Journal of Local and Global Health Science - Proceedings of the 24th World International Traffic Medicine Association Congress, Qatar 2015, November 2015

Traffic has become essential to our daily life. It is necessary to handle it properly by means of prediction, planning and management. This is especially true for the rapid development of road networks in the country and the exponential increase in the number of drivers, vehicles and the related industry development. In recent years, traffic safety, as well as the prevention and treatment of accident injuries have received more attention. In parallel traffic medicine also has appeared as an advanced practical medical concept. This paper aims to discuss the importance of awareness-raising and education as well as the development of the presentation of the methods of promoting the protection culture to avoid traffic accidents and achieve road safety, first aid and medical treatment. These elements, in turn, lead to the reduction of fatalities and injuries in road traffic crashes and disabilities induced by traffic accidents in the world, as well as the related effects, be they economic or psychological, with a view to improving health and safety standards for road users and achieving a better life quality. Unprecedented breakthroughs, challenges and changes pervade modern society and cover all aspects of life. We also witness momentous advances in knowledge, rapid communication and constant technological progress. Nothing is constant; everything surrounding us is changing and developing, a far-reaching fact covering all road elements. This paper, therefore, aims to explore many related issues: • Vehicle driver: All health and cultural aspects • Vehicle: Safety measures and methods, and the way to benefit from vehicle technological advances • Road: The minimum construction standards and use that should be guaranteed for security and safety • Laws and the State: Traffic control, clarity of laws and measures and the role of the State. • Traffic Medicine: Definition, merits and demerits as well as the importance of the officers in charge • Society: Road environment including all related contents This study identifies the significant role of the leadership in educational and social institutions and civil society for the promotion of traffic and safety culture, highlighting the role it plays in the security of the community. It is necessary to find some simple scientific means to achieve security and safety as well as to monitor the relevant strengths and weaknesses and their effects on road safety. The paper also addresses the significance of diversifying the methods of promoting this culture according to the categories of audiences. It presents the various ways of implementing recommendations, including, but not limited to, the implementation of community awarenessraising programs on traffic safety, the implementation of special training programs on traffic safety and the provision of world-class development programs in road safety engineering and road users' behaviors. It also includes the prevention of injuries, first aid programs, establishment of related student clubs in universities, enhancement of traffic medicine awareness among many other projects and programs drawing on intensifying awareness about traffic safety and medicine. Awareness-raising, culture and education constitute significant means that allow governmental bodies to handle the modern innovations positively and employ them for the development of countries and communities, with a view to deriving more and more benefits for public welfare and reducing any negative effects to reasonable limits.

For the last fourteen years in Japan, casualties due to traffic collisions have decreased. There were 9,073 traffic fatalities in 2000 and 4,113 in 2014. However, it has been argued that traffic collisions caused by one driver’s poor physical condition account for 10% of all traffic collisions. To reduce collisions to an even greater degree, this type of collision should be prevented. To investigate this issue, we studied criminal liability for drivers who caused a collision while having an epileptic seizure while driving. We searched for information on traffic collisions caused by epileptic seizures while driving, and criminal punishments for the epileptic driver. We used databases of five nationwide newspapers (Asahi, Mainichi, Nikkei, Sankei, Yomiuri). We used LEX/DB that is a database of the precedent after 1875 in Japan, too. We studied 27 cases from 1964 to 2014. Twenty drivers were prosecuted, and seven drivers were not. Seventeen of the twenty cases that were tried resulted in convictions, and all of the drivers who were found guilty had been diagnosed with epilepsy before being involved in vehicle collisions. Ten of the drivers found guilty denied criminal liability in arraignment. The sentences rendered appear to have become more severe in recent years. Criticism for vicious vehicle collisions has led to changes in public opinion in Japan, thus the punishments for traffic fatalities and injuries due to a collision became heavier after 2001. Accidents due to chronic diseases—regarded as vicious collisions—are subject to scorn from the public, resulting in harsher penalties. It is necessary for drivers to recognize the risks of having seizures while driving. Furthermore, it is necessary for doctors to give clear instructions to drivers.

