Urban Accidents Research Articles

An easy method to reduce anterior shoulder dislocation: the Spaso technique

Objective—To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. Design—Retrospective case series. Setting—Urban accident...

Improving detection of alcohol misuse in patients presenting to an accident and emergency department

Objectives—To assess and improve deployment of a brief test for alcohol misuse: the Paddington Alcohol Test (PAT). Design—Prospective study of the effects of audit feedback. Setting—An urban accident and emergency...

Evolución de la mortalidad por accidentes de tráfico en España, 1962–1994

To assess the evolution of the traffic accident mortality rate in Spain from 1962 to 1994, and the role played by its four theoretical components: motorization index (vehicles/population), accidentability index (accidents/vehicles), harmfulness index (victims/accidents) and fatality index (deaths/victims). Data from the National Population Census and the Bulletin of the Dirección General de Tráfico were collected to estimate the above mentioned indicators for all accidents and accidents in road and urban zones. Simple and multiple partial correlation coefficients among variables were calculated. Poisson regression models were also obtained. An increasing trend during the whole period was observed for the national traffic accident mortality rate, especially from 1982 to 1989 in the younger age groups, followed by a decrease since 1990. The aforementioned four components were significatively associated with the mortality rate. The strength of this association was especially high for the motorization index and for the harmfulness index when all accidents and road accidents were considered. For urban accidents, the fatality index rate is the component most strongly associated with mortality rate. The role played by the accidentability index in the magnitude of the mortality rate seems less important. The growing exposure rate to traffic accidents observed in Spain (measured by the motorization index) is not directly influenced by public heath strategies. Therefore, it seems advisable to emphasize the development of measures focused to control the other three components of traffic accident mortality rate, especially those related with harmfulness and fatality.

Characteristics of attenders and their attendances at an urban accident and emergency department over a one year period.

OBJECTIVES: To describe (1) the characteristics of attenders to an urban accident and emergency (A&E) department over a one year period according to the frequency of their attendance and (2)...

An analysis of urban collisions using an artificial intelligence model

Traditional studies on road accidents estimate the effect of variables (such as vehicular flows, road geometry, vehicular characteristics), and the calculation of the number of accidents. A descriptive statistical analysis of the accidents (those used in the model) over the period 1992–1995 is proposed. The paper describes an alternative method based on the use of artificial neural networks (ANN) in order to work out a model that relates to the analysis of vehicular accidents in Milan. The degree of danger of urban intersections using different scenarios is quantified by the ANN model. Methodology is the first result, which allows us to tackle the modelling of urban vehicular accidents by the innovative use of ANN. Other results deal with model outputs: intersection complexity may determine a higher accident index depending on the regulation of intersection. The highest index for running over of pedestrian occurs at non-signalised intersections at night-time.

Injury Severity and Duration of Hospital Stay for Urban Road Accidents in Riyadh

A sample of 1,831 victims of urban road accidents in Riyadh was analyzed. The analysis consisted of two parts. First, the injury severity of 1,006 subjects was measured by the abbreviated injury scale (AIS). More than half the subjects were scaled with severe injuries (AIS ≥ 3). Association analysis between injury severity and accident characteristics (e.g., accident time, type, and location) was performed. Second, duration of stay at the hospital was examined for cases of injury as well as deaths. The probability density functions of the length of these time periods for cases of injury and death were found to be satisfactorily described by the γ distribution and by exponential distribution, respectively.

A profile of sports hand injuries in an accident and emergency department.

OBJECTIVE: To establish a profile of sports hand injuries requiring treatment in an urban accident and emergency (A&E) department, and to determine the extent to which these injuries resulted in...

Waiting time in an urban accident and emergency department--a way to improve it.

OBJECTIVE: To determine how the introduction of a new small team consultation system could reduce the average waiting time of patients in the busy accident and emergency (A&E) department of...

School accidents to children: time to act.

OBJECTIVE: To describe the profile of injuries sustained by children in school accidents and suggest preventive measures. DESIGN: A five month prospective study of children attending an urban accident and...

