Safety Restraint Research Articles

Young Female Drivers in Fatal Crashes: Recent Trends, 1995–2004

Objective. Motor vehicle crashes are the leading cause of death for 15-to 20-year-olds. In 2004, nearly 8,000 15to 20-year-old drivers were killed in crashes. Epidemiologic studies repeatedly identify overrepresentation of young males in fatal crashes. Recent studies of young females and risk-taking behaviors (drug use, violent crime, risky sexual behavior) show unfavorable trends. The objective of this study is to study the extent of contribution of young female drivers to national fatal crashes over and to uncover unfavorable trends linked to risky driving behavior. Methods. Data from the National Highway Traffic Safety Administration's Fatal Analysis Reporting System (FARS) on drivers in crashes with one or more fatalities during 1995–2004 were studied. Five age groups were used: 16, 17, 18, 19–20, and 21–24 years. Linear regression was used to measure trends over time. The regression results represent differences in proportions and changes in proportion of crashes that fell into specified categories. The FARS multiple imputation data sets was used to estimate the proportion of drivers with positive blood alcohol, and variance estimates were corrected for the imputation procedure. Results. In all, 139,000 fatal crashes involving the noted age groups occurred over 10 years. Safety restraint use: Females had more safety restraint use (by 17.8%) but a smaller increase in use over time. Driver's license validity: The percentage of valid licensure decreased over the study for young males and females both in the general population and among drivers in fatal crashes. Single-vehicle crashes: A lower proportion of female drivers (8.9% fewer) were involved in single-vehicle fatal crashes. This proportion changed little over the study period. Alcohol use: Females had a 16.7% lower proportion than males of alcohol involvement in fatal crashes. This lower proportion was seen throughout the age groups. When accounting for change over the study period, female drivers had a similar to male increase in alcohol-involved fatal crashes. Presence of peer passengers: Female drivers were less likely to have age peers as passengers. Conclusions. While young male drivers surpass young females in number of fatal crashes, there are unfavorable trends linked to crash fatalities in young females. Our results suggest a smaller increase in safety restraint use, proportional decrease in license validity, and an increase in rate of alcohol-involved fatal crashes that approaches that seen in young males. These findings have considerable implications for future traffic safety social marketing campaigns, programs, and interventions.

Pediatric Cervical Spine Fracture Caused by an Adult 3-Point Seatbelt

The development and use of seatbelts has saved numerous lives and prevented serious injuries in the setting of automobile crashes. However, restraints designed for adults are not necessarily effective in preventing injury to small children and may actually be harmful. Here, we present a case of upper cervical spine fracture in a 5-year-old female patient caused by neck flexion over an inappropriately applied adult 3-point seatbelt during a motor vehicle collision. The American Academy of Pediatrics currently advises against the use of vehicle safety belts until the shoulder belt can be positioned across the chest with the lap belt snug across the thighs. As clinicians who care for children, it is imperative that we continue to educate parents about proper use of age-appropriate child safety restraints.

Study of Occupant Chest Deceleration Analysis for Frontal Impact of Vehicle

This paper deals with investigation to determine optimum vehicle deceleration in order to reduce occupant injuries for frontal impact of vehicle at the primary design phase. The first purpose of this investigation is to calculate occupant chest deceleration under one degree of freedom spring and mass model by using convolution integral when various frontal crash impact of vehicle occurs. Next we developed and found out how to reduce maximum chest deceleration by analyzing unit impulse response and influence curve of chest deceleration sensitivity by changing small range of vehicle deceleration fluctuation. Further we also conducted three patterns of vehicle deceleration curve sled test for frontal impact under the Hybrid III dummy restrained by the rigid seat and seatbelt. As the result, this paper reports that this method can be estimated, as for the relative comparison of occupant chest deceleration when the frontal crash impact of vehicle changes even though the real world occupant safety restraint system of seatbelt is equipped.

Fiber for Safety Restraint System for Motor Vehicles

Fiber for Safety Restraint System for Motor Vehicles

Preventive Care for Children in Low-Income Families: How Well Do Medicaid and State Children's Health Insurance Programs Do?

