Severity of Agricultural Injuries and Its Economic Consequences in Border Belt of Gurdaspur District of Punjab, India.

OBJECTIVES: This study collected data related to agricultural injuries, analyzed their causes, and suggested possible remedial actions. Few studies from developing countries have investigated this important topic. Such investigations are extremely important and are required to frame national policies. METHODS: A well-designed structured form was developed to collect and evaluate data on agricultural incidents, their causes, the severity of injuries, and possible prevention methods. The authors followed a door-to-door survey methodology to collect data with the help of local village leaders. RESULTS: Less educated and older adults in the age group 31 to 45 years were more prone to agricultural incidents (p < .05). The mean age of the victims was 35.02 years (95% CI 32.7 to 37.3); 124 (91.18%) of the victims were men; and 21 (15.4%) of the cases were fatal. Tractor rollovers caused most of the deaths. Chaff cutters were responsible for most of the incidents that required amputation. Eighteen (45%) of the chaff-cutter incidents occurred in the evening between 3:00 PM and 6:00 PM, and 12 (30%) of these incidents occurred due to fatigue. CONCLUSIONS: The authors strongly recommend that rollover protective structures (ROPS) for tractors and seat belts should be made mandatory in India. Public guidelines emphasizing mandatory higher education for farmers and a model curriculum for both schools and colleges that focuses on the safety of rural populations should be developed. Special training should be provided on the safe operation of machinery and a definitive work - rest schedule should be followed to prevent fatigue and protect agricultural workers from incidents.

Assessment of pediatric shoulder range of motion and loading response to evaluate the biofidelity of the Large Omni-directional Child (LODC) anthropomorphic test device (ATD) shoulder design.

The shoulder girdle complex, through engagement with the seat belt, influences motor vehicle occupant upper body movement during frontal impacts, affecting the movement of the head and spine. The recently developed Large Omni-directional Child (LODC) anthropomorphic test device (ATD) was designed with flexible shoulder girdle structures that capture the unique kinematics in pediatric occupants. However, the LODC shoulder has not been evaluated for biofidelity due to the lack of biomechanical data available on pediatric shoulder responses. This study evaluated quasi-static pediatric shoulder girdle complex responses through non-invasive displacement measurements. These data were obtained to evaluate, and, if necessary, improve the biofidelity of the LODC ATD. Shoulder range of motion and anthropometric measurements were obtained from 25 pediatric volunteers, ages 8-12 years old. Loads were applied bilaterally exclusively to the shoulder complexes in increments of 25 N up to 150 N per shoulder at 90 and 135 degrees of shoulder flexion. Still photos were used to determine shoulder displacement in the sagittal plane from images captured prior to and following the load applications. Data analysis consisted of motion tracking to evaluate the absolute and relative displacement of the right acromion and T1. The displacements for each volunteer were normalized based on the volunteer's shoulder width compared to the shoulder width of the LODC ATD. For the 90° load, the acromion moved relative to T1 an average of 28.1 mm forward and 3.1 mm downward at maximum displacement. For the 135° load, the acromion moved relative to T1 an average of 15.5 mm forward and 42.7 mm upward at maximum displacement. Similar displacements at higher loads indicated that the volunteers achieved their maximum range of motion. The results of this study will be compared to the LODC ATD, assessing the biofidelity of the shoulder complex.

Empirical examination of interdependent relationship between usage of seatbelt restraint system and driver-injury severity of single-vehicle crashes in Thailand using a joint econometric analysis.

OBJECTIVES: The paper aims to examine the interdependent relationship between the usage of the seatbelt restraint system and severities of the driver-injury in single-vehicle crashes. METHODS: This paper developed a comprehensive joint econometric structure - a joint random parameters binary probit-binary probit model - that allows for the simultaneous examination of injury severity of the driver in a crash, and taking into account the fact that seat belt use can be endogenous to the outcomes of driver injury. The developed model is tested using data on drivers-injury severities involved in single-vehicle crashes in Thailand from 2012-2017. RESULTS: In terms of the interdependent relationship between seatbelt use status and driver-injury severities, the findings suggest that drivers who do not use seat belts may demonstrate more dangerous or aggressive driving behaviors (such as speeding), subsequently increasing their likelihood of involvement in severe or fatal crashes. Additionally, the result also shows that drivers who are involved in speeding-related crashes are less likely to wear a seatbelt and have a higher risk of sustaining severe and fatal injuries. The findings also reveal that in crashes, drivers who are young, or operating trucks are less likely to be wearing their seat belts. The study also indicates that severe and fatal crashes are associated with factors such as elderly drivers, alcohol involvement, unbelted drivers, fatigue, depressed medians, and barrier medians. Conversely, a crash in a U-turn area, driving a passenger car, pickup truck, or large truck, or colliding with a guardrail reduces the likelihood of severe and fatal injuries. CONCLUSIONS: Neglecting the hidden endogenous effect in statistical analyses could result in an overestimation of the impact of seat belt usage on crash-injury outcomes. The findings of this study can provide valuable insights for relevant authorities aiming to improve driver safety.

