2005-2009
14
Table 2 Number and percentage of severe injuries by 19 external causes (ICD 10 Chapter 20), Thailand 2005 - 2010
YEAR
CAUSES OF INJURIES
2005
Number
%
76,482 48.98
24,746 15.85
20,562 13.17
15,533 9.95
6,595
4.22
4,337
2.78
2,796
1.79
648
0.41
82
0.05
2006
Number
%
77,910 47.90
25,977 15.97
22,492 13.83
16,261 10.00
6,381
3.92
5,018
3.08
2,992
1.84
730
0.45
84
0.05
2007
Number
75,094
25,528
22,796
15,424
6,581
4,573
2,948
617
89
%
47.36
16.10
14.38
9.73
4.15
2.88
1.86
0.39
0.06
2008
Number
%
69,099 46.20
25,437
17.01
22,562 15.08
13,704 9.16
6,289
4.20
4,449
2.97
2,773
1.85
620
0.41
84
0.06
2009
Number
%
73,775 46.49
27,225 17.16
24,822 15.64
14,668 9.24
6,116
3.85
4,078
2.57
3,037
1.91
608
0.38
70
0.04
Total
2010
Number
72,195
26,259
24,345
14,002
5,858
3,692
2,864
543
92
Transport Accidents
Accidental falls
Exposure to inanimate mechanical forces
Assaults
Intentional Self-Harm
Contact with venomous animals and plants
Exposure to animate mechanical forces
Accidental drowning and submersion
Other accidental threats to breathing
Exposure to electric current, radiation and
945
0.61
1,131
0.70
1,039
0.66
949
0.63
998
0.63
1,132
extreme ambient air temperature and pressure
Exposure to smoke, fire and flames
360
0.23
375
0.23
395
0.25
320
0.21
376
0.24
345
Contact with heat and hot substances
562
0.36
616
0.38
661
0.42
623
0.42
644
0.41
673
Exposure to forces of nature
41
0.03
84
0.05
72
0.05
37
0.02
38
0.02
48
Accidental poisoning by and exposure to noxious substance
921
0.59
930
0.57
946
0.60
828
0.55
797
0.50
800
Overexertion, travel and privation
183
0.12
245
0.15
235
0.15
214
0.14
252
0.16
221
Accidental exposure to other and unspecified factors
246
0.16
279
0.17
224
0.14
155
0.10
163
0.10
156
Event of undetermined intent
193
0.12
170
0.10
175
0.11
194
0.13
251
0.16
207
90
0.06
81
0.05
255
0.16
183
0.12
41
0.03
21
Legal intervention and operation of wars
835
0.53
904
0.56
919
0.58
1,053
0.70
726
0.46
486
Unknown causes and intent
156,157 100.00 162,660 100.00 158,571 100.00 149,573 100.00 158,685 100.00 153,939
Total
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
%
46.90
17.05
15.81
9.10
3.80
2.41
1.86
0.35
0.05
Number
444,555
155,172
137,579
89,592
37,820
26,147
17,410
3,766
501
%
47.31
16.51
14.64
9.54
4.03
2.78
1.85
0.4
0.05
0.73
6,194
0.66
0.22
0.43
0.03
0.51
0.14
0.10
0.13
0.01
0.31
100
2,171
3,779
320
5,222
1,350
1,223
1,190
671
4,923
939,585
0.23
0.40
0.03
0.56
0.14
0.13
0.13
0.07
0.52
100.00
15
Table 3 Number and percentage of deaths by 19 external causes from 2005 - 2010
CAUSES OF DEATHS
Transport Accidents
Accidental falls
Exposure to inanimate mechanical forces
Assaults
Intentional Self-Harm
Contact with venomous animals and plants
Exposure to animate mechanical forces
Accidental drowning and submersion
Other accidental threats to breathing
Exposure to electric current, radiation and
Extreme ambient air temperature and pressure
Exposure to smoke ,fire and flames
Contact with heat and hot substances
Exposure to forces of nature
Accidental poisoning by and exposure to noxious substance
Overexertion, travel and privation
Accidental exposure to other and unspecified factors
Event of undetermined intent
Legal intervention and operation of wars
Unknown causes and intent
Total
YEAR
2005
Number
%
5,392
63.70
780
9.21
153
1.81
851
10.05
575
6.79
30
0.35
33
0.39
318
3.76
6
0.07
2006
Number
%
4,910
62.59
689
8.78
130
1.66
823
10.49
505
6.44
43
0.55
25
0.32
308
3.93
3
0.04
2007
Number
%
4,587
61.83
705
9.50
139
1.87
749
10.10
496
6.69
27
0.36
26
0.35
285
3.84
4
0.05
2008
Number
%
4,153
60.57
658
9.60
161
2.35
702
10.24
484
7.06
26
0.38
34
0.50
284
4.14
3
0.04
2009
Number
%
4,423
60.50
797
10.90
160
2.19
719
9.83
524
7.17
30
0.41
28
0.38
279
3.82
10
0.14
2010
Number
%
4,318
59.92
810 11.24
163 2.26
704 9.77
511 7.09
0.42
30
0.31
22
265 3.68
0.14
10
1.65
119
99
1.17
125
1.59
112
1.51
100
1.46
93
1.27
38
5
8
9
1
33
17
0.45
0.06
0.09
0.11
0.01
0.39
0.20
34
3
29
27
1
32
15
0.43
0.04
0.37
0.34
0.01
0.41
0.19
33
4
15
12
1
41
9
0.44
0.05
0.20
0.16
0.01
0.55
0.12
31
5
6
14
0
32
25
0.45
0.07
0.09
0.20
0.00
0.47
0.36
39
7
12
13
2
21
29
0.53
0.10
0.16
0.18
0.03
0.29
0.40
35
7
10
19
2
20
19
3
0.04
8
0.10
46
0.62
13
0.19
3
0.04
114
1.35
135
1.72
128
1.73
125
1.82
122
8,465
100.00
7,845
100.00
7,419
100.00
6,856
100.00
7,311
TOTAL
Number
27,783
4,439
906
4,538
3,095
186
168
1,739
36
648
%
61.61
9.84
2.01
10.06
6.86
0.41
0.37
3.86
0.08
1.44
210
31
80
94
7
179
114
7
0.49
0.10
0.14
0.26
0.03
0.28
0.26
0.10
80
0.47
0.07
0.18
0.21
0.02
0.40
0.25
0.18
1.67
135
1.87
759
1.68
100.00
7,206
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
100
45,092
100.00
16
Table 4 Severe injury cases of alcohol use in six important causes of injuries, Thailand 2005-2010.
2005
2006
Number of
Injured Cases
Who had Detail
of Alcohol
Drinking
Number of
alcohol use
(%)
Number of
Injured
Cases Who
had Detail
of Alcohol
Drinking
Assaults
9,272
5,354
(57.74)
15,276
Transport Accidents
70,733
26,691
(37.73)
Intension Self-harm
4,983
1,163
(23.34)
Accidental Drowning
and Submersion
456
Accidental Falls
22,059
Cause of Injuries
2007
Number of Number of
Injured Cases
alcohol
Who had
Detail of
use
Alcohol
(%)
Drinking
2008
Number of
alcohol use
(%)
2009
Number of
Injured
Number of
Cases Who alcohol use
had Detail of
(%)
Alcohol
Drinking
Number of
Injured Cases
Who had
Detail of
Alcohol
Drinking
2010
Number
of
alcohol
use (%)
Number
of
Injured
Cases
Who had
Detail of
Alcohol
Drinking
Number of
alcohol use
(%)
8,706
(56.99)
15,059
8,308
(55.17)
13,958
5,783
(41.43)
13,867
7415
(53.47)
13,160
6451
(49.02)
25,960
(36.13)
71,987
25,979
(36.09)
63,607
21,398
(33.64)
68,664
22,402
(32.63)
66,767
20,343
(30.47)
5,648
1,316
(23.30)
6,288
1,296
(20.61)
4,653
1,186
(25.49)
5,295
1,219
(23.02)
5,389
1,086
(20.15)
74
(16.23)
537
78
(14.53)
550
74
(13.45)
511
62
(12.13)
480
63
(13.13)
428
71
(16.59)
1,491 (6.76)
24,264
2,410
(9.93)
25,010
2,176
(8.7)
22,290
2,344
(10.52)
26,531
2,490
(9.39)
25,600
2,411
(9.42)
23,716
1,547
(6.52)
71,852
Exposure to
1,470
1,491
1,570
1,491
1,494
20,150
22,059
22,974
21,789
Inanimate Mechanical
23,192
(6.44)
(7.30)
(6.76)
(6.83)
(6.84)
Forces
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
17
Transport Injuries
18
The Decade of Action on Road safety
INJURY SURVEILLANCE ( IS) For Road Safety
Road traffic accidents have always been among the top three of Thailand's health problems. Each year it is
found that there are more than thirteen thousand people died, over one million people injured, and several
thousand people disabled; the number will jump especially during the long consecutive seasonal holidays such as
New Year and Songkran Festival (the Thai New Year). Based on the injury and mortality data presented by the
Ministry of Public Health, the Thai government has then set this as an urgent national agenda to reduce road
traffic accidents with the five areas of the National Strategic Plan: Education and Public Relations, Enforcement
of the Laws and Rules, Engineering in the area of Road and Vehicle Safety, Emergency Medical Service (EMS),
and Evaluation and Information System.
Information system is the key to promote prevention towards road traffic accidents at the national level
and the drive to put forward the five areas of the National Strategic Plan. Thailand has been using injury data
from multiple sources such as the databases from the Office of National Police, the Ministry of Transport, etc.
One of the key systems that drives a continuing measure up to now is the National Injury Surveillance System(IS)
which has been continuously developed by the Ministry of Public Health. The system provides detailed data in
the areas of epidemiology, behavior risks and quality of health care, and is able to identify deeper problems
clearly. The system enables Thailand to make use of the aforementioned information to plan and solve road
traffic accidents as well as to drive key policies and put them into practice, such as the law requiring the driver
and the accompanying passenger of a motorcycle to wear helmets, all drivers of vehicles shall have blood alcohol
not to exceed 50 gm%, give support of the promulgation of Alcohol Consumption Control Act, push on the
issuing of laws prohibiting sales of alcohol on important Buddhist days, improve quality of medical care, transfer
of patients between hospitals, first-aid treatment of the injured at the site of accident, etc.
Thailand is ranked among one of the first fifteen countries worldwide to have the injury surveillance
system . The Thai system has been accepted by the World Health Organization that gives support to propagate
the system to other countries in the world. The system is distinctive in its features as follows:
1. It is the first system that can prioritize the problems and their causes of injuries in the country,
such as the top five causes of death including accidents from transportation, intension self-harm,
drowning, assaulting, and fall-related injury. Among these five causes, the accidents from
19
transportation result in the highest number of death and severe injury.
2. The system shows and confirms that there are cases of road accidents resulting from drunken
drivers and these are the serious causes. As a result, it is a push to implement several policies on
drinking of alcohol in relation to road driving during the past decade.
3. The system shows that accidents from driving motorcycles are causes of severe injury and
deaths among all transportation accidents. Additionally, the system can indicate any change of
the age group susceptible to cause the transportation accidents.
4. The system is the only national information system used to track alcohol consumption behavior
prior to their driving, failure to wear helmets while driving motorcycles, failure to fasten seat
belts while driving cars, and the use of mobile phones while driving.
The emphasis on the preventive measures of road accidents among the children and juvenile group should
be seriously done because the system has shown increasing trends of risk factors from year 2008-2010,
especially the drinking of alcohol prior to driving and failure not to wear the helmets while driving motorcycles.
The IS system has been proved that it is useful not only to monitor and evaluate program activities in various
areas but also the more variables could be add in as it had shown the result on research project with center of
alcohol studies in 2010 . In 2011 -2012, the project for utilizing the website to display analysis results also has
plan to set the IS in all provincial hospitals nationwide and to allow each province to make use of the
information for its own benefits and to set its preventive plans as well as to reduce its injury problems. Presently,
the injury surveillance system covers 31 provinces and 33 hospitals nationwide.
20
Severe Injuries due to Transport Accident, 2005 - 2010
The number of severe injury due to transport accidents between 2005-2010 was 444,555 with 27,783
deaths. Case fatality rate was 6.25 %. The number of death before arrival was 5,821 (20.95%), death at ER was
2,445 and death at ward was 19,517 cases.
Most of severe injury cases were in 15 -19 year age group (16.04% - 18.05%), followed by 20 – 24 year
age group (11.75% - 14.93%) and children under 15 years of age (11.54% – 12.21%). Male accounted for
72.56%-74.89% of all cases. The biggest group was unskilled laborer (35.45% - 40.94%), student (18.74% 21.26%), and agriculturist (10.46% – 11.64%). (Table 1)
Most of vehicles used by injured drivers was motorcycle (88.34% – 89.46%), followed by bicycle and
tricycle (4.55% -5.42%), pick-up (2.65% – 3.19%) and car (1.11%- 1.43%). Most of vehicles used by injured
passengers was also motorcycle (62.2% -65.06%), followed by pick-up (18.75% – 20.27%) and car (3.41% 4.57%). However, the comparison of number of severe injury due to transport accident showed that since 2008,
the biggest group of severe injury cases was injured while using van, both among injured drivers and passengers.
(Table 1)
Among severe injury cases due to transport accident between 2005-2010, 88.66% (318,091 cases) were
drivers, 5.67% (98,870 cases) were passengers, 5.67% (20,436 cases) were pedestrians. (Fig 4) Among deaths
due to transport accident, 70.83% (18,379 deaths) were drivers, 20.55 % (5,333 deaths) were passengers, 8.67%
(2,237 deaths) were pedestrians. (Fig 5)
Concerning time of event, the highest percentage of severe injury was found between 18.00 – 20.59 hr
(21.58% – 22.71%), followed by 15.00 – 17.59 hr (17.57% – 18.48%). 21.00 -23.59 hr (13.83% – 15.42%). The
highest percentage of deaths was found between 18.00 -20.59 hr (22.14% of all 6 year deaths), followed by 21.00
-23.59 hr (15.80%). (Table 2) The highest percentage of case fatality rate was found between 02.00 -06.00 hr.
Concerning month of event, the highest percentage of severe injury due to transport accident was found
in December, March, April and January. (Fig 3)
Cause of event, mostly was collision (57.69% on average) and vehicle turn-over (40.19%). (Table 3)
Among all collision, the highest case fatality rate was found in train accident (9.76%), car (9.7%), public
bus (9.42%) and bicycle/tricycle (9.32%). Among cases which fell from vehicle, the highest number of death was
found in motorcycle accident (215 cases), and pick-up (209 cases). These two groups accounted for 36.2% and
35.19% of all deaths with known injury mechanism, respectively. (Table 4)
21
The analysis of Injury Severity Score (ISS), grouped as 1-15, >15-30, >30- 45 and >45 -60, compaing
proportion of death to severe injury during 2005-2009 (5-year average) and 2010, it was found that the proportion
decrased among groups with ISS >15-30 from 28.27% to 24.22%. (Fig 5)
22
Table 1 Descriptive data of Transport Injuries year 2005- 2010, Thailand
Epidemiological
data
1.Gender
2005
Number %
57,281
Male
19,199
Female
2. Age
< 15
9,132
15 -19
13,805
20 -24
11,419
25 – 29
8,706
30-34
7,015
35-39
6,042
40-44
5,487
45-49
4,542
50-54
3,467
55-59
2,325
>60
4,540
total
76,480
3.Occupation
Labors
30,122
student
16,006
Agriculturist
8,612
Company employee 3,218
Jobless
5,759
Merchant
2,276
Civil servant
1,595
Police/military
952
Unknown
3,734
Others
4,206
Total
76,480
6. Vehicle caused injury
6.1 For Occupants
Motorcycle
11,560
Bicycle and tricycle 437
Pick up
3,523
Car
616
Van
2
Motor tricycle
185
Truck
663
Trailer
28
2006
Number
%
2007
Number
%
2008
Number
%
2009
Number
%
2010
Number %
74.89
25.11
57,665
20,245
74.02
25.98
55,449
19,645
73.84
26.16
50,385
18,713
72.92
17.08
53,533
20,240
72.56
17.44
52,458
19,737
