1. CRICOS No 00213J Major Recommendations Rural and Remote Road Safety Major Recommendations

2. Acknowledgements Government Motor Accident Insurance Commission (MAIC) Dept of Premiers & Cabinet Queensland Police Service Dept. of Emergency Services Queensland Transport Dept. of Main Roads Queensland Rail Q-Fleet Department of Natural Resources, Mines & Energy Queensland Health Austroads Regional Hospitals Mt Isa Townsville Cairns Charters Towers Mareeba Atherton University Partners James Cook University Mt Isa Centre for Rural & Remote Health (MICRRH) Queensland University of Technology, CARRS-Q

3. Research Team  Chief Investigators  Prof. Mary Sheehan, CARRS-Q  Prof. Victor Siskind, CARRS-Q  Assoc. Prof. Richard Turner, JCU  Prof. Craig Veitch, JCU  Other Major Researchers  Ross Blackman, JCU/CARRS-Q  Colin Edmonston, CARRS-Q  Dr. Teresa O’Connor, JCU  Dale Steinhardt, CARRS-Q  Gayle Sticher, CARRS-Q

4. Program Background  Program began in 2003, to investigate factors contributing to serious rural and remote road crashes

5. Program Components  The program of research involved several key components.  Road Safety in Rural and Remote Areas of Australia, 2005 (Austroads Publication) (Tziotis, M., Mabbott, N., Edmonston, C., Sheehan, M., & Dwyer, J.)  Rural and Remote Road Safety Research Project: Five year crash and area profile of North Queensland (January 1st 1998 - December 31st 2002) (CARRS-Q, 2006);  Recommendations from an international workshop on rural and remote road safety - October 2007  Rural and Remote Road Safety Study: Final Report (Sheehan, M., Siskind, V., Turner, R., Veitch, C., O’Connor, T., Steinhardt, D., Blackman, R., Edmonston, C., & Sticher, G.)

6. Road Safety in Rural and Remote Areas of Australia  Reviewed existing national and international literature  Collated all available state/national statistics  Identified key at-risk groups as well as behavioural, environmental and medical risk factors

7. Rural and Remote Road Safety Research Project: Five year crash and area profile of North Queensland (January 1st 1998 - December 31st 2002)  Presents a profile of the socio-demographic and transport statistics of the rural North Queensland study area for the Rural and Remote Road Safety Project

8. Recommendations from an international workshop on rural and remote road safety  This international symposium was convened in Brisbane to showcase and critique the preliminary findings of the Rural & Remote Road Safety project and to bring together a wide range of international, national and local stakeholders to inform recommendations.

9. Rural and Remote Road Safety Study: Final Report  The primary aim of the study was to: “Identify human factors related to the occurrence of serious traffic incidents in rural and remote areas of Australia, and to the trauma suffered by persons as a result of these incidents, using a sample drawn from a rural and remote area in north Queensland”

10. Study Area North West Far North Northern Region2005 pop.Median Age 1 M:F Ratio Northern205,62833.21.04 Far North238,45435.11.05 North West34,16730.51.17 North Qld478,24933.91.05 Queensland3,156,90335.91.00 Source: Australian Bureau of Statistics, 2006; 40% of Queensland's land area A younger and more masculine (higher M:F ratio) area than Qld as whole

11. Rural and Remote Road Safety Research Study CASE-COMPARISON STUDY Medical Data - 690 casualties Police-reported Crash Data - 413 crashes Fatal Crashes - 119 crashes - 130 resulting casualties Crash Casualty Overview Data - 732 serious crashes - 814 resulting casualties Roadside Interviews Data - 682 interviews IN-DEPTH CRASH STUDY POLICE-NARRATIVE COMPARISON STUDY FATAL CRASH STUDY Coroner’s Reports - 76 reports INJURY STUDY Interviewed Casualty Narratives - 375 crash narratives Interviewed Casualties - 404 interviews INTERVIEWED CASUALTY STUDY See p.3 of booklet

12. Major Recommendations  Male drivers and riders  Male drivers and riders should continue to be the focus of interventions, given their very high representation among rural and remote road crash fatalities and serious injuries.  The group of males aged between 30 and 50 years comprised the largest number of casualties and also must be targeted for change if there is to be a meaningful improvement in rural and remote road safety.

13. Total Fatalities by Gender

14. Major Recommendations  Motorcyclists  Single vehicle motorcycle crashes constitute over 80% of serious, on-road rural motorcycle crashes and need particular attention in development of policy and infrastructure.  The motorcycle safety consultation process currently being undertaken by Queensland Transport (via the "Motorbike Safety in Queensland - Consultation Paper" ) is strongly endorsed. As part of this process, particular attention needs to be given to initiatives designed to reduce rural and single vehicle motorcycle crashes.

15. Major Recommendations  Motorcyclists  The safety of off-road riders is a serious problem that falls outside the direct responsibility of either Transport or Health departments. Responsibility for this issue needs to be attributed to develop appropriate policy, regulations and countermeasures.

16. Vehicle Type by Location of Crash % of all crashes within area type Motorcycles highly represented (Fatal & Serious hospitalisation)

17. Major Recommendations  Road safety for Indigenous people  Continued resourcing and expansion of The Queensland Aboriginal Peoples and Torres Strait Islander Peoples Driver Licensing Program to meet the needs of remote and Indigenous communities with significantly lower licence ownership levels.  Increased attention needs to focus on the contribution of geographic disadvantage (remoteness) factors to remote and Indigenous road trauma.

18. Major Recommendations  Road environment  Speed is the ‘final common pathway’ in determining the severity of rural and remote crashes and rural speed limits should be reduced to 90km/hr for sealed off-highway roads and 80km/hr for all unsealed roads as recommended in the Austroads review and in line with the current Tasmanian government trial.  The Department of Main Roads should monitor rural crash clusters and where appropriate work with local authorities to conduct relevant audits and take mitigating action.

19. Police-reported Crashes by Speed Limit Speed limit (km/h)n% ≥100 25260.9 70-90 7016.9 ≤60 9222.2 Total 414100.0 Police-reported Units by Speeding Speeding Relatedn% Attributed579.6 Not Attributed53590.4 Total592100.0 From matched police reported records for on-road crashes

20. Crash Clusters

21. Major Recommendations  Road environment  The international experts at the workshop reviewed the data and identified the need to focus particular attention on road design management for dangerous curves. They also indicated the need to maximise the use of audio-tactile linemarking (audible lines) and rumble strips to alert drivers to dangerous conditions and behaviours.

22. Major Recommendations  Trauma costs  In accordance with Queensland Health priorities, recognition should be given to the substantial financial costs associated with acute management of trauma resulting from serious rural and remote crashes.  Efforts should be made to develop a comprehensive, regionally specific costing formula for road trauma that incorporates the pre-hospital, hospital and post-hospital phases of care. This would inform health resource allocation and facilitate the evaluation of interventions.

23. Cost Estimates Treatment Costs Cost Total costs for bed days (days=6360) $6,650,000 Cost for ICU bed days (days=734) $1,743,900 Total $8,393,900 Transport to First Hospital Costs Cost Air Transport$650,000 Road Transport$495,000 Total$1,145,000 Inter-hospital Transfer Costs Cost Air transport to second hospital$1,900,000 Air transport to third hospital$170,000 Road transport to second hospital$145,000 Road costs assoc. w/ fixed wing flights$335,000 Total$2,550,000 Average cost per bed day: $1,045 Average retrieval cost: $2,150 Average transfer cost: $6,300 Average cost per ICU bed day: $2,376

24. Major Recommendations  Trauma costs  The commitment of funds to the development of preventive strategies to reduce rural and remote crashes should take into account the potential cost savings associated with trauma.  A dedicated study of the rehabilitation needs and associated personal and healthcare costs arising from rural and remote road crashes should be undertaken.

25. Major Recommendations  Emergency services  While the study has demonstrated considerable efficiency in the response and retrieval systems of rural and remote North Queensland, relevant Intelligent Transport Systems technologies (such as vehicle alarm systems) to improve crash notification should be both developed and evaluated.

