IV.
Discussion of Research Results
A.
Carbon Monoxide
Information found through the research for this
report indicates that somewhere between 200 and 250 deaths a year that
are not known to be suicides result from vehicle-generated carbon monoxide.
These types of deaths occur more frequently than deaths from any of
the other issues researched
.
1.
1998 Death Certificates
As of the writing of this report, 122 incidents
involving 140 deaths have been located in 1998 death certificates. The
1998 deaths found in death certificates project to 190 deaths in all
of the 1998 death certificates that have been identified for this study,
including those that have not yet been received. Victims of this hazard
are predominantly adults. Only five of the 140 deaths located in death
certificates were children less than 10 years of age.
Among the scenarios encountered multiple times
are someone working on or sitting in a running vehicle with the garage
door closed, an intoxicated person who passes out in a car in a garage
with a vehicle running, and persons who are killed in a residence when
someone unintentionally leaves a vehicle running in a garage attached
to a home. Both the numbers and types of incidents found in death certificates
were supported by information found in other sources.
Details beyond what is contained in death certificates
were found for some of the cases in news articles located in LexisNexis™
as were incidents for years more recent than 1998.
Summary data relating to vehicle-generated carbon
monoxide deaths found in 1998 death certificates appear in Table II
below. Basic information about each of the incidents, including an indication
of whether or not the death was located in LexisNexis™ as well,
may be found in the Appendix I to this report.
Table II: Summary Data:
Vehicle-Generated Carbon Monoxide Deaths From 1998 Death Certificates
| Age |
# of Deaths |
In Garage, Home or Residence |
Other Location |
| |
|
In vehicle |
Not in vehicle or unclear |
|
| 90 + |
5 |
1 |
4 |
|
| 80-89 |
20 |
1 |
19 |
|
| 70-79 |
15 |
1 |
14 |
|
| 60-69 |
8 |
1 |
7 |
|
| 50-59 |
10 |
3 |
6 |
1 |
| 40-49 |
16 |
4 |
12 |
|
| 30-39 |
32 |
15 |
13 |
4 |
| 20-29 |
23 |
10 |
8 |
5 |
| 10-19 |
6 |
3 |
2 |
1 |
| 0-10 |
5 |
2 |
3 |
|
| Subtotal |
140 |
41 |
88 |
11 |
| Total |
140 |
140 |
2.
LexisNexis™
The table below reflects the vehicle-generated
carbon monoxide deaths and injuries that were located in LexisNexis™
for the period 1998-2002. The figures for 1998 include 26 deaths for
which both death certificates and articles in LexisNexis™ were
found. Four of the deaths that were found only in LexisNexis™
occurred in states from which death certificates had not been received.
The remaining deaths found in LexisNexis™ were not found in the
death certificates selected for review according to the criteria described
previously in this report.
Table III: Carbon Monoxide
Deaths and Injuries Found In LexisNexis™ (1998-2002)
| Year |
Total
Incidents |
Deaths |
Injuries |
| 1998 |
22 |
42 |
1 |
| 1999 |
17 |
27 |
15 |
| 2000 |
13 |
18 |
8 |
| 2001 |
12 |
22 |
0 |
| 2002 |
11 |
14 |
9+
(number of victims in one incident was not specified) |
3.
Literature Review
Numerous articles, including several from sources
other than those at the National Library of Medicine, relating to carbon
monoxide poisoning from vehicle-generated carbon monoxide were found.
The findings of these articles are for the most part consistent with
what was found in death certificates regarding vehicle-generated carbon
monoxide incidents. In general, these articles reported on the number
of such incidents nationally or in prescribed geographic areas or they
reported on the kinds of circumstances that led to carbon monoxide poisonings.
The articles reviewed are in the list of references at the back of this
report.
Unintentional poisonings from vehicle-generated
carbon monoxide diminished toward the close of the 20th century, with
a particular decline in these types of incidents noted in the years
following 1975 when catalytic converters were introduced into automobiles.1,
2 The steady decline from 4.0 to 0.9 deaths per 1 million person-years
since 1975 represents a 76.3 percent decrease. The total number of 1998
unintentional motor vehicle-related deaths from carbon monoxide has
been reported at 238. Most of these deaths involved adults. 1.
Vehicle-generated carbon monoxide deaths tend
to occur more often in colder climates and colder months of the year.
