Hello and welcome to the January 2024 edition of the Project Edward Podcast Series. The theme continues from last year as we invite guests to set out their own role in the safe system. My name is James Luckhurst and in this edition will be hearing from the winner of the Premier 2022 Prince Michael International Road Safety Award Professor Tim Nutbeam, who's director of the Exit Project, which has been revolutionizing extrication techniques.

Tim will be talking to us about how the project is bedded in where there's been resistance and how its key points can be replicated elsewhere in the world. First, though, we head to South Wales police headquarters to catch up with what is without exaggeration being the principality's hot road safety topic of 2023. The default 20 mile an hour speed limit introduction on restricted roads.

So let's meet two guests ready to discuss the value they think it brings and some other current matters as well. The management. Travis Lamb, currently the Deputy Chief Constable for South Wales Police and my former role was head of ops, which basically meant I looked after all things that supported policing in particular, including road policing and road safety.

So what would you say was your role in the safe system? My role is to set a strategy for how policing will work across Wales, to work with the four forces, our partners and very importantly, our GOSAFE team to create all of the right enablers, the right vision and the right resourcing to tackle that poor driver behavior, to create an environment where the roads are a safe place to be and to encourage education and an ultimately were necessary, then to ensure enforcement is in place.

But it's about basically having a strategy and a vision, working with our partners and making the roads safe to me. I am Teresa Ciano. I'm the partnership manager for Safe. I also chair Road Safety Wales and I'm a non-executive director and trustee of the Parliamentary Advisory Council for Transport Safety. So my role in NZ system is to administer offenses through use of technology in the roads that speed in mobile phones, not where you sit, but also Operation SNAP, which is where we take media footage from the public and they can use that to report driving offenses that they witness to us.

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So let's meet two guests ready to discuss the value they think it brings and some other current matters as well. The management. Travis LAMB, currently the Deputy Chief Constable for South Wales Police and my former role was head of ops, which basically meant I looked after all things that supported policing in particular, including road policing and road safety.

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So what would you say was your role in the safe system? My role is to set a strategy for how policing will work across Wales, to work with the four forces, our partners and very importantly, our GOSAFE team to create all of the right enablers, the right vision and the right resourcing to tackle that poor driver behavior, to create an environment where the roads are a safe place to be and to encourage education and an ultimately were necessary, then to ensure enforcement is in place.

Unknown

But it's about basically having a strategy and a vision, working with our partners and making the roads safe to me. I am Teresa Ciano. I'm the partnership manager for Safe. I also chair Road Safety Wales and I'm a non-executive director and trustee of the Parliamentary Advisory Council for Transport Safety. So my role in NZ system is to administer offenses through use of technology in the roads that speed in mobile phones, not where you sit, but also Operation SNAP, which is where we take media footage from the public and they can use that to report driving offenses that they witness to us.

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It's been a challenging year. You know, it's a bit to be honest, in terms of bringing in such a fundamental change. We can all think back to when we started driving and how we used to be. We have been in terms of 30 mile speed limits, but of course there are a thousand people a year who are killed or seriously injured on the roads in Wales and as a consequence this change is likely to have an impact on saving lives.

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So I think it's important, it's clear that many people favor and some people don't. And what we've tried to do is work through the balance of advising the community about why we think this is important, working with them to understand their concerns and then bringing in, in a measured way. What we really want people to do is moderate the speed.

Unknown

We don't want to enforce. So it's been challenging, but big things, things that really make a difference to people's safety in the community do take time. And they and they you know, they involve some hard work I think we've got there. But as ever, we can always learn and we can we can take views and feedback from from the community.

Unknown

Teresa, what have the Gosafe fans been doing them without enforcement in the past few months? Well, we still enforce the change on the road network, which has gone from 37% of the road network in 30 and about 3% in 20 to a flip. So the cell, 60%, the road network, we can go up to better serves our communities, rural areas and notwithstanding some of the speed limits, haven't changed, is not a blanket.

Unknown

It's a default speed limit of 20. So once we've allowed a bed in in period for speed limits, where the limit has changed, where we've tapped sites and speed limits and same, we're still out there selecting communities and notwithstanding, the vans can influence people using their mobile phones and not wearing seatbelts. So we're still out to be invisible and we're going where we need in where the intelligence tells us we need to go.

Unknown

Let's talk about community sport. What kind of feedback do you get from communities across Wales as to what their priorities are and the things that concern them? So my office gets the correspondence from the communities and we have lots of requests asking us to go and be presence there to bring speeds down in the communities. People really do feel that they want, you know, to be able to go out and enjoy their community safely, to walk cycle and take the children to school safely.

