Keeping Safe on Australian Roads: Overview of Key Determinants of Risky Driving, Passenger Injury, and Fatalities for Indigenous Populations

Social and cultural barriers associated with inequitable access to driver licensing and associated road safety education, as well as socioeconomic issues that preclude ongoing vehicle maintenance and registration, result in unsafe in-car behaviours such as passenger overcrowding. This in turn is associated with improper seatbelt usage, noncompliance with child restraint mandates, and driver distraction. For example, in Australia, where seatbelt use is mandatory, Indigenous road users are three times less likely to wear seatbelts than non-Indigenous road users. This is associated with a disproportionately high fatality rate for Indigenous drivers and passengers; 21% of Indigenous motor-vehicle occupants killed on Australian roads were not wearing a seatbelt at the time of impact. In addition, inequitable access to driver licensing instruction due to financial and cultural barriers results in Indigenous learner drivers having limited access to qualified mentors and instructors. A consequent lack of road safety instruction results in a normalising of risky driving behaviours, perpetuated through successive generations of drivers. Moreover, culturally biased driver instruction manuals, which are contextualised within an English written-language learning framework, fail to accommodate the learning needs of Indigenous peoples who may encounter difficulties with English literacy. This results in difficulty understanding the fundamental road rules, which in turn makes it difficult for young drivers to develop and sustain safe in-car behaviours. This paper considers the literature regarding road safety for Indigenous road users and critically evaluates strategies and policies that have been advanced to protect Indigenous drivers. Novel solutions to increasing road safety rule compliance are proposed, particularly in relation to passenger safety, which are uniquely embedded within Indigenous ways of knowing, being, and doing. Safe driving practices have crucial health and social implications for Indigenous communities by allowing more Indigenous people to participate in work and education opportunities, access healthcare, maintain cultural commitments, and engage with families and friends, qualities which are essential for ongoing health and wellbeing.

Factors affecting safe emergency evacuation of subways in Iran: findings of a qualitative study

Background:

Development of construction and operation of subway rail transit system in populated cities of middle- and high-income countries along with the increasing population of its users, have exacerbated the safety problems of the users against incidents and emergencies in subway stations. Although subway emergency evacuation is considered by the governments and subway network organizations as a critical task related to passengers' safety at the time of emergency, the risk of mass evacuation in station is undeniable. The main objective of this study is to identify factors affecting safe evacuation of the population from subway station and to propose the strategies for addressing them based on experiences or opinions of stakeholders in Tehran Subways, Iran.

Methods:

This is a qualitative study that was conducted between January 2017 and December 2018, in which a semi-structured interview was conducted for 17 participants among the senior managers, executive managers, subway station operations staff, and subway passengers in Tehran subway stations, in the Capital of Iran. In order to analyze the data of this qualitative study, the Graneheim and Lundman method was used and manifested content analysis approach was employed.

Results:

Based on the findings of this study, the factors affecting safe evacuation of the population from subways station were identified in four main categories covering passengers, organization, communications, and environment. Then the main categories of "culture, interaction and cooperation of passengers", "correct and timely decision-making", "notification", and "location of emergency evacuation" were emerged as safe emergency evacuation challenges and the most important findings of this study; and strategies were proposed to improve the safety of passengers at emergency evacuation of subway stations.

Conclusions:

In the present study, the lack of safe approach to improving passengers' safety in the development plan of Tehran subway rail transit network is a major concern for managers and operations staff. Therefore, changing the attitude of policy makers from focusing on the quantitative development of passenger transportation services to improving safety and then the quality of passengers' trip is taken into account as an urgent need to improve the safety of subway passengers.

A comparison of seat belt fit and comfort experience between older adults and younger front seat passengers in cars

Objective: The purpose was to study how occupant age affects seat belt fit and comfort by comparing older adults and younger occupants in the front seat of a passenger vehicle.Methods: An exploratory user study was performed for the front seat of a stationary large passenger vehicle in a laboratory environment, including 11 older (aged 72-81) and 11 younger (aged 25-30) participants. Each participant first entered the vehicle and buckled up in a predefined seat position. Next, they adjusted the seat to their preferred seat position and buckled up again. Anthropometric data were collected on height, weight, and waist and hip circumferences. Photographs and measurements were taken of seat/seat belt positions and posture, and structured interviews were conducted regarding comfort perceptions of the 2 tested scenarios, including previous experience and awareness of seat belt usage and discomfort experienced as passengers in cars.Results: Nonoptimal belt fit included shoulder belt on the shoulder edge or close to the neck or lap belt over the abdomen. Five of 11 older adults had nonoptimal belt fit in the predefined position, and in the preferred position 7 older adults had nonoptimal belt fit. Only one showed safety awareness and recognized the nonoptimal belt fit in the preferred position. In the younger group, 4 of 11 had nonoptimal belt fit in the predefined position and 4 in the preferred position. Two acknowledged the nonoptimal belt fit. Older adult participants with a more pronounced kyphotic posture had the upper part of the shoulder belt positioned closer to the suprasternal notch compared to younger participants. Older adults were also more likely to have the lower part of the shoulder belt higher up on the abdomen compared to younger participants. Participants with higher body mass indexes (BMIs) were more likely to have the shoulder belt higher up on the abdomen, independent of age and gender. When the shoulder belt was positioned higher up on the abdomen the upper portion of the shoulder belt was routed closer to the throat. Older adults preferred to sit higher up to achieve a better field of vision compared to younger adults.Conclusions: The change in body posture due to aging influences belt fit. Older adults seemed less aware of safety related to belt fit. Increased BMI influenced shoulder belt fit, independent of age. These findings are important when designing restraint systems to ensure safety for all occupants.

Using multiple imputation and propensity scores to test the effect of car seats and seat belt usage on injury severity from trauma registry data

BACKGROUND

Missing data and the retrospective, nonrandomized nature of trauma registries can decrease the quality of registry-based research. Therefore, we used multiple imputation and propensity scores to test the effect of car seats and seat belt usage on injury severity in children involved in motor vehicle crashes.

METHODS

All children admitted after injury from motor vehicle crashes who had complete data on seat belt or car seat usage from 2003 to 2006 were included in the study. The sample was divided into children younger than 4 years (n = 130) or 5 years or older (n = 575) and analyzed for seat belt usage, car seat usage, injury severity score, revised trauma score, and Glasgow Coma Scale score. Data were analyzed before and after matching on propensity scores after multiple imputation.

RESULTS

There were no outcome differences between car seat users and non-car seat users. However, there were significant improvements in injury severity score (7.0 vs. 10.1, P = .002) and revised trauma score (7.6 vs 7.3, P = .013 for seat belt users compared to nonusers) even after matching on propensity score.

CONCLUSION

Multiple imputation and propensity scores demonstrated the efficacy of seat belts, but not car seat in this preliminary study. This statistical method can strengthen registry-based research.