title: Is there a pattern in European bus and coach incidents? A literature analysis with special focus on injury causation and injury mechanisms.
abstract: In order to identify and describe a pattern in bus and coach incident related injuries and fatalities, and to suggest possible future measures for improvement of bus and coach safety, a literature analysis was performed. The results formed a multi-faceted pattern, which briefly can be described as follows; women travelled more frequently by bus as compared to men. Injuries sustained predominantly affected women 60 years of age and older. Of all traffic fatalities in Europe, bus and coach fatalities represented 0.3-0.5%. In the OECD countries, the risk of being killed or seriously injured was found to be seven to nine times lower for bus and coach occupants as compared to those of car occupants. Despite the fact that fatalities were more frequent on rural roads, a vast majority of all bus and coach casualties occurred on urban roads and in dry weather conditions. Boarding and alighting caused about one-third of all injury cases. Collisions were a major injury-contributing factor. Buses and coaches most frequently collided with cars, but unprotected road users were hit in about one-third of all cases of a collision, the point of impact on the bus or the coach being typically frontal or side. Rollovers occurred in almost all cases of severe coach crashes. In this type of crash projection, total ejection, partial ejection, intrusion and smoke inhalation were the main injury mechanisms and among those, ejection being the most dangerous. A 2-point belt may prevent passenger ejection, but in frontal crashes when the upper abdominal parts and the head hit the seatback in front, it could, however, contribute to head and thoracic injuries. Hence, a 3-point belt provides the best restraint in rollovers and frontal crashes.
authors.affiliation: Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. Pontus.albertsson@surgery.umu.se
authors.forename: Pontus
authors.initials: P
authors.lastname: Albertsson
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Falkmer
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*