Fatal Motor Vehicle Accidents Research Articles

Towards Safer Roads: A Deep Learning Approach to Driver Distraction Detection in Four-wheeler Cars

Towards Safer Roads: A Deep Learning Approach to Driver Distraction Detection in Four-wheeler Cars

Impact of Community Socioeconomic Characteristics on Emergency Medical Service Delays in Responding to Fatal Vehicle Crashes

This study aimed to determine the impact of community socioeconomic status on emergency medical services' response time for fatal vehicle crashes. Authors used the 2019 National Highway Traffic Safety Administration Fatality Analysis Reporting System and 2019-2020 Area Health Resource Files to obtain emergency medical services' time intervals and county socioeconomic characteristics (e.g., median household income, availability of trauma centers, and rurality), generating a study sample of 18,540 individuals involved in fatal vehicle crashes between January and December 2019. Generalized linear models with log-link and Gamma-family were used to obtain estimates, and other variables were adjusted in the model. Both the mean time of the emergency medical service arrival to the site of the crash and the mean transport time from the crash site to hospital varied by county SES. Counties with a higher mean household income had 12% shorter emergency medical services' arrival times and up to 7% shorter emergency medical services' hospital transport times than counties with lower SES. The emergency medical services' hospital transport times by emergency medical services also varied by proximity to trauma centers and were 15% shorter in counties that had ≥2 trauma centers than in counties without trauma centers. This study shows socioeconomic disparities in emergency medical service rescue time for fatal vehicle crashes. Community characteristics play a major role in emergency medical services' arrival time intervals. Prior research demonstrated a strong link between the timeliness of emergency medical service response and the likelihood of survival in fatal motor vehicle accidents. These findings showing that socioeconomically disadvantaged areas and those lacking trauma facilities had slower emergency medical service rescue times, suggest that socioeconomic status may be a predictor of mortality in fatal motor vehicle accidents. Effective emergency medical services are essential to reduce the morbidity and mortality among motor vehicle crash victims; however, disparities exist in the timeliness of these services by geographic and socioeconomic county characteristics. Further research is urgently needed to inform policy interventions.

The impact of employment on treatment completion rates with DWI offenders

Drivers under the influence of alcohol cause nearly one third of all fatal motor vehicle accidents. Ambulatory outpatient alcohol use disorder treatment has been clinically shown to increase abstinence, which could decrease the chance of subsequent DWI offences. Aiding clients in successful completion of this treatment is imperative to lower the recidivism rates of DWI offenses. The research question focused on if employment status can predict successful outpatient treatment completion in court mandated adults. The TEDS-D archival data set was used, consisting of data collected between 2006—2011 from federally funded substance abuse treatment centers throughout the USA. The variables of treatment level, gender, employment status, and age were used as controls. A logistic regression using a random sample of 4947 participants determined employment status was significant. The variable of age was also a significant predictor of treatment completion. Court and treatment agencies can use this information to offer more employment support to increase chances of treatment completion.

Sample size bias in the empirical assessment of the acute risks associated with daylight saving time transitions

ABSTRACT The assessment of the acute impact of daylight saving time (DST) transitions is a question of great interest for an understanding of the benefits and inconveniences of a practice that is now under public scrutiny in Europe and America. Here, we report a thorough analysis of a record of 13 well-known research studies that reported increased risks associated with DST transitions in health issues – acute myocardial infarction, ischemic strokes and trauma admissions – and in societal issues – accidents, traffic accidents and fatal motor vehicle accidents. We found that a five percent increase of the risks suffices to understand the reported increased risks associated with the spring transition. Reported values above this threshold are impacted by the sample size of the study. In the case of the autumn transition, no increase in the risks is found.

A brief assessment of eye blink drowsiness immediately prior to or following driving detects drowsiness related driving impairment.

