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

Background: Traffic injury is a major risk factor among children • Traffic injury is a leading cause of injuries among Chinese children aged 0 to 14.1 • Nowadays, family car ownership has reached 60 million in China2 Objectives: • Raise the public awareness on child passenger safety and correct usage of car seats, especially among parents through multi-sectorial collaboration Methods: • Introduce global evidence-based safety messages and technology into China • Maximize limited resources to enhance the program impact by collaboration with multi-sectors Results: • Public Awareness - Launched an ad by collaboration of Shanghai Police and had the ad aired on all the bus lines in Shanghai - Held media events with a private sector support, advocating in-and around the car safety for children, which gained 121 media reports • Education to parents and children - Educational curriculum was developed for education to parents and children by a support from a private sector - The curriculum was delivered to over 1000 kindergarten teachers • Correct usage of the car seat - “Child Passenger Safety Technician (CPST)” course was introduced into China, with 34 technicians in China now - With supports from Police, CDC, Education Bureau and a hospital, we held 4 check events, checked over 40 cars. - Four car seat check stations were set-up. Conclusion: With the multi-sectorial collaboration, we were able to have the ad to the public with free of charge, to have the curriculum covering all Shanghai kindergartens and to have the car seat check station set-up, too. Reference: 1. NCNCD Child of China CDC, Safe Kids China, Injury Prevention Promotion, 2012. 2. People's Health Publishing House, NCNCD of China, Safe Kids China, Child Passenger Safety, 2014

As an integral part of engineering safer roads, road side safety devices passively interact with errant vehicles to redirect them safely back to the road or bring them to a safe and controlled stop. These devices take the form of crash cushions, cable barriers, concrete barriers, steel barriers, guard rails, guardrail terminals and others. Placement criteria and warrants are established in the AASHTO Road Side Design Guide (1). However, before those devices are placed on the roadways, they have to be evaluated under objective test conditions.. Given that possible combinations of impact speeds, impact angles, vehicle characteristics and roadway characteristics are infinite, it is impossible to design roadside safety hardware for all those combination. Thus a “Practical Worse Case” philosophy derived from crash data analyses is followed to determine such impact conditions. In the USA, the evaluation methodologies are established in the National Cooperative Highway Research Program (NCHRP) Report 350 (2) which is now superseded by Manual for Assessing Safety Hardware (MASH) guidelines (3). In Europe a comparable set of guideline (EN 1317) is used to evaluate road safety devices under vehicular impact. Many roadway authorities around the world adopt either EN 1317 or NCHRP Report 350 with some modifications to incorporate local requirements. In the early parts of this presentation demonstrate testing conditions and criteria for quantifying the device as crashworthy under NCHRP Report 350 and MASH for some of the common road safety devices. The most common test conditions are explained in details. The key criteria of acceptance shall be presented for the most common test conditions. State of the art nonlinear finite element methodology has been gaining tractions in designing and enhancing the safety of vehicles and roadside devices. This presentation will highlight roadside safety hardware (4, 5, and 6) that was designed through extensive simulation process and had subsequent successful crash test per the latest MASH guidelines. REFERENCES 1. America Association of State Highway and Transportation Officials , Roadside Design Guide, 4th Edition, AASHTO, 2011. 2. Ross, H.E., D.L. Sicking, R.A. Zimmer, and J.D. Michie, Recommended Procedures for the Evaluation of Highway Features, NCHRP Report No. 350, 1993, Transportation Research Board: Washington, D.C. 3. AASHTO, Manual for Assessing Safety Hardware, 2009, American Association of State Highway and Transportation Officials: Washington, D.C. 4. Abu-Odeh, K.M. McCaskey, R.P. Bligh, W.L. Menges, D.L. Kuhn. Crash Test and MASH TL-3 Evaluation of the TxDOT Short Radius Guardrail. Test Report. 0-6711-1. Project No. 0-6711. Texas A&M Transportation Institute, College Station, TX. March 2015 5. A. Abu-Odeh, R.P. Bligh, M.L. Mason, W.L. Menges. Development and Evaluation of a MASH TL-3 31-Inch W-Beam Median Barrier. 9-1002-12-8. Texas A&M Transportation Institute, College Station, TX. January 2014. 6. A. Abu-Odeh, W.F. Williams, M. Ferdous, M.T. Spencer, R.P. Bligh, W.L. Menges. Safety and Integrity of Median Barrier-Mounted Hardware. 0-6646-S. Texas A&M Transportation Institute, College Station, TX. 2013.

The revolution of auto industry has led to an exponential increase in energy consumption, mainly fossil fuel, which motivated scientists to search for alternative clean, safe and sustainable energy resources. One of the promising energy sources is that produced as a byproduct from operating vehicles. This thermal energy can be harvested and reused as a viable secure source of electricity by utilizing thermoelectric (TE) devices. The TE solid state devices are designed using two dissimilar materials, p- and n-type semiconductors, connected electrically in series and thermally in parallel [1]. They can be designed to convert thermal energy from a temperature gradient into electrical energy (Seebeck effect), where carriers diffuse from the hot to the cold side creating a voltage drop and a current flow. Semiconductor materials potentially produce superior thermoelectric devices due to their higher ratio of electrical to thermal conductivity as compared to metals since the latter possess low Seebeck coefficients of 10 μV/K [2]. In this work, we present two types of thermoelectric materials designed from intermetallic Fe2VAl Heusler alloy, which comprise a new class of TE materials that are promising for many auto industry applications. This alloy was not carefully investigated in the past and did not receive significant attention yet [3]. Thermoelectric calculations showed that Fe2VAl has both p-type and n-type thermoelectric properties, which is necessary to design TE devices that consist of alternating legs of the two materials. The Seebeck coefficient has maximum values between (20 – 125) μV/K for the p-type and (19 –90) μV/K for the n-type, in the temperature range from 100 K to 800 K. References: [1] B.C. Sales, Science 295, 1248 (2002). [2] T. M. Tritt and M.A. Subramanian, MRS BULLETIN 31, MARCH 2006 [3] Kanchana et al., Phys. Rev. B 80, 125108 (2009).

Introduction In pursuit of the realization of the Qatar National Vision 2030 (QNV 2030) and to ensure the success of the hosting of the 2022 FIFA World Cup, the Qatari higher authorities have assigned paramount importance to instilling and prorogating traffic awareness among the various community groups and school students. Thus, the establishment of the National Committee for Traffic Safety (NCTS) headed by His Excellency the Prime Minister and Minister of Interior in which the relevant authorities in Qatar have been accomplished. The National Committee for Traffic Safety has prepared a general educational framework for traffic safety program, familiarizing students of all age groups with many of the traffic safety concepts to ensure instilling the needed traffic awareness. This study aims at identifying the effectiveness of the application of the general educational framework of the traffic safety program on experimental basis in some governmental and private schools in Qatar (2015-2013) in preparation to introducing it to all schools in the coming years (if the outcome of the pilot project is proved positive). Study Approach This study will be made as part of the assessment of the implementation of the procedural action plans for teaching traffic safety in Qatar. The study will include conducting a survey among school principals, teachers, parents and students, and measuring the impact of the acquisition of traffic safety knowledge on the students› behavior by examining the school zones and how far the traffic safety measures are applied. It will also follow-up the extra-curricular activities carried out by students outside the classroom. Study Expectations The results of this study are expected to contribute to the enhancement and improvement of the general framework of the proposed educational content before its application on all Qatari schools. As expected in this study, many government and private entities are to be engaged in the preparation of the teaching aids and awareness films to ensure the effective application of the traffic safety concepts on schools. It is also expected that the development of the framework would include the following aspects: preparation of teaching aids, production of awareness films appropriate for each age group and preparation of illustrative pictures and workshops designed to educate teachers before the application of the educational framework. It also aims to improve school zones to enhance traffic safety around schools in accordance with the international safety standards and measures among other improvements. References 11. Strategy for the State of Qatar 2016–2011 22. National strategy for traffic safety 2022- 2013 33. SWOV institute for road safety research. The effectiveness of road safety education. Leidschendam, Netherlands, 2006. 44. http://www.moi.gov.qa/site/arabic 55. Transport research laboratory. Road safety education in developing countries. Overseas road note 17. Berkshire, UK, 1997.

Today, the world has observed a remarkable growth in the use of transportation mobile communications for road safety. While a user in a vehicle moves to a new communication cell, a wireless terminal requests a handoff for new channel in the new cell. Due to that movement, some of the challenges issues are developed such as, the increase in traffic volumes and demand for high speed transportation mobile communications call for fast, seamless and high performance handoff in mobile communications network. When a wireless user in a vehicle moves from one base station cell to another, handoff protocols reroute the existing active connections in the new transportation cell. The future challenges in next generation high speed transportation mobile networks are to minimize the packet loss and to provide efficient use of the network resources while maintaining quality of service assurances. Therefore, the performance of efficient management and a successful handoff operation in transportation mobile networks become an important issue for road safety traffic. This work shows analytical handoff management for transportation users in a high speed mobile communications network. We demonstrate the performance of handoffs with mobility consideration using several metrics including the alteration of states prior to reaching a transportation mobility cell boundary, the speed of transportation mobile terminal, and the distance between a transportation mobile terminal and a transportation cell boundary. We illustrate the performance evaluation for the factor of transportation mobility with taking into account the high speed status of a mobile vehicle user. Numerical results of the transportation performance analysis and the probability of requiring a handoff are demonstrated using Maple. Figure 1 shows a shaped region of a cellular network and the cellular handoff model with mobility. In this abstract, we modeled the cellular handoff for multimedia users with taking the high speed mobility into account in wireless mobile networks. The performance results in terms of state probabilities and the probability that a mobile terminal reached a cell boundary were investigated. The mobilized analysis involved with number of issues such as the alternation of states before a mobile unit reached a cell boundary, the distance between the mobile terminal and a cell boundary and the speed of the vehicle. Based on the assumption of the alternation of states, there were four situations for a vehicle to reach a cell boundary. Performance results were accurately analyzed based on these four situations. It was clearly showing that for a vehicle that experienced the change of states, the outcome chance of reaching a cell boundary was proportional to the distance in between the mobile terminal and a cell boundary and inversely propositional to the speed of the vehicle. References [1] J. Naylon, D. Gilmurray, J. Porter and A. Hopper, “Low-latency handover in a wireless ATM LAN,” IEEE Journal on Selected Areas in Communication, Vol. 16, pp. 909-921, Aug. 1998. [2] A. Acharya, S. Biswas, L. French, J. LI and D. Raychaudhuri, “Handoff and location management in mobile ATM networks,” Proceeding3rd International Conference Mobile Multimedia Communication, September 1996. [3] A. Acharya, J. Li, B. Rajagopalan and D. Raychaudhuri, “Mobility management in wireless ATM networks,” IEEE Communications Magazine, pp. 100-109, 1997. [4] Y. Fei, V. W. Wong, V. C. Leung, “Efficient QoS provisioning for adaptive multimedia in mobile communication networks by reinforcement learning,” Mobile Networks and Applications, Vol. 11, pp. 101-110, 2006. [5] J. G. Guzman, j. M. Bauset, and V. Pla, “Performance bounds for mobile cellular networks with handover prediction,” Management of Multimedia Networks and Services, Springer Berlin / Heidelberg, pp. 35-46, 2005. [6] R. Zander and J. M. Kalsson, “Combining bandwidth borrowing and reservation in cellular networks,” International Journal of Wireless Information Networks, Vol. 12, No. 3, pp. 187-201, 2005. [7] G. H. Ma and A. Y. Zomaya, “an efficient channel allocation scheme for cellular network using maximum channel packing,” Wireless Communications and Mobile computing, vol. 4, pp. 683-692, 2004. [8] K. Q. Tian and D. C. Cox, “Mobility management in wireless networks: data replication strategies and applications,” Kluwer Academic Publishers, New York, 2004. [9] A. R. Momen and P. Azmi, Stochastic vehicle mobility with environmental condition adaption capability,” Wireless Communications and Mobile computing, Vol. 9, pp.1070-1080, 2008. [10] K. Ioannou, S. Kotsopoulos, and P. Stavroulakis, “Optimizing the QoS of high speed moving terminals in cellular networks,” International Journal of Communications systems, Vol. 16, pp. 851-863, 2003. [11] S. S. Rappaport, “The Multiple-call hand-off problem in high-capacity cellular communication System,” IEEE Transactions on Vehicular Technology, Vol. 40, No. 3, p.p. 546-557, 1991. [12] S. Nanda, “Teletraffic models for urban and suburban microcells: cell sizes and handoff rates,” IEEE Transactions on Vehicular Technology, Vol. 42, No. 4, p.p 673-682, 1993.

