According to the data of diagnosis procedure combination （DPC）, over 400,000 patients of heat stroke have been treated every year in Japan. And the number of the elderly patients suffering from heat stroke has been increasing in Japan. The characters of elderly heat stroke patients are the high rate occurred in house, high rate of heat stroke at rest, and high rate of severe type. Factors of high age, occurrence in house, and the heat stroke at rest were related to high mortality by the analysis of the Heat stroke Surveillance Committee of the Japanese Association for Acute Medicine （JAAM）. The causes of the heat stroke in effort are a working or sports under the sunshine, so the evaluation and treatments for the heat stroke in effort are rather easy. However, the heat stroke at rest or in house are complicated and influenced by undernutrition, dehydration, past history and/or infectious disease. Especially, the factors such as elderly female, living alone, history of psychiatric disease, hypertension, diabetes mellitus and dementia, are known as the causes of deterioration. The Japanese Ministry of Environment has explored the information and prediction of heat stroke for every prefecture on their web site （http://www.wbgt.env.go.jp）. And some studies reported that we can predict the number of heat stroke patient by the weather data. We expect that these information and studies are contributed to the prevention, the prediction and the treatment for the heat stroke in Japan.

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We discuss driving risk, driving pleasure and health from the view of interaction between task demand and human performance in car driving. Driving performance should be adapted to driving demand and the risk of accident will increase when the situation is deviated from the balance. Another important feature of car driving is that the driver can control the demand by changing speed, headway distance and so on. These features are coincident with those which realize the sense of pleasure based on the Flow theory proposed by Csikszentmihalyi. Also, the concept of demand control is closely related with the discretion that can remove the work stress to reduce risk of illness. The car driving is the most familiar experience for such positive aspect of human activity.

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The distribution of survival time after a traffic accident-related injury shows a declining curve followed by the first peak of acute death within 1 h. Annually, the police department officially announces the number traffic deaths occurring within 30 days after accidents, in addition to those occurring within 24 h. For deaths delayed by more than 24 h, the proximate causal relation of an accident to the victim’s death is often a social matter handled by courts and insurance companies. A review of forensic autopsy files from our department during 1999–2013 revealed 22 cases of delayed traffic deaths from complications including infectious disorders（n=10）, pulmonary embolism（n=9）, and others. Bacterial infection cases, diagnosed at postmortem examinations as pneumonia and sepsis, showed a mean survival time of 105.9 days, and mean age of 63.4-years old. Elderly people tend to suffer infectious disorders, and central nervous system injury accounted for eight cases. Pulmonary embolisms included fat embolism syndrome（n=5） and acute pulmonary thromboembolism（n=4）. Fat embolism syndrome and pulmonary thromboembolism respectively exhibited mean survival times of 3.7 days and 12.0 days, with respective mean injury severity score values of 20.4 and 11.8, indicating that the pulmonary embolism patients did not suffer from critical injuries in traffic accidents. Pedestrians （n=11） and motorcyclists（n=7）accounted for most road users. Regarding the delayed deaths from infectious disorders, forensic autopsy should be performed only for a few patients because of sufficient diagnosis at the hospital. In contrast, many patients who had not been expected to die collapsed from pulmonary embolism several days after injury. Their cause of death had not been diagnosed until autopsy. Extensive forensic investigations need to be performed for delayed traffic deaths.

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This study examined the attitudes of taxi drivers about changes in their physical conditions while driving. A questionnaire survey about driving and health was administered to 31 drivers who were qualified operation managers and 102 drivers working for one of the largest taxi companies in a certain prefecture. It asked about presence of chronic diseases, incidents of experiencing poor physical condition, and other relevant variables. The responses of the operation managers and drivers were compared. Furthermore, we examined the preventive measures taken to avoid traffic accidents due to changes in a driver’s physical condition. All the operation managers were men. The average age was 50.3±6.2 years, and the average amount of driving experience was 24.0±9.4 years. The drivers included 99 men and 3 women. The average age was 57.3±8.3 years, and the average amount of driving experience was 12.2±9.5 years. The average age of the managers was lower than that of the drivers（p<0.001）. In addition, the managers had more driving experience compared to the drivers （p<0.001）. The majority of the operation managers and drivers took breaks at regular intervals. The operation managers drove on average 1.7± 0.6 h before taking a break, while the drivers drove for 3.0±1.8 h. The former was significantly more likely to take regular breaks （p<0.001）. Furthermore, the operation managers had significantly more knowledge about sleep apnea syndrome compared to the drivers （p<0.001）. Such collisions caused by a change in the physical condition of the driver can be prevented by adequate health care and taking appropriate measures during emergencies. The drivers should pay attention to any changes in their own health. Effective prevention should also be implemented; operation managers should inform and educate drivers thoroughly, and share relevant information. The taxi industry confronted with serious economic difficulties. So Administrative support would be required, too by arranging the provision financial support.