Although there has been a decline in the popularity of walking, it remains a very commonly employed mode of travel and people of almost all ages and sexes walk. Walking almost inevitably involves crossing a road, where the desire line of the pedestrian conflicts with the higher speed. Where speeds are high, this can result in either delay or risk for the pedestrian and when pedestrians are children the situation becomes more complicated. Sound transportation safety policies depend on appropriate knowledge to assess the potential effectiveness of safety programs. Since children have lower abilities to detect and determine speed of vehicles they could be at risk more than other road users. Also educational programs for children vary by their age groups and as they grow up they'll have more abilities to learn new things about coping with road risks and have more experience to save themselves. This study focused on the severity of injuries and fatalities incurred by children colliding with motor vehicles. The paper includes a review of the literature and a description of new research carried out on correlates of injury severity and measures of their relative effects on fatal or high injury collisions. The study focused on rural roads in Khorasan Razavi province. Data came from police records and forensic medicine processed from 2010 to 2015. Analysis of reported accidents during recent years showed that the number of traffic accidents sharply decreased that could be a result of educational programs along with traffic calming measure around schools. However, increase or decrease in number of fatalities or accidents could be interpreted in different ways by we need strong evidences using scientific methods to analyze the results and follow the best practices.

The 1.2 million deaths per annum globally caused by road traffic injuries (RTIs) have been likened to a plane crashing every day (1). Nevertheless, RTIs are a neglected public health concern. There were 247 road traffic fatalities in Qatar in 2010, a rate of 14.4 deaths per 100,000 people. Even though recent progress has been made, this remains three times higher than Western European countries. It is akin to a plane crash every year for Qatar. This study builds on previous analyses of death rates from RTIs in Qatar (2). However, deaths represent less than 3% of all RTIs. This study uses the much larger sample size of all RTIs for 2014. It triangulates three important sources of health sector data: ambulance, emergency department and trauma registry. It analyses 13,000 patient episodes and deconstructs in more detail than heretofore the epidemiology of RTIs in Qatar. The results identify the key demographic, temporal and geographical features of this public health emergency. Qatari males aged 15-19 have a relative risk of RTI 8-11 times higher than the general population and those aged 20-24 have a relative risk 6-9 times higher (see chart for illustration). RTIs in those aged 25 and above are overwhelmingly in non-Qataris and vary substantially in type of road use between the other Arabic and South Asian resident populations. The results also identify the temporal and seasonal effects associated with RTIs and a “heat map” of the accident “hot spots” by geographical zone. It is possible to identify with a high degree of probability which road users are most at risk of harm, when and where. Using recent insights into how predictive data is used by the insurance industry, health policy makers may be able to more effectively target regulatory, technological and behavioural interventions to those most at risk. References: Hyder A A, Puvanachandra P and Allen K A. Road Traffic Injury and Trauma Care: Innovations for Policy (Road Trip). Report for the World Innovation Summit for Health (WISH), Doha 2013. 2 Consunji R J, Peralta R R, Al-Thani H and Latifi R. The Implications of the Relative Risk for Road Mortality on Road Safety Programmes in Qatar. Injury Prevention. Accessed on 29 January 2014.

Motor vehicle collisions are responsible for a large number of ocular injuries. Although ocular injuries require an early ophthalmological examination at the time of trauma to detect any type of ocular dysfunction, some ophthalmological abnormalities are not detected after the facial injury owing to failure of referral ophthalmologists. This study aimed to investigate the prevalence of requiring ophthalmological care by evaluating the patterns and severity of ocular and severe facial injuries from real-world vehicle collisions in Japan. We collected data on vehicle passengers with any facial injuries who were involved in frontal collisions. Data were obtained from in-depth data records from the Institute for Traffic Accident Research and Data Analysis (ITARDA), Japan from 1993 to 2005. Collision information and victims’ medical data were reviewed. The 226 victims had a mean age of 33.3 ± 14.9 years with an equivalent barrier speed of 35.2 ± 13.0 km/h. Thirty (13.3%) victims suffered ocular injury or fractures in the upper or middle face (OIFF). Victims with OIFF had a significantly higher severity of injuries, especially in the face and lower extremities, and suffered from a higher speed of collisions than those without OIFF (p<0.001). Victims wearing seat belts had a significantly lower prevalence of having OIFF than those not wearing seat belts. Most of the victims with OIFF (29/30) were involved in collisions without deployment of airbags. To prevent severe ocular injuries, correct use of seat belts with airbag deployment is required. Additionally, the present study enhances that more victims with OIFF are cared for by ophthalmologists immediately after the collision, improving their quality of life and preventing conflicts owing to inadequate medical management.

