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Bicycling crashes on streetcar (tram) or train tracks: mixed methods to identify prevention measures Teschke, Kay; Dennis, Jessica; Reynolds, Conor C O; Winters, Meghan; Harris, M. A Jul 22, 2016

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RESEARCH ARTICLE Open AccessBicycling crashes on streetcar (tram) ortrain tracks: mixed methods to identifyprevention measuresKay Teschke1* , Jessica Dennis2, Conor C. O. Reynolds3, Meghan Winters4 and M. Anne Harris2,5AbstractBackground: Streetcar or train tracks in urban areas are difficult for bicyclists to negotiate and are a cause ofcrashes and injuries. This study used mixed methods to identify measures to prevent such crashes, by examiningtrack-related crashes that resulted in injuries to cyclists, and obtaining information from the local transit agencyand bike shops.Methods: We compared personal, trip, and route infrastructure characteristics of 87 crashes directly involvingstreetcar or train tracks to 189 crashes in other circumstances in Toronto, Canada. We complemented this withengineering information about the rail systems, interviews of personnel at seven bike shops about advice theyprovide to customers, and width measurements of tires on commonly sold bikes.Results: In our study, 32 % of injured cyclists had crashes that directly involved tracks. The vast majority resultedfrom the bike tire being caught in the rail flangeway (gap in the road surface alongside rails), often when cyclistsmade unplanned maneuvers to avoid a collision. Track crashes were more common on major city streets withparked cars and no bike infrastructure, with left turns at intersections, with hybrid, racing and city bikes, among lessexperienced and less frequent bicyclists, and among women. Commonly sold bikes typically had tire widthsnarrower than the smallest track flangeways. There were no track crashes in route sections where streetcars andtrains had dedicated rights of way.Conclusions: Given our results, prevention efforts might be directed at individual knowledge, bicycle tires, or routedesign, but their potential for success is likely to differ. Although it may be possible to reach a broader audiencewith continued advice about how to avoid track crashes, the persistence and frequency of these crashes and theirunpredictable circumstances indicates that other solutions are needed. Using tires wider than streetcar or trainflangeways could prevent some crashes, though there are other considerations that lead many cyclists to havenarrower tires. To prevent the majority of track-involved injuries, route design measures including dedicated railrights of way, cycle tracks (physically separated bike lanes), and protected intersections would be the best strategy.Keywords: Bicycling injuries, Bike safety, Bike lanes, Public transport, Streetcar, Train, Built environment* Correspondence: kay.teschke@ubc.ca1School of Population and Public Health, University of British Columbia, 2206East Mall, Vancouver, BC V6T 1Z3, CanadaFull list of author information is available at the end of the article© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Teschke et al. BMC Public Health  (2016) 16:617 DOI 10.1186/s12889-016-3242-3BackgroundBoth bicycling and public transport are seen as means toincrease physical activity in the population and to reduceair emissions that induce climate change [1]. Amongpublic transport modes, streetcars (North Americanterm) or trams (European term) have many benefits(higher ridership and low carbon footprint) and areoften promoted over buses [2, 3]. Bicycling is oftenidentified as a means to access public transport, but thepotential impact of a transit system on bicycling injurieshas rarely been studied. In recent years, research hasbegun to report high numbers and high risks of injuriesto bicyclists riding near streetcar or train tracks [3–9].These studies include one we conducted in the citiesof Vancouver and Toronto, Canada [4, 6, 7]. The studyincluded 690 adults who were sufficiently injured in abicycling crash to require treatment at a hospital emer-gency department. Of these, 14 % had a crash that dir-ectly involved streetcar or train tracks [6]. A three-foldincreased risk of injury was observed when cycling onroutes with streetcar or train tracks, with a higher risk inthe street segments between intersections than at inter-sections themselves [4, 7]. Unlike Vancouver, Torontohas an extensive streetcar system (the largest in NorthAmerica) and 32 % of participating cyclists injured therehad crashes that directly involved tracks, compared to2.5 % in Vancouver.In this paper, we examine the Toronto crashes in moredetail, to describe the circumstances, infrastructure atthe crash sites, trip conditions, and characteristics of theinjured cyclists and their bicycles. Our goal was toidentify factors that are associated with increased or de-creased potential for crashes on tracks. We also obtainedengineering information about the tracks from the tran-sit authority and visited a sample of bicycle shops tomeasure tire sizes and interview staff about this issue.The overall aim was to identify ways to prevent suchcrashes in the future.MethodsThe injury studyThe procedures for the injury study have been describedin detail elsewhere [4, 6, 7]. The following is a summaryof the Toronto component relevant to the analysespresented in this paper. The study population consistedof adult (≥19 years) residents of Toronto who were in-jured while riding a bicycle in the city and treated within24 h in the emergency departments of St. Michael’sHospital, Toronto General Hospital or Toronto WesternHospital between May 18, 2008 and November 30, 2009.All hospitals were located in the central business district,and one was a regional