Accidents and their Prevention

Accidents are the most common cause of death in those under 45. Accidents happen, even to people who are careful, but many accidents may be avoidable if simple precautions are taken. Data suggests that accidents and injuries cost £20 billion a year in London alone.¹

In Great Britain in 2005 there were 271,017 road accident casualties; 3,201 people were killed and 28,954 people were seriously injured.²

The number of cars on the roads is continually increasing but in 2005 the Department of Transport announced that the number of deaths on the roads had fallen to the lowest level since records began. This was thought by some to be a result of the introduction of speed cameras but evidence of their possible benefit is very complex and the true cause of this trend is multifactorial.

Roads are generally safer than they were, with the exception of occasional poor design, poor maintainance and speed bumps, which may damage tyres/steering/suspension and may contribute to accidents, particularly for motor cyclists. Cars are much safer for occupants with seat belts, air bags, advanced breaking systems, electronic stability control and published crash ratings. However, safety for pedestrians still lags behind. On the whole, the chance of being killed in a crash is lowest in a large, prestigious car (with the exception of 4x4s) and highest in a small, cheaper model.

Car seats and seatbelts³

The value of seat belts is indisputable but they are not compulsory for taxi drivers, including minicab drivers or drivers of large commercial vehicles. In other vehicles, it is now compulsory for everyone to wear a seat belt, or appropriate child restraint, if available, in the front and back. All minibuses, coaches, and buses (except those designed for urban use with standing passengers), first used on or after 1 October 2001 must have seat belts fitted by the manufacturer. It is the driver's responsibility to ensure that passengers are correctly restrained.

Children up to 3 years old should travel in a rear-facing child seat. If this is in the front of the car, any airbag should be switched off. Children aged 3 years and above, until they reach either their 12th birthday or 135cm in height must use the correct restraint where seatbelts are fitted. Children over 12 years or age or 135cm or any adult passenger must use an adult seatbelt if available.

Speed

Excessive driving speed contributes to 28% of collisions in which someone is killed and 18% of those resulting in serious injury.⁴ Every year in the UK, 1000 people are killed because drivers are travelling too fast. Most accidents in which people are killed or injured happen in 30 miles per hour speed limit zones. If someone is hit by a car travelling at 30mph, 80% will survive. If someone is hit by a car travelling at 40mph, 10% will survive.⁴ Drivers must be aware of their stopping distance. Adverse road conditions and a heavily laden vehicle also increase braking distance.

Alcohol and drugs

Alcohol impairs judgement. There is impairment of reaction times, co-ordination, concentration and judgement of speed, time and distance. Some people also become over-confident or aggressive. 1 in 6 people killed on the roads dies in an accident where at least one driver was above the drink drive limit. The numbers of people drinking and driving is starting to increase again.⁵ Innocent people may be the victims.

The legal limit for alcohol in the blood is 80mg/100ml (17.4 mmol/l). This is equivalent to 35 micrograms per 100ml breath. Impairment occurs at all levels and increases as levels increase. The Royal Society for the Prevention of Accidents has called for the legal limit to be reduced to 50mg/ 100ml blood as it is in many other countries.⁵ They argue that drivers with blood levels between 50 and 80mg/ 100ml are 2 to 2.5 times more likely to be involved in a fatal accident than those with no blood alcohol and for young drivers the figure is 5 times more likely.

Drivers may also be impaired due to the use of drugs, both illicit and prescribed. There is no equivalent of the breathalyser for recreational drugs and the arresting police officer has to be accepted as an expert in deciding that the individual was intoxicated. Methods for investigating driving performance are being developed.⁶ Any drugs that cause sedation are a problem, including many antihistamines and antidepressants.

Medical conditions that affect driving

The DVLA issues guidance and regulations with regard to medical conditions that impair safe driving. Please refer to the link below.⁷

Mobile phones and driving

Research has shown that using hand-held or hands-free mobiles phones whilst driving increases the risk of the driver crashing, injuring or killing themselves and/or other people by four times.⁸ A law came into force on December 1st 2003 making it an offence for drivers to use a hand-held mobile phone whilst driving.

Motor cyclists

Motor cyclists are extremely vulnerable and represent 21% of all road fatalities but account for < 1 in 5 road users. Compulsory crash helmets have had benefit. Proper motor cycle leathers contain some body armour but this is still trivial protection compared with the body of a car and the stability of 4 wheels.

Cyclists

15,000 cyclists are killed or injured in reported road accidents in the UK each year. 90% of cycling accidents occur in urban areas. 75% of cyclists killed have major head injuries.⁹ Cycle pathways have given some benefit to cyclists. The value of cycle helmets has been disputed.^10,11

• If stopping on a hard shoulder is necessary, leave the vehicle and wait on the embankment for assistance. Stationary vehicles on the hard shoulder are at high risk of being involved in an accident. Use motorway emergency phones to ease detection of your location.
• Do not park on pavements. This puts pedestrians at risk by increasing their need to walk on the road and can also damage the pavements, also affecting pedestrian safety.
• Broken down vehicles should be moved off the road if possible. Hazard warning lights should be switched on and a high visibility jacket should be worn if available.
• Speed: Be aware of your speed when you are driving. Watch your speedometer, know the limits, concentrate and slow down when you are entering villages.
• Alcohol: Drink driving campaigns, lowering the drink drive limit, law enforcement and wider police powers to require breath tests including random breath testing may reduce drink driving. The individual should ensure that they stay within the legal alcohol limits or, better still, do not drink at all if they are driving.
• Drugs: Medicines that may have side effects that affect ability to drive should be clearly labelled. People should not drive under the influence of elicit drugs.
• Doctors should follow DVLA guidance on medical conditions that can affect driving and advise patients appropriately.
• Do not use hands-free or hand-held mobile phones whilst driving.
• The correct seatbelt or child restraint should always be used.

