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The role of the drinking driver in traffic accidents (The Grand Rapids Study)
Abstract
Blood alcohol concentrations (BACs) over 0.04% are definitely associated with an increased accident rate. The probability of accident involvement increases rapidly at BACs over 0.08%, and becomes extremely high at BACs above 0.15%. When drivers with BACs over 0.08% have accidents, they tend to have more single vehicle accidents, more severe (in terms of injury and damage) accidents and more expensive accidents than sober drivers. BACs of 0.04% and below apparently are not inconsistent with traffic safety. Many factors other than alcohol are related to the probability of accident involvement. The driver classes with the worst accident experience, in addition to the alcoholically impaired, are the young or very old, the inexperienced and those with less formal education. Persons with the most education, those with better jobs and the middle aged, have better than average accident experience. The effects of alcohol are consistent within the various socioeconomic classes considered. High BACs are always associated with bad accident experience. At the higher BACs, the difference in the accident potential between the various classes of drivers is unimportant. An important aspect of the applied survey technique is that it is adaptable to assessing the effect of various policies directed at the drinking driver. Drinking and driving is clearly associated with the frequent use, or abuse, of alcohol. Many drivers with BACs overestimate the number of drinks that it is safe to have before driving. The tendency to drive after drinking is related significantly to the socioeconomic categories appearing most frequently in the drinking driver class.
... With increasing blood alcohol concentrations (BACs), the magnitude of impairment increases [1,2]. Nevertheless, with regard to road traffic, interindividual differences at similar BACs have repeatedly been described [3,4]. ...
... Whether alcohol-related impairments are observable or not regularly depends on the complexity of the driving task [1]. In general, driving with a BAC of around 0.50 g/l increases the relative probability for single vehicle accidents by factor 2 [3]. Performance differences in comparable situations are often explainable by different states of alcohol habituation. ...
Purpose
Several studies tried to discuss and clarify the so-called Mellanby effect: Similar blood alcohol concentrations (BACs) supposedly lead to more signs of impairment in the phase of alcohol resorption than elimination. To assess this effect for alcoholised e-scooter driving, results of a real-driving fitness study were subanalysed.
Methods
Sixteen subjects (9 females; 7 males) who completed runs at comparable BACs in the phases of alcohol resorption and elimination were chosen to assess a possible “Mellanby effect”. The data of the subjects was taken from a prior e-scooter study by Zube et al., which included 63 subjects in total.
Results
In the phase of alcohol resorption, the relative driving performance was approx. 92% of the phase of elimination (p value 0.21).
Statistically significant more demerits were allocated to the obstacle “narrowing track” in the phase of resorption than elimination.
Subjects also needed significantly more time to pass the obstacles “narrowing track”, “driving in circles counterclockwise” and “thresholds” in the phase of resorption than elimination.
Discussion
The most relevant obstacle to discriminate between the two different states of alcoholisation was the narrowing track. Insofar, measurements of the standard deviation of the lateral position (SDLP) might also be a sensitive component for the detection of central nervous driving impairment during shorter trips with an e-scooter.
Additionally, driving slower during the phase of alcohol resorption seems to be the attempt to compensate alcohol-related deficits.
Conclusion
The results of the study suggest a slight Mellanby effect in e-scooter drivers.
... These results provided the basis for setting a legal BAC limit for driving in numerous countries, which was usually fixed at 0.8 g/L. 4 In 1980, McLean et al. reported that people with BAC of 0.5 g/L had a 1.83 times greater risk of being involved in a crash accident than people with a BAC of 0 g/L. 5 In the following decades, various research was undertaken to consider the association between alcohol and traffic accident risk. These studies consistently confirmed a significant increase in the relative risk of road crashes at BAC values of 0.4-0.5 g/L. ...
... The data confirm a strict correlation between BAC levels and accident risk, which is consistent with data reported in other studies. [4][5][6][7]10,11 As regards daily time distribution, 74.3% of BAC-positive-related accidents occurred during the night-time. There is a well-known increase in alcohol consumption during the second part of the day, and tiredness may also contribute. ...
According to the World Health Organization, as many as 25% of traffic accidents are linked to alcohol abuse. This study describes the results of a nine-year study performed on injured drivers (N = 12,806) in the Verona area of Northern Italy. Blood samples were mandatorily collected on injured drivers who were admitted to the Emergency Health Care Unit of Verona Hospital between 2009 and 2017, after they had been involved in a traffic accident. Blood alcohol concentration (BAC) determination was then undertaken using a validated head space-gas chromatography-flame ionisation detector (HS-GC-FID) method. We found that 21% of drivers tested positive for alcohol (BAC ≥0.01 g/L), while 16.8% presented with BAC levels above the Italian legal limit (>0.5 g/L). Of those who had positive BACs, about 50% presented with very high BAC levels (>1.5 g/L). Daily time distribution analyses, involving 2031 alcohol-positive drivers, showed a surge between 18:00 hours and 06:00 hours (74.3%), with a specific rise during the weekend (58.9%). The percentage of alcohol-related road accidents was 20.6%, which is lower than results reported in other international studies performed over the last 20 years. However, evidence that around 50% of the positive subjects showed a BAC >1.5 g/L confirms the correlation between BAC and accident risk, which becomes even more significant at progressively increasing levels of BAC. The study highlights the need to implement further strategies to both prevent and deter the use of alcohol while driving.
... Grand-Rapids-Studie (Quelle: Borkenstein et al., 1964) (Borkenstein et al., 1964). Der Umstand, dass Personen mit einem Blutalkoholwert von 0.2 Promille am wenigsten unfallgefährdet erschienen, wurde als "Grand Rapids Dip" bezeichnet (Abbildung 7). ...
... Grand-Rapids-Studie (Quelle: Borkenstein et al., 1964) (Borkenstein et al., 1964). Der Umstand, dass Personen mit einem Blutalkoholwert von 0.2 Promille am wenigsten unfallgefährdet erschienen, wurde als "Grand Rapids Dip" bezeichnet (Abbildung 7). ...
Politische Maßnahmen müssen in einer modernen Demokratie dem Prinzip der Verhältnismäßigkeit genügen. Die Frage, ob Maßnahmen verhältnismäßig sind, tangiert sowohl wichtige ethische als auch wissenschaftliche Aspekte. Mit der populären Forderung nach einer „evidenzbasierten Politik“ wird suggeriert, dass politische Entscheidungen ausschließlich aufgrund von Faktenwissen getroffen werden könnten – was einen völlig falschen Eindruck erweckt und den Stellenwert von Werturteilen maßgeblich verschleiert. Wie Wertfragen entschieden werden, hängt – ganz besonders wenn es um Alkoholpolitik geht – stark mit dem zugrundeliegenden Menschenbild, dem Gesellschafts- und Weltbild zusammen. Eine fundierte Beurteilung von Sachfragen setzt große inhaltliche und auch methodologische Kompetenz sowie eine Grundhaltung, die Unsicherheiten und Mehrdeutigkeiten offen zur Kenntnis nimmt, voraus. In einem Feld, in dem ein Großteil der empirischen Daten aus Beobachtungsstudien stammt, weil denkbare Experimente an unüberwindbaren Erkenntnisgrenzen scheitern, ist es für Forscher unverzichtbar, kreativ zu sein, viele unterschiedliche Hypothesen zur Erklärung der Wirklichkeit zu entwickeln und diese durch gezielte empirische Forschung und methodologisch korrektes Denken kritisch zu hinterfragen. Fortschritte sind hier nur möglich, wenn Unsicherheiten und Mehrdeutigkeiten offen ausgesprochen und nicht verschleiert werden. Das ist allerdings nicht leicht, weil unser primär intuitiv-assoziativ arbeitendes kognitives System irreführende Vereinfachungen und das Weglassen zentraler Aspekte in der Regel kaum bemerkt – ganz besonders, wenn wir von der Richtigkeit bestimmter Sichtweisen oder der Notwendigkeit bestimmter Maßnahmen überzeugt sind und daher nach Argumenten suchen, um unsere Überzeugungen plausibel vertreten zu können, anstatt diese kritisch zu hinterfragen.
