Change in behaviour behind ‘dramatic’ decline in child deaths on roads

Seán Egan will “forever be 17 years and 11 months”, as his mother Helen told a Sligo court recently during a case against the driver of the car involved in a single-vehicle crash in which her son died.

“Heart-rending” is how the listening judge described her testimony, in which she spoke of pain “as raw as ever” 35 months on from being woken at 4am “to every parent’s nightmare”.

It will be no comfort to this Co Limerick mother, but more than 500 other families in Ireland have been spared the inconsolable grief that comes with the death of a child, due to improvements in road safety since the 1990s. That is one conclusion of recently published research that tracks a “dramatic” decline in the number of children and adolescents killed on the Republic of Ireland’s roads between 1991 and 2015.

The risk of death in children aged one to 14 years was halved in the period after 2002 while among adolescents aged 15-19 years, a significantly lower risk from road traffic collisions (RTCs) was evident after 2006.

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The study by the National Paediatric Mortality Register (NPMR), which is based at Temple Street Children's University Hospital in Dublin, focused on trends in road traffic fatalities during a time when various safety initiatives were being taken, including new legislation and greater enforcement of regulations. While it was not trying to establish if these measures were effective in reducing child deaths, the findings do suggest they have had a considerable impact.

After infancy, the greatest cause of childhood deaths is accident and injury and the greatest proportion of those across all age groups – pre-schoolers, older children or teenagers – are the result of crashes on the roads, which account for one third of all injury deaths, says NPMR manager Dr Cliona McGarvey, who led the research.

There was an overall reduction of almost 80 per cent in the fatality rate among children aged one to 14 years – a drop from 4.01 to 0.86 deaths per 100,000. This is the equivalent to eight road deaths per year in 2011-2015, in comparison with 35 deaths a year in 1991-1995.

Legislation introduced over this period included the compulsory use of seat belts being extended to back-seat passengers (1993); introduction of the penalty points system (2002); random breath tests (2006); compulsory use of appropriate child-restraint systems (2006) and introduction of speed detection cameras nationwide (2010).

The reduction in fatalities was slower and less pronounced among those aged 15-19 years. Rates declined by 69.7 per cent, from 15.6 to 4.7 per 100,000, or from roughly 52 deaths per year to 13 deaths per year. Overall, 148 people died on Irish roads last year. “The extent of the problem in the older teenagers – particularly the male predominance which was 80 per cent at one point – was starker than I realised,” says McGarvey.

The preponderance of risk-taking among males is evident from a really young age, says Alf Nicholson, RCSI Professor of Paediatrics at Temple Street hospital, who was also involved in the research. "We've done lots of studies. From the age of one upwards, boys are very significantly at increased risk, two- or three-fold, of injury or death from accidents. Whether it is falls, burns etc – all injuries are much more common in boys than girls."

He says the 80 per cent drop in child road fatalities over 25 years is “quite amazing”, particularly when there has been a huge increase in car numbers and Irish roads have never been busier. “It is startling to see the changes that have taken place.” If we had continued the way we were, 537 more children would have lost their lives on the roads over the 20 years up to 2015.

In addition to that, he continues, for every death there would be three severe injuries and maybe 10 minor injuries – “all of those are very significant. Each death is only the tip of the iceberg.”

Nicholson was reminded recently of Ireland in times past during a trip to Bahrain. "I just couldn't believe it – exactly what we were like 25 years ago: children jumping around in the front of cars, in the back seats of car and even standing up through the sun roof, which we have left behind completely."

The fastest rate of decline in deaths among younger children occurred during a period coinciding with introduction of the penalty points system in 2002 – the primary focus of which was speed reduction.

For drivers who get exasperated behind a car that is obeying what seems like a funereal speed limit on a wide residential road, this research is a reminder that such an inconvenience is nothing compared with the agony of parents being driven behind a white coffin to their child’s funeral. “For pedestrians the main thing that matters above everything else is the speed of the car,” says Nicholson.

“If a toddler runs across the road and is knocked down, survival is just about solely dependent on how fast the car was going.”

“That’s why you have to try to ensure people in built-up areas drive safely,” he says, acknowledging that 30km/h is not easy to drive at, “but it’s the safest and in Sweden that is what they drive at”.

As regards road deaths among children under 15, Ireland is now on par with the countries in the EU that have the best road safety record. Take the aforementioned Sweden, which introduced “Vision Zero” in 1997, a strategy aimed at eliminating road deaths by 2020. While that target date has since been pushed out to 2050, the number of road deaths across all age groups has been halved since 2000.

In 2017, 10 children aged one to 14 died on roads in Sweden, which has a population of just over 10 million. The Irish rate seems comparable in that we have just under half that population, and provisional Garda figures show that six children aged under 15 died on our roads in 2017.

Nicholson believes the penalty points system “really has made a massive difference” in changing people’s behaviour. “The second thing that changed dramatically, particularly in the 15-19 age group, was reducing alcohol [limits], mandatory breath testing and further seat belt legislation.

The study points out that while road safety strategies have been implemented in Ireland in an effort to address the death toll on the roads, there has been no separate target for reducing child fatalities, which are an important risk group.

