AAAM Research Spotlight

The dangers of driving under the influence of alcohol are well documented in literature and the act of “drunk driving” is discouraged and punished around the world. Despite this, there are many cases of people unknowingly driving while intoxicated. This comes in the form of “hangover driving” or driving the morning after drinking larger quantities of alcohol. Many people plan on driving home the next morning based on their own perceived blood alcohol content (BAC), cognitive ability and hangover symptoms. The first study presented shows that 41% of their participants changed their plans on when to drive after determining their actual BAC with a breathalyzer. The next two studies show the risks of driving with a hangover. Even with a BAC below the legal limit driving was impaired [2][3]. This form of impaired driving is not as well documented. Increased education on the dangers of “hangover driving” is needed.

[1] Fernando, M., Buckland, J., Melwani, P., Tent, V., Preston, P. and Pit, S.W., 2018. Perceived driving safety and estimated blood alcohol concentration (BAC) the morning after drinking amongst young Australians attending a music festival: a cross-sectional survey. Substance abuse treatment, prevention, and policy, 13, pp.1-12.
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[2] Alford, C., Broom, C., Carver, H., Johnson, S.J., Lands, S., Reece, R. and Verster, J.C., 2020. The impact of alcohol hangover on simulated driving performance during a ‘commute to work’—Zero and residual alcohol effects compared. Journal of clinical medicine, 9(5), p.1435.
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[3] Robbins, C.J., Russell, S. and Chapman, P., 2019. Student drivers the morning after drinking: A willingness to violate road rules despite typical visual attention. Transportation research part F: traffic psychology and behaviour, 62, pp.376-389.
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Vehicle occupants of all shapes, sizes, ages, and abilities deserve the best crash protection we can provide. We have long known that a wide variety of drivers benefit from frontal airbags. This paper from the University of Michigan Transportation Research Institute investigated the common practice of permanently deactivating frontal airbags for wheelchair-seated drivers. Based on a series of sled tests and computer simulations this study supports the idea that driver airbags generally offer tangible safety benefits for a wide range of wheelchair-seated drivers in frontal crashes.

Jingwen Hu, Nichole Orton, Miriam A. Manary, Kyle Boyle & Lawrence W. Schneider (2020) Should airbags be deactivated for wheelchair-seated drivers?, Traffic Injury Prevention, 21:sup1, S37-S42, DOI: 10.1080/15389588.2020.1778676.

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Road trauma of motorcycle users is a growing concern worldwide, with more than 300,000 people killed yearly. The effort to identify effective solutions brought a team from the European network Safe2Wheelers to perform a systematic review of safety systems for powered two-wheelers. The focus was on the latest two decades of research in the field of active safety systems, spanning all stages of development from the design, through prototyping and field testing, to effectiveness evaluations, including human factor-related aspects such as system acceptability. The authors divided the 62 papers selected for a full review into 8 categories:  Antilock braking systems, Autonomous emergency braking, Collision avoidance and similar, Curve warning, Stability control, Traction control, Vision assistance, Human-machine interface & rider acceptability, and Miscellanea. The review outcomes support the implementation of solutions such as the Antilock braking system. Promising technologies currently applied to passenger cars require further consideration before they can be effectively implemented in the motorcycle fleet. Other research gaps were identified, including the need for a structured assessment of the benefits of future active safety systems, as well as the analysis of the combined effects of such systems, with full consideration of rider-system interactions.

Giovanni Savino, Roberto Lot, Matteo Massaro, Matteo Rizzi, Ioannis Symeonidis, Sebastian Will & Julie Brown (2020) Active safety systems for powered two-wheelers: A systematic review, Traffic Injury Prevention, 21:1, 78-86, DOI: 10.1080/15389588.2019.1700408.

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This year’s AAAM Annual Conference featured a wealth of interdisciplinary research, spanning topics ranging from Advanced Driver Assistance Systems (ADAS) to the latest research on drug-induced driver impairment – including a study from the University of Iowa on the perceived effects of cannabis and changes in driving performance under the influence of cannabis.

Burt, T. S., Brown, T. L., Schmitt, R., McGehee, D., Milavetz, G., Gaffney, G. R., & Berka, C. (2021). Perceived effects of cannabis and changes in driving performance under the influence of cannabis. Traffic injury prevention, 22(sup1), S8-S13.

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Automobile crashes happen when we least expect them, and it is a caregiver’s duty to ensure that their child is properly restrained at all times. In honor of National Child Passenger Safety Week, we’re highlighting two papers discussing the importance of caregiver perception on proper child restraint use. West et al. (2021) examines potential gaps between caregivers’ perception of proper child restraint use, and actual use in the field. Zonfrillo et al. (2015) examines the reasons that caregivers often give for improper child restraint. Through understanding these misperceptions we can better address common reasons for improper restraint in the field.

West, B. A., Yellman, M. A., & Rudd, R. A. (2021). Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates. Journal of safety research, 79, 110-116.

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Zonfrillo, M. R., Ferguson, R. W., & Walker, L. (2015). Reasons for child passenger nonrestraint in motor vehicles. Traffic injury prevention, 16(sup2), S41-S45.