On any given day, almost 3400 people die globally due to road traffic accidents. The global status report from WHO in 2013 estimates that in India alone approximately 231,000 people are killed due to RTAs yearly. The majority of the victims are unfortunately children, elderly and innocent pedestrians. Due to these astonishing numbers, in 2014 the UN General Assembly, in union with a dozen countries, adopted a resolution of “Improving global road safety”. The aim of this study is to assess the basic road safety knowledge and practices among the youth in a medical college in Kancheepuram district in Tamil Nadu. The data was collected through a cross sectional study using a semi structured questionnaire which was distributed to around 300 medical students. The data collected was then analyzed using standard statistical tests through SPSS. Of the 300 students, around 170 (56.6%) were female and 130 (43.3%) were males. All students were in the age range of 20-25 years. Overall safety awareness was more among the male population (76%) as compared to the female (70%). Majority (73%) of the participants also had a decent knowledge of safe road practices such as maintaining speed limits, wearing seat belts, waiting in zebra crossings, observing traffic signals and road signs. Majority (72%) also knew that talking, listening to loud music can be distracting during driving and driving under the influence can be fatal. However, approximately 40% of these same students admitted that they don’t put their knowledge to use and frequently fail to practice proper road safety. Thus, this study illustrates the need not only to provide education about road safety but to provide training and instigate stronger roles of local governments to implement these safer road practices. Only then can we effectively reduce the occurrence and morbidity of RTAs.

Pedestrian–vehicle conflicts are one of the most important safety concerns especially at intersections. Of total traffic fatalities, 30% and 36% are pedestrians in Qatar and in Japan, respectively (National Police Agency in Japan, 2015). Although pedestrians at signalized intersections are given priority during the green phase, turning vehicles in conflict often do not give the right of way to pedestrians but tend to compete for it. Furthermore, long crosswalks, short green times, and other reasons may cause pedestrians to rush or suddenly change their speed without paying attention to the surrounding conditions (Iryo-Asano et al. 2014). The sudden changes in pedestrian behavior while crossing cannot be predicted by the driver, which can cause severe conflicts. Therefore, the possible behavioral changes of pedestrians should be studied so that surrogate safety measures such as post-encroachment time can be quantitatively estimated to provide a reliable assessment of pedestrian–vehicle conflicts and their severities. Continuous pedestrian speed profiles were analyzed at signalized crosswalks considering the impact of crosswalk geometry and signal timing. Five signalized crosswalks at three intersections in Nagoya City were videotaped and individual pedestrian maneuvers were extracted by image processing. A stepwise speed function is proposed to identify significant sudden changes in individual pedestrian speed profiles. The locations and timings of these sudden speed change events were analyzed, and the influencing factors were statistically evaluated. Empirical analysis showed that sudden acceleration events were observed at the entrance points to the pedestrian–vehicle conflict area, which highlights the significance of these events to pedestrian–vehicle conflict analysis. More than a quarter of all acceleration events occurred just after the onset of the pedestrian flashing green signal indication. Furthermore, it is concluded that long crosswalks have higher percentage of speed change occurrence and as a result higher risk of crashes. In this regard, the application of two-stage pedestrian crossing is a potential solution to reduce crosswalk length and the possibility of having unpredicted pedestrian behavioral changes. In general, the results implied that pedestrian entering speed to crosswalk, necessary speed to finish crossing before the onset of the pedestrian red signal indication, and crosswalk length have a significant impact on pedestrian speed change choices. References Iryo-Asano, M., Alhajyaseen, W., and Nakamura, H. (2014) “Analysis and Modeling of Pedestrian Crossing Behavior during the Pedestrian Flashing Green Interval”, IEEE Transactions on Intelligent Transportation Systems, Vol. 99, pp. 1-12. National Police Agency, Japan, 2015. Fatal Traffic Accidents in 2014, http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001129473 (in Japanese).

Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children and adolescents. Adult ADHD is often underestimated and untreated, but may influence drivers’ behaviour in traffic. The objective of the present study is to clarify how symptoms of ADHD are associated with different types of traffic accidents. A subsample of the subjects of Estonian Psychobiological Traffic Behaviour Study was recruited at driving schools in 2014 (n=1288, mean age 23.9 (SD=9.9) years). The subjects completed web-based questionnaires including social-demographical data (gender, age, education) and the WHO Adult ADHD Self-Report Scale (ASRS) (Kessler et al., 2007) when they entered study. Data of traffic accidents from 2014 to spring 2015 were obtained from the traffic insurance fund. The Ethics Committee at the University of Tartu approved this study. This research was supported by the Health promotion research programme (TerVE) funded by the European Regional Development Fund and implemented by the Estonian Research Council. The subjects were categorized according traffic accidents respectively: 1) responsible for the traffic accident (n=26, 2.02%), 2) victim in the traffic accident (n=25, 1.94%), and 3) participating in traffic accident (n=47, 3.65%) – subjects who were responsible for the traffic accident and/or victim in the traffic accident. Males participated more often than females in all traffic accidents (p=0.0002), and in accidents as the victim (p<0.0001). Subjects with traffic accidents had significantly higher scores in the ADHD screen, inattention, hyperactivity and impulsivity, and ADHD total scales irrespective of category (Figure). Subjects with university education reported significantly higher ADHD scores in all subscales (p≤0.01), especially in attention (p=0.0003). All the associations between traffic accidents and ADHD measures remained significant when accounting for education. Subjects who reported more ADHD-related symptoms participated more likely in traffic accidents, both being responsible for and victim in accidents. Hence ADHD symptoms should be acknowledged in the curricula in driving schools for preventing traffic accidents. References: Kessler, R.C., Adler, L.A., Gruber, M.J., Sarawate, C.A., Spencer, T, & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2):52–65.

Presently there are about 53 lakh vehicles plying on Bangalore’s roads. The absolute number of road accidents has also been growing at an alarming rate which reflects concomitant investment in road safety strategies coupled with rapid rate of motorisation. At the same time, there is lacuna in the whole system of reporting, recording and analysing road traffic crashes. The process of building a report on ‘road accidents in Bangalore” started with data procurement, followed by entry of the data collected, and then analysis of accidents that took place in the years of 2011, 2012 and 2013. A broad accident pattern for these years was established on a macro level. It was inferred that accident occurrence varied between 14-15 accidents every day on an average, with accidents increasingly happening over week-ends, more in the evenings and late night hours and about 20% of the total casualties reported were pedestrians, followed by two-wheeler riders (37%) who are categorized as Vulnerable Road Users (VRUs). On a microscopical level, 10 blackspots were identified. As a pilot project, Blackspot treatment was initiated for Old Madras Road. A 10-pronged approach was adopted and counter measures were developed under all the four E’s – engineering, enforcement, education and emergency. The evaluation of the implemented measures showed that there is reduction in accidents on the stretch to the tune of almost 38% resulting in savings to the economy of Rs.34.64 Lakhs. This success is achieved in less than six months of implementation, and shows that rigorous implementation of the structures and processes re¬quired to realise the Road Safety Programme is the key to its success. The main conclusion of the report was that the accident blackspot mitigation should become a continuous programme and should feature in all the stake holders’ agenda and budgets.

From 3 lakh vehicles in 1985, to about 53 lakh now, vehicle population in Bangalore has increased more than five fold during the last two decades. While the vehicle population is growing by at least one lakh every year, total road length has remained the same. Many of the arterial roads and junctions are operating over the capacity and to upgrade the city's traffic management system and resulted in the creation of the Bangalore Traffic Improvement Project, B-TRAC 2010 by Bangalore City Traffic Police. The BTRAC Project was conceptualized to address traffic congestion in Bangalore by employing the latest traffic management technologies. The components of BTRAC which are a reality on ground include the state-of-the-art Traffic Management Center which is the hub of transportation management system in Bangalore, Intelligent Transport Systems, Surveillance and Enforcement Cameras, Signage, Road Markings, Street Furniture, Junction Improvements and Capacity Building. Various traffic and road safety education and training activities have also been conducted with citizens and traffic personnel throughout the city for generating awareness about traffic rules and familiarising them with the latest technologies being adapted. As a result of such consolidated traffic control and management effort, Bangalore today has a full-fledged traffic maintenance system. This has resulted in creating transparency in enforcing traffic rules and levying adequate and timely penalties. BTRAC has resulted in better management of traffic, ensuring safety and security on roads and prevention of road accidents, with the monitoring and regulation of flow of vehicles in a systematic manner. BTRAC has reduced the occurrence of road accidents in Bangalore and is creating a safe road environment for commuters. The absolute number of road accidents witnessed a growing trend till the year 2007 and then followed a declining trend over the consecutive years with 5230 cases being reported in 2013 and 5004 cases in 2014. Even the fatal accident rate is showing a declining trend over the past five years.

The use of helicopters and planes for transporting sick or injured patients to tertiary care centers is common practice. Aviation medicine requires a different perspective regarding patient care. One must consider the effects of higher altitudes on patients when utilizing aeromedical transportation. An endotracheal tube (ETT) utilizes air to inflate a balloon (“cuff”); the cuff invasively secures the ETT and the pressure must be measured and monitored. The amount of air placed in an ETT cuff to ensure a proper seal on an intubated patient varies among practitioners; without using a measuring device (manometer), ETT cuff pressures are unknown. In a critically ill patient, blood supply to the tracheal mucosa can become compromised, when ETT cuff pressures are sustained above 30 mm Hg for greater than 15-30 minutes potentially resulting in unnecessary airway trauma. Boyle-Mariotte’s Gas Law is used to measure ETT cuff pressures: Pcuff2=Pcuff1 + Patm1 – Patm2. Pcuff2 represents the final numerical value of the ETT cuff pressure. Pcuff1 is the initial pressure of the ETT cuff pressure at ground level, Patm1 is atmospheric pressure at ground level, and Patm2 is the barometric pressure at the cruising altitude of the aircraft. Based on Boyle-Mariotte’s formula, inflating an ETT cuff with a pressure of 18 mm Hg at zero feet ground level, (760 mm Hg) and then ascending to a flight altitude of 500 feet above ground level (746 mm Hg) would increase cuff pressure by 14 mm Hg. Based on an 18 mm Hg ETT cuff pressure at ground level, and ascending to an altitude of 1000 feet, the ETT cuff pressure would increase to 45 mm Hg of pressure-a critically high cuff pressure for a patient that may be hemodynamically compromised. Manometers must be utilized by aeromedical crews for the prevention of ETT cuff-induced tracheal mucosal lesions. References Bassi, M., Zuercher, M., Eme, J.J., &Ummenhofer, W. (2010). Endotracheal tube intracuff pressure during helicopter transport. Annals of Emergency Medicine. 56(2), 89-93. doi: 10.1016/j.annemergmed.2010.01.025 Mann, C., Parkinson, N., & Bleetman, A. (2007) Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport. Emergency Medical Journal 24, 165-167. doi: 10.1136/emj.2006.039933. Raynham, O.W., Lubbe, D.E., & Fagan, J.J. (2009). Tracheal stenosis: Preventable mortbidity on the increase in our intensive care units. South African Medical Journal 99(9), 645-646. Stein, C., Berkowitz, G., & Kramer, E. (2011). Assessment of safe endotracheal tube cuff pressures in emergency care-time for a change? South African Medical Journal 101(3), 172-173.

To elucidate crash and injury patterns of vehicle occupants in fatal motor vehicle accidents (MVA). A retrospective study of fatal MVA victims based on data from post mortem examinations between 2000-2014 in South East Norway was conducted. Within the 15 year period, 561 vehicle occupants killed in traffic were identified, 373 were vehicle drivers and 158 passengers. Compared with data from official statistics, this represents an autopsy rate of 40%. In 30 of 561 cases (5,3 %) a natural cause of death was identified at autopsy, all of which were chauffeurs. Investigation of the autopsy and police reports revealed 531 deaths due to severe injuries or complications related to these injuries. The main causes of death were multiple injuries (41,4 %), isolated injuries to the head/neck (32,2 %), chest (15,6 %) or abdominal (1,7 %) organs. Blunt force trauma due to direct impact to the head or chest was the main fatal injury mechanism for both drivers and passengers. Furthermore, drowning was the cause of death in 4,9 % of the cases and burn injuries in 2,3 %. Most of the cases were found dead at the scene with non-survivable injuries. Collisions associated with driving off the road (203 MVA) and frontal collisions (244 MVA) were most commonly observed. The average victim age was 41 years, 73 % were men. Obesity, represented by Body Mass Index greater than 30, was observed in 123 (23 %) of the cases. Totally 76 (14 %) were known drug and alcohol abusers. Identifying mortality patterns in real-world traffic crashes may yield knowledge crucial for prevention of future MVA fatalities. The preliminary results indicate obesity may be a risk factor for fatal outcome in MVAs.