In a modern democracy, political measures must comply with the principle of proportionality. The question whether measures are proportionate touches upon important ethical as well as scientific aspects. The popular demand for an “evidence-based policy” suggests that political decisions could be based exclusively on facts – cre- ating a wrong impression and concealing the importance of value judgements. How value issues are decided – especially concerning alcohol policy – is strongly related to the underlying conception of man, society and the world. Well-founded assessment of factual issues requires a high level of competence in content and methodol- ogy as well as readiness to openly acknowledge uncertainties and ambiguities. In a domain where a large part of empirical data originates from observational studies, since conceivable experiments are not feasible due to insurmountable research limitations, it is indispensable for researchers to be creative, to develop many different hypotheses explaining reality, and to critically question them through targeted empirical research, as well as thinking in a methodologically correct way. Progress is only possible if uncertainties and ambiguities are openly expressed and not concealed. To do so is not easy, however, since cognitive system primarily works intuitive-associative and hardly notices misleading simplifications and the omission of essential aspects. This is particularly true if we are convinced that certain points of view are correct or that certain measures are neces- sary and therefore look for arguments to defend our convictions instead of questioning them critically.
... Risiko for trafikkulykker hos bilførere stiger med økende blodalkoholkonsentrasjon (4,5). Ulykkesrisikoen i trafikken er også avhengig av en rekke andre variabler (5). ...
... Alkohol Auch wenn die Assoziation zwischen Alkoholkonsum und Verletzungen bereits im alten Ägypten bekannt war [36] und auch schon erste Studien zur Kausalität von Alkoholkonsum und Verkehrsunfällen 1938 durch Holcomb [37] durchgeführt worden sind, so ist jedoch spätestens seit der Grand-Rapids-Studie in den Jahren 1962 und 1963 die Beteiligung von Alkohol an Verkehrsunfällen Teil des Allgemeinwissens [38]. Das relative Risiko, im Rahmen eines Verkehrsunfalls schwer oder tödlich verletzt zu werden, ist abhängig vonderBlutalkoholkonzentration (BAK). ...
Zusammenfassung
Viele Grunderkrankungen gehen mit Symptomen einher, die die Fähigkeit, komplexe Aufgaben des Alltags zu lösen, beeinträchtigen können. Hierzu gehört auch die aktive Teilnahme am Straßenverkehr. Das Ziel von Arzneimitteltherapien ist es, sofern keine Heilung möglich ist, die Symptome soweit zu lindern, dass der Patient im Alltag so wenig Einschränkungen wie möglich erfährt. Jedoch haben etwa 20 % der ca. 100.000 in Deutschland zugelassenen Arzneimittel verkehrsrelevante Nebenwirkungen, die die Fahrsicherheit ihrerseits ebenfalls beeinträchtigen können.
So wird davon ausgegangen, dass an jedem 4. Verkehrsunfall die Wirkung eines Arzneimittels zumindest mitursächlich ist und jeder 10. Verkehrstote Psychopharmaka vor Fahrtantritt eingenommen hat. Neben Alkohol und Drogen stehen insbesondere Medikamente aus der Gruppe der Benzodiazepine, Opioide und Antidepressiva im Verdacht, die Fahrsicherheit zu beeinträchtigen. Die Effekte dieser Substanzen auf junge Menschen sind vielfach beschrieben. In dieser Übersichtsarbeit sollen speziell die verkehrsrelevanten (Neben‑)Wirkungen verschiedener Wirkstoffklassen auf betagte Personen ab 65 Jahren dargestellt werden.
Insbesondere Ältere müssen häufig verschiedene Medikamente einnehmen, die aufgrund von Grunderkrankungen anders metabolisiert werden als bei Jüngeren und darüber hinaus interagieren können. Es kann festgestellt werden, dass (1) ältere Personen häufig sensibler auf Substanzen reagieren, (2) nicht alle Vertreter einer Wirkstoffklasse den gleichen Effekt auf die Fahrsicherheit haben und (3) eine pauschale Beurteilung nicht möglich ist, sondern die Wirkungen von weiteren Faktoren, wie zum Beispiel Grunderkrankungen, Therapieregime und Einnahmezeit der Medikation, abhängen.
... A hat órán túli kognitív hatások, mint például a csökkent gátlás, csökkent munkamemória és fokozott impulzivitás, a használat után akár ≤20 órán keresztül is fennállhatnak, azonban a jelenség legfeljebb kísérleti körülmények között verifikálható, így az orvosszakértői gyakorlatban, illetve a bizonyítás során a hasonló késői tünetek fennállása természettudományos módszerekkel jelenleg nem értékelhető, nem bizonyítható. A járművezetésre gyakorolt hátrányos hatáshoz (befolyáshoz) szükséges kritikus vérkoncentrációt számos szerző vizsgálta (Borkenstein et al., 1964;Drummer et al., 2004;Laumon, Gadegbeku, Martin & Biecheler, 2005). Az összefoglaló közlemények és kísérleti adatok alapján konszenzus mutatkozik abban, hogy amennyiben cselekménykor 4-5 ng/ml közötti THC vérkoncentráció áll fenn, az a gépjármű-járművezetési képességre hátrányos hatást gyakorol (befolyásoltságot jelent), ezt az értéket 0,5 ezrelékes véralkohol koncentráció hatásával tartják összehasonlíthatónak (Grotenhermen, Leson & Berghaus, 2007). ...
A hazai igazságügyi orvosszakértői gyakorlat segítése, a szakértők és a jogalkal-mazók tájékoztatása, továbbá az igazságügyi orvosszakértői véleményalkotás egységesítése céljából a BM Egészségügyi Szakmai Kollégium Igazságügyi Orvostan, Orvosszakértés és Biztosítási Orvostan Tagozata, az orvostudományi egyetemek igazságügyi orvostani intézetei (Debreceni Egyetem, Pécsi Tudo-mányegyetem, Szegedi Tudományegyetem), a Nemzeti Szakértői és Kutató Központ (NSZKK) egységes módszertani ajánlást állított össze az igazságügyi orvosszakértők részére.Cél: A gépjárművezetésre hátrányosan ható szerek által előidézett befolyásolt-ság (bódult állapot) egységes igazságügyi orvosszakértői véleményezésének elősegítése.Módszertan: A tanulmány elkészítéséhez a szerzők megvizsgálták a hazai jogi környezetet, az irányadó joganyagot, továbbá feldolgozták a témakör releváns nemzetközi és hazai szakirodalmát.Megállapítások: A bódult állapotban elkövetett járművezetés miatt ismertté vált bűncselekmények száma az elmúlt évtizedben jelentősen megnövekedett. A szer-zők vizsgálata alapján megállapítható, hogy a gyakorlatban vizsgált klinikai tüne-tek nem adnak megfelelő diagnosztikai támpontot a befolyásoltság fennállására. Az egyes hatóanyagok emberi szervezeten belüli lebomlására vonatkozóan egyik hatóanyagtípusnál sem áll rendelkezésre elegendő mennyiségű tudományos ered-mény ahhoz, hogy a cselekményt követően biztosított mintákból a cselekmény időpontjára vonatkozó mennyiségi megállapítást lehetne tenni. Ezért a toxikoló-giai vizsgálati eredményekből, vagy laboratóriumi leleteken megjelölt értékből a cselekménykor fennálló hatóanyag-koncentrációra vonatkozóan a jelenlegi ada-tok szerint orvosszakértői módszerekkel visszaszámolás nem végezhető el. A bó-dult állapotot előidéző hatóanyagok esetében nem lehet a befolyásoltság pontos mértékére vonatkozóan megalapozott orvosszakértői megállapítást tenni, mert a hatás jellege egyénenként nagy különbséget mutat, továbbá a rendelkezésre álló természettudományos eredmények sem elegendőek. Az egyes hatóanyagok fogyasztásának kimutatására alkalmazott gyorstesztek csak tájékozódó vizsgá-latra alkalmasak. A tesztek eredménye alapján a cselekménykori bódult állapot (befolyásoltság) fennállására vonatkozó orvosszakértői vélemény nem adható.Érték: A szerzők Magyarországon elsőként fogalmaznak meg ajánlást a bódult állapot orvosszakértői véleményezésére.
... We selected the same threshold for all participants, rather than a participant-specific threshold based on their baseline performance, because computer simulations during the design phase of this study indicated that a fixed threshold would result in a wider range of caffeine recommendations than a relative threshold. Moreover, the selected target threshold of 270 ms is equivalent to the alertness impairment level of a blood alcohol concentration of ~0.06% [38][39][40], which is associated with a 2-fold increase in the risk of causing a traffic accident as compared with control drivers [41,42]. ...