Unknown

So we'd get a lot of requests to go and safe communities, very much so. We administer clean speedway trails as well. So that's community volunteers who stand in in the villages and then they report vehicles that are speeding to us and we issue an advice letter on behalf of those communities. And it's really about sending that message that we don't want to enforce.

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We want compliance and understand that we've all got a part to play in making community safer for everybody. Perhaps I could turn to you, Mr. Travers, with that. The whole idea I think it's in the National Police Chiefs Council roads policing strategy, that it is everybody's responsibility to police the roads. How do you interpret that? I think there's a few things.

Unknown

I think the first is personal responsibility for on our own behavior to make sure that we are driving and being considerate so that we're educating our children, educating the people who are around us, our friends and family to make good decisions. I think there's also a responsibility on the public where they see poor behavior to report that to us and what we can.

Unknown

We will take action. And I think then lastly, there is the there are people making decisions and working with other people to make sure that we all behave in a way that is making our roads a safer place. So some of those decisions are around environmental decisions, the use of bikes and the use of, you know, non-police in technology that brings our road speeds down.

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So there's lots of ways the public can get involved. And obviously Operation Snap is one of those key ways where the public can help us to identify poor driving behavior. Let's talk to Theresa a bit more about SNAP then, because it gives the opportunity to take action against offenders. How can we encourage more people to be willing to call out bad behavior on the roads in the way that there's a lot of encouragement to call out inappropriate behavior in the workplace, for example?

Unknown

Well, I think it's as Mr. Travis said, we've all got a collective responsibility. But when we set up snap emails and, you know, we were the first police force to do that, and it was never about asking people to police the roads on our behalf. It was around responding to the communities who were already telling us that they wanted us to do something about the people that they could use.

Unknown

What we've tried to do is turn that around and show people when we've taken action against the poor drive behavior. So you'll always have really the majority of people who will conform and who feel that sense of social injustice, where they see people with poor driving behavior. And if it doesn't happen to be a traffic officer, a police officer there, nothing perceivable can be done.

Unknown

But now with Operation Snap, they can report that to us. And I think it's about and not be in that silent majority who support us. Maybe just saying, you know, that's not acceptable. We talk and we've worked with Keele University and the university as well, and it's about that collective social norm where we all drive responsibly and it's the small minority of people that don't.

Unknown

And I think as we sort of get more and more used to that narrative, then hopefully that will make things better for everybody. And backing up SNAP supporting it is a partnership. Let's hear what you think, Mr. Travis, about the role of a partnership and how to find the right partners to work with police and who needs to be round the table to make these happen.

Unknown

So partnership is really, really important for a few reasons. Firstly, because collective effort is likely to deliver a better outcome. So working together, work as a team, but also very important for a partnership point of view is we all have different data. So for example, we'll have data around is put from speed enforcement and the health service will have information about collisions, Highways Authority, about average speeds.

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So by bringing all of that information together, we get the best intelligence picture, and that helps us make well-considered decisions. Who needs to be on the table? And everybody really strewn around the table, The people that make the decisions, the people that have the information, the people who manage the resources, be they financial or operational. So for us, key partners would be Welsh government, clearly around strategy and vision, working with the Highways Authority, working with local authorities, the Gosafe team, our blue light partners, including the police, fire and ambulance and of course, and the voluntary sector.

Unknown

There are many, many people who have an interest and a passion for this who can bring an added to what we deliver a statutory partners. Teresa, can I talk to you about the safe system? We mentioned it a lot and Project Edward has been passionate about spreading the understanding and the implementation of the safe system. What are your thoughts on making it perhaps more retail?

Unknown

Because it's very much wholesale in that we are the business where the industry and we talk to each other about it. But how do I tell people that I meet at a motorway service area who pulled in for a moment? What would they be able to understand about the safe system and how could they adopt it and be part of it?

Unknown

Because it does need everyone. It does. And I think I would categorize up as there is no one definitive type of road user. You know, if you speak to the general person inside the road, then they all have to take collective responsibility. We all use different modes of transport is not unique, that people drive just cars and don't cycle or walk.

Unknown

So I think it's about putting it into the common narrative, and I think it's about making people understand their collective behavior. And it's back to the solution. Norman of it's such a big component that we've all you know, there's lots of agencies, partnership agencies involved in that. And I think in Wales in particular, we've got a new road safety strategy coming up next year.

