Sudden natural death behind the wheel: Review of driver deaths and fitness to drive assessment history in Victoria, Australia 2012-2013.

This study reviews the circumstances and medical causes of death of motor vehicle drivers who died in circumstances of sudden illness whilst behind the wheel in Victoria, Australia 2012-13. The driver's fitness to drive assessment history was also examined to identify prevention opportunities. Deaths included in the study were those referred to a panel responsible for determining whether the driver fatality should be included in the official road toll, where prior doubt exists. A research team comprising of forensic physicians examined the case file of each death involving sudden illness. Forty-five driver deaths during the two-year period were reviewed. Ischaemic heart disease was the most common cause of death. Over 80% of drivers were male with a median age of 64 years. While limited medical history was available, significantly impacting study analysis, findings identified minimal opportunity to improve the fitness to drive review process.

Effectiveness of the 2005 compulsory personal flotation device (PFD) wearing regulations in reducing drowning deaths among recreational boaters in Victoria, Australia.

OBJECTIVE: To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia. DESIGN: A retrospective population-based 'before and after' study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters. METHODS: The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test. RESULTS: There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0-29 years (U=28.0, p=0.02) and 30-59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in 'other' boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01). CONCLUSIONS: These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.

Application of a public health framework to examine the characteristics of coroners' recommendations for injury prevention.

OBJECTIVES: Exploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners' recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention. METHODS: Deaths where coroners' recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based on principles of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6) organisation; (7) time frame for implementation. RESULTS: Coroners' recommendations were relatively rare, made in only ∼6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0-14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners' recommendations, ∼70% included at least four of the model's seven elements. The elements 'countermeasure' and 'level of intervention' were most commonly specified by coroners (∼95%) in their recommendations. CONCLUSIONS: This study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners' public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective.

Fatal injury in tree felling and related activities, Victoria, Australia 1992-2007.

This study aims to examine fatalities resulting from tree felling and related activities in Victoria, Australia, involving work and do-it-yourself (DIY) activities, 1992-2007. Case identification was undertaken using coronial databases. A manual review of coroners' findings of closed cases was performed. Data collected and examined comprised demographics, occupation, incident location, activity, equipment used, injury mechanism and cause of death. Sixty-two cases were identified during the 16-year period; over 50% comprised DIY deaths (n=33). All but one victim was male. The median age for paid workers was less than for DIY (43 years vs 59 years). One-third of work activities were performed by persons outside professional tree-felling industries. While commercial forestry and logging industries experience a high fatality rate in Australia, non-professionals are also vulnerable to tree-felling injury. Study findings identified in excess of 70% of fatal incidents involved persons not employed within a relevant industry. Prevention efforts must focus on safety beyond workplaces and certain industries alone to reduce these deaths.

Coroners' recommendations following fatal heavy vehicle crash investigations.

OBJECTIVE: This paper quantifies and describes the nature of coroners' recommendations and comments on fatal heavy vehicle crashes in Victoria, Australia. METHODS: A retrospective, descriptive study was performed using coroners' findings. Fatal heavy vehicle crashes between January 2001 and December 2007 were identified through coronial databases. Individual findings were examined by incident type. Identified recommendations or preventative comments were reviewed and compared with national heavy vehicle safety objectives. RESULTS: Of 330 fatal crashes, which resulted in 376 deaths, recommendations were made in 21 incidents (6%). From these 21 incidents, 45 separate recommendations or comments were made by coroners. Ten (22%) called for specific remedial action, predominantly targeting road environment changes; the remainder had a broader application for prevention. Of the 21 incidents from which these recommendations arose, 11 (52%) were from a public inquest. No recommendation was made following any of the 45 single heavy vehicle crashes. CONCLUSION: The frequency of coroners' recommendations varied by crash nature including vehicle type involved and number of resulting fatalities. Multiple factors are likely to influence their development, including the holding of a public inquest and the perceived level of preventability. IMPLICATIONS: Coroners' investigations serve an important public health and safety role. Recognition of the significance of recommendations for reducing the extent of injury from heavy vehicle crashes and monitoring of their uptake is vital.

Heavy vehicle driver fatalities: learning's from fatal road crash investigations in Victoria.

This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria between 1999 and 2007 and the factors associated with the crash. A descriptive study was conducted comprising the population of heavy vehicle drivers killed in a road transport crash while operating a vehicle of > or =4.5 tonne Gross Vehicle Mass (GVM) for the purposes of work. Information about the nature of crash, environmental, driver, vehicle and occupational factors were collected from the coroner's death investigation file. Of the 91 deaths identified 61 were eligible for review. All 61 cases were male, solo drivers with a mean age of 44.7 years. Most vehicles were articulated in configuration. One-third of crash scenarios involved a single vehicle leaving the roadway on a straight road. One in every six fatally injured drivers was detected with the presence of stimulants or cannabis. Twenty-two drivers were travelling at excessive or inappropriate speeds for the circumstances. Seatbelt wearing status was documented for only 25 of 61 drivers. This study is the first to comprehensively examine a population of fatally injured heavy vehicle drivers using coroner's investigation files and these findings are consistent with previous, less detailed, Australian research. Information about potential associations between occupational factors and crash risk was limited. Improving driver safety requires incorporation of occupational factors into a standardised approach to heavy vehicle crash investigations.