The REVIVE project – learning from post-crash response practice across Europe Antonio Avenoso, Executive Director, European Transport Safety Council
Post Crash Response Professor Tim Nutbeam, Consultant in Emergency Medicine, Plymouth University Hospitals, presentation notes are here
Let’s be clear – collaboration in incident management Stephen Bird, Senior Advisor, Incident Management Requirements, Highways England
The Road Collision Investigation Project Elizabeth Box, Head of Research, RAC Foundation
Road Accident In Depth Studies Phil Bailey, International Vehicle Standards, Department for Transport
From rescue, through rehabilitation, to recovery – the experience of victims, their needs and their contribution to road safety Jeannot Mersch, president, European Federation of Road Traffic Victims
Please see following video from ETA Trust https://www.eta.co.uk/trust/stop-killing-children/ and the following from FEVR https://twitter.com/FEVRorg/status/1185189538760658945
Soundbites from the ‘Post Crash Response’ conference, organised by PACTS, which takes place at the Royal College of Anaesthetists, London, on 17 October.
- The effectiveness of post-crash response is a crucial part of the safe system approach
- Conference features practitioners, politicians and researchers involved in specifying and delivering these vital services
- Click here to view the agenda
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15.40 – Panel – Supporting the victims and learning from their experiences
- Mary Williams, CEO, Brake (MW)
- Nick Simmonds, CEO, RoadPeace (NS)
- Jenny Di Fabio, National Lead for Roads Policing Family Liaison Officers (JDF)
Question: what have you learnt from working with victims?
MW: We provide services for road crash victims. What we have learnt is the diversity of needs – from accurate information, to deprivation suffered as a consequence.
Victim budgets differ for those bereaved by a road crash (£50), compared to a homicide (£5,000) – the imbalance needs to be addressed.
JDF: Impactful subject – no winners. The thing you realise is that it can happen to anybody.
We support the families and provide a link to the investigation. Looking at how we can improve the welfare and best serve the families.
NS: Collaboration is one of the key values of RoadPeace. Our role is to ensure the victim’s voice is heard.
Our members want road crime to be treated as a real crime – and for the word ‘accident’ not to be used.
Question: why aren’t victims of road collisions treated as victims of crime?
MW: This is something we (Brake) are pushing for.
We are looking to draw up a cross-department committee – Justice, Health and Transport – to assist with addressing the issue.
JDF: At the Met, we feel passionately about this. Speeding is no different to picking up a gun.
One of the hardest things is telling families they often won’t get the justice they want. Hopefully there will be changes to the sentencing guidelines.
MW: Family Liaison Officers are an amazing bunch of people – we are training more of them at Brake.
JDF: All of the FLOs have regular training to provide more information and insight
15.20 – Jeannot Mersch, President, European Federation of Road Traffic Victims
As president of the European Federation of Road Traffic Victims, Jeannot Mersch regularly travels to meet victim associations and is frequently invited to speak on road safety and post-crash response matters at conferences and seminars.
Presentation: From rescue, through rehabilitation, to recovery – the experience of victims, their needs and their contribution to road safety
European Federation of Road Traffic Victims (FEVR) – campaign for road victims’ rights and road danger reduction
Three Rs – rescue, rehabilitation, recovery
- Besides work to prevent road crashes, a proper post-crash response is essential (pillar five of road safety)
- It is interdependent with prevention
- The post-crash stage is currently being neglected
- A serious response to road death and injury and decent treatment of road victims are seen by FEVR as road victims’ human rights
FEVR studies and surveys
Blue Book 1997 – concluded:
- Information given to victims is totally inadequate
- Need of considerable emotional, practical and legal support
- Dissatisfaction with criminal & civil justice
- No legal recognition of head injury impairment
20 years later… My Life After The Crash (MyLAC)
- MyLAC is a European project that surveyed people injured in road traffic crashes across 20 European countries.