While dealing with motor vehicle collision (MVC) victims, the Paramedics on-scene make patient management decisions based on assessment of the physiological parameters, anatomic site of injury, mechanism of injury (MOI), and some special considerations (age and underlying illnesses). In victims with normal physiological and anatomical parameters, and no alarming consideration, the MOI alone is found to be an independent predictor of mortality and functional impairment (2, 3); the Emergency Physician can utilize such information to guide further management of the MVC victims. Information concerning the MOI mostly comes from the Paramedics who retrieved the patient from the crash scene. The purpose of this review is to explore the injury-predictive mechanisms of MVC and to guide the Paramedics in conveying such vital information to the Emergency Physician during handover process. A literature search was made using the online search engine PubMed to identify studies exploring the injury-predictive mechanisms of MVC. Keyword combinations were used that included: Motor/Vehicle/Collision/Road/Traffic/Accidents/Trauma/Mechanism of injury. Auto vs. pedestrian and Motorcycle crashes were excluded. A total of 8 articles were found to be relevant. The mechanisms of MVC which are highly predictive of a significant occult injury include ejection from vehicle (1,4,5), intrusion of the passenger compartment more than 12 inches (1,2,4), prolonged extrication time >20 minutes (4,5), death in the same passenger compartment (1,5), high speed crashes (4), deformity of the steering wheel (2), and rollover causing significant intrusion or ejection of the victim (1). Paramedics reporting the aforementioned crash-specific variables would alert the Emergency Physician and help him better deal with MVC victims who have normal physiological and anatomical parameters, and no alarming considerations. Provision of MVC scene photographs to the emergency physician could be a future research project to assess its impact on altering patient management and outcome. References: 1. Centers for disease control and prevention. (2012). Guidelines for filed triage of injured patient: Recommendations of the national expert panel on filed triage, 2011(MMWR 2012;61). Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr6101.pdf 2. Davidson, G.H., Rivara, F.P., Mack, C.D., Kaufman, R., Jurkocivh, G.J., Bufler, E.M. (2014). Validation of prehospital trauma triage criteria for motor vehicle collisions. J Trauma Acute Care Surg, 76(3), 755-61. 3. Haider, A.H., Chang, D.C., Haut, E.R., Cornwell, E.E 3rd., Efron, D.T. (2009). Mechanism of injury predicts patient mortality and impairment after blunt trauma. J Surg Res, 1;153(1), 138-42. 4. Palanca, S., Taylor, D.M., Bailey, M., Cameron, P.A. (2003). Mechanisms of motor vehicle accidents that predict major injury. Emerg Med (Fremantle), 15(5-6), 423-8. 5. Stuke, L.E., Duchesne, J.C., Greiffenstein, P., Mooney, J.L., Marr, A.B., Meade, P.C., McSwain, N.E., Hunt, J.P. (2013). Not all mechanisms are created equal: a single-centre experience with the national guidelines for field triage of injured patients. J Trauma Acute Care Surg, 75(1), 140-5

Not being able to drive your own car can be devastating for mobility, health, finances and self-esteem. Driving is a visually demanding task (Owsley et al., 2008) and insufficient visual field can lead to revoked license. Acquired brain damage can impair the visual field and stroke is a very common diagnosis among drivers with visual field defects. de Haan et al. (2015) identified several undocumented difficulties among patients with homonymous visual field defects. License holders with visual field defects and interested in being assessed in a driving simulator were invited to answer a short web questionnaire. During the period December 2013 to June 2015, close to 400 people responded. The group is however not representative for the population of drivers with visual filed defects. Instead, it comprise the subgroup that is most concerned to get a new driver license issued (or to keep the license if it not yet withdrawn). A vast majority in the studied group was men (83 %). Almost 3 out of 4 were aged 55 years or more. The three most common diagnosis were stroke (39 %), glaucoma (31 %) and diabetes (13 %). General health status, vision and driving ability was self-estimated as very good or relatively good by 90-95 % of the respondents on a 5-grade scale. Weekly distance driven was estimated to 200 km (median). Involvement in accidents with only property damage, near-accidents and personal injury accidents during the period 2008-2013 was experienced by 8 %, 5 % and 1 %, respectively. Drivers with visual field defects regard themselves as healthy and good drivers. The drivers do often not understand the withdrawal of the driving license; many comments that they had driven for many years without any problems and that they can compensate for the defect by head movements. References: Owsley, C., Wood, J., McGwin, G, (2008). A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology, Volume 60, Issue 3, May–June 2015, Pages 250–262. de Haan, G A., Heutink, J, Mellis-Dankers, B., Brouwer W H, Tucha O. (2015) Difficulties in Daily Life Reported by Patients With Homonymous Visual Field Defects. Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society.

Driving is a visually demanding task (Owsley, et al., 2008), manifested in visual ability requirements. Sweden, does not allow on road assessment of drivers with visual field defects. However, driving simulators can be used for fitness to drive assessment (Rizzo, 2011) but authoring driving scenarios is a critical task Vardaki et al. (2014). This paper discuss a driving simulator based assessment method aiming to assess drivers with visual field defects. The driving task includes 37 situations based on well-known critical driving situations along three driving environments: rural, motorway and urban. Most of the situations occur in urban context, e.g. pedestrians crossing the road, vehicles suddenly appearing. Each situation was assessed with a set of critical measures, e.g. brake reaction time, time based safety margins, speed keeping etc. Driving data from almost a hundred drivers, both with and without visual field defects, were collected and analyzed. The results are currently being analyzed. So far it seems like some situation were better than others, specifically in terms of timing. The possibility to drive at your own pace made some participants drive very careful and others over the speed limit. This had a strong impact on the criticality of the situations and their usefulness in determining driving ability. The developed situation on rural road worked very well, in terms of timing and criticality. The option to overtake at your own choice on the motorway introduced some variation in behavior that need further consideration. Urban road driving included critical situations difficult to master even for a driver with no visual defect. The next step will be to investigate behavior metrics in term of the ability to discriminate between those with visual field defects and those without. References: Rizzo M., (2011) Medical Disorders. Handbook of Driving Simulation for Engineering, Medicine and Psychology, CRC Press. Owsley, C., Wood, J., McGwin, G, (2008). A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology, Volume 60, Issue 3, May–June 2015, Pages 250–262. Vardaki, S, Yannis, G, Papageorgiou, S G, (2014) Assessing Selected Cognitive Impairments Using a Driving Simulator: A Focused Review. Advances in Transportation Studies, Volume 34, University Roma Tre, Pages 105 – 128

Fatal vehicle crashes are not uncommon for ambulance paramedics (1-3). Emergency services staff may be overconfident and overestimate the privileges they have on the road and overlook basic driving safety principles (4). In line with the WHO (5) a driving safety campaign targeting some 935 registered HMCAS drivers and other staff was initiated in June 2015. We aim to determine if our approach is effective in changing behaviour and believes, and reducing the number of accidents in which our vehicles are involved, and surveyed the staff. Posters and stickers were designed with respectively 6 and 4 key messages covering the most frequent issues resulting in collisions (with objects/other vehicles) or potentially putting lives at risk. These are visibly displayed at all ambulance stations and in the vehicle driving compartments. An official staff circular was then sent to inform them of the campaign. A month later a survey accessible online and on paper started to be distributed to staff. In one month 141 anonymous questionnaires were returned fully completed. On average using a 5-point Likert scale respondents rated themselves as being safe drivers (4.2/5) and estimated the monthly number of accident with HMCAS vehicles to be 15.3 (22.1/month registered in 2014) and to mainly occur at traffic light (75.2%). 75% had noticed the posters and 60% the stickers. Those who noticed could respectively cite 53.3% (3.2) and 54.6% (2.2) of the key messages. 72% of respondents (n=102) had an HMCAS driving qualification (10.9% of qualified HMCAS drivers). On average they had been involved in 0.95 accident requiring vehicle repair. As expected, staff underestimate the number of accidents. References: 1- Maguire, B. J., Hunting, K. L., Smith, G. S., & Levick, N. R. (2002). Occupational fatalities in emergency medical services: a hidden crisis. Annals of emergency medicine, 40(6), 625-632. 2- Maguire, B. J., & Smith, S. (2013). Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehospital and disaster medicine, 28(04), 376-382. 3- Becker, L. R., Zaloshnja, E., Levick, N., Li, G., & Miller, T. R. (2003). Relative risk of injury and death in ambulances and other emergency vehicles. Accident Analysis & Prevention, 35(6), 941-948. 4- Blau, G., Gibson, G., Hochner, A., & Portwood, J. (2012). Antecedents of Emergency Medical Service high-risk behaviors: Drinking and not wearing a seat belt. Journal of Workplace Behavioral Health, 27(1), 47-61. 5- World Health Organization. (2013). WHO global status report on road safety 2013: supporting a decade of action. World Health Organization. 6- 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. 7- Shepherd, J. L., Lane, D. J., Tapscott, R. L., & Gentile, D. A. (2011). Susceptible to Social Influence: Risky “Driving” in Response to Peer Pressure. Journal of Applied Social Psychology, 41(4), 773-797.

This presentation focusses on the analysis of the fundamental characteristics of traffic enforcement systems for the improvement of traffic safety and the development of a framework of principles and proposals for enforcement programs of selected traffic violations in rapidly developing countries. The methodology used includes a wide review of international literature as well as processing, evaluation and ranking of particular enforcement actions of traffic violations such as speeding, non-use of seat belt and helmet, drinking and driving and mobile phone use. A framework of principles is developed along with special actions within the integrated enforcement programs of selected violations with special emphasis to the particular driver behaviour and safety characteristics in the rapidly developing countries (pedestrian and motorcycle safety, inadequate infrastructure, lack of road safety culture).

Ambulance use in low-and middle-income countries is very low. This study assesses characteristics of road traffic injury (RTI) victims coming to emergency departments (EDs) by ambulance and compares with RTI victims coming via alternative modes of transportation. The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan from November 2010-March 2011. Univariate and multivariate logistic regression was carried out to investigate the factors associated with ambulance use in RTI patients. The variables used for regression gender, age groups, cities, hospital type, road user type and disposition. There were four age categories; ≤18 years, 19 -45 years, 45 – R years and ≥65 years. RTI patients were divided into two road-user groups; VRUs (pedestrian, motorcycle driver and passenger, bicyclists) and non-vulnerable road-users (non-VRUs) including four-wheel vehicles’ driver and passengers. Level of significance was set at 0.05. Ethical approval was obtained at all participating sites. Pak-NEDS enrolled 9769 RTI patients. The mode of arrival was known for 92.2% (n=9009) RTI patients, of which 9.1%(n=821) were brought to the ED by ambulance. The mean age was higher in the ambulance group (33.3±16.9 versus 28.8±14.1 years, p-value <0.001). The most common road-user in the ambulance group was motorcycle drivers (n=201,24.5%) and pedestrians (n=3131,38.2%) in the non-ambulance group. Head and neck injuries (n=240,32.9%) in ambulance and upper limb injuries (n=2470, 34.3%) in non-ambulance group were common. There were 3.7% (n=23) deaths in the ambulance group and only 0.6% (n=38) in the non-ambulance group. Patients of all age groups were more likely to use ambulance compared to those >65 years of age (p-value<0.001) adjusted for gender, cities, hospital type, road use type and disposition. The adjusted odds ratio of utilizing ambulances for VRUs was 1.3 times higher than non-VRUs (p-value0.008). Although the overall use of ambulance for RTI patients is very low in Pakistan, however, we found that RTI patients who used ambulance were more likely to be younger and VRUs. Majority of these patients had suffered from head and neck injuries and were more likely to die in the ED.

