PROBLEM STATEMENT Road Traffic Accident (RTA) is an increasing cause of mortality in developing countries.

In 2004 the world health organization projected this problem on the global level for the first time by recognizing Road Safety as the theme for that years World Health Day. Although RTAs are responsible for over 1.2million deaths globally, it was largely neglected because of the perception that it is unpreventable. The burden of RTAs is more prominent in developing countries. RTA is one of the factors limiting developing countries from achieving the millennium developmental goals in that it adds significantly to child and maternal mortality. It also depletes developing countries GDP, adding to extreme poverty and hunger. Over 35000 thousand deaths and over 100000 injuries are attributed to road traffic accidents in Nigeria annually. This numbers are expected to grow with the rapid expanding population and growing number of drivers. This ever growing cause of morbidity and mortality places a big burden on the economy of the country especially of the health sector. The tourism sector is also affected with a lot of countries giving advisories to their citizens on road safety in Nigeria The demography of road traffic accident victims is mostly young male who are the major working class that sustain the economy. Also a large proportion of the accidents involve children. Federal road safety commission Nigeria was established in 1982 to help reduce road accidents in Nigeria. Data from FRSC has shown that the Federal capital territory (Abuja) has the highest number of accidents in the country. These accidents tend to be fatal due to delayed response time to accidents and poor administration of first aid by first responders. In developed

countries, there is an established EMS system that responds to accidents. It is notoriously known that developing countries including Nigeria lack functional EMS system.

Using the WHO approach the cause of RTAs in Abuja can be grouped into: the road user, the vehicle and the infrastructure. The first two appears to be the more prevalent cause. Road users especially those new to Abuja are carried away by the wide and good road networks and are tempted to go beyond the speed limits. There is also an increased number of drunk driving especially on weekends. Generally, there is poor vehicle maintenance culture in Nigeria. This is partly due to poor enforcement of vehicle maintenance laws and partly economic. The infrastructure also plays a role. Although Abuja has very good modern road network, most of the roads lack speed limit signs. And where these exits they are usually covered with political posters.

The high mortality from RTAs in Abuja can be attributed to poor response time to accidents. The chances of surviving an RTA depend on how soon one gets access to first aid/health care. This can be directly linked to having an early warning system- that is, having an established communication system that can effect early response time. Also, the quality of care provided by the first responders goes a long way to reduce morbidity and mortality in RTAs. Transportation of accidents victims from point of accidents to point of care is also critical. The FRSC currently lack the capacity to air lift accident victims to points of care.

There is also a lack of coordination between various deferent first responder agencies. Mass casualty accident can easily overwhelm the response capacity and capability of the FRSC. Help of from other agencies like the civil defense, Police; military etc becomes critical in such situations. In order to ensure a flawless response in mass casualty situation requiring multiple

agency response, MOUs need to be established. Also the incident Command system with a unified command system needs to be in place. These capacities are currently lacking.

PROGRAM COMPONENT The RTA Rapid Response and Survival (RRRS) program is a 1 year training and capacity building program targeting FRSC staff in Abuja, designed to improve FRSCs ability to respond timely and efficiently to road traffic accident. The main purpose is to reduce the morbidity and mortality of road traffic accidents in Abuja. The components of this program include: Training of FRSC staff in basic cardiac life support Establishing a rapid response EMS unit in FRSC Building a rapid accident victim transportation system by establishing Air transport capability Providing mental health services to FRSC EMS team

PROGRAM DESCRIPTON Training of FRSC staff: 5 select teams of 10 (50 in total) would be selected from the Abuja FRSC staff for training. Each team would be comprised of a commanding officer, assistant commanding officer and 8 marshals with each marshal servicing as logistics; planning; operations; security and communications person while maintaining their medical competencies needed for disaster

response. Upon completing the training the trainees would have achieved the following objectives: 1. Competency in Basic disaster life support; 2. competencies in medical triage; 3. competencies in CPR 4. Competencies in disaster communication 5. Competencies in incident command system Training will be held at the FRSC training center. The training instructors will comprise of experts drawn from the military, police, academia and consultants in disaster management. The training methodology would comprise of class room lecture, table top exercises, and real time simulation exercises. An accredited instructor would train and certify the trainees on basic and advanced cardiac life support. The will be in 2 phases. The first phase comprises of a month fitness training interspersed with lectures in basic road safety regulations; training and certifications in BCLS/ACLS; table-top exercises, field exercises and training with designated air force ambulance helicopter. The second phase is the operational phase. At this phase, the trainings would have been completed and EMS capability, air ambulance capability and other program logistics would have been establish. It involves applying the skills and knowledge acquired in the training and using the improve logistics and communication towards achieving program goals. Establishing a rapid response EMS unit in FRSC:

Upon completing the training the officers and men would be commissioned as the FRSC RTA Rapid Response Corps with full EMS capability and ability to respond timely to any accident within the FRSC. Full EMS resources would be provided for this unit, including a base/station, ambulance, medical supplies, triage equipment, communication equipment and personal protection equipment. The objectives for establishing this unit are: 1. To reduce the time between the occurrence of an RTA and access to life support 2. Improve the quality of care received 3. Reduce overall mortality Building a rapid accident victim transportation system by establishing Air transport capability: This will involve collaborating with the Nigerian Air force to establish an airlift capability. An MOU would be signed with the air force establishing when, how the air ambulance can be activated. The chain of command for activation and response of the air ambulance would also be clearly established. The form and shape of a unified command during emergency response would also be established in line with the incident command system. The collaboration would be based on the Emergency Support Systems policies of the National Emergency management of Nigeria (NEMA The agency in charge of overall disaster management). Other MOUs would be signed with hospitals in Abuja to facilitate transfer of accidents victims from the first responders to the medical teams. These hospitals would be encouraged to have an established emergency response plan with the capacity to handle mass casualty events. KEY PARTNERS/ COLLABORATORS

The partners in this program include disaster experts drawn from National Emergency Management Agency (NEMA): NEMA would provide training in Emergency support Systems, Disaster management and incident command system

Nigerian Air force (NAF) NAF would provide physical trainings and co trainings with their air ambulance unit

TRAINING POPULATION DEMOGRAPHICS The training participants would be drawn from the officers and marshal cadre of the Federal Road Commission. They would comprise of 5 officers and 25 marshals. The officers are usually staff with college degrees GEOGRAPHIC AREA The program will be carried out in the five FRSC units in the five area councils of the Federal Capital Territory Abuja. These areas include Abuja Municipal Area Council (AMAC); Bwari; Abaji; Kuje; and Gwagwalada. GOALS The primary goal of this program is to reduce significantly the morbidity and mortality of road traffic accident in Abuja Nigeria. The secondary goal includes strengthening the capacity of disaster response by the FRSC.

Training Objectives By the end of the first phase of the training program, the 30 participants would have completed their physical training and didactic lectures in road safety and disaster management. The competency of the trainees following the first phase training would be accessed by their completing a timed physical drill and taking a competency exam At the end of the 2nd phase the participants should be trained and certified in BCLS and ACSL At the end of the 3rd phase

Establishing a rapid response EMS unit in FRSC (Infrastructure supply) objectives By the end of the program period, 5 fully operational RTA Rapid Response and Survival unit would have completed all trainings All housing, support equipment and medical supplies would be in place

Building a rapid accident victim transportation system by establishing Air transport capability MUOs with key stakeholder especially with the NAF establishing clear activation mechanisms of Air ambulance and establishing the chain of command TIMELINE AND KEY DELIVERABLES Activities Phase 1 Conduct pre-training medical examination and physical fitness Key Deliverables 50 Trainees recruited and assessed

evaluation for trainees Conduct a pre-training written exam in emergency management and road safety Conduct daily physical drills Daily training lectures in emergency management and road safety The knowledge level and training needs of the 50 trainees would be established Achieve physical fitness Improved knowledge in modern road traffic and emergency management practices Conduct a post phase 1 training physical drills and written exam Ev

Phase 2

Training and certification of trainees in Basic cardiac life support

50 participant trained and certified in BCLS and ACLS

Phase 3

STAFF Program Director: The Education and skill requirement for this position include

Masters Degree preferred plus 5 or more years experience; with knowledge and experience in Disaster/ Emergency Management.

Direct experience with a Nigerian Government agency procurements, especially FRSC Five years project management experience Exceptionally organized and detail oriented

Program operation officer: Program Logistics officer: Program planning officer: Program admin and finance officer: Program assistants

Program Director Public Information/ Laison

Operations

Planning

Logistics

MONITORING AND EVALUATION Monitoring and evaluation activities would be on going through out the life span of the program. The program director would supervise and direct all M&E activities. M& E data would be gathered by the training officers. They would administer the pre and post exams and also the training quality survey. The M&E would be in the form of process evaluation and outcome evaluation Measuring mastering of materials (pre and post test) Sign in sheets to see who participated in the training Post training participant satisfactory survey assessing the quality of training Timing of completing simulated exercises ORGANIZATIONAL CAPACITY Mission and history Experience in the community Recognition and support Agency Programs Governance structure Annual Budget