Emergency Departments Must Address Drinking and Driving

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Scene of alcohol-related car crash

Scene of alcohol-related car crash

Illness and death related to drinking and driving is completely preventable.   In Canada, alcohol-related car crashes cause 3-4 deaths and more than 200 injuries every day.  Emergency Departments (EDs) see a large number of these inebriated injured patients.  Occasionally, some individuals are referred to alcohol rehabilitation programs.  Many patients are discharged or admitted into hospital with little follow-up. 

The problem of drinking and driving has long been recognized by the government and the community. Together, these groups, including Mothers Against Drunk Driving, the British Columbia Automobile Association, and the Insurance Corporation of British Columbia , have funded drinking and driving public service announcements, increased road side police enforcement, and increased penalties for drinking and driving.  Even the British Columbia Liquor Store has put out public service announcements denouncing drinking and driving.

However, drinking and driving still remains a problem.  The next steps must also involve the medical community.  The term “teachable moment” has often been used to characterize ED visits, where sudden adverse health effects provide a window of opportunity to motivate individuals to change; emergency personnel therefore play a key role in promoting health behavior change.  In the United States and in England,  motivational interviewing by ED personnel has consistently led to a decrease in alcohol-related injuries and traffic violations. 

Unfortunately, ED counseling in Canada is rare.  EDs are fast-paced and busy, and lack of funding and personnel resources have limited the implementation of these programs.  There is therefore an urgent need for increased funding and hiring of ED dedicated counselors to capitalize on the ED “teachable moment”.  Within this window of opportunity, motivational interviews should be performed on all consenting ED patients with alcohol dependency or abuse problems. 

In Canada, alcohol-related motor vehicle crashes continue to claim more than 3000 lives annually and cost society up to $12.8 billion per year.  We cannot afford to lose this window of opportunity.

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10 Responses to “Emergency Departments Must Address Drinking and Driving”

  1. esangkyu Says:

    Very interesting topic. The ED in my limited experience, is a very chaotic environment where things like counseling are limited, or left to the overworked social worker. The counseling or advice from the physician for any visit is variable, and probably more so with alcohol related injuries, which can be very frustrating for the doctor. I recall speaking to many patients in the hospital for an alcohol related cause, and as I am speaking to them, I am thinking how pointless my conversation is, and how they are not listening to my message. This will undoubtedly influence the effect I can have on my patients and my attitude towards them. While there are certain individuals who will not change regardless of who says what to them, there are many that will change and distinguishing from the two in the hospital may be impossible.

    The idea of the motivational interview seems like a great one to me. It encases which concepts and facts need to be expressed on each visit, alleviating the physician from deciding how much time should be spent in counseling, which would allow consistent information given, and it applies evidence based medicine to an area that is clearly lacking.

    Daniel Rhee

  2. cdionne Says:

    I wish more ER physicians would speak out about this need, as there is most assuredly families who could truly use the support. My father was referred to an alcohol rehabilitation program after he was in an accident many, many years ago. It made all the difference in the world. After several decades of hitting the bar on Friday night after getting a paycheck and driving himself home afterwards, no amount of family intervention or number of DUI tickets had an impact. But, a doctor talking to him and referring him appropriately and following up over time DID make a difference. To my dad — but also to his family. Addressing the issue of drinking and driving has a much deeper familial impact than simply getting a dangerous drunk off the road.

  3. alulateklu Says:

    I live in a country of 80 million population but the total number of cars is less than 250, 000. Despite the small number of cars we have alarming numbers of car injuries; for example at least 1 death per day in the capital Addis Ababa, which was consistent for the last 5 years. There are multiple reasons for the high prevalence of car injuries, the most common being reckless driving which includes drunk driving. This makes the causes of car injuries in the two very dissimilar countries (Canada and Ethiopia) the same.
    The other major problem (the second commonest cause) in my case is lack of side walks! Most of the roads in the capital have no side walks as a result of which the roads are shared between human beings and cars. I think this could be improved by providing policy guidance by making side walks mandatory for all roads in residential places.

