Safe System approach for cyclists in the Netherlands: Towards zero fatalities and serious injuries?

More than one third of all road deaths in the Netherlands and more than two thirds of seriously injured casualties are cyclists. In recent years these shares have increased, despite the fact that the implementation of Safe System principles has been leading in road safety policy and has been successful in reducing the total number of road deaths. However, the annual number of fatalities among cyclists failed to decline and the number of injuries among cyclists has been increasing, especially in single-bicycle crashes. This raises the question why until now Safe System implementation has failed to contribute to the reduction of the number of casualties among cyclists. This question is urgent because of the goal to reduce the number of road deaths and serious traffic injuries in the Netherlands to (virtually) ZERO by 2050. This ambition is in line with the objectives of the European Union. The causes of the unfavourable developments in road safety for cyclists in the Netherlands and which problems require a solution are examined. This raises two questions: can improved implementation of Safe System measures reverse the negative trend, and can this result in ZERO cycling casualties in the future. The discussion involves investigating three dimensions: exposure, crash risk, and injury risk. The opportunities that technological developments may offer in future decades are also considered. It is concluded that Safe System implementation will include opportunities to make cycling considerably safer in the Netherlands. However, we face too many uncertainties to allow for developing scenarios that show how close the Netherlands will be to ZERO cyclists casualties.

Do electric bicycles cause an increased injury risk compared to conventional bicycles? The potential impact of data visualisations and corresponding conclusions.

The increasing number of bicycle crashes leading to injuries in the Netherlands is frequently related (e.g., in the media) to increased use of the electric bicycle. For this reason, policy makers face the challenge of selecting and implementing the most promising countermeasures including those focused on electric bicycles. It may be questioned, however, to what extent the electric bicycle itself is a (direct) cause of crashes leading to injuries or whether other factors are important for explaining the increased number of bicycle injury crashes. On the basis of an abbreviated list of criteria by Elvik (2011), this paper illustrates the potential influence of factor inclusions, analysis selections, and data presentations on the general impression about crash causation with the electric bicycle as an example. The aim is to provide a 'best practice guide' by taking into account (1) a theoretical explanation of causal mechanisms, (2) control for confounders, and (3) a statistical association of sufficient strength and consistency in the expected direction. We conclude that an apparent increased risk of electric bicycles may be explained by factors such as age, exposure, health factors, and gender of the cyclist. A relatively simple analysis, by comparing fatality numbers of conventional and electric bicycles, showed that including or excluding these factors may lead to vastly different interpretations of fatality causes and the relative risk of electric bicycles compared to conventional bicycles.

The relationship between cycle track width and the lateral position of cyclists, and implications for the required cycle track width.

INTRODUCTION: Sufficient cycle track width is important to prevent single-bicycle crashes and collisions between cyclists. The assumptions on which the minimum width is based in guidelines is founded on only a few studies. The aim of the present study is to investigate the relationship between cycle track width and lateral position of cyclists. METHOD: We conducted an experiment to evaluate the lateral position of cyclists along cycle tracks with different widths (Study 1). Participants cycled on an instrumented bicycle with a LIDAR to measure their lateral position. Five conditions were defined: cycle track width of 100 cm, 150 cm and 200 cm without interaction, and cycle track width of 150 cm and 200 cm with an oncoming cyclist simulated by a parked bicycle. The cross-sectional Study 2 is based on the collected lateral position measurements at cycle tracks with varying width reported in Dutch studies since 2010. RESULTS: The experimental Study 1 with 24 participants shows that an increase in cycle track width causes cyclists to ride further away from the verge and keep more distance from an oncoming cyclist. The cross-sectional Study 2 was based on lateral position measured at 33 real-life Dutch cycle tracks. Study 2 yielded similar results, indicating that doubling pavement width increases lateral position by some 50%. Study 2 shows that, compared with a solo cyclist without interaction, a right-hand cyclist of a duo and a cyclist meeting an oncoming cyclist ride around 30% closer to the verge. CONCLUSIONS: The wider the cycle track, the more distance cyclists maintain from the verge. Cyclists ride closer to the verge due to oncoming cyclists. PRACTICAL APPLICATIONS: Given a cyclists' lateral position while meeting, common variations between cyclists' steering behavior, and vehicle width and circumstances, a cycle track width of 250 cm is needed for safe meeting maneuvers.

