to the use of motorised mobility scooters

VICTORIAN INJURY SURVEILLANCE UNIT HAZARD 62 page 1

Hazard(Edition No. 62)Summer - Autumn 2006Victorian Injury Surveillance Unit (VISU)

www.monash.edu.au/muarc/visu

Monash UniversityAccident Research Centre

This and the previous edition of Hazard highlight groups of consumer products that hospital injury surveillance data indicate makesignificant contributions to injury. In this edition, we focus on the emerging concern of injury to older persons related to theirincreasing use of motorised mobility scooters.

Summary• There were 6 motorised mobility

scooter (MMS) fatalities recorded forVictoria on NCIS and 151 hospital-treated injuries recorded on the VEMDover the five-year period 2000/01 to2004/5.

• Hospital-treated injuries are probablyup to five times higher than indicated,due to shortcomings in currenthospital-based injury surveillancesystems that make it impossible ordifficult to identify emerging injuryissues related to consumer productsnewly introduced in the marketplace.

• MMS-related injuries may beincreasing over time - the annualfrequency almost doubled between2000/1 (22 cases) and 2004/5 (41cases).

• The very old (persons aged 80 yearsand older) appear to be over-represented among both fatalities andhospital-treated injury cases. This

Consumer product-related injury (2): Injury relatedto the use of motorised mobility scootersErin Cassell and Angela Clapperton

phenomenon may be related toexposure.

• All the MMS-related fatalities andaround half hospital-treated MMSinjury cases were caused by falls.Disappointingly, the VEMD casenarratives provided little informationon the mechanisms of fall injury. Theother major causes of hospital-treatedinjury cases were collisions withobjects lining pathways (bushes, treesand fences, walls etc.), collisions withcars, and tipovers on uneven surfacesor kerbs/gutters.

• Half the hospital-treated injuriesoccurred in the road environment(roads/streets/footpath) and a furtherthird in the home.

• Three of the six deaths were caused byhead injuries. Among hospital-treatedMMS cases, almost one-third involvedthe lower extremity (32%). Head/face/neck and intracranial injuries(25%) and injuries to the upperextremity (21%) were also common.

• The most common injuries overallwere open wounds to the head, faceand leg and hip fractures

There is sparse data and research on MMSinjuries. Four broad classes of contributoryfactors to injury are apparent: engineering(mainly mechanical/frame and electrical/electronic problems), environmental(mainly related to incline/ramp/curbcuts,change in surface and driveways/street/sidewalk issues), occupant (related to adiverse range of user errors caused byknowledge and skills deficiencies) andsystem (related to repairs, improperrecommendation from a distributor,inadequate training of wheelchair user andinadequate prescription).

Safety issues raised in reports include:competency assessment and training for allpotential users; use of safety equipment

The emerging issue of MMS injuryhighlights a fundamental weakness inAustralia’s consumer product safetysystem. See special commentary page12


MethodCurrently there are no codes to separatelyidentify MMS-related injury cases on ICD-10 for any cause of injury (transport, fallsetc.) so fatalities and hospital admissionsdata cannot be extracted from the ABS-DURF and the VAED. Consequently, werelied on word-searches of Victorian fatalityreports on the National CoronersInformation System (NCIS) and thenarrative (free text) data on VEMD (forboth hospital admissions and E.D.presentations - non-admissions) to identifyand extract MMS-related injury cases.

(e.g. helmet and seatbelt); licensing andregistration; clarification of third partyinsurance arrangements; regulationsrestricting MMS use in certain roadenvironments; safer design including theease of use of the braking control system,improved stability when cornering andcrossing kerbs and channels; visibility intraffic; and the hazards MMS pose to otherpedestrians. Recommendations addressinjury surveillance and research gaps andthe identified safety issues.

BackgroundThis is the second consecutive edition ofHazard focused on groups of consumerproducts that make significant contributionsto hospital-treated injury in Victoria. In theprevious Hazard (Edition 61) wehighlighted that at least 4,000 children aretreated in Victorian hospitals each year forinjuries related to falls and other mishapsinvolving playground equipment. In thisedition we investigate the injury risk to frailand disabled older people due to theirincreasing use of motorised mobilityscooters. The difficulties we encounteredin identifying motorised mobility scooter-related injury cases on hospital injurydatasets illustrate some of the shortcomingsof current hospital-based surveillancesystems for identifying emerging injuryissues in a timely manner.

As stated in Hazard 61, current injurysurveillance data collections cannot identifythe level of involvement that can beattributed to the product in causing theinjury because of the limited amount ofdata collected on each case. Products maybe involved in injury causation at a numberof levels: physical failure (design ormanufacturing faults and lack ofmaintenance); inadequate design (fornormal use, for use by target age or abilitygroups, for foreseeable mishandling ormisuse and for protection of bystanders);inadequate instructions/safety warnings;and in ways not influenced by anyshortcomings of the product due to misusebeyond the influence of the supplier andunforseen human and environmental factors(ACA, 1989). Further, in-depth analytical

research is required to prove that productsor their use actually cause injury.

In Hazard 61 we also outlined the options toimprove consumer product injury data thatwere under consideration in the AustralianProductivity Commission’s Review of theAustralian Consumer Product SafetySystem. The Commission’s final reportwas released in February 2006. The futuredirection for consumer product safety inVictoria and nationally is discussed in aspecial article starting page 12.

One major recommendation from theReview was that the Ministerial Council onConsumer Affairs initiates the developmentof a broadly based hazard identificationsystem to aggregate available informationand analysis on consumer product incidents(mainly from existing sources includinginformation from hospital emergencydepartments and admissions) anddisseminate it to all jurisdictions. Analternative option—the establishment of anational fully integrated early warningsystem involving the centralised collection,processing and assessment of raw data onproduct-related injury—was deemed toocostly for the projected benefits.

IntroductionMotorised mobility scooters (MMS),sometimes known as buggies or gophersbut also classified with other motorised(usually electric) mobility devices underthe generic terms ‘motorised wheelchairs’or ‘motor chair’ by State road and otherauthorities, are growing in popularity inAustralia as older and disabled people striveto maintain active, independent lifestyles.

New makes and models are proliferatingand safety concerns have been raised in anumber of forums because MMS arestarting to be viewed by older people as analternative to the motor vehicle rather thanonly as an aid for those who have troublewalking any distance due to a physicaldisability or a health condition. UnderAustralian Road Rules, MMS users areclassed as pedestrians and their use isrestricted to injured or disabled people.

Cases recorded on NCIS were identifiedby the following searches:

(1) Keyword search of coroners’findings for the term motorisedand scooter

(2) Object coding for –Personal useitem- Other specified personal useitem-Wheelchair

(3) Object coding for Land Vehicle-Other specified vehicles-free text(for reference to a motorisedwheelchair, scooter, motorisedpushbike).

MMS can be legally ridden on the footpathbut must not be capable of travelling morethan 10km/hr on level ground. In Victoria,MMS cannot be registered and there is nodriver’s licence requirement. MMS usersmust observe the pedestrian road rules andmust not travel on the road except where afootpath or nature strip is not available, isbeing repaired or is unsafe due to damage.

Over the past few years VISU has receiveda number of requests for data on MMS-related injuries. The difficulties we facedidentifying these injury cases on fatalityand hospital injury surveillance databasesprovide a good illustration of theshortcoming of available hospital-basedinjury datasets for the identification ofemerging injury issues relating to newerconsumer products. They also highlightinadequacies in the Australian consumersafety system.


Thirteen Victorian cases were found andseven were excluded after checking foreligibility, leaving six cases.

Preliminary analysis of VEMD casenarratives revealed that MMS werecommonly just described as ‘scooters’ inthe text, so case record selection involvedthe following age-based culling ineligiblecases:

Table 1

Source: National Coroners Information System. Cases reported to the Victorian Coroners Office, published with the permission of the VCO.

mobility scooter (which occurredin 40 of 149 records).

(4) If the injured person was agedless than 60 years, the case recordwas deleted if the narrativecontained the word ‘scooter’ butthe scooter was not described as‘motorised’.

(5) If the injured person was agedbetween 50 and 59 years, the caserecord was deleted if the narrativecontained the words ‘motorisedscooter’ but other information inthe full text narrative indicatedthat the motorised scooter wasunlikely to be a mobility scooter.

(6) If the injured person was agedless than 50 years, the case recordwas deleted if the narrativecontained the words ‘motorisedscooter’ without the word‘mobility’ or other wording thatindicated that the scooter was amobility aid.

Details of motorised mobility scooter-related fatalities recorded on the NCIS (n=6)

(1) A text search for the descriptors‘scooter’ and ‘gopher’ wasconducted on case narrative datafor all cases recorded on theVEMD between July 1, 2000 andJune 30, 2005.

(2) All case records that containedthe word ‘gopher’ in the narrativewere retained.

(3) If the injured person was aged 60years and older and the caserecord contained the word‘scooter’, the record was retainedunless other information in thefull text narrative indicated thatthe scooter was not a motorised

Results

Deaths

ICD-10 coding of death data on ABS-DURF is very restricted and there is nocode to separately identify motorisedmobility scooter-related deaths. A searchof the National Coroners InformationSystem (NCIS) found that six MMS-relatedfatalities were reported to the VictorianCoroners Office over the 5-year periodJuly 1 2000 to June 30, 2005.

Five of the six MMS-related fatalities wereaged above 70 years and four were male.All fatal incidents involved a fall from thescooter. All the deceased were in verypoor health at the time of the fall incident.

Hospital-treated injurycases (n=151)

The VEMD underestimates the size of theproblem due to missing or inadequate casenarratives, which are supposed to contain


more detailed information on themechanism and circumstances of injury.Available data indicate there were at least151 hospital-treated injury cases in Victoriarelated to motorised mobility scooters overthe 5-year period July 1 2000 to June 302005, 66 hospital admissions and 85 E.D.presentations, non-admissions. The numberof cases almost doubled over the 5-yearperiod from 22 cases in 2000/1 to 41 casesin 2004/5.

Pattern of injury

Table 2 summarises and compares thefrequency, causes and pattern of motorisedmobility scooter injury admissions and E.D.presentations (non-admissions).

• Females were over-represented inhospital-treated mobility scooter injurycases (54%), with the gender differencebeing most pronounced amongadmissions (females 67%, males 33%).

• The age pattern was fairly consistentfor admissions and E.D. presentations(non-admissions). The overall peakage group for injury was 85-89 yearolds (23%). The age group 70-74years was over-represented inadmissions compared to E.D.presentations (27% vs. 7%) and vice-versa for 75-79 year-olds (18% vs7%).

• Falls were the most common cause ofboth admitted (53%) and non-admitted(61%) injury cases. Transport-relatedinjuries (struck by/collision with car)accounted for 11% of injuries overall,but 17% of hospital admissions.

• Lower extremity injuries accountedfor almost half of the hospitaladmissions (46%). Injuries were moreevenly spread across body sites —head/face/neck (29%), upper extremity(27%), and lower extremity (21%)—among E.D. presentations (non-admissions).

• Fractures accounted for half of thehospitalisations (50%). Among E.D.presentations (non-admissions),open wounds (34%) and superficial

accidentally reversed, she was thrownoff and hit cement wall

• Back pain, low lumbar - was pushedby motor scooter against wall

• Riding scooter, ran into tree• Riding motorised scooter down hill

when hit head on guardrail• Patient was shopping, had collision

with a pram and was knocked off hermotorised scooter

• Driving electric scooter, hit curb fellout of scooter

• Fell off motorised scooter when hitcurb

Causes and circumstances of injuryFalls (n=87)Most injuries were caused by falls (n=87,58% of all hospital-treated injuries). Withthe exception of the following records thecase narratives do not provide usefuladditional information on the circumstancesof the fall:

• Injury to the head/scalp following afall off motorised scooter, had beendrinking heavily

• Fell off mobile scooter, laceration toforehead, had been drinking

• Ejected and fell from scooter whenaccelerator was inadvertently pushed

• Fell from upright position when tryingto get on electric scooter

• Fell out of scooter whilst bendingover to pick something from footpath

• Fell off scooter on foot path• Fell from scooter in church• Absconded from seniors’ village

on a motor scooter and had a fall.

Collisions with other objects (n=17)Injuries also occurred as a result of acollision with objects (n=17, 11%), oftenobjects lining pathways:• De-gloving of finger as a result of

crashing gofer/scooter into a bush• Lacerated right leg injury sustained

when electric scooter ran into bush

Collisions with motor vehicle (n=16)Eleven percent of injuries were causedby collisions with cars (n=16). Mostnarratives simply stated that the scooterand a car collided with no further detailsof the circumstances. The followingrecords provided some additionalinformation:• Painful right foot, post collision with

car, was on scooter crossing road,right foot bruised

• Crossing road on motorised scooterwhen hit by car at low speed, damageto scooter

• Riding motorised scooter onfootpath, hit by a car backing out,patient has fractured neck of femur

• Driving a motorised scooter, hit frombehind by car

Roll/tip overs (n=7)Rolling the scooter or being tipped fromit accounted for an additional 5% of MMSinjuries (n=7).• Scooter incident, overbalanced and

rolled to gutter from footpath• Using battery scooter chair on

uneven ground and it rolled, pain toright shoulder unable to raise arm

injuries (20%) were the mostcommon injury types.

• The most frequently occurringspecific injuries overall were openwound to the head (7%), open woundto the lower leg (7%), hip fracture(7%) and open wound to the face(6%).

• The patterns of activity when injuredand location of injury were similar.‘Leisure’ was the most frequentlyrecorded activity at the time of injury(58% of both admitted and non-admitted cases) and the road, streetand highway the most commonlocation of injury (53% of admittedcases and 51% of non-admittedcases), followed by the home (29%and 33% respectively).

• Driving motor scooter at 8km/hr.collision with fence, foot becameentangled, scooter kept going leavingpatient behind, externally rotatingright ankle and knee

• Hit by automatic door whilst shopping-riding in motorised scooter, sustaineda fracture of the right tibia and fibula

• On scooter at home when front wheelgot caught in garden bed, patientattempted to release scooter but


Pattern of hospital-treated motorised mobility scooter related injury, July 2000-June 2005 Table 2

Source: VEMD July 2000-June 2005, admissions and non-admissions included


• Riding scooter, tipped over when gettingout of it

• Scooter accident, overbalanced androlled to gutter from footpath

Other casesThe remaining case records (n=24,16%) didnot provide any further details on thecircumstances of the injury event

DiscussionThere were 6 motorised mobility scooter(MMS) fatalities (recorded on NCIS) and151 hospital-treated injuries (recorded onthe VEMD) over the five-year period 2000/01 to 2004/5. Hospital-treated injuries areprobably up to five times higher than found,due to data coding and quality issues thatmake it impossible or difficult to identifyemerging injury issues related to newlyintroduced consumer products in currenthospital-based injury surveillance systems.

The only comprehensive data on the numberof MMS in use in Victoria is sourced from the1998 and 2003 ABS Survey of DisabilityAgeing and Carers. Unfortunately, scooteruse data by persons with a disability werereported differently from each survey. The1998 survey found that 11,700 adultAustralians with a disability were usingmobility scooters, 0.4% of the total number ofadults with a disability living in households in1998. The term ‘household’ excludes personsliving in special accommodation. Fifty-threeper cent of adult scooter users were aged 64years and over. Extrapolating from these data,the estimated figure for Victoria in 1998 isapproximately 2,500 adult mobility scooterusers. The 2003 survey found that a total of24,000 Australian adults and children with adisability living in private and non-privatedwellings (which includes those living inspecial accommodation) used a mobilityscooter. The Victorian figure for adults onlywas 8,700 scooter users (personalcommunication, Ken Black, Australian Bureauof Statistics), indicating a more than 3-foldincrease in the use of the mobility scooters byadult Victorians over the 5-year period betweensurveys. No comprehensive Victorian salesdata are available including sales togovernment agencies and direct sales to

members of the public. Data supplied by theVictorian Department of Human Services(DHS) Aids and Equipment Program (A&EP),the largest government scheme supplyingmobility aids in Victoria, show that a total of1,500 mobility scooters were purchased andsupplied to Victorians persons with a disabilitythrough this scheme since July 1, 1997(Department of Infrastructure, 2002).

