© Springer Nature Singapore Pte Ltd. 2017
Xiaobing Fu and Liangming Liu (eds.)Advanced Trauma and Surgery10.1007/978-981-10-2425-2_5Current Developments on Traffic Medicine
(1)
State Key Laboratory of Trauma, Burns and Combined Injury, Institute for Traffic Medicine, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing, People’s Republic of China
Abstract
Traffic medicine is a multidisciplinary and comprehensive subject pertaining to the development of traffic injury and is a subject of science and technology which studies the generation rules, preventions and treatments of traffic injuries. The disciplines contributing to traffic medicine include psychology, sociology, statistics, engineering, biomechanics, law, policing, policy analysis, pharmacology, emergency medicine, surgery, as well as rehabilitation medicine and much more. This chapter mainly shows the development of traffic medicine as below. (1) A good road safety strategy is the primary key for traffic safety . WHO calls countries to have their own road traffic safety strategies to control their traffic injuries and to make safer roads. To achieve safety strategies, countries need continuously to perfect road traffic safety laws and regulations, to provide safer roads and vehicles, to guide road user with safe behavior, and to provide efficient emergence system and medical care standards for the traffic injuries. (2) The study on epidemiology is a very important basis of looking for effective and targeted countermeasures on traffic injury control and prevention. The big data mining is an innovative and effective strategy for traffic safety. The cores of the big data are data integration, data link construct, data mining and service. (3) Traffic injury is the leading cause of death for children under the age of 19 in the world. Many projects which are driven by science studies, involving innovative behavior psychology—social theory and technologies, hierarchical school educations and multi-level implementation have effectively reduced child traffic injuries. (4) More and more studies focus on diseases and sickness, medicines and chemical reagents that may involve in traffic accidents, such as: attention deficit/hyperactivity disorder (ADHD), obstructive sleep apnoea, morbid obesity, dementia, after stroke, hearing impairment, epilepsy, hypoglycemia, posttraumatic stress disorder (PTSD), pregnancy, etc. (5) The performance and distinct biosocial profiles of high-risk drivers (HRDs) were studied by means of some new technologies, such as in vehicle driver monitoring system and medical-psychological assessment (MPA) system, and some positive results have achieved. (6) In recent years, forensic medicine of traffic injury has combined with more factors of clinic medicine, social psychology, vehicles, road and road users. (7) A high-efficiency medical rescue and care system could minimize potentially avoidable the deaths and the disabled caused by traffic injury. An effective medical rescue and care system should include an effective and efficient communication network, transport vehicles, pre-hospital care providers, emergency department, ICU, specialized department, and effective medical care standards. (8) There are more and more new developing traffic safety technologies appearing. In-vehicle information systems (IVIS), vehicular networking, internet of things (IoT), vehicular cloud computing (VCC), intelligent transportation systems(ITS), etc. make driving more safe. Intelligent safety roads will be more forgiving of humans’ errors and could communicate with vehicles initiatively. Examples are presented in this paper.
Keywords
Traffic medicineTraffic injuryTraffic safetyDriving adaptability1 Introduction
Data from World Health Organization (WHO) showed that there were more than 1.25 million people die on the world’s roads in 2013, making road traffic injuries a leading cause of death globally [1]. Road traffic injuries have become a very important public health problem in our world, especially for low and middle-income countries in which road traffic injuries are a very severe development issue.
Traffic medicine is a multidisciplinary and comprehensive subject pertaining to the development of traffic injury . The first paper with insightful contents on car driving was published in the American Journal of Psychology in July 1938 [2]. Since that time an enormous technical literature devoted to traffic crash, traffic injury and traffic safety has emerged, resulting in a solid edifice of detailed knowledge about traffic medicine [3].
Traffic medicine is a subject of science and technology which studies the generation rules, preventions and treatments of traffic injuries. Traffic medicine is a subject that encompasses all those disciplines, techniques, methods, and policies aimed at reducing the harm traffic crashes inflict on human beings. It includes studies about characteristics and classification of traffic injury, epidemiology of traffic crash and injury, psychology and ability of road users, injury mechanism, death causes, emergency medical care and treatment of traffic injury, traffic injury prevention and traffic safety. For the traffic safety, it also includes studying the knowledge and ways to enable those with reduced capabilities due to aging, illness, drug usages, and policies to prohibit from driving which no longer able to drive with adequate safety. The disciplines related to traffic medicine include psychology, sociology, statistics, engineering, biomechanics, law, policing, policy analysis, pharmacology, emergency medicine, surgery, rehabilitation medicine and so on [4].
