The state of the residential fire fatality problem in Sweden: Epidemiology,risk factors,and event typologies

IntroductionResidential fires represent the largest category of fatal fires in Sweden. The purpose of this study was to describe the epidemiology of fatal residential fires in Sweden and to identify clusters of events.MethodData was collected from a database that combines information on fatal fires with data from forensic examinations and the Swedish Cause of Death-register. Mortality rates were calculated for different strata using population statistics and rescue service turnout reports. Cluster analysis was performed using multiple correspondence analysis with agglomerative hierarchical clustering.ResultsMale sex, old age, smoking, and alcohol were identified as risk factors, and the most common primary injury diagnosis was exposure to toxic gases. Compared to non-fatal fires, fatal residential fires more often originated in the bedroom, were more often caused by smoking, and were more likely to occur at night. Six clusters were identified. The first two clusters were both smoking-related, but were separated into (1) fatalities that often involved elderly people, usually female, whose clothes were ignited (17% of the sample), (2) middle-aged (45–64 years old), (often) intoxicated men, where the fire usually originated in furniture (30%). Other clusters that were identified in the analysis were related to (3) fires caused by technical fault, started in electrical installations in single houses (13%), (4) cooking appliances left on (8%), (5) events with unknown cause, room and object of origin (25%), and (6) deliberately set fires (7%).ConclusionsFatal residential fires were unevenly distributed in the Swedish population. To further reduce the incidence of fire mortality, specialized prevention efforts that focus on the different needs of each cluster are required.Practical applicationsCooperation between various societal functions, e.g. rescue services, elderly care, psychiatric clinics and other social services, with an application of both human and technological interventions, should reduce residential fire mortality in Sweden.     

Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles

Objective: There have been substantial reductions in motor vehicle crash–related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database.

Methods: Instances of non-traffic injuries and fatalities in the United States to children 0–14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication.

Results: Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths.

Conclusions: Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.     

Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket,Thailand

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system’s ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand.

Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS’s usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system).

Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket.

Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket’s road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.     

Etiology of fatal thoracic aortic injuries: Secondary data analysis

Objectives: Motor vehicle crashes remain a leading cause of death in the United States (US). Thoracic aortic dissection due to blunt trauma remains a major injury mechanism, and up to 90% of these injuries result in death on the scene. The objective of this study is to understand the modern risk factors and etiology of fatal thoracic aortic injuries in the current US fleet.

Methods: Using a unique, linked, Fatality Analysis Reporting System (FARS) and Multiple Cause of Death (MCOD) database from 2000–2010, 144,169 drivers over 16 years of age who suffered fatal injuries were identified. The merged database provides an unparalleled fidelity for identifying thoracic aortic injuries due to motor vehicle accidents. Thoracic aortic injuries were defined by ICD-10 codes S250. Univariate and multivariate logistic regression models for presence of any thoracic aortic injuries were fitted. Age, gender, BMI weight categories, vehicle class, model year, crash type/direction, severity of crash damage, airbag deployment location, and seatbelt use, fatal injury codes, and location of injury were considered. Odds ratios (OR) and corresponding 95% confidence intervals (95%CI) are calculated.

Results: There were 2953 deaths (2.10%) related to thoracic aortic injuries that met the inclusion criteria. Nearside crashes were associated with an increased odds (OR = 1.42, 1.1-1.83), while rollover crashes (OR =.44,.29-.66) were associated with a reduced odds of fatal thoracic aortic injury. Using backward selection on the full multivariate model, the only significant model effects that remained were vehicle type, crash type, body region, and injury type.

Conclusions: The increased prevalence of fatal thoracic aortic injury in nearside crashes, increasing age, and vehicle type provide some insight into the current US fleet. Important factors, including model year, had significantly lower levels of the injury in univariate analysis, demonstrating the effect of safety improvements in newer model vehicles. Further study of this fatal injury is warranted, including comparisons of those who survive the injury.     

