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

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

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

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

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

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

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

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

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

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

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

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).