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Alcohol, Drugs and Fatal Accidents in Brescia and the Italian Highway Code Regulations
M. Bernini, A.Conti, F. De Ferrari, M. Fornaciari, E. Saligari
Department of Forensic Medicine, University of Brescia, Spedali Civili Brescia, Italy
Total road traffic accidents (survivors and death) reported in Brescia area in 1993 are compared with similar data from a 1988 study. In particular the deaths with evidence of the presence of alcohol and/or drugs are examined also in the years 1990 to 1994.
The inadequacy of the 80mg/100ml limit beyond which driving is prohibited is underlined as alcohol has negative effects on a drivers ability at values below this level.
Likewise stressed is the insufficiency of the regulating of the method of verifying the influence of the effects of alcohol and drugs. Particularly apparent is the differing levels of legislation in the various European countries at a time when the general tendency is for legislative uniformity among member states.
ACCIDENTS IN BRESCIA
The data relevant to road traffic accidents which occurred in Brescia in 1993 are analysed and compared with those for accidents occurring in the same area during 1988 (Birbes and Coll., 1992).
The investigation covers both those persons injured and subsequently having recovered in the Brescia General Hospital (4141 in 1988 and 3336 in 1993) and those who died immediately or after a period in the hospital: 81 in 1988 and 172 in 1993.
Table 1 concerns those injured subdivided by type of accident: in both the years under review the most frequent type of accident (more than half) is represented by motor car accidents. This data, confirmed by various other surveys both national and abroad (Celesti and Bistarini 1977, Cortivo and Tantalo 1982, Tongue 1977, Mason 1978) highlights the high density of motor cars in circulation with respect to other forms of transport.
Among these accidents the most frequently occurring is collisions between motor cars (62.6% in 1988 and 65.6% in 1993) followed by motor cars leaving the road.
Comparing the two years under consideration (Tables 1-3) shows a reduction of the road traffic accidents in 1993 (3508) with respect to 1988 (4222) in parallel with an increase in lethal incidents (172 and 81 respectively). The latter mainly concerns motor vehicles, with a relatively higher frequency of leaving the road with respect to collisions between motor vehicles.
Also reported in the Tables are cases of subjects who died at the scene of the accident or shortly afterwards (within 12 hours) from trauma and on whom autopsies and, therefore, the relative toxicological analysis for alcohol and drugs,were carried out (indicated by an asterisk (*)).
In 1988, of 8 cases examined, only 2 resulted in concentrations >= the limit of 0.8 g/L as provided for in the Italian law. One was a motorcyclist, in collision with another motor vehicle, who was found to have an alcohol in blood level of 3.20 g/L and the other a car driver involved in a collision with another motor car, with a positive value of 0.9 g/L.
In 1993 5 cases of alcohol in blood at a level lower than 0.8 g/L were found while only 3 cases were found above the limit: two cases were of car drivers in collision with other cars
(1.53 g/L and 1.50 g/L) and another car driver died following a collision with a stationary object (3.20 g/L).
The above data serves to reaffirm the smallness of the number of subjects on which toxicological examinations were carried out (9.9% of the total subjects under review, equal to 253 cases). This limitation, as already expounded on by Ricossa and Col., is, on the one hand due to the prolonged survival of subjects in hospital (> 12 hrs) after the accident, which renders the investigation of alcohol in blood levels at an autopsy superfluous, and on the other hand, as very frequently happens now in our country since the promulgation of the new Penal Procedure Code (Codice di Procedura Penale)(1989), the consistent increase in the number of external examinations with the loss of an autopsy examination. This has obviously reduced the possibilities of obtaining the fluid samples necessary for toxicological analysis, thereby influencing the number of available cases for study.
These limiting factors are also evident in the toxicological surveys conducted on the four year period 1990 - 1994, where all the deaths resulting from road traffic accidents were examined where toxicological examinations had been carried out. Table 4 shows the results obtained by age group, from a total of 775 deaths 77 had undergone analysis, of which 26 (equal to 33%) resulted in concentrations of ethyl alcohol >= 0.8 g/L. In reality the number of positive cases encountered (that is with levels >= 0.1 g/L) was 46 which is equal to 60%.
It is noted moreover, how the limit provided for in our regulations (0.8 g/L) is in contrast to other European legislation which is more restrictive in the level permitted while being in control of a motor vehicle. On the other hand,we must also note that concentrations lower than 0.8 g/L can generate anomalous behaviour and therefore behaviour dangerous to the driving of motor vehicles.
In fact, in 1966, Introna recorded Italian and foreign studies and statistics which in conclusion affirmed that the"dangerousness commences with an alcohol blood level of 0.5 grams per thousand", according to the data collected by Organisation Nationale de Sčcuritč Routičre and quoted by the author, from a start point of 0.5 g/L the risk of accident curve increases exponentially.
It would therefore be desirable that the alcohol in blood limit set by Italian legislation were further reduced, both in light of the considerations, briefly outlined above, on the negative effects of alcohol on the fitness to drive a motor vehicle, and also because, as mentioned in 1963 by Cattabeni and Luvoni,"the limit should tend toward the lower values, given the eminently preventive aim of the law, for which it would appear to make sense to include among the transgressors those who are fit to drive even at a fairly high alcohol in blood level, than to exclude those who would constitute a danger to traffic safety even with a relatively modest level".
In any case it is hoped that, at least in European countries, we can reach uniformity with regards to legislation.
Birbes, M. Fornaciari, P. Pelizza -"Lesivitą da incidente stradale a Brescia nel 1988"- Quaderni Camerti, Anno XIV, n.1, 1992
Cattabeni, R. Luvoni -"La valutazione medico-legale dell'alcooimetria in tema di responsabilitą e prevenzione degli incidente stradali"- Atti del III Symposium sugli aspetti medici dell'incidente stradale, A.C.I., Salsomaggiore, 24-25 Maggio 1963.
Celesti, S. Bistarini -"La mortalitą da incidente stradale"Med. Leg. Ass., 25, 47, 1977.
Cortivo, M. Tantalo -"La mortalitą da incidente stradale nella casistica del settorato dell'Istituto di Medicina Legale di Padova relativa al quinquennio 1976-1980."
Introna -"Alcool e traffico"- Med. Leg. Ass., 14, 277, 1966.
K. Mason -"The pathology of violent injury."Ed. Edward Arnold, London, 1978.
Ricossa, F. De Ferrari, P. Del Pecchia, L. Lancini, P. Pelizza -"Alcool ed incidenti stradali: casistica del settorato medico-legale di Brescia nel decennio 1982-1991"- Arch. Med. Leg. ass., Vol. 14, Fasc. 3-4, 1992
I. Tongue, M. J. J. O'Reilly, A. Davison, N. G. Johnston, I. S. Wilkey -"Traffic crash fatalities (1968-73): Injury patterns and other factors."Med. Sci. Law, 17, 9, 1977.
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