1. The challenges for rural & remote road safety: nothing new really but what can we do about them? Presentation by Prof Mary Sheehan Sydney, 10 August 2012 Australian College of Road Safety

2. Overview 1. Context 2.Comparison of fatal and non-fatal crashes 3.Alcohol 4.Recommendations

3. 1. Context

4. “some evidence that road trauma trends over the last decade have varied between metropolitan, regional and remote areas of Australia though more work is required to better understand and respond to the road safety issues affecting people in different parts of our country” National Road Safety Strategy 2011-2020

5. Australian Annual Road Fatality Rates/ 100,000 Population: Australia 1990-1992 Australia’s Rural Road Safety Action Plan “Focus for the Future” 1996.

6. Road deaths per 100,000 population by remoteness area, Australia, 2006. Extracted from Figure 11. National Road Safety Strategy 2011-2020

7. Rural and remote areas (population =31%): 46% of the fatal crashes 48% of the fatalities. AUSTRALIA 2006 -2010: An estimated 700 persons killed annually in rural and remote crashes.

8. NCSA Traffic Safety Fact Sheet “2010 Rural/Urban Comparison” (DOT-HS-811-637) USA 2010: 30,196 fatal crashes = 32,885 fatalities. Rural areas (population =19%): 54% (16,292) of the fatal crashes 55% (18,026) of the fatalities.

9. Research team: Sheehan, Siskind, Veitch, Turner, Steinhardt, Edmonston, O’Connor, Blackman CARRS-Q Rural and Remote Road Safety Research Program

10. 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, 2008 (Sheehan, M., Siskind, V., Turner, R., Veitch, C., O’Connor, T., Steinhardt, D., Blackman, R., Edmonston, C., & Sticher, G., 2008)

11. Rural and Remote Road Safety Research Study All fatal and serious hospital crashes in rural and remote North Queensland from March 2004 to June 2007. 732 Eligible crashes (police, hospital and coroners’ data). 119 Fatal crashes. 613 Hospitalised crashes (at least 24 hours) 404 Hospital patients interviewed 682 Roadside interviews – matched to crash sites.

12. ARIA + Application (All serious study crashes, March 2004 – June 2007)

13. Crash Cluster - Ravenshoe

14. “The driver was drunk. It’s his car. He was giving us girls a lift home. Another car wanted to have a race with us and we told the driver “no”. The driver just started to laugh and wanted to race and started speeding up. We all started yelling at him that we wanted to stay alive and there was a pregnant woman in the car. We told him he should put our lives before his but he wouldn’t listen and just drove really fast. Then we hit a drain and the car clunked a few times before smashing into a building. None of us had seatbelts on except the driver.” THE CRASH

15. Contributing Circumstances to Crashes- police and interview report Contributing Circumstance Group

16. (Fatal & hospitalisation) Time of Day of Crash % of Crashes

17. 2. Fatal and Non-fatal Crashes

18. Fatal and non-fatal casualties by gender and age group FatalNon-fatal MalesFemalesMalesFemales Age (years)%% 16 - 24 23.934.330.123.9 25 - 34 29.120.023.923.2 35 - 44 17.1 19.614.8 45 - 54 12.020.011.5 55 - 64 9.45.79.215.5 65 - 74 5.102.97.1 ≥ 75 3.42.9 4.5 11735489155

19. Fatal and non-fatal casualties by road user type Road user typeFatal %Non-fatal* %Total n Car or truck driver 51.530.0269 Pedestrian 6.94.942 Car or truck passenger 21.519.4159 Cyclist 1.52.720 Motorcyclist 17.735.6263 Motorcycle pillion 0.81.612 Quad bike rider 05.336 Quad bike pillion 00.43 TOTAL130674804 *In 10 instances, non fatal, road user type was not recorded

20. Temporal characteristics of fatal and non-fatal crashes Day of weekFatal %Non-fatal* %Total % Weekday46.256.354.6 Weekend 53.843.745.4 TOTAL119606725 *In 7 cases there was insufficient information

21. Road conditions in fatal and non-fatal crashes Road conditionFatal %Non-fatal %p values Road surface Sealed/ unsealed 0.95 Wet/dry 0.10 Sealed86.486.1 Wet 78.674.1 Dry 7.812.0 Unsealed 13.613.3 Wet 13.610.7 Dry 0.02.6 Horizontal alignment Straight/ obscured/ open 0.003 Straight 52.462.8 Curved 47.637.2 View obscured 30.112.9 View open 17.524.3

22. Road conditionFatal %Non-fatal %p values Vertical alignment 0.41 Level 76.768.0 Grade 13.619.4 Crest 4.96.5 Dip 4.96.1 Roadway feature Any/none 0.14 No roadway feature 87.480.3 T-junction 7.89.7 Bridge/ causeway 1.92.3 Crossroads 1.94.8 Railway crossing 1.0 Other 01.9 Traffic control Any/none 0.91 No control 93.292.9 Give-way sign 4.94.5 Other 1.92.6

23. Road conditionFatal %Non-fatal %p values* Contributory road conditions Present/ absent 0.08 Absent 88.379.9 Present 11.720.1 Lighting conditions Day/ night 0.036 Daylight 56.268.3 Night 43.831.7 Atmospheric conditions Clear/ other 0.17 Clear 93.287.7 Raining 5.810.0 Fog 1.0 Smoke/ Dust 01.3 * p values correspond to chi-squared tests between named groups

