Impact of medical fitness to drive policies in preventing property damage, injury, and death from motor vehicle collisions in Ontario, Canada

ITMA board member Donald Redelmeier is one of the authors of an important article named “Impact of medical fitness to drive policies in preventing property damage, injury, and death from motor vehicle collisions in Ontario, Canada” recently published “in press” and on line in Journal of Safety Research

It can be found on https://www.sciencedirect.com/science/article/pii/S0022437520301079?dgcid=coauthor

This article evaluates the road safety impact of medical fitness-to-drive policies and road safety losses during the time when medical cases were still under review and the driver still active (no losses found) and what number of crashes that were prevented by the work with evaluating medical driver fitness. Quite a few collisions were prevented but the interventional effect of the medical review program differed by medical condition.

ITMA’s 27th World Conference postponed to 2021

Due to uncertainty surrounding the global coronavirus (COVID-19) pandemic, after careful review, we have eventually decided to postpone the 27th ITMA World Conference to 2021, in Tongji University, Shanghai. This is an extremely difficult decision for all of us, however, ITMA’s top priority continues to be the health, well-being, and safety of our global members and partners.
All papers that have been accepted for the proceedings for 27th ITMA will be arranged for presentations (either podium or poster) at ITMA World Conference 2021. The organizers of the 27th ITMA World Conference are continuously working hard to ensure the ITMA World Conference successful.

We are thankful for your continuous trust and strong support. We are looking forward to meeting you again in October 2021 in Shanghai, which will be a great gathering for our old and new friends in the transportation field.

27th ITMA World Conference Organizing Committee.

Efficacy of intervention at traffic schools reducing impulsive action, and association with candidate gene variants

Road traffic injuries are the leading cause of death among young people. Recognising the role of impulsive tendencies in risk taking behaviour may help novice drivers to behave more safely. Previously, a brief intervention focusing on impulsive traffic behaviour, conducted by psychologists in driving schools, has been effective [1, 2]. Following the success a new intervention study was carried out but this time the intervention was conducted by regular driving school teachers, who had previously been trained to carry out the intervention. The new intervention, similarly to the previous one, significantly decreased prevalence of traffic collisions and lowered general traffic risk (occurrence of either a recorded traffic offence or a collision). The association of impulsivity measures and candidate gene variants with risk-taking behaviour in traffic and the efficacy of the intervention is also analysed and discussed in the study. Read more in detail here!

  1. PAAVER M, EENSOO D, KAASIK K, VAHT M, MÄESTU J, HARRO J. Predicting risky driving: A novel and efficient brief intervention focusing on acknowledgement of personal risk factors. Accident Analysis & Prevention 2013;50:430–437.
  2. EENSOO D, PAAVER M, VAHT M, LOIT HM, HARRO J. Risky driving and the persistent effect of a randomized intervention focusing on impulsivity: The role of the serotonin transporter promoter polymorphism. Accident Analysis & Prevention 2018;113:19–24.

Permanent link to the publication:
http://hdl.handle.net/10062/65096

The journal file is closed until January 2020 because the period of embargo for Acta Neuropsychiatrica journal is 6 months.

Global Alliance of NGOs for Road Safety

Global Alliance of NGOs for Road Safety

ITMA has through the efforts of Alberto Silveira and our president Jack Szymanski applied for membership in an international network of NGO:s that works with traffic safety: Global Alliance of NGOs for Road Safety. We are happy to announce that ITMA is now a member of this organization.
Read more about the organization on www.roadsafetyngos.org. and especially about ITMA at http://roadsafetyngos.org/profile/282

Lars Englund, ITMA secretary

Abstracts Brazil congress

Here you can find the Abstracts from the Brasil World Congress.