Drowsy driving is a major cause of fatal and serious injury motor vehicle accidents. The inability objectively to assess drowsiness has hindered the assessment of fitness to drive and the development of drowsy driving regulations. This study evaluated whether spontaneous eye blink parameters measured briefly pre- and post-drive could be used to detect drowsy driving impairment. Twelve healthy participants (6 female) drove an instrumented vehicle for 2 h on a closed-loop track during a rested (8-10 h awake) and an extended wake condition (32-34 h awake). Pre- and post-drive, the participants completed a 5 min eye blink task, a psychomotor vigilance task (PVT), and the Karolinska sleepiness scale (KSS). Whole drive impairment was defined as >3.5 lane departures per hour. Severe end of drive impairment was defined as ≥2 lane departures in the last 15 min. The pre-drive % of time with eyes closed best predicted the whole drive impairment (area under the curve [AUC] 0.87). KSS had similar prediction ability (AUC 0.85), while PVT reaction time (AUC 0.72) was less accurate. The composite eye blink parameter, the Johns drowsiness scale was the best retrospective detector of severe end of drive impairment (AUC 0.99). The PVT reaction time (AUC 0.92) and the KSS (AUC 0.93) were less accurate. Eye blink parameters detected drowsy driving impairment with an accuracy that was similar to, or marginally better than, PVT and KSS. As eye blink measures are simple to measure, are objective and have high accuracy, they present an ideal option for the assessment of fitness for duty and roadside drowsiness.

Do Cellphone Bans Save Lives? Evidence From Handheld Laws on Traffic Fatalities

Distracted driving is one of the leading causes of fatal motor vehicle accidents in the United States. Policymakers in several states have responded to this phenomenon by implementing laws that restrict the use of handheld devices while operating a vehicle. In this paper, we utilize various quasi-experimental designs to estimate the impact of state-level handheld mandates on traffic fatalities. We find robust evidence that restricting the use of handheld devices while driving reduces daily traffic fatalities by 0.63 individuals in the short term. The results further indicate that while the magnitude of the impact is smaller in the long term, this policy is still effective at curbing traffic fatalities, saving more than 69 lives per state each year.

This issue of ACTA

This issue of ACTA

The role of vision-related problems in fatal road accidents in Finland.

To evaluate the significance of vision-related problems in fatal motor vehicle accidents (FMVAs) based on a systematic investigation process by multidisciplinary road accident investigation teams (RAITs). Retrospective registry-based study of all FMVAs during the years 2012-2016 in Finland in which driver causing the accident had a valid Finnish driving licence and the operated motor vehicle required having a driving licence. There were a total of 968 FMVAs. In only 1.3% of all the accidents, a vision-related problem was considered to have contributed to the FMVA, while an observational failure of 23.6% was the leading cause of all the FMVAs. Eye-originating vision problems are rarely a causative risk for FMVAs in Finland. Making current visual standards more stringent would unlikely to be effective in FMVA prevention.

Click it or give it: Increased seat belt law enforcement and organ donation.

Laws mandating that individuals wear a seat belt have the presumed goal of reducing motor vehicle accident fatalities, but the prevailing view is that they may reduce the number of organs available. I provide a conceptual model identifying mechanisms whereby the law could either increase or decrease organ donation. Exploiting variation across states and time in the adoption of primary seat belt enforcement, I investigate these mechanisms and estimate the effect of the law on the supply of organs. The law increases seat belt usage and decreases motor vehicle accident fatalities, which translates to a sizeable reduction in the number of motor vehicle accident-based organ donors. In contrast, the law is not associated with changes in the number of organ donors from nonmotor vehicle accident-based sources and is robust to controlling for hospital-specific effects. The effects are concentrated within organs expected to be most negatively impacted by the seat belt. Although primary enforcement represents a net-gain to society in terms of lives saved, the negative impact on organ donation suggests further emphasis be placed on policies aimed at increasing the availability of organs.

