Prevention of pelvic sepsis in major open pelviperineal injury

Compound pelvic fractures are deemed to be one of the most severe orthopaedic injuries with an extremely high morbidity and mortality. After the initial resuscitation phase the prevention of pelvic sepsis is one of the main treatment goals for patients with an open pelvic fracture. If there is a suspicion of a rectal injury or if the wounds are in the perineal area, The Princess Alexandra Hospital's management plan includes early faecal diversion combined with vigorous soft tissue debridement, VAC(®) therapy and (if indicated) external fixation of the pelvic fracture. We present our flowchart for the treatment of trauma patients with compound pelvic fractures illustrated by a case report describing a 32 year old patient who sustained an open pelvic ring injury in a workplace accident. The aim of this paper is to underline the importance of a safe, straightforward approach to compound pelvic fractures.

The effectiveness of traffic policing in reducing traffic crashes

Many governments throughout the world rely heavily on traffic law enforcement programs to modify driver behaviour and enhance road safety. There are two related functions of traffic law enforcement, apprehension and deterrence, and these are achieved through three processes: the establishment of traffic laws, the policing of those laws, and the application of penalties and sanctions to offenders. Traffic policing programs can vary by visibility (overt or covert) and deployment methods (scheduled and non-scheduled), while sanctions can serve to constrain, deter or reform offending behaviour. This chapter will review the effectiveness of traffic law enforcement strategies from the perspective of a range of high-risk, illegal driving behaviours including drink/drug driving, speeding, seat belt use and red light running. Additionally, this chapter discusses how traffic police are increasingly using technology to enforce traffic laws and thus reduce crashes. The chapter concludes that effective traffic policing involves a range of both overt and covert operations and includes a mix of automatic and more traditional manual enforcement methods. It is important to increase both the perceived and actual risk of detection by ensuring that traffic law enforcement operations are sufficiently intensive, unpredictable in nature and conducted as widely as possible across the road network. A key means of maintaining the unpredictability of operations is through the random deployment of enforcement and/or the random checking of drivers. The impact of traffic enforcement is also heightened when it is supported by public education campaigns. In the future, technological improvements will allow the use of more innovative enforcement strategies. Finally, further research is needed to continue the development of traffic policing approaches and address emerging road safety issues.

Stop and revive? : the effectiveness of nap and active rest breaks for reducing driver sleepiness

The incidence of sleep-related crashes has been estimated to account for approximately 20% of all fatal and severe crashes. The use of sleepiness countermeasures by drivers is an important component to reduce the incidence rates of sleep-related crashes. Taking a brief nap and stopping for a rest break are two highly publicised countermeasures for driver sleepiness and are also believed by drivers to be the most effective countermeasures. Despite this belief, there is scarce evidence to support the utility of these countermeasures for reducing driver sleepiness levels. Therefore, determining the effectiveness of these countermeasures is an important road safety concern. The current study utilised a young adult sample (N = 20) to investigate the effectiveness of a nap and an active rest break. The countermeasures effects were evaluated by physiological, behavioural (hazard perception skill), and subjective measures previously found sensitive to sleepiness. Participants initially completed two hours of a simulated driving task followed by a 15 minute nap opportunity or a 15 minute active rest break that included 10 minutes of brisk walking. After the break, participants completed one final hour of the simulated driving task. A within-subjects design was used so that each participant completed both the nap and the active rest break conditions on separate occasions. The analyses revealed that only the nap break provided any meaningful reduction in physiological sleepiness, reduced subjective sleepiness levels, and maintained hazard perception performance. In contrast, the active rest break had no effect for reducing physiological sleepiness and resulted in a decrement in hazard perception performance (i.e., an increase of reaction time latencies), with a transient reduction in subjective sleepiness levels. A number of theoretical, empirical and practical issues were identified by the current study.