Study objectives:
If properly consumed, caffeine can safely and effectively mitigate the effects of sleep loss on alertness. However, there are no tools to determine the amount and time to consume caffeine to maximize its effectiveness. Here, we extended the capabilities of the 2B-Alert app, a unique smartphone application that learns an individual's trait-like response to sleep loss, to provide personalized caffeine recommendations to optimize alertness.
Methods:
We prospectively validated 2B-Alert's capabilities in a 62-h total sleep deprivation study in which 21 participants used the app to measure their alertness throughout the study via the psychomotor vigilance test (PVT). Using PVT data collected during the first 36 h of the sleep challenge, the app learned the participant's sleep-loss response and provided personalized caffeine recommendations so that each participant would sustain alertness at a pre-specified target level (mean response time of 270 ms) during a 6-h period starting at 44 h of wakefulness, using the least amount of caffeine possible. Starting at 42 h, participants consumed 0 to 800 mg of caffeine, per the app recommendation.
Results:
2B-Alert recommended no caffeine to five participants, 100-400 mg to 11 participants, and 500-800 mg to five participants. Regardless of the consumed amount, participants sustained the target alertness level ~80% of the time.
Conclusions:
2B-Alert automatically learns an individual's phenotype and provides personalized caffeine recommendations in real time so that individuals achieve a desired alertness level regardless of their sleep-loss susceptibility.
... [18][19][20] A large amount of literature confirms a strict correlation between BAC levels and accident risk. 21,22 Among the accidents with drivers found positive for alcohol, 64.5% occurred during the night, and 44.9% occurred during the weekend. These data are consistent with other studies reflecting a higher risk behavior related to social drinking both in Italy and in Europe. ...
Alcohol is a significant public health issue, according to the World Health Organization. Our study aims to analyze the correlation between blood alcohol concentrations (BACs) of drivers, their demographic features, and the possible underestimation of BACs due to the time elapsed between hospital admission and blood sampling. Methods: This study includes patients evaluated for BAC levels in the emergency department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCCS from January 2013 to December 2016. BAC levels were compared in patients involved in road crashes according to age group, sex, and time of the accident. The delays in blood sampling and BAC measurement in the ED were recorded for each patient. The time between the accident and access to the hospital in most cases was unknown. Results: A total of 398 patients were included in the analysis, 107 of them had BACs more than 0.05 g/L., and 86 of these individuals had BAC levels more than 0.5 g/L. Road accident patients had higher rates of positive BAC readings at night and on weekends. A significant delay in blood sampling for BAC determination was observed. Discussion: This study demonstrates a critical bias due to the arrival time at the ED and the delay in blood sampling that inevitably influences and underestimates the BAC, resulting in possible false negative results (BAC values below the cutoff). Zero tolerance or a retrospective BAC calculation could mitigate this bias. It is necessary to implement preventive strategies to reduce instances of driving under the influence (DUI) of alcohol.
... The vehicle accident risk increases exponentially from a BAC of 0.05% (cf. e.g., Krüger, 1995;Borkenstein, Crowther, Shumate, Ziel & Zylman, 1974;Blomberg, Peck, Moskowitz, Burns & Fiorentino, 2005;Reimann et al., 2016;Krüger & Vollrath, 2004) including accident risk ratios of about 10 at a BAC of 0.11%, and of about 40 at a BAC of 0.16% upwards, compared to sober drivers (Krüger & Vollrath, 2004). ...
Driving under the influence of alcohol is one of the greatest dangers to the safety of road users not only in Germany, but across the rest of the world. An essential indicator for both punitive and corrective measures as well as for the prediction of recidivism is the blood alcohol concentration (BAC). This paper examines the relationships between BAC of first-time offenders, former drinking history, traffic related alcohol problem (TRAP), and the outcome of a medical-psychological assessment. The concept of TRAP combines syndromes from Alcohol Use Disorders (AUD) and a non-clinical delinquency category (drink and drive issue without AUD). It is in use for diagnostics among "hard core" alcohol-impaired offenders according to a diagnostic model which is applied in Germany and accepted by the legislator. The present study (N = 505) showed that a BAC of 0.11% upwards must be considered as a risk parameter for the identification of drivers with non-normative, and therefore traffic safety impairing drinking patterns. The importance of BAC as a risk indicator for road safety is underlined by significant correlations between BAC with drinking history and TRAP, but its prognostic value is poor, since BAC was unrelated to the outcome of the medical-psychological assessment. It could be demonstrated that TRAP severity increases with higher age, higher BAC, greater number of drinking days, higher occasion-related drinking amounts, and non-social drinking motivation (against stress and tension). Practical consequences are drawn regarding preconditions for re-issuing a driving licence.
... In fact, since the Grand Rapids Study [6] until present, a strong body of literature has piled highlighting that high blood alcohol concentrations (BACs) drastically increase the likelihood of occurrence of road traffic accidents [2,4,7,8]. In particular, it has been estimated that for every 0.02 g/L of BAC increase, the risk of road traffic accidents doubles [5]. ...
Background
It is well known that traffic injuries still represent one of the main causes of death and that high blood alcohol concentrations while driving significantly increase the occurrence of accidents. However, only limited literature on the correlation between chronic alcohol abuse and accident risk is available. The aim of the present study was to investigate the hypothesis of an association between elevated concentrations of carbohydrate deficient transferrin (CDT) and the occurrence of alcohol-related traffic accidents.
Methods
The analytical determinations of BAC and CDT were performed following certified methods in HS-GC-FID and HPLC, respectively. For BAC, 0.50 g/L was used as cut-off, whereas 2.0% was used for CDT, according to the standardisation proposed by IFCC. A total of 929 drivers, tested for BAC at the time of hospital admission after a traffic accident, were classified into two groups: InjDr 1 (BAC ≤ 0.50 g/L) and InjDr 2 (BAC > 0.50 g/L); all drivers were also tested for CDT.
Results
InjDr 1 included 674 individuals, only 2.5% showing a CDT above the cutoff, whereas InjDr 2 group consisted of 255 subjects, 28.6% testing positive for CDT (Odds Ratio 15.5). When subdividing the InjDr group into increasing classes of CDT, a steady increase in the percentage of BAC-positive drivers was appreciated. Moreover, average BAC was found to parallel each class of CDT.
Conclusions
The reported data strongly support the use of CDT as a biomarker of increased risk of alcohol-related traffic accidents in the procedures of re-granting of the driving license upon confiscation for “drink driving”.
... The epidemiological study by Keall et al. (2004) clearly illustrates the inadequacy of the one-dimensional approach to the role of alcohol in crash causation. The study extended the findings of Borkenstein et al. (1964) by breaking the alcohol-crash risks down by the number of passengers in the car as well as by age and sex. The researchers found that 'The risk of crashing for drivers carrying two or more passengers rises very steeply even at modest BAC levels' (p. ...
The prosecution of cannabis-presence driving offences (in the absence of any behavioural evidence of impairment) is ultimately based on the assumption that there is a tight causal relationship between positive toxicology for cannabis and impairment. The main purpose of this review is to examine the evidence for that relationship. We show that most experimental studies have failed to elicit statistically-significant cannabis-induced impairments for many of their possible outcomes. And many studies failed to demonstrate any impairment at all in regular users of cannabis (because of the development of tolerance). We argue that selective reporting by researchers, editors and the media has created the false impression that the evidence for cannabis-induced impairment is strong and consistent. Human beings are ‘over-engineered’ for the psychomotor skills required to drive safely. A benchmark level of cannabis-induced impairment is therefore required to distinguish unproblematic from ‘real-world’ impairment. The conventional benchmarks of statistical significance, effect size and BAC-equivalence are shown to be inadequate. However, a benchmark in terms of 30 years of normal cognitive aging has good face validity. The recent use of cannabis is indicated toxicologically by the presence of delta-9-tetrahydrocannabinol (THC) in blood or oral fluid. Evidence is provided that most THC-positive drivers are not impaired, and certainly not meaningfully impaired. It follows that the justice of stand-alone cannabis-presence driving offences must be questioned.
