Human factors in rural road crashes

Motor vehicle driver injury and socioeconomic status: a cohort study with prospective and retrospective driver injuries

STUDY OBJECTIVE

To investigate the association between motor vehicle driver injury and socioeconomic status.

DESIGN

Cohort study with prospective and retrospective outcomes.

SETTING

New Zealand.

PARTICIPANTS

10 525 adults (volunteer sample of a multi-industry workforce, n=8008; and a random sample of urban electoral rolls, n=2517).

OUTCOME MEASURE

Motor vehicle driver injury resulting in admission of the driver to hospital or the driver's death, or both, during the period 1988-98; hospitalisation and mortality data were obtained by record linkage to national health databases.

MAIN RESULTS

After adjustment for age and sex, driver injury risk was inversely associated with both occupational status (p for linear trend <0.0001) and educational level (p for linear trend =0.007). Participants in the lowest approximate quartile of occupational status were four times as likely (HR 4.17, 95% CI 2.31 to 7.55) to have experienced a driver injury during follow up as participants in the highest approximate quartile. Participants who had been to secondary school for less than two years were twice as likely (HR 2.26, 95% CI 1.34 to 3.81) to have experienced a driver injury as those who had been to university or polytechnic. There was little evidence that driver injury risk was associated with neighbourhood income (p for linear trend =0.12) CONCLUSIONS: Occupational status and educational level seem to be important determinants of driver injury risk. Driver injury countermeasures should be targeted to people in low status occupations, as well as to people with comparatively little formal education.

Head injury-related road crash mortality in rural Western Australia

BACKGROUND

The aim of the present paper was to assess the incidence of, and identify factors associated with road crash (RC)-related fatal head injuries in rural and metropolitan Western Australia.

METHODS

Examination of demographics, driving behaviour and RC characteristics for RC fatalities involving a head injury (Abbreviated Injury Scale (AIS) > or = 2) between 1 January 1998 and 31 December 1999 was carried out using the State Coronial Database.

RESULTS

There were 328 deaths. The median age was 28 years and 74.1% of cases were male. Seventy per cent died at the scene. Of scene survivors, 89% were transferred to a metropolitan hospital before dying. Sixty per cent of total RC and 65% of at-scene deaths occurred in rural areas. Single-vehicle crashes comprised 45% of total crashes, of which 72.8% occurred in rural locations. Poor driver behaviour was identified in 53% of deaths. Ethanol was implicated in 29.8% of deaths, other intoxicating drugs were implicated in 19.2%, speeding was implicated in 19.5%, and lack of safety restraints/devices was implicated in 22%. Poor driver behaviour was identified in 72% of single-vehicle deaths, compared with 38% of multivehicle crashes (P < 0.001). Rural people comprised 61% of rural crash victims. Ninety-one per cent of rural victims died in rural crashes. The incidence of RC death associated with head injury in the rural population is 13.4 deaths/100 000 per year, more than double that for the metropolitan population (6.4 deaths/100 000 per year; P < 0.001).

CONCLUSION

The rural population of Western Australia is overrepresented in head injury-related RC deaths. Single-vehicle crashes where unsafe driving behaviour is implicated comprise a large proportion of these. Strategies to reduce unsafe driving practices aimed at rural drivers are necessary.

Motor-vehicle crash-injury risk factors among American Indians

The rates of motor-vehicle crash mortality are highest among American Indians and Alaska Natives, compared to other ethnic groups. The aim of this study was to compare risk factors for motor-vehicle crashes and occupant injuries between rural and urban American-Indian (AI) drivers, and between rural AI and non-AI rural drivers. A statewide traffic-accident database was linked to the Indian Health Service patient-registration database to identify crashes that involved American-Indian drivers. Using a cross-sectional design, crashes occurring in a two-county region during 1989 and 1990 were studied. A total of 9329 motor-vehicle crashes involving 16,234 drivers and 6431 passengers were studied. Two percent of drivers were American Indian. Compared to American-Indian drivers in urban crashes, rural crashes involving American-Indian drivers were more likely to result in injury or death (38% vs 64% p < 0.001). The difference in risk for crashes between urban and rural non-AI drivers was not as high (42% vs 33%). Only 44 percent of rural American-Indian motor-vehicle occupants reported wearing seat belts, compared to 70 percent of urban American-Indian occupants (p < 0.05). Rates of driver alcohol impairment, as assessed by the police, were much higher among AI drivers and highest among rural AI drivers. We conclude that, compared to non-American-Indian drivers, AI drivers are less likely to be restrained and more likely to be alcohol-impaired at the time of the crash. These risks are higher among rural AI drivers than urban AI drivers.

Building community networks: a road trauma education and training program for rural areas

The work of the Road Trauma Support Team highlights the ongoing impact of road trauma on rural communities. Small population size and close social networks mean that road trauma can have a negative effect on social relations across the whole community. Much of the 'flow-on' effect of road trauma, in the form of community distress, can be alleviated by increased skills, information about responding to road trauma, and the establishment of supportive community networks. This paper reports on the implementation and evaluation of a project that addressed knowledge, skills and awareness of road trauma in rural communities. Funded by the Rural Health Support Education and Training (RHSET) program and conducted by the Road Trauma Support Team, the project focused on the impact of traumatic events in small communities and strategies to maximise effective participation of community members and health workers in response to trauma. Piloted in six rural communities in northern Tasmania, the project has developed an educational resource package.

Aetiological factors contributing to road traffic accidents in Riyadh City, Saudi Arabia

The study analysed 13,390 police records of road traffic accidents (RTAs) covering a three and a half year period according to different suspected aetiological factors. The majority of the accidents were recorded for vehicles in good condition on well-paved straight roads with well-operating traffic light systems. Adverse weather conditions such as precipitation, fog and dust were of minimal importance, with most of the accidents being reported during sunny days during the rush period of 12 noon to 3 pm. Driver's error was identified as the main contributing factor in about two thirds of all RTAs mainly as reckless driving and excess speeding. About 27% of the drivers were professional drivers and 41% were in the age group 25-35 years in good health with no alcohol or drug intake. Hence, human errors may be attributed to carelessness, experience, lack of knowledge or attention, over-exhaustion or fatigue. The effects of physical stressors on performance of drivers need to be further explored and clarified but this need not underestimate the importance of vehicle and environment since most accidents are multifactoral and a slight change in them may effectively enhance perception and minimise personal error. Recommendations for remedial measures adopting an interdisciplinary approach are presented.