Safe system approach to reducing serious injury risk in motorcyclist collisions with fixed hazards

Collisions with fixed objects in the roadway environment account for a substantial proportion of motorcyclist fatalities. Many studies have identified individual roadway environment and/or motorcyclist characteristics that are associated with the severity of the injury outcome, including the presence of roadside barriers, helmet use, alcohol use and speeding. However, no studies have reported the cumulative benefit of such characteristics on motorcycling safety. The safe system approach recognises that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles and people. The aim of the present paper is to consider these cornerstone areas concomitantly, and quantitatively assess the serious injury risk of motorcyclists in fixed object collisions using this holistic approach. A total of 1006 Australian and 15,727 (weighted) United States motorcyclist-fixed object collisions were collected retrospectively, and the serious injury risks associated with roadside barriers, helmet use, alcohol use and speeding were assessed both individually and concomitantly. The results indicate that if safety efforts are made in each of the safe system cornerstone areas, the combined effect is to substantially reduce the serious injury risk of fixed hazards to motorcyclists. The holistic approach is shown to reduce the serious injury risk considerably more than each of the safety efforts considered individually. These results promote the use of a safe system approach to motorcycling safety.     

Analysis of factors that increase motorcycle rider risk compared to car driver risk

As in other parts of the Western world, there is concern in New Zealand about increasing popularity of motorcycles because of potential increases in road trauma. This study sought to identify important factors associated with increased risk for motorcyclists to inform potential policy approaches to reduce motorcyclist injury, such as changes to motorcyclist licensing, training and education. Using data extracted from a register of all New Zealand licensed motor vehicles that were matched to crash data, statistical models were fitted to examine patterns of motorcycle risk in comparison with small cars. These showed generally elevated risks for motorcyclists compared to cars, but particularly elevated risks for motorcycle owners aged in their 20s or who lived in more urbanised settings. In crashes, motorcyclists have little protection from injury, putting the motorcyclist at high risk of injury. When comparing new motorcycles with new cars, the odds of fatal or serious injury to a motorcycle rider involved in an injury crash were almost eight times the odds for a car driver.     

Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California

The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death.     

Generalized linear regression analysis of association of universal helmet laws with motorcyclist fatality rates

This study evaluates the association of universal helmet laws with U.S. motorcyclist fatality rates from 1993 through 2002 using climate measures as statistical controls for motorcycling activity via quasi-maximum likelihood generalized linear regression analyses. Results revealed that motorcyclist fatalities and injuries are strongly associated with normalized heating degree days and precipitation inches, and that universal helmet laws are associated with lower motorcyclist fatality rates when these climate measures, and their interaction, are statistically controlled. This study shows that climate measures have considerable promise as indirect measures (proxies) of motorcycling activity in generalized linear regression studies.     

Exploring motorcyclist injury severity in approach-turn collisions at T-junctions: focusing on the effects of driver's failure to yield and junction control measures

Research has suggested that motorcyclists involved in approach-turn crashes were much more injurious than any other crash-type. This paper investigates the determinants of motorcyclist injury severity resulting from such crash types that occurred at T-junctions, with emphasis on the effects of driver's failure to give way and various junction control measures. The ordered probit models of motorcyclist injury severity were estimated using the data extracted from the STATS19 accident injury database (1991-2004). Approach-turn collisions are categorised into two sub-crashes based on the manoeuvres motorcycles and vehicles were making prior to the collisions. The modelling results uncover several important determinants of injury severity: for example, injuries appeared to be greatest when an approaching motorcycle collided with a turning-right vehicle, and such effect was found to exacerbate injury severity when stop, give-way signs and markings controlled the junction. A turning-right driver that was identified to fail to yield to an approaching motorcyclist was also found to severely injure the motorcyclist. The findings of this study may offer guidelines for further research and provide some important preliminary evidence for the development of countermeasures that may help prevent the specific hazards from occurring.     

Motorcyclist fatalities and the repeal of mandatory helmet wearing laws

Previous studies had estimated that repeal of mandatory helmet wearing laws resulted in increases in the number of fatalities ranging from nearly 40% to essentially zero. This study was performed to determine more definitively the influence on motorcyclist fatalities of these repeals. After repeal, motorcyclist fatalities increased more in the states which repealed their laws than in those which did not in 24 cases out of 26, with the 95% confidence interval for the average effect being 25 +/- 6%. It is therefore concluded that repeals of mandatory helmet wearing laws for motorcyclists were followed by substantial increases in motorcyclist fatalities.     