26. Emergency Retrieval Time Intervals Mean a Median b IQR* Notification till emergency vehicle arrived at crash site 25138-27 Arrival at crash site and arriving at first hospital 796037-60 Notification of crash and arrival at first hospital 10078.549-130 a,b – figures in minutes * Inter-quartile range  Most fatal road crash casualties appeared to have injuries that were unsurvivable at the outset

27. Major Recommendations  Enforcement  Alcohol and speed enforcement programs should target the period between 2 and 6pm because of the high numbers of crashes in the afternoon period throughout the rural region.

28. Time of Day of Crash (Fatal & Serious hospitalisation)

29. Time of Day of Crash (All Qld, 2001-2006 financ.yrs, Qld Road crash database)

30. Major Recommendations  Drink driving  Courtesy buses should be advocated and schemes such as the Skipper project promoted as local drink driving countermeasures in line with the very high levels of community support for these measures identified in the hospital study.  Programs should be developed to target the high levels of alcohol consumption identified in rural and remote areas and related involvement in crashes.  Referrals to drink driving rehabilitation programs should be mandated for recidivist offenders.

31. Courtesy Buses – Perceived Effectiveness Question RankMeanSD Courtesy buses from pubs and clubs11.53.79 Better roads21.64.99 Identifying and fixing road/traffic hazards31.68.95 QuestionRankMeanSD Courtesy buses from pubs and clubs11.61.97 Over-taking lanes21.671.05 Roadside rest facilities31.761.06 Hospitalised Sample Roadside Sample 1 = very effective; 5 = not effective at all

32. Alcohol Consumption Drinking level* HospitalRoadside No.% % Harmful drinker11756.830441.2 Drinker5928.631042.0 Non-drinker3014.612416.8 Total206100.0738100.0 * On basis of AUDIT-C score

33. BAC ≥.05 for Unit Controllers in Fatal Crashes Drink driving (BAC ≥.05) n% Attributed 3523.6 Not Attributed 11376.4 Total 148100.0 From matched police reported records for on-road crashes

34. Major Recommendations  Data requirements  Rural and remote road crashes should receive the same quality of attention as urban crashes. As such, it is strongly recommended that increased resources be committed to enable dedicated Forensic Crash Units to investigate rural and remote fatal and serious injury crashes.  Transport department records of rural and remote crashes should record the crash location using the national ARIA area classifications used by health departments as a means to better identify rural crashes.

35. Major Recommendations  Data requirements  Rural and remote crashes tend to be unnoticed except in relatively infrequent rural reviews. They should receive the same level of attention and this could be achieved if fatalities and fatal crashes were coded by the ARIA classification system and included in regular crash reporting.  Health, Transport and Police agencies should collect a common, minimal set of data relating to road crashes and injuries, including presentations to small rural and remote health facilities.

36. ARIA Application (All Qld, 2001-2006 financ.yrs, Qld Road crash database)

37. Major Recommendations  Media and community education programmes  Interventions seeking to highlight the human contribution to crashes should be prioritised. Driver distraction, alcohol and inappropriate speed for the road conditions are key examples of such behaviours.  Promotion of basic safety behaviours such as the use of seatbelts and helmets should be given a renewed focus.

38. Seatbelt Use by Casualty Severity FatalHospitalis. Seatbelt status n%n% Worn 4047.115965.9 Not worn 2832.92711.2 Unknown 1720.05522.8 Total 85100.0241100.0 From matched police reported records for on-road crashes

39. Major Recommendations  Media and community education programmes  Knowledge, attitude and behavioural factors that have been identified for the hospital Brief Intervention Trial should be considered in developing safety campaigns for rural and remote people. For example challenging the myth of the dangerous ‘other’ or ‘non-local’ driver.  Special Educational initiatives should be developed and disseminated on the different and particular tasks and hazards involved in rural and remote driving. For example the material used by Main Roads, the Australian Defence Force and local initiatives.

40. Questions?

41. Total Casualties by Gender

42. North Qld – Age/Gender Distribution