Our analyses of available VEMD injury dataindicated that MMS-related injuries haveincreased concomitantly and that females andthe very old (persons aged over 85 years) areover-represented among injury cases. Thesefindings probably relate to higher exposure toMMS in these groups. Around half the MMShospital-treated injury cases were caused byfalls but, disappointingly, the VEMD casenarratives provided little information on themechanisms of fall injury, other than indicatingalcohol involvement in some cases. The othermajor causes were collisions with objectslining pathways (bushes, trees, fences, wallsetc.), collisions with cars, and tipovers onuneven surfaces or kerbs/gutters. Half theinjuries occurred in the road environment(roads/streets/paths) and a further third in thehome. The most common injuries overallwere open wounds to the head, face and legand hip fractures. Head /face/neck andintracranial injuries accounted for 25% of allinjuries.

These findings suggest that human factors(user incompetence related to lack of trainingor lack of prerequisite competencies for safeoperation, alcohol misuse, non-wear of safetyequipment such as seat belt and helmet), designand engineering factors (MMS steering andbraking systems, device instability) andenvironmental factors (uneven terrain/pathwaysurface, poor engineering of kerbs and gutters)play some role in injury causation.

Our literature search found no published studiesexclusively focussed on MMS injury andonly one study that separately reported injuriesrelated to MMS use from powered and manualwheelchair-related injuries. Kirby et al. (1995)extracted adverse reports on injuries related towheelchairs from the United States Food andDrug Administration (FDA) databases for theperiod 1975 to 1993. The FDA is theequivalent to Australia’s Therapeutic Goods

Administration (TGA). There were 368wheelchair-related injuries recorded on theFDA database, 53% of which were related tothe use of scooters, 25% to poweredwheelchairs and 23% to manual wheelchairs.The authors comment that the number ofincidents recorded on the FDA database was‘surprisingly small’ (an average of 58.2 peryear) given that an average of 51.3 wheelchair–related deaths were reported per yearfrom the U.S. deaths certificate database andmore than 36,000 E.D. presentations werereported annually from the National ElectronicInjury Surveillance System (NEISS) databasein the same period.

Four broad classes of contributory factors(n=1276 factors in 651 records) wereimplicated in FDA-reported injury cases:engineering (61%, mainly mechanical/frameand electrical/electronic problems),environmental (25%, mainly related to incline/ramp/curbcuts, change in surface anddriveways/street/sidewalk issues), occupant(10%, related to a diverse range of occupanterrors) and system (5%, related to repairs,improper recommendation from a distributor,inadequate training of wheelchair user andinadequate prescription). Environment(~30%) and occupant (~24%) factors formeda comparatively higher proportion ofcontributory factors in mobility scooter injuryincidents than wheelchair injury incidents,and engineering factors (~53%) acomparatively lower proportion.

There was a high frequency of tip/falls injurycases (n=328) in the U.S. series mainly due toenvironmental factor (75%); uncontrolledmovement of vehicle (11%), collision (5%),executing a turn (5%); leaning/reaching (4%)and slipping out (1%). This pattern underlinesthe importance of controlling environmentalhazards and improving MMS design especiallyin relation to stability. Compared to wheelchairtip/falls, which were most commonly forwardfalls, scooter tip/falls were more likely to be inthe lateral and rear direction, which the authorsattributed to the narrow triangular footprint of3-wheeled scooters. The most commoninjuries were fracture (46%) and lacerations,contusions and abrasions (42%). The mostfrequently injured body site was the lowerextremity (39%, evenly spread across hip andthigh, knee and leg, ankle and foot) followed


by the head and neck (26%) and the upperextremity (26%, mostly wrist and handinjuries).

The safety concerns around MMS use raisedby our study, the FDA research study reportedabove, in published Australian reports onscooter safety (Brownsdon & Marcar, 2002;Brownsdon, 2002; Muir 2004) and overseasstudies on motorised wheelchair injury wereall raised in State Parliamentary Inquiries inWestern Australia (Missikos & James, 1997)and Victoria (Parliament of Victoria, 2003).Victoria’s Parliamentary Road SafetyCommittee undertook an inquiry into issuesaffecting the safety of older road users in 2003that included the safety implication ofpedestrian mobility devices. MMS safetyissues raised included: competency assessmentand training for all potential users; use ofsafety equipment when used on-road (e.g.helmet and seatbelt); licensing and registration;clarification of third party insurancearrangements; regulations restricting MMSuse in certain road environments; safer designincluding the ease of use of the braking controlsystem, improved stability when corneringand crossing kerbs and channels; visibility intraffic; and the hazards MMS pose to otherpedestrians.

The Parliamentary Road Safety Committeeexpressed concern that no government agencywas taking a lead in determining whether ornot MMS should be regulated, licensed orregistered and recommended that VicRoadsdevelop safety standards for MMS; regulatetheir use on public roadways and pathways;investigate third party insurance aspects oftheir use; and conduct an awareness campaignfocussing on the rights and responsibilities ofusers, for both the user and the general public.

the consumer and covering selection, suitabilityand safe use of MMS has been produced byChoice magazine (www.choice.com.au),Council of the Ageing (COTA) in the ACT(www.cota-act.org.au), Bass Coast ShireCouncil, Gippsland(www.basscoast.vic.gov.au), the AustralianGovernment Department of Veterans’ Affairs(www.dva.gov.au), the Independent LivingCentre of South Australia (www.ilc.asn.au),and Department of Main Roads WesternAustralia (www.mrwa.gov.au).

With reference to registration and insurance,the government response was that MMScannot be registered as a motor vehicle inVictoria so Third Party Insurance is notapplicable. This position contrasts withregistration and Third Party Insurancearrangements in other Australian States. Forexample, in New South Wales, South Australiaand Queensland, MMS are covered by ThirdParty Bodily Injury Insurance when used onpublic roadways/footpaths.

Queensland, however, is the only State inAustralia that requires registration for MMSand other motorised wheelchairs used by aperson with a disability on a road or footpath(Queensland Transport, 2006). In Queensland,motorised wheelchairs including scooters maybe registered to an individual or to organisationslike nursing homes, shopping centres,educational institutions and hire companies.There are no fees payable for registration orCompulsory Third Party (CTP) Insurance formotorised wheelchairs, however free CTP isprovided by the nominal defendant if theMMS is registered. At the time of registrationby an individual, the applicant must produce adoctor’s certificate confirming that due tosevere movement impairment they have needto use the device for assisted travel, and makea statement that they will abide by the roadrules. Similarly, at the time of registration anorganisation is required to provide a statementcertifying that the device for assisted travelwill only be used by persons producing adoctor’s certificate qualifying them for use,and only by those who also make a statementthat they will abide by the road rules.

owners is home (building) contents insuranceor separate public liability insurance. A scooterinterest group formed in NSW (the NRMAScooter Group) enlisted the aid of the InsuranceCouncil of Australia to canvass its memberson public liability coverage for MMS(Brownsdon & Marcar, 2002). Only oneinsurance group (IAG) gave a clear response,indicating that the client would be covered fortheft, damage and public liability if the driverhad listed their scooter as a ‘specified andmobile item’ on their home contents insurancepolicy.

Enquiries made for this report to RACV(aligned with but not owned by the IAGinsurance group) National Seniors Insurance(through Allianz) and the AustralianPensioners Insurance Agency elicited theinformation that their household contents(personal effects) insurance policies coverMMS, provided the client specified the itemas a personal effect/portable valuable and theMMS is not a registered vehicle and coveredby Third Party Insurance (personalcommunication, RACV, NSI & APIAmemberline consultants). Lundie InsuranceBrokers provide ‘Electric Shuttle Insurance’which includes coverage for legal liability(property damage and bodily injury to$10,000,000) and death by accident (to$10,000) (www.lundie.com). There may beother providers.

