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15 Estimating the potential cost savings associated with any of as a 12% reduction in the $3,750,385 cost estimate associated the Proven countermeasures (for which an effect size is pro- with child pedestrian deaths and injuries yields an estimated vided) is a relatively straightforward algebraic calculation saving of $450,046. when the following parameters are known: Can the typical state with 600 fatalities conduct child pedestrian training statewide for $450,046 or less? If the 1. The target group size (i.e., the number of fatalities and answer to this question is yes, then this countermeasure will injuries in crashes addressed by the countermeasure); be cost effective. That is, the benefit will exceed the cost. Even 2. The estimated effectiveness of the countermeasure if the answer is no on a statewide basis, the state may decide (i.e., the percentage reduction produced by the counter- to limit implementation of the countermeasure to those juris- measure); and dictions, typically urban, where child pedestrian crashes are 3. The estimated dollar value of each fatality and injury most common. This should substantially reduce implemen- avoided. tation costs while retaining much of the benefit. Example Proven Countermeasures The first countermeasure shown in Appendix B is School Similar calculations are possible for 23 of the Proven coun- Pedestrian Training for Children. The target population for termeasures. Such calculations, detailed in Appendix B, are this countermeasure is pedestrian crash victims, ages 6 to 12. summarized in Tables 5 through 8. The savings possible from This target group comprised 0.303% of all fatalities (129 of these 23 countermeasures for a typical state with 600 fatali- 42,642) in 2006. Based on this proportion, our "typical" state ties range from $450,046 (for school pedestrian training) to with 600 annual fatalities might expect that 1.82 of its total $121,907,025 (for automated enforcement). number of victims would be pedestrians 6 to 12 years of age. Table 5 provides cost-savings estimates for the two Proven Based on the last column of Table 2, the estimated injury/ voluntary action countermeasures for which crash/death/ fatality ratio for pedestrians is 31.4/1. Thus, this typical state injury reduction estimates are available. It suggests that an esti- might expect 57 (MAIS 1-5) injuries annually, in addition to mated savings of $450,046 would be associated with an effec- the 1.82 fatalities. tive pedestrian countermeasure and a savings of $6,140,394 Based on the estimated unit costs of $1,115,820 per fatality would be associated with an effective booster seat program. and $30,238 per MAIS 1-5 injury (see Table 3), the total cost Note that both of these countermeasures involve children, associated with 1.82 deaths and 57 injuries among child teachers, and parents. With regard to adult behavior, the lit- pedestrians would be $3,750,385 per year in this typical state. erature suggests that education and information can be effec- Again, these estimates should be considered to be conserva- tive only when it is used in support of some other measure, tive. They make no adjustment for pain and suffering and such as enforcement or sanctions. It is not likely to be effective they make no adjustments for age of the victim. The life of an when it is used alone. elderly victim, using this estimation procedure, is considered Finally, unless there is some form of mass media commu- to be equally valuable to that of a child, a teenager, the parent nications effort associated with the programs in Table 5, or of a child, or anyone else. That is, the costs reported here are there is a plan for implementing these countermeasures widely averages across all ages. across the state or across the majority of communities within The results of known evaluations of child pedestrian train- the state, these measures are likely to have only a specific effect. ing (see Appendix B) suggest that such training can reduce That is, their impact will be limited to those targets where child pedestrian injury by about 12%. Applying this effect size such programs are implemented (e.g., in a specific school or Table 5. Voluntary actions. Countermeasures Target population Highway Reduction Savings Name Cost* Description No. of No. of loss ($) (%) ($) fatalities injuries School Low Pedestrians 2 57 $3,750,385 12% $450,046 pedestrian ages 6 to 12 training for children Booster seat Medium Children ages 4 4 2,530 $80,794,661 8% $6,140,394 promotions to 8 not in booster seat *Cost column is from NHTSA (2007b).

