Traffic medicine in the Netherlands

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In a general sense Traffic Medicine in the Netherlands concerns multidisciplinary research about how to reduce traffic crashes and injuries following a “systems approach”. Several universities and research institutes are involved, including the SWOV research institute of traffic safety( 1). In a specific sense Traffic Medicine in the Netherlands concerns researching and applying regulations and methods for assessing and improving fitness to drive in persons with impairments in physical and mental functions which are relevant for driving. Important recent developments in the general and specific field are discussed. Because the Netherlands is a flat country with a moderate climate and generally small distances between destinations, bicycling is a very important mode of transport also for older persons. In general traffic safety has improved tremendously over the last years but much less so for older (65+) cyclists. This is particularly problematic because the older population is increasing and with the arrival of the e-bike, cycling is increasingly popular. Several approaches to improve bicycle safety have been proposed. The Netherlands is part of the European Union (EU) and medical aspects of driver licensing are based on Directives (2) of the European Parliament and Council. The European directive is not very detailed with regard to medical fitness to drive and individual countries can have more specific regulations. For example with regard to neurological disorders and dementia the EU directive states that: “driving licenses shall not be issued to, or renewed for, applicants or drivers suffering from a serious neurological disease or severe behavioural problems due to ageing, unless the application is supported by authorized medical opinion, and if necessary, subject to regular medical check-ups”. It will be discussed how, based on medical consensus and multidisciplinary research, this requirement has been implemented in the Netherlands. In empirical research persons with moderately severe visual (visual acuity < 0.5; homonymous hemianopia) and cognitive impairments (traumatic brain injury; stroke) have been systematically observed when actually driving. On average, driving was poorer in patients than in healthy subjects but many subjects in the patient groups drove safely and fluently and performance was not predicted sufficiently from medical and psychological characteristics (3,4). They appeared to compensate effectively, sometimes also helped by technology, for example the bi-optic telescope, and by visual training and special driving lessons. This has led to changes in regulations such that in the case of moderately severe visual and cognitive impairments on-road tests of “practical fitness to drive” have become important additions to the conventional medical and psychological assessments. Developments in intelligent driver support and autonomous vehicles promise further opportunities for compensating driver impairment but unwanted behavioural changes (adaptation) must be avoided (5).