24. Police-reported casualties by injury severity and protective equipment use Protective equipmentFatal %Non-fatal % Seatbelt Worn 47.166.0 Not worn32.911.2 Unknown20.022.8 Total100.0 Helmet Worn 73.987.6 Not worn8.76.8 Unknown17.45.6 Total100.0

25. Licence status in fatal and non-fatal crashes License statusFatal %Non-fatal %p values Licensed 83.791.0 Licensed/ unlicensed 0.34 Open65.077.2 Provisional11.610.3 Learner1.63.4 Unlicensed 16.39.0 Cancelled/ disqualified3.93.4 Never held license3.92.1 Other8.53.4 Australian operators 100.0 Not licensed in Australia 1.33.2 Unknown/ not applicable 12.710.9

26. Road conditionFatal %Non-fatal %p values Alcohol < 0.001 Attributed 30.713.7 Not attributed 69.386.3 BAC > 0.05 < 0.001 Attributed 24.09.3 Not attributed 76.090.7 Speeding related < 0.001 Attributed 18.76.6 Not attributed 81.393.4 Travelling over speed limit < 0.001 Attributed 6.70.9 Not attributed 93.399.1 Operator factors in fatal and non-fatal crashes

27. Road conditionFatal %Non-fatal %p values* Fatigue < 0.001 Attributed 16.011.6 Not attributed 84.088.4 Distraction/ inattention < 0.001 Attributed 20.025.5 Not attributed 80.074.5 Road rule violation < 0.001 Attributed 14.713.4 Not attributed 85.386.6 * p values correspond to chi-squared tests between named groups

28. Risk ratios, with 95% confidence intervals (95% C.I.), for a fatal outcome in serious crashes in North Queensland, derived by modified multiple logistic analysis. FactorRisk ratio95% CIp Alcohol involvement definite 1.71 1.15 – 2.540.01 Speeding 2.39 1.61 – 3.550.001 Speed limit 70 – 90 km/h 2.00 0.90 – 4.440.09 Speed limit 100, 110 km/h 3.53 1.73 – 7.220.001 Road rule violation 1.74 1.10 – 2.740.02 Curve – view open 1.31 0.91 – 1.870.14 Curve – view obscured 1.30 0.87 – 1.960.20 Fatigue attributed 1.57 0.93 – 2.650.09

29. Emergency Retrieval a,b – figures in minutes * Inter-quartile range Most fatal road crash casualties appeared to have injuries that were unsurvivable at the outset. Time Intervals Mean a Median b IQR* Notification of crash to arrival at first hospital 10078.549-130

30. 3. Alcohol

31. Alcohol Speeding is the Key Issue but Alcohol a Major Contributor – our findings indicate that for the same amount of forces alcohol means that you are physically compromised in regard to injury outcomes

32. Drinking levelHospital %Roadside % Harmful drinker56.841.2 Drinker28.642.0 Non-drinker14.616.8 TOTAL206738 Drinking levels in hospitalised and roadside respondents – Audit C

33. 4. Recommendations

34. Top 3 safety interventions ranked in importance by hospital patients and road side sample InterventionHospital patients Roadside sample Courtesy buses from pubs and clubs 1.5 (1)1.6 (1) Better roads 1.6 (2) Clearer identification of road hazards 1.7 (3) Overtaking lanes 1.7 (2) Roadside test facilities 1.8 (3) Importance rates from 1 = very important to 5 = not important at all.

35. Top 10 ranked in importance by hospital patients (harmful level drinkers compared with other hospital respondents) InterventionHarmful drinkersOthers Courtesy buses from pubs and clubs 1.51.6 Better roads 1.71.6 Clearer identification of road hazards 1.7 Overtaking lanes 1.7 Road-based fatigue initiatives 2.11.9 Loss of license for serious offenders 1.9 Improved mobile phone range 1.72.0 Roadside test facilities 1.92.0 Policing people riding in back of utes 2.2 RBT 2.32.2 Importance rates from 1 = very important to 5 = not important at all.

36. Key areas of intervention by cornerstone and geographical ( rural and remote)location. National Road Safety Strategy 2011-2020 Safe RoadsSafer roads programs targeting run-off-road and head-on crash risk, and safety intersection treatments. Safe SpeedsReview of speed limits on higher crash risk routes. Safe VehiclesFocus on countering run-off-road crashes. Safe Road UseImproved access to graduated licensing for disadvantaged groups.

37. Crash problem areas mapped to the strategy cornerstone areas. National Road Safety Strategy 2011-2020

38. 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 and roadside studies.

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

40. 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. Recommendations

41. 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. Recommendations

42. Public Education Programs Localize content of generic mass media campaigns with special attention to alcohol, fatigue and failure to wear seat belts Recommendation - -1996 rural and remote road safety action plan

43. AFTER THE CRASH “When we crashed other people had seen it and came over and growled at us for getting in the car with the driver. They also hit the driver for being so stupid and putting us all in danger. All five of us have ended up in hospital. We sent my cousin in the ambulance first because she was pregnant. After the crash the driver told his family that he wanted to die. But he was also like...not really caring about us. Then my cousins were hitting him and he was saying sorry”.

44. Questions? m.sheehan@qut.edu.au http://t2013.com Mark your Diaries! International Council on Alcohol, Drugs and Traffic Safety Conference (2013) 25-28 August 2013, Brisbane CRICOS No. 00213J