Risky business: safety regulations, riskcompensation, and individual behavior
Government regulations and industry practices constrain our behavior in many ways in an attempt to reduce injuries. Safety features are designed into products we use: cars now have airbags; medicine bottles have “childproof” caps. Laws require us to act in a safe manner: we must wear seat belts while driving and hard hats in construction areas. But do these measures influence our behavior in other ways? Risk compensation theory hypothesizes that they do, that we “use up” the additional safety though more risky actions. This paper surveys risk compensation by reviewing its history, discussing its theoretical foundations, outlining evidence for and against its claims, and providing the author’s own views. It concludes by discussing the relevance of risk compensation for injury prevention workers who seek to reduce unintentional injuries.
Hedlund, J. (2000) Risky business: safety regulations, risk compensation, and individual behavior. Injury Prevention 6, 82-90.
Bicycle helmets: Should cyclists wear them?
School of Mathematics and Statistics, University of New South Wales, Sydney, Australia
A Systematic Review - Conclusions
Bicycle helmet use was associated with reduced odds of head injury, serious head injury, facial injury and fatal head injury. The reduction was greater for serious or fatal head injury. Neck injury was rare and not associated with helmet use. These results support the use of strategies to increase the uptake of bicycle helmets as part of a comprehensive cycling safety plan.
The effects of (possible) risk compensation has not been adequately researched, and there is evidence estimates of helmet effectiveness are not influenced by other risk factors.
Motor vehicles do not give more/less overtaking distance for helmeted or unhelmeted cyclists.
Mandatory bicycle helmet legislation is associated with large increases in helmet wearing.
Bicycle helmet legislation is also associated with reductions in cycling fatalities, head injuries and traumatic brain injury.
SudhaJayaraman, DineshSethi, Roger Wong
Injury is one of the top ten causes of death and disability worldwide. It results in an early loss of life for many young people and ongoing high medical care costs among survivors. Advanced life support (ALS) training for ambulance crews with emphasis on trauma is believed to have contributed to a reduction in the number of deaths from injury in predominantly high‐income countries where this service is available. ALS services are also being adapted for low‐ and middle‐income countries. This review of trials found there is no evidence to suggest that ALS training for ambulance personnel improves the outcomes for injured people. (Full text)
Advanced training in trauma life support for ambulance crews
Alcohol and drug screening of occupational drivers for preventing injury
Clodagh M Cashman, Jani H Ruotsalainen, Birgit A Greiner, Paul V Beirne, Jos H Verbeek
Alcohol and drug abuse are serious public health problems worldwide. Workplace alcohol and drug testing is a common intervention, especially in developed nations, but it is costly and its use is controversial. This systematic review aimed to assess the effects of alcohol and drug screening among occupational drivers for preventing injury.
We conducted a systematic search of the literature on the effects of alcohol and drug screening among occupational drivers for preventing injury. We then appraised the quality of the studies found and assessed their results. We found two time‐series studies conducted in the USA. One was conducted in five large transportation companies, and it examined the effects of two interventions of interest: implementation of legislation for mandatory random drug testing and mandatory random and for‐cause alcohol testing. The other study was conducted using national injury data.
There is limited evidence that in the long term mandatory drug‐testing interventions can be more effective than no intervention in reducing injuries in occupational drivers. For mandatory alcohol testing there was evidence of an immediate effect only.
Given the widespread practice of alcohol and drug testing and the paucity of evaluation studies found, more evaluation studies are needed. Interrupted time‐series is a feasible study design for evaluating interventions that aim at preventing alcohol and drug related injuries. However, time‐series studies of higher quality and of long duration are needed to increase the level of evidence. A cluster‐randomised trial would be the ideal study design to evaluate the effects of interventions for injury prevention in this occupational setting. (Full text)
Alcohol ignition interlock programmes for reducing drink driving recidivism
Charlene Willis, Sean Lybrand, Nicholas Bellamy
Convicted drink drivers are sometimes offered the choice of a standard punishment, or for an alcohol ignition interlock to be fitted to their car for a fixed period. To operate a vehicle equipped with an interlock, the driver must first give a breath specimen. If the breath alcohol concentration of the specimen is too high, the vehicle will not start. A number of studies have been conducted to see whether the interlock stops drink drivers from offending again. Most of these studies have not been of high quality. The interlock seems to reduce re‐offending as long as it is still fitted to the vehicle, but there is no long‐term benefit after it has been removed. However, more studies of good quality are needed to confirm these findings. The low percentage of offenders who choose to have an interlock fitted also makes it difficult to reach firm conclusions about their effectiveness. (Full text)
Area‐wide traffic calming for preventing traffic related injuries
Frances Bunn, Timothy Collier, Chris Frost, Katharine Ker, Rebecca Steinbach, Ian Roberts, Reinhard Wentz
Road traffic crashes are a major problem worldwide. In high‐income countries, traffic calming schemes aim to make the roads safer (particularly for vulnerable road users such as pedestrians and cyclists) in areas that are particular 'hot spots'. Strategies include slowing down traffic (eg road/speed humps, mini‐roundabouts, reduced speed limit zones), visual changes (road surface treatment, changes to road lighting), redistributing traffic (blocking roads, creating one‐way streets), and/or changes to road environments (such as trees). This review found that area‐wide traffic calming may have the potential to reduce death and injuries, but more research is needed particularly in low and middle income countries. (Full text)
Bicycle helmet legislation for the uptake of helmet use
and prevention of head injuries
Alison Macpherson, Anneliese Spinks
Cycling is a popular past‐time among children and adults and is highly beneficial as a means of transport and obtaining exercise. However, cycling related injuries are common and can be severe, particularly injuries to the head.