Odds of self-reported minor cycle crashes with conventional and electric assisted cycles adjusted for cycling frequency in Dutch and Belgian adults a retrospective study.

BACKGROUND: Cycling for transportation and recreation is gaining in popularity, especially in older age groups. The rise in electric assisted cycles (EAC) may also have a role to play in this. With an increase in the number of cyclists comes an increase in the prevalence of cycle crashes. However, there is a lack of knowledge on EAC crashes and crash studies including cycle use data. An important question is also whether the high number of serious road injuries among older cyclists, is due to increased risk or more serious consequences in the event of a crash. STUDY AIM: To compare the odds of reporting a cycle crash on a conventional (CC) against electrically assisted cycle (EAC), while controlling for age, gender, BMI, impairments while cycling, cycling frequency and region of residence. METHODS: A 12-month retrospective cross-sectional survey-based study, including male and female cyclists aged 40+ years, was conducted in Belgium and the Netherlands. Socio-demographics, physical and mental impairments while cycling (such as lower reaction time), crash details and cycling frequency data were collected. Cyclists were grouped into CC, EAC or both (CC + EAC) based on the type of cycle they used during the study period. Logistic regression models were used to calculate the odds of reporting a cycle crash. Main and interaction effects were studied. RESULTS: 1,919 cyclists were included in the data analysis (63.2 ± 11.1 years; 50% women). 319 (17% of the total sample) cyclists reported a crash in the previous 12 months, of which 36% were EAC crashes. Those reporting a crash were significantly younger compared to those not reporting a crash. The following significant main effects were observed: those cycling on an EAC had a higher odds of reporting a cycle crash compared to those cycling on a CC (OR = 1.41, 95% CI = 1.01-1.97); cyclists in the category average and high on mental impairments while cycling had a higher odds of reporting a cycle crash compared to those in the category low (OR = 1.72, 95% CI = 1.23-2.40 and OR = 3.49, 95% CI = 2.51-4.90, respectively); higher cycling frequency is related to higher odds of reporting a cycle crash (OR = 3.25, 95% CI = 2.25-4.90). A significant interaction effect was observed between age category and gender (OR = 1.93, 95% CI = 1.15-3.26). Post-hoc tests revealed that men in the younger age category (40-64 years) had the highest probability (18.95%) of reporting a cycle crash, whereas men in the oldest age category (65+ years) had the lowest probability (9.99%) of reporting a cycle crash. No significant difference between age categories in women was observed. CONCLUSION: This study indicates that within a cohort of middle aged and older adults living in regions with high to low cycling modal shares, cycle type, mental impairments while cycling, cycling frequency and region of residence play a significant role in the odds of reporting a (minor) cycle crash. Men in the age category 40-64 years have a significantly higher probability of reporting a cycle crash compared to men of 65+ years. Safety campaigns and instructions should pay particular attention to men in the age category 40-64 years and those with a mental impairment while cycling.

A comprehensive analysis of the relationships between the built environment and traffic safety in the Dutch urban areas.

Built-environment factors potentially alleviate or aggravate traffic safety problems in urban areas. This paper aims to investigate the relationships of these factors with vehicle-bicycle and vehicle-vehicle property damage only (PDO) and killed and severe injury (KSI) crashes in urban areas. For this purpose, an area-level analysis using 100x100m2 cells, along with a Spatial Hurdle Negative Binomial regression model were employed. The study area is composed of a selection of municipalities in the Netherlands-Randstad Area where major land-use developments have occurred since the 1970s. The study was conducted by developing a rich dataset composed of various national and local databases. The findings reveal that built-environment factors and land-use policies have substantial impacts on safety, which cannot be neglected. The factors explaining the land-use density and diversity in the area (e.g., urbanity and function mixing levels), as well as the land-use design characteristics (indicated by average age of the neighborhoods), traffic and road network characteristics, and proximity to different destinations influence the probability, frequency, and severity of crashes in urban areas. Furthermore, low socioeconomic levels are associated with a higher frequency of traffic crashes.

