Inquiry Into Aspects of Road Safety in Australia

Inquiry into aspects of road safety in Australia

Submission to the Senate Standing Committees on Rural and Regional Affairs and Transport References Committee

June 2015

Contents

Introduction ...... 4

The burden of road trauma in Australia and current trauma trends ...... 4

About MUARC ...... 4

Abbreviations ...... 5

Executive Summary ...... 6

Responses to the Terms of Reference ...... 8

A. The social and economic cost of road-related injury and death ...... 8

Key Points (A) ...... 8

Costing and valuation of road trauma in Australia ...... 8

The health impacts of road trauma ...... 10

Methods of costing and valuing road trauma at a general level ...... 10

Implications of WTP valuation ...... 11

B. The importance of design standards on imported vehicles as Australian vehicle manufacturing winds down 14

Key Points (B) ...... 14

Australian Design Rules (ADRs) and their contribution to road safety ...... 14

The MUARC Used Car Safety Rating program ...... 16

Research Support for the Continued Formulation of Additional Australian Design Rules ...... 19

Future role of Australian Design Rules (ADRs) ...... 23

United Nations Economic Commission for Europe (UN/ECE) Regulations ...... 24

C. The impact of new technologies and advancements in understanding of vehicle design and road safety...... 27

Key Points (C) ...... 27

Retrospective effects of vehicle safety improvements ...... 28

Projected future road trauma savings due to secondary safety improvements ...... 29

Injury and cost savings associated with various safety technologies ...... 31

Issues for the introduction of new vehicle technologies...... 34

D. The different considerations affecting road safety in urban, regional and rural areas ...... 35

Key Points (D)...... 35

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 2

Fatalities and serious injury rates in urban, regional and rural areas ...... 35

Crash types and current trends in urban, regional and rural areas ...... 35

Speed related factors and Infrastructure ...... 36

Potential impacts of increased bicycle use in urban, regional and rural areas ...... 36

Recommended countermeasures ...... 36

E. Other associated matters...... 37

Key Points (E) ...... 37

Older road users ...... 37

Older Road User Risk Factors ...... 40

New vehicle technologies and the vulnerable road user ...... 42

The road environment for older road users ...... 43

Countering the ‘older driver problem’ in a Safe System context ...... 44

Improvements to licensing procedures ...... 44

Land use and transportation infrastructure...... 48

Powered Two-Wheelers (PTWs) ...... 49

Final Comments/Conclusion ...... 50

Primary challenges that face our road safety future: ...... 50

Recommended countermeasures that will provide the greatest benefits: ...... 50

References ...... 51

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 3

Introduction

The burden of road trauma in Australia and current trauma trends

While there have been significant reductions in road trauma over recent years, more than 1100 Australians were killed in road crashes during 2014 and an estimated 17,000 Australians sustained a serious injury. According to World Health Organisation figures, Australia still seriously lags behind international best countries in road safety performance. The social cost of road crashes is estimated to be between $18 -27 billion annually depending on the method used and based on most recent estimates (BITRE 2010a).

About MUARC

The Monash University Accident Research Centre (MUARC) is Australia’s largest and most respected transport safety research centre. MUARC has a multi-disciplinary team of researchers and collaborates closely with road safety stakeholders in Australia and overseas. MUARC’s research has been successfully applied across all modes of transport, reducing deaths and serious injuries through evidence-based countermeasures including translation into policy.

Contributors to this submission1

Prof. Max Cameron (Professor – Research), Statistical Analysis & Transport Systems

Assoc. Prof. Judith Charlton (Acting Director). Behavioural Science for Transport Safety

Prof. Brian Fildes (Adjunct Professor)

Assoc. Prof. Michael Fitzharris (Assoc. Director), In Depth Crash Investigations & Transport Regulation

Dr. Sjaan Koppel, Behavioural Science for Transport Safety

Dr. David Logan, Senior Research Fellow

Assoc. Prof. Stuart Newstead (Assoc. Director), Statistical Analysis & Transport Systems

Dr. Jenny Oxley, Behavioural Science for Transport Safety

Dr Trevor Allen, Research Fellow, played a major role in the integration and preparation of this submission. His contribution is acknowledged and greatly appreciated by the other contributors.

1 The views expressed in this document are those of the authors and not necessarily that of Monash University.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 4

Abbreviations ADAS Advanced Driver Assistant Systems ADR Australian Design Rule AEB Autonomous Emergency Braking BCR Benefit Cost Ratio BITRE Bureau of Infrastructure Transport and Regional Economics BTE Bureau of Transport Economics CPI Consumer Price Index DIRD Department of Infrastructure and Regional Development ECE Economic Commission for Europe ESC Electronic Stability Control FMVSS United States Federal Motor Vehicle Safety Standards GTR Global Technical Regulation HC Human Capital ISA Intelligent Speed Adaptation MMS Motorised Mobility Scooters MUARC Monash University Accident Research Centre NASS CDS National Automotive Sampling System – Crashworthiness Data System NCAP New Car Assessment Program OBPR Australian Government Office of Best Practice Regulation PWC Price Waterhouse Coopers RTA Roads and Traffic Authority of New South Wales SCI Spinal Cord Injury TAC Victorian Transport Accident Commission TfNSW Transport for New South Wales TBI Traumatic Brain Injury UN United Nations VAED Victorian Admitted Episodes Dataset WTP Willingness To Pay

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 5

Executive Summary

A. The social and economic cost of road-related injury and death

 Increased rates of survival following traffic crashes has also increased the need to understand and appreciate the full spectrum of physical and mental health impacts of road trauma. This has implications for the community view of road safety programs and their acceptance beyond the number of fatalities.

 We recommend a shift in the ‘metric of cost’ of road-related trauma to the number of persons seriously injured, based on the high number and high unit cost. The costing of road trauma also needs to be more regularly updated which requires sufficient resourcing for the Bureau of Infrastructure Transport and Regional Economics.

 Speed limits should be reduced where appropriate in line with international best practice – as they are still much higher than equivalents in Europe and the USA and. On most rural roads the optimum speed that minimises the total cost to society is typically between 5 and 15 km/hr lower than currently set speed limits, depending on vehicle and road type.

B. The importance of design standards on imported vehicles, as Australian vehicle manufacturing winds down

 The Australian Design Rules (ADRs) system has operated successfully in the context of global Original Equipment Manufacturers (OEMs). It is essential that vehicle design rules in Australia are matched to our local conditions. We argue that the ADR process will become more important to protect Australian road users in future, particularly where United Nations regulations do not exist, or where Australia wishes to drive innovation.

 It remains important that as Australia is an active participant in the UN Global Technical Regulation (GTR) process that it continues to be resourced to play this role

 There cannot be reliance on the New Car Assessment Program (NCAP) to ensure minimum safety standards of Australia’s vehicle fleet. It is necessary to have safety regulations that cover ALL portions of the vehicle fleet, including trucks, buses, and motorcycles, to which NCAP has no relevance.

C. The impact of new technologies and advancements in understanding of vehicle design and road safety

 Improvement in vehicle safety is an essential requirement for Australia to meet its road safety targets, as has been the case in the past. Over the years 2000 to 2010, the average crashworthiness of the Australian light vehicle fleet improved by 27%, representing a saving of around 2000 deaths over the time period.

 In recent years, the focus on vehicle safety has shifted from preventing vehicle occupant injuries in the event of a crash to preventing the crash occurring in the first place, through the development of vehicle based technologies.

 MUARC research has estimated the potential benefits provided by specific vehicle-based technologies aimed at crash prevention. Autonomous Emergency Braking operational at all speeds was the technology estimated to result in the largest savings in fatalities and serious injuries from light vehicle

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 6

crashes with savings of between 5 and 10% possible in 2020 relative to 2010 depending on whether the technology is mandated or allowed to penetrate gradually due to market forces.

 Over a 20 year period the gains for each crash prevention technology tested was estimated to be twice that estimated for a 10 year period, as full penetration of the fleet is achieved. Comparison of the two fitment scenarios shows additional benefits possible from mandating of the technology.

 While the introduction of new vehicle technologies such as autonomous vehicles shows great potential for reducing road trauma in Australia, there are substantial issues here to be addressed. MUARC recommends Federal Government involvement on this issue.

D. The different considerations affecting road safety in urban, regional and rural areas

 Fatality rates are five to seven times higher in regional than urban areas, and serious injury rates in regional and remote areas are double those of metropolitan areas. In regional and remote areas, three- quarters of serious injury arises from single vehicle run-off-road crashes, usually on high speed roads that frequently have poor roadside safety infrastructure.

 In metropolitan areas, more than half of serious injury crashes occur at intersections. Cyclists and pedestrians constitute a higher proportion of metropolitan fatal and serious crashes than in rural areas.

 One factor applicable to all crashes in urban, regional and rural areas is speed. Speed related factors remain one of Australia’s major causes of road trauma.

 Australian States and Territories have officially adopted a Safe System approach to initiatives aimed at reducing the burden of injury in this country. In tandem with targeted Safe System road transformations on key routes or areas, a nationally-coordinated program to adjust speed limits to levels appropriate to the remaining road and roadsides is strongly encouraged.

 The availability of world’s best vehicles with technologies aimed at reduced speeding and fatigue, as well as automatic braking and control systems, will offer substantial benefits towards reducing crashes in urban, regional and rural crashes as well as mitigating injuries in the event of a crash.

E. Other associated matters

 Our ageing population necessitates a high priority on older road users in road safety. Managing the safe mobility of older road users in rural and urban areas requires a multi-faceted approach that includes safer vehicles, improvements to licensing, further research evaluating effectiveness of modified/restricted licences, enhancements to land use, road design and infrastructure, and education and training.

 Powered two wheelers are the fastest growing form of powered transport in Australia. When combined with the vulnerability of their riders in the event of a crash, a high priority needs to be placed on motorcycle safety using a Safe Systems approach.

 MUARC strongly recommends increased funding for ongoing Federal Government research programs in vehicle safety improvements and national road infrastructure improvements

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 7

Responses to the Terms of Reference

A. The social and economic cost of road-related injury and death

Key Points (A)

 Increased rates of survival following traffic crashes has increased the need to understand and appreciate the full spectrum of physical and mental health impacts of road trauma on individuals and the community. This also helps place a more representative value on the benefits of preventing serious injury crashes.

 We strongly recommend a shift in the ‘metric of cost’ of road-related trauma to the number of persons seriously injured, based on the high number and high unit cost. This has implications for the community view of road safety programs and their acceptance beyond the number of fatalities.

 The costing and valuation and road trauma in Australia needs to be more regularly and routinely

updated with guidance from the Office of Best Practice Regulation (OBPR). This requires sufficient resourcing for the Bureau of Infrastructure Transport and Regional Economics (BITRE) to produce timely and frequent updates.

 MUARC supports the adoption of ‘Willingness To Pay’ (WTP) pricing for the societal cost of road

deaths and injuries in Australia, which has already been adopted by NSW and WA state governments. This will ultimately lead to fewer serious injuries and deaths through increased government support. Cost estimates need to also be inclusive to capture the full range of road trauma impacts, such as the use of costs appropriate to head and spinal cord injuries which are relatively high. This highlights the need for an inclusive linked data system to help guide evidence-based road safety policy.

 Speed limits should be reduced where appropriate in line with international best practice. On most

Australian rural roads the optimum speed that minimises the total cost to society is typically between 5 and 15 km/hr lower than currently set speed limits, depending on vehicle and road type (which includes costs related to increased travel time).

Costing and valuation of road trauma in Australia

The estimation of costs associated with road trauma represents a key consideration in both the design and evaluation of policy interventions. To this end, it is necessary that the cost estimates are routinely updated with guidance from the Office of Best Practice Regulation (Dept. of Finance & Deregulation, 2008) so as to ensure consistency and appropriateness of use. Moreover, cost estimates need to be necessarily inclusive to capture the full range of road trauma impacts. Specifically, the use of costs appropriate to head injury and spinal cord injuries ought to be used in combination with ‘average injury costs’ where the distribution of specific injury types is known. For example, as shown by Access Economics and used by Fitzharris and Stephan (2013), the differential cost associated with severe and moderate head injury, as well as spinal cord injury, represents a critical

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 8

consideration in the evaluation of benefits associated with road safety policy, and vehicle safety technology in particular. It is recognised though that the disaggregation of injury sub-types is a necessary pre-condition for more detailed costs to be used, and this then relates to the need for an inclusive linked data system, the power of which was demonstrated by the used of the TAC-MUARC Linked Dataset for use in the report, Assessment of the need for, and the likely benefits of, enhanced side impact protection in the form of a Pole Side Impact Global Technical Regulation. This same report also demonstrated the importance of in-depth crash data, and it is argued here that a national in-depth crash sampling system (inclusive of all road users) where national sampling weights can be used, as is the case in the U.S. with the National Automotive Sampling System – Crashworthiness Data System (NASS CDS), would provide the infrastructure required for the creation of evidence-based road safety policy.

Fatality values: The Australian Government Office of Best Practice Regulation (OBPR) offers guidance on the societal cost of a fatality which is used as the basis of all regulatory analysis (Dept. of Finance and Deregulation, 2008) with the most recent (2012) value used in vehicle safety related regulatory impact analyses being $4.9 million per incident case. This value represents an amalgam of the Value of a Statistical Life as published by the OBPR in 2007 – to reflect willingness to pay (WTP) terms, combined with broader crash costs as published in the Bureau of Transport Economics (BTE), Road Crash Costs in Australia (2000) with appropriate Consumer Price Index (CPI) inflation values used to arrive at 2012 values.

Injury values: Cost of injury values for ‘serious’ and ‘minor’ injuries were derived using the proportional relationship with the BTE serious and minor injury values against that for a fatality. To reflect willingness-to-pay terms, these relative proportions were then multiplied by the OBPR fatality value (see above). After adjustment for inflation (to 2012), the dollar values for ‘serious’ and ‘minor’ injuries were $804,618 & $29,709 per incident case respectively. These are higher than if inflation alone was applied to the BTE cost of injury values (cf. serious: $615,187; minor: $20,772) though it was considered appropriate to scale these costs so as to ensure consistency with the fatality estimation method.

It is recognised that great acuity is required when placing monetary values on regulatory impacts, particularly in the context of improved information. The third source of cost of injury data is from Access Economics, who in their report, The economic cost of SCI and TBI in Australia (Access Economics, 2009) , used Victorian TAC claims data in arriving at the societal and lifetime care costs of traumatic brain injury (TBI) and spinal cord injury (SCI). Access Economics placed the following per incident costs (2008 values) on TBI and SCI:

 Severe TBI: $4.8 million per incident case, and taken to be AIS 4+ injuries and / or a Glasgow Coma Score of 3-8,  Moderate TBI: $2.5 million per incident case, and taken to be AIS 3 and / or GCS 9-11,  TBI: $3.7 million per incident case (combined severity), and  SCI - paraplegia: $5 million per incident case.

After applying CPI to inflate these costs to 2012 values, the cost of a severe TBI is $5.3 million, the cost of moderate TBI is $2.7 million, the cost of TBI per case is $4.1 million, and the cost for paraplegia is $5.5 million. For the Benefit Cost Ratio (BCR) analysis, the injury costs are discounted using a 7% discount rate per annum.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 9

The health impacts of road trauma

With increasing rates of survival associated with traffic crashes, there is now recognition that consideration must be given to the physical and mental health impacts of injury sustained in road crashes. MUARC has a long history of examining the impacts of road trauma, with studies conducted as early as 1993 (Fildes & Oxley, 1993). Further work by Fitzharris & colleagues (2005, 2006, 2007, 2010) documented the impacts of injury.

A detailed follow-up study of the general health status and functional disability at 2-months and 6-8 months post- crash was conducted. Those injured in road crashes were otherwise healthy adults aged 18-59 years admitted to hospital, and did not include road users with moderate-severe head injury or spinal cord injury. The disability experienced by this group was significant and at 8-months post-crash, relatively few participants rated their health as excellent, only 14-15% stated their medical problems had resolved completely, and 11.5% of males and 14.8% of females were unable to resume normal employment or study. Results indicated significant levels of impairment at 2 and 8-months post-crash relative to pre-crash health status, with health domain scores up to 26% lower than pre-crash scores. Assessment of activities of daily living indicated significant functional disability. Self- reported pain was higher for both males and females at both follow-up times compared to pre-crash self- reported pain. There was a significant impact on the ability of these injured people returning to work or study, and a significant reduction in social engagement. Notably, depression and anxiety represented a significant problem for a group of these injured persons throughout their recovery.

Road crashes represent a significant source of disability in the community. It is necessary that governments and the community understand the full extent of road trauma and recognise the broader impacts beyond the traditional road toll of the number of persons killed.

We urge a shift to the number of persons seriously injured as the primary metric in road safety, given the high number and unit cost. This has implications for the community view of road safety programs and their acceptance, in addition to understanding the number of road users killed.

Methods of costing and valuing road trauma at a general level

It is important that estimates of the cost of road trauma in Australia, and the value placed on its prevention, be regularly updated. The latest report on economic costs using the Human Capital (HC) method of costing was BITRE (2009) based on 2006 figures, almost 10 years ago. It would be useful if BITRE published societal costs of injury more regularly. We therefore recommend that the BITRE be sufficiently resourced to provide timely and frequent updates.

A BITRE paper by Risbey, Cregan and De Silva (2010) on the Social Cost of Road Crashes argued that if Willingness- To-Pay (WTP) estimates for human losses were adopted in Australia, then the total costs would rise by 52% ($27.12 billion compared with $17.85 billion in 2006). Given the increasing use of WTP in many countries, MUARC supports the adoption of WTP pricing for the societal cost of road deaths and injuries in Australia. While BITRE (2009) does not provide unit costs based on the WTP method, the data provided allows an implicit value of $6.88 million per road death to be calculated, allowing a comparison with the estimated unit cost of $2.67 million using the HC method.

The NSW and WA governments have officially adopted WTP unit costs as the appropriate method for valuing reductions in road deaths and injuries in economic evaluations of road safety investment decisions. The NSW Roads and Traffic Authority commissioned Price Waterhouse Coopers (PWC) to undertake a study of WTP unit

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 10

costs in 2008 (PWC, 2008). PWC commissioned the Hensher Group at the University of Sydney to undertake stated preference surveys, and estimated the values of fatality risk, severe injury risk, hospitalised injury risk and minor injury risk (Hensher et al 2009). These values indexed to June 2014 values are shown in Table 47 extracted directly from Transport for NSW’s (2015) Principles and Guidelines for Economic Appraisal of Transport Investments and Initiatives.

The above table also shows the WTP values estimated for preventing each fatal and injury crash, derived from the per person values because, for example, each fatal crash may involve more than one person killed and also a number of persons injured. These WTP values per crash can be directly compared with the Human Capital (HC) costs per crash shown in Table 49 also extracted directly from TfNSW (2015).

It can be seen from these two tables that Australian society values the prevention of a fatal crash 2.73 times higher than the HC cost estimated by BITRE ($7.4 million compared with $2.7 million in 2014 prices). The values placed on serious injury crashes cannot be directly compared in these two tables, but the same sources indicate a WTP value about twice the HC cost. The implications of the greater value that society places on preventing road death and serious injury than was previously estimated are significant for decision-making in road safety, as outlined below.

