Commentary: Road Traffic Injury: We’ve Come a Long Way, But Not Far Enough
2015; Elsevier BV; Volume: 66; Issue: 2 Linguagem: Inglês
10.1016/j.annemergmed.2015.06.012
ISSN1097-6760
Autores Tópico(s)Trauma and Emergency Care Studies
Resumo[Kahn CA. Commentary: road traffic injury: we’ve come a long way, but not far enough. Ann Emerg Med. 2015;66:196-198.] Motor vehicle crashes are a routine part of our modern lives. We know they’re going to happen, so we design cars to protect our bodies better, we carry insurance to help protect us financially, and we design our roadways to help mitigate damage from crashes. Our local news radio stations carry traffic reports highlighting the current crashes; by that metric, perhaps things are improving because my local station now broadcasts traffic reports every 10 minutes instead of every 6. Our emergency medical services (EMS) systems owe their foundation and initial support to motor vehicle crashes, as do our trauma systems. Why are things this way, however? How did we get to the point at which our society accepts that people are going to be injured and killed every day on our roads? Why is it that 90 deaths a day on our roadways is something that most people rarely think about, whereas we worry about the safety of flying on commercial airlines, which experienced a total of 265 fatalities during the entire course of 2013?1Ranter H. Airliner accident fatalities at record low. Aviation Safety Network. Available at: http://news.aviation-safety.net/2014/01/01/aviation-safety-network-airliner-accident-fatalities-at-record-low/. Accessed June 1, 2015.Google Scholar Improvements in motor vehicle safety since the turn of the last century have been remarkable. Motor vehicles began to see widespread use in the 1920s. Associated injuries were also on the rise. Although fatalities per 100 million vehicle-miles traveled (a standard used in traffic injury research to adjust for risk exposure) have steadily declined since these data became available in 1921, fatalities as a fraction of total population shot up throughout the early 20th century. By mid century, road traffic injury in the United States was a significant problem. In 1966, when President Johnson signed the Highway Safety Act that led to the creation of the National Highway Traffic Safety Administration, 5.5 people died for every 100 million vehicle-miles traveled; there were a total of 50,894 motor vehicle fatalities. That same year, the Institute of Medicine published a landmark report, “Accidental Death and Disability: The Neglected Disease of Modern Society.” It served as a wake-up call that helped to galvanize national efforts to reduce the burden of injury from motor vehicle crashes.2Division of Medical Sciences. Accidental Death and Disability: The Neglected Disease of Modern Society. National Academy of Sciences, Washington, DC1966Google Scholar Within a relatively short time, a new federal agency had been formed to help stanch the bleeding on the roadways, EMS was born, and trauma systems were conceived. Since that time, injury and fatality rates have decreased significantly, reaching a nadir in 2011 (1.10 fatalities per 100 million vehicle-miles traveled). The coalition of governmental agencies, academic institutions, nonprofit groups, and individuals working to make this happen is impressive. The Centers for Disease Control and Prevention named the gains in motor vehicle safety one of the top 10 public health achievements of the 20th century.3Centers for Disease Control and PreventionMotor-vehicle safety: a 20th century public health achievement.MMWR Morb Mortal Wkly Rep. 1999; 48: 369-374PubMed Google Scholar So where do we stand? The referenced report from the National Highway Traffic Safety Administration describes a fairly impressive influence on societal resources (economic and otherwise) from motor vehicle crashes.4Blincoe L.J. Miller T.R. Zaloshnja E. et al.The Economic and Societal Impact of Motor Vehicle Crashes, 2010 (Revised). National Highway Traffic Safety Administration, Washington, DC2015http://www-nrd.nhtsa.dot.gov/Pubs/812013.pdfGoogle Scholar Although there are always some allowances that need to be made for results of statistical modeling, the report authors have taken great care to ensure the best accuracy possible. That said, the purely economic costs (eg, property damage, medical and legal costs, emergency services, productivity losses) of motor vehicle crashes in 2010 were a breathtaking $242 billion, or approximately 1.6% of the entire US gross domestic product that year. When you start factoring in less tangible costs such as the value of lost quality of life, that figure skyrockets to $836 billion. Each of the 32,999 persons killed in motor vehicle crashes that year represented an economic loss to society of $1.4 million, with critically injured survivors costing an average of $1 million each. Considering fatality costs with quality-of-life calculations increases the per-person cost to $9.1 million, with the similar figure for critically injured survivors increasing to $5.6 million. It’s easy for most folks to gloss over numbers of that scale, but let’s take another look. That’s a lot of money! If we were to prevent a single crash, saving just 1 life, the money saved as a result ($1.4 million) could buy a computed tomography (CT) head scan for approximately 1,400 patients. To be fair, only approximately $11,317 of that represents medical costs for fatally injured persons; if we looked at critically injured persons instead, those costs would explode to $384,273 per person. We use clinical decision rules to help us decrease health care costs, such as unnecessary head CT, but if we really want to make a difference in our national budget, we should start focusing on what happens outside of our emergency departments. A few of the subgroup analyses in this report need specific mention. First, alcohol impairment, as always, is a major contributor to motor vehicle crashes, both fatal and otherwise. In 2010, approximately 40% of crash-related fatalities were in alcohol-involved crashes; this proportion has held fairly steady for the last decade or so. The report notes that the effect of alcohol involvement increases with injury severity; although only 14% of property-damage-only crash costs were alcohol involved, alcohol-involved crashes were overrepresented with 48% of fatal injury crash costs. Although we can save a detailed discussion of alcohol impairment for another time, I’d like to share a visual description of the effect “just one more drink” can have (Figure). Motorcycles are also prominently overrepresented in fatality and cost figures. Although 14% of 2010’s motor vehicle crash fatalities were motorcyclists, motorcycles account for only 0.6% of all vehicle-miles traveled that year. When this was compared with the all-inclusive fatality and injury rates, a motorcyclist was approximately 30 times more likely to die and approximately 5 times more likely to be injured per vehicle-mile traveled than an occupant of any other passenger vehicle on the road. Although motorcycle helmets are estimated to be 37% effective in preventing fatal injuries to motorcycle riders (ie, out of every 100 unhelmeted motorcycle riders, 37 of them could have survived if all 100 had been wearing helmets), only 19 states require helmet use by all motorcyclists. Not surprisingly, helmet use is much higher where it’s mandatory; 8% of motorcyclists killed in 2013 in states with mandatory helmet laws weren’t wearing their helmets compared with 59% in states without universal helmet laws.5Traffic Safety Facts: Motorcycles, 2013 Data. National Highway Traffic Safety Administration, Washington, DC2015http://www-nrd.nhtsa.dot.gov/Pubs/812148.pdfGoogle Scholar Speed, distraction, and seat belt use are—unsurprisingly—also important factors in the societal effect of motor vehicle crashes. Approximately 32% of all 2010 motor vehicle crash fatalities involved speeding. Distracted driving was a factor in approximately 10% of all motor vehicle fatalities. Seat belt use prevented approximately 12,500 fatalities and saved approximately $50 billion in economic costs in 2010, but failure to use seat belts resulted in an additional 3,350 deaths and $10.4 billion in costs. In fact, from the time the Fatality Analysis Reporting System began collecting crash data in 1975 through 2010, seat belts prevented more than 280,000 fatalities, saving $1.2 trillion in economic costs, but their nonuse resulted in 367,000 additional fatalities and $1.1 trillion in costs. Considering the lost quality of life as well, that $1.1 trillion transforms into a bit more than $7.6 trillion in societal harm. Just imagine $1.1 trillion of wasted funds. I have trouble doing it. That’s enough money to wipe out the last 3 years or so of the US budget deficit. It’s more than 7% of our current gross domestic product. We could lop approximately 6% off the total federal debt with that money. Instead, that’s been spent on public safety costs, hospital bills, attorney fees, insurance payments, lost productivity, and other economic costs of motor vehicle crashes. Who pays for all this? As you might expect, approximately 75% of crash costs are borne by people not directly involved in the crash, including approximately 7% that come directly from public revenues. As I sit here writing this, I find that although the numbers are staggering, the human toll is incalculable. Early this morning, a drunk driver going the wrong way on a freeway fewer than 2 miles from my home struck a vehicle with 5 medical students, all scheduled to start their third year in 2 days. Two young women were killed outright, whereas 2 other students are in critical condition, with a third having experienced moderate injuries. Although of course this strikes very close to home for me—literally and figuratively—it’s soul-crushing to think of the loss not just to their families but also to society because at least 2 future healers will never again have the chance to serve their communities. It’s hard to imagine that the other 10,000 to 11,000 people who will be killed on our roadways by drunk drivers this year, along with the additional 20,000 to 22,000 likely motor vehicle crash fatalities not related to alcohol impairment, won’t leave gaping holes in the fabric of their communities as well. We’ve made amazing progress in motor vehicle safety, but there is no question that we have quite a long way to go. The Economic and Societal Impact of Motor Vehicle Crashes, 2010 (Revised)Annals of Emergency MedicineVol. 66Issue 2Preview[National Highway Traffic Safety Administration. The economic and societal impact of motor vehicle crashes, 2010 (revised).] Full-Text PDF
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