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Introduction: According to data released by the Korea National Statistical Office, the number of accidents has been decreasing since 2012. However, a considerable number of deaths related to safety accidents (23-46 deaths) are still reported annually. This study aimed to observe the correlation between accident prevention activities in the Republic of Korea (ROK) military and the incidence of safety accidents., Methods: The study used data from the 2014-2015 Military Health Survey and included 13 618 responses (Army: 8414 (61.8%); Navy/Marine: 2262 (16.6%); Air Force: 2942 (21.6%)) from the ROK military personnel. Accident experiences and thoughts on accident prevention activities were self-reported. Multiple logistic regression analysis was used to examine the validity of accident prevention activity and accident experience., Results: Of the 13 618 military personnel who responded, 12.0% reported experiencing safety accidents in the military and 1020 (7.5%) felt that accident prevention activities in the military were insufficient. On logistic regression analysis, we found a significant difference (insufficiency OR=1.56, CI 1.31 to 1.86). In particular, military personnel who belong to the Army and Navy were more likely to think that accident prevention activities were insufficient. In addition, military personnel who experienced falls/slips, crash, and laceration/puncture wound/amputation/penetrating wound accidents were more likely to think accident prevention activities were insufficient., Conclusions: Our study found that accident prevention activities in the military and accident experiences were related. It is necessary for the ROK Ministry of Defense, Army, Navy and Air Force headquarters to re-evaluate their accident prevention systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Around 372 000 people drown every year globally. In countries, such as the UK, a large proportion of these deaths are due to recreational boating accidents, and a dominant factor influencing the outcome is whether the person was wearing a personal flotation device (PFD). The rate of PFD wear is low around the world, with reported rates ranging from 5% to 40%. In an effort to combat this, the UK has been running an education campaign since 2009 to try and increase PFD wear. In this contribution, 9 years of observational data show that the educational efforts have had little impact on the rate of wear over time. Activity type and age both influenced wear rates, with kayakers and children significantly more likely to wear PFDs. This study shows that education has been ineffective and there needs to be some consideration of regulatory approaches in order to reduce drowning., Competing Interests: Competing interests: SP was previously employed by the RNLI., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011-2020 in Mexico and its states., Methods: This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011-2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states., Results: Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions., Conclusions: The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.

Aims: To investigate the changing epidemiology of open fractures in vehicle occupants, pedestrians, motorcyclists and cyclists., Materials and Methods: Data on all non-spinal open fractures admitted to the Royal Infirmary of Edinburgh after a road traffic accident between 1988 and 2010 were collected and analysed to provide information about the changing epidemiology in different patient groups. Demographic information was collected on all patients with the severity of injury being analysed with the Injury Severity Score (ISS), Musculoskeletal Index (MSI) and the number of open fractures. The severity of the open fractures was analysed using the Gustilo classification. The 23-year study period was divided into four shorter periods and the results were compared., Results: There were 696 patients treated in 23 years. Analysis showed that the incidence of RTA open fractures initially fell in both males and females and continued to fall in females during the 23 years. In males it levelled off about 2000. The age of the female patients also fell during the study period but it did not change in males. The only patient group to show an increased incidence of open fractures were cyclists. In vehicle occupants the incidence fell throughout the study period but it levelled off in pedestrians and motorcyclists. There was no difference in the severity of injury in any group during the study period. The most severe open fractures were those of the distal femur and femoral diaphysis although open tibial diaphyseal fractures were the most common fracture in all patient groups., Conclusions: Improved car design and road safety legislation has resulted in a reduction in the incidence of open fractures in vehicle occupants, pedestrians and motorcyclists. The most obvious group to have benefitted from this are older female pedestrians. The only group to show an increase in age during the study period were male motorcyclists., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Competing Interests: Competing interests: None declared.

Objectives: Helmet use is a major risk factor for road traffic injuries and fatalities. This study sought to determine the state of helmet use in Ha Nam and Ninh Binh provinces in Vietnam, and ascertain knowledge, attitudes, and practices of helmet use over time., Study Design: Observational helmet use studies, and roadside knowledge, attitudes, and practice surveys., Methods: Data were collected through observational helmet use studies at multiple sites in Ha Nam and Ninh Binh provinces over 14 rounds between June 2011 and December 2014. Six rounds of knowledge, attitude, and practice surveys were administered at gas stations between December 2011 and July 2014. Trend analysis and negative binomial regressions were used to analyze trend data., Results: Between June 2011 and December 2014, 301,981 helmet-use observations were conducted in Ha Nam and Ninh Binh. Correct helmet use increased significantly (P < 0.01) in Ha Nam from 34.3% to 76.9% (P < 0.01), while use in Ninh Binh increased from 68.9% to 72.2% (P > 0.05)., Conclusion: Helmet use has improved statistically significantly in Ha Nam but not in Ninh Binh. Ceiling effects may have limited the scope of improvements in Ninh Binh province., (Copyright © 2017. Published by Elsevier Ltd.)

Introduction: Trend analyses of hospital discharge data can raise signals for prevention policies, but are often flawed by changes in health care consumption. This is a trend analysis of the clinical incidence of paediatric trauma that used international criteria to overcome this bias. The objective is to describe trends in clinical incidence of moderate to severe paediatric trauma, and to identify target groups for prevention activities., Patients and Methods: Included were all paediatric trauma patients (0-18 years) that were discharged from the hospitals of trauma care region Central Netherlands from 1996 to 2009. Selection was made on ISS ≥ 4, and on trauma related International Classification of Diseases diagnostic codes, and trauma related external causes of injury and poisoning codes. Trend analyses were performed using Poisson loglinear regression with correction for age and gender., Results: 23,682 Patients were included, the mean incidence rate was 477/100,000 person-years. Since 2001 the incidence rate of moderate to severe trauma increased with 1.1% annually (95% confidence interval (CI) 0.7-1.5), caused by an increase of falls (3.9%, 95% CI 3.3-4.5), sport injuries (5.4%, 95% CI 4.3-6.5), and bicycle injuries (3.8%, 95% CI 2.8-4.8). The incidence of falls and sport injuries peaked in young children (0-9) and older boys (10-18) respectively. Bicycle injuries affected all children between 5 and 18., Conclusions: The incidence of paediatric trauma in the centre of the Netherlands increased since 2001. Trend analyses on moderate and severe injuries may identify target groups for prevention in a trauma region., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: Road traffic injuries (RTIs) are a major cause of both morbidity and mortality globally. Relative to countries with similar economic patterns both within and outside of South-East Asia, Cambodia's road traffic fatality rate is high, with motorcyclists accounting for more than half of all fatalities as a result of head injuries. Despite the initiation of national motorcycle helmet legislation for Cambodian drivers in 2009, helmet use among both drivers and passengers remains low., Methods: This study adopted a two-pronged approach to assess the current status of and knowledge, attitudes, and practices (KAPs) towards helmet use among drivers and passengers in five provinces in Cambodia. The objective was to better understand helmet use over a two year period since the introduction of the 2009 legislation. Researchers conducted both (1) direct observation of daytime and nighttime helmet use (January 2011-January 2013) and (2) roadside KAP interviews with motorcyclists (November 2010-November 2012)., Results: The observed helmet rate across all study sites was 33% during nighttime and 48% during daytime, with proportions up to ten times higher among drivers compared with passengers. Self-reported helmet use was higher than observed use. Within the past 30 days, 60% of respondents reported that they "always" wore a helmet when they were drivers while only 24% reported they "always" wore a helmet as a passenger. Reported barriers for use among drivers included: "driving route", "forgetfulness", and "inconvenience/discomfort.", Conclusion: Despite awareness of the protective value of helmets, motorcycle helmet use rates remain low in Cambodia. Many misconceptions remain in Cambodia regarding helmet use, including that they are unnecessary for short distance or at low speeds. These serve as an important barrier to helmet use, which, if dispelled and coupled with visible and regular enforcement, may significantly reduce the number of motorcycle-related injuries and fatalities., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This paper reports the findings of two studies made eleven years apart in Norway (Fridstrøm, 2000; Elvik and Kaminska, 2011) to evaluate effects on accidents of changes in the use of studded tyres in major cities in Norway. The first study covered the period from 1991 to 2000, the second study covered the period from 2002 to 2009. In both these periods, large changes in the percentage of cars using studded tyres were found in the cities that were included in the study. There was, in most cities, a tendency for the use of studded tyres to go down. Effects of these changes on injury accidents were evaluated by means of negative binomial regression models, using city and day as the unit of analysis, and including more than twenty explanatory variables in order to control for confounding factors. The effects of changes in the percentage of cars using studded tyres were well described by an accident modification function (dose-response curve), relating the size of changes in the number of accident to the size of the change in the use of studded tyres. Accidents during the season when the use of studded tyres is permitted were found to increase by about 5 percent if the use of studded tyres was reduced by 25 percentage points (e.g. from 50 to 25 percent) and to decline by about 2 percent when the use of studded tyres increased by 20 percentage points., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This study reviews the development of railway safety in Finland from 1959 to 2008. The results show that the level of safety has greatly improved over the past five decades. The total number of railway fatalities did not show any obvious decreasing or increasing trend during the first decade, but since the early 1970s the annual number of fatalities has decreased from about 100 to 20. The estimated overall annual reduction per year from 1970 to 2008 was 5.4% (with a 95% confidence interval from -8.2% to -2.6%). The reduction in subcategories per million train-kilometres from 1959 to 2008 was 4.4% per year for passengers, 8.3% for employees, 5.0% for road users at level crossings and 3.6% for others (mainly trespassers). The safety improvement for passengers and staff was probably influenced by the introduction of central locking of doors in passenger cars and improved procedures to protect railway employees working on the tracks. The number of road users killed at level crossings has fallen due to the installation of barriers and the construction of overpasses and underpasses at crossings with dense traffic, removal of level crossings, and an improvement of conditions such as visibility at crossings. The number of trespasser fatalities has seen the least decline. Key plans for the future include further reduction of the number of level crossings on the state railway network from the current roughly 3500-2200 by 2025, and involving communities in safety work related to railway trespassers., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

We report results from 12 years of US observational data on life jacket use among recreational boaters based on more than 480,000 boaters in 175,000 boats between 1999 and 2010. The overall wear rate was 21.7 per cent, with sharp differences by age and boat types. We found strong increasing trends in wear rates among youth boaters, but among adults, the only increase was on sailboats. The increasing trend among youth is probably due to a combination of expanding laws for mandatory life jacket use among this age group, and targeted educational campaigns promoting life jacket use for children. Future efforts to increase the prevalence of life jacket wear should target groups with low wear rates and boaters on boats most likely to capsize. Policymakers should give serious consideration to regulations requiring adult boaters to wear life jackets while boating.

The objective of this study was to qualitatively evaluate young Egyptians' perceptions, attitudes, knowledge and behaviour towards injuries before implementation of an extensive questionnaire about injuries among Egyptian youth. In 2008, five focus groups of three to nine participants each were conducted in Cairo, Egypt in Arabic to evaluate young Egyptians' attitudes towards injuries, injury prevention, and their understanding of 'accidents' and fatalism. Participants were 14-26 years of age and were from medium to high socioeconomic status. Focus group participants noted that the concept of hadthah ('accident') signified an event determined by destiny, whereas esabah ('injury') was the result of human actions. The results of these focus groups indicate that young, educated Egyptians are interested in injury prevention programmes despite low confidence in the preventability of injuries.

Aim of the Study: With respect to the restricted diagnostic possibilities at an accident scene and the limited time for decisions essential for survival, this project dealt with severe injuries with an abbreviated injury scale (AIS) 3-6 in traffic accidents. The objective was the development of a diagnostic aid that can be used directly at the accident site., Methods: The analysis was based on data from the GIDAS (German in depth accident study) files from the years 1999-2006. To investigate the accident parameters and to draw up the injury risk functions a multivariate regression analysis of 5,010 traffic accidents was performed., Results: For the 20 most prevalent severe injuries of passenger car drivers and front seat passengers the cumulative influence of clearly evident factors was depicted and the combined likelihood was calculated. For the utilization at the accident scene software has been developed to display these likelihoods in a simple and comprehensible manner., Conclusions: At the accident scene crucial diagnostic indications can be acquired with simple observation and a software-assisted analysis.

Background: The mechanism of injury is the major cause for trauma team activation and emergency room resuscitation of trauma victims. To date, it remains unclear to what extent the injury mechanism influences injury pattern and severity., Methods: A comprehensive systematic literature search based on Medline was carried out., Results: Only a limited number of studies are available which investigated the influence of injury mechanisms on injury patterns and severity. There are no specific mechanisms for traumatic brain and spine injuries. Injuries to the chest and abdomen most frequently resulted from motor vehicle accidents involving passengers sitting on the side of the impact. Steering wheel deformity correlated with the injury severity. Pelvic fractures occurred most frequently due to motor vehicle accidents. The highest mortality resulted from pedestrians being struck by a vehicle and additional loss of life in the same vehicle compartment., Conclusions: The systematic literature research showed inconsistent results regarding the influence of trauma mechanisms on the resulting injury. Therefore, a treatment algorithm for trauma patients should be independent of the mechanism which is represented in several training programs (e.g. ATLS and PHTLS). However, the mechanism of injury may increase the alertness of the trauma team with respect to injury distribution and severity.

The new AIS (Abbreviated Injury Scale) was released with an update by the AAAM (Association for the Advancement of Automotive Medicine) in 2008. It is a universal scoring system in the field of trauma applicable in clinic and research. In engineering it is used as a classification system for vehicle safety. The AIS can therefore be considered as an international, interdisciplinary and universal code of injury severity. This review focuses on a historical overview, potential applications and new coding options in the current version and also outlines the associated problems.

Motor vehicle accidents are the leading cause of severe injuries. Outcome of these victims is substantially influenced by rescue time and primary trauma centre care. Nowadays, automatic crash notification systems (ACN) are available offering the major possibility of immediate initiation of the rescue chain and thereby shortening rescue time up to 50%. According to the EU commission a nationwide equipping of motor vehicles with automatic crash notification systems could save up to 2,500 lives per year. Therefore, all new vehicles should be equipped with an automatic crash notification system by 2014. BMW is the first manufacturer to install an enhanced automatic crash notification system (eACN), which could optimize the rescue triage by estimating the risk for severe injuries (MAIS3+) based on telemetric transmitted accident data.

A very significant decline in the number of road casualties has been observed recently in France, concomitantly with a dramatic increase in law enforcement. The aim of this study was (i) to assess changes in attitudes about road traffic accident (RTA) prevention initiatives in France from 2001 to 2004 and (ii) to identify factors associated with an increase in positive attitudes towards RTA prevention initiatives. In 2001 and 2004, 9216 participants reported their attitudes towards traffic safety using the same self-administered Driving Behaviour and Road Safety Questionnaire. Sociodemographic, psychological and behavioural data were also available. The mean change in scores analysis showed that support for relaxing existing regulations decreased significantly during this period, while support for heightened enforcement and stricter regulations showed some decrease but remained high overall, especially concerning blood alcohol content and speed controls. Multivariate analyses suggest that highly educated drivers changed their attitudes towards road safety regulations more than other categories. Our results suggest that increased traffic law enforcement measures led to increasing support for current restrictions. Even if support for additional traffic law enforcement began to wane slightly in 2004, a large part of our population remained in favour of strengthening law enforcement related to speeding and drunk driving.

Aims: To assess the impact of supply reduction through Alcohol Management Plans (AMP) on the rate of serious injuries in four indigenous communities in remote Australia., Methods: An ecological study used the database of the Royal Flying Doctor Service (RFDS) to calculate trauma retrieval rates for 8 years pre- and 2 years post-AMP in four remote communities covering a period from 1 January 1995 to 24 November 2005. All serious injuries in these communities required aero-medical retrieval. Results Serious injury resulted in a total of 798 retrievals during the observation period. One-sided analysis of variance for repeated measurements over the 10 years demonstrated a significant (P = 0.021) decrease of injury retrieval rates after the introduction of the AMP. Similarly, a comparison of linear trends of injury retrieval rates pre- and post-AMP also resulted in a significant decrease (P = 0.022; one-sided paired t-test). Comparisons of injury retrieval rates of just the 2 years pre- and post-AMP also revealed a significant reduction (P = 0.001; paired t-test), with an averaged 52% decline. Identical comparisons of retrieval rates for causes other than injury revealed no significant changes. Conclusion This impact evaluation provides evidence that AMP was effective in reducing serious injury in the assessed indigenous communities.

The Fall Prevention Center of Excellence (Center), a consortium of federal, state, and private organizations, was established in 2005 to guide the implementation of a statewide initiative to prevent falls among older Californians. The process began with the convening of a representative group of recognized leaders in California's health and human services in 2003. This group engaged in a 2-day strategic planning process that culminated in the development of the California Blueprint for Fall Prevention. The overarching goal of the Blueprint is to build a statewide infrastructure for fall prevention services and programs that will serve as a model for the rest of the country. The specific goals of the Center are to establish fall prevention as a key public health priority in California; create, test, and evaluate effective and sustainable fall prevention programs; and build a comprehensive and sustainable fall prevention system in California. To accomplish these goals, the Center is currently engaged in developing and disseminating fall prevention tools and informational resources directed at the needs of both consumer and professional audiences; linking organizations involved in fall prevention while increasing awareness of fall prevention as an important public health issue; and helping communities build their capacity to effectively address falls in older adults through the delivery of integrated fall prevention services and "best practice" programs.

ProFaNE, Prevention of Falls Network Europe, is a four-year thematic network co-ordinated by the University of Manchester, UK, with 25 partners across Europe and funded by the European Community Framework 5. There are also Network Associates from a number of EU and non-EU countries who give their advice and experience at steering meetings, seminars and conferences. There are four main themes (taxonomy and co-ordination of trials; clinical assessment and management of falls; assessment of balance function; psychological aspects of falling). The work of ProFaNE is practical, in terms of developing the evidence base for implementation of effective interventions, standardising the health processes for people with a history of falls and encouraging best practice across Europe. Over the four years of the Network many key publications by the members have been regularly cited, the web membership has increased to over 2,000 members from 30 countries, there is an active discussion board and there are nearly 1,000 resources available to download. The success of the networking and relationship building in these four years has meant that many countries have adopted new national strategies to prevent falls and injuries.

This study investigates the injury rate levels, changes, and trends between 1987 and 2002 for the 14 Swedish municipalities designated as WHO Safe Communities. The injury rate was defined as the number of injured patients discharged from hospital per 1000 persons. Injury rates were age standardised. Each municipality was compared with its respective municipality group, according to a classification of Sweden's 288 municipalities into nine groups based on numerous structural parameters. The average injury rate levels for the 14 WHO-designated Safe Community municipalities ranged from 11.54 to 19.09 per 1000 population during the study period, which was defined as the time period during which a municipality's injury prevention program has been operational. Eleven of 14 municipalities had higher levels than their corresponding municipality groups. Five of the 14 municipalities "outperformed" their respective municipality groups and achieved a greater relative injury rate decrease during the study period. The trends for the 14 municipalities in relation to their municipality groups showed an inconsistent pattern, with only four municipalities exhibiting overall favourable trends for the study period.

This study gives a global overview of accidental oil spills from all sources (> or =700t) for the period 1970-2004, followed by a detailed examination of trends in accidental tanker spills. The present analysis of the number and volume of tanker spills includes temporal and spatial spill trends, aspects of spill size distribution as well as trends of key factors (i.e., flag state, hull type, tanker age, accident cause and sensitivity of location). Results show that the total number and volume of tanker spills have significantly decreased since the 1970s, which is in contrast to increases in maritime transport of oil and to popular perceptions following recent catastrophic events. However, many spills still occur in ecologically sensitive locations because the major maritime transport routes often cross the boundaries of the Large Marine Ecosystems, but the substantially lower total spill volume is an important contribution to potentially reduce overall ecosystem impacts. In summary, the improvements achieved in the past decades have been the result of a set of initiatives and regulations implemented by governments, international organizations and the shipping industry.

This paper highlights lessons from each of the Expert Panel papers in the present supplement that provide guidance for future research and initiatives. Although some shortfalls still remain in our understanding, it is argued that much has been learned and we are ready for more translation, implementation, and evaluation of multilevel interventions to help reduce young driver road trauma. Non-use of restraints, speeding, driving at night and with passengers, and fatigue are highlighted as key risk factors to address. "Best practice" intervention is proposed as implementing and strengthening graduated driver licensing systems and complementary candidate programs and research, such as hazard perception training programs. A schematic cognitive-perceptual model to explain the crash sequence process is explored. There is optimism that meaningful impacts can be made, especially coupled with the advances in vehicle technologies, but caution is necessary in the absence of targeted "real world" evaluations and broader implementation and diffusion strategies.

The extent to which various interventions to deal with the young driver crash problem have worked are discussed, and promising interventions that should be tried are identified. Traditional forms of driver licensing and driver education have not worked. Graduated licensing reduces the problem and existing laws need to be strengthened. Programs involving parents and police have shown some potential to increase compliance with graduated licensing restrictions. Insurer discount programs also have potential. In other public health areas, comprehensive programs have worked better than those based on single components. There are continuing efforts to develop new driver education and training programs and methods of delivery that can combine with graduated licensing and contribute to reductions in the young driver problem. The most promising intervention strategy is likely to be a coordinated community based program in states with strong graduated licensing laws as a foundation, involving modern education and training techniques, insurance discount programs, and well publicized enforcement and education programs featuring parents and police in combination, with as much input and participation as possible from the target group of young drivers.

Construction industry is one of the most dangerous industries, not only in the USA, but worldwide. In this longitudinal study we examined the effects of safety initiatives on the safety performance of construction companies. One of the measures commonly used in the USA to track a company's safety performance is the experience modification rate (EMR). The EMR is based on the company's safety records (injury claims) from the past three full years and is used to calculate the workers' compensation insurance premiums. In a longitudinal study, we studied the effects of safety efforts and initiatives on the EMR. The results show that safety initiatives and money spent on safety do improve safety performance, but only over time.

Studies on ergonomic intervention research aiming at improved musculoskeletal health published in Latin America in the past 20 years were reviewed. The tendencies observed over time in these studies show that interventions carried out are trying to deal with the changes occurring in the production processes in this period. Thus, more participative approaches have been used, involving different parts interested in the process. The previous transversal projects, more focused on the physical aspects of the work, are now substituted by studies including organizational and longitudinal designs. Despite this, some negative or unchanged outcomes have been obtained. Therefore, good quality intervention studies are needed to provide more generalizable data and improve our understanding on planning, implementing and sustaining effective measures for controlling work-related musculoskeletal disorders.

Injuries are now the cause of more deaths in children than the next six most frequent causes combined. It is estimated that 8.7 million injuries occur each year. Together with noninjury motor vehicle accidents and fires, these accidents cost the nation an estimated $107.3 billion. The major approaches to injury control have involved legislation, health education, and behavioral strategies. In this article, the research evidence on the effectiveness of these strategies is reviewed, and suggestions for additional research are proposed.