... When considering the differences in perceived legal deterrents between drink driving and drug driving, it is also important to acknowledge that the literature is much clearer on the risks associated with drink driving compared to drug driving. For example, it is well established that BAC levels over .04 are related to a higher crash risk (Borkenstein et al., 1964;1974). Meanwhile, a clear link between the concentration of drugs in a driver's system and crash risk has yet to be established (e.g., Lacey et al., 2016). ...
Drink and drug driving countermeasures have several similarities, yet also have a number of differences. To improve the effectiveness of these countermeasures, it is important to delineate the perceptions of both legal and non-legal factors between drink driving and drug driving. This study aimed to understand these differences and how legal and non-legal factors uniquely contribute to future intentions to engage in these illegal behaviours. A total of 546 licensed drivers who have a history of using both alcohol and drugs (marijuana, MDMA, and/or ice/speed) responded to an online survey that included legal deterrence measures as well as established measures of non-legal factors for both drink driving and drug driving. The non-legal factors included the fear of physical loss (e.g., fear of injuring yourself or others), social loss (e.g., social disapproval) and internal loss (e.g., guilt). Participants were more likely to report drug driving compared to drink driving, with a higher perceived chance of being caught for drink driving and more experience avoiding punishment for drug driving. Physical loss to others and internal loss were higher for drink driving. For both models, punishment avoidance was a significant predictor. Certainty of apprehension and severity punishment were only significant deterrents for drug driving, not drink driving. The threat of physical loss to oneself was a significant deterrent for drink driving, not drug driving. The results show that legal and non-legal deterrents are rated as lower for drug driving compared to drink driving, yet legal sanctions are still a deterrent for drug driving. Further, non-legal countermeasures are needed for both drink and drug driving that increase drivers’ perceived fear of physical loss to others, internal loss, and social sanctions associated with the behaviours.
... Im Vergleich zu früheren Jahren war auch das Risiko, schon bei niedrigerer Alkoholisierung zu verunfallen, gestiegen. So zeigte die Risikoanalyse des Deutschen Roadside-Surveys [25] eine 2,5-fache Erhöhung des Unfallrisikos zwischen 0,4 ‰ und 0,6 ‰, während die früher zur Begründung von Alkoholgrenzwerten herangezogene Grand-Rapids-Studie [9] bei 0,5 ‰ noch kein erhöhtes Unfallrisiko festgestellt hatte [52]. Die Ergebnisse der Risikoanalyse des Deutschen Roadside Surveys wurden in weiteren Unfallstudien bestätigt. ...
... According to the World Health Organization [1], alcohol is world's third leading cause of ill health and premature death. Road safety is one of the domains were the assessment of the use of alcohol is very important, as the crash rate grows rapidly with increasing BAC [2]. ...
Introduction
Excessive use of alcohol increases the risk to be involved in a road traffic accident. According to many legislations, certain maximal blood-alcohol-concentrations (BAC) have to be respected to be allowed to drive on public roads. Acute alcohol intoxication is evaluated by blood analysis or analysis of the exhaled alveolar air. In many cases, evaluation of the alcohol consumption during the past months can be useful. In this light, ethyl glucuronide (EtG), a direct alcohol biomarker which can be found in keratinized matrices (hair, nails) is valuable and can be used for the long-term follow-up of alcohol consumption.
Research aim
To compare the EtG concentration in hair and fingernails from teetotalers, and to propose a cut-off value for EtG in fingernails for alcohol abstinence.
Material and methods
Paired samples of hair and nails were collected from participants, with a minimum age of 18 years. They all stated alcohol abstinence for at least 6 months. Participants were asked to complete a questionnaire about age, gender and the use of hair care products and nail polish. Analysis of EtG in the nail and hair samples were conducted following a validated analytical method.
Results
From 126 participants a hair and nail sample were collected. Of this group, 15 participants were finally not included in the study because of insufficient amount of hair or nails collected. There were more female participants (65%) and the average age of participants was 39 years. The EtG concentration in hair was below the limit of detection of 2.1 pg/mg in all but 4 samples (2.1, 2.1, 2.9, and 3.5 pg/mg). The EtG concentration in nails was below the limit of detection in 97 of the 111 samples. The concentrations in nails ranged between 2.3 and 23 pg/mg.
Discussion and conclusion
In a population of 111 teetotalers, the 97.5% percentile of EtG concentrations in fingernails is 7.6 pg/mg. The highest EtG concentration observed was 23 pg/mg. These results suggest that the cut-off value for alcohol abstinence may be lower than the previous suggested 59 pg/mg and 37 pg/mg.
... Furthermore, the more severe the accident, the higher probability that it is alcohol Drunk Driving As a Social Problem 5 related. There is certainly a relationship between drunk driving and traffic accidents, but the preciseness of this relationship has not been determined because of the interference of other causal factors and a number of methodological measurement problems (Borkenstein et al., 1974;Jacobs, 1989:27-41;Kennedy et al., 1994). More than a decade ago, Gusfield (1976Gusfield ( , 1981 claimed that the drunkdriving problem has been constantly exaggerated through and by faulty press releases and distorted research studies (usually because of poor research design and other methodological errors). ...
... As the breath alcohol concentration increases, the probability of drunk driving will increase significantly in the future. According to Allsop [34] and Borkenstein et al. [35], with the increase of the alcohol concentration test value, the accident rate increases. e Taiwan government has raised the fines on those with higher alcohol concentrations and enforced penalties according to the Criminal Code to reduce the harm of drunk driving caused by high alcohol concentration. ...
This study explored the important factors affecting the recidivism rate of drunk driving for car and motorbike users. The respondents were students of Taiwan’s road safety training course, which was required for all drunk drivers who were suspended from driving due to the violation of regulations. The characteristics of the drunk car and motorbike drivers, such as socioeconomic variables, alcohol consumption changes, family life cycle, and changes in the number of trips, were investigated. This study estimated the models affecting the recidivism rate of drunk driving for car and motorbike users with the logistic regression model. The main variables included drivers with a university degree or above who tend not to be recidivists compared to the drivers without one. Such respondents are more willing to avoid the risk of becoming drunk driving recidivists. Moreover, the variables of alcohol use disorders’ identification test (AUDIT), breath alcohol concentration, and frequency of drunk driving all significantly affect the possibility of recidivism. In terms of family life cycle, married respondents with children aged between 1 and 5 are less likely to become drunk driving recidivists. Those who take motorbikes as an alternative vehicle after being suspended from driving cars are more likely to become drunk driving recidivists. This study suggests the measures of suspending or withdrawing car and motorbike driver’s licenses at the same time, using alcolocks to restrict the right to drive, and increasing the frequency of drunk driving crackdowns. In addition, in terms of alcohol consumption behaviors, drinkers with high risks and drunk drivers with high breath alcohol concentrations should be regarded as the key targets for future tracking in order to avoid drunk driving recidivism.
... Statistics on the proportion of alcohol intoxication among injured cases cannot establish whether there is elevated risk associated with drinking. Functional impairment from alcohol ingestion resulting in injury could occur from alcohol involvement lower than the intoxication threshold (e.g., BAC at 0.08%), as shown for traffic accidents (Borkenstein et al., 1974). Importantly, a properly defined control group is needed to quantify the increased risk of injury at a given level of alcohol consumption or BAC. ...
Background
Numerous studies of roadside accidents among emergency room patients show elevated risk of injury from acute alcohol consumption, i.e., recent drinking precedes the injury event. The observed effects are large and show a dose–response relationship. In contrast, studies quantifying the association between injury risk and chronic consumption, such as past‐year average volume, show lower relative risk estimates than those from acute consumption.
Methods
Combining data from 4 waves of US National Alcohol Surveys (NAS) for years 2000–2015 (N = 29,571, 53% overall cooperation rate), we estimated the risk of any past‐year injury from past‐year volume using logistic regression. This was contrasted with an instrumental variable (IV) analysis utilizing a 2‐stage residual inclusion (2SRI) approach to estimate injury risk from volume, which adjusted for unobserved confounders using state beer and spirits tax rates, zip code‐level outlet and bar density, and control state status as instruments.
Results
Based on the combined US population surveys and controlling for sociodemographics, using conventional logistic regression, the odds ratios of injury from an average volume of 1, 2, and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively. These compared with 1.67 [1.00, 2.78], 2.38 [0.87, 6.54], and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method.
