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Non-crash injuries in public transport

Non-crash injuries in public transport. Safety of Vehicle – Safety of Passenger Krakow 11 – 12 April, 2019 [Previous subject at 2017 conference: Safety of pedestrians and cyclists in case of a bus collision]. Introduction.

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Non-crash injuries in public transport

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  1. Non-crash injuries in public transport Safety of Vehicle – Safety of Passenger Krakow 11 – 12 April, 2019 [Previous subject at 2017 conference:Safety of pedestrians and cyclists in case of a bus collision]

  2. Introduction • The bus is the safest means of road transport. However, the spectacular nature of the occasional accidents means that the bus hits the headlines now and again. The number of fatalities in bus and coach occupants and drivers sums the 0.5% of the EU-17 fatalities. • Nevertheless, each spectacular accident involving buses or coaches leads to a public debate on bus safety across Europe. • Non-collision injuries in public buses - neglected problem EEVC VG21 Report 2011 by INSIA [2017 conference: Safety of pedestrians and cyclists in case of a bus collision] Halpern P, et.al. (2005) Non-collision injuries in public buses: a national survey of a neglected problem. Emerg Med J 2005;22:108–110.

  3. Introduction – cont. • First international bus safety research project was the ECBOS (Enhanced Coach and Bus Occupant Safety) 2000-2004 within the 5th Framework Program of the European Commission [see final publishable report: http://www.transport-research.info/sites/default/files/project/documents/20060727_144009_64237_ECBOS_Final_Report.pdf] • COST Action (Passive Safety of Buses and Coaches. Advanced Occupant Protection) 2013 – 2015 proposed by Prof. Francisco APARICIO in cooperation with more than 20 partners not approved by EC • Other: ETAC European Truck AccidentCausation (2004 - 2006) mm … • SENIORS (Safety ENhanced Innovations for Older Road userS) within the EUROPEAN COMMISSION ‘s 8th FRAMEWORK PROGRAMME “HORIZON 2020” [2017 conference: Safety of pedestrians and cyclists in case of a bus collision]

  4. Introduction – cont. • Improvement of passive safety of buses through advanced occupant protection is an important issue and one of the major theme evaluated by international regulations (UN-ECE, UN-GTR -Global Technical Regulation and EU) • Common misconception that existing regulations and standards cover all new designs and new safety ideas • Lack of international validation of safety performance of buses, coaches, trams by users organizations as in case of cars (e.g. NCAP programs) [2017 conference: Safety of pedestrians and cyclists in case of a bus collision]

  5. EEVC (European Enhanced Vehicle-Safety Committee) organization 2019 Steering Committee TF: Q-Dummy Chest and Abdominal Injury Criteria TF: TEFIRE - THOR Evaluation for Frontal Impact Regulation WG12: Crash Dummies WG13: Side Impact (Temporarily inactive) WG14: Under-run (Temporarily inactive) WG15: Compatibility (Temporarily inactive) WG16: Frontal Crash Prot. (Temporarily inactive) WG17: Pedestrian (Temporarily inactive) WG18: Child Safety (Temporarily inactive) WG19: Pri & Sec (Temporarily inactive) WG20: Rear Impact (Temporarily inactive) WG21: Accident Studies WG22: Virtual testing (Temporarily inactive) WG23: Bus Frontal Collision (Temporarily inactive) [2017 conference: Safety of pedestrians and cyclists in case of a bus collision]

  6. Pedestrian Safety: Crash prevention Road and traffic factors Reduce vehicle traveling speeds: enforce speed limits reduce speed limits: 60 to 50 km/h > 27% reduction in pedestrian fatalities* Make crossing the traffic stream safer: interrupt continuous traffic flow reduce road width make it easier for drivers to se pedestrians *Anderson RWG, McLean AJ, Farmer MJB, Lee BH, Brooks, CG. Vehicle travel speeds and the incidence of fatal pedestrian crashes. Accident Analysis and Prevention 1997; 29(5): 667-674. Full report see: http://casr.adelaide.edu.au/casrpub/show.php?id=274 [2017 conference: Safety of pedestrians and cyclists in case of a bus collision]

