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

Helmets save lives, yet many countries do not have laws about their quality assessment or how they should be worn. We assessed the effectiveness of helmet use in preventing injuries in such a setting. The data were extracted from a large road traffic injury surveillance study in Karachi, Pakistan. We assessed the association of wearing helmets with several injury outcomes including deaths, injury severity (via New Injury Severity Score, NISS ≥ 9) and moderate or severe injury (via Abbreviated Injury Score, AIS ≥ 2) to head, face, or other regions of the body. The data about helmet use was available for about 109,210 riders injured between January 2007 and December 2013. Only 6% of riders wore helmets, whereas this proportion was less than one percent in pillion riders and women. The rates were also lower among those aged 18 years or younger (1%) and those aged 18 to 25 years (4%). About 2% of riders died; 34% had an injury to the head region, 30% to face, 1% to chest, 5% to abdominal, 46% to extremities, and 61% to external body regions. Likelihood of dying was low among helmet users (adjusted odds ratio [aOR] = 0.37, 95% confidence interval [CI] = 0.28 to 0.50). Helmets reduced the likelihood of moderate to severe injuries to the head (aOR = 0.68, 95% CI = 0.58 to 0.80) but not to the face region (aOR = 1.37, 95%CI = 1.17 to 1.62). Helmet users also had severer injuries in other body regions except for chest injuries. Helmets prevented deaths and severe head injuries but had limited effectiveness in preventing facial injuries in this setting with poor helmet use standards. More work is needed to understand the helmet wearing and rider behaviours in helmet users in this setting.

Significant reductions in road trauma among young drivers could be achieved if they drove safer vehicles. Parents are likely to play a critical role in the access, timing of vehicle purchase, available budget, and vehicle choice for the young driver’s first vehicle. However, little attention has been directed to understanding the most effective communication strategies to encourage young drivers and their parents to purchase and use safe vehicles. This study was undertaken to examine existing strategies in Australia and provide recommendations for improving communication initiatives. A two-staged study was undertaken including in-depth consultation with representatives from key road safety stakeholders groups to identify current initiatives, and development of conceptual model to identify current and potential improvements to communication strategies. The findings of the consultation phase showed that a sporadic and un-coordinated approach was used regarding the promotion of key messages for purchase and use of safe vehicles and there was some suggestion that the communication medium, content and message style may not reach the target audience in the most effective way. Stakeholder representatives were unanimous in the argument that parents play an integral role. A conceptual framework was developed, depicting key stakeholders in Australia and the various interactions across stakeholders. This was instrumental in identifying areas where effective communicative initiatives and resources could be considered to increase the purchase and use of safe vehicles, including development of a widespread and accessible website and inclusion of vehicle safety choices in young driver education and training programs. The results of the study suggest that a National Framework that co-ordinates government and non-government activities and initiatives aimed at encouraging the purchase and usage of safer vehicles by parents and young drivers should be developed. The methodology can be applied to other countries to develop similar communication campaigns.

Speeding remains a major contributor to trauma on our roads, held to be a major factor in around one-third of fatal crashes and over 10 percent of all crashes (Bowie & Walz, 1994; Fildes & Lee, 1993). This study reviewed speed management strategies and key factors that should be considered through a comprehensive review of the literature. One of the most frequently used methods of managing travel speeds is the posted speed limit. The primary purpose of the speed limit is to advise drivers of the maximum reasonable and safe operating speed under favourable conditions, therefore considered to be a road safety measure. Further, speed limits are designed to be (i) related to crash risk, (ii) provide a reasonable basis for enforcement, (iii) fair in the context of traffic law, and (iv) accepted as reasonable by most road users. Traditional approaches to setting speed limits (e.g. engineering approach using the 85th percentile speed) are compared with an alternative view to setting speed limits: the Safe System approach. This approach requires that all aspects of the system work together for the safest possible outcome, with speed representing a critical component. The findings suggest that there are some inherent issues in traditional speed limit setting guidelines, particularly as drivers lack awareness of the true relationship between speed and road trauma, under-estimate crash and injury risk and over-estimate what is a safe speed, and that there is often a mismatch between environmental cues and speed limits. There are opportunities to review and strengthen speed management policies and practices with a view to creating environments that promote safe behaviour rather than relying on drivers/riders to decide what is a safe speed, complemented by strengthened Police enforcement and increased community knowledge and awareness of the importance of speed to road trauma.

Around schools, increases in walking and cycling help to reduce traffic congestion and improve the road safety and neighborhood navigation skills of children. Physical activity and independent mobility may also have a positive effect on children’s behavioural and cognitive development. Child pedestrians, however, are a vulnerable road user groups, experiencing an increased crash and injury risk relative to older pedestrians, constituting a substantial proportion of all pedestrian fatalities and serious injuries, with children below the age of 10 years of age shown to have four to 11 times greater risk of collision compared to other pedestrians, and they frequently occur around schools. In fact, vehicle collisions involving children pedestrians are considered as the most serious health risk facing children in developed worlds. School safety evaluations were conducted involving four components: i) site visits providing physical assessments of current road conditions, ii) consultation with key groups including school principals and Local Council representatives, iii) desk-top review of available behavioural and training programs, iv) workshops to develop recommendations for appropriate and sustainable conceptual solutions. Using a number of case studies, the findings suggest that evidence-based and consultative selection of initiatives can be effective in encouraging walking and cycling while providing a safer environment around schools. This can be achieved through implementation of multi-faceted initiatives including engineering treatments to enhance the safety of the physical environment around the school and on popular routes to school, as well as sustainable educational/training programs for both students and parents. Evidence-based safety assessments are useful to develop a Safe System environment around schools. A combination of improvements to road design and operation, especially vehicle speed reductions and separation of vehicles and pedestrians, and behavioural programs to improved education and training, along with enhanced supervision can achieve sustainable reductions in child pedestrian trauma around schools.