3, 4 Significant snow accumulation has also been associated
with spikes in incidents of motor vehicle-related carbon monoxide poisonings
and deaths when people sit in operating vehicles with tailpipes obstructed
by snow. 5
Alcohol intoxication is frequently involved
in motor vehicle-related carbon monoxide deaths when intoxicated persons
pass out in circumstances that expose them to this hazard. 4, 6,
7
Death certificate research and other sources
indicate that vehicle-related carbon monoxide poisonings and deaths
tend to occur when the vehicle is not moving and particularly when the
vehicle is operating in an enclosed space. However, a consistent level
of accidental vehicle-related carbon monoxide deaths, between 60 and
75 per year, while the vehicle is moving has also been
reported. 8 A report on a group of 68 cases, including one
death, over a five-year period identified a specific danger to children
riding in the backs of pickup trucks. 9
Older vehicles have been associated with an
increased risk of carbon monoxide poisonings. 7
Data from the various articles reviewed dealing
with vehicle-related carbon monoxide deaths is presented in Appendix
II.
B.
Backing
1.
1998 Death Certificates
As of the writing of this report, 91 backing
deaths have been identified in the 4,046 death certificates that have
been received. A straight-line projection based on these figures suggests
that 123 backing deaths would be located in the approximately 5,500
death certificates from 1998 that have been identified for review. The
situations in which these deaths occurred included both those that would
be considered non-traffic and some that would be considered as traffic.
The charts that follow present breakdowns of the 91 deaths.
Table IV: Backing Deaths
Identified in 1998 Death Certificates By Age*
| Age |
#
of Victims |
| 1< |
1 |
| 1-4 |
40 |
| 5-9 |
4 |
| 10-19 |
2 |
| 20-29 |
0 |
| 30-39 |
3 |
| 40-49 |
3 |
| 50-59 |
6 |
| 60-69 |
5 |
| 70+ |
27 |
| Total |
91 |
*Deaths involved occurred in both non-traffic and
traffic situations
Table V: Backing Deaths
Identified in 1998 Death Certificates By Vehicle Type
| Vehicle
Type |
#
of Victims |
| SUV |
3 |
| Van/minivan |
5 |
| Pickup
truck |
11 |
| Passenger
Car |
25 |
| Truck
- Delivery |
3 |
| Truck
- Dump |
8 |
| Truck
- Garbage/Recycling |
4 |
| Truck
Other |
13 |
| Unclear |
19 |
| Total |
91 |
Vehicle type is an example of
information that is included in death certificates that may not get
much attention from or may not be readily available to people who prepare
final death certificates. This is best demonstrated by the high percentage
(21%) of instances in which it was unclear as to the type of vehicle
involved in a backing incident. It is not uncommon for the simple word
“vehicle” or “automobile” to be used, which
leaves no clear indication as to exactly the type of vehicle that was
involved in the incident.
Table VI: Backing Deaths
Identified in 1998 Death Certificates By Location
| Location |
#
of Victims |
| Driveway |
21 |
| Home |
21 |
| Parking
Lot |
21 |
| Road/Street |
13 |
| Sidewalk |
2 |
| Other
off road |
13 |
| Total |
91 |
A complete list of all of the
backing incidents located in death certificates along with certain information
relating to each may be found in Appendix III.
2.
LexisNexis™
Table VII contains summary data reflecting the
backing deaths and injuries that were found in LexisNexis™ for
the years 1998-2002. Twenty-six (26) of the 1998 deaths were also located
in death certificates. LexisNexis™ identified a number of 1998
backing deaths (19) that occurred in states from which death certificates
were not received. The remaining 1998 backing deaths found in LexisNexis™
were not found in the death certificates selected for review according
to the criteria previously described in this report.
Table VII: Backing Incidents
(1998 – 2002) Found in LexisNexis™
| Year |
Total
Events |
Multiples
(more
than one
victim
involved) |
Deaths |
Injs. |
<1
yr.
