The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

Method

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

Results

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt.

Summary and Impact on Industry

Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.     

Comparison of risk factors for falls from height between commercial and residential roofers

Introduction

The purpose of this investigation was to compare commercial roofers and residential roofers in terms of their behaviors, beliefs, working conditions, and attitudes toward the use of fall protection devices, which could lead to fall accidents.

Methods

A cross-sectional sample of 252 roofers participated in the survey in the Midwest (Wisconsin, Illinois, Michigan, Indiana, and Iowa).

Results

Residential roofers were more likely to fall (adjusted prevalence ratio = 1.57, 95% CI = 0.86, 2.27) than commercial roofers. Existence of fall protection programs, enforcement of fall protection device use, actual use of fall protection devices, work type, company size, and race/ethnicity were significantly associated with fall accidents.

Impact on industry

This study adds insight into fall accidents from roofs in the construction industry and provides industry-specific cautions against fall accidents that can be reflected in regulatory agency implementation.     

A comparison of web-based and telephone surveys for assessing traffic safety concerns, beliefs, and behaviors

Introduction

The purpose of this investigation was to compare the results of a web-based and a telephone interview survey measuring driver concerns about a variety of traffic safety issues, their beliefs, and specific driving behaviors.

Method

State-wide, annual random digit-dial telephone surveys and web-based surveys were conducted in Maryland. A total of 1,700 drivers were surveyed by telephone and 6,806 took a web survey.

Results

Telephone respondents were more likely to be female and older. Web respondents were more likely to be white and not Latino/Hispanic. After controlling for demographic differences, telephone survey respondents were more likely to be concerned about traffic safety. They were more likely to believe that sobriety checkpoints reduce drunk driving (OR = 2.18, 95% CI 1.94, 2.45), they would be ticketed for not wearing a seat belt (OR = 1.26, 95% CI 1.12, 1.43), and they would be stopped by the police if they drove after drinking too much (OR = 1.17, 95% CI 1.03, 1.32). They were less likely to report a variety of risky behaviors including using a cell phone while driving (OR = .54, 95% CI .48, .61) and driving 10+ mph over the speed limit (OR = .81, 95% CI .72, .91), but were more likely to report having been ticketed for a moving violation in the last month (OR = 2.22, 95% CI 1.70, 2.90). Suggestions are offered for overcoming potential sources of sampling bias.

Impact on Industry

Web-based surveys produce substantially different results than random-digit-dial telephone surveys, when used for public assessments of traffic safety concerns and behaviors.     

The development and validation of a psychological contract of safety scale

Introduction

This paper builds on previous research by the author and describes the development and validation of a new measure of the psychological contract of safety. The psychological contract of safety is defined as the beliefs of individuals about reciprocal safety obligations inferred from implicit and explicit promises.

Method

A psychological contract is established when an individual believes that perceived employer and employee safety obligations are contingent on each other. A pilot test of the measure is first undertaken with participants from three different occupations: nurses, construction workers, and meat processing workers (N = 99). Item analysis is used to refine the measure and provide initial validation of the scale. A larger validation study is then conducted with a participant sample of health care workers (N = 424) to further refine the measure and to determine the psychometric properties of the scale.

Results

Item and correlational analyses produced the final employer and employee obligations scales, consisting of 21 and 17 items, respectively. Factor analyses identified two underlying dimensions in each scale comparable to that previously established in the organizational literature. These transactional and relational-type obligations provided construct validity of the scale. Internal consistency ratings using Cronbach's alpha found the components of the psychological contract of safety measure to be reliable.

Impact on Industry

The refined and validated psychological contract of safety measure will allow investigation of the positive and negative outcomes associated with fulfilment and breach of the psychological contract of safety in future research.     

Fall arrest characteristics of a scissor lift

Problem

Census of Fatal Occupational Injuries (CFOI) data indicate 306 aerial lift fatalities between 1992-2003. Seventy-eight of these fatalities specifically involved scissor lifts. Members of standards committees have requested that NIOSH conduct research to determine the effects of safety-control practices related to using fall-protection systems for scissor lifts.

Method

This research examined the structural and dynamic stability of a scissor lift subjected to fall arrest forces. This was accomplished by conducting drop tests from a scissor lift. Anchorage locations evaluated included manufacturer-supplied anchorage points on the scissor lift platform as well as mid-rail and top-rail locations.

Results

Preliminary drop tests determined that a 2400 lb maximum arrest force (MAF) could be generated by dropping 169 lb through a fall height of 36” using Nystron® rope as a lanyard. The scissor lift maintained structural and dynamic stability for all drop tests when fully extended and on an incline.

Discussion

Anchoring a fall arrest system to either the mid-rail or top-rail is not a recommended practice by the scissor lift manufacturer. Anchor points are provided on the platform floor of the scissor lift for this purpose. However, our results demonstrate that the mid-rail and top-rail absorb substantial energy from an arrested fall and may have potential as appropriate anchorage points.

Impact to Industry

Employers and workers should consider implementing fall arrest systems when using scissor lifts as part of their overall risk mitigation plan for fall injury prevention.     

Road safety in China: Analysis of current challenges

Introduction

China has the world's largest population, and is the second largest automobile market. China's economy is booming, resulting in a rapid increase in both the road infrastructure and access to private vehicles. Along with economic growth, the ownership of motorized vehicles has almost quadrupled in the past 10 years, from 42.2 million in 1997 to 159.7 million in 2007. However, at the same time, China also has a very high number of road fatalities compared to other countries, with about 100,000 reported fatalities each year.

Method

This study analyzes the Chinese road-fatality situation to identify areas in which the total harm caused by crashes can be substantially and readily reduced. It provides a comprehensive analysis of the current road-fatality situation in China using conventional indices and the likely future trends.

Results

Four areas were identified in which countermeasures have the most potential to substantially reduce fatalities in China: pedestrians and other non-motorists, nighttime driving, vehicle passengers, and motorcycles.

Conclusion

While China faces unprecedented road safety issues, this report identifies major areas in which there are opportunities to greatly reduce total harm.     

Fatal crash trends for Australian young drivers 1997-2007: Geographic and socioeconomic differentials

Background

Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES).

Methods

Young driver (17-25 years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers’ residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status.

Results

Young driver fatality rate significantly decreased 5% per year (p < 0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p < 0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality.

Conclusion

The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.     

The effect of work hours on adverse events and errors in health care

Introduction

We studied the relationship between registered nurses' extended work duration with adverse events and errors, including needlestick injuries, work-related injuries, patient falls with injury, nosocomial infections, and medication errors.

Method

Using bivariate and multivariate logistic regression, this secondary analysis of 11,516 registered nurses examined nurse characteristics, work hours, and adverse events and errors.

Results

All of the adverse event and error variables were significantly related to working more than 40 hours in the average week. Medication errors and needlestick injuries had the strongest and most consistent relationships with the work hour and voluntary overtime variables.

Discussion

This study confirms prior findings that increased work hours raise the likelihood of adverse events and errors in healthcare, and further found the same relationship with voluntary overtime.

Impact on Industry

Legislation has focused on mandatory overtime; however, this study demonstrated that voluntary overtime could also negatively impact nurse and patient safety.     

Restraint use and seating position among children less than 13 years of age: Is it still a problem?

Introduction

The purpose of this study was to calculate national estimates and examine the extent to which children prematurely use adult seat belts and ride in the front seat of a vehicle during a 30 day period.

Methods

Data were obtained from a nationally representative cross-sectional random-digit-dial telephone survey that included child-specific questions on motor vehicle restraint use and seating position.

Results

Among children less than 13 years, parents reported an estimated 618,337 who rode unrestrained and more than one million who rode in the front seat of a vehicle at least some of the time in the past 30 days. During the same time period, close to 11 million children 8 years and younger reportedly used only adult seat belts.

Discussion

Our results highlight the need for continued outreach to parents regarding optimal restraint use and rear seating position for children every trip, every time.     

Enhancing older driver safety: A driving survey and evaluation of the CarFit program

Objective

To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle.

Methods

A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n = 195) were assigned randomly to CarFit intervention (n = 83, M age = 78.1) or Comparison (n = 112, M age = 79.6) groups. After 6 months, participants completed a post-test of driving activity and CarFit recommendations.

Results

Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up.

Conclusion

CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers.

Impact on industry

CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.     

Hepatitis B virus infection among health care workers in Public Teaching Hospitals in Khartoum State, Sudan

Background

Hepatitis B virus (HBV) infection is a global public health problem. It is estimated that there are more than 300 million HBV carriers in the world.

Aim

The study aimed to examine the sero-prevalence of hepatitis B virus (HBV) markers among health care workers (HCWs) in Public Teaching Hospitals in Khartoum State, in the year 2004.

Methods

The study is an observational, cross sectional, facility-based study. It was conducted on stratified two-stage cluster random sample of 843 subjects. The study followed non-parametric statistical methods, using Z-test for single proportion.

Results

Among the 843 subjects tested for all HBV markers (Anti-HBc, HBsAg, HBsAb, and HBeAg), the prevalence of Anti-HBc, HBsAg, HBsAb, and HBeAg was found to be 57% (CI 95%:53-60%), 6% (CI 95%:4.0-8.0%), 37% (CI 95%:34-40%) and 9% (CI 95%:7-11%) respectively. P < 0.05.

Conclusion

Seroprevalence of all HBV markers (P < 0.05) was found to be significantly high, while the rate of immunity against HBV infection was low among health care workers In Public Teaching Hospitals in Khartoum State, Sudan.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

Problem

Information about where nonfatal unintentional injuries occur is limited, but bathrooms commonly are believed to be a hazardous location.

Methods

Data from a nationally representative sample of hospital emergency departments (ED) was used to quantify and characterize nonfatal unintentional bathroom injuries among people aged ≥ 15 years.

Results

In 2008, an estimated 234,094 nonfatal bathroom injuries were treated in EDs. Most injuries (81.1%) were caused by falls and 37.3% of injuries occurred when bathing, showering, or getting out of the tub or shower. Both injury and hospitalization rates increased with age.

Summary

These results suggest that bathrooms tend to be most hazardous for persons in the oldest age groups.

Impact on Industry

Bathroom injuries among all household members might be reduced by increasing awareness about potentially hazardous activities in the bathroom combined with simple environmental changes such as adding grab bars inside and outside the tub or shower.     

The relationship between recruitment processes, familiarity, trust, perceived risk and safety

Introduction and Method

Participants′ perceptions of the safety-related aspects of their organization′s recruitment processes were examined, as were their perceptions of safety aspects associated with new recruits.

Results

One hundred and fifty-four professional fire fighters indicated the trust they held in the safety-related aspects of their organizations′ selection and pre-start training. Perceived trust in pre-start training was negatively correlated (r = -.24, p < .01) with the risk associated with new recruits, and positively correlated (r = .50, p < .01) with ratings of trust in recruits to immediately work safely. Furthermore, trust in recruits to immediately work safely was negatively correlated (r = -.21, p < .01) with crews′ safety behavior toward recruits.

Conclusions

These results are interpreted as particularly dangerous for workers, as new recruits lack familiarity with aspects of their new workplace that cannot be addressed by either selection or pre-start training, making them a risk.

Impact on Industry

Organizations should actively identify new recruits, and encourage existing team members not to immediately trust new recruits to work safely.     

Assessing public opinion regarding potential ATV-related policies

Problem

States with laws regarding ATV use and safety have lower mortality and injury rates than states with few or no restrictions. Our objective was to assess the attitudes of registered Ohio voters concerning potential legislation regarding ATV use and safety to determine the feasibility of its enactment.

Method

A statewide telephone survey of 838 registered Ohio voters was conducted and results were weighted by region to accurately represent all Ohio voters.

Results

Registered voters were in favor of restricting the use of ATVs by children < 16 years (81%), prohibiting passengers on ATVs (81%), requiring helmets (78%), and requiring all ATV owners and users to take a safety class (77%). ATV riders indicated that a mandatory helmet law would increase helmet use.

