a review of riders and pedestrians in traffic collisions
Transcription
a review of riders and pedestrians in traffic collisions
A REVIEW OF RIDERS AND PEDESTRIANS IN TRAFFIC COLLIS IONS by S . J . Ash ton , J . B . Pedder and G . M. Mackay Accident Rese arch Uni t , Departrnen t o f Transportation and Environrnen tal P l annin g , Unive r s i ty of B i rmingham, U . K . ABSTRACT Thi s paper reviews the inforrnation avai lab l e on the b i omechanics o f traurna to r i ders of two-whee led machines and to pede s trians . Data corne frorn hospi tal s tudies , field accident inve s tigations and experimen tal work . A general des c r ip tion of the tr aurna received by these groups of road users is given in te rms of the f requency and severity of inj uries to the main anatorni cal regions of the body . Informat ion on the circurns tances of co l l i s ions i s s uIIUnari sed as far as i s known , i n relation to s p e c i f i c s o urces o f inj ury , the rel ative importance of vehicular and ground contacts and the inf luence o f speed on these cir cums tance s . The paper concludes by emphas i zing the importance of improved vehi c le de s i gn in m1n1m1 s 1ng inj uries to the s e classes of road use r , an area which has s o far rece ived relative ly l i t t le at ten tion. 129 INTRODUCTION The las t decade has seen a large research effort concentrated on protecting car occupants . The knowledge acquired is now being tran s lated into vehicle design so that the occupant of a new car can , in the main , expect to be substantially better protected now than would have been the case ten years ago . lock design, windscreen s , s teering assemb lies , Improvements in door compart�ent integrity and above a l l in the provis ion of seat belts , mean that given the o ccurrence of a crash, the restrained car occupant has a markedly improved chance of avoiding death or serious inj ury in comparison to the typical crash of the 1950s or early 1960s . One may suggest for examp le that the introduction of the an ti-hur s t door lock , considered as a pub li c health measure , has probably saved more lives than the vaccination agains t poliomye l i tis . Wi th compulsory use o f seat b e l ts now accepted by most motorised countries of the western world, the importance of the other road users , especially pedestrians and riders of two-wheeled machines , is now being recogni sed . The conventional wis dom that nothing can be done in the conf lict be tween an 80 kgm. pede s trian and a 1000 kgm. motor car is being questione d , and data are naw being gene rated which should eventually al low the optimum crash performance design for the vehicle exterior to be specified, j us t as the vehicle interior i s now . In many ways the s tate of � knowledge on the biomechani cs of trauma to the other ro d users parallels the work on car o ccupants of ten years ago . The time s cale for �he acqui sit ion of new knowledge is likely to be at least as long because the problems are in many ways . con f l i c ting requirement s w i l l not more comp lex and the optimisation of the various permit easy solutions . This review divides 1nto two sec tions dealing with two-wheeled machines and their riders firs t , and then pedestrians are dis cus s e .d . TWO-WHEELED VEHICLES AND THEIR RIDERS During the las t decade there has been an overall increase in the popularity of the two-wheeled veh i c l e in many countries . This res urgence has been particularly prominent over the l as t five years . Injuries and fatalities sus tained by users of these vehicles have fol lowed a similar trend. Two-wheeled vehicles p rovide an alternative form of transport to the car at low cos t . They are fas t and convenient , an insubstantial .addieion to the conges tion of high dens i ty roads . A world wide fuel shortage and subsequent increase in fuel costs , and the avai labi l i ty of a wide range of machines has increased their attractiveness in recent year s . They are made up o f two main vehicle types ; pedal cycles and motor vehicles . Pedal . cycles are propel led s o le ly by the expendit ure of user energy . Two-wheeled motor vehi cles include motorscooters , mopeds and motorcycle�. Motorscooters are typ i cally characterised by sma l ler whee l s than a �onventional motorcycle and include an open frame and p latform for fee t . Mopeds have an engine capacity not over 50c . c . and are equipped with pedals . Motorcycles are a l l other twq-wheel�d motor vehi cles or combinations . lt is recognised that the design di fferences of these three groups of motor vehicles may affect their performance in certain s ituations but as few research reports dis tinguish between them, for convenience the term "motorcycle" wi l l subsequently refer to all two-wheeled vehicles unless otherwise specified. Pedal cycles w i l l b e considered as a separate group . 130 The two-wheeled vehicle i s inherently uns tab le , therefore by the very nature of t he i r ins tab i l i ty one would expect a higher acc ident rate . especially for s ingle veh i cle accidents ( Sharp , 1 9 7 1 ) . The rel ative frequency o f two-whee led vehicle accidents i s diffi cult to as s es s . S ta t i s t i cs are confounded by the di fferences i n reporting procedures b o th w i thin and b e tween countries and the type and dens ity o f the motor vehi cle population . For ins tance , in s ome European countries - such as France , Belgium , The Nether lands , Wes t Germany , - special b i cy c l e tracks are provided along h i gh-use roads . However the main prob lem lies in the known h i gh number o f inj ury accidents which are not reported to p o l i ce authori t i e s . Pub li shed s tatis t i cs which rely s o l e ly on p o l i ce accident s tat i s t i c s are typ i ca l ly an unde restimate of the true frequency of two-wheeled vehi c le injuries in a community . Several workers have e s t ab l i shed that only about a third to a half o f all two whee led accidents result ing in medically treate d inj uries are reported o r known t o the p o l i ce ( C l ark and Mo rton, 1 9 7 1 ; Kraus , Riggins , Drysda l e , and Franti , 1 9 7 2 ) . B u l l and Rob e r ts ( 1 9 7 3 ) looked at a sample o f 1 200 cases attending the Bi rmingham Accident Hospi tal , England as a result of road accidents . In the i r samp le of 40 s e rious and 1 14 s l ight cases o f inj ury to pedal cy cl i s ts , they found only 14 s e rious and 2 2 s l i gh t cases were known to the pol ice (35% and 1 9 % ) . Mos t o f the cas e s n o t known t o the p o l i ce were riders who fe l l o f f their machine s , no o ther veh i c l e being involve d . l t i s reas onab le t o expect that any two-wheeled acciden t resulting i n no o r minor inj ury to the user and/or l i tt le damage to the machine or other property w i l l not be reported. The rate o f no t i f i cation for mo torcy cl i s ts was 85 known to po l i ce out of a total of 1 2 8 inj ury cases (66% ) . The magn i tude o f the prob lem o f two-wheeled accidents i s certainly much worse than nationally recorded numbers would ind i cate . So , f igures ob tained through p o l i ce records raust be us ed wi th caut ion, especially when making comparison s w i th o ther c lasses of road user . A l though the cas ualty rate per mi leage for two-wheeled vehi cles i s e lus ive for many countries , the numbers of p P. r s on s reported injured and k i l led in many countries is h i gh and increasing (Depar tmen t o f the Environment , 1 9 7 6 and press notice ; Drysdale , Kraus , Franti and Riggins 19 7 5 ; Bo thwe l l , 1 9 60 , 1 96 2 , 1 9 6 3 ; U . N . Economic Commi s s ion for Eruope , 1 9 7 4 ) . In general , e s timates o f accident involvement of different types of veh i c le s show that the two-whee led veh i c le produces the grea tes t rate of accident inj ury relative to mi leage performed than any o ther veh i c le type . Before looking at injury pa tterns i t w i l l be he lpful to note s ome of the character i s t i cs of the two-wheel acc i dent and the user population revealed from an overview of p e rtinent l i terature . Mo torcyc les : There i s a h i gh degree o f cons i s tency about the age and sex b i as of motorcy c l e users . The mo torcy c le operator i s predominan t ly male and under 25 years o f age . Data avai l ab le for motorcy c l e pas sengers show a s imilar trend wi th a sugges t i on o f more fema le s . A large number o f accidents involve co l l i s ions wi th another moving veh i cle . Typic a l l y , the o ther veh i c le making a right-angle turn into the intended path of the mo torcy c l e - ini tially b o th vehc i l es are trave l l ing in oppo s i te directions on the 131 s ame road . The other most s igni f i cant accident c lass are s ingle veh i cle acc idents , involving no o ther moving vehi c le s . They predominan t ly result from loss of contro l . However , the operation o f the aforementioned unreporting b i as prec ludes further conunent about the comparative rate of these two main accident c l as s e s . l t i s important to s tress that subsequent accident-type f i gures typ i cally represent only reported accidents and almo s t certainly do not reflect gene ral acc i dent-involvement trends . There i s an over-invo lvement o f motorcy c l e s w i th more powerful engines . The lower ratio of accident inj uries o c curs among persons us ing sma l l e r mo torcy c l e s ( le s s than 1 25 c . c . ) . Highes t observed ratios are f o r pers ons us ing mo torcycles w i th intermedi ate ( 250-500 c . c . ) or larger engines (500-750 c . c . ) . Further the more powe rful machines are more o f ten involved in s e rious inj ury producing acciden t s . The l arge maj ority o f motorcycle co l l i s ions w i th o ther moving vehi c l e s occur in urban areas :t at speeds unde r 40 m. p . h . Reported s ingle veh i c l e accidents o ccur at a l l speeds , but h i gher speeds are recorded for rural s ingle vehi cle accidents . PEDAL CYCLES The population o f pedal cy c l i s ts is not easy to i s o late . Mul t i speed gearing and improved li gh-we i gh t cons truction p lus the i r convenience and a t tract ivenes s to the environmental i s t , has sharp ly increased the adu l t user population i n recent years . However there remains a h i gh percent age o f chi l dren and teenagers be low the l e gal driving age and of b o th s e xes . Pedal cyc le s are used by the very young in an extension of p lay rather than as a s erious means of transpo r t . Mos t pedal cycles are used on local and residential s treets , therefore they are unlikely to be involved in high speed accidents . De s p i te the recent increase in adult pedal cy c l i s ts , the pedal cy cle accident prob lem predominan t ly involves chi ld re n . Male riders are nearly twice as often involved in acc i den ts as fema le s . l t has been sugge s te d that there i s a greater like lihood o f inj ury when a chi ld i s riding a modern ' h i gh-rise ' machine (high handle bars and a long seat wi th a back res t ) than when r i ding conventional mode l s (Craf t , Shaw and Car t l idge , 1 9 7 3 ) . However envi ronmental and r i de r character i s t i cs may explain this difference . 'Tihe concern caused by the increasing casualty rates of two-whee led vehi c le users i s ref le c te d in the increasing amount of work in thi s area . P ub li shed reports gene r a l ly be long to one o f three categorie s : inves tigations of real accidents ; experiment a l s tudie s ; mathema t i cal mode l ling and computer simulation4 A s e l e c tion of pub l i s hed work cons i dered representative of the overall two-whee l e d veh i c l e acc iden t i s reviewed . STUDlES OF REAL ACClDENTS There are two main me thods of s tudying real acciden ts . l ) A retrospective e xamination o f the accident by use o f information ava i l a b l e from p o l i ce , med i cal , and/or Coroner reports . 2 ) At-the-s cene inve s t i gation o f accidents . Compari son o f the results i s diffi cul t , the data source differs , and the cri te ria for recording and reportin g inj uries seems to vary cons iderab ly . lnj ury data i s s ummarised in F i r s t l y , s tudi es o f the former type w i l l be reviewed w i th tab les 1 to 5 . fatal accident s t udies des cribed at the end . 