 

26TH ITMA WORLD CONGRESS REPORT

Every two years ITMA elects a country to host its congress. In 2018, Brazil hosted PhDs and researchers from more than ten countries (including United States, Japan, Canada, Sweden, China, Estonia, Argentina, Costa Rica, German and Brazil) in order to discuss about traffic in a global scope. The 26th ITMA World Congress organized by INAQ, was held at Pontifícia Universidade Católica do Paraná – PUCPR, in Curitiba, from October 30 to November 1.The congress debated issues on medical specialties and other fields of expertise such as Psychology, Engineer, Law, Road Safety, Education and Public Administration, aiming to find measures to decrease the number of deaths and consequences of road accidents.

The organization of the 26th ITMA CONGRESS had the Company INAQ – AVALIAÇÃO E GESTÃO DE QUALIDADE (INAQ – Quality Assessment and Management) of the city of Curitiba, Brazil.

In the photo, the organizers, from left to right:
Organizer Psychologist Paula Herbst, Dr. Ana Maria Szymanski, Medical Student Carlos Szymanski, ITMA President Dr. Jack Szymanski, Organizer Psychologist Maria Elaine Andrade Celeira and Organizer Bruno Celeira.
Thank you for your beautiful work, professionalism and friendliness.

The pre-congress activities consisted in three workshops and oral presentations of scientific papers. The workshops themes were “Cardiovascular evaluation on physical and mental fitness to drive”, “Pre-hospital care in Curitiba: ‘From prevention to care’” and “Elderly driving behavior: How to evaluate it? An expert approach”.

The first oral presentation of scientific papers about Epidemiology, Physiology, Medicine and Public Health was about the paper “Analysis of the number of traffic accidents related to work by economic activity in Brazil, 2010 to 2016”, following “Epidemiological analysis of the profile of traffic accidents related to work in Brazil, 2009 to 2016”, “Epidemiological study on the occurrence of traffic accidents by Brazilian region, 2007 to 2016.”, “Improving timeliness and accuracy of data on road traffic injury severity in an emerging economy setting.” and also “Traffic accidents: prevalence neurologic trauma associated conditions”.

The second session was themed Psychology, Law, Education, Prevention and Risk behavior, counting with the papers: “Cyclists in high risk: traffic psychology and Vision Zero approach for better understanding and solutions” from María Cristina Isoba (speaker) and Alberto José Silveira, both ITMA members from Argentina. Also “Imprudence in the transportation of children, situations that can influence on safety”, “Knowing the Brazilian Traffic Code and the proper use of safety devices for children under 10 years old”, “Situations that may influence care when transporting children”, “The elderly and traffic accidents: education as a trauma prevention strategy”, “Traffic pastoral care, a spirituality of care”,

The third session, themed, Engineering, Management and Safety gave space to the papers: “Brazilian road safety legislation: review and analysis 1998 – 2017”, “Electronic inspection influence over the motorcyclists mortality in the city of Campina Grande, state of Paraíba”, “Hybrid vehicles safety ranking by use of a multicriteria analysis method”, “Land transport accidents related to work in Goiás, 2010 to 2017”, “Prediction of injury in traffic accidents using Machine Learning techniques”, “Prevalence of accidents with motorcycles and intake of alcohol in the city of Campina Grande, state of Paraíba”, “Traffic crashes and precipitation relationship obtained by multivariate analysis”, which was elected by examiners as the best paper, and “Evaluation of pedestrian crossing at a signalized intersection using microsimulation”.

After the memorable overture with the presence of the Paraná Military Police band that played famous traditional Brazilian music, the Congress began with many presentations. The Session 1, entitled Mortality in traffic – problems and challenges, counted as speakers: Dr. Leonard Evans – ITMA Emeritus President, representative from United States who discussed about “Deaths in road traffic – a grossly underemphasized public health problem” and Dr. Diva Eensoo, ITMA Eastern Europe Director – representative from Estonia who discussed about “Traffic Prevention, New Challenges.”. In the Session 2, entitled Data and Improvements, Dr. Zheng-guo Wang – ITMA Past President – China, gave a speech on the “Road traffic transportation safety development report China”, and Dr. Ulf Björnstig – ITMA Western Europe Director – Sweden, talked about “What happened – 20 years with Vision Zero.” During Session 3, entitled Technology and Advanced Assistance Systems Coordinated by Dr. Jack Szymanski, ITMA President, Dr. Jihong Zhou, ITMA Eastern Asia Director – China, presented the speech about “Autonomous driving and traffic safety”. Dr. Lars Englund, ITMA Immediate past president – Sweden, explored the theme “Could automatic driver assistance systems (ADAS) be the solution for persons with medical deficiencies to be able to drive again?”.