Conclusions
The association between injury and chronic alcohol consumption may be confounded by unobserved factors, resulting in a possible downward bias of the risk estimate.
... The threshold for deterioration on psychomotor tasks, including reaction time, cognitive processing, co-ordination and vigilance, is generally around 0.04 to 0.05 BAC (Eckardt et al. 1998). At a BAC of 0.08, the risk is multiplied by 10 and at BACs of 0.15 or higher, the crash risk is in the hundreds (Borkenstein et al. 1974). The majority of European countries have adopted a BAC limit of 0.05 for drivers; however, Ireland and the UK have lagged behind the rest of Europe, with an accepted BAC of 0.08. ...
... The most common combinations were alcohol þ THC (n ¼ 10), amphetamines þ benzodiazepines (n ¼ 7) and THC þ benzodiazepines (n ¼ 7). About 90% of the killed road users who tested positive had concentration in blood corresponding to the graded sanction limit corresponding to a BAC of 0.05% or higher, which in most cases is associated with clinical impairment and increased crash risk (Borkenstein et al. 1974;Blomberg et al. 2009). ...
Objective
To study the prevalence of alcohol and drugs in biological samples from drivers, motorcycle riders, bicyclists, and pedestrians involved in fatal road traffic crashes (RTCs) during 2016-2018 in Norway, both among fatally injured victims and those who survived fatal RTCs.
Methods
Anonymous information was extracted from police data. No personal data were recorded.
Results
There were 330 fatal RTCs with 349 killed road users and 384 survivors during the study period; this included 179 passengers who were excluded from the study. In total, 90% of the studied killed road users and 67% of the survivors were investigated for alcohol or drug use by analyzing biological samples. Alcohol or drugs in concentrations above the legal limits were detected in 21% of the analyzed samples. The proportion impaired by alcohol or drugs (blood alcohol concentrations equal to or greater than 0.05%, or drug concentrations above equivalent limits) was highest among killed bicyclists (43%), higher than among killed pedestrians (24%), car and van drivers (28%) and motorcyclists (20%), and significantly higher than among drivers who survived fatal crashes (4%).
Conclusions
Impairment due to use of alcohol or drugs was often a contributing factor among bicyclists, pedestrians and motor vehicle drivers who died in RTCs. Driving under the influence of alcohol or drugs was more often a contributing factor in cases where the motor vehicle driver was killed than in cases where the driver survived.
... Previous research demonstrated that a difference of 2.5 cm is comparable to the increase in SDLP observed at bloodalcohol concentration (BAC) of 0.5 g/L compared to placebo . This BAC has been found to be associated with a significantly increase in crash risk (Borkenstein, Crowther, & Shumate, 1974). It follows that an increase in SDLP of ≥2.5 cm implies a significantly increase in crash risk (Ramaekers, 2017). ...
Objective:
Previous research reported cognitive and psychomotor impairments in long-term users of benzodiazepine receptor agonists (BZRAs). This article explores the role of acute intoxication and clinical complaints.
Methods:
Neurocognitive and on-road driving performance of 19 long-term (≥6 months) regular (≥twice weekly) BZRA users with estimated plasma concentrations, based on self-reported use, exceeding the therapeutic threshold (CBZRA +), and 31 long-term regular BZRA users below (CBZRA -), was compared to that of 76 controls.
Results:
BZRA users performed worse on tasks of response speed, processing speed, and sustained attention. Age, but not CBZRA or self-reported clinical complaints, was a significant covariate. Road-tracking performance was explained by CBZRA only. The CBZRA + group exhibited increased mean standard deviation of lateral position comparable to that at blood-alcohol concentrations of 0.5 g/L.
Conclusions:
Functional impairments in long-term BZRA users are not attributable to self-reported clinical complaints or estimated BZRA concentrations, except for road-tracking, which was impaired in CBZRA + users. Limitations to address are the lack of assessment of objective clinical complaints, acute task related stress, and actual BZRA plasma concentrations. In conclusion, the results confirm previous findings that demonstrate inferior performance across several psychomotor and neurocognitive domains in long-term BZRA users.
... Drug-induced impairments in the highway-driving test have been compared to that of alcohol. Alcohol is a wellknown benchmark drug that jeopardize traffic safety and shows a clear exponential dose-dependent relationship with traffic accident risk (Borkenstein et al. 1974;Blomberg et al. 2009). The clinical relevance of performance changes in the driving test have previously been determined by establishing the relationship between blood alcohol concentration (BAC) and SDLP (Louwerens et al. 1987). ...
Introduction
Excessive Daytime Sleepiness is a core symptom of narcolepsy and idiopathic hypersomnia, which impairs driving performance. Adequate treatment improves daytime alertness, but it is unclear whether driving performance completely normalizes. This study compares driving performance of patients with narcolepsy and idiopathic hypersomnia receiving treatment to that of healthy controls.
Methods
Patients diagnosed with narcolepsy type 1 (NT1, n = 33), narcolepsy type 2 (NT2, n = 7), or idiopathic hypersomnia (IH, n = 6) performed a standardized one-hour on-the-road driving test, measuring standard deviation of lateral position (SDLP).
Results
Results showed that mean SDLP in patients did not differ significantly from controls, but the 95%CI of the mean difference (+1.02 cm) was wide (-0.72 to +2.76 cm). Analysis of subgroups, however, showed that mean SDLP in NT1 patients was significantly increased by 1.90 cm as compared to controls, indicating impairment. Moreover, four NT1 patients requested to stop the test prematurely due to self-reported somnolence, and two NT1 patients were stopped by the driving instructor for similar complaints.
Conclusion
Driving performance of NT1 patients may still be impaired, despite receiving treatment. No conclusions can be drawn for NT2 and IH patients due to the low sample sizes of these subgroups. In clinical practice, determination of fitness to drive for these patients should be based on an individual assessment in which also coping strategies are taken into account.
... Validation of the use of alcohol has been demonstrated repeatedly in road-tracking performance evaluations on highways in on-the-road driving tests (Borkenstein et al. 1974;Louwerens et al. 1987). By contrast, few DS have been validated among the more than 30 types that currently exist (Iwata et al. 2018). ...
Rationale
Although driving simulators (DS) are receiving increasing attention due to concern over traffic accidents under the influences of drugs, few DS are recognized for their reliability and validity. Therefore, the development of an evaluation system using DS for driving performance is urgently needed.
Objectives
To investigate whether the standard deviation of lateral position (SDLP) increases with blood alcohol concentration (BAC) using a DS with reliability and calculate the SDLP threshold from the difference between BAC levels of 0 and 0.05%.
Methods
Twenty healthy Japanese men performed the DS tasks up to 60 min in Study 1 and DS tasks twice at 1-week intervals in Study 2. Twenty-six healthy men conducted the same DS tasks under BAC level (0, 0.025, 0.05, and 0.09%) in double-blind, randomized, crossover trial in Study 3. The primary outcome was SDLP in a road-tracking test. The test–retest reliability of DS data was assessed, and the estimated difference in SDLP between BAC levels of 0 and 0.05% was calculated using a linear regression model.
Results
The cumulative SDLP values at 5-min intervals were stable, and the intraclass correlation coefficient for its values was 0.93. SDLP increased with BAC in a concentration-dependent manner. The predicted ΔSDLP value for the difference between BAC levels of 0 and 0.05% was 9.23 cm. No participants dropped out because of simulator sickness.
Conclusions
The new DS used in these studies has reliability, validity, and tolerability and is considered suitable for evaluating the influence of drugs on driving performance.
... With the exception of alcohol, relatively little is known about the prevalence of drugs in the systems of drivers or other roadway users (pedestrians, bicyclists) who are involved in motor vehicle crashes. A quantitative relationship between alcohol and the risk of crashes was first documented in 1964 (Borkenstein et al., 1964;Borkenstein et al., 1974) and confirmed in a later study (Blomberg et al., 2005;Blomberg et al., 2009). Another study showed the level of alcohol in a pedestrian's system was related to that person's risk of being struck by a motor vehicle (Blomberg et al., 1979). ...
