Serious injuries on the rise for Victorian road cyclists

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In recent years it’s felt like riding on the road has become increasingly unsafe, with crashes, injuries and rider deaths seemingly happening more than ever before. New research from Monash University seems to suggest it’s not just anecdotal either — more serious cycling crashes are indeed happening in Victoria, with more riders suffering serious injuries, or worse.

The paper is entitled “Road safety: serious injuries remain a major unsolved problem” and is published this month in the Medical Journal of Australia. The research considers injuries in all road users, but the findings are particularly troubling for cyclists. The incidence of serious cycling crashes increased year on year from 2007 to 2015, with the total number more than doubling by the end of that period.

Dr Ben Beck is the Deputy Head of Prehospital, Emergency and Trauma Research at Monash University, a keen road, MTB and commuter cyclist, and the lead author of the new study. He spoke with CyclingTips to discuss his team’s findings and what it all means for Victorian cyclists.

The following Q&A has been edited for fluency.


CyclingTips: Where did the idea of this study come from?

Dr Ben Beck: We’ve had a fairly large focus on fatal road traffic crashes over a long period of time. And we know that we’ve seen some benefits in terms of a number of road safety measures that have had significant reductions on deaths on our roads, but we haven’t had a great focus on serious injury. And we know that these serious injury cases can quite often lead to significant disability and can impact not only the individual but also their loved ones and society.

So what we set out to do was then try and understand how serious road injuries and fatalities were changing over time in Victoria over the period of 2007 to 2015.

How did you go about getting the data you needed?

We use data from both the Victorian State Trauma Registry, which is a population-based registry of what we call major trauma — so these are seriously injured patients — and also obtained information on pre-hospital trauma deaths from the National Coronial Information System or NCIS. What we did is we looked over time and, actually accounting for population changes over time, we looked at how trends of both fatalities and serious injuries in all road user groups were changing. And we also looked at health loss.

We have a common metric that’s used to quantify health loss that’s called a Disability Adjusted Life Year (DALY) which is really a measure that reflects the number of years lost to a disability or early death. What we’re able to do from that as well is look at the economic costs of these injuries.

How do you calculate the economic costs of the injuries?

Good question. There is a concept known as the value of a statistical life year which the Australian Government sets, which really reflects the social willingness to pay in order to prevent early death or physical harm [ed. This is currently valued at $182,000 per year]. And you can therefore associate a single DALY with an economic cost that’s associated with that health loss.

What was the total economic cost of road trauma for the period you were looking at?

We saw that the economic costs of health loss associated with these deaths and serious injuries totalled more than $14 billion1 for all road users, and it was over $700 million for pedal cyclists.

Focussing in on cyclists, what were your findings in terms of the risks to cyclists and how that changed from 2007 to 2015?

What we saw was an increase in the incidence of serious injury in our pedal cyclists that rose at around 8% per year. In fact the absolute number of cases more than doubled over the nine-year study period2.

And these are significant injuries we’re talking about. In your study you mention that you only looked at injuries with an Injury Severity Score of 12 or above. What does that correspond to? How would you describe an injury of that magnitude?

An Injury Severity Score (ISS) is a measure that combines the severity of multiple injuries. So, for example, to have an ISS greater than 12 you might have a femur fracture and then also a broken rib, or you can have a significant pelvis fracture in isolation, or you might have a significant head injury in isolation. But we know from our study that 45% of our injured cyclists were classified as what we describe as a multi-trauma, so injuries to multiple body regions.

How much of the increase in cyclist injuries, if any, can be explained by an increase in cycling participation in that time?

We actually have fairly limited data on cycling participation. One of the most commonly used data sources for cycling participation is the National Cycling Participation Survey. And what it’s shown is that cycling participation is actually declining. And so we’ve seen a decline in cycling participation from 2011 to 2017.

What might be happening, and one of the limitations that we have, both in terms of this study and from a road safety perspective, is that we don’t understand exposure in cycling. So what I mean by that is the amount of time that our cyclists are spending on the road.

