Road trauma prevention (2015)

Since the mid-1980s the college saw that it would need to widen its role in trauma prevention and management beyond those injuries which resulted from road crashes. In July 1991, the College Trauma Committee was formed which continued the college’s double commitment: prevention and mitigation of injuries, and management of injuries, encompassing injuries resulting from all sources. The college’s position on road trauma has been developed and continually updated since the original standing committee was formed in 1970. Many of the recommendations have been introduced around Australia and New Zealand although some jurisdictions are slow to take up new initiatives – such as graduated licensing and even BAC (blood alcohol content) in drivers which the college recommends should remain at .05. The college continues to play an active role in road trauma prevention. The College Trauma Committee hosts annual trauma workshops, holds regular meetings, engages with the media, hosts international speakers at the annual scientific congress, supports research, prepares submissions to inquiries and promotes and participates in trauma training such as EMST (Early Management of Severe Trauma and DSTC (Definitive Surgical Trauma Care) courses. It also plays an important advocacy role regarding issues such as Quad Bikes, Speed, Vehicle Safety and alcohol.

Many fellows of the college see the effects of road safety issues on a regular basis and in the case of trauma surgeons, almost daily. The college supports all evidence –based initiatives that assist in the prevention of road trauma and the reduction of the devastating effects of injury. Initiatives such as speed control, airbags, seat belt reminder system, electronic stability control and countermeasures for alcohol and driver distraction can all make a difference to reduce the road toll. The college regularly revises and updates its positions in accordance with safety measures that are being constantly researched and developed by a growing industry. The college recommends and supports the following positions.

Frontal protections systems (FPS)  

The college supports the following safety measures: 

• Australasian FPS be compliant with standards that offer the best outcome for pedestrians eg the current Economic Commission for Europe (ECE) pedestrian impact standard
• Policies to reduce the number of non-conforming FPS particularly in the metropolitan-based fleet, perhaps including the prohibition of sale and use of non-compliant FPS to all vehicles from a specified date
• Consideration be given as to the legality of some FPS in urban areas where the probability of a crash occurring involving a pedestrian is much higher
• Consideration be given to research and development of removable FPS for use by vehicles that are used in both urban and rural areas

Recognising the seriousness and frequency of trauma associated with railway crossings, the college recommends the following safety measures:

• A program to eliminate level crossings be pursued and, where this is not possible, that automatic boom gates, rumble strips, warning signs with flashing lights and speed restriction zones be installed
• Level crossings frequented by heavy vehicles be prioritised for safety improvement
• All level crossings be illuminated when trains are crossing
• All rail cars and engines be marked with appropriate reflector tape along the sides
• When railway crossings are used infrequently and seasonally, the decision to use the crossing should be assessed by safety officers from the road traffic authority, police and rail authorities before and during use, and signage and illumination be installed
• Police be given powers to veto the use of such a crossing if considered unsafe
• A campaign be run to educate drivers about the dangers of level crossings

The very nature of cycling makes riders extremely vulnerable to injury either by falls or collisions. The college supports the following safety measures:

• Adequate enforcement of legislation for mandatory wearing of nationally approved safety helmets with regular review of compliance
• Continued promotion of bicycle helmet wearing by national, state and local campaigns, through community road safety councils, municipal councils, school authorities and parents
• Expansion of bicycle path networks in cooperation with local government and other agencies, supporting those networks that separate motor vehicles, bicycles and pedestrians
• Mandatory use of approved tail lights, fixed reflectors, light-coloured clothing and reflectors on clothing and helmets particularly for night cycling.
• Support for initiatives which encourage all road users to share the road
• Development of national primary school bicycle education programs 

After a crash motorcycle death and injury rates are significantly higher than those involving motor vehicles. The college supports the following strategies to reduce the risk of death or injury to motorcycle riders:

• Mandatory wearing of approved helmets by all motorcycle riders and pillion passengers on and off public roads – with no exemptions on medical grounds
• Support for further research into injury patterns of motorcycle riders, pillion and sidecar passengers and motorcycle protective clothing suitable for Australasian conditions
• Support for further research into the effectiveness of daytime running lights for all motorcycles in Australasia
• Support for further development and research into other safety features such as motorcycle airbags, airbag jackets, ABS (automatic braking systems)
• Motorcycle licensing programs to take into account the higher levels of vehicle control and cognitive skill required to ride a motorcycle compared to driving a vehicle
• Support for graduated licensing programs which require a minimum age for solo riding equal to the minimum age for obtaining a probationary car driver’s licence with longer probationary periods
• Support for increasing restrictions regarding alcohol and other drugs, in light of the knowledge that riding a motorcycle requires high levels of vehicle control and cognitive skill than driving a motor vehicle
• Support for governments to view motorcycles as a significant, increasing and distinct mode of transport and form of recreation when planning roads and safety strategies
• Support for governments to place emphasis on off-road motorcycle strategies and measures such as age restrictions, mandatory helmet wearing, appropriate training and supervision, particularly for younger riders, to reduce off-road motorcycle injuries
• Support for identifiers on all motorcycles