132 POLICE AND MEDICAL DATA STUDIES Aston and Perkins ( 19 5 4 ) des cribed the inj ur ies sus tained by a l l road acci dent cases treated at the Royal Hampshire County Hospi tal , Winche s t e r , England . There were 2 6 8 motorcy c l i s ts involved ( 3 8% of the tota l ) . N o t only were they the large s t of the various groups reviewed , they also had the highes t proport ion of s evere , but non-fatal inj uries (22% ) . There were 120 cy c l i s t s . One feature o f pedal cyc l i s t s inj uries was the high proportion of upper l imb inj uries compared wi th lower limb s . The authors sugge s t a p o s s i b l e e xp l anation is that pedal cy c l i s ts put out thei r hands to prote c t thems e lves when thrown off their b i cy c le s , whereas motorcy c l i s ts trave l ling at greater speeds , do not have time to do this . Gissane , Bul l and Roberts ( 19 70 ) s tudies 4 , 342 road accident casualties who received treatment from Bi rmingham Accident Ho spi tal , Eng land , during 196 1 . There were 1 1 16 motorcy c l i s ts ( 9 2 4 riders and 192 pas s enger s ) of which 328 were treated as inpatients , 26% of the total inpatient acciden t population . Almo s t one-third of the motorcy c l e accidents involved no other vehi c le s , a s imilar number resul ted from co l l i s ions with car s . I n collis ion accidents , femoral fractures were parti cularly connno n and mos t were due to the p rimary co l li s ion impact . Thirteen percent ( 168) of the inpatient popul ation were pedal cy c li s ts , a further 659 treated as outpatients . Ab out half their accidents involved no other vehi c l e . Whitaker ( 1 9 7 6 ) des cribes inj uries sus tained in 425 motorcycle accidents reported to two divisions of the Thames Val ley P o lice , Eng land during 1 9 7 4 . In the U . S . A. , the motorcycle population and the numbe r of motorcycle accidents has increased mos t marke dly in California, s o , not surprising ly , many mo torcycle (Depar tment of the California accident s tudies have been based in this are a . Hi ghway Patro l , 1 9 6 8 ; Harano and Peck , 1968 ) . Drysdale e t a l ( 19 7 5 ) using police accident reports and hospi tal medi ca l records in Sacramento County , Cali fornia, U . S . A. identified 1 , 2 7 3 motorcycle casual ties for 19 7 0. Offi cial p o l i ce reports were avai lable for only 450 ( 3 8 . 5 % ) of the accidents . Of the s e , 6 3% involved another motor vehicle and accounted for 65% of the s erious inJ uries . Overturning the motorcycle accounted for 2 6 . 6% of a l l accidents and 2 6 . 4% of the s e rious injurie s . Of the to tal s amp l e of 1 , 2 7 3 injured persons , 1 8 ( 1 . 4% ) died , 2 5 7 (20 . 2% ) were hospi talize d and 2 9 3 ( 2 3 . 0 % ) vis i te d an emergency department for treatmen t and received outp atient care . These comprised the serious injury group . The ave rage length of s tay for a l l hospitalized persons was 12 day s , medium length of s tay was 6 day s . The bones mos t frequently injured were in the l e g ( tib ia 16 . 3% , fibula 1 1 . 6% ) o r the hand/wris t ( 1 3 . 4% ) . Thirty percent of the tibia frac tures were open . Multiple fractures or o ther s e rious inj uries were common . Serious inj uries were limited to one of four main body areas . Mos t commonly invol ved were the lower extremities ( 30 . 8% ) , upper extremities ( 2 1 . 7 % ) and the head ( 19 . 0% ) . The immediate cause of de ath for 5 of the 1 8 fatalities was mul tip le traumatic head inj uries wi thout other s e rious inj uries . Helmet use was not reported at the time o f the accident . Motorcy cles wi th more powerful engines (250 c . c . or more) were more o f ten involved in s erious inj ury producing accidents than would be expected from their dis tribu tion in the comparison group (Kraus , Riggins , Drysdale and Franti , 1 9 72 ) . The converse was true for motorcy c l e s less than 250 c . c . A c l inical analysis of 12 7 motorcycle users invo lved in accidents i n Southern 133 California was carried out by Hight , Seige! and Nahum ( 1 9 7 3 ) . The results of the.ir s tudy show definite inj ury patte rns associated with . occupant kinematic motion. Based upon the occupant kinematics they divided motorcycle accidents into three primary c l as s ifi cations : non-ej ected , ej ected, and deflecte d . Non-ej ected occupants typically came to rest within about 10-15 feet o f the impact are a . This group generally sustained the most extensive inj ury patte rn , often including severe to fatal les ions to two or three body areas . In a typical frontal impact the non-ej ected motorcyclis t moves forward in a seated pos1 t1on , the knees contact the s teering and upper fork area. Depending on the amount of pitching the motorcyclis t ' s knees will s trike the opposing vehicle or obj ect fol lowed by head contac t . The upper torso w i l l usually contact the forward surface l as t . Ejected o c cupants were generally airborne along their original direction of travel for more than 10- 1 5 fee t . Two principal e j e ction patterns occurre d . Firs t ly , acc idents invo lving contact with the f ront or rear wing of the other vehicle . Riders were ej ected over the hood or trunk . Overall inj ury severity appeared dependent on whether the head or other part of the body s truck the road surface firs t . Se condly , accidents when the motorcy c l i s t los t control and the motorcycle was overturned. Generally , the occupant deve loped l es s vertical velocity than in the f irs t e j e ction mode . Although abrasions and road burn injuries were impo rtan t , these occupants usually received moderate or less overall injuries when the head was not inj ure d . Def le c ted o ccupants included glancing impacts by the mo torcycle with the opposing veh i c le ' s front or rear corner or bumper or where the motorcy c l i s t was s t ruck on the s i de . Severe leg injury was frequent . Head injuries appeared to be lowe r . Almo s t a l l occupants received injuries to more than one body region, several to mo s t body regions . The most frequently injured part of the body was the head . Persons not wearing a he lmet sus t ained 43% severe head injuries (American Medical Association Abbreviated Inj ury S cale (A . I . S . ) 03-06 ) . In contrast only 2 ( 1 1 %) of the he lmet-wearing group received severe head inj uries . This fi gure excludes five cases of helmet ' failure ' during the impact sequence . In four of these cases the s trap or s trap connector fai le d . After head injuries , legs were the mos t frequently injured area . A high incidence of severe leg injuries (70%) was recorded for the de flected group in comparison to about 35% for each of the other two group s . The def lected occupants were subj e cted to lateral forces which tended to rip or tear the lower leg. Hight et a l comp ared the inj ury severity for operators and passengers on the same motorcycle . They found s ome difference s , occasionally passengers fared be tter in motorcycle frontal co l li s ions because they loaded the operator and were ej e cted without sustaining primary frontal impact inj uries . Where the motorcycle was s truc� on the s i de the inj ury severity was dependent on the velocity of the s triking veh i c le . In accidents where the motorcy c li s t has los t control , the passenger has a tendency to be thrown from the motorcycle firs t . The ride r ' s vertical motion or lateral separation from the machine is limited by holding onto the handlebars . One further inj ury des cribe d , dire c t ly re lated to motorcycle de sign, was the geni talia inj ury sus t ained by s i x male operators . Al though the numbers are smal l , the f i l l e r cap and the front-fork ins trumen t cluster were important causes of this inj ury . 1 34 In North Carolina , U . S . A . , the Highway Safety Research Cente r ' s accident files for 1 9 7 2 were s canned (Griffin, 1 9 7 4 ) . Of 2 , 4 10 motorcycles invo lved in accident s , 706 ( 2 9 . 3% ) were involved in s ingle vehicle accident s , and 1 , 41 8 (5 8 . 8%) collided with a car . A probably bias through unreported s ingle vehicle accidents is repor ted. This i s one of the fßw s tudies reporting es timated motorcycle speeds before the acciden t . For s ing l e vehicle accidents , 7 2 . 6% of the speed es timates lie be tween 20-59 m. p . h . , for motorcycle co l l i s ions with cars , 70 . 1% lie be tween 10-49 m . p . h . Campbe l l , Macb e th , and Ryan ( 1 9 6 7 ) iso lated 3 6 3 motorcycle accidents from Police records in the O t t awa are a , Canada, for 1 9 6 7 . There were 229 inj ury accidents in which 2 83 pers ons were recorded as k i l l e d or injured. No other vehicle was involved in only 1 1 . 2% of the accidents . Hos p i tal records were ava i l ab l e for 180 of the police reported accidents . These were supplemented with 1 7 1 motorcycle cas ual ties no t known to the po l i ce , and the inj ury dis tribution reported. C l ark and Morton ( 1 9 7 1 ) reported on 2 2 6 mo torcycle accidents in Monroe County , New York , U . S . A . in 1 9 69 ) . A simultaneous s tudy of injuries r e s u l t ing from b o th pedal cycle and motorcycle accidents was carried out from J anuary 1 , 1965 to Sep tember 1 , 1 9 6 7 in Wis consin . In Sweden , Backs trom e xamined pol ice reported traffic accident inj uries in Scanai (excluding Lund city ) in 1 9 5 8 . The i r sample included 5 4 1 motorcy c l i s t s and 256 cycli s ts . Gogler ( 1 96 2 ) analy s e d injury data for inpatients of the Heidelberg Clini c , Ge rmany , from 1 95 2 - 1 9 5 8 . B� ( 1 9 7 2 ) de s crib ed injuries received in all accidents i n O s lo and Akenshus County. Several s tudies have focused on the nature of injuries to pedal cyc l i s ts (Aldman , Thomson and Ashb e r g , 1 9 6 9 ; Chlape cka , 1 9 7 4 ; Gui chon and Myles , 1 9 75 ) . Wright ( 19 74 ) reviews s ome of the U . S . based re se arch in this are a . He concludes that about 30-40% of pedal cycle injuries involve the leg, about 20-25% involve the arm, and about 1 5 % are sus t ained by the head . For more serious injurie s , head and facial injuries account for about one-third of the inj uries . McDermo t t and Wood ( 1 9 7 5 ) s tudied 6 1 3 pedal cycle injuries treated at hospital s i n t h e greater Seattle-King County area , U. S . A. over a one year perio d . Most fatal injurie8 w�r� uf Lh� heaJ , bu t inj uries to the shouldcr wcrc cons idered unique to the pedal cyc l e . FATAL ACCIDENTS S latis ( 19 6 2 ) examined 349 cases of traffic accident fatalities in He ls inki , Finland during 1956-1960 . The s e ries includes 45 motorcycl i s ts and 56 pedal cyclis ts . For b o th groups head injuries p redominated but simultaneous injuries to several gross body areas were recorded for 55 . 5 % . They found the numbe r and distrib ution of injuries for motorcy c l i s t s seemed to depend on the type of accident . The number o f injuries sus tained was higher for accidents involving ano ther vehicle ( 2 . 2 injuries / cas e ) than for single vehicle accidents ( 1 . 4 inj urie s / case ) . G i s s ane and Bul l ( 19 6 1 ) s tudied 149 persons who died as the result of road accidents in Birmingham during 1960 and an additional 34 invo lved in fatal road accidents outside the ci ty. Of the total 34 motorcycle deaths , 26 were eje cted from the machine , and s ub s e quently 7 were run-over by other roaJ vehicle s . Seven of the 22 pedal cyc l i s ts were run ove r . Head injuries pre dominat e d , and simultaneous i nJ uries in several b o dy areas was also high . Of the 1 5 motorcy c l i s t s wearing crash h e lme t s , 8 sus tained s ome degree of b rain inj ury . However Gis s ane and Bull report 135 that even in fatal accidents fewer head injuries occur to motorcy c l i s ts wearing crash helme ts . Sev i t t ( 1 9 6 8 ) s tudied material from 250 necropsied road users in Birmingham during 1 9 6 1 - 1 9 6 6 . A later ana lysis of 2 5 4 road deaths in Bi rmingham during 1969 and 1 9 70 was carried out (Sevi t t , 1 9 72 ) . Only the injuries known to have caused or con t ributed to death were recorde d . A l l avai l ab le documents re lating t o 2 1 9 rnotorcycle accidents which occurred i n the Me tropo l i t an P o l i ce Dis trict , England during 1 9 7 0 , 1 9 7 1 and 1 9 7 2 were e xamined ( Renton , 1 9 7 3 ) . There were 2 8 4 users involved , of these 2 2 6 were ki l l e d . The accidents comprised 62 (28%) s ingle vehicle accidents , but in 46 ( 74%) of these the mo torcycle co l l ided with s omething else . Only 2 3% (SO) of the riders and 1 2% ( 8) of the pas sengers were be lieved to have received their most serious injuries frorn other vehi c l es , however a l l but 3 of these were fatal . Thirty-five percent ( 76 ) of the riders and 5 1% ( 33) of the passengers were mos t seriously injured by the road surface , of these 72 were fatally inj ured . Tonge, O ' Re i l ly and Davison ( 1 9 6 4 ) analysed data on 2 2 1 4 traff i c accident fatali ties occurring in Brisbane , Aus tra l i a , during 1 9 35- 1 9 6 3 . Brain damage occurred in 85 . 