Abteilung Verhalten und Sicherheit im Verkehr
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An approach to the standardization of accident and injury registration systems (STAIRS) in Europe
(1998)
STAIRS is a European Commission funded study whose aim is to produce a set of guidelines for a harmonised, crash injury database. The need to evaluate the effectiveness of the forthcoming European Union front and side impact directives has emphasised the need for real world crash injury data-sets that can be representative of the crash population throughout Europe. STAIRS will provide a methodology to achieve this. The ultimate aim of STAIRS is to produce a set of data collection tools which will aid decision making on vehicle crashworthiness as well as providing a means to evaluate the effectiveness of safety regulations. This paper will disseminate the up-to-date findings of the group as they try to harmonise their methods. The stage has been reached where studies into the diverse methods of the UK, French and German systems of crash injury investigation have been undertaken. An assessment has already been made of the relationships between the three current systems in order to define the areas of agreement and divergence. The conclusions reached stated that there were many areas that are already closely related and that the differences were only at the detailed level. With the emphasis on secondary safety and injury causation, core data sets were decided upon, taking into account: vehicle description, collision configuration, structural response of vehicles, restraint and airbag performance, child restraint performance, Euro NCAP, pedestrian and vehicle occupant kinematics, injury description and causation. Each variable was studied objectively, the important elements isolated and developed into a form that all partners were agreeable on. A glossary of terms is being developed as the project progresses which includes ISO standards and other definitions from the associated CAREPLUS project, which addresses the comparability of national data sets. A major consideration of the group was the data collection method to be employed. The strengths and weaknesses of each study were investigated to obtain a clear idea of which aspects offered the best way forward. The quality of this information and transference into a common format, as well as the necessary error checking systems to be employed have just been completed and are described. In tandem with this area of study the problem of the statistical relationship of each sample to the national population is also being investigated. The study proposes a mechanism to use a sample of crash injury data to represent the national and international crash injury problem
Trauma management (TM) covers two types of medical treatment: the initial one provided by Emergency Medical Services (EMS) and a further one provided by permanent medical facilities. There is a consensus in the professional literature that to reduce the severity and the number of road crash victims, the TM system should provide rapid and adequate initial care of injury, combined with sufficient further treatment at a hospital or trauma centre. Recognizing the important role of TM for reducing road crash injury outcome, it was decided, within the EU funded SafetyNet project, to develop road safety performance indicators (SPIs) which would characterize the level of TM systems" performance in European countries and enable country comparisons. The concept of TM SPIs was developed based on a literature study of performance indicators in TM, a survey of available practices in Europe and data availability examinations. A set of TM SPIs was introduced including 14 indicators which characterize five issues such as: availability of EMS stations; availability and composition of EMS medical staff; availability and composition of EMS transportation units; characteristics of the EMS response time, and availability of trauma beds in permanent medical facilities. Basic information on the TM systems was collected in close cooperation with the national expert group. A dataset with TM SPIs for 21 countries was created. It was demonstrated that the countries can be compared using selected TM SPIs. Moreover, a more general comparison of the TM systems' performance in the countries is possible, using multiple ranking and statistical weighting techniques. By both methods, final estimates were received enabling the recognition of groups of countries with similar levels of the TM system's performance. The results of various trials were consistent as to the recognition of countries with high or low level of the TM systems" performance, where in grouping countries with intermediate levels of the TM system's performance some differences were observed. The SafetyNet project's practice demonstrated that data collection for estimating TM SPIs is not an easy task but is realizable for the majority of countries. The TM SPIs" message is currently limited to the availability of trauma care services. Further development of the TM SPIs should focus on characteristics of actual treatment supplied, based on combined police and medical road crash related databases.
Various kinds of demerit point systems have been developed and implemented in European countries, aimed at tackling repeat offences in road transport by acting as a deterrent and providing sanctioning. The impact of a demerit point system on the number of crashes is often reported to be significant, but temporary. The objective of the EU BestPoint project was to establish a set of recommended practices that would result in a more effective and sustainable contribution of demerit point systems to road safety. A high actual chance of losing the licence and a high perceived chance of losing the licence are basic prerequisites for the effective operation of demerit point systems. For measures applied within the context of a demerit point system, a four-step-approach is recommended: warning letter, driver improvement course, licence withdrawal, rehabilitation course. Further recommendations concern issues like points and offences, e.g. which offences should lead to points, target groups, and the administration of demerit point systems. The final result of the EU BestPoint project is a handbook (van Schagen & Machata, 2012) which provides a concise overview of all recommended practices. The presentation/paper outlines how sustainable safety improvements can be achieved if national demerit point systems are implemented and maintained according to the recommended practices. In addition, potential further steps towards an EU-wide demerit point system (cross-border exchange on points and/or offences) are presented.
Chronic non-cancer pain (CNCP) is a major health problem. Patients are increasingly treated with chronic opioid therapy (COT). Several laboratory studies have demonstrated that long-term use of opioids does not generally impair driving related skills. But there is still a lack of studies investigating on-the-road driving performance in actual traffic. The present study assessed the impact of COT on road-tracking and car-following performance in CNCP patients. Twenty CNCP patients, long-term treated with stable doses of opioid analgesics, and 19 healthy controls conducted standardized on-the-road driving tests in normal traffic. Performance of controls with a blood alcohol concentration (BAC) of 0.5 g/L was used as a reference to define clinically relevant changes in driving performance. Standard Deviation of Lateral Position (SDLP), a measure of road-tracking control, was 2.57 cm greater in CNCP patients than in sober controls. This difference failed to reach statistical significance in a superiority test. Equivalence testing indicated that the 95% CI around the mean SDLP change was equivalent to the SDLP change seen in controls with a BAC of 0.5 g/L and did not include zero. When corrected for age differences between groups the 95% CI widened to include both the alcohol reference criterion and zero. No difference was found in car-following performance. Driving performance of CNCP patients did not significantly differ from that of controls due to large inter-individual variations. Hence in clinical practice determination of fitness to drive of CNCP patients who receive opioid treatments should be based on an individual assessment.