Children and the elderly are the focus groups in Strategisch Plat Verkeersveiligheid 2008-2020 of the Ministry of Transport, Public Works and Water Management. Children (as cyclists and passengers) and the elderly run a higher than average risk of one-sided cycling accidents requiring treatment ER (emergency room) treatment. With increasing age chances of hospitalisation after a one-sided cycling accident increase steeply. There is in general, however, no reason to discourage the elderly from cycling. According to Seidell (Standhart, 2009) cycling adds an average of twenty years, against losing one year. Children Effective measures are possible for both children and the elderly. Most effective in children is preventing getting wedged between the spokes when transporting children. There are European standards for children’s seats, but the data reveal that a good saddle does not guarantee prevention of getting wedged in the spokes. As children grow, chances increase for a foot to be caught between the spokes, as they are being transported on the back of the bicycle and the length of their legs allows getting caught. Moreover the straps fixating their feet on the footrests will be broken over time, or children refuse to be fixated. Parents assume in that case that dress guards will provide sufficient protection, but these are easily kicked and broken by children. There are reasonably priced effective kinds of spoke guards available. Education may increase parental awareness of this problem and promote solutions. Stichting Consument en Veiligheid is active in this field and cooperates with other parties like Fietsersbond and BOVAG. The Ministry of Transport, Public Works and Water Management may consider joining. Education on and testing of children’s seats had already been included as a possible measure in Strategisch Plan Verkeersveiligheid 2008-2020. The effect of this measure will approximately be in the order of 500 ER treatments and several dozen hospitalisations. Elderly Elderly cyclists may improve their safety by means of a safe bicycle, extra provisions (e.g. non-skid pedals, saddlebags, a rear-view mirror, etcetera) and behaviour (for instance not cycling too close to the kerb). These elements are discussed in the course Veilig en gezond blijven fietsen. This course is part of the Fietsersbond’s Fietsschool, also running courses for other target groups. The school started on a small scale in 2007 by training cycling teachers. For the time being it has a limited reach, but Fietsschool may go nationwide. Other avenues like senior citizens’ associations may be used as well. Prevention of one-sided cycling accidents may be a part of the Blijf veilig mobiel programme being developed by the senior citizens’ associations on behalf of the Ministry of Transport, Public Works and Water Management. If the reach of Fietsschool and the communication by means of the senior citizens’ associations is widened, results may be expected in the order of approx. 100 ER treatments and several dozen hospitalisations. Recommendations for focus groups Due to the high degree of involvement in one-sided cycling accidents of children and the elderly RWS DVS recommends communicating how the elderly and parents transporting a child by bicycle may reduce the risks. To this end DGMo may continue or reinforce the following activities: - fall prevention for elderly cyclists, among others as part of Fietsschool and by means of senior citizens’ associations - how to transport my child safely by bike, by providing advice and communication on (appropriate) use of children’s seats and spoke protection, among others by means of Stichting Consument en Veiligheid. Implementation of these measures may result in a reduction of 500 ER treatments and 50 hospitalisations. Measures aimed at risky behaviour Intoxicated drivers are a focus group in Strategisch Plan Verkeersveiligheid 2008-2020 of the Ministry of Transport, Public Works and Water Management. Legally the same rules apply to cyclists and motorists regarding alcohol abuse. The survey by Consument en Veiligheid demonstrated that in the group aged 20 to 54 11 per cent of people receiving ER treatment had drunk more than two glasses of alcohol in the six hours preceding the one-sided cycling accident. This percentage was even higher for hospitalisations. In cyclists over 55 the percentage is a mere 2%. Enforcement and education about alcohol abuse by cyclists might be possible, but this may entail drawbacks. If there is no sober driver available, part of the cyclists may switch to driving and thereby create a risk for other traffic participants. Moreover the enforcement capability used for cyclists cannot be used for motorists. And finally it is debatable whether there is public support for more enforcement on cyclists’ alcohol abuse. No indications have been found that operating a mobile phone or listening to music when cycling greatly increase risks. Distractions by for instance watching something beside the road are indeed