Implications of WTP valuation

The Safe System philosophy adopted in the National Road Safety Strategy views all road deaths and serious injuries as unacceptable and places high, perhaps infinite, value on their prevention. Nevertheless, government Treasurers and Finance Departments insist that proposals for investment in programs to prevent road trauma be justified by their expected benefits exceeding their cost. Until recent years, the expected benefits have been

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 11

based on the HC unit costs applied to the estimated reductions in road crashes at each level of injury severity of their outcome.

Since the NSW Roads and Traffic Authority have provided Australian estimates of the WTP values to prevent serious crashes, it has become possible for the economic analysis of road safety investments to reflect these values. In general, the benefit-cost ratio (BCR) of the investment is 2 to 2.5 times higher than the BCR using HC costs of serious crashes prevented. This has allowed more road safety initiatives to be supported by government and ultimately more deaths and serious injuries avoided.

WTP valuation of crashes also has implications for the economics of the speeds allowed on Australia’s rural roads and highways. In 2003, MUARC first conducted a comprehensive economic analysis of the optimum speeds of cars and trucks on each type of rural road (freeways, divided and undivided roads, including those with frequent sharp curves) for the Australian government. The analysis made use of well-established relationships linking travel speeds with road crashes, travel time, air pollution emissions and vehicle operating costs (Cameron 2003). The initial analysis used HC costs of crashes estimated by BITRE’s predecessor (BTE 2000) and State road authority costs of travel time and emissions. The methods were subsequently refined but the most significant change was the use of WTP values for crashes at each injury severity level (Cameron 2012).

The optimum speed that minimises the total cost to society for each vehicle and road type, based on WTP values or HC costs, is shown in Table 1 below together with the current speed limits on most Australian rural roads of each type (essentially also the current average cruise speeds on straight sections).

Table 1: Estimated optimum speeds using ‘willingness to pay’ (WTP) values of road trauma (PWC 2008) and using ‘human capital’ unit costs (BTE 2000) Current cruise Optimum speeds based Optimum speeds based speeds (speed limits) on WTP values on human capital costs Road environment Cars & Trucks Cars & LCVs Trucks Cars & LCVs Trucks LCVs

Rural freeways 110 100 110 95 125 100

Rural divided roads 110 100 95 90 120 95

Standard sealed 100 100 90 85 100 85 two-way undivided rural roads - curvy roads with 100 100 85 85 85 80a crossroads & towns Shoulder-sealed 100 100 90 90 105 90 two-way undivided rural roads - curvy roads with 100 100 85 85 90 85 crossroads & towns

a This estimate is less than 85 km/h because of the different vehicle operating cost model used in the early analysis compared with later (Cameron 2003 & 2012), resulting in lower estimated cost at low speeds

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 12

It was concluded from this analysis that the optimum speed on rural freeways is 110 km/h for cars and light commercial vehicles (LCVs) and 95 km/h for trucks. On other divided rural roads, the optimum speeds are 95 km/h and 90 km/h, respectively.

The current default rural speed limit of 100 km/h on divided roads, with a limit of 110 km/h on the higher quality freeways, is close to economically optimal for light vehicles but not for trucks. A limit of 90 km/h for trucks, with perhaps 95 km/h on freeways, would be appropriate.

There is economic justification for decreased speed limits on two-lane undivided rural roads, even on the safer roads with sealed shoulders. The optimum speed on these roads is no more than 90 km/h for both light vehicles and trucks. The speed limit should be at most 90 km/h on undivided rural roads.

It should be noted that the MUARC analysis fully includes the cost of travel time and its variation by trip purpose (business versus private), vehicle type and freight carried. The analysis uses the same unit costs of travel time used by State road authorities to justify road improvements to reduce time. Thus the analysis takes into account the principal objection to reduced speed limits on rural roads, namely increased travel time and potential economic damage. Further, the analysis based on WTP unit costs indicates that the greater value society now places on reducing road trauma justifies lower speeds, especially by trucks and by all vehicle types on our lower- quality rural roads.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 13

B. The importance of design standards on imported vehicles as Australian vehicle manufacturing winds down

Key Points (B)

 It is essential that vehicle design rules in Australia are matched to our local conditions, and to retain flexibility in the regulatory system and sufficient sovereignty to pursue the necessary safety requirements

 Australian Design Rules (ADRs) have operated successfully in the context of global Original Equipment Manufacturers (OEMs). While Australia is a relatively small market, there has been acceptance of

local standards even by global manufacturers. It cannot be argued that ADR’s have not been accepted as they operate in a largely import market.

 We accept in so far as possible the desire of the Australian Government to harmonise with vehicle regulations of other countries. However there is also a need to allow for higher levels of stringency

where perceived necessary and where this does not pose a ‘technical barrier to trade’.

 It is hoped that the advantages to the automotive industry of having to meet only one set of vehicle safety regulations will encourage the industry to continue to develop and implement safety technology/features well in advance of them becoming Global Technical Regulations/ADRs.

 It remains important that as Australia is an active participant in the UN Global Technical Regulation (GTR) process that it continues to be resourced to play this role

 We argue that the ADR process will become more important to protect Australian road users in future, particularly where United Nations regulations do not exist, or where Australia wishes to drive innovation.

 There cannot be reliance on the New Car Assessment Program (NCAP) to ensure minimum safety standards of Australia’s vehicle fleet. NCAP is a voluntary, consumer-based program with no command and control regulatory authority over the sale of vehicles, and does not test all vehicles in Australia’s fleet. It is necessary to have safety regulations that cover ALL portions of the vehicle

fleet, including trucks, buses, and motorcycles, to which NCAP has no relevance.

 Research by groups such as MUARC have made a significant contribution to  Australian Design Rules (ADRs) and their contribution to road safety  It is important to note firstly that the ADR process specifying minimum levels of vehicle safety in Australia is not a process which has been driven solely by the presence of a local vehicle manufacturing industry. The ADR process in Australia has been used effectively since the 1960s to ensure all vehicles sold in this country, not only those manufactured locally, meet minimum safety standards.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 14

Increasingly over time, the effectiveness of a safety feature in preventing injury in a crash or in reducing the probability of a crash has been known before the ADR which requires that safety feature has been formulated. This has occurred where the safety feature has already been present in some vehicles, overseas or in Australia, and its effectiveness has been evaluated based on the results of real world crashes. An early example of this was the seat belt, another being stronger door latches and hinges.

In other cases the expected effectiveness of an ADR has been estimated, based on its expected performance, and a more rigorous evaluation has been carried out after its implementation. The effectiveness of several United States Federal Motor Vehicle Safety Standards (FMVSS) on which some of the early ADRs were based was evaluated by Kahane (1984).

Cameron (1987) evaluated the effectiveness of those ADRs introduced to improve protection of occupants in a crash, during 1969 to 1977, using Victorian data. The results of these evaluations varied and are summarised below to illustrate the need for the analysis to consider different occupant groups, crash types and type of injury.

 ADR 2 (“anti-burst” door latches and hinges) * - was effective in reducing the risk of ejection in non-rollover crashes.  ADRs 4 and 4A (Static lap-sash seat belts) * - in addition to earlier findings about seat belt effectiveness found reduced likelihood of severe-to-fatal injury to the head, face, thorax, lower torso and lower extremities, when injured but not ejected in crashes in built-up areas, and for some body regions in open road crashes. There was an increased likelihood of minor injury to the thorax and neck.  ADRs 4B and 4C (inertia reel lap-sash seat belts) * - increased seat belt wearing rates  ADR 4D (rear seat inertia reel lap-sash seat belts) - wearing rates by rear seat occupants were not significantly different.  ADR 10A (energy-absorbing steering columns) * - reduced severity of injury, particularly in frontal crashes on the open road  ADR 10B (energy-absorbing steering columns – crash test) - insufficient data available to enable an evaluation  ADR 22 (head restraints) * - weak evidence of effectiveness in reducing whiplash injuries in rear end impacts, benefits confined to females in front left passengers seats  ADR 22A (head restraints increased minimum height) - reduced risk of whiplash injury to females in both outboard front seats in rear end impacts  ADR 29 (side door strength) * - no statistically significant evidence of reduced risk to front outboard occupants seated on the impact side in side impacts. This preliminary study was not considered conclusive because of limited data. It was noted that Kahane (1982) had found effectiveness for the equivalent standard in the USA.

While the above points to the success of component-based design regulations, the shift to performance-based standards occurred with the formulation of ADR 69, full-frontal crash protection. Within these performance- based standards, manufacturers were free to meet the test requirements of the 48 km/h test in a manner they elected. Fitzharris et. al (2004) conducted a comprehensive evaluation of ADR 69 (Full frontal crash protection) using in-depth data collected through MUARC’s in-depth crash investigation program; i.e., the now concluded Australian National Crash In-depth Study (ANCIS). The findings demonstrated a significant reduction in head and

* The words in brackets are Cameron’s description of the ADR rather than the actual title of the ADR)

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 15

thorax injury risk post-regulation. This effect was seen to be largely driven by the frontal airbag. Given the average fleet age of vehicles and the fact that new model Class MA vehicles had to comply with ADR 69 from July 1995, it can be anticipated that only some 20 years later in 2015 would be close to 90% of passenger vehicles. On this point, it is of value to note that that ADR 69 will reach full benefits realisation only now. The import of ADR 69 cannot be underestimated, and its success was followed by the introduction of the frontal offset standard (ADR 73)1 and the dynamic side impact protection standard (ADR 72), the latter being equivalent to UN ECE R95. The evolution of Australian Design Rules continues, with additions of ESC (ADR 35) and the much anticipated pole side impact ADR (refer Regulatory Impact Statement on Pole Side Impact, http://www.infrastructure.gov.au/roads/motor/design/adr_comment.aspx). The proposed new pole side impact test, following it successful ratification as a UN Regulation, and known as Global Technical Regulation was led by the Australian Government, and done so in recognition of the need to address the high number of side impact fatalities in Australia, as well as the need to play an active role in the UN Regulatory process. This point highlights the crucial role of Australian Design Rules and the role it can play internationally in setting new vehicle safety benchmarks.

These results provide some evidence that previously introduced ADRs were effective in reducing vehicle occupant injuries and their severity. They also indicate the need to monitor the effects of ADRs so that further improvements can be made where necessary.

The MUARC Used Car Safety Rating program

Another way of illustrating the effect of the ADRs and other programs on occupant protection is through monitoring the real world safety performance of vehicles in the Australian fleet and how this has changed over time. Since 1992, the Monash University Accident Research Centre (MUARC) has determined the crashworthiness rating of many car makes and models using real world crash data (Cameron, et al., 1992).

Crashworthiness ratings as defined by MUARC measure the relative safety of vehicles in preventing severe injury (death or hospitalisation) to their drivers when involved in a crash. Details of the method of calculating the crashworthiness rating of an individual vehicle, allowing for the effect of any non-vehicle factors which may influence the injury outcome (such as driver age, sex, the speed limit, the number of vehicles involved, the State and year of crash) are given in the report on the latest update of the ratings (Newstead, et al., 2014). This study utilised the data on more than three million drivers involved in tow-away crashes in the Australian mainland States during 1987-2012. Crashworthiness ratings were obtained for each of 406 car models manufactured from 1982 to 2012. The study also calculated aggressivity ratings (the risk of the driver of another car or an unprotected road user being killed or seriously injured when involved in a collision with the subject vehicle). As there are at present no ADRs covering aggressivity of a vehicle this matter will not be discussed further, other than to indicate that such ADRs are necessary, as there has been little progress in this area in the past 20 years. MUARC has already developed method to measure the effectiveness of such ADRS.

The data used for calculating the crashworthiness of individual make/models has also been used to calculate the average crashworthiness of the Australian car fleet by year of vehicle manufacture. Figure 2 (Newstead et al, 2014) shows the crashworthiness of the Australian fleet by year of manufacture from 1964 to 2012.

1 ADR 73/00, Offset Frontal Occupant Protection was mandated to apply to all new model passenger car vehicles less then 2.5 tonnes from January 2000 and all passenger car vehicles less than 2.5 tonnes from January 2004. As of Determination No. 2 of 1998, Class MA passenger cars complying with the requirements of ADR 73 may be deemed to comply with ADR 69 provided that the vehicles are fitted with dual airbags and the manufacturer can demonstrate by other allowable methods that the vehicle complies with the requirements of ADR 69. Notably, ADR 73 does not apply to forward control passenger vehicles (Class MB), off-road passenger vehicles (Class MC), and light goods vehicles (Class NA, NA1), although these vehicles must meet the requirements of ADR 69

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 16

10.0%

9.0%

8.0%

7.0%

6.0%

5.0% Average =4.3%

4.0% Crashworthiness Crashworthiness Rating 3.0%

2.0%

1.0% RATINGS

ADR4A

ADRs22A 5B,4B,

ADRs22 14,11, ADRs21 10B,

ADRs5A 4,

ADR4C ADR72

NCAP

ADRs10A8,3,2,

ADR29

ADR73

ADR69 CRASHWORTHINESS 0.0%

Year of Manufacture

Figure 2. Crashworthiness by year of manufacture (with 95% confidence limits)

Each estimate is expressed as a percentage, representing the number of drivers killed or admitted to hospital per 100 drivers involved in a crash. The 95% confidence limits on the estimates are also shown. The relatively wide confidence intervals for vehicles manufactured from 1964 to 1969 and in 2006 are a reflection of the smaller numbers of crashes involving those vehicles in the database. It should be emphasised that, as for the crashworthiness ratings for individual vehicle make/models, the results for each year have been corrected to allow for the effect of any non-vehicle factors such as driver age and sex, the speed limit, the number of vehicles involved, the State and year of the crash on injury outcomes.

The dates of introduction of the ADRs which cover occupant protection in a crash are also shown in Figure 2, together with the dates of introduction of the publication of major consumer information programs on relative vehicle safety in the Used Car Safety Ratings and of the Australian New Car Assessment Program (NCAP). The figure shows relatively little improvement for 1960s models, the considerable improvement during the 1970s, during which several key ADRs came into effect, then little change until 1985, during which time no new ADRs relating to occupant protection in cars were introduced. Since 1986 there has been a gradual improvement in crashworthiness, though at a somewhat slower rate than during the 1970s. These improvements could be the result of manufacturers progressively improving the crashworthiness of their cars, with a further contribution after 1995 from ADRs 69, 72 and 73 and the two consumer information programs.

MUARC has undertaken a similar study of crashworthiness of the New Zealand car fleet (Newstead, et al., 2008a). The results are shown in Figure 3. It can be seen that there was no improvement in crashworthiness during the period 1970 to 1983 to match the improvements observed in the Australian fleet during that period. There have, however, been progressive improvements since 1983. Although New Zealand had Traffic Regulations covering the safety of vehicles they were not as comprehensive or stringent as the ADRs. In the late 1980s, there were progressive removals of import controls and reduction of tariffs on vehicles and components. This resulted in a progressive increase in the import of used vehicles. In order to ensure appropriate safety of these vehicles during that period, a requirement was introduced that they must meet either the safety standards of the USA (FMVSS),

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 17

the UN/ECE, Japan or Australia which were in force at the date of manufacture of these vehicles. These requirements were embodied in the Transport (Vehicle Standards) Regulations (1990).

25.0%

20.0%

15.0%

Average = 7.4%

10.0% Crashworthiness Crashworthiness Rating

5.0%

0.0% 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Year of Manufacture

Figure 3. Crashworthiness by year of manufacture (with 95% confidence limits) for all vehicles (both new vehicles and used imports) in New Zealand

It is not possible to compare directly the actual crashworthiness ratings in Figures 2 and 3 directly because the calculations were based on different databases and correspondingly different methods of calculation.

180% Australia 160% New Zealand 140%

120%

100%

80%

60%

40%

20%

Crashworthiness Crashworthiness relative to 1964 vehicles 0% 1963 1968 1973 1978 1983 1988 1993 1998 2003 2008 2013 Year of vehicle manufacture

Figure 4. Crashworthiness by year of vehicle manufacture as a percentage of 1964 vehicle crashworthiness: Australia and New Zealand.

Comparison between the Australian and New Zealand fleets has been attempted in Figure 4 (Newstead, et al., 2014a), by setting the crashworthiness of the 1964 models in both fleets at 100%. Thus in Australia there has

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 18

been about a 35% improvement in crashworthiness of the 1979 models compared with the 1964 models, and about a 63% improvement for the 2006 models compared with the 1964 models. Although there was no improvement in the crashworthiness of the New Zealand fleet between 1964 and 1983, progressive improvement since then has resulted in improvement in crashworthiness of the 2006 models by about 58%. This illustrates how implementation of vehicle safety standards in New Zealand similar to the ADRs (or those of Japan, UN/ECE or the USA) has resulted in similar improvements in crashworthiness.

An important observation from Figure 2 for Australia and to some degree from Figure 3 for New Zealand is that in the early stages of improving vehicle safety ADRs have been critical in driving improvements in vehicle safety. The contrast in timing of improvement between vehicle safety in Australia and New Zealand and how this relates to the introduction of vehicle safety standards illustrates this point clearly. In later years, improvement has been driven by other forces including consumer vehicle safety information programs such as the New Car Assessment Program (ANCAP) as well as likely through increase consumer focus on and demand for safer vehicles as well as manufacturer focus on safety as a selling point. Although these forces have to some degree become a de-facto for the regulatory process, it is argued that the regulatory process is still necessary to ensure all vehicles in the market meet a minimum standard. In many instances, and particularly at the cheaper end of the vehicle market, price still dominated consumer behaviour and the potential to make poor safety choices is high. This is illustrated by examining the vehicle crashworthiness ratings of Newstead et al (2014) within the cheapest light car segment shown in Figure 5. Vehicles 14 and 22 in this figure are both of a similar age range and both imported. Vehicle 22 was rated as safer than vehicle 14 by the real-world crashworthiness rating. However, vehicle 14 sold in far greater numbers, likely due to its cheaper price. It should be noted that both of these vehicles comply with the ADRs of the time although vehicle 22 clearly exceeds the standards by a far greater amount than vehicle 14. Removing standards may introduce vehicles with worse safety standards than vehicle 14 but even cheaper and due to the lack of requirement to invest in safe design. Based on this example it is possible that such a vehicle may be highly popular in a price sensitive market.

Light 14.00% Crashworthiness Benchmark 12.00% Worse than benchmark + 1 increment Worse than benchmark + 2 increments 10.00% Worse than benchmark + 3 increments

8.00%

6.00%

4.00% CrashworthinessRating

2.00%

0.00% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Make and Model

Figure 5. Crashworthiness ratings for vehicles in the light segment.

