Presented by: Dr. Richard Harkness, CEOADEPT Driver Paul FarrellSafety First Prepared Exclusively...

Presented by:

Dr. Richard Harkness, CEO ADEPT DriverPaul Farrell Safety First

Prepared Exclusively For The

Loss Control Section ofCPCU Society

September 11, 2007Honolulu, Hawaii

Driving Miss Daisy: Safety Is No Accident!

Outline• Traffic Safety Overview

• Age Related Crash Risks– Defining the Issue– Analyzing the Factors

• Employment, Public Policy Issues

• Potential Solutions

• Summary

During this presentation…• Somewhere in the USA, 10 people will die

because of motor vehicle crashes (National Center for Statistics and Analysis, NHTSA)

• Worldwide, 274 drivers or pedestrians will perish on or next to a roadway, and another 11,415 will be injured (World Health Organization)

Global Perspective• While crash rates have generally declined

in the USA, they are climbing in other parts of the world.

• “World report on road traffic injury prevention” Highlights several provocative opinions:– traffic safety is under funded based on the

magnitude of the problem in developing countries

– Road deaths will eclipse many other health issues (TB, War, etc.) by CY 2020

Mortality Rates by Territory

Global Crash Costs

Traffic Safety• Despite best efforts of governments, insurers

and private firms, motor vehicle crashes remain:

– the leading cause of work place fatalities,

– the most costly lost-time workers compensation injury, and

– one of the leading causes of off-the-job, unintentional injury

WHY?

Traffic Safety

With limited exceptions, driving is the most complex

task people handle in the course of their day.

Traffic Safety

Despite the complexity of driving, people choose to increase their own risk, often

beyond a “break point”

Traffic SafetyOther factors affect a person’s ability to survive a crash event:

–Failure to wear seat belts

–Availability and speedy response time of rescue personnel

Traffic Safety• “Personal Use” vs. “Business Use”

Traffic Safety - Personal• Personal Use = getting to the grocery

store, or commuting to a work location.– For older drivers, driving is “lifeline” to

daily needs, social activity and gainful employment.

Traffic Safety - PersonalMost safety outreach efforts aimed at personal use are sponsored by public safety agencies, or vendors:

• NHTSA• IIHS• Police Departments• Driving Schools• National Safety Council• AAA / AAFTS

Traffic Safety - Personal

Personal use drivers participate in safety programs for many reasons.

Traffic Safety - Personal

Most safety practices for personal use driving focus on “common sense details”

Traffic Safety – Business UseBusiness use = job requires the employee to drive.

–For older commercial drivers, driving provides a source of income.

Traffic Safety - Commercial• Commercial safety training done by the

employer, often required by regulation, voluntary standards and by case law.

• Participation is mandatory, and the time spent is often eligible for compensation.

Traffic Safety - Commercial

Typically, a more formal approach to handling driver safety concerns.

Hiring / Selection

Medical Monitoring

Periodic, Specialized Training

Skills Evaluation

Annual Performance

Review

Traffic Safety

• Experience• Vehicle Design• Driver Impairments• Deadlines

• Weather• Equipment Maintenance• Distractions• Emotional Upset / Illness

Varied factors contribute to crashes:

Tool for analysis and understanding?

Haddon Matrix

FactorsPhase Human

Vehicles/Equipment

Environment

Pre-crashCrash

prevention

InformationAttitudes

ImpairmentPolice

enforcement

RoadworthinessLightingBrakingHandling

Speed management

Road design and road

layoutSpeed limitsPedestrian facilities

CrashInjury

prevention during the crash

Use of restraints

Impairment

Occupant restraints

Other safety devices

Crash-protective design

Crash-protective roadside objects

Post-crash

Life sustainingFirst-aid skill

Access to medics

Ease of accessFire risk

Rescue facilities

Congestion

Traffic Safety Analysis

All traffic safety issues can be reviewed under the Haddon Matrix:

–Youthful drivers

–Impaired driving

–Large truck vs. small car crashes

–Safety ratings

–EMT training and hospital response to crashes

Traffic Safety AnalysisFirst Dr. Harkness will help us define the scope of the age related drivers, then…

We will apply the Haddon Matrix to the issue of elderly drivers to identify the factors and suggest potential solutions to deal with aging drivers.

An Innovative Approach to Reducing Auto Collisions

Car Crashes Treated as a Behavioral Disorder

Background

Auto Crashes Resulting in Death

Driver Age Groups

Dea

ths

Per

10

0,0

00 L

icen

sed

Dri

ver

s

SOURCE: National Safety Council Injury Facts, 2004 edition p. 104

0

10

20

30

40

50

60

70

80

90

100

16-19 20-24 25-34 35-44 45-54 55-64 65-74 75 -over

1st Mission: Teens

Background

Teen Crash Statistics

• In 2003, 50% of 16-18 year-old drivers were in a police-reported collision

• Teens have the highest car crash rate of any age group

• Teens are 400% more likely to die in a car crash than 25-34 year-old drivers


16

17

18

2000

58

45

36

2003

63

49

43

Age

Year

2005

32

26

24

Police Reported Crash Rate Per 100 Drivers Each Year

SOURCE: National Safety Council Injury Facts, 2001 edition, p. 100 and Injury Facts, 2004 edition p. 104 and Injury Facts 2007 edition p. 104

On average over 50% of teens crash during the first year of driving

Background

Teen Crash Trends

Background

What Does the Data Tell Us?• Teen car crashes are decreasing.

• Still the leading cause of death for teens

• The chance of one crash in the first three years of driving is 62%*

• The chance of two crashes in the first three years of driving is 18%*

• Per mile driven, teens are 300% more likely to die in car crash.

SOURCE: National Safety Council Injury Facts, 2007 edition, p. 104

Driver Age

Annual Automobile Crashes by Age

Cra

sh

es

Pe

r 1

00

L

ice

ns

ed

Dri

ve

rs

10

1

5

20

2

5

30

3

5

40

4

5

50

5

5

60

6

5

16

19

20

45

17

18

25

55 6535

75

16 25 35 45 55 65 75

ADEPT’s Challenge: Give new-to-the-road drivers the skills that usually take years of

on-the-road experience to master


Driver Age

Background

Our Challenge

0

1

2

3

4

5

16-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Driver Age Groups

Automobile Crashes Resulting in Injury or Death

Cra

sh

es

Pe

r M

illi

on

Mil

es

Dri

ve

n

2nd Mission: Seniors

Background

• 4% of Senior Drivers, 1.2 million will be killed or injured each year.

• Seniors have the highest death rate per mile driven of any age group

• 89% of Seniors with 40% or greater visual cognition reduction will crash a car in the next three years.

Background

Senior Crash Statistics

Background

Senior Crash Trends

75+

2002

9

2003

5 Age

Year

SOURCE: National Safety Council Injury Facts, 2003 edition, p. 104 and Injury Facts, 2004 edition p. 104,and Injury facts 2005 edition p.104 and Injury Facts 2007 edition p. 104

2005

4

2004

5

75+

2002

11.5

2003

11.5

2005

11.5

2004

11.5 Age

Police Reported Crash Rate Per 100 Drivers Each Year

Fatal Crash Rate Per 100 million vehicle miles

Background

What Does the Data Tell Us?

• On a per person basis, seniors have low crash rates

• On a per mile driven basis seniors have high crash rates

• Per mile driven, drivers over 75 are 383% more likely to die in a car crash.

SOURCE: National Safety Council Injury Facts, 2007 edition, p. 104

Background

• Senior Driver Population will Grow Significantly

> Currently 30 million Senior Drivers

> Estimated 70 million Senior Drivers by 2030

Factors Analysis

We’ll focus mainly on the human factors as we largely cannot change the environment or vehicle designs.

