Roads are getting safer – but not for pedestrians

It began, as catastrophes and tragedies often do, on a day like any other. Eloise, a Melbourne mother of one, woke up early, put on a warm jumper, and, as her young son and husband slept, left on her regular morning walk about 7.30am.

The 38-year-old set out on the same route she had walked every day for years, but on this winter morning, on August 13, only minutes after she had left, a car ploughed into her a street away from her home.

Eloise was on a suburban walk when she was struck by a car in August.Credit: Luis Enrique Ascui

The impact left Eloise with a head injury so severe it required surgery to temporarily remove part of her skull, allowing her swollen brain to heal. Her family was told she was unlikely to survive, and if she did, she could be in a vegetative state, severely cognitively impaired, or permanently blind.

Eloise defied all odds and is recovering from the accident, but not all of those who are struck by vehicles have the same luck.

New police road safety data obtained by The Age shows the number of pedestrians killed by vehicles in Victoria has risen by nearly 20 per cent since 2018/19. Victoria’s population increased by about 7 per cent during that period. In the past financial year, 55 people died after being hit by a vehicle in the state.

Injuries have also soared by about 20 per cent since 2013/14 – about a third of pedestrians suffering head injuries, almost one in five suffering knee and lower leg injuries, and more than 10 per cent abdominal, lower back, lumbar spine, and pelvic injuries.

Eloise, who did not want her last name published for privacy reasons, does not remember the moment she was struck, but when she was in a coma for 12 days at The Alfred hospital in Melbourne, she had vivid dreams she had been hit by a car and left with a brain injury.

In those dreams, she kept trying to wake herself up, screaming out, thrashing her body, her arms outstretched towards the hospital machines and monitors surrounding her.

“When I woke up from the coma, it wasn’t a surprise at all what had happened to me because I had dreamt it,” she says.

“But of course, it wasn’t a dream. My nightmare was real. The doctors told me they had had to remove my skull and I thought, ‘How am I alive? How can I live like this?’”

Associate Professor Joseph Mathew, an experienced trauma physician and deputy director of Alfred Health’s trauma services, says he and his colleagues have over the past decade observed an increase in pedestrians being struck by vehicles, including larger cars such as sport utility vehicles, as sales for the cars soar in Australia.

He suspects the overall rise in cars on the roads, including larger vehicles such as SUVs, twin-cab utes and trucks, might also be playing a role in more pedestrians being severely injured when hit. There are hundreds of thousands more vehicles on Victorian roads than there were just five years ago.

In its most recent report, the Bureau of Infrastructure and Transport Research Economics said that by January 2024, there were 21.74 million registered road vehicles in Australia, up 2.7 per cent on the year before.

Large utes such as Ford F-150s, RAM series trucks, Chevrolet Silverados and Toyota Tundras, which all sell for more than $100,000, made up 4 per cent (about 10,400) of national car sales in 2023, according to the Federal Chamber of Automotive Industries.

Police crash data backs Mathew’s theory. While cars are still the most common vehicle involved in collisions, accounting for 708 accidents in 2023/24, utes and station wagons are increasingly becoming a more common feature in accidents with pedestrians. In the past financial year, the vehicles were involved in 612 crashes, almost a hundred more than five years ago.

Mathew says bigger cars with a larger mass also mean more injuries for pedestrians, particularly to the head, spine and pelvic region.

Associate Professor Joseph Mathew, deputy director of Alfred Health’s trauma services, says bigger cars play a role in pedestrians being hit.Credit: Photos by MMP - Michelle McFarla

“Because they crush the pelvis a little bit more, and when the pelvis is crushed, they bleed a lot and patients can die of bleeding,” he said.

Fractures are the most common type of injury in pedestrians hit by cars, followed by superficial injuries and open wounds, data from the Victorian Injury Surveillance Unit shows.

Most of those injuries occur in the lower limbs, pelvis, and spine in the lower back and neck, followed by the injuries to major organs in the abdomen.

Mathew has also anecdotally observed a trend in all road users, including drivers and pedestrians, being distracted by smartphones or devices such as headphones. Police crash investigators are also reporting an increase in accidents involving pedestrians jaywalking across intersections.

In the past two years, The Alfred hospital, Melbourne’s major trauma centre, has reported 20 pedestrian deaths. Staff have treated more than 350 people admitted to hospital who were struck by vehicles while walking. Of the hundreds of admissions, Mathew estimates more than 50 per cent had major trauma.

He recalls one case in striking detail where a young person was struck by a large vehicle leaving them with severe injuries to their brain, lungs, heart, pelvis, and liver.

The scene awaiting first responders was harrowing: the young person lying on the side of the road critically injured and in cardiac arrest.

“We had to do things like crack their chest open because they had a traumatic cardiac arrest,” he said referring to a treatment used by healthcare workers to aid in the resuscitation of a road trauma patient who has sustained severe thoracic or abdominal injuries.