In 2010, road traffic injuries (RTIs) are the leading cause of deaths in those aged 1-19 years globally and half of those victims are vulnerable road users (VRUs), defined as pedestrians, bicyclists and motorcyclists. Low-income countries account for the highest proportion of VRU deaths. The change in distribution of the burden of RTI during recent decades is unclear. To highlight changes over time in RTI mortality among children and adolescents VRU and non-VRU globally, by region, and by country income level between 1990 and 2013. Country-level data were extracted from the global burden of disease study, split into seven geographical regions and four income levels (low-income [LICs], lower-middle [LMICs], upper-middle [UMICs] and high-income [HICs]). Mortality rates for 1990 and 2013 were calculated considering in turn all categories of road users aggregated, VRUs and non-VRUs. For all road users aggregated, at country level RTI mortality rates decreased sharply within each country income level and each region between 1990 and 2013, but an increase of 21% was found in LMICs of Sub Saharan Africa (SSA). Mortality rates for VRUs and nVRUs also decreased remarkably except among non-VRUs from LICs where the mortality rates increased by 16%. For VRUs, the reduction in mortality rates was more than twice as high in HICs (58%) and LICs (43%) than in UMICs (20%) or LMICs (23%). Considering country income level within regions revealed increased mortality rates for non-VRUs in LICs of South Asia by (26%) and for both non-VRUs (5%) and VRUs (35%) in the LMICs of SSA There have been considerable reductions in RTI mortality rates globally and by region of the world since 1990. While there is a need for enhanced RTI prevention globally, these findings call for the intensification of preventative efforts in specific parts of the world.

The Philippines is a low-middle income country with an estimated population of 102 Million and a 2.18 annual population growth rate. The consequent urbanization has rapidly increased the number of motor vehicles resulting in increased number of road traffic injuries in the country. According to the World Health Organization, next to assault, road traffic crashes are the second leading cause of injury deaths for all ages. Among 0 to 17 years old children, road traffic crashes is also the second leading causes of deaths, next to drowning. In 2004, Safe Kids Worldwide Philippines (SKWP) and FedEx worked hand in hand to address this problem using a pedestrian safety program called “Walk This Way”. The aims are to educate the children on pedestrian safety and improve the walking environment of the schools thereby improve the safety of children and other road users while on the roads. SKWP and FedEx started to organize and build coalitions in five cities and used the three E’s - Education, Engineering and Enforcement. For education, it tries to transfer the knowledge by giving training to principals, teachers, children and parents on pedestrian safety. The Engineering component looks into improvements in the walking environment of the children and their guardians to and from the schools by working with concerned government and non-government organizations. The Enforcement component on the other hand seeks to improve implementation of pertinent laws through dialogues, advocacies and events. The Walk This Way Program has been implemented in 6 cities in the span of 11 years, 5 in a given year. In 2014 a modified approach, the Young Road Safety Advocate Program (YRSAP) was introduced. This “peer to peer” approach enlists senior outstanding students to teach younger students in their own schools. The last two years saw the training of about 900 outstanding students on pedestrian safety who in turn taught approximately 100,000 younger students. The Safe School Zone Project was developed in 2009 and was able to improve four (4) public elementary schools through road safety environment education and the installation of road signs and permanent barriers. Safe Kids Worldwide Philippines through the partnership with FedEx has been recognized in the country in the field of injury prevention programs. SKWP has been invited by the Department of Health to be a member of the Technical Working Committee on Violence and Injury Prevention. Coalitions with the various cities and elementary schools have helped increase the knowledge of over a Million children on pedestrian safety. The National TV Networks have recognized and utilized SKWP in discussions about Road Safety and has become a main resource on the recently enacted helmet law for children. National and local governments together with the involved non-government organizations have looked to Safe Kids Worldwide Philippines as a key organization in Children’s Safety Programs.

The World Report on Road Traffic Injury Prevention of 2004 recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify high-risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This presentation shares the results of an urban RTI surveillance program that has been running for the past 8 years since 2007 in the emergency departments of five major hospitals in Karachi, Pakistan. We describe the process of establishing the road injury surveillance system incorporating a multi-institution research group including physicians and transportation engineers. Data was collected from 5 city-wide hospitals with details of the injury, severity scoring and information of the circumstances of the crash. Site visits supplemented this data and the results were disseminated to municipal authorities along with low cost engineering solutions to rectify hazards in the road network. In the 8 years between 2007 and 2014, 262,269 road injury victims were registered by the surveillance system. Though 76% of the injuries were categorized as “minor”, 20% led to hospital admission and in 3% deaths occurred. The information on location of crashes and site visits led to an extensive catalogue of road network hazards and their rectification led to demonstrated reductions in crash frequency. Data was also used for safety advocacy in groups found to be vulnerable in the surveillance, such as motorcyclists, road sweepers and school going pedestrians. We demonstrate that a functional RTI surveillance program can be established and effectively managed in a developing country. The data collected and analyzed from the victim’s perspective can be a potent tool for effecting safety education and hazard rectification. Reference: Razzak J.A. , Shamim M.S. , Mehmood A. , Hussain S.A., Ali M.S. & Jooma R. (2012). A successful model of Road Traffic Injury surveillance in a developing country: process and lessons learnt. BMC Public Health, 12: 357

Road safety is a major public health concern. Between 2008 and 2010 an average of 220 people were killed each year and over 550 people were seriously injured in the State of Qatar because of road crashes. Qatar Red Crescent (QRC), as a member of The International Federation of Red Cross and Red Crescent (IFRC) which is the host of The Global Road Safety Partnership, has identified the road safety as one of its priorities to save lives and build safer communities. Methods used: • Advocate the prioritization of road safety on government's agenda. Internal road safety culture for the staffs and volunteers. • Public awareness campaigns on safe road use. Road safety education for students. • First aid courses for drivers, police officers, and the general public. QRC advocated for road safety through its involvement in the National Traffic Safety Committee. QRC volunteers and staffs, about 2500, committed to the ten road safety commitments of IFRC. The "On the Road of Safety" and "For a Safe Driving" public awareness campaigns targeted 5000. QRC school program promotes safe road practices between students, teachers, staffs, and the parents through the students. It targeted 1650 in 2014. QRC first aid training for students program "I am a paramedic" trained 16200 students between 2008 and 2015. QRC provides first aid training, with a special chapter about road safety, for about 4500 yearly. QRC assisted in writing the first aid chapter of the new driving manual in the State of Qatar. QRC is in the process of establishing partnership with the ministry of interior to provide first aid training for police officers and driving schools students. QRC will continue to have a strategic attention to continuous public education about road safety and first aid to bring death and injury down. References: 1. Global road safety partnership annual report 2013 2. Qatar National Road Safety Strategy 2013 -2022 3. IFRC 2010-2011 road safety program

The advent of the Big Data era has transformed the outlook of numerous fields in science and engineering. The transportation arena also has great expectations of taking advantage of Big Data enabled by the popularization of Intelligent Transportation Systems (ITS). The challenges in the transportation system are many, ranging from increase in travel demand, growth in congestion, need to improve safety to the reality of limited resources. Thus there is a need for more Pro-Active Traffic Management to dynamically manage recurrent and non-recurrent incident-related congestion based on prevailing traffic conditions. Processing this large data requires different analytical and data mining techniques. The presentation addresses several concepts and examples of using big data analytics. Dr. Abdel-Aty presents examples from many projects currently ongoing at the University of Central Florida (UCF). These projects deal with applications of big data analytics in safety and operation. The speech shows examples of UCF research using big data in safety analysis, adverse weather conditions and safety planning. Real-time safety, operation and adverse weather analysis are presented. For example, the viability of monitoring and improving traffic safety and operation on urban expressways in Central Florida using real-time Microwave Vehicle Detection System (MVDS) data is researched. From the perspectives of volume, velocity and variety, the MVDS should be regarded as one of the main sources of Big Data. The detection system archives spot speed, volume, lane occupancy, and vehicle type per lane on a minute basis. Real-time safety risk evaluation was developed for several expressways based on these data. Other big data applications involve combination of census, planning, safety, roadway and land use data to improve safety planning. This extensive research shows the promise and possibilities for the development of real time applications to primarily improve road safety in the context of Pro-active traffic management. It also demonstrates the transformation occurring in safety research and applications based on big data.

The Qatar Mobility Innovations Center (QMIC) has defined an integrated innovations strategy for developing and deploying local solutions and applications that tackle road safety in Qatar and the region. This strategy is based on utilizing distributed data and connected devices to deliver intelligent user-centric services and applications that will tackle different problems contributing to road accidents in Qatar and the region. In this presentation we will review key elements of this strategy, solutions, and applications that have been deployed to-date in Qatar and the ones which are under-development and pilot deployments. In particular, we will highlight the progress made in deploying a national traveler info system for delivering relevant location-based services and alerts, and a national telematics platform and services in support of monitoring driver performance. In addition, we will review the solutions being developed and deployed to minimize the use of mobile phones while driving for both consumers and enterprise segments which are part of the Salamtek (Innovations for Distracted Driving) national initiative which was launched in 2014. Finally, we will discuss the progress made in realizing a connected vehicle program in Qatar (based on using standard-compliant car-to-car and car-to-infrastructure communication protocols and technologies) and the significant potential impact in reducing road accidents in Qatar.

Traffic crashes are the obvious and tragic outcome of a complex process of which traffic, human factors, roadway engineering and surrounding environment are all contributing factors. Traffic operations, however, inflict more physical and psychological harm on human health, albeit, it is not immediately obvious as crashes. Some of those harms show symptoms over longer terms, possibly a lifetime. That, however, does not change the fact that such harms are serious infractions of public health and community wellbeing. Is there a case for traffic medicine to expand scope and involve coverage of other traffic harms? Literature and studies have now clearly demonstrated the strong direct and indirect influence of transport planning, design, and operations- including travel choices and traffic operations--on public health including traffic crashes. Beyond crashes, long term-health impacts of transport decisions and practices are now established facts. This talk will make the point that the scope of traffic safety need to move beyond the prevention (and management) of serious crashes and injuries to the promotion and adoption of transport policies and traffic operation measures that, in addition, preserve and promote public health and community wellbeing in a broader sense. It is argued that such policies and measures will, in the mid- to long-term and as a matter of necessity and logical connectedness, result in travel decisions—as in trip making and mode and route choices—and traffic operation measures—as provision of space and junction control—that, collectively, foster calmer and more equitable thus “healthier” traffic operations. The result is both short- and long-term public health improvements including reduced risks of serious crash injuries. A case study of health impacts of traffic congestion is presented. While reduction of serious crash is an urgent need the world around, the notion of traffic polices and operations as a tool to promote public health is not as obvious nor has it been part of the domain of traffic/transportation engineering or planning. The case is made that traffic operations impact public health and community wellbeing well beyond crashes, and that the professions of traffic/transport and public health collaboratively must adopt a more holistic approach to traffic safety and health: one that goes beyond immediate concerns with serious traffic crashes to one that promotes long-term healthy living of which managing serious crashes is only a part. Towards this end, changes in policies, culture, education, planning, engineering, and systems operations will be necessary, as is a systems approach.

Trauma systems have been shown to improve outcomes for trauma victims with severe and multiple complex injuries in many Western settings. This same effect have not been adequately demonstrated in rapidly developing economies nor specifically for patients with road traffic injuries [RTI's]. This session will present temporal trends in the development of the trauma system and their effect on RTI patient outcomes in Qatar. A review of each of the components of the trauma system, from pre-hospital services, emergency room care, ICU indicators, quality improvement programs, trauma registry, continuing staff education, clinical research, injury prevention and rehabilitation and their measureable impact in RTI’s will be presented and recommendations will be made for the next steps in the continued development of a national trauma system for Qatar.