Session 4 showed discussions about Preventing traffic disasters. Prof. Dr. Rafael Malagoli Rocha, biologist – postdoctoral at the University of Hamburg (Germany), Specialist in toxicology and molecular oncology. LABET – toxicology tests, spoke about “Toxicology hair tests in Brazil: our technical and epidemiological experience” and Dr. Alberto Silveira, ITMA South America Director – Argentina, talked about the activities developed by “Luchemos por la Vida – A non-profit organization that works to prevent traffic incidents in Argentina”.

Session 5 entitled Medical Proposals for Prevention presented the speech of Drs. Masahito Hitosugi, ITMA Northeastern Asia Director – Japan, talking about “How to support safety driving for drivers with brain damage post stroke in Japan” and also of Dr. Donald Redelmeier, ITMA North America Director – Canada, who talked about “Actions Against Drunk Driving – strategies proposed for physicians to help their patients to prevent drunk driving “.

Session 6 themed Driver Medical Assessment presented Dr. Egas Caparelli Moniz de Aragão Dáquer, Physician and Professor – Brazil, who spoke about “Cognitive driving evaluation”, and Dr. Enrique González Araya, from the Traffic Medicine Committee of the School of Doctors and Surgeons from Costa Rica, who presented the “Unique electronic system for the medical fitness to drive, a successful tool in Costa Rica”.

The second day of Congress began with the Session 1, entitled “Trauma care services, and hospital costs”, which included the presentations of Dr. Mariana da Matta, Emergency physician in private hospitals and SUS, Rio de Janeiro, who talked about “Traffic collisions and its relation with the use of amphetamines by professional drivers, despite the prohibition (production, prescription and use) in Brazil”, Márcio Roberto Muniz, Nurse assistant at SIATE, who talked about “SIATE Curitiba – 28 years of pre-hospital care”, Dr. Juliano Gasparetto, Hospital Cajuru Technical Director – Brazil, explained about “The impact of traffic accident on hospital costs”.

In Session 2, entitled Risk situation in vehicle direction, Dr. Ricardo Froés Camarão, CFM Representative – Brazil spoke about “The influence of traffic collisions on the physical and psychological morbidity”. Dr. Sérgio Barros Vieira, Pneumologist and Specialist in sleep medicine, spoke about “Sleep Medicine – its role in fatigue management – 18 years of experience” and Dr. José Francisco Kerr Saraiva, SOCESP President – Society of Cardiology of the State of São Paulo, spoke about “Portadores de Dispositivos Cardíacos Eletrônicos Implantáveis (DCEI – marcapassos, ressincronizadores e cardio desfibriladores) e Arritmias Cardíacas: situações de risco na direção veicular” (Carriers of pacemaker or implantable cardiac electronic devices (ICED) and Cardiac Arrhythmias: risk situations in driving).

Session 3, entitle Research and prevenions possibilities, was coordinated by Dr. Luiz Carlos Sobania, Physician creator of Curitiba’s Pre-hospital System, Member of Comissão de Políticas Médicas da SBOT (SBOT Medical Policies Commission) and Traumatology and Ortopedy Professor. At 11h30am – Dr. Washington Luiz Esteves Magalhães, Embrapa Florestas Researcher – Brazil, Possibilidade do uso da nanocelulose vegetal no tratamento de queimaduras causadas por acidente de trânsito (Vegetable nanocellulose in the treatment of burns caused by traffic accidents). At 11h50am, Rodolfo Alberto Rizzotto, SOS Estradas – Road Safety Programme coordinator and author of the study “As drogas e os Motoristas Profissionais” (Drugs and professional drivers), explained about “O exame toxicológico como política de prevenção ao uso de drogas por motoristas – os casos do Brasil e EUA” (Hair testing as a policy to prevent drug use by drivers – the cases of Brazil and USA). At 12h10pm, João Pedro Bazzo Vieira, Environmental Engineer – Cicloiguaçu Study Coordinator – Brazil explained the “Desenvolvimento em âmbito local de infraestruturas que reduzam o risco de colisões e mortes de ciclistas” (Local development of facilities that decrease the risk of collision and death of cyclsts).
After lunch time and during the entire afternoon, attendees participated in an interactive presentation of drunk busters Googles by Memorial de Segurança no Transporte, leaded by Mr. João Muller from Viking Association.

