To the Editor: I read with interest the research article by O’Connor and colleagues, which concluded that the medical and retrieval costs of road crashes in rural and remote northern Queensland represent “a considerable economic burden”.1 Although the authors noted that the broader Rural and Remote Road Safety Study aimed to also gain an understanding of the social costs of such crashes, they focused on the monetary costs in this report.

As we all know, road crashes not only cost money but have enormous personal impact, in both the short and long term, on the patients and their families. This impact is likely to be even greater for patients from rural and remote areas who are unable to be cared for in their local hospital. Remember that for almost all patients transferred, there are families who must also find their way to, and temporary accommodation (sometimes for months) in, an unfamiliar large town or city. Close family members, in addition to the patient, also suffer loss of income, disruption of schooling, and loss of personal network support due to the geographic dislocation.

Thank you to the authors of this study, which reinforces the desperate need to continue to improve local health services in rural and remote Australia, including “more efficient trauma management”,1 to contain costs and to lessen patient and family suffering.

In reply: We can only agree with Gorton about the high level of costs to families and communities caused by road trauma. While our report attempted to provide estimates of the immediate, direct costs to the medical system,1 we were well aware of the additional costs to families, particularly those from rural and remote areas, as they attempted to support their injured family member. These costs, unfortunately, are difficult to quantify, and have a long-term impact on families and communities. Although our study was able to estimate some of the costs associated with road trauma, there is a need for prospective studies with specially formulated costing tools to capture the costs more fully.

An associated study describing the impact of road trauma on the work of general practitioners in rural and remote areas2 outlined the problems that GPs have in managing chronic vehicle-related trauma without access to specialist rehabilitation services. Improving local health services may reduce some costs to families, but many of the patients retrieved from rural road crashes initially require specialist care in tertiary-level facilities.

Changing the behaviour of drivers who take risks on roads will also reduce the costs of road trauma. Unfortunately, this is a difficult process.