On the prevention of accidents and injuries : A comparative analysis of conceptual frameworks

The meaning of prevention has changed as new applications of the concept have appeared. Ideas presented in eleven different conceptual frameworks are compared. Identification of the frameworks took place through searches in databases and relevant literature. Five are general by nature, while six relate to injuries and accidents. All are supported by just a few parameters, the time dimension being the most prominent. Compatibility was established on three additional dimensions: level (individual, organizational or societal); direction (“bottom-up” or “top-down”); and in relation to the trichotomy “host-agent-environment”. An attempt to synthesize all these dimensions into one general model of accident and injury prevention is presented.     

Differences in traffic judgements between young and old adult pedestrians

Older pedestrians have been shown to be over-involved in casualty crashes, compared to younger pedestrians, in recent reports. This study set out to investigate whether older pedestrians' road crossing behaviour might render them more vulnerable to crashes because of declines in their physical, sensory, perceptual or cognitive abilities. An initial ‘blackspot’ accident analysis highlighted the types of crashes in which older (and younger) adult pedestrians were involved and likely crossing actions. Road crossing behaviour was then systematically measured from unobtrusive video recordings of individual road crossings for a sample of younger and older pedestrians at several urban locations. On two-way undivided roads, older pedestrians crossed more frequently when there was closer moving traffic and generally adopted less safe road crossing strategies than their younger counterparts. On one-way divided roads, their crossing behaviour was considerably more safe and similar to that of younger pedestrians. The findings suggest that age-related perceptual and cognitive deficits may play a substantial role in many of the crashes involving older pedestrians.     

Influence of approaching tram on behaviour of pedestrians in signalised crosswalks in Poland

Research done in two Polish cities has uncovered an influence of an approaching tram on pedestrian behaviour. The measurements were done by counting pedestrians waiting for a green signal, crossing on red signal safely, or crossing on red signal taking a risk of being hit by a car, differentiating between pedestrians attempting to board a public transport vehicle and other pedestrians. It was expected, that pedestrian behaviour might be influenced by traffic control predictability, therefore two cities were chosen for the task: Wroc?aw with fixed time traffic control and Poznań with a majority of traffic responsive traffic signals. Data from the measurements was compared in order to find behaviour patterns – the comparison led to a conclusion, that an attempt to get on board of an incoming public transport vehicle can be a major cause for pedestrians to violate a red signal, including an increase of unsafe behaviour. These pedestrians may provoke other pedestrians to cross on a red signal. On the other hand if traffic control guarantees boarding the public transport vehicle, passengers-to-be may be even more obedient than other pedestrians.     

Preferences for lives, injuries, and age: A stated preference survey

One of the more difficult ethical questions from a public decision-making perspective is whether the estimation of benefits from risk reducing projects should be influenced by factors such as age groups and risk domains. For example, should a project that saves the lives of elderly people be assigned a more different benefit value in cost-benefit analyses than one that saves the same number of children's lives? This paper examines the preferences of the general public in Sweden on these issues. We design a choice experiment in which subjects are required to make six pair-wise choices where the characteristics of each choice are accident type (fire and traffic), number of fatalities and serious injuries avoided, and age of those saved (5–15-, 35–45- and 65–75-year-olds). We find that avoiding the fatality of one 5–15-year-old is equivalent to avoiding 1.4 fatalities of 35–45-year-olds. Likewise, avoiding the fatality of one 5–15-year-old is equivalent to avoiding 3.3 fatalities of 65–75-year-olds. We find no significant differences between the causes of accident. One avoided fatality is found to be equivalent to around 3.5 avoided severe injuries, which is lower than the official value of 6 used by the Swedish Road Administration.     