The public liability insurance situation forMMS in Victoria needs to be communicatedto MMS owners as it differs from that operatingin other states of Australia. It is crucial thatMMS owners take out household contents(personal effects) or discrete mobility scooterinsurance with an insurance company thatcovers them for public liability in the event ofa scooter mishap causing injury to a third partyor damage to property outside the client’shome and on the footpath and road (if afootpath is not available). They need to makespecific enquiries and read the fine print on thepolicy to check on coverage. A related issue isthe availability of roadside assistance for MMSusers in the event of breakdown. Enquiriesrevealed that it is available from motoringorganisations such as the RACV.

These recommendations were only supportedin part by the government in its written responseto the Committee (VicRoads, 2004). Thegovernment accepted the recommendationthat a MMS safety awareness raising/educationcampaign was needed. In response, VicRoadshas produced a booklet “Guide for choosingand using a mobility scooter” that will bereleased around mid-year 2006 for broaddistribution (Personal communication, TriciaWilliams, VicRoads). Some other usefulonline or print educational material aimed at

Party Insurance in Victoria, the alternativesource of public liability insurance for MMS

Given that MMS cannot be covered by Third


MMS purchase is not regulated andcompetency assessment, training and licensingare not mandatory in any Australian State.However, both competency assessment andtraining are prerequisites for people withdisabilities applying for MMS through Federaland State funded Disability Services assistanceprograms such as the CommonwealthDepartment of Veterans’ Affairs (DVA)Rehabilitation Appliance Program (RAP) andthe Victorian Department of Human ServicesAids and Equipment Program (A&EP), andfor persons covered by Transport AccidentCommission (TAC) and WorkCoverinsurance. The process for applying for anMMS through DHS A& EP (open to allVictorians) and DVA RAP (open to warveterans or their dependents) involves acompetency assessment by a qualified therapist(usually a physiotherapist or occupationaltherapist employed by a Community HealthService but may be a private practitioner) whoapplies on behalf of the patient and then takesresponsibility for the training of the patient inthe use of the device if supplied (personalcommunication, Claire Bingham Departmentof Human Services).

knowledge of road and pedestrian safetyrules and the limitations of their scooterand many had skills deficiencies especiallyin ramp use, manoeuvring in a tight spaceand reversing (Brownsdon & Marcar,2002).

Suppliers may also provide training inscooter use, but the length of trainingreportedly varies from a quick ‘how-to’ toa 1-hour instruction session by a specialistsupplier (Brownsdon & Marcar, 2002).The Manager of the ILC in Victoria

Any Victorian interested in purchasing ascooter can access advice from a qualifiedtherapist (an occupational therapist or aphysiotherapist) through the IndependentLiving Centre (Victoria) located at Yooralla’sBrooklyn address (personal communication,Cath Williams, Manager, ILC). The ILCprovides a telephone advisory service or, for asmall fee of $15 for pensioners and $30 fornon-pensioners, provides a 90-minuteappointment with a therapist that includes trialdriving of different scooters in indoor andoutdoor environments. The therapist willmatch the scooter to the person’s skills andabilities and provides written advice on themost appropriate model/s. This service is notregarded as a full assessment because it doesnot include a home visit. The ILC also runsscooter education workshops for therapists.

There is no systematic and comprehensiveprovision of scooter training in Victoria,although an internet search and anecdotalinformation indicated that a few local councilsand health and disability services have providedtraining on an adhoc basis. The ILC does notprovide training as most of its clients arereferred by community health services or other

agencies servicing people with disabilitiesand these services usually provide someindividual training when the MMS is delivered.Some of these services also run scooter trainingdays, but again provision is not systematic andmany MMS users probably receive inadequateor no formal training.

A comprehensive training resource,Scooter Safe, is available through the NationalRoads and Motorists’ Association (NRMA),accessed on-line at( h t t p : / / w w w . m y n r m a . c o m . a u /safety_scooter_safe.asp) and COTA (ACT)(http://www.cota-act.org.au). COTA (ACT)and Able Access prepared this resource in2002 for use by occupational therapists andcommunity health professionals who prescribeMMS as a mobility aid, suppliers of MMSand equipment services. It is not designed asa tool for assessing a person’s potential forsafe MMS use. The resource includes: TheTraining Handbook; an IBM compatible diskcontaining a Power Point presentation of the 5training modules; templates for overheadtransparencies; the Scooter Safe User Guide(for participants); a training video: There’ssomething about scooters; and a resourcelist for further information. The training,which may be done in one workshop orspread over several sessions, covers fivemodules: (1) Rights and responsibilitiesof motorised wheelchair users; (2) Safemotorised wheelchair driving practices;(3) Australian Road Rules; (4) Maintenanceof motorised wheelchairs; and (5) Practicalsession (conducted outdoors on an obstaclecourse).

The development of this resource involvedpiloting the training with groups of MMSusers. Some participants exhibited limited


provisions of the Federal Trade PracticesAct 1974 and the Victorian Fair TradingAct 1999. Unsatisfied consumers canregister complaints about faulty productsor unfair trading practices to the AustralianCompetition and Consumer Commission(ACCC) or Consumer Affairs, Victoria orseek redress through the VCAT SmallClaims Tribunal. While there are AustralianStandards that guide the design andmanufacture of wheelchairs (includingMMS) they are not mandatory orperformance based and individualmanufacturers may use them at theirdiscretion.

There are currently 19 separate but relatedAustralian Standards (AS) on manual andelectric wheelchairs, including motorisedscooters (see list in references) which arebased on three International Standards (ISO6440 Wheelchairs – Nomenclature, termsand definitions; ISO 7176: 1998 –Wheelchairs; Parts 1-14 (a series of methodsof test and measurement of wheelchairs) andISO 7930 —Wheelchairs type classificationbased on appearance). Because MMS arevery different vehicles to wheelchairs, therehave been calls for Standards Australia todevelop separate standards for MMS(Brownsdon & Marcar, 2002; Brownsdon,2002; Muir 2004). The Wheelchair Safety atRail Level Crossings Taskforce also raisedseveral concerns about the adequacy of thecurrent Standards and recommended furtherresearch into aspects of wheelchair design(mainly related to safe negotiation of railwaystracks and stability) and consideration ofmandatory standards for wheelchairs(Department of Infrastructure, 2002).

The Australian Standards for wheelchairs arecurrently under review by the relevantCommittee of Standards Australia at the behestof the TGA. It is a major revision. The newAustralian Standards will follow therequirements of the European Standards (EN12183;1999 – Part 1 Manual wheelchairs andEN 12184 – Part 2 Electrically poweredwheelchairs scooters and their chargers) asthese are viewed as vastly superior to the ISOstandards and are performance based (personalcommunication, Diana Mead, StandardsAustralia). The development of the newStandards, even though they are based on

Browndon & Macar recommended thatthe ACT government, in partnership withinterest groups, develop a compulsory Codeof Conduct for suppliers. No action hasbeen taken on this recommendation(Personal communication, AllanBrownsdon, COTA- ACT). However,the Department of Main Roads, WesternAustralia has produced a set of guidelinesfor suppliers in response to keyrecommendations in the report ‘Mobilitywith Safety’ prepared for the Ministerial

Review Committee on Wheelchair Safety(1997). The published Guidelines coverbest practice in standards of serviceprovision, information and training andcustomer focus and provide a goodblueprint for the development of a ‘Codeof Practice’ for suppliers in Victoria(www.mrwa.gov.au).

commented that good suppliers recognisethey are not trainers and refer customers tothe ILC or other disability serviceorganisations with trained therapists forassessment and training (Personalcommunication, Cath Williams, ILC).Brownsdon and Macar (2002) concludedfrom their investigations in the ACT thatkey suppliers of MMS appear to beoperating responsibly. However, they foundthat matching of the user’s personalcharacteristics and abilities (and projectedMMS usage) to the most appropriate MMSwas not always performed adequately byall suppliers and that introductory trainingby suppliers varied in quality. MMS arealso available on the second-hand marketand purchasers may not access any expertadvice on the suitability of the device, orany training.

