bluuebunny/crossref_metadata_2025 huggingface dataset:
Endotracheal tube cuff pressure during aeromedical transport
Authors: Graham Sean
Published: November 2015

The use of helicopters and planes for transporting sick or injured patients to tertiary care centers is common practice. Aviation medicine requires a different perspective regarding patient care. One must consider the effects of higher altitudes on patients when utilizing aeromedical transportation. An endotracheal tube (ETT) utilizes air to inflate a balloon (“cuff”); the cuff invasively secures the ETT and the pressure must be measured and monitored. The amount of air placed in an ETT cuff to ensure a proper seal on an intubated patient varies among practitioners; without using a measuring device (manometer), ETT cuff pressures are unknown. In a critically ill patient, blood supply to the tracheal mucosa can become compromised, when ETT cuff pressures are sustained above 30 mm Hg for greater than 15-30 minutes potentially resulting in unnecessary airway trauma. Boyle-Mariotte’s Gas Law is used to measure ETT cuff pressures: Pcuff2=Pcuff1 + Patm1 – Patm2. Pcuff2 represents the final numerical value of the ETT cuff pressure. Pcuff1 is the initial pressure of the ETT cuff pressure at ground level, Patm1 is atmospheric pressure at ground level, and Patm2 is the barometric pressure at the cruising altitude of the aircraft. Based on Boyle-Mariotte’s formula, inflating an ETT cuff with a pressure of 18 mm Hg at zero feet ground level, (760 mm Hg) and then ascending to a flight altitude of 500 feet above ground level (746 mm Hg) would increase cuff pressure by 14 mm Hg. Based on an 18 mm Hg ETT cuff pressure at ground level, and ascending to an altitude of 1000 feet, the ETT cuff pressure would increase to 45 mm Hg of pressure-a critically high cuff pressure for a patient that may be hemodynamically compromised. Manometers must be utilized by aeromedical crews for the prevention of ETT cuff-induced tracheal mucosal lesions.
References
Bassi, M., Zuercher, M., Eme, J.J., &Ummenhofer, W. (2010). Endotracheal tube intracuff pressure during helicopter transport. Annals of Emergency Medicine. 56(2), 89-93. doi: 10.1016/j.annemergmed.2010.01.025
Mann, C., Parkinson, N., & Bleetman, A. (2007) Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport. Emergency Medical Journal 24, 165-167. doi: 10.1136/emj.2006.039933.
Raynham, O.W., Lubbe, D.E., & Fagan, J.J. (2009). Tracheal stenosis: Preventable mortbidity on the increase in our intensive care units. South African Medical Journal 99(9), 645-646.
Stein, C., Berkowitz, G., & Kramer, E. (2011). Assessment of safe endotracheal tube cuff pressures in emergency care-time for a change? South African Medical Journal 101(3), 172-173.
Addressing the pandemic on our roads
Authors: Rahman Adnan
Published: November 2015

Reviewing the progress made in UN's Decade of Action on Road Safety 2011-20, it is clear that much remains to be done. The problem of road safety is reaching pandemic proportions; there are 1.3 million traffic related deaths annually, 50 million are disabled because of injuries from road traffic accidents every year, people road accidents are the 8th leading cause of non-natural death, road accidents are the leading cause of death among 15-29 year olds, 60% of all traffic deaths are among 15-44 year olds, traffic accidents result in a loss equal to 1-2% of national GNP.
As road infrastructure expands and becomes better in many parts of the world, and motorisation rates increase, the need to act to address this pandemic on our roads is becoming ever more urgent.
In this presentation I will outline a strategy for countries to address the pandemic of death and injury from road accidents. This strategy is based on:
• The UN's five pillars – Road safety management, safer roads and mobility, vehicles, road users, and post-crash response,
• The safe system approach,
• Building political commitment and stakeholder support for improving safety,
• Performance management,
• Evidence, and
• Providing value for money
What we do not know, hardly know, and really know about traffic safety
Authors: Evans Leonard
Published: November 2015

