'Safety in the Grey Zone': Evaluation of a training program to improve the safety of incident responders on high-speed roads.

INTRODUCTION: Workers operating on high-speed roads (i.e., incident responders and emergency service workers) are at significant risk of being fatally injured while working. An identified gap in current prevention strategies is training focused on developing the skills of workers to effectively communicate and coordinate safety responses when operating on roads. METHODS: This study discusses the development of a program designed to optimize communication and coordination of safety practices at the scene of an incident on a high-speed road. The program is referred to as 'Safety in the Grey Zone.' The goal of the study is to present the results from an evaluation on its implementation across 23 sessions involving 158 participants from 7 incident response agencies in 1 state in Australia. RESULTS: The results of this study provide support for effectiveness in implementing the program as planned. The results also provide preliminary support for effectiveness of the program in achieving its learning outcomes as demonstrated by feedback received from participants following completion of the program. CONCLUSIONS: The findings of this study provide recommendations to consider in the program's future roll-out, as well as suggestions for future evaluations to assess the program's effectiveness in improving the safety of incident responders operating on high-speed roads.

Factors Associated with Lost Time Injury among Paramedics in Victoria, Australia.

BACKGROUND: The dynamic and uncontrolled nature of paramedic work frequently exposes these workers to physical and psychological injury. Often paramedic injury rates are estimated based on national injury surveillance data or compensation databases. These data sources tend to only capture cases of a more serious nature and overlook the broader factors that contribute to injury. This limits our understanding of the true burden of paramedic injury and the characteristics associated with increased injury severity. OBJECTIVES: To describe the incidence and proportions of paramedic occupational injury in Victoria, Australia, and to determine the injury-related characteristics associated with lost time from work. METHODS: A retrospective analysis of paramedic injury report data from the single state-wide ambulance service in Victoria, Australia - Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Chi-square tests of independence were used to explore shift and injury characteristic variables that may be associated with time lost from work. RESULTS: Over the study period, 7,591 paramedic injuries were reported that met the inclusion criteria, of which 2,124 (28%) resulted in lost time from work. The cumulative incidence of paramedic injury was 333.8 injuries per 1,000 FTE workers per year, and the rate of lost time injury was 93.0 per 1,000 FTE workers per year. Musculoskeletal injuries were the most frequently reported injury type irrespective of lost time status. Manual handling followed by psychological stressors were the two leading mechanisms of injury based on incidence. Psychological injury was associated with lost time from work (X2= 384.2, p < 0.001). Conversely, injury to the head and neck (X2= 7.5, p = 0.006), and upper limb injuries (X2= 104.5, p < 0.001), were more strongly associated with no lost time from work. CONCLUSIONS: Paramedics working in Victoria have a higher rate of work-related injury than other Australian workers. Injury-related factors that are often overlooked, such as time, shift type, location, and injury characteristics, all contribute to an increased risk of lost time injury. An understanding of the factors that contribute to an increase in injury severity may facilitate the development and targeting of appropriate interventions.

Exploring factors associated with paramedic work-related psychological injury through data linkage.

INTRODUCTION: In comparison to the general population and other emergency services workers, paramedics experience high rates of work-related psychological injury. However, there is limited understanding of the case and practitioner-related factors that increase the risk of psychological injury among these workers. This paper aims to identify case and practitioner-related factors associated with paramedic work-related psychological injury in Victoria, Australia, through data linkage. METHODS: Data linkage of 7,223 paramedic injury reports with electronic patient care records, and paramedic demographic data from the single state-wide ambulance service in Victoria, Australia - Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Factors associated with paramedic psychological injury were assessed using multivariable logistic regression analysis. RESULTS: A total of 4,641 (64%) injury reports were successfully linked, of which, 244 (5%) were psychological injuries. Shift hours between 0401 and 0800 (AOR 1.83; 95%CI: 1.12-2.97), cardiac arrest or deceased patient attendances (AOR 2.15; 95%CI: 1.06-4.34), hospital or medical center case locations (AOR 2.44; 95%CI: 1.22-4.91), and Priority 0 (AOR 2.27; 95%CI: 1.26-4.09), Priority 2 (AOR 1.56; 95%CI: 1.04-2.33), and Priority 3 (AOR 1.95; 95%CI: 1.15-3.32) dispatch codes were associated with increased odds of psychological injury. Increasing patient age (AOR 0.98; 95%CI: 0.97-0.99), and the absence of other emergency services on scene (AOR 0.50; 95%CI: 0.34-0.72) were associated with decreased odds of paramedic psychological injury. CONCLUSIONS: This is the first study to collectively examine and identify EMS case and practitioner-related characteristics associated with paramedic psychological injury through data linkage of EMS agency-level data sources. PRACTICAL APPLICATION: The findings of this study highlight the dispatch case characteristics that may increase the risk of a paramedic sustaining a work-related psychological injury, and consequently facilitate the early identification, intervention, and support of the individuals most at risk.