Research Support for the Continued Formulation of Additional Australian Design Rules

During the past 25 years, MUARC has undertaken research related to vehicle safety. During 1989 and 1990 investigation of 229 crashes in which at least one car occupant was taken to hospital identified a number of

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 19

potential countermeasures to minimise injury to front seat occupants in a frontal crash (Fildes, et al., 1991). A subsequent report was commissioned by the Federal Office of Road Safety with two objectives:

1. “To identify the most cost beneficial mix of countermeasures, [identified in the earlier report] 2. To provide a sound basis for policy decisions in the preparation of Australian Design Rules.” (MUARC, 1992)

Three different packages of countermeasures were recommended each of which was estimated to be cost beneficial, based on estimates of injury reductions likely to be achieved and an assessment of likely costs. Each of the packages included:  energy absorbing steering wheel  seat belt pretensioner  webbing clamp  seat belt geometry and seat improvements  knee bolsters

One option also included a full sized airbag, another a smaller facebag plus a seat belt warning device and the third had no airbag but a seat belt warning device.

Following consideration of this report and the results of some crash testing, ADR 69 “Full frontal impact occupant protection” was formulated with an implementation date of January 1995 for new models and one year later for existing models. This ADR specified a barrier crash test based on that used by the FMVSS Standard, but allowed the test dummy to be restrained by the seat belt in the vehicle. This was a logical concession in Australia where over 90% of front seat occupants wear a seat belt. This allowed the use of smaller airbags with less aggressive deployment than those in the USA, which were required to provide protection without a seat belt. In fact some vehicles were able to meet the requirement of this ADR without an airbag. Unfortunately, the ADR allowed a non-intrusive seat belt warning device, such as a warning light to be displayed for as little as four seconds, whereas the original report had recommended a more intrusive seat belt warning device which would remain operating if the seat belt was not worn.

Some years later, and following work conducted by Fildes et al (2002), a Regulatory Impact Statement regarding an ADR requirement for an audible seat belt warning device to remain in operation until the seat belt was worn was not considered to be necessary (Dept. of Transport and Regional Services, 2004). Unfortunately crash investigations estimate that still about 20% of drivers and front seat passengers killed or seriously injured are not wearing their seat belt.

In 1993, the Federal Office of Road Safety commissioned MUARC to undertake another study to examine the level of protection available for occupants seriously injured in side impacts and what could be done to reduce the severity of such injuries. The main source of data for this study was that collected from 198 side impact crashes in the period 1989 to 1992. The report discussed the scope for a number of relevant injury countermeasures as well as the differences between FMVSS 214 for side impact protection and the proposed ECE requirements involving different dummies and different test procedures. It suggested that an attempt should be made to determine the likely benefits and costs of both these regulations in the Australian environment (Fildes, et al., 1994).

A further report estimated the likely benefits if Australia were to adopt a new dynamic side impact ADR similar to the US FMVSS 214 or the proposed ECE Regulation 95. It was found that the estimated benefits were similar and it recommended that in the short term, the ADR should require compliance with either of these two standards,

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 20

with suitable lead time for implementation (Fildes, et al., 1995). This report provided the basis for the formulation of ADR 72, Dynamic Side Impact Occupant Protection.

MUARC also undertook a study to determine whether an ADR similar to the proposed EEVC frontal offset crash requirement would be warranted in addition to ADR 69, particularly to provide better protection against lower leg injuries. It was found that considerable injury savings could be SN - expected and that an ADR would be warranted (Fildes, et al., 1996). This report provided the basis for the adoption of ADR 73, Offset Frontal Impact Occupant Protection (as noted above).

More recent work at MUARC focussed on the safety benefits of Electronic Stability Control (ESC). Research conducted by Scully and Newstead (2007, 2008) demonstrated the effectiveness of ESC for passenger cars (32% reduction) and for 4WD / SUVs (68%). The effect on multi vehicle crashes was not clear from this analysis, involving 7,699 crashed vehicles fitted with ESC, in Australia and New Zealand (Scully and Newstead, 2007). The study confirmed the results of earlier studies of the effectiveness of ESC in Europe and the USA, where even greater reductions were found for single vehicle crashes. This study led to the implementation of ADR 31/02 (2009) mandating ESC in all class MA passenger vehicles in Australia, a mandate still not found in other countries, notably New Zealand. It is also noteworthy that this mandate has been made in relatively recent times when local vehicle sales have been at historically low levels (i.e. the mandate affects imported vehicles most). This design rule ensure ESC applied for new passenger cars, passenger vans and Sports Utility Vehicles through Australian Design Rules (ADRs) 31/02 Brake Systems for Passenger Cars and 35/03 Commercial Vehicle Brake Systems. These requirements applied from November 2011 for newly approved models and from November 2013 for all remaining models.

Further work conducted by MUARC (Fitzharris, Scully, Newstead, 2010) on the likely benefits of ESC for light commercial vehicles enabled Australia to propose amendments to UN ECE Regulation No. 13, whereby the fitment of ESC would have been extended to category N1 (Class NA or light goods vehicles; Proposal for draft amendments to ECE Regulation No. 13, 71st GRRF, 13-15 September 2011, Agenda item 3(a)). Interestingly, after a Regulatory Impact Statement in Australia (ref below) published in 2013, the Australian Government introduced a requirement through Australian Design Rules 31/03 and 35/05 under section 7 of the Motor Vehicle Standards Act 1989 for Electronic Stability Control (ESC) to be fitted to new light commercial vehicles (LCVs) where ESC will be mandated from 2015 for new vehicle models and 2017 for all new vehicles (http://www.comlaw.gov.au/Details/F2013L01570).

ESC can be viewed as a tremendous regulatory success. However, it is an interesting counterpoint that consumer led demand precipitated by the Victorian Transport Accident Commission and also NCAP plays a role in shifting the market. Nonetheless, ESC fitment rates remained poor for some vehicle categories until moves were made to regulate. A case in point is the poor fitment rate of ESC in Class NA (light goods) vehicles (see Figure 6 below), and thus the regulatory action by the Australian Government was necessary, and commendable. This example precisely highlights the need for regulatory action in the form of Australian Design Rules.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 21

100%

90% Light

80% Small 70% Medium 60% Large 50% People 40% Mover Sports 30% Upper

Standard Equipment Standard 20% Large 10% SUV 0% Vans

PU-CC 4x2 Percent of new vehicles sold with ESC fitted as as fitted ESC with sold vehicles new of Percent

PU-CC 4x4

Jul-Sep 2007 Jul-Sep 2008 Jul-Sep 2009 Jul-Sep 2010 Jul-Sep 2011 Jul-Sep

Apr-Jun 2007 Apr-Jun 2008 Apr-Jun 2009 Apr-Jun 2010 Apr-Jun 2011 Apr-Jun

Oct-Dec 2006 Oct-Dec 2007 Jan-Mar 2007 Oct-Dec 2008 Jan-Mar 2008 Oct-Dec 2009 Jan-Mar 2009 Oct-Dec 2010 Jan-Mar 2010 Oct-Dec 2011 Jan-Mar 2011 Oct-Dec 2012 Jan-Mar Sales Quarter, Year

Figure 6. Percent of new vehicle sales with ESC fitted as standard equipment, Victoria 2006-2012 (Source: Fitzharris & Stephan, 2013)

There have been other research projects undertaken by MUARC which have estimated the effectiveness of specific vehicle safety features, which have not (yet) resulted in the formulation of an ADR. Two examples are given below.

Intelligent Speed Adaptation

In the TAC SafeCar Project, the Intelligent Speed Adaptation System was found to reduce mean, maximum and 85th percentile speeds and reduced speed variability in most speed zones. Based on these measurements it was calculated that the system could be expected to reduce fatal crashes by 7.6% and injury crashes by 5.8% (Regan, et al., 2006). Studies in Europe have reported even larger reductions.

Seatbelt Reminder Systems

As noted earlier, MUARC conducted work on the expected benefit/cost ratio of an audible seat belt reminder system was calculated for four different devices with assumed effectiveness in increasing the belt use rate among non-wearers, ranging from 10% to 40%. All were found to have benefits exceeding their costs when fitted for only the driver, or for both front seat occupants (Fildes, et al., 2002).

Low Speed Autonomous Emergency Braking (AEB)

An international consortium of governments, industry and consumer groups (including MUARC) was formed in 2012 to evaluate the benefits of various new Advanced Driver Assistant Systems (ADAS) technologies, using a meta-analysis procedure developed in the previous MUNDS project (Fildes et al, 2013).

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 22

Low Speed Autonomous Braking (City Safe) has been progressively fitted to vehicles, predominantly in Europe. Recent evaluations by the consortium (VVSMA) showed that the number of real-world rear-end crashes was reduced by a statistically significant 38% for vehicles fitted with low speed AEB compared to a comparison sample of equivalent vehicles. There was no statistical difference between urban (≤60km/h) and rural (>60km/h) speed zones. Moreover, the meta-analysis approach used in this analysis offered a unique contribution to the evaluation of vehicle safety technologies internationally and proved to be reliable with robust findings. The meta-analysis approach offer opportunities to evaluate these technologies faster than any one country could do.

Anti-lock braking (ABS) systems for Motorcycles

There are now numerous emerging vehicle safety technologies that offer similar potential benefits to ESC if mandated through the ADR process. The most notable of these is Anti-lock braking systems (ABS) for motorcycles. Preliminary international evidence suggests that this technology could result in reduced injury crashes for motorcycles of more than 30 percent (Rizzi et al, 2015). Local research is currently underway to evaluate the effectiveness of this technology for Australian motorcyclists.

Future role of Australian Design Rules (ADRs)

Most safety technologies are the result of research and development by one or more automotive companies, who sometimes also take up technologies resulting from research by other organisations. Hence, initially, improvements in vehicle safety depend on innovations by sections of the automotive industry and the desire of some companies to produce even safer products. Although the safety feature/technology was already present in some makes of vehicles, these generally tended to be the more expensive makes and in some instances were available only in the more expensive models of these makes. The primary role of the ADRs is to ensure that the minimum performance of such technologies is clearly defined and that it is provided in all new cars as from some future date. It is also important that an ADR does not restrict innovation, which can usually be done by making it a performance requirement.

It has been said that the ADRs have provided “a level playing field” and ensures all new vehicles permitted for sale in Australia meet particular safety standards

Where safety features have required the inclusion of additional components e.g. airbags or seat belt retractors, the assurance of a continued large volume market has resulted in progressive reductions in the cost of the components, as large volume production and associated design improvements have been implemented.

Often there has been a period of several years between the technology first appearing on some makes and the formulation of the ADR, with a further delay of several years before the implementation date, to allow reasonable lead time for all manufacturers to be able to incorporate the technology at a reasonable cost. In some instances the ADR is implemented in two phases, first for all newly released vehicles and sometime later for all vehicles (for example ADR 69). A recent example of the time periods involved is Electronic Stability Control (see Figure 6 above), which was available on some top-of-the-line European cars imported into Australia since about 1997, was available in about 40% of new cars sold in Victoria by the end of 2007, and will be mandated for all new vehicles from 2017.

In the early days of the ADR system, up to 1975, a considerable number of ADRs, covering most of the proven safety technologies/features known at the time were formulated. Then there was a period of relatively little activity, other than for safety in buses, until ADRs 69, 72 and 73 were formulated in the mid-1990s. Since then,

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 23

and despite the non-acceptance of a revision to ADR 69 which would have required a more aggressive seat belt warning device, there was an apparent lull in rulemaking until 2009 / 2010 when moves were initiated to examine ESC, and later a new pole side impact test under the UN GTR process.

While the ADRs generally cover passenger cars and their derivatives, there is a need to ensure that other classes of popular passenger carrying vehicles (e.g. 4 wheel-drives and commercial utilities) are included given their growth in popularity in Australia in recent years. A recent successful example of this is ADR 35, ESC fitment in Class NA (light goods) vehicles, though we argue that improvements in the safety standards of these and other larger vehicles, as well as powered two-wheelers needs to be pursued more aggressively.

It is understood that any proposed ADR, or amendment to an ADR, must go through the procedures set up by the 1994 COAG Agreement, i.e. Regulation Impact Statements to be approved by the Office of Best Practice Regulation, as well as requirements to harmonise with the UN Global Technical Agreement (see below) where possible. Given the processes and lead times for regulatory action, it is argued here that there is a clear need to ensure the local regulatory authorities are sufficiently resourced to promote the rapid development of new safety standards. To do otherwise could result in delaying or rejecting the implementation of proven safety features, even when they are subject to an international standard, could be responsible for preventing loss of numerous lives and injuries in motor vehicle crashes.

Furthermore, there is a need to examine how to reduce the time period between when a new safety feature/technology is first determined to be effective and the date of implementation of an ADR related to the safety performance enabled by use of the technology. Such an examination may, however, need to take into account the requirements of the UN/ECE global agreement, discussed next.

United Nations Economic Commission for Europe (UN/ECE) Regulations

At a global level, a number of global agreements exist concerning uniform technical requirements for vehicles. Australia is a signatory of the ‘1958 Agreement’ and the acceded to the 1998 Global Agreement on concerning the establishment of UN Global Technical Regulations in June 2008. As a consequence, Australia has a clear preference to harmonise its standards within the context of the 1998 Global Agreement and has been an active participant in the UN Global Technical Regulation process. The intent of the 1998 Agreement is to: ‘…continuously improve global safety, decrease environmental pollution and consumption of energy and improve anti-theft performance of vehicles and related components and equipment through globally uniform technical regulations. This shall be done whilst providing a predictable regulatory framework for a global automotive industry and for the consumers and their associations. (UN, 2012 World Forum For Harmonization Of Vehicle Regulations, 3rd Edition, p.15)

The UN/ECE Global Agreement recognises that the automotive industry has become essentially a global industry and there are considerable economic advantages in having a single set of global vehicle safety standards. Australia’s accession to the agreement could potentially limit the scope for the ADRs to include unique requirements to meet unique Australian conditions, as was done in the past in relation to components such as seat belts and their anchorages (ADRs 4 and 5) at a time when there was a need to deal with the consequences of our compulsory seat belt wearing laws (Vulcan, 1998).

Notably, Article 7.1 of the Agreement requires any Contracting Party that votes in favour of a Global Technical Regulation to “submit the Technical Regulation to the process used by that Contracting Party to adopt such a Technical Regulation … and seek to make a final decision expeditiously.” There are important differences in the provisions for mutual recognition and commencement of rulemaking between the 1958 and 1998 Agreements.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 24

However, it appears that the 1998 Agreement is sufficiently flexible to accommodate these concerns by permitting any signatory to initiate a GTR and also for an alternative specification being met until such a time the full standard can be met. Notably, any new legislation in the form of an Australian Design Rule, even were it a GTR, falls under section 7 of the Motor Vehicle Standards Act 1989.

Australia acceded to the Agreement stating that it “… will enable a greater role for Australia in developing international vehicle standards and a reduction in the costs of conformance testing.” (Dept. of Infrastructure, Transport, Regional Development and Local Government, 2007/2008 Annual Report).

Indeed, the leadership of Mr Robert Hogan and the Vehicle Standards team must be commended for leading the successful development and ratification of UN GTR 14, which was adopted as a UN Regulation. Australia initiated the development of the pole side impact standard within WP.29 as was concerned by the high number of deaths in side impact crashes and the poor fitment rate of side curtain airbags, in spite of NCAP test requirements historically (see Fitzharris and Stephan, 2013). As noted above, a Regulatory Impact Statement for the new pole side impact test has been released for comment (June 2015). MUARC is proud to have played a supporting role for the development of the GTR under the sponsorship of the Department. Specifically, MUARC provided a data driven crash-based studies on the actual, and likely benefits, of vehicle safety improvements, for example, the recent adoption of Global Technical Regulation 14 on pole side impact throughout the WP.29 process. This process highlighted the important role Australia can play in shaping its own vehicle safety standards whilst being an active participant on the global stage.

It remains important that as Australia is an active participant in the UN GTR process that it continues to be resourced to play this role. This will ultimately lead for expeditious adoption in Australia, of Global Technical Regulations as soon as they are established under the Agreement. Presumably it would be desirable for the Australian Transport Council and the Australian Government to agree that Australia should support any Global Technical Regulation which has the potential to provide cost effective benefits and when established under the Agreement, to subject it to the Australian ADR processes as rapidly as possible

It is hoped that the advantages to the automotive industry of having to meet only one set of vehicle safety regulations will encourage the industry to continue to develop and implement safety technology/features well in advance of them becoming Global Technical Regulations/ADRs.

Furthermore, it is becoming increasingly difficult to formulate performance standards for some of the safety features/technologies recently introduced by some manufacturers or being developed. This is particularly so for some crash avoidance technologies. Hence there is scope for the use of strategies to encourage development and implementation by manufacturers of such advanced technologies, at the earliest possible date.

It is absolutely critical that the Department of Infrastructure and Regional Development (DIRD) continues to maintain and develop world’s best vehicle standards in this country in spite of the fact that the local manufacture of cars will soon cease. Without maintaining and developing best practice vehicle standards, Australia is vulnerable to getting sub-standard vehicles in future, which potentially compromises road safety for the life of these vehicles.

It is critical, therefore, that the Australian Government expand the funding of DIRD to a level sufficient to maintain and upgrade vehicle standards, to provide resources to facilitate their involvement in international standard committees such as EEVC and WP29 in Genève, and supporting local research needs in this area

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 25

It is also important that the Australian Government, through the DIRD, encourage and support continuing activities with the Australasian NCAP program to further maximise the level of vehicle safety for consumers in this region.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 26

C. The impact of new technologies and advancements in understanding of vehicle design and road safety

Key Points (C)

 Improvements in vehicle safety is an essential requirement for Australia to meet its road safety targets, as has been the case in the past. MUARC research showed that over the years 2000 to 2010, the average crashworthiness of the Australian light vehicle fleet improved by 27%, representing a saving of around 2000 deaths over the time period.

 MUARC research has estimated the potential benefits provided by specific vehicle-based technologies aimed at crash prevention. In doing so, this research has identified which technologies should be adopted with the highest priority based on expected trauma reductions and economic benefits.

 Autonomous Emergency Braking operational at all speeds was the technology estimated to result in the largest savings in fatalities and serious injuries from light vehicle crashes with savings of between 5 and 10% possible in 2020 relative to 2010 depending on whether the technology is mandated or allowed to penetrate gradually due to market forces.

through the regulatory ADR process.

compliance of vehicles with international best practice standards as well as supporting the ANCAP roadmap aimed at ensuring these technologies are available to Australian vehicle consumers.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 27

Improving vehicle safety is a primary focus for meeting road safety targets in Australia and New Zealand. MUARC research has identified constant improvements in occupant protection performance in a crash (crashworthiness or “secondary safety”) of new light vehicles entering the fleet (see Figure 2 above). Applying these estimates enables year on year improvement in the average crashworthiness of the whole light vehicle fleet to be quantified and the resulting reductions in deaths and serious injuries resulting from vehicle safety improvements to be estimated.