72.66
17.34
11.94
18.05
14.93
11.38
9.17
7.9
7.17
5.93
4.53
3.04
5.93
100
9,504
13,974
11,062
8,658
6,987
6,221
5,650
4,681
3,670
2,522
4,967
77,896
12.2
17.94
14.2
11.11
8.97
7.99
7.25
6.01
4.71
3.24
6.38
100
9,086
13,176
10,214
8,005
6,738
6,004
5,594
4,628
3,912
2,615
5,061
75,033
12.11
17.56
13.61
10.67
8.98
8.0
7.46
6.17
5.21
3.49
6.75
100
8,436
11,804
8,681
7,347
6,298
5,547
5,236
4,415
3,701
2,668
4,960
69,093
12.21
17.08
12.56
10.63
9.12
8.03
7.58
6.39
5.36
3.86
7.18
100
8,949
12,429
8,892
7,581
6,603
5,839
5,574
4,962
4,197
3,009
5,738
73,773
12.13
16.85
12.05
10.28
8.95
7.91
7.56
6.73
5.69
4.08
7.78
100
8332
11577
8482
7294
6562
5885
5596
5085
4440
3008
5931
72,192
11.54
16.04
11.75
10.10
9.09
8.15
7.75
7.04
6.15
4.17
8.22
100
39.39
20.93
11.26
4.21
7.53
2.98
2.09
1.24
4.88
5.50
100
30,119
16,532
8,494
3,196
5,909
2,301
1,564
899
4,077
4,680
77,771
38.73
21.26
10.92
4.11
7.60
2.96
2.01
1.16
5.24
6.02
100
30,742
15,880
7,854
2,827
5,583
2,204
1,470
913
3,788
3,833
75,094
40.94
21.15
10.46
3.76
7.43
2.93
1.96
1.22
5.04
5.1
100
24,724
14,155
8,026
3,115
4,378
2,301
1,370
712
4,470
5,717
68,968
35.85
20.52
11.64
4.52
6.35
3.34
1.99
1.03
6.48
8.29
100
26,106
14,975
8,043
2,928
5,252
2,258
1,333
816
5,639
6,284
73,634
35.45
20.34
10.92
3.98
7.13
3.07
1.81
1.12
7.66
8.53
100
25,786
13,560
7,838
2,760
5,496
2,351
1,166
750
8,046
4,417
72,170
35.73
18.79
10.86
3.82
7.62
3.26
1.62
1.04
11.15
6.12
100
64.08
2.42
19.53
3.41
0.01
1.03
3.68
0.16
11,571
440
3,401
627
2
171
527
32
65.06
2.47
19.12
3.53
0.01
0.96
2.96
0.18
10,612
446
3,375
567
5
165
489
47
63.74
2.68
20.27
3.41
0.03
0.99
2.94
0.28
9,720
455
2,845
600
129
169
341
47
64.06 10,087
3.0
408
18.75 3,059
3.95
656
0.85
177
1.11
193
2.25
416
0.31
62
63.04
2.55
19.12
4.10
1.11
1.21
2.60
0.39
9,401
316
3,013
691
219
196
440
50
62.2
2.09
19.94
4.57
1.45
1.3
2.91
0.33
23
Agricultural vehicle
Bus
Taxi
others
Total
6.2 For riders/drivers
Motorcycle
Bicycle and tricycle
Pick up
Car
Motor tricycle
Van
Bus
Agriculture vehicle
Trailer
Taxi
Truck
Others
Total
378
285
13
349
18,039
2.1
1.58
0.07
1.93
100
386
284
8
337
17,786
2.17
1.6
0.04
1.89
100
364
307
10
262
16,649
2.19
1.84
0.06
1.57
100
323
265
17
262
15,173
2.13
1.75
0.11
1.73
100
342
301
6
294
16,001
2.14
1.88
0.04
1.84
100
274
230
19
264
15,113
1.81
1.52
0.13
1.75
100
47,510
2,420
1,436
590
265
5
20
306
60
14
373
148
53,147
89.39
4.55
2.7
1.11
0.5
0.01
0.04
0.58
0.11
0.03
0.7
0.28
100
49,074
2,555
1,454
618
296
4
28
323
55
9
339
102
54,857
89.46
4.66
2.65
1.13
0.54
0.01
0.05
0.59
0.1
0.02
0.62
0.19
100
47,920
2,542
1,559
635
261
4
17
326
56
6
288
89
53,703
89.23
4.73
2.9
1.18
0.49
0.01
0.03
0.61
0.1
0.01
0.54
0.17
100
43,781
2,686
1,367
680
238
47
22
296
64
11
273
92
49,557
88.34
5.42
2.76
1.37
0.48
0.09
0.04
0.6
0.13
0.02
0.55
0.19
100
47,490
2,654
1,570
721
287
49
33
338
67
8
288
105
53,610
88.58
4.95
2.93
1.34
0.54
0.09
0.06
0.63
0.12
0.01
0.54
0.2
100
46,917
2,483
1,690
756
301
70
22
295
75
10
292
115
53,026
88.48
4.68
3.19
1.43
0.57
0.13
0.04
0.56
0.14
0.02
0.55
0.22
100
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Table 2
Number and Percentage of Transport accident classified by accident time, Thailand Year 2005 - 2010
Accident
2005
2006
2007
2008
2009
2010
Injuries
Death
Injuries
Death
Injuries
Death
Injuries
Death
Injuries
Death
Injuries
Death
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
0.00 - 02.59
am.
6,963
(9.11)
576
(10.68)
6,914
522
6,566
450
8,660
5,968
(10)
(8.74)
(9.81)
(12.53)
424
(9.59)
5944
(8.87)
497
(11.97)
402
(9.39)
03.00 - 05.59
am
2,965
(3.87)
229
(4.24)
3,040
236
3120
241
2,867
(3.9)
(4.81)
(4.15)
(5.25)
(4.15)
06.00 - 08.59
am
6,133
(8.02)
408
(7.56)
6,598
405
(8.25)
383
(8.35)
5,589
(8.47)
6,295
(8.38)
09.00 - 11.59
am.
7,216
(9.43)
463
(9.45)
7,603
434
(9.76)
(8.84)
7,297
(9.72)
0.00 - 02.59
pm.
8,304
(10.86)
510
(9.45)
8,568
491
03.00 -05.59
pm
13,496
(17.65)
782
(14.50)
(11)
14,057
(18.04)
(10)
697
(14.2)
time
(8.09)
180
(4.33)
3,320
6,534
(8.09)
354
(8.52)
437
(9.53)
6,573
(9.51)
8,388
(11.17)
471
(10.27)
13,877
(18.47)
679
(14.8)
(4.5)
232
(5.25)
(8.24)
3503
(4.85)
6628
254
(5.93)
(8.86)
402
(9.09)
(9.17)
403
(9.41)
361
(8.69)
7,580
(10.27)
446
(10.08)
7,484
(10.36)
434
(10.14)
7,562
(10.94)
447
(10.76)
8,782
11.91)
503
(11.37)
8,409
(11.65)
462
(10.79)
12,136
(17.56)
595
(14.33)
13,265
(18.37)
649
(14.67)
13,265
(18.37)
680
(15.88)
24
06.00 - 08.59
pm.
17,235
(22.53)
1,213
(22.49)
09.00 –11.59
.pm
11,797
(15.42)
907
(16.82)
Unknown
2373
(3.10)
304
(5.63)
Total
76,482
(100)
5392
(100 )
17,369
1,038
(21.58)
(21.14)
11,386
826
(14.62)
(16.82)
2,375
261
(3.05)
(5.32)
77,910
4,910
(100)
(100)
17,029
(22.67)
1,029
(22.43)
15,170
(21.96)
927
(22.32)
16,763
(22.71)
1006
(22.74)
16,291
(22.57)
930
(21.72)
11,124
(14.81)
697
(15.2)
9,553
(13.83)
650
(15.65)
10,463
(14.18)
664
(15.01)
10,057
(13.94)
641
(14.97)
1,398
(3.10)
199
(4.36)
989
(0.85)
142
(6.01)
757
(1.03)
97
(2.19)
614
(0.85)
75
(1.75)
75,094
(100)
4,587
(100 )
69,099
(100)
4,153
(100 )
73,432
(100)
4,423
(100 )
72,195
(100)
4,281
(100 )
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Table 3 Number and percentage of Transport Injury according to Mechanism of injury, Year 2005-2010
2005
Number %
2006
Number %
2007
Number %
2008
Number %
2009
Number %
2010
Number %
Collision
40,002
58.16
41,062
58.35
39,324
57.63
35,867
57.78
38,399
57.3
37,182
56.86
Vehicle down,
sink, over turned
27,277
39.66
27,849
39.57
27,486
40.28
24,904
40.12
27,095
40.43
26,890
41.12
Fall from vehicle
1,499
2.18
1,460
2.07
1,421
2.08
1,308
2.11
1,518
2.27
1,321
2.02
70,371
100.00
68,231
100.00
62,079
100.00
67,012
100.00
65,393
100.00
Injury from
Total
68,778 100.00
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Table 4 Total of Number and percentage of injuries and death classified by vehicle of injured persons according to
mechanism of transport injuries 2005 - 2010.
Collision
Fall from vehicle
Vehicle down, sink, over turned
Vehicle of Injuried
person
Injury
%
Death
Row %
Injury
%
Bicycle, Tricycle
6,781
2.92
632
9.32
309
3.63
3
0.97
198,625
85.67
13,216
6.65
3055
35.87
215
Tricycle
1,418
0.61
126
8.89
144
1.69
Car
4,874
2.10
473
9.7
24
Pick up
14,787
6.38
1181
7.99
Truck
1,981
0.85
143
Trailer
307
0.13
Local Minibus
Bus
464
764
Taxi
%
Death
Row %
9122
5.65
121
1.33
7.04
134,013
83.01
4814
3.59
6
4.17
1039
0.64
58
5.58
0.28
4
16.67
2352
1.46
144
6.12
2,123
24.92
209
9.84
9,890
6.13
666
6.73
7.22
827
10.29
49
5.93
1676
1.04
83
4.95
17
5.54
83
0.97
6
7.23
227
0.14
8
3.52
0.2
0.33
24
72
5.17
9.42
212
175
2.49
2.05
9
14
4.25
8
183
774
0.11
0.48
14
22
7.65
2.84
90
0.04
6
6.67
9
0.11
0
0
28
0.02
2
7.14
Train
41
0.02
4
9.76
168
1.97
18
10.71
45
0.03
4
8.89
Boat
24
0.01
1
4.17
34
0.39
1
2.94
16
0.01
1
6.25
Motorcycle
Death Row % Injury
25
Agriculture Vehicle
871
0.38
62
7.12
1102
12.93
46
4.17
1507
0.93
71
4.71
Van
425
0.18
37
8.71
14
0.16
1
7.14
281
0.17
8
2.8
others
393
0.17
27
6.78
239
2.8
13
5.44
292
0.18
31
10.62
231,845
100
16,021
6.91
8,518
100
594
6.97
161445
100
6047
3.74
Total
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Figure 1. Percentage of severe transport injuries who died according age group year 2005 - 2010.
Year 2005
Year 2007
Year 2008
yr
yr
>
=
60
-5
9
yr
55
yr
50
-5
4
yr
45
-4
9
yr
40
-4
4
yr
-3
9
35
-3
4
yr
Year 2006
30
-2
9
yr
25
-2
4
yr
20
-1
9
yr
15
-1
4
yr
10
yr
4
59
1
<
1-
ag
e
gr
ou
p
20
18
16
14
12
10
8
6
4
2
0
Year 2010
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Figure 2. Percentage of severe transport injuries who died according time of injuries occurred, year 2005 - 2010.
01
TI
M
E
O
F
A
C
C
ID
.0
E
N
0T
01
.5
03
9
.0
A
0M
03
.
05
.5
9
.0
A
0M
05
.
.5
07
9
.0
A
0M
07
.
.5
09
9
.0
A
0M
09
.
.5
11
9
.0
A
0M
11
.
.
01
59
.0
A
0M
01
.
.5
03
9
.0
P
0
M
-0
.
3
.5
05
9
.0
P
0
M
-0
.
5
07
.5
9
.0
P
0
M
-0
.
7
.5
09
9
.0
P
0
M
-0
.
9
.
11
59
.0
P
0
M
-1
.
1
.5
9
P
M
.
10
9
8
7
6
5
4
3
2
1
0
year 2005
year 2006
year 2007
year 2008
year 2009
year 2010
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Number of severe injuries
Figure 3. Percentage of severe transport injuries who died according to month of injuries occurred, year 2005-2010
8000
7000
6000
5000
4000
3000
2000
1000
0
Jan.
Feb.
Mar.
2005
Apr.
May
2006
Jun.
Jul.
Month
2007
Aug.
2008
Sep.
2009
Oct.
Nov.
2010
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Dec.
26
Figure 4 Total number and Percentage of severe injuries from Transport accidents categorized by road type users,
Thailand Year 2005 - 2010.
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Figure 5 Total number and Percentage of death cases from Transport accidents categorized by road type users,
Thailand Year 2005 – 2010
Occupant, 5322,
20.52%
Pedestrian, 2237,
8.62%
Driver/Operator,
18379, 70.86%
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
27
Percentage of patients
hos pitalized for road traffic injuries
who died
Figure 5 Percentage of severe injuries from transport accidents who died by Injury Severity Score year 2005 - 2009
(average 5 years) and 2010
95.74
94.02
100
86.23
90
80
84.02
70.43
70
56.48
60
50
40
28.27
30
20
10.74
24.22
13.74
10
0
ISS 1-15
>15-30
>30-45
IS S
AVERAGE 5 Yr (2005-2010)
>45-60
>60-75
2010
Source of data : 28 IS Sentinel hospitals , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
Figure 6 Number of severe injuries and death by sentinel hospitals of Injury Surveillance, Thailand year 2005 – 2010
10,833
15,236
20,861
13,842
13,814
Dead before arrival
5
182
433
22
240
Total Death
Dead at ER
23
67
198
105
58
Dead at inpatient ward
698
492
1,216
887
805
9,953
114
60
424
30,765
712
393
1,562
17,064
29,199
25,014
25,653
16,228
12,364
19,846
17,978
12,529
12,693
10,801
20,027
22,094
75
184
37
557
325
198
141
315
84
196
154
481
233
55
29
271
79
35
67
81
67
57
77
44
59
97
666
2,196
860
993
554
322
724
911
873
294
297
717
990
Hospital
Severe injuries
Phranakorn Sri Ayuttha
Saraburi
Chonburi
Rayong
Phrapokklao (Chantaburi)
Chao Phya Abhai Bhubhej
(Prajeanburi)
Maharaj Nakornratchasima
(Nakornratchasima)
Surin
Sappasitprasong (Ubonrachthani)
Khonkaen
Udonthanee
Lampang
Utaradit
Chiangrai Prachanukroh (Chiangrai)
Sawanpracharuk ( Nakornsawan)
Buddhachinaraj (Phitsanulok)
Rachaburi
Choaphraya Yommarat (Supanburee)
Nakornpathom
Nakornsrithammaraj
28
Suratthani
Hadyai (Songkla)
Trang
Yala
Phranangklao
BhuddasoThorn(Chachoengsao)
Lerdsin ( Bangkok)
Nopparat Rajathanee (Bangkok)
Total
20,480
15,616
18,836
7,998
4,786
14,312
2,879
2,854
444,555
181
315
229
30
39
316
4
19
5,821
129
73
96
75
47
64
7
32
2,445
769
456
514
303
242
544
68
140
19,517
Source of data : 28 IS Sentinel hospitals in 27 provinces , Injury Surveillance ( IS) Bureau of Epidemiology, department of Disease Control, Ministry of Public Health
29
Severe injuries related to motorcycle accident, 2005-2010
The analysis of data from National Injury Surveillance, Bureau of Epidemiology, Ministry of Public Health,
which were collected by 28 participating hospitals during 2005-2010 revealed that, severe injuries (admitted
cases, observed cases, dead before arrival and dead at ER) related to motorcycle accident (motorcycle drivers and
passengers) accounted for the largest part of severe injuries due to transport accident (78.9% among 444,555
severely injured cases and 74.4% among deaths). (Table 1-2)
Among all severely injured drivers and passengers, motorcycle accident still was a main cause of transport
injuries (83.2%) and accounted for 80.9% of all deaths related to transport accident. (Table 3-4) Moreover, 57.2%
of severely injured pedestrians were hit by motorcycles. (Fig 1)
Table 1 Number and percentage of severe injury-related transport accidents and injuries from motorcycle crashes (drivers and
passengers), Thailand 2005-2009
Year
Severe injuries
*Row%
All causes of injuries
Transport injuries
2005
2006
2007
2008
2009
2010
156,157
162,660
158,571
149,573
158,685
153,939
76,482
77,910
75,094
69,099
73,775
72,195
49.0
47.9
47.4
46.2
46.5
46.9
Total
939,585
444,555
47.3
Motorcycle related injuries
**Row%
60,172
61,719
59,473
54,346
58,274
56,987
350,971
78.7
79.2
79.2
78.6
79.0
78.9
78.9
*Row% = transport injuries (included pedestrians)/all causes of injuries x 100
**Row% = motorcycle injuries/transport injuries (included pedestrians) x 100
Source: 28 sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health Thailand, 2005-2010
Table 2 Number and percentage of DEATHS from motorcycle crashes, Thailand 2005-2009
Year
2005
2006
2007
2008
2009
2010
Total
All causes of injury deaths
8,465
7,845
7,419
6,856
7,311
7,172
45,068
Injury deaths
Transport injury- deaths
%
5,392
63.7
4,910
62.6
4,587
61.8
4,153
60.6
4,423
60.5
4,318
60.2
27,783
61.6
Deaths related motorcycle accidents
4,067
3,664
3,437
3,068
3,254
3,151
20,641
*Row% = transport injuries/all causes of injuries x 100 (included pedestrians)
**Row% = motorcycle injuries/transport injuries x 100 (included pedestrians)
Source: 28 sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health Thailand, 2005-2010
%
75.4
74.6
74.9
73.9
73.6
73.0
74.4
30
Figure 1 Motorcycle involved in severe injuries-related
Figure 1 Motorcycle involved in severe injuries-related transport accidents, Thailand year 2010
transport accidents, Thailand 2010
Pedestrians were hit by
• Motorcycle 57.2
• Pick-up/van 25.8
Pedestrians
• Car 8.2
3220, 4%
• Truck 2.8
• Others 5.9
Passengers
Passengers
16014, 22%
• Motorcycle 63.4
• Pick-up/van 19.2
• Car 4.1
• Truck 2.6
• Bicycle/3-Wheeler 2.6
• Others 8.1
879, 1%
Drivers
53638, 73%
Drivers
• Motorcycle 88.7
• Bicycle/3-Wheeler 4.6
• Pick-up/van 2.9
• Cars 1.3
• Others 2.0
Source: Injury
28 Sentinel
hospitals,
National
InjuryofSurveillance
System,
Source: 28 sentinel hospitals, National
Surveillance
System,
Bureau
Epidemiology,
Ministry of Public Health Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
During 2005-2010, there were 350,971 severe injuries related to motorcycle accident. Among these, there were
20,641 deaths which accounted for 78.7%-79.0% of all severe injuries related to transport accident (pedestrians
included), and accounted for 79%-82% among all deaths related to transport accident. Case fatality rates were
between 5.5% - 6.8%.
Comparing between 2005 and 2010, it was found that severe injuries related to motorcycle accident showed a
decreasing trend, both in severely injured cases and deaths. (Table 1-2) The age of severely injured cases were
between 1 month to 89 years old, with the median of 25-29 years. The biggest group was between 17-18 years of
age, male (75%). The median age of dead groups were 33-35 years old and the biggest group was between 20-25
years of age, and male (75% - 77%). Proportion of male in dead group was high (79% - 82%). There were also
