Source · Prevention of Future Deaths

Mollie Gifford

Ref: 2020-0211 Date: 30 Sep 2020 Coroner: James Bennett Area: Birmingham and Solihull Responses identified: 1 / 2 View PDF

Standard lorry mirrors provide distorted, inadequate vision and are prone to dirt, creating an avoidable blind spot risk for drivers and posing a danger to other road users.

Date 30 Sep 2020

56-day deadline 29 Jan 2021 est.

Responses identified 1 of 2

Road (Highways Safety) related deaths

Coroner's concerns

AI summary

Standard lorry mirrors provide distorted, inadequate vision and are prone to dirt, creating an avoidable blind spot risk for drivers and posing a danger to other road users.

View full coroner's concerns

I heard evidence from a forensic collision investigator of 15 years’ experience. Mr previously served for 23 years as a police officer involved in road traffic investigation and reconstruction
– for the last 5 years he was in charge of a police collision investigation unit. Mr explained that the lorry cab was fitted with standard class 5 and 6 mirrors. He estimated in his career he had been involved in around 150 collisions between lorries and other road users and pedestrians where the class 5 and 6 mirrors did not provide the cab driver with adequate vision. The mirrors are convex and therefore even when clean provide a distorted view, but as they are prone to collect road dirt and spray, the distortion is easily amplified, making it difficult for cab drivers to see movement and colour. Some cab drivers will have a false sense of security about the ability of class 5 and 6 mirrors to provide a comprehensive view of other road users and pedestrians around the cab when stationary. Mr went on to explain that camera units are available on the market to stream live footage of around the cab to the driver on a screen. Camera units offer a clearer view, are not subject to the same distortion as class 5 and 6 mirrors and it is easier to pick out movement and different colours.

My ongoing concern is that standard class 5 and 6 mirrors create an avoidable risk cab drivers will not see other road users and pedestrians in close proximity to the cab when stationary.

Responses

1 respondent

Department for Transport Central Government

PDF

Action Planned

The Department for Transport notes that camera-monitor systems are permitted as an alternative to mirrors. It is working internationally to develop requirements to improve vision for drivers around large goods vehicles, including improved direct vision and warning systems for vulnerable road users, with agreement anticipated later in the year. (AI summary)

View full response

Dear Mr Bennett,

Thank you for your report dated 30 September, under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. The report was sent to the Department for Transport (DfT) and to the Driver and Vehicle Standards Agency (DVSA) following the conclusion of your inquest into the death of Mollie Matilda Gifford. I am replying on behalf of the both DVSA and DfT as Head of International Vehicle Standards, which is the lead division on vehicle construction standards.

During the inquest you heard evidence that drivers of large goods vehicles are not afforded an adequate view of pedestrians in close proximity to their vehicle when viewed in the Class V and Class VI mirrors. A forensic collision investigator explained that the use of a camera system could provide a clearer view of pedestrians.

All new vehicle types need to be approved prior to their registration and use on GB roads to demonstrate that they comply with a range of technical construction standards. The requirements for indirect vision are set out in the United Nations Economic Commission for Europe (UNECE) Regulation 46 which permits mirrors or camera-monitor systems (CMS) to be fitted to the vehicle.

Once a vehicle enters service the relevant regulations are the Road Vehicles (Construction and Use) Regulations 1986 (C & U) which governs the ongoing requirements for the indirect vision devices. C & U includes the option of UNECE Regulation 46 thereby allowing CMS as an alternative to Class V and Class VI mirrors. Department for Transport Great Minster House 33 Horseferry Road London SW1P 4DR Tel: 0300 330 3000 Web Site: www.gov.uk/dft Our Ref:

15 January 2021

The CMS and mirrors permitted under C & U each has benefits in different circumstances. The selection of which system to use is one for the operator to consider, taking account of the nature of their operating environment.

You will be interested to know that the DfT is working at international level to develop appropriate requirements to improve vision for drivers around large goods vehicles. This work includes improved direct vision for the driver through vehicle windows and the windscreen, a moving-off information system to provide a warning to the driver if a vulnerable road user is in front of a vehicle, a blind spot information system to detect cyclists alongside vehicles and provide a warning to the driver, and reversing detection using cameras or sensors.

The requirements for the majority of these improvements should be agreed by global technical experts at the UNECE in April this year, and we anticipate their adoption into international law later in the year. This should ensure that drivers of future designs of vehicles will be better able to identify people in close proximity to their vehicle.

I hope you find this information helpful and are reassured that the Department already permits the use of CMS, as well as being engaged in the development of additional vehicle requirements to improve protection for vulnerable road users.

Head of International Vehicle Standards

Report sections

Investigation and inquest

On 19/04/2018 I commenced an investigation into the death of Mollie Matilda Gifford. The investigation concluded at the end of an inquest on 29th September 2020. The conclusion of the inquest was: ‘Died from unknown causes after being admitted to hospital with trauma caused during a road traffic collision.’

Circumstances of the death

On 16 March 2018 Mollie was waiting at a traffic light controlled pedestrian crossing on Bromford Lane. A large goods vehicle, travelling towards Erdington, approached from the nearby junction with Washwood Heath Road and came to a halt 4 meters beyond the stop line. The cab had standard class 5 and 6 mirrors to assist the driver with visibility around the cab whilst stationary. It is unknown how close Mollie was to the cab as she crossed the road, but the closer she was the less visible she would have been to the driver. Mollie was walking slowly and was in front of the cab when the lights changed to green. The driver was unaware of Mollie and drove into her as he pulled away at slow speed. Mollie was admitted to Queen Elizabeth Hospital. She had suffered significant rib fractures, including a flail segment, and an associated haemothorax. She required a total right arm amputation following severe comminuted displaced fractures to her arm and hand. She had a number of complications including intermittent atrial fibrillation, breathing difficulties, a blood clot in her remaining left arm, and she suffered a small stroke. By 26 March there was some improvement in her condition, she was moving both lower limbs and remaining upper limb, and was alert and co-operative. On 28 March she was transferred to a general ward. However, she became symptomatic of a chest infection and deteriorated, dying at 9.50pm on 29 March. A standard post-mortem was performed and offered a cause of death relating to the trauma caused by the collision. There was no examination of the brain and no histology of the lungs. Two forensic pathologists conducted a paper review and disagreed with the stated cause of death. Whilst they felt the chest was the most likely cause of death, they could not say so with certainty. Therefore, the cause of death and role of the collision remains unknown.

The opinion of the forensic pathologists who conducted a paper review was that the medical cause of was ‘unascertained’.

Copies sent to

West Midlands Police3) , andfollowing

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Report details

Reference: 2020-0211
Date of report: 30 September 2020
Coroner: James Bennett
Coroner area: Birmingham and Solihull

Responses identified

Responses identified 1 of 2

1 response not yet linked

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 29 Jan 2021 (estimated).

Sent to

Department for Transport

Drivers and Vehicle Standards Agency

Source links

Judiciary.uk page → Report PDF →

Data: judiciary.uk under OGL.