In 2004, there were 230 child fatalities due to accidents in England and Wales, the highest numbers being in 5-14 year olds. The commonest cause of accidental injury in children presenting to UK hospitals is falls. Others include suffocating and choking, burns and scalds and poisoning. A recent report by the Audit Commission and the Healthcare Commission states that each year there are 2 million attendances to accident and emergency departments by children as a result of accidents that might have been prevented.¹³ Accidents are more common in the lower socio-economic groups.

Frailty and health problems make the elderly, particularly those over the age of 75, at increased risk of accidents, usually occurring in the home. Falls are the most common cause. Inability to get up after falling puts the person at risk of hypothermia and pressure sores. Hip fractures after falls are a major cause of morbidity and mortality.

NICE guidelines were issued in 2004 on the assessment and prevention of falls in older people.¹⁴ They state that older people should be asked routinely if they have fallen in the past year. Those who have fallen, or those considered at risk of falling, should have a multifactorial falls risk assessment and should be considered for interventions including those to improve their strength and balance and remove any home hazards.

In England and Wales in 2004, there were 3,892 accidental deaths in and around the home.² Those most at risk of serious or fatal injury in the home are young children and the elderly. Falls are the most common type of accident.

In 2004, fire brigades attended 442,700 fires in the UK. There were 508 fire-related deaths and 14,600 nonfatal casualties.² A large proportion of fires in homes were accidental, the main causes being misuse of equipment/appliances and chip pan fires.

Home accident prevention¹⁵

Fire and electrical safety

• Fit smoke detectors on every floor and renew batteries regularly.
• Plan your fire escape route.
• Use fire guards.
• Keep portable heaters and candles away from furniture, clothes and curtains.
• Fat friers are a serious fire risk. If a fat fire starts it must be covered with a fire blanket or wet cloth. Pouring water on a burning chip pan spreads the fire.
• Do not overload circuits, including using multiple adapters in sockets.
• Have your wiring checked regularly.
• Always ensure electrical equipment that you buy has been safety tested.
• Do not smoke in bed.
• Keep matches and lighters away from children.

Heating and cooking

• Never block air vents. Service heating appliances and sweep chimneys annually.
• Be alert to the symptoms of carbon monoxide poisoning (drowsiness, flu symptoms).
• Turn the handle of pots and pans inwards on the cooker so that they can be less easily grasped by small children.
• Keep hot liquids such as tea or coffee and knives away from children.

Medicines and cleaning fluids

• Consider keeping these in a lockable cabinet.
• Always ensure containers are clearly labelled.
• Keep out of the reach of children.

Other measures

• Stairs should have banisters or rails.
• Avoid loose rugs and flooring.
• Only climb up on something firm and strong.
• Cover garden ponds/swimming pools if small children are about.
• When using power tools use adequate protection including sturdy shoes, gloves and goggles. Always wear proper shoes when mowing the lawn.
• Improve lighting in halls and stairways.

Learning to swim may well save your life. There are a few basic rules about swimming:

• Never swim alone. Even a strong swimmer can get cramp and drown.
• Never dive into shallow water.
• Beware of rivers where reeds, currents, eddies and whirl-pools can be deceptive. In the sea there are tides, currents and offshore winds that can sweep a person out.
• Always wear a life jacket for sports like yachting and water skiing.
• The survival time in very cold water is a few minutes, and if you must enter cold water for rescue, allow a few moments to control the cold hyperventilatory reflex.
• Never go swimming under the influence of alcohol.

There are many benefits from practicing sport activities including physical, psychological and social, and it should be encouraged. However, sport may also be dangerous and accidents and even death can result. Some extreme sports designed for adrenaline junkies involve a degree of risk taking, real or apparent. Sky diving, bungee jumping, skiing and snow boarding are all examples. The increased popularity of scuba diving, particularly the rapid holiday courses, has also resulted in many deaths. Being well equipped, supervised and well trained when taking part in these sports can help to minimise these risks.

The rules of sport have often been designed or adapted with safety in mind. Boxing referees stop fights sooner these days and the rules of rugby have been changed to reduce neck injuries in scrums, rucks and mauls. Football referees are strict about dangerous tackles. In judo it is illegal to put fingers inside the opponent's jacket sleeve or trouser leg so that fingers are protected.

Protective equipment is important and far more protection is worn when practicing sports now than a few decades ago, e.g. helmet wearing in cricket. Unfortunately, for many young people involved in sports such as skate boarding or mountain biking, wearing protective equipment is "uncool". Protective equipment for sport must be worn and the rules must be enforced.

During 2005/2006 there were 148,713 occupational injuries reported, of which 212 were fatal.²
All places of work are potentially dangerous whether an oil rig, a coal mine, a factory, an office or a kitchen. The Health and Safety Executive has stipulated rules about safety in the workplace. It also has the necessary powers to inspect and enforce them. Safety equipment must be worn. Risks must be appreciated. Every workplace should have a safety officer who is responsible for identifying danger and advocating action. As doctors, we have a duty to be aware of measures to prevent infection and needle-stick injury.

The scope of accident prevention is enormous and this article has touched superficially on just a few aspects. Doctors and other healthcare professionals give advice about healthy lifestyles and this should include accident prevention. The word accident may imply that accidents are unavoidable. A life without risk is impossible but the risk of accidents can be reduced by simple precautions and thinking ahead. Be aware of the potential for risk. Treat all risk situations with all due respect. This includes in the home or garden, in the work place, on the road or during leisure activities such as hill walking or mountain climbing. Think of others, especially children and the elderly. Once an accident has happened it is too late to go back and take precautions.