Protection of vulnerable road users is important to reduce traffic fatality in Japan. The use of active safety devices that can detect cyclists is considered to be an effective countermeasure for reducing the severity of injuries and number of cyclist fatality. The detailed features of car–cyclist contact scenarios need to be clarified to develop such safety devices. Since there is limited information on real-world accidents, the present study investigates near-miss scenarios captured by drive recorders installed in passenger cars. In this study, we showed the similarities of the contact situations between near-miss car-to-bicycle incidents and real-world fatal cyclist accidents. Then we analyzed video frames of 161 near-miss data when bicycles were crossing the road in front of the forward-moving cars to understand the contact situations between cars and bicycles. Additionally, using a video recorded by a drive recorder, we calculated the estimated collision time from the car velocity and the distance between the car and bicycle. For the definition of the estimated collision time, the worst situation was assumed to be that when a car moved toward a cyclist without the driver realizing the cyclist and braking. The results indicated that the average estimated collision time in the cases where bicycles emerged from behind obstructions was shorter than that in the cases where drivers had unobstructed views of the bicycles. When we consider the estimated collision time in the test protocol of evaluation for safety performance of active safety devices, two scenarios should be employed; bicycle emerged from behind unobstructed views and bicycle emerged from behind obstructions.

Road traffic injuries are second leading cause of mortality in hospitals of Ministry of Health (MOH) – Kingdom of Saudi Arabia (KSA) (1), costing billions of Saudi Riyals annually (2). The Injury & Accidents Prevention Program in MOH, realizing the dearth of data about injuries, designed a uniform Injury Surveillance System in 2013, with assistance of the World Health Organization (WHO) and in collaboration with Ministry of Interior and Red Crescent. The Injury Surveillance System aimed to gather regular ongoing information for prevention and control of injuries and efficient use of resources. The pilot phase involved a multistage stratified random sample, where half of 20 health regions were selected in first stage and 14 health facilities from each region in second stage stratified by type and level of facility. A minimum of two physicians from each selected health facility were trained on the predesigned tool, adopted and modified from WHO-CDC Guidelines (3), before the start of data collection. The data on the prescribed form was collected at the healthcare facilities and communicated through Regional Coordinator to the Injury & Accident Prevention Program in MOH on regularly basis for entry and analysis. Injuries were third highest cases (15%) after falls (31%) and blunt force (20%) among the 10,008 reported cases. About 32% of drivers were reported to be over-speeding; in 13.7%, condition of vehicle was flawed; and some 13 % crashes seemingly occurred due to bad weather. The pilot identified that data from health facilities is very useful for decision making. Surveillance system is efficient and has the capacity to capture injury cases reporting to health facilities, but necessitates the inclusion of nurses and paramedics besides the attending physicians, to distribute the work load. Robust functioning of the system would require more ownership of the regional offices, besides continuous commitment of senior management at MOH. References: 1. Annual statistical report – 1431 (2011), Riyadh, Saudi Arabia, Ministry of Health 2. Al-Naami MY, Arafah MA, Al-Ibrahim FS. Trauma care systems in Saudi Arabia: an agenda for action. Ann Saudi Med. 2010, Jan-Feb;30(1):50–8. PMID:20103958 3. Y. Holder et al. Injury Surveillance Guidelines. World Health Organization, 2001

Annually 1.2 million deaths occur globally due to road traffic injuries; additionally, 20-50 million are injured or disabled ("Global status report", 2013). Concomitant with rapid socioeconomic growth, infrastructure development and increased vehicle ownership, injury, disability and mortality due to road traffic collisions are high in the Gulf Cooperation Council countries. This is also true for Qatar where road traffic collisions are one of the leading causes of premature mortality (Bener et al., 2012). Road traffic mortality in Qatar (2010) is 14 per 100,000 population. Young adult males are disproportionately affected ("Global status report", 2013). Laws pertaining to seat belt and mobile phone use exist; however, there is a lack of enforcement. We collected data regarding seat belt and mobile phone use while driving in college students, majority of whom were in the age group 18-24 years. The data was collected via a self-administered survey in two colleges. The total sample consisted of 419 students but 321 admitted to driving a vehicle. Overall seat belt use among drivers was reported at 51% “always”, 41% “sometimes”, and 8% “never”. Overall mobile phone use was reported at 23% “always”, 64% “sometimes”, and 13% “never”. Females were significantly more likely than males to use seat belt and less likely to use mobile phone while driving. Additionally, drivers at or below the age of 25 were significantly more likely to use seat belt and less likely to use mobile phone than those over 25 years old (Table 1). The results give us reliable estimates of seat belt and mobile phone use prevalence in young adult drivers in Qatar. Increased awareness and enforcement of road safety laws are required to control this epidemic of road traffic injury, disability and fatality. These findings are of public health importance and deserve our attention.

