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Emergency Physicians International was founded in 2010 as a way to tell the stories of the heroic men and women developing emergency medicine around the globe. This magazine is dedicated to their tireless efforts saving lives in the harshest conditions, 24/7/365.

Meet Graham, Australia's Face for Vehicular Trauma

Meet Graham, Australia's Face for Vehicular Trauma

“The skid marks were there for a couple of decades.”

In the summer of 1976, Robert Linstrom had a summer job delivering Wayne Works school buses from Richmond, Indiana to Framingham, Massachusetts—a 13-hour drive. “We would drive out and back, and out and back, about 2 times a week…it was a great job for a college kid.”

Around 6:30 am on July 28, Linstrom was about 15 miles outside of Columbus, Ohio, only one hour into the trip. A typical thick morning fog enclosed I-70 East. “I saw the back end of the semi maybe a second before hitting it.” Several minutes earlier, a truck driver had parked his rig in the right lane of the interstate, mistakenly thinking he had pulled it off the road. Linstrom crashed into it at full speed.

“The shock I took through my arms and legs was cataclysmic,” Linstrom said. “Instinctively, I went for the brake and gripped the steering wheel with my arms…I was a pretty strong young adult, had played some football, and was in pretty good shape.”  

The impact shattered Linstrom’s arms and legs in nine different places. His feet broke through the floor of the bus, trapping his legs in the engine compartment. His hand went through the console. After the initial shock he was thrown back into the seat and then forward again, flattening the steering wheel with his chest. He was wearing a lap belt only, as shoulder harnesses were not common at the time. When he regained consciousness, his eyeglasses were embedded in the dashboard.

Linstrom referred to his injuries as “a cacophony of fractures.” After a four-hour extraction with the help of the West Jefferson Volunteer Fire Department’s newly purchased Jaws of Life, Linstrom was taken to Doctors’ West Trauma Center. Over four days he had a total of 12 surgeries, including an exploratory laparotomy for internal bleeding. His course was complicated by gangrene of his leg, and, at one point he signed the surgical order for amputation of his own leg. Miraculously, the next day the inflammation had improved enough for his surgeons to save his leg. Despite this, it was projected he would never walk again.

It is almost impossible for most people to recognize their risk of injury in a serious road accident. According to the WHO, road trauma was the 9th most common cause of death globally in 2012, killing over 1.2 million people. It is the number one single cause of death between the ages of 15 and 29. But for the average person, even such dramatic and tragic statistics are sterilized, faceless.  

“We sort of have this positive outlook, this sort of optimism bias that things will be okay—that we can survive higher speed car crashes,” said Samantha Cockfield, the Senior Manager for Road Safety at the Transport Accident Commission (TAC) in Victoria, Australia. “We’re not designed to survive, as humans, to travel at high speeds on our roads. We can survive around 30 kilometers per hour, 25 miles per hour, before we start to break, and very quickly. What can we do about it as individuals? How do we take care, how do we make sure that we buy the right cars, travel at the right speeds, and then try to understand the [road] system…in order to make changes?

TAC officials in Victoria had already confronted citizens with the idea that nobody deserves to die on the road, and that perhaps it wasn’t so outlandish to have a target of zero deaths or injuries from car and pedestrian crashes. “We did that quite intentionally through a campaign called ‘Man on the Street,’” said Cockfield, who noted that TAC is well known for its public education strategies, and for bringing a different and creative approach to safety education. In ‘Man on the Street,’ TAC went out into the streets and asked Victorians directly: first, how many people did they think died in traffic accidents per year? Second, how many people should be dying?

Cockfield has no hesitation over making road safety personal. “We found one person who said about 70 people; 70 people was the right number of people who would die on our streets,” she said. “And then we actually asked him to come back and do a training film for the TAC.” During this training film, however, the TAC interviewers flipped the script. “So when he went back and said ‘70 people’ in the training video, we actually brought his family—70 of his family and friends—into the picture,” said Cockfield. “Of course, it’s a very emotional moment.”
This year TAC introduced a new project called “Meet Graham” which attempted to put a face (and body) on human vulnerability behind the wheel. For the Graham project, Cockfield’s team wanted to commission an art installation that would bring this concept to life.

The Australian artist Patricia Piccinini was one of the first collaborators to join the Graham project. Piccinini’s work explores the effects of technological advances, including biotechnology. “[She] worked in the space between art, science, and trying to bring social meaning to art,” said Cockfield. “She was quite a natural choice.” Two additional contributors provided scientific and medical expertise to the project: David Logan, a researcher at Monash University Accident Research Center, who knows specifically how energy forces in a crash affect vehicles and humans; and Christian Kenfield, a surgeon at the Royal Melbourne Hospital, who deals with road trauma on a daily basis.

