an annual growth rate of fatal injuries is 5% ( 1 ) . according to a report by who , india is a leading county in the number of deaths in rta in the world ranking . according to data for 2007 , 114,590 people died in india as a result of rta . the second place belongs to china with 89,455 deaths . according to statistics ( 2 ) , 5 12% of all deaths 2847% of the total number of deaths is deaths at an rta site or during transportation ( 3 ) . their negative consequences by far exceed outcomes of both communicable and some non - communicable diseases ( 4 , 5 ) . to date , traffic accidents have become one of the main causes of injury , disability and mortality worldwide ( 68 ) . projections show that the global annual number of deaths on roads will increase in the next 20 years by 65% unless effective road safety measures are undertaken to prevent traffic accidents and reduce severity of their outcomes ( 7 ) . one mechanism for reducing deaths from rta is compliance with the rules of a so - called  golden hour  and a so - called  diamond half an hour  , when required medical care is provided to victims in the first hour after an injury is received . a review of research in europe ( 9 ) showed that about 50% of deaths from rta occur within a few minutes at a site of an accident or en - route to hospital . fifteen% of victims die in hospital within four hours after an accident and 35% die after four hours . a comparative study of deaths from rta in several countries ( 10 ) showed that the majority of deaths in low and middle - income countries occur before admission to hospital . world leading countries experience shows that the use of air medical / ambulance service ( ams ) in cases of rta reduces mortality by 3040% . in kazakhstan , one , among already existing action plans and mechanisms to reduce fatalities , the use of small aircrafts ( helicopters ) can reduce time to hospital admission and increase efficiency of actions provided after an rta ( 11 ) . medical assistance through the ams is defined as providing emergency medical care by means of an air ambulance in cases of lack of medical equipment or professional qualified staff at a medical organisation where a patient is located ( 12 ) . the purpose of the ams is to transfer a patient to an appropriate medical facility in life - threatening events due to sudden illness , accident , complications during pregnancy and childbirth , man - made accidents and natural disasters , and rta ( 11 , 13 ) . this paper analyses death rates in kazakhstan associated with rta in recent years , outlines trends of rates analysed by gender and age , and provides area spatial assessment of rta death rates in regions of the country . it offers justification for introduction of the ams to reduce the death rate caused by rta and the algorithm for the use of the ams . the study is based on the data on deaths from rta in 20042010 obtained from the agency for statistics of the republic of kazakhstan ( 14 ) . data on the population of kazakhstan has been obtained from the agency for statistics of the republic of kazakhstan ( 1518 ) . the study design is a retrospective analysis of mortality with the use of descriptive and analytical methods to epidemiology . by the use of conventional methods of biomedical statistics ( 19 , 20 ) extensive , crude , the average value ( m ) and the mean error ( m ) were determined . the 95% confidence interval ( 95% ci ) was calculated by the formula : 
 95%ci = m1.96mthe dynamics of fatalities during seven years was studied . the least - squares trends were calculated : 
 y = a+bxwhere : y - adjusted value ; x - conditioned series of numbers , symmetrically located with respect to zero ; a - conditioned medium ; b - adjusted factor . to calculate the average annual growth rate and / or increase in the dynamic range we used a geometric mean , equal to an n - root of the product of annual growth rates : 
 t = t1t2t3  tnnwhere t  annual growth rates and / or growth , n - number of rates . in developing area cartograms it is based on the definition of standard deviation (  ) from the mean ( x ) . the scale steps cartograms were determined as follows : 1 ) ( x-1.5 ) +  ; 2 ) ( x-1.5 ) + 2 ; 3 ) ( x-1.5 ) + 3 , etc . the grouping of rates were produced by the formula x0.5 , corresponding to an average level ( x-0.5 , and x + 0.5 ) . along with the above methods , information analysis was employed to determine major trends in medical emergencies based on the study of international experience . a content analysis method was used to examine the regulatory framework for the use of ambulances in the republic of kazakhstan . it microsoft office 2007 software ( excel , word , access ) and biostat were used to process the data . totally , 27,003 deaths from rta were registered in kazakhstan in 20042010 , from which 19,923 ( 73.8% ) of fatalities were males and 7,080 ( 26.2% ) were women . the distribution by gender and age is represented in table 1 . as seen from table 1 , a high proportion of deaths ( both genders ) were established in the group of 2029 year olds ( 25.5% ) . a similar pattern was observed in both men ( 27.4% ) and women ( 20.0% ) . in general , the ratio of men to women was 2.81 . the largest difference between men and women this ratio was more in favour of men , except the group of 80 year olds