Seat Belt Use Research Articles

The Effects of a Stepped-Care Mental Health Program on Trauma Recidivism at a Level 1 Trauma Center

OBJECTIVES: This study aimed to analyze the effects of a stepped-care mental health program (TRRP) on trauma recidivism at a single institution. METHODS: Designs: Retrospective review. Setting: single Level 1 trauma center. Patient Selection Criteria: Trauma activation patients presenting at a single Level 1 trauma center between 2017-2021 were selected. Data on demographics, mechanism of injury, readmissions, and TRRP participation were recorded. Outcome Measures and Comparisons: Main outcomes included recidivism rates, risk factors for re-presentation, and determining if a change in readmission risk existed after participation in TRRP. RESULTS: 4,484 patients were included, with a mean age of 44.8 years. 65.9% were males and 34.1% were female. 14.2% (637/4,484) patients presented to the same institution having experienced an unrelated traumatic incident after their index injury. 75.6% patients identified by TRRP participated in at least one TRRP service. Patients who did not participate in TRRP were statistically significantly more likely to be recidivists (15.6%) compared to those who did (10.9%, p<0.001). Multivariable binary logistic regression analysis demonstrated statistically significant associations between increased trauma recidivism and being unmarried, Black/African American race, no use of seatbelts, alcohol intoxication at index injury, history of depression, alcohol use disorder, smoking, and government insurance (p≤0.024). The multivariable regression model predicted a decrease in trauma recidivism by 33% in privately insured patients (p=0.002), by 33% after participation in TRRP (p<0.001), and by 18% after participation in each additional step of the TRRP program (p<0.001). CONCLUSIONS: Results demonstrate reduced rates of trauma recidivism with involvement of the Trauma Resilience and Recovery Program. While programs focused solely on psychosocial interventions may be sufficient to reduce the risk of subsequent traumatic events, further development of trauma rehabilitation programs should address both the psychosocial consequences of traumatic injuries as well as re-injury and readmission prevention. LEVEL OF EVIDENCE: III

Behaviour of motorcyclists and bicyclists before and after a road safety campaign, China.

To examine changes in red-light running and distracted riding among motorcyclists and cyclists before and after the 2020 implementation of the One Helmet, One Seatbelt campaign in China. We obtained 192 hours of film before (2019) and after (2021) implementation of the campaign in eight road intersections in Changsha. We calculated percentages and ratios of red-light running and distracted riding. To assess the associations between these traffic behaviours and the campaign, we used multivariable logistic regression models to calculate adjusted odds ratios (aOR). We filmed 5256 motorcyclists and cyclists in 2019 and 6269 in 2021. Red-light running decreased from 45.1% to 41.5% during this period (ratio: 0.92; 95% confidence interval, CI: 0.88-0.96), while distracted riding increased from 3.5% to 5.0% (ratio: 1.42; 95% CI: 1.19-1.69). After adjusting for covariates, male riders were more likely to run a red light compared to female riders (aOR: 1.28; 95% CI: 1.06-1.55). Red-light running was also more likely among electric bicycle riders (aOR: 1.46; 95% CI: 1.10-1.95) and motorcyclists (aOR: 1.47; 95% CI: 1.13-1.90) compared to traditional cyclists. All types of riders were less prone to run a red light during peak hours than off-peak hours (aOR: 0.85; 95% CI: 0.73-0.99). Distracted riding was more common on weekends compared to weekdays (aOR: 3.01; 95% CI: 2.02-4.49). China's national road safety campaign, which focuses on helmet and seatbelt use, was associated with reduced red-light running. Strict enforcement and targeted modifications could improve the campaign's effectiveness.

Predicting risky driving behaviours using the theory of planned behaviour: A meta-analysis

The current meta-analysis explored the efficacy of the theory of planned behaviour (TPB) in predicting high-risk driving behaviours. Specifically, we examined speeding (in relation to exceeding the limit as well as speed compliance), driving under the influence, distracted driving, and seat belt use. We searched four electronic databases (i.e., PubMed, Web of Science, Scopus, and ProQuest) and included original studies that quantitatively measured the relationships between the TPB variables (attitude, subjective norm, perceived behavioural control [PBC], intention, and prospective/objective behaviour). The study identified 80 records with 94 independent samples. Studies were assessed for risk of bias using the JBI checklist for cross-sectional studies and compliance with the TPB guidelines. Together, attitude, subjective norm and PBC explained between 30 % and 51 % of variance found in intention, with attitude showing as the strongest predictor for intention across the different driving behaviours. The findings also showed that the model explained 36 %–48 % variance found in predicting the observed and/or prospective behaviours for distracted driving, speed compliance and speeding. Understanding the varying strengths and thus relative importance of TPB constructs in predicting different risky driving behaviours is crucial for developing targeted road safety interventions.

Head and Neck Airbag Penetrating Injuries.

Airbags have significantly decreased fatalities in frontal vehicle accidents, but their deployment can lead to more severe injuries and rarely death. The authors present a case of a penetrating injury causing tissue loss in the left cheek, an "explosion" of the zygomatic arch, and facial nerve damage, discussing the management in the contest of literature examining similar injuries in the head and neck region. Reviewing English literature from 1995 to 2023, 9 patients experienced severe airbag-related penetrating head and neck injuries, in 3 cases resulting in death. In addition, we describe the case of a young male reporting a deep cheek laceration with facial nerve damage, tissue loss, and comminuted maxilla-zygomatic fracture; 48 hours after trauma, he underwent surgical reconstruction using a bilobed flap, direct suture of the resected masseter muscle, closed reduction of the comminuted zygomatic arch fracture, and direct neurorrhaphy of the lacerated facial nerve. Five months after surgery, facial nerve function recovery was observed. Mouth opening was restored, but a mixed low-medium hearing loss persisted for high frequencies. In another case marginal nerve damage was reported, but management is not described. The use of seat belts and airbags has led to a significant reduction in the incidence of facial fractures and fatalities after motor vehicle accidents, but at the same time, in some cases, complex facial trauma and/or penetrating injury can be observed. In case of suspected or certain facial nerve damage, it is mandatory to perform exploration and eventual reconstruction within 72 hours.

Seat Belt Use and Perceptions Among Inter-Urban Commercial Vehicle Drivers in Ilorin, Nigeria

Seat Belt Use and Perceptions Among Inter-Urban Commercial Vehicle Drivers in Ilorin, Nigeria

Implementation of stroke care & road safety in India: Lessons from Australia.

India is home to one-fifth of the world's population and is currently the fastest-growing economy. As the health industry is growing, India needs to develop robust implementation of evidence-based health care addressing the major public health issues. Two of such issues India is grappling with are the establishment of stroke care and the reduction of road accidents. Australia has achieved notable success in implementing stroke care and reducing road accidents. In stroke, Australian initiatives include dedicated stroke units, the development of clinical guidelines, the implementation of acute interventions, the establishment of a national stroke foundation, and the stroke registry. As a result, the combined, primary, and secondary prevention measures, acute treatment, and rehabilitation have reduced the total disease burden of stroke from 2003 to 2023 by 53 per cent, from 7.4 to 3.5 Disability Adjusted Life Years (DALYS) per 1,000 population, which is a 56 per cent decline in fatal burden and 23 per cent decline in non-fatal burden. For road safety, Australia implemented evidence-based practices such as education, legislation including mandatory use of seat belts, and other road safety initiatives. Data show that seat belt use reached 98 per cent in Australia in 2023. Furthermore, about 20 per cent of drivers as well as passengers who were killed in crashes in 2024 did not wear seat belts. The reduction of speed limits in built-up areas, the adoption of monitoring technology, and the clever use of infrastructure are proving to be effective in reducing fatalities and serious injuries. Australia's implementation research can provide valuable insights into the efforts of mitigating the impact of stroke and enhancing road safety in India.