Measuring accident risk exposure for pedestrians in different micro-environments

Pedestrians are mainly exposed to the risk of road accident when crossing a road in urban areas. Traditionally in the road safety field, the risk of accident for pedestrian is estimated as a rate of accident involvement per unit of time spent on the road network. The objective of this research is to develop an approach of accident risk based on the concept of risk exposure used in environmental epidemiology, such as in the case of exposure to pollutants. This type of indicator would be useful for comparing the effects of urban transportation policy scenarios on pedestrian safety. The first step is to create an indicator of pedestrians’ exposure, which is based on motorised vehicles’ “concentration” by lane and also takes account of traffic speed and time spent to cross. This is applied to two specific micro-environments: junctions and mid-block locations. A model of pedestrians’ crossing behaviour along a trip is then developed, based on a hierarchical choice between junctions and mid-block locations and taking account of origin and destination, traffic characteristics and pedestrian facilities. Finally, a complete framework is produced for modelling pedestrians’ exposure in the light of their crossing behaviour. The feasibility of this approach is demonstrated on an artificial network and a first set of results is obtained from the validation of the models in observational studies.     

Epidemiology of accidental drowning in Denmark 1989–1993

Three hundred and forty-nine cases of accidental drowning or cooling in water occurring in Denmark from 1989 to 1993 have been studied. The incidence was highest in 0–4-year-old children, in middle-aged men, and in old people. A third of the children drowned in private pools. A quarter of all fatalities occurred during leisure boating. At least half of those that drowned in this way did not wear a life-jacket and could have been saved if they had been wearing one. Between a third and a half of the adult drownings were related to alcohol intake, and a large number of inebriated men fell into harbour basins and other water bodies. A few final remarks are made on the prospects for preventing accidental drowning in children, elderly people and adult males.     

Hazard perception test for pedestrians

Research Goal

This research was aimed to construct and develop a unique system for training of pedestrians – children, adults and older persons – to cross streets safely and especially to detect successfully on-road hazards as pedestrians. For this purpose, an interactive computerized program has been inspired by the format of the popular HPT (hazard perception test) for drivers.

Methods

The HPTP (hazard perception test for pedestrians) includes 10 pairs of video clips that were filmed in various locations but had a similar hazardous element. The clips presented potentially dangerous crossing scenarios such as a vehicle merging from the right side of the road from the perspective of the pedestrian who is trying to cross the street. The participants were asked to press the spacebar key every time they identified an approaching hazard. The participants were instructed to use the arrow keys for moving the viewing panel to the left or to the right in order to enlarge the field of view accordingly. Totally, 359 participants took part. Adults, children, and elders were assigned to two practice groups and three control groups in a 3 (age groups) × 5 (experimental groups) design. One practice group underwent pretest, practice, discussion and posttest, the second experimental group through pretest, practice and posttest, one control group that underwent posttest only, the second control group underwent pretest, discussion and posttest and the third control group underwent both pretest and posttest.

Findings

The most important finding was that children and adults who underwent practice received higher scores in the posttest compared to the pretest. Also, children who underwent practice increased their use of the arrow keys in the posttest compared to the pretest. Across conditions men scored higher than women on the HPTP, and used the keys more often. Age differences were found, with adults scoring being the highest, followed by children and the older persons.     

The relative risk of nearside accidents is high for the youngest and oldest pedestrians

Police road accident data from Great Britain for 1990–2009 were analysed. RR_NF is the risk of a casualty occurring in the first half of road crossing, the half nearest to the pedestrian‘s starting position at the roadside, compared to the risk of it occurring in the second half. Children and younger adult pedestrians had a high relative risk of being killed or seriously injured in the nearside of the road (RR_NF). RR_NF decreased with age, for men and women, but rose again for people aged over 85 years. It was also substantially lower for children under 10 years old. Three possible explanations for lifespan changes in RR_NF were evaluated: that change results from slower walking speeds, from a specific failure to attend to the far side before beginning to cross, or from generalised attention control failure. Young people‘s higher RR_NF is consistent with evidence that they are prone to generalised attention control failures.     

The prevalence and reliability of visibility aid and other risk factor data for uninjured cyclists and pedestrians in Edmonton, Alberta, Canada