With respect to safe design, the respectiverole of government bodies that have someresponsibility under federal and statelegislation for the safety of MMS requiresclarification. Responsibility is dividedbetween the Therapeutic GoodsAdministration (TGA), Consumer Affairsbodies (state and federal) and State RoadAuthorities.

The Therapeutic Goods Act is only relevantif the sponsor/manufacturer of the MMS

makes a therapeutic claim for the device,but most manufacturers of MMS sold inAustralia would not make such a claim. Ifthe manufacturer claims that the device istherapeutic then, under the TherapeuticGoods (Medical Devices) Regulations2002, the mobility scooter would have tobe registered on the Australian Register ofTherapeutic Goods (ARTG). MMS aregrouped with wheelchairs and classified asa Class 1 medical device, the lowest of fourrisk classifications (TGA, 2003). As such,they undergo a less stringent form ofconformity assessment than higher-classdevices and are not required to be certifiedby the TGA or an overseas-notified body.

The responsibility of conformity assessmentof safety and performance (against theessential principles detailed in theregulations) rests with the manufacturer.Inclusion of the medical device on theARTG by the TGA denotes approval forsupply in Australia. Advertisements fordevices included on ARTG must complywith the Therapeutic Goods AdvertisingCode and the manufacturer of the device isresponsible for post market surveillance(information gathering about deviceperformance in the market including theconduct of customer surveys andinvestigation of customer complaints) andvigilance (mandatory reporting of adverseevents to the TGA). The authors understandthat there are TGA regulatory requirementsfor advertising and labelling that must bemet for all medical devices.

The ILC (Victoria) has organisedworkshops for Victorian wheelchair(including MMS) suppliers to ensure theyare aware of their responsibilities underTG regulations. The TGA is responsiblefor post-market monitoring of complianceincluding product reviews, manufacturingsite audits and product testing.

Given that most MMS on the market wouldnot fall under the umbrella of the TGAbecause manufacturers would not registerthem on the ARTG, buyers of MMS haveto rely for protection on the generalconsumer product safety and fair trading


disaggregate MMS falls cases from poweredand manual wheelchair falls cases.

existing international standards, requires agreat deal of work and it is anticipated thatthey will not be put out for public commentuntil the end of 2006, with a projected releasedate in mid-2007. Unfortunately, Standardsare unlikely to deal sufficiently with theuser-device interface issues identified by ourresearch. A co-ordinated national approach isneeded and a lead authority needs to beidentified urgently to take control of what maybe an impending epidemic of deaths andinjuries associated with MMS.

The other major area that requires attention isimprovements to injury surveillance datasystems to ensure that MMS injury cases (andother emerging consumer product-relatedinjury cases) presenting to hospitals arecaptured on the datasets in a timely way. TheNational Coroners Information System (NCIS)is a good source of data on emerging injuryissues in relation to injury fatalities becausethe database has a function to word-search alltext reports on the database to identify casesrelated to the consumer product of interest(NCIS, www.ncis.org.au). Full Coroners’Reports provide reliable information, where itis available, on the contribution of the consumerproduct to the fatal injury.

By contrast, current hospital-based injurysurveillance systems are not adequately gearedto provide early warning of consumer productinvolvement in injury and also do not supplycomplete and reliable data. All hospitaladmissions data on the VAED are coded andthe current study on MMS injuries provides agood example of the shortcomings of a codedsystem for the timely identification of emerginginjury issues. The VAED classification system(International Classification of Diseases, 10th

Revision with Australian Modifications – ICD-10-AM) currently contains no specific codesto disaggregate MMS admissions from thedataset for any cause of injury (transport-related, falls etc.). Powered wheelchairs (andpresumably powered mobility scooters) aredefined as pedestrian conveyances and arecurrently grouped with pedestrians on footunder the transport accident cause of injurycodes (V01-V09). The falls coding (W00-19) includes a specific code for fall involvingwheelchair (W05), that presumably coversMMS, but there are currently no sub-codes to

Every two years the National Centre forClassification in Health (NCCH) reviews theadequacy of ICD-10-AM (used to codeadmissions in the VAED), providing theopportunity to add further AustralianModifications. This process is reactive ratherthan anticipatory and changes, afteracceptance, take two years to come into effect.A submission to add a fifth character (digit) tothe pedestrian coding in the transport-relatedcause of injury classification (V01-V09Pedestrian injured in transport accident) toseparately identify wheelchair and motorisedmobility scooter cases (and other casesinvolving pedestrian conveyances) has alreadybeen accepted for the 5th edition and willcome into effect on July 1, 2006. The first yearof VAED hospital admissions data with thiscoding (2006/7 data) will be available in early2008.

As a result of the current study VISU willmake a submission to NCCH, to be consideredat their 2006 review, to add a fourth character(digit) to code W05 Falls involvingwheelchairs to separately identify manualwheelchair, motorised wheelchair and MMSfalls cases. Changes to other causes of injurycodes to identify MMS cases are not currentlyfeasible. Of course, the vital first step in injurysurveillance data collection is that informationon the mechanism (including consumerproduct involved if any) and injurycircumstances are noted on the paper/computerised patient records by hospital staff.

The VEMD has more potential to identifyemerging injury issues in a timely fashion.From 2005, all 37 Victorian public hospitalswith a 24-hour E.D. service contribute injurydata to the VEMD, so the system has thecapacity to capture most injury cases presentingto emergency departments in Victoria(including admissions). There is also thecapacity on the VEMD to record details of theconsumer product involved in the injury eventin the case narrative (free text) field. However,motorised mobility scooter data cases are notreliably reported or identified because ofnomenclature issues and missing, incompleteand poor quality narratives. The most recent

quality check of VEMD case narrative datasubmitted to VISU for the period July-December 2004, identified that on averageonly 34% of current narratives provided byhospitals are graded ‘good to excellent’ interms of the additional information they giveon consumer product involvement andmechanism and circumstances of injury.

The collection of complete and reliable dataon consumer product involvement in injurywould require injury surveillance systemsupgrades (to introduce factor codes), dataquality incentives at the participating hospitallevel (perhaps confined to a representative orsentinel group of hospitals), and ongoing in-house training of the E.D. staff entering data.The possibility of payments to hospitals forinjury data collection, contingent on dataquality, should be considered.

Recommendations• (The Victorian government should)

clarify which government department/agency should take the lead on motorisedmobility scooter safety and also definethe respective roles of the TherapeuticGoods Administration (TGA), federaland state consumer affairs departmentsand VicRoads with regard to safe designand monitoring of product defects aswell as user-device interface safety issues.

• Conduct a comprehensive consumersurvey to better understand currentmotorised mobility scooter usage andsafety issues including: userdemographics; reasons for obtainingscooter; benefits (new activities), sourceand selection of scooter and theassessment processes involved; accessto and adequacy of training; usagepatterns and maintenance schedule;reliability (mechanical and componentfailures) and after-sales service; and dataon the nature, location and mechanism(including trigger factor/s) of scootermishaps and associated injuries(including the site and type of injury, costof treatment and long-term sequelae).

• Conduct laboratory research into thestability of motorised mobility scooters,turning, negotiating bevelled door


thresholds and other bumps, ramps, kerbsand gutters and on different riding surfaces,and the effectiveness of seat belt use in lowspeed crashes.

• Expand assessment and trainingopportunities so that all potential mobilityscooter users are assessed by a trainedtherapist and undergo competency-basedtraining.

• Investigate the potential benefits of addedsafety features such as rollover protection,seat belts and personal protectiveequipment including helmets and gloves.

• Expand the falls cause coding in the ICD-10-AM to disaggregate scooter falls casesfrom other wheelchair falls cases

• Upgrade VEMD to collect reliable data onconsumer product involvement in injury (bythe introduction of factor codes) andimplement data quality incentives at theparticipating hospital level (perhaps confinedto a representative or sentinel group ofhospitals), and ongoing in-house trainingof the ED staff entering data.

