In recent years, collisions of vehicles caused by driverʼs poor health have increased. Cardiac disorders, cerebrovascular diseases, and aorta dissections/ aorta aneurysms accounted for approximately 30％ of the causes of health-related vehicle collisions, and for more than 80％ of fatal collisions. These diseases are strongly associated with lifestyle illnesses. In addition, it has been reported that lifestyle illnesses are closely associated with sleep apnea syndrome. The nature of their occupation puts drivers at increased risk of such diseases. Employers are obliged to manage the mental and physical health of drivers. The Ministry of Land, Infrastructure, Transport and Tourism of Japan formulated a health management manual for employers to adhere to legally prescribed obligations effectively. However, several vehicle collisions caused by driverʼs poor health because of employersʼ negligence of basic obligations have occurred even in recent years. When a driver causes a collision because of his poor physical conditions, the employers may be liable to criminal, administrative, and civil charges. Criminal liability includes fines, punishment, and penal servitude. Civil liability refers to the compensation for damages. Administrative responsibility incorporates orders such as the suspension of vehicles or the rescission of service company authorization. Such liabilities erode social trust and result in economic losses. Transportation service companies face a serious shortage of human resources. Good health management secures driversʼ features. Thus, employer ought to consider measures for effective health management so that drivers with poor conditions return to work or remain employed.

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Electric wheelchairs are becoming popular in Japan as a means of transportation for the elderly. Due to the growing aging population, the number of traffic accidents involving electric wheelchairs is expected to increase in the future. Side collisions account for the highest percentage of traffic accidents involving electric wheelchairs. In our previous research, a physical crash test was carried out to simulate a side collision of an electric wheelchair with an automobile. It was found that head of the occupant in the electric wheelchair hit the road surface, which caused a head injury. However, the behavior in head injury mechanism at various collision speeds has not been studied sufficiently. In addition, the effectiveness of occupantʼs protection devices has not been adequately studied. The aim of this study is to understand the mechanism of head injuries caused as a result of side collisions of electric wheelchairs by using CAE （Computer Aided Engineering） analysis, and to evaluate the effectiveness of occupantʼs protection devices. The CAE analysis showed that the electric wheelchair occupant was thrown out of the electric wheelchair after leaning on the vehicle side, and then, the occupantʼs head and upper body hit the road surface when the collision speeds were 20-40km/h. The occupantʼs fall behavior depends on the collision speed; therefore, the factors that caused the head injury were inconsistent. The head injury value of HIC₃₆ also depended on the collision speed. The HIC₃₆ exceeded the injury threshold in some collision speeds. Next, the occupantʼs protection devices were evaluated. When a lap belt was fastened, the HIC₃₆ exceeded the injury threshold when the collision speeds were 15-40 km/h, because the occupant of the electric wheelchair fell with occupantʼs head toward the road surface. When the armrests of the electric wheelchair were flipped up and the occupant wore helmet, the occupant fell to the vehicle side when the collision speed was within 30km/h. In addition, the helmet reduced the impact to the occupantʼs head, therefore the HIC₃₆ was below the injury threshold when the collision speeds were 10-40 km/h. From these results, there are effective for reducing head injury to the occupant that the occupant wears helmet without lap belt and armrests on electric wheelchairs are flipped up.

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Collisions or near-miss incidents caused by pregnant women drivers are likely to pose a life-threatening risk to the mother and fetus. Therefore, it is urgently necessary to analyze the causes of these events in pregnant women and ensure their safety. To clarify the actual conditions and causes of events in pregnant women drivers and to conduct safety education, we performed a questionnaire survey for pregnant women. The subjects were 696 pregnant women vehicle drivers who visited obstetrics and gynecology outpatient clinics or the maternity class. The collision rate for pregnant women drivers was 2.9％, and that of near-miss incidents was 7.8%. Of these, 4.6％ had vehicle collisions or near-miss incidents caused by themselves. The most common cause of events was “distraction”, followed by feeling discomfort due to “morning sickness”. When comparing the causes of events between early and late pregnancy, “feeling discomfort due to morning sickness” was significantly more common in early pregnancy（p＜0.05）. Since approximately one in ten pregnant women drivers experienced collisions or near-miss incidents, more attention is needed to promote safe driving. Due to the fact that several symptoms, especially in early pregnancy, might influence vehicle driving, healthcare providers prefer to advise pregnant women to drive under good health condition with adequate self-checkups.

