Driving toward injury-free roadways

In the afternoon of Wednesday, 17 April 2024, a cyclist was struck and killed by a pickup truck in East Vancouver. This tragic event was the 14th death due to a road crash in Metro Vancouver this year, and the province-wide fatality count is higher still. For every road death, there are severalfold more people requiring hospitalization or other health care due to traffic-related crashes, which cause roughly 300 fatalities, 4000 hospitalizations, and 60 000 emergency department visits per year in British Columbia.[1] The overwhelming majority of these harms can be prevented.

The vision-zero approach to road crashes aims to eliminate fatalities and serious injuries due to road crashes by addressing the transportation infrastructure and policy decisions that are the root causes of road crashes. This goal has been endorsed by BC’s Office of the Provincial Health Officer, which has called for comprehensive action in the areas of safe speeds, safe roadways, safe vehicles, and safe road users.[2]

Safe vehicle speeds are crucial to prevent serious injuries due to crashes; higher speeds make crashes both more likely to occur and more severe in their outcomes. A substantial body of evidence indicates that a pedestrian struck by a vehicle moving at 50 km/h may have a 20% chance of survival, while a pedestrian struck at 30 km/h has a greater than 90% chance of survival.[3] Action from local governments has been promising: over 60 municipalities in BC have lowered speed limits from the standard 50 km/h to 30 or 40 km/h in specified areas or community-wide.

Posted speed limits are one of many important tools available to improve driving safety. Also important is that the design of roadways promotes safety and is coherent with posted speed limits. Traffic-calming design choices such as narrower lanes, speed humps, and small roundabouts on residential streets have been shown to decrease vehicle speeds.[4] Meanwhile, interventions such as raised crosswalks and protected cycling lanes can facilitate safe movement amid roadways.

While roadway designs and policies can decrease the harms from crashes, an overall transportation mode shift away from personal vehicles may be most impactful. Strategies to support walking, cycling, and public transit use can decrease injury risk at the population level. Safe and active transportation options can prevent chronic diseases and promote mental health while improving access to work, education, and recreation. Importantly, these more-sustainable modes of transportation can support the imperative of climate change mitigation while also promoting health.

The current burden of injuries and deaths due to road crashes carries an estimated cost of $492 million per year in BC;[1] the human cost of lives lost and altered cannot be assigned a dollar value. Health care related to road crashes is delivered in medical specialties including emergency medicine, family medicine, and orthopaedics. Likewise, physicians practising in the separate day-to-day worlds of public health and trauma surgery recently advocated to Vancouver City Council in favor of a motion to reduce local speeds, which passed unanimously. Just as the medical community advocated with others for seatbelt laws a generation ago, we can work together today for safe transportation.
—Michael Schwandt, MD, MPH, FRCPC


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


1.    BC Injury Research and Prevention Unit. Cost of injury in British Columbia. Accessed 25 April 2024. www.costofinjury.ca/bc/cost-of-injury-in-british-columbia.
2.    Office of the Provincial Health Officer, BC Ministry of Health. Where the rubber meets the road: Reducing the impact of motor vehicle crashes on health and well-being in BC. 2016. Accessed 25 April 2024. www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/annual-reports/reducing-motor-vehicle-crashes-bc.pdf
3.    World Health Organization. Speed management: A road safety manual for decision-makers and practitioners. 2nd ed. 2023. Accessed 25 April 2024. www.who.int/publications/m/item/speed-management--a-road-safety-manual-for-decision-makers-and-practitioners.-2nd-edition.
4.    RoadSafetyBC. Module 1: Protecting people walking and cycling. In: BC community road safety toolkit. 2018. Accessed 25 April 2024. www2.gov.bc.ca/assets/gov/driving-and-transportation/driving/consequences/vision-zero/community_road_safety_toolkit_module1.pdf

Michael Schwandt, MD, MPH. Driving toward injury-free roadways. BCMJ, Vol. 66, No. , June, 2024, Page(s) - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply