Fatigue in multiple-car fatal accidents

In a re-examination of 334 fatal multiple car accidents, without any reasonable explanation besides possible intoxication, 205 drivers were found responsible for the accident. Twenty-one of these accidents happened between midnight and 0600 h and 11 of the drivers were found to be intoxicated with a blood/alcohol content (BAC) of more than 0.080%. The remaining 184 accidents took place during the rest of the day and 55 drivers were intoxicated. By comparing this apparent over-representation of intoxicated drivers in night-time accidents with that of a control group of no less than 15,923 drivers, it was possible to convert this over-representation into an under-representation. This decline in accidents while under influence seems to indicate another human accident factor specific to night-time traffic. It is concluded that fatigue is an overlooked but most obvious cause of otherwise unexplainable accidents in the night-time traffic.     

Medical driver selection and alcohol

Due to the rapid development of motorisation in the past few decades, the epidemic of traffic injuries has become a serious problem. Numerous studies indicate that the human factor, often in connection with alcohol consumption, plays a major role in traffic accidents. Studies also show that people addicted to alcohol often drive under the influence and are not deterred by the possibility of punishment, e.g. a revocation of their driving licence.Our study examined people who caused traffic accidents under the influence of alcohol in Slovenia, the consequences of their actions, police and judicial measures and medical selection.In the last decade, the share of people causing traffic accidents under the influence of alcohol in Slovenia has been on the rise. Higher blood alcohol levels are found in people causing fatal traffic accidents, most of them are cyclists, pedestrians and tractor drivers, aged between 25 and 34; the accidents are most common on village roads, on weekends. The discrepancy between numbers of intoxicated drivers with suspended driving licences (approximately 8500/year) and between numbers of successfully terminated judicial procedures is particularly worrisome. When these drivers get their licences back, the medical selection process is inadequate.Our results emphasise the problem of medical selection for reinstatement of penalized drivers. The inadequate approach currently in force allows too many dangerous drivers, most still addicted to alcohol, to return to traffic without medical selection. The only solution to this problem is an immediate change in legislation that would require rigorous medical selection for all reinstatements of drivers who drove under the influence of alcohol. This would decrease the numbers of intoxicated drivers in traffic and at least partly decrease the numbers of alcohol addicts in society.     

涉嫌酒后驾驶交通事故人体损伤与驾驶员血中乙醇质量浓度关系研究

目的探讨涉嫌酒后驾驶所致道路交通事故中人体损伤情况与驾驶员血中乙醇质量浓度关系,为预防、控制道路交通事故及人体损伤提供依据。方法对467例涉嫌酒后驾驶机动车的道路交通事故损伤人员相关鉴定资料与肇事驾驶员血中乙醇质量浓度进行系统分析性研究。结果涉嫌酒后驾驶发生道路交通事故的损伤人员中,以20~39岁男性居多;事故中驾驶员损伤机率最高;酒后交通事故以长头小车及摩托车最多,而驾驶员血中乙醇质量浓度（BAC）为0.1~20mg/100mL浓度的摩托车驾乘人员伤亡构成比最高;酒后驾驶机动车肇事导致的人体致命性损伤及人员死亡的饮酒组危险程度均高于未饮酒组,在驾驶员血中乙醇质量浓度（BAC）为0.1~20mg/100mL组与20.1~80mg/100mL组比较无明显差异。结论酒后驾驶肇事导致的人员伤亡比未饮酒驾车交通事故严重;未达酒后驾车组（BAC为0.1~20mg/100mL）和酒后驾车组（BAC为20.1~80mg/100mL）交通事故导致的人员伤亡无明显差异。研究结果提示,应降低饮酒后驾车血中乙醇质量浓度（BAC）法定标准阈值,进一步控制和减少道路交通事故人身伤亡率。     

1110例汽车驾驶员及乘员交通伤特点分析

目的比较道路交通事故中汽车驾驶员及乘员的损伤特点,为汽车安全设计及事故预防提供参考。方法选择2006～2009年受理的交通伤害案件中373例汽车驾驶员及737例汽车乘员的伤残评定资料进行回顾性分析,对损伤部位的分布,多发伤的数量以及伤残等级进行比较。结果驾驶员损伤部位明显较乘员多,肢体、胸腹损伤发生率明显较乘员高,脊柱损伤的发生率明显较乘员低;驾驶员身体左侧受伤的几率较右侧高,而乘员左右损伤差异不显著;两类人员损伤所致伤残等级腹部、盆部分布显著不同,而其他部位无显著差异,但胸部、脊柱部位高等级伤残构成比乘员略多于驾驶员。结论汽车驾驶员与乘员损伤部位、数量及部分部位的损伤致残程度有差异,值得汽车安全设计及交通管理部门参考。     

Law defining the critical level of driver fatigue in terms of hours without sleep: Criminal justice professionals' opinions and fatal accident data

The aims of the present study were to determine the support among criminal justice professionals for a law that defines the critical limit of driver fatigue in terms of 24 consecutive hours of wakefulness; and to determine how many drivers causing fatal accidents would be potentially covered by such a law. The data included an online questionnaire data collected from 325 criminal justice professionals (96 prosecutors, 129 traffic police officers, and 100 local police officers with experience in traffic surveillance and accident investigations) and the national database of fatal road accidents studied in depth (N = 1871; 2002–2008). The support for such a law was quite low among prosecutors while police officers were more in favor than against it. Only a handful of the (survived) drivers who caused a fatal accident were awake for more than 24 consecutive hours. We discuss several challenges and considerations associated with such a law.     

Psychoactive drugs in the road traffic in the legal and consultative aspects—Experience gained by the Forensic Medicine Department, Silesian University of Medicine, Katowice

Introduction

In the years 1997–2007 in the Forensic Medicine Department, Silesian University of Medicine, Katowice a total of 785 blood samples collected from drivers being the perpetrators of road accidents was tested for the presence of psychoactive drugs.

Methods

The studies took advantage of FPIA (Abbott), ELISA (Neogen), LC–MS and GC FID.

Results

21% of tested samples were positive. In the blood of the driver cannabinoids, amphetamine and its derivatives were most frequently found. Moreover, individual opium alkaloids, their combinations with barbiturates, benzodiazepines or amphetamine, benzodiazepine derivatives (isolated cases), drugs of benzodiazepine group in combination with barbiturates, tramadol or tricyclic anti-depressants (isolated cases), carbamazepine, phenotiazine, cocaine, dibenzepine, benzene, toluene and acetone were determined.

Conclusion

The obtained results showed cannabinoids and amphetamine derivatives to be the most frequent whereas opium alkaloids, barbiturates and benzodiazepines rather rare psychoactive drugs found in the tested blood samples of the drivers involved in the road accidents. The authors suggest screening psychoactive drugs not only in drivers involved in road accidents but also those put through the routine road check procedures. While giving opinions on the influence of the above mentioned drugs on the psychophysical efficiency of road traffic users, drugs and compounds which are not subject to legal control but have an effect on the human psychomotor efficiency and thus, enhance the risk of the road accident should be also taken into account.     

Is Toxoplasma gondii a potential risk for traffic accidents in Turkey?

In Turkey, traffic accidents are the major causes of mortality and morbidity. According to the statistics made by Turkish Security Headquarters in the year 2000, 7500 people are killed in the traffic accidents every year. Drivers are mostly blamed for the traffic accidents. Tired, weary, sleepy and absentminded driving are common reasons for traffic accidents due to many reasons. Among these reasons mental and reflex conditions of drivers are significant. Toxoplasmosis is one of the most common zoonoses throughout the world. In immunocomponent adults, toxoplasmosis has no clinical signs or symptoms and infection in such people can only be detected by serological examinations. This kind of latent or dormant toxoplasmosis can be located in neural or muscular tissues and cause prolonged reaction times of the muscles. Extended reaction times also lead to deceleration of the reflexes which could be a major cause of the traffic accidents. By the light of this situation, the incidence of Toxoplasma gondii is investigated among the population who were involved in a traffic accident while driving. A total of 185 people (100 men and 85 women), aged between 21 and 40 years, living in Izmir and Manisa cities, were enrolled in the study group (SG) during a period of 6 months time. Their informed consents were taken initially and the laboratory tests of all these individuals related to blood alcohol levels after the accidents were found negative. The control group (CG) were also consisted 185 people (95 men and 90 women), residents of the same region, in same age group. The people in CG had no clinical signs or symptoms concerning toxoplasmosis. All collected sera were examined using a commercial IgG and IgM ELISA kit. According to the results of serological tests of the SG, 45 (24.32%) sera were IgG positive, six (3.24%) were IgM positive and 10 (5.40%) were both IgG and IgM positive. On the other hand in CG, 12 (6.48%) people found IgG positive, one (0.54%) found IgM positive and three (1.62%) found both IgG and IgM positive. This data was considered as statistically significant by Yates corrected chi2-test. (p < 0.05). In conclusion, there is an increased risk for traffic accidents for drivers owing to these high seroprevalence of latent toxoplasmosis. Prospective studies are still necessary on this subject but latent toxoplasmosis of drivers should be taken into account while developing strategies to prevent traffic accidents in Turkey.     