Session 4 Traffic Law was the theme of this session, coordinated by Danilo Oliveira da Silva, from Pró Saúde.
At 1h30pm, Rochane Ponzi, , Comissão Especial de Trânsito (Special Traffic Commission) from OAB-RS – Brazil, talked about “A prova acusatória nas infrações por embriaguez no volante” (The accusatory evidence on drunk driving violations). At 1h50pm, Marcio Dias, from Comissão de Direito de Trânsito (Comission on Traffic Law) – OAB-RJ – Brazil, explained about “DPVAT – os procedimentos de indenização, número de mortes, motivos de negativa, a importância dos laudos médicos” (DPVAT – damages procedures, number of deaths, reasons for denail, the importance of medical statement), at 2h20pm, Luiz Otávio Maciel Miranda Advisor at DETRAN/PA – Brazil presented his thesis on “Instrumentos jurídicos das Nações Unidas sobre segurança viária e a importância da adesão dos países a esses instrumentos” (UN legal instruments on road safety and the importance of the accession of countries to these instruments).
At the end of the speech, Dr. Luiz Otávio Maciel Miranda asked permission from the organzers before gifting Dr. Enrique Arrayas, from Costa Rica, a copy of the United Nations Vienna Convention on Road Traffic, 1968. The Convention was published by UN’s Economic Commission for Europe (UNECE), and signed in November 8, 1968, turning 50 years in 2018. He emphasized the role played by Costa Rica on ratifying the text and becoming Part at the accord, alongside Brazil, Guyana, Peru, Uruguay and 73 other countries that have acceded to the Convention.

Session 5Non-governmental entities commited to traffic safety, was the topic of this session, coordinated by Master and Psychologist specialist in traffic Maria Elaine Andrade Celeira de Lima, INAQ Director, who spoke about activities performed by her company in behalf of education and traffic quality. The session started at 2h50pm and counted with participation of Mrs. Anaelse Oliveira coordinator of the Programa Volvo de Segurança no Trânsito who apoke about “O compromisso da iniciativa privada para a segurança viária” (Private sector commitment for traffic safety) and of Mr. Fernando Diniz, Engineer and President of the NGO Trânsito Amigo, who spoke about his work to increase awareness for traffic safety.

Session 6, Coordinated by J. Pedro Corrêa, Consultant in Traffic safety programs, was entitled Traffic education as a behavior change promoter. It started at 4pm – Tânia Mascarenhas from Comissão Estadual Intersetorial de Prevenção de Acidentes e Segurança no Trânsito (State intersectorial Commission for accidents prevention and traffic safety) – Brazil, “Projeto Vida no Trânsito” (Life in Traffic Project); at 4h20pm, Alessandra Bianchi from Conselho Regional de Psicologia (Regional Council of Psychology) – Brazil “Entre o saber e o fazer: desafios para a compreensão sobre o comportamento do condutor” (Between to know and to do: Challenges to the understanding about driver behavior) and at 4h40pm, Êrica Nickel Traffic specialist and Master of Education – Brazil, spoke about “Educação urbana: desenvolvendo pessoas para cidades inteligentes” (Urban education: developing people for smart cities).

Audience overview
225 people attended 26TH ITMA WORLD CONGRESS, including attendees, speakers, supporters, booth exhibitors and guests. In addition to researchers coming from Europe, Asia and North America, experts in road safety throughout the country were also present. Registration was opened to the general public, admitting registration from different fields of expertise and a multidisciplinary debate. Therefore, 26TH ITMA WORLD CONGRESS counted with the participation of physicians, psychologists, engineers, lawyers, nurses, rescuers, firefighters, military policemen, road safety technicians, teachers and public and private administrators.

Book Review Traffic Safety

Book Review Traffic Safety

Title: Traffic Safety
Author: Leonard Evans
Publisher: Science Serving Society, Bloomfield Michigan, USA
Other details: 445 p. Price: $ 99.50

In this admirable monograph, our immediate -past president Leonard Evans presents his vision for a safer traffic system. He eloquently argues that current safety policy of many countries, the USA prominently among them, dramatically fails. Each year hundred thousands of lives and billions of dollars are spilled, and millions of severe injuries are needlessly sustained, many leading to life long disabilities. He further argues that modest changes to a number of components of the traffic safety system currently in place can, in combination, lead to major reductions in harm.

According to him the key to progress is a different relationship between those at risk and the institutions in place to protect them. The goal of traffic law is not to apprehend and punish violations, but to reduce harm by preventing violations. A breakthrough in road traffic safety can be achieved by adopting the same two central principles that led to such outstanding safety in commercial air travel. First, the primary goal must be to prevent crashes, not to make it safer to crash. Second, drivers must follow rules based on inputs from many professional disciplines, rather than relying mainly on what they have learned from their personal experience. A central idea is that public support for electronically monitoring and enforcing driver behaviour should be increased and this could be reached by making the public aware of the high extent to which risk in traffic is due to other drivers.

Evans bases his conclusions on a thorough statistical analysis of the safety effects and costs/benefits of technical safety measures like airbags, which he discusses very critically, and on an analysis of human factors in traffic performance and traffic behaviour, like effects of age and gender. With regard to technical constructions to reduce the effect of a crash, he argues that only limited additional safety value at relatively excessive financial costs, can be obtained beyond the massive positive effects already obtained by the safety belt and vehicle design changes over the decades.

To illustrate this point he shows that “a belted driver in a modern car is less than half as likely to die as a driver in a 1950 car of similar mass in an identical crash (p, 415)” . He further shows that the airbag has yielded only little additional safety in comparison to that, and it did so at a (too) high financial cost. As he is convinced by his analyses and observations that the two factors that overwhelmingly determine an individual’s risk in traffic are the individual’s behaviour and the behaviour of other road users, he thinks the focus must now be on traffic behaviour and he argues that in this area large improvements in traffic safety can be obtained at acceptable costs, using new technological developments in the domain of driver monitoring and traffic law enforcement.

Most importantly, however, policy changes in designing and enforcing traffic safety measures would be required starting from the view that traffic unsafety is a major public health problem which government has an obligation to address. An already implicitly accepted principle must be even more openly embraced, namely that driving is a public, not a a private activity, weakening privacy arguments to oppose using technology to better enforce traffic law. Evans realizes, however, that such measures can only be effective if the public accepts them, so the public must be convinced that traffic law enforcement is not just another revenue-raising scheme.

Each individual chapter of this higly readable and important book will now be briefly mentioned, summarizing its major conclusions.

In chapter 1 (introduction) the magnitude of the world’s traffic unsafety problem is drawn and the superiority of crash prevention over crashworthiness interventions is argued. “This is because crashworthiness measures typically convert fatalities into serious injuries, whereas when the crash is prevented , all harm from it is prevented (p. 17)”. Also he introduces the rates and statisticall background used to describe traffic unsafety and shows that ” different rates address different questions – no one rate is superior to others in any general sense”.

In chapter 2 (data sources) properties of data sets that are essential to derive the quantitative results central to scientific understanding are introduced. A very importantant data set is the Fatality Analysis Reporting System (FARS), a census of all fatal crashes on US public roads since 1 January 1975 (now above 1.000.000 fatalities). Also various injury classification systems are discussed but it seems that their reliability is less than for fatalities, also depending on financial aspects of the medical care system.