children under 15 years of age among severe injuries related to motorcycle accident (10.1% in severely injured
cases and 5.8% in dead group). (Table 3-4)
31
Table 3 Characteristics of motorcycle injuries, Thailand 2005-2010
Characteristics
of injuries from mc-crashes
Transport injuries (n)
2005
2006
2007
Year
2008
76,482
77,910
75,094
69,099
73,775
72,195
444,555
Motorcycle-related injuries (n)
60,171
61,719
59,176
54,346
58,274
56,987
350,971
Mc injuries of transport injuries (included pedestrians) (%)
78.7
79.2
79.2
78.6
79.0
78.9
78.9
Mc injuries of all vehicles (%)
Male (%)
83.2
76.7
83.7
75.4
83.4
75.1
82.8
74.2
83.0
73.6
82.9
75.0
83.2
75
2009
2010
Total
-
Female (%)
23.3
24.6
24.9
25.8
26.4
25.0
25
-
Sex ratio (male : female)
3.3
3.1
3.0
2.9
2.8
3.0
3.0
0-98
0-98
0-98
0-98
0-96
0-98
0-98
Age (Years)
Age range
-
Median age
25
26
26
27
28
29
27
-
Mode
18
18
18
17
18
18
18
-
Age<15years (n)
5,415
5,802
5,681
5,217
7,809
5,389
35,313
-
% of all ages
9.0
9.4
9.6
9.6
13.4
9.5
10.1
-
Age<18years (n)
12,877
13,393
13,078
11,956
12,654
11,829
75,787
-
% of all ages
21.4
21.7
22.1
22.0
21.7
20.8
21.6
Source: 28 sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health Thailand, 2005-2010
Table 4 Characteristics of DEATHS from motorcycle crashes, Thailand 2005-2010
Characteristics
DEATHS from mc-crashes
Transport injuries (n)
2005
2006
2007
Year
2008
5,392
4,910
4,587
4,153
4,423
4,318
27,783
Motorcycle related injuries (n)
4,067
3,664
3,437
3,068
3,254
3,151
20,641
Mc injuries of transport injury (included pedestrians) (%)
75.4
74.6
74.9
73.9
73.6
73.0
74.4
Mc injuries of all vehicles (%)
81.8
81.3
81.4
80.5
80.7
79.7
80.9
Injury-case fatality rate (CFR)
6.8
5.9
5.8
5.6
5.6
5.5
5.9
2009
2010
Total
-
Male (%)
82.7
81.3
81.0
79.0
79.9
80.2
80.7
-
Female (%)
17.3
18.7
19.0
21.0
20.1
19.8
19.3
-
Sex ratio (male : female)
4.8
4.3
4.3
3.8
4.0
4.1
4.2
0-85
0-91
0-96
0-88
0-88
0-89
0-90
Age (Years)
Age range
-
Median age
33
33
34
34
35
34
34
-
Mode
20
20
25
20
25
20
21
32
-
age<15years (n)
199
194
186
163
182
258
1,182
-
% of all ages
4.9
5.3
5.4
5.3
5.6
8.2
5.8
-
age<18years (n)
569
546
488
454
488
542
3,087
-
% of all ages
14.0
14.9
14.2
14.8
15.0
17.2
15
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Severe injuries related to motorcycle accident, 2010
In 2010, there were 56,987 severe injuries related to motorcycle accident. Among them, there were 3,151 deaths,
with case fatality rate of 5.5%. Comparing to 2005, the number of severe injuries decreased by 5.3% and number
of death decreased by 22.5%. However, motorcycles still took the largest proportion among all types of vehicle
which caused severely injured and dead cases. (Table 3-4, Fig 2-3)
Figure 2 Number and proportion of transport injuries
by type of vehicles, 2010
1,459 (2%)
1,238
739, 498, 132,
1% 1% 0% 126, 0% (2%)
2,802 (4%)
Pick up
4,739 (7%)
Motorcycle
56,849 (83%)
motorcycle
pick up
bicycle/3-wheeler
car
van
motor 3-wheeler
trailer
truck
others
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
33
Figure 3 Number and proportion of deaths-related transport
accidents, by type of vehicles, 2010
123, 3%
38, 1%
7, 0%
5, 0%
36, 1%
68, 2%
motorcycle
144, 4%
pick up
car
Pick up
374 (9%)
bicycle/3-wheeler
van
Motorcycle
3,124 (80%)
motor 3-wheeler
truck
trailer
others
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
Most of severe injury cases and deaths related to motorcycle accident were male (75% and 80.2% respectively).
Among injured drivers related to motorcycle accident, male also accounted for 79% and 87% of injured cases and
deaths, respectively. Among injured passengers related to motorcycle accident, 48.1% were male and 51.9% were
female. The corresponding figures in dead group were 47.7% and 52.3% respectively. (Fig 4-5)
Concerning time of event, during nighttime (20:00-01:59 hr), severely injured cases were male more than female,
that is, during 20:00-21:59 hr, 92.9% of injured cases were male; during 00:00-01:59 hr, 93.7% of injured cases
were male; and the percentage was highest during 22:00-23:59 hr, 95.8% of injured cases were male.
Figure 4 Number of motorcycle driver injuries
by age and sex 2010
Number
1600
Male
1400
Female
1200
1000
800
600
400
200
0
7
9
11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79
Age (years)
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
34
Figure 5 Number of motorcycle passenger deaths from
transport crashes by age and sex ,Thailand 2010
Number
300
Male
Female
250
200
150
100
50
0
0
2
4
6
8
10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80
Age (years)
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
Concerning age, the largest group of severely injured cases and deaths was between 15-19 years of age (18.8%
and 14.6% respectively), followed by 20-24 years and 24-29 years of age (13.1% and 10.7% respectively). (Fig
6-7) The most common age of injury cases and deaths was 18 years old.
Figure 6 injuries-related motorcycle crashes by age
groups, Thailand 2010
Figure 6 Injuries-related motorcycle crashes by age groups, Thailand 2010
Age (years)
371
75-79
720
70-74
1,050
65-69
1,640
60-64
2,165
55-59
3,314
50-54
3,886
45-49
4,296
40-44
4,563
35-39
5,270
30-34
6,063
24-29
7,406
20-24
10,662
15-19
3,699
10-14
18.8%
620
5-9
701
0-4
0
1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 12,000
Source:
28 SentinelSource:
hospitals,28National
Injury
Surveillance
System, Injury
Bureau Surveillance
of Epidemiology,System,
Ministry of Public Health, Thailand
Number
Sentinel
hospitals,
National
Bureau of Epidemiology, Ministry of Public Health, Thailand
35
Figure 7 Number of DEATHS-related motorcycle crashes by age groups, Thailand 2010
Figure 7 number of DEATHS-related motorcycle crashes by
age groups, Thailand 2010
Age (years)
44
75-79
80
70-74
95
65-69
145
60-64
158
55-59
240
50-54
265
45-49
40-44
260
35-39
259
306
30-34
320
24-29
378
20-24
458
15-19
60
10-14
14.6%
12
5-9
28
0-4
0
100
200
300
400
500
Source:Number
28 Sentinel hospitals,
National
Injury Surveillance
Bureau
of Surveillance
Epidemiology,System,
Ministry of Public Health, Thailand
Source:
28 Sentinel
hospitals,System,
National
Injury
Bureau of Epidemiology, Ministry of Public Health, Thailand
The youngest severely injured case was 1 month old and the oldest was 98 years old. Injured children under 11
years old mostly were passengers, however, severely injured cases who were over 12 years old mostly were
drivers, and proportion of injured drivers increased with age, and reached the maximum at the age of 18 (82.8%).
(Fig 8-9)
Figure 8 Number of motorcycle passenger and driver injuries by age and sex, Thailand 2010
Figure 8 Number of motorcycle passenger and driver injuries
by age and sex, Thailand 2010
Number
2,000
motorcycle passengers
1,800
motorcycle drivers
1,600
1,400
1,200
1,000
800
600
400
200
0
0
2
4
6
8
10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72
Age (years)
Sentinel
Injury
Surveillance
System,
Source: 28 SentinelSource:
hospitals, 28
National
Injuryhospitals,
SurveillanceNational
System, Bureau
of Epidemiology,
Ministry
of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
36
Figure 9 Proportion
of motorcycle
passenger and of
driver
injuries by age, Thailand
2010 and driver
Figure
9 proportion
motorcycle
passenger
injuries by age, Thailand 2010
100%
motorcycle drivers
90%
motorcycle passengers
80%
70%
60%
50%
40%
30%
20%
10%
0%
0
3
6
9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72
Age (years)
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
Most of motorcycle accidents occurred between 18:00-19:59 hr (16.8%), 20:00-21:59 hr (14.0%), and 16:0017:00 hr (10.7%) (Fig 10)
Figure 10
Figure 10 Proportion of motorcycle injuries
by time
occurrence,
Thailand
Proportion of motorcycle
injuriesof
by time
of occurrence, Thailand
2010 2010
18
%
16.8
16
14.0
14
12
10.7
10
9.5
8.4
8
7.5
6.3
6
6.0
6.2
06-07:59
08-09:59
5.8
4.8
4.0
4
2
0
00-01:59
02-03:59
04-05:59
10-11:59
12-13:59
14-15:59
16-17:59
18-19:59
20-21:59
22-23:59
Time of occurrence (hr)
Source: 28 Sentinel hospitals,
National
Injury Surveillance
Bureau
of Epidemiology,
Source:
28 Sentinel
hospitals,System,
National
Injury
SurveillanceMinistry
System,of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
The highest percentage of severe injuries related to motorcycle accident was found in December, November and
March (5,483; 5,242 and 4,775 cases respectively). (Fig 3) The highest percentage of deaths related to motorcycle
accident was found in January, December and April (306; 295 and 292 deaths respectively). (Fig 11-12)
37
Figure 11 Number of severe injury-related motorcycle crashes by month,
Thailand 2005-2010
Figure 11 Number of severe injury-related motorcycle crashes by month, Thailand 2005-2010
Number
7,000
6,000
5,000
4,000
3,000
2,000
2005
2008
Average
1,000
2006
2009
2007
2010
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Figure 12
Source: 28 Sentinel
hospitals, Nationalmotorcycle
Injury Surveillance
System,by month,
Figure 12 Number
of DEATHS-related
crashes
Bureau of Epidemiology, Ministry of Public Health, Thailand
Number DEATHS-related motorcycle
crashes by 2005-2010
month, Thailand 2005-2010
Thailand
Number
450
400
350
300
250
200
150
2005
2008
Average
100
2006
2009
2007
2010
50
0
Jan
Feb Mar Apr May Jun
Jul
Aug Sep
Oct Nov Dec
Source: 28 Sentinel hospitals,
National
Injury Surveillance
Bureau
of Epidemiology,
of Public Health, Thailand
Source:
28 Sentinel
hospitals,System,
National
Injury
SurveillanceMinistry
System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
Provinces which had the highest number of severe injuries related to motorcycle accident were Ubonrajchathani,
Nakorn Rajchasima, Udonthani and Khon Kaen. The numbers of cases were 3,219-3,929 in 2010. (Table 5)
Provinces that had the highest proportions of severe injuries related to motorcycle accident were Rayong, Trang
and Chieng Rai (85.8%, 84.8% and 83.0% of all cases) (Table 6) During 2005-2010, provinces with increasing
numbers of severe injuries related to motorcycle accident were Surin (29.3%), Yala (24.6%), Trang (19.6%) and
38
Khon Kaen (13.4%). However, the information from 28 participating hospitals revealed that the numbers of
severe injuries related to motorcycle accident decreased by 5.3%, except in the southern Thailand where the
number of severe injuries increased in all provinces but Nakorn Srithammarat. (Table 5) Provinces with the
highest proportions of severe injuries related to motorcycle accident were Rayong, Songkhla (Haadyai) and
Chieng Rai (85.8%, 84.8% and 83.0% of all severe injuries due to transport accident respectively). Provinces
with the highest proportions of deaths related to motorcycle accident were Rayong (84.9%), Prachinburi and
Trang (81.3%). (Table 6)
Table 5 Number of motorcycle injuries-related transport accidents, Thailand 2005-2010
Sentinel hospitals
(Provinces)
Bangkok (2Hospitals)
Nonthaburi
Ayutthaya
Saraburi
Chonburi
Rayong
Chanthaburi
Chachoengsao
Prachin Buri
Nakhon Ratchasima
Surin
Ubon Ratchathani
Khonkaen
Udon Thani
Lampang
Uttaradit
Chiang Rai
Nakhon Sawan
Phisanulok
Ratchaburi
Suphan Buri
Nakhon Pathom
Nakhon Si Thammarat
Surat Thani
Songkhla (Haad Yai)
Trang
Yala
Total
Severely injuries (n)
2005
2006
2007
2008
2009
2010
Total
781
683
1,471
2,187
2,780
2,208
2,003
1,977
1,477
3,889
2,058
3,987
3,327
3,475
2,238
1,637
3,040
2,399
1,660
1,762
1,512
2,563
3,196
2,620
2,003
2,204
1,035
60,172
819
674
1,382
2,016
2,838
2,019
2,127
2,005
1,393
3,885
2,040
3,954
3,208
3,700
2,159
1,726
3,304
2,450
1,831
1,825
1,435
2,629
3,316
2,872
2,162
2,905
1,045
61,719
650
642
1,349
1,944
2,865
1,701
2,063
1,939
1,418
3,863
2,223
3,774
3,210
3,559
2,182
1,719
2,870
2,132
1,714
1,688
1,521
2,699
3,075
2,673
2,128
2,932
940
59,473
646
489
1,402
1,846
2,682
2,022
1,715
1,785
1,325
3,110
2,125
3,701
3,115
2,829
1,938
1,256
2,532
2,148
930
1,591
1,320
2,811
2,846
2,438
2,070
2,779
895
54,346
592
573
1,291
1,865
2,778
1,969
1,611
1,767
1,180
3,874
2,485
3,940
3,609
3,245
2,109
1,619
3,035
2,348
1,758
1,558
1,198
2,703
2,813
2,477
2,188
2,600
1,089
58,274
784
495
1,268
1,648
2,892
1,753
1,584
1,799
1,113
3,870
2,661
3,929
3,773
3,219
2,171
1,736
1,378
2,138
1,836
1,521
1,405
2,437
2,757
2,784
2,109
2,637
1,290
56,987
4,272
3,556
8,163
11,506
16,835
11,672
11,103
11,272
7,906
22,491
13,592
23,285
20,242
20,027
12,797
9,693
16,159
13,615
9,729
9,945
8,391
15,842
18,003
15,864
12,660
16,057
6,294
350,971
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
2005-2010
0.4
-27.5
-13.8
-24.6
4.0
-20.6
-20.9
-9.0
-24.6
-0.5
29.3
-1.5
13.4
-7.4
-3.0
6.0
-54.7
-10.9
10.6
-13.7
-7.1
-4.9
-13.7
6.3
5.3
19.6
24.6
-5.3
39
Table 6 Proportion of motorcycle injuries and deaths from transport accidents, Thailand 2010
Sentinel hospitals
(Provinces)
Bangkok (2Hospitals)
Nonthaburi
Ayutthaya
Saraburi
Chonburi
Rayong
Chanthaburi
Chachoengsao
Prachin Buri
Nakhon Ratchasima
Surin
Ubon Ratchathani
Khonkaen
Udon Thani
Lampang
Uttaradit
Chiang Rai
Nakhon Sawan
Phisanulok
Ratchaburi
Suphan Buri
Nakhon Pathom
Nakhon Si Thammarat
Surat Thani
Songkhla (Haad Yai)
Trang
Yala
Total
Severe Injuries (Injuries included deaths)
Transport
Motorcycle
Row%
injuries
injuries
1,053
784
74.5
678
495
73.0
1,704
1,268
74.4
2,308
1,648
71.4
3,535
2,892
81.8
2,044
1,753
85.8
2,021
1,584
78.4
2,271
1,799
79.2
1,392
1,113
80.0
5,283
3,870
73.3
3,283
2,661
81.1
4,907
3,929
80.1
4,595
3,773
82.1
4,167
3,219
77.2
2,702
2,171
80.3
2,253
1,736
77.1
1,661
1,378
83.0
2,784
2,138
76.8
2,305
1,836
79.7
1,959
1,521
77.6
1,779
1,405
79.0
3,112
2,437
78.3
3,445
2757
80.0
3,617
2,784
77.0
2,585
2,109
81.6
3,111
2,637
84.8
1,641
1,290
78.6
72,195
56,987
78.9
Transport deaths
49
33
128
139
249
159
130
151
80
413
121
363
160
274
150
101
73
237
140
115
99
187
205
228
117
139
78
4,318
Deaths
Motorcycle
deaths
36
18
86
84
198
135
98
114
65
259
88
280
128
202
114
71
59
167
103
84
70
129
138
163
89
113
60
3,151
Row%
Mc injury case
fatality rate
73.5
54.5
67.2
60.4
79.5
84.9
75.4
75.5
81.3
62.7
72.7
77.1
80.0
73.7
76.0
70.3
80.8
70.5
73.6
73.0
70.7
69.0
67.3
71.5
76.1
81.3
76.9
73.0
4.6
3.6
6.8
5.1
6.8
7.7
6.2
6.3
5.8
6.7
3.3
7.1
3.4
6.3
5.3
4.1
4.3
7.8
5.6
5.5
5.0
5.3
5.0
5.9
4.2
4.3
4.7
4.6
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Most of severely injured cases were unskilled laborer (41%-45%), student (23%-24%) and agriculturist (11%14%). (Table 7)
40
Table 7 Proportion of injuries from motorcycle crashes by occupation, Thailand 2005-2010
Motorcycle injuries
Occupation (n)
2007
Year
2008
2005
2006
2009
2010
Total
56,006
56,745
55,168
48,827
51,187
46,544
314,477

Unskilled laborer
44.0
43.5
45.2
41.2
41.5
45.3
43.5

Student
22.7
23.4
23.3
23.5
23.8
23.8
23.4

Agriculture
12.2
12.0
11.4
13.0
12.7
13.7
13.5

Others
21.1
21.1
20.1
22.3
22
17.2
19.6
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Risk behaviors
Non helmet use
Most of severely injured cases did not wear helmet at the time of accident. Proportions of non-helmet injured
motorcyclists and passengers increase annually, from 83.5% in 2005 to 87.6% in 2010. And also, the proportions
in dead group increase from 91.0% in 2005 to 93.9% in 2010. Among children under 15 years of age, the
proportion of non-helmet injured cases increased from 96.0% to 98.2%, and from 96.2% to 96.7% in dead group.
(Table 9-10)

Male had higher proportion of non helmet use than female in all age-groups. The non helmet use rate in
male was 88% and in female was 85%.

Children between 2-5 years of age had the highest non helmet use rate (99.3%) and 6-14 years old had
97.0% non helmet use rate.

Severely injured students had the highest non helmet use rate as compared to other groups of occupation
(91.1%), followed by agriculturist (90.8%), and unskilled laborer (86.9%). Among the dead, agriculturist
had the highest non helmet use rate (96.7%), followed by unskilled laborer (??%) and student (94.0%).

Provinces which had the highest proportion of non helmet use rate were Supanburi and Chonburi
(98.1%), followed by Rajburi and Yala (97.6% and 96.7% respectively). Provinces that have 100% non
helmet use rate in dead group were Nonthaburi, Supanburi and Yala. (Fig 13-14)

Comparing between 2005 and 2010, it was found than non helmet use rates among injured cases
increased in almost all provinces, except Ayutthaya, Bangkok (Lerdsin and Nopparat Rajthani hospital),
Nakorn Rajchasima, Nakorn Srithammarat, Rajburi, Trang and Songkhla (HaadYai). (Fig 15)
41
Figure 13
Figure 13 Percentage of non helmet use of severely injured from
Percentage of non helmet use of severely injured from motorcycle accidents, Thailand 2010
motorcycle accidents, Thailand 2010
Average
Bangkok
Nakhon Ratchasima
Songkhla (Haad Yai)
Prachin Buri
Rayong
Nakhon Sawan
Chanthaburi
Ubon Ratchathani
Phisanulok
Ayutthaya
Uttaradit
Nakhon Si Thammarat
Nakhon Pathom
Khonkaen
everage
Surin
Lampang
Surat Thani
Trang
Saraburi
Chachoengsao
Udon Thani
Chiang Rai
Nonthaburi
Yala
Ratchaburi
Chonburi
Suphan Buri
87.6
56.2
72.6
79.4
83.8
83.8
83.9
84.1
84.3
86.0
86.2
86.8
86.9
87.1
87.1
87.6
87.6
89.4
89.6
90.5
92.1
93.8
94.3
94.4
95.5
96.7
97.2
98.1
98.1
% 0
20
40
60
80
100
Source:National
28 Sentinel
National
Surveillance
System,
Source: 28 Sentinel hospitals,
Injuryhospitals,
Surveillance
System,Injury
Bureau
of Epidemiology,
Ministry of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
Figure 14
Figure 14
Percentage
non
helmet
use of
deaths
related
Percentage
of non
helmet use of of
deaths
related
motorcycle
accidents,
Thailand
2010motorcycle
accidents, Thailand 2010
everage
Bangkok
Nakhon Ratchasima
Ayutthaya
Chanthaburi
Surat Thani
Nakhon Si Thammarat
Phisanulok
Songkhla (Haad Yai)
Lampang
Ubon Ratchathani
Nakhon Sawan
Nakhon Pathom
Trang
Rayong
Saraburi
Surin
Uttaradit
Khonkaen
Prachin Buri
Chonburi
Chiang Rai
Ratchaburi
Chachoengsao
Udon Thani
Yala
Suphan Buri
Nonthaburi
% 0
93.9
65.2
72.6
79.2
88.2
89.7
90.4
90.5
90.9
91.5
92.1
92.7
93.5
94.4
94.4
95.9
95.9
96.1
97.0
97.6
98.0
98.1
98.7
99.0
99.1
100.0
100.0
100.0
20
40
60
80
100
Sentinel
hospitals,System,
National
InjuryofSurveillance
System,
Source: 28 Sentinel hospitals,Source:
National28Injury
Surveillance
Bureau
Epidemiology,
Ministry of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
42
Figure 15
Figure 15 Percentage of non helmet use of severely injured from motorcycle
Percentage of non helmet
use of severely
injured fromThailand
motorcycle2005-2010
accidents, by province, Thailand 2005-2010
accidents,
by province,
87.6
everage
Yala
Trang
Songkhla (Haad Yai)
Surat Thani
Nakhon Si Thammarat
Phisanulok
Nakhon Sawan
Chiang Rai
Uttaradit
Lampang
Udon Thani
Khonkaen
Ubon Ratchathani
Surin
Nakhon Ratchasima
Prachin Buri
Nakhon Pathom
Suphan Buri
Ratchaburi
Chachoengsao
Chanthaburi
Rayong
Chonburi
Saraburi
Ayutthaya
Nonthaburi
Bangkok
96.7
90.5
79.4
89.6
86.9
86.0
83.9
94.4
86.8
89.4
94.3
87.1
84.3
87.6
72.6
83.8
87.1
98.1
97.2
93.8
84.1
83.8
98.1
92.1
86.2
95.5
56.2
0
20
40
60
80
100
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Source: 28 Sentinel hospitals,
National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
Alcohol use
The proportion of drunk driving among injured motorcyclists decreased from 46.4% to 39.5% in 2010. The
alcohol use rate also decreased in 0-15 year and 0-17 year age-groups. (Table 8)

Alcohol use rate among motorcycle drivers was two times higher than passengers (39.5% and 19.5%
respectively).

Drunk drivers had higher rate of vehicle overturned than non-drinkers (56.2% and 34.6% respectively).
Severe injuries among non-drinkers mostly occurred by collision (65.0%).

Among injured cases, male was 5 times more frequently found as alcohol users than female (47.8% and
9.4% respectively).

Chieng Rai province had the highest rate of alcohol use among injured cases related to motorcycle
accident (58.3%), followed by Ubon Rajchathani (57.0%). Songkhla province (HaadYai) had the highest
rate of alcohol use among deaths related to motorcycle accident (70.6%), followed by Nonthaburi
(67.1%). Province which had the lowest alcohol use rate among injured and dead cases related to
motorcycle accident was Yala (1.5% in injured cases and 2.8% in dead cases). (Table 15-16)

Provinces which had the highest alcohol use rate among injured cases under 18 years of age were
Lampang, Nakorn Sawan and Songkhla (HaadYai) (39.3%, 34.6%, 32.2% respectively). (Fig 17)

Provinces which had high alcohol use rate in all age groups and among injured cases under 18 years of
age were Lampang, Nakorn Sawan and Songkhla (HaadYai). (Fig 18)
43


The minimum age of injured cases related to motorcycle accident was 13 years old (1.2%). Injured cases
with the highest alcohol use rate were at the age of 23 years (52.3%). (Fig 19)
Soldier and police are occupations which were most related to motorcycle accident injuries (51.2% of all
injured cases), followed by unskilled laborer (45.4%). (Fig 20)
Figure 16 Figure
Percentage
alcohol involvement
among motorcycle
driver injuries-related
transports accidents,
by hospital,
15 ofPercentage
of alcohol
involvement
among motorcycle
driver
Thailand 2010 injuries-related transport accidents, by hospital, Thailand 2010
Yala
Chonburi
Ratchaburi
Suphan Buri
Surat Thani
Ayutthaya
Nakhon Si Thammarat
Chachoengsao
Nonthaburi
Nakhon Pathom
Prachin Buri
Trang
Songkhla (Haad Yai)
Saraburi
Nakhon Sawan
Bangkok (2hosp)
Khonkaen
Rayong
Udon Thani
Chanthaburi
Nakhon Ratchasima
Phisanulok
Surin
Uttaradit
Lampang
Ubon Ratchathani
Chiang Rai
28 sentinel hospitals
1.2
16.0
16.2
17.2
23.3
24.4
27.4
31.0
31.1
31.2
33.6
34.8
36.8
37.3
38.6
40.7
47.2
47.4
47.8
48.2
48.7
50.3
51.6
52.0
52.4
57.0
58.3
39.5
0
10
20
30
40
50
60
70
80
90
Source:
28 Sentinel
hospitals,
National
Injury
SurveillanceMinistry
System,
Source: 28 Sentinel hospitals,
National
Injury Surveillance
System,
Bureau
of Epidemiology,
of Public Health, Thailand %
100
Bureau of Epidemiology, Ministry of Public Health, Thailand
Figure 17 Figure
Percentage
alcohol involvement
among motorcycle
driver DEATHS-related
accidents,driver
by hospital,
16ofPercentage
of alcohol
involvement
among transports
motorcycle
DEATHS-related
transport accidents, by hospital, Thailand 2010
Thailand
2010
Yala
Surin
Nakhon Si…
Lampang
Chiang Rai
Chachoengsao
Suphan Buri
Udon Thani
Chonburi
Surat Thani
Ayutthaya
Chanthaburi
Uttaradit
Nakhon Pathom
Ubon Ratchathani
Saraburi
Nakhon Sawan
Prachin Buri
Ratchaburi
Trang
Nakhon Ratchasima
Khonkaen
Rayong
Phisanulok
Bangkok (2hosp)
Nonthaburi
Songkhla (Haad Yai)
28 sentinel hospitals
0
2.8
5.4
7.1
12.5
14.3
16.7
21.8
25.0
28.1
28.6
30.4
32.3
34.1
35.6
37.5
46.0
46.5
46.6
48.3
48.3
48.5
51.5
58.7
59.6
64.5
67.1
70.6
39.2
10
20
30
40
50
60
70
80
90
Source:
28 Sentinel
hospitals,
National
Surveillance
System,
Source: 28 Sentinel hospitals,
National
Injury Surveillance
System,
BureauInjury
of Epidemiology,
Ministry
of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
100
%
44
Figure 18
Figureof 17
Percentage
of alcohol
among
motorcycle
Percentage
alcohol
involvement among
motorcycle involvement
driver injuries, age <18
years, Thailand
2010
driver injuries, age <18 years, Thailand 2010
Yala
Chachoengsao
Nakhon Si Thammarat
Udon Thani
Nonthaburi
Phisanulok
Nakhon Pathom
Ubon Ratchathani
Surat Thani
Chanthaburi
Uttaradit
Nakhon Ratchasima
Suphan Buri
Rayong
Ratchaburi
Khonkaen
Saraburi
Trang
Ayutthaya
Chonburi
Chiang Rai
Prachin Buri
Surin
Bangkok (2hosp)
Songkhla (Haad Yai)
Nakhon Sawan
Lampang
28 sentinel hospitals
0.5
3.1
3.2
3.9
5.1
5.1
5.5
6.3
6.8
7.7
8.1
9.6
11.8
13.2
14.2
14.3
14.6
15.8
23.7
24.3
24.5
25.3
25.7
26.5
32.2
34.6
39.3
17.1
0
Figure 19
10
20
30
40
50
60
70
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
80
90
100
Figure 18 Percentage of alcohol involvement among motorcycle
Percentage of alcohol involvement among motorcycle driver injuries, age and <18 years old, Thailand 2010
driver injuries, all age and <18 years old, Thailand 2010
0.5
1.2
Yala
Chonburi
Ratchaburi
Suphan Buri
Surat Thani
Ayutthaya
Nakhon Si Thammarat
Chachoengsao
Nonthaburi
Nakhon Pathom
Prachin Buri
Trang
Songkhla (Haad Yai)
Saraburi
Nakhon Sawan
Bangkok (2hosp)
Khonkaen
Rayong
Udon Thani
Chanthaburi
Nakhon Ratchasima
Phisanulok
Surin
Uttaradit
Lampang
Ubon Ratchathani
Chiang Rai
28 sentinel hospitals
16.0
6.8
14.2
16.2
11.8 17.2
3.2
3.1
5.1
5.5
15.8
14.6
14.3
13.2
3.9
7.7
9.6
5.1
39.3
6.3
17.1
10
20
<18
all age
23.3
23.7
24.4
27.4
31.0
31.1
31.2
25.3 33.6
34.8
32.236.8
37.3
34.638.6
26.5
40.7
25.7
8.1
0
24.3
47.2
47.4
47.8
48.2
48.7
50.3
51.6
52.0
52.4
57.0
58.3
24.5
39.5
30
40
50
60
70
80
90
100
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
45
Figure 20
Figure 19 proportion of alcohol used in motorcycle injury-related
Proportion of alcohol used
in motorcycle
motorcycle injury-related
transport accidents,
transport
accidents,
by age Thailand
2010 by age Thailand 2010
%
100
90
80
70
60
52
52
5151
494849 49505151 504950
49
4849
47
4646 464646
444542
43
50
4747
42
40
40
33
30
3132
29
252624
23
20
15
10
0
43
42 40
39
38373937 36
36
0 0 0 0 0 0 0 0 1
1
3
4
14
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65
Age (years)
Source: 28 Sentinel hospitals, National Injury Surveillance System,
of Epidemiology,
Public Health,Ministry
Thailandof Public Health, Thailand
Source: 28 Sentinel hospitals, NationalBureau
Injury Surveillance
System,Ministry
Bureau of
of Epidemiology,
Figure 21
Figure 20 proportion of alcohol involvement in mc drivers-related
Proportion of transport
alcohol involvement
in mc drivers-related
transport accidents,
by occupation,
accidents,
by occupation,
Thailand
2010 Thailand 2010
16.0
Government Official
28.5
Deaths
Injuries
18.7
Student
20.0
22.9
Business/trading
25.3
33.3
Government enterprise official
43.7
40.0
Private company employee
37.7
41.4
Unskilled laborer
45.4
46.0
Agriculture
43.9
47.8
Police/Soldier
51.2
%0
20
40
60
Sentinel
hospitals,
National
Injury
Surveillance System,
Source: 28 Sentinel hospitals, Source:
National28
Injury
Surveillance
System,
Bureau
of Epidemiology,
Ministry of Public Health, Thailand
Bureau of Epidemiology, Ministry of Public Health, Thailand
46
Table 8 Numbers and proportions of non helmet use and alcohol use among severe injuries related to motorcycle
accident, by age, 2005-2010
2005
2006
2007
Year
2008
All Injuries (n)
54,807
56,026
54,476
50,123
54,268
52,476
Total
322,176
Non helmet use (n)
45,768
47,449
47,076
43,865
47,293
45,953
277,404
-
all age (%)
83.5
84.7
86.4
87.5
87.2
87.6
86.2
-
<15 years old (%)
95.0
96.4
96.6
96.9
98.2
96.4
alcohol use (mc drivers) %
all age
<18 years old
46.4
21.2
43.8
19.1
41.1
17.9
39.5
17.1
39.5
17.1
42.5
19.4
Injuries from mc-crashes
95.1
44.4
24.1
2009
2010
<15 years old
7.2
7.1
5.9
4.9
4.5
4.4
6.1
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
-
Table 9 Numbers and proportions of non helmet use and alcohol use among dead cases related to motorcycle
accident, by age, 2005-2010
DEATHS from mc-crashes
All DEATHS (n)
Non helmet use (n)
all age (%)
<15 years old (%)
alcohol use (mc drivers) %
all age
<18 years old
2005
2006
2007
Year
2008
2009
2010
Total
2,664
2,425
91.0
96.2
2,340
2,184
93.3
95.9
2,225
2,079
93.4
100.0
2,135
1,976
92.6
96.3
2,244
2,084
92.9
97.1
2,128
1,984
93.9
96.7
13,736
12,732
92.9
97.0
51.1
24.6
44.2
24.3
43.6
23.0
40.1
24.4
39.0
16.5
39.2
16.7
41.9
21.6
<15 years old
25.9
10.0
20.0
6.9
4.5
4.5
12.0
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
-
47
Mechanism of injuries
During 2005-2010, proportions of types of mechanism of injuries among severe injury cases related to
motorcycle accident was quite stable. Most of injuries (56.6% in injured cases and 69.2% in dead cases) occurred
by collision (either with other vehicles, objects or buildings). (Table 10-11) Severely injured cases who were
under 18 years old had higher collision rate than persons over 18 years old (61.7% and 56.4% respectively).
Among injured motorcycle drivers, most of injuries among drivers who were under 10 years of age was caused
by vehicle overturn. Proportion of collision was highest among injured cases who were over 60 years old (67.9%)
and cases who were between 15-19 years old (61.1%). (Fig 21) Most of injured cases who fell from vehicle were
between 15-19 years old, followed by chidren under 5 years old (most of them were 2-3 years old).
Table 10 Number and proportion of mechanism of injuries among injured cases related to motorcycle accident,
2005-2010
Injuries from mc-crashes
Mechanism of motorcycle injury

