TRAFFIC ACCIDENTS AND PSYCHO ACTIVE DRUGS BY REVIEW OF NE CROPSY REPORTS OF A UNIVERSITY INSTITUTE OF FORENSIC MEDICINE (BRESCIA ITALY)

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1 TRAFFIC ACCIDENTS AND PSYCHO ACTIVE DRUGS BY REVIEW OF NE CROPSY REPORTS OF A UNIVERSITY INSTITUTE OF FORENSIC MEDICINE (BRESCIA ITALY) PierLuigi Del Pecchia, Paolo Pelizza, Cristina Hicossa Psychomotor performance of the individual is among the most important causes of traffic accidents as well as roads and weather conditions and vehicles efficency. As regards driving behaviour the abuse of psychoactive substances, particularly of alcohol, induced different countries to adopt legislative misures about the matter. In the period traffic road accidents related deaths have been observed at the Forensic Medicine Institute of Brescia (Italy). The present study has been carried out retrospectively by examining the necropsy records concerning this period. As first we excluded all the cases which underwent medical treatment, the cases whose cause of death had been certified on the basis of the only external inspection, the cases in which the victim was passenger of the involved vehicles and, finally, all the cases in which it had been tecnically impossible to carry out the toxicological analysis. The selected group was inclusive of 139 cases in which blood alcohol concentration (BAC), on samples taken at the autopsy, was available: three of these cases had also analytical positivity to morphine, methadone* and benzodiazepines respectively; four more cases were positive only for cocaine (2) or morphine (2). As first data have been examined with the purpose to evaluate an eventual correlation between abuse of alcoholics and drugs, sex and age of the victim as well as time of the accidents. Moreover accident modalities have been related to the results of toxicological analyses, in the purpose to analyze an eventual correlation between these two factors. As regard sex distribution (tab.l) males rapresented the vast majority of the examined cases (114 out of 139). The age range (tab.2) betweeen 21 and 50 years accounted for the 55% of the cases; the age distribution changes if only cyclist or pedestrian are considered, because of higher number of deaths in the age group over 50. Cases with BAC > 0,1 g/1 (fig.l) rapresent nearly 46% of the total ca 990 Alcohol, Drugs and Traffic Safety - T92 Ed. by Utzelmann / Berghaus / Kroj Verlag TÜV Rheinland GmbH, Köln -1993

2 ses, while if we consider only BAG > 0,5 g/1 or BAC >0,8 g/1 the relative percentages are 38% and 35%. Anyway, the intake of alcoholic beverages is diffused especially between 30 and 70 s years of age. Cyclists are the road-user group (tab.3) which more frequently result positive for blood alcohol tests (BAC > 0,1 g/1). If we consider cases with BAC > 0,8 g/1 there is a higher frequency in the pedestrian group. In 134 cases it has been possible to ascertain the hour of the day of the accident (tab.4); in the second ha1f of the day there have been more accidents. Considering the BAC > 0,5 or 0,8 g/1 (fig. 2) it has been noted an increase in number of cases during the evening and night. We have found no particular distribution of accidents during the day of week (tab.5); on the contrary, the correlation between BAC and day of week, shows that most cases positive for alcohol test were involved in traffic accidents during monday and Saturday (fig.3); if only BAC > 0,8 g/1 is considered tha vast majority of cases occurred on monday, Saturday and sunday. As regards the 7 cases with toxicological analysis the accidents always occurred during night and weekends; in 6 cases it was clearly evident the impairment of driving ability due to drug intoxication (all single car accidents). In order to obtain more accurate data concerning accident modalities, road caracteristics and conditions, wheather and lighting conditions we reviwed the police reports described in the judicial proceedings and particularly officer s assesment of the causes of the crash. According to this further data it has been possible to identify anomalous behaviours of the victims, that is violations of the traffic rules with clear responsability of the subject in creating the dangerous situation (invasion of the opposite lane, speeding, etc.). To evaluate the role of blood alcohol level in the dynamics of the accident we excluded all the cases in which external factors, such as poor visibility or bad road conditions were present. According to these criteria 56 cases were selected and used for further analysis; in 38 cases the behaviour could be considered "anomalous" while in 18 no responsability of the victim was assessed. Further split of the cases has been operated according to BAC equal or below and above 0,5 g/1 (tab.6). Data analysis was performed u sing Chi-square test (p < 0,025). The number of road users with BAC above 0,5 g/1 was significantly higher for the cases with "anomalous behav iour". In conclusion our data confirm that ethanol causes impairment of individual s psychomotor performances since blood concentrations above 0,5 g/1. 991

