Injuries in special transportation services for elderly and disabled--a multi-methodology approach to estimate incidence and societal costs.

OBJECTIVE: Previous research has shown that elderly and disabled travelers using Special Transportation Services (STS) are injured without being involved in a vehicle crash. In order to estimate the true costs for these vehicle-related injuries, the focus needs to be adjusted towards an incident/traveler-oriented perspective. The aim of the project was thus to utilize such a perspective, in order to make a best estimation of the true costs for injury incidents, related to STS in Sweden. METHODS: In order to address the chosen perspective, a mixed-method approach was used, involving quantitative as well as qualitative research methods applied on four different sets of data, the hospital-based material (n=32), two sets of STS material (n=127), and interview-based material (n=1,000). RESULTS: The results showed that the injury incidence rate in STS is considerable, i.e., 3.2 per 100,000 trips (ranging from 1.5-1.9 in STS taxis and 3.6-5.6 in STS special vehicles). However, this high incidence rate is not due to road traffic crashes, but to non-collision injury incidents involving elderly and frail passengers, easily sustaining injuries from minor to moderate external violence. Typically, this violence is affecting an older female STS user, while entering and exiting the vehicle. The true costs were estimated to be $35 million per annum or $2.6 per trip. CONCLUSION: Future injury prevention measures should thus focus on safety in entering and exiting procedures.

Use of seat belts in cars with different seat belt reminder systems. A study of injured car drivers.

The use of seat belts in cars with different seat belt reminder systems was analyzed in a population of 477 injured car drivers, transported by ambulance to Umeå University Hospital after car crashes. The ambulance personnel acted as independent observers regarding the use of seat belts. In this population the non-users were significantly (multivariate logistic regression) fewer (12%) in cars with a combined light and sound reminder, compared to cars without reminder (23%). In cars with only a light signal the proportion of non-users was the same as in cars without any reminder at all. An introduction of more effective reminders, at least in new cars, might be an effective way to increase seat belt usage rates in the long-term.

Sick leave and disability pension among passenger car occupants injured in urban traffic.

STUDY DESIGN: A follow-up cohort study of passenger car occupants injured in car crashes in an urban area in Sweden. OBJECTIVES: To analyze the injuries, injury events, and long-term consequences of injuries in car crashes. SUMMARY OF BACKGROUND DATA: The consequences of car crashes usually are described in terms of the number of people injured, the severity of injuries, or the number of inpatient days. Certain types of crash injuries can results in long-term sick leave and granting of disability pension. The increased socioeconomic significance of these outcomes is not always indicated by analysis of commonly used variables. METHODS: Two hundred fifty-five passenger car occupants aged 16-64 years who were injured in car crashes in urban traffic were analyzed in terms of length of sick leave and receipt of disability pension. RESULTS: Strain of the cervical spine was the most common type of injury (55%, 141 injuries), and these injuries accounted for 82% of all sick leave taken within 2.5 years after the injury event. Injury to the cervical spine in 16 of 18 cases resulted in long-term sick leave or dependence on disability pension. The most common injury mechanism was rear-end collisions (39%). This type of crash resulted in 64% of all sick-leave days within 2.5 years after the injury event. Twelve out of 18 injured people on long-term sick leave or receiving disability pension had been in cars struck from behind. CONCLUSIONS: It is important to include long-term consequences in the form of sick leave and disability pension when describing the consequences of different types of car crashes and injuries.

Vehicle-related fatalities among Swedish conscripts.

All traffic fatalities among conscripts in Sweden from 1979 through 1988 (N = 106) were studied. More than half (58%) of the victims were on leave, nearly one-third (30%) were traveling to or from the regiment, and 13 (12%) were on duty. Forty-one percent of the drivers on leave who were involved in crashes were inebriated; the mean blood alcohol concentration was 1.6 g/kg. Fifty-two percent of the conscripts on leave were injured in single-vehicle crashes. Fatalities occurring during travel to or from the regiment most often occurred in crashes with another vehicle (69%), and all the drivers were sober. At least one of the fatally injured drivers on duty was inebriated, and in another two crashes, safety belts were not used although this was compulsory for both passengers and drivers. We conclude that collective travel could reduce the danger in traveling to and from the regiment. In addition, identifying alcohol abusers and preventing them from driving is of prime importance. Increased use of safety belts and installation of airbags should also be beneficial as well.

Collisions with passenger cars and moose, Sweden.

The number of collisions between motor vehicles and moose is increasing in many countries. Collisions with large, high animals such as moose cause typical rear- and downward deformation of the windshield pillars and front roof, most pronounced for small passenger cars; the injury risk increases with the deformation of the car. A strengthening of the windshield pillars and front roof and the use of antilacerative windshields would reduce the injury risk to car occupants.

Motorcycle fatalities in Sweden.

An analysis has been made of 129 motorcycle fatalities, 119 men and 10 women, who were killed in 125 accidents during 1979-1981. Sixty-seven of the 125 drivers were teenagers. Twenty-seven drivers had no licence. Ninety-nine riders were killed on sections of roads with a speed limit of 70 km/h or less. More than half of the decreased died in collisions with other vehicles. Eight lost their lives in accidents where an animal, in seven cases a moose, was involved, and six people died in wobbling accidents. The injuries were often multiple and serious, most of the riders died of head or cervical spine injuries (73) or of chest injuries (44). Altogether, 30 riders died in accidents in which people who were under the influence of alcohol were involved. Raising the minimum driving age, minimizing the possibility of illicit driving and elimination of such roadside hazards as poles and trees would reduce the fatality rate.