Driving under the influence in Greece: a 7-year survey (1998-2004)

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the southern part of Greece. The objective of the present study was to identify the prevalence of alcohol and other psychoactive substances among drivers involved in road traffic accidents in Greece during the period 1998-2004. Alcohol was detected in the blood of about 37% of the drivers involved in traffic accident during the years 1998-2000. The detection of alcohol was lower (29%) in the years 2001-2004. Cannabis, benzodiazepines, opiates, and cocaine were found in 4%, 4%, 4% and 1% of the total number of cases, respectively. The above values were compared with those of a previous study concerning the period 1995-1997 and the reasons for the reduction of the number of alcohol-related traffic accidents during the last years are discussed.     

道路交通事故死亡案例驾驶员损伤特征分析

目的针对交通事故中驾驶员和乘客的损伤,辨别驾驶员损伤的特征性改变,从而为交通事故中准确认定驾驶员提供科学的证据支撑。方法对2006—2014年间,黑龙江省垦区内126例汽车交通事故死亡案例数据进行回顾性研究,分析汽车事故死亡案例驾驶员损伤特征,探讨驾乘人员损伤的法医学鉴定要点。结果驾驶员颈部、胸部、腹部的损伤多见,可检见汽车部件所致特征性损伤。乘员仅头面部及四肢与汽车接触部位有特征性损伤,其他部位未检见可明确汽车部件所致特征性损伤。结论损伤部位、类型与死亡人员的驾乘身份有关。     

Diffuse vascular injury in fatal road traffic accident victims: its relationship to diffuse axonal injury

The authors have reported a macro- and microscopic study of brain lesions in 120 victims of fatal road traffic accidents, independent of the survival time. Diffuse vascular injury (DVI) was found in 14 patients (11.7%). All patients with DVI died within 24 h after the accident. The 14 patients with DVI also showed severe (Grade 2 or 3) diffuse axonal injury (DAI). Since DVI is restricted to road traffic accidents and incompatible with life, the high frequency observed in our series could be explained by the fact that all 120 patients were victims of road traffic accidents, and 69.2% had died within 24 h after the accident. The association between DVI and severe DAI (Grades 2 and 3) suggests that both lesions depend on the same mechanism, with the degree of axonal and vascular damage being determined by the intensity of the head acceleration. Our results show a relationship between DVI and DAI that suggest there may be a spectrum or at least a continuum between these entities as distinct from DVI being a separate entity.     

Prevalence of alcohol in blood samples from traffic accident cases in Turkey

Alcohol is one of the main causes of traffic accidents worldwide. With a population of 70 million, 12 million vehicles, and 18 million drivers (16% women), Turkey is one of the European countries that has a high incidence of road traffic accidents.In accordance with Turkish laws, subjects were considered to be positive when alcohol blood concentration exceeded 50 mg/100 mL. The objective of the present study was to obtain reliable and comparable data about alcohol use in traffic cases in Turkey. All cases are admitted to the emergency department at Ege University Medical Faculty. The cases from police officers are described as traffic control cases. Alcohol was detected in the blood of about 54.4% of the traffic-related cases during October 2005 to March 2007. It has been observed that, in 17.4% of the traffic accident cases, the blood alcohol level was 50 mg/dL or less, which is the legal limit in Turkey for car drivers. Alcohol prevalence was 57.2% in male cases and 43.6% in female cases. In alcohol-positive cases; the ratios for males were 1.73 times more frequent in traffic-related cases. Prevalence data will help traffic safety professionals to adequately allocate resources and plan future efforts in reducing drinking-and-driving behavior and thereby reduce traffic accidents.     

