Overview While Asia and the Pacific has achieved an 11% reduction in road traffic fatalities since 2010—outpacing the global average of 5%—this progress masks deep disparities, particularly in post-crash care and health system response. As we move into the second half of the UN Decade of Action for Road Safety (2021–2030), the intersection of transport and health demands greater attention, especially in low- and middle-income countries. Every minute, someone dies on the roads in Asia. In 2021 alone, over 694,000 lives were lost in the region, or almost 60% of the global total. Road crashes are now the leading cause of death for young people aged 15–29 and the second leading cause for children aged 5–14. These figures are not just statistics—they represent a public health crisis. Timely emergency medical response and trauma care can mean the difference between life and death, yet this component is underdeveloped in much of the region. In low and middle-income countries, pre-hospital mortality often doubles that of high-income countries. Global attention on road safety measures had increased over the past decades but many low and middle-income countries still lack well-resourced and coordinated trauma systems. Moreover, most efforts remained heavily focused on prevention, often neglecting the development of robust, system-level responses to crashes when they occur. Strengthening post-crash care systems remains a critical and under-addressed gap in efforts to reduce traffic-related morbidity and mortality. The health sector bears much of the burden of road traffic injuries, alongside the transport sector. Crashes generate significant demand for emergency care, treatment, and rehabilitation, straining already limited health resources. In low-income settings, this often results in high out-of-pocket costs for victims and their families, deepening economic hardship. To effectively address these growing crises, a coordinated approach that bridges the transport and health sectors is essential. This article shares highlights of a working paper that examines prevailing barriers to implementing effective trauma-care, outlining potential benefits, and proposing key recommendations to guide the development of a sustainable and comprehensive, multisectoral post-crash response framework. A joint collaboration between Johns Hopkins University’s International Jury Research Unit and the Asian Development Bank, the study also recommends strategies to improve the system in order to move forward to achieving the universal health coverage. Benefits of Effective Post-Crash Care Systems Dramatically reduces preventable mortalities. A population-based study has shown that the implementation of trauma-care systems can reduce mortality resulting from traffic-related injuries by 15% to 20%. Improves recovery time and reduces the risk of death and permanent disability. A reduction in pre-hospital response time from 25 minutes to 15 minutes can cut deaths by 33%. Early medical intervention, rehabilitation, and follow-up care enable patients to regain function more rapidly and return to normal life sooner. Reduces economic burden. Effective post-crash care reduces the overall cost associated with hospital care and rehabilitation, while contributing to increase in human capital and productivity. Strengthens health system resilience. By equipping emergency services and healthcare facilities to better respond to traffic injuries and in times of crisis, it ensures equal access to care regardless of ethnicity, origin, or background. It also prepares the health system to respond to other emergencies, such as disasters caused by natural hazards. Key Recommendations For a post-crash response to be effective, it requires a systematically coordinated, well-integrated, and geographically organized approach. It demands a seamless delivery of inclusive and comprehensive care across the continuum—from the time of injury to transport to acute facilities, and to rehabilitation. Key approaches to improve trauma-care response are as follows: Prehospital care (provided at the scene of the crash): Communication – An effective emergency response system relies on a single, universally-recognized, and easy-to-remember emergency number. Many low and middle-income countries face fragmented emergency services, often operating multiple systems with different contact numbers, which hampers timely response. Emergency Transport – A well-organized system facilitates timely dispatch of appropriately equipped ambulances based on accurate information from the scene. A clear guideline on different types of transportation available depending on the severity and urgency of the case can minimize the risk of resource overuse. Many low and middle-income countries lack sufficient and properly equipped emergency transport services. Triage – Efficient triage systems help assess the severity of injuries, prioritize treatment needs, and allocate medical resources accordingly. This process ensures that patients receive the right care at the right time for improved overall outcomes. First aid management – In the absence of trained personnel, immediate care may be provided by bystanders or lay first-responders to stabilize victims quickly in remote or underserved areas. Therefore, community health literacy and basic first-aid training for the general public are essential. Hospital care: Human Resources – An adequate number of staff who are well trained and equipped in the case of emergency crisis, and who receive appropriate administrative support can provide timely and effective care. Infrastructure – Hospitals equipped with appropriate trauma facilities, medical equipment, and sufficient supplies can manage a wide range of