Time of day effects on railroad roadway worker injury risk

IntroductionThe purpose of this study is to examine how time of day affects injury risk of railroad maintenance of way employees and signalmen (roadway workers). Railroads reported 15,654 serious roadway worker injuries between 1997 and 2014. Roadway workers primarily work outdoors on or near railroad tracks and frequently encounter hazardous conditions. To avoid closing an active rail line during peak hours, railroads sometimes require roadway workers to work at night. Previous studies of roadway worker injury have not adequately accounted for exposure to time of day effects, nor have they investigated the human factors issues contributing to roadway worker injury.MethodThe Federal Railroad Administration (FRA) database of injury reports provided data for circadian rhythm models of the odds of fatal and nonfatal injuries. The FRA database and fatal injury investigation reports also permitted an analysis of the circumstances and the human factors issues associated with injuries that occur at different times of day.ResultsOdds of injury increased during nighttime work. The odds of nonfatal injury for both roadway worker crafts rose above 9:1 in the early morning hours. The relative odds of a fatal injury also increased significantly at night. A human factors analysis suggested that during all three shifts most nonfatal injuries involve workload, but workload was not identified as a factor in fatal injuries.ConclusionsNighttime work is more hazardous for roadway workers than daytime work. Several factors related to fatigue and other conditions appear to increase the risk of injury during the outdoor, nighttime work required of roadway workers.Practical applicationFor practical reasons, nighttime roadway work is sometimes unavoidable. Therefore, new practices for nighttime work must be developed to adequately address fatigue and protect roadway workers from harm.     

Fatal crashes involving large numbers of vehicles and weather

IntroductionAdverse weather has been recognized as a significant threat to traffic safety. However, relationships between fatal crashes involving large numbers of vehicles and weather are rarely studied according to the low occurrence of crashes involving large numbers of vehicles.MethodBy using all 1,513,792 fatal crashes in the Fatality Analysis Reporting System (FARS) data, 1975–2014, we successfully described these relationships.ResultsWe found: (a) fatal crashes involving more than 35 vehicles are most likely to occur in snow or fog; (b) fatal crashes in rain are three times as likely to involve 10 or more vehicles as fatal crashes in good weather; (c) fatal crashes in snow [or fog] are 24 times [35 times] as likely to involve 10 or more vehicles as fatal crashes in good weather. If the example had used 20 vehicles, the risk ratios would be 6 for rain, 158 for snow, and 171 for fog.ConclusionsTo reduce the risk of involvement in fatal crashes with large numbers of vehicles, drivers should slow down more than they currently do under adverse weather conditions. Driver deaths per fatal crash increase slowly with increasing numbers of involved vehicles when it is snowing or raining, but more steeply when clear or foggy.Practical applicationsWe conclude that in order to reduce risk of involvement in crashes involving large numbers of vehicles, drivers must reduce speed in fog, and in snow or rain, reduce speed by even more than they already do.     

Assessing regulatory effectiveness with exogenously declining risk: a case study of the CPSC's 1973 mattress standard

INTRODUCTION: This paper examines the contribution of the U.S. Consumer Product Safety Commission's (CPSC) 1973 cigarette ignition mattress flammability standard to reduce mattress fires since 1980, when the U.S. Fire Administration's National Fire Incident Reporting System became fully operational. METHOD: The paper attempts to separate the effect of the cigarette ignition standard from the declining trend in mattress fires that would have resulted without the standard. We analyze the impact of the 1973 cigarette standard on smoking material ignition fires, deaths, and injuries as well as its effect on fires, deaths, and injuries from all ignition sources (smoking material ignitions, open-flame ignitions, and other ignition sources). Impacts on Industry: The results suggest that the 1973 mattress standard has effectively reduced the mattress fire risk and that further reductions in risk via actions tied specifically to cigarette ignition are likely to be difficult to achieve.     