Oman has undergone a rapid epidemiological transition, and has witnessed substantial social and economic changes in the last four decades. Based on oil revenues, the government of Oman has accelerated the development, in the present context, of road network and rapid growth of motorization. Despite the positive side of the substantial development, however, there are other challenges appeared on the scene that have negative impacts. Today, road traffic crashes, injuries and fatalities are a public health challenge in Oman in terms of immeasurable human suffering along with the huge economic and social costs incurred as well as becoming a burden on health sector i.e. main external cause of morbidity, particularly among young and adults. Oman presents a fertile ground to explore the contributory factors of road traffic crashes and their consequences of injuries and fatalities. Recognizing the importance of research to understand road traffic injuries and provide effective interventions, The Research Council initiated a strategic program for road safety research within Oman in April 2010, the Road Safety Research Program (RSRP). The main objective of the RSRP is to promote scientific research and build national capacity in road safety research for the purpose of supporting decision makers in implementing evidence-based solutions to combat road traffic injuries in the Sultanate of Oman. The RSRP has operated on the basis of competitive and commissioned research grants as means to promote innovative research projects that would have a direct bearing on reducing the burden of road traffic injuries (RTI) in Oman. This presentation will highlight major projects funded within the RSRP that address low enforcement and traffic policing as a major intervention for road safety. In particular, this presentation will present findings from projects exploring traffic policing in Oman, evaluation of the deterrence practices for heavy vehicle safety, and traffic enforcement for novice driver safety. The presentation will also present some of the findings of a series of qualitative observations and interviews were conducted in Oman with 47 truck drivers. One objective of these observations was to explore the role enforcement strategies by the police in mitigating the risk of road traffic crashes of heavy vehicles using the deterrence theory. In addition, the presentation will show some of the findings from a study sought to explore the relationship between policing enforcement as well as current licensing system and young driver behavior using Akers' social learning theory. The study was conducted among 1319 Omani young drivers (72.9% Male and 27.1% female). Finally the presentation will discuss the implication of the findings of these studies suggest recommendations for improving deterrence and police enforcement in Oman and the region to improve road safety.

Introduction: Road traffic injuries are the leading cause of death among young people, aged 15-29 years (1). It is generally accepted that the high rate of adolescent injuries may be due to a variety of factors. Studies have shown young drivers are more likely to underestimate the probability of specific risks caused by traffic situations, as well as to overestimate their own driving skills making them more vulnerable to trauma. It has also been hypothesized that adolescents are more prone to motor vehicle collisions due to their risk-taking attitudes (2). There is consensus among experts in the field of road safety that the best road safety strategies and programs are based on research-driven and psycho-social theories of behavior (3). The P.A.R.T.Y. (Prevent Alcohol and Risk-Related Trauma in Youth) Program is one of those programs. Developed in 1986, P.A.R.T.Y. is a one day, in hospital injury awareness and prevention program for youth aged 15 and older. The goal is to provide young people with information about trauma that will enable them to recognize their injury risks, make prevention-oriented choices and adopt behaviours that minimize unnecessary risks through vivid clinical reality. Attitudes towards risk taking in traffic have been correlated with aggressive driving behavior, speeding, and intention to commit traffic law violations. Thus, an effective intervention to increase road safety may be to change the attitudes that influence the driving behavior of adolescents. This is consistent with the cognitive dissonance theory, which states that changing the beliefs that underlie certain behaviors can cause a behavioral change (2). From these theories, one can expect that changing the risk taking attitudes of adolescents can lead to a decrease in the probability of collisions. A recent meta-analysis suggested interventions aimed at influencing attitudes might be the most effective measure to improve safety on the roads (2). Methods: Several research studies have been undertaken to determine effectiveness and changes in attitudinal risk behavior from youth attending the P.A.R.T.Y. A ten-year longitudinal study was conducted to determine whether students who attended P.A.R.T.Y. had a reduction in injuries compared with a matched control group of students based on age, gender and geographic area who did not attend the program. Students follow the course of injury from occurrence through transport, treatment, rehabilitation and community re-integration phases. Additionally by augmenting a didactic format through a technologically innovative approach including but not limited to vivid clinical reality, social media, interactive websites and simulators we see attitudinal and behavioural changes. Results: The 10 year longitudinal study showed P.A.R.T.Y. participants had a lower incidence of traumatic injuries than a control group of non-P.A.R.T.Y. participants of the same age, gender, residential area, and initial year in database, during the 10-year study (4). Conclusion: Research-driven, psycho-social theories of behavior and technologically innovative approaches have proven it is possible to influence behavior through the delivery of well-designed and well-executed road safety strategies, programs and campaigns. Providing students with real-life education to depict the vivid clinical reality of injuries was shown to be a compelling and effective method of education. References 1. Road safety basic facts. World Health Organization. 2013 [cited July 28, 2015]. Available from:http://www.who.int/violence_injury_prevention/publications/road_traffic/Road_safety_media_brief_full_document.pdf 2. Pal Ulleberg, T.R., Risk-taking attitudes among young drivers: The psychometric qualities and imensionality of an instrument to measure young drivers' risk-taking attitudes. Scandinavian Journal of Psychology, 2002. 43(3): p. 227-237. 3. Road Safety Campaigns: What the research tells us. Traffic Injury Research Foundation.2015 [cited July 7, 2015]. Available from: http://www.tirf.ca/publications/PDF_publications/2015_RoadSafetyCampaigns_Report_2.pdf 4. Banfield JM, Gomez M, Kiss A, Redelmeier DA, Brenneman F. Effectiveness of the P.A.R.T.Y. (prevent alcohol and risk-related trauma in youth) program in preventing traumatic injuries: A 10-year analysis. J Trauma. 2011 Mar;70(3):732-5.

Qatar is one of the 20 countries of the IDF MENA region. Three hundred and eighty seven million people have diabetes worldwide and more than 37 million people in the MENA Region; by 2035 this will rise to 68 million. There were 303,700 cases of diabetes in Qatar in 2014. Large number of diabetic patients will seek or currently hold a license to drive. Most of these patients are either on oral medications or insulin to control their diabetes. Hypoglycemia is one of the major complications related to diabetes treatment. Many large studies have shown an increased risk of hypoglycemia with tight blood sugar control. Unfortunately most diabetes medication can cause hypoglycemia. Hypoglycemia has been associated with cardiac arrhythmia, a decreased ability to drive and driving mishap. Recent meta-analysis of 15 studies showed a risk road traffic collisions (RTC) of 12-19% greater than general populations. The most significant subgroup of persons with diabetes is those on insulin therapy. The single most significant factor associated with RTC appears to be history of recent severe hypoglycemia. Government regulations have not been established in most of GSC and MENA in general. All EU countries do have regulations for diabetes and driving. Many US states have a restrictive license program for drivers with medical conditions including diabetes. These regulations include more frequent medical examination to denial of driving license, e.g.in those patients with hypoglycemia unawareness. Also more restriction regulations have been established for drivers who are using insulin and buses and heavy goods trucks.

Young drivers run a greater risk everywhere. Better understanding of the underlying processes to this problem are a useful tool in preventive endeavors. An understanding that a person’s life ambition and context of driving mostly influence young drivers in terms of traffic safety more than their ability of mastering different driving situations and their skill of vehicle maneuvering is important to understand young drivers overrisk. Research has indicated that a hierarchical approach to the task of driving can help to identify specifically which skills a driver needs to avoid crashes and injuries. Keskinen (1996) divided the task of driving into four separate levels (4. goals for life and skills for living, 3. goals and context of driving, 2. mastering traffic situations and 1. vehicle maneuvering) in which the higher levels are considered to always affect behavior on the lower levels.The idea behind a hierarchical approach is that success as well as failure on the higher levels will affect the demand on lower levels (Hatakka et al. 2002). Keskinen and others later developed a proficiency model comprising Goals for Driver Education (GDE) (Hatakka et al. 2002). The GDE matrix states specifically what driver training should focus on in order to produce the safest possible new drivers. Understanding the GDE matrix offers the possibility to use it to develop different countermeasures for young drivers. If this is adapted as closely as possible to this group and their driving situations, it should be possible to significantly enhance safety. Driver education or communication campaigns cannot be expected to radically change a young person’s life goals. Special courses for young drivers designed to make individuals conscious of their personal tendencies and the type of social context that affects their driving behaviour could be helpful, whether offered via the ordinary school system or at driving schools.To change a young driver’s goals behind driving and the context in which it is done, a variety of different methods of persuasion should be used. For example, communication campaigns and increased enforcement may be used simultaneously and in particular target young males. (Engström et al. 2003). Communication campaigns that employ persuasive, emotional messages are most effective where young drivers are concerned. Attitudes about safety are formed at an early age, long before legal driving, and therefore it would also be important also to target young adolescents. Laws need enforcement to be effective and should target areas of particular risk to young drivers References Engström I, Gregersen NP, Hernetkoski K, et al. (2003) Young novice drivers, driver education and training: A literature review. Linköping, Sweden: Swedish National Road and Transport Research Institute. Hatakka M, Keskinen E, Gregersen NP, et al. (2002) From control of the vehicle to personal self-control; broadening the perspectives to driver education. Transportation Research Part F 2002;5:201–15. Keskinen, E. (1996). Why do young drivers have more accidents? Junge Fahrer und Fahrerinnen. Referate der Ersten Interdiziplina¨ren Fachkonferenz, December 12–14, 1994 in Cologne. Berichte der Bundesanstalt fur Strassenwesen. Mensch und Sicherheit, Heft M 52, 1996.

As President of the German Road Safety Association and Vice President of the German Road Safety Council, I strongly force the way of the Vision Zero as a permanent strategy to reduce accidents and to avoid victims of the fast-growing road traffic. In this strategy are some components which have to be realized. One is an intensive campaigning for more safety by changing the behavior of the car users inside the traffic and the mobility of passengers, but also strict rules which have to be accepted by car owners and users. The third main aspect is the construction of roads with a self explaining structure (to be secure by using them). Last but not least we need a functioning rescue system for the victims of accidents which helps to save life in the worst case. All those measures have to be implement in a short time in order to achieve educational effects on the one hand and to reduce accidents on the other. Our international experience in Europe, Iran and China are good basements for the necessary roll out processes.

Within the German road traffic safety system, the Medical-Psychological Assessment (MPA) has a more than six-decade-old history and tradition. According to the German traffic law system a driver has to make sure to drive only in a good physical and mental condition and to obey the traffic regulations. If drivers are sanctioned for driving under the influence (alcohol), driving while intoxicated (illegal drugs) or received offences for reverse or repeated violations to traffic rules etc. they have to pass the MPA before getting their driving license back or to avoid a withdrawal of their driving license. The MPA is an integrated medical and psychological examination usually containing the elements •Questionnaire (biography, driving history, knowledge of driving rules) •Medical examination (medical history, physical examination, laboratory analysis) •Psychological interview ((alcohol or drug consumption style, change of behaviors and attitudes, perception of problems in future) •Psychophysical computer-based test of cognitive functions (reaction capacity, visual perception, concentration, vigilance) The examination can be complemented by a driving test in real traffic under defined conditions. The integration of the data from different sources is outlined in a basic manual, the MPA-Expert-Manual, which is published. Inspection principles and rating criteria to identify the quality and intensity of the drivers personal problems (e.g. alcohol addiction, abuse of alcohol, habituation of high consume levels, risky attitudes to drive under the influence), the process of change and the stability of the behavior in future funds the interdisciplinary decision-making procedure, and lead to a MPA-report that is transparent and traceable for public servants or court members. Due to the importance of this measure for the applicants and for traffic safety the MPA has repeatedly been evaluated in terms of its effectiveness (recidivism rates after a probation period of 3 years, data from the Central Index for Traffic Offenders of the Federal Motor Transport Agency). The results show over the years a decrease of the percentage DUI- and DWI-offenders with a relapse (current state A 8 %) and therefore indicate the predictive reliability of the MPA. There are still problems with drivers with multiple traffic offences (e.g., speeding, tail gaiting), who have a relapse rate of more than 40 %. Altogether the MPA-system in Germany can be regarded as an effective measure in the German licensing procedure in preventing recidivism and an important approach for improving traffic safety.

In a general sense Traffic Medicine in the Netherlands concerns multidisciplinary research about how to reduce traffic crashes and injuries following a “systems approach”. Several universities and research institutes are involved, including the SWOV research institute of traffic safety( 1). In a specific sense Traffic Medicine in the Netherlands concerns researching and applying regulations and methods for assessing and improving fitness to drive in persons with impairments in physical and mental functions which are relevant for driving. Important recent developments in the general and specific field are discussed. Because the Netherlands is a flat country with a moderate climate and generally small distances between destinations, bicycling is a very important mode of transport also for older persons. In general traffic safety has improved tremendously over the last years but much less so for older (65+) cyclists. This is particularly problematic because the older population is increasing and with the arrival of the e-bike, cycling is increasingly popular. Several approaches to improve bicycle safety have been proposed. The Netherlands is part of the European Union (EU) and medical aspects of driver licensing are based on Directives (2) of the European Parliament and Council. The European directive is not very detailed with regard to medical fitness to drive and individual countries can have more specific regulations. For example with regard to neurological disorders and dementia the EU directive states that: “driving licenses shall not be issued to, or renewed for, applicants or drivers suffering from a serious neurological disease or severe behavioural problems due to ageing, unless the application is supported by authorized medical opinion, and if necessary, subject to regular medical check-ups”. It will be discussed how, based on medical consensus and multidisciplinary research, this requirement has been implemented in the Netherlands. In empirical research persons with moderately severe visual (visual acuity < 0.5; homonymous hemianopia) and cognitive impairments (traumatic brain injury; stroke) have been systematically observed when actually driving. On average, driving was poorer in patients than in healthy subjects but many subjects in the patient groups drove safely and fluently and performance was not predicted sufficiently from medical and psychological characteristics (3,4). They appeared to compensate effectively, sometimes also helped by technology, for example the bi-optic telescope, and by visual training and special driving lessons. This has led to changes in regulations such that in the case of moderately severe visual and cognitive impairments on-road tests of “practical fitness to drive” have become important additions to the conventional medical and psychological assessments. Developments in intelligent driver support and autonomous vehicles promise further opportunities for compensating driver impairment but unwanted behavioural changes (adaptation) must be avoided (5). References: 1.SWOV publishes great overviews of recent developments in traffic safety research in its factsheets: http://www.swov.nl/uk/Research/factsheets.htm 2.Directive 2006/126/EC of the European Parliament and of the Council of 20 December 2006 on driving licenses including more recent amendments: http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=URISERV:l24141 3.Coeckelbergh T.R.M, Brouwer W.H., Cornelissen F.W., Kooijman A.C. 2004).Predicting practical fitness to drive in drivers with visual field defects caused by ocular pathology. Human Factors,46, p.748-760. 4.Brouwer, W.H., & Withaar, F.K. (1997). Fitness to drive after traumatic brain injury. Neuropsychological Rehabilitation, 7, p.177-193. 5.Dotzauer, M., Caljouw, S. R., De Waard, D., & Brouwer, W. H. (2015). Longer-term effects of ADAS use on speed and headway control

High-risk drivers (HRDs) prone to repeat episodes of dangerous driving are over-represented in road traffic morbidity, making them important targets for selective prevention. Better understanding of why some drivers engage in risky behavior is a necessary precursor to the design of effective prevention programs. Nevertheless, HRD research has traditionally focused on healthy young drivers and their self-reported personality features and driving behavior or intentions, and not on bona fide HRD populations and direct observation of their risk-taking behaviors of most concern. In total, the complex nature of HRD is not adequately addressed. A contemporary paradigm for understanding HRD behavior is to identify meaningful subgroups whose members share common characteristics and pathways to risk taking, and thus are likely to show selective treatment responsivity. For this approach, a more integrative, deep-level approach (i.e., beyond reliance on subjective reports) is advantageous. Previous studies by our group into different forms of HRD reveals dysregulation in two neurobiological systems, executive control related to the prefrontal cortex (e.g., 1,2,3), and the cortisol stress response related to the hypothalamic-pituitary-adrenal axis (e.g., 4,5). While promising, the findings are fragmented. We recently recruited three distinct HRD groups (males, N = 138, aged 19-39 years) based upon documented driving behavior: 1) drivers who engage in multiple forms of risk taking; 2) speeders/reckless drivers; and 3) alcohol impaired drivers, as well as a healthy, aged-matched, non-HRD control group. Assessment included psychosocial adjustment, personality, functional tests and assays of the above neurobiological processes, and simulated driving behavior. Our main hypothesis was that each HRD subgroup possesses a distinct biosocial profile. Preliminary results supported our hypothesis. The mixed profile closely resembles a ‘cold’ antisocial phenotype in which chronic under arousal interferes with avoidance learning - which leads to asocial risk seeking. The speeders/reckless drivers comprise a phenotype involving the most dangerous behavior and externalizing features, including competitiveness, impulsivity, reward driven decision-making, and weak inhibitory control. Interestingly, the impaired drivers showed poor inhibitory control, alcohol misuse, yet safe driving in simulation. This suggests that their risk taking involves and interaction between alcohol misuse and poor inhibitory control. Overall, these findings signal that development of novel and targeted HRD interventions may come from more integrative research approaches. References: 1. Bouchard SM, Brown TG, Nadeau L. Decision-making capacities and affective reward anticipation in DWI recidivists compared to non-offenders: A preliminary study. Accident Analysis & Prevention. 2012;45(2):580-7. 2. Ouimet MC, Brown TG, Nadeau L, et al. Neurocognitive characteristics of DUI recidivists. Accident Analysis & Prevention. 2007;39(4):743-50. 3. Dedovic K, Pruessner J, Tremblay J, Nadeau L, Ouimet MC, Lepage M, Brown T.G. Examining cortical thickness in male and female first-time driving while impaired with alcohol offenders. Neuroscience Letters. 2015; In review. 4. Brown TG, Gianoulakis C, Tremblay J, et al. Salivary cortisol: a predictor of convictions for driving under the influence of alcohol? Alcohol & Alcoholism. 2005;40(5):474-81. 5.Ouimet M, Brown TG, Guo F, et al. Higher crash and near-crash rates in teenaged drivers with lower cortisol response: An 18-month longitudinal, naturalistic study. JAMA Pediatrics. 2014;168(6):517-22.

Safe driving campaigns in Qatar are in their infancy. The first campaigns were fear appeals that typically involved pictures of vehicles that had been smashed almost beyond recognition in accidents posted on signs around the capital city, Doha. A second generation of campaigns has recently been developed that are also fear appeal based, but feature more sophisticated messaging and visuals than the first group did. While laudable in their goals, both set of campaigns are not based on either a theoretical framework or research on the target audience. Evaluation research on the specific campaigns has not been conducted making assessment of message efficacy difficult. Even if the campaigns have had some effectiveness, 18-25 year old Qatari men, our target audience, continue to be the highest risk group, involved in a disproportionate number of MVCs, suggesting the campaigns are not working for this cohort at all. One of the common reasons message campaigns fail to have the intended effect is the lack of correspondence between the message content, form and design and the audience’s attitudes and beliefs (Yzer, 2012). The stronger the match is between the message and the audience, the higher the likelihood of persuasion. Creating a message that is closely tailored an audience requires an understanding of the way they think and are likely to respond to messages. We conducted focus group discussions with 18-25 year old Qatari male drivers to discover their driving attitudes and behaviors to provide guidance for tailored message campaigns designed to change their attitudes and behavior. We discovered that the perceived capability of actually changing one’s behavior is seriously impeded by a couple of characteristics our respondents shared and that they typically engage in quite risky driving behaviors. The two characteristics our respondents reported are fatalism and high sensation seeking. Fatalism is a belief that what happens to a person is not as a result from their own behaviors but rather is caused by an entity higher that them, typically God, but non-religious people can nonetheless still have high levels of fatalism (Shen & Condit, 2012). A high level of fatalism presents a challenge to message campaigns because the message recipients, who believe they do not have control over their own fate, may reject the desired behavioral change. High sensation seeking increases the resistance to a more negative attitude toward reckless driving – because it is rewarded by both the psychological pleasure derived from dangerous actions and by young men’s peers. Driving at excessive speeds and refusing to wear seat belts are some of the high-risk behaviors our respondents reported. The combination of fatalism and high sensations seeking coupled with routine engagement in risky driving behaviors makes our respondents a particularly difficult group in which to inspire behavioral change. Message campaigns must take these factors into account to increase their likelihood of success and decrease the high MVC rates that are taking too many young lives in Qatar. References Shen, L. & Condit, C. (2012). Addressing fatalism with health communication messages. In Health Communication Message Design, Ed. H. Cho, Sage. Yzer, M., (2012). The integrative model of behavioral prediction as a tool for designing health messages. In Health Communication Message Design, Ed. H. Cho, Sage.

International statistics show that Australia is one of the top 10 countries in terms of road crashes per 100,000 population. In spite of this, four people are killed and 90 seriously injured every day on Australian roads. In 2011, the Australian Transport and Infrastructure Council released a National Road Safety Strategy (NRSS) for Australia, calling for a reduction of at least 30 percent of deaths and serious injuries on our roads by the year 2020. The strategy is based on Safe System principles embracing the principle that in the longer term, no person should be killed or seriously injured on Australian roads. It accepts that people using the road network will inevitably make mistakes and that the road system must be more forgiving of these errors. It relies on better management of crash energy within the system to keep this within human tolerance. This adherence to what is generally known as Vision Zero aligns Australia with international best practice. To help achieve the immediate goal outlined in the strategy, a National Road Safety Action Plan (NRSAP) was recently adopted for the first three years from 2015 to 2017 focusing on four key areas – Safe Roads; Safe Speeds; Safe Vehicles; and Safe People. The action plan is focused on national efforts and activities to achieve long-term and permanent reductions in road trauma in line with the NRSS target. It aims to achieve these improvements through strategic investment in infrastructure and vehicle safety initiatives using best practice and capacity building as shown below: 1.Safe Roads: The plan calls for short- and long-term initiatives for road improvements based on best available evidence on road authorities at all government levels is necessary to ensure that Safe System principles are applied to all new road projects. 2.Safe Vehicles: Comprehensive regulatory and consumer tests are called for to ensure that proven safety design features and technologies are mandated in new Australian vehicles as quickly as possible. 3.Safe Speeds: Speed enforcement has been shown to be an effective management tool against speed-related crashes. The plan calls for a number of initiatives aimed at reducing speed-related risk. 4.Safe People: Various initiatives were outlined to improved driver and rider risk such as supervised learner driving hours, provisional licence periods, passenger night time restrictions, sanctions for speed and alcohol offences, and mobile phone bans. The strategy notes that there is potential to achieve large and lasting road safety benefits for all Australians, providing there is significant commitment by government and non-governments in implementing the actions outlined. If the strategy is to be successful, it will be necessary to maintain this trend in fatal and serious injury improvements, achieving a target of around 860 deaths and associated serious injuries by 2020. It will be quite a challenge to maintain this trend over this decade but clearly important in terms of road trauma improvement in Australia. Disclaimer: The views expressed in this paper are those of the author and do not necessarily reflect those of the Australian Transport and Infrastructure Council, its partners, and Monash University.

