Private Vehicle Transport Research Articles

Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial.

Background: The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.Methods: Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.Results: Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, P = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.Conclusion: Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.

PLANNING THE INSERTION OF SUSTAINABLE TRANSPORT MODES BASED ON AN ACCESSIBILITY ANALYSIS. CASE STUDY: SAN JOSÉ DEL GUAVIARE, COLOMBIA

This research objective is to determine the impact on the operability of private vehicle transport mode, given the proposed implementation of the new bicycle route, pedestrian a transit network in San Jose del Guaviare (Colombia), with the aim to propose an urban planning instrument for decision-making that promotes the insertion of alternative transport means to a private vehicle. The methodology includes the application of transport infrastructure supply models as an evaluation basis, supported by geographical accessibility, coverage and geospatial impact analyses. The main results show that the proposal for the insertion of alternative modes of transport would be beneficial in terms of providing other mobility options for the inhabitants without deteriorating the current mobility conditions of the private mode. The above result point to the benefits that are shown for the municipality's development and planning to maximize their use by decision-makers.

Geographic Accessibility and Completion of Initial Low-Dose CT-Based Lung Cancer Screening in an Urban Safety-Net Population.

Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system. Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution. A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P=.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals. In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.

Shortening Door-to-Balloon Time: The Use of Ambulance versus Private Vehicle for Patients with ST-Segment Elevation Acute Myocardial Infarction.

Time is critical when dealing with acute myocardial infarction (AMI) patients in the Emergency Department (ED), as 90 min is crucial for overall health. Using non-EMS transportation for critical patients, such as patients with acute myocardial infarction, to a hospital might delay the rapid identification of the underlying medical disease and initiating definitive treatment. We aim to evaluate the association between the mode of transportation and the D2B time in patients presenting at the ED with AMI. We conducted a retrospective cohort study with patients who presented at ED with AMI and underwent percutaneous coronary intervention (PCI). The participants were patients with confirmed AMI at the ED of King Abdullah Medical City (KAMC) from January 2019 to December 2019. In total, 162 AMI patients were enrolled in the study and divided based on the method of transportation. Less than half (n=65, 40.1%) were transported with an ambulance and 97 (59.9%) patients with a private car. The door-to-balloon (D2B) time for the ambulance group was 93.6±38.31 minutes, and the private car group was 93.8±30.88 minutes. There was no statistical significance when comparing the D2B time between the private car group and the ambulance group (P = 0.1870). Finally, ambulance transport significantly shortened the time to first ED physician contact. However, it was not associated with shortened D2B time when compared to private vehicle transport.

Understanding Travel Considerations and Barriers for People with Disabilities to Using Current Modes of Transportation Through Journey Mapping.

This study aimed to apply a journey mapping methodology to identify travel considerations and barriers for people with disabilities (PWDs) at each travel stage, from considering a trip through to arriving at the destination for their current modes of transportation, with the objective of understanding and avoiding "pain points" during a transition to autonomous driving systems. Twenty PWDs, including those with physical, visual, aural, cognitive, and combined physical/visual impairments, participated in a semistructured one-on-one interview. Descriptive statistics were used for demographic information, and qualitative content analysis was used to analyze the transcribed interviews and extract themes. Themes were further organized by the modes of transportation used. The top four themes in considering and planning a trip were third-party assistance availability (private vehicle, public transportation, and paratransit), finding an accessible or suitable parking space (private vehicle), access to a service location (public transportation and paratransit), and transportation schedules (public transportation and paratransit). The top four travel barriers to locating, entering, riding, and exiting transportation and arriving at the destination were vehicle ingress/egress (private vehicle and public transportation), concerns about wheelchair securement (public transportation and paratransit), requiring third-party assistance (private vehicle and public transportation), and accessibility to service locations (public transportation). The study suggests that to mitigate travel considerations and barriers for PWDs, vehicle-specific barriers and infrastructure issues should be addressed simultaneously. We anticipate that the findings will provide insights into the design and development of autonomous vehicles, to better accommodate the needs of PWDs.