3% of total motorcycle casua l t ies and 80 . 1% of a l l pedal cyclis t s . I n 70 . 3% mo torcy c l i s ts and 7 1 . 3% pedal cy c l i s ts there was an as sociated skull fracture . The incidence of crash helmet wearing was not reported . A continuation of this s tudy was carried out for 1 96 3- 19 6 8 . (Tonge , O ' Re i l ly , Davison and Johnston , 1 9 7 2 ) . There was no change in proportion of head fractures , but there was a decrease in the occurrence of brain damage . Only 4 mo torcy c l i s t s were known to be wearing a crash helme t . J amieson and Tait ( 1960) report an inves tigation of 1000 consecut ive admi s s ions to hospi tals on deaths due to traf f i c accident inj ury in Brisbane during 1962- 1 9 6 3 . There were 1 5 1 rnotorcy clis ts and 7 0 pedal cycl i s ts . Injury distribution for motorscooter riders , p i l lion pas sengers , and other two-wheeled motor vehi cle users were simi l ar . However there was a greater incidence of severe mul ti p le injuries in the latter group . Injury patterns of p i l l ion passengers sugge s t they are protected by the rider from the ini ti a l frontal con tact inj ury . Hodge ( 1 9 6 2 ) reported an inves tigation of injuries for 1 7 4 road accident deaths in the Adel aide metropo l i tan area during 1959- 19 6 1 . Twne ty-eight mo torcy c l i s t s were k i l led , 2 4 sus taining fractured skul l s . Henderson ( 1 9 70) e xamined p o l ice records for 120 motorcycle accident fatalities in New South Wales , Aus tral i a , during 1970. Al though the data source did not provide detai l ed injury dat a , in 72 . 5% of the samp l e head and /or neck inj ury was reported as a maj o r cause of death . Graham ( 19 6 9 ) looked a t autopsy reports for 324 of 352 motorcycle f atalities in Los Ange les , Cal i fornia from 1 9 6 2- 1 9 66 . AT-THE- S CENE INVE STIGATION Jamieson , Duggan , Twedde l l , Pope and Zvirbulis ( 19 7 1 ) report on 2 1 8 accidents attended Brisbane during 1 9 6 3 . Only 14 were mo torcycles , invo lving 18 persons , and there were 9 pedal cycl i s ts . Although the numbers are small they found that the severe .motorcy c l i s t injuries resu l ted frorn vehicle con tact . 136 An at-the-s cene inves t i gation of injury producing traf f i c accidents was carried out in Ade laide , Aus tralia in 1963 and 1 9 6 4 (Robertson, McLean , and Ryan 1966 ; Ryan , 196 7 ) . The 408 accidents inves tigated included 74 motorcyclists and 45 pedal cy clis ts . About one - third of all two-wheeled veh icle accidents invo lved co l l i s ion with cars or trucks . Fractures of the lower half of the tibia and f ibula were common , attributed to contact w i th the car bumper . When the s ide of a motorcycle is hit by the front of a car , the legs of the rider are exposed to direct impact from the front of the car , particu l arly the bumper b ar . Al though the bumper height varies with vehicle make , a t the time o f this s tudy , the authors recorded the bumper bar generally about 6- 1 2 inches above the foot r e s t of the cyc l e . They a l s o concluded that fractures of the sma l l bones o f the hand were typically caused as the motorcycle handgrip swung agains t the car . The road was reported the most connnon cause of head inj urie s . Howeve r , overal l , injuries sus tained through vehicle contact were more severe . Kolbus zewski , Mackay , Fonseka , Blair and Clayton ( 1 9 6 9 ) describe at- the-s cene inve s tigation o f 425 road accidents in Bi rmingham during 1965 and 1 966 , and 2 10 in Worcestershire 1 9 6 7- 1 9 6 8 . The proportion of motorcy clis ts who were concus s e d was higher in frontal impact co l l i s ions . S ide impacts resulted in a higher proportion of leg fractures (McLean and Mackay , 1970) . The injuries received by 17 riders were compared with that of their passengers . The riders received more lower leg and arm fractures , though there was no diffe rence in the incidence of concus s i on. Newman and Webs te r ( 1 9 7 4 ) des cribe an at-the-s cene inve s t i gation of 1 3 3 motorcycle accidents in O t t awa, Canada during 1 9 7 3 . Over 65% of the 100 accidents reported to the police invo led ano ther vehic le . Single vehi cle accidents predominantly resulted from loss of contro l . The large s t proportion of al l accidents ( 20 . 6%) In an analysis of the inj ury mechanics of the occurred at an interse c tion . motorcycle accidents , Newman and Webster are in general in agreement with Hight et al. Notwi ths tanding the difference in s tudy me thodo logy there i s gene ral agreement that the overal l pattern o f inj ury sus tained by users of two-whee led vehicle s , is one o f severi ty and mu ltiplici ty . Head injuries predominate , fol lowed by lower l imb injuries and then injuries to the upper arm. Injuries sus tained corne from three primary sources - the machine , the obj ect s truck , and the road surface . Typ i cal ly two-whee l e d vehicles are invo lved in two types of accidents . 1 ) Co l l i s ion with another vehic le . The oc cupant is protected from the machine , sometimes receiving injuries as he/she passes over the handle bars . However the maj or traurna are sus t ained during the primary impact with the other vehi c l e . The o ccupant then f a l l s to the ground where additional injuries may be received from the road surface or other intervening obj e c ts . The machine is usually badly darnaged , front wheel and front fork distortion is typical . In more severe accidents dis tortion may extend to the frame . 2 ) Single vehicle accidents as the ride r looses control of the machine . As the machine overturns the rider usually s lides along the road surface independent of the bike . The rider s trikes whatever obj ects may be in his /her path . There is l i t t l e damage to the machine . EXPERIMENTAL WORK Severy , Brink and B laisde l l ( 1 9 70) report on 7 co l l i s ion e xperiments be tween a motorcycle and rider s triking the s i de of a passenger car . Independent variab les 137 s tudied were speed at impac t , s ize of motorcy cle , pos ition impacted along the · s i de of the passenger car . Methodology, including apparatus and dunnny specifi cations is des cr :lb e d . A t impact the ' rider ' s l ides forward maintaining a normal seated posi tion un til its knees impact an opposing s tructure . The knee contact causes the torso to undergo a j ackknife action frequently accompanied by torso e levation over the hand lebars and into or rotating over the car . Damage to the mo torcycles was confined almo s t exclus ively to the front whee l suspension sys tem. In gene r a l motorcycle col lapse was comp l e te 40-60 ms fol lowing contac t , after maximum col lapse the rear of the motorcycle e levates , then re turns . The sequential nature of the mo torcycle co l l apse produces a continuous dece le ration pattern . Considering this and the extended dis tance availab le for the motor cyc l i s ts to decelerate before impact they sugge s t a pass ive restraint sys tem for the legs and torso would al low the rider to decelerate in a much safer manne r . Prote ction would b e given during primary impact without s igni ficantly reducing the handling character i s t i cs of the mo torcycle . A series of 4 1 motorcycle tes ts were run at the Mo tor Indus tries Re s e arch As soci ation Crash Tes t Faci l i ty , Nune aton, England (Peterson and Bo thwe l l , 1 9 7 3 ) . They were the beginnings of a progrannne initiated by the University of Denver Re s e ar ch Ins ti tute to es tab lish the role of the various aspects of mo torcycle des i gn in producing injuries and so to provide safety performance Standards . The tes ts simulated a representative group of traffic accidents . Several hazards in perpendicular impacts were identifie d , i . e . the fire hazard created by ' f lip-top ' f i l l e r caps and fibre g lass fuel tanks from the ini tial p e lvic impact on the fuel-tank ; leg/pelvis imp act with handleb ars /s teering head and other body contacts on sharp proj e ctions on the motorcycle . Taneda ( 19 73) reports on ini tial experiments in Japan on the simulation of mo torcycle co l li s ions with a fixed or moving barrie r . COMPUTER S IMULATION Three digi tal computer programmes have been developed by the Unive r s i ty of Denver Denver Research Insti tute (Pe terson and Bo thwe l l , 1 9 7 3 ) . Firs t ly , a two-dimens ional ten degree-of-freedom model of the motorcycle and rider was deve lop e d . The se cond progrannne is a modified version of the f i rs t . The third progrannne is a digital computer simulation o f the three-dimensional notion of a nine degree-of-freedom mode l of the motorcycle , Work is curren t ly underway to modify the CALSPAN 3D-Occupant-Simulation for use as a model for the 3D notion of the motorcycle us e r (Fleck , But ler and Voge l , 1 9 7 4 ) . COUNTERMEASURES Except for the advent of the protec tive helme t , there has been no s i gnifi cant injury protection device for users of two-wheeled vehicles . Crash he lme ts The high incidence of head injuries for a l l types of two-whee led traf f i c accidents 1 38 is we l l e s t ab lishe d . Cairns ( 19 4 1 ) reported on the s ignifi cance o f the crash he lmet in the reduction of head injuries . Crash helmets have improved a great deal s ince then , and p re s ent day helmets are manuf actured according to more rigorous de s i gn specifications . Avai lab le res earch li tera ture shows that the use of prote ctive helmets is an effective means of reducing the occurrence and seve r i ty of head injuries in accidents (Chandler and Thompson, 1 95 7 ; Fo ldvary and Lane , 1964; Honda Overseas Driving Safety Promotion Commi t tee , 1 9 7 2 ) . Several s tudies report that the presence or absence of crash helmets have li t t le effect on the incidence o f head injuries . However , such conclusions are usual ly i l l-founded . There is a typical s ample b i as - only motorcycle accidents resul ting in injury sufficient to cause death or require hospi tal treatment are include d . I t seems highly likely that on occas ions where a he lme t effe ctively prevented any head inj ury , no as s i s tance was neede d , and so the accident was no t reported. Crash he lmet ' f ailure ' has been reported. Frequently failure of the fas tening device to adequately re tain the helmet in pos i t ion for the duration of the accident (Renton, 1 9 7 3 ) . I t seems obvious from reported inJ ury patterns , that head prote ction should extend to the pedal cyc l i s ts . Lewicki and Newman ( 1 9 75 ) discuss this need and outline specific requirements of such a helme t . Efforts have not only been directed a t improving the performance o f protective Imp rovements in motorcycle des i gn is the subj e c t of an increasing number helme t s . o f pub lished reports (Second International Congres s , Bar to l , Livers and Hirsch , 1 9 7 3 ) . The s tructural s afety measures can be divided into two main categorie s . Firs tly , accident prevention s afety measure s . These inc lude an ti-skid devices , improved s teering/handling characteri s ti cs , improved tyre performance , increased machine visib i l i ty , e t c . Se condly , safety measures for the reduction of the severity of o ccupant inj ury . Severy e t al ( 1 9 70) sugge s t that substantial inj ury reduction in motorcy c l e / auto mob ile c o l l i s ions can be accomp l ished by modi f i cation of mo torcycle des i gn . They cons ider i t would be impractical to improve the s ides of cars s o as to at tenuate the force of impact t o r the motorcyc l i s ts . The recognition o f the high incidence of lower l imb injuries is reflected in the avai lab i l i ty of crash b ars and leg shie lds . However their current de s i gn is inade quate . Accident cases h ave been reported whe re these leg ' guards ' have folded back , and trapped the l eg agains t the res t of the machine (Kolbus zewski e t al , 1 9 6 9 ; Japanese Council o f Traffic Safety , 1 9 7 1 ) . Bo thwe l l ( 19 6 2 ) sugges te d that the b e s t protect ion to the motorcy c li s t would be gained by a combination of s ome s o r t of retentive harne s s and suitab ly shaped ro l l-b ars . Wes co t t ( 1 9 75 ) extends this concep t . Using s caled mode ls he describes rather extreme des i gn modifications to ensure motorcy c l i s t retention and pro te ction during accidents . 