Commentary: Supersized vans: A supersized problem

Abstract

Whether it's “supersized” meals or vehicles, living in a “supersized” world seems to be a continual and present threat to our well-being and the well-being of our patients. This month's National Highway Traffic Safety Administration (NHTSA) Notes deals with the special risks of large, 15-passenger vans. Most of us have been occupants in these vans while traveling to a conference hotel from the airport or vice versa. Fifteen-passenger vans are also commonly used to transport college athletic teams and church groups. Although federal law prohibits the sale of these vehicles for the transportation of school children, it is not uncommon for these vehicles to be used for programs before and after school, and there is no system to evaluate their use once the vans leave the dealer's lot. Herein lies a considerable threat to our families, friends, neighbors, and patients. At first glance, the latest NHTSA technical report, Analysis of Crashes Involving 15-Passenger Vans,1.Subramanian R. Analysis of Crashes Involving 15-Passenger Vans. Washington, DC: National Center for Statistics and Analysis, National Highway Traffic Safety Administration; 2004. DOT HS 809 735. Available at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2004/809735Van.pdf. Accessed August 18, 2004.Google Scholar may seem a little esoteric and perhaps not particularly relevant to the practice of emergency medicine. However, as trauma care providers, we are keenly aware of the devastation that crashes can have on our patients and their families, and in these crashes, large groups of people may be injured at one time. There were more than 500,000 vans of this type registered in the United States in 2002, representing approximately 0.25% of the passenger fleet. However, the number of registered vans increased threefold from 1990 to 2002 and is expected to increase further. The findings for 15-passenger vans also apply to 12-passenger vans. Although the total of 1,111 occupant fatalities over an 11-year period may not seem like a huge problem, the real tragedy is that the vast majority of these deaths were entirely preventable. The 2 biggest issues in these deaths are clear-cut: rollover crashes and lack of safety belt use by the occupants. Rollover events occurred in 29% of all crashes that caused occupant fatalities in 20032.Fatality Analysis Reporting System (FARS) Web-Based Encyclopedia. National Center for Statistics and Analysis, National Highway Traffic Safety Administration. Available at: http://www-fars.NHTSA.dot.gov. Accessed August 20, 2004.Google Scholar but played a role in fully 65% of the occupant fatalities in 15-passenger vans in this report. Although the majority of fatally injured occupants in all passenger vehicles are unbelted, that number is decreasing: from 59% in 1994 to 56% in 2002.3.Fatality Analysis Reporting System (FARS) Web-Based Encyclopedia. National Center for Statistics and Analysis, National Highway Traffic Safety Administration. Trends Report Restraints. Available at: http://www-fars.NHTSA.dot.gov. Accessed August 20, 2004.Google Scholar By contrast, the overwhelming majority (76%) of the dead occupants of 15-passenger vans were unbelted. The propensity for 15-passenger vans to roll over is not unique. Taller vehicles are at increased risk of rolling over, in part because of their higher center of gravity relative to their track width. Passengers and luggage placed into the van ride above the unloaded vehicle's center of gravity and can increase the risk of rolling over by raising the center of gravity. Luggage placed on the roof and unbalanced cargo loads can also directly affect the vehicle's stability, increasing its risk of rolling over. The majority of rollover events in real world crashes are “trip-overs,” where the lateral acceleration of the vehicle is stopped suddenly by a curb, pothole, or a change in the quality of the pavement.4.Parenteau C.S. Viano D.C. Shah M. et al.Field relevance of a suite of rollover tests to real-world crashes and injuries.Accid Anal Prev. 2003; 35: 103-110Crossref PubMed Scopus (49) Google Scholar As the upper portion of the vehicle continues to move laterally, the tires are prevented from moving in the same direction, and the vehicle begins to roll over. Roadway geometry and the driver's understanding of it thus play a significant role in rollover crashes. If the driver takes on a curve in the road at just above the threshold speed, or underestimates the amount of steering required to make the turn at any speed, the outside wheels can trip on the road edge, causing a single-vehicle rollover crash. Of course, vehicles do not generally roll over spontaneously while parked. Rollovers occur only while the vehicle is being driven; thus, human factors play a central role in rollover crashes. If the driver fails to recognize the special characteristics of these vans, the crash risk increases. Although younger, less experienced drivers are generally more likely to be involved in a crash, this effect is magnified for rollover crashes. Nonrollover crash rates for drivers younger than 20 years in sport utility vehicles (SUVs) are more than 4 times those of drivers aged 20 to 60 years (per mile driven). However, the rollover crash rates for the same young drivers in SUVs are more than 11 times higher than for older drivers.5.Kweon Y.J. Kockelman K.M. Overall injury risk to different drivers: combining exposure, frequency, and severity models.Accid Anal Prev. 2003; 35: 441-450Crossref PubMed Scopus (139) Google Scholar Unfortunately, the rollover risk is even higher when the 15-passenger van is fully loaded. In an SUV fully loaded with passengers (rather than just a driver), the risk of rollover increases by nearly a factor of 2. In a fully loaded 15-passenger van, the rollover risk increases by a factor of 5. Combining a young, less experienced driver and a fully loaded 15-passenger van is likely to increase the risk of a rollover crash exponentially. The