- The aim was to highlight the many consequences of traffic crashes, from a medical, psychological and economic point of view.
- Road traffic injuries are increasingly considered as an additional indicator for road safety policy making.
- Almost 80% of people seriously injured in road traffic crashes never recover fully
- The psychological toll is high and should not be underestimated.
- Clearly demonstrates that the effects of a road traffic crash are not limited to material and physical damage alone.
- The victims and those around them continue to bear the psychological and financial effects of a collision, often for the rest of their lives.
- Create public Centers for free support & financial support to Victim Associations
- Require Insurance companies to provide immediate advance payments
- Treat certain violations as premeditated criminal offences
Serious post crash response is a vital road safety component
EU Victim of Crime Directive
- Right to protection and to individual assessment
- Right to participate in criminal proceedings
- Right to support
- Right to information
- Right to understand
- Rights of victims’ family members
Road danger reduction through Safe System approach
- Safe vehicles
- Safe infrastructure
- Safe users
- Safe speeds
Setting targets: Vision Zero
What do we need?
- Real partnerships with real advocates
- High level political will
- Victims voices considered
14.30 – Donald Macdonald and Phil Bailey, International Vehicle Standards Division, Department for Transport
Donald and Phil are responsible for the development of policy on vehicle construction requirements to improve the safety and accessibility of road vehicles.
Presentation: Technology challenges and opportunities: RAIDS, e-call, EDRs and CAVs
Phil Bailey – RAIDS
Collision investigation is not new
RAIDS has been running since 2012 – over 2,000 detailed collision investigations
- On scene: 1,100
- Retrospective: 900
RAIDS programme funded and managed by the Department for Transport – but a team effort with partners
- Each case has in the region of 50 photographs
- Drive through to recreate the scene
- Injury mechanisms – where the occupants made contact with the vehicle
Anonymous data – not seeking to determine responsibility
Organisations can have access to the RAIDS database (free of charge) – for the purpose of research
DfT can see who has used the data, and what they have used it for
RAIDS – phase 2
Current focus on:
- Vulnerable road users
- Advanced assistance
- Electronical vehicle data
- Maintain database – but increase usage
- Continue investigating
- Address challenges associated with identifying vehicles with automated features
Donald McDonald – Pan European eCall and Connected Vehicles
What is eCall?
- System to alert the emergency services of a collision
- Intended to reduce response times
- Sends information of vehicle location
When is it of benefit?
- Single vehicle accidents
- Remote rural locations
- Collision is unlikely to be discovered by passing traffic
- Needs to have mobile phone signal to work
Vehicle data and communications:
- eCAll SMS and voice communication – dormant until there is a collison, constantly overwritten, last three data points for vehicle location and must be cleared from the vehicle within 12 hours
- Third party systems – subject to agreement with vehicle owner
- Event data recorder
14.10 – Liz Box, Head of Research, RAC Foundation
Elizabeth Box is head of research at the RAC Foundation, an independent charity established to promote for the public benefit research into environmental, economic, mobility and safety issues relating to the use of motor vehicles.
Presentation: The Road Collision Investigation Project
Road Collision Investigation Project – purpose:
- To establish whether there is a business case for putting more resource into the investigation of road crashes based on a comparison with the approach to crash investigation used for other modes (rail, air & sea) and safety critical industries (oil & gas)
- Establishing how feedback from investigation of individual incidents can better inform policy development.
- Developing new approaches to harvesting and analysing of data from different sources, including information from police investigations beyond that captured in STATS19.
Governance and reporting:
- Project run by the RAC Foundation
- In collaboration with, and supported by the DfT, Highways England, National Police Chiefs Council and others
- The Safe Systems approach is based on a kinetic energy model where road safety outcomes are achieved by separating sources of kinetic energy in moving vehicles in order that it is not transferred to road users
Four sections of safe systems:
- Safe roads
- Safe speeds
- Safe people
- Safe vehicles
Learning from other sectors:
- Strengths & limitations of Investigatory bodies
- Investigation models
- Selecting cases
- Investigatory skills
- Data quality
- Case outcome use
- Local level analysis
- International review of collision investigation functions & formats
- Social & economic costs of collisions
Keen to engage with experts – keep in touch with progress via the RAC Foundation website.