In chapter 3 ( overview of traffic fatalities) it is shown how as countries motorize, traffic fatalities per year initially increase steeply to maximum and then decline. Also it is shown how the higher the motorization, the lower are the fatalities per registered vehicle. Male fatalities outnumber female ones by more than a factor of 2. Even for non-drivers, such as pedestrians and passengers, male fatalities outnumber female. Most vehicle occupants are killed in single vehicle crashes, rollover being the most harmful event. Safety belt use by occupants killed in rollover crashes -often ejected from the vehicle- is very low on average. Remaining in the vehicle, accomplished by properly wearing a safety belt, reduces risk by about 80 %.

In chapter 4 (vehicle mass and size) Newtonian mechanics is applied to predict how the weight and size of cars influence fatality risk. Confronting the equations with the FARS data it can be shown that for two-vehicle crashes, if one car is twice as heavy as the other, the driver in the lighter car is 12 times as likely to die as the driver in the heavier car. Size also matters: “A car can be made lighter while at the same time safer to the occupants and to the occupants of other vehicles into which it crashes by increasing its length (p. 95)”. SUV’s are discussed also; their weigth may be a positive safety feature, at least for who is inside, but their higher rollover opportunity is a negative feature.

In chapter 5 (environment, roadway and vehicle) many prejudices about safety and unsafety are tripped up. It is shown that statistically –in terms of fatalitities per distance- it is actually safter to drive in winter on snowy roads than in summer on dry roads. Also it is shown that in terms of fatalities the safety effect of ABS is not positive. It is true that it reduces crashes on wet roadways becuase it prevents skidding but it appears that rollover risk increases. The underlying explanation presented is speed; snow reduces travel speed leading to greater safety and the superior braking performance with ABS encourages small increases in speed. Also the application of modern –European style – roundabouts is promoted in the chapter, again because they reduce speed and because they “essentially eliminate the most severe type of intersection crash- one vehicle striking another on the side”.

In chapter 6 (gender, age and alcohol effects on survival) it is shown that these three factors have large effects on the physical vulnerability (fragility) of the body, as defined in terms of fatality risks, given the same impact. Young adullt males who have used no alcohol are most “robust”. Seventy year old males have about 3.5 times greater fatality risks than 20 year old males. Adult females are more fragile than males by a factor of about 1.3 but before age 15 and after age 50 there is no gender difference. Children are more vulnerable than young adults. Also, given the same impact, drivers with higher blood alcohol concentration are substantially more vulnerable. In all these cases other causes of the different fatalty risks have been neatly controlled, most importantly by the use of the famous “double pair comparison-method”.

In chapter 7 (older drivers) an interesting distinction is made between risks to the drivers themselves and threats they pose to other road users. In one of the tables based on FARS data on pedestrians killed by impact from a car, Evans shows that, on average, licensing an 80 year old poses a 70 % less threat than licencing a 20 years old. Risks older driver themselves face are mostly determined by increased physical vulnerability, although in the age range from 75 and up there is evidence of increasing fatalty risks over and above the vulnerability effect caused by decresing performance levels. Evans does not advocate to base licencing decisons on high age. Because of the large individual differences, he advocates tests that apply to all without regard to age. He finishes the chapter as follows (p. 172): “Young male drivers have the highest fatality and crash rates, and pose the greatest risk to other road users. A central finding of traffic safety in every country in the world is that traffic crashes are overwhelmingly a problem of young male drivers”.

