Opportunities and New Challenges for Impacting Transport Safety Among Children, Teens, and Young Adults

Flaura Koplin Winston, University of Pennsylvania, USA

Protecting children, youth, and young adults from crash injury and its consequences is an increasingly complex task. It requires more than a multi-pronged approach; it demands interdisciplinary work.  Without such integration, approaches to finding and implementing solutions can be fragmented, inefficient, ineffective, or in the worse case, harmful. The 1990’s crisis of air bag death-related deaths to children brought this issue to the forefront. Safety engineering systems were not designed to perform under real world conditions involving passenger behaviors of children. Many children rode inappropriately or unrestrained in the right front seat, placing them “out of position” when air bags deployed with resultant severe and fatal injuries even in low severity crashes.

Traffic safety integration should occur on at least four levels. The most obvious level involves the collaboration among professionals with different expertise. Child development is as important a component as the social and family environment as the engineering and biomechanics. This provides depth and breadth of understanding. Another level involves integration from research to action to impact.  This integration requires involvement of ultimate users of products and programs – practitioners, policymakers, and the public – from inception to broad dissemination. A third level of integration recognizes the possibility of failure of design or unintended implementation of products and programs and incorporates backup strategies for protection. The primary goal of countermeasures is to avert crashes; however, when these strategies fail and crashes occur, interventions should be in place to reduce the incidence and severity of injuries; and when failures in occupant protection occur, medical and psychosocial management strategies should be in place to increase survival and recovery from the injuries. A final level of integration involves debate and analysis to ensure that strategies optimize trade-offs in and cost-benefit of countermeasures. No strategy is a panacea. A safety device that prevents one type of injury in children may increase the risk of another injury type or increase the risk of adult injuries. Conversely, crash avoidance technology that works well with experienced, adult drivers may fail with novice teen drivers.

Over the past decade comprehensive study of traffic safety failures and successes has resulted in lessons learned in best practice for integrated traffic safety.  This paper will discuss some of these lessons and how they can be applied to addressing anticipated challenges in child and adolescent traffic safety.

Quality improvement programs should be expanded to identify and address “prevention errors,” such as the health system’s inability to effect changes that reduce crashes and use of appropriate restraints in motor vehicles. This is not a new concept for disease prevention: think “vaccine failure.” When a child today contracts a vaccine-preventable disease, physicians are required to notify the health authorities and steps are taken to avoid a recurrence in another child. For example, a recent response to post-vaccination varicella occurrence was a requirement for a booster dose of vaccine.

Once we have an understanding of the necessary prevention strategies, we need to deliver them through effective programs and to sufficiently fund the initiatives. It is also imperative to develop best practice guidelines for prevention and counseling and to measure the effectiveness of our programs. For this to occur, we must develop sound prevention quality performance and effectiveness metrics.

For each of my research findings I know that there are many non-medical audiences needing to be reached. These include legislators, policymakers, employers, engineers, designers, and families, all of whom have a stake in translating injury prevention research into action. Unfortunately, our academic publications are not easily accessible by them.

In my approach, I incorporate these stakeholders, the end-users of my research, into the research plan. Before I embark on a study, I review the research question and proposed data collection with representatives of the stakeholder groups to determine if my planned dataset is complete. Would the relevance of the research be enhanced by additional questions with associated data elements? Once my team conducts the study and analyzes the data, I return to these groups of “policy influencers” to help interpret the results and to suggest plans of action. Finally, I translate the science into terms that matter and create materials and training on their use for these various groups, the “stakeholders for the science.” This integrated “research-to-action” approach fosters efficient knowledge transfer, due in part to the tremendous buy-in from the beginning of the research by the people who have the power to implement change based on the findings.

Recently, the Substance Abuse and Mental Health Services Administration coined the term “trauma-informed care”. Such ideal clinical care for injury and violence would address not only the survivor’s medical and surgical needs, but also the survivors’ response to the trauma. This care would thereby aid the healing and rehabilitation process. Moreover, from a staff perspective, a trauma-informed approach would result in a cultural shift that recognizes and addresses the personal, emotional stress associated with caring for these patients. With this approach, the work environment would become more effective, patient outcomes would improve and, ultimately, bottom-line costs would be reduced.

Finally, trauma care needs to go beyond the treatment of the physical injury. It has to move to treating the likely psychosocial consequences, focusing not only on full recovery, but also on prevention of recurrence. PTSD is a common outcome of injury; yet, most injured patients with PTSD go undiagnosed and untreated. As another example, alcoholics with injuries all too often get patched up and sent out without adequate treatment to address the root cause of their injury, their addiction. Victims of domestic or interpersonal violence also are often treated and released to the same setting where the incidents occurred without any guidance or resources to prevent future injuries.