Preventing Emergency Vehicle Crashes: Status and Challenges of Human Factors Issues.

OBJECTIVE: This study reports current status of knowledge and challenges associated with the emergency vehicle (police car, fire truck, and ambulance) crashes, with respect to the major contributing risk factors. BACKGROUND: Emergency vehicle crashes are a serious nationwide problem, causing injury and death to emergency responders and citizens. Understanding the underlying causes of these crashes is critical for establishing effective strategies for reducing the occurrence of similar incidents. METHOD: We reviewed the broader literature associated with the contributing factors for emergency vehicle crashes: peer-reviewed journal papers; and reports, policies, and manuals published by government agencies, universities, and research institutes. RESULTS: Major risk factors for emergency vehicle crashes identified in this study were organized into four categories: driver, task, vehicle, and environmental factors. Also, current countermeasures and interventions to mitigate the hazards of emergency vehicle crashes were discussed, and new ideas for future studies were suggested. CONCLUSION: Risk factors, control measures, and knowledge gaps relevant to emergency vehicle crashes were presented. Six research concepts are offered for the human factors community to address. Among the topics are emergency vehicle driver risky behavior carryover between emergency response and return from a call, distraction in emergency vehicle driving, in-vehicle driver assistance technologies, vehicle red light running, and pedestrian crash control. APPLICATION: This information is helpful for emergency vehicle drivers, safety practitioners, public safety agencies, and research communities to mitigate crash risks. It also offers ideas for researchers to advance technologies and strategies to further emergency vehicle safety on the road.

Occupational ladder fall injuries - United States, 2011.

Falls remain a leading cause of unintentional injury mortality nationwide [corrected].Among workers, approximately 20% of fall injuries involve ladders. Among construction workers, an estimated 81% of fall injuries treated in U.S. emergency departments (EDs) involve a ladder. To fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple surveillance systems: 1) the Census of Fatal Occupational Injuries (CFOI), 2) the Survey of Occupational Injuries and Illnesses (SOII), and 3) the National Electronic Injury Surveillance System-occupational supplement (NEISS-Work). In 2011, work-related ladder fall injuries (LFIs) resulted in 113 fatalities (0.09 per 100,000 full-time equivalent [FTE] workers), an estimated 15,460 nonfatal injuries reported by employers that involved ≥1 days away from work (DAFW), and an estimated 34,000 nonfatal injuries treated in EDs. Rates for nonfatal, work-related, ED-treated LFIs were higher (2.6 per 10,000 FTE) than those for such injuries reported by employers (1.2 per 10,000 FTE). LFIs represent a substantial public health burden of preventable injuries for workers. Because falls are the leading cause of work-related injuries and deaths in construction, NIOSH, the Occupational Safety and Health Administration, and the Center for Construction Research and Training are promoting a national campaign to prevent workplace falls. NIOSH is also developing innovative technologies to complement safe ladder use.

Crystal structure of a supercharged variant of the human enteropeptidase light chain.

The highly specific serine protease human enteropeptidase light chain cleaves the Asp4Lys recognition sequence and represents an interesting enzyme for biotechnological applications. The human enzyme shows 10 times faster kinetics compared to other animal sources but low solubility under low salt conditions, which hampers protein production and crystallization. Therefore, a supercharged variant (N6D/G21D/G22D/N142D/K210E/C112S) with increased solubility was used for crystallization. The structure (resolution, 1.9 Å) displays a typical α/ß trypsin-like serine protease-fold. The mutations introduced for protein supercharging generate larger clusters of negative potential on both sites of the active cleft but do not affect the structural integrity of the protein.

Selected movement and force pattern differences in rail- and rung-climbing of fire apparatus aerial ladders at 52.5° slope.

