Background Australian road safety remains a major policy concern from premature mortality and disability. Inequities exit in transport injuries with greater burden in Aboriginal and Torres Strait Islander communities.

Objective Focus on Indigenous Knowledges to characterise the journey for Aboriginal and Torres Strait Islander patient journeys from road traffic injuries. Aims 1. examine prevention strategies through causal factors from road traffic crashes in South Australia (SA) and New South Wales (NSW), Aim 2. examine access to road injury compensation schemes.

Methods Indigenous Governance of Project Data occurred through Aboriginal research leadership and an Aboriginal and Torres Strait Islander Governance Group. This acted to protect Indigenous Knowledges and enact Data Governance processes for Data Sovereignty. Knowledge interface methodology informed a mixed-methods approach. Participants were Aboriginal and Torres Strait Islander individuals involved in a road traffic crash above 18 years of age. Administration data over 10 years (June 2012-June 2022) from Transport for NSW and the SA Trauma Registry, were analysed using a strength-based multinomial logistic regression model. The Indigenous data collection method of yarning occurred with participants, thematic analysis identified enablers and barriers to compensation schemes.

Results Multinomial logistic regression identified factors which decreased the odds of no/minor injuries: head on crashes, 10 km/h increase in speed, non-intersection crashes, yearly increases in age or driving unauthorised. Metropolitan crashes increased the odds of no/minor injuries after a crash to country areas (OR 1.34; 95% CI 1.07–1.67). No difference in injury severity was found between crashing on a curved compared to a straight stretch of road. Aboriginal and Torres Strait Islander participants reported strong impacts by their traffic injuries across physical, psychosocial financial, logistical and time domains. Limited participants accessed road traffic injury compensation, barriers included claim time-frames, and access to culturally appropriate compensation support which was further impacted by in hospital care received.

Conclusions Co-designed strength-based road safety campaigns with Aboriginal and Torres Strait Islander communities needs to focus on a variety of contexts, for example country driving, or diving across the life span. Similarly, culturally safe and appropriate compensation support is urgently needed for Aboriginal and Torres Strait Islander communities.