Bicycle helmets have been advocated as a means of reducing the severity of head injuries, however voluntary use of helmets is low among the general population. Bicycle helmet laws mandating their use have thus been implemented in a number of jurisdictions word‐wide in order to increase helmet use. These laws have proved to be controversial with opponents arguing that the laws may dissuade people from cycling or may result in greater injury rates among cyclists due to risk compensation. This review searched for the best evidence to investigate what effect bicycle helmet laws have had. There were no randomised controlled trials found, however five studies with a contemporary control were located that looked at bicycle related head injury or bicycle helmet use. The results of these studies indicated a positive effect of bicycle helmet laws for increasing helmet use and reducing head injuries in the target population compared to controls (either jurisdictions without helmet laws or non‐target populations). None of the included studies measured actual bicycle use so it was not possible to evaluate the claim that fewer individuals were cycling due to the implementation of the helmet laws. Although the results of the review support bicycle helmet legislation for reducing head injuries, the evidence is currently insufficient to either support or negate the claims of bicycle helmet opponents that helmet laws may discourage cycling. (Full text)
Cycling infrastructure for reducing cycling injuries in cyclists
Caroline A Mulvaney, Sherie Smith, Michael C Watson, John Parkin, Carol Coupland, Philip Miller,Denise Kendrick, Hugh McClintock
This review aimed to answer the question "what effect do different types of cycling infrastructure have on cycling injuries and collisions?". Cycling infrastructure involves changes which are made to the road design or management of the road for cyclists. We aimed to include studies which looked at the effects of three types of cycling infrastructure:
That which aims to manage the shared use of the road space for both motor vehicles and cyclists, for example, cycle lanes and shared use of a bus lane;
That which separates cycle traffic from motorised traffic and may include special routes just for cycle traffic, for example, cycle tracks and cycle paths. These may be shared with pedestrians;
Management of the roads to include separation of motor vehicle and cycle traffic (for example, traffic rules that ban certain types of traffic from making particular turns) and cycle turns at traffic signals.
Comparisons were made with either routes or crossings that either did not have cycling infrastructure in place or had a different type of infrastructure. We were interested in studies with both adults and children. The primary outcome of interest was cycling injuries suffered as a result of a cycling collision. Secondary outcomes were collision rates for cyclists; and cycle counts, that is the number of cyclists using the infrastructure.
Cycling infrastructure involves making changes to the road environment to provide special facilities for cyclists. These may include putting in cycle lanes or giving cyclists right of way at junctions, or separating cyclists from fast‐moving or high‐volume traffic. Speed limits may be introduced which means cyclists share the road with vehicles moving more slowly. This review is important because if we want to get more people cycling, we need to know whether cycling infrastructure helps to keep cyclists safe.
We searched world‐wide research literature up to March 2015.
The types of studies that could be included in this review are randomised controlled trials, cluster randomised controlled trials, controlled before‐after studies, and interrupted times series studies. We found 21 studies looking at the effects of 11 different types of cycling infrastructure. No studies reported self‐reported injuries or medically attended injuries. Fourteen studies reported police‐reported ‘cycle crashes’ or ‘accidents’ or ‘injury crashes’ and the other studies reported outcomes such as number of “cycle accidents” or “crashes involving cyclists”. Nine studies reported collisions by severity; seven studies reported on age of casualty; and two studies reported on sex. One study reported on the level of social deprivation. Cycle flow was collected in 14 studies.
