Talking Points

December 7, 2004
10:00am
American Hospital Association
One North Franklin
Conference Room 27104
Chicago, IL 60606

Dr. Andrea Barthwell Talking Points

• Good morning, my name is Dr. Andrea Barthwell, I am the former Deputy Director for Demand Reduction for the White House Office of National Drug Control Policy and Co-Chairperson of End Needless Death on Our Roadways or END.
• END is a physician, nurse and other healthcare provider organization dedicated to exploring new and innovative strategies for addressing impaired and other dangerous driving behaviors.
• Motorists are facing an epidemic of death on our roadways, and tragically many of these fatalities and serious injuries could have been prevented through behavioral changes.
• For example, everyday in the United States, people are killed and seriously injured because they fail to take the simple life saving precaution of wearing their safety belt.
• Studies demonstrate, again and again, that the greatest deterrent to traffic fatalities and injuries is for motorists to buckle up themselves and their children.
• Safety belts are the most effective safety devices in vehicles today. Because of the efforts of the National Highway Traffic Safety Administration and its many partners, safety belt usage now stands at 79 percent nationwide.
• While efforts have been successful, to realize the full life-saving potential of safety belts, usage rates nationwide must increase to between 85 and 90 percent.
• A more difficult challenge, however, can be found in the area of impaired driving.
• America is at a crucial point, requiring all of us to do more if we are to significantly reduce the number of alcohol and drug related traffic crashes.
• Statistics indicate a growing number of motorists continue to make the wrong choice and drive impaired. Every year, 1.5 million impaired drivers are arrested, yet only one arrest occurs for every 722 instances of impaired driving. As a result, one in three Americans will be affected by the violent crime of impaired driving during their lifetime.
• Impaired driving like unbelted motorists is a problem that involves a disproportionate number of young male drivers. Many young people, especially young males think they are indestructible – that they’ll live forever. For them, messages about the lifesaving benefits of safe and sober driving often fall on deaf ears. However, the threat of being arrested or getting fined has proven to change behavior.
• States that have toughened, publicized and enforced DUI laws have seen traffic fatalities and injuries decrease. Unfortunately, motor vehicle fatalities involving impaired driving have reached a plateau in recent years.
• Efforts must be re-focused on the persistent problem of impaired driving. We must develop new and innovative strategies to address this deadly problem.
• To begin the processes of reversing this trend, today the physicians, nurses and other healthcare providers of END are announcing the Fatal Fifteen. The Fatal Fifteen are states in which 44 percent or more of all traffic fatalities are alcohol related.
• The Fatal Fifteen include: Connecticut, District of Columbia, Hawaii, Illinois, Louisiana, Massachusetts, Montana, Nevada, New Mexico, North Dakota, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Texas, and Wisconsin.
• We are calling on each of the fifteen Governors of the Fatal Fifteen as well as the Mayor of Washington, D.C. and the Governor of Puerto Rico to create or refocus a task force in their states dedicated to exploring new and innovative strategies for addressing impaired and other dangerous driving behaviors.
• The physicians and other healthcare provider members of END are committed to taking an active leadership role on these task forces. It is our hope to work with the states and other traffic safety advocates by providing our expertise and knowledge in addressing and preventing dangerous driving behaviors.
• To speak more about our initiative, it is my pleasure to introduce Donald McNamara, Regional Administrator from the National Highway Traffic Safety Administration.

Mr. Don McNamara Talking Points

• Thank you Dr. Barthwell.
• December and the holiday season is a most appropriate time to introduce END. While the holiday season is a time for excitement, celebration and family, it is also a time of impaired driving and senseless death and injury. Statistics show that last year, over 17,000 motorists were killed nationwide in traffic crashes involving impaired drivers.
• December is Drunk and Drugged Driving Prevention month. It is also one of the year’s peak impaired driving seasons. Young male drivers between the ages of 21 and 34 are involved in the highest number of impaired driving crashes. Adding to this tragedy, young motorists are the group least likely to buckle their safety belts.
• Every day physicians, nurses, EMS technicians and other health care providers are called upon to take heroic steps in an attempt to save the lives of people injured in motor vehicle crashes. Unfortunately, all too often they are unsuccessful.
• Their involvement often means that those of us committed to traffic safety have failed. Our message went unheard or unheeded. Someone, usually a young person, chose to drive impaired. They probably also chose not to wear their safety belt. Law enforcement didn’t catch up with them this time. That young person was in a violent car crash.
• Physicians, nurses, EMS technicians and other healthcare providers have the unenviable task of wading through broken glass, and ripped flesh in an attempt to put that young life back together again.
• Often, they have the most unappealing job of all…telling family members that their loved one is gone forever. They are the messengers of bad news that causes a level of grief that parents, children, family and friends must endure forever.
• Tragically, traffic related fatalities often have three elements in common. Alcohol, no safety belt and a teen or other young person was involved.
• Today, I’m excited about the prospects of what an organization like END can accomplish.
• Because physicians, nurses and EMS professionals see the effects of traffic crashes every day, they can speak with more passion, experience and authority on the devastation car crashes can cause.
• As an organized group, END will be a powerful force for good in the effort to end needless death on our roadways. I am looking forward to working with END for years to come.
• I would now like to introduce Dr. Thomas Esposito, Co –Chairperson of END and Director of Loyola University Medical Center’s Injury Analysis and Prevention Program.

