ALCOHOL AND ACCIDENTS

by Alcohol Concern Information and Communications Team

This Fact Sheet looks at the problem of alcohol and accidents drawing together the main statistics in this area.

Alcohol is estimated to be a factor in 20-30% of all accidents.(1) In a review of English-language literature over the past 45 years, Hingson and Howland established that:

• 13-37% of non-fatal falls
• 21-47% of drownings
• 9-86% of burn deaths

are alcohol-related. (2)

Also alcohol-related are:

• 25% of accidents at work (3)
• 14% of all road accident deaths (4)
• 30% accidents involving pedestrians. (5)

Honkanen points out that the alcohol consumption patterns of a population are reflected in injury patterns. Injuries among the population groups who consume most (e.g. non-professional men of working age) are most likely to be alcohol-related; so are injuries at certain times (nights, weekends) and in certain places (restaurants and streets). (1).

How alcohol contributes to accidents

Alcohol is known to impair judgement, inclining people to take risks; it also contributes to accidents in a range of other ways:

• Drownings Most drownings occur in unsupervised bodies of water; intoxicated persons may also be more inclined to swim alone at night or boat without flotation devices. Alcohol may induce swimmers to stay in cold water too long, by creating a false sense of warmth. This may lead to hyperventilation and/or increased venous pressure and pulse rate which, in turn, can lead to cardiovascular collapse. Alcohol may also increase the risk of caloric labyrinthitis, a condition which may cause a person suddenly thrown into the water to swim down, rather than up.
• Falls Studies have shown that, at 100mg alcohol/100ml blood (5-6 units for a man, 3-4 for a woman), a significant amount of swaying occurs when standing upright. 6 At this level of intoxication, people also experience divided attention performance, visual acuity and adaptation to brightness and glare, all of which contribute to falls. Slower reflexes and diminished co-ordination can also mean heavier falls and less ability to respond in time to avert a head injury (a high proportion of HASS and LASS involve head injuries).
• Burns Alcohol can cause drowsiness, which may prompt some people to fall asleep while smoking; it can also lessen the likelihood of noticing smoke or hearing fire alarms. Intoxication can heighten disorientation and impede escape.
• Drink-driving accidents The present drink-driving limit is 80mg alcohol/100ml blood. However, impairment to driving ability occurs long before this limit is reached.

At 20-50 mg alcohol/100ml blood ( 1½-3 units for men, ½ -2 units for women), the ability to see or to locate moving lights correctly is already diminished, as is the ability to judge distances. The tendency to take risks is increased.

At 50-80 mg alcohol/100 ml blood (3-5 units for men, 2-3 for women) ability to judge distances is positively impaired; so is the adaptability of the eyes to changing light conditions; sensitivity to red lights is also impaired. Reactions are slower and concentration span is shorter.

By the time the legal limit (80mg alcohol/100ml blood) is reached, drinkers are 5 times more likely to have a driving accident than before starting drinking.

At 80-120 mg alcohol/100 ml blood (5-8 units for men, 3-5 for women) euphoria sets in and, with it, an overestimation of one's abilities which leads to reckless driving. The driver will begin to suffer from impairment of peripheral vision (resulting in accidents due to hitting vehicles when passing), impairment of perception of obstacles and of ability to assess dimension.

At 120 mg alcohol/100 ml blood, the driver is 10 times as likely to have an accident as if there were no alcohol in his/her blood.(7)

Alcohol and reduced injury survival

Alcohol can act at a cellular level to prevent post-injury homeostasis, and can reduce the likelihood of survival from falls, near-drownings and burns. (1) It can interfere with the normal, vasoconstriction response to shock and with the cough reflex, increasing the likelihood of suffocation from respiratory obstruction. Alcohol may also provoke arrhythmias. Finally, alcohol can impede diagnosis and treatment: it may make it difficult for a doctor to assess the extent of brain injury, and may dull pain and so delay a person in seeking medical treatment (e.g. for abdominal injuries).

Health of the Nation

The Health of the Nation highlights alcohol as a significant factor in accidents: in particular, in fatal accidents amongst young men, in accidents involving pedestrians, and occurring to children, as charges of intoxicated adults. The Key Area Handbook (4) on accidents encourages health authorities to include accident prevention in the review process for provider agencies and to require providers to contribute to strategies, and action, to reduce accidents. The importance of improved data gathering is also stressed, particularly in relation to A & E departments. Contracts with mental health units might ensure adequate liaison with A & E departments and hospital wards about any patients who have possible alcohol or drug problems.

