Memorandum from the British Medical Association
(RS 76)
DRINK DRIVING
The BMA has called on the Government to reduce
the permitted blood alcohol concentration (BAC) level from 80mg/100ml
(80 milligrams (mg) of alcohol for every 100 millilitres (ml)
of blood in the body) to 50mg and supports the introduction of
random breath testing. These are life-saving measures.
Almost every European country has a 50mg or
lower limit and the UK needs to follow this lead.i
Latest statistics
— Estimates for 2006 suggest that 6%
of all road casualties and 17% of road deaths occurred when someone
was driving while over the legal limit for alcohol.
— Provisional estimates indicate that
the number of deaths in accidents involving drink driving was
540, 2% lower than in 2005 and 4% lower than in 2004. Final estimates
will be available later in the year.
— In addition to those fatalities,
around 2,340 people were seriously injured in drink-drive accidents
in 2004, in the order of 2,090 were seriously injured in 2005
and provisional estimates for 2006 are of the order of 1,960.
— Although deaths and injuries increased
during the period of 1999 to 2002 from 15,580 to 20,100, it appears
that this trend is beginning to be reversed. It is estimated that
there were around 16,980 drink-drive casualties of all severities
in 2004, around 15,400 in 2005 and a provisional estimate of 14,380
for 2006.
— In 1998 and 1999 the number of people
killed in drink-drive accidents fell to a recorded low of 460
deaths per year. However, by 2003 this figure had risen dramatically
to 580 deaths per year and remained at that figure for a consecutive
year; the highest recorded number of drink-drive fatalities per
year since 1996. The number of deaths per year dropped marginally
in 2005 to 550 and again in 2006 to 540.
— Regarding the number of breath tests,
the number of screening tests required to be carried out increased
dramatically during the mid 1990s, but has reduced again in recent
years. Failure rates remained relatively stable during the late
1990s, but the number of failure rates has risen each year since
2000, despite a continuing decrease in the number of tests requiring
administration. ii (iv for all above)
— The Association of Chief Police Officers
(ACPO) reported that the total number of breath tests conducted
during December 2007 was 155,216 (2006: 145,867). The total number
of positive, refused or failed breath tests was 7,774 (2006: 9,658).
iii
The relative risk of accident involvement increases
significantly above 50mg. The BMA believes that a reduction in
the BAC level will prevent deaths and reduce the number of lives
ruined by drink drivers. Research has found that there is a marked
deterioration in driving performance between a BAC of 50mg/100ml
and 80mg/100ml. The relative crash risk of drivers with a BAC
of 50mg/100ml is double that for a person with a zero BAC; the
risk rises to 10 times for a BAC of 80mg/100ml. iv Professor Richard
Allsop, now Emeritus Professor at the Centre for Transport Studies
at University College London in a 2005 Parliamentary Advisory
Council for Transport Safety (PACTS) research briefing concluded
that lowering the BAC level could be expected to lead to about
65 fewer deaths and 250 fewer serious injuries per year. This
estimate is based on the 2003 road casualty figures.v The Government's
own estimate in 1998 was that reducing the limit to 50mg could
save around 50 lives and 250 serious injuries a year. vi
Time series analysis in New South Wales and
Queensland, observing a reduction in the BAC from 80mg to 50mg
noticed a significant reduction in all collision and fatality
measures in both states. vii In New South Wales serious collisions
were observed to drop be seven per cent and fatal collisions by
eight per cent. In Queensland serious collisions dropped by 14%
and fatal collisions dropped by 18%.
For further information please see: www.bma.org.uk/ap.nsf/Content/Drinkinganddriving
DRUG DRIVING
The BMA recognises that drugs (both illegal
and prescribed) can adversely affect the ability to drive safely.
Millions of people regularly take drugs such as anti-depressants,
painkillers, anti-histamines and cough mixtures, all of which
can have a sedative effect. Whilst current research does not yet
provide definitive answers, drug driving is a recognised concern
in research and by motoring bodies.
