Road traffic deaths, which affect people in their productive years, are projected to be the third leading cause of death by the year 2030. While most studies have focused on road infrastructure and vehicle safety, this study examined something new: the impact of prehospital response to road traffic accidents on the rate of death. Some countries send physicians to the scene of an accident; some send paramedics or registered nurses. The question this research sought to answer was whether the use of physician responders resulted in a lower rate of death compared to the use of nonphysician responders. The literature makes it clear that rate of road traffic death is related to country income and governance indicators, so first those variables needed to be equalized. My conceptual framework for this cross-sectional correlation study was the Haddon matrix, which organizes injuries by temporal (pre-event, event, and postevent) and epidemiological (host, agent, and environment) factors. Using World Health Organization data on road traffic injury and country income, World Bank data on governance indicators, and a literature search of 67 countries' prehospital response profiles, significant negative correlations (p > 0.001) were found for road traffic deaths and income, r (65) = -0.68, and governance indicators, r (65) = -0.646. No significant difference in the rate of road traffic death was found between physician and nonphysician prehospital staffing. Because increasing countries' income and improving governance are long-term, ambitious goals for developing countries, training nonphysician prehospital responders appears to be the most effective social change to decrease the burden of road traffic deaths.

Objectives This thesis is based on 4 papers that were all written with the same intent, which was to describe and demonstrate how epidemiologic concepts and data can serve as a basis for improved validity of probabilistic conclusions in forensic medicine (FM). Conclusions based on probability are common in FM, and the validity of probabilistic conclusions is dependant on their foundation, which is often no more than personal experience. Forensic epidemiology (FE) describes the use and application of epidemiologic methods and data to questions encountered in the practice of FM, as a means of providing an evidence-based foundation, and thus increased validity, for certain types of opinions. The 4 papers comprising this thesis describe 4 unique applications of FE that have the common goal of assessing probabilities associated with evidence gathered during the course of the investigation of traumatic injury and death.   Materials and Methods Paper I used a case study of a fatal traffic crash in which the seat position of the surviving occupant was uncertain as an example for describing a probabilistic approach to the investigation of occupant position in a fatal crash. The methods involved the matching of the occupants’ injuries to the vehicular and crash evidence in order to assess the probability that the surviving occupant was either the driver or passenger of the vehicle at the time of the crash. In the second and third papers, epidemiologic data pertaining to traffic crash-related injuries from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) was used to assess the utility and strength of evidence, such as vehicle deformation and occupant injury of a particular severity and pattern, as a means of assessing the probability of an uncertain issue of interest. The issue of interest in Paper II was the seat position of the occupant at the time of a rollover crash (similar to Paper I), and the association that was investigated was the relationship between the degree of downward roof deformation and likelihood of a serious head and neck injury in the occupant. The analysis was directed at the circumstance in which a vehicle has sustained roof deformation on one side but not the other, and only one of the occupants has sustained a serious head or neck injury. In Paper III the issue of interest was whether an occupant was using a seat belt prior to being ejected from a passenger vehicle, when there was evidence that the seat belt could have unlatched during a crash, and thus it was uncertain whether the occupant was restrained and then ejected after the seat belt unlatched, or unrestrained. Of particular interest was the relative frequency of injury to the upper extremity closest to the side window (the outboard upper extremity [OUE]), as several prior authors have postulated that during ejection when the seat belt has become unlatched the retracting seat belt would invariably cinch around the OUE and cause serious injury. In Paper IV the focus of the analysis was the predictability of the distribution of skull and cervical spine fractures associated with fatal falls as a function of the fall circumstances. Swedish autopsy data were used as the source material for this study. Results In Paper I the indifferent pre-crash probability that the survivor was the driver (0.5) was modified by the evidence to arrive at a post-test odds of 19 to 1 that he was driving. In Paper II NASS-CDS data for 960 (unweighted) occupants of rollover crashes were included in the analysis. The association between downward roof deformation and head and neck injury severity (as represented by a composite numerical value [HNISS] ranging from 1 to 75) was as follows: for each unit increase of the HNISS there were increased odds of 4% that the occupant was exposed to >8 cm of roof crush versus <8 cm; 6% for >15 cm compared to <8 cm, and 11% for >30 cm of roof crush compared to <8 cm. In Paper III NASS-CDS data for 232,931 (weighted) ejected occupants were included in the analysis, with 497 coded as seat belt failures, and 232,434 coded as unbelted. Of the 7 injury types included in the analysis, only OUE and serious head injury were found to have a significant adjusted association with seat belt failure, (OR=3.87, [95% CI 1.2, 13.0] and 3.1, [95% CI 1.0, 9.7], respectively). The results were used to construct a table of post-test probabilities that combined the derived sensitivity and (1 - specificity) rates with a range of pre-crash seat belt use rates so that the results could be used in an investigation of a suspected case of belt latch failure. In Paper IV, the circumstances of 1,008 fatal falls were grouped in 3 categories of increasing fall height; falls occurring at ground level, falls from a height of <3 meters or down stairs, and falls from ≥3 meters. Logistic regression modeling revealed significantly increased odds of skull base and lower cervical fracture in the middle (<3 m) and upper (≥3 m) fall height groups, relative to ground level falls, as follows: (lower cervical <3 m falls, OR = 2.55 [1.32, 4.92]; lower cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base <3 m falls, OR = 1.82 [1.32, 2.50]; skull base ≥3 m falls, OR = 2.30 [1.55, 3.40]). Additionally, C0-C1 dislocations were strongly related to fall height, with an OR of 8.3 for the injury in a ≥3 m fall versus ground level. Conclusions In this thesis 4 applications of FE methodology were described. In all of the applications epidemiologic data resulting from prior FM investigations were analyzed in order to draw probabilistic conclusions that could be reliably applied to the circumstances of a specific investigation. It is hoped that this thesis will serve to demonstrate the utility of FE in enhancing evidence-based practice in FM.

No description available.

Background Major road traffic crashes (RTCs) can have a significant impact on the survivors, their family, and their friends, as well as on emergency personnel, volunteers, and others involved. However, survivors’ perspectives are rare or missing in research on major RTCs in Sweden. A comprehensive understanding of the survivors and their experiences is also lacking. By studying what it is like to survive a major RTC, the care and support provided to survivors can be adapted and improved. The overall aim is to broaden the understanding of the short- and long-term consequences and experiences of surviving a major bus crash. Methods The contexts are two bus crashes that occurred in Sweden, in February 2007 and December 2014. In total, the participants are 110 out of the 112 survivors, and the data is collected through telephone interviews, official reports, and medical records at one month, three months, and five years after the crashes. Analysis methods include qualitative content analysis, descriptive statistics, thematic analysis, and mixed methods research analysis. Results One month after the crash, most of the survivors were experiencing minor or major physical and/or psychological stress in their everyday lives (Study I). Four main findings were identified regarding their experiences of immediate care (Study II): prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support, and satisfactory initial care and support. The importance of compassion and being close to others was also highlighted. Five years after the bus crash in Rasbo (Study III), survivors were still struggling with physical injuries and mental problems. Other long-term consequences were a lasting sense of connectedness among fellow passengers, a gratitude for life, as well as feelings of distress in traffic, especially in regard to buses. The main findings from study IV indicated that injury severity did not seem to affect mental health, and that social aspects were important to the recovery process. There was an interconnection among survivors in which they seemed to be linked to each other’s recovery. Conclusion A strong need for short- and long-term social and psychological support in terms of compassion and community is evident in all the studies. The survivors ought to be acknowledged as capable and having the resources to contribute to their own and their fellow survivors’ recovery and health. There is a need for greater understanding of how different the survivors are, with each one of them having various physical, psychological, social, and existential needs. / Bakgrund Stora trafikskadehändelser kan ha en betydande inverkan på de överlevande och deras närståendes liv, likaså på sjukvårdspersonal, vittnen, och andra som är involverade. Trots detta så är de överlevandes perspektiv sällsynta eller saknas i forskning om stora trafikskadehändelser i Sverige. Det saknas även en helhetsförståelse av överlevande och deras erfarenheter. Genom att studera hur det är att överleva en busskrasch kan omhändertagande och stöd anpassas och förbättras. Det övergripande syftet är att öka förståelsen av kort- och långsiktiga konsekvenser och erfarenheter av att överleva en stor busskrasch. Metod Kontexten är två busskrascher som inträffade i februari 2007 och december 2014 i Sverige. Antal deltagare är 110 av 112 överlevande och data samlades in en månad, tre månader och fem år efter krascherna, via telefonintervjuer, officiella rapporter och medicinska journaler. Analysmetoder inkluderar kvalitativ innehållsanalys, deskriptiv statistik, tematisk analys och mixad metod. Resultat En månad efter kraschen upplevde överlevande fysiskt obehag och/eller psykisk stress i varierande grad i sin vardag (Studie I). Gällande upplevelser av det initiala omhändertagandet (Studie II) identifierades fyra huvudresultat; obehag på skadeplats, brister i omhändertagande och bemötande, missnöje med krisstöd, och tillfredsställande initialt omhändertagande och stöd. Betydelsen av empati och medkänsla från personal och frivilliga samt samhörighet med medpassagerare lyftes fram av de överlevande. Fem år efter busskraschen i Rasbo (Studie III) fanns det överlevande som fortfarande kämpade med fysiska skador och psykiska problem. Andra tydliga långsiktiga konsekvenser var en bestående gemenskap mellan medpassagerare, en tacksamhet över livet, samt oro och rädsla i trafiken, speciellt vid bussåkande. Uppföljningen efter busskraschen i Tranemo (Studie IV) indikerade att sociala aspekter var betydelsefulla för återhämtningsprocessen hos överlevande och att skadornas svårighetsgrad inte var betydande för det psykiska välbefinnandet. En stark samhörighet upplevdes bland de närstående som reste tillsammans och de verkade följa varandras återhämtning. Slutsatser Ett starkt behov av kort- och långsiktigt socialt och psykologiskt stöd i form av gemenskap och empati är tydligt i samtliga studier. De överlevande bör uppmärksammas som aktörer med kapacitet och resurser till att bidra till sin egen och medpassagerares återhämtning och hälsa. Det behövs en ökad förståelse för hur olika de överlevande är, med varierande fysiska, psykologiska, sociala, och existentiella behov.