Some latest developments on traffic medicine will be list as follows in this paper.
2 Road Safety Strategy
Road traffic crash causes more than 1.25 million deaths per year and is a leading cause of death globally, and is the first cause of death among those aged 15–29 years. Road traffic injury is a heavy burden of national economies and households, and also a difficult burden for the sustainable development goals of the world and each countries. Facing the severe fact, it is very important that there must be definite road safety targets and goals for every region, every country and whole globe to effectively reduce and control road traffic injuries.
In September 2015, heads of state attending the United Nations General Assembly adopted the historic Sustainable Development Goals. One of the new Sustainable Development Goals targets is to reduce 50 % of the global road traffic deaths and injuries by 2020. Inclusion of such an ambitious road traffic fatality target is a significant advance for road traffic safety. It is also a significant advance that more and more people have accepted the knowledge based on strong scientific evidence that there is considerable evidence about interventions that are effective at making roads safer. There are many countries that have successfully implemented these interventions have seen corresponding reductions in road traffic deaths.
WHO has been promoting the Decade of Action for Road Safety (2011–2020) that calls on countries to implement the measures identified internationally to make their roads safer. The campaign has promoted countries and international community to do more for the road traffic safety and to galvanize greater and faster actions. Based on empirical and epidemiological researches, WHO calls countries to have their own road traffic safety strategies to control their traffic injuries and to make safer roads. WHO asks each country to focus their strategy more on road safety legislations, safer vehicles and roads.
2.1 Road Safety Legislations
According WHO’s data, there are 17 countries, representing 409 million people, have amended their traffic laws on one or more key risk factors for road traffic injuries in the last 3 years and bring them in line with best practice. It is believed that the most positive changes to road user’s behavior will occur when these road safety legislations were supported by strong and sustained enforcement, and public awareness. Road safety laws could improve road user’s behavior and reduce the amount of road traffic crashes, deaths and injuries, especially laws about speed, drink driving, seat-belts, helmets and child restraints which relate to the five key risk factors of road traffic.
Research showed that the likelihood of traffic crash and severity of traffic injuries are rising when the average traffic speed rise, especially for motorcyclists, cyclists and pedestrians. The death rate of adult pedestrian has less than 20 % when impact speed of car is less than 50 km/h, but the death rate will be 60 % when impact speed is 80 km/h. WHO suggests that maximum urban speed limits should be lower than or equal to 50 km/h, and should has sustained and visible speed limit legislation enforcement.
WHO indicates that drinking driving increases the likelihood of road traffic crash, traffic death and serious injury. Setting and enforcing legislation on blood alcohol concentration (BAC) limits of 0.5 g/L can significantly reduce alcohol-related crashes. For young and novice drivers, the legislation of lower BAC limits is suggested as BACs ≤0.2 g/L. There only are 34 countries, representing 2.1 billion people, have drinking driving laws in line with best practice. So it is necessary to extend the legislation and good practice globally.
Motorcycle helmet laws should apply to all riders and should combine with specify helmet quality standard. Research showed that motorcycle helmet can reduce almost 40 % of death and 70 % severe injury in motorcycle traffic crashes. But only 44 countries, representing 1.2 billion people (most in high-income countries), have laws that require the helmet to be weared and refer to a particular helmet standard. South-east Asia region and the western pacific region who are known to have a high proportion of motorcycle deaths have less laws related with motorcycle helmet wearing.
Seatbelt can prevent the fatality among drivers and front-seat passengers by 45–50 %, and the minor and serious injuries by 20–45 % respectively. Seatbelts also can reduce fatal and serious injuries by 25 % and minor injuries by up to 75 % for rear-seat passengers. Though 105 countries have comprehensive seatbelt laws, covering 67 % of the world’s population, but only 52 countries are good in the enforcement of seatbelt laws. It suggests there are a lot should be done about the enforcement of seatbelt laws all around the world.