and older ( 11.7 ) . the average age ( both genders ) was 35.9  0.3 years ( 95% ci = 35.436.4 ) . in men , the age was 35.2  0.3 years ( 95% ci = 34.735.7 ) and was significantly ( p<0.05 ) lower than that of women which was 38.0  0.4 years ( 95% ci = 37.338.8 ) . an average annual growth rate in both genders together ( t = + 0.4% ) and males ( t = + 0.5% ) were more pronounced more than in female population ( t = + 0.03% ) . this rate in men was 38.33.2/0000 ( 95% ci = 31.944.6/0000 ) and was three times as high in women  12.61.1/0000 ( 95% ci = 10.414.8/0000 ) . the dynamics of crude rates tended to increase from 20.3/0000(2004 ) to 20.9/0000 in 2010 . adjusted rates show a reverse trend with an average annual decrease ( t= 2.3% ) ( fig . the trend of adjusted rates also decreased ( t = 2.6% ) . adjusted rates in the dynamics of the female population decreased . age specific death rates were the highest among 2029 year olds ( 36.03.7/0000 ) , 3039 year olds ( 37.23.2/0000 ) and 4049 year olds ( 33.02.8/0000 ) ( fig . age specific death rates among female population were the highest in 5059 year olds ( 16.60.9 ) and 7079 year olds ( 16.90.6 ) ( fig . the analysis of the 95% ci of age specific death rates of male and female population showed a significant difference ( p<0.05 ) because they do not overlap ( table 2 ) . in dynamics of age adjusted death rates for the total population a decrease in almost all age groups is observed , except for the groups of 6069 years old ( tgr=+0.1% ) and 7079 years old ( tgr=+0.4% ) . at the same time these trends were most pronounced among the group of 3039 years old ( tdec = 3.3% ) , 2029 ( tdec = 3.7% ) and 80 years old and older ( tdec= 6.4% ) ( table 3 ) . in dynamics of age adjusted death rates for male population , a tendency to grow is observed only among the group of 6069 year olds . the average annual growth rate amounts to tgr = + 0.9% . in other age groups , trends in age adjusted death rates decline . an average annual decline ranges from tdec = 1.7% ( 5059 year old ) to tdec = 8.1% ( 80 tear old ) ( table 3 ) . in women , age adjusted trends in death rates demonstrate growth in the age group of 7079 tgr = + 0.8% . in other age groups , trends decline from tdec = 1.2% among 6069 year olds to l tdec = 5.9% among 80 year olds and older ( table 3 ) . the rates were identified as low ( to 18.3/0000 , average ( from 18.3 to 24.0/0000 ) and high ( from 24.0/0000 and above ) . based on this scale , an area cartogram by regions of the country was compiled . regions with low rates ( to 18.3/0000 ) were atyrau region ( 12.8/0000 ) , kostanai region ( 13.4/0000 ) , aktobe region ( 16.4/0000 ) , north - kazakhstan region ( 16.9/0000 ) and west - kazakhstan region ( 17.6/0000 ) as well as almaty city ( 16.0/0000 ) and astana city ( 17.9/0000 ) . regions with average rates ( from 18.3 to 24.0/0000 ) were east - kazakhstan region ( 20.3/0000 ) , kyzylorda region ( 21.6/0000 ) , pavlodar region ( 22.6/0000 ) and karaganda ( 23.5/0000 ) . region with high rates ( from 2.5/0000 and above ) were akmola region ( 24.3/0000 ) , mangistau region ( 25.9/0000 ) , zhambyl region ( 27.3/0000 ) , almaty region ( 29.3/0000 ) and south - kazakhstan ( 32.4/0000 ) . the identified regional differences in mortality from rta in kazakhstan are explained to certain extent by administrative and territorial characteristics of the regions ( socio - demographic characteristics , quality of roads and other factors related to roads , etc . ) . at the same time the analysis showed that the ratio of deaths between men and women was higher for men in almost all age groups . the exception is the age group of 80 year olds and older , where more women died than men ( 11.7 ) . it was established that man died from rta at an earlier age ( 35.2 years old ) than women ( 38.0 years old ) . the analysis of mortality from rta in the country shows that death rates in men were significantly higher in all age groups compared with those in women . the highest peak among men is observed in the age group of 3039 years old . while the death rate among women was the highest among 5059 years old and 7079 year olds . in dynamics trends in adjusted age rates grew in men of 6069 years old and in women of 7079 years old . this is reflected in the dynamics of rates for the total population , where growth is observed in the group of 7079 year olds . for the purposes of spatial assessment of mortality from rta , rates were indicated as follows : a low rate ( to18.3/0000 ) , an average rate ( from 18.3 to 24.0/0000 ) , and high rate ( from 24.0/0000 and above ) . the area cartogram shows that high rates are observed in akmola region ( 24.3/0000 ) , mangistau ( 25.9/0000 ) , zhambyl region ( 27.3/0000 ) , almaty region ( 29.3/0000 ) and south kazakhstan ( 32.4/0000 ) . the identified epidemiological characteristics of the population death rate from rta should be used for integrated and targeted interventions to enhance prevention of injuries from rta , as well as organisational and methodological approaches to monitoring and evaluation of mortality from rta . to reduce risks in road traffic systems of the world there must be a willingness of governments , industrialists , nongovernment organisations and international organisations to work in this direction and make decisions based on available information ( 7 ) . action plans for road safety should be aimed at protecting the most vulnerable road users . in kazakhstan , an important action point was adoption of the law on strengthening administrative responsibility for non - use of seat belts in vehicles , driving under the influence of alcohol and use of a telephone by a driver when driving ( 22 ) . as requested by the head of state in his address to the nation of kazakhstan  build the future together !  