Accidents involving off-road motor vehicles in a northern community.

The increasing number of accidents associated with off-road motor vehicles used for recreational purposes prompted this prospective study. During 1985 the records of victims of all motor vehicle accidents who were seen at the Hudson Bay Union Hospital, Hudson Bay, Sask., were studied; patients involved in on-road vehicle accidents were included for comparison. Emphasis was placed on age, vehicle type, mechanism of accident, injury severity and the use of safety features. Almost half of the victims of off-road vehicle accidents were under 16 years of age. The poor adherence to government legislation and manufacturer recommendations was evident in the number of people who did not wear helmets or use headlights.     

Floor anchorage load and safety space for adult wheelchair users during a crash

Over the last 20 years in France as well as generally in Europe and also in North America, the integration of disabled people into society has become a more and more pressing issue. Work is in progress to increase the safety level of wheelchair occupants up to becoming equivalent to that of able-bodied road vehicles occupants. Present world practices are that wheelchair occupants who are unable to transfer to a vehicle seat for transportation remain in their wheelchair, which is secured to the vehicle floor using tie downs, and the occupant is restrained in the wheelchair. The aim of this paper was to perform a series of crash tests to make sure that the current standards are suitable to identify possible failures in safety in the restraint systems intended for wheelchair users. To date, there is no specific regulatory criterion related to floor anchorage for wheelchairs in vehicles during a crash. At a 48 km/h crash test, loads reached 30 kN on rear anchorage, and 13 kN on shoulder belt. Also the kinematics analysis of the wheelchair user during impact pointed out dimension of his safety space.     

Canadian ground ambulance services: provincial funding and standards for equipment and training.

There is an increasing demand for improved, up-to-date training and equipment for ground ambulance services across Canada. This paper presents the results of a survey of ambulance operations and their funding by the provinces, as well as a comparison of provincial legislation and recommendations on standards for equipment and the training of ambulance personnel. The training standards were found to be very diverse, and the legislated or recommended equipment standards did not meet those of the American College of Surgeons committee on trauma (ACSCT). The cost of ambulance services per capita and the cost to the user of an average 43-km run varied widely between the provinces. There was no correlation between the second cost and how well the province met the ACSCT''s equipment standards.     

Drinking and Driving

Alcohol misuse generates many health and social problems at a cost that society is increasingly unwilling to sustain. One of the most tragic consequences of alcohol misuse is the result of drinking and driving. Each week, impaired drivers kill 40 Canadian men, women and children and injure 1250 others. The Canadian Medical Association (CMA), in its campaign against drinking and driving, has recommended that a condition of obtaining or renewing a driver''s licence include the individual''s written consent to allow the taking of blood samples by qualified medical personnel when deemed necessary by law enforcement agencies. CMA has recommended to the provinces that the legal age for the purchase and public possession of alcohol be raised to 21. CMA also supports the ban of all alcohol advertising in the electronic media and emphasizes that since alcohol is a drug, all containers should be visibly labelled “Misuse of this Product can be Injurious to Health”. CMA continues to support and encourage the federal and provincial governments in their battle to prevent alcohol-related deaths and injuries through education, control of advertising, use of breathalyzer devices, mandatory blood alcohol testing and legislation enacting stiffer penalties for drinking and driving.     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians'' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

CMA brief offers suggestions as federal commission studies country's blood-gathering system

The CMA hopes the Commission of Inquity on the Blood System, chaired by Mr. Justice Horace Krever, “will restore faith in a system that is essential for the health and safety of all Canadians.” However, the cost implications any recommendations may have for the health care system must also be taken into consideration. The CMA made several recommendations in response to the commission''s interim report.     

Resuscitation of the terminally ill

The CMA believes that there are conditions of ill health and inevitable death for which a “no resuscitation” order, signed by the attending physician, is appropriate and ethically acceptable. The association encourages physicians who are faced with the decision of writing a “no resuscitation” or “do not resuscitate” order to consider the clinical criteria and procedural guidelines in the Joint Statement on Terminal Illness. This protocol is intended as a basic, national guideline for those involved in the care of the terminally ill. Individual institutions may wish to develop their own directives as an adjunct to the national statement.     

