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This paper set out to examine the possibilities for injury avoidance implications for older drivers in crashes, based on crash and injury patterns among older drivers and current trends in ageing in most western societies. A number of safety technologies were identified and discussed which have potential for improving vehicle older driver crash avoidance and crashworthiness. While there were some promising estimates available of the likely benefits of this technology for improving safety, it is evident that they need to be confirmed for older drivers, given their age-related disabilities and sensory limitations. Further research is urgently required to ensure that these technologies yield safety benefits without any disbenefits for older drivers.rn
Pelvic fracture, cracking or breaking of a portion of the pelvis are extremely common injuries in the side impact collisions of motor vehicles. Due to both its shape and structural architecture, mechanics of the pelvic bone is complicated. There is a lack of knowledge regarding the dynamic behavior of the pelvis and its biomechanical tolerance under impact environment. Hence this study is aimed at the understanding of the mechanical response of the human pelvis with three-dimensional finite element (FE) models, under side impact load, applied through a structure, equivalent to a car door. The door structure was modeled, considering few layers, consisting of foam (Styrodur®, 3035 CS), plastic (UHMWPE), steel, glass and steel, putting them in series. A soft tissue layer (equivalent to fat) was also considered on the greater trochanter location. These FE models (with and without the car door structure) were analyzed with ANSYS-LS-DYNA-® dynamic finite element software to compare the effect of the car door padding system for shock absorption. It was observed that with proper combination of shock absorbing material (foam, etc.) and its thickness, the transmission of impact load to the body part (pelvis, etc.) from the outer surface of the car door could be reduced.
The improvement of passive car security devices led to a reduction of injuries, especially of the head, the neck and the torso mainly due to the airbag function. The passenger's foot and ankle could not profit from this development. Some investigators even reported a progression of leg injuries (1). In this study, we investigated a current collective of patients with foot and ankle fractures or severe soft tissue injuries in relation with defined crash parameters. Special interest was paid to the car's footwell.
The so-called "seat-belt injuries" or "seat-belt syndromes", described as 2-point seat-belt injuries, contain heavy inflection injuries of the lumbal spinal column, combined with heavy abdominal injuries as rupture of the upper intestinal bold or heavy injuries of the upper entrails. With "playing" children in the font of the car, with inappropriate plant of 3-point belts, identical injuries can occur.
This paper reviews briefly the evolution of the investigation of transport accidents from the early beginnings when individual events were studied but systematic data was not collected. In the transport modes other than on the roads, accident investigation early on, even of single events, was important in introducing safety improvements. Road accidents, however, evolved enormously with the growth of car ownership without any comparable political response to the consequent deaths and injuries, equivalent to what happened with the other modes. From the 1950s data bases started to contribute to our knowledge of the epidemiology of road traffic injuries, and in-depth sample studies have contributed much to the body of knowledge in the last 30 years. However, even the basic input and output variables of a crash, its severity and the seriousness of the outcomes in terms of injuries and their consequences are not complete or agreed upon. Issues of experimental design and sampling are discussed. It is proposed that the most important area for current research to address is the effect of population variations on injury outcomes. The need for the establishment of good data bases for active safety issues is emphasised with the consequent need for better links between the research community and the police.
Nowadays airbags are part of the standard equipment in almost all new cars. While airbags are saving an increasing number of people from severe injuries and death in moderate and high speed crashes, they do not completely prevent dashboard injuries. The most common mechanism in dashboard injuries is a posteriorly directed force to the proximal tibia with the knee flexed. This may occur during a motor vehicle frontal impact accident when a knee of the driver or the front-seat passenger strikes the dashboard. The posterior force can be combined with a abducting or rotational force leading to concomitant lateral or posterolateral injury. Car and airbag manufacturers therefore develop special inflatable systems to reduce the impact force in dashboard injuries. Every new inflatable system, however, has to be evaluated in out of position situations in which the system might cause injuries to certain body areas. Therefore, we investigated a new kneebag system in different critical seating positions of post mortem test subjects (PMTS). The tested knee airbag module is a folded airbag (18 litre volume) which is installed below the lower section of the instrument panel of a passenger car. Using four PMTS (2 male, 2 female, age 36"67) the following positions were tested: normal seating position, knee flexed >90 degrees and knee flexed <60 degrees in static deployment tests with direct contact. In addition a dynamic test (48.8kph, AAMA-pulse) was carried out with the PMTS belted in a normal seating position. The inflation phase and the impact of the system on the knee/lower leg were analysed by high speed videos. After the test the lower legs of the PMTS were examined by Xray and autopsy. All soft tissue injuries and bone fractures were recorded. All the tests could be evaluated. Except some superficial skin lesions in the impact area no fracture of the bones around the knee and no knee ligament and tendon injuries were observed. Neither video analysis nor autopsy of the PMTS showed any critical contact injuries caused by the inflation process of the bag. Therefore, it can be concluded that in the tested seating positions which are the most critical for the knee area the knee bag system is safe.
Empirical vehicle crashworthiness studies are usually based on national or in-depth traffic accident surveys: Data on accident-involved cars/drivers are analysed in order to quantify the chance of driver injury and to assess certain risk factors like car make and model. As the cars/drivers involved in the same accident form a "cluster", where the size of the cluster equals the number of accident-involved parties, traffic accident survey data are typical multi-level data with accidents as first-level or primary and cars/drivers as secondlevel or secondary units (car occupants in general are to be considered as third level units). Consequently, appropriate statistical multi-level models are to be used for driver injury risk estimation purposes as these models properly account for the cluster structure of traffic accident survey data. In recent years various types of regression models for clustered data have been developed in the statistical sciences. This paper presents multi-level statistical models, which are generally applicable for vehicle crashworthiness assessment in the sense that data on single and multiple car crashes can be analysed simultaneously. As a special case of multi-level modelling driver injury risk estimation based on paired-by-collision car/driver data is considered. It is demonstrated that assessment results may be seriously biased, if the cluster structure inherent in traffic accident survey data is erroneously ignored in the data analysis stage.