The potential of vehicle and road infrastructure interventions in fatal bicyclist accidents on Swedish roads—What can in-depth studies tell us?

Abstract

Objective: The objective of this article is to describe the characteristics of fatal crashes with bicyclists on Swedish roads in rural and urban areas and to investigate the potential of bicycle helmets and different vehicle and road infrastructure interventions to prevent them. The study has a comprehensive approach to provide road authorities and vehicle manufacturers with recommendations for future priorities.

Methods: The Swedish Transport Administration’s (STA) in-depth database of fatal crashes was used for case-by-case analysis of fatal cycling accidents (2006–2016) on rural (n?=?82) and urban (n?=?102) roads. The database consists of information from the police, medical journals, autopsy reports, accident analyses performed by STA, and witness statements. The potential of helmet use and various vehicle and road infrastructure safety interventions was determined retrospectively for each case by analyzing the chain of events leading to the fatality. The potential of vehicle safety countermeasures was analyzed based on prognoses on their implementation rates in the Swedish vehicle fleet.

Results: The most common accident scenario on rural roads was that the bicyclist was struck while cycling along the side of the road. On urban roads, the majority of accidents occurred in intersections. Most accidents involved a passenger car, but heavy trucks were also common, especially in urban areas. Most accidents occurred in daylight conditions (73%). Almost half (46%) of nonhelmeted bicyclists would have survived with a helmet. It was assessed that nearly 60% of the fatal accidents could be addressed by advanced vehicle safety technologies, especially autonomous emergency braking with the ability to detect bicyclists. With regard to interventions in the road infrastructure, separated paths for bicyclists and bicycle crossings with speed calming measures were found to have the greatest safety potential. Results indicated that 91% of fatally injured bicyclists could potentially be saved with known techniques. However, it will take a long time for such technologies to be widespread.

Conclusions: The majority of fatally injured bicyclists studied could potentially be saved with known techniques. A speedy implementation of important vehicle safety systems is recommended. A fast introduction of effective interventions in the road infrastructure is also necessary, preferably with a plan for prioritization.     

Population-based assessment of a vehicle fleet with seat belts providing lower shoulder belt forces than today

Objective: The objective of this study was to quantify the population-based effects of a lower shoulder belt load limit on front row occupants in frontal car crashes.

Method: Crashes of modern vehicles from the GIDAS (German In-Depth Accident Study) are corrected for bias and projected to the national level. Injury risk functions are computed for the injury severity levels Maximum Abbreviated Injury Scale (MAIS) 2+, MAIS 3+, and fatal, stratified by 2 age cohorts (16–44 years of age and 45 years or older). To assess the field effectivity of a “softer belt,” the projected crash frequency data are modified separately for the 2 age cohorts such that its risk structure represents the risk of a softer belt. Given those 2 samples, the field effectivity of a softer belt is derived for several shares of the younger age cohort according to the injury severity levels MAIS 2+, MAIS 3+, and fatal.

Results: The injury risk distribution of the projected crash frequency data, represented here by the injury risk functions obtained, fits well into the injury risk distribution of other data sets (Sweden, United States, and Japan) given in the literature. The relative effects of a lower belt force are stable over the different ratios of the younger and old age cohorts. At the MAIS 2+ level, a lower belt force can significantly reduce the number of injuries (about 10%). A lower belt force does not significantly affect the number of MAIS 3+ injuries. A lower belt force can, however, more than double the number of fatal injuries.

Conclusions: Because the number of fatal injuries rises dramatically due to lower belt force, the reduction in the number of MAIS 2+ injuries comes at a very high cost. Therefore, whether reducing the belt force limit is the right approach is questionable.     

Disparities in the prevalence of smoke alarms in U.S. households: Conclusions drawn from published case studies

Introduction

Deaths from fires and burns are a leading cause of fatal home injury in the United States. Smoke alarms are one of the most effective interventions to prevent residential fire deaths. Nationwide, more than 95% of homes are estimated to have at least one smoke alarm. There is evidence that homes at highest risk of fire deaths lag behind national averages in smoke alarm use and maintenance.