Satisfaction with the accident and emergency department--a postal survey of general practitioners' views.

To survey general practitioners' opinions of the quality of care offered by an urban accident and emergency (A&E) department. A postal questionnaire was used. The questionnaire addressed issues of patient treatment, communications between hospital and GPs, and the GPs' perceptions of patient satisfaction. Questions required graded responses. Response rate was 57% (91 of 160 GPs mailed). 96% and 91% of responders respectively were satisfied with patient assessment and treatment, and 70% were satisfied with the explanation given to the patient. Problems were highlighted in communications between the department and GPs. 68% reported that adult patients always/usually gave their practice a hand written letter detailing their initial A&E attendance. Concerns were expressed about the content, illegibility, and inconvenience of this form. 42% of GPs reported never/rarely receiving a typed summary of patients discharged from the A&E review clinic. 28% of GPs would have appreciated a telephone call from the department on occasions. The areas of most patient dissatisfaction were perceived by GPs as: waiting time (67%), communication (19%), staff attitude (7%), and actual treatment (7%). A postal survey of local GPs can give valuable information about the quality of care provided by a hospital department. Overall GP satisfaction with the service was high, but there are concerns about aspects of written and telephone communications between the department and GPs, which can be addressed.

Does the Dangerous Dogs Act protect against animal attacks: a prospective study of mammalian bites in the Accident and Emergency department

This comparative prospective study of mammalian bites attending one urban Accident and Emergency department before the implementation of the Dangerous Dogs Act 1991 and again 2 years later, was to see the effect of the Act on the pattern of injury. The study comprised a simple questionnaire detailing the injury, the implicated species, and the treatment or referral if applicable. In both groups studied (before and after implementation of the Act) 134 consecutive bites were recorded, contributing 1.2 per cent and 1.23 per cent of total attendances during these respective periods. Dogs were found to bite most commonly: in the pre-legislation group 73.9 per cent were due to dog bites and in the post-legislation group 73.1 per cent. In both groups studied, human bites occurred as the second most common mammalian bite; 17.9 per cent in the pre-legislation group and 12.7 per cent in the post-legislation group. Human bites were as common as those from the most implicated breed of dog. In general human bites were found to require more active treatment and specialist referral. The study demonstrates the vast majority of such injuries are treated within Emergency departments. This study also shows how dangerous breeds compare with others that bite, demonstrating that these breeds contribute to only a small proportion of these injuries. This comparative study clearly demonstrates little impact on rate of attendances for such injuries since the introduction of the 1991 Act. If legislation aims to reduce and prevent injury from animal bites, in its present form it does little to protect the public; this study suggests a wider control of the dog population may be required.

Deregulation of heavy freight transport in New Zealand and its effects on road safety

In October 1983 the deregulation of the road freight industry in New Zealand began with the removal of a 150 km restriction on road carriage in competition with rail and the replacement of a quantitative road transport licensing system with a qualitative system. The effects of this change on freight movements and road safety are analysed. Although rail instituted measures aimed at increasing efficiency while reducing its freight rates and increasing its responsiveness to customers’ needs, the road freight activity increased after deregulation. The study concludes that after the deregulation the trucks’ share of accidents has increased except in the case of urban fatal accidents where it shows an opposite trend.

Rural and urban accident rates differ

Rural and urban accident rates differ

PATIENT SATISFACTION IN AN URBAN ACCIDENT AND EMERGENCY DEPARTMENT

SUMMARYThe aim of this study was to assess patients' opinions about their experience of attending an urban Accident and Emergency department. They were given a questionnaire designed to demonstrate any shortcomings in the delivery of care which required corrective actions. Just over half (50.8%) the patients responded, 411 (95%) of whom recorded satisfaction with the outcome of their visit (P = 0.0001). There was significant correlation between patient satisfaction and waiting time to see the doctor (P = 0.003), the doctor's explanation about management (P = 0.02), and total time spent in the department (P = 0.01). A total of 120 patients (27.8%) did not receive any explanation from the nurse about what was going to happen, and 267 (61.6%) received no information about possible delay. These factors did not significantly influence patients' satisfaction with the outcome, but they need to be addressed as they will obviously lead to an improved service.

