title: Use of car crashes resulting in fatal and serious injuries to analyze a safe road transport system model and to identify system weaknesses.
abstract: OBJECTIVE
  The objective of this study was to evaluate a model for a safe road transport system, based on some safety performance indicators regarding the road user, the vehicle, and the road, by using crashes with fatally and seriously injured car occupants. The study also aimed to evaluate whether the model could be used to identify system weaknesses and components (road user, vehicles, and road) where improvements would yield the highest potential for further reductions in serious injuries.
  
  
  METHODS
  Real-life car crashes with serious injury outcomes (Maximum Abbreviated Injury Scale 2+) were classified according to the vehicle's safety rating by Euro NCAP (European New Car Assessment Programme) and whether the vehicle was fitted with ESC (Electronic Stability Control). For each crash, the road was also classified according to EuroRAP (European Road Assessment Programme) criteria, and human behavior in terms of speeding, seat belt use, and driving under the influence of alcohol/drugs. Each crash was compared and classified according to the model criteria. Crashes where the safety criteria were not met in more than one of the 3 components were reclassified to identify whether all the components were correlated to the injury outcome. In-depth crash injury data collected by the UK On The Spot (OTS) accident investigation project was used in this study. All crashes in the OTS database occurring between 2000 and 2005 with a car occupant with injury rated MAIS2+ were included, for a total of 101 crashes with 120 occupants.
  
  
  RESULTS
  It was possible to classify 90 percent of the crashes according to the model. Eighty-six percent of the occupants were injured when more than one of the 3 components were noncompliant with the safety criteria. These cases were reclassified to identify whether all of the components were correlated to the injury outcome. In 39 of the total 108 cases, at least two components were still seen to interact. The remaining cases were only related to one of the safety criteria, namely, the road user (26), the vehicle (19), and the road (24). The criteria for the road and the vehicle did not address multiple event crashes, rear-end crashes, hitting stationary/parked vehicles, or trailers.
  
  
  CONCLUSIONS
  The model for a safe road transport system was found useful to classify fatal and serious road vehicle crashes. It was possible to classify 90 percent of the crashes according to the safety road transport model. For all these cases it was possible to identify weaknesses and parts of the road transport system with the highest potential to prevent fatal and serious injuries. Injury outcomes were mostly related to an interaction between the 3 components: the road, the vehicle, and the road user.
authors.affiliation: Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Stockholm, Sweden. helena.stigson-konsult@folksam.se
authors.forename: Helena
authors.initials: H
authors.lastname: Stigson
authors.forename: Julian
authors.initials: J
authors.lastname: Hill
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000145:classification* / Q000401:mortality / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011482:Protective Devices; D012449:Safety / Q000592:standards*; D014186:Transportation / Q000592:standards*; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult