Maria Segui-Gomez

Reducing Risks to Children in Vehicles With Passenger Airbags

This review examines the risk that passenger airbags pose for children and discusses behavioral and technologic measures aimed at protecting children from airbag deployment. Although airbags reduce fatal crash injuries among adult drivers and passengers, this safety technology increases mortality risk among children younger than age 12. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. As new vehicles are resold to buyers who tend to be less safety-conscious than new car owners, the number of children endangered by passenger airbag deployment may increase. For vehicles already in the fleet, strong measures are required to secure children in the rear seat and increase the proper use of appropriate restraint systems through police enforcement of laws. One promising strategy is to amend child passenger safety laws to require that parents secure children in the rear seats. For future vehicles, a mandatory performance standard should be adopted that suppresses airbag deployment automatically if a child is located in the front passenger seat. Other promising improvements in airbag design also are discussed. Major changes in passenger airbag design must be evaluated in a broad analytical framework that considers the welfare of adults as well as children.

EVALUATING INTERVENTIONS THAT PROMOTE THE USE OF REAR SEATS FOR CHILDREN

OBJECTIVEnTo evaluate interventions that promote the use of the rear seat among children riding in motor vehicles.nnnSEARCH STRATEGIESnUsing the Cochrane Collaboration search strategy, we searched in electronic databases and reference lists of past reviews and review articles. We also searched among studies from government and research agencies in the United States and abroad, and contacted experts in the field.nnnSELECTION CRITERIAnStudies for selection had to be evaluations of interventions in defined populations, with a clear description of the program and the outcomes evaluated. Outcomes had to be measured in an objective manner, and there needed to be a comparison group.nnnDATA COLLECTION AND ANALYSISnSix studies met the selection criteria. Changes in the proportion of observed children traveling in the rear seats before and after the implementation of the intervention were the main outcome of interest.nnnMAIN RESULTSnTwo studies evaluating the effectiveness of educational campaigns promoting the use of the rear seat found increases in the proportion of children riding in the rear seats, but only in one study were the increases statistically significant (from 86% to 91%). The four remaining studies reported changes in seating location as a side effect of legislation requiring child restraint use among children traveling in the front seats. In two of these four studies, the percentage of children riding in the rear seats significantly increased from 49% to 62% and from 88% to 98%. In the remaining two studies there were small, but not statistically significant, changes in the proportion of children riding in the rear seats, with percentages remaining around 60% and 85%.nnnCONCLUSIONSnInterventions aimed at promoting the use of rear seats by children traveling in motor vehicles have been rare. Only one educational program whose only objective was to promote rear seating location was found and this 1973 Danish study had a positive impact. The other educational campaign, a pilot program that also focused on improving child restraint use, had no significant impact in promoting seating of children in the rear. We did not find any evaluation of legislation prohibiting children to sit in the front seats. Legislation requiring proper child restraint use in the front seats (and thus, compelling unrestrained children to seat in the rear) has produced, for the most part, a nonsignificant increase in the proportions of children sitting in the rear.

Where children sit in motor vehicles: a comparison of selected European and American cities.

Objectives—To ascertain whether there are differences in child seating location between selected cities in the US and continental Europe, and if differences exist, to ascertain what factors predict them. Setting—Boston and New Orleans, which have no laws regarding child seating location, and Paris, Frankfurt, and Brussels, which for approximately 20 years have had laws requiring children under the ages of 10 or 12 to sit in the rear. Methods—Observations were made in the first quarter of 1997 at several locations in or near each city. The vehicle seating capacity, total number of occupants, the seating location of adults and children, and driver shoulder belt use were recorded for each vehicle with at least one child. The predictors of a vehicle having a child in the front were estimated using logistic regression. Results—Data on 5501 children riding in 3778 vehicles were collected. Adjusting for differences in vehicle seating capacity, occupant mix, and driver shoulder belt use, vehicles in the European cities are significantly less likely to have a child in the front seat than vehicles in the American cities. Conclusions—Cities with no history of laws prohibiting children from sitting in the front, vehicles with low seating capacity, vehicles with no adult (other than the driver) or many child passengers, and unbelted drivers were associated with a higher likelihood of children riding in the front seat. It is feasible for a society to insist, through custom and/or law, that children sit in the back seat.

Airbag Safety and the Distance of the Driver from the Steering Wheel

To the Editor: Actuarial data indicate that driver-side airbags reduce the overall risk of death from a car accident by 11 percent,1 but airbag-induced injuries (both fatal and nonfatal) have been reported.2 The drivers proximity to the airbag is an important safety issue. Under a new government policy, drivers are being encouraged to maintain a safe distance from the steering wheel or, if that is not feasible, to obtain a manual cutoff switch for their airbags.3 Yet drivers may not properly estimate their proximity to the steering wheel. In order to evaluate the degree of misperception, we conducted a cross-sectional .xa0.xa0.

Validating analytical judgments: the case of the airbag's lifesaving effectiveness

Abstract Based primarily on experimental testing and engineering judgment, early evaluations of airbags made variable predictions of their lifesaving benefits. The official estimates of the US government from 1977 to 1987 were that between 6000 and 9000 lives could be saved each year if all passenger cars were equipped with full-front airbags. Now, over a decade later, extensive real-world crash experience in the US has been analyzed to validate early predictions. Lifesaving estimates have been revised downward and the official US government position in 1997 was that, overall, approximately 3000 lives will be saved each year when the vehicle fleet is fully-equipped with frontal airbags. This article explores the reasons for poor validity of early lifesaving forecasts for airbags. We found that airbag effectiveness for unbelted adult occupants was overestimated, the number of adult motorists who would wear safety belts was underestimated, and that early analyses generally did not adequately address heterogeneity in the vehicle fleet or people. For each source of error, we discuss why technical specialists may have erred and what lessons can be gleaned from this case study in validation.