Child health problems that are caused or exacerbated by health behaviors remain a leading cause of medical spending for children. We examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year. We used children who were aged 3 to 17 and living in families with incomes of <250% of the federal poverty level in the Medical Expenditure Panel Survey data from 2001 to 2003 to estimate linear probability models on receipt of preventive advice. The main outcome measures were receipt of clinician's advice about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a bicycle helmet. We also examined 2 related barriers to receiving clinician advice: whether the child had any preventive care visits in the past year and whether the child had a usual source of care other than a hospital emergency department. Publicly insured children were more likely than privately insured, full-year-uninsured children, and part-year-uninsured children to have had a preventive care visit in the past year, but regardless of health insurance group, many children went without preventive care. Even conditional on having had a preventive care visit, 48% did not receive clinician advice in any of the areas measured, and 41% of the overweight children were advised about neither healthy eating nor exercise in the past year. Enrolling more uninsured children in Medicaid and State Children's Health Insurance Programs could improve the chances that families receive advice about health behaviors and injury prevention; however, nearly half of the children who were insured for the entire year did not receive important advice from their clinicians.

Development of a tool for risk assessment to facilitate safety and appropriate restraint

Restraint is a method of involuntarily restraining the movement of the whole or a portion of a patient's body to control behaviour and prevent injury to the patient or others. Restraint has been correlated with poor patient outcomes, higher mortality rates, increases in hospitalization, nosocomial infections, pressure sores, and increased levels of confusion. It can often be extremely difficult to maintain patient safety without acting in a way that might provoke an allegation of abuse. The aim of this article is to discuss some of the difficulties that presented themselves to nurses in the Royal Hallamshire Hospital's neuroscience unit following a decision to justify actions to use restraints. The development of a functional risk assessment tool for use in cases of challenging behaviour is explained and its use discussed in relation to legal and consent requirements.

323: Effect of an Educational Intervention on the Knowledge and Use of Child Car Safety Restraints in Parents of 4-12-Year-Old Children

323: Effect of an Educational Intervention on the Knowledge and Use of Child Car Safety Restraints in Parents of 4-12-Year-Old Children

Differences in Pediatric Preventive Care Counseling by Provider Type

Many children in the United States do not receive advice about health behaviors and injury prevention during routine preventive care visits. We investigated the role of provider type in the probability of receiving advice. We analyzed children aged 3 to 17 in the Medical Expenditure Panel Data 2002 to 2003 surveys who had only 1 preventive clinic or office visit in the past year. We examined whether provider type affects whether the child is advised about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a helmet when riding a bicycle. Pediatricians were more likely to advise about healthy eating (63.6% vs 46.8% for other physicians and 41.1% for nonphysicians; P < .01). They were also more likely than nonphysicians to advise about exercise (40.1% vs 22.2%), the harmful effects of parental smoking (42.4% vs 21.4%), proper safety restraints in a car (39.9% vs 20.5%), and use of a bicycle helmet (45.7% vs 20.9%). Regardless of provider type, rates of advice were low. Many pediatric providers, particularly those not trained as pediatricians, are missing opportunities to advise about health behaviors and injury prevention.

Motor Vehicle Crashes and Injury among High School and College Aged Drivers. Miami-Dade County, FL 2005

Purpose To describe motor vehicle crashes and injury occurring among high school and college aged drivers in order to guide prevention efforts targeted toward reducing motor vehicle related injuries among the young population. Methods The 2005 crash data used in this study was obtained from the Florida Department of Highway Safety and Motor Vehicles. Data was analyzed using SAS by age, injury severity, alcohol/drug involvement, restraint use, day of week, and time of day. Results There were 16,311 drivers between the ages of 15–24 involved in motor vehicle crashes. Of these, over a 1/3 were injured, 14% were unrestrained, and 1.5% were alcohol and/or drug related. Alcohol and/or drug use among college aged drivers 20–24 years of age was higher than that in other age groups. The majority of crashes (38%) occurred between the hours of 12 PM and 5 PM. Friday and Saturday accounted for 30% of all crashes in this age group. High school and college aged drivers were less likely to use safety restraints compared to all other age groups. Those without restraints were 5 times more likely to suffer severe injuries. Drivers who were using alcohol and/or drugs were twice as likely to be unrestrained and three times more likely to be severely injured. Among those using alcohol and/or drugs 27% were not restrained. Over half of drivers using alcohol and/or drugs crashed between the hours of 12 AM and 5 AM. Conclusion Interventions targeting 15–24 year olds should focus on increasing safety belt use in this age group. Furthermore, college based interventions should also aim to reduce impaired driving due to alcohol and/or drugs. Since the majority of crashes occurred between the hours of 12 PM and 5 PM, intervention campaigns should target students as they leave the school premises for lunch or after class. In addition, localities should make use of readily available data such as the Florida Department of Highway Safety and Motor Vehicles crash database in order to enhance injury surveillance activities and program planning and evaluation.

