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27 passenger restrictions, license suspension, and warning letters. Shift in Strategy Countermeasures that can be implemented at comparatively little direct cost to the state (e.g., offender-pay counter- It should be noted that the above strategy for countermea- measures) include mandatory attendance at alcohol treat- sure selection differs from current guidelines. Currently, the ment, alcohol interlocks, and red-light running cameras. All recommended approach is to (1) conduct problem identifi- of these efforts should be given serious consideration in the cation, (2) identify priority areas, (3) formulate goals and development of a state highway safety plan. Cost benefit objectives for each priority area, then (4) select countermea- ratios for these countermeasures, if calculated, would be sures that will lead to the accomplishment of those goals. enormous. The present analysis suggests that this is not the optimal Next, there are several countermeasures for which the approach. Specifically, it is highly likely that there will be no benefit/cost ratio measured in terms of dollars is large but effective and cost-effective countermeasures available to achieve that may be difficult to implement given the current political significant impact in some program/problem areas. Even if a climate. These countermeasures include universal mandatory potentially effective countermeasure is available, it may not motorcycle helmet law, primary seat belt law, speed cameras, be possible to implement that countermeasure at this time. For and reduced speed limit. Each of these countermeasures, if instance, it may not be possible at this time to enact a univer- not already in place, should be implemented as soon as it is sal mandatory helmet law for all motorcycle riders. Or, in your feasible to do so. state it may not be possible to conduct sobriety checkpoints. Several countermeasures fall between these two cost ex- Similarly, speed cameras, a primary seat belt law, or restrictions tremes. These include child pedestrian training, booster seat on plea bargaining may not be viable options at this time. promotions, high-visibility enforcement, ALR, mass media The present analysis suggests that the availability of effective/ in support of alcohol enforcement, community programs cost-effective countermeasures that can realistically be imple- for under age 21 enforcement, individual meetings, and mented at this time is a major limiting factor. Highway safety group meetings. For each of these, it will be necessary for a plans should attempt to avoid objectives that are unattainable, state to estimate its own costs for "fully" implementing given current technology and political climate. Rather, they these programs. Once the costs have been estimated, the should focus funds and other resources primarily on those benefit/cost ratio can be estimated using the expected effec- objectives that can be addressed. Therefore, the strategy rec- tiveness (shown in Appendix B) and the cost data shown in ommended in this document is for the state to (1) conduct Table 9. problem identification (as above), (2) identify priority areas A state may conclude that it would be better served by im- (as above), (3) identify cost-effective countermeasures that plementing a program on a regional basis instead of statewide. can be implemented, and then and only then (4) formulate All of the benefit and implementation cost numbers can be realistic objectives based on the expected effectiveness of the scaled accordingly just by entering the total number of deaths identified countermeasures. for that region, relative to those of the "typical" state (to get an Consider, for instance, the objectives of the health care estimate of total costs) and then entering the number of deaths delivery system, which includes doctors, hospitals, medical for the targeted population in the region involved. Programs insurance companies, etc. This system is presented with a that may fall into this category of regional or sub-group im- range of medical conditions. Some of these conditions can be plementation include child pedestrian safety (urban), red-light treated, given current technology, and some cannot. The ob- running (urban and suburban), community under age-21 jective of the system is to treat those that can be treated. The enforcement (college towns), and reduced speed limit for best that can be accomplished for the remainder is to attempt pedestrians (urban). to deal with the symptoms since the underlying problem can This exercise will result in a series of countermeasures that not be solved given current medical technology. The limiting the state intends to include in its highway safety plan. At least factor is the availability of a course of treatment. Although the some of these countermeasures will be accompanied by desire may be to cure everyone, the system can only realisti- benefit/cost estimates. Other countermeasures may be cally cure those medical conditions that are treatable now, at implemented with little cost or on a user-pay basis such that this time, in this place, with available technology. the benefit/cost ratio is not relevant. Similarly, although highway safety professionals may wish Note that all of the selected countermeasures--Proven, to save everyone, they can only realistically deal with those Proven without injury reduction estimates, and Likely--can deaths and injuries for which there is an available counter- be assessed with respect to the target groups listed in Table 9. measure that can be implemented in their state, at this time. Measures attempting to deal with a large target group will be This list of effective countermeasures is the limiting factor favored, other things being equal, over measures dealing with and, as such, it is the driving consideration in the develop- a much smaller target group. ment of a highway safety plan.