- Email: [email protected]
Commentary: Riding off into the sunset: Implications of an aging motorcyclist population
NHTSA NOTES
According to “Fatal Single Vehicle Motorcycle Crashes,” more than 38,000 motorcyclists were killed in these crashes between 1975 and 1999. Single vehicle crashes account for approximately 45% of all motorcyclist fatalities. Motorcyclist fatalities in single vehicle motorcycle crashes decreased until 1996, reaching an historic low that year and again in 1997. As with other types of fatal motorcycle crashes, in 1998 fatalities once again began to increase, by 11.2% in 1998 and another 9.4% in 1999. Most of the fatality increase in these single vehicle crashes during this period was among riders age 40 and older. Helmet use, improper licensing, and speeding add to the overall problem when associated with high alcohol use among motorcycle operators in single vehicle crashes. Half of all fatally injured occupants did not wear a helmet in 1999, almost one third of those killed that year did not have a proper license, and speed was a contributing factor in more than half of the deaths. The type of roads, coupled with speeding and alcohol, contributes to the overall problem of motorcyclist fatalities in single vehicle crashes. More than half (57%) of the motorcyclist fatalities occurred on rural roads in 1999. Approximately 85% of all motorcyclist fatalities in single vehicle crashes occurred on undivided roadways and roadways that had a median but no barrier. Vehicle maneuvering is another critical factor in the single vehicle crashes when other major factors such as rural roadways, high alcohol use among riders, speeding, undivided roadways, and nighttime riding are added. Fifty percent of motorcyclist fatalities occurred while the vehicle was negotiating a curve. These combined factors show that more than 80% of motorcyclist fatalities occur off the roadway and more than 50% record a collision with a fixed object as the most harmful event. Copies of the 2 reports, “Recent Trends in Fatal Motorcycle Crashes” (DOT HS 809 271), June 2001, and “Fatal Single Vehicle Motorcycle Crashes” (DOT HS 809 360), October 2001, are available by sending a fax request to 202-366-7078 or by written request to NHTSA, 400 7th Street SW (NRD-31), Washington, DC 20590. The reports are also available through the agency’s toll-free line, 800-934-8517, and are on the NHTSA Web site at: http://www.
1 9 6
-nrd.nhtsa.dot.gov/departments/nrd30/ncsa/AvailInf.html.
Commentary: Riding Off Into the Sunset: Implications of an Aging Motorcyclist Population [Marottoli RA. Commentary: Riding off into the sunset: implications of an aging motorcyclist population. Ann Emerg Med. February 2002;39:196-197.] The recently completed analyses on fatal motorcycle crashes by the National Highway Traffic Safety Administration (NHTSA), entitled “Recent Trends in Fatal Motorcycle Crashes” and “Fatal Single Vehicle Motorcycle Crashes,” provide intriguing findings that ultimately raise more questions than they answer. Although the number of motorcycle fatalities is small compared with the total number of vehicle fatalities in the United States, there are a number of issues of some concern. Of particular concern to me as a physician, and especially as a geriatrician, are the dramatic increases in the number and proportion of fatalities among “older” motorcycle riders in the past decade and particularly in the past few years. These findings raise a number of parallels to older automobile drivers that deserve commentary. The questions raised may lead to further data collection that ultimately helps to better understand the causes of these trends and leads to interventions to curtail them. Before doing so, however, there is at least one caveat that needs to be kept in mind: “older” is a relative term (thankfully). In these analyses of motorcycle operators, “older” is defined as 40 years and above, while in most studies of “older” automobile drivers, the lower age limit is 65 years old. What were the findings of interest? Ownership and frequency of motorcycle use among “older” riders increased in the past decade. Although there was an initial decrease in the total number of motorcyclist fatalities, in the past several years fatalities among motorcycle riders have increased. The greatest proportionate increase in fatalities,
