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.

Helmet wearing behavior where people often ride motorcycle in Ethiopia: A cross-sectional study.

BACKGROUND: Road traffic accidents are a major global concern that affects all people regardless of their age, sex, wealth, and ethnicity. Injuries and deaths due to motorcycles are increasing, especially in developing countries. Wearing helmet is effective in reducing deaths and injuries caused by motorcycle accidents. OBJECTIVES: To assess the magnitude of helmet wearing behavior and its determinants among motorcycle riders in Sawula and Bulky towns, Gofa zone, Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted from April, 15 to May 25, 2020, among 422 motorcycle drivers in Sawula and Bulky towns, where people often drive motorcycles. A stratified sampling technique was used to recruit sampled drivers in a face-to-face interview. Data were entered into EPI-data version 3.1 software and exported to SPSS version 23 software to manage analysis. Descriptive analyses such as frequency, percentage, mean and standard deviation were performed as necessary. Logistic regression models were fitted to identify the predictors of helmet wearing behavior. Adjusted odds ratios (AOR) with 95% confidence interval (CI) were used to determine the magnitude and strength of the association. RESULTS: A total of 403 motorcycle drivers participated in the study which gave a 95.5% response rate. Among 403 motorcycle riders, only 12.4% (95% CI, 9.2 to 15.6%) wore helmets while driving motorcycles. Having license [AOR 3.51(95% C.I 1.56-7.89)], driving distance >10Km [AOR 2.53(95% C.I 1.08-5.91)], History of exposure to accident [AOR 2.71(95% C.I 1.32-5.55)], driving experience of ≥10 years [AOR 2.98 (95% C.I 1.25-7.09)] and high perceived susceptibility to accident [AOR 3.10(95% C.I 1.29-7.46)] had statistically significant association with helmet wearing compared to their counterparts. CONCLUSIONS: This study found that helmet-wearing behavior was very low. Having a license, driving distance, exposure to accidents, driving experience, and accident risk perception were determinants of helmet wearing behavior. These determinants imply the need for interventions that focus on behavioral change communications such as awareness creation campaigns and mandatory helmet wearing laws.

Determining passenger car equivalent (PCEs) for pretimed signalized intersections with severe motorcycle composition using Bayesian linear regression.

Pretimed signalized intersection is known as a common source of congestion, especially in urban heterogeneous traffic. Furthermore, the accuracy of saturation flow rate is found to cause efficient and vital capacity estimation, in order to ensure optimal design and operation of the signal timings. Presently, the traffic also consists of diverse vehicle presence, each with its own static and dynamic characteristics. The passenger car equivalent (PCE) in an essential unit is also used to measure heterogenous traffic into the PCU (Passenger Car Unit). Based on the collection of observed data at three targets in Banda Aceh City, this study aims to redetermine the PCEs by using Bayesian linear regression, through the Random-walk Metropolis-Hastings and Gibbs sampling. The result showed that the obtained PCE values were 0.24, 1.0, and 0.80 for motorcycle (MC), passenger car (PC), and motorized rickshaw (MR), respectively. It also showed that a significant deviation was found between new and IHCM PCEs, as the source of error was partially due to the vehicle compositions. The present traffic characteristics were also substantially different from the prevailing conditions of IHCM 1997. Therefore, the proposed PCEs enhanced the accuracy of base saturation flow prediction, provided support for traffic operation design, alleviated congestion, and reduced delay within the city, which in turn improved the estimation of signalized intersection capacity.

Loss of years of healthy life due to road incidents of motorcyclists in the city of Medellin, 2012 to 2015.