Responders had to do what is known as a “scoop and run”, a method used to transport the most critically injured patients to hospital as fast as possible.

Over the next three hours, a team of about 25 highly experienced doctors and healthcare workers used more than 100 units of blood to keep the victim alive, but the injuries were too much for the body to bear. The victim died the same day.

“Even the most experienced medical staff still get traumatised at the end by a case like that because of the sheer amount of work we do on a young person to keep them alive, and after all that we still might not succeed,” Mathew says.

Those who do survive, like Eloise, face a long, difficult road to recovery.

She woke up paralysed on the left side of her body and was told by her medical team it could be between nine and 12 months before her skull, which was partially removed as part of a procedure known as a decompressive craniectomy, could be repaired. The procedure saved her life, by reducing pressure on her brain.

Eloise woke up paralysed on the left side of her body and had to have part of her skull removed.Credit: Luis Enrique Ascui

“It was my son’s birthday in November. He was getting ready to turn four,” she recalls. “I remember lying there thinking, ‘No, I’m not waiting a year to get my skull back. I’m getting home from my son’s birthday. I’m going to walk again, get my surgery, and be home in time.’”

Against all the odds, and after a stay in the acquired brain injury unit at Caulfield and a final surgery to mend her skull, Eloise returned home in time for her son’s birthday.

“My recovery has been miraculous,” she says.

“I have so much gratitude, but a lot of grief for the life I had. What has really helped me in terms of my recovery is that I don’t look at the top of the staircase. I look at the next step I want to achieve. It keeps me grounded and gives me that hope that I am building a new, beautiful life.”

Others hit by vehicles endure lengthy periods in intensive care with injuries such as bleeding on the brain or recovering from life-altering injuries such as amputation of their limbs or neck or spinal damage, which can leave people paraplegic or quadriplegic.

“They’ve got significant deficits going forward in their lives, which include limb injuries,” Mathew said.

“A sizable number of them are head injuries because they are usually thrown into the air, and when they hit the ground, they hit the head, their face, their neck.”

Eloise still suffers from debilitating vertigo and cognitive fatigue, particularly when she has to focus for too long.

“I think of my brain like a computer, in a way, where it just overheats from taking on too much,” she says. “Trying to process too much, a loud crowd, loud sounds, standing for a long time just means my brain shuts down and forces me to rest.”

Mathew says that while progress has been made in vehicle safety, such as the introduction of airbags and seatbelts over the years to reduce fatalities for those inside a car, pedestrians now share the road with more vehicles than ever, including e-scooters, cyclists and public transport such as trams.

“Pedestrians remain completely exposed because they are not walking around wearing helmets,” he says. “Even if they get hit between 20 and 30km/h, which sounds like low velocity, it’s significant velocity and causes quite significant injury.”

Ben Rossiter, chief executive of Victoria Walks, a VicHealth-funded group that advocates for pedestrians, says that despite all the road campaigns over the years, the state has failed to make any real headway on pedestrian safety. He says an increasing number of walkers killed are elderly.

More than 60 per cent of female pedestrians killed in the past five years were aged 60 and over, despite women aged between 30 and 39 accounting for the largest number of female pedestrians hit, police data shows.

“We need to have safer roads and safer environments that protect people walking,” Rossiter says. “That’s a really critical thing, and we’re not doing that well.”

Rossiter says data suggests about 24 per cent of fatalities or serious injuries occur in metro areas, noting that in some parts of the city, the speed limits are too high by international standards and there are not enough safe pedestrian crossings.

Road Policing Assistant Commissioner Glenn Weir.Credit: Joe Armao

International research suggests if a walker is hit by a car travelling at 30km/h, they have a 90 per cent chance of survival. This plummets to just 10 per cent if a car is travelling at 50km/h.

Similar trials in Britain have led to notable reductions in road trauma when 30km/h zones were enforced. Trial 30km/h zones have been rolled out recently in some of Melbourne’s inner-city suburbs by local councils to reduce crashes and protect walkers, sparking debate.

Victoria’s assistant commissioner for road policing, Glenn Weir, says lower speed limits are part of the solution, but there is no silver bullet. Common sense, personal responsibility, and doing the right thing by other road users by not speeding or walking through a red light also played a crucial role.

“You get one chance,” Weir says. “If you make a mistake or put yourself at risk and something happens, unfortunately, it’s quite probable that you’ll pay the ultimate price or a high price for a very long time.

“We deal with it and we move on. But the families and the friends of people who see it, they deal with it forever. People just have to realise that a moment in time can last forever.”

Eloise says she did not break any road rules when she was struck. She was not wearing headphones, and she says she looked both ways before crossing the road.

“I felt compelled to share my story because people do get distracted or they break seemingly simple rules because they don’t think they have big consequences,” she says.

“But everyone has a right to be safe on the roads. The lives of myself, my husband, my son and my parents, my family were shattered in a split second that I don’t even remember.“