old |
1-4 |
5-12 |
13-21 |
22-64 |
>64 |
Car |
Pickup |
Van,
Minibus
or SUV |
Gbge./
Dump
Truck |
Truck-
Other |
Other/
Un-
specified |
| ‘98 |
68 |
1 |
56* |
13 |
1 |
34 |
9 |
0 |
14 |
11 |
15 |
10 |
10 |
2/6 |
13 |
12 |
| ‘99 |
52 |
1 |
42 |
11 |
1 |
22 |
5 |
2 |
14 |
9 |
16 |
7 |
7 |
4/4 |
12 |
2 |
| ‘00 |
56 |
4 |
47 |
13 |
0 |
33 |
4 |
0 |
17 |
6 |
16 |
10 |
9 |
1/6 |
11 |
3 |
| ‘01 |
58 |
1 |
50 |
9 |
0 |
27 |
3 |
1 |
17 |
11 |
11 |
10 |
8 |
9/6 |
10 |
4 |
| ‘02 |
63 |
2 |
55 |
10 |
0 |
34 |
3 |
2 |
14 |
12 |
8 |
15 |
11 |
8/5 |
11 |
5 |
| Total |
297 |
9 |
250 |
56 |
2 |
150 |
24 |
5 |
76 |
49 |
66 |
52 |
45 |
24/27 |
57 |
26 |
*Includes 26 deaths that were also found in death
certificates.
3.
Fatality Analysis Reporting System
Table VIII contains summary data relating to
the 102 backing incidents found in FARS in 2000 and 2001. Fourteen (14)
of these backing incidents were located in LexisNexis™ as well.
Table IX provides summary data relating to the location of the backing
incidents found in FARS. Detailed information about each of the 102
backing incidents that was found in FARS may be found in Appendix IV.
Table VIII: Summary Data
from Backing Deaths Identified in FARS – 2000, 2001
| Year |
Total
Events |
Multiples
|
Deaths |
Injs. |
<1
|
1-4 |
5-12 |
13-21 |
22-64 |
>64 |
Car |
Pick
up |
Van,
Minibus, SUV or station wagon |
Gbge
Truck |
Truck-
Other |
Other/
unspecified |
| ‘00 |
57 |
4 |
57 |
4 |
|
18 |
4 |
1 |
12 |
26 |
15 |
12 |
19 |
3 |
5 |
3 |
| ‘01 |
45 |
3 |
45 |
6* |
|
12 |
3 |
3 |
8 |
22 |
11 |
9 |
12 |
5 |
1 |
7 |
| Total |
102 |
7 |
102 |
10* |
|
30 |
7 |
4 |
20 |
48 |
26 |
21 |
31 |
8 |
6 |
10 |
*The age of three of the injured was not given. These
three are therefore not included in the totals for any of the
age groups indicated.
Table IX: 2000, 2001 Backing
Deaths Identified in FARS By Location
| Location |
2000 |
2001 |
| Driveway |
|
20 |
| Parking
Lot |
4 |
1 |
| Road/Street |
14 |
14 |
| Other/Unclear |
15 |
10 |
| Total |
57 |
45 |
4.
Literature Review
Death certificate research and an examination
of other sources confirm that the annual number of deaths resulting
from vehicles backing up is small in comparison to deaths due to other
types of vehicle crashes. In spite of these relatively small numbers,
there are certain characteristics of these incidents that emerged from
both the original research conducted for this report and in academic
research examined.
Very young children, particularly those between
one and four years of age, seem especially vulnerable to being killed
by a vehicle backing up. 10-15 Off-road locations, such as
driveways and parking lots, are common locations where backing incidents
occur. 11-14, 16, 17 The drivers of vehicles involved in
these types of incidents are often parents, relatives or other people,
such as neighbors, known to the family of the children involved. 10,
17 Larger vehicles for personal use, such as SUVs, van and pickup
trucks, are often the vehicles involved in these types of incidents.
10-12
Summaries of research articles reviewed for
this report, and selected data from those articles, are provided in
Appendix V.
5.
Injury Databases
While a smattering of information relating to
injuries and the issues under study was found in other sources, the
National Electronic Injury Surveillance System (NEISS) of the Consumer
Product Safety Commission (CPSC) and NHTSA’s General Estimates
System (GES) represented particularly good sources of data specifically
relating to non-traffic and non-crash injuries, especially those resulting
from backing incidents. The somewhat disparate results found in these
two sources, however, make it difficult to make any but very broad statements
regarding backing injuries.
Nearly 6,700 backing injuries were found in
a recent year’s worth (July 1, 2000 to June 30, 2001) of NEISS
data. More than 85 percent of the injured were “treated and released.”
Nearly 2,400 average annual backing incidents were found in five years
worth of GES data. More than 83 percent of these backing injuries were
recorded as either “no injury,” “possible injury,”
or “non incapacitating evident injury.” The primary reason
for the disparity in the data between the two sources is the completely
different methods by which the data were gathered and the different
people involved. NEISS gathers data from a probability sample of 100
hospital emergency departments. GES gathers its data from a representative
sample of police reported motor vehicle crashes. Clearly there are backing
incidents resulting in injury, usually minor, that cause the injured
person to seek medical help, but that occur under circumstances that
do not warrant a police report. In fact, several sources examined for
this report suggested that about half the motor vehicle crashes in the
country are not reported to the police. What seems to be true about
vehicle-related backing injuries, based on the NEISS and GES data, is
that there are several thousand such injuries a year and the majority
of the injuries involved are minor.
Data derived from NEISS and GES is contained
in Appendix VI.
C.
Vehicle Heat
1.
1998 Death Certificates
Passenger Compartment
As of this writing, a total of 22 deaths from
heat exposure inside the passenger compartment of a motor vehicle have
been located in the death certificates reviewed. A straight-line projection
based on these results indicates that ultimately 29 vehicle heat deaths
would be found in all the death certificates from the states. Six of
the victims were adults. All of the other victims identified were four
years old or younger.
The study of 1997 death certificates found 25
passenger compartment heat-related deaths, which projects to a total
of 27 such deaths. This is consistent with the 1998 findings.
Trunk
Seven of the 11 trunk entrapment deaths that
were the impetus for the establishment of the new Federal Motor Vehicle
Safety Standard, (FMVSS) No. 401; Internal Trunk Release were confirmed
in 1998 death certificates received. Death certificates for the four
other deaths were not received because no death certificates from the
state in which those deaths occurred had been received at the time this
report was finalized. Other deaths from trunk entrapment that were located
in news accounts in LexisNexis™ are reported on in the next section.
A complete listing of each passenger compartment vehicle heat incident
along with basic information relating to each appears in Appendix VII.
2.
LexisNexis™
Passenger Compartment
A total of 117 deaths of persons who died inside
the passenger compartment of a vehicle from excessive heat were located
in LexisNexis™ for the five-year period 1998-2002. Of the 24 vehicle
heat-related deaths found in LexisNexis™ for 1998, thirteen (13)
matched deaths that were located in death certificates. Four 1998 vehicle
heat deaths found in LexisNexis™ occurred in states from which
death certificates were not received. The remaining deaths were not
found in the death certificates selected for review according to the
criteria previously described in this report. Data reflecting the vehicle
heat deaths found in LexisNexis™ appears in the table that follows.
Table X:1998-2002: Vehicle
Heat Deaths & Injuries Found In LexisNexis™ By Age
| Age |
1998 |
1999 |
2000 |
2001 |
2002 |
| |
Deaths |
Injs |
Deaths |
Injs |
Deaths |
Injs |
Deaths |
Injs |
Deaths |
Injs |
| |
9 |
2 |
6 |
3 |
6 |
1 |
11 |
2 |
11 |
7 |
| 1-4 |
14 |
2 |
16 |
2 |
8 |
4 |
17 |
5 |
12 |
4 |
| 5-9 |
|
|
1 |
4 |
|
|
|
|
2 |
3 |
| 10
-Adult |
1 |
|
|
|
2 |
|
|
|
|
|
| Total |
24* |
4 |
23 |
9 |
16 |
5 |
28 |
7 |
25 |
14 |
Note: Additional victims who suffered no injury were
also found in LexisNexis™ articles.
*Includes 13 deaths for which death certificates were also found.
Trunk
A total of 16 incidents of unintentional trunk
entrapment were found in LexisNexis™ dating back to 1987. These
incidents involved a total of 25 deaths, one injury and one person who
apparently did not sustain any injuries. The vast majority of the victims
were young children ages six or younger with only four of the 27 victims
outside that age range.
The six incidents and 15 deaths, all involving
children six years of age or younger, found for the period 1987-1998
is less than what was found by the Centers for Disease Control and Prevention
(CDC) in similar LexisNexis™ research published in the December
4, 1998 issue of the Morbidity and Mortality Weekly Report.
That paper, titled “Fatal Car Trunk Entrapment Involving Children
– United States, 1987-1998,” found a total of 19 children
six years of age or younger who died in nine incidents.
As indicated earlier, seven of the 11 trunk
entrapment deaths that were the impetus for the establishment of a new
Federal Motor Vehicle Safety Standard, (FMVSS) No. 401: Internal Trunk
Release were located in 1998 death certificates received. All of these
deaths were also located in LexisNexis™ as were the four 1998
trunk entrapment deaths for which death certificates were not received
because, for various reasons, death certificates from the state involved
were not obtained as part of this study. These 11 trunk entrapment deaths
were the only such deaths identified as having occurred in 1998.