OBJECTIVE: Determine the loss of years of healthy life due to road incidents of motorcyclists in the city of Medellin from 2012 to 2015. METHODS: Descriptive study with data on health care of injured motorcyclists and deaths adjusted with the Preston and Coale method, and OPS proportional distribution for the period 2012-2015. The years of life lost due to premature death (YLLs), years lived with disability (YLDs), and the disability-adjusted life years (DALYs) were calculated according to the new methodology designed for that purpose. RESULTS: The loss of years of healthy life due to road incidents of motorcyclists in the four-year period was 80,046 DALYs (823.8 per 100,000 inhabitants), with a higher proportion in men (81.3% and a ratio of 5 to 1 compared to women); the YLDs was 66.6% with marked differences in favor of men. There was nearly a 38% difference in the ages of 15 to 19 as well as a 19% difference from 30 to 49, compared to women. Premature death (YLLs) contributed to 33.4% of DALYs, with significant presentation in the above-mentioned age groups. CONCLUSIONS: The greatest loss of years of healthy life due to road incidents of motorcyclists in Medellin was due to non-fatal injuries and was concentrated in young men. If the trend of motorcycle road incidents continues, both local and national road safety plans will fail to accomplish the expected results, especially among motorcycle users.

Effect of COVID-19 on epidemiological characteristics of road traffic injuries in Suzhou: a retrospective study.

BACKGROUND: To present the new trends in epidemiology of road traffic injuries (RTIs) during the Coronavirus disease 2019 (COVID-19) pandemic in Suzhou. METHODS: Pre-hospital records of RTIs from January to May in 2020 and the same period in 2019 were obtained from the database of Suzhou pre-hospital emergency center, Jiangsu, China. Data were extracted for analysis, including demographic characteristics, pre-hospital vital signs, transport, shock index, consciousness, pre-hospital death. A retrospective study comparing epidemiological characteristics of RTIs in Suzhou during the 5-month period in 2020 to the parallel period in 2019 was performed. RESULTS: A total of 7288 RTIs in 2020 and 8869 in 2019 met inclusion criteria. The overall volume of RTIs has statistical difference between the 2 years (p < 0.001), with fewer RTIs in 2020 compared with 2019. Electric bicycle related RTIs increased during the pandemic (2641, 36.24% vs 2380, 26.84%, p < 0.001), with a higher incidence of RTIs with disorder of consciousness (DOC) (7.22% vs 6.13%, p = 0.006). CONCLUSIONS: Under the impact of COVID-19, the total number of RTIs in Suzhou from January to May 2020 decreased. This observation was coupled with a rise in electric bicycle related injuries and an increase in the incidence of RTIs with DOC.

The effect of motorcyclists' age on injury severities in single-motorcycle crashes with unobserved heterogeneity.

INTRODUCTION: Due to the myriad of unique characteristics associated with motorcycle operation, motorcycle safety is a public health concern as complex as it is serious. National crash data suggest motorcyclists are 28 times more likely to be killed when compared to passenger car occupants. In the state of Florida, motorcycle crashes are 1.5 times more likely to result in the death of the rider, placing Florida among the top deadliest states for motorcyclists in the nation. Using police-reported data from 2016, this study addresses the complex and interconnected nature of the many characteristics associated with motorcycle operation by investigating the effect of age on motorcyclists' riding behavior as it relates to injury severity for single-motorcycle crashes in the state of Florida. METHOD: To account for unobserved heterogeneity in the crash data, mixed logit models with heterogeneity in means and variances were estimated to model three injury severity outcomes (non-visible, severe, and fatal) for three age groups (under 30, 30-49, and 50 and above). RESULTS: Model results indicate that age affects motorcyclists' safety perception and ability to assess risks, thereby influencing their involvement in risky behaviors. Characteristics unique to motorcycle operation-spatial characteristics, speed, motorcycle type, time of day, helmet usage, alcohol consumption, ejection from motorcycle, passenger presence, endorsement status, and lighting-are further complicated by their dependency on the characteristics of the individual motorcyclist. Age of motorcyclist indicates a relationship between motorcyclists' behavior and perceived safety. CONCLUSION: The model results indicated that statistically significant parameters constituted different models and they were not equal across the age groups of motorcyclists: aged under 30, aged 30-49, and aged 50 and above. Through advanced econometric modeling, this study fills a gap in the existing literature and assists the safety professionals, motorcycle trainers, policymakers, law enforcement agencies, and roadway designers in developing countermeasures.

Severity and patterns of injury in helmeted vs. non-helmeted motorcyclists in a rural state.

INTRODUCTION: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders. METHODS: Retrospective review (2014-2018) of a single level 1 trauma center's registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student's t-test or Pearson's χ2p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained. RESULTS: Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS. CONCLUSIONS: Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.

Comparison of motor vehicle-involved e-scooter and bicycle crashes using standardized crash typology.

INTRODUCTION: The market share of e-scooters in the United States has proliferated in cities: 86 million trips were made on shared e-scooters in 2019, a more than 100% increase compared to 2018. However, the interaction of e-scooters with other road users and infrastructure remains uncertain. METHOD: This study scrutinized 52 e-scooter and 79 bicycle police-reported crashes in Nashville, Tennessee, from April 2018 to April 2020 from the Tennessee Integrated Traffic Analysis Network (TITAN) database. We used descriptive analysis and a recent prototype version of the Pedestrian and Bicycle Crash Analysis Tool (PBCAT) to classify crashes based on the locations of the crashes relative to roadway segments or intersections, as well as the maneuver of the motor vehicle and e-scooter/bicycle relative to the motor vehicle. RESULTS: Two crash typologies can explain the majority of e-scooter crashes, while bicycle crashes are distributed over several crash typologies. Additionally, 1 in 10 e-scooter- and bicycle-motor vehicle crashes leads to the injury or fatality of the e-scooter rider or bicyclist. Furthermore, we noted statistically significant differences in spatial and temporal distribution, demographics, lighting conditions, and crash distance from home for e-scooter and bicycle crashes. CONCLUSIONS: The police crash report provides a comprehensive picture of e-scooter safety complementing existing literature. We found that e-scooter crash characteristics do not fully overlap with features of bicycle crashes. PRACTICAL IMPLICATIONS: A generalized engineering, education, and enforcement treatment to reduce and prevent e-scooter and bicycle crashes, injuries, and fatalities might not result in equal outcomes for each mode. More rigorous enforcement could be implemented to deter e-scooters riders under the age of 18 years and e-scooter safety campaigns could target female riders.

A comparison of motorcycle instructor candidate selection practices in the United States.

INTRODUCTION: An essential aspect of motorcycle rider education is how the instructor selection process impacts student learning, sometimes referred to as the human element, as it is a significant factor influencing curriculum success. Student and program achievements are partially contingent on instructors who understand the curriculum and facilitate student learning during instruction. Previous research on motorcycle rider education has emphasized a need for the examination of instructor selection and development, stating that quality education is reliant on instructors who are competent and qualified. METHOD: By applying an exploratory study method, state and military Motorcycle Safety Education Program Managers and Instructor Trainers were examined and compared through telephonic interviews to develop a greater understanding of instructor candidate selection criteria and vetting processes. RESULTS: The results suggest that changes in instructor candidate selection systems may improve decisions about a candidate's job and organizational fit. CONCLUSIONS: Study conclusions indicate that use of multiple and thorough assessments to determine a candidate's motivation, social disposition, and emotional intelligence before preparation courses may better identify candidates and align potential job and organization fit within the discipline. Practical Application: Applications of the findings would include a standardized selection process with improved interviews and pre-course auditing, and candidate expectation management before the selection to attend preparation or certification courses. The efforts potentially decrease long-term costs and deficiencies when candidates have an inconsistent job or organizational fit, departing from organizations after short periods or by not providing consistent quality instruction to students. The study recommendations, when implemented, can improve most educational disciplines where instructors are selected for technical instructional positions where students risk injury or harm.

Epidemiology of Fractures Sustained During Electric Scooter Accidents: A Retrospective Review of 563 Cases.