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Pediatric vehicular heatstroke is one of the leading causes of non-crash-related motor vehicle deaths in children. Vanos et. al. developed a thermal heat balance model for a small child, utilizing experimental vehicle interior temperature data of enclosed vehicles parked in the shade and sun exposed. Their study indicates that shade-parked vehicles heat more slowly than sun-exposed vehicles but can still achieve dangerously high interior temperatures that result in lethal body core temperatures in young children. Additionally, Hammett et al. provided an analysis of the circumstances surrounding pediatric vehicular heatstroke. Such data provides scientific evidence to support public health messaging and education of the dangers of leaving children unattended in vehicles.

Jennifer K. Vanos, Ariane Middel, Michelle N. Poletti & Nancy J. Selover (2018) Evaluating the impact of solar radiation on pediatric heat balance within enclosed, hot vehicles, Temperature, 5:3, 276-292, DOI: 10.1080/23328940.2018.1468205.

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Hammett DL, Kennedy TM, Selbst SM, Rollins A, Fennell JE. Pediatric Heatstroke Fatalities Caused by Being Left in Motor Vehicles. Pediatr Emerg Care. 2021 Dec 1;37(12):e1560-e1565. doi: 10.1097/PEC.0000000000002115. PMID: 32472925.

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Wali, B., Khattak, A. J., & Ahmad, N. (2019). Examining correlations between motorcyclist’s conspicuity, apparel related factors and injury severity score: Evidence from new motorcycle crash causation study. Accident Analysis & Prevention, 131, 45-62.

With the summer travel season in full swing, it’s a good time to remember that road safety lies at the intersection of infrastructure, driver perception, and protective gear. This study from the Collaborative Sciences Center for Road Safety uses the Injury Severity Score (a multi-trauma metric derived from the Abbreviated Injury Scale) to study various factors influencing motorcyclist safety, including the influence of protective clothing, conspicuity, and rider experience on injury risk.

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Developed by AAAM, the impact of the Abbreviated Injury Scale (AIS) extends well beyond roadway safety. AIS is one of the most common anatomic scales for classifying traumatic injuries and is used in various aspects of trauma research around the world. We are proud to highlight the following studies, which illustrate how AIS is used in trauma research for defense applications, helping identify risk factors and strategies for combat injury prevention.

McGuire, R., Hepper, A., & Harrison, K. (2019). From Northern Ireland to Afghanistan: half a century of blast injuries. BMJ Military Health, 165(1), 27-32.

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D’Souza, E. W., MacGregor, A. J., Dougherty, A. L., Olson, A. S., Champion, H. R., & Galarneau, M. R. (2022). Combat injury profiles among US military personnel who survived serious wounds in Iraq and Afghanistan: A latent class analysis. PLoS one, 17(4), e0266588. 

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Lee, John D., “Dynamics of Driver Distraction: The process of engaging and disengaging,” Annals of Advances in Automotive Medicine. 2014 Mar; 58: 24–32.

A pressing issue affecting roadway safety is driver distraction, which has historically been considered a consequence of excessive mental workload and limited attentional resources. This paper presents the “dynamics” of distraction, particularly of how drivers engage and disengage with driving. The findings can help with developing strategies and features to minimize driver distraction, especially with interruption management.

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McMurry, T. L., Sherwood, C., Poplin, G. S., Seguí-Gómez, M., & Crandall, J. (2015). Implications of functional capacity loss and fatality for vehicle safety prioritization. Traffic injury prevention, 16(sup2), S140-S145.

The Functional Capacity Index (FCI) is used to quantify the long-term effects of injuries in survivors of serious motor vehicle crashes. This study investigated the use of the FCI as a tool for establishing vehicle safety priorities by comparing the life-year burden of injuries to the burden of fatality in the NASS-CDS crash database.

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AAAM Position Statement: “Blood Alcohol Concentration Limit for Driving”.

AAAM holds the position that all jurisdictions should adopt a 0.05g/dL blood alcohol concentration (BAC) as the legal limit for driving. According to the literature, critical driving performance is significantly impaired if a driver’s BAC is greater than or equal to 0.05g/dL and most are impaired even below 0.05g/dL. Lowering the legal BAC limit when driving to 0.05g/dL or lower reduces alcohol-related crashes and fatalities.

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Timothy L. Brown, Christian Richard, Amir Meghdadi, Jared Poole, Abigail Fink, Marija Stevanović Karić, Marissa McConnell, Greg Rupp, Rose Schmitt, Gary G. Gaffney, Gary Milavetz & Chris Berka (2020) EEG Biomarkers Acquired During a Short, Straight-Line Simulated Drive to Predict Impairment from Cannabis Intoxication, Traffic Injury PreventioL, 21:sup1, S130 S134, DOI: 10.1080/15389588.2020.1814957.

