Which drugs are associated with highest risk for being arrested for driving under the influence? A case-control study. Psychoactive substance use and the risk of motor vehicle accidents. Prevalence of drugs in oral fluid from truck drivers in Brazilian highways. Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil. Alcohol and marijuana use while driving--an unexpected crash risk in Pakistani commercial drivers: a cross-sectional survey A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in northern Sweden. Association Between Travel Length and Drug Use Among Brazilian Truck Drivers Prevalence of psychoactive drug use among drivers in Thailand: a roadside survey. Relative Benefits of Stimulant Therapy With OROS Methylphenidate Versus Mixed Amphetamine Salts Extended Release in Improving the Driving Performance of Adolescent Drivers With Attention-Deficit/Hyperactivity Disorder A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway. Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. The effects of dexamphetamine on simulated driving performance Road traffic accidents with vehicular entrapment: incidence of major injuries and need for advanced life support. The Risk of Motor Vehicle Accidents Involving Drivers With Prescriptions for Codeine or Tramadol Post-Traumatic Stress Impacts on Quality of Life in Children After Road Traffic Accidents: Prospective Study Radiation exposure as a consequence of spinal immobilization and extrication. Acute stress disorder symptoms in children and their parents after pediatric traffic injury. Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. Effects of Amphetamine and Barbiturate on Body Experience Injured pedestrians in Cape Town--the role of alcohol. Dissociation and post-traumatic stress disorder: two prospective studies of road traffic accident survivors. Awareness of driving while sleepy and road traffic accidents: prospective study in GAZEL cohort A randomised controlled trial of psychological debriefing for victims of road traffic accidents
The aim of this study was to determine the association between drug type and arrest for driving under the influence of drugs ( DUID ) by calculating odds ratios ( ORs ) using a case-control design . A DUID arrest is in most cases related to aberrant or risky driving and might therefore be regarded as a proxy for a drug related traffic crash . The ' cases ' were 2738 drivers arrested on suspicion of drugged driving from April 2008 to March 2009 with blood alcohol concentrations below the legal limit of 0.2g/L ; 794 were arrested due to involvement in road traffic crashes , whereas 1944 were arrested for other reasons , mainly dangerous driving , suspected impairment when stopped in traffic controls , or because of phone calls to the police from other road users or observers . The ' controls ' were 9375 r and om drivers in normal traffic , also with alcohol concentrations below this limit . Blood sample s from ' cases ' and oral fluid sample s from ' controls ' were analyzed for 15 drugs that have legislative concentration limits in Norway , in addition to two other commonly detected psychoactive drugs . The most prevalent illicit drug in the control group was tetrahydrocannabinol ( THC ; 0.58 % ) , which was also commonly found in sample s from drivers arrested due to road crash ( 15.6 % ) or arrested for other reasons ( 21.8 % ) . Amphetamine/methamphetamine was most prevalent among arrested drivers involved in crashes ( 30.6 % ) and drivers arrested for other reasons ( 56.9 % ) , whereas only 0.18 % of the control group was positive for amphetamine/methamphetamine . The single-use substances which gave highest OR for police arrest were amphetamine/methamphetamine , alprazolam , clonazepam and oxazepam . The majority of the alprazolam and clonazepam findings were probably due to non-therapeutic use of medicinal drugs purchased on the illegal market . Combinations of two or more drugs yielded higher ORs than the use of single substances ; combinations of amphetamine/methamphetamine and benzodiazepines gave the highest risk The driving performance is easily impaired as a consequence of the use of alcohol and /or licit and illicit drugs . However , the role of drugs other than alcohol in motor vehicle accidents has not been well established . The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation . A prospect i ve observational case-control study was conducted in the Tilburg region of The Netherl and s from May 2000 to August 2001 . Cases were car or van drivers involved in road crashes needing hospitalisation . Demographic and trauma related data was collected from hospital and ambulance records . Urine and /or blood sample s were collected on admission . Controls were drivers recruited at r and om while driving on public roads . Sampling was conducted by research ers , in close collaboration with the Tilburg police , covering different days of the week and times of the day . Respondents were interviewed and asked for a urine sample . If no urine sample could be collected , a blood sample was