BACKGROUND: The use of electric scooters (e-scooters) has dramatically increased as they become an attractive alternative for public transportation in busy metropolitan areas worldwide. Despite their benefits, e-scooters challenge the health-care system with poorly understood forms of injuries, mainly orthopaedic fractures. To our knowledge, this study is the first to investigate e-scooter-related orthopaedic fracture patterns, mechanisms of injury, and management. METHODS: Data on 3,331 e-scooter-related admissions were retrospectively collected between May 2017 and February 2020 in a level-I trauma center. These admissions were analyzed for demographic variables, orthopaedic fracture diagnosis (using the AO/OTA classification), associated injuries, and surgical treatment. RESULTS: During the study period, a total of 716 fractures were diagnosed in 563 patients, with 46.4% of the patients requiring hospitalization. Of 492 upper-limb fractures, 89.2% occurred in a rider fall mechanism; and of 210 lower-limb fractures, 15.7% occurred in rider-vehicle collisions. Fifty-nine percent of long bone fractures were complex fragmentary and/or intra-articular fractures. Orthopaedic surgeons recommended that 225 fractures undergo surgical treatment. The most common upper-limb fracture was AO/OTA class 2R1A, with open reduction and internal fixation of the distal part of the radius being the most common upper-limb procedure (n = 58). The most common lower-limb fracture was AO/OTA class 41C, with open reduction and internal fixation of the proximal part of the tibia being the most common procedure (n = 28). A total of 22 patients (3.9%) required reoperation within 1 year. CONCLUSIONS: This investigation provides unique information on demographic characteristics, patterns, and treatment of orthopaedic fractures secondary to the high-energy mechanism of e-scooter injuries. These new in-depth data are important, first, for health-care system preparedness with regard to management and resource allocation to treat these challenging injuries and, second, for legislators promoting safety and injury prevention strategies.

Blunt adrenal gland injury: The impact of extra-abdominal injury.

BACKGROUND: Blunt adrenal gland injuries are considered uncommon. Moreover, the factors associated with the mechanisms of the injury following blunt trauma are unclear. In this study, we determined the factors associated with blunt adrenal gland injury (BAGI). MATERIALS AND METHODS: A total of 315 patients with blunt abdominal trauma were admitted to our institution during a 12-year period. After excluding 26 patients who were under 18 years old and 27 patients who were in cardiopulmonary arrest on arrival, 262 eligible patients were retrospectively reviewed. Patient characteristics, mechanism of injury, intervention, and associated organ injuries were compared between those with and without BAGI. RESULTS: Blunt adrenal gland injury was identified in 38 of 262 patients (14.5%). The right side was the predominant site of injury (68%). There were no differences in vital sign, in-hospital mortality, intervention, and concomitant abdominal organ injuries between those with and without adrenal gland injury. Patients with BAGI had a higher frequency of fall and motorcycle collision as mechanisms of injury. In addition, patients with BAGI had a higher injury severity score and a higher frequency of concomitant severe head, chest, and pelvic injuries. CONCLUSION: The results of the present study suggest that the deceleration injury leading to concomitant head, chest, or pelvic injuries with blunt abdominal trauma may be associated with the mechanism of BAGI. LEVEL OF EVIDENCE: Prognostic study, level IV.

Motorcycle helmet selection and usage for improved safety: A systematic review on the protective effects of helmet type and fastening.

OBJECTIVE: Motorcycle helmets are the most common and effective protective device to reduce head injuries and mortality in crashes among powered two-wheeler riders. Even if they are globally recognized as effective, there are still concerns regarding their correct use, which is necessary to achieve maximum head protection. The goal of this systematic review is to assess which characteristics of helmet design and use showed a positive influence on rider safety, in order to provide insights to improve end-user helmet usage. METHODS: A literature search was carried out combining two sets of keywords, one related with either motorcycle or rider and the other referring to either protective equipment or injuries. After the exclusion of duplicates, 977 papers were screened by reviewers, thus identifying 32 papers that were analyzed in group discussions. RESULTS: Among the papers included in this study, no strong conflicting conclusions emerged in their results. The studies focusing on the use of different types of helmets highlighted that full-face helmets, compared with other standard helmets, have a positive influence on head injuries and facial injuries. Correct fastening was clearly beneficial for head and facial injuries, induced injuries, and helmet ejection. CONCLUSIONS: This systematic review provides important insights to improve the usage of helmets by end-users. Correct fastening is a crucial factor to avoid helmet roll-off during a crash. Most studies agreed that full-face helmets provide higher protection in comparison with other standard helmets, especially for facial injuries, and no negative influence with respect to neck and spinal injuries.