Cervical vertebral and spinal cord injuries in rollover occupants

BackgroundRollover crashes continue to be a substantial public health issue in North America. Previous research has shown that the cervical spine is the most injured spine segment in rollovers, but much of the past research has focused on risk factors rather than the actual cervical spine injuries. We sought to examine how different types of cervical spine injuries (vertebral and/or cord injury) vary with different occupant-related factors in rollovers and to compare these with non-rollovers.MethodsWe obtained crash and injury information from the National Automotive Sampling System–Crashworthiness Data System (NASS-CDS) for 2005–2015 and Crash Investigation Sampling System (CISS) for 2017–2022. Based on weighted data, we calculated relative risks to assess how occupant sex, seat belt use, ejection status, and fatal outcome relate to the rate of different cervical spine injuries in rollovers and non-rollovers.ResultsIn NASS-CDS occupants with cervical spine injuries (N = 111,040 weighted cases), about 91.5% experienced at least one vertebral injury whereas only 11.3% experienced a spinal cord injury (most of which had a concomitant vertebral fracture). All types of cervical spine injuries we examined were 3.4–5.2 times more likely to occur in rollovers compared to non-rollovers. These relative risks were similar for both sexes, belted and unbelted, non-ejected, and non-fatal occupants. The number of weighted CISS occupants with cervical spine injuries (N = 42,003) was smaller than in the NASS analysis, but cervical spine injuries remained 6.25 to 6.36 times more likely in rollovers compared to non-rollovers despite a more modern vehicle fleet.ConclusionsThese findings underscore the continued need for rollover-specific safety countermeasures, especially those focused on cervical spine injury prevention, and elucidate the frequency, severity and other characteristics of the specific vertebral and spinal cord injuries being sustained in rollovers. Our findings suggest that countermeasures focused on preventing cervical vertebral fractures will also effectively prevent most cervical spinal cord injuries.

Motor vehicle collision characteristics and hospitalization outcomes associated with mild traumatic brain injury and concomitant whiplash injury.

Few large studies have investigated the factors and outcomes related to concomitant injuries occurring alongside mild traumatic brain injury (mTBI) after motor vehicle collisions (MVCs). Thus, the objective of this study was to assess whether MVC characteristics predict which patients with mTBI will have concomitant whiplash injury, and whether concomitant whiplash injury affects care utilization for these patients. This retrospective cohort study included 22,213 patients with mTBI after MVC identified from the American College of Surgeons Trauma Quality Programs dataset. A hierarchical logistic regression model was constructed to investigate patient and MVC factors associated with concomitant whiplash injury. Propensity score matching on whiplash status, in conjunction with a multivariable logistic regression model, assessed if concomitant whiplash affected odds of hospitalization. In the subgroup of patients who were hospitalized, associations with hospital length of stay (LOS) and discharge disposition were investigated. The median (IQR) age was 34 (24-51) years, with a median Glasgow Coma Scale score at presentation of 15 (15-15). Patients with concomitant whiplash were older (median 36 years vs 34 years, p = 0.03) and had higher rates of hospitalization (75% vs 64%, p < 0.001). In the hierarchical model for associations with concomitant whiplash injury, patients with blood alcohol content (BAC) greater than the federal driving limit had lower odds of concomitant whiplash (OR 0.63, 95% CI 0.49-0.81) along with those who had airbag deployment (OR 0.80, 95% CI 0.68-0.95), but seatbelt use was associated with greater odds (OR 1.41, 95% CI 1.16-1.71). After matching, concomitant whiplash was independently associated with increased odds of hospitalization (OR 1.67, 95% CI 1.40-1.99) while seatbelt use was associated with decreased odds (OR 0.88, 95% CI 0.81-0.95). Among hospitalized patients, concomitant whiplash was not associated with hospital LOS or discharge disposition. MVC characteristics such as alcohol consumption and airbag deployment were protective toward development of concomitant whiplash for mTBI patients, while seatbelt use was associated with higher risk. Concomitant whiplash increases the odds of hospitalization for mTBI patients but does not affect hospital LOS or discharge disposition, while seatbelt use is associated with lower rates of hospitalization and a more favorable hospital course. These findings provide context to injury patterns and care provision after a common mechanism of injury.

