360 Soziale Probleme und Sozialdienste; Verbände
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Institut
- Sonstige (240) (entfernen)
A change emerges in hospital landscape due to health political measures, which in consequence also influences the pre-clinical medical care of emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data of Bavarian emergency medical services. In Bavaria, in 2006 it was necessary to call an emergency doctor in the case of 14.261 traffic accidents. Predominantly the patients were provided by land-based life saving appliances, air rescue services were only applied in 19.1 % of the cases. 47.6 % of patients being involved in a traffic accident were transported into a primary health care hospital. A prehospital interval of more than 60 minutes was calculated in 20 % of emergency care. 96.2 % of the patients were transported to hospitals of tertiary or maximum supply by air rescue services. The life saving appliances" readiness for action is however restricted to daylight. A further limitation appeared for routine office hours in hospitals: Only 36.7 % of accidents occurred in this time frame. An increase of hospitalizations in clinics of maximum supply appeared from 2002 until 2006 while simultaneously the prehospital period was extended. To assure a sufficient medical care of seriously injured persons further on, a fulltime and area-wide expostulation of efficient facilities is necessary. For this purpose it is necessary to establish regional trauma networks as well as emergency medical service at night time. Beyond that, a cost efficient compensation of the structural, personnel and logistic expenses has to be assured.
The Centre for Automotive Safety Research (formerly the Road Accident Research Unit) at the University of Adelaide in South Australia has a history of in-depth crash investigation going back to the 1970s. In recent years, our focus has been on studying factors that contribute to road crashes, with an emphasis on the role of road infrastructure. Our method involves crash notification by the South Australian Ambulance Service and detailed investigation of the crash scene usually before the crash-involved vehicles have been moved. This at-scene data collection is supplemented with police crash reports, Coroner- reports including autopsy findings for fatal crashes, case notes from hospitals for all injured persons, structured interviews with crash participants and witnesses, and computerised reconstruction of the events of the crash. One of the most notable research findings to emerge from our in-depth work has been the relationship between travelling speed and the risk of crash involvement. By comparing the calculated free speeds of crash-involved vehicles (cases) with the measured speeds of non-crash-involved vehicles travelling on the same roads at the same time of day (controls), we were able to establish that an exponential relationship exists between travelling speed and the likelihood of involvement in a casualty crash. This was the case for both metropolitan and rural areas. This research prompted the reduction of some speed limits in Australia, which has resulted in notable decreases in crash numbers. Another finding of interest in our recent investigation of 298 mostly daytime crashes in metropolitan Adelaide was that medical conditions make a sizeable contribution to the occurrence of road crashes. We found that almost half of the drivers, riders and pedestrians involved in the collisions had at least one pre-existing medical condition, and half of these individuals had two or more such conditions. We found that a medical condition was the direct causal factor in 13% of the casualty crashes investigated and accounted for 23% of all hospital admission or fatal crash outcomes. A follow-up study of all hospital admissions for road crashes in Adelaide is now going ahead to look further at this problem. The paper also describes studies looking specifically at pedestrian crashes. These include studies of the relationship between travelling speed and the risk of a fatal pedestrian crash, and studies utilising real crash data to validate headforms and test dummies used in the assessment of the safety of new vehicles in the event of a collision with a pedestrian.