Recognising the major role that vehicle standards and features play in the reduction of road trauma, the college recommends the following measures be supported:

• Vehicle safety features such as, but not limited to, front, side and curtain airbags, anti-lock braking systems, electronic stability control and aggressive seat belt reminder systems be installed in all new cars
• Close liaison between vehicle designers, road engineers and those who treat road trauma victims to ensure vehicle safety improvements are in line with world’s best practice
• Clinical representation on a national design rules committee
• Programs such as the Australian New Car Assessment Program (ANCAP) and mandatory display of car safety ratings at point of sale to communicate the importance of safety
• Vehicle safety advertising codes that place safety as the highest priority
• Mandatory wearing of approved seat belts or other restraints by all occupants wherever seated in a motor vehicle including buses, and there be no l exemption from wearing a restraint on medical grounds
• Mandatory wearing of approved child restraints and use of booster seats for all children up to 135 cm
• Support for Government loan and community-based schemes designed to improve availability of approved infant and child restraints

Recognising the major role that excessive speed plays in the causation of serious road crashes particularly in combination with alcohol. The college supports the following: 

• Appropriate speed limits be adopted having regard to the environment, traffic density and such other considerations as may be relevant to safe road usage
• Enforcement programs and initiatives be intensified so that there will be a higher chance of detection and penalties for drivers and riders who exceed the posted limits
• Radar detection devices in vehicles be banned. Speed limits be reduced on both urban non-arterial roads and regional/small towns, and that there be consistency of speed limits in shopping centres, school zones and precincts of high risk to pedestrians, and cyclists
• Cancellation of licence for drivers and riders exceeding the speed limit by the specified margin be supported
• The gradation of speed penalties be commensurate with the level of danger
• All heavy vehicles such as trucks, coaches and buses be fitted with speed governors and effective monitoring programs and adequate penalties for tampering with such devices be enforced
• Regular reviews of speed limits occur taking into consideration what road users suggest are appropriate in the particular situation
• Signs advising changes in speed limits be prominently displayed on all roads

The college, aware of the diversity of licence regulations in various jurisdictions, recommends the following licensing initiatives:

Young drivers

• The application of a graduated licensing system whereby newly licensed drivers have a period of time in which to gain experience

• Increasing the probationary period to an age which research shows a greater ability to assess risks, control impulsive behaviour and handle distractions
• A national minimum driving age of 18 years
• A national minimum learner driver age of 16 years and at least 120 hours of supervised pre-licence driving (a minimum of 10% of these to be with a fully qualified driving instructor) in varying conditions
• Passenger restrictions, particularly in the first year of licenced driving
• Night time curfews, particularly in the first year of licenced driving
• Zero blood alcohol for all probationary drivers
• Prohibition of use of telephones within motor vehicles by learner or probationary drivers
• Vehicle power restrictions for all learner and probationary drivers
• A graded demerit point allowance system for drivers up to the age of 25 years
• Mandate basic first aid training as part of the driver licensing system

 

Older and impaired drivers

• Policies which strike a balance between the rights of our senior community for mobility and independence and their responsibilities as safe drivers

• Further research and development into effective methods of identifying hazardous drivers
• Self-assessment style tools which older drivers should be asked to consider at licence renewal. These could also have potential for use by a general practitioner. For example a driver could be asked to respond to a health questionnaire either by themselves or in conjunction with their regular medical practitioner which would provide the driver with an opportunity to seriously consider their driving ability on a regular basis. A general practitioner could use these tools to monitor a patient on a regular basis
• Restricted licences which can allow drivers to maintain mobility and independence in lower risk situations, an ‘R plate’ system is supported
• Policies which improve the availability of alternative transport options and encourage their use by senior community members
• Policies which improve the safety of the Australasian vehicle fleet and encourage their purchase by older drivers as a way of reducing injury severity