A recent MUARC study (Budd et. al, 2015) based on data and output from the Used Car Safety Ratings research program has estimated the impact improvements in vehicle secondary safety (occupant protection performance in a crash) have had in reducing deaths and serious trauma in Australia over the years 2000-2010. Future expected trends in vehicle secondary safety and trauma impacts were then estimated by projecting the estimates to 2020. Potential additional benefits of emerging vehicle crash avoidance technologies were then estimated by applying estimated effectiveness of these technologies based on prospective evaluations to the projected crashes vehicle population to 2020. Crash avoidance technologies considered were: Electronic Stability Control (for all vehicles in New Zealand and light commercial vehicles in Australia), Autonomous Emergency Braking Systems, Fatigue Warning Systems, Lane Departure Warning Systems and Lane Change (Blind Spot) Warning Systems. Retrospective effects of vehicle safety improvements

The MUARC study quantified the significant impact improving vehicle secondary safety has made to reducing serious road trauma in Australia (Budd et. al, 2015). Over the years 2000 to 2010, the average crashworthiness of the Australian light vehicle fleet has improved by 27% as shown in Figure 7A. This represents a saving of around 2000 deaths over the time period. Figure 7B shows the number of observed vehicle occupant deaths in Australia over the period 2000-2010 along with the number that would have been expected if the cross sectional secondary safety of the Australian vehicle fleet had remained the same as in 2000. To a large degree, these improvements are a reflection of the improvement in vehicle safety wrought through the introduction of the offset frontal impact standards and side impact standards mandated through ADRs 73 and 72 respectively early in this period and the permeation of vehicles complying with these standards into the fleet overt time.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 28

5.00%

4.50%

4.00%

3.50%

3.00%

2.50%

2.00%

Fleet Average Average Fleet Crashworthiness 1.50%

1.00%

0.50%

0.00% 1998 2000 2002 2004 2006 2008 2010 2012 Crash Year

Figure 7A: Change in average crashworthiness of the Australian vehicle fleet by calendar year

1,500

1,400

1,300

1,200

1,100

1,000

Australian Vehicle Occupant Fatalities

900 Vehicle OccupantFatalities

Predicted fatalities with no improvement 800 in vehicle crashworthiness

700

600 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Crash Year

Figure 7B: Estimated effects on vehicle occupant fatalities of vehicle fleet crashworthiness improvements in Australia Projected future road trauma savings due to secondary safety improvements

The future expected trend in light vehicle secondary safety due to secondary safety improvements was estimated to 2020 using projections for injury crashes and fleet mix involving light passenger vehicles. Future crashworthiness improvements were modelled under 2 scenarios:

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 29

1. stalled crashworthiness at 2010 new vehicle levels where the average crashworthiness of new vehicles entering the fleet over the period 2011-2020 were assumed to be the same as those entering new in 2010; and

2. business as usual where crashworthiness improvements for vehicles entering the fleet over the years 2011-2020 are assumed to improve at the same rates ab observed over 2000-2010.

The stalled crashworthiness scenario might be realised if improvement in vehicle safety standards through relaxing the ADR process were lost. Future trauma savings due to vehicle secondary safety improvement were estimated by comparing the projected safety of the 2020 crashed vehicle fleet to that of 2010.

Table 2A shows the estimated number of crashed light vehicles along with fatal and serious injuries and the economic cost of those injuries resulting from these crashes in Australia in 2010 and projected in 2020. Costs were estimated using Human Capital injury costing data from the Australian Commonwealth Bureau of Infrastructure Transport and Regional Economics (BITRE 2010). Table 2A. Baseline 2010 and 2020 year vehicle fleet crashed passenger vehicles, occupant fatal and serious injuries and cost of injuries in 2010 AU$

2010 2020

A B

(Business as usual) (Stalled Crashworthiness)

Crashed vehicles 91,422 86,981

F&S injuries 3,821 2,350 2,870

Cost $1,656,121,346 $688,264,103 $840,563,686

Table 2B shows both the absolute and percentage difference in 2020 crashes vehicles and resulting fatalities, serious injuries and costs compared to 2010 derived from Table 2A under both projected crashworthiness scenarios. Table 2B. Estimated savings in vehicles involved in injury crashes, fatalities and serious injuries and injury costs in 2020 compared to 2010

Absolute Savings (2010-2020) Percentage Savings (2010-2020)

A B A B

(Business as (Business as (Stalled (Stalled Crashworthiness) usual) usual) Crashworthiness)

ALL vehicles 4,441 5%

F&S Injuries 1,470 950 38% 25%

Cost $967,857,243 $815,557,660 58% 49%

The saving in fatal and serious injuries through projected future improvement in secondary safety of the Australian light vehicle fleet in 2020 compared to 2010 was 950 under the scenario of stalled crashworthiness and 1,470 if CWRs continues to improve according to past trends. These benefits result from improvements in secondary safety of 25% and 38% respectively in 2020 compared to 2010. The annual economic benefit of these

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 30

reductions was estimated to be between $815M and $968M. Figure 7C shows the estimated cross sectional crashworthiness of the Australian light vehicle fleet relative to 2010 for each of the years from 2011-2020 which underlies the estimates provided in Tables 2A and 2B Importantly, it highlights the additional 15% saving in deaths and serious injuries possible if improvements in vehicle safety seen over the previous decade are maintained in the future through continued regulatory and other supportive processes.

1.00

0.95

0.90

0.85

0.80

0.75

0.70 Stalled Crashworthiness 0.65 Business as Usual Crashworthiness 0.60

Proportionserious of2010 and occupant fatal injuries 0.55

0.50 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Crash Year

Figure 7C. Proportion of 2010 fatalities and serious injuries expected in 2011 to 2020 due only to vehicle secondary safety improvements, Australia

Injury and cost savings associated with various safety technologies

In recent years, focus on vehicle safety has shifted from preventing vehicle occupant injuries in the event of a crash to preventing the crash occurring in the first place (crash risk or primary safety) through the development vehicle based technologies. Electronic Stability Control is a notable example of such a technology which evaluation has shown to be highly effective in reducing crash risk. A number of emerging crash avoidance technologies are now being made available in new vehicles in Australia and New Zealand which have the potential to further reduce serious road trauma through reducing crash risk. The recent MUARC study (Budd et. al, 2015) also estimated the potential contribution emerging vehicle crash avoidance technologies will make to reducing serious road trauma in Australia and New Zealand. In doing so the study identified which technologies should be adopted with the highest priority based on expected trauma reductions and economic benefits.

The savings to fatal and serious injuries from these vehicles entering the fleet associated with technology fitment was estimated for Autonomous Emergency Braking Systems (operating at all speeds as well as only speeds of 80km/h and above), Electronic Stability Control (for all vehicles in NZ and for light commercial vehicles in Australia) and Fatigue, Lane Departure and Lane Change (Blind Spot) Warning systems. The savings associated with fitment of the selected safety technologies were on top of those expected purely through projected improvements to vehicle secondary safety.

The projected benefits of each crash avoidance technology were estimated under the two scenarios of future crashworthiness performance described in the previous section as well as for two scenarios of penetration the technology:

T1 - All vehicles mandated to have the technology from 2014 (through a regulatory ADR based process)

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 31

T2 - Gradual penetration of the technology into the new vehicle fleet based on market forces

These two penetration scenarios for new vehicles are illustrated in Figure 7D. The only exception to these scenarios was for ESC fitment to light commercial vehicles in Australia where this technology is mandated from 2016 as illustrated in Figure 7D.

Figure 7D. Australian fitment models for ESC and emerging safety technologies (T1 and T2)

Table 2C summarises the estimated reductions in fatal and serious injuries in Australia expected by 2020 relative 2010 associated with each of the technologies considered above the savings estimated through secondary safety improvements. Economic savings to the community are also shown each with a range reflecting the variation due to the scenarios considered.

Table 2C. Summary of average estimated savings in fatal and serious injuries (%) and injury cost (million 2010 AU$) for each safety technology over the period 2010-2020 and savings extremes by jurisdiction and vehicle type. Australia

Safety System % F&SI Saving and Cost Saving Range Autonomous Emergency Braking- All Speeds 5-10 % $108-297M

Autonomous Emergency Braking - Speeds >=80 km/hr 1.5-3.1% $35-96M

Lane Departure Warning 0.2-0.5% $6-16M Fatigue Warning 1.5-3.2 $36-98M Lane Change (Blind Spot) Warning 0.6-1.2% $14-37M

ESC Light Commercial Vehicles 4.5-5.7% $142-143M

Figures 7E and 7F show the percentage savings in fatal and serious injuries relative to 2010 in Australia for each year from 2011-2020 estimated for each technology considered under the mandate from 2014 (T1) and gradual penetration scenario (T2) respectively.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 32

0.99

0.98

0.97

0.96 Lane DepartGrtr Spd+fwy T1 0.95 Lane Change T1 FC (AEB) >=80 T1 0.94 Fatigue T1 ESC - Commercial Vehicles 0.93

Proportion of serious and fatal occupant injuries by crash year c.f. 2010c.f. year crash by injuries occupant fatal and serious of Proportion FC (AEB) All Speed T1

0.92 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Crash Year

Figure 7E. Proportion of 2010 vehicle occupant fatal and serious injuries estimated each crash year from 2011-2020 from safety technology fitment mandated in 2014, Australia

0.995

0.99

0.985

0.98

0.975 Lane DepartGrtr Spd+fwy T2

0.97 Lane Change T2 FC (AEB) >=80 T2 0.965 Fatigue T2 ESC - Commercial Vehicles 0.96

FC (AEB) All Speed T2 Proportion of serious and fatal occupant injuries by crash year c.f. 2010c.f. year crash by injuries occupant fatal and serious of Proportion

0.955 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Crash Year

Figure 7F. Proportion of 2010 vehicle occupant fatal and serious injuries estimated each crash year from 2011-2020 from safety technology fitment with gradual fleet penetration, Australia

In Australia, Autonomous Emergency Braking operational at all speeds was the technology estimated to result in the largest savings in fatalities and serious injuries from light vehicle crashes with savings of between 5 and 10% possible in 2020 relative to 2010 depending on whether the technology is mandated or allowed to penetrate gradually due to market forces. Limiting AEB effectiveness to only high speed crashes (80km/h or more) showed reductions of only 1.5-3.1%. ESC for commercial vehicles was also estimated to have large potential benefits with reduction in fatal and serious injuries of between 4.5 and 5.7%. ESC will be mandated in light commercial vehicles

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 33

in Australia from 2016. Potential fatal and serious injury savings from the remaining technologies were much smaller with estimated savings of 1.5 and 3.2% for fatigue warning systems, 0.6 and 1.2% for lane change (blind spot) warning systems and 0.2-0.5% for lane departure warning systems over a 10 year period.

Over a 20 year period the gains estimated in the MUARC study for each technology will be twice that estimated for a 10 year period as full penetration of the fleet is achieved. Comparison of the two fitment scenarios shows the additional benefits possible from mandating of the technology through the regulatory ADR process. For example, mandating AEB is estimate to lead to a 7% reduction in serious trauma through crash avoidance over a 10 year period compared to a 4% reduction through natural progression. Earlier mandate produces bigger differences showing the value in the regulatory process.

Issues for the introduction of new vehicle technologies

Current trends in vehicle safety internationally focus on crash avoidance as well as crashworthiness technologies. While much of this is the initiative of vehicle manufacturers, early evaluations show significant benefits in terms of fewer deaths and serious injuries, in line with Australasia’s safe system policies.

Internationally, governments and automotive Original Equipment Manufacturers (OEMs) are very focussed on vehicle to vehicle and infrastructure communications as well as autonomous vehicles. There are substantial issues here to be addressed, in particular, human factors and driver choice and behavioural challenges associated with the shift of driving tasks from the human to automated systems. Australia must get involved in these issues to be sure that the vehicles that will come to our shores in future to optimise the safety benefits of these developments.

Thus, MUARC recommends the need for Federal Government involvement, both through the development and compliance of vehicles with international best practice standards as well as supporting the ANCAP roadmap aimed at ensuring these technologies are available to Australian vehicle consumers.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 34

D. The different considerations affecting road safety in urban, regional and rural areas

Key Points (D)

 Fatality rates are five to seven times higher in regional than urban areas, and serious injury rates in regional and remote areas are double those of metropolitan areas.

 In metropolitan areas, more than half of serious injury crashes occur at intersections. In regional and

remote areas three-quarters of serious injury arises from single vehicle run-off-road crashes, usually on high speed roads that frequently have poor roadside safety infrastructure

 Younger drivers tend to be over-represented in regional areas compared with metropolitan, while cyclists and pedestrians constitute a higher proportion of metropolitan fatal and serious crashes when

compared to regional and rural areas.

 One factor applicable to crashes in urban, regional and rural areas is speed. Speed related factors remain one of Australia’s major causes of road trauma. Our urban and rural speed limits are still much higher than equivalents in Europe and the USA .

 Australian states and territories have officially adopted a Safe System approach to initiatives aimed at reducing the burden of injury in this country. It is acknowledged, however, that it is unrealistic to

expect that the levels of funding required to bring the safety standards of Australian road safety infrastructure to Safe System levels.

 More realistically, in tandem with targeted Safe System transformations on key routes or areas, a nationally-coordinated program to adjust speed limits to levels appropriate to the remaining road and

roadsides is strongly encouraged.

 The availability of world’s best vehicles with technologies aimed at reduced speeding and fatigue, as

well as automatic braking and control systems will also offer substantial benefits towards reducing crashes in urban, regional and rural crashes as well as mitigating injuries in the event of a crash.

Fatalities and serious injury rates in urban, regional and rural areas

There are significant differences between major cities, regional, outer regional and remote areas of Australia. While fatality rates in most metropolitan areas are low (around 2-3 per 100,000 population), they are five to seven times higher in regional areas and up to 10 times higher in remote areas. Similarly, serious injury rates in regional and remote areas are double those of metropolitan levels.

Crash types and current trends in urban, regional and rural areas

The crash types experienced also vary dramatically by region. In metropolitan areas, intersection crashes typically comprise more than half the serious injury crashes, while in regional and remote areas three-quarters of serious

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 35

injury arises from single vehicle run-off-road crashes, usually on high speed roads that frequently have poor roadside safety infrastructure.

Younger drivers tend to be over-represented in regional areas compared with metropolitan, while cyclists and pedestrians constitute a higher proportion of metropolitan fatal and serious crashes.

Also of note are the rapidly-growing outer urban fringes of the major cities, with Melbourne and Perth exemplifying this trend. In these areas population growth is high, with corresponding increases in vehicular travel, yet the standard of the roads is lagging traffic growth. In the outer Melbourne LGAs, including Casey, Cardinia, Wyndham and Whittlesea, for example, nearly a quarter of serious crashes are occurring in 80 km/h speed zones. This represents double the proportion occurring in this speed zone in either metropolitan or regional areas and is likely due to roads of relatively low standard experiencing high levels of traffic due to rapid adjacent land development.

Speed related factors and Infrastructure

Speeding and speed related factors remain one of Australia’s major causes of road trauma. Urban and rural speed limits are still much higher than equivalents in Europe and the USA and need to be in line with international best practice. Road infrastructure improvements in sealed shoulders, barrier protection and separated travel lanes are already showing benefits in run-off road crashes. Improved lane discipline would further help to reduce crashes in these areas from unsafe vehicle manoeuvres.

Potential impacts of increased bicycle use in urban, regional and rural areas

Bicycle use is rapidly increasing in urban, regional and rural areas as Australians take up this form of mobility in the interest of healthy activities and less road congestion, as it is in many European and North and South American countries. Without best practice safety infrastructure, it is likely that road crashes involving cyclists with cars and trucks will increase working against current trends in crash and injury reductions.

Recommended countermeasures

Speed limits and targeted Safe System transformations of the road infrastructure

It is acknowledged that it is unrealistic to expect that the levels of funding required to bring the safety standards of Australian road safety infrastructure to Safe System levels. More realistically, in tandem with targeted Safe System transformations on key routes or areas, a nationally-coordinated program to adjust speed limits to levels appropriate to the remaining road and roadsides is strongly encouraged. The evidence in favour of reduced travel speeds is unequivocal worldwide, but will need to be accompanied by a comprehensive public awareness and education campaign and appropriate levels of enforcement to ensure its long term success.

Emerging vehicle technologies Many problems remain in road safety that need to be addressed to ensure continuing safety reductions in urban, regional and rural areas. In particular, the availability of world’s best vehicles with technologies aimed at reduced speeding and fatigue, as well as automatic braking and control systems will offer substantial benefits towards reducing crashes in urban, regional and rural crashes as well as mitigating injuries in the event of a crash.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 36

E. Other associated matters.

Key Points (E)

 Our ageing population necessitates a high priority on older road users in the road safety context. Managing the safe mobility of older road users in rural and urban areas will require a multi-faceted approach that includes:  Safer vehicles: promote the purchase of safer vehicles that can optimally protect older car occupants  Improvements to the licensing system: a more unified and targeted approach, a system based on

functional performance (not age-based), which uses effective strategies and valid tools to assist in identifying those at risk.  Further research to evaluate safety and mobility outcomes associated with modified/restricted (e.g. local area) licences.  Enhancements to land use, road design and infrastructure: improved guidelines for road and

infrastructure design (especially intersections, high speed road environments, and strip shopping centres), improved infrastructure for use of Motorised Mobility Scooters (MMS), and provision of adequate public and alternative (community-based) transport.  Education and training: evidence-based driver refresher courses, cognitive training, especially hazard perception and safe gap selection, educational resources providing strategies to maintain safe driving practices, making timely and appropriate decisions about the transition to non- driving, and planning ahead for use of alternative transport.  MUARC strongly recommends increased funding for ongoing federal government research

programs in vehicle safety improvements and national road infrastructure improvements that will support the safe mobility of older road users

 Powered two wheelers are the fastest growing form of powered transport in Australia. When combined with their vulnerability in the event of a crash, a high priority needs to be placed on

motorcycle safety using a safe systems approach.

Older road users

Over the next four to five decades, Australia will experience significant growth in both the absolute and proportional number of older adults within the community. By 2061, the proportion of Australian adults aged 65 years and over is expected to reach 22 percent and the proportion aged 85 years and over is expected to reach five percent (Australian Bureau of Statistics, 2013).

It is predicted that the transport needs of current and future older road users will be significant (Pruchno, 2012). Compared to previous cohorts, current and future older road users are more likely to: be better educated and more affluent (Frey, 2010), be healthier (Chen & Millar, 2000), have longer life expectancies and work for more of their senior years (Quinn, 2010). It is also predicted that current and future older road users will have distinctively different mobility characteristics to previous cohorts. The private motor vehicle is likely to remain the principal mode of transport for the current and future older road users who, it is predicted, will be more likely be licenced

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 37

to drive, travel more frequently, travel greater distances, and will have higher expectations with regard to maintaining personal mobility (OECD, 2001). Indeed, Koppel and Berecki-Gisolf (2015) recently demonstrated that the baby boomer cohort (1946–1965) in Victoria, Australia is 1.7 times larger than the cohort before them and at age 60 years, license prevalence among baby boomers was higher than in previous cohorts: 88% in the 1936– 1945 cohort vs. 96% in the 1946–1955 cohort. When the baby boomers reach 65 years (average) in 2021, there will be over twice as many license holders among them than in the preceding cohort (n = 1,300,094 vs. 630,830, respectively). In addition, there is significant promotion of ‘Active Travel’ for older adults, with some evidence that older adults are increasingly engaging in active modes of travel such as walking and cycling (Garrard, 2009; Sallis, Frank, Saelens, & Kraft, 2004). As such, current and future older road users will generate a significantly greater demand for mobility, as vehicle drivers, occupants, pedestrians, and users of other modes of transport such as motorised mobility scooters (MMS), bicycles and public transport. This is due to them: working longer into older age, socialising more actively, participating in more leisure activities and remaining in suburban homes much longer (Chen & Millar, 2000; Pruchno, 2012; Quinn, 2010).

