Summary of influences that led to introduction of frontal airbags on US passenger vehicles.

OBJECTIVE: The history of airbags for occupant protection in frontal crashes is reviewed from the perspective of a former Senior Executive at NHTSA from the early 1970's to the late 1980's. This paper summarizes the factors that led to regulatory delays as well as those that led to voluntary adoption of airbags by several manufacturers. METHODS: The regulatory history and interactions with airbag suppliers and vehicle manufactures is recounted citing key steps in the evolution of frontal airbags. RESULTS: When the Advanced Notice of Proposed Rulemaking for Standard 208, "Occupant Protection" was issued on July 2, 1969 the Safety Agency anticipated that the industry response would provide automatic frontal crash protection from airbags that deployed to protect all front seat occupants from injury in severe frontal crashes. It was not until, September 1, 1998 that airbags were required in all cars and light trucks. The interim 29 years involved a series of stops and starts during which most of the original airbag suppliers lost interest and abandoned the airbag market. The issues associated with airbags and their place in Standard 208 were directly influenced by interventions from the President, the Congress, the Supreme Court, Secretaries of Transportation, NHTSA Administrators, the Presidents of US Auto Companies and Senior Executives of Insurance Companies. CONCLUSION: In 1966, there was support from the US auto industry for a single source of safety regulations that apply to new vehicles sold in the US. This is evidenced by the unanimous passage by the House of Representatives and Senate of the Law that created the Federal auto safety regulatory framework. The Law also required seatbelts in new cars and prohibited States from making separate safety rules. However, the large safety benefits offered by seatbelts were negated because they were rarely used. Consequently, finding ways of providing high levels of protection without requiring action by occupants became a goal of the new Safety Agency. The airbag offered the possibility of achieving that goal.From the initial airbag notice of proposed rulemaking on July 2, 1969, Safety Agency required 2 years to resolve objections before a final Standard 208 could be issued (on July 8,1971). The subsequent industry opposition to the Standard 208 employed Presidential influence and Court suits to cause a 5½ year delay until the Coleman Decision on December 6, 1976. Changes in regulatory approach of the Ford, Carter, and Reagan Administrations and associated Court suits caused another 7½ year delay until the Dole Decision on July 17, 1984. It required another 7 ½, until December 18, 1991, for market forces to reduce industry opposition to airbags and permit Congress to pass a law that mandated them. Another 6½ years of lead time was required before all cars and light trucks were required to meet the airbag standard. During the mid and late 1980's vehicle safety ratings, seatbelt use laws, and Vince and Larry PSA's had all acted to increase safety awareness and safety belt use. Consequently, added public demand for vehicle safety features slowly developed. Changes in economic incentives encouraged a number of vehicle lines to install driver airbags as standard equipment and the feature was being widely advertised by Chrysler. This combination of events made it possible for Congress to pass and President Bush 41 to sign legislation requiring airbags in cars and light trucks by September 1, 1998 - more than 29 years after the initial rulemaking notice in 1969.

How do bicyclists respond to vehicles with adaptive headlamp systems? A nighttime study in an immersive virtual environment.

INTRODUCTION: The risk of motor vehicle-bicyclist crashes and fatalities is greater during nighttime than daytime lighting conditions, even though there are fewer cyclists on roadways at night. Vehicle Adaptive Headlamp Systems (AHS) aim to increase the visibility of bicyclists for drivers by directing a spotlight to illuminate bicyclists on or near the roadway. AHS technology also serves to alert bicyclists to the approaching vehicle by illuminating the road beneath the rider and by projecting a warning icon on the roadway. METHOD: Here, we examined how bicyclists respond to different AHS designs using a large screen, immersive virtual environment. Participants bicycled along a virtual road during nighttime lighting conditions and were overtaken by vehicles with and without an AHS system. The experiment included five treatment conditions with five different AHS designs. In each design a box of white light was projected beneath the rider; in four of the designs an icon was also projected on the road that varied in color (white or red) and position (to the left of the rider at midline or to the left of the front wheel). Participants in the control condition experienced only non-AHS vehicles. RESULTS: We found that riders in all AHS treatment conditions moved significantly farther away from overtaking vehicles with AHS systems, whereas riders in the control condition did not significantly move away from overtaking vehicles without AHS systems. PRACTICAL APPLICATIONS: The experiment demonstrates that AHS has potential to increase bicycling safety by influencing riders to steer away from overtaking vehicles.