A gap in knowledge exists regarding drug use among drivers and other road users (pedestrians, bicyclists) who are seriously or fatally injured in crashes in the United States. This study examines the prevalence of alcohol as well as selected over-the-counter, prescription, and illegal drugs in the blood of seriously or fatally injured drivers and other crash victims near the time of their crashes before and during the COVID-19 public health emergency. Data was collected at Level 1 trauma centers and medical examiner offices. The 3,003 participants represent a convenience sample of roadway users who were seriously or fatally injured during the study period. Trauma centers and medical examiners made available small volumes of blood for toxicological analyses from the total collected during their normal clinical procedures. The results indicate drug prevalence was high among seriously and fatally injured roadway users before the public health emergency began and was even higher during, especially for alcohol, cannabinoids (active THC), and opioids. Drivers in particular showed significantly higher overall drug prevalence during the public health emergency, with 64.7% testing positive for at least one active drug, compared to 50.8% before. Drivers also showed an increase in testing positive for two or more categories of drugs going from 17.6% before to 25.3% during the public health emergency. Of particular note, active THC was more prevalent among drivers during the public health emergency than alcohol (32.7% versus 28.3%), and opioid use among drivers almost doubled from 7.5% to 13.9%. Overall, the results of this study suggest the highway safety community should be concerned about the impact of other drugs as well as alcohol. In particular, the observed cannabis and opioid prevalence rates before and during the public health emergency could be indicative of a growing problem. These findings are prevalence rates only and cannot be used to determine whether the people were impaired at the time of their crash.
Primer trabajo en Latinoamérica que enfoca la temática de la seguridad vial desde diferentes perspectivas disciplinarias como el derecho, la ingeniería vial, la medicina forense y la criminalística, tratando la problemática de la siniestralidad vial con la finalidad puesta en la prevención y en la concienciación del riesgo vial.
Background:
β-myrcene, one of the most common terpenes found in cannabis, has been associated with sedation. We propose that β-myrcene contributes to driving impairment even in the absence of cannabinoids.
Aim:
To conduct a double-blind, placebo-controlled crossover pilot study of the effect of β- myrcene on performance on a driving simulator.
Method:
A small sample (n=10) of participants attended two experimental sessions, one in which they were randomized to receive 15 mg of pure β-myrcene in a capsule versus a canola oil control. Each session, participants completed a baseline block and three follow-up blocks on a STISIM driving simulator.
Results:
β-myrcene was associated with statistically significant reductions in speed control and increased errors on a divided attention task. Other measures did not approach statistical significance but fit the pattern of results consistent with the hypothesis that β-myrcene impairs simulated driving.
Conclusions:
This pilot study produced proof-of-principle evidence that the terpene β-myrcene, an agent commonly found in cannabis, can contributes to impairment of driving-related skills. Understanding how compounds other than THC affect driving risk will strengthen the field's understanding of drugged driving.
Most common law nations impose minimum sentences for drunk driving. Israel introduced a mandatory minimum law in 1995 requiring a two–year license disqualification regardless of intoxication level. In theory, the new law allows minimal room for deviation. In practice, however, our study demonstrates that the law in action has diverged significantly from “blackletter law.” Through an integrated historical, quantitative, and qualitative analysis that follows the law from its inception to the present day, we explore the root causes of this deviation and the mechanisms of circumvention. Based on quantitative data collected on drunk driving cases between 2008 and 2022 and a survey of professionals specializing in traffic law, we highlight how the law’s perceived harshness has contributed to plea bargains becoming the normative means of circumventing the law. This circumvention undermines the law’s original intention, that is, uniformity, proportionality, and equity in sentencing. Multiple variables including appearances in court, legal representation, jurisdiction, and the judge’s identity result in comparably guilty defendants receiving different sentences. Given these disparities, we propose replacing the current minimum sentence with a graduated minimum based on intoxication levels; limiting prosecutorial and judicial discretion; and providing court date reminders and public counsel to minimize harm to vulnerable populations.
Brief interventions for alcohol are an evidence informed approach to addressing the needs of the many people who may benefit from reducing their alcohol consumption. This chapter will outline the two different types of intervention:
1.
Simple brief intervention
2.
Extended brief intervention
… and the basic principles underlying these approaches. Brief interventions are firmly grounded in theory; therefore, this chapter will highlight those most commonly associated with this approach, including social learning theory, cognitive behavioural therapy, motivational interviewing, and the transtheoretical (stages of change) model. Evidence will be presented concerning the effectiveness and cost-effectiveness of brief alcohol interventions in both hospital and home settings. As well as general hospital wards other medical settings, such as primary healthcare and hospital emergency departments, are appropriate locations for brief alcohol intervention. Despite people responding positively to brief alcohol intervention when delivered in an appropriate context and by a professional with whom they have developed a relationship and rapport, professionals cite several barriers to its implementation. As excessive alcohol consumption is associated with social as well as health problems, brief interventions sometime occur within other contexts, such as criminal justice, educational, work, and social service settings. While brief alcohol interventions can be effective in these contexts, there can be issues with stigma associated with receiving a brief alcohol intervention in these settings. However, it has been found that neither the setting nor content of the brief alcohol intervention appears to significantly moderate its effectiveness, although nurses play a positive role in their delivery; therefore, services should select the brief intervention tool that best suits their needs. Digital intervention, which can be delivered in the home, are an effective alternative often preferred by younger people.KeywordsSimple brief interventionExtended brief interventionBrief intervention theoryHospital settingsHome settingsBarriers
This chapter details the range of physical health issues that arise from alcohol use. While the focus on alcohol is usually on behavioral issues such as alcohol dependence, violence, and suicide and self-harm while intoxicated, there is a raft of physical health problems linked with both short-term harmful drinking and longer-term heavy dependent drinking.These problems seem to be dose-dependent but with wide variations in susceptibility and account for significant premature morbidity and mortality.In 2016 alcohol was the seventh most important contributing risk factor to the global burden of disease, accounting for 4.2% of total disability-adjusted life years lost (Global Burden of Disease, Lancet 390:1345–422, 2017). The overwhelming disease burden is due to physical health problems arising from alcohol use.KeywordsIntoxicationConfusionWernicke’s EncephalopathyKorsakoff’s PsychosisBrain injuryLiver diseaseMalignancy
Breath alcohol testing offers significant advantages over blood alcohol testing. As a result, several million breath alcohol tests are conducted globally each year, mainly for the enforcement of drunk driving laws. The main types of breath alcohol testing instruments are passive alcohol sensors, screening devices, alcohol ignition interlock devices, and evidential breath alcohol instruments. Infrared (IR) spectrophotometry, electrochemical (fuel cells) and dual IR/electrochemical technology, and gas chromatography are the main methods of analysis for breath alcohol. Proper scientific controls such as duplicate breath alcohol testing, air blanks, and calibration checks are necessary to ensure the reliability of evidential breath alcohol testing. The blood to breath alcohol ratio, mouth alcohol effect, and specificity are also presented in this article.
Alcohol, or chemically ethanol, is the most common drug used in the community. It is also the most abused and is by far the most common drug associated with forensic matters. Consequently, it is the most common substance analyzed by laboratories engaged in such activities. The interpretation of these results is, therefore, an important task for any laboratory and associated experts engaged by the courts.
Rationale: Alcohol-induced driving impairment can occur with any departure from a zero-blood alcohol concentration (BAC). Because intoxication is characterised by impaired judgement, drivers under the influence of alcohol may overestimate their capacity to safely operate a vehicle.
Objectives: This study examined the effects of alcohol on driving performance, four-choice reaction time (FCRT), and self-rated confidence in driving ability. It specifically focused on alcohol doses equal to commonly enforced legal BAC limits (i.e. 0.05% and 0.08%).
Methods: A randomized, double-blind, placebo-controlled design was utilised. Seventeen participants were tested in three conditions: placebo and two alcohol conditions aiming for BACs of 0.05% and 0.08%. Participants underwent a baseline FCRT task and a 1-h simulated highway driving task before completing another FCRT task and rated their confidence in their driving ability.
Results: The high and low alcohol dose conditions resulted in a mean BAC of 0.07%, and 0.04%, respectively (n = 17). The high BAC treatment significantly increased standard deviation of lateral position (SDLP) by 4.06 ± 5.21 cm and standard deviation of speed (SDS) by 0.69 ± 0.17 km/h relative to placebo, while confidence in driving ability remained unchanged across treatments. FCRT performance was impaired by the high BAC treatment (all < 0.01), but there we no significant differences between placebo and low BAC conditions.
