Collisions involving senior drivers: high-risk conditions and locations

OBJECTIVES: To better understand the characteristics of crashes involving senior drivers 65 and older, studies of these crashes were reviewed. METHODS: The review focused primarily on North American studies published since 1990. Studies point to important differences between the crashes of senior drivers and those of younger drivers. RESULTS. Numerous studies have found that senior drivers' crashes are much more likely than crashes of younger drivers to occur at intersections. Senior drivers have particularly high rates of involvement in intersection crashes when they are turning, and even more so when they are turning left. Senior drivers are more likely than younger drivers to have been at fault in these situations, typically because they failed to yield the right-of-way, disregarded the traffic signal, or committed some other traffic violation. Studies also suggest that the extent of overinvolvement of senior drivers in certain types of crashes generally increases with advancing age. CONCLUSIONS. The extent to which the distinctive characteristics of senior drivers' crashes may be due to changing travel patterns associated with aging, or physical or cognitive impairments related to the aging process, is unclear. Further research is needed to understand the pre-crash circumstances of older drivers' intersection crashes.     

Animal-related injuries: a population-based study of a five-state region in the upper Midwest: Regional Rural Injury Study II

PROBLEM: While agricultural injury has been identified among the major causes of occupational injury mortality and morbidity, data have been limited pertinent to the magnitude, consequences, and potential risk factors for animal-related injuries -- a major source of morbidity among agricultural operations. METHODS: Demographics, exposure, and injury data were collected for 1999 and 2001 among agricultural households in a five-state region. Causal models facilitated survey design, data analyses, and interpretation of results; directed acyclic graphs guided multivariate modeling. RESULTS: From 7,420 households (84% response of eligible), a total of 5,045 injury events were reported; 1,016 (20.1%) were animal-related. Multivariate analyses revealed increased risks for those <20 years; residents of all states compared to Minnesota; all age groups compared to 0-4 years; >0 hours worked; and prior agricultural injury history. For those 20+ years, increased risks were identified for: South Dakota residents; males; >0 hours worked; and prior agricultural injury history. For those cases <20 and 20+ years of age, 58% and 46%, respectively, resulted in lost work time on their agricultural operations (31% and 50%, one week or more). CONCLUSIONS: Animal-related injury has a major impact on the agricultural industry. Results serve as a basis for interventions and further research. IMPACT ON INDUSTRY: The impact of animal-related injuries on the agricultural industry appears significant; among age groups <20 and 20+, 85% and 82%, respectively, had some resulting restriction. For all events combined, 29% and 30%, respectively, involved restriction from one week to 3+ months; 12% and 15% involved restriction for one month or more. Among those <20 and 20+ years of age, 58% and 46%, respectively, lost work time on their own agricultural operation as a result of injuries associated with their own operation; 22% and 15% lost one week or more. Moreover, of the non-agriculture-related injuries, 31% and 50% resulted in lost work time on their own operation; 15% and 28%, respectively, lost one week or more. Restrictions such as these can affect the productivity of the operation, resulting in financial impacts, especially on small operations that have few people to manage the required tasks.     

Hardcore drinking drivers and other contributors to the alcohol-impaired driving problem: need for a comprehensive approach