common practice of asking an inexperienced camp counselor, athletic team captain, or youth group leader with a valid driver's license to take on the job of the group van driver is plainly dangerous, and even more dangerous if the van is full. Although safety belts are available in every seating position in these large vans, the vast majority of those who were killed in these vehicles were not using them. This is particularly disappointing because we know that safety belts are effective in preventing death or serious injury during rollover crashes. Although they are nearly 50% effective at preventing death or serious injury in all crashes, the effect approaches 80% for passengers in the rear seats of an SUV.6.National Highway Traffic Safety Administration Web site. The economic impact of motor vehicle crashes: safety belt use. Available at: http://www.nhtsa.dot.gov/people/economic/EconImpact2000/safety_belt_use.htm. Accessed August 22, 2004.Google Scholar The main effect of safety belts in rollover crashes is to prevent ejection from the vehicle. Eleven percent of unbelted occupants are ejected in fatal nonrollover crashes, but 51% are ejected in fatal rollover crashes.7.US Department of Transportation, National Highway Safety Administration Web site. Research note: analysis of ejection in fatal crashes. November 1997. Available at: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/1997/Ejecnote.pdf. Accessed August 22, 2004.Google Scholar This points to the violent nature of a rollover crash and the tremendous forces that are unleashed on vehicle occupants. This brings us to ask, “Why is it that so many occupants in 15-passenger vans are not using their safety belts?” It may be that traveling “in the back” of the supersized van provides the occupants a false sense of security. Unfortunately, the protective effect of a rear seating position may not exist when the primary crash event is a rollover. What's more, some of the seat belt configurations are unusual in these large vans; some belts are located a few feet behind the occupant, requiring him/her to reach back to buckle up. This additional effort on the part of the occupant, particularly for the part-time seat belt user, may deter belt use in a potentially risky situation. However, the main reason for nonuse is likely to be that no one asks or requires the van passengers to buckle up. To date, only 6 states (CA, DE, NY, NM, OR, WA) and the District of Columbia have primary enforcement seat belt laws that require belt use for all occupants in all seating positions.8.Insurance Institute for Highway Safety Web site. Safety belt use laws. Available at: http://www.hwysafety.org/safetypercent5Ffacts/statepercent5Flaws/restrain3.htm. Accessed August 22, 2004.Google Scholar Because of these 2 problems—rollover crashes and safety belt use—NHTSA has issued several consumer advisories about 15-passenger vans. The most recent was issued in June 2004, on the heels of the report discussed in this issue. NHTSA strongly recommends that only trained, experienced drivers operate 15-passenger vans and that all occupants of 15-passenger vans use a seat belt at all times.9.US Department of Transportation, National Highway Traffic Safety Administration Web site. Consumer advisory. Issued June 1, 2004. Available at: http://www.nhtsa.dot.gov/nhtsa/announce/press/pressdisplay.cfm?year=2004&filename=midadd_06-01.html. Accessed August 20, 2004.Google Scholar The National Collegiate Athletic Association (NCAA), concerned about fatalities involving college athletic team members, has issued its own recommendations. These suggest that institutions using 15-passenger vans require safety belt use by all occupants, require the driver to be well rested, and require that all driving be done during daylight hours and never from midnight to 6 am.10.Williams B. Precautions essential during van travel. NCAA Division II update. 2003;7:4. Available at: http://www1.ncaa.org/membership/governance/division_II/d2_newsletter/200312_d2_newsletter.pdf. Accessed August 30, 2004.Google Scholar Oklahoma State University has arguably the most complete policy on team travel. For 12- and 15-passenger vans, they require that the driver undergo special training, be older than 21 years, not be a member of the team in question, and have a commercial driver's license. In addition, the van itself cannot be loaded at more than two thirds of its passenger capacity, and if the trip is more than 350 miles or continues past 2 am, there must be a qualified, paid driver.11.Oklahoma State University Athletics Web site. Oklahoma State travel policy. Available at: http://www.okstate.com/SportSelect.dbml?DB_OEM_ID=200&KEY=&SPID=162&SPSID=2438. Accessed August 30, 2004.Google Scholar Unfortunately, both the NCAA recommendations and the Oklahoma State University policy fall short of requiring that all occupants be properly belted. Supersized crashes and the injuries they cause are preventable when experienced, educated drivers are at the wheel and when passengers are wearing safety belts. If your child's summer camp, after school program, or athletic team or your church or hotel-airport shuttle service are using one of these large vans, ask who is driving and what their experience is, and make sure you and your family are always buckled up. Supersizing the van should not mean supersizing the risk of injury! Analysis of Crashes Involving 15-Passenger VansAnnals of Emergency MedicineVol. 44Issue 6PreviewTeenage soccer players, seasonal firefighters, church choir members, commuter vanpoolers, work crews, tourists, the elderly, and children in day care centers are all common occupants in the roughly 500,000 registered 15-passenger vans on America's roads today. The 15-passenger van is the largest passenger vehicle a driver can operate without a commercial driver's license. For the past 4 years, federal consumer advisories have warned about safety concerns while driving these vans, which were originally used for cargo, not people. Full-Text PDF