The road injury chain of survival : A framework for improving trauma outcomes

13 June 2025

Professor Tim Nutbeam and Willem Stassen have developed the Road Injury Chain of Survival as a tool to plan, assess, and strengthen post-collision care systems—especially in settings where resources are constrained and the burden of road injury is highest. Tools like this only have real-world impact if they’re accessible to those designing and delivering solutions.

Road injury remains a leading cause of death globally, with approximately 1.3 million deaths occurring annually. Beyond fatalities, an estimated 20 to 50 million people sustain road injuries each year, many of which lead to long-term disability and socioeconomic burden. 

The concept of a "chain of survival" has been transformative in improving survival rates for cardiac arrest, where standardised interventions at multiple levels of care have dramatically increased the likelihood of survival. The proposed Road Injury Chain of Survival consists of five essential links, each representing a critical component of post-collision care: Early Recognition and Call for Help, Early Rescue, Early Initial Care, Early Transport, and Early Hospital Care and Rehabilitation.