Aspects of Road‐Accident Death Analyses

The time period between an urban road accident and death due to it, is investigated. Age and sex of injured persons were found to have no significant effect on time till death. The analysis distinguishes between a set of data that includes persons killed on site and a data set from which they are excluded. The probability density function (pdf) of the length of these time periods, when expressed in hours, was found to be satisfactorily described by a Weibull distribution for both cases. When these lengths are expressed in days the Gamma distribution gave the best fit. Linear relationships between the cumulative percentage of injured persons dead by time (and log(r) are also established with very high correlation coefficients, but are proposed only for time period lengths less than 30 days. Ways in which the results of this analysis can be used towards unification of road accident death recording in the various countries, so that valid international accident statistics comparisons are possible, are indicated.

Analysis of the frequency and duration of freeway accidents in Seattle

Accidents occurring on congested urban freeways can have enormous impacts in terms of lost commuter time. This paper presents an appropriate statistical analysis of urban freeway accident frequency and duration and discusses how this analysis can be used to guide management strategies that seek to reduce the traffic-related impacts of accidents. The findings and demonstration of analysis procedures should be of considerable value to ongoing and future studies in this area.

Evaluation of a computerised system for medical records in an Accident and Emergency department

This paper deals with the impact of the installation of a computerised record and data handling system in an urban Accident and Emergency department. This system became fully operational on the 14th of August, 1989 and replaced the previous manual method of administration. The new system allows 'real time' handling of patient details and generation of letters to both specialists and general practitioners. Audit of the department workload and data generation for research are improved. The current situation is described as well as potential benefits and constraints of the system.

Experience of medical audit in an urban accident and Emergency (A&E) Department : Maitra, AK, Accident and Emergency Department, Royal Victoria Infirmary, University of Newcastle upon Tyne, UK

Experience of medical audit in an urban accident and Emergency (A&E) Department : Maitra, AK, Accident and Emergency Department, Royal Victoria Infirmary, University of Newcastle upon Tyne, UK

Urban Trees and Roadside Safety

This paper describes a research project performed as part of a clear zone implementation program for Huntsville, Alabama. A literature review and a field investigation program were the two major components of the project. Investigators visited the sites of 164 urban tree accidents to identify their characteristics. Time of day, day of week, accident severity, roadway geometry, pavement surface condition, lateral distance from the pavement to the tree, tree size, and tree density were among the characteristics investigated. Among the major findings were that: there were strong similarities between urban and rural tree collision patterns, but urban accidents were less severe; the outside of horizontal curves was highly over‐represented; and 80% of the collisions were within 20 ft of the pavement edge. Recommendations were provided for city ordinances and operating procedures for future tree plantings. A plan was also devised for retrofitting the clear zone concept to existing trees along city streets.

Traffic safety, usability and streetscape effects of new design principles for major urban roads

An important aspect of area-wide traffic calming concepts is the integration of major urban roads, because 70 to 80 percent of all urban accidents occur on major roads. Traffic calming which is primarily based on the locational shift to such main thoroughfares is socially injust, because — in spite of all disturbances on those streets — about one quarter of the urban population live there. Social justice can only be somewhat achieved if the expenditures for traffic calming and streetscaping are not used — as today is most common — for accumulating the advantages in the low traffic side streets, but aimed at a partial balance and compensation for the strains caused by car traffic on the major streets. Some compensatory measures and new design principles will be discussed. Backgrounds are the experience in six German model cities of area-wide traffic calming, several research projects and the discussion about new guidelines for major urban roads. Where traffic and environmental burdens focus, the concentration concept should be extended by compensatory measures. That is the state of discussion in Germany examplified by nine topics.