Driving errors as a function of listening to music and FM radio: A simulator study.

OBJECTIVES: Driving is a dynamic activity that takes place in a constantly changing environment, carrying safety implications not only for the driver but also for other road users. Despite the potentially life-threatening consequences of incorrect driving behavior, drivers often engage in activities unrelated to driving. This study aims to investigate the frequency and types of errors committed by drivers when they are distracted compared to when they are not distracted. METHODS: A total of 64 young male participants volunteered for the study, completing four driving trials in a driving simulator. The trials consisted of different distraction conditions: listening to researcher-selected music, driver-selected music, FM radio conversation, and driving without any auditory distractions. The simulated driving scenario resembled a semi-urban environment, with a track length of 12 km. RESULTS: The findings of the study indicate that drivers are more prone to making errors when engaged in FM radio conversations compared to listening to music. Additionally, errors related to speeding were found to be more prevalent across all experimental conditions. CONCLUSIONS: These results emphasize the significance of reducing distractions while driving to improve road safety. The findings add to our understanding of the particular distractions that carry higher risks and underscore the necessity for focused interventions to reduce driver errors, especially related to FM radio conversations. Future research can delve into additional factors that contribute to driving errors and develop effective strategies to promote safer driving practices.

Mortalidad en accidentes por moto en Venezuela, y su relación con Políticas Públicas de seguridad vial y preventiva,1996-2018 / Mortality in motorcycle accidents in Venezuela and relationship with public road safety and preventive policies, 1996 - 2018

Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.

Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.

Older Adults and Unintentional Injury.

Clinicians play an important role in the prevention of unintentional injuries. Falls and motor vehicle crashes (MVC) have predictable and overlapping antecedents. Systematic screening for and management of vision impairment, frailty, cognitive impairment, polypharmacy, and inappropriate medications will reduce both falls and MVC risks. Fall-prevention measures, such as strength training, need to be more widely prescribed by physicians and implemented by older adults. Technologically tailored approaches are needed to leverage fall-reduction programs at home, as well as education of older adults regarding home hazards.

Mitigation of signalized intersection collision risks with trajectory based dynamic dilemma zone protection.

Dilemma zone is one of the major factors causing red-light violations, right-angled and rear-end crashes at signalized intersections. In this paper, a dilemma zone protection system is introduced, which employs a dynamic vehicular trajectory optimization approach to guide vehicles approaching a signalized intersection. Unlike conventional methods that aim to eliminate dilemma zones, this system adjusts the speed profiles of individual vehicles to shift the distribution of dilemma zones and prevent vehicles from becoming trapped. Extensive simulated experiments were conducted to test and validate the proposed system for both individual vehicles and platoons. Results demonstrate that the system offers superior protection for individual vehicles, with full coverage across various settings of initial speeds and distances to the stop line. In the traffic environment with realistic platooning settings, the proposed system significantly reduces the number of vehicles in the dilemma zone, resulting in improved operational and safety benefits such as reduced risks of hazardous maneuvers and savings in vehicular delay.

A framework for proactive safety evaluation of intersection using surrogate safety measures and non-compliance behavior.