Importance of Mobility for Older Road Users

Mobility is essential for older adults’ independence, as well as ensuring good health and quality of life by virtue of enabling continued access to essential services, activities, and other people (Metz, 2000; Oxley & Whelan, 2008; Ross, Schmidt, & Ball, 2013; Webber, Porter, & Menec, 2010).

Remaining an active driver is important for maintaining independence and well-being (Freeman, Gange, Munoz, & West, 2006; Persson, 1993). However, as lifestyles change and skills and abilities decline with age, it is inevitable that at some point most individuals will consider restricting or ceasing driving (O'Hern & Oxley, 2015). There is evidence of negative psychosocial and health consequences of driving restriction (Fonda, Wallace, & Herzog, 2001) and driving cessation (Edwards, Perkins, Ross, & Reynolds, 2009; Fonda et al., 2001; Freeman et al., 2006; Marottoli et al., 2000; Marottoli et al., 1997; Mezuk & Rebok, 2008; Ragland, Satariano, & MacLeod, 2005; Windsor, Anstey, Butterworth, Luszcz, & Andrews, 2007; Yassuda, Wilson, & von Mering, 1997). These include: a sense of lost independence and personal identity (Burkhardt, Berger, Creedon, & McGavock, 1998; Yassuda et al., 1997); social isolation (Marottoli et al., 2000; Mezuk & Rebok, 2008); decline in overall quality of life (Fonda et al., 2001; Marottoli et al., 2000); higher likelihood of clinically significant depression (Azad, Byszewski, Amos, & Molnar, 2002; Marottoli et al., 1997; Windsor et al., 2007), heart disease, fractures, and stroke (Bassuk, Glass, & Berkman, 1999; Fonda et al., 2001; Marottoli et al., 2000). However, there is also some evidence that, with the aid of resources, planning, appropriate timing and decision making, some older adults can and do make a successful transition from driving to non-driving (Oxley & Charlton, 2009).

After driving, walking represents older adults’ second most frequent mode of transportation (Council on the Aging, 2004) and their preferred recreational activity (Australian Bureau of Statistics, 2011). While walking is important to many older adults to conduct short trips to carry out essential daily tasks, it has also been shown to be important factor in older adults’ health (e.g., decreasing the risk for chronic disease [e.g., diabetes and heart disease], and protecting aspects of cognitive functioning, psychological well-being, and fitness (Binder et al., 2002; Garrard, 2009; Visser, Pluijm, Stel, Bosscher, & Deeg, 2002; Wang, Van Belle, Kukull, & Larson, 2002).

An increasing proportion of Australian older adults who cannot drive or walk, and who still need and desire independent mobility to engage in activities of daily living are using MMS (Jancey et al., 2013; Johnson, Rose, & Oxley, 2013). MMS enable people to maintain a degree of independence and participation in their community, in addition to potentially enabling them to extend the time that they are able to live in their own home (Missikos & James, 1997). Indeed, Daff recently noted that ‘more than other modes, scooters (MMS) are a transitional mode which liberates older adults for perhaps 3 to 5 years’ (Austroads, 2010). Cycling is another form of active

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 38

transport that is widely promoted as an alternative to car use. While the use of bicycles is increasing rapidly amongst younger adults, there is little known about bicycle usage amongst older adults in Australasia. There is some suggestion, however, that eBikes are becoming increasingly popular among older riders (personal communication, M. Johnson).

For people who restrict or cease driving, or those who choose not to drive in certain circumstances, the availability of other forms of transportation is critical to maintaining mobility (Marottoli & Coughlin, 2011). A range of options beyond private motor vehicles and walking may be available, based on the need, resources, and geographic features of a given community. These may include a range of public transportation options as well as community transit services, private taxis, volunteer networks, and informal transportation provided by friends and family.

Older Road Users’ Risk

While there is a strong emphasis around the world for older road users to maintain their mobility for as long as possible, their safety is also a serious community concern (Langford & Koppel, 2006). Indeed, the Bureau of Infrastructure Transport and Regional Economics [BITRE] (2014) recently examined fatality crash data from the Australian Road Deaths Database (ARDD) for the period 2004-2013 and demonstrated that while the total annual road crash fatalities had declined by 24.6 percent, road crash fatalities for older road users (i.e., aged 65 years and older) had increased by 8 percent. Most road crash fatalities were vehicle occupants (vehicle drivers or passengers) for all road user age groups. However, compared to younger road users, there were comparatively more pedestrian fatalities among older road users and fewer motorcyclist and cyclist fatalities.

Older Drivers Risk

While current figures show that older drivers are currently involved in fewer but increasing crashes in terms of absolute numbers, they represent one of the highest risk categories for crashes involving serious injury and death per number of drivers and per distance travelled (Koppel et al., 2011; Langford & Koppel, 2006; OECD, 2001).

In-depth crash analyses have shown that older drivers in Australia have noticeably different crash patterns from those of their younger counterparts (Koppel et al., 2011; Langford & Koppel, 2006). For example, older drivers are more likely to crash: during daylight hours; at low speeds; with low BAC levels; at intersections; with other vehicles (multi-vehicle crashes); and with a severe injury outcome (Eberhard, 2007; Fildes et al., 1994, BITRE, 2014).

Older Pedestrian Risk

Older adults are more likely to die as a pedestrian than when using any other mode of transportation (Sleet et al., 2010). The BITRE (2014) report demonstrated that older pedestrian fatalities have not significantly decreased over the past decade. Moreover, in most Australasian jurisdictions, older adults comprise a significant proportion of all pedestrian deaths and serious injuries. For example, in Victoria alone, adults aged 70 years and older made up 37 percent of all-aged pedestrian fatalities during the past five years (TAC, 2014).

Unlike younger adult pedestrian crashes (in which alcohol consumption and distraction seem to be the main predisposing factors), older pedestrian crashes tend to: involve crossing the road in complex urban areas, in shopping centres, often involve a turning or reversing vehicle, occur during daylight hours, during good weather, in familiar surroundings and near their home (OECD, 2001; Oxley & Whelan, 2008; Whelan, Langford, Oxley, Koppel, & Charlton, 2006). Older pedestrian collisions often result from the pedestrians’ inability to handle

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 39

complex traffic situations such crossing a street without traffic signals or a roadway in a busy location (Oxley & Whelan, 2008), in combination with high vehicle speeds.

Older Motorised Mobility Scooter (MMS) User Risk

It is a difficult task to examine crash and injury risk amongst MMS users. Crashes involving MMS are underreported and better data on crashes and injuries are needed to better understand the extent of MMS related injuries (Cassell & Clapperton, 2006). In 2006, Cassell and Clapperton analysed fatality (n=6) and injury crash (n=75) data from Victoria from 2000/01 to 2004/05. They reported that MMS related injuries almost doubled over the reported period (Cassell & Clapperton, 2006). Johnson and colleagues (Johnson et al., 2013) extended these findings by reviewing hospital emergency department presentations, including subsequent admissions for the 8 year period from 2004/05-2011/12. They reported that the number of hospital presentations due to people being injured while using MMS has increased in the state of Victoria with the highest number of presentations recorded in 2010/11.

Older Road User Risk Factors

The exact measurement of older road users’ crash risk varies according to the particular measures used. Notwithstanding, a number of older road user risk factors are described below.

Frailty

Much of the older road user injury profile has been attributed to their greater frailty and reduced tolerance to injury (OECD, 2001) compared with younger adults, primarily due to reductions in bone and neuromuscular strength and fracture tolerance (Dejeammes & Ramet, 1996; Padmanaban, 2001). According to Evans (2004), in the same crash: a 79-year-old man is 3.2 times more likely to die compared to a 32-year-old man; a 79-year-old woman is 2.7 times more likely to die compared to a 32-year-old woman. Li and colleagues (2003) reported that older drivers’ over representation in fatalities could be primarily explained by frailty, which accounted for 60−90 percent of the fatalities. Older adults also take longer to recover from injuries than younger adults (OECD, 2001;)

While it is well established that older road users are more likely to be injured in the event of a crash, there is little information about age-related differences in specific types of injury incurred. However, much of the recent evidence points to a greater susceptibility to serious chest injuries (including rib fractures, collapsed lungs, damaged hearts and ruptured arteries) compared with younger counterparts (Augenstein, 2001; Morris, Welsh, Frampton, Charlton, & Fildes, 2003a; Morris, Welsh, & Hassan, 2003b; Welsh, Morris, Hassan, Charlton, & Fildes, 2006) and that these injuries are predominantly due to forces exerted by the restraint system, particularly in frontal impacts. Further research has showed that older people often do not have the lung capacity to recover from such injuries and found that older people died from chest injuries at markedly higher rates than younger adults in crashes. More recently, Koppel et al. (2011) demonstrated that in terms of injury outcomes, older drivers sustained a significantly higher proportion of injuries to the thorax (30.9% compared to 18.5% of middle-aged drivers). Conversely, a significantly higher proportion of middle-aged drivers sustained suffered some form of injury to the neck (30.6% compared to 12.1% of older drivers).

Frailty is also likely to be the predominant explanation for increased injury risk amongst other older road user groups (as pedestrians, cyclists, MMS users etc.).

Age-related sensory, cognitive, and physical impairments

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 40

Older road users’ risk has also been attributed to their age-related sensory, cognitive, and physical impairments. While there are many individual differences in the ageing process, even relatively healthy older adults are likely to experience some level of functional decline in sensory, cognitive and physical abilities. These may include: decline in visual acuity and/or contrast sensitivity; visual field loss; reduced dark adaptation and glare recovery; loss of auditory capacity; reduced perceptual performance; reductions in motion perception; a decline in attentional and/or cognitive processing ability; reduced memory functions; neuromuscular and strength loss; postural control and gait changes, and slowed reaction time (Janke, 1994; Stelmach & Nahom, 1992). Of relevance to older road users is how the degradation of these skills relates to safe road use and whether they place older road users at an increased risk of crash-related injuries and/or death. Current evidence for causal relationships between specific medical conditions and increased crash risk is limited (Charlton et al., 2010; Dobbs, 2001; Marshall, 2008; Vaa, 2003). Clearly, not all medical conditions affect injury risk in the road system to the same extent and not all individuals with the same condition will be affected in the same way (Charlton et al., 2010). Indeed, it is not necessarily the medical condition and/or medical complications per se that affects road use, but rather the functional impairments that may be associated with these conditions. In addition, the extent to which individuals may be able to adapt or compensate for their functional impairment while using the road will undoubtedly have some bearing on their likelihood of crash involvement. An extensive program of research commissioned by Austroads highlights the importance of a referral-based licensing with a focus on functional abilities for safe driving, as a central strategy to effectively manage the risk associated with medical fitness to drive and functional impairments (Charlton et al., 2008; Fildes et al., 2000; Fildes et al., 2004; Langford et al., 2009).

Medical fitness to drive

There is an international effort to improve medical best practice guidelines. Preliminary work relating to the accessibility and usability of guidelines is published in Rapoport and colleagues (2014). Further work is needed to update guidelines, ensuring the highest level of evidence is used where available to inform decisions about fitness to drive. Previous comprehensive reviews of medical conditions and crash risk (eg. Charlton et. al, 2010) are now in urgent need of updating. In part, this will be addressed through a Canadian Institutes of Health research (CIHR) grant in an international collaboration led by Rapoport at the U of Toronto (A/Prof Jude Charlton and Dr Sjaan Koppel are the lead Australian Investigators on this project). The objective of the project is to create an up-to- date knowledge synthesis and clinical guidelines on driving risks with two topics of high priority for updating: traumatic brain injury (TBI) and dementia. The knowledge synthesis will leverage skills of Canadian and international knowledge experts, and incorporate the input of clinician and transportation knowledge-users as well as drivers, patients and caregivers. While the project is specifically designed to inform and update the Canadian fitness to drive guidelines, the findings relating to driving with dementia (and brain injury) will be highly relevant to Australia.

The NTC will be kept informed of this research and MUARC recommends that the evidence base derived from the project be considered for the current NTC review of Austroads Fitness to Drive Guidelines.

Vehicle Choice

Recent Australian research (Budd et al., 2012) examined the influence vehicle choice has on older driver road trauma outcomes. It examined the specific vehicle types currently driven by older drivers in conjunction with the crash types they are typically involved to make inference about the road trauma benefits that could be realised had older drivers crashed in safer vehicles. The study drew the following conclusions:

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 41

 Compared to younger drivers (35-54 years old), older drivers were more likely to be injured in a crash and the injury was more likely to be serious, and older female drivers were more likely to be injured or seriously injured than older male drivers.  The vehicles crashed by older drivers were general smaller and older than average and tended to have poorer average crashworthiness compared to vehicles driven by younger drivers. The poorer average crashworthiness is particularly evident among the 75+ year old age group of crash-involved drivers.  Crash-involved older drivers tend to crash in vehicles which were purchased new or only a few years old and they retain these vehicles for long periods, possibly until they no longer wish to drive anymore.  Optimising safe vehicle choice by older drivers has the potential to result in serious injury and fatal crash reductions of up to 90 percent if vehicle cost was not a factor. When optimum safe vehicle choices were restricted to popular (affordable) models of at least a year 2000 manufacture, fatal and serious injury crash reductions of up to 37 percent could be achieved. When choices were further restricted to match the market group of choice, serious injury and fatal crash reductions up to 19 percent could be achieved.

The study identified that older driver vehicle choice is a key contributing risk factor to higher death and serious injury rates amongst this cohort. It also identified the potential road safety benefits in encouraging older drivers to purchase safer vehicles and to upgrade to safer vehicles if they continue to drive well into their older years. Koppel, Clark, Hoareau, Charlton, & Newstead (2013) also highlighted the low priority of vehicle safety amongst older people in the vehicle purchase process.

Other associated research has identified further vehicle related risk factors for older drivers. For example, Keall and Newstead (2007) identified high rollover crash risk for older females in large SUV type vehicles without electronic stability control whilst Watson and colleagues (2009) identified poor secondary safety outcomes for females in certain types of commercial vehicles. Furthermore, the relative over involvement of older drivers in multi vehicle crashes reported by Budd and colleagues (2012) combined with their frailty identified the propensity for older drivers to downsize into vehicles which are significantly lighter than the fleet average as a key risk factor.

New vehicle technologies and the vulnerable road user

The issue of how new technologies address the needs of vulnerable road users is not well understood. A number of studies have indicated that in-vehicle technologies such as Advanced Driver Assistance Systems (ADAS) and In- vehicle Information Systems (IVIS) may provide assistance to older drivers (Davidse, 2007). However, these technologies will only have the potential to benefit older drivers if their design is congruent with the complex needs and diverse abilities of this driving cohort. The design of ADAS and IVIS is largely informed by automotive Human Machine Interface (HMI) design and performance guidelines, of which a number currently exist (e.g. European Statement of Principles (ESoP); Alliance of Automotive Manufacturers (AAM) Statement of Principles, etc). Automotive guidelines are designed to inform the safe design and assessment of in-vehicle systems, particularly in relation to driver workload and distraction. However, it is unclear to what extent the declining physical and cognitive capabilities of older drivers are addressed in current automotive HMI guidelines.

MUARC researchers have recently reviewed current guidelines for IVIS and ADAS with respect to how, and to what extent, they address age-related changes in cognitive and physical capacities (Koppel Young & Charlton, 2015). Key automotive HMI design guidelines were reviewed in relation to how they address older driver visual, cognitive and physical limitations: European Statement of Principles (ESoP); Alliance of Automotive Manufacturers (AAM) Statement of Principles; Japanese Automobile Manufacturers Association (JAMA) Guidelines; Transport Research Laboratory (TRL) Design Guidelines; and NHTSA Visual-Manual Driver Distraction Guidelines for In-Vehicle Electronic Devices (Phase 1 Guidelines). The guidelines were first searched for key words

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 42

(e.g. older driver; age, seniors, impairment, cognitive and physical function and ability) and were then examined in more detail to identify the extent to which specific guidelines address the cognitive and physical impairments experienced by older drivers. The outcomes of the review revealed that most of the HMI guidelines do not address design issues related to older driver impairments, either specifically or generally. In fact, in many of the guidelines driver age is not mentioned at all. The outcomes of the review highlight a number of areas where the current HMI design guidelines do not adequately account for the physical and cognitive limitations of older drivers. It is recognised that this is likely due to a lack of supporting research data on which to base more specific HMI design guidance for this driving population. In order for older drivers to reap the full benefits that use of in- vehicle technology is likely to afford, it is critical that further work establish how older driver limitations and capabilities can be supported by the system design process, including their inclusion into automotive HMI design guidelines.

Additionally, new vehicle technologies are being designed with little or no consideration of acceptability/usability for specific user groups such as older drivers. [For comprehensive reviews of how these technologies impact vulnerable users including young and older drivers, see Rudin-Brown & Jamson, (2013). Behavioural Adaptation and Road Safety: Theory, Evidence and Action. CRC Press, Boca Raton, FL). Bryden’s recent doctoral thesis also addresses some aspects of older people’s usability and acceptance of vehicle technologies (e.g. see Bryden et al, 2014).

Other MUARC publications relating to older people’s adaptability to new technologies and susceptibility to distraction (by technologies) can be found in the following reference sources: Koppel & Charlton (2013) and Koppel, Charlton & Fildes (2009)

The road environment for older road users

Road design and operation plays a major role in road safety and is likely to contribute to the driving and walking difficulties of older people. It appears that the complexity of the road environment can place increasing demands on an older person’s capabilities and adaptability, whilst normal ageing diminishes the capacity to cope with such situations. This places older road users at a double disadvantage. As a result, older adults are often forced to perform under a time pressure that, for some, may exceed their attentional and cognitive capacities.

It is important to recognise that the road transport system has, in general, not explicitly taken the older road user into consideration and there is a real and urgent need to design road environments that are more forgiving of the limitations of older road users. In summary, the complexity of the road environment can place increasing demands on an older driver’s adaptability, while ageing can diminish the capacity to cope with such situations.

While many have considered that the older driver problem is mainly on urban roads, some recent work in South Australia suggests that this may not be the case (Thompson et al., 2013). Older drivers who live in rural or remote areas are of particular interest because the nature of their driving environments may further increase their risk on the road and restrict their mobility. This research does suggest some means by which safe and sustainable mobility may be achieved for older rural drivers, including: modifying the rural driving environment (e.g. decreasing speed limits) and encouraging the use of newer vehicles, which provide better protection in a crash.

