Mats Öström

Single-vehicle crashes and alcohol: a retrospective study of passenger car fatalities in Northern Sweden

This retrospective study of fatal passenger car crash victims in northern Sweden compares 396 multiple-vehicle (MV) and 201 single-vehicle (SV) fatalities from 1980 through 1989. Compared to MV fatalities, SV victims were more frequently males, were younger, were more often inebriated, had higher blood alcohol concentrations, had a higher frequency of fatty liver, and were less often restrained. The SV fatalities occurred most often from May through October, from Fridays through Sundays, and from 9 p.m. to 6 a.m. The road surface was usually dry, especially for drunken SV drivers. The SV drivers also more often lacked a valid drivers license. The study confirms that alcohol is one of the most important factors associated with traffic fatalities, particularly in SV crashes. More than half (56%) of the SV victims were inebriated by alcohol (MV, 11%), had a mean blood alcohol concentration of 1.9 g/l (MV, 1.6 g/l), and one-third had a fatty liver (MV, 20%). We also found a relation between fatty liver and increased blood alcohol concentrations, suggesting that studies regarding the role of alcohol in traffic fatalities should also include an evaluation of liver morphology.

Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

NATURAL DEATH WHILE DRIVING

Of sudden natural deaths while driving, 126 occurred during 1980 through 1985 in the northern half of Sweden. The mean age of the 69 car driver victims was 59 years, considerably higher than that of traumatic car deaths, and all but 2 were males. The mean age of 57 operators of other vehicles was 66 years, and of these, 6 were women. Seven car drivers were stricken during commercial employment. Most accidents occurred during daytime and the distribution of the weekdays was fairly even. Ischemic heart disease accounted for 112 deaths, and other cardiovascular diseases for an additional 9 deaths. Only 1/5 of the victims experienced previous symptoms of disease. Out of at least 31 other persons at risk in the car deaths, only 2 passengers suffered minor injuries. The trauma in the deceased was in most cases minor in both car and other vehicle deaths. Property damage was also minimal. At least 1/3 of the drivers were able to stop the car before becoming unconscious. In none of the car cases was alcohol detected in the blood, while alcohol was identified in at least 2 of the other vehicle victims. The findings here agree with previous studies that natural deaths at the wheel are fairly uncommon, and that the risk for other persons is not significant. The value of adequate postmortem examinations of drivers dying in traffic is stressed--natural deaths can otherwise be overlooked.

Influence of energy drinks and alcohol on post-exercise heart rate recovery and heart rate variability

Background:  Media have anecdotally reported that drinking energy drinks in combination with alcohol and exercise could cause sudden cardiac death. This study investigated changes in the electrocardiogram (ECG) and heart rate variability after intake of an energy drink, taken in combination with alcohol and exercise.

Head and face injuries in bicyclists--with special reference to possible effects of helmet use

Fatal and nonfatal head and face injuries to unhelmeted bicyclists were analyzed to assess the injury-reducing potential of bicycle helmet use. Of the fatally injured, 64% (median age, 55 years) had fatal head and face injuries compared with 38% (median age, 18 years) with head and face injuries in the nonfatal injury group. The fatally injured often had multiple impact points, mostly to the occipital and temporal regions. Brain contusions, most often to the frontal and temporal lobes, were the most common cause of fatal injury, followed by subdural hematomas. In the nonfatal injury group abrasions/lacerations were most common type of injury, followed by cerebral concussions/contusions and superficial contusions. If all types of injuries to bicyclists are taken into account a helmet might have had an injury-reducing effect in two of every five fatal cases and in one of every five nonfatal cases. To increase the helmet use among bicyclists, a law, as in Australia, would be an excellent instrument.