injuries and conditions effectively. Definitive care – Clear protocols that guide hospital admission, treatment, and discharge, or guidelines on stabilizing the patient and transferring to a higher-level facility for treatment can make post-care more effective. Posthospital care (care provided at follow-up, focused on recovery and restoring of functions): Rehabilitation should be integrated in the system. Rehabilitation care needs to be an integral part of the treatment plan to improve the long-term wellbeing and functionality of injured persons. It could include physical and occupational therapy but also extends to mental health services and other rehabilitation care that will improve functioning. Surveillance systems Such devices are essential tools for the health and transport sector alike, to monitor road traffic injuries, assess patient outcomes, and pinpoint high-risk groups or locations. These insights inform targeted enhancements in trauma care, guide effective resource allocation, and support coordinated responses among emergency services. Multiagency collaboration Multiagency involvement across the system can make response more effective. The transport sector may ensure the development and availability of emergency transport vehicles and accessible transport routes (roads, air transport), while the health sector may ensure the development and availability of health infrastructure, resources, emergency services, facilities, supplies, and human resources, among several others. Conclusion Transport-related injuries carry a significant burden on both health systems and national economy. There must be a sustained dual focus on prevention (safe roads, vehicles, speeds, etc) and response (post-crash care). Addressing this issue requires a well-coordinated, organized and sustained commitment from both the transport and health sector teams to join efforts to strengthen post-crash care systems, prevent crashes, and dramatically increase survival and recovery for those that still occur. Strengthening these systems will not only enhance the quality of equity of emergency care but also support progress towards achieving Universal Health Coverage and Sustainable Development Goals. Note: The findings in this article were based on ADB Working Paper No. 104 (December 2024) “The Case for Investing in Post-Crash Care in Asia and the Pacific” led by Associate Professor Abdulgafoor M. Bachani, Nishit Patel, and Hanaa Ahsan of the Johns Hopkins International Injury Research Unit (IIRU). This was conceptualized as part of background paper for the Trauma Care Systems Improvement for Road Safety Workshop, jointly organized by ADB Health and Transport Sectors Groups. David Shelton, Diana Marie Hernandez-Louis, Michelle Apostol, Peter Sbirakos, and Polin Ly Dy contributed to various stages of the workshop, working paper, and this subsequent article. Resources Asian Development Bank. 2024. The Case for Investing in Post-Crash Care in Asia and the Pacific. ADB Sustainable Development Bank Working Paper Series No. 104. European Commission. 2023. Road Safety Thematic Report – Post-Impact Care. European Road Safety Observatory. Brussels, European Commission, Directorate General for Transport. Organisation for Economic Co-operation and Development. 2023. Health at a Glance: Asia/Pacific 2022: Measuring Progress Towards Universal Health Coverage. World Health Organization. 2016. Post-Crash Response: Supporting Those Affected by Road Traffic Crashes. WHO. 2023. Global Status Report on Road Safety 2023. Vol. 15. Ask the Experts Abdulgafoor M. Bachani Associate Professor, International Health Director, Johns Hopkins International Injury Research Unit Dr. Bachani is a global public health leader and expert in health systems, injury prevention, disability, and rehabilitation. He develops approaches for (i) to measure disability and understand the long-term health, economic, and societal consequences of injuries; (ii) strengthen health systems to enhance access to rehabilitation services in low-resource settings; (iii) apply novel ICT approaches to injury prevention, disability, and rehabilitation; and (iv) develop sustainable capacity for research and practice in the field of injury prevention, disability, and rehabilitation. Priti Gautam Senior Transport Specialist (Road Safety), Transport Sector Office, Asian Development Bank Priti Gautam promotes and supports ADB projects to achieve road safety outcomes and oversees the Asia-Pacific Road Safety Observatory. Previously, she spent 8 years at the United Nations as Head of Office and Advisor to the UN Special Envoy for Road Safety. With 15 years of experience, her focus areas include road safety, mobility, and injury prevention. She holds a Master’s in Public Health from University of California, Los Angeles, and a Bachelor’s in Economics from Boston College in the US. Follow Priti Gautam on Vasoontara Sbirakos Yiengprugsawan Senior Universal Health Coverage Specialist (Service Delivery), Human and Social Development Office, Sector Department 3, Asian Development Bank Vasoontara Sbirakos Yiengprugsawan oversees ADB’s technical assistance on strengthening primary healthcare and management of chronic noncommunicable diseases and mental health. She has held senior health research positions in Australia, a WHO Fellowship with the Asia Pacific Observatory on Health Systems and Policies, and worked in policy and research with a UN Migration Agency in Geneva. She holds a PhD in Epidemiology, Economics and Population Health from Australian National University and MA in International Development from Syracuse University. Follow Vasoontara Sbirakos Yiengprugsawan on Leave your question or comment in the section below: View the discussion thread.