Estimated Injury Risk for Specific Injuries and Body Regions in Frontal Motor Vehicle Crashes

Objective: Injury risk curves estimate motor vehicle crash (MVC) occupant injury risk from vehicle, crash, and/or occupant factors. Many vehicles are equipped with event data recorders (EDRs) that collect data including the crash speed and restraint status during a MVC. This study's goal was to use regulation-required data elements for EDRs to compute occupant injury risk for (1) specific injuries and (2) specific body regions in frontal MVCs from weighted NASS-CDS data.

Methods: Logistic regression analysis of NASS-CDS single-impact frontal MVCs involving front seat occupants with frontal airbag deployment was used to produce 23 risk curves for specific injuries and 17 risk curves for Abbreviated Injury Scale (AIS) 2+ to 5+ body region injuries. Risk curves were produced for the following body regions: head and thorax (AIS 2+, 3+, 4+, 5+), face (AIS 2+), abdomen, spine, upper extremity, and lower extremity (AIS 2+, 3+). Injury risk with 95% confidence intervals was estimated for 15–105 km/h longitudinal delta-Vs and belt status was adjusted for as a covariate.

Results: Overall, belted occupants had lower estimated risks compared to unbelted occupants and the risk of injury increased as longitudinal delta-V increased. Belt status was a significant predictor for 13 specific injuries and all body region injuries with the exception of AIS 2+ and 3+ spine injuries. Specific injuries and body region injuries that occurred more frequently in NASS-CDS also tended to carry higher risks when evaluated at a 56 km/h longitudinal delta-V. In the belted population, injury risks that ranked in the top 33% included 4 upper extremity fractures (ulna, radius, clavicle, carpus/metacarpus), 2 lower extremity fractures (fibula, metatarsal/tarsal), and a knee sprain (2.4–4.6% risk). Unbelted injury risks ranked in the top 33% included 4 lower extremity fractures (femur, fibula, metatarsal/tarsal, patella), 2 head injuries with less than one hour or unspecified prior unconsciousness, and a lung contusion (4.6–9.9% risk). The 6 body region curves with the highest risks were for AIS 2+ lower extremity, upper extremity, thorax, and head injury and AIS 3+ lower extremity and thorax injury (15.9–43.8% risk).

Conclusions: These injury risk curves can be implemented into advanced automatic crash notification (AACN) algorithms that utilize vehicle EDR measurements to predict occupant injury immediately following a MVC. Through integration with AACN, these injury risk curves can provide emergency medical services (EMS) and other patient care providers with information on suspected occupant injuries to improve injury detection and patient triage.     

New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

Adaptive co-management and network learning in the Room for the River programme

Adaptive co-management and learning are paramount for integrated flood risk management. Relevant literature focuses on adaptation at the level of physical and societal systems. The level of projects and programmes is largely overlooked, but they comprise interventions that adapt our physical systems and they provide opportunities for learning to contribute to transitions of societal systems. This paper aims to increase understanding on how learning takes place and can be stimulated within a programme. The mixed-method case study of Room for the River, a €2.3 billion programme for flood risk management, shows that a programme can be organised using various governance arrangements to stimulate learning and be a means for adaptive co-management to deliver upon environmental objectives.     

Parental supervision and discomfort with children walking to school in low-income communities in Cape Town,South Africa

Objective: The risk of pedestrian injury is compounded for children living in low-income communities due to factors such as poor road and pedestrian infrastructure, reliance on walking as a means of transport, and compromised supervision. Parents play an important role in child pedestrian safety. The primary objective of this study was to examine the effects of child pedestrian variables on parental discomfort with regard to letting their child walk to and from school and on the frequency of adult supervision.

Methods: A cross-sectional study was conducted using a convenience sample from 3 schools participating in a pedestrian safety school initiative. The schools are situated in low-income, high-risk communities in the City of Cape Town. A parent survey form was translated into isiXhosa and sent home with learners to those parents who had consented to participate. The response rate was 70.4%, and only parents of children who walk to and from school were included in the final sample (n = 359). Child pedestrian variables include the time taken to walk to school, parental rating of the child's ability to safely cross the road, and the frequency of adult supervision.