Motor Vehicle Crash and Hospital Charges in Front- and Rear-Seated Restrained and Unrestrained Adult Motor Vehicle Occupants.

There are reports that historically higher mortality observed for front- compared to rear-seated adult motor vehicle (MV) occupants has narrowed. Vast improvements have been made in strengthening laws and restraint use in front-, but not rear-seated occupants suggesting there may be value in expanding the science on rear-seat safety. METHODS: A linked 2016-2017 hospital and MV crash data set, the Crash Outcomes Data Evaluation System (CODES), was used to compare characteristics of front-seated (n = 115,939) and rear-seated (n = 5729) adults aged 18 years and older involved in a MV crash in New York State (NYS). A primary enforced seat belt law existed for front-seated, but not rear-seated occupants. Statistical analysis employed SAS 9.4. RESULTS: Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%, p < 0.0001) and to have more moderate-to-severe injury/death (11.9% vs. 11.3%, p < 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury/death (21.5% vs. 7.5%, p < 0.0001) and 4-fold higher hospitalization. More than 95% of ejections were unrestrained and had 7-fold higher medical charges. Unrestrained occupants' hospital stays were longer, charges and societal financial costs higher. CONCLUSIONS: These findings extend the science of rear-seat safety in seriously injured rear-seated occupants, document increased medical charges and support the need to educate consumers and policy makers on the health and financial risks of adults riding unrestrained in the rear seat. The lack of restraint use in adult rear-seated motor vehicle occupants consumes scarce health care dollars for treatment of this serious, but largely preventable injury.

Assessment of seat-belt related injuries using the FORTIS forensic system.

This study presents (1) a case of an injury to an unbelted passenger and (2) the possibilities of proving the occurrence of injuries to traffic accident participants. We demonstrate the case of an injury to a passenger who failed to fasten her seat belt, and question whether her injuries would have been equally serious if she had fastened her seat belt. Theoretical bases and methods for the interdisciplinary procedure of medical examiners using the PC Fortis program and technical analysts of traffic accidents using the PC Crash program are presented. Furthermore, individual practical steps are documented, the result showing that the injuries to the passenger would have occurred, but, to a minimum extent, i.e., 6.9% of the original injuries, which would have not exceeded the legal limit for damage to health.

[Forensic assessment of seat belt injuries caused to a minor passenger in the rear seat]. / Sudebno-meditsinskaya otsenka povrezhdenii ot vozdeistviya remnya bezopasnosti, prichinennykh nesovershennoletnemu passazhiru zadnego siden'ya.

The purpose of this work is to draw attention to the problem of child injuries in road traffic accidents. Children are the most vulnerable road users. Seat belts as elements of passive safety of cars cannot always provide the necessary protection. In some cases, they act as traumatic objects. A case of a thoracic spine injury (fractures of the bodies of two thoracic vertebrae) in a minor child who was on a booster and fixed with a standard seat belt is presented. The data of clinical and special research methods are presented, as well as options for solving some forensic issues are considered.

Does Abdominal Seat Belt Sign Warrant Admission After a Negative CT Scan? A Cost-Utility Analysis.

BACKGROUND: Rapid deceleration against a seat belt during a motor vehicle collision (MVC) may result in an abdominal seat belt sign (ASBS), which is associated with a higher risk of hollow viscus injury (HVI). After a negative abdominal CT scan, management of patients with ASBS is variable, but recent evidence suggests emergency department (ED) discharge may be safe. Therefore, we hypothesized that discharge from the ED is cost-effective compared with 23-h observation or hospital admission for patients with ASBS and a negative CT. METHODS: A cost-utility model was developed for an evaluable patient with ASBS and negative CT scan using TreeAge software. ED discharge was compared with 23-h observation and admission. Analysis was from a health care-based third-party payer perspective. Quality-adjusted life years (QALYs) were based on 3-y expected outcomes. Probability and costs were estimated from published literature and the Healthcare Cost and Utilization Project. RESULTS: In our base case, ED discharge was the most cost-effective strategy, yielding a cost of $706 with 2.86 QALYs. The average costs of 23-h observation and hospital admission were $2600 and $8,827, respectively, with 2.87 QALYs gained each. The strategy of ED observation becomes cost-effective when the rate of HVI after ED discharge exceeds 2.3%. In a Monte Carlo simulation, ED discharge was the optimal strategy in 91% of 1000 trials of the model. CONCLUSIONS: ED discharge is a cost-effective strategy for evaluable patients with ASBS and a negative abdominal CT and remains so when the risk of HVI after ED discharge is higher than currently assumed.