This study compares human climbing performance, including climbing speed and movement and force patterns, between rail- and rung-climbing styles for a moderate aerial ladder slope (52.5°). Hand and foot movements and forces were recorded for 9 male and 10 female firefighters as they ascended and descended a 3.4-m ladder using elevated handrails (rail-climbing) or rungs (rung-climbing) for hand support. The results indicated that climbers used three or more points of contact 54% of the time for rung-climbing and 100% of the time for rail-climbing. Furthermore, rail-climbing was 10% faster than rung-climbing. In rail-climbing, the lateral hand forces were mostly directed away from the body; while during rung-climbing, they were alternated in lateral and medial directions. Overall, the results suggested that rail-climbing provides better control over body positioning and faster climbing speed. Furthermore, the continuous contact of both hands in rail-climbing may reduce the fall risk by facilitating the recovery from a slip or perturbation.

Evaluation of advanced curve speed warning system to prevent fire truck rollover crashes.

INTRODUCTION: A disproportionately high number of deadly crash-incidents involve fire-tanker rollovers during emergency response driving. Most of these rollover incidents occur at dangerous horizontal curves ("curves") due to unsafe speed. This study examined the effects of a curve speed warning system (CSWS) on fire tanker drivers' emergency response behavior to develop system improvement suggestions. METHOD: Twenty-four firefighters participated in driving tests using a simulator. A fire tanker model, carrying a full tank of water, was used in emergency driving tests performed with and without CSWS. The CSWS was designed using the algorithm for passenger vehicles with a few initial modifications considering the unique requirements of heavy fire tanker and emergency driving. RESULTS: The results indicated that the CSWS was effective in issuing preemptive warnings when the drivers were approaching curves with unsafe speed during emergency response. Warnings occurred more frequently at curves with smaller radius. Although the CSWS improved driving performance, it did not significantly reduce the number of rollover events. A detailed analysis of the rollover events provided suggestions for improvement of CSWS algorithms. CONCLUSIONS: To further improve the CSWS algorithm, the following may be considered: including increased safety speed margin below the rollover critical speed, moving the speed warning trigger from the curve apex to the curve entry point, extending the safe speed-control zone to cover the entire curve, and employing artificial intelligence to accommodate individual driving styles. PRACTICAL APPLICATIONS: Fire tankers continue to be at increased risk of rollover during emergency response due to unsafe negotiation of dangerous curves. Development and use of advanced driver assist systems such as CSWS evaluated in this study may be an effective strategy to prevent deadly rollover crash-incidents. The knowledge generated by this study will be useful for system designers to improve the CSWS specifically designed for heavy emergency vehicles.

Evaluation of advanced curve speed warning system for fire trucks.

A curve speed warning system (CSWS) for firetrucks was developed and tested in this study. The CSWS algorithm was developed based on guidelines in the public domain for general vehicles and modified for firetrucks for their configuration and emergency driving. Twenty-four firefighters participated in the test in a driving simulator. The results show that the CSWS was effective in issuing preemptive warnings when the drivers were approaching curves with unsafe speed during emergency responses. Drivers reduced their driving speed at curve approaching and entering phases for most challenging curves, without affecting the overall time in completing the test route. Drivers had reduced number of severe braking and decreased average in-curve distance traveled over the safety speed limits, when the CSWS was in use. Drivers also rated the CSWS as assisting, effective and useful. In summary, the CSWS can enhance firetruck safety during emergency driving without sacrificing drivers' precious response time.

Effects of aerial ladder rung spacing on firefighter climbing biomechanics.

This study investigated the effects of aerial ladder rung spacing on firefighter climbing biomechanics. Ten female and 9 male firefighters ascended and descended instrumented ladders with rungs spaced at 356 mm (current design) and 305 mm in a laboratory setup. The climbing tests were performed at five ladder slope and handrail conditions: 30° with low (305 mm) and high (914 mm) handrails, 52.5° with and without a low handrail, and 75° without a handrail. Foot and hand forces and body movements were recorded and used to calculate joint moments of the upper and lower body. Reduced rung spacing resulted in reduced foot forces, reduced hand forces, and reduced ankle transverse moment. It was also associated with increased climbing speed for female climbers, and increased ankle vertical overshoot. The results indicate that reduced rung spacing on aerial ladders may lead to lower biomechanical stress; better climbing efficiency and safety; and reduced climbing speed disparity across sexes.

Clinicopathological prognostic factors for upper tract urothelial carcinoma.

