Influence of deficiencies in traffic control devices in crashes on two-lane rural roads

Strategies to enhance the level of service and safety of rural roads: A case study

Faced with the contradiction between the increasing traffic volume and the aging road infrastructures in the rural area, this paper aims to propose feasible strategies to enhance the level of service and safety, by a case study of the rural area in the north Jintan district. In order to figure out current issues related to rural roads, a carefully designed investigation has been conducted, and the results of the two-week investigation include roads' basic information, traffic signs and protective facilities, surrounding landscape, and etc. Based on the field driving tests, specific problems including signs category, signs installation and facility maintenance have been fully analyzed. Meanwhile, the problem of roadnet connectivity has also been pointed out through the theory of complex network, and results show that the average node clustering coefficient and shortest path length perform worse than the demonstration plot of other rural districts. For the sake of rural traffic safety and management efficiency, both quantified and qualified strategies have been put forward. The quantified strategies include the regular inspection indicators, the safety sight distance at T-type crossings, as well as the risk severity of sections and the crossings. The qualified strategies involve the management of trucks and roadworks, the setting of signalized intersections, and the timely updates of traffic signs and facilities. Finally, an intelligent management system framework has been established for rural road traffic, with highly interconnected modules of data acquisition, risk identification and information publishing.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Profiles of pregnant women encountering motor vehicle crashes in Taiwan, 2008-2017

BACKGROUND

Understanding demographic profiles is essential to the assessment of health burden imposed by motor vehicle crashes (MVCs) on pregnant women. However, Asian studies that have examined it are lacking. The study aimed to describe the demographic characteristics and prevalence of MVCs involving pregnant women in Taiwan.

METHODS

A cross-sectional study conducted by the Taiwan Birth Notification dataset from 2008 to 2017 was linked with the police-reported traffic collision registry to identify pregnant women involved in MVCs. The pregnant women were categorized according to their gestational age, age at delivery, the role of road user (driver, passenger, or pedestrian), and vehicle types (car, two-wheeled motor vehicle, or others). A chi-square test was performed for the significance test.

RESULTS

A total of 22,134 (1.13%) pregnant women were involved in MVCs in the study period. Two-wheeled motor vehicle (47.9%) and driver (81.4%) were the mainly reported vehicle type and road user at the crash scenes, respectively. The majority of MVCs occurred in pregnant women aged 28-34 years. The number of MVCs rapidly declined after 37 weeks of gestation, especially two-wheeled motor vehicle or car crashes. However, the number of pedestrian victims climbed up during the third trimester.

CONCLUSION

Pregnant women are susceptible to MVCs regardless of their gestational age, role of a road user, or type of vehicle. The findings of this study emphasize the need for increased awareness of traffic collision prevention among pregnant women aged 28-34. In addition, improving pedestrian safety is essential for the reduction of pregnant victims.

Impact of the decision-making environment on policy responses to road worker fatality in Manitoba and Saskatchewan

OBJECTIVES

Fatal accidents often lead to policy changes. However, the existing decision-making environment is critical to policy responses. This study compares the policy responses to similar events in Manitoba and Saskatchewan. The key question explores the extent to which the policy decisions in each province differ despite the similarity of the events.

METHODS

Key documents were examined. Provincial court rulings, workplace health & safety incident investigation reports, court transcripts and police reports were used to compare resulting policy changes as well as the socio-political and economic decision-making context. Relevant clauses in resulting legislation were also compared to assess the specific changes that were made in each province.

RESULTS

In each province, a young, female highway construction worker was killed. However, the provinces responded in very different ways. In Saskatchewan, the Premier called for recommendations to improve worker safety, initiating an in-depth governmental study and the development of a broad safety strategy. In Manitoba, political and social pressures shifted the decision-making environment and contributed to the rushed passing of a bill focused on traffic fine increases that resulted in record-breaking traffic fine revenue while failing to include broader safety measures.

CONCLUSION

Different decision-making contexts can lead to vastly different policy outcomes even when responding to very similar events. Key differences included time constraints, access to information and the nature of the political process invoked.