Safety restraint injuries in fatal motor vehicle collisions.

The presence of an apparent seat belt mark (SBM) on a car crash occupant is often used as evidence for use of a seat belt at the time of the crash and, conversely, the lack of a SBM is used as an indication that no seat belt was used. This study examined whether there are clear indications of seat belt use to be found at autopsy and evaluated the sensitivity and specificity of apparent SBM and whether the use of a seat belt and seating location affects the type and severity of injuries sustained. Information on the type of injuries sustained and seatbelt use was retrieved from autopsy reports and police reports, respectively, for cases of fatal motor vehicle collisions occurring in Sydney, Australia over a 5-year period. In this study, a SBM was only found on restrained occupants. The proportion of restrained occupants with evidence of a SBM was 36% (sensitivity), whilst unrestrained occupants showed no evidence of a SBM (100% specificity). A SBM was also found to reliably reflect the seating position of the occupant. We conclude that restrained occupants can be expected to show evidence of the seat belt in just over one third of cases and that the absence of a SBM is not necessarily an indication that no seat belt was used. Spurious SBM is very unlikely to be present if the occupant was unrestrained.

Modeling mechanisms of skull base injury for drivers in motor vehicle collisions

To develop biomechanical variable models for driver skull base injury mechanisms in motor vehicle collisions. Retrospective database review. Biomechanical collision variables and safety restraint data were analyzed for Crash Injury Research and Engineering Network skull base trauma subjects enrolled during the recruitment period between 1996 and 2005. For drivers satisfying inclusion criteria (n = 26), injury resulted from contact with rigid vehicle structural elements in 82%, and occurred in 50% despite both seatbelt and air bags. Eight percent used neither seatbelts nor air bags. Seventy-two percent involved vector velocity changes greater than 30 mph. The relative morbidity of skull base injuries was also detailed. The majority of driver skull base injuries resulted from contact with rigid vehicle structural elements in high velocity crashes. Seatbelt and air bag use could not be definitively correlated with skull base injury. Injury mechanism models can be developed that facilitate further investigations to determine impact and scope on a national scale.

Crash Risk in General Aviation

Noncommercial flights, usually called general aviation, encompass a wide variety of activities, including emergency medical services (EMS), sightseeing, flight training, traffic reporting, aerial surveys, search and rescue, crop dusting, firefighting, logging, recreation, and personal or business use. In this commentary article, the authors examine the crash risk of private airplane flights, identify major factors influencing survival in aviation crashes, and discuss possible approaches for improving the safety of general aviation. The authors note that the fatal crash rate for general aviation, 1.31 fatal crashes per 100,000 flights hours, is 82 times the rate for major airlines, a difference that has persisted over several decades. General aviation flights are particularly vulnerable to adverse weather conditions and other environmental factors (such as wires or terrain). Other risk factors include alcohol-impaired pilots, sudden incapacitation of the pilot (particularly crucial in light of the lack of a co-pilot on most small aircraft), pilot inexperience, and nonconformist flying behavior. Risks for crash fatality include aircraft fire, instrument meteorological conditions, off-airport location, and failure to use safety restraints; the authors briefly consider approaches to reduce each of these risks. The authors conclude with a consideration of the intersection of general aviation and medicine, focusing particularly on transporting patients from crash sites and between medical facilities (EMS flight crews), and on physician pilots. The safety of general aviation could be increased with interventions to improve fuel system integrity and restraint systems, enhance general crashworthiness of small aircraft, and reduce weather-related crashes through pilot training and avionics technology.

Improvement in booster seat use in Tennessee.

Tennessee enacted an enhanced child safety restraint law in July 2004, which included new requirements for booster seat use among 4- to 8-year-old children. The goal of this study was to evaluate the appropriate use of child safety restraints and knowledge of the enhanced law before and after its implementation. On-site child safety restraint assessments and brief driver interviews for cars with passengers 0 to 8 years of age were conducted at 34 sites in 3 urban counties in Tennessee. Assessments were conducted 2 to 3 months before implementation of the law and 1 year after implementation of the law. Appropriateness of restraint use was defined on the basis of language in the enhanced law. Data were obtained for 1247 child passengers transported by 1191 drivers; 333 of the children were 0 to 3 years of age, and 914 were 4 to 8 years of age (the primary age group targeted by the enhanced law). Significant improvement in appropriate booster seat use was seen for 4- to 8-year-old passengers after implementation (39%), compared with use before implementation (29%). There was no improvement in the rate of appropriate restraint use for younger children (<4 years of age) after implementation. Black passengers 4 to 8 years of age were twice as likely as white child passengers to be unrestrained, before and after implementation. Seventy-nine percent of drivers reported awareness of the new restraint law after implementation; the majority of drivers obtained information from television advertisements. Improvements in booster seat use were seen after adoption of an enhanced state law requiring use; however, racial differences in restraint use persisted among 4- to 8-year-old passengers. Additional study of barriers to booster seat use among drivers of black child passengers and unrestrained children is warranted.