Collision by or with vehicles/pedestrians/objects
2005
2006
2007
Year
2008
58,318
59,984
57,933
52,394
56,394
56,359
341,382
57.5
57.7
57.3
57.1
56.6
56.6
57.1
39.2
39.1
39.6
39.5
39.9
39.9
39.5
2009
2010
Total
or building

No other vehicle involved

Fall from vehicle
0.9
0.8
0.9
1.0
1.0
1.0
0.9

Others (vehicle burst or burned)
2.5
2.4
2.2
2.5
2.5
2.6
2.4
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Table 11 Numbers and proportions of mechanism of injuries among dead cases related to motorcycle accident,
2005-2010
DEATHS from mc-crashes
2005
Mechanism of motorcycle injury

Collision by or with vehicles/pedestrians/objects
2006
2007
Year
2008
2009
2010
Total
2,563
2,428
2,241
1,968
3,113
2,145
14,458
65.3
69.6
67.6
67.8
69.3
69.2
68.0
26.8
24.1
26.4
25.5
23.7
23.8
25.1
or building

No other vehicle involved

Fall from vehicle
1.2
1.1
0.9
0.9
1.1
1.1
1.1

Others (vehicle burst or burned)
5.0
5.2
5.0
5.8
5.9
5.9
5.5
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
48
Figure 22
Figure 21 Mechanism of motorcycle injuries-related transport accidents
(drivers)
by age
groups,
Thailand
Mechanism of motorcycle
injuries-related
transport
accidents
(drivers)2010
by age groups, Thailand 2010
Age (years)
60+
67.9
55-59
32
56.3
43.6
0.1
0.1
50-54
53
46.9
0.1
45-49
54.8
44.8
0.4
40-44
53.7
46.1
0.2
35-39
54
45.8
0.2
30-34
55.1
44.7
0.2
25-29
54.8
45.0
0.2
20-24
57.6
15-19
42.2
61.1
10-14
38.8
52.9
<10
47.1
39.9
0%
20%
60.1
40%
60%
Collision by or with
Vehicle over turned, sank
Fall from vehicle
0.2
0.1
0
0
80%
100%
Source: 28 Sentinel hospitals, National
Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
Severity of injuries
Among severe injuries related to motorcycle accident, 9.9% had severe brain injury (Glasow Coma Scale 3-8),
4.6% had moderate brain injury (Glasow Coma Scale 9-12), and 85.5% had mild or minor brain injury.
Proportion of severe brain injuries among helmet users was lower than non helmet users (2.9% and 8.4%
respectively). (Fig22) Proportion of severe brain injuries among non alcohol users was lower than alcohol users
(4.0% and 9.1% respectively). (Fig23) More than half (54.9%) of injured cases with unknown helmet use had
severe brain injuries. The unknown status of helmet use occurred due to the fact that 50.4% of them were referred
from other health care authorities and 27.4% were sent from scene sites without any information. Most of them
(69.1%) were transferred by EMS. One fourth of severe injury cases with severe brain injury did not disclose
helmet use status. Severe injury cases whose motorcycle collided with vans had the highest rate of severe brain
injuries (18.1%, drivers and passengers), followed by collided with pick-up trucks (10.9%). (Fig 24) Almost half
(42.7%) of severe injury cases related to motorcycle accident had head injuries (ICD-10 code S00-S09 head, and
the corresponding figure in dead cases was 70.8%. The second biggest group was hand and wrist injury (S60-S69
wrist and hand) (10.3%). The second biggest group among dead cases related to motorcycle accident had
abdomen, lower back, lumbar spine and pelvis injuries, 13.3% (S30-S39 abdomen, lower back, lumbar spine and
pelvis).
49
Mode of transfer to hospitals
Proportion of severe injury cases which were transferred to hospitals by EMS increased annually, from 1.5% in
2005 to 69.1% in 2010. The quality of care among severe injury cases which were referred from other health care
authorities was improved, both in terms of coverage and quality of care.
Figure 22
severity
headininjuries
by use of
helmet
in MCThailand 2010
Figure 23 Proportion
of Proportion
severity or headof
injuries
by use of
of helmet
MC injuries-related
transport
accidents,
injuries-related transport accidents, Thailand 2010
100%
90%
8.4
4.3
2.9
1.7
80%
54.9
70%
60%
Severe brain injury
50%
40%
87.3
95.4
Moderate brian injury
16.4
Mild brain injury
30%
20%
28.7
10%
0%
Non use
Use
Unknown
Helmet use
Figure 24
Source: 28
hospitals,
Surveillance
Figure 22 Proportion
ofSentinel
severity
ofNational
headInjury
injuries
bySystem,
alcohol involvement
Bureau of Epidemiology, Ministry of Public Health, Thailand
inofmotorcycle
2010
Proportion of severity
head injuries bydriver
alcoholinjuries,
involvementThailand
in motorcycle
driver injuries, Thailand 2010
100%
90%
4
1.8
9.1
5.5
80%
55
70%
60%
50%
Severe brain injury
94.2
40%
85.3
Moderate brian injury
15.6
Mild brain injury
30%
20%
29.4
10%
0%
Non use
Use
Unknown
Alcohol involvement
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
50
Figure 23 Proportion of severe brain injuries in motorcycle users (driver
Figure 25 Proportion
of severe brain
in motorcycle
+ passenger) by type
of vehiclewith,
that the motorcycle
+ passenger)
by injuries
type of
vehicle users
that(driver
the motorcycle
collided
collided with, Thailand 2010
Thailand 2010
Truck
6.4
Vehicle over turned, sank
7.9
Motorcycle
8.4
Car
8.6
Pick up
10.9
Van
18.1
0%
Mild brain injury
20%
40%
60%
Moderate brian injury
80%
100%
Severe brain injury
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Source: 28 Sentinel hospitals, National Injury Surveillance System,
Bureau of Epidemiology, Ministry of Public Health, Thailand
Summary and discussion
The result of analysis of data collected from 28 participating hospitals in National Injury Surveillance System
during 2005-2010 revealed that:

each year, there were 54,000-61,000 severe injury cases related to motorcycle accident who were
admitted into 28 sentinel hospitals. Among them, 3,000-4,000 died. The number of severe injury cases
under 15 years old was 5,000-6,000 and 200 died.

numbers of severe injury cases and deaths decreased annually. However, most of southern provinces had
increased numbers of injuries.

proportions of severe injury cases of age 15-19 years provided the highest proportion (mode was 17-18
years old age group).

among injured motorcycle drivers, there were males more than females, among passengers, there were
females more than males.

most of injured children under 12 years old were passengers, however, injured cases over 12 years old
mostly were drivers.

injured cases who were under 10 years old mostly injured by vehicle overturn without collision.
51











injured cases who were over 60 years old mostly injured by collision with other vehicles or objects, or
buildings. The second largest group was injured cases between 15-19 years old.
proportion of non helmet users increased annually in every age-group. (95%-100% among injured cases
under 15 years of age).
the highest proportion of non helmet use was found in student.
injured motorcycle drivers drunk as twice of passengers.
injured motorcycle drivers who drank alcohol were mostly injured by vehicle overturn.
male-injured motorcycle drivers were 5 times of alcohol use higher than female.
the minimum age of injured motorcycle drivers who drank alcohol was 13 years old, and the age of 23
years old had the highest rate of alcohol use (52.3%).
soldiers and police was occupation with the highest alcohol use rate among injured cases (51.2%),
unskilled laborer had the rate of 45.4%.
injured cases who were non helmet users had severe brain injury (Glasow Coma Scale 3-8) 3 times
higher than helmet users.
injured cases who were alcohol users had severe brain injury (Glasow Coma Scale 3-8) 2.3 times higher
than non alcohol users.
motorcycle accidents which collided with vans caused severe brain injury more than collision with other
types of vehicle.
In 2010, motorcycles accounted for 60.2% of all registered vehicles. However, injuries and deaths caused by
motorcycle accident accounted for 83% of all transport injuries. Motorcycles were vehicles which prone to
accident 35 times more than other types of vehicle (National Center for Statistics and Analysis, NHTSA-Traffic
Safety Facts, Updated March 2008)1 However, motorcycle license for driving are allowed for persons who are
younger than car licensing. This may influence the high risk of injuries and deaths found in this study, which
revealed that most of injured and dead cases were between 15-19 years of age. The number of injured children
between 11-12 years old rose sharply, as compared to other age groups. The proportion increased continuously up
to the age of 18, which had the highest rate of injuries caused by collision. Motorcycle drivers who were under
10 years old were mostly injured by vehicle overturn. Proportion of alcohol use increased from the age of 14
years, and continued to rise up to age 19. The age of 23 years had the highest rate of alcohol use. In the USA,
injured cases mostly were in the age group of 20-29 years old and alcohol use rate was highest in the age group of
40-49 years. 2
52
Non helmet use rate among injured motorcycle drivers and passengers were still high, and became higher
annually, even though Thailand issued mandatory helmet use for 16 years (since 1996). Almost all of injured
cases aged 2-5 years (99.3%) did not wear helmet.
Speeding might be one of the important factors. Injured cases who wore helmet and was non alcohol users with
aged less than 18 years old had higher rate of severe brain injury than 18-89 year age group, and also had the
highest rate of injuries and deaths related to motorcycle accident.
Recommendations

Law enforcement should be done, especially on helmet use and drunk driving. Check points on roads should
be set up more frequently. Since 2007, the punishment of drunk driving is a repeal of driving license with 10
year imprisonment and 200,000 Baht fine.

The rule for motorcycle licensing should be revised in accordance with WHO recommendations (World
Health Organization-Regional Office for South-East Asia, Recommendation of the Expert Group on
Preventing Motorcycle Injuries in Children 2010), which also include the rule of transportation by and the
merchandizing motorcycles. 3
- age of legal motorcycle drivers should be over 18 years old, which equal to car drivers.
motorcycle passengers should be more than 5 years old.
market price of motorcycle should cover 2 helmets, one of which is for children.