trauma centre.Eligible participants were interviewed in person bytrained interviewers about personal characteristics, tripconditions, and crash circumstances, using a structuredquestionnaire [10] as soon as possible after the injury tomaximize recall. Crash circumstances were derived fromparticipants’ answers to the following questions: In your own words, please describe thecircumstances of the injury incident. Was this a collision between you and a motorvehicle, person, animal or object (includingholes in the road)? If yes, what did you collide with? (response options:car, SUV, pick-up truck, or van; motorcycle orscooter; large truck; bus or streetcar; pedestrian;cyclist; animal; other non-motorized wheeledtransport; pot hole or other hole; streetcar or traintrack)Personal characteristics queried in the interview andused in analyses presented here included sex, age, andthree factors potentially related to cycling skill: whetherthey had taken an urban cycling training course; whetherthey considered themselves an experienced cyclist; andthe number of times they had cycled in the last year(reported by season and summed). Trip characteristicsincluded weather, purpose, bike type, and whether medi-cations, alcohol or marijuana were used in the 6 h prior.Bike type was queried with a poster of photos showingan example of each of the following types: city, touring,hybrid, racing, folding, cruiser, mountain and recum-bent. Participants were also able to specify other biketypes.Structured site observations were made to documentcharacteristics of injury and control sites, and allowroute infrastructure classification [4, 7, 11]. The observa-tions were made blind to whether an injury took place atthe site or not. In the current analyses, only the injurysite data were used. Infrastructure characteristics used inthese analyses were selected primarily if they wereshown to be related to injury risk in previous analyses:route type, intersection location or not, grade, and pres-ence of construction [4, 7]. Route type at an intersectionwas defined as the route type the cyclist arrived from.To determine whether a crash directly involved street-car or train tracks, several steps were involved [6]. Theblinded and objective site observation data were used toidentify whether the crash was at a site where trackswere present. Wherever this was the case, the closed-ended interview response about what the participantcollided with and the open-ended interview response de-scribing the crash circumstances were reviewed. Eachcrash resulting from the participant’s bike slipping on atrack rail, hitting a track component, or its tire beingcaught in the rail flangeway was separately coded andcounted. These circumstances were classified as “injuryTeschke et al. BMC Public Health  (2016) 16:617 Page 2 of 10directly involved a streetcar or train track”; all otherinjuries were classified as “other or unknown injury cir-cumstance”. The interview data were also used to clas-sify whether a motor vehicle was involved in the crash(i.e., a collision with a motor vehicle or a crash after amaneuver to avoid a collision with a motor vehicle).Data analyses were performed using JMP 11 (SASInstitute, Cary, NC). Descriptive data on crash circum-stances, infrastructure at the crash site, trip conditionsand personal characteristics were compared for injuriesinvolving streetcar or train tracks vs. other or unknowncircumstances. The Chi2 test (categorical independentvariables) and t-test (continuous independent variables)were used to identify factors that differed betweencategories of the dependent variable: injury directlyinvolved streetcar or train tracks vs. other or unknowninjury circumstances. Variables that were significant inthe bivariate analyses (p < 0.05) were offered to multiplelogistic regression. Two independent variables werestrongly associated with each other (experienced cyclistand cycling frequency). Of the two, only cyclingfrequency was significant in multiple regression andretained in the final model.Streetcar tracks in TorontoThe Toronto Transit Commission Streetcar Departmentwas contacted to obtain the engineering specifications ofthe streetcar rails and flangeways (gap in the road sur-face alongside rails) and other characteristics of thestreetcar rail infrastructure, and to provide comparisonsto train infrastructure in the city.Survey of Toronto bike shopsIn the summer of 2015, we sought input from eight bi-cycle shops within 7 km of the Toronto central businessdistrict and recognized by investigators as frequented bycommuter cyclists. Five of the shops were in the down-town core, two to the east, and one to the north. Eachshop was sent an introductory letter explaining the pur-pose of the survey and the procedures involved. Thiswas followed with a phone call requesting participationand setting up a time to visit the shop. The survey wasopen to all shop employees; the position of the staffmember interviewed was not recorded. The followingopen-ended questions were asked: What types of cyclists shop at this store? Do any shoppers ask about ways to avoid streetcartrack injuries? What advice do you give? To yourknowledge, does this store have a policy or standardrecommendation for customers concerned aboutstreetcar track injuries? There are hundreds of tire sizes and styles. Do yousell any tires (or do you know of any tires) that areless likely to get caught in a streetcar track grooveor slip on streetcar track surfaces? Do you think there are any other bicycle, wheel, ortire design elements that could reduce the risk ofstreetcar track injuries?We asked to be shown popular bikes and to measuretheir tires. The following data were recorded: bike type;tire manufacturer; tire size as imprinted on the tire; andmeasured tire width (including knobs, if