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Evidence suggests that older driver safety may be improved by good vehicle maintenance, in-vehicle advanced technologies, and proper vehicle adaptations. This study explored the prevalence of several measures of vehicle maintenance and damage among older drivers through inspection of their vehicles. We also investigated the prevalence of in-vehicle technologies and aftermarket adaptations. Vehicle inspections were conducted by trained research staff using an objective, standardized procedure. This procedure, developed by a multidisciplinary team of researchers, was based on a review of inspection checklists used by automobile dealerships and the project team's expertise. The study used baseline data from vehicles of 2988 participants in the multi-site Longitudinal Research on Aging Drivers (LongROAD) study. Among this cohort, vehicles were well maintained, had little damage, and contained a range of advanced technologies but few aftermarket adaptations. Implications of study findings for occupational therapy practice are discussed. [ABSTRACT FROM AUTHOR]

The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13–19 years four (2.7%) by both narcotics and methylenedioxymethamphetamine, six (4.0%) by cocaine only, and 14 (9.4%) by volatile substances (e.g., butane, Freon, nitrous oxide, and propane). The annual death rate from drug abuse for teenagers increased from 1.4 deaths per 100,000 population in 1991 to 2.7 deaths per 100,000 population in 2006 (chi-square test for time trend, p < 0.01). The increase in teenager drug abuse deaths occurred in 1999 and since has remained at a higher rate. Further analysis revealed that the increase in drug abuse deaths was attributable to a large degree to narcotic drugs, particularly heroin ⁄ morphine and methadone, and was confined to teenagers residing in the suburban and rural areas. [ABSTRACT FROM AUTHOR]

Introduction: The associations of pilot error with the type of flight operations and basic weather conditions are well documented. The correlation between pilot characteristics and error is less clear. This study aims to examine whether pilot age is associated with the prevalence and patterns of pilot error in air taxi crashes., Methods: Investigation reports from the National Transportation Safety Board for crashes involving non-scheduled Part 135 operations (i.e., air taxis) in the United States between 1983 and 2002 were reviewed to identify pilot error and other contributing factors. Crash circumstances and the presence and type of pilot error were analyzed in relation to pilot age using Chi-square tests., Results: Of the 1751 air taxi crashes studied, 28% resulted from mechanical failure, 25% from loss of control at landing or takeoff, 7% from visual flight rule conditions into instrument meteorological conditions, 7% from fuel starvation, 5% from taxiing, and 28% from other causes. Crashes among older pilots were more likely to occur during the daytime rather than at night and off airport than on airport. The patterns of pilot error in air taxi crashes were similar across age groups. Of the errors identified, 27% were flawed decisions, 26% were inattentiveness, 23% mishandled aircraft kinetics, 15% mishandled wind and/or runway conditions, and 11% were others., Conclusions: Pilot age is associated with crash circumstances but not with the prevalence and patterns of pilot error in air taxi crashes. Lack of age-related differences in pilot error may be attributable to the "safe worker effect."

Objectives: To determine the proportion of patients rerouted during ambulance diversion periods and factors associated with reroute., Methods: A retrospective cohort design was used to examine reroute practices of prehospital providers in central Maryland in 2000. Ambulance transport and diversion data were merged to identify transports that occurred during diversion periods. The proportion of patients rerouted when the closest hospital was on diversion was determined. Generalized estimating equation modeling identified patient, transport, and hospital factors that influenced the likelihood of reroute., Results: Central Maryland hospitals were on diversion 25% of the time in 2000, although it varied by hospital (range of 1-34%). There were 128,165 transports during the study period, of which 18,633 occurred when the closest hospital was on diversion. Of these, only 23% were rerouted. More than half of all transports during a diversion period (53%) occurred when multiple neighboring hospitals were also on diversion. The factors that influenced the likelihood of reroute the most were hospital-related factors. Large volume hospitals and hospitals that spent more time on diversion were less likely to have transports rerouted to them., Conclusions: Rerouted transports more frequently go to lower volume, less busy hospitals. However, only a small proportion of patients were rerouted. Prehospital providers have limited options because often when one hospital is on diversion, other nearby hospitals are as well. Although ambulance diversion may be an important signal of hospital distress, in this region it infrequently resulted in its intended outcome, rerouting patients to less crowded facilities.

Background: The effects of alcohol on piloting performance have been studied extensively. Information describing alcohol-related aviation crashes, however, is scant., Methods: We developed a data system for fatally injured pilots in Maryland, New Mexico, and North Carolina by linking autopsy data from the state medical examiner offices and crash investigation reports from the National Transportation Safety Board. Alcohol-related crashes are defined as those in which the pilot had a blood alcohol concentration of 20 mg/dL or greater. Differences between alcohol- and non-alcohol-related crashes were assessed with regard to pilot characteristics, crash circumstances, and human factors., Results: The National Transportation Safety Board recorded 313 general aviation crashes fatal to the pilot in the three states between 1985 and 2000. Of these crashes, 255 (81%) were matched successfully with medical examiner records. Alcohol testing results were available for 233 of the fatally injured pilots. Of those tested for alcohol, 25 (11%) had blood alcohol concentrations > or =20 mg/dL (mean=75 +/- 64 mg/dL). The majority of alcohol-related crashes (52%) occurred at night (7p.m. to 6a.m.), compared with 28% of other crashes (P < 0.01). Alcohol-related crashes were significantly more likely than other crashes to have involved continued flight under visual flight rules (VFR) into instrument meteorological conditions (IMC) (32% versus 12%, P < 0.01), and flawed decisions (64% versus 41%, P = 0.03)., Conclusions: Distinctive epidemiological patterns are exhibited in alcohol-related fatal general aviation crashes. Alcohol appears to play a particularly important role in crashes involving flight under VFR into IMC.