ELDERLY IN THE TRAFFIC ENVIRONMENT: ANALYSIS OF FATAL CRASHES IN NORTHERN SWEDEN

Fatal crashes of the elderly (> or = 60 years; N = 379) in northern Sweden in the traffic environment, between 1977 and 1986, were investigated using autopsy and police reports. Males had double the death rate of females. The car occupants made up the largest category (43%) followed by pedestrians, pedalcyclists, and two-wheel-motorvehicle (TWMV) riders, but the risk of fatal injury per unit distance travelled was highest for pedestrians and pedalcyclists. Most car occupants were killed in vehicle-vehicle crashes, mostly in the daylight and at intersections or straight roads. Ice and/or snow (31%) was the major precrash factor. In two-thirds of single car crashes, roadside hazards such as trees were involved. Most elderly fatally injured car drivers were responsible for the crash, and they were commonly involved in collisions with oncoming vehicles. Only 4% of the fatally injured car drivers were driving under the influence of alcohol. Head injuries appeared to be more common in side impact than in frontal impacts. Serious chest injuries were more common than head injuries in car crashes. One-quarter of the pedestrians were injured at pedestrian crossings and about half during darkness. One in six pedestrians were under the influence of alcohol. All pedalcyclists were injured in collisions with motor vehicles and most were injured at intersections. Pedestrians, pedalcyclists, and TWMV riders had more serious head injuries than chest injuries.

Preventability of vehicle-related fatalities

Several different methods have been used to evaluate the survivability of traffic injuries. Previously published methods were reviewed to develop a specific method for vehicle-related fatalities. All fatally injured victims (n = 474) of vehicle-related crashes in the four northern-most counties of Sweden during a 5-year period were studied. Almost half (48%) of the victims had non-survivable injuries. The remaining cases were classified into different injury groups according to the Injury Severity Score (ISS) including 56 (12%) with an ISS < 25, 150 (32%) with ISS 25-49 and 42 (9%) with ISS 50-74. The median distance from the scene to the nearest hospital was 49 km. In the cases with ISS < 50 the medical care was further analyzed. In close to half of these cases, the victim did not receive optimal care in time with transportation time being of major importance. The absence of first aid was judged to have contributed to the death in 4% of the cases.

Carbon monoxide suicide from car exhausts

STUDY OBJECTIVE the aim of the study was to analyse the victims and circumstances in carbon monoxide suicides from car exhausts in order to find strategies for mitigation of the suicide risk. DESIGN necropsy, police and hospital records were scrutinized for 194 victims who committed suicide by carbon monoxide poisoning from car exhausts during a four-year period in Sweden. SETTING AND PARTICIPANTS the State Institutes of Forensic Medicine in Umeå and Stockholm. RESULTS a higher incidence (24.2/million population) was seen in the rural region than in the urban region (14.9). Males dominated (88%), most of them middle aged. Most victims committed suicide in a car outdoors. A vacuum cleaner tube connected to the compartment was most commonly used. Severe disease, mostly psychiatric, was seen in 61% of the victims. Drugs were detected in 8% of the victims under psychiatric treatment. In 37%, earlier suicide behaviour was documented. Suicide notes were found in 40%. Blood alcohol was detected in 51% of the victims and other drugs in 7%. CONCLUSIONS environmental changes may reduce the number of carbon monoxide suicide from car exhausts, e.g. introduction of a law requiring catalyst exhaust, of automatic idling stop, and of exhaust pipes incompatible with vacuum cleaner tubes. The importance of accurate treatment of psychiatric patients is stressed.

NATIONAL SUICIDE PREVENTION PROGRAMME AND RAILWAY SUICIDE

Suicidal behaviour is a public health problem closely related to other problems such as mental illness, abuse, violence and accidents. This approach is illustrated by the prevention of railway suicides. A theoretical framework is sketched, which allows for the use of principles from injury prevention in the prevention of suicide. ICD-9 encoded death certificates from 1974, 1980, 1986 and 1987 which concerned suicides and undetermined deaths on roads and railways were analysed (N = 294). Additional data were collected from autopsy, police and hospital protocols and from interviews with engine-drivers. Railroad victims dominated the sample (78% of cases). The mean age was 42 yr. Alcohol was detected in 27% of cases, drugs in 36% and severe illness (mostly psychiatric) in 57%. The relationship between types of collision and nature of injury is discussed. Environmental changes, such as changing the locomotive front design, are suggested as strategies for reducing accidents and suicides on railways.

Differences between older and younger drivers; characteristics of fatal car crashes and driver injuries

Car drivers (greater than or equal to 18 years; n = 514) in Northern Sweden who were fatally injured over a 13-year-period were investigated using autopsy and police reports. Fatalities per unit distance and per licenced driver were highest for the greater than = 70-year-old and = 60-year-old drivers were more often at fault than the = 60-year-old drivers were more likely to die as a consequence of less severe injuries than the less than 60-year-old ones. The belted younger drivers had fewer fatal chest injuries and more head injuries than the non-belted ones. In older drivers, fatal head injuries were more common in side impacts than in frontal impacts. Older drivers got more post-traumatic complications than the younger ones.