  7. Pedestrian Safety: Crash prevention Road and traffic factors Exposure control: reduce number of pedestrians exposed to risk (busses, public transport) restrict vehicle traffic (city centre) Pedestrian characteristics Child pedestrians (supervision, training) Adult pedestrians ( crossing behavior, alcohol intoxication) Elderly pedestrians (physical disabilities) [2017 conference: Safety of pedestrians and cyclists in case of a bus collision]

  8. Pedestrian Safety: Crash prevention Driver characteristics Physical condition: alcohol etc… Divided attention: mobile phones etc… Driving behavior: rapid lane changes etc… Vehicle characteristics Vehicle aggressivity Vehicle conspicuity and audible warning Breaking performance Earlier detection of the pedestrian Vehicle glazing: light transmission [2017 conference: Safety of pedestrians and cyclists in case of a bus collision]

  9. Bus and coach road safety • safe vehicle • safe driver • safe company International Road Transport Union. (2014). Bus and coach road safety.

  10. Non-collision injuries on public transport Historical look back • 1980 - One of the earliest studies reviewed accident data (12 months, 30 bus operators, covering about 30000 vehicles in the UK) • 56% of the passenger injuries were sustained in non- collision accidents • 43% of these occurred to passengers over 60 years old • This general pattern was reflected in research from Sweden, USA and other countries. Leyland: Passenger problems on moving buses. (1980) Edited by Transport and Road Research Laboratory, UK: Transport and Road Research Laboratory.

  11. Percentage of fatalities in accidents involving HGVs and buses or coaches of all road fatalities, EU, 2006-2015 CARE database (EUROSTAT for population data), data available in May 2017. European Road Safety Observatory (ERSO). Traffic Safety Basic Facts.

  12. Fatality rates per million population in accidents involving HGVs and buses or coaches by country, 2015 or latest available year Belgium - BE Denmark - DK Germany - DE Estonia - EE Finland - FI France - FR Greece - EL Hungary - HU Italy - IT Iceland - IS Latvia - LV Lithuania - LT Luxembourg - LU Malta - MT Netherlands - NL Norway - NO Austria - AT Poland - PL Portugal - PT Slovenia - SI Slovakia - SK Spain - ES Czech Republic - CZ Sweden - SE Switzerland - CH CARE database (EUROSTAT for population data), data available in May 2017. European Road Safety Observatory (ERSO). Traffic Safety Basic Facts.

  13. Distribution of fatalities in accidents involving HGVs and buses or coaches by age group, EU, 2015 CARE database (EUROSTAT for population data), data available in May 2017. European Road Safety Observatory (ERSO). Traffic Safety Basic Facts.

  14. City-bus accident circumstances: injury percentage by kind of accident ECBOS Enhanced Coach and Bus Occupant Safety. (2004) Summary Report

  15. City-bus accident circumstances: injury percentage by kind of no collision accident ECBOS Enhanced Coach and Bus Occupant Safety. (2004) Summary Report

  16. Major existing active safety directives and regulations Directive 70/388/EEC UNECE Regulation 28.00 Audible warning Directive 78/316/EEC UNECE Regulation 121.00 Identification controls Directive 75/443/EEC UNECE Regulation 39.00 Speedometer and reverse gear Directive 70/311/EEC UNECE Regulation 79.01 Steering effort Directive 71/320/EEC UNECE Regulation 13.10 Braking Directive 2003/97/EC UNECE Regulation 46.02 Indirect vision Directive 76/756/EEC UNECE Regulation 48.03 Lighting installation Directive 92/23/EC UNECE Regulation 54.00 Tyres International Road Transport Union. (2014). Bus and coach road safety.