Unknown

It's likely to have this system at its heart and what that is, is around all of the collective partner agencies helps local authorities ourselves in policing as well. Just getting the message out. And I think we've got to tailor messaging very differently. Some of that will be explaining the impact of of road deaths, road collisions, and we do that through the Legacy Project, where we've got people who share their collective experience and we've got things like snapped, which is where we say, look at this, more stress.

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And the silly risk, But sometimes they get away with it. And I think then that mixed messaging a little bit more difficult. So we can still have that messaging around risk and collective responsibility, but it won't work for everybody. And it's just recognizing that we need to tailor the approach. And in Road Safety Wales, we look at cycle training for the new generation.

Unknown

We subsidies in that. For Wales, it's about trying to get as much positive messaging as we can about the part we can all play on it. And for some people it would be, you know, they would be determined to break the law and consistently and that's what an app is for. And then eventually they lose their license. And in Gosafe as well, we do the administration for Operation two pitch, which is the vehicles with no insurance.

Unknown

We started reporting people as well for sort of dealing with no tax and duty. And we're really proud to be part of that. You know, it's run by New point, but we've got a small part to play in that and not to roam, taking really determined, dangerous drivers off road, as well as getting the message to the general motorist that they've got a responsibility themselves.

Unknown

Let's bring things to a conclusion. Mr. Travers With Wales and its default 20 year world leaders, I've heard from Scotland, for example, that they'd love what you've got. So, you know, how do you spread the word? How? What advice would you give to other jurisdictions looking at what you do and wanting to replicate it? I think the first thing I would say is follow the data, have a have a really good case so that you can engage and explain to your communities what it is you seek to do and why.

Unknown

I think very, very important that you have your partners who are working together to come up with effective solutions, lots and lots of communications. Your communities giving people an opportunity to comment on how things should be delivered and then ultimately a really good operational plan to make it all land changing, every road sign across the country is a really challenging piece of work to do, and then having that in a lawful manner in which you can encourage, engage and actually help people to make the decisions for themselves.

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Enforcement has to be the last option is the last thing that we want to do. We want people to make wise decisions for themselves because they recognize it's the right thing that's going to keep them and their loved ones safe. DCC Mark Travers from South Wales Police and Teresa Giuliano from Gosafe, Wales. Now it's time to hear about the exit project.

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Exactly what was the exit project and what were its key findings? The exit project was a multi-disc plenary collaboration where we worked with clinicians, operational specialists, fire and rescue services, biomechanics statistician and many others to consider the very early phases of post collision care following a motor vehicle collision. About 40% of patients will remain trapped. And how we approach these patients, how we get that initial phase right, is really important for starting the chain of survival, which will keep this person safe and well and give them optimum outcomes from the point of injury.

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All the way through to their rehabilitation and hopefully return to a normal and happy and healthy life. The key findings of the exit project were that applying a lens of evidence based medicine. So considering this phase of care as we would a scientific medical project worked and as a result of the collaboration and looking at this area deeply, we've come up with some new recommendations.

Unknown

I guess the principal findings are that we've got new, fresh insights into the injuries which people suffer following a motor vehicle collision. We've got an idea of how those injuries interact. So you can imagine a neck injury and a chest injury and a double injury might all affect each other. We know that the rate of spinal cord injury that many people are worried about is relatively low.

Unknown

When we look at all patients with extrication, it's less than 1%. But the rates of head injury, significant chest injury and a double injury is is higher. We demonstrated that some of the techniques that we use to get people out of their cars when they're trapped don't work as expected. And we've made some recommendations, for example, self extrication to try and speed up that process and to make it more patient centered.

Unknown

Importantly, as part of the exit project, we spoke to patients and asked them what their extrication experience was like. And we know that speaking kindly, explaining what's going on, holding your hand all make a really positive impact to the patient's experience. So I guess our key finding is that multidisciplinary collaboration works, science works, and we need to regularly revisit these ideas.

Unknown

So we get it right now and we get it right in the future. It's disturbing to know that long established extrication techniques based on minimizing secondary spinal injury were not evidence based and may even have contributed to injury and maybe even death. How were they allowed to remain as good practice for so long? I think this is a really interesting question, and it's probably important to acknowledge that this isn't unique to this area of practice.

Unknown

And often in medicine and in operational care, we revisit what we've done for years and find out perhaps that it works or perhaps that it wasn't working. So having our minds open to accepting that things might not have been ideal and working together to implement change is a key part of governance and ensuring that we're doing the right thing for our patients.

