Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Public health response requires careful thought
- Paul A Pilkington (7 October 2005)
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Undesirable aliens
- Nicholas C Lee (7 October 2005)
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Why no call for helmets
- David Hansen (7 October 2005)
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Pedestrian safety rating
- Stephen M McDonnell (9 October 2005)
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Missing most important factor
- Peter J Miles (9 October 2005)
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Motor vehicle crash compatibility
- Ediriweera B.R., Desapriya, Dr. Ian Pike (9 October 2005)
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SUVs and cyclists
- Stuart Connelly (9 October 2005)
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SUVs and road safety in developing countries
- Rakhi Dandona (10 October 2005)
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SUV's and smoking analogy
- Brian Power (10 October 2005)
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A paradox; attitudes to SUVS and 'slam-door' rolling stock
- Tony H. Reinhardt-Rutland (11 October 2005)
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Enforcement, engineering; what about education?
- Jennifer M Caddy (11 October 2005)
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Not all SUV's are to blame
- John S Watts (11 October 2005)
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Spare a thought for the occupants of the SUV
- William R Glazebrook (11 October 2005)
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Pedestrian protection
- Frazer Goodwin (12 October 2005)
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SUV driving and adaptive behaviour
- Robert A DAVIS, NW10 2AS (12 October 2005)
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The Real Danger of SUVs are their Contribution to Climate Change
- Julie White (12 October 2005)
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The case for tobacco-style labelling on SUVs and their advertisments
- Andrew M Simms (12 October 2005)
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Re: Spare a thought for the occupants of the SUV
- Richard M Evans (13 October 2005)
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the psychology of SUV use
- David R J Jarrett (13 October 2005)
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Why stop at the dangers of SUVs?
- Mike RUTHERFORD (13 October 2005)
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Re: Why stop at the dangers of SUVs?
- Fiona C Cowan (13 October 2005)
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Re: Re: Spare a thought for the occupants of the SUV
- Martin Ferry (14 October 2005)
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complexity
- jon meredith (14 October 2005)
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SUV witch hunt?
- Brian Harding (14 October 2005)
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A dissenting voice
- Finn Morgan (14 October 2005)
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Designed to kill.
- Abraham Cutajar (15 October 2005)
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SUV and the older pedestrians - a personal view
- Bryan F Warren (19 October 2005)
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Editorial about dangers of SUVs is seriously flawed
- Ikechukwu O. Azuonye (23 October 2005)
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Re: Editorial about dangers of SUVs is seriously flawed
- Brian Morgan (24 October 2005)
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Re: Response to 'Editorial about dangers of SUVs is seriously flawed'
- Ikechukwu Azuonye (25 October 2005)
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Authors' reply
- Desmond O'Neill, Ciarán Simms (29 October 2005)
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Re: Authors' reply
- Ikechukwu O. Azuonye (2 November 2005)
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Straw Man
- Stewart Lo (3 November 2005)
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Re: Re: Authors' reply
- Frazer Goodwin (3 November 2005)
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Paul A Pilkington, Lecturer in Public Health University of the West of England
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Dear Editor, Simms and O’Neill call for a public health response to the rise in Sports Utility Vehicles (SUVs) [1]. Firstly, we must determine whether reducing SUV prevalence will improve the public’s health, understand why sales have increased, and then determine how we can try to reduce demand. The authors outline that risks of a pedestrian fatality when in collision with an SUV is nearly doubled compared to a normal car. Reducing their popularity appears then to be a worthwhile public health endeavour. Whether SUV drivers are more likely to be involved in a serious road collision as other drivers is important, and improving recording of crash data by vehicle type is crucial in investigating this. Why have sales of SUVs increased? The motoring industry is key –selling the dream of off-road driving and a world of adventure [2]. Another factor could be the popularity of caravans, with people choosing a sturdier vehicle to pull it. Then there is risk transference - do SUV purchasers believe that they are protecting themselves and their family from the effects of a possible crash? Whatever, we must understand the behaviour in order to change it. While informing consumers of the increased risk to pedestrians may reduce demand, its potential effect is debatable – the “But I’m a safe driver” syndrome may triumph. Tax increases could be more effective, which coupled with recent hikes in petrol prices may dissuade people on economic grounds. We could also tackle the perception that occupants of SUVs are safer in crashes, as studies indicate higher death rates and a greater chance of roll-over in SUVs than conventional cars [3]. Barriers to reducing demand will come from the motoring industry. The SUV market is worth millions and I imagine they will do their best to protect and promote it. Yours, Paul Pilkington References [1] Simms C and O’Neill D. Sports utility vehicles and older pedestrians. BMJ 2005; 331; 787-788. [2] Land Rover Freelander Web Site. http://www.landrover.com/gb/en/Vehicles/Freelander/Gallery/Gallery_video.htm Last Accessed 07.10.05 [3] United States General Accounting Office. Report to Congressional Requesters. Research continues on a variety of factors that contribute to motor vehicle crashes. March 2003. http://www.gao.gov/new.items/d03436.pdf Last Accessed 07.10.05 Competing interests: None declared |
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Nicholas C Lee, Occupational Medicine Heathrow UB70EH
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SUVs (sports untility vehicles, aka Chelsea tractors) are undesirable additions to our overcrowded roads from practically every point of view. They are environmentally unfriendly, visually unattractive, and take up far too much space on narrow roads and parking spaces intended for more normal-sized vehicles. Not only am I sure that this paper has highlighted a very real hazard regarding the geometry of their front ends, but I believe that the parked larger ones can also impede the view of pedestrians trying to see if it is clear to cross the road. Given the political connections and economic clout of the car industry, it is probably a non-starter to call for them to be banned. However, surely George Brown could impose a swingeing tax on them to discourage their use except for agricultural purposes? Competing interests: None declared |
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David Hansen, Outsider Edinburgh
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Having read about the increased head injuries caused to pedestrians I was expecting a call for pedestrians to be forced to wear helmets to protect themselves from 4x4s, or at least a call elderly pedestrians "protect" themselves in this way. The contrast with similar calls for cyclists to "protect" themselves is marked. Readers may like to ponder on this contrast. Competing interests: None declared |
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Stephen M McDonnell, Clinical Research Fellow Nuffield Orthopaedic Centre
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I have read with interest you article on SUV’s and the elderly. It is in fact many families who buy these vehicles, unaware of their increased potential dangers over a regular car. If manufactures were required to publish within their literature the pedestrian injury data as some form of score for a particular model as a “Pedestrian Industry Score” people may well think twice before buying. Competing interests: None declared |