3 REFERENCES 1 - Dati ISTAT, "Statistica degli incidenti stradali anno 1990", annuario n.38, ed Gualdi G., Anselmi E., Ricci P., Offiani C., "Uso ed abuso di Alcool, Sostanze Stupefacenti e Psicotrope ed Incidenti Stradali", Rivista Italiana di Medicina Legale, IX, , Mason A.P., McBay J., D.A.B.F.T., "Ethanol, Marijuana and Other Drug Use in 600 Drivers Killed in Single Vehicle Crashes in North Carolina, ", Journal of Forensic Sciences, JFSCA, 29, (4), , Gjerde H., Kinn G., "Impairment in Drivers due to Cannabis in Combination with other Drugs", Forensic Science International, 50, 57-60, Christensen L.Q., Nielsen L.M., Nielsen S.L., "Traffic Accidents and Drivers Suspected for Drug Influence", Forensic Science International, 45, , Manzo L., "Interferenze tra Alcool e Medicamenti", in "Nuovi aspetti di Tossicologia Sperimentale e Clinica", Edizioni Medico Scientifiche, Torino, Dubowski K.M., "Adsorption, Distribution and Elimination of Alcohol: Highway safety Aspects", (Review), Journal of Alcohol, 10, , Baylor A.M., Layne C.S., Mayfield R.D., "effects of Ethanol on Human Fractionated Response Times, Drug and Alcohol Dependence, 23, 31-40, Garriot J.C.,Di Maio V. JM, Zumwalt R.E., Petty GS, "Incidence of Drugs and Alcohol in Fatally Injured Motor Vehicle Drivers, Journal of Forensic Sciences, 22, (2), , PAB Raffle, "Interrelation between Alcohol and Accidents", Journal of Royal Society of Medicine, 82, , ] - Starmer G.A., Cairns D., Mascord D.J., Peri J., "Drugs in Drivers who Presented to Ospital After a Crash", Atti de "International Workshop on Drugs and Driving", Padova, 21 Oct. - 1 Nov Gjerde H., Beylich K.M., Morland J., "Incidence of Positive Alcohol and Drug Finings in Blood Samples from Fatally Injured Motor Vehicle Drivers in Norway", Atti de "International Workshop on Drugs and Driving", Padova, 21 Oct - 1 Nov Pentilla A., Karhunen P.J., Lalu K., Pikkarainen J., "Drugs vs. Alcohol Associated with Driving while Intoxicated in Helsinki", Atti de "International Workshop on Drugs and Driving", Padova 21 Oct -1 Nov Vural N., Saygu S., "A Survey of Blood Alcohol Effects on Drivers in Ankara", Atti de "International Workshop on Drugs and Driving", Padova, 21 Oct. - 1 Nov

4 15 - Sweedler B.M., "Drug Use Fatally Injured Drivers of Heavy Truks", Atti de "International Workshop on Drugs and Driving", Padova, 21 Oct. - 1 Nov Contacts Dr. Cristina Ricossa, Dr. Paolo Pelizza, Dr. PierLuigi Del Pecchia Tel or Institute of Forensic Medicine - University of Brescia Spedali Civili Brescia Fax

5 t a b. 1 Fatal road accidents by sex of victims and year: cases submitted to toxicological analysis SEX YEARS TOT M F TOT tab. 2 Traffic accident related deaths by age and blood ethanol level AGE BLOOD ALCOHOL CONCENTRATION (a/1) TOTAL <0,1 0,1-0,5 0,51-.0,8. 0,81-1 1,1-2,0 2,1-3,0 3,1-4,0 > > TOTAL

6 t a b. 5 Cases by blood ethanol level and road user AGONIST BLOOD ALCOHOL CONCENTRATION ( TOTAL < 0,1 0,1-0,5 0,5 1-0,8 1-1,1-2,0 2,1-3,0 3,1-4,0 > 4 heavy m otorvh elcle d rive rs car d rive rs m otorcyclists,.üi - - L, cyclists pedestrt ans TOTAL tab. 4 Cases by blood ethanol level and hour HOUR RANGE < 0,1 0,1-0,5 0,51-0,8 BLOOD ALCOHOL CONCENTRATION ( g/1 ) 0,81-1 1,1-2,0 2,1-3,0 3,1-4,0 > 4 TOTAL TOTAL

7 t a b. 5 Cases by blood ethanol level and days DAYS BLOOD ALCOHOL CONCENTRATION (q /l) TOTAL < 0,1 0,1-0,5 0,5 1-0,8 0, ,1-2,0 2,1-3,0 3,1-4,0 > 4 mon tue wed thur f r l sat sun TOTAL tab. 6 Cases of traffic road accidents in favourable driving circumstances BLOOD ALCOHOL CONCENTRATION g/1 <0,1 -...: >0.5 > 0,8 Anomalous behaviour N onnal behaviour

8 U line Ha/i B BAO0. lg /1 H BAC>0.Sg/l H BAC>0.8g/l >80 Age in years F ig. 1 x of 1 RR c a s e s B BAC=0 ü BAO0 1 S3 BAC>0 5 H BAC> hour of day 997

9 Fig. 3 0!>!) 8 998