present). Biketype was recorded as described by bike shop personnel.Measurements (tire width, tire depth, wheel width) weretaken on inflated tires mounted on bicycle wheels, usingcalipers (Capri Tools, CP20001, Pomona, California).Tire widths were summarized overall and by bike typeas means, minima and maxima. Overall proportionsnarrower and wider than Toronto streetcar flangewayswere calculated. The measured tire widths werecompared to the widths printed by the manufactureron the tire.ResultsStreetcar and train tracks in TorontoToronto’s streetcar system has about 80 km of doubletrack (one set in each direction) (personal communica-tion, Stephen Lam, Toronto Transit Commission, May2015). Most of the eleven routes operate in mixed traffic,but three operate in dedicated rights of way (for street-cars only, except at intersections). Streetcar tracks inToronto are typically constructed with two types of rail(Fig. 1): girder rails and tee rails. Wheels ride on the railsurface and are held in position by a larger diameterflange on one side of the wheel (Fig. 1c) that rides in aslot beside the rail: the “flangeway”. In girder rails, theflangeway is part of the cast steel rail, whereas flange-ways for tee rails are constructed as they are laid in thestreet concrete. Most straight sections of Toronto street-car tracks are constructed with tee rails and most curvesuse girder rails. The flangeway of girder rail used inToronto has a typical width at the top of 37.5 mm(millimeter) and a width just below the surface of34.5 mm, though the width changes as the railhead isworn. Tee rail flangeways vary in width; US guidelinesindicate widths in similar systems of 38 to 50 mm [12].Railway train rights of way are private except at roadcrossings (personal communication, Stephen Lam,Toronto Transit Commission, May 2015). Tracks areconstructed with tee rails that sit atop railway ties formost of their distance. At road crossings, the rail is em-bedded in the road surface material (concrete or asphalt)and flangeways are constructed as for streetcar tracks. Rail-ways in Canada can use the same tee rail as the Torontostreetcar system (Fig. 1b), though on high tonnage lines,heavier rail with the same profile is used [13].Teschke et al. BMC Public Health  (2016) 16:617 Page 3 of 10The injury studyOur study included 276 people who had been injuredwhile cycling and attended one of the three participatingToronto emergency departments. Of these, 139 hadcrashes at sites where streetcar or train tracks werepresent and 87 of those had crashes that directlyinvolved the tracks. Three of the people who crashed ata streetcar track location could not remember enoughdetail about their crash to determine if the tracks weredirectly involved; these were classified as havingunknown circumstances. None of the study participantshad a collision with a streetcar or train.The vast majority (85 %) of the track crashes resultedfrom the bicycle tire being caught in the flangeway(Table 1). The remainder resulted from tires slipping onthe rail surface (just over half of slips occurred duringrain, snow or fog conditions). Table 1 provides sampledescriptions of the circumstances leading to track-involved crashes. None of the track crashes includedcollisions with other parties, but a common feature wassudden maneuvers to avoid collisions (mainly withmotor vehicles, but also cyclists and pedestrians); theseresulted in unanticipated track crossings or crossings atshallower angles than planned.Table 2 summarizes data on the crash circumstances,route infrastructure at the crash site, trip conditions,and personal characteristics of the cyclists injured instreetcar or train track crashes vs. in other circum-stances. Six factors had significant associations withcrashes that directly involved tracks. A higher propor-tion of track crashes than other crashes were on majorstreets with parked cars and no bike infrastructure(Fig. 2). A slightly higher proportion of track crashesthan other crashes were at intersections, mainly becauseof a much higher proportion of left turn crashes. Biketypes with higher proportions involved in track crasheswere hybrid, racing, and city bikes. Women and inexperi-enced cyclists had higher proportions of track crashes.People who had track crashes cycled on average lessfrequently than those who had other crash circumstances.Other characteristics did not significantly differ be-tween track-involved and other crash circumstances, butprovide a picture of the crashes. Of track crashes, 41 %involved motor vehicles, 60 % occurred on flat grades,and 15 % occurred where construction was present.Most track crashes happened on clear days (60 %), andabout half happened on commutes to work or school oron the job. Cyclists had rarely used prescription medica-tions (6 %), alcohol (12 %) or marijuana (1 %) in the 6 hprior to the trip. The majority of those injured on street-car or train tracks were ages 20 to 39 (67 %). Few hadurban cycling training (6 %).Fig. 1 Toronto rails, flangeways and wheels. a Profile of girder rail (NP4aMOD) with integrated flangeway. b Profile of tee rail (115 lb AREA)showing flangeway created by gap between side of rail and adjacent concrete. c Streetcar or train wheels on tee rail, showing larger diameterflanges that hold wheels in place. d Example of how flangeway widths can vary along a streetcar line. (Image c: Wikimedia Commons, Pantoine)Teschke et al. BMC Public Health  (2016) 16:617 Page 4 of 10In multiple logistic regression (Table 3), route type,intersection status, sex and cycling frequency weresignificantly associated with whether a crash directlyinvolved a streetcar or train track vs. not. Majorstreets with parked cars and no bike infrastructurehad higher odds of a track-involved crash than allother route types. Left turns