A positive psychology framework for understanding teenage driving behaviors: Examining the role of life purpose and mindfulness

Objective The overwhelming majority of teenage driving research in the US is framed around characteristics associated with risk, rather than factors that promote safety. In this study, we examine the role of purpose in life and mindfulness as two factors that may be associated with safer driving behaviors. Methods Using survey responses from a nationally representative sample of teenagers (aged 16–19) we used structural equation modeling to construct three latent variables – sense of purpose, mindfulness, and risky driving—and evaluate the associations between these latent variables among teenage drivers. Risky driving was based on measures of self-reported distracted driving, drunk driving, driving under the influence of marijuana and other drugs, inconsistent seatbelt use, and riding with an impaired driver. Results We found that sense of purpose and mindfulness were associated with fewer risky driving behaviors. We also identified mindfulness as a mediator between sense of purpose and risky driving. Conclusions Purpose in life and mindfulness are associated with fewer risky driving behaviors among US teenagers. Driver education and training could include components related to purpose and mindfulness, in order to promote safer driving behaviors in this population.

Safety climate and seat belt use in the fire service

Objective Motor vehicle incidents or apparatus crashes are a leading cause of firefighter fatalities in the United States. Nonuse of seat belts has been linked to some of these fatalities. This research seeks to understand the relationship between safety climate and seat belt use among firefighters, as findings will provide insights into factors that may bolster seat belt use and protect firefighters. Methods Data were collected from 208 career firefighters working for a city fire department in the southeastern United States. Structural equation modeling was used to test a hypothesized model and to assess the relationships between organizational safety climate, work group safety climate and seat belt use. Results It was determined that positive perceptions of workgroup safety climate, as a higher order factor, comprised of supervisor support, horizontal cohesion, and vertical cohesion, was positively associated with seat belt use within a sample of firefighters. Organizational level safety climate did not have a significant relationship with seat belt use but did positively influence workgroup safety climate perceptions. Conclusions Safety climate has been associated with safety compliance and participation behaviors, but more research was needed to specifically examine the impact of safety climate on seat belt use in firefighters. The findings point to the importance of safety climate as a leading indicator and predictor of seat belt use. Bolstering safety climate through safety programs, commitment to safety, effective communication, supportive supervisors and cohesion should ultimately aid in bolstering seat belt use among firefighters, which is important to curtailing firefighter injuries and fatalities.

Convolutional Neural Network and LSTM for Seat Belt Detection in Vehicles using YOLO3

The application of an electronic violation detection system has begun to be implemented in many countries using CCTV cameras installed at highway and toll road points. However, the development of a violation detection system using data in the form of images that have a high level of accuracy is still a challenge for researchers. Several types of violations detected include the use of seat belts, the use of cell phones while driving, which is influenced by the number of vehicles, vehicle speed and lighting, which can increase the difficulty in the detection process. This research developed a traffic violation detection system using a hybrid model, namely the CNN and LSTM algorithms for the application of discipline using seat belts. The dataset was obtained from RoboFlow Universe with a total of 199 front view car images consists of 82 using seatbelts and 78 not using seatbelts for the training process. The CNN algorithm plays a role in the feature extraction process from input image data, while the LSTM algorithm plays a role in the prediction process. Additionally, the performance evaluation of the CNN+LSTM algorithm will be measured using the accuracy value to measure the performance of the training process and testing process. When measuring the performance of the training process, it will be compared with several basic detection models used, such as CNN, VGG16, ResNet50, MobileNetV2, Yolo3, Yolo3+LSTM. The test results show that Yolo3+LSTM has a higher accuracy compared to the others, at 89%. Next, in the testing process, the CNN+LSTM model will be compared with the basic method, namely CNN. The test results show that the CNN+LSTM models have a higher accuracy of 89%. Meanwhile, in the basic CNN model, the resulting accuracy was 85%.

