BACKGROUND: In-flight medical emergency (IFE) impose considerable challenges on healthcare workers (HCWs) because of limited resources, constrained environment, and medico-legal issues. This study assessed HCWs knowledge, willingness, and confidence in addressing in-flight medical emergencies.
METHODS: A cross-sectional study was conducted between June and August 2023 among nurses and physicians working in primary healthcare centers and governmental hospitals in Bahrain. Subjects were selected using stratified random sampling; a self-administered online questionnaire of high reliability (Cronbach alpha = 0.914) was used to collect the data. Logistic regression analysis were performed to determine association of knowledge, willingness, and confidence in dealing with in-flight emergencies with various characteristics of HCWs.
RESULTS: The study included 805 HCWs with mean age of 35.5 years (SD=9.2). The findings indicated deficiency in training, with <10% of participants trained on IFE. A considerable proportion of participants exhibited low levels of knowledge (88.3%) and confidence (75.9%) with IFE. Nonetheless, more than half of the participants expressed the willingness to assist in IFE (59.1%). Non-Bahraini healthcare professionals (odds ratio [OR] = 2.901, P < 0.001) had higher knowledge of IFE. Nurses (OR = 1.642, P = 0.047) and participants with longer work experience had higher willingness to assist in IFE. In addition, professionals who were non-Bahraini (OR = 3.249, P < 0.001), working in secondary care (OR = 1.619, 95% confidence interval P = 0.021), had had training on IFE (OR = 2.247, P = 0.004), and had encountered IFE before (OR = 1.974, P = 0.006) had greater self-confidence levels.
CONCLUSIONS: Considering the low levels of knowledge and confidence healthcare professionals in Bahrain had with regard to IFE, targeted training initiatives and educational programs are necessary to improve HCW\'s confidence and preparedness to deal with such emergencies.

In-flight medical incidents are becoming increasingly critical as passengers with diverse health profiles increase in the skies. In this paper, we reviewed how airlines, aviation authorities, and healthcare professionals respond to such emergencies. The analysis was focused on the strategies developed by the top ten airlines in the world by examining training in basic first aid, collaboration with ground-based medical support, and use of onboard medical equipment. Appropriate training of crew members, availability of adequate medical resources on board airplanes, and improved capabilities of dialogue between a flying plane and medical doctors on the ground will contribute to a positive outcome of the majority of medical issues on board airlines. In this respect, the adoption of advanced telemedicine solutions and the improvement of real-time teleconsultations between aircraft and ground-based professionals can represent the future of aviation medicine, offering more safety and peace of mind to passengers in case of medical problems during a flight.

Social and cultural barriers associated with inequitable access to driver licensing and associated road safety education, as well as socioeconomic issues that preclude ongoing vehicle maintenance and registration, result in unsafe in-car behaviours such as passenger overcrowding. This in turn is associated with improper seatbelt usage, noncompliance with child restraint mandates, and driver distraction. For example, in Australia, where seatbelt use is mandatory, Indigenous road users are three times less likely to wear seatbelts than non-Indigenous road users. This is associated with a disproportionately high fatality rate for Indigenous drivers and passengers; 21% of Indigenous motor-vehicle occupants killed on Australian roads were not wearing a seatbelt at the time of impact. In addition, inequitable access to driver licensing instruction due to financial and cultural barriers results in Indigenous learner drivers having limited access to qualified mentors and instructors. A consequent lack of road safety instruction results in a normalising of risky driving behaviours, perpetuated through successive generations of drivers. Moreover, culturally biased driver instruction manuals, which are contextualised within an English written-language learning framework, fail to accommodate the learning needs of Indigenous peoples who may encounter difficulties with English literacy. This results in difficulty understanding the fundamental road rules, which in turn makes it difficult for young drivers to develop and sustain safe in-car behaviours. This paper considers the literature regarding road safety for Indigenous road users and critically evaluates strategies and policies that have been advanced to protect Indigenous drivers. Novel solutions to increasing road safety rule compliance are proposed, particularly in relation to passenger safety, which are uniquely embedded within Indigenous ways of knowing, being, and doing. Safe driving practices have crucial health and social implications for Indigenous communities by allowing more Indigenous people to participate in work and education opportunities, access healthcare, maintain cultural commitments, and engage with families and friends, qualities which are essential for ongoing health and wellbeing.