Human Factors: Pre-Crash

Impaired or Diminished Visual Acuity:– Changes in eye shape

– Cataracts

– Lens degradation

– Diseases affecting vision such as Macular Degeneration, HIV, Diabetes


Mental impairment:–Dementia, Alzheimer's

–Mental impairment by proper or improper use of medication for other conditions

–Emotional duress


Training and Awareness:– Scanning around vehicle for

right of way, merging, passing

– Situational awareness

– Practice traffic/road rules

– Spot and react to pedestrians

Human Factors: Post-CrashCrash Injuries and Treatment:– Increased susceptibility to crash injuries

(chest contusions and various fractures)

– Medical complications that may inhibit recovery

– “Fragility”

Vehicle Factors: Pre-Crash

• Size and weight of car

• Crash testing & safety ratings

• Are there supplemental safety systems in place (side/curtain airbags, traction control, etc.)?

Environmental Factors• Older drivers (age 70+) had more crashes at

intersections than younger drivers

• This type of crash accounted for about half of fatal crashes among drivers aged 85+

• Has there been enough attention to making roadway designs easy to understand and see?

Haddon Analysis - Conclusions• The human factors, specifically a person’s

medical/biological condition, have the most direct impact on crash causation.

• The most promising programs to address these concerns focus on licensing, monitoring, & training.

Health Monitoring - Obstacles

• Highly personal and can be emotional.

• Requires professional diagnosis/testing of driver.

• This raises additional questions of:– When to start testing (what age)?– Frequency of evaluations?– Cost (how much and who pays)?– Voluntary or compulsory?

Health Monitoring - Solutions

• Mandatory reporting of “unfit to drive” by physicians is in place in Canada

• USA is different:

• Fifty States = fifty guidelines for physicians

• AMA provides a guide (online)http://www.ama-assn.org/ama/pub/category/10791.html

Performance Monitoring

These systems range from “How’s My Driving?” call in programs to Satellite based Global Positioning Systems (GPS)– The systems have been widely documented

as effective in most commercial use settings.– Crash rate reductions of 20-30% are common– Many commercial insurers have loss control

programs to provide, or encourage policyholders to adopt such systems.

Performance MonitoringThe success of these programs comes from several critical factors:– The data generated is funneled through a

central contact person and evaluated based on a specific benchmark of performance.

– Affected drivers “must” participate in corrective coaching, counseling, training or if needed discipline.

Performance Monitoring• Personal use of these systems is not as

well documented. Limitations include:– Who serves as “coach”?– What is the basis of setting a realistic

benchmark with the study group so small?

• These systems may have some bearing if they come complete with recommendations, training resources, etc.

Self Monitoring & Education

• Driver Competency Assessment Protocols

• www.agenet.com – checklist for older drivers

• www.seniordrivers.org – various resources

• AAA -- Roadwise Review

The Adept Driving Program

Re-Engineering Teen Crash Reduction Training

Crash reduction training differs from traditional pre-licensing drivers education in several critical ways

• Development process

• What it teaches

• When it teaches

• How it teaches


Medical Model Approach To Behavior Modification

• Epidemiology Studies

• Empirically Based Treatments

• Best Absorption Practices

• Behavior Intervention Treatment

• Clinical Trials


Step 1 Epidemiology Studies

• Convened a blue-ribbon panel of world-recognized experts:

– Dr. Herb Simpson (Chair)– Dr. Baruch Fischhoff– Dr. Richard Jessor– Dr. James McKnight– Dr. Allison Rossett

• Objective: Conduct research to identify the causes of teen driver collisions.