Road environment, crash type and hospitalisation of bicyclists and motorcyclists presented to emergency departments in Western Australia

Emergency presentations by bicyclists and motorcyclists are often the result from a fall or non-motor vehicle collision that occurred in off-road locations. Consequently, they are unlikely to be captured by police records. If the injury is not severe enough to warrant hospitalisation, they will also not be captured by the hospital admission system. To ascertain the nature and type of these crash events, a 6-month prospective study was undertaken of bicyclists and motorcyclists who presented to emergency departments in Perth, Western Australia, due to involvement in a crash or non-motor vehicle collision. Of the 330 eligible presentations, 151 bicyclists and 104 motorcyclists agreed to participate in a structured interview, representing a response rate of 77.3%. Among them, 120 (79%) bicyclists and 71 (68%) motorcyclists had a fall or non-motor vehicle collision, and many of the crashes (88 (58%) and 47 (45%), respectively) occurred off-road. Moreover, 26.5% of bicyclist and 62.5% of motorcyclist presentations led to hospital admissions. Multivariate logistic regression analysis further showed that the crash location and road type affected hospitalisation for both groups. Although, crashes occurring in rural areas contributed 14% of the events overall, their adjusted risk of hospitalisation increased five times when compared to metropolitan locations. Crash preventive measures targeting rural areas should be considered to further improve the safety of bicyclists and motorcyclists.     

Injury typology of fatal motorcycle collisions with roadside barriers in Australia and New Zealand

Motorcyclists contribute significantly to road trauma around the world through the high incidence of serious injuries and fatalities. The role of roadside safety barriers in such trauma is an area of growing concern amongst motorcyclists, road authorities and road safety researchers and advocates. This paper presents a case series analysis of motorcyclists that were fatally injured following a collision with a roadside barrier during the period 2001–2006 in Australia and New Zealand. Injury profiles and severities are detailed, and associations with crash characteristics are investigated. It is shown that the thorax region had the highest incidence of injury and the highest incidence of maximum injury in fatal motorcycle-barrier crashes, followed by the head region. This is in contrast to fatal motorcycle crashes in all single- and multi-vehicle crash modes, where head injury predominates. The injury profiles of motorcyclists that slid into barriers and those that collided with barriers in the upright posture were similar. However, those that slid in were more likely to receive thorax and pelvis injuries.     

Effect of the helmet act for motorcyclists in Thailand

OBJECTIVES: This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand. METHODS: Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994-1995) and after (1996-1997) enforcement of the helmet act. During the study period, there were 12002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital. RESULTS: After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers. CONCLUSION: Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.     

Motorcycle helmet use and the risk of head,neck, and fatal injury: Revisiting the Hurt Study

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein’s models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein’s analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31–0.52) and fatal injury (RR 0.44, 95% CI 0.26–0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40–0.99), after controlling for multiple potential confounders.     

The frequency and predictors of helmet use among Iranian motorcyclists: A quantitative and qualitative study

Objective

This study examines the rate of helmet use and identifies barriers and facilitators of wearing helmets among Iranian motorcyclists. A mixed-method approach was used, including a structured seasonal survey with specific observations of a random sample of 6010 riders and qualitative methods that included 29 in-depth interviews and seven focus groups (n = 31).

Results

Only 10% of motorcyclists wear a standard helmet while riding. However, another 23% of motorcyclists used non-standard or partial helmets that covered only part of the head and do not prevent head trauma injuries effectively. We observed only 2 of 264 child passengers and 22 of 1951 adult passengers wearing helmets. Almost no one used protective pants or clothing made to be more visible in traffic. Themes emerged from qualitative interviews and were grouped into three main categories: (1) helmet characteristics; (2) social and cultural factors; and (3) personal and psychological factors.

Conclusion

Overall, the motorcyclists in our study believed that wearing a safety helmet protects them against serious injuries or death during a crash; however, only a small percentage of the motorcyclists used safety helmets. National intervention programs addressing motorcycle safety should aim to overcome barriers to and promote facilitators of helmet use, including providing inexpensive standard helmets, banning manufacturing/using unsafe partial or dummy helmets, as well as enforcing helmet use on a consistent basis.     

Barriers to, and factors associated, with observed motorcycle helmet use in Vietnam

This study investigated barriers to, and factors associated with, observed motorcycle helmet use among motorcyclists in Hai Duong Province, Vietnam. The findings highlighted an array of factors associated with observed helmet use namely, support for universal helmet legislation and a positive attitude towards what might be perceived as negative attributes of helmet use such as inconvenience and discomfort in hot weather. As well, older age (greater than 25 years in age), riding on a compulsory road, being a driver, trips of greater than 10 km, higher levels of education (having a university degree and higher) were found to be key determinants of helmet use. Despite over 95% of motorcyclists disagreeing with the statement that wearing a helmet does not reduce the severity of head injury in a crash, most motorcyclists believed that helmets did not need to be worn for a short trip. Overall, only 23% of motorcyclists were observed wearing a helmet. The authors conclude that efforts to increase helmet use need to focus on the necessity for universal helmet legislation in association with identifying solutions to reduce the negative attitudes towards helmet use.     

Motorcycling experience and hazard perception

Studies of hazard perception skills in car drivers suggest that the ability to spot hazards improves with driving experience. Is this the case with motorcyclists? Sixty-one motorcyclists, split across three groups (novice, experienced and advanced riders) were tested on a hazard perception test containing video clips filmed from the perspective of a motorcyclist. Response times to hazards revealed that the advanced riders (who had completed an advanced riding course) were the fastest, and the experienced riders were the slowest to respond to hazards, with novice riders falling in-between. Advanced riders were also found to make more internal attributions regarding the causes of the hazards than novice riders (though on a general measure of Locus of Control there was no difference between groups). The results demonstrate a link between advanced training and motorcycling hazard perception skill, but raise important concerns about the effects of mere experience on rider safety. This challenges previous conceptions that simply extrapolated from our understanding of the hazard perception skills of car drivers to this particularly vulnerable group of road users.     

