Volume 2 Number 2 REPORTS OF MEETINGS 161

severe deceleration injuries, including internal injuries of the heart and rupture of the bronchus and aorta, were shown.

All that was said was pertinent to the handling of modern trauma. It proved to be a well balanced programme, yet fractures constituted only a small

part. This is, however, a true reflection of the diversity of the subject which underlines the need for a surgeon to be in charge who has at least an understanding, if not a profound knowledge of head, chest, and abdominal injuries.

J.H.H.

ROAD SAFETY PROJECT

N.A.T.O. Committee on the Challenges o f Modern Society, Brussels, 12 June, 1970

AMONG the activities of the Nor th Atlantic Treaty Organizat ion has been the establ ishment of a Commit tee on the Challenges of Modern Society. This Commit tee arranged an accident investiga- tion ' w o r k s h o p ' to consider its road safety project. The ' workshop ' met at N.A.T.O. head- quarters and was at tended by engineers from both the motor car industry and organs of government and by doctors f rom eight European countries and from Canada, the United States, and Japan.

The general purpose of the meeting and the plan of the project was introduced by Dr. Robert Brenner of the U.S. Department of Transportation, who empha- sized that the purpose was to achieve results that would enable governments to know what steps should next be taken to reduce the toll of road accidents. It would start with a case study programme from mid-1970 to October, 1971, collect impressions at an international symposium in October, 1971, and put forward in October, 1972, a plan upon which it was hoped that governments would act. Mr. R..4. Wilson described in some detail the way in which the General Motors Corporation had gone about its study of how engineers can make motor cars less dangerous. He emphasized the importance of studies in the field but went on to explain the difficulties that arose from there being frequent changes among so many different models of motor cars. There were four considerations: the efficacy of current safety measures, the likely efficacy of future measures, future problems, with an eye to the financial advantage of solving them, and the im- pact tolerance of the human body.

As time went by, the scope for improvement was reduced because increasing understanding of safety measures found its way into designs; at the same time, the financial advantage of technical improvement became smaller. Among the most useful experimental work had been that of working out the forces gener- ated in accidents by reproducing in the laboratory the deformations found in damaged vehicles.

Because of the speed with which conditions change, it was desirable that newly acquired information about safety measures should reach engineers and designers as soon as possible. This in turn required special care in the choice of fields of enquiry and of means of collecting information and perhaps most important of all, it called for the compatibility of results from different sources and during different periods. It meant combining detailed consideration of particular features of design and construction with the collection of large amounts of more general

information. Mr. Wilson went on to describe his Corporation's means of collecting, recording, and analysing information and gave examples of the way in which such information had been put to use. He also showed the benefits that could come from having the co-operation of motor insurance companies.

In answer to questions, he said that special training was provided for key persons in the completion of forms, and that the cost of recording each case was of the order of £10-12, with a similar expenditure for feeding the information into a computer. Twelve persons had been engaged in the documentation of 3000 accidents; others had prepared information for electronic computation.

Mr. E. Flamboe, of the U.S. Department of Trans- portation, described the system used for investigating accidents in his country. It has five levels and starts with the police, whose reports can be enlarged, by arrangement, to include information on a subject of particular interest. This subject may be changed when the direction of interest is changed. State ~ Go teams ' include representatives of the police, traffic engineering, and the mechanical side of the State's Highways Department. Their tasks are to identify causes of accidents and to make recommendations for improving conditions on the roads. Federal ' G o teams' include engineers, physiologists, and behavi- oural scientists. They investigate special sorts of accidents, provide a link between federal and state agencies, and arrange for field trials and other appli- cations of new knowledge and methods. Finally, there is a multidisciplinary team with representatives of several branches of medicine, surgery, and patho- logy, of the relevant branches of engineering, of the police, and of the legal profession.

Fifteen such teams are already working in universi- ties and research institutes and will be used to train similar teams from other countries co-operating in the road safety project. It is intended that there will be 30 such teams eventually and that their fields of study will not all be the same. These investigations have shown, among other things, the part played in accidents by high-powered cars and by the unfamiliar- ity of some drivers with the vehicles they drive.

A National Accident Summary File, built up from the reports of the individual States, has enabled a wide range of tables of information to be drawn up by computer. The national file is about 3 years behind the events it summarizes.

Dr. G. M. Mackay, of the Department of Trans- portation of the University of Birmingham, spoke of methods of recording the position, degree, and nature of deformation of vehicles. Records of this sort

162 INJURY" THE BRITISH JOURNAL OF ACCIDENT SURGERY Injury Oct. 1970

are essential for any attempt to establish comparable records and there is urgent need for them for European use.

Dr. Alan Nahum, of the University of California, gave a strikingly illustrated account of the difficulties and dangers of field studies, and he showed that much of the information gathered was unreliable and even useless. Nevertheless, useful information had been gathered to show, for example, that at any particular speed of impact, older and heavier persons were likely to suffer more serious injuries than younger and lighter persons, and that heavier vehicles made for more serious injury. It was also shown that wind- screens with high resistance to penetration had not so far been a cause of death, and that energy-absorbing steering columns had reduced the severity of injury.

Information of this sort rested upon having a scale of injury of the human body, which was then des- cribed by Dr. J. D. States of Rochester University. Nine grades of severity were defined; minor, moderate, and severe but carrying no threat to life; severe and carrying a threat to life but with probable survival; critical in which survival was uncertain; and fatal. There were four categories of fatal injury, determined by whether the victims died with one fatal injury more or less than 24 hours after the accident, or whether there were 2 or more than 2 separate fatal lesions. A 'comprehensive research injury scale ' was also devised to give 5 grades each of: period of treatment; frequency or incidence of the injury; dissipation of energy; threat to life; and permanent incapacity. The establishment of this scale depended more upon judgement and experience than upon accurately measurable characteristics and it required corrections, for example, for the effect of age upon the 'progress and consequences of a fracture of the tibia. Experimental work with corpses had provided much useful information, but the most useful informa- t ion came from careful correlation of the mutual

effects of person and vehicle coming violently into contact, and then reproducing in the laboratory the deformation found in the vehicle.

Mr. Scott Lee of the U.S. Department of Trans- portation, described the procedures used in the field for studying vehicle accidents. Once the objectives have been decided, it is necessary to obtain the co-operation of transport authorities, of those respon- sible for enforcement of traffic laws, and of public health and of legal authorities. From the motor car industry it is necessary to have the assistance of design as well as safety engineering research staff. Hospitals, medical associations, insurance companies, garages, and lawyers all had a part to play and must be urged and enabled to play it. It is important to recognize that when there is no legal or mechanical reason for a damaged vehicle to be held for examination, the investigating team can make only the examination that the owner will allow, often at a time of emotional disturbance and perhaps increasing lateness for an appointment.

The collection, recording, analysis and application of information requires a team of appropriate composition to function at the place of accident, in laboratories, and elsewhere, and there must be a careful study of methods and results so as to identify and correct faults in the system. It also requires an organization that enables the right persons to be in the right place at the right time and with the right equipment.

The concluding address was by Dr. Brenner, who outlined the steps proposed for starting the project and maintaining it, with particular attention to the need for suitable co-ordination.

Each contribution evoked questions and discussion, from which it appeared that there was no serious criticism from the audience of what had been proposed from the platform.

P.S.L.