ABSTRACT:

Introduction:

Urban transit accident are a global public health problem. The objective of this study was to describe the profile of the victims and the occurrences of urban transit accidents attended to by emergency mobile care services (Serviço de Atendimento Móvel de Urgência- SAMU) in Recife, and their distribution based on spatial analysis.

Methodology:

An ecological study, developed through secondary data from emergency mobile care services in Recife, referring to the total number of occurrences of urban transit accidents attended to from January 1 to June 30, 2015. The spatial analysis was performed using the Moran index.

Results:

Basic support units performed most of the emergency services (89.2%). Among the victims, there was a predominance of males (76.8%) and an age group of 20 - 29 years old (31.5%). Collisions were responsible for 59.9% of the transit accidents, and motorcycles for 61.6% of the accidents among all means of transportation. Friday was the day that showed the highest risk for treatment, and there was a concentration of events between 6:00 am - 8:59am and 6:00pm - 8:59pm. The MoranMap identified critical areas where calls came from traffic accidents during the period analyzed.

Discussion:

The records of the mobile service from the spatial analysis are an important source of information for health surveillance.

Conclusion:

The spatial analysis of urban transit accidents identified regions with a positive spatial correlation, providing subsidies to the logistical planning of emergency mobile care services. This study is groundbreaking in that it offers such information about the region.

Keywords:
Traffic accidents; Emergency medical services; Spatial analysis; Health services research; Uses of epidemiology; Descriptive epidemiology

INTRODUCTION

For several years, the United Nations (UN) has recognized urban traffic accidents as a serious public health problem worldwide, because they are accompanied by high morbidity and mortality rates¹1. World Health Organization (WHO). Promovendo a defesa da segurança viária e das vítimas de lesões causadas pelo trânsito: um guia para organizações não governamentais. Geneva: WHO;2013. [Internet]. Disponível em: http://apps.who.int/iris/bitstream/10665/44854/8/9789248503320_por.pdf (Acessado em 24 de novembro de 2015).
http://apps.who.int/iris/bitstream/10665... ^,22. Maciel WV, Maciel SS, Farias AH, Silva ET, Gondim LA, Oliveira TF. Internações hospitalares por fraturas do crânio e dos ossos da face no nordeste brasileiro. Revista da Amrigs 2009; 53(1): 28-33.. Approximately 1.2 million deaths a year result from traffic accidents. Of those deaths, 90% occur in low- and middle-income countries³3. World Health Organization (WHO). Road traffic injuries. Fact sheet. Geneva: WHO; 2016. [Internet]. Disponível em: http://www.who.int/mediacentre/factsheets/fs358/en/ (Acessado em 12 de novembro de 2015).
http://www.who.int/mediacentre/factsheet... .

Brazil is one of the leading countries in mortality rates from urban traffic accidents. The majority of deaths and hospitalizations caused by these accidents are observed among males, black people, young adults, individuals with low education and motorcyclists⁴4. Andrade SS, Jorge MH. Estimate of physical sequelae in victims of road traffic accidents hospitalized in the Public Health System. Rev bras Epidemiol 2016; 19(1): 100-11. DOI: 10.1590/1980-5497201600010009
https://doi.org/10.1590/1980-54972016000... ^,55. Ascari RA, Chapieski CM, Silva OM, Frigo J. Perfil epidemiológico de vítimas de acidente de trânsito. Rev Enferm UFSM 2013; 3(1): 112-21. DOI: 10.5902/217976927711
https://doi.org/10.5902/217976927711... ^,66. Bacchieri G, Barros AJ. Traffic accidents in Brazil from 1998 to 2010: many changes and few effects. Rev Saúde Pública [online] 2011; 45(5): 949-63. DOI: 10.1590/S0034-89102011005000069
https://doi.org/10.1590/S0034-8910201100... ^,77. Franco MS, Lins AC, Lima AK, Araújo TL, Amaral RC. Caracterização de pacientes vítimas de acidentes de transito admitidos em hospital regional da Paraíba. R Interd 2015; 8(2): 123-29.^,88. Malta DC, Andrade SS, Gomes N, Silva MM, Morais OL, Reis AA, et al. Injuries from traffic accidents and use of protection equipment in the Brazilian population, according to a population-based study. Ciênc saúde coletiva 2016; 21(2): 399-410. DOI: 10.1590/1413-81232015212.23742015
https://doi.org/10.1590/1413-81232015212... .

The high rate of urban traffic accidents in the country may be associated with the Brazilian culture of people using public spaces as if they were their own, so that motor vehicles are seen and used as an instrument of power, lead to civil disobedience with regard to traffic laws and are connected to alcohol consumption⁹9. Moyses SJ. Determinação sociocultural dos acidentes de transporte terrestre (ATT). Ciênc saúde coletiva 2012; 17(9): 2241-3. DOI: 10.1590/S1413-81232012000900005
https://doi.org/10.1590/S1413-8123201200... ^,1010. Cerqueira GL. Consumo de álcool e outras drogas por jovens condutores. [Internet]. Disponível em: http://www.psicologia.pt. (Acessado em 11 de outubro de 2015).
http://www.psicologia.pt... .

States in the Northeast of the country had increased mortality rates from urban traffic accidents¹¹11. Morais OL, Montenegro MM, Monteiro RA, Siqueira JB, Silva MM, Lima CM, et al. Mortalidade por acidentes de transporte terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc saúde coletiva 2012; 17(9): 2223-36. DOI: 10.1590/S1413-81232012000900002
https://doi.org/10.1590/S1413-8123201200... . There were also reports of less frequent seat belt use in both the front and rear seats, greater proportions of accidents involving bicycles and motorcycles, in addition to victims who claimed to have stopped performing usual daily activities due to injuries resulting from traffic accidents¹²12. Malta DC, Mascarenhas MD, Bernal RT, Silva MM, Pereira CA, Minayo MC, et al. Análise das ocorrências das lesões no trânsito e fatores relacionados segundo resultados da pesquisa nacional por amostra de domicílios (PNAD) Brasil, 2008. Ciênc saúde coletiva 2011; 16(9): 3679-87. DOI: 10.1590/S1413-81232011001000005
https://doi.org/10.1590/S1413-8123201100... .

In Pernambuco, there was a growth of 875% in the mortality coefficient of motorcyclists per 100,000 inhabitants between 1996 and 2006. The observed increase in the production of motorcycles is a possible explanation for the increased accidents involving this type of vehicle¹³13. Silva PH, Lima ML, Moreira RS, Souza WV, Cabral AP. Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil. Rev Saúde Pública 2011; 45(2): 409-15. DOI: 10.1590/S0034-89102011005000010
https://doi.org/10.1590/S0034-8910201100... .

Pedestrians, cyclists and motorcyclists are groups of victims who, in addition to representing half of all deaths by traffic accidents worldwide³3. World Health Organization (WHO). Road traffic injuries. Fact sheet. Geneva: WHO; 2016. [Internet]. Disponível em: http://www.who.int/mediacentre/factsheets/fs358/en/ (Acessado em 12 de novembro de 2015).
http://www.who.int/mediacentre/factsheet... , greatly impact the frequency of occurrences (about 89%) in emergency hospital units and the Emergency Mobile Care Services (Serviço de Atendimento Móvel de Urgência-SAMU) ¹⁴14. Cabral AP, Souza WV, Lima ML. Serviço de atendimento móvel de urgência: um observatório dos acidentes de transportes terrestre em nível local. Rev Bras Epidemiol 2011; 14(1): 03-14. DOI: 10.1590/S1415-790X2011000100001
https://doi.org/10.1590/S1415-790X201100... ^,1515. Gawryszewski VP, Coelho HM, Sarpelini S, Zan R, Jorge MH, Rodrigues EM. Land transport injuries among emergency department visits in the state of São Paulo, in 2005. Rev Saúde Pública 2009; 43(2): 275-82. DOI: 10.1590/S0034-89102009000200008
https://doi.org/10.1590/S0034-8910200900... .

SAMU, an important mobile pre-hospital component of the National Emergency Care Policy, launched in 2003¹⁶16. Brasil. Ministério da Saúde. Política nacional de atenção às urgências. Série E. Legislação de Saúde. Brasília: Editora do Ministério da Saúde 2006; 256. [Internet]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_atencao_urgencias_3ed.pdf (Acessado em 16 de novembro de 2015).
http://bvsms.saude.gov.br/bvs/publicacoe... , is a 24-hour free service that provides guidance and sends manned vehicles containing trained staff. It is accessed through a telephone number and activated by an Emergency Regulation Center¹⁷17. Brasil. Ministério da Saúde. Portal da Saúde. O que é o SAMU 192? Criado em 13 de Junho de 2014. [Internet]. Disponível em: http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/secretarias/951-sas-raiz/dahu-raiz/forca-nacional-do-sus/l2-forca-nacional-do-sus/13407-servico-de-atendimento-movel-de-urgencia-samu-192 (Acessado em 16 de novembro de 2015).
http://portalsaude.saude.gov.br/index.ph... .

Currently, SAMU serves 75% of the Brazilian population¹⁷17. Brasil. Ministério da Saúde. Portal da Saúde. O que é o SAMU 192? Criado em 13 de Junho de 2014. [Internet]. Disponível em: http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/secretarias/951-sas-raiz/dahu-raiz/forca-nacional-do-sus/l2-forca-nacional-do-sus/13407-servico-de-atendimento-movel-de-urgencia-samu-192 (Acessado em 16 de novembro de 2015).
http://portalsaude.saude.gov.br/index.ph... . In Recife, SAMU was inaugurated on December 21, 2001. As the capital of Pernambuco, Recife hosts the headquarters of the Metropolitan SAMU Medical Regulation Center of Recife. The headquarters regulates 17 municipalities in the Metropolitan Region¹⁸18. Prefeitura do Recife. SAMU. [Internet]. Disponível em: http://www2.recife.pe.gov.br/servico/samu-0 (Acessado em 02 de abril de 2015).
http://www2.recife.pe.gov.br/servico/sam... .

In Brazil, the Ministry of Health (MoH) has supported states and municipalities to increase their ability to implement surveillance interventions and prevent deaths and injuries caused by traffic accidents¹⁹19. Novoa AM, Perez K, Borrell C. Efectividad de las intervenciones de seguridad vial basadas en la evidencia: una revision de la literatura. Gac Sanit 2009; 23(6): 553.e1-553.e14.. An example of this support is the Life in Transit Project, (Projeto Vida no Trânsito), which is part of a bigger project called Traffic Safety in Ten Countries (Segurança no Trânsito em Dez Países)²⁰20. Hyder AA, Allen KA, Di Pietro G, Adriazola CA, Sobel R, Larson K, et al. Addressing the implementation gap in global road safety: exploring features of an effective response and introducing a 10-country program. Am J Public Health 2012; 102(6): 1061-7. DOI: 10.2105/AJPH.2011.300563
https://doi.org/10.2105/AJPH.2011.300563... , which has the objective to aid managers through training, planning, monitoring, follow-up and intervention evaluation¹¹11. Morais OL, Montenegro MM, Monteiro RA, Siqueira JB, Silva MM, Lima CM, et al. Mortalidade por acidentes de transporte terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc saúde coletiva 2012; 17(9): 2223-36. DOI: 10.1590/S1413-81232012000900002
https://doi.org/10.1590/S1413-8123201200... .

In order to subside possible policies for the prevention of urban traffic accidents, spatial analysis is considered a powerful public health tool. It makes spatial patterns of a phenomenon visible, even with sparse data,²¹21. Best N, Richardson S, Thomson U. A comparison of bayesian spatial models for disease mapping. Stat Methods Med Res 2005; 14(1): 35-59. DOI: 10.1191/0962280205sm388oa
https://doi.org/10.1191/0962280205sm388o... through the construction of maps, and through the mapping of risk factors in the population ²²22. Bailey TC. Métodos estatísticos espaciais em saúde. Cad Saúde Pública 2001; 17(5): 1083-98. DOI: 10.1590/S0102-311X2001000500011
https://doi.org/10.1590/S0102-311X200100... ^,2323. Bailey TC, Carvalho MS, Lapa TM, Souza WV, Brewer MJ. Modeling of under-detection of cases in disease surveillance. Annals of Epidemiology 2005; 15(5): 335-43. DOI: 10.1016/j.annepidem.2004.09.013
https://doi.org/10.1016/j.annepidem.2004... . The spatialization of traffic accidents is important in order to provide subsidies for the planning and execution of public policies, which increase the effectiveness and efficiency in reducing and preventing these injuries²⁴24. Souza VR, Cavenaghi S, Alves JE, Magalhães MA. Análise espacial dos acidentes de trânsito com vítimas fatais: comparação entre o local de residência e de ocorrência do acidente no Rio de Janeiro. Rev Bras Estud Popul 2008; 25(2): 353-64. DOI: 10.1590/S0102-30982008000200010
https://doi.org/10.1590/S0102-3098200800... .

The present study had the objective of describing the profile of victims served by SAMU in Recife and the occurrence of urban traffic accidents, as well as their distribution based on a spatial analysis.

METHODS

The present study was of ecological design and was developed through the collection of secondary data from Recife’s SAMU database. It looked at the total number of urban traffic accidents from January 1^st to June 30^th of 2015.

The study site was the municipality of Recife, the capital of Pernambuco. The city was divided into 94 clustered neighborhoods and into 6 political-administrative regions (PARs)²⁵25. Brasil. Secretaria de Saúde do Recife. Plano Municipal de Saúde 2014 - 2017. Governo Municipal. Secretaria Executiva de Coordenação Geral, Gerência Geral de Planejamento. Recife: Secretaria de Saúde do Recife: 2014. 84 p.. In 2010, the municipality had a population of 1,537,704 inhabitants distributed among 218.435 km² and a population density of 7,039.64 inhab/km²²⁶26. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Diretoria de Pesquisas (DPE). Coordenação de População e Indicadores Socias - COPIS. [Internet]. Disponível em: http://cidades.ibge.gov.br/xtras/perfil.php?lang=&codmun=261160&search=pernambuco|recife (Acessado em 11 de novembro de 2015).
http://cidades.ibge.gov.br/xtras/perfil.... . The reference population was estimated by the Health Department of Recife for 2015, and had 1,598,096 inhabitants. The study included 1,225 victims of urban traffic accidents that were attended to by the SAMU of Recife.

The following were described: the type of ambulance, the destination facilities, the victim’s condition (gender, age range, means of transportation) and the nature of the accident (collision, vehicle tipping or rolling over, crashing into fixed objects, being run over and falling in/from the vehicle). Relative frequencies and relative rates were calculated considering the resident population (incidence rate: IR; number of occurrences/population exposed for every 10,000 inhabitants).

The statistical analysis was performed using the BioEstat 5.3 program. Poisson’s regression was used in order to estimate the relative risk (RR) and the confidence interval values of 95% (95%CI) of the association between days of the week, time and neighborhood of the accidents. Tuesdays were considered the reference day (for week days) and the period from 12:00am to 2:59am (for operating hours), due to the low flow of people who could influence the occurrence of the accidents.