Revisiting the relationship between traffic accidents, real economic activity and other factors in Spain.

This paper analyzes the relationship between road traffic accidents and real economic activity in Spain, using data on accidents, fatalities and injuries from January 1975 to December 2016. Our results show the historical asymmetric cyclical behavior of traffic accidents variables. This relationship is more evident for accidents and injuries, while fatalities have shown a different pattern since 2002. Besides using aggregate data, we have analyzed urban and nonurban accidents separately. We analyze the effect of economic variables, public policy interventions and other potential factors affecting traffic series. Regarding policy interventions, we confirm a permanent reduction in all accident rates associated with the mandatory use of seatbelts on car passengers since 1992. However, the penalty points system introduced in July 2006 has only had temporary effects. We have also shown the effect of economic variables such as Industrial Production Index, gasoline and diesel consumption and registration of new vehicles and, as a novelty, the benefits of using the composite coincident and leading indicators of the Spanish economy.

Health Risk Factors Among Miners, Oil and Gas Extraction Workers, Other Manual Labor Workers, and Nonmanual Labor Workers, BRFSS 2013-2017, 32 States.

Background: Analyzing health risk factors among current workers by industry and occupation (IO) provides information on disparities between worker groups, especially when comparing workers within manual labor occupations. Mining and oil and gas extraction (OGE) are unique industries with different work environments that could affect health risk factors. The study objective was to compare the prevalence of health risk factors of miners, OGE, other manual labor, and nonmanual labor workers. Methods: The Behavioral Risk Factor Surveillance System's IO module was analyzed for years 2013-2017 to compare prevalences of excessive alcohol use, smoking, smokeless tobacco use, seat belt use, inadequate sleep, and obesity among four worker groups. National Health Interview Survey IO codes were used to categorize miners, OGE, other manual labor, and nonmanual labor workers. Findings: Miners and OGE workers had higher prevalence estimates than both nonmanual and manual labor workers for all health risk factors except current smoking. Both miners and OGE workers were significantly more likely than other manual labor workers to report smokeless tobacco use and not always wearing seatbelts. Compared with other manual labor workers, OGE workers were significantly more likely to report obesity, and miners were significantly more likely to report inadequate sleep. Conclusion/Application to Practice: Prevalence of most health risk factors differed among miners, OGE, other manual labor, and nonmanual labor workers. These differences could lead to disparities in health outcomes. Occupational health professionals in mining and OGE can use this information to inform and target integrated wellness and health and safety programs.

Affordability and Availability of Child Restraints in an Under-Served Population in South Africa.

BACKGROUND: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5's and 24.5 per 100,000 for 5-14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. METHODS: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. CONCLUSIONS: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

Biomechanical Responses and Injury Assessment of Post Mortem Human Subjects in Various Rear-facing Seating Configurations.

The objective of this study was to generate biomechanical corridors from post-mortem human subjects (PMHS) in two different seatback recline angles in 56 km/h sled tests simulating a rear-facing occupant during a frontal vehicle impact. PMHS were placed in a production seat which included an integrated seat belt. To achieve a repeatable configuration, the seat was rigidized in the rearward direction using a reinforcing frame that allowed for adjustability in both seatback recline angle and head restraint position. The frame contained instrumentation to measure occupant loads applied to the head restraint and seatback. To measure PMHS kinematics, the head, spine, pelvis, and lower extremities were instrumented with accelerometers and angular rate sensors. Strain gages were attached to anterior and posterior aspects of the ribs, as well as the mid-shaft of the femora and tibiae, to determine fracture timing. A chestband was installed at the mid sternum to quantify chest deformation. Biomechanical corridors for each body and seat location were generated for each recline angle to provide data for quantitatively evaluating the biofidelity of ATDs and HBMs. Injuries included upper extremity injuries, rib fractures, pelvis fractures, and lower extremity injuries. More injuries were documented in the 45-degree recline case than in the 25-degree recline case. These injuries are likely due to the excessive ramping up and corresponding kinematics of the PMHS. Biomechanical corridors and injury information presented in this study could guide the design of HBMs and ATDs in rigid, reclined, rear-facing seating configurations during a high-speed frontal impact.