Step 1: Content Validation

• TIRF Research findings– Should be offered Post DE (after the 30/6)– Only empirically related content should be taught

• Key Factors that contribute to the greater crash risk of young drivers– Psychomotor skills (steering control, speed control,

integration and multitasking)– Perceptual skills (visual search & hazard detection)– Cognitive skills (risk assessment & decision making)– Attitudes and Motivations (risky lifestyle, risk taking)

• A different design training system is needed


Step 2: Empirically Based Treatments

• Research Results – Six highly correlated factors:

– Factor #1: Speed control– Factor #2: Space management– Factor #3: Risk perception– Factor #4: Visual search– Factor #5: Hazard recognition– Factor #6: Lifestyle Issues


Step 3: Best Absorption

• Determine best practices to modify behavior• Determine best learning modalities to increase

retention and practice • Gained consensus on curriculum content and

instructional technology• Result: ADEPT’s teenSMART training system

was born


Over $6 Million in Development


Step 4: Behavior Intervention

• Produced integrated, multi-media home study behavior intervention system

Workbooks

In-Car Guide

Interactive computer-based training on 6 CDs

DVD or VHSvideo segments

• Growth in knowledge

• Skill improvement

• Behavioral change

• Crash frequency


Step 5: Clinical Trials

Let’s See It…



How is teenSMART different from Driver Education

• Goals• Content• Teaching Effectiveness • Breadth and Depth• Position in Teen’s Learning Curve• Teen Motivation• Teaching Context • Parent Involvement• Measure of Success

Effectiveness of teenSMART Training

Absorption Effectiveness

• Is there measurable improvement in subject content knowledge?– 150 Subjects – Pre-post Design, parallel forms – Control for pre-testing effects– Visual Search, space management, speed

control, hazard recognition, risk and benefit perception

– ANOVA showed significant gains (p<.001) in all Knowledge areas

– Range: 22% to 42% in knowledge gains

Independent research conducted by Dr. Herb Simpson, Dr. Julie Downs, Dr. Baruch Fischhoff and Dan Mayhew


Absorption Effectiveness

• Is there measurable improvement in driving skills?– 150 subjects– Pre-post Design, parallel forms – Control for pre-testing effects– Hazard clicking, Risk-0-meter, Where is it,

Driver action*, What’s the clue*– ANOVA showed significant gains (p<.01) in

Hazard clicking, Risk-o-meter and Where is it– Range: 9% to 41% in skill gains * Not significant



Behavior Modification Effectiveness

• Is there measurable improvement in behind the wheel driving behavior?– Drive test 50 subjects– Pre-post Design, Video taped– Control for pre-testing effects– Speed control, Space management,

Visual search– MANOVA showed significant gains p<.05

in all three areas



Crash Reduction Effectiveness

1999 California DMV at fault collision report study

N=280, 16 – 19 year oldsOne year follow up

Collision reportedYES NO

teenSMART

(10.3%)

Safety ConscienceMatched Control Group (14.8%)

15 130

20 115

ADEPT conducted research using DMV collision reports

20 115



Does Improvement in Knowledge, Skills and Driving Behavior result in fewer young driver crashes?

145 teens aged 16 - 19 years had 30% fewer crashes one year after teenSMART training when compared to a safety-conscious control group from the same high schools and timeframe that were matched by age, gender and driving experience. Chi Square: Not significant



262 1973

29,378 155,508

2002 Insurance organization collision report study

N=187,121, Aged 16,17&18Collisions per annualized exposure


teenSMART

(11.5%)

Matched Control Group (15.9%)




In 2002 a study that involved 2235 teenSMART trained and 184,886 matched control group teens illustrated a 27.7% reduction in collision claims for the teenSMART group. Chi Square=28.72 P<.001




N=262,589, Aged 16 and 17Collisions per annualized exposure


teenSMART

Matched Control Group

726 6446

36,843 218,754








N=163,801 Age 18Collisions per annualized exposure


teenSMART

Matched Control Group

328 3183

19,541 140,749





Benefits for Teen Drivers and Parents

• Financial– Discounted insurance premiums– Decreased car repair costs– Fewer insurance claims & deductible costs– Fewer medical claims & costs– Fewer traffic citations