at intersections hadmuch higher odds of a track-involved crash com-pared to other intersection movements and non-intersections. People who cycled more frequently hadlower odds of a track-involved crash. Women hadhigher odds than men of a track-involved crash.Survey of Toronto bike shopsSeven of the eight invited bike shops participated in thesurvey. As expected given the shop selection, commutercyclists were their main customers (50 to 85 %) and theymainly bought commuter, hybrid, comfort or city bikes.Recreational cyclists were the next largest group (15 to50 %), buying mountain bikes in addition to the biketypes typically purchased by commuters. Smaller nichegroups bought fat, road, racing, or recumbent bikes ortrikes. Most stores had more male than female cus-tomers, though several reported 40 % or more of theircustomers as women. One store catered to families.All bike shop personnel reported that some customers,particularly those who were less experienced, askedabout how to handle streetcar tracks, including askingwhether wider tires or mountain bikes would help. Allindicated that they advised such customers to be awareof tracks and cross them at appropriate angles: at least45°, 90° optimally. Shop personnel reported selling widetires to concerned customers, but many were reluctantto advise this, for several reasons: they considered widetires to be slower and less efficient for commuting; theythought very wide tires (e.g., fat bike tires that are over100 mm wide) would be needed to avoid being caught inall flangeways; they thought that some wide tires maystill get caught especially if they have knobs on them;and they thought that wide tires would still have the riskof slipping on track surfaces. Other advice that shoppersonnel reported giving to concerned customers in-cluded planning their routes to avoid streets with street-car tracks, making two-stage left turns at intersectionswith tracks, being extra cautious in wet and icy weather,and keeping tires inflated. Most shop personnel indi-cated that there were no tires that could prevent slippingon rail surfaces, but one mentioned slick tires withgrooves to help move water away from the center, andtwo mentioned tires made from “tackier” rubber com-pounds, though they thought these wear more quickly.Table 4 summarizes width measurements of tires onbikes commonly sold at the participating shops. Thewidths spanned a wide range, from 24.8 mm on a singlespeed racing style bike to 112 mm on a fat bike. Most ofthe tires were narrow enough to be caught in the nar-rowest streetcar track flangeways (34.5 mm) and only afew were wider than the widest likely flangeways inToronto (50 mm). Some bike types had consistent tiresizes (e.g., single speed bikes had consistently narrowtires < 30 mm; touring or road bikes medium width tiresfrom 33 to 37 mm; and cruiser bikes wide tires ≥ 49 mm),whereas others, particularly city and hybrid bikes, hadbroad ranges of tire widths. We compared measured tireswidths with the manufacturer widths imprinted on the tireand found they agreed very well (mean |difference| =1.7 mm, SD (standard deviation) = 1.1 mm, range 0 toTable 1 Circumstances of crashes directly involving streetcar(N = 83) or train tracks (N = 4), with examplesaTire caught in track flangeway, N = 74 (85.1 % of track injuries)Intersection examplesI had been cycling on the right side of the road but I wanted tomake a left turn and while moving to the centre of the lane my bikewheels got caught in the streetcar tracks.As I approached an intersection, there was a car in front of meturning right. To go straight, I moved around the car into the left lanebut as I did, my front tire got stuck in the streetcar track.I had a green light so I proceeded through the light. A cyclist turnedright onto the bike path I came from. I swerved to avoid her and mywheel got caught in the train track.Non-intersection examplesAs I was cycling in the curb lane, a truck passed me, stopped andturned on his hazards. I went around him on the left which put mebetween the street car tracks. As I was going over the street cartracks my back wheel got caught.There was an ambulance coming from behind me and a car parallelparking in front of me. I moved across the tracks to avoid the car.When I attempted to move back into the right lane, my back wheelgot caught in the streetcar track.I was biking in the right hand lane and in front of me a woman openedher car door. I moved to the center lane, but as I was moving back tothe right lane my front tire got caught in a streetcar track.There were three big trucks parked in the curb lane. I moved intothe lane beside me to avoid them. I looked back to move backinto the curb lane when my front tire got caught in the streetcartracks.There was another cyclist ahead of me. I moved into the left lane andpassed her. When I attempted to move back into the right lane, myfront wheel got caught in a street car track.Tire slipped on track rail, N = 13 (14.9 % of track injuries)The roads were very wet and slick. I was travelling south, turning left.I was leaning into the turn. I hopped over the first streetcar rail andwas getting ready to cross the next rail when my back tire slipped onthe track.I came to two sets of railway tracks. I slowed down and crossed thefirst set but when I started to cross the second set, my front tire slidon the wet track.aAs described by injured cyclists in TorontoTeschke et al. BMC Public Health  (2016) 16:617 Page 5 of 104.4 mm). Toronto has a public bike share program in thedowntown core (1000 bikes in 2014); its bikes have49.5 mm tires (personal communication, Scott Hancock,Motivate Company Toronto, January 2016).DiscussionThe 87 cyclists injured in track-involved crashes inthis study, recruited at three Toronto emergencydepartments over an 18-month