This study was conducted to determine the prevalence and reliability of risk factors collected on uninjured cyclists-pedestrians in Edmonton, Alberta, and what characteristics predict cyclist-pedestrian visibility. At randomly selected locations from July 2004 to August 2004, two independent observers recorded cyclist-pedestrian characteristics such as age, sex, clothing color, use of reflectors, flags, helmets, and a subjective impression of visibility. Data were collected on 836 individuals; most were either walking/jogging (approximately 63%) or cycling (approximately 33%). For non-cyclists, the prevalence of bright colored clothing on the trunk ranged from 12.7 to 14.7%. Few people used any kind of reflective strips. Inter-observer agreement (Kappa) ranged from 0.37 (visibility assessment) to 0.99 (sex). For cyclists, 17-19% of headgear was brightly colored, and 13-14% was white. Approximately one-fourth had a front light; half had a rear reflector. Few cyclists used a flag and just over half used spoke reflectors. Kappa ranged from 0.35 (observer assessed speed) to 0.95 (head gear and sex). A major trunk color of orange, red, yellow or white resulted in a higher visibility rating for both cyclists and pedestrians. The results indicate a low prevalence of visibility aid use among cyclists and pedestrians, but there appears to be acceptable inter-observer reliability for most data collected. Further work is required before an overall visibility rating can be used in place of component scores.     

Personality and risk perception in transport

Within research on individual variations in risk perception, personality has been suggested as one important factor. In the present study, personality traits (44 items from the Big Five inventory) were investigated in relation to risk perception in transport and transport behavioural adaptations. In a sample of 312 participants, we found that the personality trait ‘emotional stability versus neuroticism’ was negatively correlated with risk perception (operationalised as “thinking about the possibility”) of an accident (−0.38) and an unpleasant incident, such as crime, violence, robbery (−0.25). ‘Agreeableness’ was also negatively related to risk perception, however first and foremost in relation to perceived risk for unpleasant incidents on transport modes in which one interacts with other people (0.25). Moreover, regression analyses showed that ‘emotional stability’ was a significant predictor of behavioural adaptations on bus. Regression analyses explained between 17 and 26 percent of variance in behavioural adaptations. The results show that different groups of people vary systematically in their perception of risk in transport. Furthermore, these differences are manifest as a difference in risk-preventive behaviour at a strategic level, i.e. as decisions about avoiding risky situations.     

Estimating transport fatality risk from past accident data

This paper examines the statistical properties of estimates of fatal accident rates, mean fatalities per accident, and fatality rates when these estimates are based on past accident data. The statistical properties are illustrated by two long-term transport fatal accident datasets from Great Britain, the principal one for railways and the other for roads, chosen to provide a statistical contrast. In both modes, the accident rates have fallen substantially over the long term. Two statistical estimates of current accident and fatality rates are presented for each dataset, one based only on recent data and the other based on estimates of long-term trends. The trend-based estimate is preferred for train accidents because this makes maximum use of the limited and variable data; the recent data are preferred for road accidents because this avoids unnecessary dependence on modelling the trends. For train accidents, the estimated fatality rate based on past accidents is compared with an estimate produced by the railway industry using a risk model. The statistical estimate is less than half the industry's estimate, and the paper concludes that the statistical estimate is to be preferred.     

Distribution of transport injury and related risk behaviours in a large national cohort of Thai adults

Background

A major barrier to addressing the problem of transport injury in low to middle-income countries is the lack of information regarding the incidence of traffic crashes and the demographic, behavioural and socio-economic determinants of crash-related injury. This study aimed to determine the baseline frequency and distribution of transport injury and the prevalence of various road safety behaviours in a newly recruited cohort of Thai adults.

Methods

The Thai Health-Risk Transition Study includes an ongoing population-based cohort study of 87,134 adult students residing across Thailand. Baseline survey data from 2005 includes data on self-reported transport injury within the previous 12 months and demographic, behavioural and transportation factors that could be linked to Thailand's transport risks.

Results

Overall, 7279 (8.4% or 8354 per 100,000) of respondents reported that their most serious injury in the 12 months prior to recruitment in the cohort was transport-related, with risk being higher for males and those aged 15–19 years. Most transport injuries occurred while using motorcycles. A much higher proportion of males reported driving after three or more glasses of alcohol at least once in the previous year compared to females. The prevalence of motorcycle helmet and seat belt wearing in this sample were higher than previously reported for Thailand.

Conclusions

The reported data provide the basis for monitoring changes in traffic crash risks and risk behaviours in a cohort of adults in the context of ongoing implementation of policy and programs that are currently being introduced to address the problem of transport-related injury in Thailand.     