Evaluation of Adolescents' Awareness of Seat Belt Use and the Relationship with Risky Behaviors.

The one of the leading causes of adolescent morbidity and mortality worldwide is motor vehicle accidents (MVA). The use of seat belts significantly lowers MVA fatalities and injuries. The aim of this study is to investigate adolescent seat belt usage patterns and relation with risky behaviors. The study conducted at two medical institutions with non-immigrant and literate adolescents aged 12-18. Demographics, seat belt use, and risk-taking behavior were collected through questionnaires. 726 teenagers (422 girls and 304 boys) with an average age of 176.7 ± 23.37 months participated in the study. Parents' educational levels and front-seat belt use have been found to be correlated. Comparatively to non-users, seat belt users demonstrated lower risk scores (total, traffic, substance, and social). The use of seat belts was significantly predicted by traffic risk, according to logistic regression. The frequency of seatbelt use was higher among participants from cities with higher socioeconomic status. As a result, it was found that adolescents who exhibited more risky behaviors had a lower frequency of seat belt use and seat belt use was associated with socioeconomic level and parental education level. It is thought that population-based studies to be conducted on this subject are important.

Risk and Protective Factors for Injury in Adult Front- and Rear-Seated Motor Vehicle Occupants in New York State.

Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study examines risk and protective factors associated with injury severity in front- and rear-seated adults involved in a motor vehicle crash in New York State. The Crash Outcome Data Evaluation System (CODES) (2016-2017) was used to examine injury severity in front- and rear-seated occupants aged 18 years or older (N = 958,704) involved in a motor vehicle crash. CODES uses probabilistic linkage of New York State hospitalization, emergency department, and police and motorist crash reports. Multivariable logistic regression models with MI analyze employed SAS 9.4. Odds ratios are reported as OR with 95% CI. The mortality rate was approximately 1.5 times higher for rear-seated than front-seated occupants (136.60 vs. 92.45 per 100,000), with rear-seated occupants more frequently unrestrained than front-seated occupants (15.28% vs. 1.70%, p < 0.0001). In adjusted analyses that did not include restraint status, serious injury/death was higher in rear-seated compared to front-seated occupants (OR:1.272, 1.146-1.412), but lower once restraint use was added (OR: 0.851, 0.771-0.939). Unrestrained rear-seated occupants exhibited higher serious injury/death than restrained front-seated occupants. Unrestrained teens aged 18-19 years old exhibit mortality per 100,000 occupants that is more similar to that of the oldest two age groups than to other young and middle-aged adults. Speeding, a drinking driver, and older vehicles were among the independent predictors of serious injury/death. Unrestrained rear-seated adult occupants exhibit higher severe injury/death than restrained front-seated occupants. When restrained, rear-seated occupants are less likely to be seriously injured than restrained front-seated occupants.

Identifying Traveler Groups Lacking in Seatbelt Usage and Suggesting Policy Measures

This study was aimed to identify the traveler groups who are exposed to potential of severe injury due to lack of seatbelt use. Moreover, policy measures have been suggested to enhance seatbelt use among such groups. A hybrid data collection approach was adopted to gather traveler information. Seatbelt usage questionnaire was used as the survey instrument. The survey was carried out in the parking lots of educational and commercial facilities around Bahrain. Statistical tests, namely, t-tests and Analysis of Variance (ANOVA), were used to compare the attributes of travelers. Literature review was used to verify the findings of this study and identify common traveler groups which are lacking in seatbelt use. The recommendations are also provided on policy measures which could be adopted globally to promote seatbelt use. It was found that occupation, education, gender, nationality and accident occurrence have significant impact on seatbelt wearing. It was also found that accident experience and seatbelt wearing, both are dependent on travelers’ social and cultural background rather than each other. The findings of this study matched previous literature. Groups lacking in seatbelt use included male passengers belonging to lower- and middle-income groups which fits the description of expatriate workers in Bahrain. Some policy measures, appropriate to these groups, have also been suggested.