After months of work, this multidisciplinary team created Graham, a flat-faced, barrel chested, neck-less man-creature who, according to the Towards Zero website, is “the only person designed to survive on our roads.”

“The anticipation about what Graham would look like lasted for many months,” Cockfield said. “We had no idea what he would look like until about a week and a half before he was launched, so that was definitely the most exciting part of it.”  

Graham’s name was selected almost at random as that of a mid-forty-ish, average Australian male. “It was a working title, but it stuck,” said Cockfield, laughing. “We did try to find another name for him, but we just thought, no, now he’s Graham. He was born Graham.”
Graham is not built for looks. Anything but average-looking, he is bulky and distorted.  While his over-padded face gives him an almost sweetly simple expression, his hulking chest and limbs suggest he might be able to crush a less crash-proof human. His body has multiple features meant to protect him from the forces at play in a traffic accident: his brain is held in place by ligaments and cushioned with extra cerebrospinal fluid, intended to preserve it from abrupt deceleration injuries; his chest serves as a fleshy airbag; his hoof-like feet allow him to spring out of the path of an oncoming car.

“You realize how much there is to be gained when you work in a partnership across disciplines,” said Cockfield. “These are really different fields that would never have crossed paths otherwise, and the power of those three people working together was also really exciting to see.”

Robert Linstrom’s physical recovery was slow. After five months of various treatments, “…what would have been common at the time would have been a body cast. “His surgeon used an unusual technique to promote healing by early weight bearing on the broken bone.  He was in full leg braces when he returned to college the following spring as a sophomore, braces that would stay on for over a year.  

Returning to daily life was difficult for Linstrom. “I went from a strapping college freshman, and being as independent as I can be, to wearing this identity as a disabled person.” Because of his doctors, “great support” from friends and family, and certainly in part due to his own attitude, his recovery was remarkably complete. “Five years later I was backpacking in the Cascades. I never really had a sense I wasn’t going to continue to improve.” Today, Linstrom is a senior pastor of a church in Grand Rapids, Michigan, husband of 32 years to his wife, Rebecca, and father of three sons. “In general, I’m just amazingly fortunate.”

The goal of Project Graham was to highlight that humans are not built for the impacts and forces involved in a car crash. Linstrom understands this vulnerability more than most: a scattering of small scars on his forearm marks the spot where he laid his head during his extraction, not knowing there was glass embedded in his face. “For months and months I had a bruise in the shape of the steering wheel on my chest, which was a very poignant reminder of the force of that impact,” he said. “I appreciate the Australian initiative to say ‘this is what we would have to evolve to, to survive these impacts.’ The shock to the body is phenomenal.”
Education is just the beginning for members of TAC. Cockfield spoke of encouraging new safety innovations, such as lane departure warnings, and emergency braking, which detects vehicles and pedestrians in a vehicle’s path. “Human behavior is going to become less and less of a problem because the vehicles will be interconnected and so advanced that it’s going to be very hard to have a crash,” she said.

Linstrom also spoke of safety advances in vehicles: “I was intrigued by how easily people climb out of Formula One accidents unscathed. We have the technology, and we have the ability to not need to be so evolved.”

These new innovations are not a solution for everyone, especially some of those at highest risk. The WHO points out that while low- and middle-income countries have only about half of the world’s vehicles, they suffer 90% of the world’s fatal traffic accidents. In the wealthiest countries, the wealthiest people—those who can afford safe, new cars—are those least likely to die on the roads.

Linstrom and Cockfield both expressed concerns that both cost and convenience limited progress. “Some of those changes are changes that people don’t necessarily think are going to improve their lives,” said Cockfield. “When we start putting out barrier systems down the middle of the roads, or we look at speed limits and sometimes drop them, people feel like they’re being punished sometimes. We just need them to understand why we’re doing it.”
Despite the practical challenges, the last thing TAC and the creators of Graham can accept is complacency. “No matter how well intentioned or how well-behaved or how much we improve our road-user behavior people, will still make mistakes, people are fallible, and those mistakes shouldn’t cost people their lives,” Cockfield said.  

“We realized that in fact there’s this sort of feeling of inevitability—that people must be killed or seriously injured for us to have an effective and modern transport system,” Cockfield continued. “But we know that with these technology advances, and better design of roads, and just setting the speed limits right, that we can eliminate most road trauma. It’s not impossible that, say, in 30 to 50 years, we could see a day where nobody gets killed on our roads. So for us the whole campaign was about how to get people to believe that ‘zero’ is actually our long-term aim and it is achievable.”


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