Method

We compiled a comprehensive list of published studies that focus on smoke alarm prevalence in high-risk homes. Our findings show that there are substantial gaps in both smoke alarm presence and functional status between high-risk homes and national average estimates.

Conclusions

To save more lives, improved efforts are needed to reduce the disparity in smoke alarm prevalence and functional use in the United States.     

Tractor rollover fatalities,analyzing accident scenario

IntroductionIn many countries, traditional data sources for collecting injuries of workers covered by compulsory accident insurance have recently been integrated by new observatories whose results may differ. A comparative analysis of the Italian data collection systems related to fatal tractor accidents in agriculture was performed focusing on tractor rollover fatalities with the aim of analyzing the accident scenario.MethodData from the Operational Archives of the Italian Workers Compensation Authority (INAIL), which collects injuries of workers covered by compulsory accident insurance and those of the National Surveillance System (INAIL_ASL), which provides narrative text reports of work-related fatal accidents have been analyzed and compared to the information collected by the INAIL Observatory. The INAL Observatory was recently set up to complement the collection of fatal accidents involving agricultural machinery. Italian data were then compared to data available at an international level. Fatal tractor accidents vary considerably with respect to fatal accidents in agriculture, being 10.6 and 43.7% for the Operational Archives and Surveillance System, respectively. National Surveillance System records, implemented with narrative texts allowed the accident scenario to be defined.Results71.7% of fatal tractor-related accidents refer to non-ROPS equipped vehicles and of these, 26.5% involved machines originally mounted with a ROPS that had been removed or was inoperative in the folded-down position during the rollover event. Just one fatal event from a collapsed ROPS on the overturned tractor was recorded. It is interesting that 16.6% of fatal accidents involved a clear environmental factor.Practical applicationA campaign to train tractor drivers on the correct use of the combination ROPS and seatbelt can contribute to decreasing rollover events with fatal outcomes. Contemporarily a strict requirement to install ROPS and a seatbelt on tractors, combined to an official inspection at the farm level, can increase the chance of survival in a rollover accident.     

Crash risk of ESC-fitted passenger cars

Objective: We examined both fatal and injury at-fault crashes of a population of passenger cars fitted with electronic stability control (ESC). Crash rates were calculated in relation to both registration years and mileage. Crash rates were also calculated for a non-ESC car population and crash rate ratios were calculated to compare the crash risk between ESC-fitted and non-ESC-fitted passenger cars.

Methods: Passenger car models with and without ESC were identified (ESC-equipped cars: 3,352,813 registration years; non-ESC-equipped: 5,839,946 registration years) and their vehicle information for the period 2009–2013, including mileage (ESC-equipped vehicles: 89.3 billion kilometers; non-ESC-equipped: 72.4 billion kilometers), was drawn from the national Vehicular and Driver Data Register.

The registry of Finnish road accident investigation teams was accessed and all fatal at-fault crashes among the cars in the study populations (ESC 97; non-ESC 377) for the period 2009–2013 were analyzed. The motor insurance database includes at-fault crashes leading to injuries and was utilized for analyses (ESC: N?=?8,827, non-ESC: N?=?21,437).

Crash rates and crash rate ratios were calculated to evaluate crash risk of both ESC-equipped and non-ESC-equipped passenger cars. Poisson regression was used to model crash involvement rate ratios both per registration year and per mileage for vehicles with ESC and without ESC, controlling for age and gender of the vehicle owner and vehicle mass.

Results: Passenger cars fitted with ESC showed lower crash rates than non-ESC-equipped cars in all crash types studied. In general, the difference in crash rates between ESC-equipped and non-ESC-equipped vehicles was greater when the crashes were compared to the mileage rather than registration years. The mileage-proportional crash rate of ESC-equipped cars was 64% (95% confidence interval, 61%; 67%) lower in run-off-road crashes resulting in injury and as much as 82% (65%; 91%) lower in fatal run-off-road crashes when suicides and disease attacks were not taken into account.