Smoking and health

Cigarette smoking is the leading cause of preventable death and disease in Canada, accounting for some 30 000 deaths annually. This enormous health cost to Canadians has led the Canadian Medical Association (CMA) to promote initiatives regarding smoking prevention programs in schools, legislation to prevent smoking in government buildings and controls on smoking in private buildings, particularly places of work. The CMA recommends the prohibition of all forms of tobacco advertising/promotion in Canada, including advertising in conjunction with athletic events. The CMA also supports the taxation of tobacco products at a level to discourage their purchase, with revenue earmarked for health budgets, and the association is encouraging the federal government to develop alternative crop incentives for tobacco farmers. The norm of nonsmoking is a social attitude the CMA is working toward developing in all Canadians.     

Guidelines for physicians reviewing proposed legislation on health care occupations

The premise of the CMA guidelines is that legislation on health care occupations should protect the public and therefore should be based on the needs of the patient rather than on the wishes of the health care worker. Health care should be provided by personnel with appropriate training; thus, the scope of practice of any group must be based on relevant educational preparation. In a review of legislation the procedure for amending both the statutes and the regulations should be examined.     

Pediatric and Youth Traffic-Collision Injuries in Al Ain,United Arab Emirates: A Prospective Study

Aim

To study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries.

Methods

All RTC injured children and youth (0–19-year-olds) who were admitted to Al Ain City’s two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed.

Results

245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet.

Conclusions

Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.     

The Value of Safety Belts: A Review

The literature is reviewed to ascertain the values and dangers of safety belts. They are said to reduce the risk of major or fatal injury in impacts by nearly 60%. An incidence of abdominal trauma of the order of 0.5% is ascribed to the safety belt, and in addition there is a low incidence of a specific type of spinal fracture. The safety belt has not been shown to make injuries worse, and in causing injuries of its own has prevented more serious ones. The design of the safety belt is discussed; the three-point (lap-and-diagonal) belt is probably the best type for automobiles currently available. Recent research suggests that more sophisticated restraint systems may make survival possible in very severe impacts.     

A computational study of injury severity and pattern sustained by overweight drivers in frontal motor vehicle crashes

The objective of this study was to examine the role of body mass and subcutaneous fat in injury severity and pattern sustained by overweight drivers. Finite element models were created to represent the geometry and properties of subcutaneous adipose tissue in the torso with data obtained from reconstructed magnetic resonance imaging data-sets. The torso adipose tissue models were then integrated into the standard multibody dummy models together with increased inertial parameters and sizes of the limbs to represent overweight occupants. Frontal crash simulations were carried out considering a variety of occupant restraint systems and regional body injuries were measured. The results revealed that differences in body mass and fat distribution have an impact on injury severity and pattern. Even though the torso adipose tissue of overweight subjects contributed to reduce abdominal injury, the momentum effect of a greater body mass of overweight subjects was more dominant over the cushion effect of the adipose tissue, increasing risk of other regional body injuries except abdomen. Through statistical analysis of the results, strong correlations (p < 0.01) were found between body mass index and regional body injuries except neck injury. The analysis also revealed that a greater momentum of overweight males leads to greater forward torso and pelvic excursions that account for higher risks (p < 0.001) of head, thorax and lower extremity injury than observed in non-overweight males. The findings have important implications for improving the vehicle and occupant safety systems designed for the increasing global obese population.     

Sulfite Additives

The CMA recommends that sulfites be banned as food preservatives when satisfactory and safe alternatives are available. When there is no suitable substitute strict labelling requirements on foods should be imposed for sulfite additives. The association supports the efforts of the Health Protection Branch of the Department of National Health and Welfare to regulate sulfites in the food and drug industry to prevent adverse reactions in people sensitive to sulfites. The CMA recommends that the Department of National Health and Welfare establish a federal-provincial liaison group that has the authority to introduce additive standards for food producers, distributors and restaurants and to monitor foods at the consumer level for the presence of allergenic additives.     