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Peter J Miles, Project Management Geulph, Ontario, N1K 1A5
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While the authors have put together a cogent argument technically, I believe they have left out the most important factor, the driver's behaviour (regardless of vehicle type). This, I feel, drives towards solutions that are technical in nature when the real problem is social. There are just too many bad drivers on the road. And many of the safety features added to cars over the last few years have been abrogated by changes in drivers' behaviour. For example, it appears to me that impovements in the cars brakes (disc brakes, ABS) have only resulted in drivers driving much closer to the vehicle in front, and better percieved traction control (4 wheel drive) has resulted in drivers driving faster in wet or icy conditions. In Canada we see many 4 wheel drive SUVs in the ditch on a snowy day, probably the result of over confidence. All of this is very difficult to police. The spaces between cars cannot be measured accurately enough to establish regulations, and neither can variable speed limits be based on current and changing weather conditions. All of this is regulated by the driver himself. Any policing of these is left to an investigating officer who is limited to the testimonies of those involved in the accidents, who are not likely to implicate themselves, and witnesses who are not likely to have seen the events leading up to a crash but rather looked in the right direction when they heard the bang. The insurance industry is another means of control, however it is also limited to a post incident approach. There are age adjustments and type of vehicle adjustments to the cost of insurance, but the real control is in renewal cost post accident, when the damage has already been done. The insurance industry cannot differentiate a good driver from a bad driver before they get on the road. Unfortunately, when insurance costs and traffic offence fines are hiked up to try to control drivers' behaviour there is a tremendous hue and cry from the public and there are always willing politicians to "take up the cause" (i.e. get elected/ stay in office) to abrogate this means of control. This leaves only technological solutions available to treat what is really a social problem. So we end up analyzing the geometry and physics when we should really be analyzing the psychology and sociology. Competing interests: None declared |
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Ediriweera B.R., Desapriya, Research Associate Department of Pediatrics,BC Injury Research and Prevention - University of British Columbia-V6H 3V4, Dr. Ian Pike
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Despite the many safety improvements to new passenger vehicles, there is growing concern regarding an increased risk of injury to vehicle drivers occupants and pedestrians during a collision between vehicles of differing size and mass (1, 2). Chief determinants for the degree of severity of injuries in motor vehicle collisions are vehicle size and weight. The European Commission (EC) has stated that if all cars were designed to be equal in standard to the best car currently available in each class, then an estimated 50 % of all fatal and disabling injuries could be avoided (1). SUVs differ from cars in three key areas. They have greater mass and stiffness, resulting in higher intrusion when striking smaller cars. Additionally, the geometry places bumpers above the frames of struck cars again resulting in greater intrusion. As a result, the safety designs that were effective ten or fifteen years ago are not adequate in today’s incompatible vehicle collisions. New technology needs to be developed and implemented (3) Whilst mass is an issue with respect to survivability in crashes, researchers are finding good vehicle geometry and energy absorbing interfaces to be key factors in developing a heavy vehicle that is crash compatible with the average car fleet (2). Safety standards for front-end construction which would make vehicles less hazardous to pedestrians and cyclists may be as important as standards that affect vehicle occupants. Political obstacles have made such standards difficult to implement (2, 3, 4) A major design feature of heavy vehicles identified as significantly exacerbating the injury risk to pedestrians, cyclists and vehicle occupants, is the high stiffness and aggressiveness of the front structures. Many studies in North America and Europe have identified that the front, side and rear design of SUVs can be effectively modified to significantly reduce the harm potential of heavy vehicle crashes. (2) Road users everywhere deserve better and safer road travel. (1, 2, 3, 4, 5).To minimize the economic burden of vehicle body damage and road trauma, policy makers should promote the purchase of small cars with good occupant protection. Traffic safety literature indicates that SUVs and trucks inflict a larger external safety cost when involved in a collision, causing damage to other vehicles, road infrastructure, road side objects and vulnerable road users. It is recommended that SUVs be taxed at higher rates than small cars by incorporating a surcharge for safety into road use taxes, annual vehicle insurance fees or vehicle registration fees. We expect that these initiatives will result in improved traffic safety for older drivers, pedestrians and all other vulnerable road users. REFERENCES: 1. World Health Organization (WHO) World Report on Road Traffic Injury Prevention 2004-WHO Geneva Switzerland. 2. Desapriya E.B., Chipman, M., Joshi, P., Pike, I., The risk of injury and vehicle damage in vehicle mismatched crashes. Injury Control Safety Promotion.12 (3):191-192(2005). 3. Rowe, S.A., Sochor, M.S., Staples, K.S., Wahl, W.L., Wang S.C., Pelvic ring fractures: implications of vehicle design, crash type, and occupant characteristics. Surgery. 136(4); 842-7 (2004). 4. Simms, E., O’Neill, D., Sports utility vehicles and older pedestrians. BMJ 331; 787-788 (2005) 5. Acierno S., Kaufman R., Rivara F.P., Vehicle mismatch: injury patterns and severity. Accident Analysis Prevention 36(5):761-72; (2004). Competing interests: None declared |
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Stuart Connelly, Engineer BH12 1JB
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I have long suspected that pedestrians are more likey to seriously injured following a collision with an SUV as compared with a car. So unfortunately the findings of this paper do not surprise me. It is also abundantly clear to me that SUVs pose an even greater threat to cyclists. As well as the greater risk of injury following a collision, the chances of collision in the first place are considerably higher. There are two principle factors that lead me to this conclusion. Firstly many SUV drivers are unaware of the width of their vehicle and size the wake resulting from an travelling a large vehicle at speed. Secondly their driving habits are often gained from years of driving traditional cars. On narrow roads there are sitations where a car can pass with ease, in the same situation an SUV driver needs to slow down or wait before passing a cyclist. Often the driver is not aware of the dangers. The net result of this is that SUVs are far more likely to hit a cyclist when passing, or cause the cyclist lose control while passing at speed. When a collision occurs the risks again are increased. A cyclist / SUV collision is particularly dangerous because of the lower centre of gravity of a cyclist. There is no "wrap and carry" when a cyclist collides with an SUV. My suspision is the same issues apply to motorcyclists. I make these observations based on practical experience as a regular cyclist rather than medical or statistical analysis. In summary SUVs are bad for the environment, bad for pedestrians (young and old) and bad for other two-wheeled road users. I congratulate the authors on their study into the dangers of SUVs and would appeal to them to expand their work to look at the risks to cyclists, motorcyclists and other pedestian groups. Hopefully before too long SUVs will carry a health warning!! Competing interests: None declared |
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Rakhi Dandona, Associate Professor, Health Studies Area Administrative Staff College of India, Raj Bhavan Road, Hyderabad - 500 082, India