Conclusions: The findings of this study show that driving performance and associated psychomotor functioning become significantly impaired below legally permissible driving limits in some jurisdictions. We identified a dissociation between driving performance and subjective awareness of impairment. Despite a significantly diminished driving ability at 0.07% BAC, drivers were unaware of their impairment.
Zusammenfassung
Kognitive Auffälligkeiten bei Patienten mit chronischen Schmerzen finden in wissenschaftlichen Untersuchungen zunehmend Beachtung. Die Folgen dieser kognitiven Störungen in Bezug auf die Schmerzbewältigung, die Alltagsgestaltung und die Kraftfahreignung werden in der klinischen Praxis jedoch kaum berücksichtigt, obwohl die Hälfte aller Patienten davon betroffen ist. Die vorliegende Arbeit fasst die aktuelle Studienlage zusammen und diskutiert Möglichkeiten der Integration in die klinische und therapeutische Versorgung.
Fifty years of evolution of transportation research is revisited based on bibliometric indicators of nearly 50,000 articles, the collective publication of all transportation journals. A multitude of objective indicators all consistently determined four major divisions in the field: (i) network analysis and traffic flow, (ii) economics of transportation and logistics, (iii) travel behaviour, and (iv) road safety. Trending themes of research within the abovementioned divisions respectively are: (i) macroscopic fundamental diagram and public transport network design, (ii) nil (no distinct trending topic), (iii) land-use, active transportation, residential self-selection, travel experience/satisfaction, social exclusion and transport/spatial equity, and (iv) statistical modelling of road accidents. Furthermore, clusters of research related to topics of (a) shared mobility, (b) electric mobility, and (c) autonomous mobility constitute trending topics that are each a cross between multiple divisions of the field. These outcomes document major directions to which the transportation research is headed. Additional outcome is determination of influential outsiders, seminal articles published by non-transportation journals that have proven instrumental in the development of transportation science.
Amaç: Çalışmamızda, araç içi trafik kazası sonucu yaralanıp acil servise başvuran hastaların demografik özelliklerinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmamızda 01.01.2015-31.12.2015 tarihleri arasında ayaktan veya 112 ambulans servisi ile başvuran 1338 hasta retrospektif olarak değerlendirildi. Hastaların yaş, cinsiyet, Glasgow Koma Skoru (GKS), patolojik bulguları, alkol varlığı, yaralanma bölgeleri, istenilen ultrasonografi/bilgisayarlı tomografi, konsültasyon, yatış durumları ve mortalite oranları incelendi.
Bulgular: Hastaların yaş ortancası 30 yıl olup, %69,7’si erkekti. Hastaların %99’unun GKS’si 14-15 aralığındaydı. Hastaların %5,2’sinin alkollü olduğu saptandı. En sık lezyonların baş-boyun (%53,1) ve ekstremitlerde (%45,9) olduğu saptandı. Çalışmamızda olguların %17,9’u basit tıbbı müdahale ile giderilemeyecek lezyon içermekteydi. Basit tıbbi müdahale ile giderilemeyen hastaların yaş ortancası anlamlı olarak yüksekti (p <0,05). Cinsiyet ve alkol alımı ile lezyon ciddiyeti arasında ilişki saptanmadı (p >0,05). Baş-boyun yaralanmalarının basit tıbbi müdahale ile giderilme sıklığı yüksek iken, diğer lokalizasyon travmalarının Basit tıbbi müdahale ile giderilmeme sıklığı yüksek saptandı (p <0,05). En sık istenen tetkikin beyin tomografisi, en az istenen tetkikin de ultrason olduğu saptandı. Lezyon saptama sıklığı ekstremite travmalarında çekilen tomografilerde en fazla iken en az lezyonun da ultrasonda belirlendiği saptandı. Hastaların %46,1’inin ilgili kliniklere konsülte edildiği, %8,5’inin yatırıldığı saptandı. Hastalar için en sık ortopedi ve beyin cerrahi kliniklerinden konsültasyon istendiği ve kliniklerine yatırıldığı saptandı. Hastaların mortalite oranı %0,9 olarak saptandı. Eksitus olan hastalardaki erkek sıklığının yüksek, GKS’nin düşük, baş-boyun, toraks, spinal travma ve batın travma sıklığının yüksek olduğu saptandı (p <0,05). İntrakranial kanama, kranium fraktürü, pnömotoraks, hemotoraks ve batın içi kanaması olan hastaların mortalite oranı anlamlı olarak yüksek saptandı (p <0,05).
Sonuç: Travma bölgelerinde belirlenen lezyonların çoğunluğu fizik muayene ile saptanabilir, acil servislerde lezyon olan bölgeye yönelik tetkik yapılması ve literatürdeki önerilere bağlı kalınması tetkik sayısını azaltabilir. Lezyonların fizik muayene ile tespit edilmesi durumunda mortaliteye yol açan lezyonlara müdahale hızlandırılabilir.
The development of drug driving policies should rest on sound epidemiological evidence as to the crash risks of driving after using psychoactive drugs. The findings from individual studies of the increased risk of crashing from the acute use of cannabis range in size from no increase (and perhaps even a protective effect) to a 10-fold increase. Coherent cannabis-driving policies cannot readily be developed from such an incoherent evidence base. A weighted average measure of risk, as provided by a meta-analysis, might be useful. However, if the range of risks found in the cannabis-crash studies reflects the different ways that a variety of biases are being expressed, then the simple application of a meta-analysis might provide little more than an average measure of bias. In other words, if the biases were predominantly inflationary, the meta-analysis would give an inflated estimate of crash risk; and if the biases were predominantly deflationary, the meta-analysis would give a deflated estimate of risk.
The diversion of a driver’s attention from the essential tasks required when driving a vehicle has been demonstrated to significantly increase the risk of having a road crash. Mobile phone use by drivers is widely recognised as increasing crash risk, while many other common distractions, such as eating or adjusting vehicle controls, are also problematic but less well understood. This study was aimed at objectively measuring the prevalence of various in-vehicle distracting driver behaviours in moving traffic. Covert video surveillance was deployed, using specialist video camera systems at four elevated locations on South Australian roads. Video was recorded and then analysed by multiple independent researchers. A total of 920 drivers were observed in the footage, and 8.9% of all drivers were observed to be potentially distracted. The majority of drivers were in passenger vehicles (94.6%) and among these drivers 8.6% were distracted in comparison to 14% of heavy vehicle drivers. The most prevalent driver distractions observed included mobile phone use (2.5%), reaching for, or holding an object (1.8%), eating or drinking (1.5%) and wearing headphones (0.9%). A higher speed zone was associated with a lower proportion of distracted driving behaviour. Reducing mobile phone use in vehicles through blocking technologies and police enforcement will decrease distracted driving and distraction related crashes; however, other in-vehicle distractions are also pervasive and require interventions to reduce distracted driving. Importantly, this methodology can be used to objectively monitor the prevalence of distracted driving behaviours over time and to evaluate interventions aimed at changing distracted driving behaviour.
Fifty years of evolution of the transportation field is revisited at a macro scale using scientometric analysis of all publications in all 39 journals indexed in the category of Transportation by the Web of Science. The size of the literature is estimated to have reached 50,000 documents. At the highest level of aggregation, four major divisions of the literature are differentiated through these analyses, namely (i) network analysis and traffic flow, (ii) economics of transportation and logistics, (iii) travel behaviour, and (iv) road safety. Influential and emerging authors of each division are identified. Temporal trends in transportation research are also investigated via document co-citation analysis. This analysis identifies various major streams of transportation research while determining their approximate time of emergence and duration of activity. It documents topics that have been most trendy at any period of time during the last fifty years. Three clusters associated with the travel behaviour division (collectively embodying topics of land-use, active transportation, residential self-selection, traveller experience/satisfaction, social exclusion and transport/spatial equity), one cluster of statistical modelling of road accidents, and a cluster of network modelling linked predominantly to the notion of macroscopic fundamental diagram demonstrate characteristics of being current hot topics of the field. Three smaller clusters linked predominantly to electric mobility and autonomous/automated vehicles show characteristics of being emerging hot topics. A cluster labelled shared mobility is the youngest emerging cluster. Influential articles within each cluster of references are identified. Additional outcomes are the determination the influential outsiders of the transportation field.
