Alcohol and Car Crashes
Young, male adolescents have the highest risk of dying in car crashes.
Intoxication with alcohol and other drugs increases their risk. In my
neighborhood, the police consider accidents caused by drunk drivers to be the
most serious and preventable drinking hazard. They routinely employ road blocks
to screen all drivers for intoxication. If anyone is found with blood alcohol
above the legal limit, their car is impounded and their driver’s license is
suspended on the spot.
In a US survey, about 1 in 7 Americans aged 12 or older in 2002 (14.2
percent, or 33.5 million persons) drove under the influence of alcohol at least
once in the 12 months prior to the interview. Males were nearly twice as likely
as females (18.8 vs. 9.9 percent, respectively) to have driven under the
influence of alcohol. More than 1 in 4 (26.6 percent) young adults aged 18 to 25
reported driving under the influence of alcohol at least once in the prior year.
Ramsey suggested: “It used to be believed that you drove better after a few
drinks. This misconception was staunchly held despite proof that alcohol, a
central nervous system depressant, retards and interferes with the performance
of complex motor skills. The alcohol myth was finally refuted in a 1969 Michigan
study that introduced a phenomenon since called "the Borkenstein curve." The
curve demonstrated that the likelihood of a motorist's having a motor vehicle
accident increased proportionately to increased levels blood alcohol content
(BAC). The curve also revealed a marked difference in risk at the 0.08 BAC level
(i.e., 0.08 g of alcohol per 100 mL of blood). At the time this study was
released, legislators in many countries were trying to determine appropriate BAC
levels for impaired driving offences. A Canadian parliamentary committee chose
.08 and incorporated it into the Criminal Code. Authorities around the world
still disagree, however, on what the BAC limit should be. European nations have
set limits between 0.02 and 0.05, Australia at 0.05, and most American states at
0.10.
Mercer suggested: “The role of both alcohol and other drugs in traffic crashes
has probably been seriously underestimated. Society awoke some years ago to the
problem of drinking and driving… the numbers of alcohol-caused crashes are
likely underestimated. Except for coroner reports, most of our information about
impairment and traffic crashes comes from police reports. Since many crashes are
not reported to the police, however, and since the police attend only about half
of those that are reported, the role of alcohol is almost certainly greater than
the statistics suggest. A B.C. study involving the RCMP and the provincial
coroner's office analyzed the blood and crash reports of all fatally injured
drivers in 1991. It found that about 57% had alcohol and/or other drugs in their
blood at the time of the crash. The investigation also revealed that, of the
fatally injured drivers, 38% tested positive for alcohol alone, 11% for alcohol
and other drugs, and 8% for non-alcoholic drugs alone. The most common drugs
present besides alcohol were cannabis (13%), central nervous system depressants
such as tranquilizers (7%), and cocaine (4%). A recent U.S. study examined the
role of alcohol in crashes; 18% of crashes with property damage only and 28% of
non-fatal injury cases involved alcohol and/or other drugs.”
Trauma Centers
Trauma surgeon, Gentilello, reported that fifty percent of patients admitted
to a to a trauma center are intoxicated by alcohol and suggested that a serious
injury represents a crisis. Attending surgeons can, in theory, inspire their
injured, alcoholic patient to address their drinking problem. Patient
re-education interventions begun in trauma centers can reduce subsequent injury
rates by 50%, drunk driving arrests by 66%, and save $4 in healthcare costs for
every dollar invested.
However, MDs in trauma centers are reluctant to document elevated blood
alcohol levels because of insurance and legal liabilities. In the US antiquated
laws sometimes penalize trauma surgeons who document levels of blood alcohol.
Gentilello stated: “I've been taking trauma calls for 20 years, and I can tell
you: The next time an intoxicated patient crashes their car it may be into you,
your spouse, or your child. A recent survey of trauma surgeons documented that
82% would be willing to start an alcohol screening and intervention program in
their center if the insurance obstacles were removed.
