What are the real costs of major trauma?

Background This economic evaluation reports the results of a detailed study of the cost of major trauma treated at Princess Alexandra Hospital (PAH), Australia. Methods A bottom-up approach was used to collect and aggregate the direct and indirect costs generated by a sample of 30 inpatients treated for major trauma at PAH in 2004. Major trauma was defined as an admission for Multiple Significant Trauma with an Injury Severity Score >15. Direct and indirect costs were amalgamated from three sources, (1) PAH inpatient costs, (2) Medicare Australia, and (3) a survey instrument. Inpatient costs included the initial episode of inpatient care including clinical and outpatient services and any subsequent representations for ongoing-related medical treatment. Medicare Australia provided an itemized list of pharmaceutical and ambulatory goods and services. The survey instrument collected out-of-pocket expenses and opportunity cost of employment forgone. Inpatient data obtained from a publically funded trauma registry were used to control for any potential bias in our sample. Costs are reported in Australian dollars for 2004 and 2008. Results The average direct and indirect costs of major trauma incurred up to 1-year postdischarge were estimated to be A$78,577 and A$24,273, respectively. The aggregate costs, for the State of Queensland, were estimated to range from A$86.1 million to $106.4 million in 2004 and from A$135 million to A$166.4 million in 2008. Conclusion These results demonstrate that (1) the costs of major trauma are significantly higher than previously reported estimates and (2) the cost of readmissions increased inpatient costs by 38.1%.

The road safety implications of illegal street racing and associated risky driving behaviours : an analysis of offences and offenders

The purpose of this study was to explore the road safety implications of illegal street racing and associated risky driving behaviours. This issue was considered in two ways: Phase 1 examined the descriptions of 848 illegal street racing and associated risky driving offences that occurred in Queensland, Australia, in order to estimate the risk associated with these behaviours; and Phase 2 examined the traffic and crash histories of the 802 male offenders involved in these offences, and compared them to those of an age-matched comparison group, in order to examine the risk associated with the driver. It was found in Phase 1 that only 3.7% of these offences resulted in a crash (none of which were fatal), and that these crashes tended to be single-vehicle crashes where the driver lost control of the vehicle and collided with a fixed object. Phase 2 found that the offender sample had significantly more traffic infringements, licence sanctions and crashes in the previous three years than the comparison group. It was concluded that while only a small proportion of racing and associated offences result in a crash, these offenders appear to be generally risky drivers that warrant special attention.

The high road or the low road? Alternatives for Australia's future

The OECD suggests that countries now have a choice. They can focus on development based on either:  competition via investment in technology and innovation - which is important in high knowledge industries and high innovation economies, or  competition via exchange rates and wages - which is important in industries producing standardised, lower-tech goods and services. The first route will maximise higher-skilled, higher-paid employment growth and living standards. Given the lack of control over the exchange rate, the second route requires competition based on wages. It is essential to understand that markets themselves won’t shift a country from one path to the other. These conclusions arise from the OECD’s recognition that technical progress - the creation of new products or the adoption of more efficient methods of production - is the main source of economic growth and enhanced quality of life. Technological change is, the OECD suggests, ...also the engine for job creation as higher wages and profits resulting from technology-induced productivity gains and lower prices lead to increased demand for new products from existing as well as new industries (1997: 4).Further, Competitiveness in high-technology industries is mainly driven by technology factors and much less by wage and exchange rate movements, while the reverse is true in low-technology industries (OECD 1996e: 12). The OECD has shown that sound macroeconomic conditions, such as the low inflation and reduced public sector debt visible in almost all member countries in the 1990s, are not enough to deal with high levels of unemployment and the need to increase levels of income: If economic performance is to improve, additional structural reform, which can increase innovation and the diffusion of technologies within and among national economies, seems necessary (OECD 1997: 4 Emphasis added).

Summary report : the high road or the low road? Alternatives for Australia's future

This document is a summary of the findings of the inaugural study commissioned by the Australian Business Foundation Limited. It was conducted by Professor Jane Marceau, Pro-Vice Chancellor (Research) at the University of Western Sydney Macarthur, Dr Karen Manley, Visiting Research Fellow at the University of Western Sydney Macarthur and Mr Derek Sicklen, Managing Director of Australian Economic Analysis Pty Limited. The full report is available from the Australian Business Foundation. The Australian Business Foundation Limited is a recently formed independent economic and industry policy think-tank. It has been established and sponsored by Australian Business Limited, a pre-eminent and long-standing industry association and business services network. The report is in three parts. The first reviews the key findings of contemporary international economic and innovation-oriented analyses of the characteristics of high growth economies. The second assesses the shape, structure and dynamics of Australian industry as these compare with the characteristics for successful economic development suggested in the literature. Finally, the report indicates the nature of urgently required policy directions.