  17. Major existing passive safety directives and regulations Directive 92/22/EEC UNECE Regulation 43.00 Safety glazing Directive 92/24//EEC UNECE Regulation 89.00 Speed limiters Directive 74/408/EEC UNECE Regulation 80.01 Seat strength Directive 77/541/EEC UNECE Regulation 16.04 Safety belts Directive 76/115/EEC UNECE Regulation 14.06 Safety belt anchorage Directive 70/221/EEC UNECE Regulation 34.02 Fuel Tank Regulation 661/2009/EC General safety International Road Transport Union. (2014). Bus and coach road safety.

  18. Non-collision injuries in public buses a neglected problem Mechanism of the 120 injuries from Tel-Aviv Sourasky Medical Center Tel Aviv during 1998 (120 cases: 86 females (71.7%) and 34 males (28.3%)) Mechanism Number % Acceleration/deceleration 63 51.2 Boarding/alighting 35 28.5 Closing of doors 6 4.9 Bus swerving during a turn 9 7.3 Halpern P, et.al. (2005). Non-collision injuries in public buses: a national survey of a neglected problem . Emerg Med J. 22 pp. 108–110.

  19. Non-collision injuries in public buses a neglected problem Mechanism of the 120 injuries from Tel-Aviv Sourasky Medical Center Tel Aviv during 1998 (120 cases: 86 females (71.7%) and 34 males (28.3%)) Age (y) Number % <18 8 6.7 19–34 22 18.3 35–54 23 19.2 55–74 43 35.8 75+ 24 20.0 Halpern P, et.al. (2005). Non-collision injuries in public buses: a national survey of a neglected problem . Emerg Med J. 22 pp. 108–110.

  20. Non-collision injuries in public buses a neglected problem Passenger location at the time of injury (total number = 120) Position Number % Standing 67 55.8 Moving 30 25.0 Sitting 23 19.2 Halpern P, et.al. (2005). Non-collision injuries in public buses: a national survey of a neglected problem . Emerg Med J. 22 pp. 108–110.

  21. Non-collision injuries in public buses a neglected problem Sites of the 120 injuries Site Number % Limb 62 33.3 Head 54 29.0 Spine 41 22.0 (whiplash incl.) Chest 11 5.9 Pelvis 12 6.5 Abdomen 4 2.2 Skin 2 1.1 Often multiple injuries that are more complex than a single injury, even when there are only slight injuries. Halpern P, et.al. (2005). Non-collision injuries in public buses: a national survey of a neglected problem . Emerg Med J. 22 pp. 108–110.

  22. Passenger balance whilst walking on the lower deck • ANOVA test conducted on measures of changes in gait (DST - double support time) as a measure of balance, taking into account passengers’ age and gender as well as the acceleration of the bus. • The design of the lower deck of the bus does not affect passenger balance. • Higher acceleration levels force all but older and female passengers to reduce double support time. • Passengers’ ability to control balance reduces with the increase of acceleration. • Middle-aged of both genders and men present more difficulties in controlling their balance in all cases Karekla X., Tyler N. (2018). Reducing non-collision injuries aboard buses: Passenger balance whilst walking on the lower deck. Safety Science, Volume 105, June 2018, pp. 128-133

  23. Passenger balance whilst climbing the stairs • Same methodology as in previous study (ANOVA) • Bus acceleration and passenger age and gender influence passenger stability. • The bus staircase design significantly affects people’s ability to control balance. • Male passengers require longer DST to compensate for their lost balance. • Male middle-aged passengers present higher difficulty in controlling balance. • Bus acceleration of 1.0 m/s2 will reduce the number of falls aboard buses. Karekla X., Tyler N. (2019). Reducing non-collision injuries aboard buses: Passenger balance whilst climbing the stairs. Safety Science, Volume 112, February 2019, pp. 152-161