Morbid obesity is a major public health problem in high-income, developed and fast developing countries. The potential effects of morbid obesity on road crash risk have rarely been investigated. In this study, we evaluated road crash risks in morbidly obese drivers who underwent bariatric surgery. We conducted a self-matched cohort analysis of morbidly obese adult patients in Ontario (Canada) who underwent bariatric surgery between April 1, 2006 and March 31, 2011. We used a province-wide emergency department database to determine their involvement in a road crash as a driver. We compared crash incidence per 1,000 patient-years in the three-year interval before surgery to three years after surgery. The cohort included a total of 8,815 patients; most (81%) were women. About 4% (n=333) of them were involved in a crash during six years of follow-up. Of them, 175 had 182 crashes before surgery and 165 patients had 174 crashes after surgery. The road crash incidence was similar before and after surgery, i.e., 7 per 1,000 patient-years. This road crash incidence was three times higher than the population rate of 2 per 1,000 patient-years. Crash risks were similar before and after surgery among those who were diagnosed with an obstructive sleep apnea (Incidence rate ratio [IRR]= 0.95, 95% Confidence Interval [CI] = 0.73 - 1.23) and other patients (IRR = 0.96; 95% CI=0.69-1.37). Morbid obesity may be associated with increased crash risk. These findings favor crash risk assessment in morbidly obese drivers.

We assessed obesity trends in US drivers involved in fatal crashes since 1999 and distinguished whether crash risk factors were different between obese and non-obese drivers. We included drivers of passenger cars involved in fatal traffic crashes between January 1, 1999 and December 31, 2012. Obesity was classified according to the World Health Organization guidelines and profiled between 1999 and 2012 using adjusted prevalence ratio (aPR) from log-binomial regression models. Differences in crash risks (e.g., fatality, drunk-driving, seat-belt non-use) between obese and non-obese drivers were estimated as adjusted odds ratio (aOR) using logistic regression models. A total of 753,024 US drivers were involved in fatal crashes, of whom obesity information was available in 534,887. About 56% (n=299,078) were driving passenger cars. The prevalence of class I obesity increased from 10% in 1999 to 14% in 2012 (aPR=1.50, 95% confidence intervals [95%CI]=1.42-1.58), class II obesity from 3% to 5% (aPR=2.22, 95%CI=2.05-3.01), and class III obesity from 1% to 2% (aPR=2.65; 95%CI=2.27-3.10). Compared to non-obese controls, obese drivers had significantly higher risks for fatality (1.10≤aOR≤1.47), seat-belt non-use (1.00≤aOR≤1.21), need for extrication (1.01≤aOR≤1.23), and ambulance transport time ≥30min (1.01≤aOR≤1.28). Compared to non-obese controls, obese drivers were less likely to drink-drive (0.41≤aOR≤0.72) and speed ≥65mph (0.78≤aOR≤0.93).. The rising national prevalence of obesity extends to US drivers involved in fatal crashes and indicates the need to improve seat-belt use, vehicle design, and post-crash care for this vulnerable population.