Compliance of commercial motorcycle riders with road safety regulations in a peri-urban town of Ghana.

BACKGROUND: While motorcycles are essential for moving people and goods, they are also, a significant contributor to Road Traffic Accidents (RTAs), making it a public health issue of concern globally. The Hohoe Municipal Hospital records increasing RTAs due to commercial motorcycles. Determining motorcycle riders' compliance with road safety regulations is critical in helping to curb this menace. METHOD: A cross-sectional study was employed involving a multistage sample of 238 motorcycle riders. Data were collected using a pretested structured questionnaire and entered into Epi Data version 3.2 software and exported to STATA software version 12 for analysis. Descriptive and inferential analyses were done while statistical significance was determined at 95% reliability interval and p-value of 0.05. FINDINGS: The level of compliance with road safety regulations among respondents was 59.2%. The mean age of respondents was 29.9 ± 7.9 years, and all respondents were males. Respondents who did not own their motorbikes were 0.39 times less likely to comply with road safety regulations compared to their counterparts who owned one, while those without alternate occupations were 0.51times less likely to comply with road safety regulations compared to those with an additional occupation. Those aged between 30-39 years and 40-49 years were 2.37 and 4.1 times more likely to comply with road safety regulations, respectively, compared to those aged ≤29 years, and those who did not smoke were 3.15 times more likely to comply with road safety regulations than those who smoked. CONCLUSION: Compliance to safety regulations are fairly low and although motorcycle usage on a commercial basis is yet to be legalised in Ghana, routine education targeting riders who smoke, do not have alternate occupations, do not own motorbikes and younger riders will improve their compliance. Also, riders should be encouraged to obtain their license from the appropriate authorities.

Field testing the applicability of motorcycle autonomous emergency braking (MAEB) during pre-crash avoidance maneuver.

OBJECTIVE: Autonomous Emergency Braking (AEB) is a promising technology for crash avoidance or pre-crash impact speed reduction through the automatic application of braking force. Implementation of AEB technology on motorcycles (MAEB) is still problematic as its interaction with the rider may compromise the safety. In previous studies, MAEB interventions at low decelerations were shown to be easily manageable by common riders in straight line condition, but they were not previously tested in lateral maneuvers such as lane change and swerving, which are common in pre-crash situations. The objective of this paper is to assess the applicability of MAEB activation during lateral avoidance maneuver and to estimate its benefits in this scenario. METHODS: Field tests were carried out involving common riders as participants, using a test protocol developed on the experience of previous studies. The test vehicle was a sport-touring motorcycle equipped with an automatic braking system that could be activated remotely by researchers to simulate MAEB intervention. The motorcycle was equipped with outriggers to prevent capsizing. The Automatic Braking (AB) interventions using a nominal deceleration of 0.3 g were deployed at pseudo-random times in conditions of straight-line travel and a sharp lane-change maneuver emulating a pre-crash avoidance action. The straight-line trials were used as the reference condition for analysis. RESULTS: Thirty-one participants experienced AB interventions in straight-line and lane-change at an average speed of 44.5 km/h. The automatic braking was deployed in all the key phases of the avoidance maneuver. The system reached a deceleration of 0.3 g for a time of intervention of approximately 1 s. The participants were consistently able to control the vehicle during the automatic braking interventions and were always able to complete the lane-change maneuver. The speed reductions obtained with the AB interventions during lane change were very similar to those obtained in the straight-line conditions. CONCLUSIONS: MAEB interventions with decelerations up to 0.3 g can be easily managed by motorcycle riders not only in straight-line conditions but also during an avoidance maneuver. Further investigations using higher deceleration values are now possible.

The association between the score of adult attention-deficit/hyperactivity traits and risky driving behaviors with alcohol intake and narcotics consumption among Iranian motorcyclists.