Conceptualizing and communicating organizational risk dynamics in the thoroughness–efficiency space

Organizations that design and/or operate complex systems have to make trade-offs between multiple, interacting, and sometimes conflicting goals at both the individual and organizational levels. Identifying, communicating, and resolving the conflict or tension between multiple organizational goals is challenging. Furthermore, maintaining an appropriate level of safety in such complex environments is difficult for a number of reasons discussed in this paper. The objective of this paper is to propose a set of related concepts that can help conceptualize organizational risk and help managers to understand the implications of various performance and resource pressures and make appropriate trade-offs between efficiency and thoroughness that maintain system safety. The concepts here introduced include (1) the thoroughness–efficiency space for classifying organizational behavior, and the various resource/performance and regulatory pressures that can displace organizations from one quadrant to another within this space, (2) the thoroughness–efficiency barrier and safety threshold, and (3) the efficiency penalty that organizations should accept, and not trade against organizational thoroughness, in order to maintain safety. Unfortunately, many accidents share a conceptual sameness in the way they occur. That sameness can be related to the dynamics conceptualized in this paper and the violation of the safety threshold. This sameness is the sad story of the Bhopal accident, the Piper Alpha accident, and score of others. Finally, we highlight the importance of a positive safety culture as an essential complement to regulatory pressure in maintaining safety. We illustrate the “slippery slope of thoroughness” along which organizational behavior slides under the influence of performance pressure, and suggest that a positive safety culture can be conceived of as “pulling this slippery slope” up and preventing the violation of the safety threshold.     

Traffic education for young pedestrians: An introduction

This paper introduces a collection of six detailed studies dealing with various aspects of the traffic education of young children, between 4 and 8 years of age. Young children run disproportionate risks because their developmental possibilities and skills are limited. Yet they can perform reasonably well in certain types of traffic tasks. Also they can be taught in ways that will improve both their perception and choice of safe situations and their behavior in such situations.     

Relative risk of injury and death in ambulances and other emergency vehicles

This study addresses of the impacts of emergency vehicle (ambulances, police cars and fire trucks) occupant seating position, restraint use and vehicle response status on injuries and fatalities. Multi-way frequency and ordinal logistic regression analyses were performed on two large national databases, the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS) and the General Estimates System (GES). One model estimated the relative risk ratios for different levels of injury severity to occupants traveling in ambulances. Restrained ambulance occupants involved in a crash were significantly less likely to be killed or seriously injured than unrestrained occupants. Ambulance rear occupants were significantly more likely to be killed than front-seat occupants. Ambulance occupants traveling non-emergency were more likely than occupants traveling emergency to be killed or severely injured. Unrestrained ambulance occupants, occupants riding in the patient compartment and especially unrestrained occupants riding in the patient compartment were at substantially increased risk of injury and death when involved in a crash. A second model incorporated police cars and fire trucks. In the combined ambulance–fire truck–police car model, the likelihood of an occupant fatality for those involved in a crash was higher for routine responses. Relative to police cars and fire trucks, ambulances experienced the highest percentage of fatal crashes where occupants are killed and the highest percentage of crashes where occupants are injured. Lack of restraint use and/or responding with ‘lights and siren’ characterized the vast majority of fatalities among fire truck occupants. A third model incorporated non-special use van and passenger car occupants, which otherwise replicated the second model. Our findings suggest that ambulance crewmembers riding in the back and firefighters in any seating position, should be restrained whenever feasible. Family members accompanying ambulance patients should ride in the front-seat of the ambulance.     

Pedestrian- and driver-related factors associated with the risk of causing collisions involving pedestrians in Spain

This study aimed to quantify the association between pedestrian- and driver-related factors and the risk of causing road crashes involving pedestrians in urban areas in Spain between 1993 and 2011. From the nationwide police-based registry of road crashes with victims in Spain, we analyzed all 63,205 pairs of pedestrians and drivers involved in crashes in urban areas in which only the pedestrian or only the driver was at fault. Logistic regression models were used to obtain adjusted odds ratios to assess the strength of association between each individual-related variable and the pedestrian’s odds of being at fault for the crash (and conversely, the driver’s odds of not being at fault).The subgroups of road users at high risk of causing a road crash with a pedestrian in urban areas were young and male pedestrians, pedestrians with psychophysical conditions or health problems, the youngest and the oldest drivers, and drivers with markers of high-risk behaviors (alcohol use, nonuse of safety devices, and driving without a valid license). These subgroups should be targeted by preventive strategies intended to decrease the rate of urban road crashes involving pedestrians in Spain.     