period, appear tocomprise the largest case series involving streetcarand train tracks reported to date. Three other studiesidentified cases in a single hospital over a similartime period: 41 emergency department cases inSheffield [3]; ten hospitalized cases in Amsterdam [9];and five emergency department cases (all e-bikeusers) in Bern [5]. A Dutch study in 13 hospitalsreported on four emergency department cases [14].As in our study, the dominant scenario for trackcrashes in most European studies was bike tires beingcaught in the flangeway [3, 5, 9]. The exception wasthat all four Dutch cases involved bicycle wheelsTable 2 Crash circumstances, crash site infrastructure, tripconditions and cyclist characteristics, 276 cyclists injured in TorontoCrash directlyinvolvedstreetcar ortrain trackOther orunknowncrashcircumstanceN % N %87 a31.5 189 a68.5Crash circumstancesMotor vehicle involved 36 b41.4 97 c51.9Infrastructure at Crash SiteRoute typedMajor street with parked cars,no bike infrastructure49 56.3 53 28.0Major street, no parked cars,no bike infrastructure26 29.9 58 30.7Major street with painted bike lane 7 8.0 29 15.3Residential street 2 2.3 20 10.6Sidewalk or multiuse path 3 3.4 29 15.3Intersection statusdNon-intersection 59 67.8 143 75.7Intersection, straight through 13 14.9 42 22.2Intersection, right turn 2 2.3 3 1.6Intersection, left turn 13 14.9 1 0.5GradeDownhill 28 32.2 75 39.7Flat 52 59.8 91 48.1Uphill 7 8.0 23 12.2Construction present 13 14.9 21 11.1Trip ConditionsWeather during tripClear 52 59.8 127 69.4Cloud cover 20 23.0 35 19.1Rain, snow or fog 12 13.8 13 7.1Wind 3 3.4 8 4.4Trip purposeMultiple 4 4.6 12 6.3Personal business 21 24.1 31 16.4Recreation 9 10.3 33 17.5Social reasons 11 12.6 37 19.6Commute to work or school, job 42 48.3 76 40.2Bike type used on tripdHybrid 37 42.5 49 25.9Racing, track, fixed gear 14 16.1 24 12.7City 6 6.9 9 4.8Mountain 17 19.5 57 30.2Touring/road 9 10.3 32 16.9Other: BMX, cruiser, folding 4 4.6 18 9.5Table 2 Crash circumstances, crash site infrastructure, tripconditions and cyclist characteristics, 276 cyclists injured in Toronto(Continued)Drugs or alcohol used in 6 h prior to tripMedication 5 5.7 17 9.0Alcohol 10 11.5 18 9.5Marijuana 1 1.1 4 2.1Cyclist characteristicsAge20–29 32 36.8 60 31.730–39 26 29.9 57 30.240–49 13 14.9 29 15.350–59 11 12.6 26 13.860 + 5 5.7 17 9.0SexdFemale 52 59.8 69 36.7Male 35 40.2 119 63.3Urban cycling training course takenYes 5 5.7 7 3.7No 82 94.3 182 96.3Experienced cyclistdYes 74 85.1 181 95.7No 13 14.9 8 4.2Cycling frequency (times per year)d mean 123(SD 72.4)mean 149(SD 74.0)a % of all 276 injured cyclistsb % of 87 injuries on tracks (applies to all following % in this column)c % of 189 injuries not on tracks (applies to all following % in this column)d Variable distribution significantly different (p < 0.05) for “crash directlyinvolved streetcar or train track” vs. “other or unknown crash circumstance”Teschke et al. BMC Public Health  (2016) 16:617 Page 6 of 10being deflected by tram rails [14]. Two Europeanstudies described the types and severity of injuries(dominantly fractures and about a quarter of casesadmitted to hospital) [3, 9]. We did not gather dataon the types of injury, but we examined some aspectsof injury severity in an earlier analysis [15]. We didnot find greater severity (e.g., transport by ambulance,hospital admission) among cyclists injured at siteswith streetcar or train tracks.Personal characteristicsWe examined personal, trip and infrastructure charac-teristics related to track-involved crashes vs. othercrash circumstances. Females were over-represented intrack crashes (60 % female) compared to other crashes(37 %) and compared to the Toronto cycling population(34 %) [16]. The European studies did not provide com-parisons, but reported that the majority of those injuredon tracks were male [3, 5, 9]. We found that youngeradults (ages 20 to 39, 67 %) were also somewhat over-represented in the track-involved crashes but notsignificantly so compared to other crashes (62 %). Theinjured cyclists in our study appear to have been youn-ger than Toronto cyclists in general, based on a reportthat used different age categories (ages 15 to 34, 37 %),perhaps because our study area included large univer-sities, many of whose students commute by bike [16].Inexperience and less frequent cycling were associatedwith track-involved crashes in our study. The Sheffieldstudy began immediately after their first tram line be-came operational and they found that cycling injuriesFig. 2 Examples of route types with streetcars in Toronto. a Majorstreet with parked cars, no bike infrastructure. b Major street, noparked cars, no bike infrastructure. c Major street with painted bikelane. d Major street with dedicated streetcar right of way. e Complexnetwork of rails and flangeways at intersection of two streets withstreetcar lines. (Photos a, b, e: Wikimedia Commons, Hallgrimsson)Table 3 Factors associated with crashes directly involvingstreetcar or train track vs. other or unknown circumstancesORa 95 % CIbRoute typeMajor street with parked cars,no bike infrastructure1.0 refMajor street, no parked cars,no bike infrastructure0.44 (0.22, 0.86)Major street with painted bike lane 0.15 (0.04, 0.43)Residential street 0.12 (0.02, 0.46)Sidewalk or multiuse path 0.12 (0.03, 0.38)Intersection statusNon-intersection 1.0 refIntersection, straight through 0.84 (0.38, 1.77)Intersection, right turn 1.03 (0.12, 7.26)Intersection, left turn 43.4 (7.54, 838)SexMale 1.0 refFemale 2.10 (1.13, 3.92)Cycling frequencyAdditional 100 times cycling per year 0.67 (0.44, 0.99)a Odds ratios (OR) from multiple logistic regression, N = 276 injured cyclists inToronto. Bold indicates odds ratio is statistically significantb 95 % confidence interval (CI)Teschke et al. BMC