A Retrospective study on Non Fatal Motor Vehicle Accident cases in the Emergency Department, Saveetha Medical College, Chennai

Aim & Objectives: To retrospectively study non fatal RTAs in the emergency department of SMCH with help of AR registers while studying various factors involving like pattern, site and time of injuries and age of the person involved. Materials and Methodology: Data was collected for complete one year and all the cases in the year were included in the study, which thus constitute sample for the study. The retrospective study group consisted of all the RTA victims reporting to Emergency Department of SMCH in the study period from 1st January 2018 to 31st December 2018. These collected data were compiled with help of Excel. Results: In this study a total of 911 cases were included who were admitted in the emergency department of SMCH. Males were the most commonly involved. Around 95% of the cases involved 2 wheelers. 65% of the accidents took place in the 6pm to 9pm range. Commonly involved age group is 18-30. 20% showed head injuries but the majority had injured their limbs. Conclusion: This suggests that there has to be more awareness created amongst the youth population encouraging them to wear helmets and seat belts. More advancement is required in the field of automotive safety. Road safety must be embedded in the children’s curriculum from lower grade itself. More involvement of Traffic police, NGOs and other public awareness groups are required to enforce this.

An evaluation of postmortem concentrations of Δ9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH)

Δ9-tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, leads to impaired cognitive and psychomotor function resulting in an increased risk of fatal motor vehicle collisions and other traumas resulting in death. It is important to measure cannabinoids in postmortem cases to improve understanding of this growing public safety issue. However, postmortem concentrations of THC and its primary inactive metabolite, 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH), have not been extensively studied. We aim to further characterize postmortem concentrations of THC and THCCOOH in peripheral blood with and without preservation, central blood, and central “serum” to support improved forensic interpretation. Cannabinoids were extracted from blood and “serum” from twenty-five decedents using solid phase extraction followed by quantification using gas chromatography – mass spectrometry. We evaluated the impact of sample preservation, reported central blood-to-peripheral blood (CB:PB) ratios and blood-to-”serum” ratios, and assessed the relationship of CB:PB and postmortem interval for THC and THCCOOH. Correlations of preserved compared to unpreserved blood were strong with r2 > 0.97. The median CB:PB ratios were 1.1 and 1.3 for THC and THCCOOH, respectively. THCCOOH CB:PB was significantly higher than 1.0 (p-value < 0.001). The CB:PB ratio was only weakly correlated with PMI for both compounds. The median blood-to-”serum” ratio was 1.0 for THC and 0.8 for THCCOOH. The blood-to-”serum” ratio of THCCOOH was significantly lower than 1.0 (p-value < 0.001). Results demonstrated minimal potential for postmortem redistribution of THC and THCCOOH and that the ratio of blood-to-”serum” in postmortem samples differs from the blood-to-plasma ratio established in living humans. Based on these results, it is not recommended to apply a correction factor to THC and THCCOOH concentrations from postmortem blood samples. Our study improves the understanding of postmortem cannabinoid concentrations to support forensic interpretation in cases of fatal motor vehicle accidents.

A short survival time after last psychiatric hospitalization in drivers with psychotic disorder killed in fatal motor vehicle accidents

BackgroundResearch-based evidence on patients with psychotic disorders involved in fatal motor vehicle accidents (FMVA) remains limited. The current study analyzes the characteristics of FMVA drivers, who had been hospitalized due to psychotic disorders within a five-year-time-period prior to their death in traffic accidents. Material and methodsData sources included three national registers: The Finnish Database of Road and Cross-Country Accidents, the Care Register for Health Care and the National Cause of Death Register. The register-linkage was made using personal identity codes, unique for each Finnish citizen. The initial study population consisted of 4930 drivers killed in FMVA in Finland between the years 1990–2011. A total of 94 (1.9%) Finnish drivers had a hospital-diagnosed psychotic disorder made during the five years preceding their FMVA. The psychotic disorders of the study subjects were categorized into: schizophrenia (n = 27, 28.7%), other specified psychoses (n = 39, 41.5%) and unspecified psychoses (n = 28, 29.8%). ResultsAbout one half of the FMVA drivers with schizophrenia or unspecified psychoses and 41% of those with other specified psychoses had been discharged from psychiatric care within three months prior to their death in traffic accidents. ConclusionsBased on our study findings and the lack of concise guidelines for assessing psychotic patients' fitness-to-drive, we recommend a minimum temporary driving restriction of three months for all patients after hospitalization for psychosis.