14.00 – Frances Senior, Capability Manager for Forensic Collision Investigation, NPCC
Frances has 25 years Police Service, the majority of which has been within Crime Scene Investigation. She has worked on some of the most high profile crime and RTC scenes within West Yorkshire and has extensive experience in forensic co-ordination and management.
Presentation: Forensic Collision Investigation Network
Previously unknown are – but now progressing
The science involved needs testing and accreditation
327 practitioners in the country – got to capture all the evidence before the scene is re-opened
Can provide evidence at court – unlike CSIs or fingerprint officers
How to address? – The Forensic Collision Investigation Network
National mandate and governance = raising the standards
- Setting national FCI standards
- National Peer review
- Testing the science
13.45 – Detective Superintendent Andrew Cox, Metropolitan Police
Andy currently has a highly prominent role as London’s lead for Vision Zero (road danger reduction) which provides the responsibility of saving life and investigating homicide (road death) whilst strategically managing extreme risks and threats to the community and organisation
Presentation: Police collision investigation – now and in the future
The Vision Zero Action Plan
Vision Zero Action Plan is a plan to 2041 that focuses on intelligence led action to reduce risk on our streets, as part of the overall ambition to eliminate deaths and serious injuries on the whole transport network. It is based on three principles:
- A fundamental conviction that loss of life and serious injuries are not acceptable nor inevitable
- Requires reducing the dominance of motor vehicles and the targeting of road danger at source
- Ensuring road danger reduction is a common priority central to all transport schemes
The plan follows the Safe System approach
People make mistakes, so the system needs to accommodate human error and ensure impact energy levels are not sufficient to cause fatal or serious injury. The plan contains actions to deliver:
- Safe speeds
- Safe streets
- Safe vehicles
- Safe behaviours
Vision Zero – safe behaviours
To target the riskiest behaviours:
- TfL provides funding each year to the MPS to support transport related enforcement, including targeted action to make roads safer.
- Marketing/communications will give greater focus to speeding and risky manoeuvres, and tie in with local policing activity.
- The MPS 3-tiered road danger reduction approach:
Highly targeted activity: identify and remove the most dangerous offenders – e.g. disqualified drivers – from the roads
Intelligence-led tactical activity focused on location/time/mode/user/offence: Officers will be deployed to places and at times where we know traffic offences, such as speeding are more likely to happen and the risk of locations is higher.
High visibility activity with randomised deployments: Increasing the unpredictability of police enforcement to maximise the coverage and visibility of enforcement activity and the deterrent effect
Traffic offence public reporting (Roadsafe)
As well as reporting road traffic collisions online, any road traffic offences corroborated by digital media evidence can be reported on the Met Police website.
- Reporting of offences was promoted in March 2016, October 2016 and Nov 2018, following implementation of on-line reporting capability and latterly the media upload functionality
- Signs are placed on Vision Zero priority roads, encouraging
the public to report dangerous driving they have witnessed
at the location and deter drivers.
- They may not see a visible police presence but they do not know who may have a dash cam and report their bad driving!
The Vision Zero Action Plan concludes with a commitment to continually strengthening our programme to address future challenges and achieve our long-term ambitions
- Monitor and measure the impact and progress of actions
- New powers necessary for effectively tackling danger
- Measuring risk rather than casualties
- Use of data
- New and emerging vehicle technology
Met Police collision investigation
- Fatal and life changing
- Four bases
- SCIU & FCIU
- Detective based
- Review Process (including cold case)
- Independent Advisory Group / victims right to review
- National group (policy/practice & consistency)
12.00: Panel – emergency services
- Dan Cody, South East Coast Ambulance Trust (DC)
- Tony Crook, National Fire Chiefs’ Council (TC)
- Ch Supt Colin Wingrove, Metropolitan Police Service (CW)
Question: are things fully integrated between services? Or can more be done?
