The First Ten Years

Prof. Peter Vulcan - Founding Director

Introduction

The Centre was established in 1987 to meet a need for an independent, multi-disciplinary research organisation to undertake some longer term road research as well as evaluation of safety initiatives. It was considered that outsourcing such research to a University Centre would be more effective and efficient than undertaking it within government departments. The partnership between the Road Traffic Authority (later VicRoads), the Transport Accident Commission and Monash University was established on this basis. The Ministry for Police and Emergency Services (later Department of Justice) and Royal Automobile Club of Victoria (RACV) Ltd. joined this partnership in 1990 and 1991 respectively to expand the Centre's baseline research program. Additional research contracts from the Federal Office of Road Safety and other States commenced in 1988 and led to progressive growth of the road safety research program.

There was also recognition that many of the principles which had been applied successfully to road safety would be relevant to injury prevention in other settings, such as the home, at work, in sport and recreation, and on farms. Consequently the scope to undertake such research was included in the Centre's original objectives. The Victorian Health Promotion Foundation and Department of Health (now Human Services) and the National Health & Medical Research Council provided the initial funding for such research, which has since attracted wider support.

In this tenth Annual Report, it seems opportune to summarise some of the contributions by the Centre and its staff to road safety and injury prevention generally, with emphasis given to work outside the scope of this year's report.

Road Safety

Systems Analyses

After several years of progressive increase in road fatalities and injuries, a major initiative directed at drink driving was introduced in late 1989 and another aimed at excessive speeding in early 1990.

From 1989 to 1992 road fatalities in Victoria were reduced by almost 50% and serious injuries by more than 40%. These lower levels have been maintained ever since, resulting in the Victorian fatality rate (per vehicle) being one of the lowest in the world.

The Centre undertook evaluations of the 'booze bus' and speed camera programs including their supporting publicity campaigns. The initial process and outcome evaluations provided early feedback to the Police and TAC, which was used to 'fine tune' the programs. The large benefit/cost ratios calculated for these two programs (greater than 20:1) were important in decisions to continue investment of considerable resources in these programs. Further analyses estimated the contribution of other factors to the overall reductions including the accident black spot program, bicycle helmet wearing and the downturn in the economy.

In response to a request by the new TAC Chairman in 1993, time series analyses were used to estimate the effect of the advertisements alone. It was found that the intensity (audience reach) of those advertisements which supported the 'booze bus' and speed camera enforcement was strongly correlated to the relevant monthly casualties. The resulting relationship between advertising levels and reduction in casualty crashes has been used as a guide for determining the level of advertising placements.

In recent years, estimates by the Centre of likely claim reductions and costs to the TAC have been used as one of the criteria in determining TAC investment in road safety initiatives. Process and outcome evaluations of TAC road safety programs have been undertaken whenever practicable.

Although the 'booze bus' and speed camera programs were also associated with a reduction in pedestrian fatalities from 1989 to 1992, a range of studies on further improvements to pedestrian safety has been undertaken. These have led to the development for VicRoads of a multi-action pedestrian safety program to be implemented in the City of Stonnington. If successful, this program will be extended to other municipalities with similar safety concerns.

Figure 1 - Percentage change from 1987 - road fatalities, serious injuries and other injuries, Victoria

Several studies have addressed the worrying trend of a continued high level of motorcycle crashes, including a case control study of motorcycle crashes in Melbourne resulting in hospitalisation, which has quantified the main risk factors related to the rider and the motorcycle, i.e. the differences between those who crashed and those who rode past without crashing.

Vehicle Safety

A study of 500 modern car crashes for the Federal Office of Road Safety in which at least one vehicle occupant was killed or hospitalised provided the basis for recommendations of measures to improve occupant protection in passenger cars sold in Australia.

This research led to further studies of the likely benefits and costs of a range of occupant protective measures in frontal crashes using the 'Harm method' of injury cost analysis, developed for such studies. The analysis was extended to estimate the likely benefits of implementing either the U.S. or the European Standards for side impact protection and recently the benefits of implementing a Standard for offset frontal impact protection.

These studies have contributed to decisions to introduce new Australian Design Rules for Vehicle Safety No. 69/00 'Full Frontal Impact Occupant Protection' and No. 72/00 'Dynamic Side Impact Occupant Protection' and to move towards a rule for offset frontal impact protection.

Evaluation studies of the performance of airbags in Australian vehicles have been undertaken initially for GMH Commodores and now extended to cover other GMH models, Ford Falcon and other Australian built cars. These studies have shown the desirability of airbags as 'supplementary' restraint systems to seat belts and have confirmed that the problems currently experienced in the U.S.A. (fatalities resulting from people being too close to the airbag during rapid deployment, and placing child restraints in the front seat) are not present in this country.

The results of this work were presented to the U.S. National Highway Traffic Safety Administration to assist in their deliberations about changes to the U.S. Standard to improve their systems.

Studies of heavy vehicle crashes have led to a range of recommendations aimed particularly at improving heavy vehicle safety. In most fatal crashes involving a truck, it is the other road users who are killed and recommendations to improve truck design to protect them have been made. Improved energy absorbing designs for rear underrun protection have been developed and installed by some builders of heavy vehicles.

The development of the driver protection ratings by make/model based on their performance in real world crashes has been important in providing consumers with safety information about used cars. Work on the correlation of some measurements taken in laboratory crash tests (NCAP) with those derived from real world crashes has been critically acclaimed, and a co-operative project with the Insurance Institute for Highway Safety, USA is being developed to extend the number of cars in the study.

Road Improvements

Analyses of crashes at traffic signals led to recommendations for improvements, including the need for fully controlled right turn phases (green and red turn arrows) wherever possible and examined the traffic capacity consequences of such installations.

Evaluation of the effectiveness of sealing gravel shoulders on two lane rural roads found high benefit/cost ratios, related to amount of traffic flow. This provided input into decisions for a significantly expanded shoulder sealing program.

Analyses of the effectiveness of various accident black spot treatments provided feedback to the TAC and VicRoads of the relative benefit/cost ratios of each different treatment, as well as showing that for the whole program benefits considerably outweighed the costs. The main contribution of this research will be towards even more effective investment strategies for improving the safety of the road environment.

Road User Safety

A major program aimed at understanding the over-involvement of young drivers in crashes was commenced several years ago. One of the conclusions was that while novice drivers generally had adequate manipulative skills, they lacked cognitive skills, which were progressively acquired through several years of driving experience. This contributed to several initiatives to encourage learner drivers to gain more on-road experience prior to obtaining a probationary licence.

It also led to the TAC providing (on loan) two state-of-the-art driving simulators, so that a training program could be developed to improve cognitive skills such as risk perception, time sharing and attentional control.

A young driver research strategy was developed by the Centre and accepted by VicRoads as a basis for future decisions regarding research and action in this area.

Research on older road users and the problems they face as their performance progressively deteriorates has resulted in the development of an older driver strategy and an older pedestrian strategy due to be completed soon. These strategies highlight priorities for new safety initiatives and further research in the years ahead.

Additional research is currently in progress aimed at better understanding why drivers speed. This project aims to identify how future initiatives might be targeted to bring about a change in attitude, similar to that which occurred with drink-driving. An innovative program of research has also been undertaken to develop a range of inexpensive on-road treatments aimed at improving speed behaviour by modifying a driver's perception of the road ahead.

Research on the fundamental nature of fatigue and the role of rest periods and food has been used to assist in publicity and 'coffee break' programs aimed at reducing the incidence of fatigue as a cause of crashes. The multi-million dollar, international research and development of a driver fatigue detection device is being closely monitored. This device shows considerable potential for adoption in Australia in the longer term.

Policy and Strategy Advice

The Centre has provided policy and strategic advice based on research, through representation on the Victorian Road Safety Co-ordination Council and its successor, the Road Safety Reference Group.

Staff have provided advice on the results of Victorian road safety initiatives to road safety authorities and police in South Australia, Tasmania, Western Australia, New Zealand and KwaZulu-Natal, Republic of South Africa.

Papers on the Centre's research findings have also been presented at a large number of national and international conferences, as well as in scientific journals.

Injury prevention

Introduction

When the injury prevention research program began in 1988, there was little infrastructure support for such activities and it was necessary to work with government departments and non-government agencies to establish appropriate support. Centre staff contributed to development of the national and Victorian injury prevention strategies, the development of the necessary databases and training of practitioners. The Centre's program has also contributed to reductions to injury deaths, including child deaths, which are shown in Figure 2.

