HIBBING, MINN. On a day early in January, 1982, Hibbing pathologist Donald J. Nollet, M.D. went home for lunch, as is his custom. He flipped on the television to a national network news broadcast, where the first item he heard was a report that 50 per cent of motor vehicle accidents involve someone who is intoxicated. Dr. Nollet, who serves as County Medical Examiner, turned down the sound on the program, went to the telephone, and placed a call to the station in Atlanta. Routed to the news director, Dr. Nollet explained, "I was just listening to your news report on alcohol-related motor vehicle accidents. I don't know where you got that 50 per cent figure, but here in Saint Louis County in Minnesota, drinking is a factor in 90 per cent of the cases, not 50 per cent." The news director listened, the noon news anchor team did a telephone interview with Dr. Nollet, and later that afternoon, an updated news report gave his figures and comments concerning automobile accidents and fatalities due to the actions of drivers who had been drinking . - MORE drinking/driving ad one The statistics Dr. Nollet gave the news network that day were the justcompleted 1981 report, showing that of 31 accidents, only three were what Dr. Nollet calls "real accidents" - cases were no one involved had been drinking or was intoxicated. Of the 28 persons killed, six were completely innocent victims, with blood alcohol content (BAC) tests showing no alcohol present. Records kept during 1982 and 1983 indicate "nothing has changed percentagewise," Dr. Nollet reports, "despite the fact that the number of accidents is down slightly. The level of involvement of alcohol in those accidents that do occur remains extremely high." Dr. Nollet believes what he finds concerning alcohol-related motor vehicle accidents in his county is "not that different from what is occurring elsewhere in the country. I don't believe people here drink more than people anywhere else," he says. "I think whatever is true here is true throughout the nation." The Minnesota pathologist's observations appear to be valid. A recently completed study of motor vehicle accidents during 1982 in Fulton County, Georgia reveals that in 46 accidents in which BACs were taken of the persons involved, 42- or 91 per cent of the drivers had been drinking and 39 --or 84 per cent were legally intoxicated. Says County Medical Examiner Robert R. Stivers, M.D. in Atlanta: "Medical examiners have said for years that the rate of alcohol involvement in motor vehicle accidents is far higher than has been supposed. Now we are beginning to collect data that can provide more conclusive and effective information. We're coming up with documented figures of 91 per cent. That scares people, and I think that's part of our job - to make the public aware of what is taking place on our streets and highways." Joseph C. Rupp, M.D., Medical Examiner for Nueces County in Texas, confirms what Doctors Nollet and Stivers report. "Our death rate in multiple vehicle accidents shows alcohol involvement in more than 50 per cent of the cases," he reports. - "But then if you consider only the driver at fault in fatal accidents, and single vehicle accident fatalities, we would approach 90 to 100 per cent alcohol-related incidents. "I would wager it is the same the nation over." Page Hudson, M.D. serves as State Medical Examiner in North Carolina, one of only a few states with such an office. "I would agree that the figures generally used are on the conservative side," notes Dr. Hudson, who records statistics for all motor vehicle accidents in North Carolina. drinking/driving ad two "In driver fatalities resulting from single car crashes, legal intoxication levels are found about 65 per cent of the time. Add the drivers with alcohol at less than the legally presumptive intoxication concentration, which is .1 grams per cent, and our totals would then approach 80 per cent of drivers killed." Figures from a 1981-82 study of drivers in single vehicle accidents who died within an hour of the crash show 80 per cent had been drinking, with 68 per cent at the .1 intoxication level. Of the drivers killed in multiple vehicle accidents, 34 per cent had been drinking, of which 25 per cent were intoxicated.. Over the 13-year period 1970 through 1982, Dr. Hudson reports, 68 per cent of all fatalities resulting from single vehicle accidents - or 2,745 of 4,038 drivers had been drinking, with 2,342 or 58 per cent intoxicated. Multiple vehicle accident statistics show that of 3,461 drivers killed, 1,211 - or 35 per cent had been drinking, and 934 or 27 per cent -- were at the legal intoxication level. -- - - The driver alcohol.use rate in fatalities due to multiple car accidents appears to run only about 40 per cent, Dr. Hudson suggests, "presumably because there are essentially innocent drivers who are killed by cars driven by persons who have been drinking but survive the accident." However, Dr. Hudson adds, "there are certain times and situations where I would bet aine to one on alcohol being present in motor vehicle accidents. An example would be a Friday or Saturday night episode involving a single car crash where the driver is a male in his 20s. In 90 per cent of such cases, that accident might be alcohol-related." One of the persons most surprised at the Fulton County findings is Ruth Berkelman, M.D., the medical epidemiologist with the Centers for Disease Control in Atlanta who directed the study there. Dr. Berkelman was serving a residency in preventive medicine with the Georgia Department of Human Resources when she became involved in the motor vehicle accident study. Her original thought was "to show the medical examiner's data base as something that public health personnel should be looking at