Pedestrian falls: A review of the literature and future research directions.

INTRODUCTION: Pedestrian falls (PFs) - falls in public spaces without collisions with other road users - are a significant cause of serious transport-related injuries, amounting to three-quarters of all pedestrians admitted to hospital. METHODS: This scoping review examined peer-reviewed research on PFs published between 1995 and 2015. Electronic databases (Scopus, SafetyLit, and PubMed) were used to find studies identifying PFs or outdoor falls (the latter also including falls in gardens). RESULTS: We identified only 28 studies reporting relevant information on PFs (i.e., 15 prospective, 10 retrospective, and 3 intervention studies). The results show that more walking is related to a lower risk of PFs. Older people, especially older women, have a higher risk of (injurious) PFs. Outdoor fall victims have equally good or better health characteristics and scores on balance tests compared to those who have not experienced such falls. Road factors such as uneven surfaces, busy junctions, stairs, and slippery surfaces seem to play an important role in PFs, but much of the research on these factors is of a qualitative nature. CONCLUSIONS: PF victims are generally in good health (apart from normal age-related problems) but at risk due to road factors. PRACTICAL APPLICATIONS: We recommend to adopt a human factors approach. The road system should be adapted to human capabilities and limitations including those of pedestrians. Measures such as preventing uneven surfaces and good winter maintenance seem to be effective. However, we advise more quantitative research on road factors to inform design guidelines and standards for public space authorities given the qualitative nature of current research on road factors.

Silver-coated endoprosthetic replacement of the proximal humerus in case of tumour-is there an increased risk of periprosthetic infection by using a trevira tube?

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate if there is an increased risk of periprosthetic infection (PJI) in patients following replacement of the proximal humerus by using a modular tumour prosthesis in combination with a trevira tube. METHODS: Thirty patients were treated by using a modular tumour endoprosthesis (MUTARS®) following intra-articular resection of the proximal humerus. Fifteen patients received treatment by using a trevira tube. In 15 further cases the use of a trevira tube was not necessary. The mean follow-up time was 26 months (range: 24 months to 84 months). Both, Enneking score and range of motion (ROM), was evaluated. Further radiographs were obtained in two planes. RESULTS: The survival rate one year after surgery was 83 % and 63 % after two years. We recorded a 96 % survival of the limb two years after surgery. We also observed only one case of periprosthetic joint infection (PJI) in the entire follow-up period in one patient who received treatment with a trevira tube. The mean Enneking score was 20 points (range 8 to 26 points). ROM was equal in both study groups. In total 20 % of the treated patients (n = 6) suffered complications. CONCLUSIONS: Replacement of the proximal humerus by using a trevira tube in combination with a modular tumour endoprosthesis is a safe and viable treatment option for both, bone tumours and metastases. There is no statistically significant increased risk of infection by using trevira tube even among immunosuppressed patients. LEVEL OF EVIDENCE: Level 3, retrospective comparative study.

Can cycling safety be improved by opening all unidirectional cycle paths for cycle traffic in both directions? A theoretical examination of available literature and data.

Many studies have found bicycle-motor vehicle crashes to be more likely on bidirectional cycle paths than on unidirectional cycle paths because drivers do not expect cyclists riding at the right side of the road. In this paper we discuss the hypothesis that opening all unidirectional cycle paths for cycle traffic in both directions prevent this lack of expectancy and accordingly improves cycling safety. A new national standard requires careful consideration because a reversal is difficult once cyclists are used to their new freedom of route choice. We therefore explored the hypothesis using available data, research, and theories. The results show that of the length of cycle paths along distributor roads in the Netherlands, 72% is bidirectional. If drivers would become used to cyclists riding at the left side of the road, this result raises the question of why bidirectional cycle paths in the Netherlands still have a poor safety record compared to unidirectional cycle paths. Moreover, our exploration suggested that bidirectional cycle paths have additional safety problems. It increases the complexity of unsignalized intersections because drivers have to scan more directions in a short period of time. Moreover, there are some indications that the likelihood of frontal crashes between cyclists increases. We reject the hypothesis that opening all unidirectional cycle paths for cycle traffic in both directions will improve cycle safety. We recommend more attention for mitigating measures given the widespread application of bidirectional cycle paths in the Netherlands.