OBJECTIVE: Understanding the hardcore drinking driver concept in the context of the alcohol-impaired driving problem. METHOD: Review of the relevant literature. RESULTS: As progress against alcohol-impaired driving slowed in the early 1990s, public and political attention turned to "hardcore" drinking drivers, and they have been a priority for the past 15 years. Though intuitive, the hardcore concept has been difficult to conceptualize. Its definition of hard-to-change chronic heavy drinking drivers focuses on a group that is not easily identifiable and ignores many who account for a large portion of alcohol-impaired driving crashes. These include drivers who drink heavily on occasion and drivers who drink at more moderate levels that elevate crash risk. Emphasis on the hardcore has focused attention on the small proportion of drinking drivers who have been detected and arrested, whereas the vast majority of drinking drivers go undetected. Some countermeasures aimed at the hardcore group have been effective in reducing recidivism, but attention and resources also need to be given to general deterrent initiatives (e.g., 0.08 g/dL, sobriety checkpoints, administrative license suspension). There has been no reduction in the overall alcohol-impaired driving problem since the mid-1990s. CONCLUSION: Reductions in the alcohol-impaired driving problem require that attention be focused on all relevant target groups. Some benefits could accrue by recognizing that countermeasures developed for hardcore drinking drivers, such as alcohol ignition interlocks and vehicle or plate impoundment, might also be effective with more numerous first-time offenders. However, such strategies are likely to be most effective against recidivism (specific deterrence). Greater gains could be achieved through general deterrent efforts (increasing the real and perceived risk of arrest and punishment to all drinking drivers), along with application of public health measures designed to reduce overall consumption. Additional ways need to be found to separate drinking and driving, either through cultural changes in drinking and/or driving behavior or, in the future, with the use of technology that can make vehicles inoperable by drivers with illegal blood alcohol concentrations.     

Effectiveness and driver acceptance of the Honda belt reminder system

OBJECTIVE: Prior research suggests that vehicle-based seat belt reminder systems can produce moderate increases in belt use rates. However, these findings were based on a limited set of Ford vehicles in one geographic location. As more vehicles with reminder systems enter the market, it is important to determine their effectiveness as well as acceptance by consumers. The present study investigated the effectiveness of Honda's belt reminder system. METHODS: Driver belt use was observed unobtrusively as drivers brought their Honda vehicles to dealerships for service. Drivers also were asked to complete a mail-in survey designed to elicit their experience with the system. RESULTS: Belt use was significantly higher among drivers of vehicles with belt reminders compared with drivers of vehicles without reminders (90 vs. 84 percent). Use rates in vehicles with reminders were higher among both male and female drivers and in all vehicle types observed. Drivers of the Honda vehicles with belt reminders viewed the system very favorably, and nearly 90 percent said they would want one in their next vehicle. The reminder was perceived to be most effective by part-time belt users; 81 percent of part-time users said they now use belts more often, compared with 32 percent of respondents who said they always use belts and 18 percent who use belts occasionally. CONCLUSION: Belt reminders in Honda as well as Ford vehicles are increasing. Although the increase is moderate (5.6 percentage points), on a national level it could have prevented at least 736 driver deaths in 2004.     

The effectiveness of electronic stability control in reducing real-world crashes: a literature review

OBJECTIVE: Electronic stability control (ESC) is designed to help drivers maintain heading control of their vehicles in high-speed or sudden maneuvers and on slippery roads. The wider proliferation of ESC across the vehicle fleet has allowed evaluation of its effects in real-world crashes in many countries, including Japan, Germany, Sweden, France, Great Britain, and the United States. This article provides a summary of the findings. METHODS: Studies that examined the real-world effectiveness of ESC were reviewed. Crash effects have been examined for different roadways, using differing analytic methods, different crash severities, and different make/model vehicles including both cars and SUVs. The review discusses the methodological differences and examines the findings according to vehicle type, crash type and severity, and road conditions. RESULTS: The overwhelming majority of studies find that ESC is highly effective in reducing single-vehicle crashes in cars and SUVs. Fatal single-vehicle crashes involving cars are reduced by about 30-50% and SUVs by 50-70%. Fatal rollover crashes are estimated to be about 70-90% lower with ESC regardless of vehicle type. A number of studies find improved effectiveness in reducing crashes when road conditions are slippery. There is little or no effect of ESC in all multi-vehicle crashes; however, there is a 17-38% reduction in more serious, fatal multi-vehicle crashes. CONCLUSIONS: Given the extraordinary benefits of ESC in preventing crashes, especially those with more serious outcomes, the implementation of ESC should be accelerated to cover the full range of passenger vehicles in both developed and developing markets.     

The older driver with dementia: an updated literature review

INTRODUCTION: At some point during their illness, drivers with dementia pose a public safety risk. METHOD: To address the issue of determining driving competence in drivers with dementia, the authors reviewed 11 studies. RESULTS: When comparing different driving assessments, the authors found that while road tests, simulators, and neuropsychological tests are important, each has limitations. CONCLUSION: Neuropsychological tests that highlighted visual spatial skills, attention, and reaction time provided the most meaningful correlations with driving performance. Furthermore, the authors recommend that patients with MMSE scores of 24 or less have a driving evaluation, and that driving evaluations be repeated at six month intervals or more frequently if a noticeable decline is observed. IMPACT: Because many older adults with dementia continue to drive, competence must be addressed.     

Other high-risk factors for young drivers--how graduated licensing does,doesn't,or could address them

PROBLEM: Young drivers, particularly those who are newly licensed, have a very high crash risk. This paper examines the risk factors underlying their high crash rates and assesses the extent to which existing graduated licensing programs address these risks and whether improvements to these programs should be considered. METHOD: Review and synthesis of the literature. RESULTS: The elevated risk among young drivers of being in an injury crash is the result of a number of factors found alone or in combination, such as risky driving, alcohol use, seat belt nonuse, driver distraction, fatigue, and vehicle choice. Nighttime and passenger restrictions, adopted widely in the United States, work by keeping drivers out of hazardous situations rather than by addressing risk factors directly. However, the risk factors remain in play in driving situations not specifically restricted by law. Although other graduated licensing components adopted around the world-more stringent exit tests (i.e., you need to pass a test to move to the next stage), hazard perception tests, and restrictions on speed, vehicle power, and roadway access-make sense based on the identified risk factors, they are not yet supported by research. Should research findings warrant it, consideration should be given to providing guidance to parents about how to keep their beginning drivers safe, including information on vehicle choice. IMPACT ON RESEARCH, PRACTICE, AND POLICY: Researchers should continue to monitor and to evaluate innovative approaches to reduce the crash risk of young drivers. The effectiveness of new approaches should be established before adoption on a wider scale takes place.     

Maternal serum human chorionic gonadotropin levels in twin pregnancies

Introduction of combined screening with maternal serum alpha-fetoprotein and human chorionic gonadotropin (MShCG) assays for fetal chromosome defects requires establishment of the normal range for twins. This report documents that the normal range for MShCG between 15 and 19 weeks in twin gestations was 1.84–2.41 multiples of the singleton median. Of the 192 twin pregnancies studied, 31.7 and 47.9 per cent had MShCG values ≥2.5 and ≥ 2.0 multiples of the singleton median, respectively.     

The effects of chemical protective suits on human performance

Workers in the chemical industry are often required to wear protective suits while performing tasks. While these suits can be life saving, they increase the difficulty and discomfort faced by the wearer. This research explores the performance of individuals wearing the highly cumbersome Level A suit. The suits are heat-retentive and can cause fatigue that affects performance by increasing response time and decreasing accuracy. Members of Missouri’s Civil Support Team (CST) served as subjects for this research. They conducted fine and gross motor tests. Their completion time and accuracy were evaluated both out-of-suit and in-suit for the Level A chemical protective suits.A t-test was conducted to evaluate the effect of the Level A suits on performance. Results showed a significant increase in completion time and errors for gross motor tasks. This type of task had up to a 103% increase in time required and up to a 34% decrease in accuracy. The suit’s impact on fine motor skill was also significant, but to a lesser extent. Repeated measures test was performed to evaluate any potential time-in-suit effect. A decrease in mean task completion time was observed for some of the tasks. There was a corresponding decrease in accuracy but no consistent time-in-suit effect was identified.The results indicate the need for care when designing procedures and equipement to be used by humans wearing restrictive PPE. It is important to take human limitations into consideration in the design phase in order to decrease the need for human adaptation and increase system safety. To achieve this, understanding human factors is imperative when designing equipment, tasks, or procedures for workers wearing PPE.