World-wide crash data suggests that complex intersections are particularly troublesome for older drivers (Stamatiadis, Taylor & McKelvey, (1991; Benekohal, Resende, Shim et al., 1992; Fildes, Corben, Morris et al., 2000; Oxley, Logan & O’Hern, 2015). Others, too, have reported that rear-end collisions, crashes at signalised

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 43

intersections, crashes while merging and during backing manoeuvres and turning across traffic are common forms of crashes for older drivers (Garber & Srinivasan, 1991; Transportation Research Board, 1992; McKnight, 1996).

Complex traffic situations may lead to difficulty in making appropriate decisions for older drivers because they must integrate and process many sources of information and act on that information. At a complex intersection requiring integration of a great deal of visual information, for example, quick interpretation of the most important stimuli constitutes a difficult task for older drivers and may result in inaccurate perception of the approach of vehicles or even disregard of important perceptual cues altogether (Brébion, Smith & Ehrlich, 1997; Staplin, Lococo, Byington & Harkey, 2001; Oxley et al., 2015).

Similarly for older pedestrians, the road environment plays a significant role in collision risk. A recent analysis of older pedestrian crashes in Victoria (O’Hern, Oxley & Logan, 2015) showed that concentrations of older pedestrian crashes occurred in complex traffic environments such as strip shopping centres on busy arterial roads. Many of these locations were characterised by higher volumes of two-way vehicular traffic accompanied with limited opportunities for pedestrians to cross the road. Relatively few mid-block crossing location opportunities frequently result in older pedestrians crossing the road at un-controlled locations. This can be a very complex crossing manoeuvre for older pedestrians with a mix of vehicular traffic travelling in each direction. These findings support previous research (Oxley et al., 1997) and suggest that older pedestrians experience difficulty in such locations and make poor gap selection decisions: they are more likely to cross when vehicle traffic is closer, accept short gaps in traffic and generally adopting less safe crossing strategies compared to younger pedestrian cohorts.

Countering the ‘older driver problem’ in a Safe System context

Two principal objectives of Australasia’s ‘Safe System’ approach to road safety are the prevention of crashes and where this fails, the management of crash energy to prevent the occurrence of deaths and serious injuries while using the transport system. Older road users pose a particular challenge in this context, given their greater physical frailty, their preponderance of urban driving and for some at least, their reduced fitness to drive. An additional challenge lies in maintaining their safe mobility for as long as possible.

Current evidence suggests that initiatives within four broad categories within a Safe System framework can make significant gains in reducing trauma amongst older road users. These consist of: (1) safer roads, through a series of land use, infrastructure and design improvements particularly governing urban intersections and strip shopping centres; (2) safer vehicles, through both the promotion of crashworthiness as a critical consideration when purchasing a vehicle and the wide use of developed and developing ITS technologies; (3) safer speeds especially at intersections and strip shopping centres; and (4) safer road users, through both improved licensing and assessment procedures to identify the minority of older drivers with reduced fitness to drive, as well as educational efforts to encourage safer road use habits particularly (but not only) through self-regulation and evidence-based training (see Korner-Bitensky et al, 2009 and Kua et al., 2007 for reviews) .

Improvements to licensing procedures

Age-based versus functional performance-based

Traditionally, licensing procedures have been largely age-based testing of fitness-to-drive. However, in recent years, these systems have lost favour, mainly due to their cost, no demonstrable effectiveness in reducing crash and injury risk, and they are discriminatory. The safety effects of age-based mandatory licensing assessments for older drivers have been studied across many different contexts and with different study designs (Meng & Siren,

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 44

2012; Grabowski, Campbell, & Morrisey, 2004;Levy, Vernick, & Howard, 1995); Langford, Fitzharris, Koppel, & Newstead, 2004; Langford, Fitzharris, Newstead, & Koppel, 2004)

Overall, the evidence suggests that age-based mandatory licensing assessments have no positive safety effect in reducing older driver crash risk. In addition, research suggests that age-based mandatory assessments may prompt premature driving cessation, which can be associated with a range of negative psychosocial and health consequences, including loss of independence, increased health problems such as heart disease, stroke and depression (Edwards et. al, 2009; Fonda, Wallace, & Herzog, 2001; Freeman, Gange, Munoz, & West, 2006; Marottoli et al., 2000; Marottoli et al., 1997; Mezuk & Rebok, 2008; Ragland, Satariano, & MacLeod, 2005; Windsor et al., 2007; Yassuda, Wilson, & von Mering, 1997) or may force older individuals to shift from driving a vehicle to more high-risk modes of transport, such as walking etc. (Hakamies-Blomqvist et al., 1996).

An alternative is to consider licensing systems that are based on functional performance, rather than mass age- based across-the-board testing. Such systems would alleviate discriminatory ageist aspects, overall costs, and reduce voluntary driving cessation and the mobility/health consequences of doing so (especially amongst those who may not need to stop driving).

A national unified approach to licensing

Perceived heightened crash risk and/or increased driving exposure for future older drivers has prompted many jurisdictions in Australia and elsewhere to implement stringent licensing conditions, whereby older drivers are required to regularly prove their fitness-to-drive through medical assessment and/or on-road testing (Langford & Koppel, 2006a).

The licence re-assessment practices vary considerably across the different jurisdictions in Australia and notwithstanding recent changes away from mandatory assessment in three jurisdictions (WA, SA, Tas), there remains a need for a more unified approach, nationally (ATC 2011). At one extreme, the New South Wales requirement entails both medical examinations and on-road assessment for specified age groups. In contrast, Victoria, South Australia and Tasmania have no regular testing, whether medical or on-road. In addition, Queensland and Western Australia occupy the middle ground in that they require mandatory medical examination but do not routinely require on-road testing. Over and above the mandatory requirements, any driver of any age in any jurisdiction can be required to demonstrate fitness to continue driving through a variety of assessment means.

Moreover, there is no uniform approach to assessing fitness-to-drive and specific aspects of medical conditions and associated functional impairments.

Current evidence for causal relationships between specific medical conditions and increased crash risk is limited (Charlton et al., 2010; Dobbs, 2001; Marshall, 2008). Clearly, not all medical conditions affect injury risk in the road system to the same extent and not all individuals with the same condition will be affected in the same way (Charlton et al., 2010). The severity of the condition and other characteristics of the disorder are likely to be important determinants of crash risk. Notwithstanding the paucity of evidence linking health, medical conditions and driving, there is mounting evidence that a number of age-related functional impairments may be of sizeable concern to road safety. Indeed, it is not necessarily the medical condition and/or medical complications per se that affect driving, but rather the functional impairments that may be associated with these conditions. In discussing the merits of focussing on impairments in assessing risk, Marottoli (2001) noted that functional impairments are “the common pathway through which … medical conditions affect driving capability and … can be relatively easy to test”.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 45

Therefore a more targeted approach to licence re-assessment is required, one that is based on functional performance and not age per se, based on a referral system (and with the assistance of GPs to identify those at risk), and one that can clearly identify fitness to drive and assist those who are unsafe to continue driving with alternative means of transport.

International collaborative research informing licensing and assessment practices:

MUARC with Canadian partners are leading a world first international collaborative study (Candrive/Ozcandrive) which will provide key assessment tools to improve licensing systems (Marshall et al, 2013). Using a longitudinal design, the study is tracking health, functional abilities and real-world driving patterns of drivers aged over 70 years. The partnership comprises eight institutions including Monash University, La Trobe University, VicRoads, the Victorian Department of Justice, the Victorian Transport Accident Commission, Eastern Health, The Ottawa Hospital Research Institute and the New Zealand Road Safety Trust.

Specifically, the project will deliver two important products for assessing older driver risk:

 a simple, objective screening tool (Decision Rule) to assist health-care professionals to identify at-risk older drivers. Completion of the Decision Rule is expected by the end of 2015.  a tool for objective monitoring of on-road driving (Driver Observation Schedule, eDOS) which may be the basis of a suitable ‘local-area’ licence test. This component is now completed and a number of papers have been published describing the tool (eg. Vlahodimitrakou et al., 2013).

In addition to these key products, the international partnership will:

 describe the natural driving life course of seniors, including distance travelled, self-regulation and transition from driving to driving cessation (Boag, Charlton & Koppel, 2014);  contribute to improved licensing, transport and health policy for seniors; and  inform relevant professionals and wider community of latest developments in managing safe mobility of older people.

The study is now nearing the end of its 5th year. Research outcomes are being disseminated as they are completed through regular communications with the project’s advisory panel of key partners and more broadly through MUARC’s wider stakeholder networks.

Licence restrictions

Complementing a referral-based licensing approach is the provision of a licence with modified conditions tailored to suit driver needs (Charlton, 2013). The concept of modified licenses for older drivers is not a new phenomenon. In the 1980s, Waller advocated for a ‘graduated licensing system’:

“Possibly the most important modification that should be considered for older drivers is a graduated driving reduction program. Just as there is growing recognition that young beginning drivers should not be introduced into the driving population all at once but rather eased in gradually, it should be recognized that many, if not most, older drivers do not have to be abruptly removed from the driving population. … It is not suggested that restrictions should be imposed indiscriminately or in accordance with specific chronological ages. However, it is recommended that clearer guidelines be established for how and when, as well as what kind of, restrictions should be placed on some older applicants.” Waller, 1988, p 86)

Licence restrictions aim to operate at one of three levels by:

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 46

 improving the individual’s fitness to drive - for example by wearing corrective lenses;  making the vehicle safer - for example by requiring automatic transmission; and  reducing exposure to particular driving scenarios- for example, not driving at night or geographic restrictions to local and familiar roads

In North America, there is an emerging research interest in modified/conditional/restricted licences as a strategy for maintaining safe mobility for older and impaired drivers. Similarly, a recent approach introduced in NSW in 2008 is an optional ‘modified driver licence’ which permits local area driving and has no on-road test requirement. Around one third of all drivers at age 85 years have opted for the local area driver licence since its introduction in 2009. Preliminary evaluations of NSW modified licence system (RTA, personal communication June 1, 2012) and Victorian restricted licences have reported indicative evidence that drivers with restrictions are safer that drivers with no restrictions (Langford & Koppel, 2011).

While licence restrictions (not exclusively for older drivers) have a long history, there is minimal knowledge of the frequency with which they are applied and the criteria used for their application. Further, they have rarely been evaluated especially in regard to safety outcomes. New research is needed:

Findings from Candrive/Ozcandrive will be able to address some key issues relating to licensing modifications. For example: to what extent do older drivers self-impose ‘a graduated driving reduction program’? A report to VicRoads provides some preliminary findings on these questions for Years 1-3 driving (Boag et al, 2014).

Additionally, MUARC proposes that a national research program is needed to evaluate whether there are possible safety benefits if some drivers with impairments operated within a ‘graduated driving reduction program’. An important aspect of such an evaluation will be to consider the impact of restrictions on rural and remote older drivers versus older urban residents. Additionally, this research might include an evaluation of the changes introduced in NSW in 2008, comparing the safety benefits pre and post- introduction of the modified local area restriction.

Self-regulation

Moreover, the extent to which individuals may be able to adapt or compensate for their impairment while driving will undoubtedly have some bearing on their likelihood of crash involvement. Indeed, Meyer (2004) has proposed that drivers can be highly adaptive and can compensate for deficiencies in certain areas by adapting their behaviour (i.e., changing the conditions in which they drive, using different driving techniques, or using in- vehicle technologies to assist with some of their deficiencies) to minimise their crash risk. Recent research suggests that, contrary to expectations based on increased licensure and travel by older drivers, older drivers’ fatal crash risk has declined during the past decade and has declined at a faster rate than for middle-age drivers (Cheung & McCartt, 2011). More specifically, Cheung and McCartt reported that while the licensing rate for drivers aged 70 years and older increased from 73 to 78 percent between 1997 and 2008 in the United States, fatal passenger vehicle crashes per licensed drivers in this age group decreased by 37 percent, compared with a decrease of 23 percent for drivers aged 35 to 54 years. The authors also reported that the decline was greatest (47%) among older drivers aged 80 years and older. One of the explanations for this decline is that older drivers are self-regulating their driving as a strategy for maintaining their mobility while reducing crash risk (Braitman & Williams, 2011).

Older drivers’ capacity to moderate their risk is a crucial element in determining their safety. Many older drivers become aware of their declines in functional capacities and adapt their driving patterns to match these changes by self-regulating when, where and how they drive (Baldock, Mathias, McLean, & Berndt, 2006; Blanchard, Myers,

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 47

& Porter, 2010; Charlton et al., 2006; Molnar & Eby, 2008; Molnar et al., 2013 a. 2013b., 2013c, 2014a.). For example, older adults may reduce their exposure by driving fewer annual kilometres, making shorter trips and making fewer trips by destination chaining (i.e, linking multiple trips together) (Benekohal et. al, 1994; Rosenbloom, 1995, 1999). Older drivers have also been found to: avoid complex traffic manoeuvres that are cognitively demanding (Ball et al., 1998; Hakamies-Blomqvist & Wahlstrom, 1998), limit their peak hour and night driving, restrict long distance travel, take more frequent breaks, and drive only on familiar and well lit roads (Ernst & O’Connor, 1988; Smiley, 1999). Several studies have also shown that most older drivers recognize that good vision is one of the most important elements for safe driving and often cite poor vision as a major determinant for reducing driving at night or in poor weather (Kostyniuk & Shope, 1998; Marottoli et al., 1993; Persson, 1993). This evidence suggests that at least some older adults are able to compensate well for limitations in their abilities in such a way that is likely to minimise exposure to difficult driving situations to reduce their crash risk.

There are some groups, however, who may lack that capacity or lack of insight to appropriately self-regulate their own driving. For example, there is a concern that lack of insight associated with dementia will reduce drivers’ capacity to self-regulate appropriately. While there is lack of clarity about fitness to drive as the severity of impairment progresses, the evidence shows that in general, drivers with dementia have a 2-3 times increased risk of a crash, many of which result in injury or death. Managing a successful transition to non-driving for these groups of seniors is therefore a difficult task and may require multiple approaches including strategies for improving the medical review and restricted licensing protocols or provision of resources for drivers and their families/carers to assist with the decision to stop driving.

Land use and transportation infrastructure.

Using projections of ageing within certain urban, regional, and rural areas, combined with current and future land-use and transportation infrastructure provision plans, it should be possible to highlight those areas where older adults are likely to experience the lowest rates of mode choice and highest rates of transport crash and injury risk under various scenarios.

One way to gauge the transportation options in a community is to consider the issues of availability, accessibility, acceptability, affordability, and adaptability (Kerschner & Aizenberg, 2004). Other considerations are land use planning, infrastructure and road design. These elements must be considered in the context of community design for older residents or to accommodate the needs of a community as it evolves, and particularly as the population ages in place (Giuliano, 2004).

It has been consistently demonstrated that land use and the built environment significantly the availability of transportation modes and their use (Ewing & Cervero, 2010). In turn, mode choice is also significantly associated with relative risk of death or injury per km travelled (Elvik, 2009). People transitioning into older age who do not also transition into areas of high density, high land-use diversity, low distance to destinations, and of high design standards (e.g., in the form of adequate infrastructure for protecting vulnerable road users) face the possibility of becoming stranded when the use of a private motor vehicle is no longer an option for them. Therefore, in urban or rural areas where land-use density and diversity are low, where active transport infrastructure is poor, and essential services are distant, the planning and provision of adequate public transportation and infrastructure for aging residents to maintain adequate independent mobility may be paramount in maintaining both safety and quality of life (Oxley & Whelan, 2008).

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 48

Powered Two-Wheelers (PTWs)

Powered two wheelers (which includes both motorcycles and scooters) are a significant part of Australia’s transport future. Registrations for powered two-wheelers (PTWs) increased by 25% between 2009 and 2014, compared to 11% for passenger vehicles over the same period (Australian Bureau of Statistics, 2014). This is likely a combination of increased popularity of powered two wheelers for commuting in urban areas, as well as increased recreational use of motorcycles in regional and rural areas. Although trends in motorcycle fatality rates (relative to the number of registered motorcycles) are declining, motorcycle fatalities comprise an increasing proportion of all road deaths due to increased motorcycling and the dramatic improvements in motor car safety over recent decades (Haworth, 2012). The vulnerability of motorcyclists is reflected in hospital admission rates in 2005-6 that were 10 times higher than those of passenger cars per 10,000 registered vehicles (Berry and Harrison, 2008). Therefore future road safety strategies aimed at reducing rates of serious injury to motorcyclists should place a high priority on reducing the incidence of crashes involving PTWs.

MUARC is currently completing a population-based case-control study of serious motorcycle crashes in Victoria, aimed at providing up-to-date evidence-based countermeasures for improving motorcycle safety (Day et al., 2013). The results of this study are expected to be available later in 2015.

One area that remains poorly understood are serious injury off-road PTW crashes (typically occurring in regional and remote areas), which are estimated to represent about one-third of all hospital injury admissions involving a PTW rider (Source: Victorian Admitted Episodes Dataset, 2009-2014). There remains very little understanding of the factors related to crash risk amongst this group of PTW riders. One preliminary finding from the early recruited cases (n=75) showed that the most common crash scenario was another vehicle turning into the path of the rider (Allen et. al, 2013). Evidence from simulator-based research conducted at MUARC suggests that a low prevalence of motorcycles can reduce a drivers’ ability to detect them in traffic (Beanland, Lenne et al. 2014). . In the area of vehicle-based technology for motorcycle safety, the most promising technology currently available is anti-lock brakes (Rizzi et al., 2015). The European Commission has already passed legislation for the mandatory fitment of anti-lock brakes to all new motorcycles (over 125cc) from 2016.

The use of motorcycle protective clothing has been shown to reduce the risk and severity of injury in the event of a crash, particularly when fitted with body armour (de Rome et al., 2011, de Rome et al., 2012). However, research investigating the failure rates of jackets, pants and gloves indicates the need to ensure PTW clothing available in Australia is fit for purpose (de Rome et. al., 2011). The European Union has specific (CE) standards which the set minimum levels of construction and test performance of all motorcycle clothing that claims to be protective from injury. In Australia, guidelines have been issued to manufacturers (Standards Australia, 2002) but there are no mandated minimum standards for motorcycle protective clothing, or the requirement to provide information to the consumer about whether clothing meets those guidelines (de Rome et al., 2013). We therefore recommend investment in introduction of minimum standards for motorcycle protective clothing appropriate to Australian conditions, and other evidence-based strategies aimed at increasing the proportion of PTW riders wearing clothing with the best possible protection.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 49

Final Comments/Conclusion

Despite significant reductions in road trauma over recent years, Australia still lags well behind international best countries in road safety performance. The shift in assessment of the cost of road trauma to ‘Willingness To Pay’ methods further emphasises the potential benefits to be gained by increasing federal government commitment to reducing road deaths and serious injuries.

Primary challenges that face our road safety future:

 The increasing representation of vulnerable road users in road trauma statistics, including cyclists, pedestrians and motorcyclists

 The increasing age of our road user population – this has implications not only for road safety but requires addressing broader issues of health and mobility as the proportion of older Australians increases

 The introduction of new vehicle safety technologies - it is important we maximise the opportunities of these technologies in reducing road trauma, while minimising the potential risks

 The acceptance of lower speeds and speed limits by the community

Recommended countermeasures that will provide the greatest benefits:

 Safer Speeds : A commitment to reductions in speeds and speed zones, based on international best practise and economic costings. This will need to include evidence-based strategies to maximise acceptance and engagement of the community in this process.