requested . All blood and urine sample s were tested for alcohol and a number of licit and illicit drugs . The main outcome measures were odds ratios ( OR ) for injury crash associated with single or multiple use of several drugs by drivers . The risk for road trauma was increased for single use of benzodiazepines ( adjusted OR 5.1 ( 95 % Cl : 1.8 - 14.0 ) ) and alcohol ( blood alcohol concentrations of 0.50 - 0.79 g/l , adjusted OR 5.5 ( 95 % Cl : 1.3 - 23.2 ) and > or=0.8 g/l , adjusted OR 15.5 ( 95 % Cl : 7.1 - 33.9 ) ) . High relative risks were estimated for drivers using combinations of drugs ( adjusted OR 6.1 ( 95 % Cl : 2.6 - 14.1 ) ) and those using a combination of drugs and alcohol ( OR 112.2 ( 95 % Cl : 14.1 - 892 ) ) . Increased risks , although not statistically significantly , were assessed for drivers using amphetamines , cocaine , or opiates . No increased risk for road trauma was found for drivers exposed to cannabis . The study concludes that drug use , especially alcohol , benzodiazepines and multiple drug use and drug-alcohol combinations , among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation Traffic accidents are responsible for 1.25 million deaths worldwide and are the most common cause of death among those aged 15 - 29 years . In Brazil , traffic accidents caused more than 44,000 deaths in 2014 . The use of psychoactive drugs is an important risk factor for being involved in traffic accidents . Previous studies have found that psychoactive substances are commonly used by truck drivers in Brazil to maintain their extensive work schedule and stay awake while driving during nighttime hours . The state of Sao Paulo is one of the most important states regarding goods transportation . Important highways cross through Sao Paulo to other regions from Brazil and to other countries in Latin America . This study aims to determine the prevalence of illicit drug use by truck drivers in the state of Sao Paulo through toxicological analyses of oral fluid . Truck drivers were r and omly stopped by police officers on federal roads during morning hours . Oral fluid sample s were collected using the Quantisal ™ device . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Oral fluid sample s were screened for amphetamine , cocaine , and tetrahydrocannabinol ( Δ9-THC ) by ELISA and the confirmation was performed using ultra performance liquid chromatography with t and em mass spectrometry detection ( UPLC-MS/MS ) . Of the 764 drivers stopped , 762 agreed to participate . The participants were driving an average of 614 km and 9.4h a day . Of the total sample s , 5.2 % ( n=40 ) tested positive for drugs . Cocaine was the most frequently found drug ( n=21 ) , followed by amphetamine ( n=16 ) and Δ9-THC ( n=8 ) . All drivers were men with an average age of 42.5 years . With these results we were able to verify that many truck drivers were still consuming psychoactive drugs while driving , and cocaine was the most prevalent one . This reinforces the need for preventive measures aim ed at controlling the use of illicit drugs by truck drivers in Brazil Drugs are important risk factors for traffic accidents . In Brazil , truck drivers report using amphetamines to maintain their extensive work schedule and stay awake . These drugs can be obtained without prescription easily on Brazilian roads . The use of these stimulants can result in health problems and can be associated with traffic accidents . There are Brazilian studies that show that drivers use drugs . However , these studies are question naire-based and do not always reflect real-life situations . The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State , Brazil , during 2009 . Drivers of large trucks were r and omly stopped by police officers on the interstate roads during morning hours . After being informed of the goals of the study , the drivers gave written informed consent before providing a urine sample . In addition , a question naire concerning sociodemographic characteristics and health information was administered . Urine sample s were screened for amphetamines , cocaine , and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry ( GC-MS ) . Of the 488 drivers stopped , 456 ( 93.4 % ) provided urine sample s , and 9.3 % of them ( n=42 ) tested positive for drugs . Amphetamines were the most commonly found ( n=26 ) drug , representing 61.9 % of the positive sample s. Ten cases tested positive for cocaine ( 23.8 % ) , and five for cannabinoids ( 11.9 % ) . All drivers were male with a mean age of 40 ± 10.8 years , and 29.3 % of them reported some health problem ( diabetes , high blood pressure and /or stress ) . A high incidence of truck drivers who tested positive for drug use was found , among other reported health problems . Thus , there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aim ed at controlling the use of drugs by truck drivers in Brazil Background A significant proportion of road traffic crashes are attributable to alcohol and marijuana use while driving globally . Sale and use of both substances is illegal in Pakistan and is not considered a threat for road traffic injuries . However literature hints that this may not be the case . We did this study to assess usage of alcohol and marijuana in Pakistani commercial drivers . Methods A sample of 857 commercial bus and truck drivers was interviewed in October 2008 at the largest commercial vehicle station in Rawalpindi and Islamabad , Pakistan .  Time location cluster sampling was used to select the subjects and a structured question naire was used to assess the basic demographic profile , substance abuse habits of the drivers while on the road , and reasons for usage of illicit substances while driving were recorded . Self reported information was collected after obtaining informed consent . Chi square and fisher exact tests were used to assess differences between groups and logistic regression was used to identify significant associations between driver characteristics and alcohol and marijuana use . Results Almost 10 % of truck drivers use alcohol while driving on Pakistani roads . Marijuana use is almost 30 % in some groups . Statistically different patterns of usage are seen between population subgroups based on age , ethnicity , education , and marital status . Regression analysis shows association of alcohol and marijuana use with road rage and error behaviours , and also with an increased risk of being involved in road crashes . The reported reasons for using alcohol or marijuana show a general lack of awareness of the hazardous nature of this practice among the commercial driver population . Conclusion Alcohol and marijuana use is highly prevalent in Pakistani commercial drivers . The issue needs to be recognized by concerned authorities and methods such as r and om breath tests and sobriety check points need to be employed for proper law enforcement OBJECTIVE To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000 - 2009 . DESIGN Descriptive epidemiology determined by prospect ively collected data from a defined population . SETTING The study was conducted at a public hospital in Sweden . PARTICIPANTS The population of the hospital 's catchment area ( 136,600 inhabitants in 1999 and 144,500 in 2009 ) . METHODS At the emergency department , all injured persons ( approximately 11,000 per year ) were asked to answer a question naire about the injury incident . Data from the medical records also were analyzed . From 2000 - 2009 , 15,506 persons were injured in vehicle crashes . Persons who were subject to an acute neck injury within whiplash-associated disorder grade s 1 - 3 were included . The overall and annual incidences were calculated as incidence . Age , gender , type of injury event , and direction of impact were described . The incidences were compared with national statistics on insurance cl aims from 2003 , 2007 , and 2008 to detect changes in the proportions of cl aims . MAIN OUTCOME MEASURES The annual incidence of acute whiplash injuries . Secondary outcome measures were types of injury events , age and gender distribution , changes in the proportion of rear-end crashes during 2000 - 2009 , and changes in the proportion of insurance cl aims during 2003 - 2008 . RESULTS During 2000 - 2009 , 3297 cases of acute whiplash injury were encountered . The overall incidence was 235/100,000/year . The average yearly increase in incidence was 1.0 % . Women comprised 51.9 % and men 48.1 % of the injured . Car occupants ( 86.4 % ) and bicycle riders ( 6.1 % ) were most frequently injured . The proportion of rear-end crashes decreased from 55 % to 45 % from 2000 - 2009 . The proportion of insurance cl aims significantly decreased between 2003 and 2008 ( P < .0001 , χ(2 ) test ) . CONCLUSION The incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area , except in 2007 and 2008 , when a peak occurred Objective : To investigate whether the use of the stimulants amphetamines and cocaine by truck drivers in Brazil was related to travel length . Methods : Truck drivers were r and omly stopped by the Federal Highway Police on interstate roads in Sao Paulo State during morning hours from 2008 to 2011 and invited to participate in the project “ Com and os de Saúde nas Rodovias ” ( Health Comm and s on the Roads ) . Participants were asked about the use of drugs , travel distance , and age , and gender was recorded . Sample s of urine were collected and analyzed for amphetamine , benzoylecgonine ( a metabolite of cocaine ) , and carboxytetrahydrocannabinol ( THC-COOH ; a metabolite of cannabis ) by immunological screening and quantification by gas chromatography – mass spectroscopy . Results : Current use of amphetamine , cocaine , and cannabis was reported by 5.7 % , 0.7 % , and 0.3 % of the truck drivers , respectively . Amphetamine , benzoylecgonine , and THC-COOH were found in urine sample s from 5.4 % , 2.6,% and in 1.0 % of the drivers , respectively . There was a significant association between the positive cases for amphetamine and reported travel length ; 9.9 % of urine sample s from drivers who reported travel length of more than 