The neighborhood was the spacial unit adopted. Maps were constructed with the absolute distribution of the total numbers of visits (equal intervals) and of RR (quartile). Subsequently, a spatial analysis was performed, with the objective of identifying clusters with statistical significance, which allow for the prioritizing of injury control actions. The Moran index was adopted, with a variation from -1 to 1. The values close to zero indicate the absence of spatial correlation - difference among neighborhoods close to each other. The positive values indicate positive spatial autocorrelation, meaning that there are similarities between neighborhoods close to each other, and negative values have negative spatial autocorrelation¹³13. Silva PH, Lima ML, Moreira RS, Souza WV, Cabral AP. Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil. Rev Saúde Pública 2011; 45(2): 409-15. DOI: 10.1590/S0034-89102011005000010
https://doi.org/10.1590/S0034-8910201100... ^,2727. Krempi AP. Explorando recursos de estatística espacial para análise de acessibilidade na cidade de Bauru. Escola de Engenharia de São Carlos: Universidade de São Paulo 2004. [Dissertação de Mestrado]. Disponível em: http://www.teses.usp.br/teses/disponiveis/18/18137/tde-10032005-064613/pt-br.php (Acessado em 17 de outubro de 2015).
http://www.teses.usp.br/teses/disponivei... . In general, the Moran index is a test whose null hypothesis is of spatial independence. In this case, its value is zero. Positive values (between 0 and +1) indicate direct correlation, and negative ones (between 0 and -1) indicate inverse correlation²⁸28. Câmara G, Carvalho MS, Cruz OG, Correa V. Análise espacial de dados geográficos: Cap. 5, análise espacial de áreas. Brasília, EMBRAPA, 2004 [Internet]. Disponível em: http://www.dpi.inpe.br/gilberto/livro/analise/cap5-areas.pdf (Acessado em 17 de abril de 2017).
http://www.dpi.inpe.br/gilberto/livro/an... . The analysis of spatial distribution of the services had three stages. The first stage identified critical transition areas and used Moran’s spreading diagram to compare the spatial dependency of each neighborhood. In this stage, the quadrants are interpreted as: Q1 (positive values, positive means); Q2 (negative values, negative means), which indicates the points of positive spatial association or points that are similar to their neighbors; Q3 (positive values, negative means); and Q4 (negative values, positive means), which indicates points of negative spatial association, and neighborhoods with values different from other neighborhoods close by. This stage is visually represented with a BoxMap¹³13. Silva PH, Lima ML, Moreira RS, Souza WV, Cabral AP. Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil. Rev Saúde Pública 2011; 45(2): 409-15. DOI: 10.1590/S0034-89102011005000010
https://doi.org/10.1590/S0034-8910201100... ^,2727. Krempi AP. Explorando recursos de estatística espacial para análise de acessibilidade na cidade de Bauru. Escola de Engenharia de São Carlos: Universidade de São Paulo 2004. [Dissertação de Mestrado]. Disponível em: http://www.teses.usp.br/teses/disponiveis/18/18137/tde-10032005-064613/pt-br.php (Acessado em 17 de outubro de 2015).
http://www.teses.usp.br/teses/disponivei... ^,2828. Câmara G, Carvalho MS, Cruz OG, Correa V. Análise espacial de dados geográficos: Cap. 5, análise espacial de áreas. Brasília, EMBRAPA, 2004 [Internet]. Disponível em: http://www.dpi.inpe.br/gilberto/livro/analise/cap5-areas.pdf (Acessado em 17 de abril de 2017).
http://www.dpi.inpe.br/gilberto/livro/an... .

In the second stage, a local indicator of spatial association (LISA) is used, which detects regions that have a significantly different local correlation compared to the rest of the data. This is possible through the application of local spatial autocorrelation statistics. A significance evaluation is done by comparing the values observed with a series of values obtained through the permutation of values of neighboring areas. Local rates are classified as non-significant and with significance of 95, 99 and 99.9%¹³13. Silva PH, Lima ML, Moreira RS, Souza WV, Cabral AP. Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil. Rev Saúde Pública 2011; 45(2): 409-15. DOI: 10.1590/S0034-89102011005000010
https://doi.org/10.1590/S0034-8910201100... ^,2727. Krempi AP. Explorando recursos de estatística espacial para análise de acessibilidade na cidade de Bauru. Escola de Engenharia de São Carlos: Universidade de São Paulo 2004. [Dissertação de Mestrado]. Disponível em: http://www.teses.usp.br/teses/disponiveis/18/18137/tde-10032005-064613/pt-br.php (Acessado em 17 de outubro de 2015).
http://www.teses.usp.br/teses/disponivei... .

The third stage merges zones with positive spatial relation identified by the BoxMap (with spatial significance above 95%) and those with positive spatial relation identified by the LisaMap. The combination of these two groups generated the MoranMap. Critical areas were those that consisted of neighborhoods classified as Q1 in the MoranMap¹³13. Silva PH, Lima ML, Moreira RS, Souza WV, Cabral AP. Spatial study of mortality in motorcycle accidents in the State of Pernambuco, Northeastern Brazil. Rev Saúde Pública 2011; 45(2): 409-15. DOI: 10.1590/S0034-89102011005000010
https://doi.org/10.1590/S0034-8910201100... ^,2727. Krempi AP. Explorando recursos de estatística espacial para análise de acessibilidade na cidade de Bauru. Escola de Engenharia de São Carlos: Universidade de São Paulo 2004. [Dissertação de Mestrado]. Disponível em: http://www.teses.usp.br/teses/disponiveis/18/18137/tde-10032005-064613/pt-br.php (Acessado em 17 de outubro de 2015).
http://www.teses.usp.br/teses/disponivei... .

The spatial exploratory analysis for the identification of transition areas and critical areas of the events studied were performed with the help of electronic Excel^© spreadsheets and TerraView software, version 4.2.2. The results were represented in the digital cartographic base of Recife.

This Project was approved by the Research Ethics Committee in agreement with Resolution No. 466/2012, which regulates research with human beings, and which is from the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), CAEE: 53175716.2.0000.5201.

RESULTS

In the period studied, 1,225 victims of urban traffic accidents were attended to by SAMU in the city of Recife, Pernambuco. This value corresponds to 45.4% of the total number of services performed by SAMU (n = 2,698), considering all causes.

The Basic Support Units (unidades de suporte básico - USBs) performed most of the services. Most of the victims were taken to public health network units, mainly the Municipal Emergency Care Units (Unidades de Pronto Atendimento - UPAs) (Table 1).

Victims were mostly males (a ratio of 3.6 men for each woman). The most common age range was from 20 to 29 years old, and the least frequent age range was from 0 to 9 years old. Approximately 60% of the cases were caused by a collision. As for the victim’s means of transportation, motorcycles were most frequently involved in urban traffic accidents (Table 1).

When observing the distribution of care per day of the week, with Tuesday as the reference, it was found that Friday had a 29% higher risk of urban traffic accidents. Assistance occurred about 5 times more often from 6:00am to 8:59am and from 6:00pm to 8:59pm, in relation to the reference time period of 12:00am to 2:59am (Table 2).