When policy hits the road: Safe System in Victoria's policy environment.

The Safe System approach has globally become the dominant means to address road trauma, with bodies such as the Organisation for Economic Co-operation and Development, European Union, World Bank, World Health Organization, National and State Australian Governments and the United Nations encouraging its uptake. However, whilst there has been significant growth in its application, limited attention has been paid to the extent to which Safe System is integrated into public policy. Anecdotally, as an early adopter of the Safe System approach, Victoria's experience acts an instructive case for other jurisdictions applying the concept to policy. Using an interpretive qualitative case study approach, this study explored whether a) Safe System has influenced Victoria's road safety policy development to date, and b) if the extent to which Safe System has been integrated into public policy. Semi-structured interviews were conducted with Victoria's strategic, government-based, road safety decision-makers. Interviews were structured around the World Health Organization's Policy Development Process framework. The results indicate that Safe System has an implicit role in Victoria's road safety policy. When viewed through the lens of a policy integration framework, the analysis found only partial integration of the Safe System concept within road safety policy in Victoria, with limited flow-on effects of the framework on the policy frame, subsystems, goals and instruments. Governance frameworks, management structures and policy objectives are all influenced by Safe System, with the road safety problem having clearly been established as a cross-cutting issue. However, additional refinement of policy instruments to articulate the role of Safe System as well actively employing the approach in the policy development process is required. These findings confirm that while Victoria's use of Safe System is noteworthy, it may be beneficial for the framework to feature more prominently in policy for it to have the intended effect on road safety.

Occupational injury among paramedics: a systematic review.

INTRODUCTION: Paramedics are frequently exposed to acute and/or chronic environmental, operational and patient-related factors that increase their risk of physical and psychological injury. However, there has been wide variation in reported paramedic injury rates. This systematic review aims to synthesise the evidence to examine the incidence and nature of occupational injury among paramedics. METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO 2020: CRD42020164556). A systematic search of four electronic databases was conducted for the years 2004-2019. Peer-reviewed studies examining the incidence and proportions of paramedic occupational injury within civilian emergency medical services (EMS) were included. Injury types, mechanisms, contributing factors and incidence of injury were synthesised narratively. RESULTS: Twelve studies met the inclusion criteria. The incidence of injury ranged from 29.7 to 345.6 injuries per 1000 workers per year. Sprains and strains were the most reported injury types, and the trunk and upper limbs were the main sites. Body motion was the most frequently reported mechanism of injury, accounting for 35%-55% of all injuries. Female paramedics had a proportionally higher rate of injury compared with male paramedics. Paramedics aged 25-34 years accounted for the majority of fatal (mean 34.0%) and non-fatal (mean 51.7%) injuries. CONCLUSION: This review highlights the increased risk of occupational injury among paramedics and provides further insight into their overall injury profile.

Safety outcomes for incident responders operating on high speed roads: An analysis of the relationship with behaviour, motivation and role clarity.

High-speed roads present a considerable level of risk for frontline workers operating in these environments. To optimise safety, prevention activities need to target the key skills required to mitigate risk. The aim of this research was to explore the behavioural (compliance, participation, voice), motivational (safety motivation) and work demand (role clarity) factors that influence safety outcomes for incident responders working on high-speed roads. Safety outcomes included secondary incidents and near misses with passing vehicles. A total of 295 complete survey responses were received from six emergency service and incident response agencies in one Australian state. Data were analysed using structural equation modelling. The results showed that higher levels of safety voice, safety motivation and, role clarity were significantly associated with safer self-reported safety outcomes after controlling for the number of incidents attended. The findings from this study will be used to guide the development of a training program to improve the cognitive, behavioural and perceptual skills of incident responders operating on high-speed roads. Some insight into the structure and format of this program is provided.