270 km were positive for amphetamine , and 10.9 % of those drivers reported current use of amphetamines . In most cases , appetite suppressants containing amphetamines had been used , but the purpose was most often to stay awake and alert while driving . Truck drivers with travel length of more than 270 km had significantly higher odds ratio ( OR ) for having a urine sample that was positive for amphetamine when adjusted for age as confounding factor ( OR = 9.41 , 95 % confidence interval [ CI ] , 3.97–22.26 ) . No significant association was found between the use of cocaine or cannabis and travel length . Conclusion : Truck drivers who reported driving more than 270 km had significantly higher frequencies of urine sample s positive for amphetamine and reported significantly more frequent current use of amphetamines than those who reported shorter driving distances The objective of this study was to determine the prevalence of psychoactive drug and alcohol use among general drivers and predictors of the drug use in Thail and . One thous and six hundred and thirty-five motor vehicle drivers were r and omly selected from five geographical regions of Thail and between December 2005 and May 2006 . The prevalence of psychoactive drugs was determined using urine tests by gas chromatography/mass spectrometry ( GC/MS ) . Among 1635 drivers , 5.5 % were tested positive for breath alcohol with 2 % having a level exceeding the legal limit ( > or = 50mg% ) . Psychoactive drug was presented in 158 ( 9.7 % ) urine sample s for drug analysis . The top 3 most frequently detected licit drugs were  antihistamines  ( 2.0 % ) , sedative cough suppressant  ( 0.7 % ) and benzodiazepines ( 0.2 % ) . Illicit drugs detected included amphetamine ( 1.8 % ) , cannabis ( 1.1 % ) ,  mitragynine ( Kratom ) ( 0.9 % ) and morphine ( 0.1 % ) . Only type of driver ( commercial/non-commercial ) was a significant predictor with psychoactive drug use . The prevalence of psychoactive drug use among drivers not involved in road crashes in Thail and was not as low as an earlier study in Europe using objective measurements , particularly among commercial drivers . However , for illicit drugs , the prevalence detected in this study was lower than those of earlier studies from high-income countries OBJECTIVE . Automobile accidents are the leading cause of death among adolescents , and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder . Studies have demonstrated that stimulants improve driving performance . This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations . METHODS . Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylpheni date , 30 mg of mixed amphetamine salts extended release , or placebo in a r and omized , double-blind , placebo-controlled , crossover study design . During laboratory testing , adolescents drove a driving simulator at 5:00 pm , 8:00 pm , and 11:00 pm . Driving performance was rated by adolescents and investigators . RESULTS . The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder ( 19 boys/16 girls ) . The mean age was 17.8 years . The overall Impaired Driving Score demonstrated that OROS methylpheni date led to better driving performance compared with placebo and mixed amphetamine salts extended release , whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo . Specifically , relative to placebo , OROS methylpheni date result ed in less time driving off the road , fewer instances of speeding , less erratic speed control , more time executing left turns , and less inappropriate use of brakes .  OROS methylpheni date and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder . CONCLUSIONS . This study vali date s the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder . In the study , OROS methylpheni date promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release BACKGROUND A large proportion of road traffic crashes are related to driving under the influence ( DUI ) of alcohol or drugs . The aim of this study was to compare the use of alcohol , illegal drugs and psychoactive medicinal drugs among r and om drivers in Brazil and Norway , two countries with the same legal limit for drunk driving , but with marked differences in legislation history , enforcement and penalties for DUI , and to discuss any differences found . METHODS Roadside surveys were conducted on Fridays and Saturdays between noon and midnight . Sample s of oral fluid were collected for analysis of drugs , whereas alcohol was determined by breath testing or by analysis of oral fluid . RESULTS High participation rates of 94 - 97 % were obtained in both countries . The weighted prevalence of driving with alcohol concentrations in breath or oral fluid equivalent to blood alcohol concentrations ( BAC ) above 0.2g/L was 2.7 % ( 95 % CI 2.2 - 3.3 ) in Brazil and 0.2 % ( 95 % CI 0.0 - 0.5 ) in Norway . Stimulants ( amphetamines or cocaine ) were found in sample s from 1.0 % ( 95 % CI 0.7 - 1.4 ) of drivers in Brazil and 0.3 % ( 95 % CI 0.1 - 0.7 ) in Norway . The prevalence of amphetamines was highest among Brazilian