In chapter 8 (driver performance) the knowledge, skill and perceptual and cognive abilities of drivers are discussed. In a computational example on reaction time and braking, Evans shows that small reductions in reaction time can produce large reductions in the probability of crashes which he then applies to understand the positive effects of the high-mounted stop lamps. He also critically discusses driving simulators, His central argument is that driving simulators are unlikely to produce knowledge relevant to traffic safety becuae they measure driver performance”what a driver can do” and not driving behaviour “what the driver in fact chooses to do”. The latter factor, however. primarily determines traffic unsafety. In my view this argument most clearly applies to the “healthy younger driver unsafety problem but less to the use of simulators in training and assesment of functionally impaired drivers who may have a safety problem on the level of skills and abilities. With regard to the healhy young driver he illustrates that the basic skills required to start, stop, and steer are acquired remarkably easily and quickly. Nevertheless risk taking behaviours associated with youth, and lack of higher level driving skills contribute to a 10 times higher crash risks in teenagers beinning to drive than in 40-50 years old drivers. He proposes extending and refining graduated licensing as a major contribution to traffic safety.

In chapter 9 (driver behaviour) a central element of driver behaviour is focused, namely chosing travel speed. Ïncreasing speed increases the risk of crashing, of being injured and of being killed. A one percent increase in speed increases fatality risk by between 4 and 12 %. From relating data on crimes, testosterone level, gender and crash involvement, Evans comes to the conclusion that the high crash rates for male and young drivers reflect inherent immutable biological characteristics and he thinks it is not wise for traffic safety policy to try to change these characteristics. Rather it mist be tried to reduce risks for everyone.

In chapter 10 (alcohol) the effect of large dosed of alcohol on fatality risk are explained from riskier manoeuvres (behaviour), impaired skills (performance) and incresed physical vulnerability, in that order. The dubious role of the alcohol industry is discussed. Leonard Evans thinks that large reductions in US traffic deaths can be achieved by expanding the use of sobriety check lanes, increasing taxes on alcohol, especially beer, and prohibiting beer advertising on television. He is rather positive about “alcohol ignition interlock systems” but discusses them as devices for repeat offenders only, who are only a small minority of all offenders. Reading the book as a whole, makes one wonder, however, why this device is not made obligatory for any car driven by 16-24 years old drivers, rather than obliging potentially confidence- and speed-raising technology like ABS and airbags.

In chapter 11 (occupant protection) the effects of protection devices on fatalities are assessed and discussed. The safety belt and the motorcycle helmets are unprecedented successes, having reduced driver fatality risk in a crash by 42 %. and 28 % respectively. Since drivers who do not spontaneously use safety belts differ from natural bucklers in the sense that they tend drive more risky anyway, getting the former ones into the belts would lead to large reduction of fatalities. This should provide “increased motivation to pass stronger belt wearing laws and enforce them vigorously (p. 305)”.

In chapter 12 (airbag benefits, airbag costs) the (US) policy and the safety evidence with regard to airbags are skillfully filleted and the airbag is shown to be very expensive fish with only faint taste and nasty fishbones. In this chapter and in in chapter 15 the US policy with regard to pushing the airbag and the role of the NHTSA are very criticallly discussed.

In chapter 13 (measures to improve traffic safety) a systems framework is used to sort out the independent and interactive effects of road user factors (driver behaviour and driving performance) and engineering factors, namely characteristics of the infrastructure (traffic and roadway) and the vehicle (automotive). According to him, engineering factors have only accounted for a small proportion of the enormous decline in fatalities per vehicle since the beginning of motorization and for the large differences in traffic unsafety between countries. Evans argues that the countermeasures that have produced the largest change in behaviour, and consequently largest reductions in traffic harm, are all legislative and continuing on this track he promotes more effective enforcement of traffic law, particularly with regard to speeding and not using seat belts, as the most effective approaches to improve traffic safety. Another interesting feature of the chapter is the comparison between the safety characteristics of commercial air carriers and road transportation. In airline travel the number one priority is on avoiding the crash rather than marginally increase the probability of surviving it. ” When road safety transfers its main focus to the prevention, rather than the survival, of crashes, it can start moving in the direction of the extraordinary safety achieved in airline travel (p. 355)”.

In chapter 14 (how you can reduce your risk) Evans gives sometimes very personal suggestions about (not) getting involved in at-fault and not-at-fault crashes, including flashing brake light to deter tailgaters (altruistically he warns against doing that if the tailgater is also being tailgated). He also advises not to drive a company car and not to take insurance for coverage of repair and replacement of your own vehicle, refering to Milton Friedman’s famous oneliner “Nobody spends somebody else’s money as carefully as he spends his own”.