In recent years, identifying road users' behavior and conflicts at intersections have become an essential data source for evaluating traffic safety. According to the Federal Highway Administration (FHWA), in 2020, more than 50% of fatal and injury crashes occurred at or near intersections, necessitating further investigation. This study developed an innovative artificial intelligence (AI)-based video analytic tool to assess intersection safety using surrogate safety measures and non-compliance behavior. To extract the trajectory data, a real-time AI detection model - YOLO-v5 with a tracking framework based on the DeepSORT algorithm was deployed. 54 h of high-resolution video data were collected at six signalized intersections (including three 3-leg and three 4-leg intersections) in Glassboro, New Jersey. Non-compliance behaviors, such as redlight running and pedestrian crossing outside the crosswalk, are captured to better understand the risky behaviors at these locations. The proposed approach achieved an accuracy of 92% to 98% for detecting and tracking road users' trajectories. Additionally, the developed tool also provided directional traffic volumes, pedestrian volumes, vehicles running a red light, pedestrian crossing outside the crosswalk events, and PET and TTC for crossing conflicts between vehicles. Furthermore, an extreme value theory (EVT) was used to estimate the number of crashes at each intersection utilizing the frequency of PETs and TTCs. Finally, the intersections were ranked based on the calculated score considering the severity of crashes. Overall, the developed tool and the crash estimation, as well as the model and ranking method, can provide valuable information for engineers and policymakers to assess the safety of intersections and implement effective countermeasures to mitigate intersection-involved crashes.

Associations between vision impairment and vision-related interventions on crash risk and driving cessation: systematic review and meta-analysis.

OBJECTIVES: To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs. DESIGN: Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis. PARTICIPANTS: Drivers of four-wheeled vehicles of all ages with no cognitive declines. PRIMARY AND SECONDARY OUTCOMES: MVC involvement (primary) and driving cessation (secondary). RESULTS: 101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I2=46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I2=0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I2=28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I2=93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I2=3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I2=22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I2=75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I2=63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I2=97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD. CONCLUSION: Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety. PROSPERO REGISTRATION NUMBER: CRD42020172153.

An integrated intelligent intersection control system for preventing rear-end and angled crashes: System design and deployment results.

In view of the dynamic all-red extension (DARE) system's effectiveness in preventing angled crashes (Park et al., 2018), this study has further enhanced its function to contend with rear-end collisions with dynamic green extension (DGE). With such a function, the enhanced Integrated Intelligent Intersection control system (III-CS) is capable of dynamically terminating the green at the interval of the lowest rear-end collision risk, so as to prevent undesirable "max-out" under actuated signal control which often traps some vehicles in the dilemma zone during high-volume traffic conditions. To ensure its effectiveness in practice, the proposed III-CS has been designed with the following new features: (i) executing the DGE within a customized time window of the green phase to ensure the signal's effective coordination with its neighboring intersections; (ii) adopting the comparison-based heuristic for the DGE's real-time risk prediction so as to circumvent the computing and communications delays. The results of two after-deployment assessments show that the system's DARE has perfectly detected all red-light runners; 66.7 percent of the decisions by the DGE module were observed to achieve the control objective during the first field assessment. The DGE's performance in making optimal decisions has improved over time and reached the level of 81.3% in the second field evaluation. Other measures of effectiveness, such as the number of vehicles trapped in the dilemma zone and the average deceleration rate of the driving populations approaching the target intersection, have also evolved to the anticipated trend after the deployment.

Lessons learned? Increasing injury severity of electric-scooter accidents over a period of one year: a monocentric follow-up study at a level 1 trauma center.

PURPOSE: After major COVID-19 lockdown measures were suspended in 2021, E-scooter mobility regrew rapidly. In the meantime, multiple studies were published on the potential risks for e-scooter drivers and the necessity for wearing protective equipment. But did the drivers learn their lessons? METHODS: We observed data of E-scooter-related accidents admitted to the emergency department of a level 1 German trauma center in the year 2021 and compared the data with our previous report (July 2019-July 2020). RESULTS: N = 97 E-scooter-related accidents were included, marking a 50% increase when compared to the previous observation. Most patients were young adults (28.18 ± 1.13 years) with a notable shift towards a male population (25 vs. 63, p = 0.007). While the injury pattern remained unchanged, injury severity, reflected by a significant increase in shock room treatments (p = 0.005), hospital admissions (p = 0.45), and ICU admissions (p = 0.028), increased. Lastly, we report a higher injury severity of patients driving under the influence of alcohol, expressed by significant differences in hospital admissions, shock room treatments, ICU admissions, intracerebral bleeding (p < 0.0001), and injuries requiring surgery (p = 0.0017). CONCLUSION: The increase in injury severity and especially the substantial number of accidents due to driving under the influence of alcohol, are alarming for both trauma- and neurosurgeons. As the controversy surrounding the general use of E-scooters will continue, we urge representatives to intensify their efforts regarding prevention campaigns focusing on the potential dangers of E-scooters, especially when driving under the influence of alcohol.

Reducing the incidence and mortality of traumatic brain injury in Latin America.

Traumatic brain injury (TBI) represents a considerable portion of the global injury burden. The incidence of TBI will continue to increase in view of an increase in population density, an aging population, and the increased use of motor vehicles, motorcycles, and bicycles. The most common causes of TBI are falls and road traffic injuries. Deaths related to road traffic injury are three times higher in low-and middle-income countries (LMIC) than in high-income countries (HIC). The Latin American Caribbean region has the highest incidence of TBI worldwide, primarily caused by road traffic injuries. Data from HIC indicates that road traffic injuries can be successfully prevented through concerted efforts at the national level, with coordinated and multisector responses to the problem. Such actions require implementation of proven measures to address the safety of road users and the vehicles themselves, road infrastructure, and post-crash care. In this review, we focus on the epidemiology of TBI in Latin America and the implementation of solutions and preventive measures to decrease mortality and long-term disability.

Immunochromatography screening devices for cannabinoids in oral fluid sample

Abstract Cannabis sativa L. is one of the most consumed drugs in the world and recent studies have associated its use with an increase in the number of traffic accidents in different countries. In many countries, like Brazil, simple and reliable methodologies are still needed for the detection of drugs on site, mainly cannabinoids, considering its prevalence of use and oral fluid (OF) has been proved as an appropriate biological matrix for this purpose. Considering that, this work aims to review previous studies on immunochromatographic devices for on-site detection of cannabinoids in OF, discussing their sensitivity, specificity, cut-offs values and confirmatory methods. This data shows the importance of choosing a screening device and it reinforces the need for its implementation in Brazil. The research was conducted on 5 databases and all original articles, published in the last 10 years, were selected. A total of 32 articles were found, providing data for 17 screening devices of distinct brands. Only 2 screening devices showed satisfactory sensitivity and specificity in the evaluated studies (≥80% and ≥90% respectively). However, it should be considered that the screening devices still have some limitations, such as a higher cut-off than those recommended by international guidelines (cut-off > 2 ng/mL), therefore demonstrating the need for more studies in the area and the importance of confirmatory analysis usually fulfilled by LC-MS/MS, GC-MS/MS or GC-MS. Thus, the screening analyzes should not be evaluated by itself, but in association with confirmatory results and observational traits (behavioral changes), for a better understanding of the traffic scenario

Childhood injury prevention: Where we've been and where we need to be.

Injury remains the leading cause of death for children and adolescents in the US, and firearm injury has overtaken motor-vehicle crashes as the leading mechanism in the US since the topic of injury prevention was last reviewed in this journal. The success of injury prevention efforts relies on multidisciplinary collaboration, and pediatric surgeons play a central role as clinicians who provide and coordinate the care for injured children, as trauma program leaders, and as advocates for children's health and safety. This review will provide a concise history of injury prevention in the US and highlights three areas where pediatric surgeons have an opportunity to impart impactful change in their communities that could lead to lower injury rates.

Identifying distracted-driving events from on-road observations using a moving vehicle: A case study in New Jersey.