Using data mining on road asset management data in analysing road crashes

Road safety is a major concern worldwide. Road safety will improve as road conditions and their effects on crashes are continually investigated. This paper proposes to use the capability of data mining to include the greater set of road variables for all available crashes with skid resistance values across the Queensland state main road network in order to understand the relationships among crash, traffic and road variables. This paper presents a data mining based methodology for the road asset management data to find out the various road properties that contribute unduly to crashes. The models demonstrate high levels of accuracy in predicting crashes in roads when various road properties are included. This paper presents the findings of these models to show the relationships among skid resistance, crashes, crash characteristics and other road characteristics such as seal type, seal age, road type, texture depth, lane count, pavement width, rutting, speed limit, traffic rates intersections, traffic signage and road design and so on.

Road crash proneness prediction using data mining

Developing safe and sustainable road systems is a common goal in all countries. Applications to assist with road asset management and crash minimization are sought universally. This paper presents a data mining methodology using decision trees for modeling the crash proneness of road segments using available road and crash attributes. The models quantify the concept of crash proneness and demonstrate that road segments with only a few crashes have more in common with non-crash roads than roads with higher crash counts. This paper also examines ways of dealing with highly unbalanced data sets encountered in the study.

Identifying differences in wet and dry road crashes using data mining

It is commonly accepted that wet roads have higher risk of crash than dry roads; however, providing evidence to support this assumption presents some difficulty. This paper presents a data mining case study in which predictive data mining is applied to model the skid resistance and crash relationship to search for discernable differences in the probability of wet and dry road segments having crashes based on skid resistance. The models identify an increased probability of wet road segments having crashes for mid-range skid resistance values.

Using data mining to predict road crash count with a focus on skid resistance values

Road crashes cost world and Australian society a significant proportion of GDP, affecting productivity and causing significant suffering for communities and individuals. This paper presents a case study that generates data mining models that contribute to understanding of road crashes by allowing examination of the role of skid resistance (F60) and other road attributes in road crashes. Predictive data mining algorithms, primarily regression trees, were used to produce road segment crash count models from the road and traffic attributes of crash scenarios. The rules derived from the regression trees provide evidence of the significance of road attributes in contributing to crash, with a focus on the evaluation of skid resistance.

The Brisbane Cordon scheme : part A - preliminary investigation

It could be said that road congestion is one of the most significant problems within any modern metropolitan area. For several decades now, around the globe, congestion in metropolitan areas has been worsening for two main reasons. Firstly, road congestion has significantly increased due to a higher demand for road space because of growth in populations, economic activity and incomes (Hensher & Puckett, 2007). This factor, in conjunction with a significant lack of investment in new road and public transport infrastructure, has seen the road network capacities of cities exceeded by traffic volumes and thus, resulted in increased traffic congestion. This relentless increase in road traffic congestion has resulted in a dramatic increase in costs for both the road users and ultimately the metropolitan areas concerned (Bureau of Transport and Regional Economics, 2007). In response to this issue, several major cities around the world, including London, Stockholm and Singapore, have implemented congestion-charging schemes in order to combat the effects of road congestion. A congestion-charging scheme provides a mechanism for regulating traffic flows into the congested areas of a city, whilst simultaneously generating public revenue that can be used to improve both the public transport and road networks of the region. The aim of this paper was to assess the concept of congestion-charging, whilst reflecting on the experiences of various cities that have already implemented such systems. The findings from this paper have been used to inform the design of a congestion-charging scheme for the city of Brisbane in Australia in a supplementary study (Whitehead, Bunker, & Chung, 2011). The first section of this paper examines the background to road congestion; the theory behind different congestion-charging schemes; and the various technologies involved with the concept. The second section of this paper details the experiences, in relation to implementing a congestion-charging scheme, from the city of Stockholm in Sweden. This research has been crucial in forming a list of recommendations and lessons learnt for the design of a congestion-charging scheme in Australia. It is these recommendations that directly inform the proposed design of the Brisbane Cordon Scheme detailed in Whitehead et al. (2011).