Incidence of fatalities of road traffic accidents associated with alcohol consumption and the use of psychoactive drugs: A 7-year survey (2011-2017).

Driving under the influence of alcohol and/or psychoactive substances increases the risk of severe, even fatal motor vehicle accidents. The aim of this descriptive study was to present the impact of alcohol and/or psychoactive substances on fatal road traffic accidents (RTAs) during the period 2011-2017. For this purpose, the toxicological investigation reports from the Department of Forensic Medicine and Toxicology of the University of Athens were used. In total, 1,841 (32.2%) of the autopsies conducted by the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens over a 7-year period (2011-2017) were victims of fatal RTAs. Blood and urine samples were collected and analyzed for the presence of alcohol and psychoactive substances. The results were classified according to sex, age, victim (car driver, motorcyclist, pedestrian, or passenger) and the date the accident occurred (day, month and year). In total, 40.7% of the RTA-related fatalities were associated with alcohol consumption, among which 20.3% were car drivers. Of these, 87.3% were male victims. A higher frequency of RTA-related fatalities associated with a blood alcohol concentration (BAC) >110 mg/dl was encountered in younger compared with older age groups. Psychoactive substances were detected in 348 (18.9%) of the victims (cannabis in 46.6% of these, benzodiazepines in 25.9%, opiates in 16.4% and cocaine in 11.1% of these). The percentage of the RTA-related victims that had consumed alcohol in combination with other psychoactive substances was 4.5%. On the whole, the findings of this study suggest that alcohol and psychoactive substances are probably risk factors for RTA-related fatalities.

Personality disorders of drivers killed in fatal motor vehicle accidents in Finland during 1990-2011.

To examine the association of personality disorders (PDs) to deaths of drivers in fatal motor vehicle accidents (FMVAs) and analyze gender differences in lifetime psychiatric disorders and medico-legal findings at the time of accident. The study sample consisted of 4810 Finnish drivers killed in FMVAs in Finland between 1990 and 2011. Doctor-diagnosed PD was found in 146 drivers (118 men and 28 women). The information of psychiatric morbidity was obtained from the Finnish Care Register for Health Care. The proportion of deceased drivers with PDs had increased significantly over the study period, particularly among females and those with PD not otherwise specified (NOS). Suicidality and use of medication affecting driving ability were more common among females with PD compared to males with PD. 88% of all deceased drivers with PD had comorbid psychiatric disorders. Our findings indicate that PDs may predispose drivers to FMVAs, particularly females. This study emphasizes the importance of evaluating the fitness-to-drive of subjects with PD and especially comorbid substance use disorders, which may relate to an increased risk of fatal motor accidents.

Sleep versus non−sleep-related fatal road accidents

ObjectiveTo study different factors that are associated with fatal sleepiness-related motor vehicle accidents (FSMVA) and in other types of fatal motor vehicle accidents (FMVA) in Finland. MethodsAll FMVA that were caused by falling asleep at the wheel (FSMVA) during the years 2005–2014 were investigated using OTI (Finnish Crash Data Institute) data. The control group consisted of 136 drivers who died in other types of FMVA in 2013. A total of 258 accidents were investigated. ResultsThe mean age of the 122 drivers in the FSMVA group was 44 (standard deviation 19) years; there were 100 men (82%) and 22 women. The mean age of the 136 control drivers was 45 (standard deviation 19) years; there were 116 men (85%) and 20 women. Short sleep time (<6 h) during the previous night before the accident was the most prominent independent risk factor for FSMVA compared to other FMVA (p < 0.05). None of the other driver-related factors (diseases, blood alcohol level, illegal drugs, body mass index, medications, age, sex) differed significantly between the two groups. ConclusionShort sleep is a major cause of fatal sleepiness-related motor vehicle accidents. Driver health factors such as sleep apnea or acute/chronic diseases as well as use of sedative medications and drugs are known risk factors for FSMVA, but these factors are associated also with other types of accidents. Healthy individuals are at risk for falling asleep while driving if they are sleep deprived. All drivers should be aware of the importance of adequate sleep.