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Dear Editor, Simms and O’Neill have highlighted the increased vulnerability of pedestrians in collision with Sports Utility Vehicles (SUVs) which could reverse the achievements in road safety in the developed world.[1] Addressing the hazards posed by SUVs is also an emerging road safety challenge in the developing countries such as India. SUVs are increasingly becoming popular in India with an estimated increase of 47% growth in SUV sales in 2002-03 as compared with 19% growth in car sales.[2] International automobile companies from the developed world are targeting the Indian market with SUVs,[3][4][5] even though the road infrastructure and road user pattern in India is not conducive for driving such vehicles. From what is seen on the Indian roads, rich people own SUVs but their drivers from lower socio-economic strata drive these SUVs. These powerful vehicles give a great deal of “power” to these drivers translating into over-speeding and rash driving on the roads, and such driving is possible because of low traffic law enforcement in India.[6] Some SUVs also have a high steel structure covering the front of the vehicle to protect the bonnet of these vehicles incase of collision with another vehicle. This probably would add to the severity of injuries to pedestrians incase of a collision with SUV. Pedestrians and users of motorised two-wheeled vehicles are among the groups vulnerable to road traffic injuries in India, and they are in the age group of 16-49 years.[7] The risk of fatality and injuries from SUVs for both these groups needs to be understood in India. In addition to robust road crash data collection highlighting vehicle type and increasing awareness among the policy makers about road safety issues with SUVs on Indian roads, advocacy is needed to promote an integrated assessment of health and safety concerns into transport policies within the given road infrastructure and road user pattern in India before an automobile company is given permission to launch any type of vehicle on Indian roads. (rakhi@asci.org.in) 1. Simms C and O’Neill D. Sports utility vehicles and older pedestrians. BMJ 2005;331:787-8. 2. The Financial Express. GM India betting big on SUV Tavera. 3 June 2005; http://www.financialexpress.com/fe_full_story.php?content_id=60593 (accessed 10 October 2005). 3. General Motors India Private Limited. http://www.gm.com/company/corp_info/global_operations/asia_pacific/indi.html (accessed 10 October 2005). 4. Ford India. Sports Utility Vehicles. http://www.india.ford.com/servlet/ContentServer?cid=1058776334212 &pagename=FAPWebIn%2FPage%2FmodelHomePage_Temp&c=Page (accessed 10 October 2005). 5. Toyota India. Land Cruiser Prado. http://www.toyotabharat.com/showroom/prado/index.html (accessed 10 October 2005). 6. Dandona R, Kumar GA, Dandona L. Traffic law enforcement in Hyderabad, India. Intl J Inj Control Saf Promot 2005;12:167-176. 7. Dandona R, Mishra A. Deaths due to road traffic crashes in Hyderabad city in India: need for strengthening surveillance. Natl Med J India 2004;17:74-79. Competing interests: None declared |
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Brian Power, Pharmacist Wirral CH49 5PE
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Firstly I would like to congratulate the authors of this excellent report on highlighting a problem that many of us have suspected has existed for some time. However the suggested solution of applying "health warnings" to SUV's is unlikely to work in the same way that health warnings on cigarette have not been a success. Using the example of how Ireland has tackled its passive smoking problem by banning smoking in public places we need to encourage the government to do the same here not just for smoking but also for non- essential SUV use. Competing interests: I am a regular cyclist |
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Tony H. Reinhardt-Rutland, Reader in Psychology University of Ulster
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Recently, I commented on the paradox regarding attitudes to safety in private versus public transport (The Psychologist, 2005, volume 18(10), page 199). I suggested that obvious, cheaply-implemented safety improvements to private motoring - the example of banning cell-phone use was under discussion - are often greeted with a chorus of protest that they impinge on the "freedom" of the motorist. In contrast, public transport is expected to spend vast sums of money to improve safety, even if the improvement is likely to be marginal; I cited the example of the replacement of 'slam-door' rolling stock on Britain's railways, which casualty records suggest will have a minimal effect. The case of sports utility vehicles represents another expression of this paradox. It is self-evidently obvious that pedestrians will be more damaged by a bigger heavier vehicle which will likely be travelling faster than - say - a modest hatchback. Yet, one gets very little sense that the motoring community wants to eliminate SUVs in the way that slam-door rolling stock is being eliminated on the railways. Until the vociferous motoring lobby is curbed and the safety of private motoring is treated with the same sense of purpose as that expected of public transport, I see little optimism that the important message from Simms and O'Neil's article will be acted upon. Competing interests: None declared |
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Jennifer M Caddy, Retired consultant anaesthetist Pontefract
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Simms and O'Neill in their editorial criticise SUVs and their manufacturers but not those responsible for the vehicles' position and speed on the roads, namely the drivers. They suggest raising public awareness of the risk to pedestrians from SUVs but do not suggest raising driving standards. Perhaps it is time for 'traffic safety activists in the health professions' to set a good example by passing an advanced driving test. Competing interests: JC passed the RoSPA Advanced Drivers' Association (RoADA) driving test in 1992 and has maintained her gold standard on all subsequent three-yearly retests. She is a member of a local group of RoADA and does not drive an SUV. |
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John S Watts, Locum Consultant Psychiatrist Child and Adolescent Mental Health Service, Lenworth Clinic, 239 Hythe Raod, Ashford, Kent. TN24 0QE
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EDITOR - The Simms and O'Neill article contributes some interesting thoughts to a highly emotive subject (1). However, I wish to dispel a myth - not all 4X4 vehicles are poorly designed with regards to pedestrian safety, and not all non-SUV cars offer better protection that their all- wheel-drive cousins. For example, the European New Car Assessment Programme (Euro NCAP) reports that the Honda CR-V scored three stars out of a possible four in 2002, one of the highest pedestrian safety scores recorded (2). In contrast, the Audi TT roadster scored no stars in 2003 (3), and the Renault Clio one star in 2005 (4). In this world of evidence-based practice, it is important to try to avoid the perils of generalisation, for example, as shown in sweeping statements such as "The proliferation of sport utility vehicles represents a backwards step in safer vehicle design", and to try to base statements on fact. Undoubtedly car design is a factor in pedestrian safety in an impact, but this is not confined to one particular class of vehicle. References: 1. Simms C and O’Neill D. Sports utility vehicles and older pedestrians. BMJ 2005;331:787-8. 2. Euro NCAP website, accessed 10/10/2005. http://www.euroncap.com/content/safety_ratings/ratings.php?id1=10 3. Euro NCAP website, accessed 10/10/2005. http://www.euroncap.com/content/safety_ratings/ratings.php?id1=8 4. Euro NCAP website, accessed 10/10/2005. http://www.euroncap.com/content/safety_ratings/ratings.php?id1=1 Competing interests: The author is a driver of a Honda CR-V |
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William R Glazebrook, SpR in Emergency Medicine London
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Simms and O'Neill's research comes as no shock, but as an SUV driver myself, I am bored by the constant bad press we get. If it isn't that we are more lethal to pedestrians or other road users, it's that we are more lethal to the enviroment. Has anyone looked into the increase in protection bestowed upon the occupants of these vehicles? I know that by driving an SUV I am protecting my wife and my children from the dangers of other road users. Call me selfish, but they are my priority. Competing interests: None declared |
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Frazer Goodwin, Policy Officer European Transport Safety Council, Brussels B-1040