Driver distance from the steering wheel: perception and objective measurement.

OBJECTIVESnThis study assessed the accuracy of driver perceptions of the distance between the drivers nose and the steering wheel of the vehicle as a factor in considering driver disconnection of an airbag contained in the steering wheel for preventing injury to the driver in an accident.nnnMETHODSnA cross-sectional survey of 1000 drivers was done to obtain perceived and objective measurements of the distance between the drivers nose and the steering wheel of the vehicle.nnnRESULTSnOf 234 drivers who believed that they sat within 12 inches of the steering wheel, only 8 (3%) actually did so, whereas of 658 drivers who did not believe that they sat within 12 inches of the wheel, 14 (2%) did so. Shorter drivers were more likely than taller ones to both underestimate and overestimate their seating distance.nnnCONCLUSIONSnConsiderable misperception of drivers distance from the wheel indicates that drivers should objectively measure this distance.

Calidad de los diagnósticos en urgencias de las lesiones por causas externas que requieren ingreso hospitalario

Objetivo Determinar la calidad de los diagnosticos realizados en losservicios de urgencias para aquellos pacientes con lesiones porcausas extemas que requieren ingreso hospitalario. Metodos Se recuperaron los codigos diagnosticos de las lesiones por causas externas generados en los servicios de urgencias y tras el alta hospitalaria de una muestra de 339 pacientes. Se calculo la gravedad de los pacientes con la Puntuacion de la Gravedad de las Lesiones (Injury Severity Score) utilizando un procedimiento de transformacion automatica delos diagnosticos. Se compararon los diagnosticos efectuados en urgencias con los del alta, clasificados en categorias diagnosticas, y se evaluo su calidad utilizando medidas de exactitud (grupos de Percy) y repetibilidad (porcentaje de concordancia). La repetibilidad de la medida de la gravedad resultante se determino con el porcentaje de concordancia y el coeficiente de correlacion intraclase. Resultados Se recogio una media de 1,1 diagnosticos por individuo en urgencias y 1,4 tras el alta. Al alta se notificaron mas diagnosticos en cada categoria, excepto en aquellas que incluyen lesiones mas inespecificas. En general, la informacion de urgencias infranotifico los diagnosticos. La comparacion de la distribucion de la gravedad utilizando ambas fuentes de informacion indica valores superiores con la informacion al alta, aunque la correlacion (0,61) indica una fiabilidad de moderada a buena. El porcentaje de concordancia de la gravedad agrupada en categorias fue del 63%. Conclusion En los servicios hospitalarios de urgencias se recoge informacion diagnostica relativa a la gravedad de los individuos que requieren ingreso hospitalario de suficiente calidad para ser utilizada para monitorizar tendencias en la magnitud y distribucion de las lesiones por causas externas a nivel poblacional. Sin embargo, para estudios especificos relativos a la gravedad de las lesiones de los individuos ingresados, se recomienda la utilizacion de la informacion diagnostica al alta.

Use of national health interview data to measure the burden of disease and injuries

Background: Although it is acknowledged that injuries place a substantial burden on populations throughout the world, few studies have measured the burden of non-fatal injuries and compared it with that of other health conditions. Methods: Data for the adult population were obtained from the 2001 Spanish National Health Interview, a household telephone survey of the Spanish population. Differences in six measures of burden were compared for up to 11 conditions by age and gender. Proportions and their 95% CIs are reported. Results: Injuries contribute 11–23% of the total health burden of the adult Spanish population, depending on which of the six indicators is used. They rank first and second out of the 11 conditions with regard to emergency visits and hospital admission, respectively. They rank third to sixth when other measures are chosen (ie, reduction in leisure activities, reduction in main activities, consulting a doctor, bedridden for half a day). Rheumatological, cardiovascular, and respiratory conditions are the only other conditions with a burden of comparable magnitude. Conclusion: In the adult Spanish population, injuries are an important cause of burden, regardless of the specific indicator used to define burden. These findings are likely to be equally applicable in similar countries. This type of comparison may raise the profile of injuries among health professionals and policy makers.

17 Emerging issues in road safety

When the expression “emerging issues” is used in transport safety, most believe one is about to unveil a new risk or problem not yet included in the rooster of problems to tackle. My goal during the talk is to present the audience with three alternative but complementary interpretations of this expression more fitting to a 2016 international conference. Firstly, emerging issues in road safety relate to the emergency needed to implement measures to reduce mortality rates as high as 25 per 100,000 population to, for example a 5 deaths per 100,000 target. How to promote this is mostly a matter of societal and political will. Secondly, it relates to the emergency required to demonstrate that bringing those even low 5 deaths per 100,000 to Zero is possible which would then bring us to aspects such as the ageing of the population with is associated comorbidities and therapeutic drug prescriptions, the high illegal drug consumption rates behind the wheel many countries are unveiling, or improvements in the assessment of psychophysical abilities to drive, at any particular time or in general. This mostly relates to the willingness to promote efficient collaboration between the health and mobility sectors in each country. Last, but not least, it relates to the emergency of introducing the new mobility patterns and mechanisms which include the possibility of reducing the need for physical mobility with the implementation of telecommunications, the replacement of the machines we use to move on fostering walking, cycling and less external energy demanding equipment, and the introduction of autonomous driving. Autonomous driving allows assisted mobility even to those whose psychophysical health may not be optimal. Autonomous vehicles are already around us and they allow us to completely redesign what we understand as active or passive safety. This last interpretation of the term “emergency” relates to the profound societal changes that we are undergoing with the information and technological revolution we are living through.