Alcohol policy and fatal alcohol-related crashes in Finland 2000–2016

ABSTRACTObjective: The purpose of this study was to explore the relationship between annual alcohol consumption per capita/alcohol price index and the number of alcohol-related fatal motor vehicle accidents (AFMVAs). We were particularly interested in whether a tax reduction in 2004 increased the number of alcohol-related accidents.Method: The data consisted of all fatal motor vehicle accidents (FMVAs) during the years 2000–2016 obtained from a database maintained by the Finnish Crash Data Institute (OTI). The data included all fatally injured drivers. We compared the OTI data to official statistics on annual alcohol consumption and the alcohol price index.Results: There were 3,447 fatally injured drivers, of which 25% (n = 869) were intoxicated (blood alcohol concentration [BAC] ≥ 0.05%). After the reduction of the alcohol tax in 2004, the alcohol consumption rose 12.4% from 2003 to 2005 and AFMVAs rose 38%. There was a strong correlation (r = 0.7000, P < .018) between the recorded consumption of alcohol and the number of AFMVAs. There was a strong negative correlation between AFMVAs and the combined (retail + restaurant sales) alcohol price index (r = −0.7863, P = .0005). A linear mixed-effects model showed that a 1-L increase in total alcohol consumption per capita per year increases AFMVAs by 10.6 and a one-unit increase in the price index decreases AFMVAs by 1.8 per year.Conclusions: The correlation between alcohol consumption and alcohol-related crashes should be considered when making political decisions regarding alcohol price and availability. Any further liberalization of the alcohol policy would likely lead to an increase in alcohol-related fatal motor vehicle accidents. Similar consequences are likely to occur with drugs. Alcohol price policy is an effective way to improve road safety, but other measures taken to prevent FMVAs also seem to reduce the prevalence of AFMVAs.

Post-traumatic stress reactions in young victims of road traffic accidents

ABSTRACTMany children and adolescents are exposed to traumatic experiences every year. Over 30% of these children develop a clinical syndrome with emotional, behavioural, cognitive, social, and physical symptoms called post-traumatic stress disorder (PTSD). Road traffic accidents (RTAs) are the main cause of morbidity and mortality in ages 0–19 in industrialized countries. In Greece, 30,000 individuals are injured and 2000 die in RTAs every year, 40% of them between 15 and 34 years old. Findings from previous research exhibit that each fatal motor vehicle accident is related to 50 severe injuries. Although distress after the accident can persist for several months and the need of early assessment and treatment has been highlighted, the emotional needs of children involved in RTAs are rarely recognized and children have received hardly any planned intervention (Kramer & Landolt, 2014). In addition, studies on the extent to which the degree of physical injury predicts PTSD development show mixed results (Delahanty, Raimonde, Spoonster, and Cullado, 2003). In these relatively limited studies, contradicting results concerning the relationship between demographic, accident and trauma factors and the psychological symptoms are shown.In a previous study (Pervanidou et al., 2007), which was conducted over a two-year period, the main aim was to identify and evaluate the severity of PTSD symptoms after a RTA. Furthermore, epidemiological, psychosocial and clinical characteristics related to the disorder were reviewed. The sample consisted of 57 children (39 male, 18 female), aged 7–18, who were admitted to ‘Aghia Sophia’ Children’s General Hospital and other hospitals. Self-reported questionnaires and a semi-structured psychiatric diagnostic interview (K-SADS-PL) were administered. Stress-related hormones were also measured. Assessment took place during the admission to the general hospital, in one month, and six months later. There was a community control group of 30 children/adolescents.Concerning the type of the accident, 36 (59%) of the young victims were traumatized as pedestrians, while 25 (41%) were passengers. The severity of body injury was mild in 21 (34.4%), moderate in 24 (39.3%) and severe in 16 (26.2%) victims. Results showed that 38.3% of children/adolescents who were involved in a RTA suffered from PTSD one month afterwards, while the percentage is significantly lower (15%) six months after the RTA. PTSD symptoms were experienced by children of all ages, although boys were most likely to be affected, especially those who were severely injured during the accident. The only predictor variable that had a significant positive effect on the development of PTSD (one month after the accident) was current maternal PTSD symptoms. Important findings regarding the consequent short- and/or long-term alterations on the circulating concentrations of stress hormones and adipo-cytokines were established as well (Pervanidou et al., 2007).Despite increasing attention over the past 20 years, PTSD is a significant public health issue that has not been properly addressed. It is well documented that highly stressful events affect the normal activity of the neurotransmitter norepinephrine and elevate levels of the hormone cortisol. Furthermore, continuous arousal during the course of time may produce difficulty in the hippocampus’s ability to manage in the future highly stressful events. Children and adolescents may respond to a traumatic event differently, depending on the degree of exposure, the age or developmental stage, the effect of the personal impact and the proximity to the actual traumatizing event. In our study, almost one out of three young victims of RTAs was found to suffer from PTSD a month later, confirming previous findings. The child’s perception of the accident was important, with badly injured children being more likely to develop PTSD. Further research could contribute to improved treatment approaches to reduce the devastating personal and societal impact of PTSD.