Prediction of rear-seat belt use: Application of extended theory of planned behavior

Objectives Rear-seat belts have been shown to significantly reduce the severity of road vehicle collisions and fatalities. However, their use by rear-seat passengers is significantly less than that by front-seat passengers. Thus, the psychological factors underlying individuals’ decision to wear a seat belt in the rear seat require further investigation. Methods An extended theory of planned behavior (eTPB) was used to examine individuals’ behavior of wearing a rear-seat belt. An online survey was conducted and a total of 515 valid questionnaires were collected in China. Results While attitude, descriptive norms, and law enforcement all have a significant effect on individuals’ intention to wear a seat belt in the rear, subjective norms and perceived behavioral control do not. Individuals’ attitudes toward wearing a seat belt in the rear seat are significantly influenced by law enforcement and behavioral intention, but not by perceived behavioral control. The mediation effect analysis reveals that law enforcement has the greatest overall effect on behavior, followed by attitude and descriptive norms. Conclusions The results of this paper contribute to more effective recommendations to improve the use of rear seat belts and to safeguard rear seat passengers.

IJCM_246A: Estimating the prevalence of seat belt usage in motor cars: A descriptive cross-sectional study in Mangalore

Background: Every year 1.25 million people die of road traffic accidents. Several safety measures can be taken to prevent RTAs. The SDG 2030 set the target to halve the number of global death and injuries from road traffic accidents by the year 2020. The aim of this study is to estimate the prevalence of seat belt use and factors influencing it including driver characteristics, type of car and time of day and distractions while driving. Methodology: This Descriptive cross-sectional study was set on the major roads and intersections of Mangalore, recruiting the drivers and front-seat passengers in the motor cars at the time and site of observation. Results: A total of 6165 motor cars were observed. 15 (0.2%) of these cars had completely tinted car windows, therefore out of the total, 6150 motor cars could be properly observed. 70.91% (4361) of drivers were wearing seat belts. Seat belt usage among drivers was found to be higher on highways (76.6%) as compared to on residential and city roads (69.3%). In vicinity of traffic police, 76.5% of drivers were observed to be wearing seat belts in contrary only 67.8% of them were wearing seatbelts in the absence of traffic police. Prevalence of mobile phone use and other distractions amongst drivers was 2.1%. Out of 2646 adult front seat passengers observed, only 10.9% were wearing seat belts. Conclusion: Among drivers, type of motor car, traffic zone and type of road and presence of traffic police in vicinity are significantly associated factors with seatbelt usage. Among adult front seat passengers, type of motor car, traffic zone, type of road and presence of traffic police in vicinity are significantly associated. Among front seat child passengers, type of road and traffic zone are significantly associated with seat belt usage.

Identifying community safety and policy-based injury prevention opportunities to reduce golf cart injuries.

