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"Traumatic asphyxia with associated visceral injuries resulting from low-velocity compression of the torso," is the Medical Journal of Australia's summary of the typical driveway accident injury. That's surgical jargon for crushed lungs, ruptured internal organs and young lives in the balance.
Last weekend's tragedy when Wallabies rugby legend Phil Kearns ran over his 19-month-old daughter, Andie, in the driveway of their Sydney home was almost a textbook case in its combination of unpredictable child and heavyweight vehicle.
Each wheel in an average sized four-wheel drive carries a load of about 500kg. "It's effectively no different to a steamroller," says consulting engineer Michael Paine. But if it misses the child's head, their chance of recovery is surprisingly high.
A study published by the MJA in 2000 found "final outcome was recorded as satisfactory or good for 34 of the 41 survivors, with a full return to normal activities and no significant physical or psychological sequelae (effects)". Head injuries killed 13 of the 14 children who died in driveway accidents in the 12 years of the study, from 1988 until 1999.
The NSW Commissioner for Children and Young People found that between 1996 and 2003, 31 children died in driveways. Of these, 19 deaths involved 4WDs.
The MJA study found driveway accidents are a significant hazard, accounting for 12 per cent of child pedestrian injuries and 8 per cent of child vehicle deaths. It concluded that 4WD vehicles are more likely than passenger cars to run over children.
"Both 4WDs and light commercial vehicles accounted for a much higher number of the fatalities in our study than would be expected from their prevalence on the roads," it found.
At the time of publication 4WDs and light commercial vehicles accounted for about 30.4 per cent of registered motor vehicles in NSW but were involved in nearly two-thirds of the deaths in driveway accidents — giving them a 2.5 times greater risk of fatally running over a child compared with other vehicle types.
In a 2002 paper, consultant engineer and safety expert Michael Paine pondered why, and suggested several possible factors. They included the increased danger to children posed by the large wheels of a 4WD as opposed to a car, and the poor side visibility of many 4WDs: "The relatively poor field of view to the side due to the height of the driver, (means) that small children can approach the danger zone at the back of the vehicle without detection by the driver," Paine wrote.
"The diameter and cross section of their tyres is bigger which might be leading to a greater risk of them crushing a child in these situations," he said yesterday. "And while recent visibility studies have found passenger cars can have worse rear visibility than many 4WDs there's been no attention to visibility out to the side."
But engineer and road safety advocate John Cadogan says 4WDs are an easy target. "They've become the de facto family station wagon so they do tend to be found in driveways and around children. I think that's why they're over-represented," he says.
Demonising types of vehicles and owners avoids the main issue, says Cadogan. "The only way to be safe is to be diligent. For example, getting in your car or 4WD or any vehicle and taking off backwards down the driveway because you're late is a negligent act." Paine and Cadogan agree technology such as reversing cameras can play a part in reducing the risk of a driveway accident.
Lexus and Land Rover offer reversing cameras on their 4WDs and Ford offers one on the Territory crossover vehicle. But aftermarket systems can be fitted to many other vehicles.
"You can buy an aftermarket reversing camera to fit most vehicles for about $500 installed," says Cadogan. When you think of the horror of running over your own child — because most drivers who run over kids are their parents — it would be money well spent.
Cadogan says even devices as simple as extra mirrors are worthwhile — so long as the driver gets into the habit of using them.
"It really comes down to diligence."
Other technologies, such as ultrasonic parking aids, are directed more towards protecting vehicle bumpers than detecting children. "They can be set up to be more sensitive but then they go off so often that drivers end up ignoring them. If you are in your own driveway the temptation is to think it's a false alarm rather than someone behind you," says Cadogan.
"Vehicle devices can help but they're no substitute for adult awareness and supervision," he says. "You just can't leave a child near a vehicle that's likely to move."
Awareness is the key, says Paine, citing a public education campaign conducted by state roads bodies that appears to be cutting the driveway accident rate.
"The number of cases has dropped dramatically in the last two years," he says.
Cadogan says there are three steps parents can take to make their driveways safer.
"Firstly identify where your kids are and don't even move the car if you're unsure," he says. Secondly, he advises fitting a reversing camera or extra mirrors but cautions devices alone don't save lives. "And finally, write to your local federal MP and ask why there's no rear visibility standard for vehicles in the Australian design rules, because believe it or not, there's none."