Evolution of a holistic systems approach to planning and managing road safety: the Victorian case study, 1970-2015.

BACKGROUND: The Victorian Safe System approach to road safety slowly evolved from a combination of the Swedish Vision Zero philosophy and the Sustainable Safety model developed by the Dutch. The Safe System approach reframes the way in which road safety is viewed and managed. METHODS: This paper presents a case study of the institutional change required to underpin the transformation to a holistic approach to planning and managing road safety in Victoria, Australia. RESULTS: The adoption and implementation of a Safe System approach require strong institutional leadership and close cooperation among all the key agencies involved, and Victoria was fortunate in that it had a long history of strong interagency mechanisms in place. However, the challenges in the implementation of the Safe System strategy in Victoria are generally neither technical nor scientific; they are predominantly social and political. While many governments purport to develop strategies based on Safe System thinking, on-the-ground action still very much depends on what politicians perceive to be publicly acceptable, and Victoria is no exception. CONCLUSIONS: This is a case study of the complexity of institutional change and is presented in the hope that the lessons may prove useful for others seeking to adopt more holistic planning and management of road safety. There is still much work to be done in Victoria, but the institutional cultural shift has taken root. Ongoing efforts must be continued to achieve alert and compliant road users; however, major underpinning benefits will be achieved through focusing on road network safety improvements (achieving forgiving infrastructure, such as wire rope barriers) in conjunction with reviews of posted speed limits (to be set in response to the level of protection offered by the road infrastructure) and by the progressive introduction into the fleet of modern vehicle safety features.

Medical review licensing outcomes in drivers with visual field loss in Victoria, Australia.

BACKGROUND: Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. METHODS: A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field-related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. RESULTS: Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n = 194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self-referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority's Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. CONCLUSION: The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.

Parents' attitudes, knowledge and behaviours relating to safe child occupant travel.

This study investigated parents' attitudes, knowledge and behaviours relating to safe child occupant travel following new Australian legislation regarding child restraint system (CRS) and motor vehicle restraint use for children aged 7 years and under. A questionnaire exploring attitudes, knowledge and behaviours regarding general road safety, as well as safe child occupant travel, was completed by 272 participants with at least one child aged between 3 and 10 years residing in the Australian state of Victoria. Responses to the questionnaire revealed that participants' attitudes, knowledge and behaviours towards road safety in general were fairly positive, with most participants reporting that they restrict their alcohol consumption or do not drink at all while driving (87%), drive at or below the speed limit (85%) and 'always' wear their seatbelts (98%). However, more than half of the participants reported engaging in distracting behaviours 'sometimes' or 'often' (54%) and a small proportion of participants indicated that they 'sometimes' engaged in aggressive driving (14%). Regarding their attitudes, knowledge and behaviours relating to safe child occupant travel, most participants reported that they 'always' restrain their children (99%). However, there was a surprisingly high proportion of participants who did not know the appropriate age thresholds' to transition their child from a booster seat to an adult seatbelt (53%) or the age for which it is appropriate for their child to sit in the front passenger seat of the vehicle (20%). Logistic regression analyses revealed that parents' knowledge regarding safe child occupant travel was significantly related to their attitudes, knowledge and behaviours towards road safety in general, such as drinking habits while driving and CRS safety knowledge. Based on the findings of this study, a number of recommendations are made for strategies to enhance parents' attitudes, knowledge and behaviours relating to safe child occupant travel, as well as for future research.

Driving responses of older and younger drivers in a driving simulator.

This paper reports the findings of a study of younger and older driver behaviour to hazardous traffic manoeuvres in a driving simulator. Hazardous situations on a highway and residential drive were studied and drivers' vision and vehicle performance responses were collected. While all drivers were able to avoid crashes, the finding that older drivers were consistently slower to fixate hazardous stimuli in the driving environment and were slower to respond presents a potentially serious road safety concern. Further research is warranted, especially under conditions of increasing traffic complexity.