Document Type

Article

Abstract

This is a retrospective research paper on measures taken to prevent over-the-embankment (OTB) motor vehicle crashes in the Hoopa Area of Northern California. OTB crashes are defined as any motor vehicle crash that results in that vehicle leaving the roadway and continuing down an embankment. The roadways included for the purposes of this study will be limited to those state highways, local roads, and major spur roads within the approximately 50 mile radius which constitutes the Hoopa Health Association emergency medical services response zone. This study demonstrates that the bluff areas are over-represented for fatal and critical injuries from all motor vehicle crashes in the Hoopa Area. It will further show that the nature of these fatalities is primarily major systems trauma. It is meant to reinforce the conclusion that improved rescue operations and response is not the answer for multiple trauma patients, since even under optimal conditions the time needed for response time, rescue time and the time involved in transport to the nearest contract care emergency unit (52 miles) is far too much time to respond to severe systems trauma. The methodology used in this study was reasonably simple, inexpensive and low-tech surveillance used to predict OTB crash clustering. It was implemented by an Emergency Medical Service Coordinator who had also served as a rescuer. The focal points of the surveillance efforts were the bluff areas that presented a major problem for rescuers because of their height and extreme steepness. The author began a program of video taping the areas where the most severe problems were occurring. He would accompany ambulance units, and record road features, embankments, shoulder widths, and slide marks soon after the accidents had occurred. He began the video taping in 1985. In 1985, coincidental to the video taping campaign, Cal-Trans found itself at fault in two substantial lawsuits in the Hoopa Area. The one was for inadequate road width, and the second was for actions taken by a state road crew at the scene of a diesel spill that caused a double fatality in the North Hoopa Bluffs. At approximately the same time, a Cal-Trans employee developed a means for anchoring guard rails underneath the roadway, using cantilevered steel I-Beams set into ditches under the roadbed. This and the lawsuits and the video campaign resulted in a massive campaign to install guardrail on the bluffs and in widening the roads and other roadbed improvements.Based on the ongoing surveillance of data, since the installation of the guardrail, there is a very strong correlation between the date of installation and a downturn in the number of OTB crashes. The existence of the guardrail has not increased or been a factor in head oncrashes. The cantilevered guardrail seem to be holding up well to ""brushing"" impacts and falling rocks along the bluffs without any obvious signs of weakening. There are still embankments that are unprotected. There are some dangerous turns where guardrail weren\'t installed completely. These areas will continue to be especially hazardous until they are improved. Lack of visibility of a problem often prevents that problem from being addressed or allows it to be set aside. In OTB crashes multiple systems trauma is most often the killer. Seat belts are a good preventive measure to avoid ejection from the vehicle once the accident is in progress. Other factors in the occurrence of OTB crashes are age of driver, speed and road condition, sex of the driver, familiarity with the road. and sensory impairment from drugs, alcohol, and lack of sleep.The author determined that prevention would reduce fatalities far more than efforts to treat trauma after the fact. He also suggests exploration for altering the environment in an effort to prevent accidental injury rather than or in addition to education efforts.

Publication Date

1989

Publisher

Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-86).

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