Conclusions: Our results show that modern passenger cars provide a significant crash risk reduction, which depends on both ESC and passive safety features introduced. Results also show that exposure evaluation in terms of registration years (or vehicle population) instead of true mileage can provide an overly pessimistic view of the crash risk.     

油品火灾形势分析研究

根据<中国消防年鉴对近年油品火灾起数、造成人员伤亡、直接财产损失、起火原因等情况进行分析,揭示油品火灾的特点和规律,分析油品消防安全工作的薄弱环节和重点方向,并对今后如何做好油品消防安全工作提出对策和建议.     

The direct costs of fatal and non-fatal falls among older adults — United States

IntroductionThis study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars.MethodIncidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index.ResultsIn 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women.ConclusionMedically treated falls among older adults, especially among older women, are associated with substantial economic costs.Practical applicationWidely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.     

Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden

IntroductionInjuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren.MethodsTwo samples were used: a population-based register study containing data from 18,416 children ranging from the ages of 6–17 years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (~ 15 years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using χ²-tests and log-binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls.ResultsAfter adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 1.32–2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27–1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57–1.14]).ConclusionsThe results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies.Practical applicationsParents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.     

Fatal injuries among Hispanic workers in the U.S. construction industry: Findings from FACE investigation reports

IntroductionIdentifying and understanding the characteristics of workplace accidents can provide vital information required to clarify their causes and prevent similar accidents from happening in the future. The Hispanic workforce represents a significant segment of the U.S. construction labor force that is projected to continue increasing in population. The government statistical data show higher rates of fatalities among Hispanic workers when compared to other ethnic groups.MethodThis study aims to provide details about the trends of fatal injuries among Hispanic workers. The study examined 92 government investigation reports to reveal the general trends, then an examination of fatal fall injuries within the study sample was conducted since falling is the predominant cause of fatal injuries.ResultsThe findings suggest differences in accident characteristics between Hispanic workers and all workers, which could indicate a need for different interventions to improve the overall site safety. The study also revealed the dire need to propose revised investigation procedures that would help identify the root causes of accidents, which in turn leads to better recommendations and interventions.     

Decreasing residential fire death rates and the association with the prevalence of adult cigarette smoking — United States, 1999–2015

IntroductionEach year from 1999 through 2015, residential fires caused between 2,000 and 3,000 deaths in the U.S., totaling approximately 45,000 deaths during this period. A disproportionate number of such deaths are attributable to smoking in the home. This study examines national trends in residential fire death rates, overall and smoking-related, and their relationship to adult cigarette smoking prevalence, over this same period.MethodsSummary data characterizing annual U.S. residential fire deaths and annual prevalence of adult cigarette smoking for the years 1999–2015, drawn from the National Vital Statistics System, the National Fire Protection Association, and the National Health Interview Survey were used to relate trends in overall and smoking-related rates of residential fire death to changes in adult cigarette smoking prevalence.ResultsStatistically significant downward trends were identified for both the rate of residential fire death (an average annual decrease of 2.2% – 2.6%) and the rate of residential fire death attributed to smoking (an average annual decrease of 3.5%). The decreasing rate of residential fire death was strongly correlated with a gradually declining year-to-year prevalence of adult cigarette smoking (r = 0.83), as was the decreasing rate of residential fire death attributed to smoking (r = 0.80).Conclusions and practical applicationsDecreasing U.S. residential fire death rates, both overall and smoking-related, coincided with a declining prevalence of adult cigarette smoking during 1999–2015. These findings further support tobacco control efforts and fire prevention strategies that include promotion of smoke-free homes. While the general health benefits of refraining from smoking are widely accepted, injury prevention represents a potential benefit that is less recognized.