The question that’s asked in the National Cycling Participation Survey is ‘Have you cycled in the last week? Or have you cycled in the last month? Or have you cycle in the last year?’ So you can clearly, within those groups, get quite significant changes in terms of the amount of time a cyclist might spend on the road, for example.

So we’re not really sure what’s explaining these increases [in cyclist injuries] but it’s clear that we have a really big problem on our hands.

What would you suggest we do to make the roads safer for cyclists?

I think that we clearly need to take a systems approach to this problem. I don’t think there’s going to be one quick win here that’s going to solve our problems. So we need to consider all elements.

Clearly there’s a need for greater investment in cycling-specific infrastructure. We can improve our roads through investment in things like dedicated and separated bicycle lanes. We can also consider safer speeds through lower speed limits to protect vulnerable road users, such as that proposed by the Yarra Council recently.

And also safer people. So improving the culture around cyclists as legitimate road users through things like enhanced legislation, education and training for all road users.

Given what you’ve found here, what’s the next line of inquiry you’d like to take?

We’ve done some research in the past with cyclists who were hospitalised, to try and get a better understanding of how these crashes are occurring. And what we’ve seen is that a tick over a half of these crashes occur with interactions with motor vehicles. And so clearly what we need to be doing is trying to provide cyclists with separated infrastructure. But what we need to do is continue to explore what are going to be the most effective methods in reducing cycling injury.

We also know that a number of these events are single-cyclist-only events. And so we also need to consider the role of cyclists in moderating their behaviour. And I would personally like to try and explore those single-cyclist-only crashes a little more to get a greater understanding of how exactly they’re occurring so that we can then try and inform education and training packages around that.

I also think that we need to better understand barriers to participation. We know that one of the biggest drivers of people not up-taking cycling is related to how safe they feel on our roads. And so if we can continue to try and promote cycling, try and enhance the environment that cyclists can ride in, in order to try and remove the potential for interactions with motor vehicles and make that whole experience of cycling more enjoyable and more safe, then hopefully we will continue to see growth in participation.

Anecdotally you hear a lot of people saying they feel less safe on the roads these days, given the number of crashes we hear about. What’s your perspective about riding on the road generally? Should cyclists be afraid of riding on the road?

Cyclists certainly shouldn’t feel like it’s dangerous riding on our roads. We need to provide them with the environment that makes it feel safe. But evidently, and our results suggest that perhaps we’re not doing that as well as we possibly can at the moment.

Personally I have changed the way in which I ride in terms of the routes that I take and potentially that’s due to the exposure that I have with the research that we do. But I am electing to try and use bike paths and alternate modes and indoor training more and more and limiting my exposure on the road. Now that’s not what I want, but it’s the reality.

I think if we can try and create some kind of a network of interconnected safe cycleways throughout metropolitan Melbourne we would really see a greater level of cycling participation and hopefully reduced levels of injury. So we need these superhighways of cycle paths that can funnel everyone into the city, for example, but then also have interconnections between these paths that aren’t just normal residential roads but have some kind of dedicated cycling infrastructure so that we can ferry cyclists throughout our road network in a safe manner.

Is there anything else you wanted to add?

We’ve spoken a lot about numbers … but these are all people. These are serious crashes that have really potentially negative impacts on people’s lives and not just their lives but their loved ones’ and everyone around them. So it’s not acceptable that we’ve got these injury rates — it’s simply not acceptable. And we as a road safety community, as the public, as cyclists, as all road users, we’ve got to do everything that we can.

This is just simply unacceptable.

Footnotes

1. The researchers were also concerned to note that the incidence of major trauma for vehicle occupants, motorcyclists and pedestrians didn’t decline from 2007 to 2015. Given this trajectory, they write, “it is likely that current road safety targets, such as those set by the World Health Organization and the Victorian state government, will be difficult to meet”.

2. This doubling of total cases led to an significant increase in cyclist DALYs. To quote from the paper: “For all road traffic users, DALYs declined by 13% between 2007 and 2015 … In contrast, DALYs for pedal cyclists increased by 56%.”

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