truck drivers ( 3.6 % ; 95 % CI 2.0 - 6.4 ) . Tetrahydrocannabinol was found in sample s from 0.5 % ( 95 % CI 0.3 - 0.8 ) of drivers in Brazil and 1.0 % ( 95 % CI 0.6 - 1.5 ) in Norway , whereas benzodiazepines or zopiclone were found in 1.0 % ( 95 % CI 0.7 - 1.4 ) and 1.7 % ( 95 % CI 1.2 - 2.4 ) of the sample s from Brazil and Norway , respectively . CONCLUSIONS The difference in the prevalence of alcohol may be related to the fact that Norway has implemented steps to reduce drunk driving since 1936 , whereas Brazil has attempted to do the same for only a few years . Differences for drugs may be related to different patterns in the use of stimulants , cannabis and medicines This study investigated whether OROS methylpheni date ( OROS MPH , Concerta ) or extended-release mixed amphetamine salts ( se-AMPH ER , Adderall XR ) were associated with worsening of driving performance , or drug rebound , relative to placebo 16 - 17 hours post-ingestion . Nineteen male adolescent drivers aged 17 - 19 with attention-deficit/hyperactivity disorder ( ADHD ) were compared on a virtual reality driving simulator and an on-road drive after taking 72 mg of OROS MPH , 30 mg of se-AMPH ER , or placebo . Medication was taken at 08:00 in a r and omized , double-blind , placebo-controlled , crossover study . Participants drove a simulator at 17:00 , 20:00 , 23:00 , and 01:00 , and drove their own cars over a 16-mile road course at 24:00 . The main outcome measures were composite scores of driving performance . Neither OROS MPH nor se-AMPH ER was associated with significant worsening of simulator performance relative to placebo 17 hours post-ingestion in group comparisons . However , inattentive on-road driving errors were significantly more common on se-AMPH ER relative to placebo at midnight ( p = 0.04 ) , suggesting possible rebound . During both late simulator and on-road testing , driving performance variance was approximately 300 % greater during the se-AMPH ER compared to the OROS MPH condition Rationale The number of road fatalities related to the presence of amphetamines in drivers has been relatively constant over the past 10 years . However , there remains uncertainty as to the extent that these drugs induce driving impairment , and whether any such impairments translate to an increase in road fatalities . Objectives To examine the acute effects of 0.42 mg/kg dexamphetamine on simulated driving performance , and to establish which , if any , simulated driving abilities become impaired following dexamphetamine administration . Methods A repeated- measures , counter-balanced , double-blind , placebo-controlled design was employed . Twenty healthy volunteers completed two treatment conditions—0.42 mg/kg dexamphetamine and placebo . Performance was assessed using a driving simulator task .  Blood and saliva sample s were obtained prior to the driving tasks and immediately after task completion ( 120 min and 170 min post-drug administration , respectively ) . Results Mean dexamphetamine blood concentrations were 83 ng/ml and 98 ng/ml at 120 min and 170 min , respectively . Results indicated a decrease in overall simulated driving ability following dexamphetamine administration during the day-time but not the night-time scenario tasks . Contributing to this performance reduction , “ incorrect signalling ” , “ failing to stop at a red traffic light ” and “ slow reaction times ” were the behaviours most strongly affected by dexamphetamine . Conclusions The decrease in simulated driving ability observed during the day-time driving tasks are consistent with the perceptual narrowing or tunnel vision that is associated with dexamphetamine consumption Road traffic accidents ( RTAs ) with entrapment are perceived as a challenge to emergency systems because of the severity of the ensuing traumas and the inherent complexity of the rescue procedures . To clarify these two aspects this prospect i ve cohort study enrolling 244 entrapped trauma patients was conducted by a Regional Medical Helicopter Service . Forty-six victims ( 18.9 % ) were found dead , 101 ( 51 % ) of the 198 patients who reached the hospital alive had an injury severity score ( ISS ) > or = 16 . The use of seat belts was associated with lower trauma severity . Out of the 101 severely traumatized patients ( ISS > or = 16 ) , 46 ( 42.6 % ) were intubated at road side , 12 required decompression of a tension pneumothorax on the scene and in 15 cases a pneumothorax was drained during the early intrahospital phase . Thirty-six ( 34.7 % ) patients had the first systolic blood pressure ( SBP ) < or = 90 mmHg and were then aggressively infused : in 75 % of these cases , the SBP on arrival at the emergency department increased . The first SBP was significantly correlated with mortality . There was no correlation of extrication time , total rescue time and mortality . Fourteen patients ( 13.9 % ) died during hospitalization . These data demonstrate that a high percentage of entrapped patients require advanced life support ( ALS ) , including on scene intubation and chest decompression .  