The Department of Transport (DoT) in Abu Dhabi has recognised that while minibuses play a key role in transporting people within the United Arab Emirates, levels of fatal and serious injury among minibus occupants in crashes are high. As a first step toward addressing this problem, the DoT commissioned a benchmarking study to gain an understanding of the state of the minibus fleet, focusing on fundamental vehicle safety aspects, as well as fitment rates of safety features such as airbags and stability control systems. Furthermore, the in-service condition of vehicles was also assessed. Data was collected from 566 minibuses in Abu Dhabi and Dubai, comprising more than 80 separate data points characterising the presence, nature and condition of each vehicle. An innovative system was developed to combine these variables to yield a weighted safety score that allowed them to be grouped into categories for later input into a benefit cost analysis of a replacement program. A star rating system was used for the categorisation process because it allows for good discrimination between safety levels while remaining easy to comprehend. The results of the benchmarking study showed that despite the fleet being quite uniform by make and model, there was considerable variation among individual vehicles in terms of seat belt fitment rates and rear passenger compartment seat mounting integrity in particular. Many vehicles in current operation are deficient both in terms of primary and secondary safety, compounded by inconsistent fitment of passenger seat belts. This in-depth survey has provided significant additional information unavailable from registration data and provides a valuable insight into the state of minibus safety in the UAE. The data acquired will be used to conduct a benefit cost analysis targeted at determining the optimal means for implementing significant improvements to the minibus fleet.

Controlling the speed of vehicles on various roads and streets is crucial in order to maintain the safety of people and to prevent any possibility of injury or death. One technique that is widely used in Qatar to force road users to reduce their vehicles’ speed is the installation of speed humps and tables. In this study, an evaluation of speed humps and tables in selected areas of Qatar was conducted, since they vary in shape and size and many complaints are raised about their inverse effect on driving safety. The aim of this study was to observe the condition of these traffic calming measures in Qatar. The condition of speed humps and tables was investigated by classifying them based on their dimensions, and verifying if they were constructed according to Ashghal’s standards. The following areas were selected for the study: Qatar University, Male Campus (fully covered) and three neighborhoods: Al-Aziziya, Al-Mura and Al-Waab (partially covered). Two parameters were taken into consideration, height and length of both speed humps and tables. Measurements were taken through site visits to each area, recording dimensions of each speed hump and table using measuring tools as well as taking photographic pictures for reference. The results show considerable variation in height and length dimensions of speed humps and tables. By comparing these results with Ashghal’s standards, it was found that for speed humps, few matched the standard specification for height, but almost none matched the standard for length. None of the speed tables met the standard for both height and length dimensions. The study concludes most of the speed humps and tables in the areas covered in the study do not meet Ashghal’s standard specification for height and length dimensions and re-construction according to standards is recommended.

Since 2010, Sweden presents suicides in road traffic separately from fatalities caused by accidents. The aim with this study was to assess the number of road traffic suicides by studying the fatality from three angles; the vehicle, the road and the road user. The main focus was to develop and perform a psychosocial examination of the road user. First, a method was developed for classification of road fatalities to determine if they were caused by accident or suicide and criteria was developed for selection of cases that are to undergo the classification process. The examination of the road user was performed in cooperating with accident investigators at the Transport Administration, the police, relatives, witnesses, as well as with information from autopsy reports, and case records from earlier medical service. During 2012, an investigator in behavioural science, experienced from counselling at hospitals conducted the examinations. The suspected suicides were classified by an expert group of five persons with knowledge in forensic medicine, psychology and traffic safety using the classification system. First, the classification was made without the psychosocial examination. A second classification was performed with the additional psychosocial information. Forty-nine cases were studied. In 2012, twenty-two (7%) cases were classified as suicides without the psychosocial information and thirty-six (11%) with all information included. The unclear cases were reduced from 20 to 8. From 2013 and forward the classifications were made only once with all information. In 2012-2014, 89 (10%) fatalities were classified as suicides. Year 2010-2011, when the classifications were made without additional psychosocial information, 6% of the fatalities were classified as suicides [Skyltfondsprojekt;TRV2011-13351]. By including psychosocial factors in the classification of suspected suicides the number of unclear cases were reduced. In order to work with suicide prevention the size and the pattern of the problem must be known.

Not all fatalities in road traffic are accidents; some are suicides. Since 2010, Sweden have been presenting suicides in road traffic separately from fatalities caused by accidents. To carry out this task a method has been developed for classification of road traffic fatalities in order to determine if the fatality was caused by accident or suicide. A five-grade classification scale was developed. Grade one indicated a clear suicide and grade five a clear accident. The definition of grade one was suicide with a clear statement of the suicidal intent. Grade two indicated an almost certain suicide but the intention was based primarily on the course of event and psychosocial information of the road user. Grade three indicated that the information was not sufficient to determine whether the fatality was the result of a suicide or an accident and grade four indicated an almost certain accident. Fatalities in grade one and two are classified as suicides. Criteria for cases that are to undergo the classification process include to examine the traffic event together with knowledge of background factors, for example prior suicide attempts, indirect suicidal communication, knowledge of ongoing depression etc. From 2012, the classification has been performed with additional information from a psychosocial examination. From 2010 to 2014, a total of 128 fatalities have been classified as suicides, 46 as grade one and 82 as grade two. From 2012 to 2014, when the psychosocial information was included in the analysis, 10% of all fatalities were classified as suicides. Analysis of gender, age, collision types, influence of alcohol, use of seatbelt, time etc., has been performed. The method can be used to determine which fatalities in road traffic are caused by suicide or accident. The method can be used on all modes of transport.

The aim of this study was to determine the incidence pattern of the burden severe traumatic brain injuries (TBIs) among young children in Qatar and to suggest practical prevention policies that can be implemented in Qatar. This is a retrospective study that included all pediatric cases of severe TBI during the period from January 2002 to December 2008. The study was conducted among children aged 14 years or less at the Children Rehabilitation Unit, Pediatric Department, Hamad General Hospital. The Glasgow Coma Scale (GCS) was used to assess severity of TBIs. This study was based on 65 children suffering from severe traumatic brain injury, of which 12 of them died within the first month of admission in pediatric intensive care unit. The predominant gender was male (73.8%), of which non-Qataris form 50.8%. Predominant mechanisms of injury were road traffic accident (84.6%), then injuries due to falls (10.8%), followed by sports and recreation injuries. Among our patients 43.1% had spasticity, 33.8% experienced posttraumatic epilepsy. Better outcomes were observed after severe TBI among older children. The current study revealed that 24.6% had communication disorder, 26.2% had poor cognition, 24.6% had hemiplegia, 18.5% had abnormal behavior and 15.4% had a vegetative state. All the patients (98.5%) required physiotherapy and occupational therapy, 50.8% of them required speech therapy and swallowing assessment. Further, 47.7% required braces either ankle foot orthosis or hands splints; also, 16.9% required behavior therapy and we have used Botox injection in only 6.2% of the spastic patients. Finally, the incidence of TBIs from road traffic crashes and injuries in Qatar are increasing significantly compared to other developing and developed countries. In conclusion, the present study findings provided an overview of TBI in Qatar and mostly related to the road traffic crashes and injuries.

An increasing part of the global population holds a driver’s license. Thus, a greater variety of prerequisites regarding the fitness to drive will occur, increasing the demand for assessing fitness to drive. However, today, there is a lack of internationally agreed upon methods for assessing the fitness to drive. Specifically, there is a need to develop methods to assess cognitive abilities required for driving safely (Hird, Vetivelu, Saposnik, & Schweizer, 2014; Vrkljan, Myers, Crizzle, Blanchard, & Marshall, 2013). The aim of the present project was to develop an objective and scientifically valid method for assessing cognitive aspects of the fitness to drive in a few targeted groups. The aim was to design and implement a mini-simulator for assessing fitness to drive. The target groups included stroke, mild cognitive impairment, ageing and ADHD. A mini-simulator as well as test scenarios for the assessment of cognitive aspects of fitness to drive was designed (see figure 1). A literature review was undertaken regarding previous research on assessing fitness to drive in the targeted groups. The features of the focused diagnosis were studied regarding underlying cognitive impairment with bearing on driving ability. Each scenario of the simulator drive was designed to enable assessment of these cognitive abilities. Examples of diagnose features that were included were risk taking, distraction, impulsivity, inattention, cognitive flexibility, overconfidence, reaction time, responsiveness, neglect, divided attention and memory. A fixed based mini-simulator was built (Figure 1). To assess the cognitive features mentioned, a road stretch was designed. The road included rural road, highway and urban road. The speed limits varied as well as the landscape surrounding the road. Along the road, different, more or less critical situations, were staged enabling assessment of the targeted cognitive abilities. The mini-simulator met the expectations regarding a good implementation of the simulated scenarios. Future research include validation of the mini-simulator and the scenarios. References Hird, M. A., Vetivelu, A., Saposnik, G., Schweizer, T. A. (2014). Cognitive, On-road, and simulator-based Driving Assessment after Stroke. Journal of Stroke and Cerebrovascular Diseases, 23(10), 2654-2670. Doi.org/10.1016/j.jstrokecerebrovasdis.2014.06.010 Vrkljan, B. H., Myers, A. M., Crizzle, A. M., Blanchard, R. A., & Marshall, S. C. (2013). Evaluating medically at-risk drivers: A survey of assessment practices in Canada. Canadian Journal of Occupational Therapy, 80(5), 295-303. Doi: 10.1177/0008417413511788

Providing safe roads around schools is a challenge faced by all communities. Children’s behaviour is unpredictable and their safety is of particular concern in an area where there is often a mix of vulnerable road users and motor vehicles. In 2011, Ashghal commissioned a major road safety contract to conduct road safety assessments at 200 schools throughout Qatar. The results have since been collated into a comprehensive school safety improvements program and Ashghal is now constructing safe and convenient school zones for all road users throughout Qatar, based on the principles of a Safe System. The Qatar National Road Safety Strategy (2013-2022) has a vision of “a safe road transport system that protects all road users from death and serious injury” and adopts the Safe System as the guiding principle for building safe roads. The Safe System acknowledges that people make mistakes and that there is a limit to human injury tolerance. For example, a pedestrian hit at 30km/h is likely to survive (OECD, 2008). Whereas, a pedestrian hit at 60km/h is likely to be killed. Schools in Qatar are being treated with standard traffic engineering measures in a way that aims to achieve a Safe System 30km/h environment. Schools that have been completed show tremendous success and the benefits are being directly felt by parents, teachers, children and key stakeholders. Survey results show that vehicle speeds within school zones are successfully lowered to Safe System limits and that these speed reductions are being achieved over a 24 hour period without the need for Police enforcement. The improvements carried out to date have been well received and are seen as a positive step towards Qatar’s ambitious road safety vision. Site observations and speed surveys undertaken to date support the proposition of developing Safe System schools in Qatar. References: Qatar National Road Safety Strategy (2013-2022) Marsh, F. Principles of road design under a Safe System. ITS & Road Safety Conference, 22-23 September 2014, Doha, Qatar. OECD (Organization for Economic Cooperation and Development), 2008. Towards Zero, Ambitious Road Safety Targets and the Safe System Approach, In International Transport Forum, OECD Transport Research Centre, Paris. UN (United Nations), 2011. Global Plan for the Decade of Action for Road Safety 2011-2020, UN Road Safety Collaboration, Geneva.

Road traffic accidents are an emerging public health problem. The deaths due to road traffic injuries represent only a small fraction of the total waste of human and social resources. Road traffic injuries leading to disabilities are often neglected part of the problem. In the year of 2010, it was reported 2721 have died and 26487 have sustained injuries due to road traffic accidents. Sri Lanka being a middle income country, the information on disability following road traffic injuries is scarce. Therefore, a descriptive cross sectional study was conducted to describe the functional disability of road traffic injury patients. A descriptive cross sectional study was conducted among 881road traffic injury patients admitted to the National Hospital of Sri Lanka. The functional disability of activities of daily living was assessed on admission and after three months of hospital discharge using validated Sinhala version of 10 item- Barthel Index. The total score of the index was 0 to 20 and score of less than 19 was considered as functional disability. Injury severity was measured using Injury Severity Score (ISS) based in Abbreviated Injury Severity Scale (AIS). There were 793 (90.1%) males and 88 (9.9%) females. Of them 551 (56.9%) had sustained injuries to one AIS body regions, 322 (36.5%) and 58 (6.6%) had sustained injuries to two and three or more than three AIS body region respectively. The mean (±SD) total score of Barthel Index on admission and three months after discharge were 12.8(±4.4) and 18.2(± 2.9) respectively. Functional disability was observed in 91.1% of the injured at admission and 33.9% at three months after hospital discharge (p=0.00). At three months after the injury significant increase proportion of functional disability was observed with increase number of body regions injured (p=0.000) and with increase injury severity (p=0.000). Functional disability of road traffic injury patients on admission had reduced to 33.9% at three months after discharge from the hospital. One third of the study population was having functional disability at three months of the hospital discharge is note worthy to take actions.