Thesis (M.Med. (Forensic Pathology)) -- University of Limpopo, 2022 / Introduction and background: Road traffic fatalities remain a worldwide burden with more than half of those fatalities comprising of vulnerable road users (pedestrians, cyclists and motorcyclists). This prompted the World Health Organization and United Nations to establish Sustainable Developmental Goals aimed at reducing road traffic crashes. The study explored factors relating to pedestrian fatalities on the R71 road, which may inform future interventions to enhance pedestrian safety. Aim: The study aimed at profiling pedestrian road traffic crash fatalities on the R71 road admitted at Polokwane Forensic Pathology Services. Methodology: A quantitative descriptive study utilising total population purposive sampling of pedestrians that demised because of R71 road traffic crashes over a 3-year period was done. There were 65 cases studied. Results: The study revealed that the fatalities were more male adult pedestrians than females, who were between 20 -39 years old. Majority of those pedestrians were wearing dark coloured clothing with no reflectors on. The pedestrian fatalities were mostly seen over the weekend and between evening and midnight. The fatalities peaked in December and February (summer season). The common locality of the pedestrian fatalities was Mankweng and Mentz village (Area 3). Most of those pedestrians sustained head injuries. Conclusion: Contributory factors and injuries of those pedestrian fatalities that demised because of R71 road traffic crashes were identified, which some were similar to those already highlighted in literature.

This research assessed the criminological significance of motor vehicle crash data within the criminal justice context. The study was conducted at the southern region Accident Bureau of the Ekurhuleni Metropolitan Police Department (EMPD). The objectives of this research are to: a. Explore and describe the extent and criminological impact of road traffic crashes on a macro level. b. Explore and describe the impact of road traffic crashes on a micro level. c. Explain the criminological significance of road traffic crash data in relation to effective road safety management. d. Evaluate and describe the attendance and recording procedure of road crashes. e. Evaluate and describe the supervisor’s responsibility in relation to the quality of crash data recorded. f. Evaluate and describe the effectiveness of crash statistics accessed by management and/or officials. g. Evaluate and explain the current prosecution procedure as part of the CJS. h. Evaluate existing policy about the crash-recording process applicable to operational law enforcement practitioners of the EMPD. i. Explore and describe the current state of motor vehicle insurance and its necessity from a criminological perspective. The researcher followed a mixed-methods approach, collecting quantitative data from recorded Accident Report Forms and qualitative data from interviews with participants active in their fields of expertise. Road crashes are characterised by injury and damage; victims suffer trauma and economic consequences, and the society and the economy as a whole are affected. The research suggests that accurate road crash data form a crucial component in the investigation, prosecution and development of road safety strategies in the quest towards improved road safety efforts. It also indicates that existing crash data are of such a sub-standard that traffic professionals will not be able to develop effective and efficient road safety strategies in pursuit of road safety / Criminology and Security Science / M.A. (Criminology)