139 INTRODUCTION TO PEDESTRIAN INJURY STUDY Three dis tinct methods of s t udying the prob lem of inj ury causation to pedestr ians are use d ; they are the inves tigation of real accidents , the reproduction o f accidents b y experimental tests and the s imulation of accidents b y mathematical mode l l ing. Accident s tudies can be based on the data that are routinely noted by the po l i ce or the hosp i tal s , or on data col lected by specific accident s tudies . The first s tudies of pedes trian accidents described the inJuries sus tained by pedestrians and compared them with other road user casual ties . Thes e s tudies based on medical dat a , whi l s t describ ing the nature and location of the injuries provided no information about the accident circumstances or the cause of the inj ury The use o f police data enab les the general overa l l features o f accidents to be describ e d , for examp l e factors such as the age and sex of the casua l t ies , the total number of casual ties , the time and date of the accident and the vehicles invo lved can b e adequately cons idere d . However data on the injuries sus tained is limited due to the methods us ed for noting inj ury . In Great Bri tain the following injury c l as s i f i cations are us e d : ' S light Injury ' - an inj ury of a minor character such as a sprain, bruise or a cut or laceration not j udged to be severe . ' Serious Inj ury ' - an injury for which a person is detained in ho spital as an ' inpatient ' or any of the fol lowing injuries whe ther or not he is detained in hospital : fractures , concuss ion , internal injuries , crushings , severe cuts and lacerations , severe general shock requiring medi cal treat men t . ' Ki l le d ' - died wi thin 3 0 days o f an accident . By combining p o l i ce and medical records the maximum amount of information can be gleaned from the data that are routinely no ted . Differences in inj ury pat terns b e tween different types of accidents can be examined and given large enough samp les i t is possib le that differences in inj ury patterns be tween different vehi cle types can be shown . The usefulness of this data is limited by the information ava i l ab l e ; the police rarely note the exact location and nature of the pedes trian contacts on the vehi c l e , or ascertain the speed of the vehicle at impact . When i t is required that the cause of inj ury be determined i t is ne ces s ary to carry out accident s tudies with this as one of the obj ectives ; this type of s tudy norma l ly requires an at-the-scene inve s t i gation b y ski l led accident inves tigators . A number of s tudies have been made throughout the wor l d , the maj ority o f which have cons idered a l l road users not j us t pede s t rians . Experimental work ranges frorn the tes ting of various sect ions of the vehicle s tructure , for exarnp le the st iffness of the b onne t , to the reproduction of real accide�ts using anthroporne tric dummies and cadavers . Mos t of the experimental tes t work performed has used anthropornetric dunnni es and has been concerned with inves tigating the variations in pedes trian dynarni cs with changes in vehi cle shape and impact ve locity . Tests have been performed using real vehi cles and tes t vehi cles in which the vehi cle shape parame ters can b e eas i ly al tere d . One important aspect of cadaver work has been the determination o f human tolerances . 140 Another approach to unders tanding the dynamics of pedes trian accidents is the use of mathematical mode ls and computer simulation, the accuracy of the s imulation depending on the sophi s t ication of the mode l . The use of anthropome tric dunnni es in experimental tests and mathematical mode ls in computer s imulations has led to the development o f methods to predict the severity of injuries that could be e xpe cted in similar real accident si tuations , so that comparisons b e tween different des i gns can be made . In the fol lowing pages a b rief review o f the pub lished work on pedes trian injuries and vehi cle des i gn w i l l be made . REAL ACCIDENT STUDIES INJURY STUDIE S The various medi cal s tudies that h ave described pedes trian injuries can be divided into two main groups ; those which des cribed the injuries sus tained by fata l ly inj ured pedes trians and those which reported on a l l casualties . S tudies of the latter type wi l l be considered firs t . Aston and Perkins ( 19 5 4 ) reported on a l l road accident casua l t ies treated at the Royal Hampshire Ho s p i t a l , Winche s t e r , England in 195 1 and 1 9 5 2 . Gis s ane , Bull and Roberts ( 1 9 70) described the injuries sus tained by one year ' s admissions , 1 9 6 1 , to the B i rmingham Accident Hospi t a l , and the long term consequences of those inj uries . In Germany Gogler ( 19 6 2 ) considered in-patients treated in Heidelburg clinic b e tween 1 9 5 2 and 195 8 . In S candinavia Backstrom ( 1963) described the injuries received in traffic accidents in S cania , South Sweden , excluding the city of Lund, for the year 1 9 5 8 . B� ( 19 72 ) described injuries received in a l l accidents around O s l o , Norway . In b o th these s tudies a l l severities of inj ury were take n . McN i co l-Smith and Le theren ( 19 6 1 ) reported on one years admi s s ions , from Apri l 1 1 9 5 9 to March 31 1960 , to Alfred Hos p i tal , Melbourne , Aus tralia . Jamieson and Tait ( 19 6 6 ) considered 1000 consecutive hospital admiss ions or fata l i ties resulting from accidents in the c i ty of Brisbane . In a l l these s tudies pedes trians formed only a sma l l proportion of the total s tudy . The s tudy b y McNicol-Smith and Letheren was based on a l l accidents whi l s t the other s tudies reported s o l e ly on road accidents . Direct comparisons be tween the re sults of these s tudies are not pos sib le due to the differences in definit ions and se lect ion criteri a . Aston and Perkins , Back s trom and B � described a l l severities of inj ury , whi l s t the other s tudies consid ered only hospi tal inpatien ts . The de scriptions of injuries varied throughout the s tudies , for e xamp le Aston and Perkins divided the body into head and neck, trunk , arms and legs ; the arms and legs b e ing further subdivided into left or righ t , and above or be low the e lb ow : Gogler s p l i t the body into head , spine , ehes t , abdomen , p e lvis , upper limbs and lower limb s . Table 6 gives de tai l s of these s tudies . N o t withs tanding the differences b e tween the s tudies there is general agreement that head injuries predominate , f o l lowed by injuries to the lower limb s . Injuries to the upper limbs ranked third. 14 1 Tab le 7 sunnna rizes the results of the various s tudies of fatal pedes trian dCCLdents . Again direct comparisons b e tween the s tudies are not possible due to differences in the description and severity of inj uries note d . Tonge e t a l ( 1969 , 1 9 7 2 ) in describing leg injuries have divided the legs into left and right s i de and upper and lower l e g . Other authors have considered all leg injuries togethe r . However general conclusions about the pattern of inj ury can be rnade , there being general agreernent that the head is the area mos t frequently inj ured followed by the lower limbs including the pelvis , the thorax, the abdornen and finally the upper limb s . POLICE DATA STUDIES Hutchinson ( 19 7 4 i , 1 9 7 4 i i ) at Unive r s i ty Col lege London has analysed national police s tatis tics to inves tigate the differences in injury severity sus tained by pedes trians s truck by different vehi cle types . He used as a measure of severity the ratio of severe injuries ( s erious and fatal inj uries ) to a l l injuries and , in order t o minimize the effect of spee d , only accidents occurring in areas sub j e ct to a 30 mph ( �50 km/h) speed lirnit were cons idere d . He found sma l l but s tatis tica l ly s i gnifi cant differences b e tween the severity of injuries for different car types but was unab le to re late the differences to variations in vehicle shap e . Vaughan ( 19 72 ) in a s tudy in Sydney Aus tralia supp lied special forrns for police officers to cornplete on pedes trian accidents so that more data than that routinely noted could b e obtained . He cons idered the first location of the contact on the vehi c l e , the action of the pedes trian and the speed of the vehi cle at impact. The sarnp l e cons i s te d of 119 pedes trians of whom 19 were ki l led . At leas t 16 of the 19 fatalities had head injurie s , in the other 3 cases exact details of the injuries were not known . Fifty two persons had injuries classified as severe and 18 ( 34 . 6% ) of those pedes trians had head inj uries . There was no s ignificant difference b e tween the mean impact speed of the fatal and severely injured ped es trians but there was a difference be tween the mean impact speed of those groups and the moderately injured pedes trians . McLean ( 19 72 ) in New York used data co l lected by the police to inves tigate the differences in injury severity sustained by pede s t rians s t ruck by Cadi l lacs and Volkswagens . He supp lemented the police data by ques tionnaires to pedes trians and drivers . From an initial s amp l e of 5 35 Cadillacs and 584 Volkswagens , the exclusion of cases where the contact was not fronta l , where no e s t imate of impact speed could be made and where there was insufficient information to determine the inj ury severity , limited the final analysis to 1 5 2 Cadil lacs of which 9 invo lved fata l i t i es and 1 6 6 Volkswagens of wh ich 7 invo lved fata l i tes . l t was from this samp l e that the conclusions that "A pedes trian is more likely to be ki l led if he is s truck by the front of a Cadi l lac rather than by a Vo lkswagen" and "half of the pedes trian fatalities occurring in col lis ions with the fronts of Cadi l lacs may be able to be e l iminated by rede s i gning the shape of the front of the car" were made . The sma l l number of fatalities in each group makes the reliab i l i ty of the conclusions questionable as the differences could have arisen due to variations in inj ury susceptib ility due to age differences and injury to lerance dif ferences . Indeed at one s t age in the analysis it was noted that "Cad i l lacs have a higher case fata l i ty rate but Volkswagens have a higher rate of severe injuries" 142 0 A s tudy o f one year ' s pedes trian accidents in New South Wales (Fisher and Hal l , 1 9 7 2 ) us ed routine police dat a . A description of the injuries sus tained b y the injured and k i l led was given using the inj ury data noted by the police officer, but it was noted that this was the leas t rel iab le data in the s tudy . Neverthe less the reported pattern of injuries was in general agreement with that reported in other s tudies . The influence of frontal des i gn on injuries was cons idered by grouping the vehicle makes into three groups , each having different frontal shapes ; these shapes were a) h i gh square front consisting of Ford Falcon and Fairmont , b ) low square front cons is ting of Morris Mini and 1 100 and c ) low s loping front consis ting of Volkswagen Bee t le . No s i gnifi cant difference in the numher of injuries per accident was found but there was a signifi cant diffe rence in the fatality rates , fatalities being over-represented for the Vo lkswagen Bee t le and under-represented for the Ford group . l t mus t be noted that the number of fata l i t ies invo lved were sma l l being 7 , 8 and 12 for the three shapes respectively and the reservations noted to McLean ' s s tudy app ly . l t was found that head injuries were more frequent ( 6 4 . 6% ) in the Volkswagen Beetle group than in the Mini / 1 100 group (55 . 0%) and the Ford Falcon/Fairmont group (43 . 