Driving is a visually demanding task (Kotecha, Spratt and Viswanathan, 2008). Does individuals with visual deficits fulfill the “Fitness to drive” criteria? The developed simulator based method presented below was driven by the purpose to be able to discriminate between individuals with and without visual deficits. (Owsley, Wood, and McGwin, 2015). An advanced driving simulator was used to develop a simulated driving task, which also included a choice reaction test performed while driving on a rural road. Twenty-four drivers with various visual field impairments were compared to 55 drivers without visual defects. Two types of traffic signs positioned 5, 10, and 15 degrees (left, right) horizontally were used as stimuli. The test included both single and double stimuli. Drivers reacted by pressing buttons attached to the drivers fingers. It was found that the visually impaired drivers reacted 23% slower (1.46s vs. 1.19s) and had 14% less correct number of hits (74% vs. 84%) for single stimuli trials. Reaction time for double stimuli trials was 15% longer (1,68s vs. 1.46s) and hit rate was 27% less (69% vs. 88%). When the results from a secondary trial for drivers visual impairments were compared the normal sighted drivers’ first try the differences decreased but were still statistical significant. For single stimuli 17% slower, 5% less correct and for double stimuli 5% slower and 13% less correct hits. It was concluded that the developed test was useful in order to detect performance differences between drivers with visual impairments compared to drivers with an unimpaired visual field. However, the test should be completed with other performance assessment of more naturalistic critical traffic situations in order to be used as an instrument to measure “Fitness to drive”. Furthermore, the analysis needs to be complemented with an analysis which consider diagnosis and cognitive status.

Backgrounds: Pre-hospital emergency call is a crucial index to indicate emergency disease spectrum. For Beijing, which has changed greatly in economy and population, analyzing the trend of the emergency disease spectrum can greatly contribute to formulate the pre-hospital emergency planning. Methods: In this 10-year retrospective study, pre-hospital emergency records of Beijing Emergency Medical Center from 2003 to 2012 were collected. Medical Priority Dispatch System was used to classify the call demands. Linear regression models were constructed to examine the changing trends. Results: 2,410,575 cases were collected, and 2,278,415 of them were analyzed in this study. The results showed that: 1. In the past decade, the number of pre-hospital emergency call demands soared from 150,656 to 309,297 (204.6%, 2012/ 2003, p<0.001). 2. The top five call demands based on the rank of proportion were trauma related demands(25.4%, including falls（5.0%）, traffic/ transportation incidents(7.2%) and traumatic injuries(13.1%)), sick person(17.7%), heart problems(11.4%), unconscious/fainting（10.0%） and breathing problems（8.1%）Also, they were the top five fastest growing call demands. Conclusion: Compared with the growth of population (145.4%, 2012/2003), pre-hospital emergency calls increased much more, which shows a growing desire on ambulance service. Different from developed countries, the proportion of trauma related cases was constantly in the top rank and continuously increasing, much higher than that in San Francisco (15.7%), which could be resulted from accelerated city construction and rapid augment of vehicle quantity(244.8%, 2012/ 2003). Based on the changes and trends of pre-hospital emergency disease spectrum, it is encouraged to provide specific training program for emergency medical service staff and improve related medical devices. Note: Beijing emergency medical center is the only pre-hospital emergency system of Beijing government

Objective: This study aims to evaluate the effects of standardization processes in improving severe trauma treatments in China. Methods: This study was conducted in 12 hospitals located in 12 geographically and industrially different cities in China. A standard process on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating pre-hospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and one year after the implementation of standardization processes. Results: The outcomes of a total of 74,615 and 12051 cases of severe trauma were collected from 12 hospitals before the implementation of standardization processes. Implementation of the standardization processes led to efficient cooperation and information sharing of different treatmen services. The emergency response time, pre-hospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24±4.32、45.69±3.89、6.38±1.05、17.53±0.72 minutes, and 33.82±3.87%, n=441,respectively before the Implementation of the standardization and significantly reduced to 10.11±3.21、22.39±4.32、3.26±0.89、3.45±0.45 minutes, and20.49±3.11 %, seperatly, n=495, (P<0.05) after that. Conclusion: Staff training and standardization processes can significantly improve the treatment efficiency of severe trauma based on current personnel and organizations of severe trauma treatments in China.

This research considers a Bayesian analysis of crash data in an attempt to predict, from a group of potential collision hotspot sites, which of these sites could benefit from treatment with a road safety scheme. Intrinsic to the analysis is the identification of trend and site-specific regression to the mean (RTM) effects. As in a standard retrospective before-after study to evaluate the effectiveness of a change in e.g. the geometric design of an intersection, observed collision rates are adjusted using values from a suitable crash prediction model (CPM). In any year, collision rates, which are unusually high/low will be suitably depressed/inflated according to the posterior distributions for collision rates at each site, hence giving a more realistic summary of safety in that year. Where site characteristic information (e.g. annual figures for average speed or traffic flow) for use in the CPM is limited, standard techniques from time series analysis are employed to exploit any time dependent (autoregressive) structure observed in historical collision rates at each site. The Bayesian posterior predictive distribution is then used to predict collision rates at each site in future years, having adjusted for trend, RTM and any autoregression in collision rates at each site. This equips road safety practitioners with the necessary methodology to identify, and possibly treat, such locations before these collisions occur and this has the potential to help, inform, and direct, investment in future road safety schemes. In this research, crash data from the United Kingdom and Germany were analysed, and results have shown that this methodology is transferable between regions. The methodology is currently being implemented into a prototype software application to be tested by local road safety practitioners later in the year in the UK.

