Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A vital issue...
- Paul A Smith (27 June 2006)
-
Safety and speed
- James Woodcock (28 June 2006)
-
Schools obstruct road safety measures
- Peter M English (7 July 2006)
-
Road safety and statistics for road-traffic accidents (RTAs): Other reasons for arguing a mismatch
- Tony H Reinhardt-Rutland (8 July 2006)
-
Non fatal RTAs, could you help?
- Chris A Peach, Stephen McDonnell (11 July 2006)
-
Road casualties and collisions - more work required
- Jon P Farr (12 July 2006)
|
|
|||
|
Paul A Smith, Road Safety Analyst Safe Speed HQ - IV19 1PE
Send response to journal:
|
I observed anomalies in the official serious injury statistics in 2003. In particular a drift in ‘lethality ratios’ caught my eye. [1] Further investigations revealed that the official serious injury statistics were extremely vulnerable to a range of external influences, and that they were not behaving consistently with other road safety indicators. [2] Consideration was given to the idea that lethality ratios were varying due to safety interventions (for example air bags) so a further check was carried out to determine if the effect was apparent across different road types and different road user groups. [3] I drew the conclusion that the serious injury series was not reliable due to alterations in reporting or other consideration, and that the series was unsuitable for year on year road safety comparisons. Wider views of road safety policy based on speed limits, speed enforcement and reducing vehicle speeds indicated that this policy was very unlikely to be effective – mainly because road safety actually exists in the psychological domain. Issues like average driver quality are far more significant than marginal changes in the speed chosen by the majority of responsible motorists. While engineering improvements have been ongoing in vehicles and roads, and while post crash medical care has continued to improve, something else has apparently offset these substantial benefits to provide static death rates and, we are just learning, static serious injury rates. The obvious confounder is growth in traffic, but even the most cursory examination reveals that traffic growth has been nowhere near sufficient to account for the unexpectedly poor trends. I believe that policy - particularly high levels of enforcement by speed camera - has had substantial negative effects on driver quality. I am most grateful to Mike Gill et al for bringing this issue to the fore and providing solid evidence that Department for Transport claims and policies are optimistic at best. [1] http://www.safespeed.org.uk/lethality.html [2] http://www.safespeed.org.uk/serious.html [3] http://www.safespeed.org.uk/serious2.html Competing interests: Founder of the Safe Speed road safety campaign |
|||
|
|
|||
|
James Woodcock, Research Student LSHTM, Keppel Street, London WC1E 7HT
Send response to journal:
|
It is an anomaly that road traffic injuries are taken from police rather than health service figures and this article does an important job of highlighting difference in their trends. However, it is a mistake to identify improvements in safety with reduction in injury rates. Motorways are extremely dangerous for pedestrians, hence it is illegal to walk on them and few would try. One impact of more and faster traffic is less walking and cycling, reducing the opportunities for injuries among these groups and for physical activity. However, this is not an improvement in road safety but a response to increased danger. In response to Paul Smith, he is widely known as a campaigner against speed cameras. If he would like to consider reasons why injury rates are not falling he could try looking at increased use of mobile phones and SUVs, both established risk factors for crashes. If one wants to read from campaigners who support serious reasearch and put health and environment before love of speed, readers would be advised to check out the Slower Speeds Initiative, http://www.slower-speeds.org.uk Competing interests: None declared |
|||
|
|
|||
|
Peter M English, Consultant in Public Health Medicine Leatherhead, KT22 9RX
Send response to journal:
|
Schools in my home county of Surrey seem to compete to have the most conservative school uniforms (despite a complete absence of evidence that school uniforms bring any benefits). Most require students to wear dark- coloured outer clothing, and explicitly ban brighter coloured outer clothing. This prevents students from following the universal guidance to wear light- brightly-coloured clothes to increase conspicuity and reduce their odds of adding to the pedestrian accident statistics. School governing bodies have absolute say over this, and many refuse to discuss the issue, simply dismissing as "inappropriate" advice from road safety officers and organisations, and suggestions from parents, that they might permit more appropriate outer clothing. We should be encouraging children to walk or cycle to school; and schools should help us by not creating unnecessary additional disincentives. Competing interests: I have children at school in Surrey |