DC: A number of factors influence ambulance priorities – road collisions make up such a small part of caseload.
Already stretched – time for people to engage in road safety activities can be limited.
Comes down to a numbers game about impact – although this doesn’t necessarily make it right
Question: Is the answer upskilling communities?
DC: The best use of the ambulance service is educational.
Where we can play a significant part is the advice we give. At present, the advice around RTC is to stay away – not help like in situations like heart attacks etc.
TC: Mixed picture in the fire service. We’ve been working on it for years. Some will have basic first aid training – some more advanced.
CW: All police officers have a level of first aid training – which gets refreshed every year.
Question: What is the role of road safety partnerships?
DC: Partnerships are a great forum, with a lot of output – particularly when it comes to young drivers, motorcyclists.
But not standardised
TC: Important to have a coordinator for the partnership – can ‘heard’ everyone together a
CW: In London, partnership working is superb – highlighted by the Vision Zero strategy
Our blind spot is working with local authorities – more we can do at a local level.
Partnership working creates building blocks to achieving goals.
Question: telematics insurance policies – can they be an answer?
CW: Black boxes should be routinely in cars – same as dash cams. So much data that investigators can now access – to work out driver behaviour etc.
11.40 – Richard Martin, Office of Police and Crime Commissioner for Devon and Cornwall
Presentation: Multi-skilling the first responder – experience from the Devon and Cornwall
No PCC would say road safety isn’t important – but all have different priorities.
Devon, Cornwall and the Isles of Scilly:
- Largest police force area in England
- 13,700 miles of road – 85% of which are rural
- Road network and emergency services stretched by tourists – who rely on the roads
- 4,754 road casualties in 2018
- Road safety is a concern for the community – 85% believe road traffic laws should be more stringently enforced by the police
It’s better to prevent collisions – but when they do happen, it’s important to provide the best service possible
Tri-service safety officers
Collaboration between local police force, fire service, ambulance service and council in Cornwall – all provide funding to the scheme
Tri-service officers are:
- Quite often the first on the scene
- Provide quick, on the scene assessment
- Able to reduce demand on regular officers – while providing uniformed presence
Road Collision Innovation Challenge:
- To explore solutions that will enable officers to reduce evidential capture time by 50% during a collision investigation
- PCCs for Devon & Cornwall and Dorset looking to award a contract of up to £200,000
DfT and Home Office Roads Policing Review:
- A two-year review of roads policing to explore portenation, alternative models to increase road traffic compliance, reduce casualties.
11.20 – Stephen Bird, Senior Advisor, Incident Management Requirements, Highways England
Stephen Bird has operational experience as a Highways England traffic officer at tactical and strategic level. He now works to support incident management standards with responsibility for Highways England CLEAR initiative.
Presentation: Let’s be clear – collaboration in incident management
Highways England does a lot of work to prevent collisions – but ultimately they still occur.
CLEAR – campaign launched in 2012.
We don’t just clear incidents – we CLEAR them.
C – Collision
L – Lead
E – Evaluate
A – Act
R – Re-open
CLEAR is a way of working that puts the welfare of our responders and customers at the heart of our incident management decisions.
Collisions and other incidents can close carriageway lanes which adversely affects the economy
Effective leadership needs to be established to coordinate the incident response
Understanding the scale of the incident ensures a proportionate response
All incident respondents act in partnership, recognising and respecting differing organisational responsibilities
Carriageway lanes are re-opened ASAP to reduce the impact of road closures on road users and the economy
Challenges that CLEAR aims to overcome
- Fire and Ambulance crews respond to incidents that take place at a variety of different locations.
- The frequency of attending motorway incidents for Fire and Ambulance personnel can be sporadic.
