Lightweight Run Over By Heavyweight—Reflections on a Bicycle Accident from a HOP Perspective

On Wednesday morning 23 October 2019, Martin Vosseler was on his way to work on his push bike. He was riding along Austrasse, a residential street in Basel, Switzerland (Figures 1, 2). According to a police statement in a Swiss newspaper, Martin “fell off his pushbike while a truck was overtaking. Subsequently [he] was rolled over by the rear axle of the truck [and] died at the scene of the accident” (translated from German).[1] A breathalyser test of the truck driver—a routine check for police to conduct under the given circumstances—turned out negative.[2]

Figure 1. Scene of the accident on 23 October 2019.[3]

In Switzerland, road traffic takes place on the right-hand side (Figure 2). Besides car parking on the right, Austrasse accommodates a one-way, city-outbound lane for public traffic, separated by a white centre line on the ground. Trams operate in both directions in frequent and regular intervals. The stopping area for city-inbound trams is prohibited for public traffic use (white markers). A red-white triangle sign indicates an upcoming narrowing further down the street (Figure 2). 

Figure 2. Diagram of the accident site.[17]

When looking at the photo of the accident showing the truck and white police tent covering the victim (Figure 3), the viewer may experience a sense of resentment and blame. It may feel difficult not to jump to conclusions and allocate blame to those involved. In hindsight, it almost seems reasonable to blame the truck driver for overtaking or the victim for potentially falling off their push bike. One might be tempted to think, “How could a truck have attempted to overtake a cyclist under those circumstances?” “How are cars, trucks, trams and cyclist supposed to safely make their way through Austrasse, especially in busy rush hour traffic?”

Figure 3. Scene of the accident on 23 October 2019.[3]

To blame is human. It is a natural response. Yet blame does not help prevent reoccurrence. It does not improve safety. Blame hampers learning and making steps towards improvement. Because without learning and improving, every accident, injury and fatality is even more meaningless. Through the words of the priest at the funeral, Martin’s family and closest friends expressed their intention and desire to move beyond resentment and blame (translated from German)[4]

“We have no resentment. Also not against the truck driver or their company. Martin has become a victimlike a series of otherswho have become victims because we live the way we live. This is an important message to the truck driver who has been involved [in this accident] without any [negative] intentions.”

Indeed, accident statistics provide some insight regarding the dangers on roads in Switzerland.[5] In 2018, 4,676 people were injured in accidents involving bicycles and e-bikes (3,629 on bicycles), of which 3,451 people were lightly injured (2,725 on bicycles), 1,186 people were seriously injured (877 on bicycles), and 39 people were killed (27 on bicycles). Compared to railroad transport, it is 59 times more dangerous to drive a car and 669 times more dangerous to ride a bicycle on Swiss roads.[6] 

The statistics reflect the challenges on the road, where people’s behaviour is influenced by the context. Austrasse—and particularly the section where the accident occurred—is considered an uncomfortable road for cyclists.[7] Push bike riders are supposed to keep enough distance from the parked cars, which, however, is difficult due to the tram tracks.[8] The tracks are lowered into the ground and wide and deep enough to catch the wheels of a regular push bike.[9] Cyclists have the choice to ride on the right, left or in the middle of the tracks. Riding on the left and middle of the tracks reduces the distance from passing traffic and trams from the opposite direction. On the right, there is only approximately half a meter between the tracks and parked cars,[7] bearing an increased risk of being surprised by people suddenly opening car doors or stepping out between the parked cars.[8] Road vehicles are increasingly becoming larger and wider, using more space and exceeding marked parking lots.[10] When riding between tram tracks, cyclists experience road rage by cars, such as being pressed from behind, honked at, or overtaken on minimal distance. Such and similar occasions present error traps and an increased risk to cyclists. 

The reasons for Martin to fall off his push bike remain subject of present investigations.[11] However, when considering human error as normal and accidents as the absence of capacity—as inspired by the operating philosophy of ‘Human and Organisational Performance’ (HOP)[12]—the actual reasons for any fall of a cyclist are of less interest—or uninteresting whatsoever.[13,14] Humans are fallible. People make mistakes and will make mistakes. Cyclists have fallen off their bikes and they will fall in the future. 

Reminding cyclists not to fall and try harder to avoid accidents is hardly useful because it does not add capacity to manage the complex nature of road traffic.[13] Safety is about the presence of capacity. Capacity is the availability of unused resources to successfully deal with eventualities. Examples are extra fuel in the car, additional battery charge on the mobile phone, or bike paths/lanes that provide added space between cyclists and other traffic. Modern cars are increasingly equipped with the capacity to reduce the consequences of impacts, such as air bags and roll protection, because the car industry has shifted its mindset toward expecting that cars will be crashed.[13] This option is largely unavailable to cyclists, making them weaker participants who require protection by improved road design. 