Automotive Engineering, Mechanical Engineering and TechnologyrnAbstract: The degrees of injury severity, as a rule injuries scaled by AIS of specific regions of the human body, investigated out of road traffic accidents correspond to the body-specific loading values, which are found out with the aid of experimental or mathematical simulation of crash tests with motor vehicles or with sled tests. The coherence between the injured human being on the one hand and the physical and the theoretical model respectively on the other hand is established by the risk function, which describes the probability of degrees of injury severity in dependence on the protection criteria. Due to the different physical characteristics in the simulation, e.g. accelerations, forces, compressions and their velocity, the compilation of these quantities, comparable to the MAIS, the maximal occurred single AIS obtained in accident analysis is much more difficult in the simulation than in the accident occurrence. Therefore it is obvious to normalize the loading values gained out of simulation and to summarise them to an entire value in a suitable manner, the safety index.rn
The fact that ADAC Air Rescue handles approximately 4,000 road accident missions every year gave rise to set up an accident research programme for which ADAC Air Rescue provides its data. This data is of initial informational quality and will be supplemented by data from the police, experts, fire brigades as well as hospitals and forensic institutes. Although the number of cases is still rather low, certain tendencies can be identified. The causes for most accidents occur when joining or intersecting traffic, followed by speeding in road bends and tailgating. Many accidents involve HGV rear end collisions, often causing serious injuries, considerable damage and technical problems for the rescue operations. With regard to the various impact types, it has become obvious that most of the extremely serious injuries are inflicted during a passenger car side impact. In addition, access to and removal of trapped passengers is becoming more and more complicated, partly due to the increasing use of high-strength materials, and rescue operations tend to be more time consuming.
Bicyclists are minimally or unprotected road users. Their vulnerability results in a high injury risk despite their relatively low own speed. However, the actual injury situation of bicyclists has not been investigated very well so far. The purpose of this study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. Technical and medical data were prospectively collected shortly after the accident at the accident scenes and medical institutions providing care for the injured. Data of injured bicyclists from 1985 to 2003 were analyzed for the following parameters: collision opponent, collision type, collision speed (km/h), Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), incidence of polytrauma (Injury Severity Score >16), incidence of death (death before end of first hospital stay). 4,264 injured bicyclists were included. 55% were male and 45% female. The age was grouped to preschool age in 0.9%, 6 to 12 years in 10.8%, 13 to 17 years in 10.4%, 18 to 64 years in 64.7%, and over 64 years in 13.2%. The MAIS was 1 in 78.8%, 2 in 17.0%, 3 in 3.0%, 4 in 0.6%, 5 in 0.4%, and 6 in 0.2%. The incidence of polytrauma was 0.9%, and the incidence of death was 0.5%. The incidence of injuries to different body regions was as follows: head, 47.8%; neck, 5.2%, thorax, 21%; upper extremities, 46.3%; abdomen, 5.8%; pelvis, 11.5%, lower extremities, 62.1%. The accident location was urban in 95.2%, and rural in 4.8%. The accidents happened during daylight in 82.4%, during night in 12.2%, and during dawn/dusk in 5.3%. The road situation was as follows: straight, 27.3%; bend, 3.0%; junction, 32.0%; crossing, 26.4%; gate, 5.9%; others, 5.4%. The collision opponents were cars in 65.8%, trucks in 7.2%, bicycles in 7.4%, standing objects in 8.8%, multiple objects in 4.3%, and others in 6.5%. The collision speed was grouped <31 in 77.9%, 31-50 in 4.9%, 51-70 in 3.7%, and >70 in 1.5%. The helmet use rate was 1.5%. 68% of the registered head injuries were located in the effective helmet protection area. In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two thirds of the head injuries could have been prevented by helmets. Accidents are concentrated to crossings, junctions and gates. A significant lower mean injury severity was observed in victims using separate bicycle lanes. These results do strongly support the extension or addition of bicycle lanes and their consequent use. However, the lanes are frequently interrupted at crossings and junctions. This emphasizes also the important endangering of bicyclists coming from crossings, junctions and gates, i.e. all situations in which contact of bicyclists to motorized vehicles is possible. Redesigning junctions and bicycle traffic lanes to minimize the possibility of this dangerous contact would be preventive measures. A more consequent helmet use and use and an extension of bicycle paths for a better separation of bicyclists and motorized vehicle would be simple but very effective preventive measures.
