Impaired Driving. Javier Romero MD FACS. Co-Director Department of Trauma Services Ventura County Medical Center

Transcription

1 Impaired Driving Javier Romero MD FACS Co-Director Department of Trauma Services Ventura County Medical Center

2 How big is the problem? Deaths from fire attributed to alcohol Deaths from drowning attributed to alcohol 30% 30% Deaths due to accidental falls attributed to alcohol 40%

3 (continued) How big is the problem? Deaths from auto crashes attributed to alcohol Homicides attributed to alcohol 45% 30%

4 How many lives lost due to alcohol in one year? 100,000 CDC Report: Alcohol Consumption and Mortality

5 Annual Death Statistics

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7 Impaired Driving 2012: 10,000 died in alcohol related crashes (1 every 51 mins) CA: 12,000 of 17,200 injured by drunken driving crashes CA: 802 total deaths from drunken driving CA:97 Teen deaths from drunken driving

8 Cost of Alcohol-Related Injury Medical expenses $5.4 billion Criminal justice spending and property damage $7.8 billion Work Losses $25.3 billion Quality of life costs $48.8 billion Total annual cost: $87.3 billion Alcohol costs California State Budget 2010 Rosen, et al. Alcoholism, Clinical and Experimental Research Nov;32(11):

9 Unintentional Injuries Those who drink have a greater chance of dying from injury and sustaining nonfatal injury Even drinking at relatively low levels (1 drink/day) are at greater risk of injury

10 Why Trauma? 15%-50% injured patients in the emergency department have alcohol dependence, compared with 7%-8% of the general population Trauma is a teachable moment -cause and effect are connected Gentilelloet al shows 30 min interventions 1. reduced overall Alcohol intake 2. lowered trauma recidivism by 47%

11 What we do! SBIRT Screening Brief Intervention Referral to Treatment Screen with RAPS4

12 Rapid Alcohol Problem Screening (RAPS4) Who: All Trauma (Tier I-II) Patients >14 years that require admission to the hospital What: Positive Blood Alcohol Level or UrineTox RAPS4 conducted if RAPS4 positive Intervention Where: In the Hospital by Alcohol and Drug Counselor

13 Study Description SBIRT-validating the efficacy of the RAPS 4, alcohol and drug intervention program at VCMC.

14 Hypothesis In-hospital alcohol intervention to trauma patients has decreased RAPS4 positivity and also gives high referral compliance to Outpatient Referral Center. Question to answer: Does intervention decrease alcohol dependence?

15 Sample group: All respondents with positive RAPS4 RAPS 4 Results: 2010 N=204 Number of patients Pos 1 Pos 2 Pos 3 Pos 4 Negative Number of + responses to RAPS 4 questions VCMC Trauma Data

16 Results Yes, SBIRT shows effectiveness in reducing overall value of RAPS4 responses. Average Difference After SBIRT RAPS 4 Value Initial RAPS 4 Intervention After SBIRT

17 Conclusions Screening, Brief Intervention, and Referral to Treatment (SBIRT) has shown positive improvement in the sample population for decreasing alcohol dependence. There is little to no compliance in patients attending or making an outpatient referral appointment.

18 Recommendations: 1. Better hand-off for referral to treatment centers. 2. Maintain consistent follow-up contact in 3, 6, 12 month intervals. 3. In-hospital treatment services for alcohol abuse.

19 Texting distracted driving

20 LAWS July 2008 Hand held device use ban while driving June 2009 Ban on texting while driving

21 States Without Distracted Driving Laws ATOM 3 Arizona, Texas, Oklahoma, Mississippi, Missouri, Montana Texting + driving = 6X > danger vs. drunk driving (NHTSA)

22 Distracted Driving 71% of Teens/Young Adults sent txt while driving 78% of Teens/Young Adults read a txt while driving 50% feel txt -> NO difference on performance 90% feel unsafe when passenger, while driver uses handheld device

23 Distracted Driving Texting + driving = 1.6 million crashes/year 421,000 people injured in crashes due to distraction 2012: 3,328 drivers killed due to distraction 12% of fatal crashes were Teen drivers (14 18 years) 24% of distracted Teen drivers were using cell phone 20% of Teen drivers had alcohol in system

24 Case Scenario 26-year old male Driving and texting High speed MVC into a tree Tier I activation

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28 SYNTHETIC CANNABINOIDS

29 THC Natural Marijuana

30 HU-210 Synthetic cannabinoids aka spice times more powerful the cannabis

31 Drug test THC HU-210

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33 Clinical Presentation DRUG SCREEN Currently trauma centers don t have a screening tool for detection Military has a screening tool, but costly

34 Clinical Presentation (continued) HU-120 Derivative of THC, synthetic x stronger CB 1, CB 2 have stronger affinity

35 Clinical Presentation At VCMC, 4 documented cases 3 out of 4 required ICU care No documented death in our facility However, there were 4 related deaths with the use of synthetic THC so far in 2015 Suspect under reporting due to difficulty in screening and detection of synthetic THC

36 Injury Prevention Distracted Driving Educational Events (national and local high schools) Every 15 Minutes at local high schools (2-day event) Monthly Events: Start Smart 11 classes, approximately 150 new teen drivers and their parents OB Celebration 12 events, Spoke with over 1600 new parentsabout home safety and child safety seat use Car Seat Inspection Stations participated in 27 stations, checked approximately 120 child safety seats, put a lot of kids back into booster seats! (In collaboration with our Safe Kids Ventura County Coalition) Curbside Coffee and Chat with Ventura Police Department visited 13 elementary schools and discussed new Car Seat law and proper selection and use of child safety seats with parents Operation Peace Works Call-Ins Dr. Duncan sits on panel for these monthly presentations.

37 Controlled Chaos