Motorcycle helmet effect on a per-crash basis in Thailand and the United States

OBJECTIVE: To compare the effectiveness of motorcycle helmets seen in prospective on-the-street motorcycle accident investigations. The data are drawn from two detailed, in-depth studies of motorcycle accidents, in which trained investigators collected extensive accident evidence on-scene immediately after the crash. This article compares helmeted and unhelmeted motorcycle riders on a per-accident basis for fatality rates, the rate of serious (AIS > 2) brain injuries among survivors, or an outcome that involved either of the two. METHODS: Nine hundred motorcycle crashes in Los Angeles and 969 crashes in Thailand were investigated in detail at the accident scenes, including photos of vehicles, skids, damage, and sometimes the rider. Helmets were collected and injury information was obtained from riders and care providers. This evidence was then used to reconstruct collision events to identify speeds, precrash motions, collision contacts, injury causation, and helmet performance. RESULTS: In both studies, approximately 6% of riders were killed and 20-25% were hospitalized. Overall, unhelmeted riders were two to three times as likely to be killed, and three times as likely to suffer either death or survival with AIS > 2 brain injury. Unhelmeted survivors had three to four times as many AIS > 2 brain injuries as helmeted riders on a per-crash basis. Nearly 100% of riders with AIS > 4 somatic injuries died. Such injuries were 30% of Thailand fatalities and 57% of L.A. fatalities, but only about 2-3% of the overall accident population. Among the 97-98% of riders with AIS < 5 somatic injuries, helmet use could prevent about three-fourths of fatalities and brain injuries. CONCLUSIONS: Helmets were extremely effective in preventing brain injury and death in 97% of the accident population in less-than-extreme crashes. Helmet use cannot prevent all fatalities because many of those killed succumb to below-the-neck injuries that a helmet cannot prevent.     

The effects of a mandatory motorcycle helmet law on helmet use and injury patterns among motorcyclist fatalities

BACKGROUND: The National Highway Traffic Safety Administration (NHTSA) has found that motorcycle helmets are 37% effective in preventing death and 65% effective in preventing brain injuries in a crash. Unfortunately, in 1995 Congress lifted federal sanctions against states without helmet laws and since then there have been a number of primary motorcycle helmet laws repealed or weakened. More lives could be saved and serious injuries avoided if there was increased helmet use throughout the United States. METHODS: This study analyzed helmet use and injury patterns among motorcycle riders in the United States involved in fatal crashes from 1995 through 2003 and compared the results between states with and without a primary helmet law. Age, sex, injury severity and helmet use are some of the variables obtained from the Fatality Analysis Reporting System (FARS). RESULTS: In the 20 states and the District of Columbia, which currently have a primary helmet law, 84.0% of fatally injured riders were wearing a helmet. In the 27 states with a secondary helmet law, 36.2% of fatalities used a helmet, and in the remaining three states with no law at all, helmet use dropped to 17.6%. In the two states (Arkansas and Texas) that changed from a primary helmet law to a secondary helmet law in 1997, helmet use decreased from 78.2% in 1996 to 31.7% in 2000. CONCLUSION: If all states were to enact a primary motorcycle helmet law, helmet use would dramatically increase while decreasing the number of motorcyclist head injuries and fatalities. IMPACT ON INDUSTRY: The results of this study will hopefully persuade law makers to enact primary helmet laws in all states throughout the nation. Helmet manufacturers can use this data to design more comfortable helmets while also improving upon the protective qualities of these safety devices.     

Utilization of state-wide hospital separations data and the injury impairment scale to assess the incidence of spinal cord injury arising from motor vehicle traffic crashes

The objectives of this study were to determine whether routine state-wide hospitalization data can be used for population level surveillance of the incidence of spinal cord injury (SCI) from motor vehicle traffic crashes (MVTCs) and to verify the coverage of the Australian Spinal Cord Injury Register. A method was developed to identify new injury incidents from routine South Australian hospitalization data. Mapping software was then used to derive the Abbreviated Injury Scale (AIS) and Injury Impairment Scale (IIS) codes for each incident case of spinal injury using the principal diagnosis code on the hospital data file. IIS code values in the range from 3 to 6 were considered to be comparable with the SCI coding criteria utilized by the Australian Spinal Cord Injury Register (ASCIR) which were based on the criteria of the American Spinal Injury Association. The number of estimated new incident cases of SCI based on the IIS coding of hospitalization data was compared with the actual number reported from the ASCIR. The case numbers were highly comparable overall and also by time and age group suggesting that the coverage of the ASCIR was very high. The results of the study support use of the IIS for estimating incident case numbers of MVTC-related SCI from routine state-wide hospitalization data. If routine hospital separations data elsewhere were suitable for the purpose and the IIS also proves to be applicable to non-MVTC-related SCI, the incidence of SCI could be monitored in state and national populations using the IIS and this could provide an alternative data source where registers of SCI do not exist. In addition, the IIS provides a means to assess coverage where registers do exist.     

How motorcycle helmets affect trauma mortality: Clinical and policy implications

Background: Motorcycles are the most popular vehicles in Taiwan, where more than 14.8 million motorcycles (1 motorcycle per 1.6 people) are in service. Despite the mandatory helmet law passed in 1997, less than 80% of motorcyclists in Taiwan wear helmets.

Objective: The objective of this study was to analyze the effect of using motorcycle helmets on fatality rates.

Methods: A clinical data set including 2,868 trauma patients was analyzed; the cross-sectional registration database was administered by a university medical center in Central Taiwan. A path analysis framework and multiple logistic regressions were used to estimate the marginal effect of helmet use on mortality.

Results: Using a helmet did not directly reduce the mortality rate but rather indirectly reduced the mortality rate through intervening variables such as the severity of head injuries, number of craniotomies, and complications during therapeutic processes. Wearing a helmet can reduce the fatality rate by 1.3%, the rate of severe head injury by 34.5%, the craniotomy rate by 7.8%, and the rate of complications during therapeutic processes by 1.5%. These rates comprise 33.3% of the mortality rate for people who do not wear helmets, 67.3% of the severe head injury rate, 60.0% of the craniotomy rate, and 12.2% of the rate of complications during therapeutic processes.

Discussion: Wearing a helmet and trauma system designation are crucial factors that reduce the fatality rate.     

Motorcycle conspicuity: An evaluation and synthesis of influential factors

Motorcycles are overrepresented in fatal motor vehicle accidents: The death rate for motorcycle riders of about 35 per 100,000,000 miles of travel compares with an overall vehicle death rate of 2.57 per 100,000,000 miles. In the attempt to reduce the frequency of automobile-motorcycle collisions, numerous studies have manipulated motorcycle and motorcyclist characteristics to enhance conspicuity. In this paper, we give a review of studies that examined the effectiveness of these measures. Subsequently, we take a critical look at the methods used in these studies to evaluate the effectiveness of conspicuity treatments. Furthermore, we identify factors yet to be considered in the empirical research in this area that may contribute to collisions with motorcycles. These include information-processing failures at the identification and decision stage, as well as more or less permanent factors potentially responsible for different information-processing failures. Transient factors related to the failure to detect motorcycles might include alcohol, fatigue/lack of sleep, inattention, and information overload, whereas more permanent factors might include “cognitive” conspicuity and fi eld dependence.     

Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome

Objective: Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists.

Method: This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated.

Results: The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this sample differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading; however, a larger sample of these injuries needs to be investigated.

Conclusion: Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.     

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.     

Characteristics and clinical outcomes of head-injured cyclists with and without helmets in urban and rural areas of Taiwan: A 15-year study

Objective: Bicycle riding is increasingly popular in Taiwan, but the number of cyclists injured and cyclists' death rates are both increasing. The aim of this study was to investigate the different characteristics and clinical outcomes of traffic accident–related head injuries among cyclists in urban and rural areas.

Methods: Records of 812 patients (533 urban and 279 rural) admitted to 27 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study. Demographics, details about the accident, protective helmet use, and clinical outcomes were then subjected to analysis.

Results: Urban victims were more likely to be injured during morning and early evening rush hours and rural victims during the day; most urban victims were between 19 and 34 years of age and injured in the slow lane; rural victims tended to be younger or older and were injured in the fast lane (all P ≤.001). Riders who wore a helmet were less likely to suffer loss of consciousness (odds ratio [OR] = 0.31), amnesia (OR = 0.069), neurological disorders (OR = 0.205), or facial fractures (OR = 0.369). Older age, more severe head injuries, and bicycle–motor vehicle collisions influenced the severity of symptoms on admission and the residual effects at discharge.

Conclusions: Differences in the characteristics of injuries in urban and rural areas and the utilization of protective helmets may help government authorities adopt appropriate policies to promote safer and more enjoyable cycling.     

Lifting technique and abdominal belt usage: a biomechanical, physiological and subjective investigation

Some 10 male subjects carried out a repetitive lifting task for 15 min under four conditions on separate days. Subjects used either a squat lifting or a stoop lifting technique with or without an abdominal belt on each day. Measurements of spinal shrinkage, heart rate, perceived exertion and regional body pain were made under each condition. Although there was a significant difference in spinal shrinkage under all lifting conditions compared with shrinkage during 15 min of quiet standing (4.36 ± 2.24 vs. 1.13 ± 1.18 mm), there were no significant differences in shrinkage between the conditions. The subjects' heart rates were higher during the squat lift than the stoop lift (123 vs. 97 beats/min; p < 0.001). While the squat lift was perceived to be the safest lift by 90% of the subjects, 60% regarded this lift as the least preferred method (with or without the belt). Although all 10 subjects perceived the safest lifting method to involve the use of the belt, 50% rated the belt as their least preferred lifting condition. The findings cast doubt on the efficacy and acceptability of both abdominal belts and the practice of training workers in ‘safe’ lifting techniques and indicate that individual characteristics and preferences need to be considered when attempting to improve the safety of manual handling operations in industry.     

Risk-taking, warning labels, training, and regulation: Are they associated with the use of helmets by all-terrain vehicle riders?

Training programs and warning labels have been advocated as a means of convincing consumers to follow safety precautions when using all-terrain vehicles (ATVs), and are emphasized in the recent consent decree signed between the Consumer Product Safety Commission and ATV manufacturers. An alternative approach is to mandate safe behavior through regulations and law. This field study of ATV operator behavior conducted in six states in 1988 and 1989 provides initial insight into the effectiveness of these approaches. Logit analysis revealed that helmet use was significantly higher when required by law or when riders had 3 or more years of riding experience. Helmet use was significantly lower when riders rode frequently, when helmets were perceived as uncomfortable or not used on motorcycles, and when subjects had been moderately or seriously injured in ATV accidents. The presence of warning labels, reading of a manual, and participation in a training course were not significantly related to helmet use.     

Occupational injury and accident research: A comprehensive review

In this paper, a comprehensive review of the concepts of occupational injury and accident causation and prevention is presented. Starting with hazard identification, the issues on risk assessment, accident causation, and intervention strategies are discussed progressively. The distinctiveness and overlaps in accident and injury research are highlighted. Both empirical research in terms of hypotheses tested and theoretical research such as accident causation models are compared and contrasted. Finally, based on the critical appraisal of the comprehensive review, future research directions on occupational injury research are delineated.     

Adolescent driving: Characteristics associated with single-vehicle and injury crashes

The high motor-vehicle crash rate of young drivers may be attributed to both driving inexperience and a greater tendency to engage in risk-taking behavior. This study examines risk-taking behavior, as indicated by single-vehicle crashes and injury crashes, and factors associated with these behaviors, based on measures of demographic, psychosocial, and substance use obtained from high school senior questionnaires. Because previous work indicated different predictors for young men and young women, separate logistic regression analyses were conducted. For young women, propensity toward cigarette use was associated with higher rates of single-vehicle crashes; while race, alcohol misuse, and friends' involvement with alcohol and marijuana were associated with injury crashes. For young men, availability of substances, driving frequency, alcohol misuse, and propensity toward marijuana use were associated with higher rates of single-vehicle crashes. Young men's living situation, availability of substances, and marijuana use were related to injury crashes.     

Seatbelt non-use and car crash injury: an interview study

OBJECTIVES: To examine the relationship between seatbelt non-use at the time of a crash, habitual non-use of seatbelts, and car crash injury; and to calculate the population attributable risk for car crash injury due to seatbelt non-use. METHODS: A population-based case control, interview study in Auckland, New Zealand, with 571 injured or killed drivers as cases and 588 population-based controls randomly selected from the driving population. RESULTS: Unbelted drivers had 10 times the risk of involvement in an injury crash compared to belted drivers after adjustment for multiple confounders. Habitual non-users were likely to be unbelted when involved in a crash. The population attributable risk for seatbelt non-use was 13%. CONCLUSIONS: Non-use of seatbelts is very strongly associated with increased injury crash involvement. Even where seatbelt use rates are higher than 90%, there remains a small group of habitual non-users who are at high risk; these drivers may benefit from targeted interventions.     

Underground coal mining injury: A look at how age and experience relate to days lost from work following an injury

Coal has been mined in the United States since colonial times and coal mining has always been a dangerous occupation. Despite the dangers involved in coal mining, coal is essential to the functioning of our society. Coal provides energy for products, businesses, and homes. Not only is coal mining a dangerous occupation, but, like many other industries, coal mining has also been referred to as a “graying occupation” as many coal miners are reaching retirement age. Younger workers possess certain advantages as older workers may have age-associated decrements in cognitive function, health, and recuperative ability. Although there are documented decreases in health and safety associated with age, there are also benefits at the workplace associated with increasing age. Increasing age brings about more experience and familiarity with the work environment. This study used the Mine Safety and Health Administration’s (MSHA) database on accidents, injury, and illness from the years 2003 through 2007 to examine how age, experience at the current mine, total years experience as a coal miner, and experience in the current job affects injury severity. The results of the data indicated that there was a relationship between age and days lost as well as total mining experience and days lost following an injury. Furthermore, the data indicated an increased risk of overexertion injuries as age increases. These are important findings for the coal mining industry as many miners are more experienced and older.     

The injury problem among older adults: mortality, morbidity and costs

The Journal of Safety Research has partnered with the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the seventh in a series of CDC articles.