As marijuana laws continue to be rolled back or relaxed around the United States, driving while under the influence of cannabis is of growing concern. One of the biggest issues is that there is not yet a reliable method to measure acute cannabis intoxication. Dr. Tim Brown and his collaborators at the University of Iowa and elsewhere published this study in 2020 as part of their work to better understand how we can assess driver performance and how it is affected by cannabis impairment.

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Haddon W; (1970). The Pre-Crash, Crash, and Post-Crash Parts of the Highway Safety Problem. Annual Proceedings/Association for the Advancement of Automotive Medicine (AAAM). 14. Ann Arbor, MI, November 19-20.

Introducing the “Haddon Matrix”, Dr. William Haddon describes the whole-of-field approach needed to address the pre-crash, in-crash, and post-crash causes of injury and fatality from automobile collisions. Published in 1970, this study gives context to the substantial advancements that have been made through steady, determined progress in automobile and roadway safety, and is also prescient to enduring challenges. Highlighting the critical roles of research, roadway, and human infrastructure, this study is a must-read for all transportation safety professionals.

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Sjaan Koppel, Jesús Jiménez Octavio, Katarina Bohman, David Logan, Wassim Raphael, Leonardo Quintana Jimenez & Francisco Lopez-Valdes (2019). Seating Configuration and Position Preferences in Fully Automated Vehicles. Traffic Injury Prevention, 20:sup2, S103-S109, DOI: 10.1080/15389588.2019.1625336.

In this study, Prof. Sjaan Koppel and collaborators from across the globe studied preferences anticipated for a future of fully automated vehicles by carrying out an international survey. Their aim was to find out the preferred seating configuration, activity, and willingness to wear different seatbelt configurations from participants. The study is valuable for guiding future research on restraining systems for new seating postures enabled by autonomous vehicles.

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Loftis, K. L., Price, J., & Gillich, P. J. (2018). Evolution of the Abbreviated Injury Scale: 1990–2015. Traffic injury prevention, 19(sup2), S109-S113. 

The Abbreviated Injury Scale (AIS) has been improved since its inception in the mid-1960s. This article explains how AIS codes have changed over the last 25 years to become an internationally accepted tool for categorizing injuries.

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Tylko, S., Locey, C. M., Garcia-Espana, J. F., Arbogast, K. B., & Maltese, M. R. (2013). Comparative Performance of Rear Facing Child Restraint Systems on the CMVSS 213 Bench and Vehicle Seats. Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Annual Scientific Conference, 57, 311–328.

Tylko et al. compare child restraint test results using the FMVSS/CMVSS 213 test bench and production vehicle seats, and discuss how the differences that they observed may affect our understanding of the relative effectiveness of different installation methods for child restraints. 

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Weiss, E., Fisher Thiel, M., Sultana, N., Hannan, C., & Seacrist, T. (2018). Advanced driver assistance systems for teen drivers: Teen and parent impressions, perceived need, and intervention preferences. Traffic injury prevention, 19(sup1), S120-S124.

More new vehicles are equipped with Advanced Driver Assistance Systems (ADAS) than ever before. This novel study showed how teen drivers – a population that may benefit the most from ADAS – perceive ADAS. These findings can aid in future ADAS development and the education of these technologies, especially for novice and teen drivers.

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Seacrist, T., Douglas, E. C., Huang, E., Megariotis, J., Prabahar, A., Kashem, A., Elzarka, A., Haber, L., MacKinney, T., & Loeb, H. (2018). Analysis of near crashes among teen, young adult, and experienced adult drivers using the SHRP2 naturalistic driving study. Traffic injury prevention, 19(sup1), S89-S96.

Understanding the real-world driving experiences of teen drivers can provide valuable insights on their driving behavior and, ultimately, ways to improve it. This paper, which made use of the Strategic Highway Research Program 2 (SHRP2) Naturalistic Driving Study (NDS), studied teen driver near crashes. These findings can aid policy efforts, vehicle development, educational campaigns, legislation, and other actions for improvement.

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Lee, H. Y., Youk, H., Ii Lee, J., Kang, C. Y., Kong, J. S., Sung, S., Kang I. H., Lee J. H., Kim O. H., Jung W. J., Lee K. H., Youn Y. H., & Park, J. C. (2018). Injury analysis of patients according to impact patterns involved in pedestrian traffic crashes. Traffic injury prevention, 19 (sup1), S153-S157.

This article is a collaboration among emergency medicine physicians, engineers and traffic accident forensic experts in the Republic of Korea. This multidisciplinary team analyzed injury data from non-fatally and fatally injured pedestrians who presented to the emergency room and correlated it with the motor vehicle-pedestrian kinematic trajectories. The findings of the authors are applicable to the clinical setting. This publication is an example of the application of AIS coding in an international study.

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Baker, S. P., O’Neill, B., Haddon, W., & Long, W. B. (1974). The injury severity score: development and potential usefulness. In Proceedings: American Association for Automotive Medicine Annual Conference (Vol. 18, pp. 58-74). Association for the Advancement of Automotive Medicine.

In this landmark 1974 study, former AAAM President Sue Baker and colleagues introduce a new metric linking AIS to mortality risk for multi-trauma – the Injury Severity Score (ISS).

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