Road deaths and injuries are increasing in India due to unprecedented motorization and expansion of infrastructure amidst absence of strong road safety policies and programmes. In 2014, 141,000 persons died and 4,77,731 persons were injured as per official reports (1). However, data from World Health Organization, Global Burden of Disease 2013 and independent Indian studies estimate these numbers to be much higher due to underreporting of Road Traffic Injuries (RTIs). Nearly 10-30% of hospital registrations are due to RTIs and majority of them are discharged with varying levels of disabilities. Individuals in the age group of 15-44 years, men and, middle and poorer sections of society are affected most in RTIs. Pedestrians, motorcycle riders / pillions and bicyclists, the vulnerable road users, are killed and disabled in large numbers. The economic losses from road crashes are estimated to be 3% of GDP and are increasing from year to year (2). Amidst significant regional variations, many Indian states have road deaths much above the national average. Indian states that have progressed in development, infrastructure, education and per capita incomes also have the highest rates. While urban deaths account for nearly a fifth of total deaths and injuries, Indian highways account for more than 50% of deaths and injuries and are likely to increase with further growth in infrastructure (1). This distribution clearly implies that transport and mobility growth should be accompanied by road safety as well. Road crashes occur due to a complex interaction of human, vehicle and environmental factors in heterogeneous transport environments. Despite the growing number of crashes, the understanding of road crashes in India has been limited. All official reports till date indicate ‘human error, driver negligence, rash driving, careless driving’ as the major cause, thereby implicating human behaviour to a larger extent. However, independent limited research in recent years has informed that several issues in road environment, vehicle safety, behaviour of road users, enforcement of safety laws, availability and affordability of trauma care and others are responsible for both causation and poor outcomes in road crashes (3). Most glaringly, the absence of an efficient road safety management system has resulted in piecemeal and fragmented solutions. Many high-income countries implemented systematic interventions based on a scientific understanding of road safety (Haddon’s matrix, safe systems approach, public health understanding, and others) and successfully demonstrated that road crashes are predictable and preventable (4). As the causes for road crashes are multiple, interventions need to be several and needs prioritisation in India. Road safety management through a clearly defined road safety policy, a central coordinating agency to guide-coordinate-monitor-direct-implement and evaluate activities, improving human/financial/ physical resources are urgently required to develop a road map for future activities. Safe infrastructure development through low cost and sustainable engineering solutions that are geared for people’s needs and travel patterns addressing both mobility and safety is critical. Vehicle safety that adheres to safety standards is vital to make people safer. Strict implementation of proven and effective interventions (e.g., helmets and safety belt laws, drink drive laws, speed control measures, and visibility related measures) are required to make people safe and reduce poor outcomes. Good trauma care practices that include rehabilitation services are highly essential to save the injured. Undoubtedly, all these activities need to be driven by evidence based practices and data driven systems. As road safety is the shared responsibility of different ministries and departments at this time, it requires participation from health and all other sectors to develop integrated, intersectoral and coordinated approaches (5). References: 1.National Crime Records Bureau. Accidental deaths and suicides in India 2014. Ministry of Home Affairs, Government of India, New Delhi, 2015 2.Gururaj G. Road safety in India- A framework for action. Publication No. 83, National Institute of Mental Health and Neuro Sciences, Bangalore, 2012 3.Gururaj G and Bangalore Injury Surveillance Collaborators Group. Bangalore Road Safety and Injury Prevention Program: Results and Learning, Publication no 81, National Institute of Mental Health and Neuro Sciences, Bangalore, 2011 4.World Health Organization. Global status Report on Road Safety, Geneva, 2013 5.World Health Organization .Global plan for the Decade of Action for Road Safety 2011 – 20, http://www.who.int/roadsafety/decade_of_action/plan/plan_english.pdf?ua=1, accessed on 28th July 2015

Injury contributes approximately 12% of the world’s burden of injury and there is increasing evidence that injury results in the new onset of a range of psychiatric disorders. Posttraumatic stress disorder (PTSD) is one of the more common psychiatric disorders after injury due to road crashes and other forms of traumatic injury. The incidence of PTSD in a number of well controlled studies has been reported at 10-25% but it has been reported to be less than 10% in other studies. In one large longitudinal study, where patients were followed up to 12 months after injury, 31% of patients had developed a psychiatric diagnosis at 12 months and 22% had a new psychiatric diagnosis. PTSD can occur in combination with other psychiatric disorders or as a single diagnosis. The most common new psychiatric disorders in the above study were depression, generalised anxiety disorder, PTSD and agoraphobia. Many patients with psychiatric symptoms after injury did not seek professional assistance and only a minority of patients (33%) sought mental health treatment at 12 months. Functional impairment (physical, psychological, social and environmental impairment) at 3 months has also been shown increase the risk of the development of a psychiatric disorder at 12 months. PTSD symptoms (intrusive thoughts, avoidance behaviour and hyper-arousal symptoms) may persist or become worse if not diagnosed and treated within the first 12 months. These symptoms can be extremely debilitating and lead to social isolation, relationship breakdown and ongoing psychological dysfunction. The presence of head injury, substance abuse, depression and other psychiatric disorders may further complicate the diagnosis and treatment of PTSD and other psychiatric disorders. The presence of mild Traumatic Brain Injury increases the risk of subsequent development of PTSD, panic disorders, agoraphobia and social phobia. A biological model of anxiety disorder suggests that fear is mediated by impaired regulation of the amygdala by the ventral medial prefrontal cortex and damage to this area may lead to increased vulnerability of the patient to develop anxiety and depression due to impaired neural regulation. The main issue associated with the diagnosis and treatment of patients with PTSD and other psychiatric disorders depends on appropriate presentation and available treatment options including cognitive behavioural therapy, desensitisation or drug treatment. It appears that up to 33% of patients may develop a psychiatric illness after a traumatic injury and this may lead to significant functional impairment and social dysfunction. Public health initiatives are required to address the mental health burden caused by these disorders. I will address some of the newer approaches to both the early identification and diagnosis of these disorders and suggest some early interventions for both the treatment and prevention of these debilitating psychiatric disorders.

Most of the world's population and economic growth is occurring in the cities. Essential as the movements of people and goods are to the economic and social aspects of urban life, they present people and their surrounding with the ever-increasing problems. As a consequence, world's cities face traffic congestion associated with imbalance of the available road space and operation vehicles, slow traffic flow, poor access to main activity centers, high transport cost, waste of time, psychological effects, decline productivity and increase discomfort. Vehicle emissions have their economic and health effects. Road accidents and their fatalities and injuries, pedestrian movements, socioeconomic impacts, inefficient road infrastructure, and unsafe design are also critical issues. To overcome urban transport problems, the UN Habitat has stressed that the conventional solutions of transport planning have proven their inefficiency during the past decades. The pattern and cost of land use, urban structure, population distribution, tight budget, stand-alone projects, lack of expertise, and other factors restrict the impose of successful road facility. Besides, maximizing road network capacity is not the only solution to tackle transport problems, due to the facts of high demand for urban road space and less supply, transport problems are accelerating at higher rate than population and economic growth, and building new road infrastructure requires long period due to complex project cycles. Introduction of the traditional traffic management measures to control vehicle operations is also proved partial solution. Transfer from private vehicles to public transport use is not fully acceptable solution by majority of the community in some countries beside lack of current public transport services. Another serious obstacle is institutional, due to involvement of several organizations in the transport sector, lack of interagency coordination, insufficient enforcement, unavailability of common policy and performance indicators, and insufficient information. Community concern about transport efficiency and the negative drawbacks has increased. Politician and government agencies face increasing pressure to protect the quality of urban environment, create livable cities, maintain the right access and run efficient and integrated transport system. At present, Transport Demand Management (TDM) is emerging as a fashionable concept among planners and decision-makers for sustainable urban development and minimizing transport drawbacks, since traditional transport techniques have reached their effective limits in most cities. The paper addressee merits of the TDM which aim to modify trip makers behavior and habits, reduce use of private vehicles (drive-alone transport), influence mode choice, minimize travel time, alleviate congestion and enhance road safety. Assessment is presented into the practical techniques of the TDM such as congestion charging, public transport priorities, sustainable road network development, ridesharing schemes, service centers, transport-land use planning, communications, restricting use of road space and vehicles, private sector programs, school programs, working hour schemes, and traffic monitoring centers. The paper also explores development conditions, programs and performance of the TDM systems in different parts of the world such as London, Singapore, Stockholm, Dubai and Victoria (Australia) which alleviated congestion, enhanced road safety, and promoted equity in transport accessibility for passengers, pedestrians, freight, community and economic viability. The paper stresses that TDM is the only sustainable approach to accommodate the ever-increasing demand for travel and tackle transport problems, as part of a comprehensive and balanced policy for today and future cities. TDM should be associated with shift in behavior, involvement of private sector, community groups and government organizations, efficient institutional capacity, action plan, and lead agency. TDM program should be linked with the national vision, transport system, development plan, and community benefits and expectations through short term and long-term strategy. Government leadership is crucial.

Safe automobile driving requires sufficient vision, cognition, and physical capability that, in turn, depend on the relative integrity of cerebral functioning. Fairly common medical conditions such as dementia, stroke, and seizures affect the brain, and may therefore compromise safe driving. Evidence of unsafe or impaired driving in these diagnostic groups has been presented, but has also been subject to debate. Furthermore, legislation regarding license holding for people with different medical conditions varies widely across countries and states. Nonetheless, it is important, in the clinical context, to determine whether patients should drive, when their medical conditions may put them or other road-users at risk. When patients with dementia and post-stroke conditions are not evidently either fit or unfit to drive, assessments should ideally be carried out by multi-professional teams comprising physicians, neuropsychologists, and/or occupational therapists. Areas addressed should be visual functioning, cognition (with an examination of domains such as attention, speed, and visuospatial ability), and the ability to handle the vehicle. It is also necessary to consider additional factors such as medication use, the presence of co-morbidities and risk of recurrence of stroke, and the risk or speed of progression that makes it necessary to reexamine the patient at suitable intervals (in cases of dementia, at least on a yearly basis). Professionals should be aware of the fact that there is no perfect ‘golden standard’ against which to compare the outcome of the clinical examinations and that factors such as the occurrence of adverse traffic events or the compensatory potential of the individual patient, based on insight and/or premorbid driving skill, should be taken into consideration. Losing consciousness while driving constitutes a considerable traffic hazard, but there is no clear-cut evidence that drivers with epilepsy or seizures are over-represented in motor vehicle crashes. Legislators in different countries have differing approaches to the granting of driving privileges to patients who have had seizures and the required duration of a seizure-free period before driving can be resumed can vary considerably on grounds that do not appear to be scientifically based.

Traffic fatality data for four continents, namely Asia, Africa, Europe and North America, are analysed and modelled here. The analysis is based on gathered traffic death frequencies and rates for over three decades considering 176 countries within the four continents. The predicted values for the coming decade, based on best regression fits, are also analysed. The data sums to over 28,000 records. Official publications, well-known databases, journal papers, official web-sites and personal correspondance were manily employed in collecting the necessary data. While fatlity and vehicular data for the developed countries and few other less developed countries take no time to compile; those for most of the other countries are highly time consuming and distracting, due to the presence of conflicting data, to be processed. It took over three years to gather such data. Such large gathered data for such long period of time are yet not observed in the literature using the common means. Moreover, while future trends of traffic fatalities in Europe and North America are very common and widely presented; that in Asia and Africa are very scarce and lack accuracy due to lack of long-term data. The results indicate that traffic fatalities in Asia and Africa raised from 153 thousands and 46 thousands during 1980 to 384 thousands and 90 thousands deaths during 2011, in respective order; that in Europe and North America dropped from 97 thousands and 57 thousands deaths to 39 thousands and 33 thousands, respectively. It is also intresting to mention that the traffic fatalities in the Arab world sharply increased from 22,145 during 1980 to 37,736 during 2011. It is expected to pass 45 thousands deaths during 2021. The traffic fatalities in the four continents will add up to just 790 thousands considering a flat rate of adjustment factor for underreporting. This however raises serious question regarding underreporting of the official records. Nevertheless, while the roadway deaths in Europe and North America is expected to drop by around 40 and 20%, respectively by the year 2025, according to the models developed here, that in Asia and Africa is expected to increase by around 15 and 70%, respectively. The fatality rates per population followed a very similar pattern, but steeper, of the fatality frequency. There are many contributory factors leading to such high traffic deaths in Asia and Africa. These include, among many other factors, lack of measurable long term safety plans on real ground, inconsistent handling of traffic safety strategies, poor involvement of NGO’s, poor coordination between various stake holders, poor research involvement in the traffic safety crises and limited post-accident rehabilitation centres. Selected References 1. World Health Organization, Eastern Mediterranean Status Report on Road Safety Call for Action, Regional office for the Eastern Mediterranean, 2010. 2. UNECE Transport Division, Handbook of Transport Statistics in the UNECE region 2006, Geneva, Switzerland, 2007. 3. Jacobs, G., Aeron-Thomas, A. and Astrop, A., Estimating Global Road Fatalities, Transport Research Laboratory and Department for International Development, TRL Report 445, UK, 2000. 4. Al-Madani, H., Crash Deaths in the Arab World During Three Decades: Challenges and Opportunities, Session on UN Decade of Action for Road Safety: Progress Report, IRF 17th World Meeting, Reyadh, Saudi Arabia, 2013. 5. Kopits, E. and Cropper, M., Traffic Fatalities and Economic Growth, University of Maryland and Resources for the Future, Policy Research Working Paper 3035, World Bank.

• Cite worldwide research & statistics on motor vehicle collisions (number of deaths, injuries and primary cause of road incidences). • Explain the concepts of defensive driving (which was pioneered and developed by the National Safety Council in 1964) • Discuss distracted driving (e.g., use of cell phones or texting while driving) which has joined speeding and alcohol as one of the 3 leading factors in fatal and serious injury crashes • Benefits of managing work-related road safety and the need to promote safe driving practices and a positive safety culture at work. • Explain why the adoption and enforcement of traffic laws appears inadequate in many countries (subtopics include excessive speed, seat-belt use, drinking and driving, use of motorcycle helmets, and use of child restraints in a vehicle).