With the benefit of hindsight, it has become apparent that Austrasse did not incorporate the necessary capacity to maintain safe traffic flow at the time of the accident. There was insufficient space for a truck and cyclist to safely travel alongside each other. The unintended outcome of a fall had the potential of fatal consequences. Sufficient space was missing to allow cyclists to fail safely, i.e. to fall without being rolled over by other traffic. There were no controls to prevent severe consequences and create recoverability.[13] 

No plans are yet in place to improve traffic conditions on Austrasse.[8] But the accident has triggered responses to learn from the event and improve road safety. An interpellation has been handed in to the government to investigate and find answers to questions concerning roads in which trams operate, such as those:[10]

  • Which roads provide 1 meter or less between the tram tracks and the curb or parked cars?
  • Is it possible to remove centre lines or replace continuous centre lines with broken centre lines to allow cars to overtake cyclists with the recommended distance of 1.5m or more? 
  • Is the government willing to add and change signage and speed limits? 

Ideas for improvement aim at increasing the capacity to allow for human error without—or less severe—consequences. An example is the removal and replacement of present car parking with bike paths to provide cyclists with additional space.[8,9] A Switzerland-wide trial has been conducted in multiple towns since 2016 by the Federal Roads Office and Swiss Council for Accident Prevention.[14] As part of the project, two streets in Basel were exclusively converted to so called ‘bicycle roads,’ where conditions were changed to protect cyclists, such as limiting the speed to 30km/h or adding additional signs (Figure 4). The results show great acceptance, an increased sense of safety and comfort by cyclists, and a larger number of cyclists using the paths of up to 40%.[15] 

Figure 4. Examples of alterations to road conditions as part of a trial to improve bicycle safety.[15]

Another systems response to improving bicycle safety is a project to remove the present gaps of tram tracks (Figure 5). Rubbers inserted into the tracks are squished by the wheels of passing trams, and otherwise smoothly level the tracks with the road to prevent bicycle wheels from getting caught in the tracks.[10,17] The new system is currently being tested by the manufacturer, tram operation authorities and cyclists under various conditions, including water, carnival confetti, thawing salt, as well as track fractures and repairs. 

 Figure 5. Trial project to remove gaps within tram tracks.[16] 

Some of the present efforts are promising to improving road safety. Sadly, they come too late for the victims injured or killed in road traffic accidents to date. There are pockets of brilliant ideas for improvement, yet progress is slow, and efforts are hardly coordinated across different groups of stakeholders, such as research centres, unions and the government. Without timely efforts to learn and improve, the question is not if but when the next incident will occur. Additional systemic interventions are required to prevent reoccurrence. They could involve further government initiatives to collaborate with cyclist organisations to identify hotspots, provide an understanding where defences are limited, and implement additional protection to some of the weakest participants in road traffic.[13]

Three months after the incident, paintings on the side of the road and a white-painted bicycle chained to a pole are symbols to remember the victim and the fatal bicycle accident (Figure 6). Yet changes to the road conditions on Austrasse remain outstanding. The street accommodates much traffic. Cyclists share the road with cars, trams and trucks. And despite being of average size, some of the trucks are unable to remain within the lane without running onto or over the centre line when passing through the location where lightweight Martin was run over by a heavyweight.[4]

Figure 6: Location of the accident on 2 January 2020.[17]

References:

[1] www.srf.ch/news/regional/basel-baselland/trauer-in-basel-umweltaktivist-martin-vosseler-kommt-bei-velounfall-ums-leben
[2] www.bazonline.ch/basel/stadt/der-getoetete-velofahrer-war-martin-vosseler/story/31715246
[3] www.bzbasel.ch/basel/basel-stadt/verkehrsunfall-mit-todesfolge-an-der-austrasse-das-opfer-war-martin-vosseler-71-135855684#
[4] www.youtube.com/watch?v=51HV0b130JM&feature=youtu.be
[5] www.bfs.admin.ch/bfs/de/home/statistiken/mobilitaet-verkehr/unfaelle-umweltauswirkungen/verkehrsunfaelle/strassenverkehr.html
[6] www.bfs.admin.ch/bfs/de/home/statistiken/mobilitaet-verkehr/unfaelle-umweltauswirkungen/verkehrsunfaelle.html
[7] www.onlinereports.ch/News.99+M5ee9a24c8fa.0.html
[8] www.20min.ch/schweiz/basel/story/-Mit-einem-Velostreifen-waere-das-nicht-passiert–17322337
[9] www.bikecitizens.net/de/strassenbahnschienen-fuer-radfahrer-sicher-machen/
[10] telebasel.ch/2019/10/29/nach-vosseler-unfall-politiker-fordert-massnahmen/?channel=105100#comments-exp
[11] www.onlinereports.ch/News.99+M59577b90234.0.html
[12] Conklin, T. (2019). The 5 Principles of Human Performance: A Contemporary Update of the Building Blocks of Human Performance for the New View of Safety. Independently published.
[13] Conklin, T. (Host). (2015-present). Preaccident Investigation Podcast [Audio podcast]. Retrieved from preaccidentpodcast.podbean.com.
[14] www.mobilitaet.bs.ch/velo/pilotversuch/velostrassen.html
[15] ASTRA. (2018). Pilotversuch Velostrassen. Retrieved from bit.ly/3btvmZV
[16] www.srf.ch/play/tv/srf-news/video/endlich-velotaugliche-tramschienen?id=4f06ee6e-6844-40aa-ae52-ed2137735aee
[17] Pictures taken by author on 2 January 2020.

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As a Human Factors and safety specialist, I help organisations in various industries tackle everyday safety and Human Factors challenges to improve safety management.

4 Comments

  1. Tom McDaniel Reply

    I struggle to recognize why we are still looking at incidents for learning. Yes, they can provide this but the opportunity is to build the capacity and capability to find organizational management and cultural systems that are working well or those that are failed, weak, or non-existent. This continued practice only goes to solidify the false assumptions that the lack of an incident means that the task was successful. If we are going to progress into the next stage or age of safety (5th age), we need to get past these reviews.

    Every time we post something about our incident rates, every time we hold a safety stand down after an incident, every time we send out a safety gram after an incident, we are unknowingly admitting that we are stuck in our capacity and capability to learn.

    We have done a terrible job teaching our management about how to measure safety where now all they expect are rate reviews.

    As an industry we are stuck, but we don’t have to be. Safety-II and Safety Differently are bridges to help get us to this next level; that’s all. They are very powerful but we have yet to define all of the narratives and practices to make them integral into all operations. We will get there as the need exists for this next maturity.

    This is a great review. I think the author should be commended. But I will continue to ask “Why are we waiting for failure to learn?” Absolutely everything can be learned from tasks without obvious incident.

    1. Heather Kahle Reply

      Interesting perspective Tom and while learning without incident would be utopian, as the article points out, humans are fallible (‘they will continue to fall’…off bikes or scaffolding or whatever…). Investigations will never (nor should they) cease so to learn from incident (while not ideal), is necessary and powerful. Regulators around the globe, will investigate (families, the public, demand it). Our response should be deliberate and effective and learning is key. I work in the safety domain and applying Safety II (the work of Sidney, Erik, Todd and others) specifically to preventing struck-bys and it is so challenging because in the wake of an incident people want justice not just avenues to build capacity. sadly looking at disparate pieces of the system, and laying blame doesn’t the system or anyone in the system well. Learning from what goes well as well as what goes wrong is important.

  2. Adam Johns Reply

    An excellent article capturing the principles that people accountable for any safety-critical system need to consider. I particularly like the way the author articulates the issue of blame and learning. Very well written.

    “To blame is human. It is a natural response. Yet blame does not help prevent reoccurrence. It does not improve safety. Blame hampers learning and making steps towards improvement. Because without learning and improving, every accident, injury and fatality is even more meaningless.”

  3. Steven Prevette Reply

    This was a good article, and does leave you somewhat unfulfilled in terms of – why can’t “they” fix that situation?

    But it is real-world. We have risks out there, yes, people will fall off their push bikes, and I hear the “excuse” all the time of you can’t prevent stupidity. (Oh that indicates blame . . .)

    I assume from the article that indeed this was a known problem, as various fixes are already in the works, maybe just not at this specific location.

    My job is indeed tracking injury rates, and reacting to the latest event. People do leap to blame, but we do try to deal with the HOP side of things. And yes, we do a lot of leading indicators in terms of management field observations, employees doing behavior based safety observations, and trying to predict and manage our risk and try to get the funding needed to do that.

    It’s not a perfect world, we can’t all wrap ourselves in bubble wrap (and that would not help in the instance of being run over), but I do appreciate our efforts to move forward.

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