In recent years special attention has been paid to reducing the number of fatalities resulting from road traffic accidents. The ambitious target to cut in half the number of road users who are killed each year by 2010 compared with the 2001 figures, as set out in the European White Paper "European Transport Policy for 2010: Time to Decide" implies a general approach covering all kinds of road users. Much has been achieved, e.g. in relation to the safety of car passengers and pedestrians but PTW accidents still represent a significant proportion of fatal road accidents. More than 6,000 motorcyclists die annually on European roads which amounts to 16% of the EU-15 road fatalities. The European Commission therefore launched in 2004 a Sub- Project dealing with motorcycle accidents within an Integrated Project called APROSYS (Advanced PROtection SYStems) forming part of the 6th Framework Programme. In a first step, the combined national statistical data collections of Germany, Italy, the Netherlands and Spain were analysed. Amongst other things parameters like accident location, road conditions, road alignment and injury severity have been explored. The main focus of the analysis was on serious and fatal motorcycle accidents and the results showed similar trends in all four countries. From these results 7 accident scenarios were selected for further investigation via such in-depth databases as the DEKRA database, the GIDAS 2002 database, the COST 327 database and the Dutch element of the MAIDS database. Three tasks, namely the study of PTW collisions with passenger cars, PTW accidents involving road infrastructure features, and motorcyclist protective devices have been assessed and these will concentrate inter alia on accident causes, rider kinematics and injury patterns. A detailed literature review together with the findings of the in-depths database analysis is presented in the paper. Conclusions are drawn and the further stages of the project are highlighted.
Empirical vehicle crashworthiness studies are usually based on national or in-depth traffic accident surveys: Data on accident-involved cars/drivers are analysed in order to quantify the chance of driver injury and to assess certain risk factors like car make and model. As the cars/drivers involved in the same accident form a "cluster", where the size of the cluster equals the number of accident-involved parties, traffic accident survey data are typical multi-level data with accidents as first-level or primary and cars/drivers as secondlevel or secondary units (car occupants in general are to be considered as third level units). Consequently, appropriate statistical multi-level models are to be used for driver injury risk estimation purposes as these models properly account for the cluster structure of traffic accident survey data. In recent years various types of regression models for clustered data have been developed in the statistical sciences. This paper presents multi-level statistical models, which are generally applicable for vehicle crashworthiness assessment in the sense that data on single and multiple car crashes can be analysed simultaneously. As a special case of multi-level modelling driver injury risk estimation based on paired-by-collision car/driver data is considered. It is demonstrated that assessment results may be seriously biased, if the cluster structure inherent in traffic accident survey data is erroneously ignored in the data analysis stage.
During the last 5 years, the number of cars fitted with side airbags has dramatically increased. They are now standard equipment, even on many smaller cars or less luxurious vehicles. While some side airbags offer thoracic protection alone, there are those that combine thoracic and head protection (of which most deploy from the seat). Other systems employ separate airbags for head and thorax protection, which are designed to be effective noticeably in a crash against a pole. This paper proposes an evaluation of the effectiveness of side airbags in preventing thoracic injuries to passenger car occupants involved in side crashes. First, the target population (who can take benefit of side airbag deployment and in what circumstances) is defined. Side airbags can be especially effective in cases of impacts on the door with intrusion at a certain impact speed. Then, an example case of a side impact with side airbag deployment is given were side airbag deployment is thought to have had a positive effect on injury outcome. A further case is presented where the impact configuration is likely to have reduced the effect of side airbag deployment on injury outcome. Finally, the estimation of side airbag effectiveness (in terms of additional occupant protection brought exclusively by the airbag) is proposed by comparing injury risk sustained by occupants in (more or less) similar cars (fitted or non fitted with airbags) because, during these years, car structure, and side airbag conception have considerably evolved. In-depth accident data from France, the UK and Germany has been collected. Out of 2,035 side impact accident cases available in the databases, we selected 435 occupants of passenger cars (built from 1998 onwards) involved in an injury accident between year 1998 and year 2004 for EES (Energy Equivalent Speed) values between 20km/h and 50km/h. The occupants, belted or not, were sat on the struck side, whatever the obstacle and type of accidents (intersection, loss of control, etc.). For multiple impact crashes, the side impact is assumed to be the more severe one. Passenger cars were fitted with (96) or without (339) side airbags. Most of the potential risk explanatory variables were correctly and reliably reported in the databases (velocity " impact zone " impact angle " occupant characteristics, etc.). The analysis compared injury risks for different levels of EES and different types of side airbags. A logistic regression model was also computed with injury variables (such as thoracic AIS 2+ or AIS 3+) as the dependant variable and other variables (including airbag type and EES) as explanatory injury risk factors. Results revealed statistically non-significant reductions in thoracic AIS 2+ and AIS 3+ injury risk in side airbag equipped cars in the impact violence range selected (odds ratio between 0.84 and 0.98 depending on types of airbags). The results are discussed. The non-significance is assumed to be due to a low number of cases. Statistical analysis for head injuries was not possible due to the low number of accident cases with passenger cars fitted with head airbags in the databases. Moreover, the discrepancies between the data coming from different countries (especially calculation of EES) might have introduced instability in the analysis.