1%) , ( the differences however were j us t not s i gnifi cant at the 5% leve l ) . ACCIDENT STUDIES The data ava i l ab le from the detailed s tudy of real accidents ranges from the pre sentation of a single case in great detail to the analysis of large numhers of accidents each of whi ch has been subj e c t to an in-depth inves tigation . Schmidt and Nagel ( 1 9 7 1 ) gave de tails of an accident in which prompt medical at tention resulted in the survival of a female pedes trian s truck by a car at approximately 50 m . p . h . ( 80 km/h) . In Aus tralia at-the-s cene s tudies have been carried out in Brisbane by Jamieson e t al ( 19 71 ) and in Ade laide by Robertson , McLean and Ryan ( 1966 ) . In the Brisbane s tudy Jamieson e t a l , inve s t igated 49 accidents involving 5 1 lt was pedes trians ; 3 4 o f these pedes trians were s truck by the front o f a car . found that, considering a l l the pede s t r ians and a l l severities of inj ury , head and l e g inj uries were the injuries most frequently sus taine d ; 6 4 . 7% sus tained head injuries , 70 . 6% injuries to the right leg and 7 2 . 5% injuries to the left leg. The 34 cases where a pedes trian was s t ruck by the front o f a car were considered in some detai l , but the sma l l number of cases made comparison of the factors influencing inj ury impossib le . However it was sugges ted that when the vehicle is braking i t is preferab l e for the motion of the pedes trian after impact to cons i s t o f trans lation , rather than rotation , as rotation of the head towards the car can result in head impacts on the s tiff vehicle s tructures and rotation away from the car exposes the pede s t ri an to being run over by the vehi cle . Robertson, McLean and Ryan reported on 79 accidents involving 82 pede s t rians ; 6 3 of the pedes trians were invo lved with cars and 4 5 were s truck b y the front o f a car . For pedes tri ans s truck by cars , and for a l l severities of injury, injuries to the head and the legs were the injuries most frequen t ly sus tained 8 7 . 3% re ceiving lower limb injuries and 76 . 2% head injuries . l t was noted that 83 . 6% o f the leg injuries and 3 5 . 4% of the head injuries resulted from vehi c l e contact . Half the fatal head injuries came from vehi cle contact and half from ground contac t . In an attempt to cons ider the effect of vehi c l e shape on inj ury severity a comparison · was made of the seve r i ty of injuries sus tained by pedes trians s truck by the front of Vo lkswagen 1200 ' s and Ford Falcons . l t was concluded that : 143 ' (a ) b e l ow 20 m . p . h . ( <. 30km/h) a Falcon is more likely to injure a pedes trian seriously than is a Volkswagen 1 2 00 . (b ) in the speed range 20-25 m . p . h . ( 30-40 km/h) the inj ury producing potential is the same for each of these two cars . ( c ) above 25 m . p . h . (40•km/h) the Volkswagen 1200 wi l l probably cause more severe injuries than the Falcon ' However the small number o f cases available for analy s i s , 6 Volkswagens and 6 Falcons , makes these conclusions extremely tenuous . Variations in the age of the pedes trians in each group could have a greater effect on inj ury severity than the vehi c l e shap e . Wooler ( 19 6 8) reanalysed the re s u l ts o f these two s tudies with particular emphas is on the speeds of the vehi cles . He cons idered the re lationships b e tween impact speed and trave l ling speed and concluded that at trave lling speeds greater than 25 m . p . h . ( 40 km/h) the impact speed is norma l ly close to the trave l ling speed. The Transport and Road Re search Laboratory in the United Kingdom (T . R . R. L . 1 9 7 4 ) have s tudied pedes trian accidents using a follow-up technique , the vehi cle being e xamined a few days after the acciden t . The s tudy reported on mechanisms of inj ury to 104 pedes trians requiring hospi tal inpatient treatment and 45 fatally injured pede s trians . l t was reported that ' the region of the body mos t commonly injured by contact with the vehi cle is the lower leg' and that ' for the upper part of the body . . . contact with the ground is of almes t equal importance as a cause of injury ' The b umper bar was identified as b e ing respons ib le for 84 . 1% of lower leg injuries and the windscreen frame as respons ib le for 33 . 9% of the head inJ uries . The se figures only refer to si tuations where the cause of inj ury could be es tab li shed . In 22 . 0% of the injuries the cause could not be de termined . In Germany at-the-s cene accident inve s tigations have been carried out in Hannover and Berlin under the direction of the Institute of Automotive Engineering at the Technical University Berlin . Wanderer and Weber ( 19 74 ) reported on 50 pedes trian accidents . They suggested that approximately two-thirds o f minor injuries (65 . 6% ) were caused b y ground contact but that for the more severe injuries the vehicle was most frequently respons ib l e ; for AIS 04 83 . 3% of the injuries were vehi cle induced. Figures were presented showing the average AIS rating by impact speed for vehicle contacts and ground contacts for two vehi c l e shapes , the Volkswagen Bee t le and the more connnon rectangular front s tructure or ' pontoon form' . l t was sugges ted that there was li ttle difference in the severity o f ground induced injury sus tained b e tween the two shapes but that at higher speeds less severe injuries followed contact by the Volkswagen . Once again only a sma l l number of cases were availab le for analysis and the resul ts mus t be treated with caution. S turtz et al ( 1 9 74 ; 1 9 7 5 ) have described the s tudy in greater detail and in a review paper by Appel , S turtz and Gotzen ( 19 7 5 ) the various res ul ts of the study were presented. Appel et al reported on 150 pedes trian accidents ; 80 of which involved children defined as a person under 15 yrs o l d . lt was noted that contact with the vehi c le 144 generally produces more severe injuries than contact with the roa d . were divided into three main shapes . Vehicles - the box form : - these are vehicles �ith a flat front s tructure such as the Volkswagen Minibus - the pontoon form : - the normal rec tangu lar f ront s tructure - the ' v ' form : - these are vehicles with a low front s tructure and smoothly curved bonne t s tructure such as the Vo lkswagen Beetle l t was found that injuries from contact with the box form were generally more severe than injuries f o l lowing contact with the pontoon form or ' v ' form. At low speeds , less than 4 3 km/h ("' 2 7 m. p . h . ) the pontoon form is more dangerous than the ' v ' form but that at higher speeds the converse is true . Differences in inj ury pat terns b e tween the various shapes were noted. For children the head was the body area mo s t frequently involved for all three shapes . With the pontoon form 54% were reported to h ave upper leg injuries and 28% lower leg injuries whi l s t w i th the ' v ' form 1 1 % had upper l e g injuries and 6 7% lower l e g inj uries . No injuries to the legs were recorded for the b ox form. The number of pedes trians contacted by each shape and their age dis tribution was not given, consequently the confidence of the results is open to que s t ion . For adults it was noted that ehe s t injuries were rnore frequent with the box form than the o ther two forms and that abdominal injuries were more frequent with the box form and the pontoon form than with the ' v ' form. These variations in inj ury with vehicle shape for b o th the chi l dren and adults are what would be expected from considering the areas of the body exposed to the ini tial vehi c le contac t . The que s t ion of different inj ury potential b e tween the various vehicle shapes was a l s o considered by Schneider and Be ier ( 1 9 7 4 ) . They noted the injuries sus tained by pedes trians s truck by the three b a s i c shapes using data from autopsies and police reports . The effect of the location of the leading edge of the pontoon form was cons idered by taking cases where the leading edge was a) near the centre of gravity of the pedes trian , and b) about 20-38cms ( 8- 1 5 inche s ) be low the centre of gravity . Differences in inj ury between the different shapes were note d . For e xamp le when the pede s tr i an was s truck at the centre of gravi ty , pelvic injuries were more frequent than femoral injuries but when the cont act was b e low the cPntrP. of gravity the converse was true . When the s triking vehicle had a ' v ' form then i t was found that b o th pelvic and femoral injuries were infrequen t . An at-the-s cene s tudy of accidents including pedestrian accidents has been carried out in the City of Houston by the Universi ty of Houston (Tharp 19 7 4 ; Tharp and Tsongos 19 74 ) . One hundred and seventy five ( 1 7 5 ) accidents invo lving 190 pedes trians ; 1 35 accidents involving 148 pedestrians were classified as frontal impac ts . When only cases where the pedes trian sus tained a direct b l ow from the vehi c le , rather than a glancing contact i . e . corner contact are cons idere d , the total reduces to 103 acciden ts . The relat ionship b etween impact speed and severity was examined by performing a regression analy s i s on impact speed and inj ury severity rated on the Abb reviated Inj ury S cale ' ( i n the ana lysis the original version of the AIS in which the f atal i t i es were divided into different leve ls was used) . From this analysis it was concluded tha t : ' a) A fata l i ty w i l l result only occasionally ( le s s than 5 % probab i l i ty ) from a colli sion when the vehicle speed is 2 0 m . p . h . ( 32km/h) o r les s . b ) Multiple fatal injurie s , . . . re sult from impact speeds above 30 m. p . h . ( 4 8 km/h) . 145 c) The average impact speed for an injury severity of AIS 04 ( serious injury) is 22 m . p . h . ( 35 km/h) with 90% confidence levels at 11 m . p . h . ( 1 8 km/h) and 3 3 m . p . h . ( 5 3 km/h) . ' These results take no account of the age of the pedes trian . l t was s tated in the report that the correlation coe ffi cient for age and severity varied b e tween 0 . 35 and 0 . 2 4 whi l s t the correlation coefficient for impact speed and severity was 0 . 86 . However a comparison b e tween pede s t rian age and impact speed sugge s te d that these variab les were relate d ; a greater proportion of chil dren i n the sample b e ing involved in low speed ( < 15 m. p . h . ( 2 4 km/h) ) accidents . Corne l l Aeronautical Laboratory conducted a s tudy of 265 car-pedes trian accidents in Toronto as part of a s tudy into pedestrian, mo torcycle and cycle accidents ( C . A. L . 1 9 7 1 ) . The s tudy was based o n accidents inves tigated e i ther b y the police using specia l ly des i gned forms or by an accident inves tigation team from Corne l l . In addition the team from Corne l l extended the data on those accidents inves tigated by the police by follow-up procedures . In describing the injuries , a l l injuries to the various body areas were no ted , rather than the mos t severe inj ury as in mos t o ther s tudie s . The pedes trians were divided into two groups , children and adu l ts , by height of pedes trian rath e r than age , the dividing l ine being a height of 48 inches (122 cms ) . An�lysis of the data was by these height groups , by two speed groupings - less than 20 m. p . h . ( 32 km/h) and greater than or equal to 24 m. p . h . ( 32 km/h) by type of vehi cle - Ame ri can cars , foreign sports cars and Vo lkswagen bee t le s , and by location of con tact - front or s i de . l t was reported that for frontal impacts with American cars 45 . 9 % of a l l injuries to adults and 5 1 . 6% o f all injuries to chil dren were vehicle induced and that if only non-minor injuries are cons idered the importance of vehicle induced injuries increases ; 64 . 9% o f non-minor injuries to adul t s and 7 1 . 9% of non-minor injuries to children being vehicle induce d . Head injuries were the mos t frequent inj ury sus tained by chi ldren accounting for 3 3 . 6% of a l l injuries . For adults head injuries were the s e cond most frequent inj ury accounting for 20 . 0% of the injuries , leg injuries accounting for 3 3 . 6% of the inj urie s . lt was noted that the maj ori ty of minor head injuries were ground induce d ; 7 7 . 8% of the minor head injuries sus t ained by adults and 7 1 . 4 % of those s us tained by chi ldren being cause d by ground contac t . However for non-minor head injuries i t was found that for adults 49 . 