Young adults, aged between 15 and 24, are identified as being especially at risk. The Key Area Handbook on accidents recommends that a local strategy for young people includes ensuring full awareness of the effects of alcohol and drugs, their relation to risk changing and the scope for behavioural change. Police and probation officers are also urged to develop specialised rehabilitation for drink-drive offenders of young adults. Strategies for reducing alcohol-related (or other) accidents in the workplace are not discussed.

Alcohol-related home and leisure accidents

Table 1 shows the national estimates for non-fatal accidents in home and leisure contexts in 1991. The estimates are gathered through the Home Accident Surveillance System (HASS) and the Leisure Accident Surveillance System (LASS), both set up by the Consumer Safety Unit (CSU) at the Dept of Trade and Industry. (8)

Data collection

The 1991 HASS data was gathered from 18 hospitals in the UK between November 1990 and October 1991. The sample is selected from those hospitals with a 24-hour A & E Dept service recording at least 10,000 cases per year. 13 of these 18 hospitals also collected LASS data during the same period.

Reception staff identify admissions whose injuries have been sustained in and around the home, or in a leisure context, and, for each case, an accident clerk completes an accident form. Details of the accident are gained by interviewing the patient or the person accompanying them. Questionnaires do not include specific reference to alcohol, so accidents are recorded as alcohol-related through details volunteered by the interviewee. This is likely to mean that present national estimates fall short of the true incidence of alcohol-related accidents. The CSU are reluctant to add questions relating to alcohol, on the basis that many people would answer untruthfully or refuse to answer at all.

Table 1: Alcohol-related home (HASS) and leisure (LASS) accidents, non-fatal, national estimates/ Alcohol-related home accident deaths from HADD, national figures: 1987-1991

Table 2: Home (HASS) and leisure (LASS) non-fatal accidents 1987-1991: total figures and incidence of alcohol-related accidents

Home and leisure accidents (non-fatal)

The figures show a dramatic increase in the number of alcohol-related accidents recorded through HASS and LASS between 1987 and 1991, with alcohol-related home accidents increasing nearly threefold in that time, from 6000 to 15,000, and leisure accidents increasing nearly fourfold, from 10,000 to 36,000. The CSU is not aware of any change in data collection methods during this time which might explain this increase.

The most common alcohol-related HASS accident in 1991 was falling on the stairs (28%). The most common bodily injury was to the head (30%). 65% of HASS accidents involved men, 35% women.

The most common LASS accident in 1991 was a fall classified as "other" (i.e. not from stairs, a ladder, a building, between two levels or on the same level), accounting for 33% of all LASS accidents, closely followed by a fall on the same level (31%). The majority occurred in unspecified locations (50%), followed by on the road or at a bus station (36%). The most common injury was cuts/lacerations (43%), followed by injury to the head (33%). 81% of LASS accidents involved men, 19% involved women.

Home deaths

Table 1 also shows figures from the CSU's Home Accident Deaths Database (HADD), a national database comprising data from the Office of Population Censuses and Surveys, the Home Office and the Area Electricity Boards. The most recent data for HADD relates to 1990. HADD figures may be added to those from HASS for the total number of alcohol-related home accidents in a year.

As with LASS and HASS, HADD figures show a marked increase, although not as steep, between 1987 and 1990. There are also signs of a slight increase in alcohol-related home accident deaths as a proportion of all home accident fatalities. 58% of all alcohol-related home accident deaths were male, 42% female. 92% involved poisoning or inhalation.

1. Honkanen, R (1993) Alcohol in home and leisure injuries Addiction, vol 88, pp939 944
2. Hingson, R and Howland, J (1993) Alcohol and non-traffic unintended injuries Addiction vol.88, pp877-883
3. International Labour Office (1987) Responses to drugs and alcohol in the workplace. Geneva: ILO
4. Department of Health (1993) Health of the Nation key area handbook: accidents. London: HMSO
5. Directorate of Statistics (1993): Drinking and driving in injury road accidents Great Britain 1991: the facts (Accident factsheet series 2, no 4) London: Department of Transport
6. Perrine, MW (1973) Alcohol influences on drinking-related behaviour: a critical review of laboratory studies of neurophysiological, neuromuscular and sensory activity Journal of Safety Research, vol 5, pp165-184
7. Denney, RC (1986) Alcohol and accidents London: Sigma Press
8. Consumer Safety Unit (1993) Home and Leisure Accident Research: 1991 data (and preceding years) London: Department of Trade and Industry