The effect of transport mode on mortality following isolated penetrating torso Trauma

BackgroundPrehospital interventions may increase the time to definitive care. Compared to ground ambulance, we hypothesize improved mortality for patients with isolated, penetrating torso injuries transported via private vehicle. MethodsWe reviewed the National Trauma Data Bank (2017–2021) for adults with isolated, penetrating torso injuries stratified by mechanism (stabbing vs. firearm) and transport mode (private vehicle vs. ground ambulance). We performed a multivariable logistic regression to estimate the effect of transport mode on mortality. Results48,444 patients met our inclusion criteria. Patients transported by ambulance, injured by stabbing (n = 26,633) and by firearm (n = 21,811) had adjusted odds ratios of 1.81 (95%CI 1.05–3.14, p = 0.03) and 1.66 (95%CI 1.32–2.09,p < 0.001) respectively for mortality compared to private vehicle transport. ConclusionPatients with penetrating torso injuries have nearly twice the odds of mortality when transported by ground ambulance than private vehicles, despite injury severity. The “scoop and run” strategy may confer a survival benefit in this population.

The Characterization of Trauma Patients Utilizing Private Vehicle Transport (PVT) to the Emergency Department (ED)

Introduction:Existing studies have identified the national rate of PVT for severely injured patients to be 9-16%, our ED has displayed a PVT incidence of 35.4%, suggesting a substantial difference in ED arrival. This study aims to explore descriptive demographics and injury characteristics of patients who arrived by PVT to our ED.Method:A prospective, single-center observational study conducted in Detroit, Michigan. Included patients aged 15 ≥ years who arrived at the ED by PVT for blunt or penetrating trauma. The sample population consisted of 128 patients from August 2019-April 2021. Each subject completed a survey regarding their injury and prehospital care. A retrospective chart review was conducted to acquire information on their injuries.Results:The mean age was 44.3 ± 20.3 years old, range 15-93. 51/128 female, 77/128 male. Patients comprised 93/128 African American, 19/128 Caucasian, 4/128 Asian, 4/128 Hispanic/Latino, and 8/128 other. The most common insurance was Medicaid, comprising 63/128 patients, 25/128 of patients had Medicare and 38/128 had private coverage. Utilizing ESI indices to evaluate severity levels, 73/128 arrived at the ED with an ESI level of 3, 47/128 level of 2, 5/128 level of 4, and 3/128 level of 1, the most severe. Majority of patients 36/128, presented with trauma-related injuries due to a fall. 25/128 presented with a laceration, and 22/128 presented after a motor vehicle crash. The upper extremities were the most common location of trauma 38/128 followed by the lower extremities 23/128. The mean ED length of stay was 11.18 hours.Conclusion:Overall, the findings from this study allowed us to characterize our population of PVT trauma patients through their demographics and injury characteristics. We were able to establish some descriptive characteristics that delineate the population of patients at our ED in Detroit, which is the first step in identifying why trauma patients choose varying modes of transportation.

Effectiveness of the policy for organising self-evacuation by private vehicle transport, as verified in microsimulations

The research focus was on analysing evacuation using data on the process in a selected area located within the boundaries of the Polish capital, Warsaw. The simulations were conducted to determine the consequences of private vehicle evacuation on the load of the road network, and enabled observations at the scale of the entire set of junctions, while also taking into account factor whose impact on the transport system cannot be captured by any systematic measurements (evacuation). The research procedure comprised three major stages. First, the evacuation documentation for Warsaw was reviewed. Due to the lack of detailed guidelines within the documentation, the data essential for the construction of traffic models had to be acquired (stage two), and the evacuation process was modelled in various scenarios (stage three), based on the Vissim software. The study considered five evacuation scenarios and zero variant for the two transport peaks. Thus, the total number of simulations, amounted to twelve. The results of the analysis revealed that although the deterioration of overall traffic conditions is particularly evident in Scenario 5, the evacuation process itself is still most efficient in this scenario. The traffic simulations conducted prove that it is impossible for an effective evacuation to be conducted without a disturbance to the normal traffic flow, and the ensuing accumulation may be detrimental for all road users.

Stop the Bleed: Now Wait for EMS or Get in the Car and Drive? A Secondary Analysis of an Eastern Association for the Surgery of Trauma Multicenter Trial

INTRODUCTION: The Stop the Bleed campaign asks that bystanders take an active role in controlling hemorrhage after trauma. However, whether extending the bystanders’ duty to perform private vehicle transport (PVT) results in improved survival is unknown. We hypothesized that in urban penetrating trauma, where prehospital procedures have shown to be harmful, PVT would result in improved outcomes compared with advanced life support (ALS) transport. METHODS: Post hoc analysis of an EAST multicenter, prospective observational trial was performed on adult patients with penetrating torso or extremity trauma at 25 urban trauma centers. Patients were allocated to PVT or ALS using nearest neighbor propensity score matching. Wilcoxon signed-rank or McNemar test and logistic regression were performed for univariate and multivariate analyses. RESULTS: Of 1,830 total patients, 397 (21.7%) had PVT, and 1,433 (78.3%) had ALS transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. Patients were primarily male (n = 702, 90.2%), Black (n = 537, 69%), and injured by gunshot wounds (n = 497, 63.9%). ALS transport had significantly higher emergency department (4.8% vs 1.9%, p = 0.02) and overall mortality (5.4% vs 2.8%, p = 0.02). Logistic regression demonstrated PVT was associated with survival (odds ratio 0.30, 95% CI 0.10 to 0.84, p = 0.02). Variables associated with mortality included increasing Injury Severity Score and thoracic injuries (Table 1). Complications did not differ between groups. Table 1. - Logistic Regression Analysis of Patient and Injury Factors on Mortality Parameter Odds Ratio 95% CI p Value Age, y 1.02 0.98–1.05 0.40 Male 2.95 0.31–27.8 0.34 Injury Severity Score 1.10 1.07–1.13 0.001 Private vehicle transport 0.30 0.10–0.84 0.02 Thoracic injury 8.39 2.64–36.6 0.001 Abdomen injury 2.10 0.80–5.52 0.13 Pelvis injury 0.92 0.18–4.76 0.92 Extremity injury 1.18 0.47–2.97 0.72 CONCLUSION: Immediate PVT in lieu of prehospital procedures (by ALS) may improve outcomes in urban penetrating trauma. Bystander education incorporating PVT in this specific patient population could save lives.

Warm Up the Car? Association Between Private Vehicle Transport and Mortality for Patients with Firearm Assault

Warm Up the Car? Association Between Private Vehicle Transport and Mortality for Patients with Firearm Assault

Emergency management of self-evacuation from flood hazard areas in Poland

This paper analyses the effectiveness of self-evacuation activities of population by private vehicle transport from flood hazard areas, aimed at minimising the negative effects of flooding.. The paper relies on a four-step traffic model which is based, inter alia, on the results of questionnaire studies. Moreover, the model takes into account the entirety of national traffic, which allows the methodological problems related to the border effect to be overcome. As shown in the study, the shortest or the fastest routes achievable in the pre-flood period are not always most optimal when the flood has already occurred. In such a case, evacuation planning will increase the efficiency of the process. Thus, inadequate designation of evacuation routes may adversely affect the process of relocating people to places of safety. Therefore, it is important to create plans that provide information on evacuation zones, routes and destinations.

Bicycle Repositioning Problem with Integration of Private Vehicle and Public Transport

Bicycle Repositioning Problem with Integration of Private Vehicle and Public Transport

A clustering method for measuring accessibility and equity in public transportation service: Case study of Melbourne

This paper proposes a Modified Cumulative Accessibility (MCA) measure incorporating actual travel demand information (Origin-Destination trip patterns) to improve the accuracy of the measure as a reliable proxy for equity evaluation and amelioration in accessing Public Transportation (PT) services. The travel demand information is reflected into the MCA measure by evaluating and clustering PT and Private Vehicle Transportation (PVT) trip diaries. Both vertical and horizontal equities are measured for the network's Transportation Analysis Zones (TAZs). To redress the inequities, a priority list of operational recommendations for each TAZ is identified. The proposed method is tested with the Greater Melbourne area datasets and the TAZs with the highest inequity along with prescribed operational recommendations are identified. In terms of equitable distribution of public transportation service, a major observation from the case study model was that the outer suburban areas located in the eastern side of the the Melbourne metropolitan area are relatively underserved as compared to the inner and western suburbs.

The Impact of Prehospital Transport Mode on Mortality of Penetrating Trauma Patients

ObjectiveThe optimal mode of transport of trauma patients from the scene to the hospital remains unknown. We aimed to study the impact of different prehospital modes of transport of penetrating trauma patients on hospital mortality. MethodsUsing the Trauma Quality Improvement Program 2010 to 2016 database, we identified all adults with a penetrating injury. Univariate then multivariable logistic regression analyses were performed to study the correlation between the mode of transport and in-hospital mortality, adjusting for several covariates. ResultsA total of 92,427 subjects were included. The overall mean transport time for patients transported by a ground ambulance, helicopter, fixed wing ambulance, and police/private vehicle were 32.2, 61.2, 68.9, and 28.2 minutes, respectively. Multivariable analyses revealed that compared with ground ambulance, helicopter transport was associated with a 34% decrease in the odds of mortality (odds ratio = 0.66, P < .0001), whereas police transport and private vehicle transport were associated with a 52% decrease in the odds of mortality (odds ratio = 0.48, P < .0001). ConclusionHelicopter, police, and private vehicle transports are associated with a decreased odds of mortality compared with ground ambulance. Further research should examine the variation in levels of care within different modes of prehospital transport.

Clinical Characteristics of Patients with Cancer Presenting to the Emergency Department and Their Use of Emergency Medical Service Transport

Objectives: Although life-threatening emergencies for cancer patients are relatively rare, cancer patients often seek care in the emergency department. The use of emergency medical service (EMS) by these patients is not well studied. The aim of this study was to investigate the characteristics of cancer patients who present to the emergency department (ED) for care and compare characteristics of patients transported by EMS vs. those transported by private vehicle. Methods: Our retrospective cohort study was conducted in an EMS system with 21,070 annual transports and an academic ED with 129,263 annual visits. Our study consisted of patients with a new diagnosis of cancer between January 1 and July 1, 2015 who subsequently presented to the ED between January 1, 2015 and July 1, 2017. Study variables included patient demographics, mode of ED arrival, cancer type and treatment, patient clinical characteristics, and disposition. To describe differences in patient characteristics of EMS vs. private vehicle transport, we report variable frequencies and stratified them by mode of transport. Results: Of the 2,727 patients with a new diagnosis of cancer, 1,303 (47.8%) presented to the ED with a total of 3,590 visits in 30 months. EMS transported 22% of cancer patients to the ED vs. 78% transported by private vehicle. Thus, cancer patients would make up approximately 1.5% (781/52,675) of all EMS transports during the study period. For those transported by EMS, the most common chief complaints were respiratory distress (16.0%), pain (15.4%), and neurological symptoms (12.6%). Patients with cancer of the lung/respiratory tract (21.5%), upper GI (12.4%), and central nervous system (CNS) (11.0%) were most frequently transported by EMS. Older age, presence of CNS cancer, presentation with neurological or cardiovascular complaints, and higher acuity were significantly associated with EMS transport to ED, while gender and pain severity were not. Patients transported by EMS were more likely to be hospitalized and for greater than 2 days (p < 0.0001). Conclusions: Cancer patients frequently seek emergency care after initial diagnosis, most commonly present for symptom relief, and are often admitted. Patients transported by EMS are more likely to be admitted and for longer periods of time.

The Effect of Physical and Socio-cultural Environments on the Access of Family Planning Service in Poor Couples of Reproductive Age in Sabu Raijua Regency

One strategic decision from Indonesian government in order to slow the rate of population growth is national family planning (FP) program. One common problem regarding contraceptives in the community is the presence of negative perception regarding contraceptives. Numerous growing rumors or believes in the community often produces fear regarding contraceptives usage. This research aimed to analyze and study the influence of physical and socio-cultural environments on the access of family planning service in poor couples of reproductive age in Sabu Raijua Regency. This was an analytic observational study using mixed method. The results of quantitative analysis showed that factors which affect the access of FP service in poor couples of reproductive age were believe (p-value of 0.046), significant others (p-value of 0.014), and transportation (p-value of 0.0001). Meanwhile, tradition did not have significant effect (p-value of 1.000). From the results of qualitative analysis, several believes were found in the people of Sabu Raijua Regency, namely: FP could cause disease, FP could cause infertility, ancestor’s prohibition, and local believes (Jingitiu). Significant others factors consisted of lack of support or the presence of prohibition from husband or parent-in-law on the ground of fear that the wife could be sick or could not work appropriately. Transportation factor consisted of lack of private vehicle or public transportation which made the respondent reluctant to access FP service (probability of 92.99%).