Global bike share: What the data tells us about road safety.

INTRODUCTION: Bike share has emerged as a rapidly growing mode of transport in over 800 cities globally, up from just a handful in the 1990s. Some analysts had forecast a rise in the number of bicycle crashes after the introduction of bike share, but empirical research on bike share safety is rare. The goal of this study is to examine the impact of bike share programs on cycling safety. METHODS: The paper has two substudies. Study 1 was a secondary analysis of longitudinal hospital injury data from the Graves et al. (2014) study. It compared cycling safety in cities that introduced bike share programs with cities that did not. Study 2 combined ridership data with crash data of selected North American and European cities to compare bike share users to other cyclists. RESULTS: Study 1 indicated that the introduction of a bike share system was associated with a reduction in cycling injury risk. Study 2 found that bike share users were less likely than other cyclists to sustain fatal or severe injuries. CONCLUSIONS: On a per kilometer basis, bike share is associated with decreased risk of both fatal and non-fatal bicycle crashes when compared to private bike riding. PRACTICAL APPLICATIONS: The results of this study suggest that concerns of decreased levels of cycling safety are unjustified and should not prevent decision makers from introducing public bike share schemes, especially if combined with other safety measures like traffic calming.

Dutch Cycling: Quantifying the Health and Related Economic Benefits.

The Netherlands is well known for their high bicycle use. We used the Health Economic Assessment Tool and life table calculations to quantify the population-level health benefits from Dutch cycling levels. Cycling prevents about 6500 deaths each year, and Dutch people have half-a-year-longer life expectancy because of cycling. These health benefits correspond to more than 3% of the Dutch gross domestic product. Our study confirmed that investments in bicycle-promoting policies (e.g., improved bicycle infrastructure and facilities) will likely yield a high cost-benefit ratio in the long term.

An international review of the frequency of single-bicycle crashes (SBCs) and their relation to bicycle modal share.

OBJECTIVES: To study cyclists' share of transport modes (modal share) and single-bicycle crashes (SBCs) in different countries in order to investigate if the proportion of cyclist injuries resulting from SBCs is affected by variation in modal share. METHODS: A literature search identified figures (largely from western countries) on SBC casualties who are fatally injured, hospitalised or treated at an emergency department. Correlation and regression analyses were used to investigate how bicycle modal share is related to SBCs. RESULTS: On average, 17% of fatal injuries to cyclists are caused by SBCs. Different countries show a range of values between 5% and 30%. Between 60% and 95% of cyclists admitted to hospitals or treated at emergency departments are victims of SBCs. The proportion of all injured cyclists who are injured in SBCs is unrelated to the share of cycling in the modal split. The share of SBC casualties among the total number of road crash casualties increases proportionally less than the increase in bicycle modal share. CONCLUSIONS: While most fatal injuries among cyclists are due to motor vehicle-bicycle crashes, most hospital admissions and emergency department attendances result from SBCs. As found in previous studies of cyclists injured in collisions, this study found that the increase in the number of SBC casualties is proportionally less than the increase in bicycle modal share.

A conceptual framework for road safety and mobility applied to cycling safety.

Scientific literature lacks a model which combines exposure to risk, risk, and the relationship between them. This paper presents a conceptual road safety framework comprising mutually interacting factors for exposure to risk resulting from travel behaviour (volumes, modal split, and distribution of traffic over time and space) and for risk (crash and injury risk). The framework's three determinants for travel behaviour are locations of activities; resistances (generalized transport costs); needs, opportunities, and abilities. Crash and injury risks are modelled by the three 'safety pillars': infrastructure, road users and the vehicles they use. Creating a link in the framework between risk and exposure is important because of the 'non-linear relationship' between them, i.e. risk tends to decrease as exposure increases. Furthermore, 'perceived' risk (a type of travel resistance) plays a role in mode choice, i.e. the perception that a certain type of vehicle is unsafe can be a deterrent to its use. This paper uses theories to explain how the elements in the model interact. Cycling is an area where governments typically have goals for both mobility and safety. To exemplify application of the model, the paper uses the framework to link research on cycling (safety) to land use and infrastructure. The model's value lies in its ability to identify potential consequences of measures and policies for both exposure and risk. This is important from a scientific perspective and for policy makers who often have objectives for both mobility and safety.