The neighborhoods with the highest frequency of traffic accidents were: Ibura (n = 76; 6.2%), located in the southern zone of the municipality; followed by Santo Amaro (n = 62; 5.1%), in the central zone; and Boa Viagem (n = 54; 4.4%), in the south zone (Figure 1A). The incidence of traffic accident assistance in the municipality was 7.67 times per 10,000 inhabitants. The neighborhoods with the highest RRs for the occurrence of traffic accidents were: Santo Antônio (RR = 43.76; 95%CI [23, 74; 80, 72]), followed by the neighborhood in Recife (RR = 23.17; 95%CI [12, 87; 41, 75]), which are both from the central zone of the municipality, and the University Campus (RR = 19.82; 95%CI [11, 52; 34, 08]), in the northwestern region of the municipality (Table 3 and Figure 1B).

When exploring the spatial dependency of this kind of occurrence using the BoxMap, positive correlation areas were identified in the south and northeast zones of the municipality (Table 3 and Figure 2A). The BoxMap also shows areas with negative spatial autocorrelation, represented by regions Q3 and Q4, which may indicate potential critical nodes (Figure 2A).

Finally, the MoranMap statistically confirms that the south regions of the municipality have the highest relevance for the occurrence of services provided after urban traffic accidents during the period analyzed. Transition regions in the vicinity of critical areas are also kept in the final model (Table 3 and Figure 2B).

DISCUSSION

This study observed that most of the assistance provided to victims of urban traffic accidents was performed by the USBs. This corroborates studies carried out in the state of Paraíba, whose findings reveal that more than 90% of services were performed by basic ambulances²⁹29. Pereira AP, Moraes RM, Vianna RP. Aplicação do método scan para a detecção de conglomerados espaciais dos acidentes de trânsito ocorridos em João Pessoa-PB. Hygeia 2014; 10(18): 82-97.^,3030. Soares RA, Pereira AP, Moraes RM, Vianna RP. Caracterização das vítimas de acidentes de trânsito atendidas pelo Serviço de Atendimento Móvel de Urgência (SAMU) no Município de João Pessoa, Estado da Paraíba, Brasil, em 2010. Epidemiol Serv Saúde 2012; 21(4): 589-600. DOI: 10.5123/S1679-49742012000400008
https://doi.org/10.5123/S1679-4974201200... . These are similar results to those found in other studies³¹31. Dias LK. Avaliação do serviço de atendimento móvel de urgência na atenção aos acidentes de trânsito na zona urbana de sobral - CE. Universidade Federal do Ceará 2016. [Dissertação de Mestrado]. Disponível em: http://repositorio.ufc.br/bitstream/riufc/19191/1/2016_dis_lksdias.pdf (Acessado em 04 de outubro de 2016).
http://repositorio.ufc.br/bitstream/riuf... ^,3232. Soares RA, Pereira AP, Moraes RM, Vianna RP. Modelo de suporte à decisão para a gravidade de ferimentos das vítimas de acidentes de trânsito atendidas pelo samu 192. Rev Saúde.Com 2013; 9(2): 2-16.^,3333. Silva JK, Rios MA, Amaral TF, Silva PL. Profile of road transport accidents met by the mobile urgency attendance service. J Nurs UFPE on line 2016; 10(1): 9-17. DOI: 10.5205/reuol.8423-73529-1-RV1001201602
https://doi.org/10.5205/reuol.8423-73529... . One of the possible explanations is the fact that the municipality has the mostly this kind of ambulance. There are five times more USBs than advanced support units (unidades de suporte avançado - USAs).

As for destination units, the results observed were consistent with other studies²⁹29. Pereira AP, Moraes RM, Vianna RP. Aplicação do método scan para a detecção de conglomerados espaciais dos acidentes de trânsito ocorridos em João Pessoa-PB. Hygeia 2014; 10(18): 82-97.^,3030. Soares RA, Pereira AP, Moraes RM, Vianna RP. Caracterização das vítimas de acidentes de trânsito atendidas pelo Serviço de Atendimento Móvel de Urgência (SAMU) no Município de João Pessoa, Estado da Paraíba, Brasil, em 2010. Epidemiol Serv Saúde 2012; 21(4): 589-600. DOI: 10.5123/S1679-49742012000400008
https://doi.org/10.5123/S1679-4974201200... ^,3131. Dias LK. Avaliação do serviço de atendimento móvel de urgência na atenção aos acidentes de trânsito na zona urbana de sobral - CE. Universidade Federal do Ceará 2016. [Dissertação de Mestrado]. Disponível em: http://repositorio.ufc.br/bitstream/riufc/19191/1/2016_dis_lksdias.pdf (Acessado em 04 de outubro de 2016).
http://repositorio.ufc.br/bitstream/riuf... , in which most victims were taken to a trauma hospital in the city. Especially in Recife, the high number of referrals to UPAs is due to their connection with one other, ever since January 2010, when they were integrated into the state emergency network.