The reduction of the fuel consumption and of the pollution through the city public transport

The public transportation represents the ideal solution that can be offered with the purpose of satisfying the mobility request through an urban area. A highly organized and efficient public transportation system which offers adequate movement possibilities, in a short time and through high safety and comfort conditions, forms the basis of an urban transportation system that improves the sustainable development of a urban area. Over this paperwork it is going to be estimated the optimization effects of the Pitesti urban transportation system, and even more, it is going to be established the „translation” way of the different improvements for the public transportation system as input data into the urban transport model. In this way it will be shown how the renewal of the vehicles and the modernization of the bus stations could get to the increasing of the urban transport share, thus succeeding the decrease of the own vehicles transport. As a consequence, through the private vehicles movements decrease it is get, in the end, a fuel consumption and gas emissions reduction, in the same time resulting a high traffic performance both for the public transportation and for the own private vehicle transportation

The Urban Liveability Index: developing a policy-relevant urban liveability composite measure and evaluating associations with transport mode choice

BackgroundDesigning healthy, liveable cities is a global priority. Current liveability indices are aggregated at the city-level, do not reflect spatial variation within cities, and are often not aligned to policy or health.ObjectivesTo combine policy-relevant liveability indicators associated with health into a spatial Urban Liveability Index (ULI) and examine its association with adult travel behaviours.MethodsWe developed methods to calculate spatial liveability indicators and the ULI for all residential addresses in Melbourne, Australia. Associations between the address-level ULI and adult travel behaviours from the 2012–2014 Victorian Integrated Survey of Travel and Activity (VISTA) (n = 12,323) were analysed using multilevel logistic regression. Sensitivity analyses to evaluate impact of methodological choices on distribution of liveability as assessed by the ULI and associations with travel mode choice were also conducted.ResultsLiveability estimates were calculated for 1,550,641 residential addresses. ULI scores were positively associated with active transport behaviour: for each unit increase in the ULI score the estimated adjusted odds ratio (OR) for: walking increased by 12% (95% Credible Interval: 9%, 15%); cycling increased by 10% (4%, 17%); public transport increased by 15% (11%, 19%); and private vehicle transport decreased by 12% (− 9%, − 15%).ConclusionsThe ULI provides an evidence-informed and policy-relevant measure of urban liveability, that is significantly and approximately linearly associated with adult travel behaviours in the Melbourne context. The ULI can be used to evaluate progress towards implementing policies designed to achieve more liveable cities, identify spatial inequities, and examine relationships with health and wellbeing.

Global transport emissions in the Swedish carbon footprint

Transport is perhaps one of the more difficult sources of emissions to address. Whilst opportunities are available for electrification of road vehicle fleets, air transport and the long distance freight of goods are more challenging. Further, due to the fragmentation of global supply chains, where materials can cross the world multiple times before ending up with a final consumer, it is important to understand the contribution of emissions caused by transport, and especially international transport, in relation to the consumption of goods and services. This paper provides evidence based insights into the contribution of CO2 emissions from transport to consumption footprints in Sweden. We give an extensive discussion of the treatment of transport in multi-regional input-output based approaches which can give insight into how different transport emissions can be accounted for. Secondly, we estimate the amount of CO2 emissions in the footprint coming from transport for Sweden. Results show that 14% (12 Mton) of the total Swedish CO2 footprint (84 Mton) was coming from transport activities occurring in the global supply chain. Most of these emissions were caused by transport in supply chains of consumed goods and services such as construction, household appliances and motor vehicles (8.5 Mton). However, the final consumption of package holidays and flights form the single biggest category with 3.5 Mton of the total 12 Mton CO2 of embodied transport emissions. With direct household emissions of vehicle transport in Sweden being 8.5 Mton, the emissions embodied in goods and services (excluding the package holidays and flights) are nearly equivalent to all the private vehicle transport of Swedish citizens.

Time efficiency of transport in Poland

For several years, one can observe a clear upward trend in the mobility of Poles. Due to aspects concerning, in particular, environmental protection, the most desirable phenomenon would be a significant reduction in the use of private vehicles (passenger cars) for collective transport (especially rail). This is possible especially when there is access to an extensive communication network. The time and cost of traveling with alternative transport is very important. Therefore, the purpose of the publication is to analyze the time efficiency of rail and private vehicle transport, between provincial cities in Poland, based on the designed indicator. It was based on the average length of travel time and the average distance between points. The study covered private cars and railway transport.