What trauma from commercial vehicle crashes is telling us

A common message in the media has been that trucks are becoming increasingly dangerous. Transport Canada’s data make it plain that truck drivers aren’t the ones who wind up in our hospitals most frequently: between 2012 and 2021, commercial vehicles were involved in roughly 8% of collisions on Canadian roads, and they accounted for approximately 20% of all road-user fatalities.¹ It doesn’t take much for an 80 000-lb vehicle to do a great deal of harm. In 2023 alone, 399 of Canada’s 1964 road deaths, just over 1 in 5, involved a commercial vehicle.² The trend in volume, to be fair, seems better than the trend in outcome distribution suggests: fatalities in commercial vehicle collisions fell from 400 in 2012 to 343 in 2021, and serious injuries decreased by almost one-third over the same period.¹ The fatality rate per billion vehicle-kilometres travelled is also down 34% since 2012.¹ What hasn’t improved is who suffers because of the collisions that still happen.

Of the deaths resulting from commercial vehicle crashes, 70% are occupants of the other vehicle, 15% are occupants of the commercial vehicle itself, 12% are pedestrians, and 3% are cyclists.¹ This pattern holds when considering serious injuries: 59% occur among occupants of the other vehicle, 29% among occupants of the commercial vehicle, 9% among pedestrians, and 3% among cyclists.¹ An older comparative analysis found that heavy trucks carry a fatality rate of 8.0 per 10 000 registered vehicles compared with 1.5 for all vehicles on the road, which is greater than a 5-fold difference in lethality.³ Heavy trucks are not unusually crash-prone, but when crashes occur, they kill with unusual efficiency.

Pedestrians and cyclists involved in collisions with heavy trucks don’t suffer the same injuries as those involved in collisions with sedans. A Canadian Automobile Association analysis found that 19% of cyclists killed in this country were hit by a heavy truck, which is a striking figure given how small a fraction of the vehicle fleet such trucks represent.² Of the roughly 1058 cyclists killed on Canadian roads between 2002 and 2021, about 1 in 5 deaths were at the wheels of a truck.² Civil engineers and urban planners in many cities have been trying for nearly 2 decades to divert heavy commercial vehicles toward larger, safer roadways to reduce the risk of collisions. Large commercial vehicles travelling down small urban streets that were never intended to facilitate such mechanical volume raise serious concerns and therefore highlight the importance of monitoring by law enforcement.

Older pedestrians, who are slower to clear an intersection and less able to tolerate polytrauma resulting from a crash, are absorbing a disproportionate share of the risk from urban collisions. The mechanism of injury is not all about driver skill, but rather geometry. The US National Transportation Safety Board’s (NTSB) investigation of pedestrian and cyclist fatalities due to collisions with large trucks found that right-side impact predominates, consistent with the position of the truck’s largest blind spot, and that this blind spot impinges on a substantial portion of the driver’s forward field of view regardless of how attentive or well-trained that driver is.⁴ In more than half of urban collisions in which a stopped truck struck a pedestrian in a crosswalk while pulling away, the NTSB found the driver did not know a person had been hit until someone else alerted them.⁴ A more recent safe-systems analysis of urban cyclist deaths found that nearly one-third of urban commercial vehicle–cyclist fatalities involved heavy trucks, frequently through “side-underride,” meaning the cyclist was drawn beneath the rear wheels following lateral contact.⁵ The US Government Accountability Office concluded this year that larger vehicles performing low-visibility manoeuvres pose materially higher risk to pedestrians and cyclists, and that regulators still lack the data to properly quantify truck blind-zone geometry against outcomes.⁶ No equivalent Canadian data set exists connecting blind-spot geometry to outcomes; we are relying on American and European crash reconstruction to understand hazards playing out on our own streets.

It has been argued that a meaningful minority of underprepared commercial drivers are on the road because of gaps in training verification, and that minority is disproportionately involved in crashes. The structural pressure behind that gap is real. At least 32% of Canadian truck drivers are age 55 years or older, compared with 21.8% of the overall labour force, and the industry has faced an estimated shortfall of 48 000 long-haul drivers.^7,8 Mandatory Entry-Level Training, introduced after the Humboldt Broncos crash in 2018,⁹ has not been adopted uniformly across provinces.¹⁰ The industry’s own trade press has been unusually candid, stating that minimum compliance has, in places, replaced actual competence.¹¹ Reliance on temporary foreign labour to address the driver shortage is debated, as federal Temporary Foreign Worker Program (TFWP) approvals for truck drivers quadrupled between 2016 and 2024 before decreasing after federal tightening.¹⁰ A 2026 investigation found carriers previously flagged as unsafe continued to receive approval to hire under the TFWP.¹² Labour advocates argue the real problem causing the shortage is deteriorating wages and conditions rather than a genuine absence of applicants from Canada.¹³ There is some confidence that the shared root cause is weak verification of competence at the point of hire as well as weak audit capacity to identify the carriers who cut corners.

The literature recommends that clinicians document crash characteristics systematically enough to anticipate occult injury in high-severity collisions.¹⁴ Perhaps this recommendation could extend to documenting vehicle type, point of impact, and pedestrian or cyclist involvement. Aggregating these data nationally would be difficult, but neither industry nor government has had much incentive to undertake the effort. However, 20% of road deaths, disproportionately borne by people who never chose to share a lane with an 80 000-lb vehicle, is not a statistic we should treat as background noise. Arguably, clinicians are already building a case series, 1 patient at a time; we might as well document it properly.

Interestingly, the fusion of artificial intelligence (AI) with autonomous driving for both commercial and personal vehicles has the potential to mitigate a reasonable proportion of these concerns. More specifically, driver error, inappropriate commercial route selection, and inadequate driver training and requirements will all be in some way addressed by this rapidly approaching technology. While the specific timeline of autonomous AI commercial deliveries and driving is unclear, it doesn’t seem too distant. Once technologically available, presumably vehicle insurance companies will act as a catalyst given their ability to raise insurance rates to ensure or force wide adoption of newer, safer technology. Let’s hope that stricter regulations and improved training standards for commercial drivers as well as new technologies with a focus on road safety are just around the corner.