交通意外事故尸体剖验37例

本文作者报告陆上交通意外尸体剖验37例。事故类型分路人车撞、汽车相撞、汽车撞静物及摩托车事故四种。路人被车撞致死者,损伤分布广,种类多,有5种不同的损伤。摩托车事故死亡者胸腹部损伤多,突出的是胸主动脉横裂。汽车驾驶员的损伤以胸腹部为多。其中因车撞车驾驶员死亡者,头部损伤常不严重。各种不同的损伤各有一定的特征。作者强调了要注意酒精与车祸的关系。     

Amnesia and responsibility following brain concussion. A study of 70 patients

Hit- and run traffic accidents frequently occur because an intention to hide drunkenness. Later, the accused claims that he or she had amnesia due to concussion at the time of accident and what followed. In most cases, the question arises as to whether it is the truth or just a story to protect the defendant from punishment. To study this question, 70 patients (39 male, 31 female) were interrogated. They were asked about the duration of their amnesia and their ability to recall their own actions, or what they had been told. In 80% of the persons examined there was only a short period of amnesia (less than 30 min). Of 12 cases with a longer period of amnesia, 7 were also intoxicated from alcohol (one case had a concentration of 3.1%). In only one person suffering from concussion could it definitely be proved that the actions taking place long after the accident, were usually not comparable with evidence given in court.     

Occupational workplace and traffic fatalities in Alsace, France (2000–2005): Results of toxicological investigations

France ranks as leader country in Europe for the consumption of cannabis as well as of psychoactive medications. Whereas the relationship between psychotropics and road accidents is now well-established, few data are still available on the influence of drugs on occupational accidents. The purpose of the present study was to measure the prevalence of psychoactive drug intake (alcohol excepted) among victims of occupational fatalities (including workplace accidents + traffic accidents, i.e. on the way to and from work) occurred in the region Alsace over the period 2000–2005. Data were collected by compiling files on occupational accidents from two different public agencies (CRAM, Regional Sickness Fund Alsace-Moselle; DRTEFP, Regional Department of Work, Employment and Professional Training) together with those from the Medico-Legal Institute of Strasbourg over the period tested. Data analysis showed that 3% of the victims of workplace fatalities were under the influence of drugs (alcohol excluded) at the time of accident, as well as 5% of the victims of occupational traffic accidents. Our results also highlight a low rate of toxicological analyses, since these investigations were requested by the authorities in 41% of traffic victims and only 15% of workplace victims. In France, the relevance of psychoactive drug intake in occupational deaths is much better targeted in the case of traffic fatalities (due to the existence of specific regulations, e.g. compulsory urinalysis for drugs of abuse in drivers involved in a road accident) than in those occurred at workplace (no specific regulations).     

酒后驾车道路交通事故流行病学研究

目的比较酒后驾车交通事故与非酒后驾车交通事故的流行特征。方法1999～2003年成都地区酒后驾车交通事故542例组成病例组,另从同期发生的75324例交通事故数据库中随机抽取1%非酒后驾车交通事故731例组成对照组。运用统计方法进行分析。结果酒后驾车交通事故造成人员死亡的危险度是非酒后驾车的1.72倍,两类事故的24小时分布基本呈相反趋势,酒后驾车非职业驾驶员和非驾驶员所占比例明显高于其他原因导致的交通事故(P<0.001),酒后驾车造成车辆的损害程度强于非酒后驾车,两类事故机动车的出行目的亦明显不同。结论酒后驾车交通事故较非酒后驾车交通事故后果严重,酒后驾车交通事故有不同于非酒后驾车交通事故的流行规律。     