Figure 2 - Child injury deaths, Victoria (0-14 years)

The total lifetime cost of injury to Victoria for injuries sustained in 1993/94 was determined at $2,583 million in a Centre study undertaken for the Department of Human Services.

Injury Databases

Since 1989 the Centre has been provided with data from the Victorian Inpatient Morbidity Dataset about persons admitted to hospital. While this dataset contained important information about the nature of injuries and their frequency, it had limited information about the factors contributing to the injury.

The establishment of appropriate databases was the first step in the Centre's injury prevention research program.

In 1990 the Centre was funded by VicHealth to expand the existing child injury surveillance system at three Melbourne hospitals to an all age system at seven hospitals. This provided for the first time detailed information on the factors leading to injury (the how, what, when and why). Commencing in 1995 the system has been expanded to 25 participating hospitals and been converted from a paper based to an electronic input system - the Victorian Emergency Minimum Dataset.

In 1991 the Centre began working with the State Coroner to convert the comprehensive paper based Coronial records to an electronic database which has led to the Coroner's Facilitation System. More recently, MUARC has entered into a Monash consortium, led by the Department of Forensic Medicine, to develop a National Coronial Information System.

Domestic

Structural features of the home are associated with at least 30% of child and 26% of adult home injuries. The provision by MUARC of injury data related to specific aspects of home design, and applied research have underpinned several safety improvements to home design as well as further recommendations, yet to be implemented. In recent years in Victoria, for example, smoke alarm regulations have been introduced progressively to the stage where all domestic dwellings will be required to have them installed by 1999. A case-control study conducted by MUARC has confirmed the protective effect of smoke alarms. The Centre's research underpinned the development of finger jam protection devices for the hinge side of doors. These devices have been manufactured and sold following research findings that 60% of these significant injuries to young children involve the hinge side of the door.

Falls among the elderly are one of the major causes of serious injury requiring hospitalisation. A major falls prevention study involving an exercise and balance program, home hazard removal and vision testing and correction is being undertaken in co-operation with the City of Whitehorse. The results of the study will measure the effectiveness of each of these measures alone and in combination and could provide the basis of a statewide or national falls prevention program.

Product safety

Products are estimated to be associated with almost 5.5 million cases of medically treated injuries annually in Australia. A study for the Australian National Audit Office estimated the direct hospital and medical cost of unintentional product related injury to be at least $1,355 million annually.

The Centre has made a substantial contribution to product safety in the following areas:

• Childhood poisoning

A collaborative childhood poisoning project, undertaken with the Royal Children's Hospital and the Department of Human Services identified and studied 7 agents accessed commonly by young children. Recommendations from this project have also been disseminated by means of international conference proceedings, workshops with manufacturers and other key players, and 100,000 brochures targeted to parents of children in the at risk age group (funded by Esso Australia). Design changes recommended by the project have been implemented for packaging of infant formula paracetamol with a child resistant dropper, and promotion of the use of bait stations for rodenticides.

• Mandation of child resistance for cigarette lighters

Impetus for regulating cigarette lighters followed a number of child deaths. The Centre undertook data analyses, publication, consultation with industry and regulators (including a visit to the U.S. Federal Consumer Product Safety Commission) and provided the Australian Department of Industry, Science and Tourism with the basis for regulating on child resistant cigarette lighters, which was implemented from 1997.

• Suicide prevention

The high frequency of carbon monoxide motor vehicle exhaust gassing suicides (500 deaths/year in Australia) was reported by the Centre and brought to the attention of appropriate authorities some years ago. Research has identified potentially cost beneficial design solutions and a national committee, with MUARC representation, is working towards implementation.

• Review and mandation of nursery furniture standards, as described in Translating Research into Action.

Sports and recreational injury

Sports injury is second only to road trauma as the cause of injury hospitalisation in young males. Hospital data analyses together with participation data, where available, and assessment of effective countermeasures have resulted in the widespread dissemination of recommendations for current best practice. The Centre has completed a number of countermeasure reviews to provide sporting bodies with the information they need to reduce injuries in their sports, and to generate further research hypotheses. These include: cricket, running, alpine skiing, cross country skiing, snowboarding, soccer, equestrian sports, baseball and softball.