Public Health  (2016) 16:617 Page 7 of 10peaked 3 to 6 months later, then declined by about50 % [3]. They attributed this to media attention tothe issue, supporting the idea that knowledge relatedto tracks could be helpful. Bike shop personnel con-tacted in this study all felt that the best protectionfor cyclists was to know how to behave near tracks,including being alert and crossing the tracks at aperpendicular angle. Similar guidance is provided inan Ontario government cycling skills guide, and addswaiting for breaks in traffic and potentially dismount-ing to cross tracks [17]. Since left turns can makeperpendicular track crossing difficult (especially wherethere are complicated track patterns, Fig. 2e) andresulted in much higher odds of track-involvedcrashes, education materials could also encouragetwo-stage left turns.Our results provide some support for the idea thatincreased knowledge or maneuvering skill may help,given that certain demographic groups were over-represented in track-involved crashes (e.g., less fre-quent cyclists, women), however a number of factorssuggest education may not make a great difference.Those crashing on tracks were not especially inex-perienced (average cycling frequency of 123 trips peryear). Many of the crashes resulted from sudden ma-neuvers to avoid collisions with motor vehicles, othercyclists and pedestrians, situations that did not allowprior knowledge to be used as planned. Some cyclists(children, people with certain disabilities or who donot speak English) may not be reached by or be ableto implement guidance about tracks. Finally, informa-tion about how to ride near tracks is long-standingand common in Toronto, yet the injury toll is veryhigh. These caveats underscore the need for otherapproaches.Bike tire characteristicsBike shop personnel reported that some cyclists requesttires wide enough not to be caught in track flangeways.Our analyses showed that bike type was associated withwhether injury circumstances were track-involved ornot. Bike types more frequently in track-involvedcrashes had either consistently narrow tire widths(racing, single speed) or wide ranges of tire widths(hybrid, city) in the bike shop survey. Over half the tireson commonly sold bicycles were so narrow that theywould fit in any of the track flangeways in Toronto.Although bike shop staff thought that only fat bike tireswould be guaranteed not to be caught in the flange-ways, tires of ~ 50 mm or greater on cruiser, comfort,and bike share bikes may reduce the likelihood of beingcaught in many, perhaps most, flangeways and areworthy of further study.Route characteristicsRoute type was associated with track-involved crashes.On major streets with no bike infrastructure, it matteredwhether there were parked cars or not (Fig. 2). Thesetwo route types have similar presence of streetcar ortrain tracks [7], but those without parked cars had lessthan half the odds of track-involved crashes. Theabsence of car parking provides cyclists with more roomto maneuver and avoid track crashes when somethingunexpected takes place in front of them (Table 1).Removing car parking on streets with streetcar lineswould improve conditions for cycling, especially if thespace freed up were used for cycle tracks (as discussedbelow). Painted bike lanes, residential streets, and side-walks or multiuse paths all had considerably lower oddsof track-involved crashes than major streets with no bikeinfrastructure. This was almost certainly because theseTable 4 Measured tire widths of bicycles commonly sold in seven Toronto bike shops, by bike typeN Mean width(mm)Minimum width(mm)Maximum width(mm)Proportion<34.5 mmaProportion> 50 mmbAll bike types 37 37.5 24.8 112 54 % 8 %Single speed, fixed gear 5 27.1 24.8 29.8Commuter 9 34.4 29.9 38.8City 7 34.4 27.1 47.8Hybrid 8 35.2 25.6 55.7Touring, road 3 35.6 32.7 37.1Cruiser 2 54.5 49.0 60.0Other: comfort, cargo, fat 3 67.9 41.8 112Bike Share Toronto bikesc 49.5mm millimetera Narrow enough to be caught in most Toronto streetcar flangewaysb Widest flangeway specified in US guidelines for streetcar systems similar to Toronto’s [12]c Personal communication, Scott Hancock, Motivate Company Toronto, January 2016Teschke et al. BMC Public Health  (2016) 16:617 Page 8 of 10route types were much less likely to have streetcar ortrain tracks [7].In the Netherlands, cyclists on major streets aretypically provided cycle tracks (also called physically pro-tected, segregated or separated bike lanes) and on-streettram lines typically have their own rights of way [14, 18].This may account for the low numbers of tram-relatedcrashes observed in the Dutch study [14]. Our injurystudy showed that cycle tracks greatly reduced injuryrisk to bicyclists [4, 7], but at the time of the study allexamples of this infrastructure were in Vancouver, notToronto. One Toronto streetcar line had its own right ofway during the study period (Fig. 2) and all train linesdid. We did a post-hoc check of whether any of thetrack-involved crashes were along these lines. None oftrack crashes between intersections were along them,but some were at their intersections (where there is noseparation). Even if cycle tracks or designated rail rightsof way would prevent only crashes that are not at inter-sections, track-involved crashes would be substantiallyreduced, since most (68 %) were not at intersections.Left turns at intersections were highly overrepresentedin track-involved crashes. This problem could also beaddressed with Dutch-style infrastructure, often called“protected intersections”. Such intersections commonlyfeature corner islands that direct cyclists coming fromcycle tracks to make two-stage left turns, as pedestriansdo [19]. This would make it much easier to cross tracksat right angles, but could add long delays at