Unknown

Every time. I think in this particular case there was probably a lack of ownership. So from a medical perspective, when a patient remains trapped, they might seem like they're owned by the fire rescue service in terms of how they're going to come out of their car and what route that's going to be. And from an operational from a fire and rescue pit perspective, when a someone's in their car and they're injured with their clinical injuries and those injuries are going to affect the extrication strategy, it probably looks like a clinical problem to solve.

Unknown

I think the important thing is, is that through multidisciplinary working and the application of science, we've got a much better understanding of these initial phases of care and we've started to work on the path not only to put that right and to offer our patients an optimal experience and also optimal outcomes, which of course are super important, but also to regularly revisit this area of practice to keep our eye on it, to keep it under the magnifying glass, to keep applying science this area, so that we can really consider the latest evidence and how we do our best by our patients.

Unknown

Tim How well as a you step out self extrication guide being received so the you step out extrication guide is a tool to help disseminate some of the findings of the exit project. One of the findings of the exit project was that traditional extrication techniques do not work as expected and that some of those techniques that we fought caused the minimum amounts of movements, caused lots of movements, and some of those techniques which we thought caused lots of movement, caused a minimum amount of movement.

Unknown

And if we all worried about the movement of the spine, perhaps we are in a small group of patients who have potential spinal cord injury. Then if we want to minimize movements, we will ask the patient to initiate, initiate movements if they can, and that includes self extrication. So that includes stepping out of the car themselves. The you step out tool was a way of capturing some of the indications and some of the checks and balances that you need to do before you ask someone to step out of the car.

Unknown

It's still only in its very nascent primitive stages and hasn't gone through a formal rollout process yet. The feedback that we've got is that it's understandable and people like it, but we still get to evaluate it formally. And unfortunately these things take time, but we seem to be making small steps in the right direction. One of the impacts listed for the project was that rescue times would be reduced and resources would be more effectively utilized and therefore available for other patients and patient experience would be improved.

Unknown

So from what you know, these is this now happening across the country? And are there promising results to show from any recent incident data? One of the key findings of the exit project was that we needed better data in this area, so we needed better data around extrication times, the interaction between injuries and extrication, the interaction between kinematics and safety systems and injuries and extrication.

Unknown

And this first phase of post collision, post-crash care. We've still got lots of work to do in this area. So we've not got the fidelity of data we'd like in order to answer this question. What I'd like to do is answer this question in 1 to 4 years, times when we have brought that data together and we can give more of an accurate picture of what's going on from the data that is available.

Unknown

I can tell you the extrication practice is changing. For example, the number of roof type extrication that we see as a proportion of total expectations is dropping. And we've certainly heard of some really positive stories of where the exit principles have been applied and patients have survived who perhaps would not otherwise have done so. I guess as with any initiatives, it's not going to draw 100% support from everywhere.

Unknown

So has there been any resistance to the new guidelines, and if so, from whom and why? So this is a really interesting one. And in some ways I wish there had been more resistance and more feedback so that we could look to learn how we could do better in terms of disseminating the message and sharing best practice. So the feedback that we've had has all been really positive and I'm super open to non positive feedback as well.

Unknown

But this is going to take time. For many, many years we've told clinicians and firefighters that small movements may kill a patient. They make their spinal cord injury worse and we have to reverse a lot of what people have been trained to what we've been told over many years. So this is going to take time. It is incorporated into the guidance which guides paramedics and the guidance which guides fire rescue services.

Unknown

And we're looking at putting on some further consensus studies and study days to look at particular aspects of that process, gain consensus and fill in some of the gaps kind of arise and cross our so that we can move forward with this. Finally, Tim, the Prince Michael Awards stressed the benefits of replicability. So have other jurisdictions expressed interest or implemented this good practice themselves?

Unknown

Yes. This is really, really exciting. We've had contact for many different areas around the world, from Australia, from Canada, from parts of South America, from some southern African countries. About 90. Portugal, many places around the world. And we've had support from the World Rescue Organization in terms of spreading these messages. So we do hope that we are leading the way in this area.

Unknown

And this will lead to national and international change, which we're very excited by. We're currently working on a project which we hope to get funding for, looking at how the project principles might be applied across a range of Southern African countries. Watch this space. Hopefully I'll be able to update you more on this next year. Professor Tim Nutbeam identifying some exciting outcomes from the exit project.

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