Males and young adults deserve special attention in regard to the promotion of actions that prevent urban traffic accidents, since these groups are the most affected. Similar results were found in other studies⁴4. Andrade SS, Jorge MH. Estimate of physical sequelae in victims of road traffic accidents hospitalized in the Public Health System. Rev bras Epidemiol 2016; 19(1): 100-11. DOI: 10.1590/1980-5497201600010009
https://doi.org/10.1590/1980-54972016000... ^,55. Ascari RA, Chapieski CM, Silva OM, Frigo J. Perfil epidemiológico de vítimas de acidente de trânsito. Rev Enferm UFSM 2013; 3(1): 112-21. DOI: 10.5902/217976927711
https://doi.org/10.5902/217976927711... ^,66. Bacchieri G, Barros AJ. Traffic accidents in Brazil from 1998 to 2010: many changes and few effects. Rev Saúde Pública [online] 2011; 45(5): 949-63. DOI: 10.1590/S0034-89102011005000069
https://doi.org/10.1590/S0034-8910201100... ^,77. Franco MS, Lins AC, Lima AK, Araújo TL, Amaral RC. Caracterização de pacientes vítimas de acidentes de transito admitidos em hospital regional da Paraíba. R Interd 2015; 8(2): 123-29.^,1414. Cabral AP, Souza WV, Lima ML. Serviço de atendimento móvel de urgência: um observatório dos acidentes de transportes terrestre em nível local. Rev Bras Epidemiol 2011; 14(1): 03-14. DOI: 10.1590/S1415-790X2011000100001
https://doi.org/10.1590/S1415-790X201100... ^,3131. Dias LK. Avaliação do serviço de atendimento móvel de urgência na atenção aos acidentes de trânsito na zona urbana de sobral - CE. Universidade Federal do Ceará 2016. [Dissertação de Mestrado]. Disponível em: http://repositorio.ufc.br/bitstream/riufc/19191/1/2016_dis_lksdias.pdf (Acessado em 04 de outubro de 2016).
http://repositorio.ufc.br/bitstream/riuf... ^,3333. Silva JK, Rios MA, Amaral TF, Silva PL. Profile of road transport accidents met by the mobile urgency attendance service. J Nurs UFPE on line 2016; 10(1): 9-17. DOI: 10.5205/reuol.8423-73529-1-RV1001201602
https://doi.org/10.5205/reuol.8423-73529... ^,3434. Cabral AP, Souza WV. Serviço de atendimento móvel de urgência (SAMU): análise da demanda e sua distribuição espacial em uma cidade do Nordeste brasileiro. Rev Bras Epidemiol 2008; 11(4): 530-40. DOI: 10.1590/S1415-790X2008000400002
https://doi.org/10.1590/S1415-790X200800... . According to the World Health Organization (WHO), these groups are about three times more likely to die in a transportation accident than young women³3. World Health Organization (WHO). Road traffic injuries. Fact sheet. Geneva: WHO; 2016. [Internet]. Disponível em: http://www.who.int/mediacentre/factsheets/fs358/en/ (Acessado em 12 de novembro de 2015).
http://www.who.int/mediacentre/factsheet... .

This data may be a consequence of the young male population’s exposure to traffic. Based on social and cultural behaviors, this group takes more risks when driving vehicles. These risks include driving at high speeds, using inappropriate maneuvers and drinking alcohol¹⁴14. Cabral AP, Souza WV, Lima ML. Serviço de atendimento móvel de urgência: um observatório dos acidentes de transportes terrestre em nível local. Rev Bras Epidemiol 2011; 14(1): 03-14. DOI: 10.1590/S1415-790X2011000100001
https://doi.org/10.1590/S1415-790X201100... . Those and other foolish behaviors are determinant characteristics for the alarming transportation accident rates in this population³⁵35. Miranda AL, Sarti EC. Consumo de bebidas alcoólicas e os acidentes de trânsito: o impacto da homologação da lei seca em Campo Grande-MS. Ensaios Cienc, Cienc Biol Agrar Saúde 2011; 15(6): 155-71.. Potential social security expenses may be generated, raising costs to public coffers, due to the victims’ impossibility to work and complete rehabilitation at the same time³⁶36. Nunes MN, Nascimento LF. Análise espacial de óbitos por acidentes de trânsito, antes e após a Lei Seca, nas microrregiões do Estado de São Paulo. Rev Assoc Med Bras 2012; 58(6): 685-90. DOI: 10.1016/S2255-4823(12)70272-2
https://doi.org/10.1016/S2255-4823(12)70... .

Collision is one of the most common types of accidents, especially when they include motorcycles²⁹29. Pereira AP, Moraes RM, Vianna RP. Aplicação do método scan para a detecção de conglomerados espaciais dos acidentes de trânsito ocorridos em João Pessoa-PB. Hygeia 2014; 10(18): 82-97.^,3030. Soares RA, Pereira AP, Moraes RM, Vianna RP. Caracterização das vítimas de acidentes de trânsito atendidas pelo Serviço de Atendimento Móvel de Urgência (SAMU) no Município de João Pessoa, Estado da Paraíba, Brasil, em 2010. Epidemiol Serv Saúde 2012; 21(4): 589-600. DOI: 10.5123/S1679-49742012000400008
https://doi.org/10.5123/S1679-4974201200... ^,3737. Rodrigues AS, Fernandes PG. Avaliação das características dos acidentes de trânsito do município de Botucatu e suas associações com as condições climáticas. Tekhne e Logos, Botucatu 2015; 6(2): 70-84.^,3838. Almeida RL, Filho JG, Braga JU, Magalhães FB, Macedo MC, Silva KA. Man, road and vehicle: risk factors associated with the severity of traffic accidents. Rev Saúde Pública 2013; 47(4): 718-31. DOI: 10.1590/S0034-8910.2013047003657
https://doi.org/10.1590/S0034-8910.20130... . Other studies displayed similar results, with motorcycles in first place in the involvement in traffic accidents¹⁴14. Cabral AP, Souza WV, Lima ML. Serviço de atendimento móvel de urgência: um observatório dos acidentes de transportes terrestre em nível local. Rev Bras Epidemiol 2011; 14(1): 03-14. DOI: 10.1590/S1415-790X2011000100001
https://doi.org/10.1590/S1415-790X201100... ^,2929. Pereira AP, Moraes RM, Vianna RP. Aplicação do método scan para a detecção de conglomerados espaciais dos acidentes de trânsito ocorridos em João Pessoa-PB. Hygeia 2014; 10(18): 82-97.^,3030. Soares RA, Pereira AP, Moraes RM, Vianna RP. Caracterização das vítimas de acidentes de trânsito atendidas pelo Serviço de Atendimento Móvel de Urgência (SAMU) no Município de João Pessoa, Estado da Paraíba, Brasil, em 2010. Epidemiol Serv Saúde 2012; 21(4): 589-600. DOI: 10.5123/S1679-49742012000400008
https://doi.org/10.5123/S1679-4974201200... ^,3333. Silva JK, Rios MA, Amaral TF, Silva PL. Profile of road transport accidents met by the mobile urgency attendance service. J Nurs UFPE on line 2016; 10(1): 9-17. DOI: 10.5205/reuol.8423-73529-1-RV1001201602
https://doi.org/10.5205/reuol.8423-73529... ^,3939. Marín-León L, Belon AP, Barros MB, Almeida SD, Restitutti MC. Tendência dos acidentes de trânsito em Campinas, São Paulo, Brasil: importância crescente dos motociclistas. Cad Saúde Pública 2012; 28(1): 39-51. DOI: 10.1590/S0102-311X2012000100005
https://doi.org/10.1590/S0102-311X201200... .

Motorcycles became a very popular automotive vehicle for many reasons, including the ease with which they can be acquired and paid for, their agility in slow traffic in large metropolises and the money they saves on fuel and maintenance. All of these factors may directly influence the populations’ choice, resulting, thus, in an increased number of motorcycles and, consequently, an increased frequency of motorcycle accidents. It should be considered that this increase in the purchase of motorcycles is not accompanied by appropriate investment for drivers’ safety ⁴⁰40. Anjos KC, Evangelista MR, Silva JS, Zumiotti AV. Paciente vítima de violência no trânsito: análise do perfil socioeconômico, características do acidente e intervenção do serviço social na emergência. Acta Ortop Bras 2007; 15(5):262-6. DOI: 10.1590/S1413-78522007000500006
https://doi.org/10.1590/S1413-7852200700... ^,4141. Felix NR, Oliveira SR, Cunha NA, Schirmer C. Caracterização das vítimas de acidente motociclistico atendidas pelo serviço de atendimento pré-hospitalar. Revista Eletrônica Gestão & Saúde 2013; 04(04): 1399-411.^,4242. Nolasco TR, Andrade SM, Silva BA. Capacidade funcional de vítimas de acidentes de trânsito em Campo Grande, Mato Grosso do Sul. Ensaios Cienc, Cienc Biol Agrar Saúde 2016; 20(2): 104-10..

When observing services according to day of the week and time of the accident, Friday had the most occurrences. However, other studies³³33. Silva JK, Rios MA, Amaral TF, Silva PL. Profile of road transport accidents met by the mobile urgency attendance service. J Nurs UFPE on line 2016; 10(1): 9-17. DOI: 10.5205/reuol.8423-73529-1-RV1001201602
https://doi.org/10.5205/reuol.8423-73529... ^,3434. Cabral AP, Souza WV. Serviço de atendimento móvel de urgência (SAMU): análise da demanda e sua distribuição espacial em uma cidade do Nordeste brasileiro. Rev Bras Epidemiol 2008; 11(4): 530-40. DOI: 10.1590/S1415-790X2008000400002
https://doi.org/10.1590/S1415-790X200800... ^,4242. Nolasco TR, Andrade SM, Silva BA. Capacidade funcional de vítimas de acidentes de trânsito em Campo Grande, Mato Grosso do Sul. Ensaios Cienc, Cienc Biol Agrar Saúde 2016; 20(2): 104-10.^,4343. Vieira RC, Hora EC, Oliveira DV, Vaez AC. Levantamento epidemiológico dos acidentes motociclísticos atendidos em um centro de referência ao trauma de Sergipe. Rev Esc Enferm USP 2011; 45(6): 1359-63. DOI: 10.1590/S0080-62342011000600012
https://doi.org/10.1590/S0080-6234201100... reported that the highest frequency of transportation accidents occurred on Sundays, probably due to a greater number of commemorative events, among other factors, such as alcohol consumption, passing at high speeds, and risky maneuvers.

The times with the most occurrences are probably related to the rush hour times of the city, i.e., the time when the most vehicles are in movement, going back and forth from work, college and school. Similar studies carried out in the municipality of Olinda¹⁴14. Cabral AP, Souza WV, Lima ML. Serviço de atendimento móvel de urgência: um observatório dos acidentes de transportes terrestre em nível local. Rev Bras Epidemiol 2011; 14(1): 03-14. DOI: 10.1590/S1415-790X2011000100001
https://doi.org/10.1590/S1415-790X201100... , observed a predominance of occurrences between 6:00pm and 11:59pm, which could be explained by fatigue as well as physical and mental exhaustion, which make people more vulnerable to accidents.

When analyzing the frequency of accidents by neighborhood, it is possible to suggest some hypotheses regarding the neighborhoods with the highest numbers of urban traffic accidents. For example, the neighborhoods are traversed by large high-traffic vehicle highways, which access important parts of the city, such as universities and airports. Some neighborhoods also connect the central and northern zones of Recife, with access roads marked by retention points.

Another important neighborhood, in addition to being touristy and having the city’s main beach also has most of the hotel network and a significant amount of schools, restaurants, doctors’ offices and a shopping mall. These factors contribute to increase the flow of vehicles on main avenues.

Commercial neighborhoods that are known for their cultural and tourist programs, such as Carnival and Christmas festivities, are located in the central region of the city. They have a greater risk of transportation accidents, which is expected, considering the high vehicle flow and low resident population. A similar result was found in another study²⁹29. Pereira AP, Moraes RM, Vianna RP. Aplicação do método scan para a detecção de conglomerados espaciais dos acidentes de trânsito ocorridos em João Pessoa-PB. Hygeia 2014; 10(18): 82-97., in a commercial neighborhood in the municipality of João Pessoa, Paraíba, which had the highest risk for SAMU services.