A DESCRIPTIVE ANALYSIS OF MOTOR VEHICLE CRASHES AT AN URBAN CHILDRENʼS HOSPITAL FOLLOWING AN EDUCATIONAL INTERVENTION ON CHILD RESTRAINT.

Purpose Motor vehicle crashes (MVCs) are the leading cause of morbidity and mortality in children. Studies have shown that use of proper safety restraints can improve the rate of death and injuries. Since 1998, Alabama has made significant improvements in MV legislation, educational services, and established car seat-fitting programs. Consequently, significant increases in car seat use have occurred. This study analyzes MVC trauma patient visits at a local pediatric trauma center from 1998 through 2005. The primary study question is do recent improvements in MV safety in Alabama lead to discernible changes in pediatric MVC visits at a hospital trauma center? Methods A trauma database is maintained by the trauma service coordinator at the Children9s Hospital of Alabama. All patients who are activated as trauma patients are entered into the database. MVC data include basic demographic information, type of trauma, if restraints were used, and, if so, what kind. Injury severity scores and disposition information were also noted. After institutional review board approval, the database was accessed for MVA trauma code information. Data were analyzed using Epi Info®. Results Since 1998, the total number of trauma codes has averaged 446 per year. The proportion of MVC codes has decreased from 52.6% of total codes in 1998 to 46.4% in 2005 (z = 1.78, p = 08). The average age of the MVC patient in 1998 was 8.2 years compared with 9.0 years in 2005. The percentage of MVC trauma patients discharged from the hospital has not changed (95.3% in 1998 compared with 95.9% in 2005). The number of MVC trauma patients using some form of restraint increased from 37.6% in 1998 to 51.3% in 2005 (z = 4.05, p Conclusions Statewide MV laws, educational interventions, and car seat-fitting services working in tandem can lead to significant increases in car seat use with corresponding decreases in MVC injury. This research demonstrates that such decreases can be detected at local levels using trauma code patient data sets. These data sets are a useful surveillance method that can help evaluate the effectiveness of statewide interventions.

Validation of pre-crash systems with vehicle hardware-in-the-loop experiments

Pre-Crash Systems (PCSs) use an environment sensor to improve the effectiveness of reversible passive safety restraints by activating them before a collision occurs. Obviously, a PCS should meet very high safety and reliability requirements. A PCS must therefore be thoroughly tested for a wide range of (near-)collision scenarios. This paper presents a new method for the validation of a PCS using Vehicle Hardware-In-the-Loop (VEHIL) experiments. The VEHIL laboratory enables collision-free testing of a PCS-equipped vehicle in a Hardware-In-the-Loop (HIL) environment, where only the relative motion between host and target vehicle is reproduced. With accurate and repeatable VEHIL experiments the validation of a PCS is carried out safer, cheaper and more efficient. The added value of VEHIL is demonstrated with a prototype PCS. This system uses a radar system to detect a pre-crash situation and a reversible belt retractor to bring the occupant in an optimal position for the crash.

A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study

To compare the demographic, clinical, and psychiatric characteristics of residents living in small (< or = 15 beds) and large assisted living (AL) facilities in the United States. One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL. Aspects of care delivery were also compared. Small facilities had a higher prevalence of dementia (81%) compared to larger facilities (63%) and the mean Mini-Mental State Examination (MMSE) across all residents in small facilities (mean 13.04) was than in large facilities (mean 19.93)(p = 0.000). Almost all (98%) of the residents of small homes carried a diagnosis of a dementia or other psychiatric diagnosis, compared to 74% of residents in large facilities (p < 0.001). Psychosis in particular was more prevalent in the smaller homes and the mean Neuropsychiatric Inventory score, a measure of neuropsychiatric symptoms, was higher compared to large homes. Falls were more common in larger homes despite a greater number of personal care hours per week. The use of safety devices and restraints was significantly less common in large facilities compared to smaller homes, where 'geri-chair' and bedrails were more often used. Rates of dementia and psychiatric disorder differ in assisted living facilities depending on size of facility.