|||
|
|
|||
|
Tony H Reinhardt-Rutland, Reader in Psychology University of Ulster, BT37 0QB
Send response to journal:
|
Gill et al show that the police report fewer RTA casualties than is evident from hospital admissions, invoking concern that an unduly rosy message is being conveyed about road safety. There are other reasons for believing that RTA statistics over many years should be interpreted with caution. British RTA deaths are down 50% per year from a peak of 7500 in the late 1960s to 3400 at present. The improvement in RTA injuries has been proportionately much less: down 20% from 373,000 in the late 1960s to 290,000 at present (1) - and without correction for anomalies of the sort Gill et al report. One reason for the reduced mortality relative to injury may concern traffic density: while traffic jams fifty years ago were confined to urban routes at the start and end of the working day, they are now common. Slowed traffic inevitably elicits less severe RTAs. Comparing low-density rural areas with high-density urban areas for a given year supports this assertion: rural mortality relative to injury is 3-4 times greater than urban mortality relative to injury(2). Multiplying the current RTA deaths by this value would suggest that the roads are less safe than fifty years ago. The issues are exacerbated by those RTAs that do not cause either injury or death. Unfortunately, the rates of these damage-only RTAs have not been recorded, a serious omission for the interpretation of RTA rates as a whole. Insurance data provide some insight, but are intermittent and do not list RTA claims separately. Nonetheless, Davis in 1992 estimated that damage-only RTAs accounted for 80-95% of all RTAs. He also reported a 61% increase in the number of insurance claims during 1981-9 (3). Recent government statistics indicate a continuing upward trend: for 1997-2003, the monetary value of insurance claims increased by 44% (1). Increase in damage-only RTAs relative to casualty RTAs is consistent with changes in safety-related engineering: seat-belts, ABS brakes, "crumple zones" and so on. A severity of RTA that previously killed or injured motorists now merely damages property. And, of course, there is plenty of evidence that the safety advantage is undermined because driving becomes less cautious (4). One can conclude that RTA rates as a whole have increased substantially. The issues go beyond those of the motorist's safety: less cautious driving and more RTAs make walking and cycling less attractive. Public transport is also undermined, since walking and cycling are the likely means of accessing public transport. The issues therefore extend to the encouragement of healthier lifestyles. References (1) Transport Statistics Great Britain. London: HMSO, 2005. (2) Adams J G U. Risk. London:UCL,1995. (3) Davis R. Death on the Streets. Hawes:Leading Edge, 1992. (4) Reinhardt-Rutland A H. Seat-belts and behavioural adaptation. Safety Sci 2001;39: 145-155. Competing interests: None declared |
|||
|
|
|||
|
Chris A Peach, Senior Senior House Officer Trauma and Orthopaedic Surgery Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks, HP21 8AL, Stephen McDonnell
Send response to journal:
|
We were very interested to read the article highlighting the considerable morbidity and mortality on England’s roads. These articles as well as recent experiences of stopping at several roadside incidents have made us consider if an accident victim could benefit from our years of training and experience whilst the emergency services arrive? For example: it is a quiet Sunday afternoon and you are unfortunate enough to encounter an accident on a deserted country lane. A motorcyclist has collided with a car and two victims are presented before you. With no basic equipment you might offer little more first aid than a member of the public. However with equipment in the car considered essential by paramedics for personal protection and basic life support, one could perhaps be of more help to these patients. This posed us another question. What items would you have in your car? You certainly will not need a spinal board and thoracotomy set, however we suggest the following items are cheap, easy to use, treat life threatening conditions, offer personal protection and have no expiry date. Therefore, once assembled, your kit can be forgotten about until the need to use it arises. • Gloves – a few pairs can be given to others to help.
This is not a comprehensive doctors field medical bag, nor will it cover every eventuality. However, this may provoke others in the primary care community to think how they will use their skills next time they stop at a roadside incident. Competing interests: None declared |
|||
|
|
|||
|
Jon P Farr, Road Safety Team employee Devon County Council
Send response to journal:
|
I read with interest the analysis of road casualty data and observations of driver behaviour within the 8th July BMJ, and as someone who is involved in road safety I would like the opportunity to provide some comment. The reason for the analysis of risk taking behaviour within drivers of ‘four wheel drive’ vehicles out was unclear. There was no comparison of behaviour between other readily identifiable groups, such as drivers of high value luxury saloons, two seater 'sports cars', family saloons, light or large commercial vehicles etc. Within the ‘four wheel drive’ market there is a differentiation between larger 4 wheel drives and so called ‘softroaders’. The two sub types of vehicle are sold in to different market segments, with different appeal, with no doubt different behavioural attributes, to further compound the complexity, a survey of rural versus urban behaviour may have been useful. To state the obvious, it is the driver, not vehicle which exhibits behaviour, although the vehicle may or may not give an insight into the individual driving it, I would suggest that it is not safe to make assumptions driver behaviour purely on the basis of vehicle type. It is not known if other observable data (for example approximate age or sex of the person driving, time of day etc.), was gathered to enable identify detailed driver risk taking behaviour, but clearly this would have been useful and readily gathered. The research into under reporting of casualty collisions is intriguing; I have seen some of the data for both police and the NHS locally. The local trends suggest that the reporting of killed or serious injury collisions by the police has fallen over the period from 1996 to 2004. The reporting of casualty collisions reported via hospital sources has shown less consistent trends (over a shorter time period). However the number of ‘Damage Only Collisions’ (where no serious injury is reported) has also increased in the same time period. So the implication that minor collisions are simply not being reported seems to be contradictory here. One hypothesis is that increased reporting of ‘Damage Only’ collisions and higher levels of reporting in hospital data may be related to behaviour driven by insurance claims, however no research has been conducted into this as far as I am aware. Figures quoted from the Police data are sometimes for killed or serious injury (KSI) collisions rather than casualties. I would imagine that HES data could only report the number of individuals affected rather than the number of incidents causing them, I am not sure if this was the case in this study. The number of admissions is potentially significantly affected by changes in hospital practice and facilities. An area where admissions were seen to increase may also correspond with an area where the opening of an additional observation ward was known to have occurred. Hospital data as well as police data has been shown to have flaws. In some cases road casualty incidents recorded in hospital data had no obvious correlation with traffic related injuries. These error sources are unquantified in both data sets as far as I am aware, as are any changes in the methods of data gathering activities within the NHS. At the more tragic end of the scale - a casualty who is 'dead on arrival' at hospital, rightly, is not likely to get the same level of follow through in the NHS, as a patient who can be treated. Conversely for the Police, a death on the road will receive a high level of resource and follow through. Identifying risk groups by looking into admission rates for males to females, or age ranges for example, may be more useful in establishing useful interventions. Looking to the casualty rates within different professions and employing organisations in order to identify further risk groups. Those who drive as part of their employment are also exposed to greater risk by virtue of being on the road more frequently.. The observation concerning motorcyclists and children is also thought provoking. The increasing number of motorcycling fatalities has by and large mirrored the increased levels of motorcycle ownership in the UK. Locally the number of motorcycling casualties represents between 20 – 30% of police reported fatalities (with significant variations from year to year). It is generally thought that motorcyclists represent 1-2% of all road users. Clearly this is of concern to all those involved in road safety. Dry weather and bank holidays seem to be factors linked to increased numbers of casualties, and interventions again need to be tailored to suit these need. I do not have the corresponding figures for the child population changes, but I suspect that it has not dropped at the same rate as the casualty levels, so what have we been doing right with child road collision casualties? I am not aware of how issues such as the outbreak of foot and mouth may have affected collisions on the road, but some data suggests there was an improvement in road casualty rates in that year. Over the last few years I have had the opportunity to see some of the research conducted concerning road safety and collision injuries. Multi factorial events such as road traffic collisions, defy simplistic uncompensated analysis, so I fear there is a lot more work to be done. Competing interests: None declared |
|||