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Abu-Zidan: The need for trauma systems in the United Arab Emirates

Trauma is a major health problem in the United Arab Emirates (UAE), where it is the second most common cause of death, being responsible for 17% of mortalities.1 The death rate from road traffic collisions in the UAE has been estimated by the World Health Organization at 37 per 100 000 population per year, making it one of the highest in the world.2 Victims of these accidents are predominantly young. The use of seat belts, however, reduces the numbers of severe injuries and deaths among vehicle occupants.3

We recently undertook a prospective study of 766 patients injured in road traffic accidents who were admitted to Al Ain and Tawam Hospitals in Al Ain over a period of 18 months.4 Only 17.6% of these patients had been wearing seat belts. Those who did not use seat belts were significantly younger, had more serious injuries to the head, chest, back and lower body, required more surgical operations and stayed in hospital for longer. Seat belts were used by 26% of drivers, 11.5% of front-seat passengers and 1.5% of back-seat passengers. Only 4% of UAE nationals in this study used seat belts, compared with 31% of non-UAE nationals.4 Although legislation requiring the use of seat belts has been in force in the UAE since 1999,5 this is mandatory for drivers and front-seat passengers only. This explains the very low rate of compliance among back-seat passengers. We hope that these findings will persuade legislators in the UAE to extend the law; making the use of seat belts compulsory for all vehicle occupants will have a significant impact on a population of more than 6 million people.

In another study, we compared seat belt compliance and road traffic death rates in the Gulf Cooperation Council (GCC) countries with those of another 37 high-income countries.6 The estimated death rate from road traffic accidents in the GCC countries was more than double that of other countries included in the study, with a median seat belt compliance rate of 48% compared with 85.5% in the other countries. The percentage of vehicle occupants who did not use seat belts was the only significant factor predicting mortality rates in a multiple linear regression model.

Furthermore, we have examined the correlation between seat belt use and road traffic deaths using data from 46 high-income countries.7 A linear regression analysis showed a highly significant negative correlation between seat belt compliance and road traffic death rates in these countries (P < 0.00001; R = −0.77).

The above findings highlight the need for a holistic approach to reducing deaths from trauma in the UAE. Our strategy for public health should tackle injury in the same way as disease, with the development of trauma systems which emphasize injury prevention as well as the training of health providers, pre-hospital care, triage and transportation of trauma victims, clinical care and rehabilitation after discharge from hospital. This should be facilitated by a coordinated system of leadership, law enforcement, financial support and system development.8

Implementation of such trauma systems will improve outcomes in mass casualty situations and disasters. To achieve this, an interdisciplinary collaboration is required between health leaders, legislators, strategic planners, health care providers, public health experts, clinical researchers, educators, economists and law enforcers.

In June 2011, the UAE introduced legislation making the use of child seats in vehicles compulsory.9 Furthermore, both Abu Dhabi and Dubai are currently working to build their own injury surveillance systems. These are important steps towards establishing the necessary trauma systems in these Emirates.



Ministry of Health. Health Policy Sector Annual Report. Abu Dhabi, United Arab Emirates: Ministry of Health; 2010, pp. 2–13.


World Health Organization. Global Status Report On road Safety: Time for action. Geneva: World Health Organization; 2009. URL: (accessed 15 January 2010).


Cummings P. Association of seat belt use with death: a comparison of estimates based on data from police and estimates based on data from trained crash investigators. Inj Prev 2002; 8:338–41.


Abu-Zidan FM, Abbas AK, Hefny AF, Eid HO, Grivna M. Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study. World J Surg 2012; 36:255–9.


El-Sadig M, Sarfraz Alam M, Carter AO, et al. Evaluation of effectiveness of safety seatbelt legislation in the United Arab Emirates. Accid Anal Prev 2004; 36:399–404.


Abbas AK, Hefny AF, Abu-Zidan FM. Seatbelt compliance and mortality in the Gulf Cooperation Council countries in comparison with other high-income countries. Ann Saudi Med 2011; 31:347–50.


Abbas AK, Hefny AF, Abu-Zidan FM. Seatbelts and road traffic collision injuries. World J Emerg Surg 2011; 6:18.


Hoff WS,Schwab CW. Trauma system development in North America. Clin Orthop Relat Res 2004; 422:17–22.


Gulf News. New Rules Issued on Installing Children's Car Seats. 2011. URL: (accessed 18 September 2011).

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