• Crash Prevention– Improved “skill factor” performance– Fewer collisions– Fewer injuries and deaths

• Freedom of Mobility– Retention of driving privileges

Benefits for Insurance Companies 1: Financial

• Significantly Improved Claims Experience and Loss Ratio’s

• Improved Customer Retention

• Premium Growth

• Over 100% discount recovery2: Marketing

• Improved Competitive Pricing

• Powerful, Award Winning Marketing Message

• Excellent Prospecting Tool

3: Public and Customer Relations• Consistent with Company Image

• Recognition for Pioneering a Breakthrough Product with the Power to Reduce Teen Injuries and Death

Re-Engineering Senior Driver Crash Reduction Training

Crash reduction training differs from traditional senior driver driver education in several critical ways

• Development process

• What it teaches

• When it teaches

• How it teaches


Medical Model Approach To Behavior Modification

• Epidemiology Studies

• Empirically Based Treatments

• Best Absorption Practices

• Behavior Intervention Treatment

• Clinical Trials


Visual Cognition and Accidents Useful field of view (UFOV) impairment and senior crash rates is well

documented in medical journals. Over 50 publications

Mean Crash Fequency as a Function of UFOV Reduction

0

0.5

1

1.5

2

2.5

3

10% 20% 30% 40% 50% 60% 70% 80% 90%

Percentage Reduction in UFOV

Me

an

Cra

sh

F

req

ue

nc

y

[Source: Ball, Karlene, et. al., Visual Attention Problems as a Predictor of Vehicle Crashes in Older Drivers, Investigative Ophthalmology & Visual Science, J.B. Lippincott Company, Vol.. 34, No. 11, Oct., 1993]


Senior driver age is not a good indicator of crash likelihood

Reduction in visual cognition and visual memory is the best indicator of senior crash likelihood.

Mean Crash Frequency as a Function of Age and UFOV

Reduction

0

1

2

3

Age 55-64 Age 65 -74 Age 75 or greater

Percentage Reduction in UFOV

Me

an

Cra

sh

Less than 40%41 - 90%

[Source: Ball, Karlene, et. al., Visual Attention Problems as a Predictor of Vehicle Crashes in Older Drivers, Investigative Ophthalmology & Visual Science, J.B. Lippincott Company, Vol.. 34, No. 11, Oct., 1993]

Summary

• Empirically developed

• Science-based content

• Validated instructional technology

• Proven crash reduction

• Comprehensive and effective program

Bottom Line

• Fewer collisions

• Better driving skills that reduce chances of injury

• Parents and family are engaged

• Strong economic incentive for all stakeholders

Technology Demonstration

Full Motion - Real Life Driving Challenges

Public Policy Issues - Licensing

This is an example of the confusion surrounding the underlying cause – medical condition not age. Some possible solutions:

– “Accelerated Renewal” cycles after some threshold age (shorter renewal cycles)

– Special provisions for older drivers such as vision checks, road tests

– Restrict renewal by mail after a certain age

Other Concerns - Employment

Supervisors of drivers of commercial vehicles may set policies governing ability to perform job duties

– Unfairly Discriminatory?– Employers can require physicals for WC issues– DOT Regulations require periodic physicals

Summary

Aging drivers have an increased risk of crash and fatality due to medical conditions such as:

– Cognitive and visual impairments– Fragility or a susceptibility to be injured– Difficulty in recovering from extensive injuries

Summary

Minimizing the potential for crashes by elderly drivers can be accomplished when:1. A monitoring program is in place to notice

key health, behavior or performance changes–Physicians are part of the team–Self monitoring and education are treated

as important by the affected driver(s)

Summary

2. Licensing programs treat drivers respectfully, fairly and with public safety properly balanced

3. Employers understand and properly practice their rights and responsibilities under employment and case law:– Provide safety programs– Comply with regulations (physicals)– Treat each employee fairly

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