A further exploration of sensation seeking propensity, reward sensitivity, depression, anxiety, and the risky behaviour of young novice drivers in a structural equation model

Young novice drivers constitute a major public health concern due to the number of crashes in which they are involved, and the resultant injuries and fatalities. Previous research suggests psychological traits (reward sensitivity, sensation seeking propensity), and psychological states (anxiety, depression) influence their risky behaviour. The relationships between gender, anxiety, depression, reward sensitivity, sensation seeking propensity and risky driving are explored. Participants (390 intermediate drivers, 17-25 years) completed two online surveys at a six month interval. Surveys comprised sociodemographics, Brief Sensation Seeking Scale, Kessler’s Psychological Distress Scale, an abridged Sensitivity to Reward Questionnaire, and risky driving behaviour was measured by the Behaviour of Young Novice Drivers Scale. Structural equation modelling revealed anxiety, reward sensitivity and sensation seeking propensity predicted risky driving. Gender was a moderator, with only reward sensitivity predicting risky driving for males. Future interventions which consider the role of rewards, sensation seeking, and mental health may contribute to improved road safety for younger and older road users alike.

“They’re lunatics on the road” : Exploring the normative influences of parents, friends, and police on young novices’ risky driving decisions

Purpose: Young novice drivers experience significantly greater risk of being injured or killed in car crashes than older more experienced drivers. This research utilised a qualitative approach guided by the framework of Akers’ social learning theory. It explored young novice drivers’ perspectives on risky driving including rewards and punishments expected from and administered by parents, friends, and police, imitation of parents’ and friends’ driving, and advantages and disadvantages of risky driving. Methods: Twenty-one young drivers (12 females, 9 males) aged 16–25 years (M = 17.71 years, SD = 2.15) with a Learner (n = 11) or Provisional (n = 10) driver licence participated in individual or small group interviews. Findings and conclusions: Content analysis supported four themes: (1) rewards and (2) punishments for risky driving, and the influence of (3) parents and (4) friends. The young novice drivers differed in their vulnerability to the negative influences of friends and parents, with some novices advising they were able to resist risky normative influences whilst others felt they could not. The authority of the police as enforcers of road rules was either accepted and respected or seen as being used to persecute young novices. These findings suggest that road safety interventions should consider the normative influence of parents and friends on the risky and safe behaviour of young novices. Police were also seen as influential upon behaviour. Future research should explore the complicated relationship between parents, friends, the police, young novices, and their risky driving behaviour.

On the significance of omitted variables in intersection crash modeling

Advances in safety research—trying to improve the collective understanding of motor vehicle crash causes and contributing factors—rest upon the pursuit of numerous lines of research inquiry. The research community has focused considerable attention on analytical methods development (negative binomial models, simultaneous equations, etc.), on better experimental designs (before-after studies, comparison sites, etc.), on improving exposure measures, and on model specification improvements (additive terms, non-linear relations, etc.). One might logically seek to know which lines of inquiry might provide the most significant improvements in understanding crash causation and/or prediction. It is the contention of this paper that the exclusion of important variables (causal or surrogate measures of causal variables) cause omitted variable bias in model estimation and is an important and neglected line of inquiry in safety research. In particular, spatially related variables are often difficult to collect and omitted from crash models—but offer significant opportunities to better understand contributing factors and/or causes of crashes. This study examines the role of important variables (other than Average Annual Daily Traffic (AADT)) that are generally omitted from intersection crash prediction models. In addition to the geometric and traffic regulatory information of intersection, the proposed model includes many spatial factors such as local influences of weather, sun glare, proximity to drinking establishments, and proximity to schools—representing a mix of potential environmental and human factors that are theoretically important, but rarely used. Results suggest that these variables in addition to AADT have significant explanatory power, and their exclusion leads to omitted variable bias. Provided is evidence that variable exclusion overstates the effect of minor road AADT by as much as 40% and major road AADT by 14%.

A research framework for assessing the effects of heat stress on construction workers

Hong Kong in summer (June - October) is hot and humid. Construction workers have to undertake physically demanding activities and often in confined spaces. They are vulnerable to heat stress in summer hence health and safety measures associated to heat stress measured by scientific and clinical parameters are urgently needed. This paper provides an initial report of a research project funded by the Research Grants Council (RGC) of the HKSAR. The aim of this study is to develop a set of indices measured by clinical and scientific methods to detect impending attacks of heat stress. These indices would be of tremendous value in better safeguarding workers’ health and safety by reducing the occurrences of heat stress on site. This paper firstly reports on the statistics of construction incidents arising from heat stress. Qualitative and quantitative research methods applied in conducting the research are discussed. It is believed that the construction industry and the government would benefit a lot as a result of this study.

