Alcohol-related accidents and injuries

Summary

• Alcohol has a range of psychomotor and cognitive effects that increase accident risk
• Alcohol consumption is closely regulated in relation to the operation of transport systems and other safety sensitive environments and activities
• Research has found that the severity of both limb and head injury correlate directly with blood alcohol concentration
• Alcohol-related accidents that occur within the home can often have fatal outcomes, the increase risk of injury extends beyond the home too
• Alcohol affects a person’s likelihood to be both a victim of, and to perpetrate, injury through violence
• Accidents due to alcohol (including drink-driving accidents) are the leading cause of death among young adults

Introduction

Alcohol-related health harm is not just limited to chronic disease or physical illness. The presence of alcohol in the body has also been shown to increase the severity of injuries from accidents [1].

Alcohol-related accidents and injuries

Alcohol has a range of psychomotor and cognitive effects that increase accident risk on reaction times, cognitive processing, coordination, vigilance, vision and hearing, even at low blood alcohol levels. For these reasons alcohol consumption is normally closely regulated in relation to the operation of transport systems and other safety sensitive environments and activities.

Adverse effects on vision have been found at blood alcohol concentrations of 30mg ethanol per 100ml blood, and the psychomotor skills required for driving have been found to show impairment from 40mg/100ml (in the UK the legal blood alcohol limit for drivers is 80mg/100ml). Raised risk of accident can also remain for some time after drinking, as skills and faculties do not necessarily return to normal immediately even once all alcohol has left the body. Drink-driving vehicles in general is a dangerous activity, as the number of alcohol-related serious injuries and deaths on Great Britain’s roads demonstrates. Since 2010, 4% – 5% of all reported road traffic accidents involved at least one driver over the drink drive limit have accounted for around. Between 13% – 16% of all deaths on GB roads over the same period did so too [2].

Impairment of faculties can also have a dangerous effect on the control of aircraft. In a study of airline pilots who had to perform routine tasks in a simulator under three alcohol test conditions, it was found that:

• before the ingestion of any alcohol, 10% of them could not perform all the operations correctly;
• after reaching a blood alcohol concentration of 100mg/dl, 89% could not perform all the operations correctly;
• and 14 hours later, after all the alcohol had left their systems, 68% still could not perform all the operations correctly [3].

A study published in the Emergency Medicine Journal investigating the relationship between the pattern and severity of injury sustained during falls among 351 patients found a positive correlation between with blood alcohol concentration. Not only were alcohol-related falls more often associated with severe craniofacial injury, but the severity of both limb and head injury correlated directly with blood alcohol concentration [4].

Alcohol-related accidents that occur within the home can often have fatal outcomes. In 2008, the London Fire Brigade estimated that almost a third of accidental fire deaths in the capital were alcohol-related [5]. At a conservative estimate, it is believed that a total of 400 people die in alcohol-related home accidents every year [6]. Indeed, in a survey of emergency responders in England, almost nine in ten (88%) of firefighters saw alcohol as having a large impact on the risk of fire and related injuries [7].

Alcohol’s ability to increase the risk of danger extends beyond the home too: the International Labour Organisation (ILO) estimated that up to 40% of accidents at
work involve or are related to alcohol use [8]. An Institute of Alcohol Studies report on the cost of workplace hangovers found that [9]:

A number of studies (though not all) [10] indicate that drinking can impair people’s performance at work – unsurprising, given that alcohol has a negative effect on cognitive and motor skills long after it has been consumed [11]. Heavier drinkers tend to report lower productivity, lower quality work and are more likely to get into arguments or accidents [12].

Alcohol consumption affects a person’s likelihood to be both a victim of, and to perpetrate, injury through violence. For victims in particular, cognitive effects of alcohol may reduce ‘ability to recognise warning signs in potentially violent situations’ while for perpetrators, alcohol consumption may affect self-control [13]. In 2017/18 in England and Wales, in 561,000 violent incidents – around two fifths (39%) of violent crimes – and around a third (31%) of incidents of domestic violence, the perpetrator was thought to be under the influence of alcohol [14]. Figures from 2013/14 suggested that of all those aged 16 to 59 years in England and Wales who had ever experienced a serious sexual assault since the age of 16, more than a third (36%) believed the perpetrator to be under the influence of alcohol [15].

A significant proportion of avoidable deaths and hospital admissions each year are particularly attributable to the alcohol consumption of young people [16]. A government white paper on public health published in 2010 emphasised the danger of alcohol misuse to young people’s lives, stating that accidents due to alcohol (including drink-driving accidents) are the leading cause of death among 16–24-year-olds [17].