4% were caused by veh i c l e contact but that for chi l dren 80% were caused by vehicle contact . In England on-the- spot s tudies of accidents in Bi rmingham in 1 9 65 and 1966 and in Worcestershire in 1967 and 1 9 6 8 provided data on 103 pede s t rian accidents . The me thodology of these s tudies was reported by Kolbus zewski e t al ( 1969 ) . McLean and Mackay ( 19 70) sugges ted that child pedes trians were less severely injured than adults and that this could be due to differences in impact speeds and locat ions of ini t i a l contact on the vehicle rather than differences in inj ury tolerance . Fonseka ( 19 6 9 ) noted that chi l dren , ' be cause of their sma l l height and low centre of gravity they were thrown downwards . Provided they are no t run over thi s appears be tter than being thrown upwards to be h i t by the res t of the car ' . A further s tudy of only pede s t rian accidents was s tarted in Sep tember 19 7 3 . Ashton, Hayes and Mackay ( 19 74) described the resul ts of the firs t 100 accidents inve s t i gated in the s tudy together with an analysis of the cases inve s t igated previous ly . Particular atten tion was paid to the ques tion of bumper location and it was shown that a b umper height of 1 8-20 inches (45-50 cms ) results in the maximum number of pedes trians sus taining a direct knee contact . In a l ater report on 1 7 1 pedes trians s truck by cars or car derivatives (As hton 1 9 75) it was s tated that ' - chi ldren sus tain less severe injuries than adults at high impact speeds and that this is mainly due to their sustaining less severe 146 head injuries . - for b o th children and adults the head is the body area sustaining most life threatening or fatal inJuri es . - l ife threatening or fatal head injuries are more of ten caused by vehicle contact than road contact . - the windscreen frame is responsible for mos t of the l i fe threatening o r fatal head injuries caused by vehicle contact . At the end of this review are Tab les 6 through 9 which s unnna rise the dis tributions of injuries to pede s trians des cribed in these various s tudie s . Table 6 l i s t s the re l ative frequencies of injuries to the body areas of pede s t rians based on s tudies of hosp i ta l data. Tab le 7 sunnna rises the same type of data for fatally injured pedes trians . Table 8 s imilarly lis ts the rel ative frequencies of injuries to various body areas for pedes trians b ased on field accident s tudy data. These three tables ( 6 8) are all tabulations of the injuries per person. Tab le 9 l i s ts the data in an alternative form, i . e . the rel ative frequency of injuries to body areas out of the total number of injuries (not persons ) in the samp l e s e xamine d . - 147 EXPERIMENTAL WORK A comprehensive programme investigating probl eros of pedes trian protection is being carried out at the Ins ti tute of Automo tive Engineering, Be r l in Technical University . A s eries of vehi cle-pedes trian c o l l i s i on tes ts using three different vehicle shapes , the Volkswagen Bee t l e , the Opel R3 and the Volkswagen Mini truck, have been performed ( Kuhne l 1 9 7 4 ; Kuhne l and Rau 1 9 7 4 ) . In these tests a moving pedes trian dummy was used rather than a s tationary dummy as this was fe l t to be more representative o f real accidents . l t was found that with the Opel and the Vo lkswagen Bee t le the pedes trian gene rally rotated through 90°, meaning that the legs did not rise above the level of the front o f the b onne t , up to impact speeds of 30 km/h ( 19 m. p . h . ) . At higher speeds the angle of rotation increases ; the rotation angle was generally greater for the Vo lkswagen Beetle than for the Ope l . The height that the centre of gravity reaches was also monitored and it was found that the dummy tended to be thrown higher into the air by the Vo lkswagen B e e t le than by the Ope l . With the s lab fronted min itruck the rotation angle was always zero and the dummy was not thrown into the a i r . It was noted that head contact w i th the windscreen frame produced much higher head acclerat ions than contact with other vehicle s truc tures and that in general higher head accelerat ions resul ted from impact by the Opel than by e i ther of the Vo lkswagens . The ground contact tended to be more severe , at higher spee ds , fol lowing impact by the Vo lkswagen Beet le , ref l e cting the greater height reached by the dummy . Kuhnel ( 1 9 7 4 ( i i ) ) sugges ted that the problem w i th the conventional ' pontoon' form car was the s t iff leading edge which resulted in considerab le inj ury and that perhaps the best form may be a pontoon form with a much softer l eading edge . The accuracy o f experimental col l i s i ons has been considered by reproducing real accidents (Kuhne l , Wanderer and O t te 1 9 7 5 ) . A tes t trol ley has been developed on which the shape of the veh i c le front s tructure can be a l tered so that the effects of variations in des ign on pedes trian dynami cs can be s tudied ( Kramer 1 9 7 4 ) . The effect of varying the height and s lope of the b onne t on a rounded front pontoon shape vehi c l e has been inves tigated ( Kramer 1 9 7 5 ) . The overall length of the b onne t was l . lm (�43 inches ) , the s lope was varied from 1° to 60 , and the height of the front of the bonnet from 85 cms (""llr' 3 3 ! inches) through 9 5 cms ("'='3 7 ! inches ) to 105 cms <'=" 4 1 ! inches ) . The height and s lope of the bonnet were b o th found to have an infl uence on the point of head contact and hence on the severity of the head injuri es . The mo s t favourab le si tuation for head contact was found to be with the low hood ( 85 cms) and it was sugge s ted that this height together with a smooth s loping profile would be preferab le . It was found that the initial vehicle con tact provided higher accelerations and impact forces than the se condary contact with the ground . From inj ury tolerance work using cadavers (Burrow 19 7 1 ; Krame r , Burrow and Heger 1 9 7 3 ) a te chnique has been developed for e s t imating the severity of leg injuries from the measurements recorded in experimen tal tests using dummies (Kraroer 1 9 7 4 ) . The s ame technique has also been app lied to ehe s t injuries (Kramer and Heger 1 9 7 5 ) . The Laboratory of Physiology and Biomechanics of the As sociation Peugeo t-Renaul t have · conducted an extens ive s eries of e xperimental pede s t rian collisions in which eight different vehi cles and two dummies , adu l t and chi l d , were used ( S t cherbatcheff e t al 1 9 75 ) . The vehicles were divided into three groups for an alysis �- 148 a ) low, short vehicles - height of front s tructure less than 70 cms - bonnet l ength less than 100 cms - height of front s tructure b e tween 70 cms and 80 cms b ) medium vehicles - bonne t length be tween 100 cms and 130 cms c) high , long veh i c l es - height of front s tructure greater than 80 cms - bonnet length greater than 130 cms . For the adult i t was found that the traj e ctory of the head and the lo cation of the head impact varied with the shape of the vehi c l e , a ' hi gh ' vehicle producing a curved head traj e c tory ending with a b onne t impact whi l s t a ' low ' vehicle produced a f latter traj e c tory ending with an impact with the windscreen or frame ; the head to vehicle impact ve locity was found to b e be tween 0 . 8 and 1 . 2 times the veh i c l e impact speed . The atti tude of the dummy at the se condary impact with the ground was found to be inf luenced to a greater extent by the length of the b onne t , and to a lesser extent by the col l i s ion speed . Wi th regard to the relative importance of vehi cle and ground head contacts i t was noted that the severity of the vehi cle head contact increases with increasing col l i s ion speed but that there was l i t t l e correla tion between impact speed and ground head contact severi ty . In general however the severity of the head to ground contact was lowe s t for the long b onnet vehi cles . At co l l i s ion speeds less than 32 km/h ( 2 0 m . p . h . ) the head to ground contact was more severe than the head to vehicle contact whi l s t at impact speeds be tween 32 and 40 km/h (20 to 25 m . p . h . ) head contacts with ' medium' and ' shor t ' vehi cles were o f the s ame severity as the ground contacts but with the long vehicle the ground contact tended to be less severe than the vehicle contact . For the chi ld the height o f the front s tructure was found to have a s ignificant effect on the mo tion. The low front s tructure resulted in the child leaving the vehi cle with an angular rotation of the head towards the vehi c le , this motion could be des cribe d as the legs being knocked away . The high front s tructure produced the opposite s i tuation w i th the chi ld b e ing knocked over resul t ing in a higher head to ground impact ve loci ty . l t was found generally that the head to ground contacts tended to be more severe than the head to vehicle con tac t s . The reproduction o f real accidents using b o th anthropome tric dununi es and cadavers has been performed w i th par t i cular emphas i s on the cause of the head injuries ( S tcherbatcheff e t a l , 1 9 7 5 ) . One of the main differences b e tween dummi es and real peop le is that dununies are made much s trenger and in an at temp t to produce more rea l i s t i c dunnni es frangible lower l imbs have been deve loped ( S t cherbatcheff e t al 1 9 7 3) . In the Uni te d S tates a series of 12 pedes trian impact experiments was carried out at the Unive rs i ty of California in 1964 ( Severy and Brink 1966 ; Severy 1970) . Pedes trian s i ze was con s i dered by using a number of dunnni es : a toddler dunnny , a 3 year o l d chi l d dunnny , a 6 year o l d chi l d dununy and an adult dunnny . Impact speeds were varied from 10 m. p . h . (16 km/h) to 40 m . p . h . (64 km/h) in 10 m. p . h . ( 16 km/h) s tep s . l t was concluded from this s tudy that ' Auto-pedestrian accidents are mul tiple impact events for which the ini t i a l car to pedes trian contacts are not nece s s ar i ly the most serious trauma likely to be inf licted . Subsequent impact with the p avement wi l l , for many acciden ts , produce injuries more serious than the original vehi cle imp ac t ' • • • • . With respect to vehicle shape i t was s ugge s ted that wedge shape front ends increase 149 upward proj e c tion of the pedes trian. A s tudy at Bat te l le using a t e s t buck con s i s ting of a s ty lized car front s tructure on an impact s led inves ti gated the effect of vehic l e design using two basir vehi cle pro f i le s , a s tandard Ame ri can car profi le and a low s loping profile , and two pedes trian s i zes , a 6 year o l d child and an adu l t . I t was noted that ' wh i l e (on a limited sample b as i s ) the low profile seems to cause lower injury. severi ty than the s tandard profi le at a 10 m. p . h . ( 1 6 km/h) impact , i t also tends to cause a greater severity at higher speeds ' . An important feature of the s tudy was the making of s ix identical tests to examine repeatab i l i ty o f dununy respons e . Repeatab i li ty was found t o be b e t ter than expected, the atti tude of the dununy at the same time after ini t i al contact being virtually the s ame in each tes t (Herridge and Fri tz 1 9 7 3 ) . The same te s t buck was us ed in a later s tudy using cadavers (Pritz e t a l , 1 9 75 ) . Results from th:i.s s tudy sugges ted that , with regard to leg injuries , a s ignifi cant increase in injuries occurs in the 15-20 m. p . h . ( 2 4- 3 2 km/h ) imp ac t , that the inj uries are locali zed at the point of contact and that dire ct impacts near the j oints produce substantially more severe injuries than impacts away from the j oint. The reaction b e tween the pedes trian and the ground was measured and it was found that sof tening the b umper reduced the leg-bumper force but increased the foot- ground frictional force . No reduction in inj ury severity was found with the softened b umper and it was sugge s te d that this was probably due to the increase in the ground frictional forces of f s e t ting the reduced bumper force . The head velocity was calculated at the posi tion at which the windscreen would be and i t was found that lowering the front s tructure resulted in an increased head ve loci ty . There was also s ome indication that s o f tening the front s tructure increased the h ead ve locity . From te s ts in Japan using three different vehi cles , a Volkswagen 1200 , a Pub l i ca which has a low front and s loping bonnet and a B l uebird which has a high front and a f l at bonne t . i t was suggested that the lower the initial contact the greater the angular rotation of the p edes trian and the higher the pedes trian is thrown (Kendo and Taneda 1 9 7 1 ) . At low impact speeds , 30 km/h ( 18 m . p . h . ) vehicles with low f ront s tructures are preferab le but that at around 40 km/h ( 2 4 m. p . h . ) no diff erences were de tected be tween the vehi c les (Taneda et a l 1 9 7 3) . Fiat carried out a series of pedestrian impact tes ts as part of the i r Experimental Safety Vehicle (ESV) progrannne (Montanari 1 9 7 4 ) . The motion of pede s t r i ans s t ruck by the various E . S . V . ' s was presented but as the vehic les were s imilar in de s i gn the effect o f vehi cle shape was no t discus s e d . I n the Uni ted Kingdom experimental t e s t s using vehicles have been carried out by Bri tish Ley land (Finch 1 9 7 4 ) (New Scien t i s t 1 9 7 4 ) and at the Transport and Road Re s e arch Laboratory ( T . R . R . L . 