risk-heightening (for instance more collisions with bollards), but education in this respect is not effective. Within the framework of this project no measures have been found to have a substantial effect in combination with public support. However, behavioural risks may be counteracted in part by providing a lenient infrastructure to cyclists. If bollards are removed or made more distinctive, someone who is distracted will not collide with it or at least not as easily. If the outline of a bike path is more recognisable and the width is sufficient, cyclists will not as easily wind up in the verge as a result of inattention or avoiding manoeuvres. Infrastructural measures In approximately half of all one-sided cycling accidents infrastructure plays a role. Although there are as yet no effect studies, improving the infrastructure appears to carry a substantial effect. These measures are not inexpensive, but have many other advantages in addition to increasing safety. Cycling comfort increases, which may promote cycling. More cycling positively affects flow of motor vehicles, air quality, health, et cetera. Road maintenance has been devolved. Appendix 2 provides a survey of effective measures that may be taken by local authorities. Infrastructural measures are mainly outside the range of influence of national authorities. There are various reasons for the Ministry of Transport, Public Works and Water Management to promote a local approach: - the problem of increasing numbers of hospitalisations in one-sided cycling accidents is apparent at the national level and mainly invisible at the local level, for the time being (one-sided cycling accidents are barely registered by BRON, if at all); - at the national level there are currently insufficient measures available to effect a decrease in the number of hospitalisations in one-sided cycling accidents. Without the cooperation of local road maintenance authorities reaching the targeted number of hospitalisations for 2020 (12,500 hospitalisations) will be difficult; - if individual road maintenance authorities manage to acquire knowledge, they will hardly be likely to do this and share this knowledge as long as the problem remains invisible; In order to entice local road maintenance authorities to tackle this problem national authorities may arrange for the problem to become visible and knowledge how to tackle it is spread. There is much to be gained by stimulating local road maintenance authorities to use BDU funds for infrastructural measures in order to reduce the chances of one-sided cycling accidents. RWS DVS recommends the following infrastructural measures: - allow elaboration of knowledge on infrastructural influences on one-sided cycling accidents and make it accessible to road maintenance authorities; - disseminate knowledge on infrastructural influences on one-sided cycling accidents, for instance by Nationaal Mobiliteitsberaad and KPVV/Fietsberaad; - have towns benchmark infrastructural characteristics that are important for one-sided cycling accidents. By making the relation to infrastructural characteristics more explicit by means of a benchmark, the problem of one-sided cycling accidents becomes more distinctive. By dissemination of knowledge local authorities get the means to tackle the problem. A combination of intensive dissemination of knowledge and benchmarking, as described above, may lead to a reduction of approximately 4000 ER treatments and 500 hospitalisations. To ensure this effect the study into distinctiveness of bollards and outlines of the road should also be carried out. Further research RWS DVS recommends the following additional research: - conduct at short notice a study into measures to improve distinctiveness of bollards and recognition of the outline of bike paths. On the basis of this study it is clear that these aspects are important for the elderly (visual abilities decrease with age) and the visually impaired. There are methods available to reach concrete recommendations for road maintenance authorities. Recently Mr. Atsma of CDA (Atsma, 2008) called attention to the accessibility of bike paths for visually-impaired cyclists, in part because of the high numbers of one-sided cycling accidents. A study into the distinctiveness of bollards and recognition of the outline of bike paths is in keeping with this demand. Of course there are numerous other issues where further study would be useful, for instance grip of bicycle tyres (slips occur frequently), the texture of materials used for permanent and temporary road surfaces where cyclists ride and measures to increase skid resistance, the influence of the width of bicycle provisions on behaviour and safety of cyclists, safe cycling for the elderly, et cetera. This recommendation for further research has been selected in the assumption that this may lead to effective measures benefiting all cyclists, but particularly the elderly. The elderly have been identified as a major focus group in Strategisch Plan Verkeersveiligheid 2008-2020.