 Safer Vehicles: Investment in maximising the road safety benefits provided by new vehicle safety technologies (crash avoidance, crash worthiness), including a plan to address issues in the introduction of autonomous vehicles.

 Safer Roads: Increased investment in road infrastructure using a safe systems framework. This includes particular focus on reducing crash and serious injury risk for vulnerable road users (cyclists, pedestrians, motorcyclists).

 Government commitment and facilitation of high quality road safety research. It is important that researchers have sufficient resources and data to guide best road safety strategies to meet our road safety targets. The work of MUARC has been underpinned by crash data; a new paradigm of understanding serious injury is needed and data linkage studies will facilitate this, in combination with in- depth sampling systems across all road user groups. We urge the Australian Government to facilitate this process.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 50

References

Access Economics (2009). The economic cost of spinal cord injury and traumatic brain injury in Australia. Melbourne: Access Economics Pty Limited for The Victorian Neurotrauma Initiative.

Allen, T., L. Day, M. G. Lenne, M. Symmons, P. Hillard, S. Newstead and R. McClure (2013). "Finding evidence- based strategies to improve motorcycle safety: a case-control study on serious injury crashes in Victoria." Proceedings of Road Safety Research and Policing and Education Conference. Brisbane, Australia.

Anderson, R., Hutchinson, TP., Linke, B. & Ponte, G. (2011). Analysis of crash data to estimate the benefits of emerging vehicle technology, Centre for Automotive Safety Research, The University of Adelaide. Report No. CASR094.

ATC - Australian Transport Council (2011). National Road Safety Strategy 2011–2020. Austroads (2011). ‘Guide to project evaluation, part 4, project evaluation data, updated RUE unit values, August 2011’. Austroads, Sydney, NSW.

Augenstein, J. (2001). Differences in clinical response between the young and the elderly. Paper presented at the Aging and Driving Symposium, Association for the Advancement of Automotive Medicine, Des Plaines, IL.

Australian Bureau of Statistics. (2011). Australian Social Trends Canberra, Australia: Australian Bureau of Statistics.

Australian Bureau of Statistics. (2013). Population Projections, Australia, 2012 (base) to 2101. Canberra, ACT Australia: Australian Bureau of Statistics.

Australian Bureau of Statistics (2014). "Motor Vehicle Census, 31 January 2014." Australian Bureau of Statistics, Canberra 9309.0.

Austroads. (2010). Operational impacts of alternative private passenger vehicles. In A. Ltd (Ed.), (Vol. Austroads Publication No. AP-R351/10). Sydney.

Azad, N., Byszewski, A., Amos, S., & Molnar, F. (2002). A survey of the impact of driving cessation on older drivers. Geriatrics Today: Journal of the Canadian Geriatrics Society, 5, 170-174.

Baldock MRJ, Mathias JL, McLean AJ, Kloeden CN, Berndt A. (2006). Self-regulation of driving and older drivers' functional abilities. Clinical Gerontologist, 30(1), 53-70.

Ball, K., Owsley, C., Stalvey, Roeneker, D., Sloane, M., & Graves, M. (1998). Driving avoidance and functional impairment in older drivers. Accident Analysis and Prevention, 30(3), 313-322.

Bassuk, S. S., Glass, T. A., & Berkman, L. F. (1999). Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annuals of Internal Medicine, 131, 165-173.

Benekohal, R., Resende, P., Shim, E., Michaels, R., & Weeks, B. (1992). Highway operations problems of elderly drivers in Illinois (Report No. FHWA-IL-023). Springfield, USA. Federal Highway Administration, US Department of Transportation.

Boag, R., Charlton, J.L., Koppel, S. (2014). Older Driver Naturalistic Driving Patterns: Early findings from the Ozcandrive Study. Report to VicRoads.

BTE - Bureau of Transport Economics (2000). ‘Road crash costs in Australia’. Report 102. Bureau of Transport Economics (BTE), Canberra, ACT.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 51

BITRE - Bureau of Infrastructure Transport and Regional Economics (2009). ‘Cost of road crashes in Australia 2006’, report 118, BITRE, Canberra, ACT.

Binder, E., Schechtman, K., Ehsani, A., Steger‐May, K., Brown, M., Sinacore, D.,Holloszy, J. (2002). Effects of Exercise Training on Frailty in Community‐Dwelling Older Adults: Results of a Randomized, Controlled Trial. Journal of the American Geriatrics Society, 50(12), 1921-1928.

Blanchard RA, Myers AM, Porter MM. (2010). Correspondence between self-reported and objective measures of driving exposure and patterns in older drivers. Accident Analysis and Prevention. 2010;42:523–529. doi:10.1016/j.aap.2009.09.018.

Braitman KA, Williams AF. (2011). Changes in self-regulatory driving among older drivers over time. Traffic Injury Prevention. 12(6): 568-75.

Brébion, G., Smith, M., & Ehrlich, M. (1997). Working memory and aging: Deficit or strategy differences? Aging, Neuropsychology and Cognition, 4(1), 58-73.

Bryden, K. J., Charlton, J. L., Oxley, J. A., & Lowndes, G. (2014). Acceptance of Navigation Systems by Older Drivers. Gerontechnology, 13(1):21-28 doi: http://dx.doi.org/10.4017/gt.2014.13.1.011.00

Budd, L, .Keall, M. and Newstead, S. (2015) Retrospective and Prospective Changes in Secondary Safety of the Australian And New Zealand Vehicle Fleets and the Potential Influence of New Vehicle Safety Technologies, Monash University Accident Research Centre (Report in press)

Budd, L., Scully, M., Newstead, S., & Watson, L. (2012). The potential crash and injury reduction benefits of safer vehicle choices for older drivers in Australia and New Zealand Melbourne, Australia: Monash University Accident Research Centre.

Bureau of Infrastructure Transport and Regional Economics. (2014). Road safety of older Australians: recent statistics: Bureau of Infrastructure, Transport and Regional Economics.

Burkhardt, J. C., Berger, A. M., Creedon, M. A., & McGavock, A. T. (1998). Mobility and Independence. Changes and challenges for older drivers. Washington, D. C: U.S. Department of Health and Human Services and the National Highway Traffic Safety Administration.

Cameron, MH (2003), ‘Potential benefits and costs of speed changes on rural roads’. Report No. CR 216. Australian Transport Safety Bureau, Canberra, ACT.

Cameron, MH (2012). ‘Optimum speeds on rural roads based on “willingness to pay” values of road trauma’. Journal of the Australasian College of Road Safety, Vol. 23, No. 3, August 2012.

Cameron, M.H. (1987) ‘The effectiveness of Australian Design Rules aimed at occupant protection’, Seminar on Structural Crashworthiness and Property Damage Accidents, Monash University Department of Civil Engineering

Cameron, M. H., Mach, T. & Neiger, D. (1992) Vehicle crashworthiness ratings: Victoria 1983-90 and NSW 1989-90 crashes. Summary Report, Monash University Accident Research Centre, Report No. 28

Cameron, M. H., Mach, T. & Neiger, D. (1992) Vehicle crashworthiness ratings: Victoria 1983-90 and NSW 1989-90 crashes, Technical report, Monash University Accident Research Centre, Report No. 25

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 52

Cassell, E., & Clapperton, A. (2006) Consumer product-related injury (2): injury related to the use of motorised mobility scooters. Melbourne, Australia: Victorian Injury Surveillance Unit, Monash University.

Charlton, J.L. (2012) Practical and system issues associated with determining fitness to drive from an Australian perspective. Invited paper presented to national symposium: Global Perspectives on Assessing Older Drivers: Science Informing Public Policy. June 21-23, Calgary, Alberta, Canada.

Charlton, J., Koppel, S., Odell, M., Devlin, A., Langford, J., O'Hare, M., Kopinathan, C., Andrea, D., Smith, G., Khodr, B., Edquist, J., Muir, C. & Scully, M. (2010). Influence of chronic illness on crash involvement of motor vehicle drivers. Melbourne, Australia: Monash University Accident Research Centre.

Charlton, J., Langford, J., Fildes, B., Oxley, J., Congiu, M., & Bohensky, M. (2008). Trial of a model licence reassessment procedure for older drivers; Stage 3 Research. Austroads Report AP-R322/08.

Chen, J., & Millar, W. (2000). Are recent cohorts healthier than their predecessors? Health Reports-Statistics Canada, 11(4), 9-24.

Cheung, I., & McCartt, A. (2011). Declines in fatal crashes of older drivers: Changes in crash risk and survivability. Accident Analysis & Prevention, 43(3), 666-674

Council on the Aging. (2004). Older Persons’ Road Safety Needs Analysis for the ACT. Canberra, Australia: COTA- ACT.

Davidse, R.J. (2007). Assisting the older driver; Intersection design and in-car devices to improve the safety of the older driver. SWOV, Leidschendam.

Day, L., Lenne, M. G., Symmons, M., Hillard, P., Newstead, S. V., Allen, T., & McClure, R. (2013). Population based case–control study of serious nonfatal motorcycle crashes. BMC Public Health. 13(72), 1-13. DOI:10.1186/1471-2458-13-72

Department of Finance and Deregulation (2008). Best Practice Regulation Guidance Note: Value of statistical life. Canberra: Office of Best Practice Regulation, Australian Government.

Department of Infrastructure, Transport, Regional Development and Local Government, 2007/2008 Annual Report.https://www.infrastructure.gov.au/department/annual_report/2007_2008/files/DITRDLG_AR0708.p df

Department of Infrastructure and Regional Development. (2013). Regulation Impact Statement for the Control of Light Commercial Vehicle Stability, Report DoIT VSS 01/2012. Canberra; http://ris.finance.gov.au/2013/11/26/electronic-stability-control-for-light-commercial-vehicles-details-stage- regulation-impact-statement-department-of-infrastructure-and-regional-development/

Department of Infrastructure and Regional Development (2015). Regulation Impact Statement: Improved protection of occupants in side impact crashes. Australian Government. http://www.infrastructure.gov.au/roads/motor/design/adr_comment.aspx

Department of Transport and Regional Services (2004). Regulation Impact Statement - Seatbelt Reminders. Canberra.

Dejeammes, M., & Ramet, M. (1996). Aging process and safety enhancement of car occupants. Paper presented at the 15th International Technical Conference on the Enhanced Safety of Vehicles, Melbourne, Australia.de

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 53

Rome (2013). Motorcycle Protective Clothing. Australian Road Safety Research and Policing Conference, Brisbane. file:///C:/Users/tjallen/Downloads/2003.pdf de Rome L, Ivers R, Fitzharris M, Du W, Haworth N, Heritier S, Richardson D. (2011). Motorcycle protective clothing: Protection from injury or just the weather? Accident Analysis and Prevention;43:1893-1900. de Rome L, Ivers R, Fitzharris M, Haworth N, Hertier S, Richardson D. (2012). Effectiveness of motorcycle protective clothing: Riders’ health outcomes in the six months following a crash. Injury .43;2035-2045

Dobbs, B. (2001). Medical Conditions and Driving: Current Knowledge. Washington DC: National Highway Transportation Safety Administration and The Association for the Advancement of Automotive Medicine Project.

Eberhard, J. (2007). Do older drivers have a heightened crash risk? Paper presented at the Licensing Authorities’ Options for Managing Older Driver Safety: Practical Advice from the Researchers, Transportation Research Board 86th Annual Meeting, Washington DC.

Edwards, J., Perkins, M., Ross, L., & Reynolds, S. (2009). Driving Status and Three-Year Mortality Among Community-Dwelling Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 64A(2), 300-305. doi: 10.1093/gerona/gln019

Elvik, R. (2009). The handbook of road safety measures (2nd Edition. ed.). Bingley, UK: Emerald

Ernst, R., & O’Connor, P. (1988). Report on accident countermeasures focusing on elderly drivers. Road Safety Division, South Australian Department of Road Transport.

ETSC (2006) Policy Paper, ‘Seat Belt Reminders – Implementing Advanced Safety’, November 2006

Evans, L. (2004). Traffic Safety. Bloomfield Hills: Science Serving Society.

Ewing, R., & Cervero, R. (2010). Travel and the built environment. Journal of the American Planning Association, 76(3), 265-294.

Fildes, B., Corben, B., Morris, A., Oxley, J., Pronk, N., Brown, L., & Fitzharris, M. (2000). Road safety environment and design for older drivers. (Report No. AP-R169). Sydney, Australia. Austroads.

Fildes, B., Charlton, J., Pronk, Oxley, J., Newstead, S., Oxley, P., Langford, J., Frith, B. Keall, M. (2004). Model Licence Re-Assessment Procedure for Older and Disabled Drivers. Stage 2. Austroads Report AP-R259-04.

Fildes, Corben, B., Kent, S., Oxley, J., Le, T., &, & Ryan, P. (1994). Older road user crashes. Monash University Accident Research Centre.

Fildes, B. N., Digges, K., Carr, D., Dyte, D. & Vulcan, A. P. (1995) Side impact regulation benefits, Federal Office of Road Safety, CR 154

Fildes, B. N., Digges, K., Dyte, D., Gantzer, S. & Seyer, K. (1996) Benefits of a frontal offset regulation, Federal Office of Road Safety, Canberra, CR 165

Fildes, B., Fitzharris, M., Koppel, S. & Vulcan, P. (2002) Benefits of seat belt reminder systems, Australian Transport Safety Bureau (ATSB), CR 211a

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 54

Fildes, B., Keall M., Bos N., Lie A., Page Y., Pastor C., Pennisi L., Rizzi M., Thomas P., and Tingvall C. Effectiveness of low speed autonomous emergency braking in real-world rear-end crashes, Accident Analysis & Prevention, Volume 81, August 2015, Pages 24–29

Fildes B, Keall MD, Thomas P, Parkkari K, Pennisi L, Tingvall C (2013) Evaluation of the Benefits of Vehicle Safety Technology: The MUNDS Study, Accident Analysis & Prevention 55:pp. 274-281.

Fildes, B. N., Lane, J. C., Lenard, J. & Vulcan, A. P. (1991) Passenger cars and occupant injury, Federal Office of Road Safety, Canberra, CR 95.

Fildes, B. N., Lane, J. C., Lenard, J. & Vulcan, A. P. (1994) Passenger cars and occupant injury: side impact crashes, Federal Office of Road Safety, CR 134.

Fildes, B., Pronk, N., Langford, J., Hull, M., Frith, W., & Anderson, R. (2000). Model Licence Re-Assessment Procedure for Older and Disabled Drivers. Austroads Report No. AP –R176/00.

Fitzharris M, Bowman D, Ludlow K. (2010). Factors associated with return-to-work and health outcomes among survivors of road crashes in Victoria. Australian and New Zealand Journal of Public Health. 34:153-159

Fitzharris, M., Fildes, B., Charlton, J. and Kossmann, T. (2007). General health status and functional disability following injury in traffic crashes. Traffic Inj Prev. 8:1-12.

Fitzharris M, Fildes B, Charlton J. (2006). Anxiety, acute- and post-traumatic stress symptoms following involvement in traffic crashes. Annu Proc Assoc Adv Automot Med. 50:297-315.

Fitzharris M, Fildes B, Charlton J, Tingvall C. (2005) The relationship between perceived crash responsibility and post-crash depression. Annu Proc Assoc Adv Automot Med. 49:79-92.

Fitzharris, M., Fildes, B., Charlton, J. and Kossmann, T (2007). General health status and functional disability following injury in traffic crashes. Traffic Inj Prev. 8:1-12.

Fitzharris M, Fildes B, Newstead S, Logan D (2004). Benefits of Australian Design Rule 69 (full frontal crash protection) and airbags in frontal crashes in Australia. Annu Proc Assoc Adv Automot Med. 48:35-53.

Fitzharris, M., Fildes, B., Newstead, S., & Logan, D. (2006). Crash-based evaluation of Australian Design Rule 69 (full frontal crash protection). Canberra: Australian Transport Safety Bureau.

Fitzharris, M., Scully, J., & Newstead, S. (2010). Analysis of the likely benefits to Australia of the fitment of electronic stability control (ESC) in light commercial vehicles. Clayton: Monash University Accident Research Centre (Consultant Report for the Department of Infrastructure, Transport and Regional Development).

Fitzharris M, Stephan K. (2013). Assessment of the need for, and the likely benefits of, enhanced side impact protection in the form of a Pole Side Impact Global Technical Regulation. Monash University.

Fonda, S., Wallace, R., & Herzog, A. (2001). Changes in driving patterns and worsening depressive symptoms among older adults. Journal of Gerontology series B-Psychological Sciences & Socials Sciences, 56B(6), S343- 351.

Freeman, E., Gange, S. J., Munoz, B., & West, S. K. (2006). Driving status and risk of entry into long-term care in older adults. American Journal of Public Health, 96, 1254-1259.

Frey, W. (2010). Baby boomers and the new demographics of America's seniors. Generations, 34(3), 28-37.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 55

Garber, N., & Srinivasan, R. (1991). Risk assessment of elderly drivers at intersections: Statistical Modelling. Transportation Research Record, 1325.

Garrard, J. (2009). Active transport: Adults - An overview of recent evidence. Melbourne, Australia: VicHealth.

Giuliano, G. (2004). Land use and travel patterns among the elderly. Transportation in an Aging Society, 192.

Grabowski, D.C., Campbell, C.M. & Morrisey, M.A. (2004). Elderly licensure laws and motor vehicle fatalities. Journal of the American Medical Association, 291(23), 2840-2846.

Hakamies-Blomqvist, L., & Wahlström, B. (1998). Why do older drivers given up driving? Accident Analysis and Prevention, 30(3), 305-312.

Haworth, N. (2012): Powered two wheelers in a changing world- challenges and opportunities. Accid Anal Prev, 44:12–18.

Hensher, DA, Rose, JM, de Dios Ortúzar, J and Rizzi, LI (2009). ‘Estimating the willingness to pay and value of risk reduction for car occupants in the road environment’. Transportation Research Part A, vol. 43, no. 7, pp. 692–707.

Jancey, J., Cooper, L., Howat, P., Meuleners, L., Sleet, D., & Baldwin, G. (2013). Pedestrian and motorized mobility scooter safety of older people. Traffic Injury Prevention, 14(6), 647-653.

Janke, M. (1994). Age-related disabilities that may impair driving and their assessment: Literature review. Sacramento: California Department of Motor Vehicles.

Johnson, M., Rose, G., & Oxley, J. (2013). Motorised mobility scooters – understanding a growing transport mode for older Australians. Paper presented at the Proceedings of the 2013 Australasian Transport Research Forum.

Kahane, C.J. (1982) Evaluation of side structure improvements in response to Federal Motor Vehicle Safety Standard 214, Report No. DOT HS 806 314, National Highway Safety Administration, US Department of Transportation

Kahane, C.J. (1984) ‘The National Highway Traffic Safety Administration’s Evaluation of Federal Motor Vehicle Safety Standards’, SAE Paper No. 84092, Society of Automotive Engineers Inc., USA.