ReferencesAustralian Bureau of Statistics. Themes – Disability, Ageing andCarers. Use of Mobility Aids. Source: 1998 Survey of DisabilityAgeing and Carers. http://www.abs.gov.au/

Australian Consumer Association (1989). An arm and a leg.Cited in: WatsonW., Day l., Ozanne-Smith J., Lough J.

Australian Consumer Association. On your scooter. Choicemagazine January/February 2006; 32-4. www.choice.com.au

Bass Coast Transport Connections. Motorised scooters andelectric wheelchairs. Maintaining your mobility in Bass CoastShire. Effective 1 September 2005. www.basscoast.vic.gov.au

Brown J. Motorised Wheelchairs. In: Transcript of Proceedings,Mobility & Safety of Older People Conference, 27-28 August.2002, Melbourne, Victoria.

Brownsdon A & Marcar C. Scooter Safe. Use of electricscooters and wheelchairs in the ACT: Policy implications &recommendations. Council of the Ageing (ACT), HughesCommunity Centre. August 2002. www.cota-act.org.au

Council of the Ageing (ACT) & Able Access. Scooter SafeTraining Resource (Handbook, Powerpoint presentation, templatefor overhead presentation, training video, resource list). COTA(ACT), 2002.

Council of the Ageing (ACT). Motorised scooters. http://cota-act.org.au/Livedrive/scooters.html

Department for Planning and Infrastructure. Motorisedwheelchairs. Information for users. Vehicle Safety BranchInformation Bulletin IB-115A (Jan 2004). Government ofWestern Australia. http://www.wa.dpi.wa.gov/licensing/myvehicle/publications/

Department of Veteran’s Affairs. Keeping you SAFE in therider’s seat. A safety initiative for the veteran community.Commonwealth of Australia, 2003.

Department of Transport Energy and Infrastructure SouthAustralia. Road Safety South Australia. People with Disabilities– motorised wheelchairs. http://www.transport.sa.gov.au/

Independent Living Centre of South Australia. Selecting ascooter. www.ilc.asn.au

Kirby R.L. & Ackroyd-Stolarz SA. Wheelchair safety —Adverse reports to the United States Food and DrugAdministration. American Journal of Physical Medicine &Rehabilitation 1995;74:308-12

Main Roads Western Australia. Motorised wheelchairs.Suppliers guide. Government of Western Australia, 2nd editionJanuary 2005

Main Roads Western Australia. Motorised wheelchairs. UsersGuide. Government of Western Australia, 2nd edition January2005

Muir N. Motorised Scooters and Wheelchairs. A review of theissues associated with their use by seniors and people withdisabilities. Final report to the Injury Control Council of WesternAustralia (ICCWA), 2004.

National Coroners Information System. www.NCIS.org.au

Parliament of Victoria Road Safety Committee. Inquiry intoroad safety for older road users. Parliamentary Paper No. 41,Victorian Government Printer, September 2003

Queensland Transport. Motorised scooters (motorisedwheelchairs). http://www.transport.qld.gov.au/

Standards Australia. AS 3693 1989. Wheelchairs –Nomenclature, terms, definition. Standards Association ofAustralia

Standards Australia. AS 3695—1992. Wheelchairs- Productrequirement. Standards Association of Australia

Standards Australia. AS 3691.1—1990. Wheelchairs-Determination of static stability. Standards Association ofAustralia

Standards Australia. AS 3691.2—1990. Wheelchairs-Determination of dynamic stability of electric wheelchairs.Standards Association of Australia

Standards Australia. AS 3691.3—1990. Wheelchairs-Determination of efficiency of brakes. Standards Association ofAustralia

Standards Australia. AS 3691.4—1992. Wheelchairs-Determination of energy consumption of electric wheelchair.Standards Association of Australia

Standards Australia. AS 3696.5—1989/Amdt 1-1990.Wheelchairs. Part 5: Determination of overall dimensions,mass and turning space. Standards Association of Australia

Standards Australia. AS 3696.6—1990. Wheelchairs. Part 6:Determination of maximum speed, acceleration and retardationof electric wheelchairs. Standards Association of Australia

Standards Australia. AS/NZS 3698.8:1998. Wheelchairs –Requirements and test methods for static, impact and fatiguestrengths. Standards Association of Australia.

Standards Australia. AS/NZS 3696.9:1990 & Amendt 1-1991.Wheelchairs – Climactic tests for electric wheelchairs. StandardsAssociation of Australia.

Standards Australia. AS 3696.10—1990. Wheelchairs.Determination of obstacle climbing ability of electric wheelchairs.Standards Association of Australia

Standards Australia. AS 3696.11—1993. Wheelchairs – TestDummies. Standards Association of Australia

Standards Australia. AS 3696.13—1991. Wheelchairs –Determination of the co-efficient of friction of test surfaces.Standards Association of Australia.

Standards Australia. AS 3696.14—1998. Wheelchairs—Powerand control systems for electric wheelchairs – Requirementsand test methods. Standards Association of Australia.

Therapeutic Goods Administration. Australian Medical DeviceGuidelines. An overview of the new medical devices regulatorysystem. Guidance document Number 1, Version 1.6. Commonwealthof Australia 2003.

Therapeutic Goods Administration. Class 1 medical devices. FactSheet. Version 1 Revision No 2, February 2005. http://www.tga.gov.au/devices/fs_class1.htm

Victorian Department of Infrastructure. Wheelchair Safety at RailLevel Crossings Taskforce: Report to the Minister, March 2002.http://www.doi.vic.gov.au/

Victoria Parliament Road Safety Committee. Inquiry into RoadSafety For Older Road Users. September 2003

Victorian Government. Government response to the report of theRoad Safety Committee of Parliament on Safety of Older RoadUsers. Tabled in Parliament, April 2004.


Commentary: Review of the Australian Consumer Product SafetySystem: Productivity Commission Research Report (February 2006)Joan Ozanne-Smith

IntroductionThe Productivity Commission, an independentagency, is the Australian Government’sprincipal review and advisory body onmicroeconomic policy and regulation. Itconducts a broad range of public enquiriesand research on economic and social issuesaffecting the welfare of Australians. In 2005the Australian government asked theProductivity Commission to undertake aresearch study to examine the social andeconomic impact of options for reformingAustralia’s general consumer product safetysystem. The primary purpose of the study wasto inform the review of the Australian consumerproduct safety system being conducted by theMinisterial Council on Consumer Affairs(MCCA). The full 453-page study reportentitled ‘Review of the Australian ConsumerProduct Safety System’ was released on 7February 2006 and is available atwww.pc.gov.au, including the detailed termsof reference.

Key points made by the ProductivityCommission in the report are as follows:

• The current regulatory system plays anecessary and important role inidentifying and removing unsafe productsthrough recalls, bans and standards.Overall, the regulatory system incombination with other mechanisms —the market, the product liability regime,media scrutiny and consumer advocacy— deliver a reasonable level of productsafety, as expected by Australianconsumers.

• There is, however, considerable scope tomake the regulation of consumer productsafety more efficient, effective andresponsive.

• A strong case exists for nationaluniformity in the regulation of consumerproduct safety. Current differences instate regulations create inefficiencies in

a resource-constrained environment,including duplication of effort andinconsistent approaches to similar risksand hazards. The preferred model is onenational law, the Trade Practices Act,and a single regulator, the AustralianCompetition and Consumer Commission(ACCC).

• If national uniformity is not achievable,state and territory jurisdictions shouldharmonise core legislative provisionsincluding the adoption of product bansand mandatory standards on a nationalbasis.

• The Commission found merit in thefollowing legal reforms:– including ‘reasonably foreseeable

use’ in the definition of ‘unsafe’;– ensuring that services related to

the supply, installation andmaintenance of consumerproducts are covered by alljurisdictions; and

– requiring suppliers to reportproducts that are associated withserious injury or death.