Rural injury

The rural injury research and prevention program has defined the agricultural injury problem in Victoria and identified the most significant issues for further research and preventive activities. Profiles of all farm injury and adult farm work related injury have been produced and widely disseminated to inform industry prevention programs. The Centre is conducting evaluations where an intervention proceeds, e.g. Evaluation of the national training program, 'Managing Farm Safety'.

The Centre undertook a survey of Victorian farm ownership of tractors with and without rollover protection, which has informed a recent $1 million extension to government subsidies for the retro-fitting of rollover protection.

A stand alone injury data collection and analysis kit has been developed, which can be used in general practice or small hospital settings to collect data on farm and other injuries at the local level. The system incorporates detailed coding for farm injury and is available for future studies on farm injury.

Community based injury prevention

MUARC has been responsible for the evaluation of two major Victorian community based injury programs and has identified some successful interventions and recommendations for improvements to both intervention and evaluation methods. Designation of MUARC by the World Health Organisation as an Affiliated Safe Community Support Centre, has encouraged new communities working in this area to seek local injury data and advice regarding potentially successful interventions and evaluation methods.

Work Safety

In 1992, the Centre carried out a significant study into forklift safety, for the then Victorian Occupational Health and Safety Commission. This study resulted in the clear recognition and promotion of the need for effective separation of pedestrian workers and forklifts and the development of internal traffic management systems.

A study for Worksafe Australia was carried out regarding manual handling risk assessment methods in manufacturing industries. It examined the current risk assessment checksheet approach required by the regulations, and identified a number of improvements to the process. It also highlighted that unless suitable management support was in place, risk assessments would remain a low level and ad-hoc activity in the workplace.

During the past four years the Centre has had a close involvement with the Victorian WorkCover Authority in injury prevention research and the development of some of the Authority's injury prevention programs. Research has included identification of 'occupational black spots', a major regional study on nursing and transport injuries and a project aimed at improving claims information to increase its value in injury prevention activities.

Dissemination of Information

Results of research have been provided in a total of 185 reports by Centre staff, supplemented by over 50 journal articles and more than 500 presentations at Conferences. The quarterly publication, Hazard, has a print run of 2,500 copies which are widely distributed in Australia and internationally. The 33rd edition was published in December, 1997. Centre staff are members of the Editorial Boards of several of the leading international journals in the field.

Education of researchers and practitioners is also important and the Centre has run several short courses in injury prevention and on the biomechanics of impact, as well as providing subjects in the Master of Public Health and Master of Transport Engineering degrees.

Growth

In order to meet the demand for the Centre's services, staff have grown from five in 1987 to 65. Funding has been provided as shown in Figure 3.

Figure 3 - Components of income 1987-1997

The Future

Despite considerable progress to date, deaths and injuries remain a major problem on the roads, at home, at work and in sport, in both built up and rural areas. With more than 1 in 10 Victorians injured each year and a total of more than 1,400 deaths resulting from injury annually, representing total costs of more than $2.5 billion, it is clear that much more needs to be done.

The Centre has estimated that by the application of known measures, including major investment in road improvements and the progressive introduction of vehicle safety technology, as well as measures directed at road users, the road fatality rate could be more than halved by the year 2020. Research and evaluation will be important elements in the targeting and fine tuning of such programs. Further reductions will depend on the extent to which research can lead to the development of new measures. Areas in which research is needed include novice drivers, older drivers and pedestrians, driver impairment through combined effects of alcohol, drugs and fatigue, use of intelligent transport systems to simplify the driving task, as well as specific improvements to vehicles and the road system.

The ultimate levels to which road trauma can be reduced have yet to be determined. For example, it has been suggested in Sweden that it should be possible to design a road transport system so that ultimately there will be no deaths and few serious injuries. This vision was accepted by the Swedish Parliament in October 1997, although major infrastructure investment, supported by appropriate research, as well as changes in the safety/mobility trade-off, would be necessary if it were to be achieved.

The scope for injury prevention in areas other than on the road is even greater because there are many proven measures which are yet to be implemented. Research can assist in identifying measures which are likely to achieve the greatest effect per dollar invested, as well as in fine tuning, targeting and evaluating specific injury prevention programs.

In some areas, considerable research is also needed to provide a better understanding of the epidemiology of injury and injury mechanisms, which can then lead to development of preventive measures.

The Centre hopes it will be given the opportunity to continue work in co-operation with the responsible government agencies, community organisations and the private sector to assist in achieving further injury reductions.