- For those who attend incidents less regularly, knowledge of best practice protocols might not be at the forefront of responders’ minds.
JESIP – is the command structure
- Provides a command structure for incident management and frames regular ‘around the bonnet’ conversations for updates, requirements and future planning.
CLEAR – is the dialogue
- Is the basis of the conversation we have around those bonnets
Contact us: CLEAR@highwaysengland.co.uk
10.25 – Prof Tim Nutbeam, Consultant in Emergency Medicine, Plymouth University Hospitals
Tim is a consultant in emergency medicine, clinical lead for the Devon Air Ambulance and Honorary Professor of Prehospital Critical Care at the University of Plymouth.He has an academic interest in extrication and the post-collision response.
Presentation: Post-crash response – are we doing it right?
Evidence based approach
Millions and millions of scientific articles available to help shape interventions…
BUT – very few on post crash responses
A worrying trend!
When designing interventions:
- Check the evidence and research – make sure it’s of sufficient quality
- Share your own evidence (good or bad) – help people learn from mistakes
Post crash response
Focus: buddy care, brains and bleeding
Immediate deaths mainly down to brain injury – prevented by stopping collisions
Later deaths – infection, multiple organ failure – can be down to response time & post-crash care.
‘Buddy care’ model:
- Used in the military
- People trained to do a couple of medical things (nothing technical) very well – saves lives
- Start with emergency services and highways staff
- But the more widely available – ie members of the public – the more effective it will be
- Not a five day course – could be taught via a video
Bleeding control packs – stops bleeding & can save lives in the period before paramedics arrive
Time is an issue – lowering time removes complexities and saves lives!
Extrication – again, an issue of time. Takes an average of 32 mins. Reduces chances of survival.
EXIT – post collision response research & translation project
- Funded by Road Safety Trust
- Designed to improve the speed of extrication
- While also minimising movement of patient
Multi disciplinary collaboration and the application of science can work
10.05 – Antonio Avenoso, Executive Director, European Transport Safety Council
Antonio Avenoso has served as executive director of the European Transport Safety Council (ETSC) since 2001. ETSC is a Brussels-based independent non-profit making organisation dedicated to reducing the numbers of deaths and injuries in transport in Europe.
The REVIVE project – learning from postcrash response practice across Europe
ETSC – dedicated to reducing the numbers of deaths and injuries in transport in Europe (not EU)
The five pillars of road safety:
- Road safety management
- Safe vehicles
- Road user behaviour
- Post collision care – neglected over the years
The REVIVE project (supported by Toyota)
Aims to improve post-collision response and emergency care in Europe.
- REVIVE is focused on the emergency/rescue chain: from the moment a road collision occurs until the injured person is transferred to a medical facility
- Objective: improvements in emergency response that can help prevent deaths and life-changing injuries in road collisions
- The emergency response is not getting a fair share of attention in terms of research, good practice exchange and measures
- Improvements are being made elsewhere yes, but collisions still occur
- Road Safety
- Emergency Medical Services
- Fire and Rescue services
Discussions focus on:
- What works well
- What doesn’t work well
- Emerging and interesting methods/practices
- National and international initiatives
The situation differs from one country to another: for example, bystanders
- Some countries require drivers to undertake first aid training before obtaining a full licence; while others encourage them to stay away from injured people and wait for professional.
Emergency corridor – example of initiative used in some countries
- Helps emergency services reach collisions quicker
- On two lane roads – drivers create ‘corridor’ down the middle
- On roads with more lanes – drivers create corridor on left hand side
- Reduce time taken to reach 4mins – improving chances of survival by up to 40%
Case studies created – based on good practices discussed in country roundtable events
- Designed to be short introductions to a topic highlighting the background, how it works, and how it can be employed.
REVIVE advocacy work
- Valletta Declaration adopted in 2017
- Setting a target to halve serious road traffic injuries between 2020-2030 based on 2020 figures.