  24. Epidemiology of non-collision injuries in public buses (high income countries) • Older people, particularly women, are over-represented in injuries to public bus users. • The incidence of injuries on public transport is likely to be underestimated. • Injuries often occurred when standing, moving around the bus, and during acceleration or deceleration. • 18–33% of ED attenders suffered injuries such as fractures or dislocations. Kendrick D., et.al. (2015). Systematic review of the epidemiology of non-collision injuries occurring to older people during use of public buses in high income countries. Journal of Transport & Health. Volume 2, Issue 3, September 2015, pp. 394-405

  25. Emergency braking – simulation criteria limits (MADYMO) HIC 500 [-] (ECE R80) Head acceleration 80 [g] (FMVSS 201) Chest acceleration 30 [g] (ECE R80) Pelvis acceleration 130 [g] (FMVSS 214) Neck bending moment (Extension) 57 [Nm] (FMVSS 208) ECBOS Enhanced Coach and Bus Occupant Safety. (2004) Summary Report

  26. Injury values for the occupants sitting in front area ECBOS Enhanced Coach and Bus Occupant Safety. (2004) Summary Report

  27. Injury values for the occupants standing at the entrance in front of aspace divider ECBOS Enhanced Coach and Bus Occupant Safety. (2004) Summary Report

  28. INJURY EVENTS AMONG BUS AND COACH OCCUPANTS– Non-crash Injuries as Important as Crash Injuries – Analysis of a ten year complete data set from the health sector, comprising 284 injured bus and coach occupants from a well defined area in Umeå , Sweden Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  29. Number of injured in different types of incidents Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  30. Number of injured in crashes by injury severity and urban/rural road Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  31. Injury type and localization for those injured in crash incidents Björnstig U. et.al. (2005). IATSS RESEARCH Vol.29 No.1.

  32. Number of injured in non-crash incidents by injury severity and type of mechanism Three-quaters of the injured were women Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  33. Injury type and localization for those injured in non-crash events Björnstig U. et.al. (2005). IATSS RESEARCH Vol.29 No.1.

  34. Number of injured in different types of incidents • Two-thirds (106) of the non-crash victims injured when alighting (102) from, or boarding (4), a bus at stand still • Contributing causes for alighting injuries: • 57 (56%) cases slipping on wet or icy steps, or on the ground • 28 (27%) cases stumbling on the way out of the bus or coach Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  35. Number of injured in different types of incidents (cont.) • One-third (48) of the non-crash victims were injured • by falling, or by injuring themselves in some othe way, in a moving bus or coach • 54% were injured because the bus or coach was braking or accelerating • 46%, most people were injured due to, e.g. stumbling or slipping when moving in the bus during the tour, in two cases people were hit in the head by a falling TV equipment • 65% of these 48 occupants were standing Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  36. Non crash incidents and single vehicle crashes From the medical point of view, the importance of non-crash incidents is obvious More than half were injured in such incidents, 43% had MAIS 2+ injuries and 57% of all days at hospital were caused by non-crash events Single vehicle crashes had a high proportion of non-minor injuries (48%) Aerodynamic factors related to high- sided (about four meters) coaches, strong cross-winds, and slippery road conditions Björnstig U. et.al. (2005) Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  37. MADYMO model of interactions of the occupant with the interior of a common urban bus Palacio A. et.al. Non-collision Injuries In Urban Buses – Strategies For Prevention. 2009 AAP

  38. Human model behavior Palacio A. et.al. Non-collision Injuries In Urban Buses – Strategies For Prevention. 2009 AAP

  39. Discomfort feeling of standing bus passengers due to acceleration Beurier G. (2012) Analysis of the discomfort feeling of standing bus passengers…Procedia - Social and Behavioral Sciences 48, pp. 425 – 434

  40. Discomfort feeling of standing bus passengers – comfortable area red – comfortable acceleration area for all the subjects black – measured acceleration for all the trials Beurier G. (2012) Analysis of the discomfort feeling of standing bus passengers…Procedia - Social and Behavioral Sciences 48. pp. 425 – 434