The fatality and injury risk of light truck impacts with pedestrians in the United States

In the United States, passenger vehicles are shifting from a fleet populated primarily by cars to a fleet dominated by light trucks and vans (LTVs). Because light trucks are heavier, stiffer, and geometrically more blunt than passenger cars, they pose a dramatically different type of threat to pedestrians. This paper investigates the effect of striking vehicle type on pedestrian fatalities and injuries. The analysis incorporates three major sources of data, the Fatality Analysis Reporting System (FARS), the General Estimates System (GES), and the Pedestrian Crash Data Study (PCDS). The paper presents and compares pedestrian impact risk factors for sport utility vehicles, pickup trucks, vans, and cars as developed from analyses of US accident statistics. Pedestrians are found to have a two to three times greater likelihood of dying when struck by an LTV than when struck by a car. Examination of pedestrian injury distributions reveals that, given an impact speed, the probability of serious head and thoracic injury is substantially greater when the striking vehicle is an LTV rather than a car.     

ADHD and relative risk of accidents in road traffic: A meta-analysis

The present meta-analysis is based on 16 studies comprising 32 results. These studies provide sufficient data to estimate relative accident risks of drivers with ADHD. The overall estimate of relative risk for drivers with ADHD is 1.36 (95% CI: 1.18; 1.57) without control for exposure, 1.29 (1.12; 1.49) when correcting for publication bias, and 1.23 (1.04; 1.46) when controlling for exposure. A relative risk (RR) of 1.23 is exactly the same as found for drivers with cardiovascular diseases. The long-lasting assertion that “ADHD-drivers have an almost fourfold risk of accident compared to non-ADHD-drivers”, which originated from Barkley et al.’s study of 1993, is rebutted. That estimate was associated with comorbid Oppositional Defiant Disorder (ODD) and/or Conduct Disorder (CD), not with ADHD, but the assertion has incorrectly been maintained for two decades. The present study provides some support for the hypothesis that the relative accident risk of ADHD-drivers with comorbid ODD, CD and/or other conduct problems, is higher than that of ADHD-drivers without these comorbidities. The estimated RRs were 1.86 (1.27; 2.75) in a sample of ADHD-drivers in which a majority had comorbid ODD and/or CD compared to 1.31 (0.96; 1.81) in a sample of ADHD-drivers with no comorbidity. Given that ADHD-drivers most often seem to drive more than controls, and the fact that a majority of the present studies lack information about exposure, it seems more probable that the true RR is lower rather than higher than 1.23. Also the assertion that ADHD-drivers violate traffic laws more often than other drivers should be modified: ADHD-drivers do have more speeding violations, but no more drunk or reckless driving citations than drivers without ADHD. All accident studies included in the meta-analysis fail to acknowledge the distinction between deliberate violations and driving errors. The former are known to be associated with accidents, the latter are not. A hypothesis that ADHD-drivers speed more frequently than controls because it stimulates attention and reaction time is suggested.     

Superstition,risk-taking and risk perception of accidents among South African taxi drivers

The aim of this study was to investigate taxi drivers' superstition and risk perception of accidents as well as risk-taking in an urban area in South Africa. One hundred and thirty drivers of minibuses, so-called "taxis" were interviewed on the basis of: (1) a superstition scale; (2) a risk-taking scale; (3) a list of perceived causes of road traffic accidents. Drivers showed largely superstitious attitudes and expressed a high degree of risk-taking behavior.Superstition was positively correlated with the number of self-reported accidents the drivers had been involved in and the number of accidents they had witnessed. Path analysis revealed a direct path from superstition to accident involvement while the influence of formal education was negligible. Risk-taking was inversely correlated with driving experience and the number of accidents witnessed but not so with the number of accidents involved in. There was no clear pattern of associations between superstition and risk-taking and perceived causes of accidents. Superstition and risk-taking were slightly and inversely correlated with each other. It is concluded that superstition represents an attitude that is associated with a driver's accident risk, and further research on superstitious attitudes among South African drivers is advocated.