Impact on Industry

Assessing public opinion regarding public health and safety laws is a critical first step when considering legislation to improve ATV safety.     

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio

Objective

To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes.

Methods

Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges.

Results

The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR = 1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR = 3.66), being admitted to the ICU (OR = 2.51), having a high ISS (OR = 4.24), requiring rehabilitation (OR = 2.22), or death (OR = 2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI.

Conclusions

Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death.

Impact on industry

Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.     

Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors

Introduction

Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury.

Objectives

This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation.

Methods

This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household.

Results

Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country.

Conclusions

While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. Impact on industry: minimal.     

Analysis of bus collision and non-collision incidents using transit ITS and other archived operations data

Introduction

This paper analyzes factors contributing to bus operations safety incidents at TriMet, the transit provider for the Portland Oregon metropolitan region.

Method

The analysis focuses on 4,631 collision and non-collision incidents that occurred between 2006 and 2009. Empirical analysis of these incidents draws on a wide array of operator-level data recovered by transit ITS technologies in combination with information from TriMet's human resources, scheduling, and customer relations databases. Incident frequencies are estimated in relation to operators' demographic characteristics, employment status, assigned work characteristics, service delivery and performance indicators, temporal factors, and customer information.

Results

Apart from identifying factors that are empirically related to the frequency of safety incidents, the findings offer insights into operations policies and practices that hold promise for improving safety.

Impact on Industry

Potential for safety improvement based on analysis of archived operations and human resource data.     

Winter storm-related injuries in Oklahoma, January 2007

Introduction

A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel.

Methods

Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12 − 30, 2007. Medical records were retrospectively abstracted.Risk of injury was described by demographic group, injury type, and mechanism.

Results

Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39 years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years.

Conclusions

Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures.

Impact on industry

Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.     

Time trends and predictive factors for safety perceptions among incoming South Australian university students

Problem

Young workers are over-represented in injury statistics. In order to develop injury prevention strategies, this study investigated time trends and predictive factors relating to safety skills, confidence, and attitudes.

Method

Annual surveys were conducted from 2006-2009 among incoming students at the University of Adelaide. The questions addressed safety training, injury experience, and health and safety perceptions.

Results

Time trends in training, perceived safety skills, confidence, and attitudes were not significant. In terms of skills and confidence, the most important correlate was safety training outside of high school (odds ratio = 1.6), especially when repeated, assessed, or in face to face mode. Feeling strongly about safety issues was best predicted by injury experience (OR = 1.7) and gender.

Discussion

These results emphasize the value of assessed training, but they are also consistent with published U.S. data, indicating no improvement over time. It is suggested that there be a more integrated approach in safety education, involving schools and workplaces.

Impact on industry

By developing an understanding of student safety perceptions and experiences, this research aims to target strategies to reduce the excess injury rate for young workers. Workplaces should be more aware of the limitations of school-based safety education and a more integrated and evidence-based approach should be developed, involving schools and workplaces.     

Crash involvement during the different phases of the New Zealand Graduated Driver Licensing System (GDLS)

Introduction

The New Zealand Graduated Driver Licensing System (GDLS) is designed to allow novice drivers to gain driving experience under conditions of reduced risk.

Method

To examine the effectiveness of the GDLS, an analysis of how the crash involvement of novice drivers changes as drivers move through the GDLS was undertaken. Crash profiles were created by data matching the New Zealand license and crash databases, covering a time period from 1999-2006.

Results

The crash profiles show that the initial learner period of the GDLS is relatively safe and the time at which novice drivers have the highest rate of crash involvement is during the first few months of solo driving. Analysis using logistic regression also showed an effect of age and gender, with higher crash involvement associated with younger drivers and males. In addition, individuals who gained a full license within 12-18 months of holding a restricted license, due to completion of a time-discount associated educational program, had a higher level of involvement in crashes than individuals who gained a full license after 18 months.

Conclusions

The crash profiles provide an insight into the crash risk associated with different phases of the New Zealand GDLS.

Impact on Industry

Increasing the age at which drivers first begin to solo drive and the removal of the time-discount associated with completion of an educational program should be considered.