1 9 74 i ) . In particular attention has been given to the des i gn of a pedes trian catcher to keep the pedes trian on the vehicle preventing se condary ground con t act . Ro l ls-Royce have inves tigated the inf luence of vehi cle de s i gn using a s imulated vehicle impact s led and child and adult dunnni es . Amongs t the factors being considered are properties and location of the b umpe r , bannet leading edge height and p o s i t ion and b onne t and windscreen s lope . 150 Tes ts on s tructures have been carried out in Aus t ralia by Sarrailhe and Hearn ( 1 9 7 1 ) and in America b y Corne ll Aeronautical Laboratory ( C . A . L . 1 9 7 1 ) . Sarrailhe and Hearn used an impactor to inves tigate the properties of the leading edge of a number of vehicles . lt was found that the leading edge of most vehi cles tested was a s ti f f s tructure , a force of 1000 lbf producing deflec tions of less than lin ( 2 . Scm) . Tes ts on a Vo lkswagen produced a def l e ction of 6in ( 15cm) . A further tes t on the boot of a Holden showed that if the leading edge of the bonne t was des igned in the s ame way as the rear edge of the boot an improved si tuation would res u l t . The tes ts a t Corne l l used a pendulum on which a s imulated headform was mounted. Areas tes ted were the leading edge of the b onne t and the top surface of the bonne t . l t was noted that contact on the bonnet predominately resulted in e l as t i c deformation w i t h n o permanent indentation whereas leading edge contact resulted in permanent deformation. lt was sugge s te d that modifi cation of the leading edge to produce b e t te r load dis tribution should result in a reduction in pedes trian hazard. 151 MATHEMATlCAL MODELLlNG ° A two dimens ional 5 freedom pedes trian model was developed at Corne l l Aeronautical Laboratory as part of the i r res earch programme into impact pro tec tion for pedes trians and and cyc l i s t s ( C . A . L . 1 9 7 1 ) . Factors cons idered were vehi cle shape , vehi c l e front s tructure s t iffne s s , vehicle braking and pedes trian s i z e . Two vehicle shapes were s tudied, a conventional square fronted vehicle and a vehi c l e with a smoo th , r i s ing contour leading b a ck from the bumper . Comparison with the accident data co l lected in the same s tudy showed the s imula tion was reasonably good in predi cting the furthe s t point of pedes trian contact . l t was sugges ted that the risk of receiving serious or fatal injuries increases sharply b e tween 15 to 20 m. p . h . ( 24-32 km/h ) . Parame ter s tudies indicated an imp roved pedestrian environment with a more rounded front contour and a l e s s s t iff front s tructure . ° Katayama and Shimada ( 19 7 1 ) describ e d a two dimens ional 7 freedom mode l . A comparison b e tween the mode l and an e xperimental pedestrian co l l i s ion was made and reasons for the dif ferences in results dis cus s e d . · Maclaugh lin and Daniel ( 19 7 4 ) presented a parame tric s tudy of pedes trian inj ury in which a two dimensional 60 freedom model was used to inves ti gate the inf luence of cert ain vehicle and pedes trian factor s . The aspects of vehicle design considered were vehi cle shap e , s tiffnes s of the bumper and sheet me tal s tructures and the maximum a l l owab le deformation of the s tructure contacted . Pedes trian factors considered were pedes trian s i ze , orientation and muscle tension . The results of the s tudy , however , were s omewhat limited as the inf l uence of impact speed was not cons idered , a l l s imulations being made at an impact speed of 18 m. p . h . ( 2 9 km/h) . Main conclusions were that ' - pede s tr i an s i ze and orientation tended to have effects on pedes trian injury which were equally as important as the vehicle parame ter effects . - a l though vehi cle parameter changes were generally effec tive in reducing injury, no s ingle parame ter was highly dominan t . Rather they varied in re lative degree of s ignifi cance , depending on which inj ury criteria was cons idered ' . lt was sugges ted that the reduction in s tiffne s s of contacted areas was beneficial . Niederer ( 19 7 5 ) presented the f i rs t res ults of a s tudy using the CALSPAN 3 dimens i onal s imu lat ion (Fleck e t al 1 9 7 4 ) . He cons idered the case of a pedes trian s truck by a car moving at a constant speed of 20 km/h . l t was noted that a l though comparison of the results with experimental t e s t s showed that the general motion of the pedestrian was predicted, there were s ti l l a number of problems to be resolved before the mode l was acceptab le in detai l . 152 CONCLUSIONS The above reviews of the s tudies which have been conducted to date on both riders of two-wheeled machines and on pedestrians show a number of charac teri s tics common to both groups o f road users . In severe inj ury accidents , multiplicity of inj ury is the rul e , with head and lower limb injuries pre dominating . For mo torcy c l i s ts the data show that the types and frequencies of injuries vary cons iderab ly according to the configurations of the co l l i s ions and their severi ties , a l though the que s tion of col lison speed has not been examined adequately in this context . The use o f helmets by motorcy c l i s t s appears to be beneficial , but no definite s tudy of this one crash-protective i tem of mo torcycling has yet been conducted, because of the difficu l ties in the reporting procedures for s ingle vehicle accident s . This prob l em puts a reservation over much of the frequency data given in s tudies o f two-wheeler accidents which are based on p o l i ce data particularly. With regard to s tudies of specific origins of the various injuries sus tained by riders , the mo s t severe condi tion described is where the rider receives mos t of his injuries from ·s triking the opposing vehi c l e , al though the tank and handlebars of his own machine are ci ted as s i gnifi cant sources of trauma. In general much more epidemio logical s tudy of a detailed nature is needed before the various priori ties for remedial measures can be es tab lished . The biomechanics of pedes trian trauma in comparison is relatively we l l do cumen ted . Like riders , pedes trains receive head and leg injuries most frequently . For legs , b umper impacts are the main cause of serious leg injuries , and there is every sugges tion that present bumper designs are far from optimal from this point of view . Ground contacts give rise to mos t of the minor leg inj ur ies . For adult pedes trians the vehicle accounts for at least half of the s e rious head injuries and and that proportion increases with children. The severity of injuries f rom vehicular contacts in general appears to be directly related to speed but no such dependance exis t s for contacts with the ground where perhaps the orien tation of the pedes t ri an is more important than his horizontal ve locity . S tudies show that a s teep increase in pede s trian inj ury severity occurs at be tween 15 and 20 m. p . h . impact speed. Be low 1 5 m . p . h . minor injuries predominate , whi l s t above 20 m . p . h . the chances o f serious inj ury are high. Vehicle des i gn appears to have a real inf luence over the frequency and severity of p edes trian inj ury , but impact speed is a cri tical parame te r . What may be b e s t for one s i ze of pedes trian at one speed may not necessarily be good for another s e t o f condi tions . Because chi ldren form a large proportion of the pedes trian casualty populat ion , account mus t be taken of the circums tances of their accidents and injuries . At this s tage , the opt imum vehicle exterior de s i gn has n o t y e t been de fined . 153 REFERENCES ON TWO-WHEELED VEHICLE STUDY ALDMAN , B . , THORSON , J . , and ASBERG, A . ( 1 9 6 9 ) . ' Bicy cle accidents to chi l dren and b lunt trauma to the abdomen ' . Proceedings of Third Triemial Congress on Med ical and Related Asp e c t s o f Motor Vehicle Acciden t s , May 2 4 to June 4, 1 9 6 9 . ASTON , J . N . and PERKINS , T . A . - 9 1 9 5 4 ) . ' The c l inical p a ttern o f inj ury in road a c c i dents ' . B r i t i s h Medical Journal , p . 200-20 3 . BACKSTROM , C . G . 9 19 6 3 ) . ' Traf f i c injuries in South Sweden wi th special reference to medico-legal autops i e s o f car occupants and value o f s afety b e l t s , Acta Chirurgi a Scandinav i c a , Supplementum 3 0 8 . BARTOL , J . , LIVERS , G . 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SAE Paper 7 5 1 1 6 7 , Proc. 1 9 th S tapp Car Crash Conference , 1975. STURTZ , G . , SUREN , E . G . , GOTZEN , L . , BEHREN , S . K . and RICHTER, K . ( 19 75 ) . ' Kop f , Hals-und Wirb e ls avlenver letzungen und Todes ursachen vie Ausseren Verkehr s te i lnehmern ' . Proc. 2nd Int. Con f . B i omechan i cs o f Serious Trauma , I . R. C . O . B . I . , 1 9 7 5 . STURTZ , G , SUREN , E . G , GOTZEN , L . and RICHTER , K. ( 19 74) . ' Analyse von Beweguns ab l auf , Verle tzungsursache , - s chwere und - Folge bei Fuss gangerun fal len mi t Kindern durch Unfallforschung am Unfal lort" . TANEDA, K . , KONDO , M . and HIGUCHI , K . ( 19 7 3 ) . ' E xperiment on Passenger Car and Pedes trian Dunnny Co l l i s i on ' . Proc . ls t In t . Conf Biomechan i cs of Trauma , I . R. C . O . B . I . , 19 7 3 . TARRIERE , C. , STCHERBATCHEFF , G . , DUCLOS , P . and FAYON , A . ( 1 9 74) . ' Short Syn thesis of Works on Pede s tr i an Protect ion ' . Proc 5th In t . Tech. Conf . on Experimental Safety Veh i c les , N . H . T . S o A. , 1 9 7 4 . THARP , K . J . ( 19 7 4 ) . ' Mu l t i d i s cipl i nary Accident Inve s t i gation - Pedes trian Involvemen t ' . D. O . T . Report HS . 80 1 . 165 , N . H . T . S . A . , Washington , 1 9 7 4 . THARP , K. J . and TSONGOS , N . G . ( 19 7 4 ) . ' F actors in Urban Vehicle Pedes trian Collis ions ' . Pro c . 3rd Int . Cong. Automo tive Safe ty , National Motor Vehicle Safety Advisory Counci l , D. O . T . , Washington , 1 9 7 4 . TONGUE , J . I . , O ' REILLY , M. J . J . and DAVISON , A. ( 1 9 6 4 ) . ' Fatal Traf f i c Accidents in Brisbane from 1935-1964 ' . Med . J . Aus t . , Vo l . 2 , p . 81 1 , 1 9 6 4 . TONGUE , J . I . , O ' REILLY , M. J . J . , DAVI SON , A. , and JOHNSTON , N . G . ( 1 9 7 2 ) . ' Traf f i c Crash Fatali t i e s Inj ury �at terns and o ther Factors ' . Med . J . Aus t . , 19 7 2 , 2 , p . 5- 1 3 . T . R. R. L . ( 1 9 7 4 ( i ) ) . . LF 3 9 4 , April 1 9 7 4 . ' Car Front End De s ign and Pedes trian Safety ' . T . R. R. L . Leaflet 161 T . R. Ro L . ( 19 7 4 ( i i ) ) . ' Pedes trian Inj uries ' . Leaf let LF3 1 7 , Issue 4 , April 1 9 7 4 . Transport and Road Research Laboratory , VAUGHAN , R . G . ( 19 72 ) . ' A Study o f Measures to Reduce Inj uries t o Pedestrians ' . National Raad Safety Symposium, Canberra , March 1 9 7 2 . ' Fi e l d Results of Exact Acci dent Data WANDERER, U . N . and WEBER, H . M . ( 1 9 7 4 ) . Acqui s i tion on Scene ' . SAE Paper 7405 6 8 . WOOLER, J . ( 19 6 8 ) . ' Raad Traffic Accidents in Ade laide and Brisbane , Aus tralia excerpts from a Report in preparation'. Proc . 4th Conf. Aus t . Raad Re s . Board , Melbourne , 1 9 6 8 . 4 162 1-' O"I w NOTES (1968) SEVITT (1964) R L m/c p/c upp low TONGE e t al (1962) SLATIS 0962) HODGE (1961) - GISSANE & BULL STUDY 181 p/c 18 p/c c) - c) # d) e) - - 83 72 - 80 76 -1- >-- I'- _ - 2 - 2 -1- - - - / 7 1. 7 0.6 - 3.0 0.6 c) - - c) -- c) 5.5 5.5 - - -- 24 12 # - # c) - Serious injuries d) - Surface injuries e) - Lu��ar and sacral injuries #= - Fractures 22 - # ARMS - upp low - upp low L. upp L . low R.upp R . low 16 11 17 5 10 1t - - upp low ,_ upp low 33.3 - - 22 11 6 22 21 9 3.9 3.9 3.3 4.4 - 8.5 6.3 11.0 9.6 1 7. 9 - 5.9 - 21.4 14.3 18.2 - 20 . 6 - - L . upp L. low R. upp R. low L . upp L . 