  41. Highlights • Ageing population in high income countries. • Older people may be at increased risk of injury as a result of age-related health conditions such as stroke, arthritis, Parkinson’s disease, dementia, sensory or cognitive impairment, balance, mobility problems, frailty and decreased BMC. • Many injuries to older public transport users are potentially preventable. • Public buses need to be safe and accessible, and perceived as such by older people. Kendrick d., et.al. (2015). Systematic review of the epidemiology of non-collision injuries occurring to older people during use of public buses in high income countries. Journal of Transport & Health. Volume 2, Issue 3, September 2015, pp. 394-405

  42. Possible countermeasures reducing alighting or boarding injuries Good injury reducing measure would be to eliminate the level difference between the bus stop and the floor in the bus, as e.g. in the subway An example from Curitiba in Brazil of a public transport system Björnstig U. et.al. (2005). Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  43. Possible countermeasures reducing non-crash injuries in moving bus/coach • Standing passengers fell and are injured, especially under sudden acceleration or deceleration • Standing passengers difficult to avoid in urban traffic • Improvement of driving technique and interior design such as: • easily accessible handrails • soft driving manner • less stress among drivers due to tight timetables (summer and winter timetables) Björnstig U. et.al. (2005). Injury Events Among Bus and Coach Occupants – Non-crash Injuries as Important as Crash Injuries. IATSS RESEARCH Vol.29 No.1, 2005

  44. Possible countermeasures reducing non-crash injuries (cont.) • Stair well and horizontal seatback handles are particularly hazardous and the latter should be replaced with vertical handrails. • Driver training should be expanded to include video training based on multibody simulations to highlight the risks for standing passengers induced by harsh braking and acceleration. Palacio A., et.al. (2009). Non-collision injuries in urban buses—Strategies for prevention. Accident Analysis & Prevention, Volume 41, Issue 1, January 2009, pp. 1-9

  45. Other suggested countermeasures reducing non-crash injuries (cont.) • Restricting numbers of standing passengers or prohibiting standing on buses. • Restricting the standing area to the rear or centre of the bus. • Designers should pay special attention to the design of the bus interior, according to the abilities and capabilities of women's population over the age above 60. Kendall IG., et.al. (1994) A review of injuries sustained by bus passengers. Journal of Accident & Emergency Medicine 1994, 11(1):57-57.

  46. Other suggested countermeasures • Lowering the level of the bus floor • Improving the design of steps • Raising the level of bus stops by the use of ramps • Modifications of door closing mechanisms • Mechanisms to prevent the bus from starting before passengers have entered or exited the bus • Use of textured floors to prevent slips • Visual cues for floor obstructions • Minimizing hard or sharp protrusions in the bus interior • Increased number of exclusive bus lanes to prevent some instances of deceleration • …… Revieved by: Kendrick D. et.al. (2015). Systematic review of the epidemiology of non- collision injuries occurring to older people during use of public buses in high income countries. Journal of Transport & Health. Volume 2, Issue 3, September 2015, pp. 394-405

  47. Non-collision injuries in public buses - conclusions • Non-collision injuries in public buses cause significant bodily harm that can be prevented by greater attention to bus design and operational details such as driver misconduct or mechanical faults in the vehicle. • The incidence of these injuries is likely to be underestimated, since not all injuries are medically attended • More systematic (in depth) investigations of relevant incidenceswould be of great benefit to the community Halpern P, et.al. (2005). Non-collision injuries in public buses: a national survey of a neglected problem . Emerg Med J. 22 pp. 108–110.

  48. Main sources of current research related to non-collision injuries O'Neil D. (2013) Accident patterns in the ageing population: non-collision injuries on public transport and injuries of single pedestrians, 3.2, Brussels, European Commssion, Dec, 2013, 1-13 Kendrik D. et.al. (2015) Systematic review of the epidemiology of non-collision injuries occurring to older people during use of public buses in high income countries. Journal of Transport & Health. Volume 2, Issue 3, September 2015, pp. 394-405

  49. Interesting sources

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