• The Commission proposed a number ofadministrative reforms including:– consistently making hazard

identification and riskmanagement more central topolicy making, standard settingand enforcement;

– improving the focus and timelinesfor the development of mandatorystandards;

– providing better regulatoryinformation to consumers andbusinesses through a ‘one-stopshop’ internet portal; and

– establishing a nationalclearinghouse for gatheringinformation and analysis fromexisting sources to provide an

improved hazard identificationsystem.

• The Commission recommended thatefforts to improve the safety of consumerproducts would also benefit from:– a comprehensive baseline study

of consumer product-relatedaccidents and

– a review of product recallguidelines

MUARC’s response tothe reportIn Victoria alone there were an estimated 40deaths and almost 20,000 hospital admissionsfrom product-related injuries in 2002 (VISU,2004). In light of these figures, we cannotagree with the statement in the ProductivityCommission’s report that “ the current systemas a whole, seems to be generating reasonablesafety outcomes…” (p. xxvii). The totallifetime cost of only the hospital admittedcases that occurred in Victoria in 2002 is atleast $46 million.

The Productivity Commission’s report wasinformed by a U.K. Department of Trade andIndustry study of home ‘accidents’. We agreewith the finding in the U.K. study, and itsextrapolation to Australia by the ProductivityCommission, that few deaths and injuries arecaused by actual product failure. However,we disagree with the assertion in the UKreport that consumer behaviour and thephysical environment cause at least 90% ofhome injuries, given that examples to supportthis estimate include “leaving product in reachof children” (behavioural cause) and “slipperysurfaces” (physical environmental cause)which ignore any contribution of the productto these home injuries.

The alternative approach to the prevention ofhome and other injuries with consumer product


.

involvement proposed by MUARC is asfollows:• Most injuries are preventable if a

systematic, scientific approach is taken,driven by injury surveillance andresearch data. This approach has beenhighly successful in road safety.

• Blaming the victim (the consumer/injured person) is an outmoded conceptand should not shape policy responsesto consumer safety issues.

• Design solutions can eliminate or reduceinjuries where user behaviour and thephysical environment are majorcontributory factors to injury. Examplesof these solutions include rolloverprotection on tractors, domesticswimming pool fences, child resistantclosures on medications, padding oftrampoline frames and springs, impactabsorbing under-surfacing inplaygrounds, safety glass in furniture.

While there are clear advances in theProductivity Commission’s recommendations,it is our opinion that they do not go far enough.We believe that new concepts need to underpinproduct safety initiatives in Australia andpropose the following:

A proactive product safety system isinstituted.

• The community should no longer betreated as the ‘guinea pigs’ for testingnew products. The current system is tooreliant on identifying hazards and risksthrough retrospective investigations offatal and serious injury incidents.

• There should be laboratory or simulatedtesting of new or re-designed productsrather than community testing.

• An improved data system is required thatnot only identifies product-related injuries,but also has the capacity to identify productinvolvement in the mechanism of injury.

• New information tool-kits need to bedeveloped to underpin a proactive approach.For example, the Infant and Nursery ProductsAssociation of Australia (INPAA) hasestablished a ‘tool-kit’ in the form of a hazarddatabase relevant to nursery products, toinform new industry based horizontalstandards (see p. 289 of the ProductivityCommission Report).

The article on motorised mobility scooters inthis edition of Hazard illustrates an importantshortcoming of both the current and reformed

Australian Consumer Product Safety System,as proposed. The uptake of this relatively newproduct by vulnerable population groups(particularly the very old) has been rapid andthere is a substantial emerging upward trendin serious injuries related to scooter use — anestimated 200 hospital-treated injuries wereassociated with mobility scooters in Victoriaalone in the financial year 2004/2005 and thisincreasing rising trend has continued beyondthe study period. As with most product-related injuries, the major problem appears tobe at the user-machine interface.

The existing product safety system has shownitself to be incapable of responding to, or evenadequately recognising, the existence of thisand other emerging problems associated withnew products. By comparison, the publichealth system has shown some capacity toidentify and describe the epidemiology ofthese injuries, including the high-risk age group,common mechanisms, injury types and bodyregion injured. Moreover, steps have beentaken to introduce Australian modifications tothe International Classification of Diseases(ICD10-AM) coding system to specificallyidentify motorised mobility scooter-relatedinjury cases on state and national hospitaladmissions databases.

As a result, the public health sector has sourcedinformation on responsible governmentjurisdiction and injury prevention stakeholdergroups and identified potential preventionmethods. Furthermore, the issue has beenplaced into the government and public domainby recent representations to the TherapeuticGoods Administration, consumer productsafety authorities and the media by means ofpress releases.

Notwithstanding our criticisms of theProductivity Commission’s report, MUARCacknowledges and welcomes the advances thatwill be made in consumer product safety by theuptake of these recommendations:

• Commissioning of product-relatedinjury data studies

• Mandatory reporting by manufacturersof defects and injuries to the relevantregulatory authority

• Inclusion of ‘reasonably foreseeableuse’ in the definition of unsafe in bans,

recalls and mandatory standards (Note:apparently not recommended forinclusion in voluntary standards)

• Extension of regulations to cover theinstallation/service/maintenance ofproducts

• An immediate review of the standards-making process

• Linkage of hazard identification withpolicy making and enforcement ofregulations

• A funded research agenda

However, substantial shortcomings remain.There is likely to be a long lag time beforechanges happen and the residual injuryproblem is likely to remain large, even after allof the proposed reforms are in place. Thisshould be monitored. Also, the reformedsystem, as proposed, does not adequatelyaddress new products, such as motorisedmobility scooters. Finally, an ongoingcomprehensive data system (not merely theproposed one-off study) is needed to monitorinjury trends, estimate the cost of productrelated injuries and assist the development ofcost effective solutions.

ConclusionA paradigm shift is needed in Australia’sconsumer product safety system. Theproposal to include a General ProductSafety Provision (GSP) in consumerlegislation, as exists in the UK andEurope, was rejected by the ProductivityCommission. A GSP places an explicitlegal obligation on businesses to supplyonly safe consumer products and itsinclusion would have stimulated theadoption of a proactive approach byindustry and regulators and heightenedcommunity awareness and demand forsafer products. Non-inclusion of a GSPrepresents a missed opportunity in thischapter of Australia’s product safetyhistory.


- INDEX -Subject Edition Pages

Asphyxia........................................................................................................................................................60......................................... 1-13Babywalkers, update 16,20,25,34 1-4,12-13,7-8,7-8Baseball ................................................................................................................................................................................... 30 ............................................ 10-12Boating-related recreational injury ........................................................................................................................................ 56 ............................................... 1-16Bunkbeds ................................................................................................................................................................................ 11 .................................................. 12Bicycles - Bicycle related ................................................................................................................................... 6,31,34,44 .............. 1-8,9-11,8-12,7-8,10-11

- Cyclist head injury study ...................................................................................................................... 2,7,8,10 ......................................... 2,8,13,9Burns - Scalds ........................................................................................................................................................... 3,25 .......................................... 1-4,4-6

- Burns prevention ............................................................................................................................................. 12 ............................................... 1-11- Unintentional burns and scalds in vulnerable populations ........................................................................... 57 ............................................... 1-17