The July 1938 issue of the American Journal of Psychology contained an insightful paper on car driving(1). Since that time an enormous technical literature devoted to driving and traffic safety has emerged, resulting in a solid edifice of detailed knowledge(2). Yet many of the most basic questions remain unanswered according to the strictest scientific reasoning. For example, it is widely assumed that we know how a driver’s crash risk is affected by the consumption of alcohol(3). This has never been, nor ever can be, experimentally examined. Likewise, we have no direct experimental investigation of how a driver’s crash risk increases with increasing speed. Our estimate of the effectiveness of safety belts (4) in preventing fatalities rests on an assumption that we know is not true. The most reliable data we do have for most countries is a count of annual fatalities. Even though this is not quite perfect, changes from year to year are accurate provided any biases do not change much from year to year. An assumption-free dimensionless measure not subject to the above problems is a nation’s fatalities in a given year divided by that nation’s maximum number of fatalities in any year(5). Applying this measure to 2013 data from 26 countries leads to a crystal clear conclusion that is even more dramatic and irrefutable than that previously reported using earlier data.5 The USA is a stark outlier. From 1972 to 2013 traffic deaths in the USA declined by 40.1%. This was hailed as success by some USA policy leaders. However, in, for example, the Netherlands traffic deaths in the same period declined by 83.7%. If USA deaths had declined by the same percent as in the Netherlands, then in 2013 the USA would have suffered 8,87532,719 that actually occurred. If the USA had matched the declines recorded in any of 11 countries, then 20,000 fewer Americans would have been killed on the roads of the USA in 2013. The clear message is that the USA approach to safety (to be discussed) needs to change and should never be embraced by any other country.
References:
1. Gibson, JJ, Crooks, LE. A theoretical field-analysis of automobile driving, Am J Psych 1938; 5l: 453-7l. Complete text available at http://www.scienceservingsociety.com/GC.htm
2. Evans L. Traffic Safety. Bloomfield Hills, MI: Science Serving Society; 2004. Information at http://www.scienceservingsociety.com/traffic-safety.htm
3. Borkenstein RF, Crowther RF, Shumate RP, Ziel WB, Zylman, R. The role of the drinking driver in traffic accidents. Department of Police Administration, Indiana University; 1964.
4. Evans L. The effectiveness of safety belts in preventing fatalities. Accid Anal Prev. 1986; 18: 229-241.
5. Evans L. Traffic fatality reductions in the United States compared to reductions in 25 countries. Am J Public Health. 2014;104:1501-1507. Available at http://www.scienceservingsociety.com/p/195.pdf
The challenges of driving licenses in Saudi Arabia
Authors: Al Ratrout Nedal
Published: November 2015

The losses caused by traffic accidents constitutes a large socio-economic problem for the Kingdom of Saudi Arabia and has led to an in-depth study of the driver, which is the major factor in the cause of traffic accidents in any region of the world. The Kingdom of Saudi Arabia's booming economy has resulted in the employment of large numbers of immigrants who work as professional drivers in Saudi Arabia, who come from different cultural and social environments which contributes to an increase in the human factor as the major cause of traffic crashes. This paper summarizes a national study conducted in the Kingdom of Saudi Arabia of 2074 traffic crashes during the year 2011. This study also included interviews of 1067 trainees at driving schools in the same period. The study has shown that the human factor constitutes 76% of the causes of crashes in the study sample and it has also confirmed the increased crash risk for young Saudi drivers when compared to older age groups, it also showed a higher crash involvement of non-Saudi nationals over the age of 30 years. This study concluded that the number of professional drivers involved in traffic crashes from foreign nationalities is higher than the Saudis and Arab drivers, and it also shows that there is an increasing number of non-professional Saudi and Arab drivers involved in traffic crashes when compared with other nationalities. The study also indicated that there was a greater than expected rate of traffic accidents rate involving heavy vehicle drivers when compared to drivers of private vehicles. There is also a higher rate of injury accidents involving drivers of government vehicles than other professional drivers. The study also indicates that drivers of private company and government vehicles are causing more crashes than family drivers and taxi drivers. The study encourages professional drivers to learn and understand the basics of the Arabic language or English, it also recommends that the professional drivers to reassess their driving and health fitness on a regular basis and provide them with training and cultural courses that suit them and more frequent for those who are older than 30 years. The study also recommended the need to increase the standard of training programs in driving schools through utilizing visual media including video and films for the effective delivery of information to trainees of many different nationalities and culturally diverse backgrounds.
المجتمع و التعليم
Authors: Rabee Mamoun
Published: November 2015

- يتلخص البحث بان أي حادث مروري كبير، تكون نتيجته وفاة شخصين على الأقل ، يجب عمل بحث لأسباب الحادث من كل النواحي ،المرورية و الطبية و الهندسية و الأسباب التي أدت للوفاة ، و أي سبب أدى للحادث من ناحية المركبة أو السائق أو الطريق
و يقوم رجل المرور و مهندس الطرق و الطبيب ، بعمل تقرير مفصل وميداني بالتنسيق فيما بينهما ، و تحضير التقرير بشكل مختصر يوفي بالغرض و مرفق بالصور و الفيديو، خلال فتر ة من حدوث الحادث لا تتعدى الأسبوعين ، و عرض هذا التقرير أمام كل المهتمين من إدارة المرور و هندسة الطرق و الأطباء ، و بوجود رئيس مجلس الوزراء لأخذ قرارات و قوانين أنية تحد من الحادث الذي قد يحدث بالمستقبل ، و يكون تطبيق هذه القوانين مباشرة كون السلطة العليا بالدولة و المخولة متواجدة ، و نشر ذلك بوسائل الإعلام بعد اخذ الموافقات الرسمية من حيث القوانين و الخصوصية الشخصية.
Case characteristics and injury mechanisms in motor vehicle accidents in South East Norway from 2000 to 2014: An autopsy study
Authors: Mario Breen Jan , Aksel Naess Paal , Gaarder Christine , Stray-Pedersen Arne
Published: November 2015

To elucidate crash and injury patterns of vehicle occupants in fatal motor vehicle accidents (MVA). A retrospective study of fatal MVA victims based on data from post mortem examinations between 2000-2014 in South East Norway was conducted.
Within the 15 year period, 561 vehicle occupants killed in traffic were identified, 373 were vehicle drivers and 158 passengers. Compared with data from official statistics, this represents an autopsy rate of 40%. In 30 of 561 cases (5,3 %) a natural cause of death was identified at autopsy, all of which were chauffeurs. Investigation of the autopsy and police reports revealed 531 deaths due to severe injuries or complications related to these injuries. The main causes of death were multiple injuries (41,4 %), isolated injuries to the head/neck (32,2 %), chest (15,6 %) or abdominal (1,7 %) organs. Blunt force trauma due to direct impact to the head or chest was the main fatal injury mechanism for both drivers and passengers. Furthermore, drowning was the cause of death in 4,9 % of the cases and burn injuries in 2,3 %. Most of the cases were found dead at the scene with non-survivable injuries. Collisions associated with driving off the road (203 MVA) and frontal collisions (244 MVA) were most commonly observed. The average victim age was 41 years, 73 % were men. Obesity, represented by Body Mass Index greater than 30, was observed in 123 (23 %) of the cases. Totally 76 (14 %) were known drug and alcohol abusers.
Identifying mortality patterns in real-world traffic crashes may yield knowledge crucial for prevention of future MVA fatalities. The preliminary results indicate obesity may be a risk factor for fatal outcome in MVAs.
Characteristics of approach pattern in car and bicycle in Japanese traffic road
Authors: Matsui Yasuhiro , Oikawa Shoko , Hitosugi Masahito
Published: November 2015

Protection of vulnerable road users is important to reduce traffic fatality in Japan. The use of active safety devices that can detect cyclists is considered to be an effective countermeasure for reducing the severity of injuries and number of cyclist fatality. The detailed features of car–cyclist contact scenarios need to be clarified to develop such safety devices. Since there is limited information on real-world accidents, the present study investigates near-miss scenarios captured by drive recorders installed in passenger cars.

In this study, we showed the similarities of the contact situations between near-miss car-to-bicycle incidents and real-world fatal cyclist accidents. Then we analyzed video frames of 161 near-miss data when bicycles were crossing the road in front of the forward-moving cars to understand the contact situations between cars and bicycles. Additionally, using a video recorded by a drive recorder, we calculated the estimated collision time from the car velocity and the distance between the car and bicycle. For the definition of the estimated collision time, the worst situation was assumed to be that when a car moved toward a cyclist without the driver realizing the cyclist and braking.

The results indicated that the average estimated collision time in the cases where bicycles emerged from behind obstructions was shorter than that in the cases where drivers had unobstructed views of the bicycles. When we consider the estimated collision time in the test protocol of evaluation for safety performance of active safety devices, two scenarios should be employed; bicycle emerged from behind unobstructed views and bicycle emerged from behind obstructions.
Reported traffic injuries during a pilot of injury surveillance system in Kingdom of Saudi Arabia
Authors: Murdhi Alanazi Faisal , Arif Hussain Syed
Published: November 2015

Road traffic injuries are second leading cause of mortality in hospitals of Ministry of Health (MOH) – Kingdom of Saudi Arabia (KSA) (1), costing billions of Saudi Riyals annually (2). The Injury & Accidents Prevention Program in MOH, realizing the dearth of data about injuries, designed a uniform Injury Surveillance System in 2013, with assistance of the World Health Organization (WHO) and in collaboration with Ministry of Interior and Red Crescent. The Injury Surveillance System aimed to gather regular ongoing information for prevention and control of injuries and efficient use of resources.
The pilot phase involved a multistage stratified random sample, where half of 20 health regions were selected in first stage and 14 health facilities from each region in second stage stratified by type and level of facility. A minimum of two physicians from each selected health facility were trained on the predesigned tool, adopted and modified from WHO-CDC Guidelines (3), before the start of data collection. The data on the prescribed form was collected at the healthcare facilities and communicated through Regional Coordinator to the Injury & Accident Prevention Program in MOH on regularly basis for entry and analysis.
Injuries were third highest cases (15%) after falls (31%) and blunt force (20%) among the 10,008 reported cases. About 32% of drivers were reported to be over-speeding; in 13.7%, condition of vehicle was flawed; and some 13 % crashes seemingly occurred due to bad weather.
The pilot identified that data from health facilities is very useful for decision making. Surveillance system is efficient and has the capacity to capture injury cases reporting to health facilities, but necessitates the inclusion of nurses and paramedics besides the attending physicians, to distribute the work load. Robust functioning of the system would require more ownership of the regional offices, besides continuous commitment of senior management at MOH.

References:
1. Annual statistical report – 1431 (2011), Riyadh, Saudi Arabia, Ministry of Health
2. Al-Naami MY, Arafah MA, Al-Ibrahim FS. Trauma care systems in Saudi Arabia: an agenda for action. Ann Saudi Med. 2010, Jan-Feb;30(1):50–8. PMID:20103958
3. Y. Holder et al. Injury Surveillance Guidelines. World Health Organization, 2001
Seat belt and mobile phone use among young adult drivers in the State of Qatar
Authors: Cheema Sohaila , Alrouh Hekmat , Mahfoud Ziyad , Mamtani Ravinder
Published: November 2015

Annually 1.2 million deaths occur globally due to road traffic injuries; additionally, 20-50 million are injured or disabled ("Global status report", 2013). Concomitant with rapid socioeconomic growth, infrastructure development and increased vehicle ownership, injury, disability and mortality due to road traffic collisions are high in the Gulf Cooperation Council countries. This is also true for Qatar where road traffic collisions are one of the leading causes of premature mortality (Bener et al., 2012). Road traffic mortality in Qatar (2010) is 14 per 100,000 population. Young adult males are disproportionately affected ("Global status report", 2013). Laws pertaining to seat belt and mobile phone use exist; however, there is a lack of enforcement.

We collected data regarding seat belt and mobile phone use while driving in college students, majority of whom were in the age group 18-24 years. The data was collected via a self-administered survey in two colleges. The total sample consisted of 419 students but 321 admitted to driving a vehicle.

Overall seat belt use among drivers was reported at 51% “always”, 41% “sometimes”, and 8% “never”. Overall mobile phone use was reported at 23% “always”, 64% “sometimes”, and 13% “never”. Females were significantly more likely than males to use seat belt and less likely to use mobile phone while driving. Additionally, drivers at or below the age of 25 were significantly more likely to use seat belt and less likely to use mobile phone than those over 25 years old (Table 1).

The results give us reliable estimates of seat belt and mobile phone use prevalence in young adult drivers in Qatar. Increased awareness and enforcement of road safety laws are required to control this epidemic of road traffic injury, disability and fatality. These findings are of public health importance and deserve our attention.
Crash risk in morbidly obese drivers before and after bariatric surgery: A population-based cohort study
Authors: Ahmad Bhatti Junaid , Nathens Avery , Redelmeier Donald
Published: November 2015

Morbid obesity is a major public health problem in high-income, developed and fast developing countries. The potential effects of morbid obesity on road crash risk have rarely been investigated. In this study, we evaluated road crash risks in morbidly obese drivers who underwent bariatric surgery.

We conducted a self-matched cohort analysis of morbidly obese adult patients in Ontario (Canada) who underwent bariatric surgery between April 1, 2006 and March 31, 2011. We used a province-wide emergency department database to determine their involvement in a road crash as a driver. We compared crash incidence per 1,000 patient-years in the three-year interval before surgery to three years after surgery.

The cohort included a total of 8,815 patients; most (81%) were women. About 4% (n=333) of them were involved in a crash during six years of follow-up. Of them, 175 had 182 crashes before surgery and 165 patients had 174 crashes after surgery. The road crash incidence was similar before and after surgery, i.e., 7 per 1,000 patient-years. This road crash incidence was three times higher than the population rate of 2 per 1,000 patient-years. Crash risks were similar before and after surgery among those who were diagnosed with an obstructive sleep apnea (Incidence rate ratio [IRR]= 0.95, 95% Confidence Interval [CI] = 0.73 - 1.23) and other patients (IRR = 0.96; 95% CI=0.69-1.37).

Morbid obesity may be associated with increased crash risk. These findings favor crash risk assessment in morbidly obese drivers.
Drivers obesity and road crash risks in the United States
Authors: Ahmad Bhatti Junaid , Nathens Avery , A Redelmeier Donald
Published: November 2015

We assessed obesity trends in US drivers involved in fatal crashes since 1999 and distinguished whether crash risk factors were different between obese and non-obese drivers.

We included drivers of passenger cars involved in fatal traffic crashes between January 1, 1999 and December 31, 2012. Obesity was classified according to the World Health Organization guidelines and profiled between 1999 and 2012 using adjusted prevalence ratio (aPR) from log-binomial regression models. Differences in crash risks (e.g., fatality, drunk-driving, seat-belt non-use) between obese and non-obese drivers were estimated as adjusted odds ratio (aOR) using logistic regression models.

A total of 753,024 US drivers were involved in fatal crashes, of whom obesity information was available in 534,887. About 56% (n=299,078) were driving passenger cars. The prevalence of class I obesity increased from 10% in 1999 to 14% in 2012 (aPR=1.50, 95% confidence intervals [95%CI]=1.42-1.58), class II obesity from 3% to 5% (aPR=2.22, 95%CI=2.05-3.01), and class III obesity from 1% to 2% (aPR=2.65; 95%CI=2.27-3.10). Compared to non-obese controls, obese drivers had significantly higher risks for fatality (1.10≤aOR≤1.47), seat-belt non-use (1.00≤aOR≤1.21), need for extrication (1.01≤aOR≤1.23), and ambulance transport time ≥30min (1.01≤aOR≤1.28). Compared to non-obese controls, obese drivers were less likely to drink-drive (0.41≤aOR≤0.72) and speed ≥65mph (0.78≤aOR≤0.93)..

The rising national prevalence of obesity extends to US drivers involved in fatal crashes and indicates the need to improve seat-belt use, vehicle design, and post-crash care for this vulnerable population.
Encouraging a driving safety culture through positive peer pressure with courtesy
Authors: Alinier Guillaume , Verjee Mohamud
Published: November 2015

Although road safety and driver behaviour have improved over the last few years in Qatar, more accidents can be prevented and still more lives saved. One simple and very important step to reduce the severity of injuries for drivers and passengers is the proper and consistent use of a seat belt (1). Since law enforcement is not always effective, additional approaches should be used. We believe a road safety culture needs to be developed amongst drivers to further reduce road fatalities worldwide (2,3).
If something potentially unsafe is noticed (dysfunctional break light, low tire pressure, unsecured passengers,…) something needs to be done to correct the situation and prevent potential harm. Thinking “It is not my problem!” implies allowing that person or family to potentially suffer severe consequences relating to an oversight on their part. The approach which has been piloted by both authors consists of the following:
- Stationary in the traffic near a vehicle linked with a safety breach.
- Make a gentle hand wave in a welcome manner to the driver or passenger.
- Open your window to amicably mention the issue or point it by for example showing your seat belt.
- Upon resolution of the situation greet the person with a thumb up and a smile.
The experience has been positive at an estimated 95% rate, resulting in the return of a smile, the readjustment of the unsafe situation, and even many “Thank you”.
Road safety is everyone’s responsibility. Peer pressure can influence behaviour in either way depending on what is promoted (4). Such simple approach can encourage a cultural shift promoting driving safety if spread. Stickers with clear messages that can be pointed to on side windows can help communicating without opening windows and hence diminish the feeling of intimidation.

References:
1- Abu-Zidan, F. M., Abbas, A. K., Hefny, A. F., Eid, H. O., & Grivna, M. (2012). Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study. World journal of surgery, 36(2), 255-259.
2- World Health Organization. (2013). WHO global status report on road safety 2013: supporting a decade of action. World Health Organization.
3- Bener A, Verjee M, Dafeeah EE, Yousafzai MT, Mari S, Hassib A, Al-Khatib H, Choi MK, Nema N, Ozkan T, Lajunen T. (2013). A cross "ethnical" comparison of the Driver Behaviour Questionnaire (DBQ) in an economically fast developing country. Global Journal of Health Science. 5(4), 165-175.
4- Shepherd, J. L., Lane, D. J., Tapscott, R. L., & Gentile, D. A. (2011). Susceptible to Social Influence: Risky “Driving” in Response to Peer Pressure1. Journal of Applied Social Psychology, 41(4), 773-797.
Current and future trends in wireless enabling technologies for fully automomous cruise cars and their enhancement of road safety
Authors: Al Attari Jawad
Published: November 2015

Recent years have witnessed acceleration in wireless technology breakthroughs that proved to be key technology enablers of a plethora of applications that have shaped our modern society. For road safety and accident preventions, wireless technologies play a pivotal role in saving lives by assisting drivers in detecting potential collisions from blind spots and in inclement weather conditions such as thick fog or heavy rain. These wireless technologies include automotive radars for collision detections, adaptive cruise control system for autonomous cars, the Internet of Things (IoT) and 5G. While the first is considered a mature technology, the others are rich research areas that promise even greater level of driver assistance, and thus an exponential decline in road accidents and a smoother traffic flow and control, with commercialization expected in the 2020-2025 timeframe. This paper presents a detailed study of the aforementioned technologies in terms of current commercial automotive solutions, relevant future research frameworks, research and commercialization timeline, overlap with other wireless technologies such as cellular communications in the context of future 5G and IoT, and underlying physics and electronics. In addition, limitations and design challenges will also be discussed. Finally, an important comparison between the number of road accidents with and without the above technologies is presented. This comparison presents a compelling evidence that wireless technologies for the automotive industry are key to the reduction of fatal road accidents and the savings of millions of human lives.
Trends in criminal convictions in Japan for vehicle collisions where one driver suffers from an epileptic seizure
Authors: Baba Mineko , Hitosugi Masahito
Published: November 2015

For the last fourteen years in Japan, casualties due to traffic collisions have decreased. There were 9,073 traffic fatalities in 2000 and 4,113 in 2014. However, it has been argued that traffic collisions caused by one driver’s poor physical condition account for 10% of all traffic collisions. To reduce collisions to an even greater degree, this type of collision should be prevented. To investigate this issue, we studied criminal liability for drivers who caused a collision while having an epileptic seizure while driving.

We searched for information on traffic collisions caused by epileptic seizures while driving, and criminal punishments for the epileptic driver. We used databases of five nationwide newspapers (Asahi, Mainichi, Nikkei, Sankei, Yomiuri). We used LEX/DB that is a database of the precedent after 1875 in Japan, too.

We studied 27 cases from 1964 to 2014. Twenty drivers were prosecuted, and seven drivers were not. Seventeen of the twenty cases that were tried resulted in convictions, and all of the drivers who were found guilty had been diagnosed with epilepsy before being involved in vehicle collisions. Ten of the drivers found guilty denied criminal liability in arraignment. The sentences rendered appear to have become more severe in recent years.

Criticism for vicious vehicle collisions has led to changes in public opinion in Japan, thus the punishments for traffic fatalities and injuries due to a collision became heavier after 2001. Accidents due to chronic diseases—regarded as vicious collisions—are subject to scorn from the public, resulting in harsher penalties. It is necessary for drivers to recognize the risks of having seizures while driving. Furthermore, it is necessary for doctors to give clear instructions to drivers.
Embedding the Safe System into the next generation of road safety audits
Authors: de Roos Michael , Robert Vivian , Marsh Fabian
Published: November 2015

Road Safety Audits are used to identify risks and to propose remedial works on new and existing. The Safe System requires a change in focus from mitigating crashes to preventing death and serious injury. Development of the Qatar Road Safety Audit Guide (RSAG) presented an ideal opportunity to reinvigorate road safety auditing practices in accordance with the Safe System. The Public Works Authority (Ashghal) commissioned a RSAG that was to be suitable for Qatar operating environment and based on leading international practices. The Qatar National Road Safety Strategy adopts the Safe System as the model for developing and delivering road safety initiatives, it followed that the RSAG follow the same principles. This was also in accordance with the United Nations: Decade of Action for Road Safety initiative.
The RSAG adopts the survivability graph (Wramborg quoted in OECD, 2008) to rank seriousness of deficiencies identified. This allows us to focus on delivering the greatest road safety benefits.

Traditional checklists used in road safety audits have been revised to include the possibility of a a head-on crash at 70 km/h, a side-impact crash at 50 km/h, collide with a non-frangible object at 40 km/h or hit a pedestrian at 30 km/h. If the answer is yes to any of these questions there is a need to take action. The Safe System is progressively being implemented globally as a new approach to reducing the unacceptable number of people being killed or injured. The Qatar Road Safety Audit Guide has successfully demonstrated that the Safe System can be integrated into road safety auditing practices.

References
Organisation for Economic Co-operation and Development (OECD). International Transport Forum. (2008). Towards Zero: Ambitious Road Safety Targets and the Safe System Approach
Retrieved from http://www.internationaltransportforum.org/Pub/pdf/09CDsr/PDF_EN/TowardsZero.pdf
New Zealand Transport Agency (NZTA). (2013). Road safety audit procedures for projects: Guideline (interim release). Wellington
Retrieved from http://www.nzta.govt.nz/resources/road-safety-audit-procedures/docs/road-safety-audit-procedures-tfm9.pdf
Effectiveness of helmets in preventing severe injuries in a setting with poorly enforced quality standards
Authors: Ahmad Bhatti Junaid , A Razzak Junaid , Jooma Rashid
Published: November 2015

Helmets save lives, yet many countries do not have laws about their quality assessment or how they should be worn. We assessed the effectiveness of helmet use in preventing injuries in such a setting.

The data were extracted from a large road traffic injury surveillance study in Karachi, Pakistan. We assessed the association of wearing helmets with several injury outcomes including deaths, injury severity (via New Injury Severity Score, NISS ≥ 9) and moderate or severe injury (via Abbreviated Injury Score, AIS ≥ 2) to head, face, or other regions of the body.

The data about helmet use was available for about 109,210 riders injured between January 2007 and December 2013. Only 6% of riders wore helmets, whereas this proportion was less than one percent in pillion riders and women. The rates were also lower among those aged 18 years or younger (1%) and those aged 18 to 25 years (4%). About 2% of riders died; 34% had an injury to the head region, 30% to face, 1% to chest, 5% to abdominal, 46% to extremities, and 61% to external body regions. Likelihood of dying was low among helmet users (adjusted odds ratio [aOR] = 0.37, 95% confidence interval [CI] = 0.28 to 0.50). Helmets reduced the likelihood of moderate to severe injuries to the head (aOR = 0.68, 95% CI = 0.58 to 0.80) but not to the face region (aOR = 1.37, 95%CI = 1.17 to 1.62). Helmet users also had severer injuries in other body regions except for chest injuries.

Helmets prevented deaths and severe head injuries but had limited effectiveness in preventing facial injuries in this setting with poor helmet use standards. More work is needed to understand the helmet wearing and rider behaviours in helmet users in this setting.
Managing the safety of young novice drivers through safer vehicle purchase
Authors: Oxley Jennifer , Newstead Stuart , Michelle Scully
Published: November 2015

Significant reductions in road trauma among young drivers could be achieved if they drove safer vehicles. Parents are likely to play a critical role in the access, timing of vehicle purchase, available budget, and vehicle choice for the young driver’s first vehicle. However, little attention has been directed to understanding the most effective communication strategies to encourage young drivers and their parents to purchase and use safe vehicles. This study was undertaken to examine existing strategies in Australia and provide recommendations for improving communication initiatives.

A two-staged study was undertaken including in-depth consultation with representatives from key road safety stakeholders groups to identify current initiatives, and development of conceptual model to identify current and potential improvements to communication strategies.

The findings of the consultation phase showed that a sporadic and un-coordinated approach was used regarding the promotion of key messages for purchase and use of safe vehicles and there was some suggestion that the communication medium, content and message style may not reach the target audience in the most effective way. Stakeholder representatives were unanimous in the argument that parents play an integral role. A conceptual framework was developed, depicting key stakeholders in Australia and the various interactions across stakeholders. This was instrumental in identifying areas where effective communicative initiatives and resources could be considered to increase the purchase and use of safe vehicles, including development of a widespread and accessible website and inclusion of vehicle safety choices in young driver education and training programs.

The results of the study suggest that a National Framework that co-ordinates government and non-government activities and initiatives aimed at encouraging the purchase and usage of safer vehicles by parents and young drivers should be developed. The methodology can be applied to other countries to develop similar communication campaigns.
How do drivers choose a travel speed? Implications for speed management strategies in Australia
Authors: Oxley Jennifer , Corben Bruce
Published: November 2015

Speeding remains a major contributor to trauma on our roads, held to be a major factor in around one-third of fatal crashes and over 10 percent of all crashes (Bowie & Walz, 1994; Fildes & Lee, 1993).

This study reviewed speed management strategies and key factors that should be considered through a comprehensive review of the literature.

One of the most frequently used methods of managing travel speeds is the posted speed limit. The primary purpose of the speed limit is to advise drivers of the maximum reasonable and safe operating speed under favourable conditions, therefore considered to be a road safety measure. Further, speed limits are designed to be (i) related to crash risk, (ii) provide a reasonable basis for enforcement, (iii) fair in the context of traffic law, and (iv) accepted as reasonable by most road users.

Traditional approaches to setting speed limits (e.g. engineering approach using the 85th percentile speed) are compared with an alternative view to setting speed limits: the Safe System approach. This approach requires that all aspects of the system work together for the safest possible outcome, with speed representing a critical component. The findings suggest that there are some inherent issues in traditional speed limit setting guidelines, particularly as drivers lack awareness of the true relationship between speed and road trauma, under-estimate crash and injury risk and over-estimate what is a safe speed, and that there is often a mismatch between environmental cues and speed limits.
There are opportunities to review and strengthen speed management policies and practices with a view to creating environments that promote safe behaviour rather than relying on drivers/riders to decide what is a safe speed, complemented by strengthened Police enforcement and increased community knowledge and awareness of the importance of speed to road trauma.
Safety around schools
Authors: Oxley Jennifer , Logan David , O'Hern Steve
Published: November 2015

Around schools, increases in walking and cycling help to reduce traffic congestion and improve the road safety and neighborhood navigation skills of children. Physical activity and independent mobility may also have a positive effect on children’s behavioural and cognitive development. Child pedestrians, however, are a vulnerable road user groups, experiencing an increased crash and injury risk relative to older pedestrians, constituting a substantial proportion of all pedestrian fatalities and serious injuries, with children below the age of 10 years of age shown to have four to 11 times greater risk of collision compared to other pedestrians, and they frequently occur around schools. In fact, vehicle collisions involving children pedestrians are considered as the most serious health risk facing children in developed worlds.

School safety evaluations were conducted involving four components: i) site visits providing physical assessments of current road conditions, ii) consultation with key groups including school principals and Local Council representatives, iii) desk-top review of available behavioural and training programs, iv) workshops to develop recommendations for appropriate and sustainable conceptual solutions.

Using a number of case studies, the findings suggest that evidence-based and consultative selection of initiatives can be effective in encouraging walking and cycling while providing a safer environment around schools. This can be achieved through implementation of multi-faceted initiatives including engineering treatments to enhance the safety of the physical environment around the school and on popular routes to school, as well as sustainable educational/training programs for both students and parents.

Evidence-based safety assessments are useful to develop a Safe System environment around schools. A combination of improvements to road design and operation, especially vehicle speed reductions and separation of vehicles and pedestrians, and behavioural programs to improved education and training, along with enhanced supervision can achieve sustainable reductions in child pedestrian trauma around schools.
Benchmarking minibus safety in Abu Dhabi, United Arab Emirates
Authors: Logan David , Fildes Brian , Rashed Ashraf
Published: November 2015

The Department of Transport (DoT) in Abu Dhabi has recognised that while minibuses play a key role in transporting people within the United Arab Emirates, levels of fatal and serious injury among minibus occupants in crashes are high. As a first step toward addressing this problem, the DoT commissioned a benchmarking study to gain an understanding of the state of the minibus fleet, focusing on fundamental vehicle safety aspects, as well as fitment rates of safety features such as airbags and stability control systems. Furthermore, the in-service condition of vehicles was also assessed.
Data was collected from 566 minibuses in Abu Dhabi and Dubai, comprising more than 80 separate data points characterising the presence, nature and condition of each vehicle. An innovative system was developed to combine these variables to yield a weighted safety score that allowed them to be grouped into categories for later input into a benefit cost analysis of a replacement program. A star rating system was used for the categorisation process because it allows for good discrimination between safety levels while remaining easy to comprehend.
The results of the benchmarking study showed that despite the fleet being quite uniform by make and model, there was considerable variation among individual vehicles in terms of seat belt fitment rates and rear passenger compartment seat mounting integrity in particular. Many vehicles in current operation are deficient both in terms of primary and secondary safety, compounded by inconsistent fitment of passenger seat belts.
This in-depth survey has provided significant additional information unavailable from registration data and provides a valuable insight into the state of minibus safety in the UAE. The data acquired will be used to conduct a benefit cost analysis targeted at determining the optimal means for implementing significant improvements to the minibus fleet.
Evaluation of speed humps and tables in Qatar
Authors: Ebrahem Ebrahemi Mohammad , Al-Khalifa Khalifa , Hammuda Abdelmagid
Published: November 2015