  4. mkornides Says:

    The idea of using the ED to capitalize on teachable moments for intoxicated drivers is interesting. However, I don’t think it would be the most effective use of resources, considering that by the time someone reaches the ED due to an alcohol-related motor vehicle accident presumably some type of damage has already occurred. Rather than spend valuable resources on counselors dedicated to capturing this teachable moment, the money might better be spent on training existing emergency department staff on follow-up resources to which they can refer patients with alcohol dependency or abuse problems. The problem of driving while intoxicated is also one that needs to be addressed from an ecological model perspective. What leads some people to drive under the influence? Are drivers who live in the suburbs or rural areas more likely than urban dwellers to drive? Does the availability of public transportation affect the statistics of DUI arrests in areas of Canada? An evaluation of the problem may bring up solutions that can be applied as preventative measures, so less people end up in the ED departments due to alcohol-related motor vehicle accidents overall.

  5. mkornides Says:

    The idea of using the ED to capitalize on teachable moments for intoxicated drivers is interesting. However, I don’t think it would be the most effective use of resources, considering that by the time someone reaches the ED due to an alcohol-related motor vehicle accident presumably some type of damage has already occurred. Rather than spend valuable resources on counselors dedicated to capturing this teachable moment, the money might better be spent on training existing emergency department staff on follow-up resources to which they can refer patients with alcohol dependency or abuse problems. The problem of driving while intoxicated is also one that needs to be addressed from an ecological model perspective. What leads some people to drive under the influence? Are drivers who live in the suburbs or rural areas more likely than urban dwellers to drive? Does the availability of public transportation affect the statistics of DUI arrests in areas of Canada? An evaluation of the problem may bring up solutions that can be applied as preventative measures, so less people end up in the ED departments due to alcohol-related motor vehicle accidents overall.

  6. lewisbholmes Says:

    Excellent points. As a family doctor I am aware of the tragedy of drinking and driving but hadn’t thought about the “teachable moment” in the ED as a critical point for intervention. I will let the head of our ED know about this video. Thanks for the insights.

  7. asamarth Says:

    I would suggest have a team of councilors, which will visit the person immediately at home following the accident. The person will still be in the mind set of listening and change his/her behavior. In ED, the person might be too concern to get treated and may not in a mindset of listening to any such counseling!

  8. mdklinkhammer Says:

    As an ER physician, I thought I might comment on this. As a medical student interested in Emergency Medicine, I actually did research on emergency department patients and what their current stage of change was in regards to tobacco abstinence. I did this attempting to raise awareness among emergency physicians about the teachable moment as regards to tobacco use and respiratory disease, i.e. asthma attack, so the concept is certainly not a new one to me. However, after working in an emergency department for the last 5 years, with how limited my patient encounters can feel at times as I’m constantly pressured to move onto the next patient to make sure no really sick patient waits too long, I still try to address these moments, but find it challenging and don’t necessarily think the same would apply to alcohol related injuries. I feel this way largely as these patients are often still dazed or somewhat intoxicated when leaving the ED, and think that the time towards an intervention may be relatively wasted. I do think that getting these people the appropriate follow up as mentioned above would be a good idea.

  9. rockerdocmom Says:

    Very well written! A colleague of mine did a study on drinking and driving in North Carolina – focusing on the burgeoning hispanic population. Alcoholism is a major issue among hispanic teens and young adults and her study found a high incidence of drunk driving among them. The sad fact was that though some were migrant workers but most were illegal aliens and had no drivers license. Not only were they transitory but they were afraid to seek help for fear of deportation. The shortage of spanish interpreters in the ED was a huge barrier to educating the patients. The youth of the patients meant that like most young people, they were ‘invincible’ and did not think they needed to change their behaviors. My colleague was hoping to start a project to address this.

  10. motivation quote Says:

    motivation quote…

    […]Emergency Departments Must Address Drinking and Driving « SBFPHC Policy Advocacy[…]…

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