In United States jurisprudence, Reasonable Certainty is one of the criteria for the admissibility of expert opinion in litigation. One element of establishing Reasonable Certainty can be that the opinion comports with a code requirement, a voluntary-consensus standard, a handbook reference or, in their absence, with Acceptable Practice. From there, and importantly, that the claimed requirement, standard or practice is causally related to the accident under analysis. A key element in using a code, standard, or handbook reference in the Reasonably-Certain rubric is that all substantive elements, including temporality, must be met. The key elements in showing that something comports with Acceptable Practice are, in addition to the elements listed above, that the Acceptable Practice in fact exists beyond the imagination of the interested expert. Ignoring any of these elements, often deliberately, turns what should be dispositively significant elements of litigation into a meaningless check-box item. It has been my experience that many forensic practitioners simply ignore all this, citing for-one-reason-or-another irrelevant code and standards in their desire to give the work the appearance of a mantle of authority. That this is inappropriate is hopefully obvious.
Aims of the study: To determine the prevalence of alcohol or drug impairment in fatal road traffic crashes in Norway during 2005-2018, primarily among fatally injured motor vehicle drivers (including riders), and assess the degree of impairment and prevalence of problematic use of alcohol or drugs. Alcohol and drug impairment was studied in relation to age, sex, time and place of crash, type of motor vehicle, type of crash, and type of driving errors.
Methods: Data from the Crash Investigation Team Database operated by the Norwegian Public Roads Administration and forensic medicine data were used to obtain a comprehensive data set on killed drivers. Police data were used to generate statistics on killed and surviving road users involved in fatal crashes. Analytical findings of alcohol, illicit drugs and psychoactive medicinal drugs were assessed in relation to the legislative limits (corresponding to blood alcohol concentration (BAC) of 0.02 %) and limits for graded sanctions (corresponding to BAC of 0.05 % and 0.12 %) in the Road Traffic Act. Concentrations of alcohol or drugs in blood between BAC of 0.02 and 0.05 %, and corresponding values for drugs, indicate impairment in relation to the Road Traffic Act, but do not always indicate significant clinical impairment. Drivers with alcohol or drug concentrations corresponding to BAC of 0.05 % and higher, or high concentrations of amphetamines (5 times the legislative limits), were regarded as likely clinical impaired in this study.
Results: The Crash Investigation Team had recorded that 22 % of fatal road traffic crashes during 2005-2018 were related to alcohol or drug impairment. In those crashes, 546 road users were killed. The numbers of fatal crashes in related to population were highest in the northernmost and southernmost regions. The majority of the fatal crashes that happened during the night and early morning were related to alcohol or drug impairment. The prevalence of alcohol and drugs was higher among drivers killed in road departures than in collisions between two or more vehicles.
Of the killed car and van drivers, 66 % were investigated for alcohol or drug impairment by analysis of blood samples. Of those drivers, 35 % had concentrations of alcohol or drugs above the legislative limits given in the Road Traffic Act, 29 % had concentrations corresponding to BAC of 0.05 % or equivalent limits for drugs. Most of those drivers were significantly impaired, corresponding to a blood alcohol concentration of 0.12 % or more. A large proportion of those who were impaired by illicit drugs or psychoactive medicinal drugs had used two or more substances. The proportion of impaired drivers was higher among males than females, the highest proportion was observed among drivers below 40 years of age.
The proportion of alcohol impairment among killed car and van drivers declined during the study period, but no significant change was observed for drugs.
Information about alcohol and drug impairment that is not based on blood analysis is also recorded in the Crash Investigation Team Database. When combining those data with results from forensic testing, we estimated that at least 26 % of all killed car and van drivers were impaired by alcohol or drugs at the time of crash.
Among killed MC and moped riders, 64 % had been investigated for alcohol or drug impairment by analysis of blood samples. Of those riders, 26 % had concentrations of alcohol or drugs above the legislative limits; 22 % had concentrations above 0.05 % for alcohol or equivalent limits for drugs. A slightly larger proportion tested positive for illicit drugs than among killed car and van drives. When combining forensic data with data from the Crash Investigation Team Database we estimated that at least 18 % of all killed MC and moped riders were impaired by alcohol or drugs at the time of crash.
Among killed drivers of vans/lorries over 3500 kg, buses/minibuses and trucks, 7 % had concentrations of alcohol or drugs above the graded sanction limits corresponding to BAC of 0.05 %. Among drivers of other types of motor vehicles (ATVs, tractors, etc.), 31 % had concentrations of alcohol or drugs above those limits.
Alcohol or drug impaired drivers and riders killed in road traffic crashes had often been speeding and not used seatbelt or MC helmet. Impairment by alcohol or amphetamines was strongest associated with those driving errors. Impairment by medicinal drugs was associated with non-use of seatbelt, but not with speeding. It was more difficult to assess driving errors associated with cannabis impairment, as most of those who tested positive for cannabis had also used alcohol or other drugs at the same time, substances that were likely to contribute to driving errors.
Statistics from the police for the period 2016-2018 showed that few car and van drivers who were involved, but survived fatal crashes, were impaired by alcohol or drugs. Data also indicated that large proportions of killed bicycle riders and pedestrians were also impaired by alcohol or drugs corresponding to BAC of 0.05 % or more: 43 % of the bicyclists and 24 % of the pedestrians. However, those number may be inaccurate because few persons were included in the statistics. Among a total of 76 killed or surviving drivers of vans/lorries over 3500 kg, buses/minibuses and trucks, none were impaired.
Four out of five impaired drivers involved in fatal road traffic crashes had previously been convicted for criminal offences, almost half of them for drink or drug driving.
Conclusions: Test results from analysis of blood samples from drivers involved in fatal road traffic crashes indicate that the majority of those with alcohol or drug concentrations above the legislative limits had taken large doses or were multi drug users. This indicates problematic alcohol or drug use. The large proportion of drivers with previous convictions confirms this conclusion. It is important to take this fact into consideration when planning actions to reduce the prevalence of alcohol or drug impaired driving, as first time apprehension for drink or drug driving is a significant predictor for future impaired driving and involvement in road traffic crashes. The preventive effect of large fines, possible prison sentences, and suspension of the drivers’ license is insufficient. For this group of drivers, other preventive solutions must be used; both technical tools, training, and rehabilitation programmes may be used to change the drivers’ attitudes and behaviours.
Die Verkehrsmedizin als Teil der Rechtsmedizin erfüllt in der Schweiz eine wichtige präventive Aufgabe in der Sicherung aller Verkehrsteilnehmer: Sie begutachtet die medizinisch basierte Fahrfähigkeit und Fahreignung. Als empirisch konsolidiertes Querschnittsfach hat sie Informationen aus einer Vielzahl von medizinischen Fachgebieten. Wie reagiert die Verkehrsmedizin aber auf den vermehrten Anspruch evidenzbasierter Gutachten und auf anstehende Herausforderungen? Über einen historischen Abriss motivierten wir die Vorteile und das Potential einer teilweise durch Fahrsimulation ergänzten Untersuchung und einer dediziert auf Fahrsimulation basierenden, klinisch-prospektiven Forschung. Neben vorhandener Literatur stützen sich historische Aspekte u.a. auf vorhandene Expertise. Die Bewertung der Fahrsimulation für die Verkehrs- bzw. Rechtsmedizin der Schweiz stützt sich auf die Diskussion selektierter Literatur. Auftrag und Anspruch der Verkehrsmedizin haben sich mehrfach verändert. Eine übersichtsartige Betrachtung existenter Literatur legt nahe, dass massgeschneiderte Fahrsimulatoren Teil einer modernisierten Verkehrsmedizin sein können, um anstehende Herausforderungen adäquat adressieren zu können. Bisher existiert kein derartiges dediziertes Forschungsinstrument in der Schweiz. Eine auf verkehrsmedizinische Fragestellungen massgeschneiderte, realitätsnahe und niedrigschwellige Fahrsimulation als Werkzeug für klinische Studien und Individualuntersuchungen verspricht neben einer wissenschaftlichen Produktivität einen umsetzbaren und vermittelbaren Mehrwert für das übergeordnete Ziel der Sicherheit aller Verkehrsteilnehmer.
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