Sleepiness, driving, and motor vehicle accidents: A questionnaire-based survey

In Switzerland, the prevalence of an excessive daytime sleepiness (EDS) in drivers undergoing a driving capacity assessment is currently not known. In this study, private and professional drivers were evaluated by means of a paper-based questionnaire, including Epworth Sleepiness Scale, Berlin Questionnaire, and additional questions to sleepiness-related accidents, near-miss accidents, health issues, and demographic data.Of the 435 distributed questionnaires, 128 completed were returned. The response rate was 29%. The mean age of the investigated drivers was 42.5 years (20–85 years). According to the Epworth Sleepiness Scale, 9% of the participants are likely to suffer from excessive daytime sleepiness. An equal percentage has a high risk for obstructive sleep apnea syndrome based on the Berlin Questionnaire. 16% admitted an involuntary nodding off while driving a motor vehicle. This subset of the participants scored statistically significant higher on the Epworth Sleepiness Scale (p = 0.036). 8% of the participants already suffered an accident because of being sleepy while driving. An equal number experienced a sleepiness-related near-miss accident on the road. The study shows that a medical workup of excessive daytime sleepiness is highly recommended in each driver undergoing a driving capacity assessment. Routine application of easily available and time-saving assessment tools such as the Epworth Sleepiness Scale questionnaire could prevent accidents in a simple way. The applicability of the Berlin Questionnaire to screen suspected fatal sleepiness-related motor vehicle accidents is discussed.

Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland

Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990–2000 and 2007–2011, and increased between the years 2000–2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.

Comparison of fatal motor vehicle accidents at passive and active railway level crossings in Finland

The study compares accidents at passive and active railway level crossings, and both immediate and background risk factors are considered. Passive railway level crossings have no warning devices, although there might be a static warning sign. Active level crossings are equipped with automatic devices warning road users of approaching trains. The data covers all fatal motor vehicle accidents at level crossings in Finland during the years 1991 to 2011 (n=142). All these accidents have previously been investigated in detail by Road Accident Investigation Teams.Most of the accidents took place at passive level crossings. Compared to active level crossings, and related to the number of fatal accidents, passive level crossings have become proportionally more risky during the study period. Almost all the immediate risk factors in the accidents were of the human error type. Observation errors on the part of the road user were typical at passive level crossings, and risk taking at active level crossings. The environment did not support safe crossing in most of the accidents at passive level crossings. The speed limits of both the road and rail were high, visibility was insufficient, and the level crossing was often situated uphill.Active warning devices are effective in preventing accidents due to road user errors. Equipping the most dangerous passive level crossings with warning devices – low cost or conventional – would increase safety. Alternatively, some level crossings could be removed altogether. A minimum requirement is that the environmental factors at passive level crossings support safe crossing.