Developing safer passengers through a school-based injury prevention program

Motor vehicle crashes are a leading cause of death among young people. Fourteen percent of adolescents aged 13-14 report passenger-related injuries within three months. Intervention programs typically focus on young drivers and overlook passengers as potential protective influences. Graduated Driver Licensing restricts passenger numbers, and this study focuses on a complementary school-based intervention to increase passengers’ personal- and peer-protective behavior. The aim of this research was to assess the impact of the curriculum-based injury prevention program, Skills for Preventing Injury in Youth (SPIY), on passenger-related risk-taking and injuries, and intentions to intervene in friends’ risky road behavior. SPIY was implemented in Grade 8 Health classes and evaluated using survey and focus group data from 843 students across 10 Australian secondary schools. Intervention students reported less passenger-related risk-taking six months following the program. Their intention to protect friends from underage driving also increased. The results of this study show that a comprehensive, school-based program targeting individual and social changes can increase adolescent passenger safety.

Adolescent involvement in anti-social and delinquent behaviours : predicting future injury risk

The purpose of this study was to challenge the broadly based focus of injury prevention strategies towards concern with the needs of young adolescents who engage in multiple anti-social and delinquent behaviours. Five hundred and forty 13-14 year olds reported on injuries and truancy, violence, illegal road behaviours, drug, and alcohol use. Engagement in these behaviours was found to contribute to the likelihood of an injury. Those engaging in the most anti-social and delinquent behaviours were around five times more likely to report medically-treated injuries in the past three months. Their likelihood of future injury was 1.8 times more likely when they were followed up three months later. The engagement in multiple delinquent and illegal behaviours thus significantly increased the likelihood of injury and identifies a particularly vulnerable group. The findings also suggest that reaching these young people represents a key target for change strategies in injury prevention programs.

Big-five personality factors affecting driving behaviours

The factors affecting driving behaviors are various and interact simultaneously. Therefore, study of their correlations affecting on driving behaviors is of interest. This paper reports a questionnaire survey in China, focusing on the effect of Big-Five factors on speeding, drink driving, and distracted driving while Akers' social learning theory and Homel's deterrence theory were applied. The results showed that personalities had significant effect on speeding and drink driving; social factors had significant effect on speeding and distracted driving; deterrence had significant effect on speeding and drink driving; however, social learning theory did not contribute to drink driving; deterrence did not affect distracted driving. The results were discussed along with the limitation of this study.

Big-five personality factors affecting pedestrian crossing behaviours

Human personality is an important component of psychological factors affecting pedestrian crossing. This paper reports a questionnaire survey on the effects of pedestrian personalities (including neuroticism, extraversion, openness, agreeableness and conscientiousness) on pedestrian violation in China. 675 feedbacks were obtained, of which 535 samples were valid for analysis. The results of the hierarchical regression analysis showed that educational level had significant effect on violation; agreeableness had significant effect on violation, conditional compliance and unconditional compliance; consciousness had significant effect on violation and conditional compliance; extraversion had significant effect on unconditional compliance; neuroticism had significant effect on violation; educational level had significant effect on violation. The results implied that psychological measures played a very important role in pedestrian safety.

Factors affecting pedestrian crossing behaviours at signalized crosswalks in urban areas in Beijing and Singapore

This paper reports an observation investigation of pedestrian crossing behaviors conducted at signalized crosswalks in urban areas in Singapore and Beijing on typical workdays. Each crosswalk was observed 3 times in different periods, i.e. normal hours, lunch hours, and rush hours. A total of 103,956 pedestrians were observed. The results showed that lane type, lane number, intersection type, and culture had significant effect on illegal pedestrian crossing in both cities; observation period had no significant effect on pedestrian violation in both cities; the violation rate in Singapore was lower than that in Beijing. However, observers reported that illegal crossing of vulnerable pedestrians, e.g. pregnant, the lame, old men and women, was more obvious in Singapore than that in Beijing. Evidence proved the hypothesis that the violations were related to pedestrians’ cognition of the definition of safety.

Speed enforcement in Australia : a changing policy landscape shaped by public opinion

- Speeding and crash involvement in Australia - Speed management in Australia - Jurisdictional differences - National Road Safety Strategy (2011-2020) - Auditor-General reviews of speed camera programs - The role of public opinion/feedback - Implications for speed management