BACKGROUND: Motorcycle drivers are among the most vulnerable road users, accounting for a large proportion of global traffic accidents. This study aimed to investigate the association between the score of adult attention-deficit/hyperactivity (ADHD) traits and risky driving behaviors (RDB) with alcohol intake (AI) and narcotics consumption (NC) among motorcyclists in Iran. METHODS: This multi-center cross-sectional study encompassed 1747 motorcyclists from three cities in Iran. A random sampling method was applied in this study, and the required data was collected using three standard questionnaires on ADHD, substance abuse, and RDB. Independent sample t-test, covariance analysis, and quantile regression (QR) were used to analyze the data. RESULTS: The results of t-test and analysis of covariance indicated that AI and NC were significantly associated with ADHD score and RDB among the motorcycle drivers. Additionally, the QR models showed that these effects were significant at all quantiles of ADHD and RDB, even for individuals who were at lower quantiles. CONCLUSIONS: Considering the potential dangers of driving after AI and NC, appropriate measures should be adopted before certifying a driving license to screen ADHD as a predisposing factor for substance abuse and RDB. Furthermore, it is essential to equip traffic police with adequate diagnosis kits and establish heavy penalties for the offenders. In this regard, all interventions aimed to reduce traffic accidents among motorcycle drivers should be done considering the interrelationship between ADHD, RDB, and substance abuse.

Human error in motorcycle crashes: A methodology based on in-depth data to identify the skills needed and support training interventions for safe riding.

OBJECTIVE: Human error by either rider or other vehicle driver is the primary contributing factor in crashes involving powered-two-wheelers. A human-factor-based crash analysis methodology is key to enhancing the road safety effectiveness of rider training interventions. Our aim is to define a methodology that uses in-depth data to identify the skills needed by riders in the highest risk crash configurations to reduce casualty rates. METHODS: The methodology is illustrated through a case study using in-depth data of 803 powered-two-wheeler crashes. Seven types of high-risk crash configuration based on pre-crash trajectories of the road-users involved were considered to investigate the human errors as crash contributors. Primary crash contributing factor, evasive maneuvers performed, horizontal roadway alignment and speed-related factors were identified, along with the most frequent crash configurations and those with the greatest risk of severe injury. RESULTS: Straight Crossing Path/Lateral Direction was the most frequent crash configuration and Turn Across Path/Opposing Direction was identified as that with the highest risk of serious injury. Multi-vehicle crashes cannot be considered as a homogenous category of crashes to which the same human failure is attributed, as different interactions between motorcyclists and other road users are associated with both different types of human error and different rider reactions. Human error in multiple-vehicle crashes differed between those configurations related to crossroads and those related to rear-end and head-end crashes. Both single-vehicle crashes and multi-vehicle head-on crashes frequently occur along curves. The involved collision avoidance maneuvers of the riders differed significantly among the highest risk crash configurations. The most relevant lack of skills are identified and linked to their most representative context. In most cases a combination of different skills was required simultaneously to avoid the crash. CONCLUSIONS: The results contribute to understand the motorcyclists' responses in high-risk crash scenarios. The findings underline the need to group accident cases, beyond the usual single-vehicle versus multi-vehicle collision approach. The different interactions with other road users should be considered to identify the competencies of the motorcyclists needed to reduce crash risks. Our methodology can be applied to increase the motorcyclists' safety by supporting preventive actions based on riders' training and eventually ADAS design.

Investigation of accidents involving powered two wheelers and bicycles - A European in-depth study.