The incidence and treatment of sternal fractures among traffic accidents are of increasing importance to ensure best possible outcomes. Analysis of technical indicators of the collision, preclinical and clinical data of patients with sterna fractures from 1985-2004 among 42,055 injured patients were assessed by an Accident Research Unit. Two time groups were categorized: 1985-1994 (A) vs. 1995-2004 (B). 267/42,055 patients (0.64%) suffered a sterna fracture. Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251/31,183 pts), followed by 0.19% (5/2,633pts) driving motorbike, and 0.11% (4/3,258pts) driving a truck. 91% wore a safety belt. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33/255 car/trucks), with an airbag malfunction in 18%. The steering column was deformed in 39%, the steering wheel in 36%. Cars in the recent years were significantly older (7.67-±5 years (B) vs. 5.88-±5 years (A), p=0.003). Cervical spine injuries are frequent (23% vs. 22%), followed by multiple rib fractures (14% vs. 12%) and lung injuries (12% vs. 11%). We found 9/146 (6%) and 3/121 patients (3%) with heart contusion among the 267 sternal fractures. MAIS was 2.56-±1.3 vs. 2.62-±1.3 (A vs. B, p=0.349). 18% of patients were polytraumatized, with 11.2% dying at the scene, 2.3% in the hospital. Sternal fractures occur most often in old cars to seat-belted drivers often without any airbag. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10% each indicating the severity of the crash. Over a twentyyear period, the injury severity encountered was not different with 18% polytrauma patients suffering sternal fractures.
The fact that ADAC Air Rescue handles approximately 4,000 road accident missions every year gave rise to set up an accident research programme for which ADAC Air Rescue provides its data. This data is of initial informational quality and will be supplemented by data from the police, experts, fire brigades as well as hospitals and forensic institutes. Although the number of cases is still rather low, certain tendencies can be identified. The causes for most accidents occur when joining or intersecting traffic, followed by speeding in road bends and tailgating. Many accidents involve HGV rear end collisions, often causing serious injuries, considerable damage and technical problems for the rescue operations. With regard to the various impact types, it has become obvious that most of the extremely serious injuries are inflicted during a passenger car side impact. In addition, access to and removal of trapped passengers is becoming more and more complicated, partly due to the increasing use of high-strength materials, and rescue operations tend to be more time consuming.
Bicyclists are minimally or unprotected road users. Their vulnerability results in a high injury risk despite their relatively low own speed. However, the actual injury situation of bicyclists has not been investigated very well so far. The purpose of this study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. Technical and medical data were prospectively collected shortly after the accident at the accident scenes and medical institutions providing care for the injured. Data of injured bicyclists from 1985 to 2003 were analyzed for the following parameters: collision opponent, collision type, collision speed (km/h), Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), incidence of polytrauma (Injury Severity Score >16), incidence of death (death before end of first hospital stay). 4,264 injured bicyclists were included. 55% were male and 45% female. The age was grouped to preschool age in 0.9%, 6 to 12 years in 10.8%, 13 to 17 years in 10.4%, 18 to 64 years in 64.7%, and over 64 years in 13.2%. The MAIS was 1 in 78.8%, 2 in 17.0%, 3 in 3.0%, 4 in 0.6%, 5 in 0.4%, and 6 in 0.2%. The incidence of polytrauma was 0.9%, and the incidence of death was 0.5%. The incidence of injuries to different body regions was as follows: head, 47.8%; neck, 5.2%, thorax, 21%; upper extremities, 46.3%; abdomen, 5.8%; pelvis, 11.5%, lower extremities, 62.1%. The accident location was urban in 95.2%, and rural in 4.8%. The accidents happened during daylight in 82.4%, during night in 12.2%, and during dawn/dusk in 5.3%. The road situation was as follows: straight, 27.3%; bend, 3.0%; junction, 32.0%; crossing, 26.4%; gate, 5.9%; others, 5.4%. The collision opponents were cars in 65.8%, trucks in 7.2%, bicycles in 7.4%, standing objects in 8.8%, multiple objects in 4.3%, and others in 6.5%. The collision speed was grouped <31 in 77.9%, 31-50 in 4.9%, 51-70 in 3.7%, and >70 in 1.5%. The helmet use rate was 1.5%. 68% of the registered head injuries were located in the effective helmet protection area. In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two thirds of the head injuries could have been prevented by helmets. Accidents are concentrated to crossings, junctions and gates. A significant lower mean injury severity was observed in victims using separate bicycle lanes. These results do strongly support the extension or addition of bicycle lanes and their consequent use. However, the lanes are frequently interrupted at crossings and junctions. This emphasizes also the important endangering of bicyclists coming from crossings, junctions and gates, i.e. all situations in which contact of bicyclists to motorized vehicles is possible. Redesigning junctions and bicycle traffic lanes to minimize the possibility of this dangerous contact would be preventive measures. A more consequent helmet use and use and an extension of bicycle paths for a better separation of bicyclists and motorized vehicle would be simple but very effective preventive measures.