Road traffic injuries (RTI) are the leading cause of death in Qatar with one in eight deaths from all causes due to RTIs. Furthermore, motor vehicle crashes (MVC) are becoming a growing public health problem and the use of seatbelt is universally low throughout the nation. The aim of our study was to investigate and highlight potential socio-demographic risk factors that contribute to seatbelt non-compliance. A prospective cross-sectional survey of all adults admitted with orthopaedic injuries following a MVC was conducted. A physician-administered questionnaire was used to interview all patients. Univariate and multivariate logistic regression analysis was carried out to examine the association of various risk factors and seatbelt compliance. One hundred and seventy one patients were interviewed over a twelve-month period. Of the 171 patients, 103 patients (60%) (92 males, 11 females) were not wearing a seatbelt compared to 68 patients (59 males, 8 females) wearing a seatbelt. The mean age of the non-compliant patients was 32.8 years compared to 33.8 years of the compliant patients. Seatbelt compliance was associated with gender (OR: 11.3), nationality (ORs: 7.6 and 1.9), position in the car (OR: 14.2), education of the patient (ORs: 25.9 and 30.5), time of the injury (OR: 3.3), marital status (OR: 6.5), awareness of seatbelt campaign (OR: 5.9) and owner of a vehicle (OR: 11.2). The majority of non-compliant patients were single males from a Middle Eastern background that we involved in a MVC during the weekend. The majority of patients admitted with orthopaedic injuries following MVCs were not wearing seatbelts. The majority of non-compliant patients were driving 4WD vehicles and had crashes on main roads. A further national seatbelt campaign is required to promote the importance of seatbelt compliance amongst young male drivers with more stringent traffic penalties.

Hearing loss (HL) is one of the most frequent sensory deficit in humans (Stevens et al., 2013), which might reduce traffic safety. The prevalence of age-related HL is increasing (Roth et al., 2001), and as a consequence the number of road users with HL will also increase. The effects of HL on traffic safety have been investigated and the use of tactile support systems has been evaluated both in a driving simulator and in real traffic. Tactile support was used to alert the driver during the simulator drive and to facilitate navigation with a GPS during the drive in real traffic. Differences related to HL in terms of driving behavior were bound to driving condition and occurred when complexity of driving task increased. There was also an effect of HL on visual behavior, indicated in the simulator and confirmed in the field study, suggesting that drivers with HL have a more active visual behavior with more frequent glances in the rear view mirror and a general scanning of the environment before looking away from road. Tactile signal in the driver seat was found useful, both for calling for driver attention and to facilitate navigation. Also, of high relevance for the traffic safety aspect and regardless of hearing status, the tactile support lead to higher satisfaction with the navigation system, less time spent to look at the navigation display, and thus more focus on road and better driving performance. The effects of HL on traffic safety consistently point towards a generally more cautious driving behavior. Compensatory strategies associated with HL include driving at lower speeds, more comprehensive visual search behavior and less engagement in distracting activities. Evaluation of a tactile signal suggests that by adding a tactile modality, some driver assistance systems can be made accessible also for drivers with HL. At the same time the systems might be more effective for all users, which could generally increase both traffic safety and mobility. Roth, T.N., Hanebuth, D., & Probst, R. (2001). Prevalence of age-related hearing loss in Europe: a review. European Archives of Oto-Rhino-Laryngology, 268(8), 1101–1107. Stevens, G., Flaxman, S., Brunskill, E., Mascarenhas, M., Mathers, CD., & Finucane, M. (2013). Global and regional hearing impairment prevalence: an analysis of 42 studies in 29 countries. European Journal of Public Health, 23(1), 146–152.

Cardiovascular diseases (CVDs) are number one reason for human mortality around the world (Fig. 1) [1]. Pulse pressure (PP) and pulse rate (PR) are considered as the two most vital physiological markers for CVDs like myocardial infarction, cardiac arrhythmia, and heart failure. Currently, long-term PP and PR analysis is not possible due to the lack of systems that can frequently measure the data over a period of time. Motor vehicle drivers with known CVDs are at higher risk due to traffic air pollution. This paper presents our work on an inexpensive and readily deployable approach that keeps track of PP and PR with simple cameras. The computation of PP and PR makes the real-time monitoring possible. The approach makes it highly customizable and ready for on-the-go use in field by drivers, construction zone workers, healthcare workers, law enforcement agencies, etc. The video recordings of fingertips were made using a cellphone camera. The analysis extracted the pulse pressure, which was the difference between systolic and diastolic pressures, and pulse rate. The PP measured with this system was compared with a standard off-the-shelf tool. The comparison showed high accuracy. The measurement of PRs also showed a high level of reliability in comparison to the standard tool. The fundamental concept of the technology depended on the measurement of blood quantity in the fingertip arteries. The amount of blood on fingertips was different during systolic and diastolic phases. This created light intensity variations, which were extracted by analyzing the video frames. A simple embodiment of this approach can be in the dashboard of cars with a camera to create short high-resolution videos of fingertips. The doctors can remotely monitor their patients through a standard computer interface. The patients can also be trained to interpret the results of the measurement. References: 1. WHO Fact Sheet No. 317. www.who.int/mediacentre/factsheets/fs317/ (Accessed 29 Jul 2015) 2. 1950 Mortality Data: “Leading Causes of Death, 1900-1998,” Centers for Disease Control and Prevention Website (www.cdc.gov/nchs/nvss/mortality_historical_data.htm). 3. 2011 Mortality Data: Hoyert and Xu, “Deaths: Preliminary Data for 2011”, National Vital Statistics Reports, vol. 61, no. 6, 10 Oct 2012

In a report by the WHO Eastern Mediterranean Region(1), the non-use of child restraints for children was identified as a key risk factor that can be addressed by the adoption and enforcement of legislation that will increase their use. Currently, there are no child restraint laws in Qatar. The objective of the study is to report baseline data on child restraint use and to provide evidence to inform the passage of child passenger restraint laws in Qatar. This roadside observational survey was conducted as part of the Young Kids in Safe Seats Project funded by the Qatar Foundation. Trained observers conducted roadside observations of passenger restraint use in vehicles with children, less than 5 years, at 12 sampling sites. Standard data was collected per observation: seating position, restraint used and appropriateness of restraint used. Of 2232 observations of young child passengers: 41% were properly restrained, 21% improperly restrained and 38% unrestrained, 10.9% were on an adult’s lap. The most common seating location was right second row followed by left second row. These 2 locations also had the highest rates of proper restraint use. The positions with the lowest restraint use were the front and second row middle seat. One in 9 children observed was illegally seated in the front row, most on the lap of an adult [38.3%] or unrestrained [34.4%]. This is the first observational study in Qatar that measures child restraint rates in children younger than 5. Less than half of these children are traveling safely. Priority areas for intervention include: enforcement of existent laws banning children in the front seat, education about the risks for children in an adult’s lap and encouraging the proper use of age/size appropriate restraint systems. These findings can inform the development of national child passenger restraint laws. Reference: 1. Road safety in the Eastern Mediterranean Region Facts from the Global Status Report on Road Safety 2013.

Mortality for young children in motor vehicle crashes in Qatar was highest in those who were unrestrained1. Anecdotal reports have attributed low car seat use to their expense and unavailability prompting car seat giveaway programs, but an assessment of the local car seat market has not been conducted previously. This study will report the results of a rapid market survey (RMS) to understand the availability, characteristics and the cost of child restraints and make recommendations for future child restraint policies and legislation in Qatar. This RMS was conducted as part of the Young Kids in Safe Seats Project funded by the Qatar Foundation. The survey involved locating all retail outlets that sell child restraints in Qatar and collecting standard data on each restraint system: brand, model no. age/weight limits, compliance with standards, availability and language of owner's manual. The RMS showed a sufficient number and variety of car seat models [83] available at 19 retail outlets with a wide affordability range [$46 - $810]. All of the car seats complied with the European standard. Only 2% showed a date of manufacture or expiry. A user manual was available in only 71% of seats and in a variety of different languages, but only 36% in the native language of Arabic. This RMS demonstrates the availability and variety of child restraint systems in Qatar. Unavailability and expense cannot be cited as barriers to their use and the market is prepared for legislation requiring car seats for children in Qatar. Areas for improvement include: requiring user manuals for all seats, especially in Arabic, that all car seats comply with globally accepted safety standards, especially expiry/manufacturing dates, given the harsh local climate, and encouraging more variety in the local markets. References: Consunji RJ, Peralta R, Al-Thani H and Latifi R. A focused approach to the road safety of young children in Qatar. Oral Presentation. 2nd Annual Child Health Research Day. Sick Kids International/Hamad Medical Corporation Partnership. 28 January 2012. Doha, Qatar.

Introduction: In Sweden, physicians are required to report dementia patients who are unfit to drive to the Swedish Transport Agency (STA). However, physicians may refrain from reporting if there is reason to believe that the patient will cease to drive as part of an agreement. Aims: To investigate to what extent physicians address driving and dementia, and whether there is a difference in how the issue is addressed depending on patient-related factors. Material and Methods: Data on 13852 newly diagnosed dementia patients, who held a driver's license, was obtained from the Swedish Dementia Registry. Associations between patient-related factors and being reported, or an agreement being reached, were examined in binary logistic regression. Results: Physicians had not taken any action in 17% of cases. Male gender (OR 2.97, p<0.001) and living alone was associated with an increased likelihood of being reported to the STA. When compared to Alzheimer's disease (AD), Frontotemporal dementia (FTD) displayed a similar association (OR 2.38, p<0.001), while the inverse was observed in dementia with Lewy body (DLB) (OR 0.58, p=0.025). Conclusions: Physicians, collectively, omit to address the issue of diving and dementia in almost 20% of dementia patients, and are thus noncompliant with national law and regulations. Furthermore, a difference in practice was observed in patients with DLB and FTD, but more evidence is needed in order to determine what the practical implications are.

Young driver overrepresentation in road crash deaths and injuries is observed worldwide including Qatar. Multiple independent factors contribute to this high risk including age, brain development and inexperience. These factors also explain young drivers' high level deliberate risk taking behaviors including speeding. A Graduate licensing scheme (GLS) which requires new drivers to pass through multiple licensing stages (each with specific restrictions) before obtaining a full license is utilized in many countries to manage the risks of these drivers coming out of constrained learner license conditions (e.g. Australia, USA, Canada, South Africa, United Kingdom). For example, in the state of New South Wales (NSW), Australia, drivers are required to go through three licensing stages?Learner license for at least 12 months, provisional P1 license for at least 12 months, and provisional P2 license for at least 24 months. Specific restrictions apply at each license stage (e.g. Learners to observe a maximum speed limit of 80 km/h; P1 a maximum of 90km/h; P2 a maximum of 100km/h) in addition to the NSW Road Rules which apply for all license holders. The successes of GLS in reducing crash risks have been demonstrated in multiple evaluations. In July 2007 NSW introduced additional license conditions for P1 drivers including automatic license suspension if caught for any level of speeding. This tougher penalty for speeding is intended to increase deterrence for speeding and for novice drivers based on evidence of young driver over-representation in serious speed related crashes. This change brought about a 34% reduction in deaths involving novice drivers. It is recommended that GLS be implemented in Qatar with tightened license conditions for novice drivers to address the young driver serious crashes in Qatar.