intersectionsunless signal timing is optimized for cyclists and pedes-trians, as in the Netherlands.Protected intersections, cycle tracks and designatedrail rights of way all follow the Swedish “Vision Zero”transport safety principle: acknowledging the inevitabil-ity of human error and providing route designs thatminimize its consequences [20]. This vision aims toeliminate deaths and serious injuries related to transpor-tation and is beginning to be adopted by other jurisdic-tions in Europe and North America.Strengths and limitationsThis study benefitted from a large case series of track-involved crashes, a comparison group with other crashcircumstances, and systematic data on crash circum-stances, personal and trip characteristics, and route in-frastructure at the crash sites. The mixed methodsapproach also collected data about advice provided tocyclists by bike shop personnel, widths of commonlysold bike tires, and engineering specifications of systemrails and flangeways to provide a broader understandingof the problem and potential solutions.Additional data would be helpful in future studies. Wedid not request data from the injured cyclists about theirtire widths. This would be worthwhile to collect, sowidths of tires involved in crashes can be compared toflangeway widths and risk related to tire width can bedirectly determined. Other characteristics (tire pressure,presence of tire knobs, weight of the cyclist) may alterthe effective tire width and should be measured to see ifthey change the tire size needed to avoid being caught inflangeways. Direct measurements of flangeway widthsthroughout the rail system would be useful, thoughtaking measurements in situ would be a dangerousendeavor. Similarly, field tests of different tire widthswith bicycling track interaction maneuvers would be in-formative but risky to participants. In cities with street-car or tram systems, it would be interesting to surveycyclists to see if they know how to reduce their individ-ual risk of track crashes, and to survey planners andengineers to see whether they are familiar with designmeasures to reduce population risk of track crashes.This study was conducted in one city in North America.Research conducted in other areas of the world with dif-ferent cycling infrastructure, streetcar or tram infrastruc-ture, and bicycle types would help determine whetherthese influence risk. Comparisons between cities andcountries would be a great way to discover best practices.Unfortunately, such comparisons are difficult because themost common coding system for traffic injuries, theWorld Health Organization’s International Classificationof Diseases [21], provides coding for collisions with astreetcar or train, but codes collisions involving tracks in abroad category of unspecified “stationary objects”. Crashand injury reporting systems that provide sufficient speci-ficity to identify track-related crashes would allow admin-istrative data to be used to tally these events, a crucial firststep in understanding their impact [14].ConclusionsIn a city with an extensive streetcar system, one-third ofbicycling crashes directly involved streetcar or traintracks. Certain demographics were more likely to havetrack-involved crashes, suggesting that increased know-ledge about how to avoid them might be helpful. How-ever, such advice is long-standing and common inToronto, yet the injury toll is very high, underscoringthe need for other solutions. Tires wider than streetcaror train flangeways (~50 mm in the Toronto system) areanother individual-based approach, but population-based measures are likely to provide the optimalsolution. Our results showed that route infrastructuremakes a difference to the odds of track-involved injuries.Dedicated rail rights of way, cycle tracks, and protectedintersections that direct two-stage left turns are policymeasures concordant with a Vision Zero standard. Theywould prevent most of the track-involved injury scenariosobserved in this study.Teschke et al. BMC Public Health  (2016) 16:617 Page 9 of 10AbbreviationsCI, confidence interval; mm, millimeter; N, number; OR, odds ratio;SD, standard deviationAcknowledgementsWe thank the injury study participants, bike shop survey participants, TorontoTransit Commission staff and Bike Share Toronto staff for generously givingtheir time. Bike shops that kindly participated were Bateman’s BicycleCompany, Broom Wagon Cyclery, Curbside Cycle, The Cyclepath Danforth,Duke’s Cycle, Sweet Pete’s, and Urbane Cyclist. We appreciate the crashcircumstance classification system developed by Theresa Frendo, and themany contributions of University of Toronto faculty and staff (Mary Chipman,Lee Vernich, Vartouji Jazmaji, Kevin McCurley, Andrew Thomas), hospitalpersonnel (Michael Cusimano, Steve Friedman, Nada Elfeki), and citypersonnel (David Tomlinson, Barbara Wentworth) to the injury study.FundingThe injury study was funded by the Heart and Stroke Foundation of Canadaand the Canadian Institutes of Health Research (Institute of MusculoskeletalHealth and Arthritis, and Institute of Nutrition, Metabolism and Diabetes).MAH and MW were supported by awards from the Michael SmithFoundation for Health Research. JD, MAH, CCOR, and MW were supportedby awards from the Canadian Institutes of Health Research. No funding bodywas involved in the design of the study, the collection, analysis orinterpretation of the data, or writing the manuscript.Availability of data and materialsData for this study may be made available upon request to the correspondingauthor, pending agreement of the relevant ethics board(s). The request shouldstate the component of the data being requested, and the title and aim of theresearch for which the data is being requested.Authors’ contributionsKT, MAH, CCOR, MW and JD were responsible for initial conception and designof the study. JD and MAH implemented the bike shop survey. KT wasresponsible for data analyses. KT, MAH and JD drafted the article. All authorscontributed to analysis decisions, interpretation of results and critical revisionand final approval of the article, and agree to be accountable for all aspects ofthe work.Competing interestsKT, CCOR, and MW have held consultancies related to their transportation orbicycling expertise. MAH and JD have no financial or other relationships oractivities that could appear to have influenced the submitted work.Consent for publicationNot applicable.Ethics approval and consent to participateThe injury study protocol was reviewed and approved by the St. Michael’sHospital Research Ethics Office and the Toronto Academic Health SciencesNetwork Human Subjects Board. The bike shop survey protocol wasreviewed and approved by the Ryerson University Research Ethics Board. Allinjured bicyclists and bike shop personnel were adults and provided writteninformed consent to participate.Author details1School of Population and Public Health, University of British Columbia, 2206East Mall, Vancouver, BC V6T 1Z3, Canada. 2Dalla Lana School of PublicHealth, University of Toronto, Toronto, Canada. 3Institute for Resources,Environment and Sustainability, University of British Columbia, Vancouver,Canada. 4Faculty of Health Sciences, Simon Fraser University, Burnaby,Canada. 5School of Occupational and Public Health, Ryerson University,Toronto, Canada.Received: 17 February 2016 Accepted: 18 June 2016References1. Maibach E, Steg L, Anable J. Promoting physical activity and reducingclimate change: Opportunities to replace short car trips with activetransportation. Prev Med. 2009;49:326–7.2. Litman T. Rail transit in America: a comprehensive evaluation of benefits.Victoria Transport Policy Institute; 2015. http://www.vtpi.org/railben.pdf.Accessed 1 Feb 2016.3. Cameron IC, Harris NJ, Kehoe NJS. Tram-involved injuries in Sheffield. Inj.2001;32:275–7.4. Harris MA, Reynolds CCO, Winters M, Cripton PA, Shen H, Chipman M,Cusimano MD, Babul S, Brubacher JR, Friedman SM, Hunte G, Monro M,Vernich L, Teschke K. Comparing the effects of infrastructure on bicyclinginjury at intersections and non-intersections using a case-crossover design.Inj Prev. 2013;19:303–10.5. Papoutsi S, Martinolli L, Braun CT, Exadaktylos AK. E-bike injuries: Experiencefrom an urban emergency department—A retrospective study fromSwitzerland. Emerg Med Int. 2014;2014:850236. doi:10.1155/2014/850236.6. Teschke K, Frendo T, Shen H, Harris MA, Reynolds CCO, Cripton PA, Brubacher JR,Cusimano MD, Friedman SM, Hunte G, Monro M, Vernich L, Babul S, Chipman M,Winters M. Bicycling crash circumstances vary by route type: a cross-sectionalanalysis. BMC Public Health. 2014;14:1205.7. Teschke K, Harris MA, Reynolds CCO, Winters M, Babul S, Chipman M,Cusimano MD, Brubacher J, Friedman SM, Hunte G, Monro M, Shen H,Vernich L, Cripton PA. Route infrastructure and the risk of injuries tobicyclists: A case-crossover study. Am J Public Health. 2012;102:2336–43.8. Vandenbulcke G, Thomas I, Int PL. Predicting cycling accident risk in Brussels:a spatial case–control approach. Accid Anal Prev. 2014;62:341–57.9. Deunk J, Harmsen AM, Schonhuth CP, Bloemers FW. Injuries due to Wedgingof Bicycle Wheels in on-Road Tram Tracks. Arch Trauma Res. 2014;3:3–5.10. Bicyclists’ Injuries and the Cycling Environment Study, Cycling in CitiesResearch Program. Interview Form. 2008. http://cyclingincities-spph.sites.olt.ubc.ca/files/2011/10/InterviewFormFinal.pdf. Accessed 1 Feb 2016.11. Bicyclists’ Injuries and the Cycling Environment Study, Cycling in Cities ResearchProgram. Site Observation Form. 2008. http://cyclingincities-spph.sites.olt.ubc.ca/files/2011/10/SiteObservationFormFinal.pdf. Accessed 1 Feb 2016.12. Shu X, Wilson N. Use of guard/girder/restraining rails. TCRP Res ResultsDigest. 2007;82:1–37. http://www.tcrponline.org/PDFDocuments/TCRP_RRD_82.pdf. Accessed 19 Jul 2016.13. Wikipedia contributors. Rail profile. Wikipedia, The Free Encyclopedia. 2016.https://en.wikipedia.org/wiki/Rail_profile#North_America Accessed 20 Apr 2016.14. Schepers JP. A safer road environment for cyclists. TU Delft, Delft Universityof Technology; 2013. http://repository.tudelft.nl/assets/uuid:fe287480-25cc-4b7d-a6d6-1ca2b5976331/Paul_Schepers1.pdf. Accessed 18 Apr 2016.15. Cripton PA, Shen H, Brubacher JR, et al. Severity of urban cycling injuriesand the relationship with personal, trip, route and crash characteristics:analyses using four severity metrics. BMJ Open. 2015;5:e006654.doi:10.1136/bmjopen-2014-006654.16. Ledsham T, Liu G, Watt E, Wittmann K. Mapping Cycling Behaviour in Toronto,Toronto Cycling Think and Do Tank. 2013. http://www.torontocycling.org/uploads/1/3/1/3/13138411/mapping_cycling_behaviour_in_toronto_final_23_may_printer_tl.pdf. Accessed 15 Jan 2016.17. Ontario Ministry of Transportation. Cycling Skills: Ontario’s Guide to Safe Cycling.Undated. http://www.mto.gov.on.ca/english/safety/pdfs/cycling-skills.pdf.Accessed 15 Jan 2016.18. Alta Planning and Design. Bicycle Interactions and Streetcars: Lessons Learnedand Recommendations. 2008. http://www.altaplanning.com/wp-content/uploads/Bicycle_Streetcar_Memo_ALTA.pdf Accessed 1 Feb 2016.19. Wagenbuur M. Junction design in the Netherlands, Bicycle Dutch. https://bicycledutch.wordpress.com/2014/02/23/junction-design-in-the-netherlands/. Accessed24 Jan 2016.20. Vision Zero Initiative. http://www.visionzeroinitiative.com Accessed 19 July 2016.21. World Health Organization. International classification of diseases: 10th revision.2016. http://www.who.int/classifications/icd/en/. Accessed 18 Apr 2016.Teschke et al. BMC Public Health  (2016) 16:617 Page 10 of 10


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