Principals of elementary schools should not allow school children to drive motorcycles to schools, because
the maximum age of elementary school children is only 12 years old, and he/she should be encouraged to
provide school bus for children.
References
1. National Center for Statistics and Analysis. The National Highway Traffic Safety Administration. Traffic Safety Facts. DOT HS 810 806.
Updated March 2008. www.nhtsa.gov 1200 New Jersey Avenue SE, Washington, DC 20590.
2. Motorcycle Crash Statistics. The National Highway Traffic Safety Administration (http:www.nhtsa.dot.gov) Recent Trends in Fatal
Motorcycle Crashes: An Update" dated June, 2006.
3. World Health Organization. Regional Office for South-East Asia. Recommendation of the Expert Group on Preventing Motorcycle Injuries
in Children, December 2010, Bangkok, Thailand). New Delhi-110002, India.
53
Important Risk Behaviors among Severe Injuries related to Transport Injuries
The analysis of data from National Injury Surveillance, which was collected by 28 participating hospitals during
2005-2010, revealed that there were 444,555 severe injuries related to transport accident (ICD V00-V99), with
27,783 deaths. Case fatality rate was 6.25%. Female to male sex ratio was 1: 2.5. The data collected also included
risk behaviors or practices that might increase the risk and the severity of injuries related to transport accident.
The risk behaviors reported in this chapter were alcohol use and seatbelt use.
Alcohol use
The data on alcohol use was collected by interviewing and/or noticing from manner of injury cases and/or from
breath smell.
 The number of severe injury cases related to transport accident who had positive records on alcohol use
were 141,523 (34.65%). The corresponding figure was 38.02% in 2005 and 28.36% in 2010. (Fig 1)
 The number of injured drivers who drank alcohol was 118,968 (40.51%). The corresponding figure was
44.67% in 2005 and 35.82% in 2010. (Fig 2)
 The proportion among male with severe injured cases who had history of alcohol use was 41.45% and
the proportion among female was 7.84%. The corresponding figure in male was 44.5% in 2005 and
35.82% in 2010. The corresponding figure in female was 8.35% in 2005 and 7.8% in 2010. (Fig 3)
 Hospitals which had numbers of drunk severely injured cases higher than national average were Uttaradit
Hospital and Chantaburi hospital. Hospitals which had the highest proportions of drunk severely injured
cases related to transport accident were Chiengrai hospital, followed by Ubonrajchathani and Surin
hospitals. Yala hospital had the lowest proportion of drunk severe injury cases. (Table 1)
 Concerning time of event, the most frequent time of event observed was 19:00 hr, followed by 18:00 hr
and 17:00 hr. The observed time was similar to that in 2010 and in all 5 previous years. (Fig 4)
 The most common type of vehicles used by drunk severely injured cases was motorcycle, followed by
pick-up truck and bicycle/tricycle. Among dead cases, the most common type of vehicle used was
motorcycle, followed by bicycle/tricycle, and pick-up truck. (Table 2) Drivers and passengers included,
the most common type of vehicle used was self-made farm truck (38.96%), followed by car and pick-up
truck. Among dead cases in 2010, the most common type of vehicle used was tricycle (36.84%),
followed by self-made farm truck and motorcycle (33.33% and 32.61% respectively).
54
Seatbelt use
The data from Injury surveillance system 2005-2010 reported that the number of severe injuries found in other
types of vehicle apart from motorcycle was 72,265 (17.2%). The proportion of injured cases who were drivers
was 48.49%, followed by passengers (49.23%) and unknown (2.3%). Apart from motorcycle, the most common
type of vehicle used was pick-up truck (6.79%), followed by bicycle/tricycle (4.26%), car (1.16%) and truck
(1.14%). Seatbelt use rate among drivers and passengers was 8.48%. In 2005, it was found as 7.51% and
increased to 9.77% in 2010. (Fig 7)
 Severely injured drivers who used seatbelt (2005-2010) was 12.48% among male and 14.4% among
female. Proportions of seatbelt use among male was 14.71% in 2005 and increased to 11.11% in 2010.
Proportions of seatbelt use among female was 15.65% in 2005 and increased to 13.95% in 2010. (Fig 8)
 Hospitals which had high proportions of injured cases who used seatbelt (higher than national average)
were Nakorn Rajchasima, Prachinburi, Phrapokklao Chantaburi and Nakorn Srithammarat hospitals.
Hospitals which had the highest seatbelt use rate among severely injured cases were Nakorn Rajchasima,
HaadYai and Sawanpracharak hospital. Hospitals which had the lowest seatbelt use rate among severely
injured cases were Supanburi, Chonburi and Rajburi. (Table 4)
Injured parts of body
Parts of body which were injured among motorcycle accident was head. Head injuries accounted for 30.14%
(2005-2009) and accounted for 30.40% in 2010, followed by multiple injuries and knees/lower legs. (Fig 9)
Among dead cases, head injuries accounted for 40.84% (2005-2009) and became 38.04% in 2010.
55
Graph 1 : Percent of alcohol drinking among severe injured from transport injury, 2005-2010
100%
90%
80%
percent
70%
38.02
36.96
35.43
30.40
31.23
28.86
34.65
60%
Yes
50%
No
40%
30%
20%
10%
0%
Total
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Graph 2 : Percent of severe injured cases who were drunk driver , 2005-2010
100%
90%
80%
percent
70%
60%
44.67
42.68
42.17
39.58
38.04
35.82
40.51
Yes
No
50%
40%
30%
20%
10%
0%
Total 6 years
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
56
Graph 3: Percent of alcohol consumption among severe injured by sex, year 2005-9 and 2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Table 1
Percent of alcohol consumption among severe injured by sentinel hospitals, year 2005 - 2009 and 2010
Hospital
2005 - 2009 2010
Hospital
2005 - 2009 2010
Hospital
2005 - 2009 2010
1.Chiengrai
51.47 47.49 11.Udorntani
39.40 32.40 21.Nakornsithammarat
21.55 19.64
2.Ubornratchatani
45.50 44.05 12.Nakornsawan
30.80 30.51 22.Ayutdaya
13.44 17.55
3.Surin
44.62 42.88 13.Saraburi
37.09 30.02 23.Nonthaburi
28.66 16.49
4.Uttaradit
40.52 42.11 14.Lerdsin bkk
29.24 28.51 24.Suratthani
20.55 15.43
5.Lampang
43.68 42.00 15.Nopparat bkk
30.33 28.31 25.Ratchaburi
19.74 14.40
6.Pitsanulok
40.84 40.53 16.Prajeenburi
33.44 27.62 26.Supanburi
14.01 13.78
7.Chanthaburi
36.60 38.07 17.Trang
30.26 26.56 27.Chonburi
23.41 6.36
8.Khonkaen
38.09 34.58 18.Chachengsoa
27.41 24.31 28.Yala
7.34 4.29
9.Nokornratchasima
36.05 34.31 19.Nakornpathom
25.57 24.04
10.Rayong
38.30 32.45 20.Hatyai
30.12 22.84
57
Graph 4: Percent of alcohol consumption among severe injured by time of occurred injury, year 2005-9 and 2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Table 2 Percent of alcohol consumption among severe injured and death by vehicle type, year 2005-2009 and 2010
vehicle type
1. Motorcycle
2. Pick up
3.Bicycle/tricycle
4.Car
5.Motortricycle
Severe injured
2005 -2009
2010
Number (%)
Number (%)
94146 (43.1)
16208 (37.1)
2523 (37.9)
510 (33.7)
2226 (18.1)
411 (17.3)
1226(42.2)
229 (33.9)
371(29.8)
93 (33.5)
Death
2005 -2009
Number (%)
3623 (43.8)
111 (33.5)
136 (28.1)
39 (27.5)
19 (24.7)
2010
Number (%)
512 (32.6)
19 (21.6)
24 (25.5)
8 (21.6)
7 (36.8)
6.Agricultural
289(24.9)
43 (20.9)
8 (16.3)
1 (14.3)
7.
111(30.2)
36 (38.9)
3 (18.8)
2 (33.3)
8.Truck
273(16.6)
38 (11.7)
7 (14.0)
1 (14.3)
9.Van
23(24.5)
8 (12.3)
1 (33.3)
0 (0)
10.Others
161(10.2)
25 (13.2)
1(22.0)
2 (28.7)
total
101349
17601
3948
576
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
58
Graph 5 Percent of seatbelt usage among severe injured from transport injury, 2005 - 2010
100%
90%
80%
percent
70%
60%
50%
No
40%
Yes
30%
20%
10%
7.92
7.96
7.72
9.86
10.45
10.33
8.93
0%
Total 6
years
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
Graph 6 Percent of seatbelt usage among severe injured by sex, year 2005-2009 and 2010
12.00
10.00
percent
8.00
6.00
male
4.00
female
2.00
0.00
2005
2006
2007
2008
2009
2010
total 6
years
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
59
Table 4
Percent of seatbelt usage among severe injured by sentinel hospitals, year 2005 - 2009 and 2010
Hospital
2005 - 2009 2010 Hospital
2005 - 2009 2010 Hospital
2005 - 2009 2010
1.Nokornratchasima
12.92 19.32 11.Chanthaburi
10.11 19.32 21.Chachengsoa
7.00 6.56
2.Rayong
17.04 17.44 12.Pitsanulok
4.91 17.44 22.Saraburi
1.74 5.50
3.Ubornratchatani
21.48 17.36 13.Hatyai
11.10 17.36 23.Udorntani
6.61 4.92
4.Khonkaen
10.33 17.05 14.Nakornpathom
11.93 17.05 24.Ratchaburi
1.31 1.77
5.Surin
8.14 16.86 15.Nonthaburi
3.71 16.86 25.Yala
2.09 1.38
6.Uttaradit
17.56 16.50 16.Nakornsithamarat
6.61 16.50 26.Supanburi
1.81 1.10
7.Nakornsawan
8.81 15.44 17.Trang
8.86 15.44 27.Chonburi
1.80 0.26
8.Lampang
14.34 15.27 18.Ayutdaya
0.95 15.27
9.Nopparat bkk
8.37 14.89 19.Chiengrai
5.60 14.89
10.Prajeenburi
14.44 14.17 20.Suratthani
6.84 14.17
Graph 9 Percent of severe injured from motorcycle accident by organs year 2005-9 and 2010
12.Neck
Year2005-9
Year2010
11.Thorax
10.Abdomen,Back,Pelvis
9.Hip and Thigh
8.Wrist and Hand
7.Shoulder
6.Elbow and Forearm
5.Ankle and Foot
4.Unknown diagnosis
3.Knee and Lower leg
2.Injuries of multiple region
1.Head
percent
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand
60
Accidental Falls
61
Severe injury-related accidental falls (ICD-10, code W00-W19)
National Injury Surveillance System, Thailand 2005-2010
Severe injury-related accidental falls (ICD-10, code W00-W19) is a major health problem in Thailand. It
is a second rank of severe injury due to accident, in which the first rank in transport accident. Severe injuryrelated accidental falls resulted in death, disability and ER occupancy. This also resulted in high expenses and
long duration of hospital stay.
This report summarized information collected by National Injury Surveillance System, Bureau of
Epidemiology, Ministry of Public Health. The information came from 28 participating hospitals throughout
Thailand during 6 year period (2005-2010). The analysis of severe injury-related accidental falls detected from
IS, 2005-2010, revealed that there were 155.262 severe injury-related accidental falls with 4,440 deaths. Case
fatality rate was 2.85%, with 1:1.5 female:male sex ratio. The number of severe injury increased from 24,765 in
2005 to 27,236 in 2010. The number of death increased from 780 in 2005 to 810 in 2010. According to age, the
biggest group were in 5-9 year age group (9.7%), followed by 10-15 year age group (8.2%), 80+ year age group
(8.7%). The highest case fatality rate was found in 80+ year age group (5.0%), followed by 45-50 year age group
(4.85%) and 50-55 year age group (4.56%). The number of severe injury cases over 60 years of age was 45,207
(30.0% of all severe injury cases). Case fatality rate increased with age. (Fig 1,2) Most of severe injury related to
accidental falls (90-91.54%) was non-occupational. Percentage of cases with Injury Severity Score (ISS) over 15
increased from 5.46% in 2005 to 6.49% in 2010.
Most of severe injury related to accidental falls occurred at home or residential area (69.4%), within the
province (80-92%). The second most common places of accidental falls were schools, hospitals (9.81%),
followed by construction sites (5.72%), and agricultural sites (4.84%). Case fatality rate was highest among
injury events which occurred at construction sites/hotels (3.9%), followed by other places (3.5%), roads (3.28%)
and homes (3.4%). (Fig 3)
Twenty two percents of cases were unskilled laborer (34,092 cases). The second and third largest groups
were student (21.0%) and unemployed person (20.4%). Case fatality rate was highest among housewife (4.10%),
followed by unskilled laborer (4.0%), unemployed and agriculture groups (3.9% and 3.2% respectively). (Table
1)
The most frequent time of event was 16.00-18.00 hr (17.72%), followed by 14.00-16.00 hr (15.27%).
The highest case fatality rate was found at 02.00-04.00 hr (5.29%), followed by 04.00-06.00 hr and 00.00-02.00
hr (4.77% and 4.55% respectively). According to day of week, the highest percentage was on Saturday (15.4%),
62
followed by Sunday and Friday (14.95% and 14.80% respectively). Injury rate was highest in May (8.8%) and
case fatality rate was highest in February (3.41%). (Fig 4 )
The most common accidental falls was fall on the same level by slipping, tripping and stumbling (W01)
(42.5%), followed by fall out of or through buildings or its structure (W13) (9.6%), fall from tree (W14) (9.5%)
and fall from one level to another (W17) (8.3%). (Fig 5) The highest number of cases fell on the same floor level
by slipping, tripping and stumbling (W01), and the trend was increasing between 2005-2009. In 2010, there was
also a higher number of cases.
The most injured organ was head (27.0%), followed by elbow/forearm, hip/thigh (19.1% and 13.1%
respectively). (Fig 6)
Concerning injury severity, 4.2% of injured cases had Injury Severity Score (ISS) more than 15. Nakorn
Rajchasima hospital reported highest number of severe injury related to accidental fall (8.05%), followed by
Chieng Rai hospital, Udonthani hospital, Lampang hospital and Ubon Rajthani hospital (7.08%, 6.2%, 5.9% and
5.1% respectively).
In 2010, the most common method of transferring patients to hospital was made by relatives/eyewithnesses (34.1%) which the percentage was higher than 2009 (33.67%). The second most common transfer unit
was EMS (6.8%) which was also higher than 2009 (5.79%).
For first aid at accidental site and treatment received before reaching the hospital, 55.85% were not
treated by temporary splints/slabs, 51.84% were not given IV fluid. Among injured persons who were transferred
from other health care facilities, 12.39% were not given neck-splintsการดามกระดูกคอ, and 8.01% were not
given temporary splints/slabs.
Among severe injury cases which was caused by fall on the same floor level by slipping, tripping and
stumbling (W01) which accounted for 42.5% of all cases, 50.1% were male, 40% were over 60 years of age. Case
fatality rate in 30-60 year age group was higher among male than female. However, case fatality rate in 70+ years
age group was 2-3 times higher among female than male. Most of place of occurrence were home and residential
area (74.34%), followed by school and sport stadium. The event occurred mostly at 10.00-12.00 hr (17.6%),
followed by 8.00-10.00 hr, 12.00-14.00 hr and 04.00-06.00 hr (13.5%, 12.7% and 10.6% respectively).
Concerning injury severity, 4.09% of injured cases had Injury Severity Score (ISS) more than 15.
Ten percent of severe injury cases which were caused by fall on the same floor level by slipping, tripping
and stumbling (W01) were referred to Nakorn Rajchasima hospital. The figures for Udonthani, Nakornpathom,
Nakorn Srithammarat, Ubonrajchathani, Khon Kaen and Surin hospitals were 8.3%, 7.0%, 6.9%, 5.8%, 5.8% and
5.2% respectively.
63
Summary
The analysis of Injury Surveillance report, Bureau of Epidemiology, Ministry of Public Health, which
collected data from 28 participating hospitals during 2005-2010, revealed that injury due to accidental fall
(ICD10 code W00-W19) was the second rank among all injury causes. The numbers of case were 24,765 in 2005
and increased to 27,236 in 2010. The numbers of death were 780 in 2005 and increased to 810 in 2010. The total
number of cases was 155,262 with 4,440 deaths. Case fatality rate was 2.85%. Female:male sex ratio was 1: 1.5.
Injured persons age 60 years and over accounted for 30.0% of all cases, followed by persons under 15 years of
age (26.4%). Case fatality rate was high among persons age 80 years and over (5.0%). Case fatality rate also
increased with age, which corresponded to research result conducted by Pro. Dr. Suthichai (1) which stated that
rate of accidental falls was high among elderly persons, especially among those with low education and low
income. However, Injury Surveillance report stated that 26.4% of cases were persons under 15 years of age.
Injured persons with Injury Severity Score over 15 increased from 5.46% in 2005 to 6.49% in 2010.
Over 90% were non-occupational injury. The biggest groups of severe injury due to accidental falls were as
followed: place of occurrence were home and residential area, school, and construction sites; time of occurrence
were 16.00-18.00 hr; day of occurrence were Saturday and month of occurrence was May. Injured persons were
unskilled laborer, students and unemployed. Most of accidental cause was slipping, tripping and stumbling (W01)
(42.5%), followed by fall from or through buildings and/or its structure (W13) (9.6%), fall from tree ( W14)
(9.0%). Part of body which was most injured were head (27.0%), elbow/forearm (19.1%) and hip/thigh (13.1%)
which was different from the study of Stevens’ (2) in US, in which most of injured part was hip due to
osteoporosis. Injury Severity Score (ISS) over 15 was found in 4.2% of cases. Provinces which had high number
of cases were Nakorn Rajchasima (8.05%), Chieng Rai (7.08%), Udonthani (6.2%), Lampang (5.9%) and Ubon
Rajchathani (5.1%).
64
Figure 1 Number of severe injuries and death from accidental falls (W00-W19) by year
30000
25000
number
20000
severe injured
15000
death
10000
5000
0
2005
2006
2007
2008
2009
2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Figure 2 Proportion of Injury Severity Score (ISS) from accidental falls by year
100
90
80
percent
70
60
50
0-15
40
>15
30
20
10
0
2005
2006
2007
2008
2009
2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
65
Figure 3 Proportion of severe injuries and deaths from accidental falls by age groups, 2010 and 2005-2009
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Figure 4 Number of severe injuries and case fatality rate (CFR) from accidental falls by place of occurrence,
Thailand 2005 -2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
66
Table 1
Number and percent of severe injured cases and deaths from accidental falls by occupation, Thailand 2005-2010
Occupation
severe injured
death
number
percent
number
percent
1. Unskilled laborer
34,092
22.6
1,372
30.9
2. Student
31,714
21.0
84
1.9
3. No job
30,782
20.4
1,208
27.2
4. Agriculturist
16,430
10.9
532
12.0
5. Housewife
9,431
6.3
386
8.7
6. Unspecified job
5,721
3.8
195
4.4
7. children
5,621
3.7
30
0.7
8. commercial
3,046
2.0
78
1.8
9.Civil servant
2,781
1.8
78
1.8
10.Unknown
1,301
0.9
82
1.8
11. Other
9903
6.6
395
8.9
150,822
100
4,440
100.0
Total
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Figure 5 Proportion of severe injuries, deaths and case fatality rate by time of occurrence, Thailand 2005-2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
67