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16 Table 6. Laws, regulations, and policies. Countermeasures Target population Highway loss Reduction Savings ($) Name Cost Description No. of No. of ($) (%) fatalities injuries Bike helmet Medium Unhelmeted 1 91 $3,719,434 15% $557,915 laws for children bikers under age 12 Graduated Medium 16-year-old 12 3,318 $114,143,621 20% $22,828,724 driver licensing drivers Extended Low 16-year-old 12 3,318 $114,143,621 22% $25,111,597 learner permit drivers Night Low 16-year-old 4 954 $32,816,291 50% $16,408,146 restrictions drivers nighttime crashes Passenger Low 16-year-old 7 1,900 $65,373,165 33% $21,573,144 restrictions drivers w/ teen passengers Administrative High Impaired 213 9,936 $537,848,587 13% $69,920,316 license drivers revocation Primary seat Low Unbelted front 185 28,954 $1,082,328,300 7% $75,762,981 belt law seat occupants Motorcycle Low Motorcyclists 65 2,261 $141,442,973 20% $28,288,595 helmet law Reduced speed Low Pedestrians in 16 489 $32,154,461 25% $ 8,038,615 limits (for 60km/h (37 pedestrian mph) urban safety) zones community). For these countermeasures to result in a general helmet law to $75,762,981 for a primary belt law. Each of effect, one that is likely to measurably reduce deaths and in- these measures, if publicized, is likely to result in a general, juries, they must be broadly implemented across the state rather than a specific, effect. That is, each is likely to affect a and, a plan for doing so should be considered along with their large portion of the target population across the state and, as adoption. such, is likely to produce measurable reductions in deaths Table 6 lists the nine Proven countermeasures for laws, and injuries. regulations, or policies. The estimated savings associated with These countermeasures have three important advantages. these countermeasures ranges from $557,915 for a child bike First, implementation of a law can often be done at relatively Table 7. Laws plus enhancements. Countermeasures Target population Highway loss Reduction Savings ($) Name Cost Description No. of No of ($) (%) fatalities injuries Sobriety High Impaired 213 9,936 $537,848,587 20% $107,569,717 checkpoints drivers Short, high- High Unbelted front 185 28,954 $1,082,328,300 3% $27,274,673 visibility belt law seat enforcement occupants Automated High Speeding 162 14,177 $609,535,127 20% $121,907,025 enforcement: drivers speed cameras Mass media to High Impaired 213 100 $537,848,587 13% $69,920,316 support alcohol drivers enforcement or other program Community High Drinking 39 1,830 $99,061,459 10% $9,906,146 program including drivers under age-21 age 21 enforcement

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17 Table 8. Sanctions and treatments. Countermeasures Target population Highway Reduction Savings ($) Name Cost Description No. of No. of loss ($) (%) fatalities injuries Aggressive Medium Drivers w/ 47 4,250 $181,293,587 17% $30,819,910 driving: license previous suspension speeding convictions Aggressive Medium Drivers w/ 47 4,250 $181,293,587 8% $14,503,487 driving: previous individual speeding meetings convictions Aggressive Medium Drivers w/ 47 4,250 $181,293,587 5% $9,064,679 driving: group previous meetings speeding convictions Aggressive Medium Drivers w/ 47 4,250 $181,293,587 4% $7,251,743 driving: warning previous letters speeding convictions Mandatory Medium DUI-convicted 16 767 $41,509,775 7% $2,905,684 attendance at drivers in alcohol alcohol-related treatment crashes programs Alcohol Medium DUI-convicted 16 767 $41,509,775 37% $15,358,617 interlocks drivers in (when installed) alcohol-related crashes modest cost. Second, there is some permanence to their im- a general effect and, as such, each is likely to result in mea- pact (i.e., once a safety measure becomes law it tends to remain surable reductions in deaths and injuries. law). Thus, it is often true that these are one-time costs with These countermeasures are characterized by a very high benefits seen year after year thereafter. Third, all laws have the payoff. However, they can also involve high implementation potential for general, rather than specific, effects. Unlike an costs. For instance, in order for sobriety checkpoints to realize education program (or an unpublicized sanction), for which their full potential, they need to be implemented across the exposure tends to be limited, laws potentially affect everyone entire jurisdiction throughout the year. That is because their within the jurisdiction covered by them. Two of the require- implementation needs to convince all (or at least most) mo- ments for laws to be effective are that they are enforced and torists that they have a very real chance of being arrested that they (both the law and the enforcement) are publicized. should they choose to drink and drive. Available data suggest Thus, the costs of enforcement and publicity should also be that drivers resume their typical drinking and driving behav- considered when adopting any of these laws. ior when checkpoints are discontinued. Still, $107 million is Table 7 lists the five Proven countermeasures for laws plus a very large savings for the "typical" state with 600 fatalities, enhancements. The estimated savings associated with these and this countermeasure should receive serious consideration. countermeasures range from $9,906,146 for community Table 8 lists the six Proven countermeasures for sanctions programs including age-21 enforcement to $107,569,717 for and treatments. The estimated savings associated with these sobriety checkpoints and $121,907,025 for automated enforce- countermeasures range from $2,905,684 for mandatory atten- ment. Like laws, each of these countermeasures, if fully imple- dance at alcohol treatment programs to $30,819,910 for license mented and publicized, has a strong potential for providing suspensions for poor and aggressive driving records.