101• R. upp R. low - upp low - upp low # - LEGS - ->2.2 2.2 1.1 2.2 3.8 4.7 4.4 6.3 3.6 - 13.3 - 10 . 7 21.4 4.6 - 17 . 7 - - L. upp L . low R. upp R. low ,._ - - upp low _,___ #=- 12.2 9.9 8.9 - 11.1 5.9 14 . 3 - 23.5 - - - # 1! - PELVIS # a) - Concussion and brain injury 39 33 - 12.1 liver spleen 6 . 6 kidney 5 . 0 - b ) - Excluding kidneys c) - 49 39 21.0 31.0 - l ung rib - - liver 2 1 . 1 spleen 1 7 . 3 kidney 8 . 5 - 28.2 35 . 1 - b) 17.8 kidney 2 . 2 lung rib - 33. 3 - - liver 5.9 spleen 1 1 . 8 kidney 1 7 . 6 - - liver 2 8 . 6 spleen 1 7 . 9 kidney 2 1 . 4 --- ABDOMEN 10 . 7 b) kidney 3 . 6 - -- - - 11.8 11.8 23.5 14 . 3 32 . 1 28.6 27.3 40 . 9 - • 32 . 4 35 . 3 42.9 - heart lung rib - heart lung rib lun6 # rib - h:ng # rib THORAX - -- - - - dorsal 1 1 dorsal e) e) ':'"s - -1- 5.5 - 1.9 12 - dorsal lu:nbar / „ 7.1 7.1 - - dorsal l umbar - SPINE - 6.7 - 17 . 7 4.6 - 11.8 10 . 7 - - - - - - NECK ' -,_ 54.1 80 . 1 71.3 61.4 78.2 68.2 62.5 57.4 64.4 62.2 82 . 4 70 . 6 - 89 . 3 85 . 7 - - - - 86 . 4 77.3 64.7 61. 8 motorcyclist ( Al l 2-wheeled motor vehicle users) pedal cyclist upper lower lef t right SA.'1PLE : non-minor injuries SA."IPLE : 41 m/ c SA."IPLE : d) a) non-mino r injuries S�1PLE : 365 m/ c # a) # a) # - a) # - - # a) ff' a) # - - a) HEAD SAMPLE : 56 p / c maj or inj uries SAXPLE : 45 rn/c SAMPLE : 17 p / c non-minor injuries SAHPLE : 28 m/c Sfü"IPLE : 22 p / c non-mino r injuries Sfü'fPLE : 34 m/ c NOTES Tab le 1 - Relative Frequencies o f Inj uries t o Body Areas for Motorcyclis t s and Pedal Cycl i s t s Involved in .Fatal Accidents 1--' O"I � NOTES (19 7 3) - motorcyclist pedalcyclist upper lower left right SAHPLE : 10 p l c fatal injuries SAMl'LE : 25 ml c SEVITT (1973) all injuries SAi'1PLE : 284 mlc d) a) # SAMPLE : 37 p l c ...__ - d) a) Tf= HEAD non-minor injuries SAMPLE : 41 mlc NOTES 64 100 - 65 - - -. NECK \. -- 83 . 7 73.0 70. 3 - 85 . 3 63.4 73.1 - e) - - - SPINE - ./ 5.4 - 5.4 12 . 1 - " 10 - 10 - 20 2 7.5 - liver 10 . 8 spleen 8 . 1 - liver 2 4 . 4 spleen 1 2 . 1 kidney 9 . 8 ABDOMEN - ·-� 40 -- 29.7 16.2 31. 7 46 . 3 - - lung rib - lung rib THORAX a) Concussion and brain inj ury d) Surface injury e) Lumbar and sacral injuries II - Fractures 8 - 8.1 - 10 . 8 7.3 # - # - -- # PELVIS ARMS - 11 / - - - 14. l L . upp L . low R.upp R. low 2.7 2.7 8.1 5.4 - - 22.9 L . upp 4 . 8 L. low i . 3 R. upp 7 . 3 R. low 14. 6 - - LEGS - - L . upp 2 . 4 L . low 7 . 3 R . upp 4 . 8 R. low _,___ L . upp 5 . 4 8.1 L . low 2 . 7 R . upp 5 . 4 R. low 5 . 4 4.9 Relative Frequencies o f Injuries to Body Areas for Motorcyclists and Pedal Cycli s t s Involved i n Fatal Accidents mlc plc upp low L. R. - REN TON ( 1972) TONGE e t al STUDY Tab le 2 ...... °' lJ1 - all casualties all injuries SAMPLE : 569 m/ c PELLEGRINO NOTES (1960) m/c p/c upp low L. R. SAMPLE : 168 p / c hospital inpts non-minor injuries SA.'!PLE : 328 m/c SA..'1PLE : 195 p/ c - motor cycli s t -. pedal . cy c l i s t - upper - lower - left - right GISSANE, BULL, & ROBERTS (1968) (1963) SA.'!PLE : 256 p I c all casualties all inj uries SAMPLE : 541 m/ c SA.'1PLE : 747 p / c BAG<STROM ( 1962) hospital inpts all inj uries SAMPLE : 2062 m/ c SA.'!Pl.E : 120 p/c all casualties all inj uries SAMPLE : 268 m/c NOTES - (a) - (a) - ....._ 1- - -- - - - 1. 1 - 0.7 2 . 18 _,_ - 3.9 0.3 - 2.4 - 62.5 # rib - 4.2 - ...._ - - 2.7 - - - 25.0 - 33.3 - 3.0 6.0 4.5 - - 1.2 ·· •- . #L. # R. � #L. 10. 7 8.9 - - # R. # L. - :/l= R. #L. R. L. 7.1 3.0 - 11. 3 - 20. 1 46.3 35.2 - 42 . 2 32 . 4 35 . 6 - - 47 . 1 38.3 -· - 31 . 6 3.4 1. 9 4. 1 3.4 11.6 15.7 18. 3 - 11.9 - - R. L. -� .... _ -- 7.9 6.7 -34.5 30.0 45. 8 37.4 26.5 - 26.8 14.7 - - -- # R. R. L. R. L. - - 17.4 L . upp 2 1 . 7 L . low 1 2 . 5 R. upp · 12 . 5 R. low . 16. 7 L . upp L . low R . upp R. low LEGS 7.5 L . upp L . upp L. low L. low 12. 3 R. upp R. upp 9.0 R. low R. low 15 - - - - AR..'15 _,_ - - 3.1 - 5.9 4.8 - 5.6 - - -- - - - 2.7 - PELVIS _.._ / - - - ABDOMEN - - - 4.3 12.5 13.9 13.3 6.5 8.1 - - - # rib ,__ - - - 6.4 11. 7 - 11.6 THORAX - ---- - 52 . 8 - - J - 3.3 - -- - (b) -- (p) -- - >-/ ' '- - 3.7 - SPL'llE _,,1, a ) - Concussion and brain inj ury b) - Includes pelvis # - Fractures 10. 7 48.8 - 8.2 45 . 1 36.7 - 17 - - � - 72 . 7 -- 55 . 9 66.6 - � V" � - NECK V 71.5 55.8 - 51 . 9 >---- - ' ' HEAD Re lative Frequencies of Injuries to Body Areas for Two-Wheeled Vehicle Users HEIDELBERG ( 1954) ASTON & PERKINS STt;DY Tab le 3 f--' °' °' NOTES (19 72) BO (1971) HEAD 226 m/c St�IPLE : 189 ? f c hospital inpts major injuries SA.'1PLE : 345 m/ c SAMPLE : al 1 inj uries SA.'IPLE : 1 8 m/c '- ...... l \- 64.5 - 3.2 - 1.3 3.4 5.6 - - 2.1 '-. - - ABDOMEN - - - - 1.4 4.'4 5.6 15 . 7 - 14.6 THORAX - - 7.1 - b) Includes pelvis - b) - SPINE a ) Concussion and brain injury - 1.6 - 1.4 - - NECK - 45.0 14.3 61.1 hospital inpts 68. 2 non-minor injuries a) 29 . 8 SAMPLE : 1 5 1 m/ c - - ,__ SAl1PLE : 70 p / c 75 . 7 27.1 a) NOTES m/c - motorcyclist p/c - pedalcyclist L . - left R. - right CLARK & MORTON (1971) JAMIESON e t a l (1966) JANIESON & TAIT STUDY - - - PELVIS 2.6 2. 35 � 2.8 11.1 2.9 - 10 . 6 1 Table 4 - Relat ive Frequencies o f Inj uries to Body Areas for Two-Whee led Veh i cle Users / - 3.1 - ,/ -- R. L. - - 13 . 8 14.5 25.2 61.1 - R. L. - 13.8 35 . 9 42 . 7 44 . 4 38. 9 - - LEGS - 27 . 1 46.4 38.9 - ARMS - - / ...... (j'\ -.J - NOTES ( 1975) DRYSDALE e t a l (1973) HICHT et a l (1967) SLATIS (1966) & RYAN 26.4 56.0 NECK 0. 7 ,/ p / c - pedalcy c l i s t N - number of casualties m/c - motorcyc l i s t m/ c,N=370 1=505 non-minor injuries 11.3 4.1 34 a) - includes pelvis and spine I - number o f injuries 3.5 14 9 68 3) Deflected N=44 18 15 t\=36 ;.-� r 2 42 . 6 93 41 25 . 8 72 83 17. 1 46 7 ; 20 . 0 31. 43.2 14.4 47 - LEGS -1 6 . 4 -+ - 16. 8 - 1 2 1 .6 2.3 17 - ARMS 20 1.0 -1 o. 7 - - PELVIS 1 -:-) - 0.3 - 35 1.7 7 -·- 15 - 83 ,- 0.6 ; 7. 2) Ejected N=46 0.4 - 1.6 ;-; r - 31. - - 2.7 4.0 ABDOMEN 53 51'--. ______/ -- _ _ r 6.1 18.0 8 44. 1 '------'-/- 7 THORAX 19 � 41.1 29.6 5.3 - 5. SPINE - - - - - - ra; HEAD 92 1) Non-ej ected atics occupan t ' s ki nem a l l injuries by m!Caccidents - p / c , N=l221 1=1828 m/c,N=1776 1=2896 all injuries all casualties p / c , N =35 !=98 m/c,N=71 1=148 a l l inj uries SAJ-IPLE 324 m/ c all injuries fatalities NOTI:S The Percentage of Inj uries to a Given Body Area for Two Wheeled Vehicle Users ROBERTSON, MCLEAN , (1969) GRAHAM STUDY Table 5 1-' O'\ Q) (1962) NOTES: (1972) B (19 70) I - SAMPLE # - Fracture 648 HEAD l a) IF a) a) # ' NECK # � I\ ll 48 4 59.0 12. 1 66.7 65.9 66.6 24 . 3 22.5 53. 8 � a) - Concussion and Brain Injury • inj uri e s hospital inpatient maj o r hospital inpatient non-minor injuries SAMPLE = 39 8 Right side low - Lower 1 149 hospital inpatient non-minor injuries SAf!PLE • 243 = a 1 1 casua 1 ties a l l i nj uries SAftPLE = 220 Left side upp - Upper R L ROBERTS CISSANE, B l lLL & (1966) JAMIESON & TAIT (1963) BACKSTROM SAMPLE hospital inpatient ( 1961) 91 GOCLER • SAMPLE hospital inpatient non-minor injuries SAMPLE • 169 (1954) McNICOL SMITH & LETHEREN a l l casualties a l l inj uries ASTON & PERKINS "".' , o 5 o.o 3.2 ".' 2 2 3.0 SPINE J \ 2.8 J 14.0 4.5 1 0.0 # rib #rib THORAX ':' 3.4 4.3 26. 3 9.5 8.1 6.5 \ I\ 16 5 ABDOMEN - �8 4 #- 31�3 4.1 6.0 1F PELVIS J 8. 0 J 7.3 5.6 18.9 1 #L #R #'low # upp L . upp L. low R . upp R. low ARMS 11. 8 4.5 5.3 17 . 3 21.4 14.7 7.7 3 .0 8.8 4.4 9.9 12. l #- R #L 11 upp # low L. upp L . low R . upp R. low LEGS Re lative Frequencies of Inj uries to Body Areas for Pedestrians from Hosp i t a l based S tudies ( i . e . Injuries per Person) NOTES - STUDY Table 6 17.2 28 . 6 18.8 13. l 50.2 47.3 38 . 3 56.2 9.9 23. l 11.0 20.9 1-' O'I \.0 NOTES: (1975) L - Left R - Right ASHTON (1975) all injuries STURTZ et al = adults SAMPLE ( 30 65yr) (15 - 65yr) 37 l5yr) cars HEAD l l • 6.1 83. 3 13 3 l b) b) a) ,/ 0.0 76�2 a) a) SPINE ' , 76 . 5 90 81 92 NECK y 64 . 7 ... 64 . 7 • a) - Pelvis includes Spine Spine included in Body Area applicable b) c) Legs includes Pe lvis adul t s ( 15yr) SAMPLE 2 66 all inj uries front contact cars children ( l5yr) SAMPLE • 5 1 = adults SAMPLE children ( SAMPLE 2 76 all injuries all contacts SAMPLE D 63 ROBERTSON , McLEAN & RYAN (1966) a l l inj uries front contact cars SAMPLE = 34 all injuries all contacts SAMPLE = 5 1 (1971) NOTES 13 5 l THORAX 25.8 5.9 23 16 20 22.2 5.9 13. 7 19.7 19.6 7 14 26 15.9 23.5 27.5 ABDOMEN c) c) a) a) a) PELVIS 47 16 17 17.5 26 . 5 25.5 Relative Frequency o f Injuries to Body Areas of Fatally Injured Pedes trians ( i . e . Injuries per Person) STUDY - JA.'!IESON et a l Table 7 L l!. L R ARMS 48.5 29.4 27 8 11 50.8 35 . 3 41.2 35 . 3 43.l c) c) . Upper Lower Upper Lower Upper Lower L R L R LEGS 87.9 78.4 30 73 27 62 40 26 87. 3 79 . 4 70.6 72 . 5 70.6 '. � -.J 0 1 : 180 B:8 B:6 cars 1 : 90 B:B B : lO 1 : 1 37 inj uries B:6 chi ldren ( 14yr) B:6 1 : 10 7 B:6 ( 14yr) B:6 i7!8 \. tall f) f) a) h) h) h) l.3 d) d} THORAX b) - Includes Hip joint 2.2 o .o 0.2 0.7 SPINE h) R - Right L - Left * - Child defined as person less I - Number of Injuries d ) - Upper Torso c) - Includes Shoulder (122cm) .30. 7 36 . 4 20.0 33.3 2 .9 J J j 1 B - Number of Body Areas than 48in 18 °".'3 \ 27.2 41 :1 \. 28.2 . NECK a ) - Dack (Thoraco-lumbar) I : 179 HEAD ' N - Number of Pedestrians N : 66 adults front contact cars all injuries N:Sl front contact cars (1975) 1 : 444 a ll inj uries ASHTON N: llO adults* front contact cars a1 1 N : 39 chi ldren* 1 : 382 front co11tact cars N : 149 non-minor injuries N:Sl al l contacts ( 19 7 l ) NOTE S ; B:6 non-minor injuries N:Sl al l contacts 1 : 95 a l l injuries N : 63 a l l contacts a l l inj uries al 1 : 170 cars non-minor injuries C.A.L. (1974) T..R. R . L . ( 1 9 71) JAMIESON ·H N : 63 (1966) al l contacts al l inj uries ROBERTSON , McLEAN & RYAN NOTES STUDY 9.5 2.8 5.4 8.0 6.3 6.7 3.9 10 . 5 8.2 PELVIS g) g) b) h) h) h) h) 14.1 14.4 7.2 11.6 6.5 c) R L R L ARMS 17.9 14.0 18.2 18 . 2 6.8 4.4 2.2 12.2 10.0 8.4 18.8 g) g) Lower Upper Knee R L R L LEGS h) - Pelvis includes Spine g) - Includes Pelvis f) - Spine included in Body Area applicable 7.3 9.3 17.8 11 . 7 3.1 11. l 7.8 5.3 5.9 e ) - Lower Torso e) e) ABDOMEN Tab le 8 - Relative Frequency o f Inj uries to Body Areas o f Pedes trians from Field Accident Studies ( i . e . Inj uri e s per Person) 1.8 32. 4 37.4 38. 3 27.7 23.6 12.8 16.7 16.7 20.6 20.0 23. 2 32 . 4 ,_. -....) ,_. fatali ties quoted in HODGE SANPLE = 121 fatalities non-minor injuries SAMPLE = 61 ECKERT e t a l HODGE fatali ties non-niinor injuries SAf!PLE = 168 fatalities non-minor injuries SA.'1PLE a 5 7 SOLHElM PERRY fatalities non-minor injuries SAMPLE • 232 HUELKE NOTE S : (1969) - Left side - Right side R upp - Upper low - Lower L DAVIS SAMPLE ( 19 7 2 ) & fatalities non-minor injuries TONGE et a l g) e) a) # # e) a) # a) # a) "II' a) HEAD NECK 42.2 55.0 d) e) f) g) 33 19.8 61 81. 4 48. 7 49 . 5 12.4 62.2 73.2 61.0 , , 12.8 2.5 7.8 2.2 7.2 g) 41. 7 44 28.S 42.2 18.3 42.4 lung rib lung rib 38 29 . 6 29 . 8 53.6 49 . S 11.S 21. 3 36. 1 67 50.0 27.8 33.9 d) heart lung rib # rib lung # rib THORAX Serious injuries Surface injuries Lumbar and Sacral injuries Fatal injuries only f) f) dorsal j J J dorsal 2 1 . 3 lumbar 1.6 - 1 0 : 16 1 -: 1 4".°l 29 . 5 4 SPINE 22. o "II' i5:5 10. 4 g) I\. 1\. I\. # ll ll 63.2 61.4 72.0 64 . 1 58. 3 77.0 54 . 1 61 61.0 69 . 1 58.8 a) - Concussion and Brain lnjury b) - Excluding Kidneys c) - Legs include Pelvis :IF - Fracture 355 SA1'1PLE = 910 ( 1964) • fatalities non-minor injuries TONGE et al ( 1968) fatali ties non-minor injuries SAflPLE = 125 Sf.VITT (1964) (1964) (1962) fatalities main cause o f death SAflPLE = 192 SLATIS ( 1962) ( 19 59) ( 1962) fatalities non-minor injuries SAMPLE X 200 McCARROLL e t a l (1961) fatalities non-minor injuries SAflPLE = 9 7 BULL NOTES & STUDY GISSANE 42.0 14 9.6 24.6 24.4 22.9 8.9 g) 19 . 8 28 liver 20.0 spleen 1 8 . 9 kidney 10. 1 liver 19 . 0 spleen 1 1 . 6 kidney 3 . 9 d) kidney b) liver 1 8 . 0 spleen 1 3 . 1 kidney 2 3 . 0 ABDOMEN g) c) # PELVIS 4.8 39 33.2 21. 8 36.0 25.6 24 . 0 49.2 66 46.0 32.0 L . upp L. low R. upp R. low L. upp L . low R. upp R. low upp low upp low # ARMS 4 14 10. 1 5.6 4.5 4.8 4.3 4.8 3.8 4.4 14 10 24.6 19.0 21.4 16.4 14 . 8 19 . 0 17.5 L. upp L. low R. upp R. low L. upp L . low R. upp R. low upp low c) upp upp upp low LEGS # Table 9 - Relative Frequency o f Inj uries to Body Areas out o f Total Number o f Injuries to Pede s trians - ( i . e . Inj ury Based) 58 17. 7 14. l 36. l 31.3 6.9 6.9 18. 7 18.7 48 16 37 70 . 2 33.3 44.8 26.2 65.6 17 53 54.0 42.3