In December 2021 Ireland declared the intention to reduce fatalities on our roads by 50 per cent by 2030 and for there to be no road deaths or serious injuries on our roads by 2050. Despite this aspirational target our road deaths have since been increasing year on year. In 2025, 190 people lost their lives on our roads. At our current trajectory we will likely be more than three times over the 2030 target of just 72 deaths.
The Irish Association for Emergency Medicine (IAEM), of which I am part, is backing other campaigners in demanding action to stop this carnage on our roads.
The true burden of road trauma on the health system is far greater than the fatality count might suggest. What this means is that the numbers killed don’t convey the numbers injured. For every death there are about 10 serious injuries – injuries that require hospitalisation for three days or admission to the high dependency or intensive care units. These patients might have internal bleeding, brain injuries or broken bones that require surgical repair. Many of these patients require a prolonged inpatient period of recovery. Many of them may not return to their pre-injury level of function and independence.
The data for these patients is captured by the Major Trauma Audit, a national audit collecting data on severely injured patients since 2013. To be included in this data set, the injury must meet the criteria mentioned above – hospitalisation for three days or admitted to high dependency or intensive care.
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For every seriously injured patient included in the Major Trauma Audit, there are again about 10 patients who have sustained an injury but whose data will not be included in any national audit. This might be a broken wrist or collarbone. Perhaps a sprained ankle or a wound. These patients present to the emergency department, receive pain relief, get an X-ray and go home the same day with a cast or a dressing.
While they are not included in any data set like the Major Trauma Audit, the impact of their injuries can still be far-reaching. Many patients will not be able to return to work or independent self-care until the broken bone has healed six weeks later. Many will suffer some degree of post-traumatic stress disorder months and sometimes years later.
Some patients we remember despite not being injured enough to be a national statistic. A few years ago I treated a patient in her 20s. She was struck by a car while running. She was training for a half marathon and was at her peak of physical fitness. The extent of her injury was a simple fracture of her pelvis. She was able to go home the same day with a set of crutches. She wasn’t counted on the Major Trauma Audit and she certainly wasn’t going to be running that half marathon. Hopefully she made a full recovery, but it is likely her life changed in the moment she was struck by that driver.
While working in paediatrics I treated a child who was cycling to school one morning when he was struck by a car. A nasty wound was easily closed with sutures and an X-ray thankfully ruled out any broken bones, but I would suspect his parents would be slow to allow him to cycle again. Until that day he was one of just 3.4 per cent of children cycling to school. With half the road deaths in the last 10 years being vulnerable road users like this child, it’s no surprise more children are not cycling to school.
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These examples illustrate how we underestimate the true impact of our dangerous roads. It’s not just deaths, it’s not just serious injuries, it is also the countless injuries that are flying below the radar that we do not measure.
Despite the mounting death toll and injury rate, there is a lack of any sense of urgency. We seem to accept danger on our roads as an inevitability. Almost every week there are multiple road deaths – all of which are preventable. What we won’t see is anger and calls for accountability.
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In healthcare, we understand that when an error happens – for example, a surgeon operates on the wrong site – it is often the system at fault, not the surgeon. We have a concept called the Swiss Cheese Model. The analogy goes that each safety check is a slice of Swiss cheese, which has holes in it. When the holes line up, an error manages to make its way through each slice of cheese and harm the patient.
We try to learn what factors from an organisational perspective contributed to this error. Once we have a better understanding as to why an error occurred, we develop systems to prevent it happening again. This is why we use checklists and why we mark the correct limb for removal with the patient awake, before surgery.
When someone loses their life on our roads, we mourn the tragic loss of life and we tell ourselves it is an unavoidable crash. But what we need to be doing is acting like every death is unacceptable and preventable. The reason our European peers have seen a 12 per cent drop in road deaths since 2019 in the same time we have seen a 31 per cent rise in ours is because we simply are not using the evidence-based solutions that already exist. We need to improve enforcement on our roads by better funding and equipping of our roads policing. We need more static speed cameras across the country.
Most of all, we need to change our attitude to road safety. We need to stop accepting these events as inevitabilities and we need to demand accountability.
In late 2025 the Government quietly abandoned plans to bring in a blanket 30km/h speed limit in all urban areas, leaving it to local authorities in their own areas and thus delaying its implementation. This measure would have saved lives on our roads. It would have been an initial step towards realising our 2030 target. However, somewhere in Government a calculation must have been made that the political cost of this measure would be greater than the political cost of more people dying.
We need to hold the Government to account on making our roads safer as a matter of urgency.
Dr John Legge is a consultant in emergency medicine at St Vincent’s University Hospital, Dublin, and a member at the Irish Association for Emergency Medicine
