title: Nonconformities in real-world fatal crashes--electronic stability control and seat belt reminders.
abstract: OBJECTIVE
  Many new safety systems are entering the market. Vision Zero is a safety strategy aiming at the elimination of fatalities and impairing injuries by the use of a holistic model for safe traffic to develop a safe system. The aim of this article is to analyze fatalities in modern cars with respect to the Vision Zero model with special respect to electronic stability control (ESC) systems and modern seat belt reminders (SBRs). The model is used to identify and understand cases where cars with ESC systems lost control and where occupants were unbelted in a seat with seat belt reminders under normal driving conditions.
  
  
  METHODS
  The model for safe traffic was used to analyze in-depth studies of fatal crashes with respect to seat belt use and loss of control. Vehicles from 2003 and later in crashes from January 2004 to mid-2010 were analyzed. The data were analyzed case by case. Cars that were equipped with ESC systems and lost control and occupants not using the seat belt in a seat with a seat belt reminder were considered as nonconformities. A total of 138 fatal crashes involving 152 fatally injured occupants were analyzed.
  
  
  RESULTS
  Cars with ESC systems had fewer loss-of-control-relevant cases than cars without ESC systems. Thirteen percent of the ESC-equipped vehicles had loss-of-control-relevant crashes and 36 percent of the cars without ESC systems had loss-of-control-relevant crashes. The analysis indicates that only one car of the 9 equipped with ESC that lost control did it on a road surface with relevant friction when driving within the speed restriction of the road. In seats with seat belt reminders that are in accordance with the European New Car Assessment Programme's (Euro NCAP) protocol, 93 percent of the occupants were using a seat belt. In seats without reminders this number was 74 percent.
  
  
  CONCLUSIONS
  This study shows that ESC systems result in a very significant reduction in fatal crashes, especially under normal driving conditions. Under extreme driving conditions such as speeding or extremely low friction (snow or on the side of the road), ESC systems can fail in keeping the car under control. Seat belt reminders result in higher seat belt use rates but the level of unbelted occupants is higher than roadside studies have indicated. The holistic Vision Zero approach helped in the analysis by identifying nonconformities and putting these into the safe systems perspective.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. anders.lie@trafikverket.se
authors.forename: Anders
authors.initials: A
authors.lastname: Lie
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000517:prevention & control; D001334:Automobile Driving / Q000523:psychology*; D001336:Automobiles / Q000706:statistics & numerical data*; D006801:Humans; D011482:Protective Devices / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000706:statistics & numerical data*; D017751:Safety Management / Q000379:methods*; D012622:Seat Belts / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology