Emergency Department presentations related to injury on public transport (all ages)

October 2008

public transport

During the 5-year period July 2003-June 2008, there were at least 1758 emergency department presentations for injury sustained within or while boarding trains, trams and buses in Victoria . This represents an average of 352 cases per year.

'Bus' was the most commonly mentioned transport type, identified in 37% of cases, followed by 'tram' (31%) and train (18%). A further 10% of cases noted a 'train station'/'railway station' specifically, while 'tram stop' (1%) and 'bus stop' (3%) were less common.

Age: ED presentations were most frequent among persons of retirement age. One third (33%) of ED presentations occurred among persons aged 65 years or older, including the 14% of all cases that occurred among elderly persons aged 80 years or more. Teenagers/young adults were also highly represented, with 15% of cases occurring among persons aged 14-24 years. Presentations were least frequent among young children aged 5-9 years (2%).

public transport fig
Source: VEMD July 2003 - June 2008
Figure 1: Public transport-related ED presentations by age group (n=1758)

Gender: Overall, females were somewhat over-represented, accounting for 58% of all cases. This is due to the pronounced over-representation of females among those aged over 50 years, for example in the 80+ age group, 75% of cases were female. Among the younger age groups the gender division was generally more even, or with a slight over-representation of males.

Table 1: Gender division of public transport related presentations by age group

Age group:

0-9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

80+

Total:

Male:

54.3%

51.2%

53.2%

52.5%

48.7%

38.0%

36.5%

32.5%

25.0%

42.2%

Female:

45.7%

48.8%

46.8%

47.5%

51.3%

62.0%

63.5%

67.5%

75.0%

57.7%

Source: VEMD July 2003 - June 2008

Injury type: Sprains or strains were the most common injury type, occurring in 24% of cases. Also frequent were fractures (20%), open wound (18%) and superficial injuries such as bruising or abrasions (14%). Injury to muscle or tendon (6%) and dislocations (3%) were less common.

Body region affected: The region most frequently injured was the lower extremity (the leg including the knee, ankle and foot, 37%), followed by the upper extremity (the arm including the elbow, wrist, hand and fingers 24%) and the head, face or neck (21%). Less frequently injured was the trunk (9%)

Injury cause: Low-level falls (below one metre in height), such as slips and trips at floor level or on steps, were the cause of nearly two thirds of ED presentations related to public transport use (63%). Next-most common were impacts with objects or surfaces (17%) followed by high level falls over 1 metre (6%). Being cut or pierced by an object (2%) and impacts with another person (2%) were relatively uncommon.

Place of occurrence: The place of injury occurrence was listed as a 'road, street or highway' in around half of cases (48%), while the category 'other specified place' (which includes railway lines and stations) accounted for 33% of cases. 'Trade or service areas' accounted for 7%, places for recreation 3%, while unspecified locations accounted for the remaining 9% of cases.

Activity when injured: Data on the activity being undertaken when injured were unreliable, 45% of cases were classified as 'other' or 'unspecified' activity while 44% were classified as 'leisure'. It should be noted however that 'leisure' is frequently used to categorise non-leisure activities of an incidental nature, such as riding a bus or alighting at a station.

Discharge status: In 83% of cases the injured individual was treated and discharged home from the emergency department. The remaining 17% required admission to a ward for further treatment or observation.

Injury prevention (safety tips): Analysis of case narratives indicated that most injuries occurred while boarding or alighting a vehicle, or when the vehicle accelerated or braked suddenly. Care should be taken around doorways and on steps to prevent trips and falls while boarding, while passengers should use handles and grab bars at all times when moving about a vehicle, and should take a seat wherever possible.

Data source: Victorian Emergency Minimum Dataset (VEMD) July 2003-June 2008 (5 years)

Search Strategy: Cases were selected where the text narrative included the terms 'train' 'tram' 'bus', 'train station', 'bus stop' and similar terms and spelling variations. Only cases occurring on a vehicle or while boarding/alighting a vehicle were extracted (i.e. road accidents and pedestrians being struck by public transport vehicles were excluded). Cases were manually checked for relevance.