Using change in a seat belt law to study racially-biased policing in South Carolina.

Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.

Experimental assessment of vehicle performance and injury risk for cutaway buses using tilt table and modified dolly rollover tests.

BACKGROUND: Rollover crashes of buses occur less frequently than do those involving passenger cars; however, they are associated with higher fatality rates. During rollover crashes, a vehicle experiences multidirectional acceleration and multiple impacts, yielding a complex interaction between structural components and its occupants. A better understanding of vehicle and occupant's motion, structural deformation, and vehicle and road interactions are necessary to improve the safety of the occupants during this event. One of the key factors in rollover crashworthiness assessment is to investigate the relationship between the strength of the vehicle's structure and the risk of injury outcomes. However, rollover crashes involving buses have received less research attention than have those involving passenger cars. Experimental studies in bus rollover safety have mainly focused on the structural integrity of the passenger compartment without considering the occupant responses. The main goal of this research is to evaluate the rollover mechanism and associated injury risk during two experimental rollover tests for a paratransit cutaway bus that is commonly used by transit agencies. METHODS: The modified dolly rollover (MDR) and tilt table (TT) tests were conducted using a similar bus and anthropomorphic test device (ATD) configurations. In each test, a 2-point and 3-point belted Hybrid III 50th percent male ATDs were used to quantify the kinematics of the occupants. The deformation index (DI), accelerations and angular velocities of the bus's CG were measured as vehicle responses. The collected data were then calibrated and filtered to assess the effects of the test procedure on kinematic responses of the vehicle and occupants. Next, the effectiveness of the 2-point vs 3-point seatbelt to reduce or prevent the injuries, the vulnerable body regions and corresponded injury risk were evaluated. RESULTS: The residual space remained intact (DI < 1) during both rollover tests, however, the ATD responses were quite different. The results of the injury assessment indicate that the risk of the injuries in the MDR test was significantly higher than the TT test. The highest risk of injuries was identified for the head, neck, and shoulder of 2-point belted ATD during the MDR test. Also, the main source of injuries during the MDR test was partial ejection due to the shattered side window, whereas for the TT test impacts between the ATDs and the side window and/or window frame were the injury causes. From the vehicle point of view, the total energy produced in the MDR was 3.5 times higher than the TT test, but the overall structural deformation in the TT test was higher than MDR test. Overall, the tilt table test provides a more severe scenario compared to the MDR test for the assessment of structural strength. Considering the limited real-world injury data in rollover crashes of buses, the MDR test presented the more realistic occupant responses.

Population-based assessment of a vehicle fleet with seat belts providing lower shoulder belt forces than today.

Objective: The objective of this study was to quantify the population-based effects of a lower shoulder belt load limit on front row occupants in frontal car crashes. Method: Crashes of modern vehicles from the GIDAS (German In-Depth Accident Study) are corrected for bias and projected to the national level. Injury risk functions are computed for the injury severity levels Maximum Abbreviated Injury Scale (MAIS) 2+, MAIS 3+, and fatal, stratified by 2 age cohorts (16-44 years of age and 45 years or older). To assess the field effectivity of a "softer belt," the projected crash frequency data are modified separately for the 2 age cohorts such that its risk structure represents the risk of a softer belt. Given those 2 samples, the field effectivity of a softer belt is derived for several shares of the younger age cohort according to the injury severity levels MAIS 2+, MAIS 3+, and fatal. Results: The injury risk distribution of the projected crash frequency data, represented here by the injury risk functions obtained, fits well into the injury risk distribution of other data sets (Sweden, United States, and Japan) given in the literature. The relative effects of a lower belt force are stable over the different ratios of the younger and old age cohorts. At the MAIS 2+ level, a lower belt force can significantly reduce the number of injuries (about 10%). A lower belt force does not significantly affect the number of MAIS 3+ injuries. A lower belt force can, however, more than double the number of fatal injuries. Conclusions: Because the number of fatal injuries rises dramatically due to lower belt force, the reduction in the number of MAIS 2+ injuries comes at a very high cost. Therefore, whether reducing the belt force limit is the right approach is questionable.

