Motor Vehicle Injury Prevention

by

David A. Sleet, David Viano, Ann Dellinger

• LAST REVIEWED: 05 May 2017
• LAST MODIFIED: 28 May 2013
• DOI: 10.1093/obo/9780199756797-0076

Introduction

One hundred years after the first self-propelled vehicle was invented, the world’s first recorded traffic death occurred when Mary Ward was thrown from the passenger seat of her cousin’s steam-powered car and rolled underneath the vehicle traveling 3-4 mph in Ireland on August 31, 1869. The first traffic fatality in the United States reportedly occurred in New York City in 1899 when Henry H. Bliss stepped off a streetcar and was struck by a passing electric-powered taxicab at the corner of Central Park West and 74th Street. By 1900 the yearly traffic death toll in the United States was up to thirty-six, and by 1972 a staggering 54,000 people were killed in traffic, and 2 million maimed. In 2009, traffic injuries were the leading cause of death of Americans aged 10–14, 15–19, and 20–24. The annual cost of motor vehicle–related fatal and nonfatal injuries is $99 billion in medical expenses and lost productivity, which is nearly the equivalent of $500 for each licensed driver in the United States. Motor vehicle travel is the most common form of transportation in the United States, although pedestrians, motorcyclists, and bicyclists are also injured in traffic. The number of registered automobiles in the United States grew from 8,000 in 1900 to 250 million in 2010, yet deaths per 100 million vehicle miles traveled actually declined by 77 percent between 1966 and 2010. Advances in the safety of vehicles, improved roads, and changes in driver behavior have led to this improvement. The conceptualization of this approach was fostered by William Haddon Jr., who developed models for exploring countermeasures to reduce or prevent injuries involving elements in the causal sequence related to the host (driver and passenger), agent (vehicle), and environment (roads and highways). Still, in 2009, the United States lost 33,808 people in traffic crashes. The major risk factors include non-use of seat belts and child restraints, alcohol, speed, non-use of helmets, and distracted driving. According to Rumar (The role of perceptual and cognitive filters in observed behavior, in Human behavior and traffic safety, Edited by L. Evans and R. Schwing. New York: Plenum, 1985) only 3 percent of crashes are due solely to the roadway environment, 2 percent solely to vehicles, and 27 percent to the combination of road environment and drivers. Globally, 1.3 million people die each year from road traffic injuries, or about 3,000 each day. Around 90 percent of those deaths occur in low- and middle-income countries. By 2020, traffic-related injuries will be the third leading contributor to the global burden of disease and injury, up from the eighth leading cause in 2009. This article describes the science of motor vehicle injury prevention and control, and identifies resources on the history, development, and application of principles of injury control to reduce traffic injury.

Introductory Works

Even though the problem of motor vehicle crashes (formerly called “accidents”) and the resultant injuries had been described in journals as early as 1922, introductory works that described the burden and addressed prevention lagged by another 35–40 years. Among the early works, Haddon 1968 is a classic paper on the need to use public health epidemiology to study traffic injuries, and was among the first to take John Gordon’s “The Epidemiology of Accidents” (Gordon 1949, cited under Key Articles and Reviews) and transform it into an approach that could be used by public health for injury prevention. Heimstra 1970 reflects a bias toward the importance of the driver as a causal factor in traffic crashes. In contrast, Baker 1971 favors policy approaches, including changing the social/administrative environment rather than individual behavior change to reduce traffic fatalities, putting more responsibility on the federal government to take decisive action. Runyan 1998 (cited under Research Methods, Theories, and Applications) introduced a third dimension to the Haddon matrix (developed in 1970) that more clearly defines interacting covariables related to costs, effectiveness, equity, and feasibility that may determine the selection of one motor vehicle intervention over another. Evans 2009 uses science to examine why so many deaths and injuries and so much property damage result from traffic crashes. Evans describes how to conduct high-quality traffic safety research and presents it in a manner that most everyone can understand. Seiffert and Wech 2007 introduces the reader to the engineering side of the traffic injury problem, and stresses the importance of considering the interaction of the driver, the vehicle, and the environment. Roberts 1971, by a physician and automotive medicine specialist, like many other works written during the period, is a comprehensive treatment of all aspects of the problem, from primary prevention to acute care and rehabilitation of traffic injuries. Vanderbilt 2009 is an entertaining yet factual book for the general public that provides insights as to why people drive as they do. Mock, et al. 2004 provides a set of trauma care guidelines useful to anyone designing and administering injury care for victims of traffic crashes.