INTRODUCTION: The aim of the present study was to evaluate the influence of clinicopathological factors including age, gender, tumor grade, tumor stage, lymphovascular invasion (LVI), tumor necrosis and previous history of non-muscle invasive bladder cancer on outcomes of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIAL AND METHODS: A total of 60 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma at our institute between 2005 to 2012 were included in our study. Univariate and multivariate analysis was performed using the Kaplan-Meier method, log rank statistics, the chi-square test and Cox regression models. RESULTS: The mean length of follow-up time was 33.3 months. There were 27 (45%) patients alive with the disease, whereas 33 (55%) were dead. In 19 cases (31.7%) the tumor grade was low, while in 41 cases (68.3%) it was high. Lymphovascular invasion was observed in 28 (46.7%) cases. Tumor necrosis was registered in 14 patients (23.3%). From the patients with LVI, 3 (9.6%) were alive, whereas from the patients negative for LVI, 75% were alive. Significant relationship was found between gender and grading and between positive LVI and low grading. CONCLUSIONS: Day case Variables such as gender, grading, tumor stage, LVI and tumor necrosis were all demonstrated to be significant independent prognostic factors for the overall survival. On the multivariate analysis only LVI remained statistically significant, which may explain the different clinical course in patients and could be considered as a part of pathological reporting and treatment planning for the future.

Functional levels of floor surface roughness for the prevention of slips and falls: clean-and-dry and soapsuds-covered wet surfaces.

Literature has shown a general trend that slip resistance performance improves with floor surface roughness. However, whether slip resistance properties are linearly correlated with surface topographies of the floors or what roughness levels are required for effective slip resistance performance still remain to be answered. This pilot study aimed to investigate slip resistance properties and identify functional levels of floor surface roughness for practical design applications in reducing the risk of slip and fall incidents. A theory model was proposed to characterize functional levels of surface roughness of floor surfaces by introducing a new concept of three distinctive zones. A series of dynamic friction tests were conducted using 3 shoes and 9 floor specimens under clean-and-dry as well as soapsuds-covered slippery wet environments. The results showed that all the tested floor-shoe combinations provided sufficient slip resistances performance under the clean-and-dry condition. A significant effect of floor type (surface roughness) on dynamic friction coefficient (DFC) was found in the soapsuds-covered wet condition. As compared to the surface roughness effects, the shoe-type effects were relatively small. Under the soapsuds-covered wet condition, floors with 50 µm in Ra roughness scale seemed to represent an upper bound in the functional range of floor surface roughness for slip resistance because further increase of surface roughness provided no additional benefit. A lower bound of the functional range for slip resistance under the soapsuds-covered wet condition was estimated from the requirement of DFC > 0.4 at Ra ≅ 17 µm. Findings from this study may have potential safety implications in the floor surface design for reducing slip and fall hazards.

Membrane protein reconstitution into liposomes guided by dual-color fluorescence cross-correlation spectroscopy.

Proteoliposomes represent nanoscale assemblies of indispensable value for studying membrane proteins in general and membrane transporters in particular. Since no universal protocol exists, conditions for proteoliposome formation must be determined on a case-by-case basis. This process will be significantly expedited if the size and composition of the assemblies can be analyzed in a single step using only microliters of sample. Here we show that dual-color fluorescence cross-correlation spectroscopy (FCCS) is of great value for optimizing the reconstitution process, because it distinguishes micelles, liposomes and aggregates in heterogeneous mixtures and permits direct monitoring of the co-localization of proteins and lipids in the diffusing assemblies. As proof-of-principle, liposomes containing the functional multidrug resistance transporter NorA from Staphylococcus aureus were prepared, demonstrating that FCCS is an excellent tool to guide the development of reconstitution protocols.

Factors affecting extension ladder angular positioning.