Controlling the speed of vehicles on various roads and streets is crucial in order to maintain the safety of people and to prevent any possibility of injury or death. One technique that is widely used in Qatar to force road users to reduce their vehicles’ speed is the installation of speed humps and tables. In this study, an evaluation of speed humps and tables in selected areas of Qatar was conducted, since they vary in shape and size and many complaints are raised about their inverse effect on driving safety. The aim of this study was to observe the condition of these traffic calming measures in Qatar.
The condition of speed humps and tables was investigated by classifying them based on their dimensions, and verifying if they were constructed according to Ashghal’s standards. The following areas were selected for the study: Qatar University, Male Campus (fully covered) and three neighborhoods: Al-Aziziya, Al-Mura and Al-Waab (partially covered). Two parameters were taken into consideration, height and length of both speed humps and tables. Measurements were taken through site visits to each area, recording dimensions of each speed hump and table using measuring tools as well as taking photographic pictures for reference.
The results show considerable variation in height and length dimensions of speed humps and tables. By comparing these results with Ashghal’s standards, it was found that for speed humps, few matched the standard specification for height, but almost none matched the standard for length. None of the speed tables met the standard for both height and length dimensions.
The study concludes most of the speed humps and tables in the areas covered in the study do not meet Ashghal’s standard specification for height and length dimensions and re-construction according to standards is recommended.
Fatalities in road traffic, a result of accidents or suicides
Authors: Andersson Anna-Lena , Svensson Kenneth
Published: November 2015

Since 2010, Sweden presents suicides in road traffic separately from fatalities caused by accidents. The aim with this study was to assess the number of road traffic suicides by studying the fatality from three angles; the vehicle, the road and the road user. The main focus was to develop and perform a psychosocial examination of the road user.

First, a method was developed for classification of road fatalities to determine if they were caused by accident or suicide and criteria was developed for selection of cases that are to undergo the classification process. The examination of the road user was performed in cooperating with accident investigators at the Transport Administration, the police, relatives, witnesses, as well as with information from autopsy reports, and case records from earlier medical service. During 2012, an investigator in behavioural science, experienced from counselling at hospitals conducted the examinations. The suspected suicides were classified by an expert group of five persons with knowledge in forensic medicine, psychology and traffic safety using the classification system. First, the classification was made without the psychosocial examination. A second classification was performed with the additional psychosocial information. Forty-nine cases were studied.

In 2012, twenty-two (7%) cases were classified as suicides without the psychosocial information and thirty-six (11%) with all information included. The unclear cases were reduced from 20 to 8. From 2013 and forward the classifications were made only once with all information. In 2012-2014, 89 (10%) fatalities were classified as suicides. Year 2010-2011, when the classifications were made without additional psychosocial information, 6% of the fatalities were classified as suicides [Skyltfondsprojekt;TRV2011-13351]. By including psychosocial factors in the classification of suspected suicides the number of unclear cases were reduced. In order to work with suicide prevention the size and the pattern of the problem must be known.
Suicide and accident classification methodology
Authors: Svensson Kenneth , Andersson Anna-Lena
Published: November 2015

Not all fatalities in road traffic are accidents; some are suicides. Since 2010, Sweden have been presenting suicides in road traffic separately from fatalities caused by accidents. To carry out this task a method has been developed for classification of road traffic fatalities in order to determine if the fatality was caused by accident or suicide.

A five-grade classification scale was developed. Grade one indicated a clear suicide and grade five a clear accident. The definition of grade one was suicide with a clear statement of the suicidal intent. Grade two indicated an almost certain suicide but the intention was based primarily on the course of event and psychosocial information of the road user. Grade three indicated that the information was not sufficient to determine whether the fatality was the result of a suicide or an accident and grade four indicated an almost certain accident. Fatalities in grade one and two are classified as suicides. Criteria for cases that are to undergo the classification process include to examine the traffic event together with knowledge of background factors, for example prior suicide attempts, indirect suicidal communication, knowledge of ongoing depression etc. From 2012, the classification has been performed with additional information from a psychosocial examination.

From 2010 to 2014, a total of 128 fatalities have been classified as suicides, 46 as grade one and 82 as grade two. From 2012 to 2014, when the psychosocial information was included in the analysis, 10% of all fatalities were classified as suicides. Analysis of gender, age, collision types, influence of alcohol, use of seatbelt, time etc., has been performed. The method can be used to determine which fatalities in road traffic are caused by suicide or accident. The method can be used on all modes of transport.