Characteristics of motorcycle-related hospitalizations: comparing states with different helmet laws

This study compares U.S. motorcycle-related hospitalizations across states with differing helmet laws. Cross-sectional analyses of hospital discharge data from 33 states participating in the Healthcare Cost and Utilization Project in 2001 were conducted. Results revealed that motorcyclists hospitalized from states without universal helmet laws are more likely to die during the hospitalization, sustain severe traumatic brain injury, be discharged to long-term care facilities, and lack private health insurance. This study further illustrates and substantiates the increased burden of hospitalization and long-term care seen in states that lack universal motorcycle helmet use laws.     

Motorcycle helmet use in relation to legal requirements

Helmet use by motorcyclists was observed in late 1978 in cities in six U.S. states with varying legal requirements regarding their use. In two cities (Baltimore, Maryland and Miami, Florida) in which all motorcyclists are legally required to wear helmets, virtually all wore helmets. In three cities (New Orleans, Louisiana, Phoenix, Arizona and Houston, Texas) where helmet use laws requiring use by all motorcyclists were changed in 1976 or 1977 so that use is required only by those less than 18 years old, wearing rates were 39, 46 and 63%, respectively. In Los Angeles, California, which has never had a law requiring helmet use, 46% wore helmets.

Based on these survey results, and on the known efficacy of helmets in reducing injuries to motorcyclists, the repeal of helmet laws that occurred in 26 states in 1976–1978 can be expected to result in major increases in motorcyclist deaths in succeeding years.     

Sex and age distribution in transport-related injuries in Tehran

Intercountry or regional differences in patterns of injury by the road user type have significant implication for prevention policies. In order to have an estimate from the existing conditions of transport-related injuries (TRIs) and especially to evaluate sex and age distribution of traffic accident victims, we analyzed information of 8426 hospitalized trauma patients during 13 months of data gathering process. Forty-five percent of the injuries were related to car accidents and men/women ratio in these patients was 4.2/1. The highest men/women ratio was (16/1) for motorcyclists, while the lowest ratio (1/1), was for rear seat car passengers. Mean (+/-S.D.) age of the patients was 31 (+/-18), and men were nearly 2 years younger than women (33 versus 31). Sixty-seven percent of the females' and 44% of the males' injuries were related to pedestrian crashes. Motorcycle-related injuries in men and car passenger related injuries in women were the second most common type of crash (42 and 22%, respectively). The use of protective devices in our population was worrisome. In only 6% of the male motorcyclists helmet use was reported, and 3% of the male car occupants had used seatbelts at the time of the accident. The condition in the female population was much worse and no use of the protective devices was reported in this group of the patients. Crude mortality rate in men was nearly two times that of women (6.2% versus 3.8%). After adjustment for age, injury severity score (ISS) and category of the road users, men and women had similar mortality rate.     

Determinants of traffic injuries in drivers and motorcyclists involved in an accident

Basic information on the risk factors of road traffic injuries in Iran is scarce. This case-control study was conducted to determine the association of potential risk factors with the incidence of injury among motor vehicle drivers and motorcyclists on Qazvin-Loshan Road. The cases were 175 drivers and motorcyclists who had a road traffic accident (RTA) and sustained an injury. The controls were 175 motorists who had a RTA, on the same road and over the same time period, without suffering any injury. The analyses were separately performed by comparing the controls with mildly and severely injured cases, using New Injury Severity Score (NISS) 15 as a threshold. The results showed that fire following collision was significant in the crude analysis of all 175 cases and controls. The severity of collision, vehicle type (motorcycle versus other vehicle crashes), and gender were significant in the multivariable analyses of both mildly and severely injured cases. Safety equipment use is only significant (adjusted odds ratio, AOR=0.44, 95% confidence interval, 95%CI=0.23-0.84) among mild cases. The number of collisions (AOR=3.87, 95%CI=1.64-9.10) and weather conditions (AOR=4.32, 95%CI=1.13-16.5) only associate significantly with the occurrence of road traffic injury in severe cases, in comparison with the controls.     

Disabilities caused by road traffic accidents and their relation to severity scores

The disabilities incurred by 2502 road accident patients admitted in three separate years to an Accident Hospital have been analysed. There were about equal numbers of disabled among pedestrians, motorcyclists and vehicle occupants. This corresponds to the high relative frequency and severity of injuries among motorcyclists. Most of the serious disabilities were caused by head or lower limb injuries. Different severities of disability were not closely correlated with Abbreviated Injury Scale (AIS), (ISS) or (PI) scores or with treatment periods but useful threshold values are described which separate groups with high and low rates of disability. For given severities of injury, disabilities were less severe among young casualties. Comparisons with other studies show rather wide variations in estimates of the incidence of slight disabilities. There is fair agreement with the present findings that serious disabilities occur in about 3% of inpatient hospital cases or in about 1% of total casualties.