A survey of rural road fatalities

Epidemiology of bicycle injuries in 13 health divisions, Islamic Republic of Iran 2003

Bicyclists are vulnerable road users for severe injury all over the world. The nature and extent of such injuries are less well known in Iran. Using data from a comprehensive survey conducted by the Ministry of Health and Medical Education in 13 health divisions of Iran, in 2003, we examined circumstances around bicyclist injury and death. Trained health workers completed the survey instruments by interviewing patients who stayed more than 24h in hospitals and/or relatives, hospital personnel and by reviewing patient charts. Data were cross-matched with medico-legal documents to prevent missing deaths. The information that was collected from 64 cities/towns' emergency departments (EDs), over the study period, showed that 440 injured cyclists were hospitalized and/or died due to traffic collisions. Most injuries occurred in males (94.8%) and in the young (median age: 14 years with 75% </=18 years). Head injury occurred in 14% of all hospitalized and in 90% of fatally injured bicyclists. Striking a moving vehicle increased the odds of death (OR: 32.3; 95% CI 3.5-291.0) as well as the odds of severe injury (OR: 1.9; 95% CI 1.2-3.2) compared with other mechanisms of injury. As a conclusion, bicyclists in Iran, particularly males and young children, are vulnerable to severe injury and death when struck by moving vehicles on highways.

Resources for managing trauma in rural New South Wales, Australia

BACKGROUND

Trauma bypass is not always appropriate in the management of rural trauma because of the large distances and travel times. Rural hospitals in New South Wales, Australia are an essential component of the statewide integrated trauma system. The present study profiles the trauma resources of base hospitals in rural New South Wales.

METHODS

A structured questionnaire, addressed to the 'Director, Emergency Department' was distributed to all rural base hospitals in New South Wales. Follow-up telephone interviews were administered to complete data collection.

RESULTS

Fourteen hospitals were identified. General and orthopaedic surgeons provided trauma care in all hospitals. Forty-three per cent of hospitals had resident subspecialty surgeons. Fifty per cent of hospitals had a formal hospital trauma team. In the remaining hospitals, the most common reason (86%) stated for the absence of a formal trauma team was a lack of personnel to provide 24 h immediate response to all trauma presentations. Seventy-one per cent of hospitals are staffed by a single doctor after hours. All hospitals had 24 h access to plain radiography and blood products. 86% had 24 h access to ultrasound and computed tomography, although always on an 'on-call' basis after hours. All hospitals had the capability to maintain ventilated patients, averaging two ventilated beds per hospital. An average of two trauma patients per hospital per month is transferred to a larger institution. Sixty-four per cent of hospitals participated in a trauma retrievals for their surrounding areas. Seventy-one per cent of hospitals engaged in quality assurance activities regarding trauma outcomes.

CONCLUSIONS

Formal responses to major trauma in rural base hospitals in New South Wales are often restricted by a lack of specialist medical personnel. Nevertheless, the majority of hospitals have the resources to manage major trauma.

Rural vs urban motor vehicle crash death rates: 20 years of FARS data

OBJECTIVES

Historically, motor vehicle crash (MVC)-related mortality is higher in rural areas than in urban areas. The authors evaluated whether the difference in rural and urban MVC deaths is persisting, and whether the frequency of patients being found dead at the scene, particularly in rural areas, is increasing.

METHODS

Fatal Accident Reporting System (FARS) data for 1977 through 1996 were reviewed. The authors determined the frequency with which crash deaths occurred, and calculated population-based and vehicle-miles-traveled-based crash death rates. They compared rates for urban and rural areas.

RESULTS

A total of 875,405 crash deaths were included in the analysis. Both population-based and vehicle-miles-traveled-based MVC deaths have decreased over the last 20 years, but rural rates remain significantly higher than urban rates. Dead-at-scene rates may be increasing, and the rural dead-at-scene rate is higher than the urban rate.

CONCLUSION

While MVC death rates are declining, the rural MVC death rate is still higher than the urban rate. Although these data may indicate some positive movement in the area of MVC-related deaths, differences in the rural and urban rates and the number of patients found dead on-scene remain as issues that require attention.