In Germany, in-depth accident investigations are carried out in the Hannover area since 1973. In 1999 a second region was added with surveys in Dresden and the surrounding area. Internationally, the acronym GIDAS (German In-Depth Accident Study) is commonly used for these surveys. Compared to many other countries, the sample sizes of the GIDAS surveys are much larger. The goal is to collect 1.000 accidents involving personal injuries per year and region. Data collection takes place by using a sampling procedure, which can be interpreted as a two-stage process with time intervals as primary units and accidents as secondary units. An important question is, to what extend these samples are representative for the target population from which they are drawn. Analyses show, for example, that accidents with persons killed or seriously injured are overrepresented in the samples compared to accidents with slightly injured persons. This means, that these data are subject to biases due to uncontrolled variation of sample inclusion probability. Therefore, appropriate weighting and expansion methods have to be applied in order to adjust or correct for these biases. The contribution describes the statistical and methodological principles underlying the GIDAS surveys with respect to sampling procedure, data collection and expansion. In addition, some suggestions regarding potential improvements of study design are made from a methodological point of view.
Annually within the European Union, there are over 50,000 road accident fatalities and 2 million other casualties, of which the majority are either the occupants of cars or other road users in collision with a car. The European Commission now has competency for vehicle-based injury countermeasures through the Whole Vehicle Type Approval system. As a result, the Commission has recognised that casualty reduction strategies must be based on a full understanding of the real-world need under European conditions and that the effectiveness of vehicle countermeasures must be properly evaluated. The PENDANT study commenced in January 2003 in order to explore the possibility of developing a co-ordinated set of targeted, in-depth crash data resources to support European Union vehicle and road safety policy. Three main work activity areas (Work Packages) commenced to provide these resources. This paper describes some of the outcomes of Work Package 2 (WP2, In-depth Crash Investigations and Data Analysis). In WP2, some 1,100 investigations of crashes involving injured car occupants were conducted in eight EU countries to a common protocol based on that developed in the STAIRS programme. This paper describes the purposes, methodology and results of WP2. It is expected that the results will be used as a co-ordinated system to inform European vehicle safety policy in a systematic, integrated manner. Furthermore, the results of the data analyses will be exploited further to provide new directions to develop injury countermeasures and regulations.
While the number of fatal accidents is diminishing every year, there is still a need of improvement and action to prevent these deaths. Basis for this purpose has to be an analysis about the factors influencing the car crash mortality. There are various studies describing the univariate influence of several factors, but crash scenarios are too complex to be described by a single variable. The multivariate analysis respects the interference of the variables and gets so to more detailed and representative results. This multivariate analysis is based on about 2,600 cases (the data have been collected by the accident research units Hannover and Dresden (during the years 1999-2003). This paper presents a multivariate model (containing ten different variables) which detects 93% of these cases properly. This means it detects the cases as truly survived and truly death.
The need for improved EU level accident information and data was identified in the EU White Paper on Transport Policy (2001)1 and detailed in the Road Safety Action Plan (2003)2. The plan specifies that the EC will develop a road safety observatory to coordinate data collection within an integrated framework.