which appears to account for the overall increase, has been among “older” riders. These have involved primarily motorcycles with large engine displacement. This occurs even though speeding is less likely to be a contributing factor in crashes among older riders than among their younger counterparts and even though older riders are more likely to wear helmets. In contrast, alcohol use was found to be quite high in this group of “older” riders, particularly among riders between the ages of 40 and 49 years, who showed the second highest alcohol use of any age group of riders, coming just after those between the ages of 30 and 39 years. These data on motorcyclists offer a number of parallels to “older” automobile drivers, keeping in mind the different definition of “older.” As the population ages, the number of older drivers has been increasing. Older drivers have a low number of crashes overall, but if one accounts for the fewer miles they drive on average, their crash rate per mile driven is higher than for middle-aged drivers. They are also more likely to be injured or die in a crash, which is thought to primarily reflect their relative frailty in comparison with younger drivers. The relative contribution of driver, vehicle, and environment factors to the occurrence of crashes and subsequent injury or death is the subject of much debate and ongoing investigation. As with older motorcycle operators, speeding is not often a factor in motor vehicle crash occurrence for older drivers. The finding that problems with braking, steering, vehicle maneuvering, and failure to negotiate curves all contribute to motorcycle crashes reflects a close parallel to what happens among older drivers, among whom there is a preponderance of crashes and violations at intersections and from lane change maneuvers. This is all well and good, but why should these findings be of concern to the medical, public health, and safety communities? First, there is the issue of awareness. Granted, my patient population is quite old, but the possibility that they might ride motorcycles, or the need to ask, seldom entered my thinking before seeing these reports. In the interest of injury prevention, this may be an important question to ask. Second and, in my opinion, most important, there is the need for more data. In particular, we need more information on the following issues:
ANNALS OF EMERGENCY MEDICINE
39:2 FEBRUARY 2002
NHTSA NOTES
• Finer breakdown by age categories; • Is the problem primarily a result of increased volume (more older riders) or are other factors contributing? • Why do crashes/fatalities occur among older riders? • Are there differences in the types of injuries sustained by older and younger riders? • What are the relative contributions of rider, vehicle, and environmental factors? Among riders, what are the contributions of functional difficulties (eg, judgment, perception, balance, coordination), inexperience (either novice riders or those who return after many years of not riding), and relative “frailty” or susceptibility to injury compared with younger riders? Are older riders buying “too much bike” in terms of speed, size, and control? Is the preponderance of rural fatalities a reflection of the nature of the crashes or of medical response time? Would operator training or retraining help to decrease the occurrence and severity of crashes, and, if so, are there enough training programs available to accommodate the increasing number of older riders? This added information would at least yield more insight to how and why crashes are occurring and, hopefully, would prompt the development and testing of intervention strategies to counteract this growing and concerning trend.
Traffic Safety Medical Fellowship One-Year Intermittent Appointment • One-year appointment available as Medical Fellow at the National Highway Traffic Safety Administration (NHTSA). • Traffic safety education, research, and writing in a variety of injury prevention areas possible: occupant safety, alcohol, novice drivers, older driver safety, child safety, pedestrians, bicycles, motorcycles, other. • Position located within US Department of Transportation in Washington, DC. • Intermittent days over 1-year period to start approximately summer 2002 (negotiable). Minimum time commitment is 30 days in 1-year period. • Some work can be completed at Fellow’s home base, at NHTSA, or a combination. • Depending on location of selected medical fellow, NHTSA reimburses travel and accommodation expenses in Washington, DC. • Fellow’s sponsoring institution supports other expenses. Qualifications • Mid-level faculty in emergency medicine (minimum 2 to 5 years post residency). • Full-time appointment at academic institution. • In good standing with hospital and academic institution. • Support agreement from Fellow’s sponsoring institution. Benefits • Guest editor for at least 1 issue of “NHTSA Notes” in Annals of Emergency Medicine. • Participation at national traffic safety and injury prevention meetings. • Collaborative development and networking in traffic injury prevention with national leaders in traffic injury control. The application deadline is April 1, 2002. Please send your CV, evidence of support from your sponsoring institution, and a letter of intent expressing your interest in the Fellowship position. In your letter of interest, please include indication of your area(s) of interest in motor vehicle injury control. These should be sent to Joan Harris, NHTSA, 400 7th Street SW (NTS20), Washington, DC 20590, or via e-mail at [email protected].
2002 Medical Toxicology Subspecialty Examination The American Board of Emergency Medicine (ABEM), the American Board of Pediatrics (ABP), and the American Board of Preventive Medicine (ABPM) will administer the certifying examination in Medical Toxicology on October 26, 2002. Physicians must submit an application to the board through which they are certified. Physicians who are certified by an American Board of Medical Specialties member board other than ABEM, ABP, and ABPM and who fulfill the eligibility criteria may apply to ABEM. On successful completion of the examination, certification is awarded by the board through which the physician submitted the application. Application materials will be available for ABEM diplomates on February 1, 2002, and will be accepted with postmark dates through May 1, 2002. ABP and ABPM diplomates should contact their boards for application cycle information. American Board of Pediatrics 111 Silver Cedar Court Chapel Hill, NC 27514-1651 919-929-0461 Fax 919-929-9255
American Board of Preventive Medicine 330 South Wells Street, Suite 1018 Chicago, IL 60606-7106 312-939-2276 Fax 312-939-2218
American Board of Emergency Medicine 3000 Coolidge Road East Lansing, MI 48823 517-332-4800 Fax 517-332-6370
FEBRUARY 2002
39:2
ANNALS OF EMERGENCY MEDICINE
1 9 7
According to “Fatal Single Vehicle Motorcycle Crashes,” more than 38,000 motorcyclists were killed in these crashes between 1975 and 1999. Single vehicle crashes account for approximately 45% of all motorcyclist fatalities. Motorcyclist fatalities in single vehicle motorcycle crashes decreased until 1996, reaching an historic low that year and again in 1997. As with other types of fatal motorcycle crashes, in 1998 fatalities once again began to increase, by 11.2% in 1998 and another 9.4% in 1999. Most of the fatality increase in these single vehicle crashes during this period was among riders age 40 and older. Helmet use, improper licensing, and speeding add to the overall problem when associated with high alcohol use among motorcycle operators in single vehicle crashes. Half of all fatally injured occupants did not wear a helmet in 1999, almost one third of those killed that year did not have a proper license, and speed was a contributing factor in more than half of the deaths. The type of roads, coupled with speeding and alcohol, contributes to the overall problem of motorcyclist fatalities in single vehicle crashes. More than half (57%) of the motorcyclist fatalities occurred on rural roads in 1999. Approximately 85% of all motorcyclist fatalities in single vehicle crashes occurred on undivided roadways and roadways that had a median but no barrier. Vehicle maneuvering is another critical factor in the single vehicle crashes when other major factors such as rural roadways, high alcohol use among riders, speeding, undivided roadways, and nighttime riding are added. Fifty percent of motorcyclist fatalities occurred while the vehicle was negotiating a curve. These combined factors show that more than 80% of motorcyclist fatalities occur off the roadway and more than 50% record a collision with a fixed object as the most harmful event. Copies of the 2 reports, “Recent Trends in Fatal Motorcycle Crashes” (DOT HS 809 271), June 2001, and “Fatal Single Vehicle Motorcycle Crashes” (DOT HS 809 360), October 2001, are available by sending a fax request to 202-366-7078 or by written request to NHTSA, 400 7th Street SW (NRD-31), Washington, DC 20590. The reports are also available through the agency’s toll-free line, 800-934-8517, and are on the NHTSA Web site at: http://www.
1 9 6
-nrd.nhtsa.dot.gov/departments/nrd30/ncsa/AvailInf.html.
Commentary: Riding Off Into the Sunset: Implications of an Aging Motorcyclist Population [Marottoli RA. Commentary: Riding off into the sunset: implications of an aging motorcyclist population. Ann Emerg Med. February 2002;39:196-197.] The recently completed analyses on fatal motorcycle crashes by the National Highway Traffic Safety Administration (NHTSA), entitled “Recent Trends in Fatal Motorcycle Crashes” and “Fatal Single Vehicle Motorcycle Crashes,” provide intriguing findings that ultimately raise more questions than they answer. Although the number of motorcycle fatalities is small compared with the total number of vehicle fatalities in the United States, there are a number of issues of some concern. Of particular concern to me as a physician, and especially as a geriatrician, are the dramatic increases in the number and proportion of fatalities among “older” motorcycle riders in the past decade and particularly in the past few years. These findings raise a number of parallels to older automobile drivers that deserve commentary. The questions raised may lead to further data collection that ultimately helps to better understand the causes of these trends and leads to interventions to curtail them. Before doing so, however, there is at least one caveat that needs to be kept in mind: “older” is a relative term (thankfully). In these analyses of motorcycle operators, “older” is defined as 40 years and above, while in most studies of “older” automobile drivers, the lower age limit is 65 years old. What were the findings of interest? Ownership and frequency of motorcycle use among “older” riders increased in the past decade. Although there was an initial decrease in the total number of motorcyclist fatalities, in the past several years fatalities among motorcycle riders have increased. The greatest proportionate increase in fatalities,