Does more cycling also reduce the risk of single-bicycle crashes?

OBJECTIVE: This paper examines the relationship between the amount of bicycle use and the number of single-bicycle crashes (ie, only one cyclist involved) in Dutch municipalities. Previous research has focused on crashes between bicycles and motor vehicles; however, most cyclists admitted to hospital are victims of single-bicycle crashes. METHODS: This correlational study used three data sets which included data relating to single-bicycle crashes and kilometres travelled by bicycle. Negative binomial regression was used to compare the amount of bicycling with the number of injuries incurred in single-bicycle crashes in Dutch municipalities. RESULTS: The likelihood of single-bicycle crashes varied inversely with the level of bicycle use. The exponent for the change in the number of single-bicycle crashes in response to changes in bicycle volumes was <1 in all analyses (ie, the increase in the number of single-bicycle crashes in a given municipality is proportionally less than the increase in the number of bicycle kilometres travelled by its inhabitants). The value was reduced in analyses of single-bicycle crashes with more severe injuries. CONCLUSIONS: Cyclists are less likely to be involved in a severe single-bicycle crash in municipalities with a high amount of cycling. Given the large numbers of patients admitted to hospital as a result of single-bicycle crashes, it is important to include the risks of these in road safety and health effect evaluations, and to take into account the non-linearity of the relationship between single-bicycle crashes and bicycle use if road safety measures are to affect the level of bicycle use.

What do cyclists need to see to avoid single-bicycle crashes?

The number of single-bicycle crash victims is substantial in countries with high levels of cycling. To study the role of visual characteristics of the infrastructure, such as pavement markings, in single-bicycle crashes, a study in two steps was conducted. In Study 1, a questionnaire study was conducted among bicycle crash victims (n = 734). Logistic regression was used to study the relationship between the crashes and age, light condition, alcohol use, gaze direction and familiarity with the crash scene. In Study 2, the image degrading and edge detection method (IDED-method) was used to investigate the visual characteristics of 21 of the crash scenes. The results of the studies indicate that crashes, in which the cyclist collided with a bollard or road narrowing or rode off the road, were related to the visual characteristics of bicycle facilities. Edge markings, especially in curves of bicycle tracks, and improved conspicuity of bollards are recommended. STATEMENT OF RELEVANCE: Elevated single-bicycle crash numbers are common in countries with high levels of cycling. No research has been conducted on what cyclists need to see to avoid this type of crash. The IDED-method to investigate crash scenes is new and proves to be a powerful tool to quantify 'visual accessibility'.

Mobile phone use while cycling: incidence and effects on behaviour and safety.

The effects of mobile phone use on cycling behaviour were studied. In study 1, the prevalence of mobile phone use while cycling was assessed. In Groningen 2.2% of cyclists were observed talking on their phone and 0.6% were text messaging or entering a phone number. In study 2, accident-involved cyclists responded to a questionnaire. Only 0.5% stated that they were using their phone at the time of the accident. In study 3, participants used a phone while cycling. The content of the conversation was manipulated and participants also had to enter a text message. Data were compared with just cycling and cycling while listening to music. Telephoning coincided with reduced speed, reduced peripheral vision performance and increased risk and mental effort ratings. Text messaging had the largest negative impact on cycling performance. Higher mental workload and lower speed may account for the relatively low number of people calling involved in accidents. STATEMENT OF RELEVANCE: Although perhaps mainly restricted to flat countries with a large proportion of cyclists, mobile phone use while cycling has increased and may be a threat to traffic safety, similar to phone use while driving a car. In this study, the extent of the problem was assessed by observing the proportion of cyclists using mobile phones, sending questionnaires to accident-involved cyclists and an experimental study was conducted on the effects of mobile phone use while cycling.