Distracted driving is a major traffic safety concern in the USA. To observe and detect distracted-driving events, various methods (e.g., surveys, videos, and simulations) involving the collection of cross-sectional data from individual subjects have been used in the transportation field. In this study, we employed an unconventional approach of on-road observations using a moving vehicle to collect data on distracted-driving events for multiple subjects in New Jersey. A data-collection crew member continuously navigated selected corridors to record driver-distraction events. A GPS (Global Positioning System) tracker was used to timestamp and record the location of each incident. Two non-parametric tests (Mann-Whitney U test and Kruskal-Wallis test) were performed to identify the significance of the variations in distracted-driving behaviors due to changes in temporal variables (e.g., day of the week, season), the type of roadway, and the geometric properties of the roadway. The results indicated that cellphone use was the leading type of distraction. Additionally, "handheld phone use (phone to ear)," "fidgeting/grooming," "drinking/eating/smoking," and "talking to passengers" events were significantly affected by the time of day and the geometric properties of the roadway. The results of this study are expected to assist state and local agencies in promoting awareness of distracted driving with the aim of reducing the frequency and severity of distracted driving-related crashes.

The Impact of Cannabis Decriminalization and Legalization on Road Safety Outcomes: A Systematic Review.

INTRODUCTION: There is substantial debate concerning the impact of cannabis decriminalization and legalization on road safety outcomes. METHODS: Seven databases were systematically searched: Embase, MEDLINE, and PsycINFO through Ovid as well as Web of Science Core Collection, SafetyLit, Criminal Justice Database (ProQuest), and Transport Research International Documentation (from inception to June 16, 2021). Eligible primary studies examined group-level cannabis decriminalization or legalization and a road safety outcome in any population. RESULTS: A total of 65 reports of 64 observational studies were eligible, including 39 that applied a quasi-experimental design. Studies examined recreational cannabis legalization (n=50), medical cannabis legalization (n=22), and cannabis decriminalization (n=5). All studies except 1 used data from the U.S. or Canada. Studies found mixed impacts of legalization on attitudes, beliefs, and self-reported driving under the influence. Medical legalization, recreational legalization, and decriminalization were associated with increases in positive cannabis tests among drivers. Few studies examined impacts on alcohol or other drug use, although findings suggested a decrease in positive alcohol tests among drivers associated with medical legalization. Medical legalization was associated with reductions in fatal motor-vehicle collisions, whereas recreational legalization was conversely associated with increases in fatal collisions. DISCUSSION: Increased cannabis positivity may reflect changes in cannabis use; however, it does not in itself indicate increased impaired driving. Subgroups impacted by medical and recreational legalization, respectively, likely explain opposing findings for fatal collisions. More research is needed concerning cannabis decriminalization; the impacts of decriminalization and legalization on nonfatal injuries, alcohol and other drugs; and the mechanisms by which legalization impacts road safety outcomes.

Risky-Driving-Image Recognition Based on Visual Attention Mechanism and Deep Learning.

Risky driving behavior seriously affects the driver's ability to react, execute and judge, which is one of the major causes of traffic accidents. The timely and accurate identification of the driving status of drivers is particularly important, since drivers can quickly adjust their driving status to avoid safety accidents. In order to further improve the identification accuracy, this paper proposes a risky-driving image-recognition system based on the visual attention mechanism and deep-learning technology to identify four types of driving status images including normal driving, driving while smoking, driving while drinking and driving while talking. With reference to ResNet, we build four deep-learning models with different depths and embed the proposed visual attention blocks into the image-classification model. The experimental results indicate that the classification accuracy of the ResNet models with lower depth can exceed the ResNet models with higher depth by embedding the visual attention modules, while there is no significant change in model complexity, which could improve the model recognition accuracy without reducing the recognition efficiency.

Developing a two-stage auditory warning system for safe driving and eco-driving at signalized intersections: A driving simulation study.