通过痕迹认定肇事车辆

随着交通事故勘验技术的发展,物证技术在重特大交通事故现场勘验以及侦破交通逃逸案件中发挥的作用越来越重要.痕迹检验技术作为物证技术的一个重要分支,在认定肇事车辆中发挥着举足轻重的作用.交通事故中的痕迹是车辆与车辆、人体、道路等客体在路面上相对高速运动形成的痕迹,相对于其它类型案件有着自己的特点.交通事故中的痕迹分布范围广、造痕体和承痕体相对运动剧烈,形成痕迹的造痕体和承痕体大多都会发生形变.基于交通事故中痕迹形成的这些特点,交通事故中的痕迹检验难度是比较大的.但交通事故中车辆的特殊结构形成的印压痕迹、车辆轮胎、摩托车车篮等造痕体在灰尘等介质作用下在人体的衣服等表面形成的印压痕迹都可以很好反映造痕体的外部结构特征,从这些痕迹反映出造痕体的外部结构特征可以寻找和认定交通肇事车辆.     

Detection of polybrominated biphenyl ethers (PBDEs) in pediatric hair as a tool for determining in utero exposure

This study presents the prevalence of ethanol and illicit drugs in fatal road traffic accident victims in the Centre of Portugal between January 1990 and December 2007. Among the violent deaths, road traffic accidents presented the highest percentage (around 35%; n=3095), but decreasing throughout the years. Accidents were preponderant in males (about 80%; n=2402), between 21 and 30 years-old. Accidents involving drivers (55%; n=1310) were of the most common, being the car the main vehicle (45%), followed by the motorcycle (40%). An alcohol analysis request was present in 50% of the cases (n=1687), but increasing each year. Ethanol concentrations >1.2g/L, the legal limit in Portugal, were found in 55% (n=283) of the cases. Concerning drugs of abuse requests, only 4.4% (n=137) and 17.3% (58 cases) of the cases included the analysis at the Forensic Pathology Department (FPD) and at the Medico-Legal Office (MLO), respectively. Among the road accident cases analysed, 18 were positive, mainly in men (84%), between 21 and 30 years-old; opiates (47.1%; n=8) and cannabinoids (50%; n=4) were the most found, at the FPD and at the MLO, respectively. In conclusion, ethanol was identified as a key factor to traffic accidents, which explains the definition of specific legislation and methods of enforcement to prohibit this form of impairing. Nevertheless, ethanol still remains the psychoactive substance most frequently identified in the blood of divers killed in road-traffic crashes, recommending additional actions of supervision and control.     

离婚后情绪波动与交通事故的发生

目前由于驾驶者生活中的不良情绪导致的交通事故，尤其是驾驶者为责任方的交通事故近年来逐渐增多。本文对离婚引起驾驶者的情绪异常导致的交通事故进行综述，从驾驶者的性别、年龄、职业和行驶里程等方面分析说明了与离婚有关的交通事故的特点，认为情绪压力致饮酒增多是导致情绪相关交通事故的主要原因。并提出预防与情绪相关的交通事故的建议，以制定相应的法律法规，从而减少情绪驾车引起的交通事故。     

论道路交通事故与驾驶员血中酒精含量关系

目的探讨道路交通事故与饮酒驾车血中酒精含量关系及其法医学意义,为预防、控制道路交通事故提供重要依据。方法对2005份道路交通事故肇事驾驶员血酒精鉴定资料进行系统分析性研究。结果饮酒驾车以男性为主,女性饮酒驾车出现醉酒驾车的比例与男性无差别。市区驾驶员醉酒驾车高于郊区。驾驶员BAC<20mg/100mL肇事导致死亡的比例高于饮酒驾车肇事组(BAC20￣79mg/100ML),而BAC≥80mg/100mL则低于饮酒驾车肇事组。结论应降低饮酒驾车和醉酒驾车BAC标准,以利于减少交通事故肇事死亡率。     

Blunt pancreatic trauma by a wheelchair user restraint system during a traffic accident.

Traffic accidents are the most common cause of blunt pancreatic trauma, and most injuries occur in unrestrained drivers. Blunt pancreatic trauma in a passenger or a restrained driver is rare. In this report, we describe a case of blunt pancreatic trauma caused by a restraint system for wheelchair users during a traffic accident.