On my most recent night shift at Penn Presbyterian Medical Center’s emergency department, a call that came in overhead from an emergency medical services team froze me in my tracks. “Trauma alert. A 21-year-old female with 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, we got another call that the other victim from that crash was also en route with unstable vital signs.
As we gowned up and took our positions in the trauma bay, I could hear the first patient being wheeled in by the paramedics. She was screaming hysterically with slurred speech, “I’m sorry! I’m sorry! Please save her!” The paramedics slid her backboard onto the gurney. As we spoke with her, we all noticed a heavy smell of alcohol on her breath.
We worked quickly to give her and her friend the best possible outcome.
Scenes like this play out every day in emergency departments across the country, an all-too-frequent reminder of persistent — but preventable — toll of people making the irrational decision to drive while intoxicated.
Alcohol-impaired driving kills 29 people every day in the United States, more than 10,000 per year, and injures hundreds more, costing more than $121 billion each year. Nearly 2 out of every 5 deaths from these accidents are victims other than the intoxicated driver.
A significant amount of progress has been made in reducing alcohol-impaired driving fatalities since the 1980s, yet 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 by far the leading cause of motor vehicle fatalities. Among developed nations, the U.S. has the highest proportion of alcohol-impaired driving fatalities. This is unacceptable.
The National Academies of Sciences, Engineering, and Medicine convened a committee to study this issue. I was honored to be part of the committee, along with two of my colleagues from Penn Medicine. After a year of work, the committee released its report Wednesday. “Getting to Zero Alcohol-Impaired Driving Fatalities: A Comprehensive Approach to a Persistent Problem” maps out the behavioral processes and context that contribute to this 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.
I applied my lens as a faculty member in Penn’s Center for Health Incentives and Behavioral Economics to the issue. The decision to drive while intoxicated is a fundamentally irrational behavior, one that everyone knows is not in their best long-term interest. Yet some people regularly do it anyway. People who drive after several drinks tend to lack self-control and are more shortsighted, as is the case with many other impulsive behaviors. This explains individuals’ decisions to have “just one more drink” when already feeling intoxicated and then driving home because leaving the car behind is too much of a hassle to pick up in the morning.
People who frequently drink and drive are also poor planners, which may explain the tendency to not plan a ride in advance. That means policies to make transportation alternatives other than driving the default option when drinking are key. Keeping these behavioral insights in mind, the committee developed a comprehensive approach to counter impulsivity and lack of self-control, especially among those who get arrested for drinking and driving.
The committee made 20 conclusions and 16 recommendations 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 limit percent from 0.08 percent to 0.05 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 blood alcohol content exceeds the legal limit.
Third, we need post-arrest and post-crash interventions to address high rates of repeat offenders. For example, DWI courts — specialized courts aimed at changing the behavior of driving while intoxicated 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 blow into a breath-testing device in order to start the car.
The committee made additional recommendations regarding data and surveillance systems and how to generate action. We also highlighted several areas of future research, including better understanding of 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, we can save more lives and reduce health care costs. And maybe Saturday nights in the emergency department will be a little bit more mundane, which would be a good thing.
Kit Delgado, M.D., 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.