Road transport: new life cycle inventories for fossil-fuelled passenger cars and non-exhaust emissions in ecoinvent v3

Purpose

The paper presents new and updated datasets for the operation of fossil-fuelled passenger cars. These are intended to be used either as background processes or in the comparative assessment of transport options. Central goals were to achieve a high level of consistency, transparency and flexibility for a representative range of current vehicle sizes, emission standards and fuel types, and to make a clear definition between exhaust and non-exhaust emissions. The latter is an important contribution to studies focusing on hybrid and electric vehicles.

Methods

The datasets are the direct development of those available in ecoinvent v2 and are largely based on updated versions of the same sources. The datasets address petrol, diesel and natural gas vehicle fuels. The number of datasets was increased to cover small, medium and large vehicles. Other data sources were used in order to fill data gaps and to balance inconsistencies, particularly for the natural gas vehicles. Parameterisation was incorporated via the ecoeditor tool. This allows the datasets to be adapted for use as foreground processes and also increases transparency. An important method used was to observe the trends in fuel consumption and emissions across all sizes and emission standards simultaneously so that consistency would be achieved across the whole range of vehicles. Non-exhaust emissions were made dependent on vehicle weight and thereby independent of vehicle type.

Results and discussion

Some significant changes in individual emission factors between the v2 and v3 datasets was shown. This can be explained by a combination of corrections, updates based on more recent versions of the data sources, and attempts to make the datasets consistent to each other. This has also meant that the non-exhaust emissions are readily definable in terms of brake, tyre and road wear as a factor of vehicle weight, with the intention that this data can be applied to passenger vehicles of all technologies.

Conclusions

Fuel consumption, emission factors and infrastructure demand have been improved, extended and updated for petrol, diesel and natural gas vehicles adhering to the Euro 3, 4 and 5 emissions standards. Using the ecoeditor tool, significant parameterisation was included which has made the datasets far more flexible, consistent and transparent. The clear definition of non-exhaust emissions means that these can easily be applied to studies on hybrid and electric vehicles.

     

The Association between Regional Environmental Factors and Road Trauma Rates: A Geospatial Analysis of 10 Years of Road Traffic Crashes in British Columbia,Canada

BackgroundBritish Columbia, Canada is a geographically large jurisdiction with varied environmental and socio-cultural contexts. This cross-sectional study examined variation in motor vehicle crash rates across 100 police patrols to investigate the association of crashes with key explanatory factors.MethodsEleven crash outcomes (total crashes, injury crashes, fatal crashes, speed related fatal crashes, total fatalities, single-vehicle night-time crashes, rear-end collisions, and collisions involving heavy vehicles, pedestrians, cyclists, or motorcyclists) were identified from police collision reports and insurance claims and mapped to police patrols. Six potential explanatory factors (intensity of traffic law enforcement, speed limits, climate, remoteness, socio-economic factors, and alcohol consumption) were also mapped to police patrols. We then studied the association between crashes and explanatory factors using negative binomial models with crash count per patrol as the response variable and explanatory factors as covariates.ResultsBetween 2003 and 2012 there were 1,434,239 insurance claim collisions, 386,326 police reported crashes, and 3,404 fatal crashes. Across police patrols, there was marked variation in per capita crash rate and in potential explanatory factors. Several factors were associated with crash rates. Percent roads with speed limits ≤ 60 km/hr was positively associated with total crashes, injury crashes, rear end collisions, and collisions involving pedestrians, cyclists, and heavy vehicles; and negatively associated with single vehicle night-time crashes, fatal crashes, fatal speeding crashes, and total fatalities. Higher winter temperature was associated with lower rates of overall collisions, single vehicle night-time collisions, collisions involving heavy vehicles, and total fatalities. Lower socio-economic status was associated with higher rates of injury collisions, pedestrian collisions, fatal speeding collisions, and fatal collisions. Regions with dedicated traffic officers had fewer fatal crashes and fewer fatal speed related crashes but more rear end crashes and more crashes involving cyclists or pedestrians. The number of traffic citations per 1000 drivers was positively associated with total crashes, fatal crashes, total fatalities, fatal speeding crashes, injury crashes, single vehicle night-time crashes, and heavy vehicle crashes. Possible explanations for these associations are discussed.ConclusionsThere is wide variation in per capita rates of motor vehicle crashes across BC police patrols. Some variation is explained by factors such as climate, road type, remoteness, socioeconomic variables, and enforcement intensity. The ability of explanatory factors to predict crash rates would be improved if considered with local traffic volume by all travel modes.     