In chapter 15 (the dramatic failure of US safety policy) he exposes a negative side of a legislative approach to traffic safety, particularly the one sided US focus on technological changes to the crashworthiness of cars, independent of driver behaviour, encouraging people’s ideas that deaths in traffic are mainly due to unsafe and defective vehicles. He also blames the NHTSA and the media for their dubious roles. “The media did not mention that these factors had only little to do with the overwhelming majority of the 40.000 annual US deaths. The crucial factors over which driver do have control, wearing belts, alcohol, speeding…were deemphasized. Yet these are the factors that have massive effects on safety (p. 408)”.

In chapter 16 (Vision for a safer tomorrow) Leonard Evans sketches his program for improving road safety. A central idea is that public support for enforcing traffic law should be increased and this could be reached if public awareness of the high extent to which risk in traffic is due to other drivers. In 69 % of the US fatalities in a given year a driver other than the person killed was involved and for less motorized countries this percentage is even larger. “A major adavance in safety will occur if the public realizes that more effective monitoring of other drivers (with regard to speeding and belt use) provides them far more protection than searching luggage (for bombs and guns on airports) (p. 414)”. With regard to the question what should be done with fines, he categorically opposes using them for nonspecific governement funding and he suggests they should be kept in a separate account, at the end of the year divided equally among all licence holders.

Announcement: The 26th ITMA Congress Will be Held in Curitiba, Brazil from October 30 to November 1, 2018

Announcement: The 26th ITMA Congress Will be Held in Curitiba, Brazil from October 30 to November 1, 2018

THE 26TH ITMA CONGRESS

Tuesday, October 30 – to Thursday, November 1, 2018 – Curitiba, Brazil

(www.itma-congress-2018.com)

DEATHS IN ROAD TRAFFIC – THE WORLD’S MOST UNDER-RECOGNIZED PROBLEM – HOW TO CHANGE THAT?

The International Traffic Medicine Association – ITMA will be holding its 26th World Congress in Curitiba, Brazil, from Tuesday, October 30 – to Thursday, November 1, 2018.

The organization was founded in 1960 mainly composed by physicians aiming to prevent crashes, and reduce deaths and injuries caused by traffic traumas. In more than 50 years of history, the association has been constantly working with the collaboration of experts from numerous fields and different parts of the world, counting even with the participation of the WHO and other organs of the UN.

The ITMA World Congress is another substantial opportunity to discuss matters of medicine, psychology or physiology with traffic medicine experts, engineers, designers, lawyers, manufacturers, policy makers, police officers and public administration involving traffic safety.

The congress will focus on issues such as the Advanced Driver Assistance System (ADAS), Support to safety driving for drivers with brain damage, Swedish Vision Zero program, what happened after 20 years, Proposed actions for the prevention of drunk drivers, New challenges to the prevention of traffic violence, as well as many other issues aiming to establish strategies for cultural and social changes in order to achieve a safer traffic for every person.

We are proud to invite you to share ideas and knowledge concerning traffic medicine in a multidisciplinary environment during 26th World Congress! Please visit the Congress website for more details (www.itma-congress-2018.com). See this announcement in Portuguese here.

Donald Redelmeier Found Full Moon is Associated with Fatal Motorcycle Crashes

Donald Redelmeier Found Full Moon is Associated with Fatal Motorcycle Crashes

ITMA’s Regional Director in North America, Dr. Donald Redelmeier recently published his work on BMJ to describe the relationship between the full moon and an increased risk of fatal motorcycle crashes. Although other potential confounders cannot be excluded from this relationship, it is worthy to be aware that motorcyclists are facing a higher risk of fatal crashes during a full moon. It is encouraged to ride with extra care under such a circumstance and appreciate the power of seemingly minor distractions at all times.

Click the image below or the following link to see the full-length paper: “The full moon and motorcycle related mortality: population based double control study“.