Experience of the State of Qatar Introduction: Since the second half of the last decade of the twentieth century, Qatar has witnessed the implementation of a comprehensive development plan in various economic, urban and social scales. This comprehensive plan granted greater attention to developing the infrastructure and providing the necessary facilities. Road network development, with world-class engineering standards, was conducted with a view to improving the transportation system and providing suitable conditions for its sustainability. Another objective was to align the carrying capacity and design components of this system with the increase in the number of vehicles and population in the wake of the rising numbers of foreign workers and technical personnel induced by the implementation of the plan, along with the soaring number of various driver licenses and different types of registered vehicles. Components of the Study The study examined and analyzed statistical data of a number of elements, some of which are shown in Figure (1) below: 1. Statistics documented by the relevant authorities, showing a rise in the number of foreigners, which drove the population to grow four folds; 2. The number of vehicles registered at the Traffic Department, which also increased in proportion to the rate in (1) above; 3. The significant increase recorded in driver licenses awarded by the Traffic Department. The most important element in these variables is the number of injuries caused by road traffic accidents as a natural result reflecting the above-mentioned increases. Figure (2) shows the number of fatalities in road traffic accidents between 2000 and 2014, which peaked in 2006 as the fatality rate recorded 270, unprecedented in the State. Research Method The research method has mainly relied on collecting, analyzing and surveying the statistics and events documented by the relevant departments and authorities in the Ministry of Interior and other related bodies. This study comes in line with the vision and mission of the Ministry of Interior (in its capacity as the institution in charge of maintaining security and safety and protecting public and private properties, as well as establishing security and safety in the country through a highly professional performance of security services in a genuine partnership with society). During the implementation stage of the study, the documented findings have been treated as outcomes of the measures and events carried out by the Ministry with the aim of reducing road traffic accidents and mitigating the related human and material losses. The measures addressed in the study include the following: 1. The Ministry of Interior developed the legislation of Traffic Law no. 19 of 2007 to keep pace with the developments in the State, whereby stricter sanctions were introduced to the lawbreakers, mechanisms of testing drivers were activated and driving schools were developed. 2. The employment of sophisticated technologies in road traffic control and management. 3. Awareness-raising programs for the benefit of road users were adopted and carried out in a highly professional manner. Conclusions 1. The study and analysis the measures adopted show good results, as fatality rates in recent years, until 2014, are always below the rate recorded in 2006. 2. Traffic police patrols› reports and traffic surveillance systems show the development in traffic awareness and control. 3. The effective measures and programs carried out in driving schools have their positive good effects on schools, trainers and trainees. 4. This paper exposes an important aspect of development in the road traffic safety in general through the measures and effective regulations adopted. The research work also highlights some findings noticed on the road network outside cities (highways in particular) Recommendations 11. The study findings show the importance of putting laws and regulations into practice and the need for reviewing them from time to time in accordance with the changes in the components of transportation system›s design, implementation and operation. 22. It is necessary to adopt sophisticated technologies in traffic control and organization. The use of modern traffic technologies should be coordinated, serving as support means to the major components of traffic control: police and laws. References 11. Traffic control reports for the years 2014-2000/ Traffic Department 22. Statistics documented at the Information System Department/ Ministry of Interior 33. Periodic reports issued by Road Engineering Department/ Radar Section in coordination with Public Works Authority 44. Road accident investigation reports/ Patrol Department/Traffic Department. 55. Expert studies presented to the Traffic Department for the period 2012-23010 on the development of driving schools.

Managing the safety of high-risk drivers continues to be a major challenge. The traditional approach has been to develop training and education based programs in order to achieve this. Relatively few of these types of road safety education programs have been evaluated and for those that have included effective evaluation the results have been disappointing in terms of reducing the subsequent crash risk of participants. Some interventions have even been shown to increase the crash risk of drivers (McKenna, F.P., 2010). A recent development in driver behavior management is vehicle-based safety monitoring technology, the motor vehicle equivalent of the "black box" in aircraft that records data on driver behavior from a variety of sources (Horrey et al., 2012). Recent research in the use of driver monitoring has identified key behaviors of high risk drivers (Klauer et al., 2009) and has demonstrated how it can be utilized to manage those behaviors and reduce crash risk (Horrey et al., 2012). This new technology enables intervention models that are more focused on the specific risky driving behaviors of individual drivers. Programs for high-risk drivers (e.g. traffic offenders, young drivers) should involve the systematic long term monitoring and coaching/counseling of the individual driver. The success of this type of intervention model has already been demonstrated by the widely adopted alcohol interlock programs for drink driving offenders (Casanova-Powell et al., 2015). A key component of alcohol interlock programs is that they are included in driver licensing legislation. To be effective, vehicle-based safety monitoring technology also needs to be included in driver licensing legislation. This legislation should require the use of safety monitoring in a variety of areas including as part of graduated driver license systems, fleet management systems and for traffic offenders. References: McKenna, F.P., 2010. Education in Road Safety. Are we getting it right? RAC Foundation Report 10/113, UK. William J. Horrey, Mary F. Lesch, Marvin J. Dainoff, Michelle M. Robertson, Y. Ian Noy. (2012) On-Board Safety Monitoring Systems for Driving: Review, Knowledge Gaps, and Framework. Journal of Safety Research 43, 49-58. Online publication date: 1-Feb-2012. Klauer, S. G., Dingus, T. A., Neale, V. L., Sudweeks, J. D., & Ramsey, D. J. (2009). Comparing real-world behaviors of drivers with high vs. low rates of crashes and near-crashes (Report No. DOT HS 811 091). Washington, DC: National Highway Traffic Safety Administration. Casanova-Powell, T., Hedlund, J., Leaf, W., & Tison, J. (2015, May). Evaluation of State ignition interlock programs: Interlock use analyses from 28 States, 2006–2011. (Report No. DOT HS 812 145). Washington, DC: National Highway Traffic Safety Administration, & Atlanta: Centers for Disease Control and Prevention.

School buses and minibuses are one of the major modes of traveling for students in the state of Qatar. Many studies pointed to the fact that school buses travelling are safer for students than walking or car riding (Bolte, et al., 2000; Hinch, et al., 2002). For that reason, safety measures and performance of school buses in the State of Qatar should be studied and evaluated carefully and wisely. The project aims were done through merged qualitative and quantitative methods. Initially a safety checklist was constructed for school buses and a comprehensive schools map to evaluate of the current safety measures in school buses and to understand the conditions around the surrounding areas like the location of the bus stops and the availability of signage. Then, the second step focuses on conducting a survey for school bus drivers, school bus guides, students, and parents. Finally, the third steps compares between the school bus safety strategies followed in the State of Qatar and the strategies followed in other high income countries. The results of the field visits revealed many very important statistics for all surveys on the safety of school bus and the surrounding areas as well as the behavior of students and drivers. The results revealed that most of the parents are not happy with the safety while loading and unloading and with the safety procedures. In addition, 43% of school bus users didn’t attend any training or workshops about the safety procedures in school bus. References: [1] Bolte, K. et al., 2000. Simulations of Large School Bus Crashes. [Online] Available at: http://papers.sae.org/2000-01-0469/ [Accessed 10 october 2014]. [2] Hinch, J. et al., 2002. School Bus Safety: Crashworthiness Research, Washington: National Highway Traffic Safety Administration.