OBJECTIVE: The study objectives were to identify factors affecting extension ladders' angular positioning and evaluate the effectiveness of two anthropometric positioning methods. BACKGROUND: A leading cause for extension ladder fall incidents is a slide-out event, usually related to suboptimal ladder inclination. An improved ladder positioning method or procedure could reduce the risk of ladder stability failure and the related fall injury. METHOD: Participants in the study were 20 experienced and 20 inexperienced ladder users. A series of ladder positioning tests was performed in a laboratory environment with 4.88-m (16-ft) and 7.32-m (24-ft) ladders in extended and retracted positions. The setup methods included a no-instruction condition and two anthropometric approaches: the American National Standards Institute A14 and "fireman" methods. Performance measures included positioning angle and time. RESULTS: The results indicated that ladder setup method and ladder effective length, defined by size and extended state, affected ladder positioning angle. On average, both anthropometric methods were effective in improving extension ladder positioning; however, they required 50% more time than did the no-instruction condition and had a 9.5% probability of setting the ladder at a less-than-70 degrees angle. Shorter ladders were consistently positioned at shallower angles. CONCLUSION: Anthropometric methods may lead to safer ladder positioning than does no instruction when accurately and correctly performed. Workers tended to underperform as compared with their theoretical anthropometric estimates. Specific training or use of an assistive device may be needed to improve ladder users' performance. APPLICATION: The results provide practical insights for employers and workers to correctly set up extension ladders.

Surface supercharged human enteropeptidase light chain shows improved solubility and refolding yield.

Enteropeptidase is a serine protease used in different biotechnological applications. For many applications the smaller light chain can be used to avoid the expression of the rather large holoenzyme. Recombinant human enteropeptidase light chain (hEPL) shows high activity but low solubility and refolding yields, currently limiting its use in biotechnological applications. Here we describe several protein modifications that lead to improved solubility and refolding yield of human hEPL whilst retaining the enzyme activity. Specifically, protein surface supercharging (N6D, G21D, G22D, N141D, K209E) of the protein increased the solubility more than 100-fold. Replacement of a free cysteine residue with serine (C112S) improved the refolding yield by 50%. The heat stability of this C112S variant was also significantly improved by supercharging. This study shows that even mild protein surface supercharging can have pronounced effects on protein solubility and stability.

Effectiveness of vertical visual reference for reducing postural instability on inclined and compliant surfaces at elevation.

Falls from elevation continue to be the most serious hazard for the workers in construction. Simple and cost effective technical approaches to improve workers' balance on sloped roofs and deformable/unstable platforms have potential to reduce the risk of falls. This study evaluated the effectiveness of simple vertical structures as visual references (cue) for balance improvement. Twenty-four construction workers were tested while standing on sloped and deformable surfaces at elevation and performing undemanding visual tasks with vertical structures positioned at different proximal locations. Workers' balance performance was assessed by sway parameters calculated from the center-of-pressure movement collected with a force platform. The study results indicate increased instability on the sloped and deformable surfaces at elevation, and show that a simple vertical structure, e.g., a narrow bar, can serve as a visual cue and assist workers' balance. Workers' balance improved linearly with cue proximity in the tested distance range both on the sloped and the deformable surfaces. At a moment of instability, workers can redirect their attention to a proximal structure, available in the line of sight, to assist balance control. These findings may be useful in modifying elevated work environments and construction procedures to improve workers' postural balance during various construction phases.

Footwear effects on walking balance at elevation.

The study evaluated the effects of shoe style on workers' instability during walking at elevation. Twenty-four construction workers performed walking tasks on roof planks in a surround-screen virtual reality system, which simulated a residential roof environment. Three common athletic and three work shoe styles were tested on wide, narrow and tilted planks on a simulated roof and on an unrestricted surface at simulated ground. Dependent variables included lateral angular velocities of the trunk and the rear foot, as well as the workers' rated perceptions of instability. The results demonstrated that shoe style significantly affected workers walking instability at elevated work environments. The results highlighted two major shoe-design pathways for improving walking balance at elevation: enhancing rear foot motion control; and improving ankle proprioception. This study also outlined some of the challenges in optimal shoe selection and specific shoe-design needs for improved walking stability during roof work. The study adds to the knowledge in the area of balance control, by emphasising the role of footwear as a critical human-support surface interface during work on narrow surfaces at height. The results can be used for footwear selection and improvements to reduce risk of falls from elevation.

Effect of scaffold end frame carrying strategies on worker stepping response, postural stability, and perceived task difficulty.