Child restraints could reduce the likelihood of crash fatalities by proximately 90 % among infants and between 54 and 80 % among young children. Only 53 countries have a child restraint laws based on age, height or weight, and apply an age or height restriction on children sitting in the front seat, representing just 17 % of the world’s population. It still a big challenge for many countries to set the laws and to achieve compliance with child restraint laws.
2.2 Safer Vehicles and Roads
To provide safer vehicles and roads also are very important traffic safety strategies for each government.
Safe vehicles play a critical role in averting crashes and reducing the likelihood of serious injuries. The United Nation (UN) World Forum for Harmonization of Vehicle Regulations is the primary global body who is responsible for the development of passenger car safety standards. Its regulations provide a legal framework covering a range of vehicle standards which would potentially save many lives if it was applied to the manufacturing and production standards. To date, most countries fail to apply minimum UN safety standards to new cars, only 40 countries which are high-income countries meet all seven vehicle standard regulations.
Road infrastructure has traditionally maximized mobility and economic efficiency at the expense of safety, especially to non-motorized road users. In many industrialized countries non-motorized road users have to face the mix traffic mode more and more severely and to involve in fast flowing vehicles. Ensuring safety measures are implemented in the design of road infrastructure projects can result in important safety gains for all road users. This is particularly true where road design and maintenance are strengthened by a safe system approach, which makes allowances for human error. The use of infrastructure interventions to help manage speed and reduce the likelihood of traffic crash (such as road widening and raised pedestrian crossings), and interventions to mitigate the severity of the traffic crash (such as using roadside barriers and roundabouts), all reduce road traffic deaths and injuries.
2.3 Implementation of Traffic Safety Strategy
To have the first level road traffic safety , it is important for every country not only to have a good road safety strategy, but also to have excellent practice and implementation. It is a common challenge for most countries in the world. To achieve safety strategies, countries need continuously to perfect road traffic safety laws and regulations, to provide safer roads and vehicles, to guide road user with safe behavior, and to provide efficient emergence system and medical care standards for the traffic injuries.
To achieve significant improvements, it is very important that there is a systematic approach in traffic safety management for each country [5]. (1) The first thing is to define the burden of road traffic accidents in the country. It includes the monetary valuation of the prevention of a fatality crashes. Generally, there is a negative correlation between the country’s road safety situation and its monetary valuation of a statistical life. Namely, countries with poor road safety situation have low values of statistical life and vice versa. (2) The decision maker (government) must give commitment. Even the strategies and measures are the most efficient, these will not be realized without commitment from decision makers. For example, for the Vision Zero policy in Sweden, their parliament passed the Road Traffic Safety Bill on Vision Zero in 1997. (3) To create a responsible body for road safety on the national level. A National Road Safety Commission/Committee should include the relevant departments, and the most important is that it should be chaired by a committed person, respected by all departments. Before jumping to road safety actions and countermeasures, the problems related to road traffic safety should be identified in a systematic way. (4) Monitoring of performance. All performance of policies and countermeasures should be monitored and evaluated continuously. Indicator data on traffic safety performance should be collected accurately and their status should be followed-up persistently and in the event of deviation from the target, relevant measures should be applied promptly.
2.4 Some Cases
In recent years, more and more countries and regions have made road safety strategies and made the traffic safety become a responsibility of the country and the society. For example:
Australian Transport and Infrastructure Council released a National Road Safety Strategy (NRSS) for Australia in 2011. The strategy is based on Safe System principles embracing the principle that no person should be seriously injured or killed on Australian roads in a longer term. NRSS asking for a reduction of at least 30 % of deaths and serious injuries on its roads by the year 2020. NRSS will focus on four key aspects—Safe Roads; Safe Speeds; Safe Vehicles; and Safe People. (1) Safe Roads: All road authorities at all government levels are asked to make sure that safe system principles are applied to every new road projects of the country. (2) Safe Speeds: The NRSS calls for a series of initiatives aimed to reduce speed-related risks. (3) Safe Vehicles: There should be a number of comprehensive regulatory and consumer tests to ensure that proven safety design features and technologies are mandated in all new vehicles of Australian. (4) Safe People: It includes to improve driver and rider behavior such as provisional licence periods, supervised learner driving hours, sanctions for speed and alcohol offences, passenger night time restrictions, and mobile phone bans [6].
Iran had passed a new traffic law in 2010 that replaced the previous one dating back to 1968. The new law have heavier penalties for major offences such as speeding, driving under the influence and dangerous driving; with stricter law enforcement, graduated driving license, and universal coverage of medical treatment costs for all traffic injuries. At the same time, Iran has noticed that there are some subjects need to be improved, for example: (1) Driving behavior either in public drivers and in private drivers; (2) Against driving under influence of drugs; (3) Improving the helmet usage in motorcycle riders; (4) Driving examinations about medical and psychological fitness for driving safety; (5) Safety vehicle manufacture within Iran; (6) More emphasis on expansion of safe highways in transportation engineering [7].
Netherlands has entered the aging society like many other developed countries. At the same time, Netherlands is a flat country with a moderate climate and generally small distances between destinations, bicycling is a very important mode of transport also for older persons. Older cyclist becomes a important factor in traffic safety in Netherlands. In the road safety strategy of Netherlands in recent years, they strengthened studies on traffic adaption of older people to help aging person and improve traffic safety. The main ways are strengthening traffic safety studies related with neurological disorders, dementia, impairment of sight and hearing of elders; studying on license issue according the physical condition, specific training of safety riding adaption, and development of intelligent driving support/auxiliary system. These works have made good progress.
3 Epidemiology and Big Data
The study on epidemiology is a very important basis of looking for effective and targeted countermeasures for traffic injury control and prevention. It is a common view of experts all around the world that low-income and middle-income countries should strengthen the road traffic safety investigation to face the high traffic injuries and death caused by their fast increasing road traffic. The investigation of traffic safety not only should pay attention to road users, vehicles, roads and environment factors, but also should keep a watchful eye on policy, culture, education, engineering, medical care, and organization system, etc. at the same time.
WHO’s data showed that road traffic caused 1.25 million deaths in 2013 all around the world and 84 % of the death came from low-income and middle-income countries. The fatality rates of low-income countries is more than double times of that in high-income countries. And it was disproportionate that the number of deaths relative to these countries’ level of motorization. 90 % of road traffic deaths occurred in low-income and middle-income countries, but the number of vehicles in these countries was just accounted for 54 % of the world’s. There are the highest road traffic death rates in the African region continues. The lowest death rates were in the high-income countries in European region which had been very successful at achieving and sustaining reductions in death rates despite rising motorization. Almost half of all deaths on the world’s roads were motorcyclists (23 %), pedestrians (22 %) and cyclists (4 %) who had the least protection in 2013. There was the highest proportion of pedestrian and cyclist deaths in African region at 43 % of all road traffic deaths. The death rates were relatively lower in the south-east Asia region than that in African region.
This partly glasses the level of traffic safety measures appropriate to protect different kinds of road users and the predominant forms of mobility in different regions.
In recent years, more and more countries are promoting various projects for deep investigation on road traffic injury. For example, China has established traffic injury database and developed China In-Depth Accident Study (CIDAS) project. Kingdom of Saudi Arabia is carrying out a Injury Surveillance System project aimed to gather regular ongoing information for prevention and control of injuries and efficient use of resources.
The United States, Britain, Australian, Sweden, China, India and many other countries are process studies on epidemiology, prevention and control of traffic injuries based on their traffic accident and injury databases.
By means of epidemiologic studies, it shows that several factors are most notable causes in road traffic crashes. Some factors such as speed, road horizontal curvature, and congestion were found to have mixed effects on road traffic safety and need particular examination. Future research directions on the traffic safety factors are improving most notably data quality, making use of advanced statistical models, and probing into the factors in rural areas and developing counties. It is also a need to have more deep investigations in the factors which are related with the effect of speed and congestion on road accidents, whether road traffic safety could be improved by the curvature improvement. The use of more sophisticated statistical models may be helpful to better understand the effect of factors on road accidents [8].
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