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An Epidemic of Trauma on U.S. Roads

By: 
Renee Despres

In an analysis released October 7, researchers at the U.S. Centers for Disease Control and Prevention (CDC) reported that in 2012, motor vehicle crashes sent 2.5 million people to emergency departments in the U.S. -- almost 7,000 people per day. Of those 2.5 million people who visited emergency rooms after traffic crashes, 200,000 were hospitalized.

Background

Most of us don’t think twice about jumping in the car to drive to the grocery store or to pick up the kids from school. Even during longer trips, we generally worry more about packing and the price of fuel than about whether we’ll make it to our destination without injury. But everyone who uses US roads and highways is at risk of injury or death from a motor vehicle crash.

Researchers often use an indicator called mortality – i.e., the number of people who die in motor vehicle crashes – to assess the impact of automobile accidents on individuals and society. And that number is significant. Traffic crashes led to nearly 23,000 fatalities in 2012, many of them in children, teens, and young adults.

But mortality only reflects a fraction of motor vehicle crash injuries. That’s why the CDC researchers set out to examine the impact of traffic crashes on survivors. To do that, they analyzed data on motor vehicle crash-related injuries from two big databases – the 2012 National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP), which is operated by the U.S. Consumer Product Safety Commission in collaboration with CDC, and the 2012 Health-care Cost and Utilization Project National Inpatient Sample (HCUP-NIS) of the U.S. Agency for Healthcare Research and Quality.

An Epidemic of Trauma

The research team published their findings in the CDC’s October 7 Vital Signs report.

The researchers found a veritable epidemic of trauma. "Motor vehicle crash injuries occur all too frequently and have health and economic costs for individuals, the health care system, and society. We need to do more to keep people safe and reduce crash injuries and medical costs," Ileana Arias, principal deputy director for the CDC said in an agency news release.

Investigators estimated that Americans made 2,519,471 emergency department visits for crash injuries, an estimated rate of 806 visits per 100,000 people living in the U.S. Very few of those visits were due to work-related crashes – only 1–2 percent. Men and women in the same age groups crashed about equally as often.

The analysis showed that the risk is greater for some groups than others. Teens and young adults aged 15 to 29 years were at the greatest risk of road crash injuries. They accounted for 38 percent of crash injuries in 2012, or nearly 1 million emergency room trips. Teens and young adults aged 15–29 year visited emergency departments at a rate almost twice the overall rate (1448/100,000 population), while adults aged 30–39 years had the second highest rate (1,075/100,000 population). Children aged 0–14 years had the lowest rate (281/100,000 population).

People 80 years and older were at greatest risk for injury severe enough to warrant hospitalization. More than one-third of people older than 80 ended up hospitalized, report authors noted.

On average, people who were hospitalized stayed in the hospital for 5.6 days for a total of 1,057,465 hospital days. Fractures led to hospitalization in almost half (45%) of cases.

People living in the average U.S. households make almost 6 trips in a vehicle per day, the researchers noted, making the risk of crash injury “widespread.”

Cost of Motor-Vehicle Crash Injuries

The lifetime medical expenses of survivors will add up to a cool $18 billion, including $10 billion for people who are admitted to hospitals and $8 billion for people who are treated in an emergency department then released. The analysis showed that the bulk of those costs – more than three-quarters – were incurred during the first 18 months after the injury.

In addition, survivors will collectively lose $33 billion worth of work over their lifetimes, authors reported. People who were treated and released will lose $9.4 billion in earnings, while those who were hospitalized will see a loss of $23.5 billion in potential work dollars.

Researchers compared these costs to those of another well-known disease, HIV, noting that “the estimated lifetime medical cost of crash injuries is approximately 50% higher than the estimated $12.6 billion cost for human immunodeficiency virus (HIV) in the United States.”

The (Sort of) Good News

As grim as those numbers are, they represented a decline in crash injuries over the previous ten years. When researchers compared their 2012 findings with those from a similar analysis in 2002, they found nearly 400,000 fewer emergency department visits and 5,771 fewer hospitalizations. The reduction in injury was also linked to significant cost savings of $1.7 billion less in lifetime medical cost and $2.3 billion less in lifetime work-loss costs.

What Needs to be Done?

As Gwen Bergen, a behavioral scientist in the division of unintentional injury prevention at the National Center for Injury Prevention and Control, said in the CDC news release "Motor vehicle crashes and related injuries are preventable.”

She added, “Although much has been done to help keep people safe on the road, no state has fully implemented all the interventions proven to increase the use of car seats, booster seats, and seat belts; reduce drinking and driving; and improve teen driver safety."

This report suggests that reducing injury from motor vehicle crashes will require a combination of education, technology, and policy changes.

How to Keep Yourself and Your Family Safe on the Road

Here are some ways you can reduce the risk for yourself, your family, and others who share the road with you:

Always wear a seatbelt.

Wear a seat belt every time you drive your vehicle – no matter how short the trip. Seat belts save lives. Data from the CDC show that people who wear seat belts reduce their risk of serious injury in a crash by about 50 percent. Pregnant women should wear the belt with the lap belt against the hip.

Air bags can also help to protect adults (not children) during a crash, but they are not a substitute for seat belts. The combination of seat belts and air bags is safest.

Don’t drink and drive

Drinking and driving kills people, yet 4 million US adults do it every year – multiple times. Americans drove after drinking too much at least 112 million times in 2010. If your blood alcohol content is greater than 0.08% (the equivalent of about 4 beers), you are considered alcohol-impaired. Alcohol-impaired drivers are involved in about 1 in 3 crash deaths, resulting in nearly 11,000 deaths in 2009. But even at a blood alcohol content level of 0.02% -- the equivalent of about two beers – people have difficulty doing two tasks at one time and experience loss of judgment.

Choose between the booze and the wheel.

Turn off the cell phones

Driving while talking on a cell phone is distracted driving – and it’s dangerous to you and everyone else on the road around you. In 2011, almost one out of four motor vehicle crashes involved cell phone use, a total of 1.3 million crashes.

Researchers who have analyzed cell phone records after crashes have shown that talking on a cell phone while driving increases your chance of being in a crash by about 1.3 times, while driving and dialing makes a crash almost three times more likely.

Cell phone use impairs critical aspects of driving performance, especially reaction time. And, despite the popularity of laws that allow the use of hands-free devices, several studies have compared the risks of hand-held versus hands-free cell phone use and found no differences. Both increase risk.

Texting while driving is even more dangerous and irresponsible, because it requires you to take your hands off the wheel and your eyes off the road. If you text while driving, you take your eyes away from the road for at least five seconds. At 55 miles an hour, that’s the same as driving the length of a football field without looking. Texting while driving increases the risk of a crash by up to 23 times.

Restrain children in the right carseat, properly installed

When correctly used, car seats can reduce the risk of injury to children by 71 percent. The American Academy of Pediatricians recommends that all children ride in a rear-facing child seat until they are 2 years old or until they outgrow the manufacturer’s height and weight recommendations for the seat. A forward-facing car seat with a harness and tether can then be used – again, use it until the child outgrows the height and weight limits for that seat.

Older children should ride in a booster seat, using a lap and shoulder belt. Booster seats can reduce injury rates by 58 percent over the use of a seat belt alone in children age 4-8.

Booster seats adjust the child’s position in the car so that the seat belt lies on bony structures like the pelvis and chest – not soft places like the abdomen or neck. During a crash, a lap belt that lies across the abdomen can cause serious and often life-threatening injuries to internal organs; a shoulder belt that crosses the child’s neck can cause injury to the trachea or even lead to strangulation or a broken neck.

The lap belt should fit flat across the child's upper thighs, and the shoulder belts should lie across the shoulder in the middle of the clavicle. Never place the shoulder belt behind the back or under the arm.

Most children need to use a booster seat until they are 8 to 12 years old. They should be at least 4 foot 9 inches tall and weigh between 80 and 100 pounds. 

Need to Know: When can kids safely ride without a booster seat?

According to SafeKids, a leading childhood safety advocacy group, children no longer need a booster seat when they can pass the “Safety Belt Fit Test”:

  • The knees bend at the edge of the seat when his or her back and bottom are against the vehicle seat back

  • The vehicle lap belt lies flat across the upper thighs

  • The shoulder belt fits across the shoulder and chest.

  • Never, ever allow a child to ride in a seat with an airbag.

  • Children should ride in the back seat until they are 13 years old.

 

Set groundrules for teens

Teens are often excited and overconfident when behind the wheel – and all too often, they take risks. Research shows that teens drive more safely when parents set limit for them and follow through with consequences if those limits are disregarded.

The American Academy of Pediatrics offers a parent/teen driving contract. Download it, read it, discuss it with your teen, and make signing it a condition for your teen to drive.