OBJECTIVE: This study determined the most favorable strategy for carrying scaffold end frames while minimizing the risk of injuries from being struck by an object, falling, and overexertion. BACKGROUND: Scaffold erectors are at risk of high exposure to the aforementioned hazards associated with the dynamic human-scaffolding interface and work environments. Identifying an optimal work strategy can help reduce risk of injuries to the worker. METHOD: Three carrying methods, four types of work surfaces, two weights of scaffold frames, and three directions of stepping movement were tested in a laboratory with 18 construction workers. RESULTS: The effects of carrying method on postural instability and task difficulty rating were significant for handling the 22-kg end frame. Response time, postural instability, and perceived task difficulty rating were significantly reduced when the 9-kg end frame was used as compared with the 22-kg frame. CONCLUSION: The symmetric side-carrying method was the best option for handling 22-kg scaffold end frames. A 9-kg end frame (e.g., made of reinforced lightweight materials) has the potential to reduce injury risk among scaffold handlers during their scaffold erection and dismantlingjobs. APPLICATION: Scaffold erectors may want to adopt the symmetric side-carrying method as the primary technique for handling the 22-kg scaffold end frame, which is currently the one most used in the industry.

Height effects in real and virtual environments.

The study compared human perceptions of height, danger, and anxiety, as well as skin conductance and heart rate responses and postural instability effects, in real and virtual height environments. The 24 participants (12 men, 12 women), whose average age was 23.6 years, performed "lean-over-the-railing" and standing tasks on real and comparable virtual balconies, using a surround-screen virtual reality (SSVR) system. The results indicate that the virtual display of elevation provided realistic perceptual experience and induced some physiological responses and postural instability effects comparable to those found in a real environment. It appears that a simulation of elevated work environment in a SSVR system, although with reduced visual fidelity, is a valid tool for safety research. Potential applications of this study include the design of virtual environments that will help in safe evaluation of human performance at elevation, identification of risk factors leading to fall incidents, and assessment of new fall prevention strategies.

Human responses to augmented virtual scaffolding models.

This study investigated the effect of adding real planks, in virtual scaffolding models of elevation, on human performance in a surround-screen virtual reality (SSVR) system. Twenty-four construction workers and 24 inexperienced controls performed walking tasks on real and virtual planks at three virtual heights (0, 6 m, 12 m) and two scaffolding-platform-width conditions (30, 60 cm). Gait patterns, walking instability measurements and cardiovascular reactivity were assessed. The results showed differences in human responses to real vs. virtual planks in walking patterns, instability score and heart-rate inter-beat intervals; it appeared that adding real planks in the SSVR virtual scaffolding model enhanced the quality of SSVR as a human - environment interface research tool. In addition, there were significant differences in performance between construction workers and the control group. The inexperienced participants were more unstable as compared to construction workers. Both groups increased their stride length with repetitions of the task, indicating a possibly confidence- or habit-related learning effect. The practical implications of this study are in the adoption of augmented virtual models of elevated construction environments for injury prevention research, and the development of programme for balance-control training to reduce the risk of falls at elevation before workers enter a construction job.

Control and perception of balance at elevated and sloped surfaces.

Understanding roof-work-related risk of falls and developing low-cost, practical engineering controls for reducing this risk remain in high demand in the construction industry. This study investigated the effects of the roof work environment characteristics of surface slope, height, and visual reference on standing balance in construction workers. The 24 participants were tested in a laboratory setting at 4 slopes (0 degrees, 18 degrees, 26 degrees, and 34 degrees), 2 heights (0, 3 m), and 2 visual conditions (with and without visual references). Postural sway characteristics were calculated using center of pressure recordings from a force platform. Workers' perceptions of postural sway and instability were also evaluated. The results indicated that slope and height synergistically increased workers' standing postural instability. Workers recognized the individual destabilizing effects of slope and height but did not recognize the synergistic effect of the two. Visual references significantly reduced the destabilizing effects of height and slope. Actual and potential applications of this research include the use of temporary level work surfaces and proximal vertical reference structures as postural instability control measures during roofing work.