which appears to account for the overall increase, has been among “older” riders. These have involved primarily motorcycles with large engine displacement. This occurs even though speeding is less likely to be a contributing factor in crashes among older riders than among their younger counterparts and even though older riders are more likely to wear helmets. In contrast, alcohol use was found to be quite high in this group of “older” riders, particularly among riders between the ages of 40 and 49 years, who showed the second highest alcohol use of any age group of riders, coming just after those between the ages of 30 and 39 years. These data on motorcyclists offer a number of parallels to “older” automobile drivers, keeping in mind the different definition of “older.” As the population ages, the number of older drivers has been increasing. Older drivers have a low number of crashes overall, but if one accounts for the fewer miles they drive on average, their crash rate per mile driven is higher than for middle-aged drivers. They are also more likely to be injured or die in a crash, which is thought to primarily reflect their relative frailty in comparison with younger drivers. The relative contribution of driver, vehicle, and environment factors to the occurrence of crashes and subsequent injury or death is the subject of much debate and ongoing investigation. As with older motorcycle operators, speeding is not often a factor in motor vehicle crash occurrence for older drivers. The finding that problems with braking, steering, vehicle maneuvering, and failure to negotiate curves all contribute to motorcycle crashes reflects a close parallel to what happens among older drivers, among whom there is a preponderance of crashes and violations at intersections and from lane change maneuvers. This is all well and good, but why should these findings be of concern to the medical, public health, and safety communities? First, there is the issue of awareness. Granted, my patient population is quite old, but the possibility that they might ride motorcycles, or the need to ask, seldom entered my thinking before seeing these reports. In the interest of injury prevention, this may be an important question to ask. Second and, in my opinion, most important, there is the need for more data. In particular, we need more information on the following issues:
ANNALS OF EMERGENCY MEDICINE
39:2 FEBRUARY 2002
NHTSA NOTES
• Finer breakdown by age categories; • Is the problem primarily a result of increased volume (more older riders) or are other factors contributing? • Why do crashes/fatalities occur among older riders? • Are there differences in the types of injuries sustained by older and younger riders? • What are the relative contributions of rider, vehicle, and environmental factors? Among riders, what are the contributions of functional difficulties (eg, judgment, perception, balance, coordination), inexperience (either novice riders or those who return after many years of not riding), and relative “frailty” or susceptibility to injury compared with younger riders? Are older riders buying “too much bike” in terms of speed, size, and control? Is the preponderance of rural fatalities a reflection of the nature of the crashes or of medical response time? Would operator training or retraining help to decrease the occurrence and severity of crashes, and, if so, are there enough training programs available to accommodate the increasing number of older riders? This added information would at least yield more insight to how and why crashes are occurring and, hopefully, would prompt the development and testing of intervention strategies to counteract this growing and concerning trend.
Traffic Safety Medical Fellowship One-Year Intermittent Appointment • One-year appointment available as Medical Fellow at the National Highway Traffic Safety Administration (NHTSA). • Traffic safety education, research, and writing in a variety of injury prevention areas possible: occupant safety, alcohol, novice drivers, older driver safety, child safety, pedestrians, bicycles, motorcycles, other. • Position located within US Department of Transportation in Washington, DC. • Intermittent days over 1-year period to start approximately summer 2002 (negotiable). Minimum time commitment is 30 days in 1-year period. • Some work can be completed at Fellow’s home base, at NHTSA, or a combination. • Depending on location of selected medical fellow, NHTSA reimburses travel and accommodation expenses in Washington, DC. • Fellow’s sponsoring institution supports other expenses. Qualifications • Mid-level faculty in emergency medicine (minimum 2 to 5 years post residency). • Full-time appointment at academic institution. • In good standing with hospital and academic institution. • Support agreement from Fellow’s sponsoring institution. Benefits • Guest editor for at least 1 issue of “NHTSA Notes” in Annals of Emergency Medicine. • Participation at national traffic safety and injury prevention meetings. • Collaborative development and networking in traffic injury prevention with national leaders in traffic injury control. The application deadline is April 1, 2002. Please send your CV, evidence of support from your sponsoring institution, and a letter of intent expressing your interest in the Fellowship position. In your letter of interest, please include indication of your area(s) of interest in motor vehicle injury control. These should be sent to Joan Harris, NHTSA, 400 7th Street SW (NTS20), Washington, DC 20590, or via e-mail at [email protected].
2002 Medical Toxicology Subspecialty Examination The American Board of Emergency Medicine (ABEM), the American Board of Pediatrics (ABP), and the American Board of Preventive Medicine (ABPM) will administer the certifying examination in Medical Toxicology on October 26, 2002. Physicians must submit an application to the board through which they are certified. Physicians who are certified by an American Board of Medical Specialties member board other than ABEM, ABP, and ABPM and who fulfill the eligibility criteria may apply to ABEM. On successful completion of the examination, certification is awarded by the board through which the physician submitted the application. Application materials will be available for ABEM diplomates on February 1, 2002, and will be accepted with postmark dates through May 1, 2002. ABP and ABPM diplomates should contact their boards for application cycle information. American Board of Pediatrics 111 Silver Cedar Court Chapel Hill, NC 27514-1651 919-929-0461 Fax 919-929-9255
American Board of Preventive Medicine 330 South Wells Street, Suite 1018 Chicago, IL 60606-7106 312-939-2276 Fax 312-939-2218
American Board of Emergency Medicine 3000 Coolidge Road East Lansing, MI 48823 517-332-4800 Fax 517-332-6370
FEBRUARY 2002
39:2
ANNALS OF EMERGENCY MEDICINE
1 9 7