In-vehicle intersection warning systems represent a promising approach for informing drivers of potential danger to reduce crashes and improve intersection safety. However, there is limited research on drivers' eco-driving performances, such as fuel consumption and emission, when drivers adapt their behaviors to the systems. In this study, an innovative two-stage in-vehicle intersection warning system was proposed to reduce red-light running (RLR) violations. Forty-five drivers participated in a simulated driving experiment and their driving performances at the intersections were evaluated to examine the effectiveness of the warning system. The measures included stop/go decision, RLR rate, average speed and deceleration, brake transition time, brake level, fuel consumption, and emission of CO and NOx. The results indicated that the warning system had a positive effect on drivers' safe driving and eco-driving performances, such as reducing the RLR rate, advancing and smoothing the deceleration and reducing fuel consumption and emission. Moreover, the impact of warning on drivers' performances varied with the time to the onset of yellow light. The research has practical implications for the automobile industry to use vehicle-to-infrastructure technology in the design of in-vehicle warning systems to improve driver behaviors at intersections.

Reducing the Neurotrauma Burden in India-A National Mobilization.

India has one of the highest TBI burdens due to road traffic accidents (RTAs), with 60% of head injuries being attributable to RTA and more than 150,000 lives being lost annually due to traumatic brain injury (TBI). These numbers have prompted institutions and organizations at international, national, and local levels to mobilize and address this burden through prevention, prehospital care, and in hospital care. Academic institutions such as Andhra Medical College have run local campaigns promoting the wearing of helmets when riding 2-wheelers. Prehospital care institutions such as Gunupati Venkata Krishna - Emergency Management and Research Institute have also made large strides nationally on delivering safe and timely care through novel and focused education to its emergency medical technicians, applying evidence-based practice to all facets of its work. These changes led to implementation of novel and innovative technological solutions for faster and more efficient responses. National institutions such as the Neurological Society of India (NSI) and Neurotrauma Society of India (NTSI) have been instrumental in promoting safety measures such as use of helmets and seatbelts through social media videos, often using celebrities to disseminate the message. NSI have also focused on sharing best practices for the management of TBI through easy-to-use platforms such as YouTube. Institutions such as American Association of Physicians of Indian Origin, NSI, and NTSI have collaboratively developed TBI management guidelines that are specific to the Indian population (supported by American Association of South Asian Neurosurgeons). Non-governmental organizations such as the Indian Head Injury Foundation and Save Life Foundation have contributed to this movement by promoting awareness through campaigns and public education. While TBI remains a large burden in India, a mobilization and coalesced efforts of such a scale holds promise for tackling this burden.

Higher risk of auto versus pedestrian crashes in school-age children on school days.

BACKGROUND: This study examines the rates of pediatric auto versus pedestrian collision (APCs) and determined ages and periods of greatest risk. We hypothesized that the rate of APC in children would be higher on school days and in the timeframes correlating with travel to and from school. METHODS: Retrospective case-control study of APC on school and nonschool days for patients younger than 18 years at an urban Level II pediatric trauma center from January 2011 to November 2019. Frequency of APC by hour of the day was plotted overall, for school versus nonschool days and for age groups: 0 year to 4 years, 5 years to 9 years, 10 years to 13 years, and 14 years to 17 years. t Test was used with a p value less than 0.05, which was considered significant. RESULTS: There were 441 pediatric APC in the study period. Frequency of all APC was greater on school days (0.174 vs. 0.101; relative risk [RR], 1.72, p < 0.001), and APC with Injury Severity Score greater than 15 (0.039 vs. 0.024; p = 0.014; RR, 1.67; 95% confidence interval, 1.10-2.56). Comparing school day with nonschool day, the 0-year to 4-year group had no significant difference in APC frequency (0.021 vs. 0.014; p = 0.129), APC frequency was higher on school days in all other age groups: 5 years to 9 years (0.036 vs. 0.019; RR, 1.89; p = 0.0134), 10 years to 13 years (0.055 vs. 0.024; RR, 2.29; p < 0.001), and 14 years to 17 years (0.061 vs. 0.044; RR, 1.39; p = 0.045). The greatest increase in APC on school days was in the 10-year to 13-year age group. DISCUSSION: All school age children are at higher risk of APC on school days. The data support our hypothesis that children are at higher risk of APC during transit to and from school. The age 10-year to 13-year group had a 129% increase in APC frequency on school days. This age group should be a focus of injury prevention efforts. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.