• Baker, Robert F. 1971. The highway risk problem: Policy issues in highway safety. New York: Wiley Interscience.

  Written by a former director of research in the Federal Highway Administration, the book argues for establishing policy as a means to control traffic crashes. A policy that sets the absolute maximum number of fatalities that will be tolerated each year, as the National Highway Traffic Safety Administration has done recently, would be a good start, claims the author.

• Evans, Leonard. 2009. Traffic safety. Bloomfield Hills, MI: Science Serving Society.

  Originally published in 2004. Leonard Evans is a master at explaining the science of traffic safety in clear and unambiguous terms. This is the best of his many writings on traffic injury trends, what is responsible for crashes, the role of seat belts, air bags and alcohol, speed, and surprising revelations about the reason for the ongoing US failure to keep up with safety progress seen in other parts of the world.

• Haddon, W., Jr. 1968. The changing approach to the epidemiology, prevention, and amelioration of trauma: The transition to approaches etiologically rather than descriptively based. American Journal of Public Health 58.8: 1431–1438.

  DOI: 10.2105/AJPH.58.8.1431

  An introduction to the Haddon matrix for identifying major areas within the highway portion of the injury problem. He describes the pre-crash phase (i.e., coefficients of friction of road surfaces), crash phase (i.e., occupant protection), and post-crash phase (i.e., emergency care and transportation) as important considerations in etiology and prevention of traffic injuries.

• Heimstra, Norman W., ed. 1970. Injury control in traffic safety. Springfield, IL: Charles C. Thomas.

  This book covers injury control and human factors in traffic. Countermeasures that modify the vehicle and roads are only briefly covered. Chapters reflect an emphasis on the importance of the driver as a causal factor in motor vehicle crashes. Driver licensing, driver education, alcohol use, attitudes, and methodological issues in traffic safety research are covered.

• Mock, C. J. D. Lormand, J. Goosen, M. Joshipura, and M. Peden, eds. 2004. Guidelines for essential trauma care. Geneva, Switzerland: World Health Organization.

  A set of achievable standards for trauma services, which could be made available to almost every injured person in the world, including resources necessary to assure such care. The specific focus is on care delivered at fixed facilities (e.g., clinics and hospitals). A companion document, Prehospital Trauma Care Systems (2005) addresses prehospital trauma care at the scene and in route to fixed facilities.

• Roberts, H. J. 1971. The causes, ecology and prevention of traffic accidents: With emphasis upon traffic medicine, epidemiology, sociology, and logistics. Springfield, IL: Charles C. Thomas.

  This voluminous 1,016-page book was one of the first to approach the traffic “accident” problem from a medical and public health perspective. This is an introduction to the whole field, from primary and secondary to tertiary prevention. It covers medical care and the causes and prevention of traffic crashes and injuries—including engineering, legal, and ecological aspects.

• Seiffert, U., and L. Wech. 2007. Automotive safety handbook. 2d ed. Warrendale, PA: SAE International.

  Examining the state-of-the-art in passenger car vehicle safety, this book features a thorough discussion of the interrelationships among the occupant, the vehicle, and the restraint system (in frontal, lateral, and rear impacts and rollover).

• Vanderbilt, Tom. 2009. Traffic: Why we drive the way we do (and what it says about us). New York and Toronto: Vintage.

  This national best-selling book explores the psychology of behavior behind the wheel, in ways never researched. Vanderbilt explains why traffic jams occur, identifies common errors drivers make in judgment, and explains why risk on the road is so complicated. While not a scientist himself, Vanderbilt uses science correctly to help the reader understand what’s safe, and unsafe, on the road.