A research team from Texas A&M University at Qatar (TAMUQ) and Texas A&M Transportation Institute (TTI) conducted during the past three years a study that focused on traffic safety situation in Qatar, tyre properties, and the influence of tyre properties on driving safety. The presentation will compare and contrast the specifications of the Gulf Standardization Organization (GSO) and other specifications used in Europe and United States. Consequently, the presentation will discuss recommendation for changes in GSO tyre specifications in order to better reflect climatic conditions in the region. One of the road safety issues in Qatar is the routine use of some drivers of off-road tyres on paved roads. The research team conducted comprehensive testing of off-road tyres and standard tyres that are used in a typical large SUV. In addition, the team developed computer models and conducted finite element analysis to simulate the driving and manoeuvring conditions of the different types of tyres. The experimental measurements and computer simulations revealed valuable information about performance of off-road tyres and risks associated of using them on roads in Qatar. The results will be very useful for the policy makers and the driving public regarding the development of regulations that control the use of off-road tyres.

Road traffic injuries found to be the second rank of Years of Life Lost (YLL) and third rank of Disability Adjusted Life Years (DALY) in Iran based on Global Burden of Disease 2010. The number of annual fatalities, which had been on the rise for several decades, reached to the maximum number of over 27500 deaths in 2005. The number decreased to 23000 in 2010 and less than 18000 in 2013. The reduction in number of deaths happened despite a four-fold increase in number of motor vehicles. Some of the interventions that might be contributing to this achievement include the following: a) the new traffic law passed in 2010 that replaced the previous one dating back to 1968. Heavier penalties for major offences like: speeding, driving under the influence and dangerous driving are considered in the new law; b) stricter law enforcement by traffic polices(1); c) mass media campaign for traffic injury prevention (1); d) using fixed speed camera systems and laser speed guns; e) universal coverage of hospital treatment costs for all traffic injuries by Ministry of Health and Medical Education(2); and f) graduated driving license. On the other side, there are areas that need to be improved, including: a) driving behavior of both public and private drivers; b) driving under influence of drugs specially among public vehicle drivers (3,4) c) motorcycle riding behavior with special emphasis on helmet use (5); d) medical and psychological fitness to drive examinations; e) vehicle safety specifically for cars manufactured within the country; f) transportation engineering with emphasis on expansion of railroads and safe highways. References: 1) Soori H1, Royanian M, Zali AR, Movahedinejad A. Road traffic injuries in Iran: the role of interventions implemented by traffic police. Traffic Injury Prevention. 2009 Aug; 10(4):375-8. 2) Karim H, Mohammadi M, Bazargan-Hejazi S, Ahmadi A. Removing the economic burden of road traffic injuries from patients: a successful model. Journal of Injury and Violence Research. 2015 Jul; 7(2): 95-96. 3) Motevalian SA, Jahani M, Mahmoodi M. Driving under influence of opiates in heavy vehicle drivers of Iran in 2001. Hakim; 2004, 7(1): 1-8. 4) Majdzadeh R, Feiz-Zadeh A, Rajabpour Z, Motevalian A, Hosseini M, Abdollahi M, Ghadirian P. Opium consumption and the risk of traffic injuries in regular users: a case-crossover study in an emergency department. Traffic Injury Prevention. 2009 Aug;10(4):325-329. 5) Motevalian SA, Asadi-Lari M, Rahimi H, Eftekhar M. Validation of a Persian Version of Motorcycle Rider Behavior Questionnaire. Annals of Advances in Automotive Medicine. 2011 Oct:91-98.

Safety education and training is one of the four basic injury prevention strategies, although there are concerns about its effectiveness. In this study, we aimed to summarize the scientific evidence on effectiveness of education and training for different road user groups. Cochrane Injuries Group, Pubmed, Campbell Systematic Reviews and TRID databases were searched for the relevant literature. Only systematic reviews or meta-analyses were recruited for this study. Pedestrian safety education can increase the knowledge of children and improve their road crossing behavior, but its effectiveness on road traffic injuries remained unknown. More evidence for adult pedestrians, especially elderly people is needed. Bicycle skill training for children and youth may increase their safety knowledge, but not necessarily improve their behavior or decrease their injury rates. Non-legislative interventions were found effective for increasing observed helmet use among bicyclists. Education only interventions were less effective than those providing free helmet. School based programs were less effective than community based. Motorcycle rider training has not found to be effective in reducing injuries. Mandatory pre-license rider training is an obstacle in motorcycle licensing process, so it indirectly reduces crashes through reduction in exposure. Quality research is needed to evaluate the effectiveness of rider training on crashes and injuries. Graduated Driving License (GDL) are designed to gradually introduce novice drivers to higher risk driving situations. GDL is effective in reducing crash rates among young drivers. Stronger GDL programs achieve greater fatality reduction. A systematic review on the effects of post-license driver education, provides no evidence of its effects on preventing road traffic crashes or injuries. Because of the large sample size included in the meta-analysis, the possibility of even modest benefits is rejected. School-based driver education can lead to early licensing, but there is no evidence that it reduces road crash involvement. The findings suggest that driver education may even lead to a modest but potentially important increase in the proportion of teenage drivers involved in road traffic crashes. There is strong evidence that education in combination with on-road training is effective on improving driving performance. There is moderate evidence that only educational intervention is not effective in reducing road traffic crashes. The evidence supports the effectiveness of interventions aimed at retraining older drivers. Review of the systematic reviews show that education only interventions are rarely effective on prevention of road traffic crashes. Except for some interventions like post-license driver education which has strong evidence based on large number of participants, in most of the subject interventions more rigorous investigation is needed especially in low- and middle- income countries.

Three thousand people, including 500 children, are killed every day on the world’s roads. These amounts to 1.2 million deaths a year .In addition more than 50 million people are seriously injured; many are disabled for life. According to WHO reports, the number of road crashes fatalities will increase worldwide by 60% by 2020. Road crashes represent a major social cost to most societies, and their management has thus been a high priority. Efforts in management have been at the levels of both prevention (via education, enforcement and engineering) and cure (via the hospital and insurance systems). A large proportion of road traffic crashes are as a result of road-user behavior and more specifically, crashes occur because of the decisions taken by road users to disobey or break the road rules, commonly referred to as human error. Crashes rates and compliance are inversely related. Law enforcement agencies like the traffic police come up with strategies including use of penalties to ensure road rules are obeyed and compliance improves. Good traffic law enforcement is essential for road safety .The main objective of law enforcement is road safety – achieved by deterring road users from committing offences, which are related to road crashes and injuries. Police activities should primarily serve as deterrence for drivers inclined to commit traffic offences through increasing road users’ perception of the risk of being caught. Consistent deterrence strategies, which typically comprise highly visible police or camera activity can bring about lasting changes in road user behavior and, as a consequence, changes in road users’ attitudes which reinforce these behavioral changes. It is generally accepted that enforcement influences driving behavior through two processes: general deterrence and specific deterrence. Enforcement of road rules should be aimed primarily at causing general deterrence because then it is not necessary for police to catch and punish road users for them to be encouraged to obey the rules. To result in general deterrence, enforcement should be: accompanied by publicity, unpredictable and difficult to avoid, a mix of highly visible and less visible activities, and continued over a long period of time. Targeted and appropriate legislation that is consistently enforced and well understood by the public is a critical component of successful enforcement. An appropriate penalty system also needs to be in place. In many cases road users do not obey traffic laws and regulations because they do not know them .yet, even when people know the rules they do not obey them .while public education programs are important in informing the general public – especially if new laws and regulations are introduced – enforcement is important if some level of compliance is to be achieved. It should be recognized that not all enforcement should involve punishment. Some enforcement activity can be aimed at offering positive feedback, or reward, or offering education and courses in improved driving, rather than a fine. To maximize the road safety benefit, enforcement should be aimed at road rule violations that have been proven to increase the likelihood or severity of crashes. Safety benefits can be further increased through intelligence led policing. In road rule enforcement, intelligence led policing involves the use of data (for example, data on when and where crashes are occurring, data on severity factors such as not using seatbelts or helmets, or data on causal factors such as speeding or drink driving) to focus enforcement on the times and places that present the greatest risk.

The main goal of this presentation is to describe the current state of research in regards to in-vehicle feedback technology aimed at young drivers. Young drivers have a higher crash risk worldwide than other age groups, and the first months after licensing are the most dangerous. Several countries have achieved important crash reductions over the past years that are associated with the implementation of graduated driver licensing programs. Provisions of these primary and secondary prevention programs includes older age at licensing and driving privileges provided gradually to young drivers, such as driving at night and with young passengers. Development of in-vehicle technology, such as feedback devices, now allows easier implementation of secondary and tertiary interventions aimed at young drivers. A number of randomized controlled trials have been published and results suggest the efficacy of in-vehicle feedback devices in reducing some indices of risky behavior, such as g-force events. Research has also identified several obstacles to deployment of these devices, including acceptance by both young drivers and their parents. Results of recent studies by our research group on efficacy (N = 160) and acceptance (N = 380) of in-vehicle devices in 18-24 year old drivers, and individual factors that influence these dimensions, will be presented in light of the current research. The main discussion will address the efficacy of in-vehicle feedback technology to reduce young drivers’ risk, its strengths, limitations, and obstacles to implementation in primary, secondary, and tertiary prevention programs.

Road traffic injuries [RTI’s] are known to be a global leading cause of death and disability. In Latin America, they have been shown in disproportionately affect young males, vulnerable road users and low-income populations. Some of the world’s highest death rates from RTI’s are found in this region and this lecture will describe the efforts to improve road safety in the Dominican Republic [DR]. Temporal trends in RTI incidence and mortality rates have been on the rise and these have been heightened by the changing demographics, increasing numbers of vulnerable road users and the influx of immigrant populations. In response, government and non-governmental agencies have been implementing a wide array of public education programs, targeted enforcement campaigns, road improvement and quality improvements in the delivery of post-crash care. An evaluation of the multi-sectorial programs to reduce the health burden from RTI’s in the DR will be presented and recommendations made for specific elements that must be retained and continued will be made.

In place of Germany as a whole, the situation of traffic medicine in Hamburg is described. As a metropolis in the north of Europe and hub for the land traffic, maritime transport and air traffic – Hamburg is a good location for the topic of traffic safety. In particular the maritime medicine as well as the production of traffic airplanes define our city. Furthermore Hamburg and the University Medical Center of Hamburg-Eppendorf (UKE), as a science location, have made a name for itself especially in the area of forensic medicine. The legal medicine and traffic medicine are key aspects in research and teaching of the UKE. The traffic medicine/road safety under the perspective of forensic medicine focuses on the following main-areas: •Determination and prognosis of fitness to drive with respect to age, illness and substance abuse/dependence •Driving under the influence of alcohol, drugs and medicaments. •Chemical-toxicological analyses, methodology, accreditation of laboratories, drug recognition training, breath alcohol analyses •Demographic change, drivers licence and old age medical condition •Accident reconstruction, with special respect to the investigation of drivers (dead or alive) Germanwings Flight 9525 (4U9525/GWI18G) is a central point of discussion. It was a scheduled international passenger flight from Barcelona in Spain to Düsseldorf Airport in Germany. On 24 March 2015, the aircraft, an Airbus A320-200, crashed in the French Alps. All 144 passengers and six crew members were killed; this was deliberately planned by the co-pilot. Having previously been treated for suicidal tendencies and been declared “unfit to work”, he caused the aircraft to crash into the mountains. Consequences? In response to the incident and the circumstances the public, experts, and authorities discussed recommendations for new policies in traffic safety.

