Guest blogger M. Kit Delgado, MD, MS, is an assistant professor of Emergency Medicine and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania, and a member of the National Academies of Sciences, Engineering, and Medicine Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities.
The EMS call that came in overhead on my most recent night shift at Penn Presbyterian Medical Center’s emergency department froze me in my tracks: “Trauma alert. 21 year-old female injuries from a motor vehicle collision. Significant damage to vehicle. Altered mental status, unstable vitals. Co-passenger ejected. ETA 5-7 minutes.” A minute later the other victim from that crash was called in overhead with unstable vital signs and was also en route.
As we gowned up with lead vests, head to toe gowns, and took our positions around the bed in the trauma bay, I could hear the first patient being wheeled in by the paramedics, screaming hysterically with slurred speech, “I’m sorry! I’m sorry! Please save her!” The paramedics slid her backboard on to the gurney. She was flailing with tears welling up in her eyes and a heavy smell of alcohol on her breath. We worked quickly to give her and her friend the best possible outcome. However, it was an all-too-frequent and salient reminder of the persistent – but preventable – toll of the irrational decision to drive while intoxicated.
Alcohol-impaired driving kills 29 people every day in the United States and injures hundreds more, leading to over $121 billion in costs annually. Nearly two out of every five deaths are victims other than the intoxicated driver.
While a significant amount of progress has been made in reducing alcohol-impaired driving fatalities since the 1980s, progress began stalling in 2009, and fatalities started increasing again in 2015. Despite diminishing attention to this persistent, completely preventable issue, alcohol impaired driving is the leading cause of motor vehicle fatalities by far, and accounts for more 10,000 deaths per year. Among developed nations, the U.S. has the highest proportion of alcohol-impaired driving fatalities. This is unacceptable.
M.Kit Delgago, MD, MS, assistant professor of Emergency Medicine and Epidemiology at the Perelman School of Medicine
For this reason, the National Academies of Sciences, Engineering, and Medicine convened a committee to study this issue, which included three Penn Medicine faculty members: Charles O’Brien, MD, PhD, a professor of Psychiatry and founder of the Penn Center for Studies of Addiction, Douglas Wiebe, an associate professor of Epidemiology and director of the Penn Injury Science Center, and myself. After a year of work, the committee released its report this week, “Getting to Zero Alcohol-Impaired Driving Fatalities: A Comprehensive Approach to a Persistent Problem.”
The report maps out the behavioral processes and context that contribute to this persistent problem and highlights interventions and actions to reduce fatalities, including ways to improve existing interventions. It also presents ideas for reviving public and policymaker attention.
Applying my lens to this problem as faculty in Penn’s Center for Health Incentives and Behavioral Economics, the decision to drive while intoxicated is a fundamentally irrational behavior, one that everyone knows is not in their best long-term interest, but some people still do it anyways on a regular basis. Like many other impulsive behaviors, it has been shown that those who drive after drinking lack self-control and are more impulsive and shortsighted. This explains individuals’ decisions to have “just one more drink” when already feeling intoxicated and to drive home because leaving the car behind is too much of a hassle to pick up in the morning.
It has also been shown that those who frequently drink and drive are also poor planners, which may explain the tendency to not plan a ride in advance. Therefore, policies that enable transportation alternatives other than driving to become the default option when drinking are key. Taking these behavioral insights in mind, the committee developed a comprehensive approach to counter the impulsivity and lack of self-control, especially among those who get arrested for drinking and driving.
In total, the committee arrived at 16 recommendations and 20 conclusions over several intervention points. First, interventions are needed to reduce drinking to impairment. For example, there is strong evidence to suggest that higher alcohol taxes reduce alcohol-impaired driving and motor vehicle crash fatalities. Yet alcohol taxes have declined in inflation-adjusted terms at both federal and state levels. Similar to what has been done with tobacco taxes, federal and state governments should raise alcohol taxes enough to have a meaningful impact on price to reduce alcohol-related crash fatalities.
Second, interventions are needed to reduce driving while impaired. These include lowering the legal blood alcohol content (BAC) limit percent from 0.08 percent to 0.5 percent as is the case in most developed countries, increasing sobriety checkpoints, boosting transportation alternatives – particularly in suburban and rural areas – and further developing in-vehicle technology that prevents the car from operating when it passively detects the driver’s BAC exceeds the legal limit.
Third, post-arrest and post-crash interventions are needed to address high rates of repeat offences. For example, DWI courts, which are specialized courts aimed at changing behavior of high-need DWI offenders through comprehensive monitoring and substance abuse treatment, have been shown to reduce repeat offense rates and should be implemented by all states. Another example is enacting all-offender ignition interlock laws in all states. These devices installed in the vehicles of DWI offenders require the driver to submit a test in a breath-testing device in order to start the car.
Additional recommendations were made regarding data and surveillance systems and how to generate action. Several areas of future research were highlighted including better understanding how to leverage smartphone-paired breath testing and wearable technologies that monitor alcohol levels for reducing this behavior.
With the systematic implementation of the evidence-based interventions highlighted in the report, more lives can saved, health care costs can be reduced, and just maybe Saturday nights in the emergency department will be a little bit more mundane, which would be a good thing.
A version of this article was also published by STAT News.