When setting groundrules with teens, be sure they include the following:

  • No cell phones: Cell phones distract you from the task at hand – driving. Texting is especially problematic, because it requires you to take your eyes off the road and hands off the wheel.
  • No extra passengers: Teens are more likely to take risks when driving with their peers. As a matter of fact, teens are more than two-and-a-half times more likely to engage in risky behaviors – such as drinking alcohol, texting, or speeding – when driving with one teen peer. The more teens in the car, the greater the risk of fatal crashes.
  • No speeding: Speed kills. It’s a simple physics equation: force = mass x velocity2 (F = mv2). That means the force that you hit something with goes up exponentially depending on speed – not on how heavy something is. Plus, at faster speeds, you’ve got less time to react. Everything happens faster – including crashes. In 2011, speeding was a factor in more than one out of three fatal car crashes involving teens.
  • No alcohol or recreational drugs: When teens drink and drive, their risk of death is much greater than an adult’s. Alcohol impairs judgment, slows reaction times, blur vision (making it harder to determine distance to an object or to figure out how fast another car is moving), and makes it more difficult to distinguish colors. It goes without saying that other recreational drugs also affect driving ability negatively. In addition, many over-the-counter and prescription medications can impair driving abilities. Some of the most common culprits are pain medications, antihistamines, cold and flu medications, anti-diarrheal and anti-nausea medications.
  • Don’t drive drowsy: Driving drowsy impairs judgment, makes it harder to pay attention, slows response time, and reduces motor control. Teens who sleep less than 8 hours a night are one-third more likely to crash than are teen who get a solid 8 hours of zzz’s.
  • Wear your seatbelt properly: Seatbelts not only protect you, they also help you to maintain control of the vehicle if you crash.

Quit when it’s time

As we age, reflexes slow and the ability to process the information we encounter while driving decreases. When reflexes slow too much, the roads become too confusing, vision becomes too poor, or physical problems make it difficult to control the vehicle, it's time to quit driving.

For many older people, letting go of the keys is an emotional and difficult decision, partly because driving is often associated with independence and adulthood. Most people live in cities or towns that are laid out so that they need to travel several miles to grocery stores, schools, workplaces, recreational facilities, and other places they may need to go. It may be difficult for older people to use public transportation options that require them to walk several blocks to their destinations. On the other hand, deciding not to drive anymore can be a relief for many people.

The National Highway Transportation Safety Agency (NHTSA) recommends that older drivers ask themselves the following questions to help assess their safety behind the wheel:

  1. How is your eyesight? Warning signs that it may be time to relinquish the wheel include difficulty reading signs or seeing street markings, cars, and other people – especially at dawn or dusk; difficulty recognizing someone you know from across the street; and having a hard timed dealing with headlight glare at night. All drivers 60 years and older should see an eye doctor yearly for a checkup.
  2. Do you have control of the vehicle? Is you have difficulty walking less than a block a day, or going up and down stairs because of pain in your legs, knees, and ankles, that’s a warning sign that you may not be able to control your vehicle. Other red flags include difficulty looking over your shoulder to change lanes, moving your foot from the gas pedal to the brake pedal, or having trouble turning the steering wheel.
  3. Does driving make you feel nervous, scared, or overwhelmed? If driving leaves you feeling anxious and confused, it’s a good bet that it’s time to stop. People who take medications that make them drowsy should never operate a motor vehicle, no matter what their age. Dizziness, seizures, and periodic loss of consciousness are extremely dangerous. And if you find yourself reacting slowly to normal driving situations, it’s time to assess your ability to drive safely.
  4. Are loved ones concerned about your driving? Loved ones are often the first to notice when driving deteriorates. If someone close to you has told you that they are concerned about your driving, it’s time to assess your driving skills.
  5. Do you drive with children or young adults? If you drive with children or young adults, be sure you are physically, cognitively, and emotionally able to handle that precious responsibility. In addition practicing safe driving habits, you should be able to ensure they are safely restrained in appropriate carseats and booster seats.

 

Additional Resources

AAA Foundation for Traffic Safety https://www.aaafoundation.org/

U.S. Centers for Disease Control and Prevention, Motor Vehicle Safety: http://www.cdc.gov/niosh/topics/motorvehicle

National Highway Traffic Safety Agency http://www.nhtsa.gov/Driving+Safety

It Can Wait Campaign: http://www.itcanwait.com

 

Primary Source 

Bergen, G. Peterson, C., Ederer, D., Florence, C., Haileyesus, T., Kresnow, M., Xu, L. (2014, October 7). Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants – United States, 2012. MMWR, 63(Early Release); 1-7.

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