Figure 6 Proportion of injury-deaths from major types of accidental falls by year, 2010 and mean (2005-2009)
from tree(w14)
mean(2005-9)
Unspecified(w19)
2010
Other fall from one level to another (w17)
from stairs and steps(w10)
fall out of or through building or structure(w13)
same level from slipping, tripping and stumbling(W01)
0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00 45.00
percent
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Figure 7 Proportion of injured organs from accidental falls by year, 2010 and mean (2005-2009)
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
68
Figure 8 Proportion of injured case from accidental fall by hospital site, Thailand 2005-2010
Nopparat bkk
Yala
Lerdsin bkk
Nonthaburi
Ayutdaya
Rayong
Prajeenburi
Chanthaburi
Supanburi
Hatyai
Pitsanulok
Trang
Chonburi
Chachengsoa
Ratchaburi
Uttaradit
Saraburi
Suratthani
Nakornpathom
Surin
Khonkaen
Nakornsawan
Nakornsithammarat
Ubornratchatani
Lampang
Udorntani
Chiengrai
Nokornratchasima
0.92
1.27
1.35
1.51
1.84
1.85
2.01
2.17
2.31
2.35
2.41
2.76
2.94
2.95
3.22
3.36
3.41
3.70
4.93
4.95
4.96
4.97
4.97
5.13
5.91
6.71
7.08
8.05
0
2
4
6
8
10
percent
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Figure 9 Case fatality rate by sex and age group among cases who falled from same level from slipping, tripping and
stumbling(W01), Thailand 2005 - 2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
69
Figure 10 Proportion of case who falled from same level from slipping, tripping and stumbling(W01) by time of occurence,
Thailand 2005 – 2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Table 2
Proportion of case who falled from same level from slipping, tripping and stumbling (W01) by place of occurence,
Thailand 2005-2010
Severe injured
death
number
percent
number
percent
1.Home
46474
74.34
1554
87.85
2.School
6754
10.80
43
2.43
3.Public stadium
1803
2.88
3
0.17
4.Road/Street
1722
2.75
53
3.00
5.Field,Farm
1504
2.41
19
1.07
6.Other
1342
2.15
32
1.81
7.Shopping place
1241
1.99
29
1.64
8.Construction site, hotel
943
1.51
16
0.90
9.Domitory, nursery, prison etc.
623
1.00
14
0.79
10. Unspecified
111
0.18
6
0.34
total
62517
100.00
1769
100.00
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Place of Falls
70
Figure 11 Proportion of case who falled from same level from slipping, tripping and stumbling (W01) by hospital site, Thailand
2005-2010
Source: 28 Sentinel hospitals, National Injury Surveillance System, Bureau of Epidemiology, Ministry of Public Health, Thailand 2005-2010
Recommendations and suggestions for further studies
The causes of falls mostly concern with personal and environmental characteristics. Most of action was
fall on the same floor level by slipping, tripping and stumbling. Therefore,
1. Preventive measures on falls should be strengthened, especially for elderly and young children.
Modifying home environment for safety should be done, including school and construction sites. Focusing in
improvement of risk area, such as inadequate lighting, slippery floor, un-leveled floored, wet floor, narrow stairs
and steps, furniture with improper placing and size, should be done. Pets in house can cause falls and injury.
Warning should be offered to care takers in order to prevent and perform risk management on different types of
places at home which prone to cause fall accident.
2. Personal characteristics of elderly persons should be studied, especially home environment, their signs
and symptoms before accidents such as medication, poor memory, physical imbalance, poor eye sight, chronic
diseases, activities while accident occurs, history of falls, etc, in order to facilitate accident prevention strategies
to be developed in the future.
References
1. Jitapunkul, S. et al. Falls and their associated factors: A national survey of the Thai elderly. Journal of the Medical
Association of Thailand.1998
2. Stevens JA., Fatalities and Injuries from Falls Among Older Adult-United States, 1993-2003 and 2001-2005. ,
National Center for Injury Prevention and Control, CDC.
71
Assaults
72
Severe injuries and deaths due to assaults, 2005-2010
Severe injuries and deaths due to assaults has been a major health problem of Thailand for a long time. It is an
important cause of all injuries occurred annually.
The Royal Thai government shows neither interest nor solid policy in an attempt to reduce this kind of population
hazard, therefore this article, based on epidemiological data, might be useful in health problem solving process in
the near future.
Bureau of Epidemiology, Ministry of Public Health, established Injury Surveillance system which injury
information from selected sentinel sites have been collected. The data shown in this report has been collected
between 2005 and 2010 from 28 participating hospitals. The information provides situations, magnitudes and
trends of severe injuries and deaths due to assaults in Thailand during the specified period.
Injury Surveillance reports from 28 participating hospitals during 2005-2010 revealed that there were 939,584
severe injuries, giving the average of 156,597 per year, with 45,065 deaths, giving the average of 7,511 per year.
The reported number of severe injuries due to assaults during 2005-2010 was 89,592 cases, giving the average of
14,932 per year. It was the fourth rank of all severe injuries, and accounted for 9.10% - 10.00% of all injuries.
There was an increasing trend in 2006, 2009; a decreasing trend in 2007-2008. In 2010, the reported number was
slightly lower than that of 2009. (Fig. 1)
The reported number of deaths due to assaults during 2005-2010 was 4,548; giving the average of 758 per year. It
was the second rank of all deaths due to severe injuries in 2005-2008, was the third rank in 2009-2010, and
accounted for 9.82% - 10.49% of deaths due to severe injuries by all causes. The highest statistics was found in
2005, and decreased in 2006-2008, increased in 2009 and decreased again in 2010. (Fig. 2)
Severe injuries due to assaults were found more among males than females (M:F = 6.3:1). The highest proportion
was found in 15-29 year age-group, followed by 30-44, 45-59, less than 15 and 60 year and over age-groups
(55.41%, 27.00%, 11.15%, 3.43% and 2.99% respectively). (Fig. 3)
Deaths due to assaults were found more among males than females, (M:F = 6.5:1). The highest proportion was
found in 15-29 year age-group, followed by 30-44, 45-59 year age group (42.22%, 32.04 % and 17.70 %
respectively). (Table 2)
By occupation, the biggest group of assault victims was laborer (46.52%), followed by student (14.58%) and
agriculturist (10.08%). (Fig. 4)
73
By province, among 28 participating hospitals, Nakorn Rajchasima hostital reported the highest number of severe
injuries due to assaults (7.44% of all severe injuries due to assaults), followed by Sappasitthiprasong Hospital
(6.57%) and Khon Kaen Hospital (5.84%). (Fig. 5)
Most of severe injuries due to assaults occurred within provincial administrative area (91.76%), only 6.91%
occurred outside provincial administrative area, and the rest (1.33%) specified unknown place of occurrence.
Most of deaths due to assaults also occurred within provincial administrative area (90.06%), only 8.97% occurred
outside provincial administrative area, and the rest (0.97%) specified unknown area of occurrence.
Concerning place of occurrence, the incidents occurred mostly in house or on housing ground (39.43%), followed
by on roads or highways (23.45%) and shops (14.77%). (Table 3)
Concerning time of event, most of victims were harmed between 18.00 - 23.59 hr (46.63%), followed by 00.00 05.59 hr (28.74%) and 12.00 - 17.59 hr (15.32%). (Table 4, Fig. 6)
Concerning day in a week, the largest number of assault cases occurred on Saturday and Sunday (17.24% and
16.18% respectively). The least number of assaults occurred on Wednesday (12.74%). (Fig. 7)
April was the month in which there was the highest number of assault cases (10.34% of severe injuries and
9.96% of deaths). (Fig. 8, Table 5)
Concerning methods of harm among severe injury cases, they were mostly harmed by sharp objects, such as
knifes/scissors (34.81%), followed by harmed by blunt objects, such as hit by wood, shot by slingshots (22.42%),
shot by other types of guns without any detail (16.24%), and hit by human force (14.08%). (Table 6)
Among 4,548 death cases, major methods of harm was shot by guns (47.38%), followed by hit by sharp objects
(21.46%), and hit by blunt objects (12.07%).
Part of body which was mostly injured was Head (27.50%), followed by Injuries of multiple regions (15.37%)
and unknown organs of injuries (9.00%). (Fig. 9)
Summary and recommendations
From above information on severe injuries and deaths between 2005-2010, it was shown that socioeconomic
problems in modern society, such as inadequate income, could have impact on quality of life and mental
insecurities of population, especially among youths and working age people. Moreover, publicizing crime and
injury events through public mass media could have impact on imitating harm-procedures in the society. Law and
civil servant sections should restrict more on purchasing and carrying guns in the public. Other governmental
organizations, such as social, behavioral, mental, criminal authorities and others, should have counseling services
for risk groups. Detailed studies on factors related to assaults, both on victims and offenders, including
precipitating factors and detailed event situations should have been conducted in order that effective preventive
74
planning could be made, which will result in decreased number of severe injuries and deaths due to assaults in
Thailand
Fig. 1
Number of severe injuries from assaults in 2005-2010, Thailand
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 2 Number of death from assaults in 2005-2010, Thailand
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 3 Number and percentage of severe injuries from assaults according to age year 2005-2010, Thailand
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 4 Number and percentage of severe injuries from assaults according to occupation year 2005-2010, Thailand
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 5 Proportion of severe injuries from assaults by sentinel hospitals
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 6 Percentage of severe injuries from assaults according to time of injury occurred by year from 2005-2010
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
75
Fig. 7 Number and percentage of severe injuries from assaults by day of the week
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 8 Number and percentage of severe injuries from assaults by month
Number
10,000
9,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
10.34
8.42
Jan
8.96
8.01
8.84
7.36 7.60
7.89
7.57
7.70
8.75
Percent
11.00
10.00
8.56 9.00
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
Feb Mar Apr May June July Aug Sep Oct Nuv Dec
Number
Percent
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Fig. 9 Number and percentage of injured organs due to severe injuries from assaults by ICD 10 chapter (S00-T79)
Error! Not a valid link.
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Note: each case possible injured 1-6 organs ICD-10 chapter 19 (S00-T79)
Table 2 Total number and percentage of death from assaults according to age group year 2005- 2010, Thailand.
Age (years)
<15 year
15 - 29
30 - 44
45 - 59
>=60
Death-related assaults
จำนวน
ร้ อยละ
120
2.64
1920
42.22
1457
805
241
32.04
17.70
5.30
76
Unknown
Total
5
4548
0.11
100.00
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Table 3
Number and percentage of severe injuries due to assaults according to Place of occurrence
Place of occurrence
2005 - 2010
Number
Percentage
Homeplace
35,324
39.43
Road
21,005
23.45
Selling and Service center
13,229
14.77
Hospital school and temple
3,319
3.70
Dormitory , prison and barracks
2,210
2.47
Factory ,construction sites
1,887
2.11
Farm and garden
1,419
1.58
Park
741
0.83
others
5,824
6.50
Unknown
4,634
5.17
89,592
100.00
Total
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Table 4
Number and Percentage of severe injuries from assaults by time of injury occurred
Period of time of occurrence
00.00 - 05.59 pm
06.00 - 11.59 pm
12.00 - 17.59 am
18.00 - 23.59 pm
Unknown
Total
2005-2010
Number Percentage
25,750
28.74
6,503
7.26
13,728
15.32
41,774
46.63
1,837
2.05
89,592
100.00
77
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Table 5 Number and percentage of severe injuries and death according to month of the year
Month
Injury
7,543
7,174
8,027
9,264
6,598
6,807
7,066
6,783
6,897
7,920
7,840
7,673
89,592
January
February
March
April
May
June
July
August
September
October
November
December
Total
Percent
8.42
8.01
8.96
10.34
7.36
7.60
7.89
7.57
7.70
8.84
8.75
8.56
100.00
Death
422
387
439
453
363
366
335
370
341
379
367
326
4,548
Percent
9.28
8.51
9.65
9.96
7.98
8.05
7.37
8.14
7.50
8.33
8.07
7.17
100.00
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
Table 6
Number and percentage of severe injuries from assaults according to concerning method
Concerning method
Harms by sharp objects
Percentage
Harm by blunt objects
Percentage
2005
2006
2007
2008
2009
2010
Total
5,699
5,691
5,336
4,781
5,073
4,605
31,185
36.69
35.00
34.60
34.89
34.59
32.89
34.81
3,541
3,710
3,489
2,993
3,326
3,024
20,083
22.80
22.82
22.62
21.84
22.68
21.60
22.42
78
Shot by other types of gun without any details
Percentage
Hit by human forces
Percentage
Others
Percentage
Total
2,431
15.65
2,013
12.96
1,849
11.90
15,533
2,708
16.65
2,197
14.14
1,955
12.02
16,261
2,473
16.03
2,176
14.01
1,950
12.64
15,424
2,184
15.94
1,986
12.79
1,760
12.84
13,704
2,357
16.07
2,054
13.22
1,858
12.67
14,668
2,400
17.14
2,193
14.12
1,780
12.71
14,002
14,553
16.24
12,619
14.08
11,152
12.45
89,592
Source: 28 Sentinel hospitals, National Injury Surveillance (IS) System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand 2005-2010
79
Appendix 1
DEVELOPMENT OF THE PROVINCIAL INJURY SURVEILLANCE ( IS) IN THAILAND
Injury is a serious public health issue with a major impact on the lives of people. It is the leading cause
of death among children and young adults and also a major cause of long and short term disability in many
countries. Effective prevention and control of injuries requires as system of surveillance that monitors the
incidence of injuries, their causes, treatment and outcomes. This requires an integrated system of data collection,
analysis and interpretation and communication. A successful system would ensure not only that decision
80
makers from the different sectors receive the information that they need for planning and evaluating policies
,programs and services, but that they receive it on a timely basis as well. In Thailand, Injuries from accidents
have been one of the important causes of death since 1969. As a result ,the Ministry of Public Health specified
the accident prevention and control as it’s major policy as of 1991. A major obstacle, however, was the lack of
epidemiological data sufficient for setting up guidelines for the prevention and correction of that problems. In
1992, the Epidemiology division(the Bureau of Epidemiology) in charging of developing the standard and
model for epidemiological operations, as well as being the Ministry of Public Health ‘s coordinating centre
disease surveillance system , assigned the Non-communicable Diseases Section to establish an injury
surveillance system in order to obtain sufficient epidemiological data. After situation analysis of problem and
the existing data system, it was found that there were few provincial hospitals and provincial public health
office those had been set up injury data system and there had so many problems due to lacking of expertise
in data system design, management and applying the information computerized technology. Consequently, injury
surveillance or injury information systems were discontinued. Those that remained and could provide date for
planning of prevention and control within the provinces could not be compared regarding the size and severity of
problems across the provinces, nor could the data be collected and analyzed to identify the problems at the
national level. This was due to the different of definition of terms and variability in data collection methods.
However, the failure of the developed systems was that they could not be used for monitoring and improving
the quality of acute and referral are for the injured, in spite of the fact both of them are major responsibilities of
the hospitals under the supervision of the Ministry of Public Health in dealing with injuries. The medical
professionals and the nurses could not utilize the data in their daily work, hence there had not the incentive for
collecting the quality data.
Therefore, The provincial injury surveillance system was established by the Non communicable
Disease section , Bureau of Epidemiology with the purposes :
1. To establish a database for assessing the quality of acute care and interfacility transfer provided to
the injured by hospital at provincial level.
2. To develop an injury surveillance system that would facilitate injury prevention and control at both
local and national levels.
It was carried out with a goal to develop model and appropriate model of provincial injury surveillance for
the development of medical service and referral systems at the provincial level. Trials and evaluation of
the five provincial models at first time were completely done and it was feasibility expanding to the other
provinces ,at now there are 29 hospitals for the sentinel sites collecting the data of injury surveillance to
planning and evaluating policies ,programs and services .
Steps in the project for establishment of the provincial injury surveillance
81
1. Reviewed related literature, study data systems of various organizations in the country from
documents, interviewing and visiting in order to analyze the systems.
2. Drafted up a model of injury surveillance at a provincial level, using the trauma registry of Khon kaen
hospital as a model since the system was still in operation and the data was utilized in developing the
medical services for the injured.
3. Held a workshop at Khon Kaen hospital for accidental experts from universities and other medical
and public health organizations to visit the hospital data system and examined the guidelines,
structure, model and responsible personnel for the provincial injury surveillance system model that
have been proposed by Bureau of Epidemiology.
4. Adjusted the pattern and operation system according to the outcome of the workshop. Drafted record
forms and a manual for recording injury surveillance data with definition and meaning of terms in the