In small US communities, golf cart utilization has become increasingly more common. In the past 3 years, the incidence and severity of pediatric golf cart-related trauma evaluated at our trauma center have noticeably increased. Thus, the aim of this study was to analyze trends, identify risk and protective factors, and provide community-level recommendations to improve golf cart safety for children in a coastal community. A retrospective cross-sectional study of our institutional trauma registry was performed. The registry was queried for golf cart injuries between 2012 and 2022. Demographics, accident details, hospital course, and outcomes were reviewed. Data analysis involved quantitative statistics. Incident locations were mapped, including additional data from the County emergency medical service. In addition, customer education at four prominent golf rental shops was observed. Annual golf cart-related traumas doubled starting in 2020. Of 235 total patients, 105 (46%) were children. Median age was 11.5 years (range, 2-17 years). Fifty-five percent were female, and 67% were non-Hispanic White. Eighty percent were out-of-county residents. The most common injury location was extremity (56%). The median Injury Severity Score was 4, and 3% died. Only 10% of children were restrained. Forty-one percent were ejected, and most (84%) were front-facing passengers. Ejection was associated with more severe injury (odds ratio, 4.13; p = 0.01). Most injuries occurred during 5 to 10 pm (47%), weekends, and summertime. Nighttime injuries were more severe than daytime ( p = 0.04). A hotspot of crashes was identified in a zone where golf carts were restricted. Rental stores provided education on seat belt use, car seat use for infants, and off-limit zones. However, rules were not enforced. Our results inform the following golf cart injury prevention opportunities: raising awareness of injury risks to children in high-tourist areas, partnering with rental stores to enforce rules, improving signage, adding protected lanes, and adopting a no nighttime operation policy. Prognostic and Epidemiological; Level IV.

Road traffic accidents, sanctions and delays in judgments in Court proceedings in Prizren - Republic of Kosovo

Abstract Traffic accidents are unexpected and unpleasant cases on the road, which often have consequences of damage to cars, people’s injuries and in more severe cases lead to death. These events occur for various reasons and can be the result of factors such as high speed, disregard for traffic signals, alcohol, unused safety belt, technical vehicle problems, bad weather conditions and dangerous drivers’ behavior. The consequences of traffic accidents can be very serious, including serious physical injuries, material damage to the vehicle, and in some cases loss of life. Some of the preventive measures to reduce the risk of traffic accidents include the respect for traffic rules, use of seat belts, non-consumption of alcohol at the time of driving, car maintenance, education and information. Road safety is a common challenge that requires cooperation and dedication from drivers, road authorities and the community in general. This challenge is faced by law enforcement institutions to perform the tasks and obligations deriving from the legislation in terms of discouraging legal violations by traffic participants. Therefore, this paper is intended for the discovery and interpretation of any stagnation or negligence that can lead to the encouragement of traffic participants to neglect traffic rules and laws. The analysis of this manuscript is accompanied with statistics, tables and graphs from 116 cases from a population of about 150,000 inhabitants.

Ambulance Traffic Crashes in Japan: Characteristics of Casualties and Efforts to Improve Ambulance Safety

Background An ambulance traffic crash not only leads to injuries among emergency medical service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, seatbelt use for casualties (ie, both fatal and nonfatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan. Methods We conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes. Results Among the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n = 3/29, 10.3%) and patients/companions (n = 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero −2.20, 95% CI: −3.6 to −0.8). Conclusion Two-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.

Prediction of Rear-Seat-Belt Use among Older Adults

The efficacy of rear seat belts in safeguarding both rear- and front-seat passengers is well established; however, the use of rear seat belts in China remains suboptimal. Furthermore, automotive transportation holds significant importance for seniors in China. Consequently, it is necessary to analyze the factors affecting intention to use rear seat belts among Chinese seniors. This study applies the hierarchical regression model to investigate the effects of sociodemographic characteristics and constructs on older adults’ backseat seat-belt use intentions. A questionnaire survey was conducted in Pingdingshan City and 551 valid questionnaires were obtained. Results show that sociodemographic characteristics exhibit a limited influence on the intention to use rear seat belts, accounting for only 16.7% of the variance in intention. However, the incorporation of additional constructs can substantially augment the model’s explanatory capacity. After incorporating the exogenous constructs of the theory of planned behavior, the model’s explanatory power for behavioral intention increased to 46.9%. Subsequently, on the inclusion of susceptibility, severity, perceived benefit, and perceived law enforcement as additional factors, the model’s capacity to account for variance in behavioral intention further improved to 62.7%. Attitude, subjective norm, perceived behavioral control, susceptibility, severity, and law enforcement have significant impact on behavioral intention.