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The article by Simms and o'Neal is a useful additional contribution to the debate on pedestrian protection in general and the safety of SUVs in particular. It is important to recall that the pedestrian protection tests used by EuroNCAP, referenced by some of the comments following the article, have been elaborated following the work completed by the European Enhanced Vehicle Safety Committee working group 17. (1) Thus the EuroNCAP pedestrian test scores are undertaken with tests developed on the basis of a low primary strike point. What is additional to this work from the Simms and O'Neal paper is the assessment of problems associated with a potentially higher primary contact point in a collission with an SUV. This, furthermore, goes further than the implications for pedestrians as it also increases the danger of "over-run" accidents due to collision between high fronted SUVs and standard sized family cars. Moreover, the EuroNCAP pedestrian protection ratings are disappointing for all model types with no manufacturer scoring the highest 4 star rating. This week the VOICE Network has named the best car make (SEAT) and the Worst car make (Audi) on the basis of average scores for manufacturers in the EuroNCAP tests(2). One of the reasons that Audi performed so badly was the zero rating given to the sport car the AudiTT. These scores contrast with the high level of 5 star awards being now made for all model types for occupant protection. It appears that people are willing to pay for their own safety but they are unwilling to pay for the safety of others - or at least this is evidently what the vehicle manufacturers believe. The relative failure of EuroNCAP to deliver substantial progress on pedestrian protection will need to be recalled by European Policy makers when the current Directive on pedestrian protection is revised later this year. With increasing SUV fleet penetration it will be important to retain strong standards for the bonnet leading edge / upper leg test in these standards. Disappointingly, the Commission downgraded this particular element in the draft proposal published earlier this year.(3) What is notable about the occupant protection rating scores in EuroNCAP is in fact the relatively poor performance of SUVs in contrast to other vehicle types. Far from having a higher average safety rating SUVs actually receive a lower average test rating and are not represented in the top 10 safer cars. Moreover, the Insurance Institute for Highway Safety has recorded SUVs being significantly overrepresented in single vehicle roll over accidents (4). There is something of a myth therefore around the idea that SUVs are inherently safer. The problems of vehicle fleet compatibility compromising gains in occupant protection for standard sized cars as SUV over run accidents increase is indeed an emerging issue which policy makers will need to address. How they do that needs to explore all potential policy instruments and this includes local circulation bans, higher taxation, warning labels that make clear the social choice consumers are making at the point of purchase, and regulatory standards that offer vulnerable road users adequate protection. (1) The latest publication from EEVC WG17 being published this summer - a contribution by G. Lawrence of the Transport Research Laboratory in the UK see http://eevc.org/publicdocs/ESV2005_WG17_05-0379-O.pdf (2) For details of the Vulnerable Road User Organisations In Cooperation Across Europe - VOICE campaign visit the web site of the Euroepan Transport Safety Council www.etsc.be and click on the VOICE logo. (3) The Commission held a public consultation on a draft Regulation revising the Directive, see http://europa.eu.int/comm/enterprise/automotive/pagesbackground/pedestrianprotection/index.htm (4)Insurance Institute for Highway Safety has a number of reports on both roll over incidence as well as a recent report on vehicle compatability. See www.iihs.org Competing interests: Policy Officer of the European Transport Safety Council - coordinator of the VOICE network of vulnerable road user organisations |
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Robert A DAVIS, Policy Advisor,Road Danger Reduction Forum LONDON NW10 2AS, NW10 2AS
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Your Editorial [1} correctly points out the significant problems posed by a particular class of private motor vehicles to one group of other road users. Unfortunately it fails to properly address this problem by omitting a fundamental reason for this. One must point out also that the problem of danger posed by SUVs is simply a more extreme version of the problems posed by all motor vehicles, and that the danger is posed to all other road users, not just elderly pedestrians. The fundamental reason for a higher involvement of SUVs in pedestrian and other road user Road Traffic Accidents (RTAs) is that SUV drivers feel better protected in their vehicle than in smaller motor vehicles. SUVs are frequently advertised as being “safer” than smaller vehicles, and give the impression of crashworthiness to potential buyers irrespective of any advertising campaigns. The common sense knowledge that road users adapt to their perception of danger – generally referred to as “risk compensation”[2} or “adaptive behaviour” – is well documented [3]. In other words, the danger from SUVs comes at least partly from a tendency by the “road safety” establishment (including the medical establishment) to protect those dangerous to others from the consequences of their actions rather than reducing danger at source by measures such as automatic speed control, black box technology to identify cause in road crashes, higher levels of law enforcement and deterrent sentencing etc. Most importantly, there is a crucial need to reduce motor vehicle traffic and the fuel burned by motor vehicles: in this case increasing the cost of fuel would reduce the attractiveness of SUVs to consumers. [4] NOTES: [1] Simms C and O’Neill D. Sports utility vehicles and older pedestrians. BMJ 2005; 331; 787-788. [2]Adams JGU. “Risk” UCL Publications 1995 [3] Davis R. ”Death on the Streets: cars and the mythology of road safety”, leading Edge Press, 1992. [4] Road Danger Reduction Forum. www.rdrf.org Competing interests: None declared |
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Julie White, GP Highgate Surgery, Tinsley, Sheffield, S9 1 WN
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Although the figures for increased mortality in SUV-pedestrian collisions are a major cause for concern, they are dwarfed by the impact climate change will have on human health. Urgent reductions in greenhouse gases are required, yet CO2 emissions from the transport sector are increasing. Increased car ownership and use is one cause, but the massive rise in popularity of SUVs and other grossly inefficient vehicles play a significant role. Taxing these dangerous and polluting machines off the road should be a priority for public health. Competing interests: None declared |
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Andrew M Simms, Policy Director nef (the new economics foundation)
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A year ago, nef (the new economics foundation) proposed that tobacco- style health warnings should be applied to SUVs and their advertising. We were delighted to see endorsement of our proposal in the BMJ. Ciaran Simms (no relation) and Desmond O’Neill, make a compelling case for the need to address the hazards posed by SUVs to pedestrians. Add to that the hazard that they pose to the wider environment and the case is even stronger. Not only do SUVs pose significantly greater risk to pedestrians and other road users than most cars, they are also significantly more damaging to the habitable atmosphere. There is now new and stronger evidence that most of the observed global warming over the last 50 years is attributable to human activities. The overwhelming majority of scientific opinion says that the twentieth century trends of increasing temperature, sea-level rise, and extreme weather will continue and intensify in the twenty first century. Even if urgent action is taken to curb greenhouse gas emissions, the long life of carbon dioxide in the atmosphere means that the earth is already ‘committed’ to a certain level of warming. Overall, according to US conservation organisation the Sierra Club, the US vehicle fleet alone emits more CO2 than all but four countries(1). Today, one in every four new vehicles bought in the US is an SUV. Only the United States itself, China, Russia and Japan emit more CO2 per annum than US vehicles. Virtually all vehicle manufacturers are investing heavily to increase their sales and range of SUV, the logical conclusion of which will be higher fatalities and injuries on the road. Whilst concerning for wealthy countries, according to recent research jointly from the World Bank and WHO, the problem will be even worse in poor countries. There are an estimated 1.2 million fatalities and up to 50 million injuries each year attributable to traffic accidents. 