This research assessed the criminological significance of motor vehicle crash data within the criminal justice context. The study was conducted at the southern region Accident Bureau of the Ekurhuleni Metropolitan Police Department (EMPD). The objectives of this research are to: a. Explore and describe the extent and criminological impact of road traffic crashes on a macro level. b. Explore and describe the impact of road traffic crashes on a micro level. c. Explain the criminological significance of road traffic crash data in relation to effective road safety management. d. Evaluate and describe the attendance and recording procedure of road crashes. e. Evaluate and describe the supervisor’s responsibility in relation to the quality of crash data recorded. f. Evaluate and describe the effectiveness of crash statistics accessed by management and/or officials. g. Evaluate and explain the current prosecution procedure as part of the CJS. h. Evaluate existing policy about the crash-recording process applicable to operational law enforcement practitioners of the EMPD. i. Explore and describe the current state of motor vehicle insurance and its necessity from a criminological perspective. The researcher followed a mixed-methods approach, collecting quantitative data from recorded Accident Report Forms and qualitative data from interviews with participants active in their fields of expertise. Road crashes are characterised by injury and damage; victims suffer trauma and economic consequences, and the society and the economy as a whole are affected. The research suggests that accurate road crash data form a crucial component in the investigation, prosecution and development of road safety strategies in the quest towards improved road safety efforts. It also indicates that existing crash data are of such a sub-standard that traffic professionals will not be able to develop effective and efficient road safety strategies in pursuit of road safety / Criminology and Security Science / M.A. (Criminology)

“Vision Zero,” first adopted by Sweden in 1997, is a road safety policy that aims to achieve a transportation system having zero fatalities or serious injuries for all modes of transportation. It takes a proactive approach to road safety system by identifying risk and taking steps to prevent injuries. Historically, traffic related crashes have disproportionately impacted vulnerable communities and system users including people of color, low income individuals, seniors, children, and pedestrians, bicyclists, and transit users (who typically walk to and from public transport). These inequities are addressed in the Vision Zero framework by prioritizing interventions in areas that need safety improvements the most. In 2016, the Alexandria City Council voted unanimously to develop a “Vision Zero” policy and program as a part of its updated transportation master plan. It required an initial equity analysis to assess the impact of traffic crashes on the traditionally underserved communities / groups (groups from at least one of these categories: low-income; minority; elderly; children; limited English proficiency; persons with disabilities; and/or pedestrians/ bicyclists/ transit users). This study combines three different methods to investigate the equity issues regarding traffic safety: 1) descriptive analysis of the spatial pattern of crashes and their relationship with the demographic profiles of neighborhoods at census block group level (for 2010-2014 period); 2) descriptive analysis of the crash trends in Alexandria; and 3) exploratory regression analyses for two different units of analysis (an aggregate regression analysis of crashes at census block group, and a disaggregate regression analysis of the individual level crash reports of traffic crashes). The analysis found that the elderly, school aged children, rail/subway users, and pedestrians had a higher risk of fatalities and severe injuries in traffic crashes. Higher job densities, alcohol impairment, and speeding were significantly related to higher KSI, whereas, smaller block sizes (higher number of street segments per sq. mile area of census block group), higher housing density, and use of safety equipment were related to lower KSI. / Master of Urban and Regional Planning

Traffic safety has been considered one of the most important issues in the transportation field. With consistent efforts of transportation engineers, Federal, State and local government officials, both fatalities and fatality rates from road traffic crashes in the United States have steadily declined from 2006 to 2011.Nevertheless, fatalities from traffic crashes slightly increased in 2012 (NHTSA, 2013). We lost 33,561 lives from road traffic crashes in the year 2012, and the road traffic crashes are still one of the leading causes of deaths, according to the Centers for Disease Control and Prevention (CDC). In recent years, efforts to incorporate traffic safety into transportation planning has been made, which is termed as transportation safety planning (TSP). The Safe, Affordable, Flexible Efficient, Transportation Equity Act - A Legacy for Users (SAFETEA-LU), which is compliant with the United States Code, compels the United States Department of Transportation to consider traffic safety in the long-term transportation planning process. Although considerable macro-level studies have been conducted to facilitate the implementation of TSP, still there are critical limitations in macroscopic safety studies are required to be investigated and remedied. First, TAZ (Traffic Analysis Zone), which is most widely used in travel demand forecasting, has crucial shortcomings for macro-level safety modeling. Moreover, macro-level safety models have accuracy problem. The low prediction power of the model may be caused by crashes that occur near the boundaries of zones, high-level aggregation, and neglecting spatial autocorrelation. In this dissertation, several methodologies are proposed to alleviate these limitations in the macro-level safety research. TSAZ (Traffic Safety Analysis Zone) is developed as a new zonal system for the macroscopic safety analysis and nested structured modeling method is suggested to improve the model performance. Also, a multivariate statistical modeling method for multiple crash types is proposed in this dissertation. Besides, a novel screening methodology for integrating two levels is suggested. The integrated screening method is suggested to overcome shortcomings of zonal-level screening, since the zonal-level screening cannot take specific sites with high risks into consideration. It is expected that the integrated screening approach can provide a comprehensive perspective by balancing two aspects: macroscopic and microscopic approaches.