Child care settings .................................................................................................................................................................. 16 ............................................... 5-11Client survey results ............................................................................................................................................................... 28 .................................................. 13Commentary: Review of the Australian Consumer Product Safety System ........................................................................ 62 ............................................ 12-14Cutting and piercing (unintentional) asasultive ............................................................................................................. 52, 55 .................................... 1-17,14-17Data base use, interpretation & example of form ................................................................................................................... 2 ................................................. 2-5Deaths from injury (Victoria) .......................................................................................................................................... 11,38 ...................................... 1-11,1-13Dishwasher machine detergents - Update ............................................................................................................................ 18 .................................................. 11DIY maintenance injuries ...................................................................................................................................................... 41 ............................................... 1-12Dog bites, dog related injuries ............................................................................................................................ 3,12,25,26,34 ....................... 5-6,12,13,7-13,2-5Domestic architectural glass ......................................................................................................................................... 7,22,25 ................................... 9-10,1-5,12Domestic Violence ............................................................................................................................................................ 21,30 .......................................... 1-9,3-4Drowning/near drowning, including updates .................................................................................................... 2,5,7,30,34,55 .................... 3,1-4,7,6-9,5-7,1-13Elastic luggage straps ............................................................................................................................................................. 43 ................................................. 2-6Escalator .................................................................................................................................................................................. 24 ............................................... 9-13Exercise bicycles, update ...................................................................................................................................................... 5,9 ......................................... 6,13-14Falls - Child, Older Persons, Home ....................................................................................................................... 44,45,48,59 .................... 1-17,1-15,1-12,1-21Farm .................................................................................................................................................................................. 30,33 ........................................... 4,1-13Finger jam (hand entrapment) ........................................................................................................................... 10,14,16,25,59 ................... 5,5-6,9-10,9-10,1-21Fireworks ................................................................................................................................................................................. 47 ................................................. 2-7Geographic regions of injury ................................................................................................................................................. 46 ............................................... 1-17Home ............................................................................................................................................................................ 14,32,59 ............................ 1-16, 1-13,1-21Horse related ....................................................................................................................................................................... 7,23 ........................................ 1-6,1-13ICD-10 AM coding developments ......................................................................................................................................... 43 ............................................... 8-13Infants - injuries in the first year of life .................................................................................................................................. 8 ............................................... 7-12Injury surveillance developments .......................................................................................................................................... 30 ................................................. 1-5Intentional ............................................................................................................................................................................... 13 ............................................... 6-11Latrobe Valley - First 3 months, Injury surveillance & prevention in L-V ................................... 9, March 1992, Feb 1994 ............................. 9-13, 1-8, 1-14Lawn mowers .......................................................................................................................................................................... 22 ................................................. 5-9Marine animals ....................................................................................................................................................................... 56 ............................................ 18-20Martial arts .............................................................................................................................................................................. 11 .................................................. 12Mobility scooters .................................................................................................................................................................... 62 ............................................... 1-12Motor vehicle related injuries, non-traffic ............................................................................................................................ 20 ................................................. 1-9Needlestick injuries ..................................................................................................................................................... 11,17,25 .................................... 12,8,10-11Nursery furniture .............................................................................................................................................................. 37,44 .................................... 1-13,11-13Older people ............................................................................................................................................................................ 19 ............................................... 1-13Off-street parking areas .......................................................................................................................................................... 20 ............................................ 10-11Playground equipment ......................................................................................................................... 3,10,14,16,25,29,44,61 .. 7-9,4,8,8-9,13,1-12,13-14,1-21Poisons - Domestic chemical and plant poisoning ........................................................................................................ 28 ................................................. 1-7

- Drug safety and poisons control ....................................................................................................................... 4 ................................................. 1-9- Dishwasher detergent, update .................................................................................................................... 10,6 ........................................... 9-10,9- Early Childhood, Child Resistant Closures .......................................................................................... 27,2,47 ................................. 1-14,3,11-15- Adult overview ................................................................................................................................................ 39 ............................................... 1-17

Power saws, Chainsaws .................................................................................................................................................... 22,28 .................................... 13-17,8-13Roller Blades, Skateboards ................................................................................................................................... 2,5,25,31,44 .................. 1-2,11-13,12,12 3-7,8School ...................................................................................................................................................................................... 10 ................................................. 1-8Shopping trolleys ......................................................................................................................................................... 22,25,42 ................................. 10-12,8-9,12Smoking-related ...................................................................................................................................................... 21,25,29,44 ................................... 10-12,6-7,8Socio-economic status and injury .......................................................................................................................................... 49 ............................................... 1-17Sports - child sports, adult sports, surf sports ...................................................................................................... 8,9,44,15,56 ............ 1-6,1-8,15-16,1-10,16-18Suicide - motor vehicle exhaust gas ...................................................................................................................... 11,20,25,41 .............................. 5-6,2-4,3-4,13Tractor ............................................................................................................................................................................... 24,47 ........................................ 1-8,8-10Trail bikes ............................................................................................................................................................................... 31 ................................................. 7-9Trampolines ................................................................................................................................................................. 13,42,61 ............................... 1-5,1-11,1-21Trends in road traffic fatality and injury in Victoria ............................................................................................................ 36 ............................................... 1-13Vapouriser units ...................................................................................................................................................................... 43 ................................................. 7-8Venomous bites and stings ..................................................................................................................................................... 35 ............................................... 1-13VISS: How it works, progress, A decade of Victorian injury surveillance ................................................................ 1,26,40 ................................. 1-8,1-5,1-17VISAR: Celebration of VISAR's achievements, VISAR name change to VISU .......................................................... 50,61 ..................................... 1-25,1Work-related ............................................................................................................................................................... 17,18,58 ....................... 1-13,1-10,1-17


VISU Executive /Editorial BoardProf Joan Ozanne-Smith, Monash University Accident Research Centre (Chair)Prof Ian Johnston, Monash University Accident Research CentreAssoc. Prof James Harrison, Research Centre for Injury Studies (SA)Assoc. Prof David Taylor, Royal Melbourne HospitalMs Erin Cassell, Monash University Accident Research CentreGuest Editor:Tricia Williams, VicRoadsSiepie Larkin, Therapeutic Goods AdministrationDee Waldron, Yooralla Society, Independent Living Cente

VISU StaffDirector: Ms Erin CassellCo-ordinator: Ms Karen AshbyResearch Fellow: Ms Angela ClappertonMedico/Clerical Support Officer: Ms Christine Chesterman

General AcknowledgementsParticipating hospitalsFrom October 1995Austin & Repatriation Medical CentreBallarat Base HospitalThe Bendigo Hospital CampusBox Hill HospitalEchuca Base HospitalThe Geelong HospitalGoulburn Valley Base HospitalMaroondah HospitalMildura Base HospitalThe Northern HospitalRoyal Children's HospitalSt Vincents Public HospitalWangaratta Base HospitalWarrnambool & District Base HospitalWestern Hospital - FootscrayWestern Hospital - SunshineWilliamstown HospitalWimmera Base HospitalFrom November 1995Dandenong Hospital

From December 1995Royal Victorian Eye & Ear HospitalFrankston Hospital

From January 1996Latrobe Regional Hospital

From July 1996Alfred HospitalMonash Medical Centre

From September 1996Angliss Hospital

From January 1997Royal Melbourne Hospital

From January 1999Werribee Mercy Hospital

From December 2000Rosebud Hospital

Coronial ServicesAccess to coronial data and links withthe development of the Coronial Servicesstatistical database are valued by VISU.

How to access VISU

data:VISU collects and analyses informationon injury problems to underpin thedevelopment of prevention strategies andtheir implementation. VISU analyses arepublicly available for teaching, researchand prevention purposes. Requests forinformation should be directed to theVISU Co-ordinator or the Director bycontacting them at the VISU office.

Contact VISU at:MUARC - Accident Research CentreBuilding 70Monash UniversityVictoria, 3800

Phone:Enquiries (03) 9905 1805Co-ordinator (03) 9905 1805Director (03) 9905 1857Fax (03) 9905 1809

Email:[email protected]

From January 2004Bairnsdale HospitalCentral Gippsland Health Service(Sale)Hamilton Base HospitalRoyal Women's HospitalSandringham & District HospitalSwan Hill HospitalWest Gippsland Hospital (Warragul)Wodonga Regional Health Group

From April 2005Casey Hospital

All issues of Hazard and otherinformation and publications of theMonash University Accident ResearchCentre can be found on our internet homepage:http://www.monash.edu.au/muarc/visu

National InjurySurveillance UnitThe advice and technical back-upprovided by NISU is of fundamentalimportance to VISU.


VISU is a project of the Monash University Accident Research Centre, funded by theDepartment of Human Services

Hazard was produced by the Victorian Injury Surveillance Unit (VISU)Illustrations by Debbie Mourtzios

ISSN-1320-0593

Printed by Work & Turner Pty Ltd, Tullamarine

to the use of motorised mobility scooters

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