INTRODUCTION: The number of road fatalities have been falling throughout the European Union (EU) over the past 20 years and most Member States have achieved an overall reduction. Research has mainly focused on protecting car occupants, with car occupant fatalities reducing significantly. However, recently there has been a plateauing in fatalities amongst 'Vulnerable Road Users' (VRUs), and in 2016 accidents involving VRUs accounted for nearly half of all EU road deaths. METHOD: The SaferWheels study collected in-depth data on 500 accidents involving Powered Two-Wheelers (PTWs) and bicycles across six European countries. A standard in-depth accident investigation methodology was used by each team. The Driver Reliability and Error Analysis Method (DREAM) was used to systematically classify accident causation factors. RESULTS: The most common causal factors related to errors in observation by the PTW/bicycle rider or the driver of the other vehicle, typically called 'looked but failed to see' accidents. Common scenarios involved the other vehicle turning or crossing in front of the PTW/bicycle. A quarter of serious or fatal injuries to PTW riders occurred in accidents where the rider lost control with no other vehicle involvement. CONCLUSIONS: Highly detailed data have been collected for 500 accidents involving PTWs or bicycles in the EU. These data can be further analyzed by researchers on a case-study basis to gain detailed insights on such accidents. Preliminary analysis suggests that 'looked but failed to see' remains a common cause, and in many cases the actions of the other vehicle were the critical factor, though PTW rider speed or inexperience played a role in some cases. Practical Applications: The collected data can be analyzed to better understand the characteristics and causes of accidents involving PTWs and bicycles in the EU. The results can be used to develop policies aimed at reducing road deaths and injuries to VRUs.

The safety potential of enhanced lateral vehicle positioning.

OBJECTIVE: The objective of this study is to estimate the potential safety benefits of Emergency Lane Keeping (ELK) and Autonomous Emergency Steering (AES) systems with precise and reliable lateral positioning. METHODS: The material comprised in-depth studies of fatal road crashes in Sweden in 2017. Crashes resulting in passenger car occupant fatality (n = 114) were included; single vehicle (n = 60) and head-on (n = 31), intersection (n = 9), rear-end (n = 5), overtaking (n = 5), animal (n = 1), other (n = 1, U-turn), and train (n = 2). Additionally, fatal collisions between motor vehicles and vulnerable road users (VRUs) were included; pedestrians (n = 36), cyclists/moped users (n = 15), and motorcyclists (n = 17). A case-by-case analysis was conducted to identify crashes potentially prevented by ELK and AES with precise (within 0.1 m accuracy) and reliable lateral positioning. The identified crashes potentially avoided by ELK systems involved unintentional drift-out-of-lane on roads with posted speed limits of ≥70 km/h (43 mph). For comparison, the same material was used to identify the potential safety benefits of the more traditional lane departure warning (LDW) and Lane Keeping Assist (LKA) systems without enhanced lateral positioning. Crashes potentially avoided by LDW/LKA occurred on roads with visible lane markings and without rumble strips on the departure side while ELK with enhanced lateral positioning is not reliant on lane markings. Collisions potentially avoided by AES occurred on roads with sufficient escape zones and road friction. RESULTS: The study shows that ELK systems with enhanced lateral positioning could potentially avoid 33 - 45 (36 - 49%) out of 91 head-on and single car crashes resulting in passenger car occupant fatality, which corresponds to a further 18% (5/28) compared to traditional lane support (LDW/LKA) without enhanced lateral positioning. The improved lane keeping addresses crashes involving absent or nonvisible lane markings that are covered by snow. Furthermore, the study shows that the evasive steering features of AES systems with enhanced lateral positioning could potentially prevent 28 (54%) out of 52 collisions resulting in passenger car occupant fatalities (i.e., head-on, intersection, rear-end, overtaking, and animal collision). Additionally, AES with enhanced lateral positioning could potentially prevent 16 (31%) out of 51 collisions between motor vehicles and vulnerable road users resulting in fatally injured pedestrians, cyclists or moped users. The total potential safety benefits of AES include both lane keeping and evasive steering features including lane escaping. The study identified that the total number of crashes potentially avoided by AES corresponds to 42% out of all crashes resulting in passenger car occupant fatalities (n = 48/114). CONCLUSIONS: This is a first attempt to identify and quantify the increase in potential safety benefits, based on the assumption that robust lateral vehicle positioning has been applied to lane keeping as well as lane escaping. In addition to the potentially increased number of prevented crashes compared to traditional lane support, a robust lateral positioning system may have the potential to improve the redundancy in positioning systems. Previous research suggests several techniques to improve lateral vehicle positioning. However, further research is required, including testing for implementation of adequately improved lateral vehicle awareness to establish which techniques are appropriate.

Patterns of traumatic injuries and outcomes to motorcyclists in a developing country: A cross-sectional study.