Dr. Thomas Esposito Talking Points

• While the effects of stricter impaired driving laws and a general change in public attitude has lowered the number of impaired driving deaths over the years, as Dr. Barthwell has said, the reduction in the death rate has reached a plateau. Unfortunately, the levels are still unacceptably high.
• Statistics do not begin to tell the story of the real pain and destruction caused by impaired drivers. Every December, and throughout the year, physicians and other health care workers treat both impaired drivers and their victims at roadside crash scenes and in hospital emergency rooms. At times, the carnage seen on our roads and in the emergency departments resembles a war zone.
• I want to take a few moments to share with you an experience I had when I was a young surgeon, many years ago. This memory still haunts me today. (Dr. Esposito Briefly describes experience when young girl came in ER with internal injuries)
• While this case is particularly memorable for me, unfortunately it is not particularly unique or rare. All to often, everyday in fact, physicians, nurses, EMS technicians and other healthcare providers see the result of crashes involving impaired and unbuckled motorists. That is why we are all here today.
• Physicians and other healthcare workers can have a large role in decreasing incidences of impaired driving simply because of our contact with patients who have alcohol and drug use problems.
• Patients with alcohol use problems are more likely to drive impaired and have higher rates of illness and motor vehicle crash injury than the general population. In fact, nearly 50 percent of all severely injured patients are injured while under the influence of alcohol.
• To speak more about the role healthcare providers can play in addressing impaired driving is Dr. Carl A. Soderstrom, Professor of Surgery, University of Maryland.

Dr. Carl Soderstrom Talking Points

• As you have heard, alcohol is a well-established cause of death and injury on the roadway. But many experts think that statistics on crashes known to be associated with alcohol only hint at the scope of the problem. Those statistics are generated primarily by police investigations. In many other cases, alcohol has played a role without anyone other than the driver being the wiser.
• We are among a growing number of health providers who think that emergency department physicians and nurses can do more than just sew up cuts or put on casts and send patients on their way. An emergency department visit is also an opportunity -- a ''teachable moment,'' as some call it -- to identify people with alcohol problems and steer them toward the help they need.
• The hospital emergency department may be one of the few chances doctors have to reach people who are at risk. Emergency departments are also the only medical care most young adults have.
• Beyond that, emergency rooms have a way of attracting people with alcohol problems. Estimates vary, but by some counts perhaps a quarter of the people who end up in emergency rooms with some kind of trauma are intoxicated. Even for those who are sober, a disproportionate number are found on further evaluation to have drinking problems.
• It has been said that hospital emergency departments have become an unintended refuge for alcohol-impaired drivers.
• One of the strategies that the members of END will explore is treating alcohol use problems by implementing a protocol of alcohol screening, brief intervention, and referral to treatment in hospital emergency departments. This in turn, may lead to fewer alcohol-related crashes.
• The screening process involves asking patients a few simple questions concerning drinking habits and consumption. An assessment is completed for patients who respond positively to one or more of the questions. The patient then undergoes a brief intervention where he/she is counseled and referred to appropriate care.
• Studies have determined that brief interventions, which are short 5-15 minute counseling sessions designed to assist the patient confront the negative consequences of his/her alcohol consumption, have proven effective in decreasing consumption among at-risk drinkers.
• Recent studies have found that the results of screening programs are promising. A report last month in The Lancet, a medical journal based in London, said that when emergency room doctors screened patients for alcohol problems and referred them to an alcohol health worker, their level of reported drinking declined over the next year. They also had fewer return visits to the emergency room.
• We believe screening and brief intervention holds much promise. It should definitely be high on the agenda as we convene traffic safety task forces in the Fatal Fifteen.