85 percent of all deaths, 96 percent of child deaths and 90 percent of ‘disability-adjusted life years (DALYs),’ (a standard WHO measure to compare disease burdens) happen in low and middle income countries. Fatalities in these countries are set to rise 80 percent by 2020 (2). But by disproportionately contributing to global warming, SUVs have wider health impacts than the direct damage that they cause to pedestrians and other road users in traffic accidents. In 2002, the World Health Organisations (WHO) estimated that 150,000 deaths and the loss of 5.5 million DALYs were already attributable to climate change, which is set to worsen significantly over coming decades. In Britain, the Government states that, “air pollution is at present responsible each year for several thousand advanced deaths; for ten to twenty thousand hospital admissions, and for many thousands of instances of illness, reduced activity, distress and discomfort”. nef believes that we need labelling to encourage people not to drive SUVs in the same way that we encourage people not to smoke. As with smoking, driving an SUV is potentially harmful not only to the user. Driving an SUV also endangers other road users, the global population and the planet. And, as most such vehicles never leave urban roads, the majority of SUVs are an expensive indulgence for which others are paying the price. Mandatory health warnings have already been successfully applied to consumer products that pose a significant threat to public health. Given the significant and rising threat to public health posed by the particular environmental and health impacts of SUVs, nef believes that both the current rules governing the labelling of vehicles and new proposals in development are insufficient to deal with the problem. If we are to see the type of behavioural changes needed to significantly reduce SUV use, tobacco-style labelling should be introduced on all new SUVs. In the UK, fuel efficiency, which is already used to assess vehicle excise duty, could be used as the basis for such a scheme. Vehicles which, for example, emit more than 200g of carbon dioxide per km travelled, could qualify. As on cigarette packets, the warnings could cover 30-50 per cent of the vehicles’ surface area and be as prominent in press advertisements as tobacco warnings. This would not stop people driving SUVs altogether, but it would develop recognition of the consequences of doing so, and encourage behavioural shift. It would also contribute significantly to the public education drive over traffic safety and global warming. Evidence from the history of tobacco labelling demonstrates that significant behavioural change requires a clear and prominent labelling system with significant emotive content. When the European Commission considered standardising the health warnings on cigarette packets throughout Europe proposals drew on a comprehensive research base of evidence. For example, work by the government department Health Canada in 1999, concluded that there was a significant linear relationship between the size of the health warning message and its influence on the decision to stop smoking in the range tested (30% to 60%, at 10% intervals). The larger the health warning message, and the greater the emotional content, (for example through the inclusion of message-enhancing pictures of diseased internal organs), the more effective was the message at encouraging smokers to stop (3,4). A study by the UK Health Education Authority in 1990, also found that the size of health warnings was critical. It identified a tendency to interpret the small size of the warnings on cigarette packets as evidence of government complicity and lack of real concern (5). Evidence in a World Bank report studying the impact of larger health warnings on cigarette packets found that in the late 1990s, new warning labels that occupied 30 per cent of each of the largest sides on the cigarette pack were found to be strongly linked with smokers’ decisions to give up or to cut down their smoking If we are to increase awareness of the risk posed by SUVs, the same rationale must be applied to all new SUVs as well as their advertising. The nef website contains an initial briefing outlining how the proposal might work in practice developed from the Europe wide approach on tobacco labelling. Notes: (1) Driving up the heat: SUVs and global warming, The Sierra Club (2) World report on road traffic injury prevention (2004) World Bank & WHO, Geneva. (3) http://www.hc-sc.gc.ca/hecs-sesc/tobacco/pdf/size2.pdf (4) http://www.hc-sc.gc.ca/hecs-sesc/tobacco/pdf/liefeld-eng.pdf (5) Health Education Authority: Health warnings on cigarette and tobacco packs: report on research to inform European standardisation, London, 1990 Sincerely, Andrew Simms, policy director, nef (the new economics foundation) www.neweconomics.org Competing interests: None declared |
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Richard M Evans, Merton Cycling Campaign London SW20
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William R Glazebrook's response is not just wickedly selfish, it is uninformed to the point that he cannot have read the article to which he was responding, whose chief message is that SUVs are more dangerous towards vulnerable road users than other cars. His response also begs the question: what is he planning to drive once everyone else has also upgraded to SUV in their own selfish safety interests? A tank perhaps? WRG asks if anyone has looked into the increase in protection bestowed upon the occupants of these vehicles. Clearly he did not do a lot of research himself before buying his SUV! He is in fact not protecting his family by driving round in a SUV: it is a myth that SUVs are safer for their occupants. Their higher centre of gravity means they are much more likely to roll over. If WRG were really keen to protect his family's interests and health, he would encourage them all to walk and cycle everywhere possible, improving their fitness, heart function, bone density, body mass index etc. But surely, as a medico, he knows that already? Competing interests: None declared |
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David R J Jarrett, consultant geriatrician Queen Alexandra Hospital, Southwick Hill Road, Portsmouth, Hants PO8 OAW, UK
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Simms and O`Niell warn of increasing death and injury from SUV ( sports utility vehicle ) use(1) and conclude that consumers should be warned of potential risk to pedestrians through notices on the vehicles. This solution fails to consider the psychology of SUV drivers, the vast majority of whom do not need four wheel drive off road capability. There are few hill farms in Chelsea. SUV ownership represents the conspicuous display of wealth and a deliberate attempt to look down on, both physically and metaphorically, poorer less important people such as public transport users and pedestrians. In the USA to drive an SUV is seen as a fundermental freedom like the other lethal freedom gun ownership. Some have tried to curb use by invoking other belief systems: WWJD " What would Jesus drive?" The authors cite the success of anti-tobacco campaigns but there is a difference; smoking mostly damages the smoker and SUV driving damages others. SUV ownership will only reduce if the cost of the vehicle truely reflects the cost to the environment through pollution and pedestrians through impact. Whilst consumers have the "I`ll give up my SUV when you prize it from my dead fingers " mentality health professionals will have to carry on prizing dead pedestrians from the front of SUV`s. 1 Simms C and O`Niell D. Sports utility vehicles and older pedestrians. BMJ 2005;331:787-8(8 October) Competing interests: None declared |
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Mike RUTHERFORD, Writer FL 33319
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We've all known for years that large, tall, heavy, square four wheel drive SUVs are usually more unfriendly to pedestrians than small, short, round, light two wheel drive passenger cars. It's blindingly obvious. But can we now widen the debate, drop the SUV obsession and talk about other, often ignored vehicles which are even more dangerous to those on foot? I'm thinking, for example of delivery vans, buses, coaches and lorries. Surely they are all considerably more hazardous to pedestrians than SUVs and therefore these people need to be told and constantly reminded of the damage such colossal vehicles can cause them. Would anybody be interested in helping me compile a league table of the least and most 'passenger friendly' vehicles on the road? Pedal cycles would, I believe, come out top followed by motorcycles, two wheel drive passenger cars, then four wheel drive SUVs, traditional black taxis or light car-derived vans. Next (in no particular order) come the tallest, largest, heaviest, most brutally-designed delivery vans, lorries, buses and coaches. Some so called bendy buses in London are now so long that they have to mount pavements to negotiate corners. Does this mean they are the least passenger friendly vehicles on the road - and the pavements? Possibly. There is little doubt in my mind that these huge goods and public service vehicles are far less pedestrian friendly than comparatively light and small SUVs. So why the obsession with the dangers of four wheel drive SUVs and barely an acknowledgement that big vans, lorries, buses and coaches are even more hazardous? Everybody seems to be ignoring the harsh fact that while it's not a good idea to be run over by any vehicle, pedestrians are better off being in collision with a 4X4 than a single or double decker bus or a 42 tonne lorry. Competing interests: None declared |