Although road safety and driver behaviour have improved over the last few years in Qatar, more accidents can be prevented and still more lives saved. One simple and very important step to reduce the severity of injuries for drivers and passengers is the proper and consistent use of a seat belt (1). Since law enforcement is not always effective, additional approaches should be used. We believe a road safety culture needs to be developed amongst drivers to further reduce road fatalities worldwide (2,3). If something potentially unsafe is noticed (dysfunctional break light, low tire pressure, unsecured passengers,…) something needs to be done to correct the situation and prevent potential harm. Thinking “It is not my problem!” implies allowing that person or family to potentially suffer severe consequences relating to an oversight on their part. The approach which has been piloted by both authors consists of the following: - Stationary in the traffic near a vehicle linked with a safety breach. - Make a gentle hand wave in a welcome manner to the driver or passenger. - Open your window to amicably mention the issue or point it by for example showing your seat belt. - Upon resolution of the situation greet the person with a thumb up and a smile. The experience has been positive at an estimated 95% rate, resulting in the return of a smile, the readjustment of the unsafe situation, and even many “Thank you”. Road safety is everyone’s responsibility. Peer pressure can influence behaviour in either way depending on what is promoted (4). Such simple approach can encourage a cultural shift promoting driving safety if spread. Stickers with clear messages that can be pointed to on side windows can help communicating without opening windows and hence diminish the feeling of intimidation. References: 1- Abu-Zidan, F. M., Abbas, A. K., Hefny, A. F., Eid, H. O., & Grivna, M. (2012). Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study. World journal of surgery, 36(2), 255-259. 2- World Health Organization. (2013). WHO global status report on road safety 2013: supporting a decade of action. World Health Organization. 3- Bener A, Verjee M, Dafeeah EE, Yousafzai MT, Mari S, Hassib A, Al-Khatib H, Choi MK, Nema N, Ozkan T, Lajunen T. (2013). A cross "ethnical" comparison of the Driver Behaviour Questionnaire (DBQ) in an economically fast developing country. Global Journal of Health Science. 5(4), 165-175. 4- Shepherd, J. L., Lane, D. J., Tapscott, R. L., & Gentile, D. A. (2011). Susceptible to Social Influence: Risky “Driving” in Response to Peer Pressure1. Journal of Applied Social Psychology, 41(4), 773-797.

Recent years have witnessed acceleration in wireless technology breakthroughs that proved to be key technology enablers of a plethora of applications that have shaped our modern society. For road safety and accident preventions, wireless technologies play a pivotal role in saving lives by assisting drivers in detecting potential collisions from blind spots and in inclement weather conditions such as thick fog or heavy rain. These wireless technologies include automotive radars for collision detections, adaptive cruise control system for autonomous cars, the Internet of Things (IoT) and 5G. While the first is considered a mature technology, the others are rich research areas that promise even greater level of driver assistance, and thus an exponential decline in road accidents and a smoother traffic flow and control, with commercialization expected in the 2020-2025 timeframe. This paper presents a detailed study of the aforementioned technologies in terms of current commercial automotive solutions, relevant future research frameworks, research and commercialization timeline, overlap with other wireless technologies such as cellular communications in the context of future 5G and IoT, and underlying physics and electronics. In addition, limitations and design challenges will also be discussed. Finally, an important comparison between the number of road accidents with and without the above technologies is presented. This comparison presents a compelling evidence that wireless technologies for the automotive industry are key to the reduction of fatal road accidents and the savings of millions of human lives.

Road Safety Audits are used to identify risks and to propose remedial works on new and existing. The Safe System requires a change in focus from mitigating crashes to preventing death and serious injury. Development of the Qatar Road Safety Audit Guide (RSAG) presented an ideal opportunity to reinvigorate road safety auditing practices in accordance with the Safe System. The Public Works Authority (Ashghal) commissioned a RSAG that was to be suitable for Qatar operating environment and based on leading international practices. The Qatar National Road Safety Strategy adopts the Safe System as the model for developing and delivering road safety initiatives, it followed that the RSAG follow the same principles. This was also in accordance with the United Nations: Decade of Action for Road Safety initiative. The RSAG adopts the survivability graph (Wramborg quoted in OECD, 2008) to rank seriousness of deficiencies identified. This allows us to focus on delivering the greatest road safety benefits. Traditional checklists used in road safety audits have been revised to include the possibility of a a head-on crash at 70 km/h, a side-impact crash at 50 km/h, collide with a non-frangible object at 40 km/h or hit a pedestrian at 30 km/h. If the answer is yes to any of these questions there is a need to take action. The Safe System is progressively being implemented globally as a new approach to reducing the unacceptable number of people being killed or injured. The Qatar Road Safety Audit Guide has successfully demonstrated that the Safe System can be integrated into road safety auditing practices. References Organisation for Economic Co-operation and Development (OECD). International Transport Forum. (2008). Towards Zero: Ambitious Road Safety Targets and the Safe System Approach Retrieved from http://www.internationaltransportforum.org/Pub/pdf/09CDsr/PDF_EN/TowardsZero.pdf New Zealand Transport Agency (NZTA). (2013). Road safety audit procedures for projects: Guideline (interim release). Wellington Retrieved from http://www.nzta.govt.nz/resources/road-safety-audit-procedures/docs/road-safety-audit-procedures-tfm9.pdf