181: Emergency Department Screening for Improper Child Safety Restraint Use—Parent Confidence Versus Practice

We hypothesized that a survey designed to measure the confidence of parents regarding appropriate safety restraint use would help to identify children improperly restrained in automobiles.

Odds of Critical Injuries in Unrestrained Pediatric Victims of Motor Vehicle Collision

To compare morbidity and mortality between pediatric victims of motor vehicle collisions (MVC) who were unrestrained to those restrained and to describe compliance with child restraint usage in our population. A retrospective consecutive chart review study was performed on MVC victims 14 years old and younger who presented to our academic, level 1 trauma emergency department in 2003. Each patient's emergency department and hospital course was reviewed and data were collected. Odds ratios (ORs) were calculated for unrestrained children with respect to restrained children for fractures; intraabdominal injuries, intrathoracic injuries, intracranial injuries, admission, surgery, blood transfusion, intubation; and deaths. Hospital charges and length of hospital stay were compared between those unrestrained and restrained. Percentage of children unrestrained was determined. Of 336 patients, 81 (24%) were unrestrained. Mean hospital stay for unrestrained children was longer, 1.94 days (95% confidence interval [CI] 0.75-3.12) versus 0.098 days (95% CI 0.02-0.21). Unrestrained victims had higher mean charges, 14,754 dollars (95% CI 7676 dollars-21,831 dollars) versus 1996 dollars (95% CI 1207 dollars-2786 dollars). Admissions (OR = 14.48, 95% CI 5.91-38.63), fractures (OR = 5.85, 95% CI 2.13-16.89), intraabdominal injuries (OR = 20.16, 95% CI 2.36-930.68), and intrathoracic injuries (OR = 13.09, 95% CI 1.26-647.05) were all more likely in unrestrained patients. No restrained child had intracranial injury, whereas 9/81 (11.11%) of unrestrained did. Odds were higher in unrestrained for surgery [OR = 13.09, 95% CI 3.30-74.33] and transfusion [OR = 27.61, 95% CI 3.56-229.85]. Ten out of 81 (12.35%) of unrestrained children required intubation versus none for restrained. The only 2 mortalities were unrestrained patients. Critical injuries and cost of care are higher in unrestrained than restrained children. Improved compliance with child safety restraint in southern Arizona should decrease childhood morbidity and mortality from MVCs.

Seatbelt use amongst taxi drivers in Beijing, China

Associated with explosive growth in motorization, China has the world's highest road toll with more than 100 000 deaths and 400 000 injuries annually. In response, the Chinese Government introduced the first road traffic safety law in 2003, which included mandatory use of seatbelts by drivers and front seat passengers. Noting frequent non-compliance to this seatbelt regulation by Beijing taxi drivers, the authors studied seatbelt use patterns as onboard observers in a convenience sample of 235 taxi trips. Findings indicated a low seatbelt-wearing rate among taxi drivers of 7.7%, an overt non-wearing rate of 57%, covert non-wearing of 35.3% and total non-compliance of 92.3%. As in high-income countries, adoption of proven safety strategies, including wearing safety restraints, could contribute to reducing the Chinese road toll, particularly as vehicle occupant numbers and the availability of restraints increases. Further investigation of reasons for non-compliance and pretence of wearing seatbelts is required to inform future seatbelt-wearing promotions, including attitudinal studies of taxi drivers. Seatbelt wearing rates should continue to be monitored.

Tilt Determination in MEMS Inertial Vestibular Prosthesis

There is a clear need for a prosthesis that improves postural stability in the balance impaired. Such a device would be used as a temporary aid during recovery from ablative inner-ear surgery, a postural monitor during rehabilitation (for example, hip surgery), and as a permanent prosthesis for those elderly prone to falls. Recently developed, small instruments have enabled wearable prostheses to augment or replace vestibular functions. The current prosthesis communicates by vibrators mounted on the subject's trunk. In this paper we emphasize the unique algorithms that enable tilt indication with modestly performing micromachined gyroscopes and accelerometers. For large angles and multiple axes, gyro drift and unwanted lateral accelerations are successfully rejected. In single-axis tests, the most dramatic results were obtained in standard operating tests where balance-impaired subjects were deprived of vision and proprioceptive inputs. Balance-impaired subjects who fell (into safety restraints) when not aided were able to stand with the prosthesis. Initial multiaxis tests with healthy subjects have shown that sway is reduced in both forward-back and sideward directions. Positive results in initial testing and a sound theoretical basis for the hardware warrant continued development and testing, which is being conducted at three sites.