Buses are a form of active transportation and can improve people\'s well-being. However, their high level of acceleration can make them less attractive to users. Even worse, they can be responsible for severe injuries that require hospitalisation or for the development of fear of falling, particularly experienced by older people. Evidence has shown that, bus acceleration up to 1.0 m/s2 enables passengers to move in a natural way inside the moving vehicle, hence reducing instability and increasing safety. Although operators might be willing to implement such an intervention, they might also be skeptical about its impact on the operation of a service, such as timetabling, travel times, waiting times, etc. The effect of a safety-driven acceleration limit on the operational characteristics of a round trip of a bus service in London is investigated by this study. Data regarding speed, acceleration and journey time were extracted from the engine of a bus and recorded at 2 Hz. Further computations estimated the passenger waiting times and headways between the examined bus and its preceding and following buses. A vehicle movement model was used to test how these operational characteristics would be affected if the acceleration limit of 1.0 m/s2 were to be implemented. The results suggest that the journey time of the proposed accessible service would be 6 min longer than the current service and passenger waiting time would increase by 2 min. One additional bus would be required to serve the same number of passengers. A discussion of the results is provided.

This study clarifies the prevalence of rear seat belt use among university students and explores the factors that influence seat belt use on general roads and expressways. Questionnaires were distributed to 1,091 students who attended health education lectures: 893 students (81.9%) agreed to participate and met the criteria; among them, 660 (73.9%) provided complete responses. While one-third (33.0%) of rear seat passengers \"always\" used seat belts on general traffic roads, three-fourths (73.2%) \"always\" used them on expressways. Multivariate analysis revealed that being male and the perception of obligation and recognition of the benefits of rear seat belt use were associated with use on general roads, whereas the possession of a driver\'s license and recognition of benefits were associated with use on expressways. Finally, we suggest that educational programs on seat belt use be developed and delivered to general road and expressway users to promote seat belt use.

Objective: The purpose was to study how occupant age affects seat belt fit and comfort by comparing older adults and younger occupants in the front seat of a passenger vehicle.Methods: An exploratory user study was performed for the front seat of a stationary large passenger vehicle in a laboratory environment, including 11 older (aged 72-81) and 11 younger (aged 25-30) participants. Each participant first entered the vehicle and buckled up in a predefined seat position. Next, they adjusted the seat to their preferred seat position and buckled up again. Anthropometric data were collected on height, weight, and waist and hip circumferences. Photographs and measurements were taken of seat/seat belt positions and posture, and structured interviews were conducted regarding comfort perceptions of the 2 tested scenarios, including previous experience and awareness of seat belt usage and discomfort experienced as passengers in cars.Results: Nonoptimal belt fit included shoulder belt on the shoulder edge or close to the neck or lap belt over the abdomen. Five of 11 older adults had nonoptimal belt fit in the predefined position, and in the preferred position 7 older adults had nonoptimal belt fit. Only one showed safety awareness and recognized the nonoptimal belt fit in the preferred position. In the younger group, 4 of 11 had nonoptimal belt fit in the predefined position and 4 in the preferred position. Two acknowledged the nonoptimal belt fit. Older adult participants with a more pronounced kyphotic posture had the upper part of the shoulder belt positioned closer to the suprasternal notch compared to younger participants. Older adults were also more likely to have the lower part of the shoulder belt higher up on the abdomen compared to younger participants. Participants with higher body mass indexes (BMIs) were more likely to have the shoulder belt higher up on the abdomen, independent of age and gender. When the shoulder belt was positioned higher up on the abdomen the upper portion of the shoulder belt was routed closer to the throat. Older adults preferred to sit higher up to achieve a better field of vision compared to younger adults.Conclusions: The change in body posture due to aging influences belt fit. Older adults seemed less aware of safety related to belt fit. Increased BMI influenced shoulder belt fit, independent of age. These findings are important when designing restraint systems to ensure safety for all occupants.

Though public transport vehicles are rarely involved in mass casualty accidents, when they are, the number of injuries and fatalities is usually high due to the high passenger capacity. Of the few studies that have been conducted on bus safety, the majority focused on vehicle safety features, road environmental factors, as well as driver characteristics. Nevertheless, few studies have attempted to investigate the underlying risk factors related to bus occupants. This article presents an investigation aimed at identifying the risk factors affecting injury severity of bus passengers with different movements.
Three different passenger movement types including standing, seated, and boarding/alighting were analyzed individually using classification and regression tree (CART) method based on publicly available accident database of Great Britain.
According to the results of exploratory analyses, passenger age and vehicle maneuver are associated with passenger injury severity in all 3 types of accidents. Moreover, the variable \"skidding and overturning\" is associated with injury severity of seated passengers and driver age is correlated with injury severity of standing and boarding/alighting passengers.
The CART method shows its ability to identify and easily explain the complicated patterns affecting passenger injury severity. Several countermeasures to reduce bus passenger injury severity are recommended.