The 5th EU Road Safety Action Programme recommends that each member state adopts a separate target for reducing road deaths and serious injury among children. "The Government's most recent strategy Closing the Gap [to reduce annual road deaths to 124 or fewer by 2020] outlines a detailed and ambitious action plan that includes children but I cannot see that there is a fixed target for reducing fatalities in children specifically," says McGarvey. "I imagine that adopting each of the recommendations outlined by the European Transport Safety Council would be the best approach to working towards such a target."

Some of these have been implemented in Ireland and they include measures such as implementing 30km/h zones, traffic calming, mandating alcohol interlocks (in-vehicle breathalyser linked to the ignition) in school buses, yearly targets for numbers of checks and compliance with traffic laws, including failing to fit children in the appropriate child restraint systems, and implementing safe bicycle infrastructure separated from motorised traffic. She adds: “The countries with the lowest child fatality rates from RTCs state no child death is acceptable.”

"Trends in road transport collision deaths in the Irish paediatric population: a retrospective review of mortality data, 1991–2015" is published in the "open" section of the online version of the BMJ (British Medical Journal) Paediatrics.

Transition year: Increasing awareness

Around the age of 14-15 years has been shown in research to be absolutely critical in the formation of young people’s attitudes and behaviour in regard to road safety.

It’s one reason why transition year in secondary school is a particularly good time to raise teenagers’ awareness of the risks and responsibilities of being a pedestrian, cyclist, passenger and a car driver.

However, the Road Safety Authority (RSA), believes it is never too young to start educating road users and its eight-strong training team goes into creches, as well as primary and secondary schools. It would also like to see such education programmes made mandatory.

"We promote and actively encourage the schools to do it and we are successful to some degree but not all schools use the interventions," says RSA spokesman Brian Farrell. It would not be uncommon, he notes, for them to be contacted by a school after a pupil has been involved in some serious road traffic incident.

For the teenagers, the RSA's virtual reality experience "Consequences", that was introduced at the end of last year, has brought awareness-raising to a new level. Once they put the goggles on, they are entering two drink-driving scenarios – one where they suffer serious injuries in a drink-drive crash, the other culminating in a prison sentence for the irresponsible driver.Road Safety Ireland (RSI), part of the long-established Rally School Ireland, has also started offering transition year groups "immersive" education at its centre in Scotstown, Co Monaghan. "What we aim to do with the teenagers is to show that they have a responsibility for their own safety and also how quickly things can go wrong," says RSI manager David Smyth. If they are properly prepared, such as making sure they have safety belts on, whether in the front or back seats, "it has potentially life-saving benefits".

The virtual reality experience used at the centre was developed by the Leicestershire police in the UK and is “absolutely class”, he says. It gives the real-life sensation of being in the passenger seat of a car driven by a young man who is driving irresponsibly and showing off to his friends in the car, leading to an accident and then the aftermath.

“It’s tough – it’s very, very realistic,” he says. Other hands-on equipment includes vision goggles to demonstrate the effect of drink, drugs and tiredness, a roll-over car and reaction testers.

Here’s 10 tips from Farrell and Smyth for parents of children at different stages:

1) If using a child car-seat, avail of the RSA's free "check it fits" roadshow which travels around the country for most of the year and is also available through Toyota dealers. Four out of every five child car-seats prove to be wrongly fitted, Farrell says. "A large chunk of that would be minor problems but still there are about a third of them that are seriously fitted incorrectly."

2) Don't be in hurry to upgrade your child to the next level of seat. "Parents think it is a developmental thing but the longer you can keep a child in that seat and not move them up to the next level the better because it offers them more protection," says Farrell.

3) Small children are "squishy", often wrapped up in layers of clothing, says Smyth, so make sure their belts are tight enough. If they are getting their arms out, the belt is not on correctly.

4) Pedestrians and cyclists of all ages need to learn to take responsibility for being visible.

5) When somebody is learning to drive, make sure the car is fitted with good quality, all-season tyres from a reputable brand, says Smyth.

6) At home, always turn the car before parking, so it is ready to drive away more safely.

7) Parents need to do additional driving with learners as the mandatory minimum of 12 lessons is not adequate to produce a confident, safe driver.

8) Don't sign your son/daughter up for 12 lessons without a trial lesson first as the youngster may not gel with that instructor and it would be better to find another, Smyth advises.

9) Always ensure young passengers are wearing a seat belt correctly, as just putting it underneath their arm can leave them at a high risk of horrific injuries, instead of no injuries.

10) Pass on to your teenager the advice Smyth gives to transition year groups about how to get out of a car when somebody is driving irresponsibly. He always first asks the groups what they think would be the most effective three words to stop a driver being reckless. The replies are usually along the lines of "please slow down". But Smyth says the three words most likely to get the driver to stop that car are: "I'm getting sick".

The Fatal Five
- Speeding
- No seatbelts
- Drink and drugs
- Fatigue
- Distraction
– Source: Road Safety Ireland

2018 figures (still provisional)
Age   Fatalities
0-5         3
6-10       0
11-15      3
16-20    12