Generally we found a lack of evidence that the types of cycling infrastructure we looked at affects injuries or collisions in cyclists. Cycle routes and networks do not seem to reduce the risk of collision. Speed limits of 20 mph, changing parts of the road network to some designs of roundabouts and changing busy parts of a cycle route may reduce the risk of collision. In terms of severity of injury, sex, age and level of social deprivation of the area, there is a lack of evidence to draw any conclusions concerning the effect of cycling infrastructure on cycling collisions.
Quality of the evidence
We carried out a thorough search for relevant papers. The quality of the evidence was low with 20 of the included 21 studies using a controlled before‐after study design. Few studies considered how factors such as weather and volume of traffic may affect collision rates. Few studies considered how changes in cycle rates seen as a result of installing infrastructure may affect changes in collision rates. (Full text)
Graduated driver licensing for reducing motor vehicle crashes among young drivers
Kelly F Russell, Ben Vandermeer, Lisa Hartling
Young drivers are at high risk of involvement in motor vehicle crashes. Graduated driver licensing (GDL) has been proposed as a means of reducing crash rates among novice drivers by gradually introducing them to higher risk driving situations. This review found 34 studies that have evaluated various types of GDL programs. All of the studies reported positive findings, with reductions for all types of crashes among all teenage drivers. However, the size of the reductions varied and, based on the included studies it is not possible to say which aspects of GDL programs have the biggest effect. Future research on GDL should evaluate the relative impact of different program components. (Full text)
Helicopter emergency medical services for adults with major trauma
Samuel M Galvagno Jr, Robert Sikorski, Jon M Hirshon, Douglas Floccare, Christopher Stephens, Deirdre Beecher, Stephen Thomas
Trauma is a leading cause of death and disability worldwide and, since the 1970s, helicopters have been used to transport people with injuries to hospitals that specialize in trauma care. Helicopters offer several potential advantages, including faster transport, and care from medical staff who are specifically trained in the management of major injuries.
We searched the medical literature for clinical studies comparing the transport of adults who had major injuries by helicopter ambulance (HEMS) or ground ambulance (GEMS). The evidence is current to April 2015.
We found 38 studies which included people from 12 countries around the world. Researchers wanted to find out if using a helicopter ambulance was any better than a ground ambulance for improving an injured person's chance of survival, or reducing the severity of long‐term disability. Some of these studies indicated some benefit of HEMS for survival after major trauma, but other studies did not. The studies were of varying sizes and used different methods to determine if more people survived when transported by HEMS versus GEMS. Some studies included helicopter teams that had specialized physicians on board whereas other helicopter crews were staffed by paramedics and nurses. Furthermore, people transported by HEMS or GEMS had varying numbers and types of procedures during travel to the trauma center. The use of some of these procedures, such as the placement of a breathing tube, may have helped improve survival in some of the studies. However, these medical procedures can also be provided during ground ambulance transport. Data regarding safety were not available in any of the included studies. Road traffic and helicopter crashes are adverse effects which can occur with either method of transport.
Quality of the evidence
Overall, the quality of the included studies was low. It is possible that HEMS may be better than GEMS for people with certain characteristics. There are various reasons why HEMS may be better, such as staff having more specialty training in managing major injuries. But more research is required to determine what elements of helicopter transport improve survival. Some studies did not describe the care available to people in the GEMS group. Due to this poor reporting it is impossible to compare the treatments people received.
Based on the current evidence, the added benefits of HEMS compared with GEMS are unclear. The results from future research might help in better allocation of HEMS within a healthcare system, with increased safety and decreased costs.(Full text)
Helmets for preventing head and facial injuries in bicyclists
Diane C Thompson, Fred Rivara, Robert Thompson
Cycling is a healthy and popular activity for people of all ages. Crashes involving bicyclists are, however, common and often involve motor vehicles. Head injuries are responsible for around three‐quarters of deaths among bicyclists involved in crashes. Facial injuries are also common. The review found that wearing a helmet reduced the risk of head or brain injury by approximately two‐thirds or more, regardless of whether the crash involved a motor vehicle. Injuries to the mid and upper face were also markedly reduced, although helmets did not prevent lower facial injuries. (Full text)
Helmets for preventing injury in motorcycle riders
Bette C Liu, Rebecca Ivers, Robyn Norton, SoufianeBoufous, Stephanie Blows, Sing Kai Lo
Motorcyclists are at high risk in traffic crashes, particularly for head injury. A review of studies concluded that helmets reduce the risk of head injury by around 69% and death by around 42%. There is, so far, insufficient evidence to compare the effectiveness of different types of helmet. Some studies have suggested that helmets may protect against facial injury and that they have no effect on neck injury, but more research is required for a conclusive answer. The review supports the view that helmet use should be actively encouraged worldwide for rider safety.