OBJECTIVE: Motorcyclists are frequently involved in road traffic accidents and may suffer polytraumatic injuries, contributing a substantial burden on healthcare systems particularly in lower-middle-income countries. This study aimed to describe patterns of injury, in-hospital course, and outcomes of road accident trauma in motorcyclists, including polytrauma, at a Trauma Facility in Pakistan. METHODS: A retrospective review was conducted by using relevant trauma codes to extract data from records for all victims presenting with motorcycle trauma between January 2018 and June 2019, to a tertiary care hospital in Pakistan. Data collected included victim characteristics, mechanism of accident, patterns of traumatic injury, management, in-hospital complications, and outcomes. Polytrauma was defined as traumatic injuries in two or more anatomic regions with abbreviated injury scale (AIS) ≥ 3. Multivariable logistic regression, adjusted for age, gender, and mechanism of accident, was performed to identify in-hospital complications and outcomes associated with polytrauma. RESULTS: A total of 514 victims, 90.9% male and 39.5% aged between 18-30 years, were included in this study. The victim was the motorcycle driver in 94.6% of cases. The most common mechanism of accident was motorcycle vs. other motor vehicle (56.2%). Patients were mostly admitted under the services of Orthopedic Surgery (50.8%) and Neurosurgery (30%), with common sites of injury being the lower extremity (42.6%), head (38.1%), and upper extremity (26.8%). Polytrauma occurred in 19.5% of victims. Patients were managed surgically in 77.3% of cases, with the most common procedure being open reduction of fractures (48.1%). Blood transfusion was required in 4.1% of patients. The commonest in-hospital complication was acute kidney injury (23.7%). The median length of stay was 3 days, and 4.1% of patients expired in the hospital. Polytrauma was significantly associated with the need for blood transfusion (2.642 [1.053-6.630]), AKI (2.212 [1.339-3.652]) and hospital length of stay (1.059 [1.025-1.094]), but not with mortality. CONCLUSION: Although orthopedic injuries occur most frequently in motorcycle trauma, polytrauma necessitating multi-disciplinary management and complicating hospital stay is also common. Understanding patterns of injuries and management in motorcycle trauma will enable trauma teams in a developing country like Pakistan to devise evidence-based management protocols, especially for cases of polytrauma.

Are motorcycles really "donorcycles"? Examining organ donation rates between unhelmeted and helmeted motorcyclists.

INTRODUCTION: Motorcycles are colloquially referred to as "donorcycles" among medical staff. However, the actual impact of helmet laws and helmet use on organ donation is unknown. Michigan's 35-year-old universal helmet law (UHL) was repealed in April 2012 and replaced by a partial-helmet law. We hypothesized that there would be an increase in organ donation rates from unhelmeted motorcyclist fatalities. METHODS: Michigan's Gift of Life Michigan organ donation database was queried from April 2008 through May 2015 in conjunction with the Michigan Trauma Quality Improvement Program database from the same time period. All in-hospital motorcycle crash fatalities were examined. RESULTS: A three-fold increase was found in the rate of organ donation for unhelmeted motorcyclists compared to helmeted motorcyclists (p = 0.006). Motorcycle crash fatalities tended to be younger in age after the UHL repeal with an average age of 32.8 years versus 40.8, however, this finding was not statistically significant (p = 0.071). Additionally, there was no significant difference in organ donation rates pre-UHL repeal (2008-2012) versus post-repeal (2012-2015). CONCLUSIONS: This is the first study to demonstrate an increased rate of organ donation among unhelmeted motorcyclist fatalities compared to helmeted rider fatalities. There was no significant increase in the rate of organ donation following the Michigan UHL repeal. However, we identified that some motorcycle crash fatalities were from illegally unhelmeted riders in the past, prior to the repeal. Practical Application: Unhelmeted motorcyclists are three times more likely than helmeted riders to become organ donors, possibly due to the well documented increase in severe traumatic brain injuries in this population. From a public health perspective, helmets should be required for all motorcyclists and efforts to advocate in favor of helmet legislation should be supported by trauma systems and health professionals.