as a part of preventive medicine efforts." As she worked on the motor vehicle accident study, Dr. Berkelman became increasingly surprised "at the proportion of alcohol involvement in these cases. I believed it was a problem about half the time, but the statistics in Fulton County were showing me that a higher percentage was alcohol-related. In single vehicle accidents, 76 per cent of the drivers had been drinking, and in 94 per cent of the multiple vehicle accidents in which BACS were performed, results showed at least one driver had been drinking." drinking/driving ad three Even President Ronald Reagan, in his press conference marking "National Drunk and Drugged Driving Awareness Week" December 11-17, used the 50 per cent figure when discussing deaths from alcohol-related motor vehicle accidents. But even though he used a figure far lower than many pathologists and medical examiners know to be the case, "just his talking about drinking and driving is a great advance," says Dr. Rupp in Corpus Christi. you "Ten years ago, couldn't have gotten the President of the United States to even discuss the subject. To have the President recognize the problem to even a 50 per cent magnitude is a giant step for mankind. It is tremendous. Remember, we make progress slowly." Dr. Rupp also gives much of the credit for the increased public awareness of the drunken driver to the concerned public groups such as Mothers Against Drunk Drivers (MADD) in several states, Illinois' Alliance Against Intoxicated Motorists (AAIM), and other similar organizations. "I don't believe they have taken many drunk drivers off the road yet, but they certainly are making the public aware of the problem," he says. To prove the seriousness of the drink and drive problem, the medical examiners agree that all persons involved in motor vehicle accidents should be tested for blood alcohol content levels within six hours of the accident. Says Dr. Nollet, only slightly in jest, "At my hospital (Central Maṣabi Medical Center of Hibbing), BACS are taken on all persons brought in from motor vehicle accidents dead or alive because I turn into such a gorilla if this isn't done. . "But I cover more than half of a 25,000 square mile county, and it isn't: easy for me to always be where the accident takes place. There are several deputy medical examiners as well as various investigators such as the highway patrol, deputy sheriffs, and a range of city and village police officers. Victims are taken to different hospitals where BACS may or may not be taken. Blood alcohols should be taken on all drivers and all victims no matter how slightly or seriously injured, as well as on those persons killed, and the levels recorded as a part of the police report. That is the only way we can get a true picture of the alcohol-related carnage on our highways." Dr. Stivers agrees, further emphasizing that the BACS should be performed "no matter what the condition of the patient or the deceased. I will gladly write any letters of support Dr. Nollet might need to get mandatory blood alcohol levels on all participants in motor vehicle accidents. Only with hard data can we get to the people such as police officials and legislators who can do what needs to be done concerning the drinking driver." 35-289 0-84-38 · MORE drinking/driving ad four The four pathologists insist that the BACS should be performed as soon as possible after the accident because the alcohol level becomes less meaningful as the alcohol is metabolized in the body. Recording the information concerning the BACS is vital, they believe, to provide the necessary studies and follow-up data. Dr. Stivers notes that "police investigating an accident are now often reluctant to name the driver who causes the accident, feeling that should be left up to the judge who hears the case. So police reports of accidents should list obvious faults, such as one driver crossing the midline or other pertinent details." Dr. Nollet reports that "in some instances a drunk driver who causes an accident but survives has his alcohol level made a part of the police report, but under certain privacy laws, that information cannot be released." Securing data in Georgia is less of a problem, since in that state the issuance of a driver's license automatically grants permission for blood alcohol levels to be taken on the driver at any time, and the Department of Public Safety will provide any information requested. However, notes Dr. Berkelman, "here as in Minnesota, the BACs are often not taken, depending upon individual circumstances. In multiple vehicle accidents in Fulton County, BACS were obtained on all drivers in only 56 per cent of the accidents." Another problem in Minnesota, described by Dr. Nollet, "is that all too often blood is drawn at the time of the accident but is sent to the Bureau of Criminal Apprehension in St. Paul. It may be two or three weeks before the report comes back to the investigating officers who have already filed their reports. Too often a decision is made that it is not worth charging the offender, since the paper work has already been completed. Even though there is a proven elevated alcohol level, the delay in delivery of the information has deterred placing charges against the intoxicated driver." Determined to impress upon both the public and professional communities the seriousness of the drinking and driving problem, some medical examiners list alcohol involvement on the death certificates they issue for persons who die in alcohol-related accidents. "If it's an innocent victim, I write 'hit by a drunk driver, says Dr. Nollet. "If the deceased is a driver who was acutely intoxicated, I note that. If it belongs there, this information is going to be on any death certificate I sign." |