on 28 january 2011 , six health and rescue points were established on accident - prone sections of roads of national importance to allow timely emergency medical care and reduce numbers of those killed in rta . on april 15 , 2011 the national air ambulance focal point was established on the basis of jsc  national scientific center of emergency medical care  . one of its main objectives is to provide emergency and urgent medical care in traffic accidents on highways . the ministries of interior affairs , health , emergency situations and transport and communications adopted a joint order named  on interaction in cases of road accidents  responsibility of medical and rescue points  ( officially known as the order of ministry of interior affairs # 308 dated 27 june 2011 ) . as directed by the ministry of interior affairs , 15 helicopter pads were established in almaty region . the coordinator of flights explained that a helicopter could land in any open area when required to transport an injured in an accident . in coordination with the ministry of health , almaty region hosted three teams of health and rescue ambulance in central district hospitals . 6 ) are used : ground transportation ( special vehicles ) and air ( specialised aircrafts an-2 and helicopters mi-8 ) . according to the scheme of medical evacuation ( transportation ) , health organisations can request air ambulance service through the duty dispatch unit of the national air ambulance focal point of the ministry of health ( 23 ) . the dispatching service center of the focal point regulates and classifies calls based on health conditions of patients and severity of cases . if a case requires urgent action , air ambulance medical transportation is provided to transport a patient from the place where a call was made on condition that there are aircraft landing facilities . if there are no conditions , patients are transferred by ground transport . also , there are cases when specialised medical teams can be transported by air to the place of a call . effective arrangement of medical care at all stages is a priority factor in reducing effects of injuries . according to health workers , every twentieth of the only 20% of deaths before arrival to hospital are associated with injuries that are not compatible with life . 80% of deaths are due to imperfection of arrangements and technology in aftermath of rta . the importance of timely medical care is determined by the fact that 50% of deaths in rta occur within a few minutes after an accident . during the first hour after every twentieth person from one hundred deceased can be saved if assistance is provided promptly and correctly at a site . lack of medical care within one hour after injury increases the number of deaths among seriously injured by 30% . lack of medical care within three hours increases the number to 60% and within six hours to 90% . the data analysis shows that the use of small aircrafts ( helicopters ) in providing adequate medical care to victims will significantly reduce mortality from rta by 2030% . the identified epidemiological characteristics of the population deaths rates from road traffic accidents should be used in integrated and targeted interventions to enhance prevention of injuries in accidents .
background : the article provides the analysis of death rates in road traffic accidents in kazakhstan from 2004 to 2010 and explores the use of sanitary aviation.methods:data of fatalities caused by road traffic accidents were collected and analysed . 
 descriptive and analytical methods of epidemiology and biomedical statistics were applied.results:totaly 27,003 people died as a result of road traffic accidents in this period . 
 the death rate for the total population due to road traffic accidents was 25.02.10/0000 . 
 the death rate for men was ( 38.33.20/0000 ) , which was higher ( p<0.05 ) than that for women ( 12.61.10/0000 ) . 
 high death rates in the entire male population were identified among men of 3039 years old , whereas the highest rates for women were attributed to the groups of 5059 years old and 7079 years old . in time dynamics 
 , death rates tended to decrease : the total population ( tdec=2.4% ) , men ( tdec=2.3% ) and women ( tdec=1.4% ) . when researching territorial relevance , the rates were established as low ( to 18.30/0000 ) , average ( between 18.3 and 24.00/0000 ) and high ( from 24.00/0000 and above ) . 
 thus , the regions with high rates included akmola region ( 24.30/0000 ) , mangistau region ( 25.90/0000 ) , zhambyl region ( 27.30/0000 ) , almaty region ( 29.30/0000 ) and south kazakhstan region ( 32.40/0000).conclusion : the identified epidemiological characteristics of the population deaths rates from road traffic accidents should be used in integrated and targeted interventions to enhance prevention of injuries in accidents .