The contribution of alcohol to the health burden of road traffic injuries [RTI’s] has been well documented in various settings. However, in a recent global report released by the WHO, almost half of all countries lack data on alcohol-related road deaths and injuries. This study will report the results of the Alcohol Screening Brief Intervention and Referral for Treatment [ASBIRT] Program of the Hamad Trauma Center [HTC]. This ASBIRT is a program of the HTC, the only Level I Trauma Center in Qatar. All severely injured patients who are treated at the HTC undergo a blood alcohol concentration [BAC] test. Those that test positive undergo a series of screening interviews to determine the nature of their alcohol use and their need for intervention or treatment. The ASBIRT conducted 578 BAC tests, on adult RTI patients, during the 1-year study period. Most tested were vehicle drivers or passengers [MVC] [58%] followed by pedestrians [27%] and ATV drivers [5%]. Eighty eight percent were males with an average age of 32 years. The over-all BAC (+) rate, for all tested victims, was 9.2%. The highest BAC (+) rates were seen in MVC [10.2%], followed by pedestrians [9.7%] and ATV drivers [9.4%]. Of testing BAC (+), 92%, were males, most were MVC [64%] and pedestrian [28%] victims, more than half [57%] were from South Asia followed by 34% from the Eastern Mediterranean Region and 7.5% needed further treatment for alcohol abuse. Alcohol use has a contributory role in one out of every 11 victims suffering from a severe RTI in Qatar. More stringent and high-visibility enforcement of existing ‘zero tolerance' laws on driving under the influence and public awareness can significantly contribute to reducing the health burden of RTI's in Qatar. Reference: Global status report on road safety 2013: supporting a decade of action. World Health Organization. May 2013. Geneva, Switzerland.

Objective: To study the mortality, causes and characteristics of child road traffic death (CRTD) in China in 2013, in order to find new ways to improve CRTD prevention and control. Materials: The road traffic death data and population data of children under 18 years old in 2013 were mainly from: (1) Annual statistics report on road traffic accident of China in 2013, by Transportation Bureau, Ministry of Public Security. (2) Annual demographic data by China State Statistics Bureau. Results: CRTD were 3994 persons and the ratio of male and female was1.64:1 in 2013. The highest CRTD occurred in 15-17 years old group which was 30.0% of total, followed by 2-5 years old group (28.3%). Mortality per million population (MPMP) of total CRTD was 14.61 persons. The highest MPMP was 23.92 persons in 15-17 years old group. MPMP of male was 16.85 persons, and the highest group was 15-17 years old group with MPMP 33.30 persons. MPMP of female was 11.99 persons, and the highest group was 2-5 years old group with MPMP 16.54 persons. The highest ratio of male and female was in 15-17 years old group(2.47:1). However, female was much more than male in 0-1 years old group (0.76:1). Brain injury was the main cause of CRTD (78.1%), followed by chest and abdomen injury (8.8%). This paper has also deeply studied on the crash reasons, part of injury, time distribution and so on about CRTD in 2013. Conclusion: The CRTD of high school and preschool children were highlight in all groups, and it was very remarkable that CRTD of female was much more than that of male in 0-1 years old group. Brain injury is the main cause of death. Cause of accident and death, injury part, gender, transportation mode and time distribution all have different characteristics in different groups.

Global road traffic accidents (RTAs) account for around 1.2 million fatalities annually and alarmingly, 30-40% of these fatalities are children [24]. Even in the UK, 60% of child deaths are from RTAs. In Asia, up to one third of these deaths are due to two-wheelers [24]. Helmets can help reduce fatalities by 25% but studies show compliance as low as 20% in Indonesia. Aims and objectives of the study were to find out why people don’t wear helmets and how to prevent head injuries in Indonesia by assessing the knowledge and attitudes of the public. Observations and interviews were carried out in Jakarta after thorough ethical consideration by the University of Leeds and the Indonesian Ministry of Health. Three observational sittings at the same location recorded characteristics of helmet use with simple analysis. Interviews featured structured questions on the knowledge and attitudes of helmet safety of students and the public. Results were then coded thematically. Observations showed low helmet use for females and children compared to adult males. Many non-wearers were also passengers. Interview results showed poor awareness of the regulations and compliance amongst the public, especially with young males, women, children, and at night. Barriers to compliance of children discussed included the overlying culture amongst Indonesians passed down by parents, the lack of enforcement by parents and police, and peer pressure. Unavailability of correctly fitting helmets for children also affected usage and police stated they were unsure and inconsistent about enforcement on children. Findings on the cultural barriers were consistent with previous studies and emphasise the importance of injury prevention to reduce global child mortality. Recommendations discovered involved media campaigns to target children using influential members. To improve the reliability, further research should be carried out in other Asian countries targeting children directly.

Effective injury mitigation measures can only be developed once a clear understanding of the problem has been obtained. The factors which contribute to the problem and hence the solution are based of analysis of real world data. The incidence of spinal injuries in traffic accidents has been identified to be a significant problem in Saudi Arabia and Gulf Countries (GCC). However, a detailed database, which could offer data from real world accidents, does not exist in this region from the world. Thus, the main aim of this study is to develop a sufficiently in-depth database, which can then be interrogated to address the problem of spinal injuries in Saudi Arabia. In this study, data on 778 spinal injuries (AIS ≥ 2) sustained by 552 casualties in 512 vehicle crashes collected from the city of Riyadh has been discussed and analysed. The primary crash factors, which might influence the occurrence and severity of spinal injuries, have been examined. In conclusion, the results obtained by this study can contribute significantly towards understanding the cause of spinal injuries and coming up with safety measures to mitigate them, especially in Saudi Arabia.