Urban road traffic scale analysis from the perspective of atmospheric environmental indicators in Tianjin,China

In order to investigate the largest motor vehicle ownership load within the scope of a city with atmospheric environmental indicators as constraint, this article estimates traffic atmospheric environmental capacity (TAEC) and carrying capacity (TAECC) in Tianjin using the A-value method recommended by the Chinese national standard. Our results indicate that NO_X carrying capacity is a key restraining factor of TAEC. According to the current vehicle emission levels per year and air quality standard, Tianjin can accommodate 4.21 million vehicles. Classified by the vehicle type, heavy trucks and large-sized passenger cars are identified as the most important restrictive factors of TAECC. Then we analyze change of TAECC and TAECC’s service life under the circumstances of clean vehicle strategy and mobility management strategy. Clean vehicles strategy represented by the elimination of heavy-polluting vehicles can reduce emissions of vehicles so that it can rapidly enhance the TAECC in the short term. Mobility management strategy represented by the car purchase restriction, which reduces total motor vehicle travel, is indispensable for improvement of TAECC in the long term. On the whole, the clean vehicles strategy and mobility management strategy should be implemented gradually.     

Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers.

OBJECTIVES--To study circumstances of bicycle accidents and nature of injuries sustained and to determine effect of safety helmets on pattern of injuries. DESIGN--Prospective study of patients with cycle related injuries. SETTING--Accident and emergency department of teaching hospital. SUBJECTS--1040 patients with complete data presenting to the department in one year with cycle related injuries, of whom 114 had worn cycle helmets when accident occurred. MAIN OUTCOME MEASURES--Type of accident and nature and distribution of injuries among patients with and without safety helmets. RESULTS--There were no significant differences between the two groups with respect to type of accident or nature and distribution of injuries other than those to the head. Head injury was sustained by 4/114 (4%) of helmet wearers compared with 100/928 (11%) of non-wearers (P = 0.023). Significantly more children wore helmets (50/309 (16%)) than did adults (64/731 (9%)) (P < 0.001). The incidence of head injuries sustained in accidents involving motor vehicles (52/288 (18%)) was significantly higher than in those not involving motor vehicles (52/754 (7%)) (chi 2 = 28.9, P < 0.0001). Multiple logistic regression analysis of probability of sustaining a head injury showed that only two variables were significant: helmet use and involvement of a motor vehicle. Mutually adjusted odds ratios showed a risk factor of 2.95 (95% confidence interval 1.95 to 4.47, P < 0.0001) for accidents involving a motor vehicle and a protective factor of 3.25 (1.17 to 9.06, P = 0.024) for wearing a helmet. CONCLUSION--The findings suggest an increased risk of sustaining head injury in a bicycle accident when a motor vehicle is involved and confirm protective effect of helmet wearing for any bicycle accident.     

QUESTIONABLE COMPENSATION CLAIMS—Principles of Special Examination

In deciding a disputed claim of disability arising from occupation, physicians should ascertain whether a patient''s medical history has any bearing on the disability; they should attempt psychologic evaluation of the patient as it may reflect on the conditions they observe in physical examination; they should investigate symptoms complained of by the patient rather than accept them as prima facie evidence of disability; and they must have knowledge of the extent to which an injury can cause disability.It is urged that standards of physical ability and disability, as well as of other physical factors which may affect compensation claims, be established by organized research.     

Questionable compensation claims; principles of special examination

In deciding a disputed claim of disability arising from occupation, physicians should ascertain whether a patient's medical history has any bearing on the disability; they should attempt psychologic evaluation of the patient as it may reflect on the conditions they observe in physical examination; they should investigate symptoms complained of by the patient rather than accept them as prima facie evidence of disability; and they must have knowledge of the extent to which an injury can cause disability. It is urged that standards of physical ability and disability, as well as of other physical factors which may affect compensation claims, be established by organized research.