Potentially preventable prehospital deaths from motor vehicle collisions.

BACKGROUND: In 2011, about 30,000 people died in motor vehicle collisions (MVCs) in the United States. We sought to evaluate the causes of prehospital deaths related to MVCs and to assess whether these deaths were potentially preventable. METHODS: Miami-Dade Medical Examiner records for 2011 were reviewed for all prehospital deaths of occupants of 4-wheeled motor vehicle collisions. Injuries were categorized by affected organ and anatomic location of the body. Cases were reviewed by a panel of 2 trauma surgeons to determine cause of death and whether the death was potentially preventable. Time to death and hospital arrival times were determined using the Fatality Analysis Reporting System (FARS) data from 2002 to 2012, which allowed comparison of our local data to national prevalence estimates. RESULTS: Local data revealed that 39% of the 98 deaths reviewed were potentially preventable (PPD). Significantly more patients with PPD had neurotrauma as a cause of death compared to those with a nonpreventable death (NPD) (44.7% vs. 25.0%, P =.049). NPDs were significantly more likely to have combined neurotrauma and hemorrhage as cause of death compared to PPDs (45.0% vs. 10.5%, P <.001). NPDs were significantly more likely to have injuries to the chest, pelvis, or spine. NPDs also had significantly more injuries to the following organ systems: lung, cardiac, and vascular chest (all P <.05). In the nationally representative FARS data from 2002 to 2012, 30% of deaths occurred on scene and another 32% occurred within 1 h of injury. When comparing the 2011 FARS data for Miami-Dade to the remainder of the United States in that year, percentage of deaths when reported on scene (25 vs. 23%, respectively) and within 1 h of injury (35 vs. 32%, respectively) were similar. CONCLUSIONS: Nationally, FARS data demonstrated that two thirds of all MVC deaths occurred within 1 h of injury. Over a third of prehospital MVC deaths were potentially preventable in our local sample. By examining injury patterns in PPDs, targeted intervention may be initiated.

Analysis of large truck rollover crashes.

OBJECTIVES: Close to a tenth of all large truck crashes result from rolling over during some maneuver. The aim of this study was to identify causes of these serious events as well as preventive measures that could be taken to reduce their number. METHODS: Detailed descriptions of 231 rollovers provided by field investigators were analyzed to identify causes. The descriptions addressed crash location, the nature of the crash, effect upon the vehicles involved, injuries and treatment, and contributing conditions. Causes were inferred from the nature of the crash. RESULTS: Almost half of the rollover crashes resulted from failing to adjust speed to curves, loads, brake condition, road surfaces, and intersections. A second major contributor involved lack of attention, including general inattention, misdirected attention, falling asleep, and distraction. The third major factor involved control errors, including oversteering, understeering, overcorrecting for errors, and minor control errors. The remainder were not driving errors and included those of other drivers, those occurring before the truck took to the road, and the condition of the vehicle before it was driven. CONCLUSIONS: Although they account for but a tenth of all large truck crashes, rollovers result from causes that are relatively unique to the vehicle and where it is driven. Programs could improve safety through the use of video to expose truck drivers to the situations causing rollovers, along with simulation allowing drivers to experience the consequences of errors without the harmful results of actual rollovers.

Analysis of large truck rollover crashes.

The Large Truck Crash Causation Study undertaken by the Federal Motor Carrier Safety Administration describes 239 crashes in which a truck rolled over. In-depth analysis revealed almost half resulted from failing to adjust speed to curves in the road, (mostly on-and off-ramps), the load being carried, condition of the brakes, road surface, and intersection conditions. A second major crash contributor involved attention: simply being inattentive, dozing or falling asleep, and distraction, all leading to situations where a sudden direction change resulted in a rollover. The third large crash contributor involved steering: over-steering to the point of rolling over, not steering enough to stay in lane, and overcorrecting to the point of having to counter-steer to remain on the road. Finally, loads are a frequent problem when drivers fail to take account of their weight, height or security, or when loading takes place before they are assigned. Instruction in rollover prevention, like most truck driver training, comes through printed publications. The use of video would help drivers recognize incipient rollovers while currently available simulation would allow drivers to experience the consequences of mistakes without risk.