This study is aimed to investigate the correlations of impact conditions and dynamic responses with the injuries and injury severity of child pedestrians by accident reconstruction. For this purpose, the pedestrian accident cases were selected from Sweden and Germany with detailed information about injuries, accident cars, and accident environment. The selected accident cases were reconstructed using mathematical models of pedestrian and passenger car. The pedestrian models were generated based on the height, weight, and age of the pedestrian involved in accidents. The car models were built up based on the corresponding accident car. The impact speeds in simulations were defined based on the reported data. The calculated physical quantities were analyzed to find the correlation with injury outcomes registered in the accident database. The reconstruction approaches are discussed in terms of data collection, estimating vehicle impact speeds, pedestrian moving speeds and initial posture, secondary ground impact, validity of the mathematical models, as well as impact biomechanics.
The so-called "seat-belt injuries" or "seat-belt syndromes", described as 2-point seat-belt injuries, contain heavy inflection injuries of the lumbal spinal column, combined with heavy abdominal injuries as rupture of the upper intestinal bold or heavy injuries of the upper entrails. With "playing" children in the font of the car, with inappropriate plant of 3-point belts, identical injuries can occur.
Rollover scenarios in Europe
(2005)
Rollover accidents seem to be a rising problem in Europe and therefore the systematic of this accident scenario should be investigated. Based on statistical investigations on major European accident databases for different countries a series of 73 real world rollover accidents was analysed. These cases were reconstructed using PC-Crash and preliminary categorised using a modified USbased rollover classification. In a first step, the rollover events were reconstructed from the point of conflict to the vehicle- rest position. The vehicles kinematics as well as its linear and rotational velocities were derived. In a second step typical velocity characteristics as well as kinematics were identified and the events categorised according to these criteria. Based on these results four main categories were defined, covering all reconstructed accidents. This categorisation was based on mechanical parameters (rotatory and translator kinematical data of the vehicle). Significant differences can be seen for different scenarios for the "first phase of rollover".
This paper describes the methodology of In-Depth Investigation in Germany on the example of GIDAS (German In-Depth Accident Study). Since 1999 in Germany a joint project between FAT (Forschungsvereinigung Automobiltechnik or Automotive Industry Research Association) and BASt (Bundesanstalt für Straßenwesen or the Federal Road Research Institute) is being carried out in Hannover and Dresden. The methodology of this project is based on a statistically orientated procedure of data sampling (sampling plan, weighting factors). The paper describes the possibilities of such in-depth investigation on the results of the offered title. The accident cases were collected randomly within GIDAS at Hannover. There are more cases existing from previous investigation started in 1985 under the same methodology. The portion of rollovers can be established at 3.7% of all accidents with casualties in the year 2000. For the study 434 cases of car accidents with rollovers are used for a detail comprehensive analysis. The accidents happened in the years 1994 to 2000 in the Hannover area. The injury distribution will report about 741 occupants with rollover accident event. The presented paper will give an overview of the accident situations following in rollover movements of cars. The distributions of injury frequencies, injury severity AIS for the whole body and for the body regions of occupants will be presented and compared to technical details like the impact speed and the deformation pattern. The speed of the car was determined at the point of rollover and on the point of accident initiency. The characteristics of the kinematics followed in a rollover movement are analyzed and the major defined types of rollover will be shown in the paper. The paper will describe the possibilities of In-Depth Investigation methods for the approach of finding countermeasures on the example of car accidents with rollover and explaining the biomechanics of injuries in rollover movements.