Injuries and fatalities occur in all forms of transportation. Numerically, road traffic accidents account for the great majority worldwide. Special questions (especially from the forensic medical point of view) are associated with maritime and flight crashes, when bodies are heavily mutilated and severely decomposed (concerning i. e. identification). – Post mortem radiological investigations are of special value (especially body scanning, pm CT, so called virtual autopsy). The pattern of injuries, toxicological findings, and trace evidence vary considerably and the whole scale of forensic medical analyses is required. This concerns for example: Pattern of injury of vehicle occupants, effect of seatbelts, vulnerability of children in vehicles, injuries to motorcyclists, pedal cyclists and pedestrians, cause of death, suicide and homicide, railway injuries and the special dynamics of other motorized transports. Concerning fitness to drive/pilot/navigate/work careful medical (i.e. concerning epilepsy), psychological (concerning psychiatric illness, substance abuse) and toxicological screenings and investigations are required. For example chronic alcoholism and drug dependence have to be evaluated (i.e. by segmented hair analysis). Such drivers are responsible for very severe crashes. According to the German law these persons are banned from driving motorized vehicles.

Pregnancy causes diverse physiologic and lifestyle changes that may contribute to increased driving and driver error. We compared a woman’s risk of a serious motor vehicle crash during her second trimester to her own baseline risk before pregnancy. We conducted a population-based self-matched exposure-crossover longitudinal cohort analysis of women who gave birth in Ontario, Canada, between April 1, 2006 and March 31, 2011 (5 years). We excluded women less than age 18 years, individuals living outside Ontario, those who lacked a valid identifier number under universal insurance, and cases managed by a midwife. The primary outcome was a motor vehicle crash resulting in a hospital emergency department visit. A total of 507,262 women gave birth during the study (mean age = 30 years, middle-low socioeconomic status = 64%, cesarean section rate = 30%). The women accounted for a total of 6,922 motor vehicle crashes as drivers during the three-year baseline interval (177 per month) and 757 motor vehicle crashes as drivers during their second trimester (252 per month). The elevated risk during the middle of pregnancy equaled a 42% increase in crash risk (95% confidence interval 32 to 53, p < 0.001). The increased risk included diverse populations, varied obstetrical cases, and different crash characteristics. The increased risk was largest in the early second trimester and compensated during the third trimester. No increase was observed in incidents involved as passengers or pedestrians, cases of intentional injury or inadvertent falls, or self-reported risky behaviors. The absolute risk amounted to an estimated 1-in-50 women experiencing a motor vehicle crash at some point during an average pregnancy, taking into account all nine months and the full spectrum of severity (fatal, injury, and vehicle damage combined). We suggest that pregnancy is associated with an increased risk of a serious motor vehicle crash during the second trimester that may merit attention in prenatal care guidelines.

Canada is a country of about 35 million people located about 11,000 kilometers away from Qatar. The purpose of this talk is to provide six informal insights from the Canadian experience that may inform traffic risks in Qatar. A greater awareness of these points, we suggest, might help lessen the losses from traffic crashes in both countries.

Saudi Arabia is a vast country of 2,149,690 km2, and is the largest Arab state in Western Asia. The Kingdom has been categorized as a high-income nation, and is part of the “Group of Twenty” (G-20) of major economies. It has a total population of approximately 27 million, one-fourth of whom are expatriates, with the highest population density (per km2) of 101 in Jizan, and 38 in Makkah, and the lowest of 2.8 in Najran, and 3.6 in Al Jawf. In KSA, motor vehicles are the main means of transportation within, and in-between cities. According to a recent estimate, more than 6 million cars are found on the roads of KSA. According to the morbidity and mortality records in the Ministry of Health (MOH) hospitals, 20% of beds are occupied by RTA victims, and 81% of deaths in the hospitals are due to RTIs. Over the past 2 decades, KSA has recorded 86,000 deaths, and 611,000 injuries in RTAs with 7% resulting in permanent disabilities. Road traffic accidents are a major health hazard with 19 killed daily, and 4 injured every hour in KSA. Al Naami et al, in his article mentioned the common reasons behind the soaring numbers of road traffic accidents in Saudi Arabia, which included the human factor, the vehicle, and the road/environment (2). Among the human factor, Driver errors account for about 80% of all RTAs in Saudi Arabia. Overspeeding is responsible for 65% of all traffic accidents (3.5 times the incidence in the USA). Violation of traffic signals at urban intersections is responsible for about 50% of accidents (4.5 times more common than in the USA). Vehicles and road layouts contribute to accidents and account for 20% of RTAs in Saudi Arabia, Tire blowouts and poor roads are very “hot” safety issues in Saudi Arabia, particularly in rural areas. Environmental factors such as rain, fog, and dust have minimal effects on RTAs in Saudi Arabia. However, extreme heat is responsible for 39% of all accidents due to tire blowouts. Heat also contributes to driver stress levels, leading to reduced mental capacity. Traffic medicine in Saudi Arabia has focused more on the prevention approach rather than the rehabilitation, The evidence sufficiently supports that the action plans in KSA so far have mostly focused on the prevention of RTIs rather than RTAs, including seat belt laws, Saher system, emergency medical rescue services, and the role of the police in the documentation of RTAs. While the international recommendations emphasize on developing institutional framework, safer roads and vehicles, proper surveillance or data system, safer road users, and post-crash care. The MOH in collaboration with the Ministry of Interior launched a road safety program called Saher in 2009. It is an automated system that was developed to manage traffic via electronic systems in major cities in Saudi Arabia, this newly established system uses a digital camera network connected to the national information center to track any violations and to control traffic. However, data on its long term effects on accidents and death are not yet available(3). Another important aspect of traffic medicine is the implementation of Trauma Registry as part of the national trauma system project, trauma registries can provide information on injury pattern and allow statistical modeling of trauma related variables to identify public health threats and prioritize interventions. Additionally registries can help monitor the epidemiology of serious injuries, track hospital performance overtime, and benchmark outcomes between hospitals and regions(4). Education and training of Trauma Human resources is another important aspect, King Abdulaziz Medical City has took the lead in a lot of medical fields disciplinary including medical education and has given trauma a major importance were KAMC has the largest ER outside North America and the 4th largest in the world. KAMC has the lead nationally if not in the region in regard to trauma courses where the main office to those courses is in King Abdulaziz Medical City.

If every driver in Sweden were to obey the speed limits there would be more than 100 lives spared each year. Every reduction of 1 km/h on average speed in the country saves approximately 20 lives per year (SRA 2015). One of many important measures in the later road safety work in Sweden is a project attempting to reduce speed, namely the implementation of speed cameras. Without a comprehensive increase in traffic surveillance it is difficult to achieve traffic safety (VTI 2005). The Swedish Road Administration together with the National Police Board put up the first speed cameras, or road safety cameras, in the late 1990’s and at the end of 2014 there were 1200 cameras monitoring 3000 kilometer of road stretches in Sweden. Before deciding where to install the road safety cameras the Swedish road traffic crash- and injury surveillance system, STRADA, was used to spot where accidents happened most frequently. STRADA is also a tool in the follow up work when evaluating the effects of the road safety cameras. The road safety camera project has been and still is a successful road safety work. When looking at data from STRADA from three examples (road 222, 225 and 268) of the approximately 120 roads with speed cameras one can see, when comparing a four year period before and after speed cameras, fatal accidents was reduced from a total of 8 to 3, and accidents with serious injuries as an outcome was reduced from 65 to 28. The road safety cameras have reduced the average speed on roads with cameras with 5% and are now appreciated to save up 20 lives and up to 50 persons from being seriously injured per year in Sweden. Speed monitoring with road safety cameras has shown to be a successful way of reducing speed and save lives on Swedish roads. Every year the cameras prevent 20 people from being killed in traffic and 50 persons are prevented from being seriously injured. In order to evaluate road safety work such as speed cameras there has to be measurements made before and after the intervention. Using data from STRADA has both been contributing to the foundation of the road safety camera project and also one of the important tools for follow up. References: Swedish Transport Administration: Trafiksäkerhetskameror (Road Safety Cameras) (in Swedish) website http://www.trafikverket.se/Privat/Resan-och-trafiken/Trafiksakerhetskameror/2015-07-22. Swedish Transport Administration: Road Safety Made in Sweden, Order no 10097 2nd Edition, http://online4.ineko.se/online/download.aspx?id=43885 2013. Jörgen Larsson, Susanne Gustafsson: Vad är en effektiv trafikövervakning? En litteraturstudie, (in Swedish) VTI notat 42-2005, Swedish National Road and Transport Research Institute 2005.

Reliable high quality traffic safety data has been essential for monitoring, developing and evaluating strategies to reduce the burden of injuries from traffic injuries. Information is often available in many different sources including police reports, ambulance/emergency medical service (EMS) run data, emergency department(ED) and hospital data, and mortality data from death certificates or medical examiner/coroner systems. However while each of these data systems has their own strengths and weakness, none can provide a comprehensive picture of traffic related injuries. Hospital trauma center records for example have extensive information on injuries and related medical problems but lack details on the mechanism of injury and crash and roadway characteristics. Often medical data cannot even distinguish drivers from pedestrians. Police or insurance crash reports on the other hand have considerable detail on the crash and circumstances surrounding it but have very poor data on the actual injuries sustained or their severity. This impedes targeting of prevention strategies towards serious injuries and fatalities. This presentation will use examples from current work on data linkage to demonstrate the value of linking traffic record data and explore how this approach can greatly advance traffic medicine and road safety in fast developing countries. In the United States linkage of crash data and medical data has been important for many traffic safety programs. One example is Maryland’s Crash Outcome Data Evaluation System (CODES) that uses probabilistic methodology to link police crash records to injury outcome records. CODES was established in an effort to improve highway safety through the use of linked motor vehicle crash data collected from police, EMS, hospitals (emergency department or inpatient admissions), and death certificates. This linked data have been used for a variety of statewide studies such as of injured motorcyclists, effectiveness of seat belts at preventing injuries, studies of older drivers, an analysis of mismatch collisions, geographic analysis of pedestrian injuries, patterns of injury in frontal collisions, costs and consequences of lower extremity injuries, the safety of newer vehicles, and the impact of casino gambling on alcohol-related crashes. A new project seeks to overcome the serious lack of reliable routine data on drug involvement in fatal crashes by linking detailed toxicology data from medical examiners with the Fatality Analysis Reporting System (FARS) in a sentinel group of states. Similar data linkage is also used in other countries such as a New Zealand study estimating underreporting of serious injuries by police reports. An Australian study noted that workers compensation datasets can identify most serious cases of occupational traffic injuries but lack valuable information on the circumstances and risk factors contributing to work-related crashes. Through linkage to police crash reports the study was able to identify high risk groups such as heavy vehicle drivers and the role played by fatigue and speeding. Many fast developing countries also have useful crash reports either from police or insurance reports. However only through linkage with medical data can their full potential for reducing the burden of serous traffic injuries be realized?

The presentation will highlight the population health effects arising from land-use changes and public policy initiatives that lead to changes in transport mode share for six international cities namely, Melbourne, Beijing, Delhi, London, Copenhagen and New York. The findings demonstrate that policies encouraging optimal land-use for active transport combined with provision of infrastructure that reduces the risk of injury for vulnerable road users (in association with road safety interventions) can produce considerable population health benefits across both chronic disease and road trauma. Without such infrastructure, however, increases in road trauma are likely, especially within highly motorised cities.

The United Nations has declared the period from 2011 to 2020 as the Decade of Action for Traffic Safety. The World Health Organization indicates that in most Latin America countries, alcohol consumption is responsible for about 8% of all existing diseases. Worldwide 35% to 50% of all serious vehicule crashes are alcohol related (JORGE, ADURA, 2012-2013). Brazil has a practical system of control to catch drunk drivers, while the abuse of other substances while driving have passed unscathed. Legal and documentary research. Samples shall be taken from hair, or in cases of alopecia, fingernails to be used for screening the Radioimmunoassay and enzyme immunoassay. In Brazil, the National Traffic Council determined a wide toxicology system of detection for consumption of psychoactive substances in the occasion of the medical exam to the obtainment of the professional driver’s license. The medical expert should consider the candidate unfit temporarily for vehicular driving, in case the examination accuses abuse of the following substances: marijuana, cocaine, crack, heroin, opiates, ecstasy or other substances that impair the drivers performance.The Brazilian Association of Traffic Medicine is against this resolution. Through an extensive review of the scientific literature, they could not find any study to justify the need of mandatory substance abuse assessment for drivers or applicants when undergoing the medical exam. The adequacy of this resolution is controversial. Currently, toxicological analysis of substances that alter the performance of the driver are used worldwide in addition to other actions such as checking the medical condition of the driver. A stricter control of the traffic laws should provide greater effectiveness in reducing road accidents.