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Fiona C Cowan, Health and Safety Trainer Western isles, Scotland HS1 2BW
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I have to agree. It would be hasty to jump to the blame of one type of non-standard vehicle above others as more likely to cause serious injury to elderly pedestrians. What difference does the bonnet height of people carriers make to injury rates, vans etc have all ben mentioned. As for environmentally unsound, I drive less than 5 000 miles a year at an average of 30mpg in an SUV smaller (and certainly narrower than my old volvo) than most family cars and people carriers. It takes me off road and enables towing on slipways where required and behaves well in between. Were my milage to increase I would have it converted to LPG as several other colleagues have done. What damage done by people driving 2.5+l cars thousands of miles, this higher mileage increasing the probability and therefore potentially increasing the risk of an accident occurring. How do such factors impact on the likelihood of injury occurence per mile per vehicle type etc? Also, what are the main root causes of geriatric injuries as a result of impacts with vehicles, would it be more beneficial to look at reduction of these rather than singling out a minority for persecution? Fiona Competing interests: None declared |
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Martin Ferry, Student G11 8QQ
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Richard Evans calls William Glazebrook "wickedly selfish" and attacks as "uninformed" the assertion that by driving an SUV, Glazebrook's protecting his family from harm. Having checked the NCAP website, I find some support for Dr Glazebrook's position: the mean safety rating for occupant protection in crash testing is higher for SUV's (4 stars) than for family cars (3.36). Assuming Dr Glazebrook drives responsibly while his wife and kids are on board the risk of flipping his SUV is negligible. NCAP ratings suggest that he's better off in an SUV if another car hits him. Competing interests: None declared |
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jon meredith, gp Glasgow G20 9DR
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very interesting. another issue is one of safety driving on roads where the proportion of SUV's is high. this creates difficulties in line of vision around these behemoth cars. so you buy a bigger one in order to feel 'above' and see better... the pollution, danger to pedestrians, and individual differences between any vehicles inherent safety to driver and passengers mean that the world would be a better place if people stood by the maxim 'less is more'. buy a bike. cars are coffins, any way you look at it. Competing interests: None declared |
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Brian Harding, film producer nebraska productions N10 2AR
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Re: Sports utility vehicles and older pedestrians
This article covers a subject which appears in great detail on many USA websites. It is undeniably interesting to study the relationship between injuries caused to different groups of pedestrians by different groups of vehicles. But it is disappointing that the article has been written without the objectivity that one may justifiably expect in a medical journal with the international standing of the BMJ. It is particularly disappointing when one considers that the slightly hysterical approach to this subject which has been apparent in several journalist reports using the same source material is repeated here. Blame it all on the SUVs! – the Chelsea tractors! It smells of the continuing witch hunt against SUVs, a group of vehicles which lacks any satisfactory definition. I suspect the reasons lie in the sobriquet “Chelsea tractors”, to describe rich mums swanning around town in big, expensive cars. The main source for the article is the paper published in Accident Analysis & Prevention (volume 36 page 295) by Clay Gabler and Devon Lefler entitled THE EMERGING THREAT OF LIGHT TRUCK IMPACTS WITH PEDESTRIANS. It has been reported in a number of periodicals, which all concentrated on the SUV results in this comprehensive study, ignoring the LIGHT TRUCK element which triggered the research. For example, T.A. Magazine Winter 2004 p.15 headlines its article “SUVs Twice as Lethal to Pedestrians”, whereas the paper’s authors describes its scope thus, in the actual words of Gabler & Lefler: “… this paper compares and contrasts the impact risk factor for pedestrians struck by sport utility vehicles, pickup trucks, vans, and passenger cars.” So why do the writers of the BMJ article write – without any references to back up the claim – “In the United States 40% of new vehicles purchased are classified as light trucks or vans (many of which are SUVs)” when Gabler and Lefler clearly analyse these types as separate groups? Surely not so they can adapt the research to fit their own conclusions? The brackets belong to Simms and O’Neill; how objectively scientific is the word “many”? Then there is the question of the appropriateness of the Gabler & Lefler paper to UK in 2005. To be fair, the BMJ article appears to be directed at an Irish readership. The data for the original paper is gathered from three main sources, all from USA: Fatality Analysis Reporting Systems (FARS), General Sampling System (GES), and the NASS Pedestrian Crash Data Study (PCDS). FARS is a comprehensive census of all traffic-related fatalities in USA. GES is a randomly sampled database of police reports of an average 60,000 accidents per year throughout USA. PCDS is a compilation of pedestrian accidents between 1994-1998 in six US major cities. FARS is only concerned with fatal accidents, but the other two include fatal and non-fatal pedestrian incidents. It should be noted that all this material relates to incidents under diverse conditions in USA nationwide, on country highways and city streets, in heatwave and blizzard, and no data is more recent than 2000. These conditions are very different from the conditions in UK in 2005. There is no reason to suppose that the circumstances of a mum on a school run in North London should relate to a speeding redneck on a South Carolina freeway, or a Celtic Tiger salesman in the boreens of Donegal. Nevertheless, in the absence of other data, this survey provides valuable and interesting information. Data is analysed for pedestrian fatalities per 1000 reported single vehicle pedestrian impacts between 1995-99, and vehicles are divided into seven categories (in descending order and number of incidents per thousand): 1. Large Vans – 259 fatalities,
Logically, any measures against SUVs on the basis of this paper should first be applied to the table leaders – Large Vans and Pickups – long before any consideration is given to penalizing SUVs. So too buses, lorries, London taxis and all other vehicles with a high, flattish front end. The Gabler-Lefler report concludes that pick-ups have the worst pedestrian accident rating. (The report is available in full at: www.me.vt.edu/gabler/publications/esvped_paper212.pdf). Interested students may also read the Pedestrian Crash Data Study interim update at: http://www.nhtsa.dot.gov/esv/16/98S6O05.PDF. Sorry – can’t find the final 1998 version on-line. In its analysis it considers injured pedestrians by age, height etc. Simms and O’Neill go into some detail to describe how the higher front end of a typical SUV causes more serious injuries in a collision with an adult pedestrian. They make no mention of the research which shows that children actually fare better than adults in such accidents. Instead they pick up another report which considers accidents to children in private driveways. Is this well- balanced analysis? There are many fundamental problems in the proposal to single out a group of vehicles for special treatment, not the least is that of definition and listing. The themes of pollution and ecological damage which surface in the Rapid Responses to the BMJ article fall into the trap of accepting a flawed grouping. In the contribution from the London-based New Economics Foundation, they even claim to have originated the daft health warning idea. A cursory look reveals that 4 x 4s come with a large variety of engines, and are not all gas-guzzlers as portrayed. Indeed, exhaust fumes from diesel engines are less harmful to the ozone layer than petrol engines, although they admittedly have other harmful side effects. And 4-wheel drive affords better road-holding and braking than conventional vehicles. Where are the figures comparing SUV accidents per mile with other vehicles? The American and Swedish studies are models of how such a survey should be carried out, but their conclusions may only be applied to pedestrians and traffic in the British Isles, and meaningful adjustments made, when similar research is conducted over here. In the meantime, critics are well advised to suppress their basic instincts to jump on the bandwagon and have a go at SUVs. Brian Harding Interests declared: Land Rover driver and older pedestrian Competing interests: None declared |
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Finn Morgan, Chief Medical Officer Healix International SW18 4DF
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So there you have it: the bigger the vehicle that hits you, the worse your injuries. I think most of us already could have guessed that. But there is another fact: elderly trauma victims have worse outcomes. Indeed. Am I alone in thinking it a contrivance to put these facts together with the social trend towards increased SUV ownership in order to claim some kind of 'new' public health emergency? Does this deserve to be the lead editorial in the BMJ? Perhaps next year we will see more such articles. Will the rise in budget airline use combined with an ageing population lead to a worrying increase in emergencies on board aircraft? Something must be done. How tiresome that this article should jump on the tired old bandwagon of 'nasty' SUVs - surely the decade's favourite whipping boy. SUVs are everywhere yet many write as if their popularity is a mystery. Do no doctors own these vehicles? The fact is they are very popular because they are excellent cars for families with children. These cars are not going to go away so their critics will have to get used to seeing people in cars that are 'bigger than they need to be'. That's what happens when you live in a free country. The other consequence of freedom is that we all are responsible for our own actions. All drivers, no matter what size their vehicle, have a responsibility to stay sober, drive safely and considerately, keep to the speed limits and watch out for pedestrians. Similarly pedestrians have a responsibility to cross the road where it is safe to do so, look both ways and not stagger around blind drunk. I believe that most vehicle/pedestrian collisons result from a failure of one or both concerned to stick to these simple rules. Doctors must resist the current fashion for seeing every risk as an excuse to dabble in social engineering. Few of us studied economics at medical school and I do not consider that we as a group are qualified to suggest tax-twiddling quick fixes to so-called 'problems' such as this. The public will not thank us for becoming dreary nannies who apper to want to micro-manage every aspect of their private lives. Competing interests: None declared |
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Abraham Cutajar, Locum gp North Devon EX39 5 EH
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What about Bull-Bars? - designed to kill large mammals - that's kangaroos - and you and I and our children. At least we should make a start here if we are not as callous as we are. Competing interests: Pedestrian, cyclist, driver and father |
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Bryan F Warren, Consultant Gastrointestinal Pathologist Oxford OX3 9DU
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This interesting and important leader discusses the relevance of vehicle type to severity of pedestrian injury. However, it does not seem to consider driver training. In the UK motorists are required sit a single driving test at one point in life. Its standard in my view does not equip motorists for modern traffic and road conditions. This is evident in the number of crashes which delay the progress of society to work each morning and the cost in lives and injuries is awful. Although a change in type of vehicle may be very important, surely a change in driver attitude and training needs to be considered. Is it time to revalidate and or educate drivers? Competing interests: None declared |
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Ikechukwu O. Azuonye, Consultant Psychiatrist 10 Harley Street, London, W1G 9PF
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EDITOR: The editorial by Simms and O'Neill [BMJ 2005;331:787-788 (8 October)] is very seriously flawed and plays into the hands of an increasingly violent and ill-informed anti-SUV ('Sports Utility Vehicle')lobby. My wife and I were in Nice, France, on holiday recently, and saw newspaper reports of anti-SUV activists slashing the tyres of SUVs - with the police deciding that no crime was being committed! This editorial mentioned the word 'drivers' only once - in connection with accidents on driveways, which the authors attributed to "the driver's reduced ability to see things aorund the vehicle". The article otherwise refers to collisions between SUVs and pedestrians, as if the SUVs were operating themselves and running around the world running people over. SUVs do not hit pedestrians any more than knives stab people, guns shoot people, bombs blow up people or nuclear devices incinerate people. It is the drivers of motor vehicles, not the motor vehicles themselves, that hit and injure or kill people. A reckless driver of a Mini will injure and kill people; a careful, experienced driver of an SUV will do no harm whatsoever. Apart from the amazing reference to SUVs taking it upon themselves to go out there and attack people, this editorial expresses other misconceptions. For the information of the authors, SUVs are not all large or high-performance. They are also not by any means the largest, or highest-fronted, vehicles on the road. HGVs, for exammple, would easily crush any SUV. Any technology that improves road safety would always be welcome - such as Speedtronic, Distronic, Parktronic and (the newly-introduced) reversing cameras on Mercedes-Benz cars - and such improvements should apply to all vehicles, not just the SUVs or executive and luxury cars. However, a far greater focus should be on the conduct of DRIVERS of motor vehicles, because it is the DRIVERS, not the cars, that cause accidents and injure or kill people. If the authors have any evidence that the DRIVERS of SUVs, small or large, are more reckless than the drivers of other vehicles, I would like to invite them to publish it. Competing interests: I drive a Jeep Grand Cherokee 4.0 Limited and a Mercedes-Benz E350 |
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Brian Morgan, Freelance Journalist Cardiff CF11 6LF
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Very interesting, it's not the SUV's that kill, it's the drivers. What about firearms? Competing interests: I do not own or drive a SUV, nor do I own or use firearms. |
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Ikechukwu Azuonye, Consultant Psychiatrist 10 Harley Street, London, W1G 9PF
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Mr Brian Morgan, Freelance Journalist in Cardiff, has written "I do not own or drive a SUV, nor do I own or use firearms." If Mr Morgan owns or uses any other form of vehicle - bicycle, motorcycle, 2 x 4 motor car, for example - and on any occasion operates such a vehicle recklessly, there would be a good chance that he would injure himself and/or another person. He states that he does not own or use firearms; that, however, does not demonstrate that he could not cause harm to others by other means if he were so minded. Mr Morgan's response demonstrates the principal point of my comment: SUVs, like any other motor vehicles, in their own right are incapable of causing any harm; but WE can USE them to cause harm to ourselves and/or others by operating them dangerously. This is the point that was completely lost on Simms and O'Neill, who wrote about SUVs as if these vehicles could start themselves, engage first gear, release the parking brake and make their way, of their own accord, on to the roads to terrorise people. Whatever happens to a motor vehicle (including the destruction of the vehicle in an accident) - unless it is the result of unforeseen mechanical failure - is the direct responsibility of THE DRIVER. Competing interests: I drive an SUV |
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Desmond O'Neill, Associate Professor of Medical Gerontology Consortium on Ageing, Trinity College Dublin, Dublin 2, Ireland, Ciarán Simms