The tables that follow provide information on
the distribution of incidents and deaths by year and the distribution
of the ages of the victims of trunk entrapment.
Table XI: Trunk Entrapment
Incidents Found in LexisNexis™: 1987 - 2003
|
Year |
Incidents |
Deaths |
Injuries |
No Injury |
| 2003 |
1 |
1 |
|
|
| 2002 |
1 |
1 |
|
|
| 2001 |
3 |
3 |
|
|
| 2000 |
3 |
4 |
|
|
| 1999 |
2 |
1 |
|
1 |
| 1998 |
3 |
11* |
|
|
| 1995 |
1 |
2 |
|
|
| 1994 |
1 |
1 |
1 |
|
| 1987 |
1 |
1 |
|
|
*Seven (7) of these deaths were also found in death
certificates. Death certificates from the state in which the remaining
four (4) deaths occurred were not received.
Table XII: Age of Trunk
Entrapment Victims, 1987 - 2003
| Age |
Number
of Victims |
| 2 |
2 |
| 3 |
6 |
| 4 |
8 |
| 5 |
3 |
| 6 |
3 |
| 9 |
1 |
| 10 |
1 |
| 12 |
1 |
| 25 |
1 |
3.
Literature Review
Only two articles relating to vehicle heat were
located. Both of these focused on measuring the extent to which passenger
compartments heat up under various conditions. There was no discussion
in either article of victims of vehicle heat incidents. 18, 19
D.
Vehicle Window
1.
1998 Death Certificates
Only four (4) deaths as a result of interaction
with a vehicle window have been located in 1998 death certificates received.
The ages of the victims were 2, 3, 3, and 6. Two involved a power window.
One apparently did not. Whether a power window was involved in the fourth
case is unclear. In one incident a child was left fastened in a car
seat while the child’s parent went back into the house. The child
somehow got out of the car seat and leaned on the power window switch,
which caused the window to rise and strangle the child. Another incident
involved a young child playing with other children. The child got into
a vehicle, opened the power window to yell to the other children and
then hit the power switch causing the window to go back up on the child’s
neck. In the third incident, a child apparently pulled itself up while
on the outside of a vehicle, stuck its head through a partially open
window, slipped, caught its neck between the window and the door frame
and was strangled. The circumstances of the fourth incident were unclear
beyond the fact that the child involved was strangled as a result of
interaction with a vehicle window.
The study of 1997 death certificates also found
four (4) deaths of children that resulted from interaction with a power
window. Only two of these could be confirmed as clearly involving a
power window.
2.
LexisNexis™
For the years 1998-2002, a total of 12 vehicle
window incidents were located in LexisNexis™. Eleven children
died as a result of these incidents. One of these eleven deaths involved
a sunroof, the only such incident located as part of this research.
One child was injured.
Summary information relating to these incidents
appears in the table below.
Table XIII: 1998-2002:
Vehicle Window Cases From LexisNexis™
| Year |
Deaths/Injuries |
Power
Window |
No
Power Window or Unclear |
Ages
of Victims |
| 1998 |
5*/0 |
3* |
2 |
6,
3, 3, 2, 2 |
| 1999 |
1/0 |
1 |
0 |
2 |
| 2000 |
0/0 |
0 |
0 |
- |
| 2001 |
2/1 |
3 |
0 |
3,
2, 2 |
| 2002 |
3/0 |
3 |
0 |
6,
3, 2 |
*Includes one vehicle sunroof incident
One of the power window deaths
in the preceding chart involved an anomalous situation in which someone
had apparently rewired the vehicle to allow the power windows to operate
even when the keys were not in the ignition.
All four of the vehicle window incidents found
in 1998 death certificates were also found in LexisNexis™. The
1998 sunroof death occurred in a state from which death certificates
were not received and therefore was not found in death certificates.
As indicated earlier, this single sunroof incident was the only such
incident found in any source as a result of the research conducted for
this report.
3.
Literature Review
Three articles were found relating to the hazard
of strangulation in a vehicle window. Two of these reported on individual
cases that occurred in the United States rather than on an evaluation
and analysis of data derived from multiple cases. 20, 21
The third estimated that there are about 499 minor injuries annually,
mostly to fingers and wrists, attributable to power windows with most
of these, about 64 percent, involving children 14 years of age and younger.
22
These articles are more fully described in Appendix
VIII.