Results: More than half of parents reported that their child walked to and from school without adult supervision. About 56% of children took less than 20 min to walk to school. Most parents (61%) were uncomfortable with their child walking to school, although the majority of parents (55.7%) rated their child's ability to cross the road safely as better or significantly better than average (compared to peers). The parents did not perceive any differences in pedestrian risk factors between boys and girls or between younger (6–9 years) and older (10–15 years) children. The time spent by a child walking to school and parents' perceptions of their child's road-crossing ability were found to be significant predictors of parental discomfort (in letting their child walk). Younger children and children who spent less time walking were more likely to be supervised by an adult.

Conclusions: Many South African schoolchildren have to navigate the roads without adult supervision from a young age. Caregivers, especially in low-income settings, often have limited options with regard to getting their child to school safely. Regardless of the child's age and gender, the time that they spend on the roads is an important factor for parents in terms of pedestrian safety.     

Minimizing irrigation water demand: An evaluation of shifting planting dates in Sri Lanka

Climate change coupled with increasing demands for water necessitates an improved understanding of the water–food nexus at a scale local enough to inform farmer adaptations. Such assessments are particularly important for nations with significant small-scale farming and high spatial variability in climate, such as Sri Lanka. By comparing historical patterns of irrigation water requirements (IWRs) to rice planting records, we estimate that shifting rice planting dates to earlier in the season could yield water savings of up to 6%. Our findings demonstrate the potential of low-cost adaptation strategies to help meet crop production demands in water-scarce environments. This local-scale assessment of IWRs in Sri Lanka highlights the value of using historical data to inform agricultural management of water resources when high-skilled forecasts are not available. Given national policies prioritizing in-country production and farmers’ sensitivities to water stress, decision-makers should consider local degrees of climate variability in institutional design of irrigation management structures.     

Impact of conservation areas on trophic interactions between apex predators and herbivores on coral reefs

Apex predators are declining at alarming rates due to exploitation by humans, but we have yet to fully discern the impacts of apex predator loss on ecosystem function. In a management context, it is critically important to clarify the role apex predators play in structuring populations of lower trophic levels. Thus, we examined the top‐down influence of reef sharks (an apex predator on coral reefs) and mesopredators on large‐bodied herbivores. We measured the abundance, size structure, and biomass of apex predators, mesopredators, and herbivores across fished, no‐take, and no‐entry management zones in the Great Barrier Reef Marine Park, Australia. Shark abundance and mesopredator size and biomass were higher in no‐entry zones than in fished and no‐take zones, which indicates the viability of strictly enforced human exclusion areas as tools for the conservation of predator communities. Changes in predator populations due to protection in no‐entry zones did not have a discernible influence on the density, size, or biomass of different functional groups of herbivorous fishes. The lack of a relationship between predators and herbivores suggests that top‐down forces may not play a strong role in regulating large‐bodied herbivorous coral reef fish populations. Given this inconsistency with traditional ecological theories of trophic cascades, trophic structures on coral reefs may need to be reassessed to enable the establishment of appropriate and effective management regimes. El Impacto de las Áreas de Conservación sobre las Interacciones Tróficas entre los Depredadores Dominantes y los Herbívoros en los Arrecifes de Coral     

Comparison of Canadian firefighters and healthy controls based on submaximal fitness testing and strength considering age and gender

Introduction. Few studies have addressed whether firefighters are fitter than the general population and possess sufficient levels of aerobic capacity and muscle strength to perform on-duty tasks in a safe and efficient manner, considering age and gender. We aimed to evaluate the fitness levels of Hamilton firefighters, and to determine the effects of age and gender. Methods. In total, 89 participants were recruited. The modified Canadian aerobic fitness test was used to determine participants’ estimated maximal oxygen consumption (V_O2max) levels. For upper and lower body strength levels, a calibrated J-Tech hand-held dynamometer and a National Institute for Occupational Safety and Health (NIOSH) lifting device was used respectively. Results. Firefighters’ mean (SD) V_O2max level was 40.30?±?6.25?ml·kg^?1·min^?1. Age proved to have a statistically significant impact on V_O2max (p?<?0.001). Gender displayed statistically significant effects on strength levels. Firefighters’ age was the only statistically significant independent variable, and accounted for 61.00% of the variance in firefighters’ aerobic capacity levels. Conclusions. Firefighters possessed somewhat similar aerobic capacities but much higher levels of body strength when compared with the general population. With age, firefighters’ aerobic capacities decreased; however, their upper and lower body strength levels remained the same.