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In Japan, a half of fatalities in traffic accident is vulnerable road user （VRU） such as pedestrian and cyclist. Therefore, the countermeasure on protection of VRU is essential for decrease the number of traffic fatalities and casualties in Japan. In this study, injury trends of pedestrian and cyclist were investigated by using Japan Trauma Data Bank （JTDB）. Especially, injuries in head and lower extremity which occur frequently in the accidents were analyzed by age and sex groups. The tendency that the percentage of head injury was the highest in JTDB was the same as that in traffic accident statistics reported by the National Police Agency. On the other hand, frequency of occurrence of pelvic injury, which has not ever been sufficiently discussed in pedestrian protection performance test and car body development, was high. The data showed that crash type （pedestrian or cyclist） and patient age affected injury location and pattern. Cyclist had a higher risk of femur fracture than pedestrian. The number of hemorrhagic brain injury and femoral neck fracture increased as patient age group became older. In conclusion, we showed sites frequently suffering from trauma in traffic accident involving VRU, which is important information for development of regulation and countermeasure to protect VRU.

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To find the effective preventive measures for taxi drivers’ health-related vehicle collisions, cross-sectional survey was performed. Self-administered questionnaires were sent to all 2156 company-employed taxi drivers in February 2013. A total of 844 questionnaires were returned. Mean age was 60.7 and 60.4％ of the drivers belonged to the companies with holding less than 30 vehicles. The 28.5％ of persons had driven under the poor health condition; the rate was significantly larger in large scale companies holding 30 or more vehicles than small scale companies. Main reasons for above answer were as follows: understanding not influence on vehicle driving（59.0％）; keeping the income（57.9％）. The 32.6％ of drivers had suffered from sudden illness while driving, however, nearly half of the persons did not stop driving immediately after the event. The 76.0％ of drivers had received the advice from the company that stop driving when sudden illness or symptoms are occurred. The rate did not differ significantly between large and small scale companies. Regarding the drivers’ requests for the companies, 34.0％ of drivers needed the comprehensive health management and 27.2％ of drivers hoped undergoing more health check-ups. To prevent vehicle collisions, the improvement of taxi drivers’ health status and education in each company should be promoted. In addition to cooporation of employers and taxi drivers, the government would induce a system to support the health management of taxi drivers.

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The aim of this study was to investigate a ratio of clients who undergone the Driving Aptitude Test（DAT）and had been assessed by our driving evaluation system. Our driving evaluation system included the following contents: interview, lecture, neuropsychological evaluation, driving skill assessment（stopping a car）, driving simulator assessment, useful field of view（UFOV）, real driving assessment（depends on symptom）and medical doctor’s judgment. Especially during the lecture, we taught patients about traffic law, application procedure of the DAT. We researched as follow: 1. recognition of the DAT, 2. the results of medical doctor’s judgment, 3. whether patients take the DAT or not, and we categorize that reason, 4. whether patients continue to drive or not, 5. effectiveness of lecture in our driving evaluation system. The results indicated that all subjects（n = 35）did not know the DAT. Twenty-six of subjects took the DAT. From results of our assessment, all of them had been advised that they could drive a car and pass the DAT. On the other hand, nine subjects who were judged to not continue driving did not take the DAT. The reason of taking or not the DAT classified each two categories; recommendation from medical staffs and knowledge acquisition, awareness from others and awareness by oneself. The answers to the questions asked during the lecture were: from 32 patients - “useful”, from 2 patients - “normal” and nobody answered “useless”. These results clarified that the DAT system was seldom recognized by brain injury patients. Before undergoing the DAT, it would be helpful if medical staffs minutely teach brain injury patients about driving with their condition. Furthermore, our result suggested that teaching information about patients who suffered a disadvantage was effective in increasing the ratio of clients who undergone the DAT.

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