Transporting Children With Special Health Care Needs.

Children with special health care needs should have access to proper resources for safe transportation as do typical children. This policy statement reviews important considerations for transporting children with special health care needs and provides current guidance for the protection of children with specific health care needs, including those with airway obstruction, orthopedic conditions or procedures, developmental delays, muscle tone abnormalities, challenging behaviors, and gastrointestinal disorders.

Assessment of seat belt use and its associated factors among public transport drivers in North Gondar, Ethiopia: a cross-sectional study.

OBJECTIVE: Road traffic injuries are the major and neglected public health challenges. It causes 1.2 million deaths and 50 million injuries yearly and the use of seat belt reduces 60% of the cases. However, little is known about the magnitude of utilizing seat belt and associated factors in Ethiopia. Hence, the aim of this study was to assess the seat belt practice and associated factors among minibus and taxi drivers. RESULTS: The magnitude of seat belt users is 69.6%. The majority (98.1%) of drivers used seat belt to minimize injuries, 95.8% to prevent casualties, 92.5% to safeguard vehicle occupants, 29.9% to generate revenue for government and 22.8% to beautify the vehicle. Almost 80% of participants reported that wearing seat belt could save lives; and 29.6% of them wear belts because of stiffer penalties. For not using seat belts, more than 18% drivers reasoned out that it is not guarantee for safety and it wastes time to wear. In the multiple logistic regression being taxi driver (AOR = 1.998, 95% CI 1.250, 3.192), being married (AOR = 2.91, 95% CI 1.118, 7.601) and attended vocational school and above (AOR = 2.140, 95% CI 1.014, 4.519) were associated with seat belt use.

Promoting youth occupant restraint based on need.

Motor vehicle crashes are a leading cause of death for youth. Appropriate occupant protection significantly reduces these preventable injuries. Secondary field observation survey records were studied to identify populations that would most likely benefit from youth occupant protection programs. Multivariate regression analysis showed that drivers of youth between 4 and 14 years were in need of programs promoting youth and driver occupant restraint use. When these drivers were using seat belts, it was 35 times more likely they had youth occupants in safety restraints. A focus on pickup truck drivers may also give these programs greater efficacy in increasing youth restraint use. This study was limited to a single state, but the approach should be transferable to other jurisdictions where youth occupant protection field observation studies are conducted.

Neighborhood-level factors affecting seat belt use.

Despite the well-known safety benefits of seat belt use, some vehicle occupants still do not use them. This is a challenge in Tennessee, which has a lower seat belt use rate compared to the United States national average. Roadside observations and interviews are the two main sources for estimating seat belt use rate and have several limitations (e.g., small sample size, social desirability bias). To address these limitations, we attributed seat belt use of individuals who were involved in traffic crashes (N = 542,776) to their corresponding home-addresses. Home-addresses were retrieved from police crash reports and were geocoded, and assigned to their corresponding census tract revealing added information about the spatial distribution of seat belt use and socioeconomics of the areas surrounding the crash victim's home. The average seat belt use rate in the metropolitan area was 88% and for the non-metropolitan area was 87%. A Tobit model was used to evaluate the relationship between the seat belt use rate for both drivers and passengers over 16 years old, with neighborhood sociodemographic variables. Population, age cohorts, race, household vehicles' ownership, household size, and education were among the predictors of the seat belt use rate. Results of this analysis could be used in safety campaign design to reach specific geographic areas and groups with a lower seat belt use rate.

Assessment of the disaster medical response system through an investigation of a 43-vehicle mass collision on Jung-ang expressway.