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SIR: The responses to the editorial on SUVs and older pedestrians have helped to develop the theme further and will hopefully encourage professional and public debate on this issue. They have also revealed some misconceptions. The perception of improved safety for SUV occupants does not take into account the increased hazard of roll-over crashes, a factor that would also not be taken into account into tests such as the Euro-NCAP tests (1). For single vehicle collisions, research by the US Department of Transport showed that rollover crashes are more likely to result in fatalities than are other types of crashes (2). That research also found that rollover rates are particularly high for SUVs. Similarly, researchers in Florida found that SUV rollovers are three times as likely as for ordinary passenger cars (3). For two vehicle crashes, mechanics dictates that, given the occurrence of a collision between vehicles of dissimilar size, the occupants of the larger, heavier vehicle will be safer than the occupants of the smaller lighter vehicle. Due to the strong mass-length correlations, if all vehicles were larger, the overall risk would be decreased, as effective stiffness reduces with length. However, in two vehicle collisions, mass difference between the vehicles is strongly linked with risk (4). Therefore, introducing additional heavier vehicles (such as SUVs) into an existing vehicle population with many smaller vehicles (and thereby increasing the number of two vehicle collisions with a mass disparity) has detrimental effects on overall population risk. A recent report has examined fatalities in Britain in the last decade and has estimated that the changing composition of the car fleet (a greater proportion of both small cars and SUVs) has increased the number of deaths by 1% between 2001 and 2002 (5). An analysis in the USA suggests that each death 'saved' in an SUV is at the expense of 4.3 extra deaths to other road users (6). This is a level of imbalance that requires formal scrutiny by society: safety of road users is a shared responsibility that needs to be negotiated at national and international levels after informed debate. For the correspondent who commented that children struck by SUVs were safer than children struck by passenger cars, the authors would be very interested in seeing the evidence for this statement, as they were not able to find any themselves. Children in general fare worse than adults in collisions with all vehicles, regardless of type. Those correspondents who drew solace from moderate (as opposed to poor or absent) EuroNCAP pedestrian safety ratings need to be aware that a current difficulty with these tests is that they involve firing dummy parts at various locations on the vehicle and measuring the response. The following dummy body parts are tested: lower and upper legforms and a headform (adult and child). There is presently no test of the central body regions which are particularly vulnerable in impacts from a high fronted vehicle such as an SUV. For example, Roudsari et al (7) have reported from the Pedestrian Crash Data Study that for passenger vehicles impacting pedestrians, the thorax and abdomen regions account for 20% and 18% of the injuries respectively, whereas for ‘light truck vans’ (SUVs, large vans and pick-ups), this rises to 37% and 33% respectively. The EuroNCAP pedestrian ratings should be interpreted in this context. References to the dangers of trucks and vans actually reinforces the message of our editorial which specifically highlighted the dangers of SUVs for two reasons: a) the rapid and continuing increase in the proportion of these vehicles means that they present an increased (and growing) risk that needs to be assessed. In contrast, the proportion of commercial vehicles is not known to be rising; and b) vehicles required for commercial purposes and those driven for domestic use should be assessed separately. Nonetheless, the authors do not dispute that trucks and buses and any other large flat fronted vehicles pose very significant risks for pedestrians, as they do for occupants of other cars in a two-vehicle collision involving such vehicles. Therefore, the current knowledge in research should be used to improve the compatibility of such vehicles as far as possible. Some progress has been made: newer SUVs generally have a lower and more rounded bonnet leading edge height than their predecessors, and this is a very positive development. Trucks and vans are a recognized hazard to other road users: not only are traffic authorities around the world aiming to reduce the injuries related to trucks and vans, but society demands higher standards of driver licensing and medical fitness to drive for those driving commercial vehicles. The very hazards associated with vans militate against the wider replacement of safer cars by van-like vehicles (SUVs) into the traffic environment. Ciaran Simms, Desmond O'Neill, Trinity Consortium on Ageing, Trinity College Dublin, Ireland. 1.European New Car Assessment Programme (EuroNCAP). http:// www.euroncap.com/ 2. Deutermann, W. Characteristics of fatal rollover crashes: NHTSA Technical Report HS-809 438. Washington DC, National Center for Statistics and Analysis, 2002. 3. Saravade S. A study of fatal rollover crashes in the State of Florida. MSc thesis, Florida State University, 2005. 4. Evans L. Driver injury and fatality risk in two-car crashes versus mass ratio inferred using Newtonian mechanics. Proc Accid Anal and Prev 1994;26:609 -616. 5. Broughton J. Car occupant and motor-cyclist deaths, 1994-2002: TRL Report 629. Crowthorne, Transport Research Laboratory, 2005. 6. White M. The "arms race" on American roads: the effect of sport utility vehicles and pickup trucks on traffic safety. J Law Economics 2004;47:333 -355. 7. Roudsari B, Mock C, Kaufmann R. An evaluation of the association between vehicle type and the source and severity of pedestrian injuries. Journal of Traffic Injury Prevention 2005;6:185-192. Competing interests: None declared |
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Ikechukwu O. Azuonye, Consultant Psychiatrist 10 Harley Street, London, W1G 9PF
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SIR:I am very disappointed that Desmond O'Neill and Ciaran Simms, in their Reply to the numerous comments on their Editorial about the 'dangers' of SUVs, still fail to make any reference to the drivers of motor vehicles. There are two important warnings displayed inside my Jeep Grand Cherokee. The first one reads (all in Capital Letters): "WARNING. DEATH OR SERIOUS INJURY CAN OCCUR. CHILDREN 12 AND UNDER CAN BE KILLED BY THE AIR BAG. THE BACK SEAT IS THE SAFEST PLACE FOR CHILDREN. NEVER PUT A REAR FACING CHILD SEAT IN THE FRONT. SIT AS FAR BACK AS POSSIBLE FROM THE AIR BAG. ALWAYS USE SEAT BELTS AND CHILD RESTRAINTS." The second warning, referenced as SF 8955014372, reads: "This utility vehicle handles and maneuvers differently from many passenger cars both on -road and off-road. You must drive it safely. As with other utility vehicles, it you make sudden sharp turns or abrupt maneuvers you may cause this vehicle to go out of control and roll over or crash - you or your passengers may be seriously injured. Read the driving guidelines in the Owner's Manual." I have had an SUV for seven years. I have not crashed this car into anything or caused it to roll over. I have not run over a child on my driveway or mowed down elderly people crossing the road. I drive this SUV in a completely different way from the way I drive my passenger car, because I know that it is a very different animal. I drive it safely, as safely as I drive the passenger car. I have personal knowledge of many people who drive SUVs, and none of them has had an accident with these cars. Simms & O'Neill's attack on SUVs in their own right is difficut to justify. If you drive an SUV as you should, neither you nor the car nor other people will come to any harm. Competing interests: I drive and SUV |
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Stewart Lo, Ordinary medical student Toronto, M1W 2Z5
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Certainly the factor of driver is important. However, the point the authors tried to make here is that SUVs increase the risk of morbidity/mortality of pedestrians because of the design intrinsic to SUVs, not because SUV drivers are more accident-prone. Failure to make any reference to the drivers of motor vehicles does not undermine the authors' point. Even taking drivers into consideration, it is reasonable to assume that the subpopulation who drive a passenger car and the subpopulation who drive a SUV consist of drivers of all levels, with similar distribution in both subpopulations - a distribution consists of novices, experienced, cautious, and dangerous drivers. Increasing the number of SUVs on the road, given the fact that they are more pedestrian-unfriendly, will certainly overall increase the risk to pedestrians. Therefore, it's not the authors' burden of proof to give any evidence that SUV drivers are more reckless; but rather the ones who disagree to give evidence that the drivers of SUVs are safer drivers. SUV is not the largest vechicle. But other vec | |||