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Opportunities to discuss the safe transportation of neonates in Japanese neonatal care are limited compared with those in other countries. We investigated the current status of and issues related to neonatal transportation by car at our hospital. Between January 2015 and December 2019, 372 neonates delivered at a local clinic had to be transported to our hospital via ambulance because of unstable conditions. Among the 372 newborns, this study included 73 who returned to the original clinic after their conditions stabilized. The proportion of car use was higher than that of ambulances when the neonates were transported to the original clinic after being discharged from the neonatal intensive care unit （NICU） throughout the five-year period （2015–2017: 100％ and 2018–2019: 50％）. Furthermore, 297 infants with a low birth weight （＜2,000 g at birth）, who were born between January 2015 and December 2019, were classified into three groups based on their anthropometric parameters （height and weight） at the time of discharge from the NICU: A （＜1,000 g）, B （1,000–1,499g）, and C （1,500–1,999g）. Our results showed that physiques in the C group, （whose severity was mild and conditions became stable fastest after admission, were the smallest among the three groups at the time of discharge. Given safe transportation after discharge, especially in infants with low birth weights who were one size smaller upon discharge than those who were born at term, it is required to pay attention to the gap between the infants and harnesses as well as the seated posture when using the child restraint system （CRS）. However, sufficient postdischarge instruction, including safe transportation, is difficult to achieve while using only the commercially available CRS. The development of a new CRS based on the recommendations of medical professionals will be required.

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To consider the possibility of survival for the victims suffering from cardiogenic cardiac arrest while vehicle driving, retrospective analysis was performed for sudden cardiac death cases. Among the forensic autopsies performed at Shiga University of Medical Science between January 2015 and January 2021, sudden cardiac death cases occurred at outdoor were selected. Then, the cases were divided into occurring while vehicle driving （Driving group） and others （Non-driving group）. Thirty-five cases with a mean age of 63.9 was composed of Driving group （20 cases） and Non-driving group （15 cases）. No significant differences of mean age, sex ratio, mean body mass index and prevalence of previous histories of the victims were found between the two groups. In Driving group, 95％ of victims had been unconscious when found by the witnesses and all victims had been cardiopulmonary arrest at the contact of emergency crews. More victims in driving group had been witnessed than those in Non-driving group （50％ vs. 13％, p=0.03）. The mean duration between the event and the contact of emergency crews was shorter in Driving group than Non-driving. For the collisions due to driverʼs health problem, because the driver might be in serious conditions, prompt rescue for drivers is required regardless of the degree of the collision. For the vehicle drivers suffering from cardiogenic cardiac arrest, if the cardiopulmonary resuscitation was performed by bystanders immediately, the number of deaths can be decreased. In future, regarding the vehicle collision due to drivers’ health problem, measures to rescue the driver and to avoid the following collision are required.

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The aging society is accelerating, and the aging of drivers is also advancing. Even though they have some kind of illness, including the elderly, they need to drive to maintain their lives and return into society. However, on the other hand, there are no end to accidents caused by sudden changes in physical condition. In the future, it is expected that autonomous driving technology will advance and make driverless vehicles, but until then, driving support is needed so that drivers can drive safely and without anxiety if the disease situation is acceptable. Therefore, in this study, we analyzed the current situation and characteristics of traffic accidents caused by epilepsy and heart disease using Japanese traffic accident statistical data. Furthermore, required support technologies for safety driving were proposed. The number of accidents with fatality caused by health-related problems were 182 in 10 years, and the number of accidents with serious and minor injuries was 2,374, showing a slight increase. According to the traffic accident statistics, they were classified into epilepsy, heart attack and cerebrovascular disorder accident, and they each accounted for almost the same proportion. Approximately 95％ occurred on general roads, and there were many single vehicle and rear-end collision accidents. The accident occurrence situation of health-related vehicle accidents was characteristic. In order for both drivers and business operators to be able to use the car safely and without anxiety, it is necessary to provide redundant three-step “safety and security” driving support. That is, medical check before driving, driving with less stress, detection of signs for physical condition, and emergency stop support are required to build safety equipment.

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