The problem of drug driving is not merely related
to drug misuse in terms of illegal drugs. The impact of some prescribed
drugs and treatments (eg sedatives, anti-depressantsviii and eye
drops) are also relevant. Although patients are warned of the
side effects (eg drowsiness, impaired vision), research has shown
that they tend to ignore the advice given to them by doctors and
pharmacists, and in information leaflets. ix
In order to assist debate and raise awareness
about this matter the BMA has produced a website outlining the
current legal situation, the implications of drug taking on driving
and the need to develop an effective drug driving test. The site
also supplies links to numerous organisations working in this
area. Please visit the below link for further details:
For further information please see: www.bma.org.uk/ap.nsf/content/drivinginfdrugs
REDUCING SPEED
LIMITS
The BMA would be supportive of the 20 mph speed
limits being used more widely. The BMA merits the extensive use
of 20 mph speed limits on roads, to cover all "walk to school"
routes, as a measure that will reduce risk of injury, promote
physical activity in school aged children and help shift the balance
between motorist and pedestrian. The BMA report Injury prevention
(2001) stated that the introduction of 20 mph speed limit zones
in parts of the UK resulted in local reductions in child road
accidents involving cyclists of 48% and a reduction of 70% in
child road accidents involving pedestrians.
PROMOTING SAFE
CYCLING
The BMA believes that cycling has many advantages
to the individual in terms of improved health and mobility, as
well as to society; it is a sustainable form of transport which
has a minimal impact upon the environment. It is the least polluting
way of travelling after walking; cycles do not produce carbon
dioxide (CO2) emissions. Cycles also require fewer resources to
manufacture and maintain compared to other modes of transport.
As a part of a range of measures to improve
cycling safety, the BMA policy is that cycle helmet wearing should
be made compulsory for both children and adults. The Association
recognises that voluntary helmet wearing should increase before
the law is enacted.
For further information please see: www.bma.org.uk/ap.nsf/Content/Cyclsafety++
FITNESS TO
DRIVE
There is only limited evidence about the number
of crashes that are caused by defined medical conditions; thus,
many of the scientific uncertainties about risk become part of
the wider public debate on who should be allowed to drive. There
are public and political demands for criteria for fitness to drive
that are clear and capable of being applied consistently. However,
there is conflict between the expectation that such criteria will
protect the public from injury and the wish to enable as many
people as possible to be permitted to drive in order to stay mobile.
Drivers also expect to be judged on their individual performance
rather than being categorised according to the diagnostic label
applied to them.
The driver as a condition of their licence is
personally responsible for ensuring that they are fit to drive,
refraining from driving if they are not and in some circumstances
informing the DVLA as the licensing authority. In addition they
must not be impaired to drive by alcohol or drugs. Their condition
must not prevent control of the vehicle or lead to careless or
dangerous driving.
For further information please see:
Fitness to drive: a guide for healthcare professionals,
Department for Transport 2006 (endorsed by the BMA's Board of
Science).
ROAD CASUALTY
DATA
The majority of road related traffic data are
formulated using police data (STATS19) where data are confined
to accidents on public highways. The STATS19 consists of injuries
reported to the police, including slight injuries (where a patient
may not require hospitalisation): typically these data exclude
non collision crashes that do not involve another vehicle. An
alternate source of information is Hospital Episode Statistics
(HES) which only covers patients admitted to hospitals. With the
example of cycle crashes, for the financial year of 2005/2006
cyclists' accidents accounted for only eight per cent of all seriously
injured STATS 19 casualties, whereas they accounted for 17% of
HES casualties.x
RELEVANT BOARD
OF SCIENCE
PUBLICATIONS/SOURCES
OF FURTHER
INFORMATION
1. Driving under the influence of drugs,
Board of Science, November 2006
2. Injury prevention, Board of Science,
June 2001
3. www.bma.org.uk/ap.nsf/Content/Drinkinganddriving
4. http://www.bma.org.uk/ap.nsf/content/drivinginfdrugs
5. www.bma.org.uk/ap.nsf/Content/promotingsafecycling
6. www.bma.org.uk/ap.nsf/Content/Cyclsafety++
7. Fitness to drive: a guide for healthcare
professionals, Fitness to drive: a guide for healthcare professionals,
Board of Science, 2006
REFERENCES
1 Blood Alcohol Concentration Limits Worldwide,
International Centre for Alcohol Policies, May 2002.
ii Road casualties Great Britain 2006: Annual
report—September 2007.
iii ACPO press release 17/1/08.
iv Babor T, Caetano R, Casswell et al (2003)
Alcohol: no ordinary commodity. Oxford: Oxford University Press.
v PACTS Research Briefing, 11 January 2005.
vi Combating drink driving—next steps,
Department for Transport, February 1998 and Tomorrow's roads:
safer for everyone, Department of Transport, March 2000, paragraph
4.19.
vii Hensbridge et al.
viii DTLR. Road safety compendium 2000/2001.
ix Eirpharm.
x Road Safety Research Report No. 69: under-reporting
of road casualties—phase 1, DfT, June 2006.
June 2008
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