record forms as well as utilization of data for each variable. The draft forms and manual were then
tried out in 5 model hospitals.
5. Improved the record forms and manual for data recording on injury surveillance according to the
result of the trial.
6. Software for microcomputer was developed so that analysis could be undertaken and utilized locally.
The program had menu form which 35 analysis tables could be selected.
7. The software was tested and adjusted according to the the results of trial.
8. Training curricula were developed for each group of personal according to the knowledge and skills
required for each group’s assigned function in operating the surveillance system in the hospital. This
included the training of hospital executives in data utilization.
9. A large general hospital was selected from Bangkok and each major region of Thailand as data
sources, taking the characteristics of sentinel sites into considerations. This hospitals would not only
be the sentinel sites but also that would be model hospitals for the system and would participate in pilot
testing of the surveillance system and provide recommendation for the adjustment needed. Selection
was done using the several criteria. There must be enough personnel, especially ER nurses, medical
statisticians in the hospital’s medical record department. The hospital had to have computers and hard
disks for data storage and processing. The director of the hospital and the heads of concerned sections
had to understand the main principle of the provincial injury surveillance system. They had to be
interested in, or had a system for data utilization in improving the quality of acute care and
interhospital transfer provided to the injured by hospitals at the provincial level. The executives and
the operating personnel had to volunteer in participating the injury surveillance project with a
82
commitment at least one year. Five model hospitals were secured : Nakornsrithammaraj Hospital,
Nakronrajchasrima Hospital, Rajvithi hospital, Rajburi Hospital and Lampang Hospital.
10. Prepared the personnel at the model hospitals by :
Organizing workshops for the executives from 5 model hospitals. It consisted
of lectures, site visit for learning about Khon Kaen trauma registry system, and
small group discussions to consider the suitability of the analyzing table in
software program and the data utilization.
Trained the operating teams of the model hospitals. These included the ER
staff, both clerk and nurses, alls staffs in the hospital’s medical record
department, and doctors who were interested so that they could take the
assigned roles in the provincial injury surveillance system.
11. Pilot tested a full scale of the provincial injury system in the five model hospitals, Started from
January1,1995.
12. The non – communicable Disease section, in cooperation with the technical staffs from the Regional
Center of Disease Prevention and Control supervised the model hospitals in order to provide
academic supports, acknowledge and solving problems in the operation system, about 1-3 months
after data collection started.
13. Analyzed data and prepared reports to distribute the information to executives in Bangkok and
provincial pilot models.
14. Evaluated the surveillance system after 6 months and 12 months of data collection.
Components of the Injury Surveillance System
1.Objectives:
- To establish a database for assessing the quality of acute care and interfacility transfer provided by
hospitals at the provincial level to the injured.
- To develop an injury surveillance system that would facilitate injury prevention and control at both of
the local and national levels.
2. Population under surveillance
Population under surveillance is all of the injured and dead from external causes( V01- Y36) presented at
emergency rooms of the hospitals which operate the provincial injury surveillance system. They are as follow:
1. Accidents
1.1 Transport Accidents
- Land transport accidents
83
- Water transport accidents
- Air and space transport accidents
1.2 Other external causes of accidental injuries
- Falls
- Exposure to inanimate mechanical forces
- Exposure to animate mechanical forces
- Accidental drowning and submersion
- Other accidental threats to breathing
- Exposure to electric current, radiation and extreme ambient air temperature and pressure
- Exposure to smoke,fire and flames
- Contact with heat and hot substances
- Contact with venomous animals and plants
- Exposure to forces of nature
- Accidental poisoning by and exposure to noxious substances
- Overexertion, travel and privation
2. Intentional Self-harm
3. Assault
4. Event of Undetermined Intent
5. Legal Intervention and Operations of Wars
The reporting criteria of the provincial injury surveillance system
All outpatient and in-patient injured and having the following causes must be reported
1. Those who have been injured within 7 days , by any of the following external causes
1.1 Transport Accidents( V01-V99)
- Land transport accidents
- Water transport accidents
- Air and space transport accidents
1.2 Other external causes of accidental injuries( W00 –X59)
- Falls
- Exposure to inanimate mechanical forces
- Exposure to animate mechanical forces
- Accidental drowning and submersion
- Other accidental threats to breathing
- Exposure to electric current, radiation and extreme ambient air temperature and pressure
84
- Exposure to smoke, fire and flames
- Contact with heat and hot substances
- Contact with venomous animals and plants
- Exposure to forces of nature
- Accidental poisoning by and exposure to noxious substances
- Overexertion, travel and privation
- Accidental exposure to other and unspecified factors
1.3 Suicide, intentional self-harm, assaults, event of undetermined intent and legal intervention and
operations of wars ( X 60-Y36)
2. Those injured who had been dead before arrival and who dies in the emergency department of
the hospital that operated the provincial surveillance system.
3. Those who are as stated in 1 and 2 , either currently live within or outside the province where the
sentinel hospital is situated.
4. The data of BP, pulse rate, R.R and coma scale first recorded at emergency room and history
of conscious since injured should be collected
Remarks : 1. The general hospitals ( medium size) collect only the data of severely injured patients,
e.g. patients who are dead before arrival or transferred from or to another hospital, or R/O head injury
cases or admitted to hospital as inpatient or held for observation, except the general hospitals (
medium size) which are specially selected to be sentinel hospital, has to use the same criteria as
regional hospital.
2. Since January 1, 2001 the sentinel hospitals could use
former criteria for data collection ( all acute injuries from external causes
of morbidity and mortality except complications from medical and surgical
care who have been injured within 7 days and presented in the emergency room
dead or alive) or could use the criteria for data collection of the medium sized
hospital as stated in 1, but will send the data to Epidemiology Division ( Bureau of
Epidemiology) only of the severely injured cases, e.g. DBA, died in ER and
patients who are kept in the hospital for observation or as inpatients.
3. Variables for data collection
Variables for data collection are essential data items of the injured and the dead, which are
in the injury surveillance form. They are as follow:
85
1. Patient demographics, i.e. patient’s name and surname ,hospital number, present address, sex, age
and occupation
2. General information of the injury such as
2.1 Date of occurrence
2.2 Time of occurrence
2.3 Date of arrival to hospital
2.4 Time of arrival to hospital
2.5 Location of occurrence
2.6 Place of occurrence
2.7 Intention related to the cause if injury
2.8 Relation of the injury to occupation
2.9 External causes of injury
2.10 Risk behaviors
2.11 The details of how the injured came or was brought to the hospital
2.12 First aids/care while transported or transferred
2.13 Patient conditions( assessed upon first arrival to the hospital)
2.14 Mechanism of injury
2.15 Status on disposition from E. R.
2.16 Time disposition from E. R.
2.17 Diagnosis
2.18 Date discharged from ward
2.19 Condition of the patient at discharge
4. Data collector
Data collectors are personnel responsible for recording the data in the injury surveillance form (
IS form) . e.g. nurse, medical registration staff, medical statisticians or assigned nurses at ward.
5. Data collection method
5.1 Tools for data collection – the injury surveillance record form which is a
trauma registry form being modified to be able gather all kinds of external
causes include submersion/drowning and poisoning.
5.2 The target group of patients for data collection- the severe injured who
admited or observed and dead due to external causes as mentioned earlier
Remarks : The record form should be kept by each hospital for at least 2 years
86
for evaluation of accuracy, completeness and timeliness.
6. Data transfer
In principle, the hospitals can collect and make use of their own on their setting, for the sentinel
sites of surveillance network were requested to submit a data diskette or attach a data file via email every 3 months.
7.personnel to be assigned for coding, editing and analyzing
The medical statisticians in medical record department are responsible for
coding, supervision of data entry and data editing. Data analysis and information
dissemination should be done, by distributing the print out of the ready made
44 tables within the hospital ( later after IS software development ,the designed tables are
tables within the hospital)
8. Sources of data
- Provincial level : larged sized ( Maharaj and regional ) hospitals and medium size general hospitals,
which operate the injury surveillance system
- National level: Bureau of Epidemiology, Department of Disease Control, Ministry of Public
Health
9.Frequency of report dissemination
- Provincial level -every 3-6 months according to agreements between the hospitals and the provincial
public health office
- National level: - at least once a year and every year
10. Data and Tools of the Injury Surviellance System that facilitate the improving the acute care
service for the injured patients
10.1 Data will be useful for the evaluation of the training and feedback to those who take the
patients from the scene of the incident( pre-hospital care quality). The data are also useful for hospital that
transfer patients to the injury surveillance hospitals, in planning and organizing activities to improve the
knowledge and practice of the personnel to suit the problem issue
10.2 TRISS Methodology: Besides a computer program that can record and analyze data in the
forms of 44 tables, this surveillance data system together with its software is capable of calculating the
probability of survival in patients with the mechanical trauma and burns, which can be used in monitoring in
the quality of hospital care. The calculation equation is taken from the Major trauma outcome study ( MTOS) in
USA which was started in 1982 and supported by the Centre for Diseases Control and Prevention, Atlanta. Data
from the study were used in creating a calculation method that could predict the probability of survival ( Ps)
87
called “ TRISS Methodology” . The definition of TRISS is the combination index based on Revised Trauma
Score at ER ( RTS) Injury Severity Score ( ISS) and patient age. It can be used to estimate the survival
probability of an injured patient from retrospective database using a logistic model:
TRISS VALUE= Ps = 1/(1+e-b)
Where Ps = probability of survival at ER
e= 2.7183 ( base of Napierian logarithm)
b = b0 + b1(RTS)+b2(ISS)+b3(A)
where RTS = Revised Trauma Score ( at ER)
ISS = Injury Severity Score (AIS85)
A = 1 if pt. age >=54 yr.
A = 0 if pt. age <54 yr and
b0 b1b2 = set of weight according to mechanism
RTS = Revised trauma score ( ER)
= 0.9368( GCSc )+0.7326(S.BPc)+0.2908(RRc)
( c= coded value)
GCS
SBP
RR
Coded value
13-15
>89
10-29
4
9-12
76-89
>29
3
6-8
50-75
6-9
2
4-5
1-49
1-5
1
3
0
0
0
GCS = Glasgow coma scale
SBP = Systolic Blood pressure
RR = Respiratory Rate
ISS = Injury Severity Score = Sum square of maximum AIS of 3 most severely injured body region ( based on
AIS 85 book)
b0
b1 ( RTS)
b2 (ISS)
b 3(A)
Blunt
-1.2470
0.9544
-0.0768
-1.9052
Penetrating -0.6029
1.1430
-0.1516
-2.6676
GLASGOW COMA SCALE
1. Eye opening
88
Spontaneous
4
To voice
3
To Pain
2
None
1
2. Verbal response
Oriented
5
Confused
4
Inappropriated words
3
Incomprehensible sounds
2
None
1
3. Motor response
Obeys commands
6
Localizes Pain
5
Withdraw( pain)
4
Flexion ( pain)
3
Extension ( pain)
2
None
1
Total GCS points ( 1+2+3)
In summary, the calculation for the survival probability( Ps) at ER needs essential data from 6 variable
groups:
1. Glasgow Coma Score
2. Systolic Blood Pressure
3. Respiratory Rate
4. Age
5. Mechanism of Trauma ( Blunt/ Penetrating)
6. BR,AIS from the final diagnosis
Benefits of the TRISS methodology at the Provincial Injury Surviellance Hospitals
1. The treatment outcome of trauma patients can be compared with the baseline norm for the patient of
the severity levels by referring to the value of patient’s survival probability and the outcome(
survive/die). There are 2 tables that show the analysis results obtained from a computer program.
2. Thesituation and trend of acute trauma care quality at the surveillance hospitals are known.
3. Ps can be used as screening tool for injured patients that need trauma audit, such as the case with
high probability of survival but dies.
89
Benefits of Information obtained from the Injury Surviellance System at the provincial level
1. The risk group of population, risk factors, determiners, sizes and trend of the problem are known.
2. Medical care and patient referral both in the terms of coverage and quality.
3. The information can be used in follow up, verifying and evaluating the medical care service
provided for the injured patients.
4. The information can be used in the internal hospital management.
5. Clusters of injuries form various causes in the communities are found. This will serve as primary
data to identify injury problems in the community, which will lead to investigations for causes
and method for solving the problems.
11. Quality Control of Injury Surveillance Data
The following activities for quality control of the injury surveillance data have been set as system
protocol.
1. Technical supervision - should be carried out in the following manners
- The model hospitals and the specially assigned hospitals under the office of the Permanent
Secretary, are supervised by Bureau of Epidemiology and the Regional Center of Disease
Prevention and Control.
- The model of hospitals under the Department of Medical Service are Supervised by
Bureau of Epidemiology.
- Other hospitals in the surveillance network are supervised by the Regional Center of
Disease Prevention and Control and the model hospitals.
The supervision procedures include sampling of data recording forms for verification of the
exactness in form filling, coding and data which already been entered into the files. Supervisors
will ask other related questions and explaining or answering the questions as well as the
suggestion for quality development. Then, they will write the reports and submit to the director
of those hospitals and the Director of Bureau of Epidemiology for acknowledgement and
solving of the related problems.
Maharaj and provincial hospitals that have established the system according to the specified
steps should be supervised at least once a year.
The evaluation of the system and the quality of data are carried out by the injury surveillance
committee. The committee consists of academic personnel from the Epidemiology division,
Bureau of non-communicable Disease, Bureau of Epidemiology, Regional Center of Disease
Prevention and Control, provincial hospitals and the representative from each of the prototype
90
hospitals. To evaluate the data quality, a statistical sample of the record will be done for
assessment within a suitable time and budget. The evaluators will do the verification the
completeness of report, the accuracy of the filling form, coding completeness and quality of
ICD-10, BR, AIS coding, the exactness of data entry ,preparation and distribution of the data
analysis tables including the application of the information for developing the hospital service
system and the injury prevention and control of the province. The evaluation results are
analyzed for the way of correcting the problems and for developing the system as a whole of the
national level. Maharaj and the center hospitals that apply for, and are selected as hospitals in the
national network for the surveillance should be evaluated regularly, the frequency in each
hospital is 5 years interval.
91
Appendix 2
92
National Injury Surveillance Record Form, Bureau of Epidemiology, THAILAND
93
Appendix 3
94
Discharged
from ER
Nurses at ER complete all variables in the
record form, including diagnosis and
outcome
All injured
patients
treated at
ER
Coding and data
analysis by
medical record
department
Observed/
admitted
Dissemination
Information
Printout/report
distribution
Nurses at ER fill out almost all
except diagnosis and outcome
except diagnosis and outcome
Discharged from
ward
DX and outcome in the chart recorded in IS
form by Medical Record Section or trained
ward nurses
Flow of IS data
95
28 SENTINEL SITES OF INJURY SURVEILLANCE(IS) ,THAILAND
DATA FOR REPORT
1. NAKORN SI THAMMARAT
2. LAMPANG
3. HADYAI
4. NAKORN RATCHASIMA
5. AYUDTHAYA
6. CHANTHABURI
7. CHONBURI
8.KHONKAEN
9. BANGKOK ( LEARDSIN HOSPITAL)
10.BANGKOK ( NOPARAT RACHATHAINI HOSPITAL)
11. NONTHABURI
12.SUPHANBURI
13. PHITSANULOK
14. PRAJEANBURI
15. UBONRACHATHANI
16. RACHABURI
17. RAYONG
18.SURAT THANI
19. SARABURI
20. SURIN
21.CHIANGRAI
22.UDON THANI
23.UTTARADIT
24. YALA
25.NAKORN PATHOM
26. TRANG
27. NAKORN SAWAN
28. CHACHOENGSA0
96
IS sentinel sites of National Injury Surveillance System in 2012
1. NAKORN SI THAMMARAT
2. LAMPANG
3. HADYAI
4. NAKORN RATCHASIMA
5. AYUDTHAYA
6. CHANTHABURI
7. CHONBURI
8.KHONKAEN
9. BANGKOK ( LEARDSIN HOSPITAL)
10.BANGKOK ( NOPARAT RACHATHAINI HOSPITAL)
11. NONTHABURI
12.SUPHANBURI
13. PHITSANULOK
14. PRAJEANBURI
15. UBONRACHATHANI
16. RACHABURI
17. RAYONG
18.SURAT THANI
19. SARABURI
20. SURIN
21.CHIANGRAI
22.UDON THANI
23.UTTARADIT
24. YALA
25.NAKORN PATHOM
26. TRANG
27. BURI RAM
28. NAKORN SAWAN
29. CHACHOENGSAO
30. PHUKET
97
31. CHUMPHON
32. KRABI
33. PHANG NGA (TAKUA PA HOSPITAL)