Review of the under the limit drink driving rehabilitation program

The combination of alcohol and driving is a major health and economic burden to most communities in industrialised countries. The total cost of crashes for Australia in 1996 was estimated at approximately 15 billion dollars and the costs for fatal crashes were about 3 billion dollars (BTE, 2000). According to the Bureau of Infrastructure, Transport and Regional Development and Local Government (2009; BITRDLG) the overall cost of road fatality crashes for 2006 $3.87 billion, with a single fatal crash costing an estimated $2.67 million. A major contributing factor to crashes involving serious injury is alcohol intoxication while driving. It is a well documented fact that consumption of liquor impairs judgment of speed, distance and increases involvement in higher risk behaviours (Waller, Hansen, Stutts, & Popkin, 1986a; Waller et al., 1986b). Waller et al. (1986a; b) asserts that liquor impairs psychomotor function and therefore renders the driver impaired in a crisis situation. This impairment includes; vision (degraded), information processing (slowed), steering, and performing two tasks at once in congested traffic (Moskowitz & Burns, 1990). As BAC levels increase the risk of crashing and fatality increase exponentially (Department of Transport and Main Roads, 2009; DTMR). According to Compton et al. (2002) as cited in the Department of Transport and Main Roads (2009), crash risk based on probability, is five times higher when the BAC is 0.10 compared to a BAC of 0.00. The type of injury patterns sustained also tends to be more severe when liquor is involved, especially with injuries to the brain (Waller et al., 1986b). Single and Rohl (1997) reported that 30% of all fatal crashes in Australia where alcohol involvement was known were associated with Breadth Analysis Content (BAC) above the legal limit of 0.05gms/100ml. Alcohol related crashes therefore contributes to a third of the total cost of fatal crashes (i.e. $1 billion annually) and crashes where alcohol is involved are more likely to result in death or serious injury (ARRB Transport Research, 1999). It is a major concern that a drug capable of impairment such as is the most available and popular drug in Australia (Australian Institute of Health and Welfare, 2007; AIHW). According to the AIHW (2007) 89.9% of the approximately 25,000 Australians over the age of 14 surveyed had consumed at some point in time, and 82.9% had consumed liquor in the previous year. This study found that 12.1% of individuals admitted to driving a motor vehicle whilst intoxicated. In general males consumed more liquor in all age groups. In Queensland there were 21503 road crashes in 2001, involving 324 fatalities and the largest contributing factor was alcohol and or drugs (Road Traffic Report, 2001). 23438 road crashes in 2004, involving 289 fatalities and the largest contributing factor was alcohol and or drugs (DTMR, 2009). Although a number of measures such as random breath testing have been effective in reducing the road toll (Watson, Fraine & Mitchell, 1995) the recidivist drink driver remains a serious problem. These findings were later supported with research by Leal, King, and Lewis (2006). This Queensland study found that of the 24661 drink drivers intercepted in 2004, 3679 (14.9%) were recidivists with multiple drink driving convictions in the previous three years covered (Leal et al., 2006). The legal definition of the term “recidivist” is consistent with the Transport Operations (Road Use Management) Act (1995) and is assigned to individuals who have been charged with multiple drink driving offences in the previous five years. In Australia relatively little attention has been given to prevention programs that target high-risk repeat drink drivers. However, over the last ten years a rehabilitation program specifically designed to reduce recidivism among repeat drink drivers has been operating in Queensland. The program, formally known as the “Under the Limit” drink driving rehabilitation program (UTL) was designed and implemented by the research team at the Centre for Accident Research and Road Safety in Queensland with funding from the Federal Office of Road Safety and the Institute of Criminology (see Sheehan, Schonfeld & Davey, 1995). By 2009 over 8500 drink-drivering offenders had been referred to the program (Australian Institute of Crime, 2009).

Work-related road risks and legal liabilities : report for the Redland City Council

Workplace serious injuries and deaths due to unsafe work practices are a substantial health and socioeconomic burden to the community, particularly in industries such as construction, agriculture and fishing, and transport and storage. Some 2000 individuals die each year from work-related causes and tens of thousands of individuals incur permanent disabling work-related injuries and the direct (e.g., medical & legal) and indirect (e.g., lost productivity) cost to the Australian economy has been estimated between $32 billion and $57 billion annually. A common cause of workplace injuries and deaths is occupational driving and work-related fatal road crashes comprise between 23 and 32% of work-related fatalities each year. A major safety concern across the various industry groups therefore involve deaths and injuries associated with work-related driving. However, while organisations emphasise safety practices in most spheres of the workplace they often neglect work-related driving and lack appropriate policies to enhance safe driving practices.