Keall, M., & Newstead, S. (2007). Four-wheel drive vehicle crash involvement risk, rollover risk and injury rate in comparison to other passenger vehicles: estimates based on Australian and New Zealand crash data and on New Zealand motor vehicle register data Melbourne, Australia: Monash University Accident Research Centre.

Kerschner, H., & Aizenberg, R. (2004). Focus group participants reflect on transportation. Paper presented at the Transportation in an aging society: A decade of experience, conference proceedings.

Koppel, S., & Berecki-Gisolf, J. (2015). Car Licensing Trends of the Babyboomer Cohort (b. 1946-1965) Compared to Earlier Birth Cohorts: Effects on the Driving Population in the State of Victoria, Australia. Traffic Injury Prevention, 16(7), 657-663

Koppel, S., Bohensky, M., Langford, J., & Taranto, D. (2011). Older Drivers, Crashes and Injuries. Traffic Injury Prevention, 12(5), 459-467.

Koppel, S., Clark, B., Hoareau, E., Charlton, J.L., & Newstead, S. (2013). How important is vehicle safety for older consumers in the vehicle purchase process? Traffic Injury Prevention, 14(6), 592-601.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 56

Koppel, S & Charlton, J.L. (2013). Behavioural adaptation and older drivers. In C. M. Rudin-Brown & S.L. Jamson, (Eds). Behavioural Adaptation and Road Safety: Theory, Evidence and Action. CRC Press, Boca Raton, FL.

Koppel, S., Charlton, J.L. & Fildes, B. (2009). Distraction and the older driver. In M. Regan, J.D.. Lee & K Young (Eds). Driver Distraction: Theory, Effects and Mitigation. Florida, USA: CRC Press

Koppel, S., Charlton, J.L., Langford, J., Di Stefano, M. Macdonald, W., Mazer, B., Gelinas, I., Vrkljan, B. & Marshall, S. (2013). The relationship between older drivers' performance on the Driving Observation Schedule (eDOS) and cognitive performance. Annals of Advances in Automotive Medicine, 57: 67-76.

Koppel, S., Charlton, J.L., Langford, J., Di Stefano, M., MacDonald, W., Vlahodimitrakou, Z.1, Mazer, B. , Gelinas, I., Vrkljan, B., Eliasz, K., Myers, A., Tuokko, H. & Marshall, S. (accepted Dec 2014) The relationship between older drivers' driving behavior, functional fitness to drive, and self-reported driving-related abilities and practices. Special Issue Candrive/Ozcandrive Canadian Journal of Aging

Koppel, S., Young, K, Charlton, J.L (2015). Towards best practice in Human Machine Interface for older drivers: A review of current design guidelines. Presentation at 'Emerging IT for Aging Drivers: Boon or Bane'. 1st International Conference on aspects of IT for the Aged Population in the context of HCI International, Los Angeles, CA, USA, August 2015.

Korner-Bitensky, N., Kua, A., Desrosiers, J., von Zwek, C., & Van Benthem, K. (2009). Older driver retraining: An updated systematic review of evidence of effectiveness. Journal of Safety Research, 40, 105-111.

Kostyniuk, L., & Shope, J. (1998). Reduction and cessation of driving among older drivers: Focus Groups. (Report UMTRI-98-26). The University of Michigan Transportation Research Institute.

Kua, A., Korner-Bitensky, N., Desrosiers, J., Man-Son-Hing, M., & Marshall, S. (2007). Older driver retraining: A systematic review of evidence of effectiveness. Journal of Safety Research, 38, 81-90.

Marshall, S.C., Man-Son-Hing, M., Bédard, M., Charlton, J., Gagnon, S., Gélinas, I., Koppel, S., Korner-Bitensky, N., Langford, J., Mazer, B., Myers, A., Naglie, G., Polgar, J., Porter, M.M., Rapoport, M., Tuokko, H., Vrkljann, B., & Woolnough, A. (2013). Protocol for Candrive II/Ozcandrive, a multicentre prospective older driver cohort study. Accident Analysis and Prevention, 61:245-252

Langford, J., Charlton, J., Bohensky, M., Irving, J., Martin, L. & Fildes, B. (2009). Older driver model assessment program: Stage 4 – validation of screening tests to assess at-risk older drivers. Austroads Report AP-R336/09.

Langford, J., Fitzharris, M., Newstead, S. & Koppel, S. (2004a). Some consequences of different older driver licensing procedures in Australia. Accident Analysis and Prevention, 36(6), 993-1001.

Langford, J., Fitzharris, M., Koppel, S. & Newstead S. (2004b). Effectiveness of mandatory license testing for older drivers in reducing crash risk among urban older Australian drivers. Traffic Injury Prevention, 5(4), 326-35.

Langford, J., & Koppel, S. (2006). Epidemiology of older driver crashes - identifying older driver risk factors and exposure patterns. Transportation Research Part F: Traffic Psychology and Behaviour, 9(5), 309-321.

Langford, J., & Koppel, S. (2011). Licence restrictions as an under-used strategy in managing older driver safety. Accident Analysis & Prevention, 43: 487-493

Levy DT, Vernick JS, Howard K.A. (1995). Relationship between driver's license renewal policies and fatal crashes involving drivers 70 years or older. Journal of the American Medical Association, 274(13), 1026-30.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 57

Li, G., Braver, E. R., & Chen, L. (2003). Fragility versus excessive crash involvement as determinants of high death rates per vehicle-mile of travel among older drivers. Accident Analysis and Prevention, 35(2), 227-235.

McKnight, J. (1996). Older driver enforcement: Accidents and violations. Paper presented at the TRB mid-year meeting on the Safe Mobility of Older Persons, Washington DC, USA.

Marottoli, de Leon, C., Glass, T., Williams, C., Cooney, L., & Berkman, L. (2000). Consequences of Driving Cessation. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55(6), S334- S340. doi: 10.1093/geronb/55.6.S334

Marottoli, R. (2001). Health issues for older road users. Transcript of Proceedings of the Mobility and Safety of Older People Conference, Melbourne.

Marottoli, R., & Coughlin, J. (2011). Walking the tightrope: Developing a systems approach to balance safety and mobility for an aging society. Journal of aging & social policy, 23(4), 372-383.

Marottoli, R., Mendes de Leon, C. F., Glass, T. A., Williams, C. S., Cooney, L. M., Berkman, L. F., & Tinetti, M. E. (1997). Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly. Journal of the American Geriatrics Society, 45(2), 202-206.

Marshall, S. (2008). The role of reduced fitness to drive due to medical impairments in explaining crashes involving older drivers. Traffic Injury Prevention, 9(4), 291-298.

Meng, A., & Siren, A. (2012). Older Drivers’ Reasons for Reducing the Overall Amount of Their Driving and for Avoiding Selected Driving Situations. Journal of Applied Gerontology. doi: 10.1177/0733464812463433

Metz, D. H. (2000). Mobility of older people and their quality of life. Transport Policy, 7(2), 149-152. doi: http://dx.doi.org/10.1016/S0967-070X(00)00004-4.

Meyer, J. 2004, 'Personal vehicle transportation', in R. W. Pew and S. B. V. Hemel (eds), Technology for Adaptive Aging, The National Academies Press, Washington, D.C., pp. 253-281.

Mezuk, B., & Rebok, G. (2008). Social Integration and Social Support Among Older Adults Following Driving Cessation. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 63(5), S298- S303.

Missikos, A., & James, K. (1997). Mobility with safety - research and policy study on electric wheelchairs and scooters. Paper presented at the 21st Australasian Transport Research Forum, Adelaide, South Australia, University of South Australia, Transport Systems Centre.

Molnar, L.J., Charlton, J.L., Eby, D.W., Langford, J., Koppel, S., Kolenic, G.E., Marshall, S. (2014). Factors Affecting Self-Regulatory Driving Practices among Older Adults. Traffic Injury Prevention. 15(3), 262-272.

Molnar, L.J., Eby, D.W., Charlton, J.L., Langford, J., Koppel, S., Marshall, S., Man-Son-Hing, M. (2013). Driving Avoidance by Older Adults: Is It Always Self-Regulation? Accident Analysis and Prevention, 61: 272-280

Molnar, L.J., Eby, D.W., Langford, J., Charlton, J.L., St. Louis, R. & Roberts, J.S. (2013). Tactical, strategic and life- goals self-regulation of driving by older adults: Development and testing of a questionnaire. Journal of Safety Research, 46, 107-117.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 58

Molnar, L.J., Charlton, J.L., Eby, D.W., Bogard, S.E., Langford, J., Koppel, S., Kolenic, G.E., Marshall, S. & Man-Son- Hing, M. (2013). Self-Regulation of Driving by Older Adults: Comparison of Self-Report and Objective Driving Data. Transportation Research Part F: Traffic Psychology and Behaviour, 20, 29–38.

Monash University Accident Research Centre (1992) Feasibility of occupant protection measures, Federal Office of Road Safety, Canberra, CR 100.

Morris, Welsh, R., Frampton, R., Charlton, J. L., & Fildes, B. (2003). Vehicle Crashworthiness and the Older Motorist. Ageing and Society, 23, 395-409.

Morris, Welsh, R., & Hassan, A. (2003). Requirements for crash protection of older drivers. Paper presented at the Proceedings of the Association for the Advancement of Automotive Medicine Conference, Lisbon, Portugal.

National Road Safety Action Plan 2007 and 2008, Australian Transport Council, page 36

Newstead, S., Watson, L. & Cameron, M. (2014) Vehicle safety ratings estimated from police reported crash data: 2008 update. Australian and New Zealand crashes during 1987-2012, Monash University Accident Research Centre, Report No. 323

Newstead, S., Watson, L. & Cameron, M. (2014a) Trends in crashworthiness of the New Zealand vehicle fleet by year of manufacture: 1964 to 2006. Supplement to report 323 Vehicle safety ratings estimated from police reported crash data: 2008 update, Monash University Accident Research Centre, Report No. 323 supplement

O'Hern, S., & Oxley, J. (2015). Understanding travel patterns to support safe active transport for older adults Journal of Transport and Health, Special Issue: Transport, Travel and Mobility in Later Life, 2(1), 79-85.

O’Hern, S., Oxley, J., & Logan, D. (in press). Older adults at increased risk as pedestrians in Victoria, Australia: An examination of crash characteristics and injury outcomes. Traffic Injury Prevention.

OECD. (2001). Ageing and Transport. Mobility needs and safety issues. Paris, France: OECD Publications.

Oxley, J., & Charlton, J. (2009). Attitudes to and mobility impacts of driving cessation: Differences between current and former drivers. Topics in Geriatric Rehabilitation, 25(1), 43-54.

Oxley, J.A. & Fildes, B.N. (1993). Pilot study of the long term effects of road crashes (Prepared by Monash University Accident Research Centre). Federal Office of Road Safety. Report No. CR 116.

Oxley, J., Fildes, B., Ihsen, E., Charlton, J.L. & Day, R. (1997). Differences in traffic judgements between young and old adult pedestrians. Accident Analysis and Prevention, 29(6), 11, 839-847.

Oxley, J., Logan, D., & O’Hern, S. (2015). Investigation into characteristics of older driver crashes. Report for VicRoads.

Oxley, J., & Whelan, M. (2008). It cannot be all about safety: the benefits of prolonged mobility. Traffic Injury Prevention, 9(4), 367-378.

Padmanaban, J. (2001). Crash injury experience of elderly drivers. Paper presented at the Aging and Driving Symposium, Association for the Advancement of Automotive Medicine, Des Plaines, IL.

Persson, D. (1993). The elderly driver: deciding when to stop. Gerontologist, 33, 88-91.

Pruchno, R. (2012). Not Your Mother’s Old Age: Baby Boomers at Age 65. The Gerontologist, 52(2), 149-152

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 59

PWC – Price Waterhouse Coopers (2008). ’Economic valuation of safety benefits, serious injuries - final report to Roads and Traffic Authority of NSW’. See also: Roads and Traffic Authority (2008). ‘Economic valuation of safety benefits: Serious injuries – Final Summary Report’. RTA, Sydney, NSW.

Quinn, J. (2010). Elders and the Future of the American Workforce. Generations, 34(3), 45-55.

Ragland, D., Satariano, W., & MacLeod, K. (2005). Driving Cessation and Increased Depressive Symptoms. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(3), 399-403. doi: 10.1093/gerona/60.3.399

Rapoport, M.J., Weegar, K., Kadulina, Y., Bédard, M., Carr, D., Charlton, J., Dow, Gillespie, I.J., Hawley, C., Koppel, C., Molnar, F., Murie-Fernandez, M., Naglie, G., O’Neill, D. McCullagh, S., Shortt, S., Simpson, C., Tuokko, H., Vrkljan, B., & Marshall, S. (2015). Quality of National Clinical Guidelines on Driving with Medical Illness. QJM 2015; doi: 10.1093/qjmed/hcv038

Regan, M., Triggs, T., Young, K., Tomasevic, N., Mitsopoulos, E., Stephan, K. & Tingvall, C. (2006) On-road evaluation of Intelligent Speed Adaptation, Following Distance Warning and Seatbelt Reminder Systems: final results of the TAC SafeCar project, Monash University Accident Research Centre, Report No. 253

Risbey, T, Cregan, M, and De Silva, H (2010). ‘Social Cost of Road Crashes’. Proceedings, Australasian Transport Research Forum, Canberra, ACT.

Rizzi, M., Strandroth J., Kullgren A., Tingvall, C. and Fildes B. (2015). Effectiveness of antilock-brakes (ABS) on motorcycles in reducing crashes, a multi-national study, Traffic Injury Prevention, Vol 16(2), pp 177-183.

Rosenbloom, S., (1995). Travel by the Elderly. In 1990 Nationwide Personal Transportation Survey: Demographic Special Reports. US Department of Transportation, Federal Highway Administration.

Rosenbloom, S. (1999). The mobility of the elderly: There’s good news and bad news. Paper presented at the Transportation in An Aging Society; A Decade of Experience Conference.

Ross, L., Schmidt, E., & Ball, K. (2013). Interventions to maintain mobility: What works? Accident Analysis & Prevention, 61, 167-196.

Rudin-Brown, C-M & Jamson, S.L. (Eds). (2013). Behavioural Adaptation and Road Safety: Theory, Evidence and Action. CRC Press, Boca Raton, FL.

Sallis, J., Frank, L., Saelens, B., & Kraft, M. (2004). Active transportation and physical activity: opportunities for collaboration on transportation and public health research. Transportation Research Part A: Policy and Practice, 38(4), 249-268.

Scully, J., & Newstead, S. (2007). Preliminary evaluation of electronic stability control effectiveness in Australia, Report 271. Clayton: Monash University Accident Research Centre.

Scully, J., & Newstead, S. (2008). Evaluation of electronic stability control effectiveness in Australia. Accid Anal Prev, 40, 2050-2057.

Sleet, D., Pollack, K., Rivara, F., Frattaroli, S., & Peek-Asa, C. (2010). It wouldn't hurt to walk: promoting pedestrian injury research. Injury Prevention, 16(3), 211-212.

Smiley, A. (1999). Adaptive strategies of older drivers. Paper presented at the Conference on Transportation in an Aging Society: A decade of Experience, Transportation Research Board, Maryland, USA

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 60

Stamatiadis, N., Taylor, W., & McKelvey, F. (1991). Elderly drivers and intersection accidents. Transportation Quarterly, 45(3), 559-571.

Staplin, L., Lococo, K., Byington, S., & Harkey, D. (2001). Highway design handbook for older drivers and pedestrians. (Report No. FHWA-RD-01-103). Washington DC, USA. Federal Highway Administration, US Department of Transportation.

Standards Australia (2002). Motorcycle protective clothing: Guidelines for manufacturing. HB 1 73-2000.

Stelmach, & Nahom, A. (1992). Cognitive-motor abilities of the elderly driver. Human Factors, 34, 53-65.

TAC (2014). http://www.tac.vic.gov.au/road-safety/statistics. Accessed September 18th 2014.

TfNSW – Transport for New South Wales (2015). ‘Principles and Guidelines for Economic Appraisal of Transport Investments and Initiatives’. Version 1.6, March 2015 (Original dated March 2013). TfNSW, Sydney, NSW.

Thompson, J.P., Baldock, M.R.J., Mathias, J.L., & Wundersitz, L.N. (2013). An examination of the environmental, driver and vehicle factors associated with the serious and fatal crashes of older rural drivers. Accident Analysis and Prevention, 50, 768-775. doi:10.1016/j.aap.2012.06.028

Transportation Research Board (1992). Research and Development Needs for Maintaining for Safety and Mobility of Older Drivers. (Circular No. 398). Washington DC, National Research Council.

Victorian Admitted Episodes Dataset (VAED). 2009-2014.

Victorian Taxi Directorate (1999) Accommodation Standards for Taxi Cabs, June 1999

Victorian Taxi Directorate (2005) Hire car age and type requirements, July 2005

Vlahodimitrakou, Z., Charlton, J.L., Langford, J., Koppel, S., Di Stefano M., et al. (2013). The development of a driver observation schedule (DOS) to study everyday driving performance of older drivers. Accident Analysis and Prevention, 61: 253-260.

Vaa, T. (2003). Impairment, diseases, age and their relative risks of accident involvement: Results from metaanalysis. Norway.

Visser, M., Pluijm, S., Stel, V., Bosscher, R., & Deeg, D. (2002). Physical activity as a determinant of change in mobility performance: The Longitudinal Aging Study Amsterdam. Journal of the American Geriatrics Society, 50(11), 1774- 1781.

Vulcan, P. (1998) 'Australian efforts to improve motor vehicle occupant protection', Proceedings International IRCOBI Conference on the Biomechanics of Impact, September, Götenborg, Sweden, pp 9-23

Wang, L., Van Belle, G., Kukull, W., & Larson, E. (2002). Predictors of functional change: a longitudinal study of nondemented people aged 65 and older. Journal of the American Geriatrics Society, 50(9), 1525-1534.

Watson, L., Newstead, S., & Scully, J. (2009). The interaction between relative vehicle secondary safety and driver demographics. Melbourne, Australia: Monash University Accident Research Centre.

Webber, S., Porter, M., & Menec, V. (2010). Mobility in older adults: a comprehensive framework. The Gerontologist, gnq013.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 61

Whelan, M., Langford, J., Oxley, J., Koppel, S., & Charlton, J. (2006). The Elderly and Mobility: A Review of the Literature (Vol. 255). Victoria, Australia: Monash University Accident Research Centre.

Windsor, T. D., Anstey, K. J., Butterworth, P., Luszcz, M. A., & Andrews, G. R. (2007). The Role of Perceived Control in Explaining Depressive Symptoms Associated With Driving Cessation in a Longitudinal Study. The Gerontologist, 47(2), 215-223.Yassuda, M., Wilson, J., & von Mering, O. (1997). Driving Cessation: The perspective of Senior Drivers. Educational Gerontology, 23(6), 525 - 538.

Senate Inquiry into Aspects of Road Safety in Australia MUARC Submission 62