- Development of eCall
- Introduction of new post-crash response KPIs
- Supporting and promoting new initiatives and research
REVIVE synthesis report
- For those in the road safety community, i.e. those who don’t necessarily have detailed knowledge of the field of emergency care and rescue.
- Designed to be an introduction to the topics involved
- Follows the steps that take place between a collision occurring and being reported, through to a victim being transferred into a medical facility.
- Includes a series of recommendations for future action and policy (EU/Member State/Industry).
For the EU:
- Mandate eCall for all remaining vehicle types
- Consider linking eCall to the rescue information sheets
- Develop key performance indicators for post-collision response and emergency care standards in Europe.
- Set common standards for the creation of emergency corridors and apply them throughout the EU.
- Encourage Member States to enforce the emergency corridor laws, with a special focus on deliberate obstruction or abuse.
For member states:
- Develop national key performance indicators and targets for post-collision response and emergency care standards.
- Ensure further education and training for FRS in extrication techniques, as experience and adequate procedures can significantly decrease extrication time.
- Prioritise short-term measures that can be implemented with existing knowledge, e.g. measures to improve speed limit compliance will reduce injury severity and have an immediate effect.
- Organise combined regular training for emergency services to improve coordination at road collision scenes.
For industry and research:
- Commit to and voluntarily equip all new smartphones with Advanced Mobile Location technology
- Commit to voluntarily equipping all new vehicles with standardised rescue sheets in line with ISO 17840 to facilitate the work of emergency services at road collisions.
- EU to support Member States in collecting numbers of seriously injured according to the MAIS 3+ definition and include numbers of seriously injured in the EU impact assessment of countermeasures.
10.00 – Sophie Ogunbiyi, Manager of External Affairs Office in London, Toyota
Sophie is external affairs manager in a corporate team responsible for managing Toyota Motor Europe’s corporate engagement with UK Government, parliament, Whitehall, devolved and regional administrations, and other related stakeholders (including UK business media).
Presentation: Toyota’s support for the ETSC REVIVE project
Shortening time between crashes and response is vital
If we can reduce time b 15-25 mins – collisions could fall by a third
Toyota has a 360 approach to road safety – includes post-crash care.
Accidents do happen – that’s a reality
Rescue time essential – why we support REVIVE project
Continue to contribute to post-crash care
9.35 – Baroness Vere of Norbiton, Minister for Roads, Department for Transport
Baroness Vere of Norbiton was appointed as a Parliamentary Under Secretary of State at the Department for Transport in April 2019. She was previously a Government Whip (Baroness in Waiting) from 2016 to 2019.
Presentation: Morning keynote
Appointed roads minister in July – critical that Government learns from experts in the field
Road safety has come a long way – in a relatively short period of time
Current road safety system not created overnight – years of work
UK roads among the safest – but reductions in casualties has plateaued.
Time to think of new policies – and new investment
Road Safety Statement (July 2017) – underpins Government work.
Focuses on a number of vulnerable road user groups: young drivers; older driver; rural road users; motorcyclists.
- THINK! – has found that humour is effective when engaging with young people.
- Funding for a variety of young driver initiatives.
- How to help them stay safe on the road for longer
- Working group has been set up
- One of the issues is tackling speeding
- Improve enforcement
- Importance of wearing helmets
Managing the aftermath of crashes – absolutely vital
- More to be done to work out the causes of crashes – investigation branch for roads.
- CRASH reporting system – makes it easier for police to work at the roadside
- All needs to tie together to identify trends
About the conference
The Safe System approach to road safety aims to minimise road deaths and life-changing injuries rather than to prevent all crashes. The effectiveness of post-crash response is therefore a crucial part of the system.
This conference will feature practitioners, politicians and researchers involved in specifying and delivering these vital services. It will present innovative working methods and question established practices.
It will challenge stakeholders to work more closely to optimise patient outcomes, learn from the events and to support victims’ families.