PURPOSE: It was considered the challenges of the actual response and the potential for improvement, including the activities of the disaster response system, national emergency medical center, and the regional base hospital for the treatment of multiple traffic accident victims. The purpose of this study was to analyze the accident management system through real investigating the multiple collision over 10 vehicles with mass casualty events as a disaster situation. METHODS: This study was retrospective study to analyze the disaster event with multiple collision traffic accident on the expressway in Korea. We visited five medical centers for eight days since the accident occurred and interviewed the injured patients in this accident to examine the health status and medical records. After that, we visited the sixteen car-repair shops in four cities for real investigate about damaged vehicles. According to the arrangement of the accident situation for the accident vehicles through real-world investigation, we reproduced all parts of the accident scene, which were real-world investigated, by the accident situation sketch program. The collected data were summarized by Collision Deformation Classification (CDC) codes, and the medical records of the occupants were assessed using the Injury Severity Score (ISS). RESULTS: The cause of the accident was snow freezing of the road. The information about 72 injured patients on 31 damaged vehicles was collected by phone, visit, and actual accident investigation. Of the 72 patients who were examined, 4 were severely injured and 68 were mildly injured. The accident occurred in the order of Sedan 13 (41.9%), SUV 11 (35.5%), Truck 4 (12.9%), Van 2 (6.5%) and Bus 1 (3.2%). The median value of the age [lower quartile and upper quartile] was 43 [34.5-52] years old and the patients included 25 drivers, 11 passengers, 7 back seat passengers, and 29 bus passengers. CONCLUSION: The primary cause of this mass collision accident was road surface freezing, but the more serious secondary cause was a driver's inability to avoid the accident scene after the first collision. The severely injured occupants were occurred on the roads outside and inside the vehicle. In the event of a disaster, various teams from the police team, firefighting team, DMAT, EMS, road management team are gathered, and communication and command system between each team is important in order to identify and solve the disaster situation. To do this, it is important to develop manuals and prepare for training through repeated simulations.

Profile and trend of risk factors for traffic accidents in schoolchildren in Brazilian capitals: PeNSE 2009, 2012 and 2015. / Perfil e tendência dos fatores de risco para acidentes de trânsito em escolares nas capitais brasileiras: PeNSE 2009, 2012 e 2015.

INTRODUCTION: Land transport accidents (LTA) are the second cause of death in schoolchildren aged 13 to 17 years. The study aims to describe the risk factors for LTA in schoolchildren from the National School Health Survey (PeNSE) of 2015 and to evaluate the trend of selected indicators in the last three editions of PeNSE. METHODOLOGY: A descriptive study on risk factors for LTA in 2015, with PeNSE data and time series trends analysis, with age-adjusted regression tests of the 2009, 2012 and 2015 editions, in Brazilian capitals. RESULTS: In 2015, 26.3% of ninth grade schoolchildren, mostly between 13 and 15 years of age, reported having been in a motor vehicle driven by someone who consumed alcohol and 32.4% had driven a motor vehicle; 30.7% of adolescents did not use seat belts in the back seat; and 16.8% of schoolchildren who ride motorcycles did not wear helmets. There was also a worsening of the indicators between 2009 and 2015, regarding driving a motor vehicle (1.0 percentage points) and having been driven by vehicle for consumption of alcoholic beverages (1.1 percentage points). DISCUSSION: The LTA occurrence results from the interaction between roads, vehicles and users, and has a strong correlation with behavior. CONCLUSIONS: The results show the need to invest in educational measures, associated with supervision, the improvement of road infrastructure, research and improvement of legislation. The monitoring of risk factors in schoolchildren substantially contributes to support intersectoral public policies interventions to reduce morbidity and mortality in traffic.

INTRODUÇÃO: Os acidentes de transporte terrestre (ATT) são a segunda causa de morte em escolares de 13 a 17 anos. O presente estudo visou descrever os fatores de risco para ATT em escolares da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015 e avaliar a tendência de indicadores selecionados nas três últimas edições da PeNSE. METODOLOGIA: Estudo descritivo sobre fatores de risco para ATT no ano de 2015, com dados da PeNSE e análise de tendência das séries temporais, com testes de regressão ajustados por idade, das edições de 2009, 2012 e 2015, nas capitais brasileiras. RESULTADOS: Em 2015, 26,3% dos escolares do nono ano, na maioria entre 13 e 15 anos, relataram terem sido conduzidos em veículo motorizado dirigido por alguém que consumiu bebida alcoólica e 32,4% relataram terem dirigido veículo motorizado; 30,7% dos adolescentes não usaram cinto de segurança no banco de trás; e 16,8% dos escolares usuários de motocicleta não usaram capacetes. Observou-se ainda tendência de piora dos indicadores entre 2009 e 2015, referentes a dirigir veículo motorizado (1,0 pontos percentuais) e ter sido conduzido em veículo por alguém que consumiu bebida alcoólica (1,1 pontos percentuais). DISCUSSÃO: A ocorrência de ATT resulta da interação entre vias, veículos e usuários, tendo forte correlação com o comportamento. CONCLUSÕES: Os resultados apontam a necessidade de investir em medidas educativas, associadas a fiscalização, a melhoria das vias, pesquisas e aprimoramento da legislação. O monitoramento dos fatores de risco em escolares contribui substancialmente para apoiar intervenções das políticas públicas intersetoriais para a redução de morbimortalidade por trânsito.