This paper set out to examine the possibilities for injury avoidance implications for older drivers in crashes, based on crash and injury patterns among older drivers and current trends in ageing in most western societies. A number of safety technologies were identified and discussed which have potential for improving vehicle older driver crash avoidance and crashworthiness. While there were some promising estimates available of the likely benefits of this technology for improving safety, it is evident that they need to be confirmed for older drivers, given their age-related disabilities and sensory limitations. Further research is urgently required to ensure that these technologies yield safety benefits without any disbenefits for older drivers.rn
Nowadays airbags are part of the standard equipment in almost all new cars. While airbags are saving an increasing number of people from severe injuries and death in moderate and high speed crashes, they do not completely prevent dashboard injuries. The most common mechanism in dashboard injuries is a posteriorly directed force to the proximal tibia with the knee flexed. This may occur during a motor vehicle frontal impact accident when a knee of the driver or the front-seat passenger strikes the dashboard. The posterior force can be combined with a abducting or rotational force leading to concomitant lateral or posterolateral injury. Car and airbag manufacturers therefore develop special inflatable systems to reduce the impact force in dashboard injuries. Every new inflatable system, however, has to be evaluated in out of position situations in which the system might cause injuries to certain body areas. Therefore, we investigated a new kneebag system in different critical seating positions of post mortem test subjects (PMTS). The tested knee airbag module is a folded airbag (18 litre volume) which is installed below the lower section of the instrument panel of a passenger car. Using four PMTS (2 male, 2 female, age 36"67) the following positions were tested: normal seating position, knee flexed >90 degrees and knee flexed <60 degrees in static deployment tests with direct contact. In addition a dynamic test (48.8kph, AAMA-pulse) was carried out with the PMTS belted in a normal seating position. The inflation phase and the impact of the system on the knee/lower leg were analysed by high speed videos. After the test the lower legs of the PMTS were examined by Xray and autopsy. All soft tissue injuries and bone fractures were recorded. All the tests could be evaluated. Except some superficial skin lesions in the impact area no fracture of the bones around the knee and no knee ligament and tendon injuries were observed. Neither video analysis nor autopsy of the PMTS showed any critical contact injuries caused by the inflation process of the bag. Therefore, it can be concluded that in the tested seating positions which are the most critical for the knee area the knee bag system is safe.
This paper reviews briefly the evolution of the investigation of transport accidents from the early beginnings when individual events were studied but systematic data was not collected. In the transport modes other than on the roads, accident investigation early on, even of single events, was important in introducing safety improvements. Road accidents, however, evolved enormously with the growth of car ownership without any comparable political response to the consequent deaths and injuries, equivalent to what happened with the other modes. From the 1950s data bases started to contribute to our knowledge of the epidemiology of road traffic injuries, and in-depth sample studies have contributed much to the body of knowledge in the last 30 years. However, even the basic input and output variables of a crash, its severity and the seriousness of the outcomes in terms of injuries and their consequences are not complete or agreed upon. Issues of experimental design and sampling are discussed. It is proposed that the most important area for current research to address is the effect of population variations on injury outcomes. The need for the establishment of good data bases for active safety issues is emphasised with the consequent need for better links between the research community and the police.
Traffic accidents were ranked the third among the major causes of death in Thailand. About 13,438 deaths and the death rate from traffic accident was 21.5 per 100,000 of population in 2002. The deaths and death rate varied upon the economic situation. After the economic crisis, traffic accidents were increased as well as the period of the bubble economy. In the Central region of Thailand numbers of road traffic crashes were lower than Bangkok Metropolis, but the highest in the number of deaths, death rate and serious injuries in 2002. Men aged 15"29 years old had higher numbers of deaths than men in other age groups and higher than women. Deaths and injuries from road traffic crashes were the highest in April and January, because there was a long weekend in those months. About 80 percent of road traffic crashes were caused by private car and motorcycle. In 2000 about 51 percent of traffic accidents took place on the straight way, followed by the junction and curves. In 2002, about 97 percent of road traffic crashes were caused by human factors including improper passing, speeding and disregarding to traffic signal, however, the identification of causes of traffic accident needed to improve. Drunk driving, disregarding on safety equipment usage, inefficiency of law enforcement and discontinuing of road safety programs were the deepest causes of traffic accidents. Research based information, a broad coalition of stakeholder and urban planning policy were needed to incorporate for a comprehensive road safety policy formulation and actions.