The highest risk areas for urban traffic accidents pointed out by the BoxMap and the MoranMap show that there is a pattern for the occurrence of such events. When observing Q1 neighborhoods in both spatial analysis techniques, it was found that the high occurrence of accidents in both (statistically significant) situations takes place in the southern region of the municipality.

A possible hypothesis for the high rates found in this region is that it contains the main traveling routes toward Suape’s Industrial Port Complex, which, since 2007, consists of one of the largest industrial and port hubs in northeastern Brazil. The complex began to attract large public and private investments, and became, along with its surroundings, a massive “construction site”⁴⁴44. Oliveira RV. Trabalho no Nordeste em perspectiva histórica. Estud Av 2016; 30(87): 49-73. DOI: 10.1590/S0103-40142016.30870004
https://doi.org/10.1590/S0103-40142016.3... , resulting in a greater flow of vehicles circulating the southern region of the capital city.

Spatial analysis studies on urban traffic accidents have proven useful in order to identify risk areas of occurrences, that is, places where surveillance actions should be revisited. They should encourage the implementation of a preventive approach in addition to provide a support tool for traffic safety actions³⁶36. Nunes MN, Nascimento LF. Análise espacial de óbitos por acidentes de trânsito, antes e após a Lei Seca, nas microrregiões do Estado de São Paulo. Rev Assoc Med Bras 2012; 58(6): 685-90. DOI: 10.1016/S2255-4823(12)70272-2
https://doi.org/10.1016/S2255-4823(12)70... ^,4545. Hernández HV. Análisis exploratorio espacial de los accidentes de tránsito en Ciudad Juárez, México. Rev Panam Salud Publica 2012; 31(5): 396-402.. Another study¹⁴14. Cabral AP, Souza WV, Lima ML. Serviço de atendimento móvel de urgência: um observatório dos acidentes de transportes terrestre em nível local. Rev Bras Epidemiol 2011; 14(1): 03-14. DOI: 10.1590/S1415-790X2011000100001
https://doi.org/10.1590/S1415-790X201100... performed using spatial analysis ratified the importance of integrating the Municipal Health Department and related organs for the implementation of preventive and corrective measures.

Research carried out in Teresina, Piauí, emphasized the importance of spatial analysis in order to determine priority areas and encourage actions from public management and professionals inserted in different health programs of different groups of users, particularly those who are most vulnerable⁴⁶46. Santos AM, Rodrigues RA, Santos CB, Caminiti GB. Distribuição geográfica dos óbitos de idosos por acidente de trânsito. Esc Anna Nery 2016; 20(1): 130-7. DOI: 10.5935/1414-8145.20160018
https://doi.org/10.5935/1414-8145.201600... .

In the present study, spatial analysis was proven feasible to identify risk areas for the occurrence of transportation accidents, by using secondary SAMU data, similarly to what was found in other studies ²⁹29. Pereira AP, Moraes RM, Vianna RP. Aplicação do método scan para a detecção de conglomerados espaciais dos acidentes de trânsito ocorridos em João Pessoa-PB. Hygeia 2014; 10(18): 82-97.^,3030. Soares RA, Pereira AP, Moraes RM, Vianna RP. Caracterização das vítimas de acidentes de trânsito atendidas pelo Serviço de Atendimento Móvel de Urgência (SAMU) no Município de João Pessoa, Estado da Paraíba, Brasil, em 2010. Epidemiol Serv Saúde 2012; 21(4): 589-600. DOI: 10.5123/S1679-49742012000400008
https://doi.org/10.5123/S1679-4974201200... . One of the limitations of this research project regards the incomplete recording of data, especially concerning greater details on the location of the occurrences, making it impossible to carry out pertinent analyses. Incidence estimates of RR, calculated based on the population living in the neighborhoods may have been affected by victims living in other municipalities, leading to an overestimation of cases in some neighborhoods. Although this is expected when it comes to metropolitan regions and when the estimated population around the municipality is not taken into account. In addition, despite the fact that SAMU covers 100% of the municipality, there are victims attended by the Fire Department or even by third parties, and these data were not considered in this study.

It is important to organize health assistance appropriately in relation to the surveillance of occurrences attended by SAMU. Furthermore, there must be a balanced approach regarding the problems identified, in agreement with the principles of the Unified Health System (Sistema Único de Saúde - SUS)³⁴34. Cabral AP, Souza WV. Serviço de atendimento móvel de urgência (SAMU): análise da demanda e sua distribuição espacial em uma cidade do Nordeste brasileiro. Rev Bras Epidemiol 2008; 11(4): 530-40. DOI: 10.1590/S1415-790X2008000400002
https://doi.org/10.1590/S1415-790X200800... . SAMU’s data sheets, based on spatial analysis, were an important source of information for health surveillance.

CONCLUSION

SAMU’s services were predominantly carried out by basic support units. Most victims consisted of young, male adults, especially motorcyclists. The spatial analysis of urban traffic accidents identified critical areas for the occurrence of assistance during the period analyzed.

The findings of this study highlight the importance of urban traffic accident prevention actions in an intersectional manner focusing, especially, on the identified risk group.

Identifying critical time periods, which coincide with traffic rush hours in the city, as well as the areas forming significant spatial regions, may be the basis for the implementation of educational actions in places that are most affect. The actions would be geared toward the most vulnerable population, thus increasing their effectiveness.

The spatial analysis of urban traffic accidents, which is unprecedented in the city of Recife, gives SAMU the possibility of using the results found in this study to plan and redistribute their decentralized units, with the objective of streamlining and improving their services.

ACKNOWLEDGEMENTS

The authors would like to thank the Epidemiological Surveillance of the Health Department of Recife and SAMU, which made this study possible.

References

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