Aggressive field resuscitation and immediate transport to a level 1 trauma centre is associated with a mortality lower than that predicted by TRISS in spite of the prolonged prehospital time Previous studies have only partially characterized the road‐accident risks linked to driving while taking opioid analgesics used for moderate pain . 1 , 2 , 3 , 4 A prospect i ve cohort design with data from national population –based registries — the Norwegian Prescription Data base and the Norwegian Road Accident Registry— and observation of > 8 million person‐years were used in order to examine whether a driver who has filled a prescription for codeine or tramadol  is at increased risk of being involved in a road accident result ing in injury to persons Objective : There is little knowledge on health-related quality of life ( HRQOL ) of injured children and adolescents after road traffic accidents ( RTA ) . Although findings in injured adults suggest that post-traumatic stress symptoms ( PTSS ) may be important predictors of HRQOL , this issue has never been prospect ively examined in children . The aim of the present study was therefore to prospect ively assess HRQOL in children after RTA and specifically examine the impact of PTSS on HRQOL . Method : Sixty-eight children ( aged 6.5–14.5 years ) were interviewed 1 month and 1 year after an RTA using the Child PTSD Reaction Index and the Toegepast Natuurwetenschappelijk Onderzoek-Academisch Ziekenhuis Leiden ( TNO-AZL ) Question naire for Children 's Health-Related Quality of Life . Parents and physicians were assessed with question naires . Results : Eleven children ( 16.2 % ) showed moderate to severe post-traumatic stress reactions at 1 month , and 12 children ( 17.6 % ) at 1 year . At 1 month , patients reported reduced motor functioning and autonomy and impairments in some parts of emotional functioning compared to a community sample . At 1 year all dimensions of HRQOL were within or above normal ranges . Multivariate analysis indicated that PTSS at 1 month significantly predicted HRQOL at 1 year . Conclusions : This prospect i ve study provides evidence for a long-term negative influence of early PTSS on HRQOL in injured children . The return of injured children to pre-injury HRQOL may therefore not only depend on optimal medical care but also on awareness and timely interventions regarding PTSS BACKGROUND Extrication and spinal immobilization in the trauma patient with unknown injuries is a common practice of emergency medical services . High-speed crashes occurring in open-wheel racing seldom result in extrication or spinal immobilization . OBJECTIVES To evaluate the safety of self-extrication in IndyCar ® ( Indianapolis , IN ) by comparing drivers self extricated with full spinal immobilization and subsequent radiation exposure . METHODS A retrospective review of prospect ively collected de-identified IndyCar ® crash and drivers ' medical records was performed at treating Level I trauma centers . One hundred thirty-five crash incidents involving drivers evaluated by a medical team were included . Any driver with severe multiple trauma was excluded due to distracting injuries . Drivers underwent st and ard protocol for postcrash injury . Diagnostic and treatment outcomes including spinal and neurologic injury , need for surgery , and radiation exposure were collected for review . RESULTS  Self-extrication  occurred in 121 ( 90 % ) crashes , and overall cumulative radiation exposure ranged from 100 to 250 mSv , or 0.82 - 2.06 mSv per driver .  Extrication with full spinal immobilization occurred in 14 ( 10 % ) drivers , with overall cumulative radiation exposure ranging from 140 to 350 mSv , or 10 - 25 mSv per driver . A total of 29 injuries were identified , nine of which ( 31 % ) were spinal . In these , six were emergency medical services extricated and three self extricated . None were unstable spinal fractures result ing in surgical care , surgical disease , or neurologic deficit . CONCLUSION In our IndyCar ® racing experience , a protocol -led self-extrication system result ed in neither a mismanagement of an unstable spinal fracture nor neurological deficit , and reduced radiation exposure OBJECTIVE The American Academy of Pediatrics highlights the important role of pediatricians in recognizing adverse child responses to tragic events , such as traffic crashes . One challenge in effectively identifying children and their parents with troubling psychological responses to trauma is that little is known about the normal range of acute psychological responses in children and their parents in the immediate aftermath of traumatic events , making identification of adverse child responses difficult . Within the first month after a traumatic event , individuals may display reexperiencing , avoidance , and hyperarousal symptoms as well as dissociation ( eg , feelings of unreality or emotional numbing ) . The presence of these responses , collectively known as acute stress disorder ( ASD ) , alerts providers to those who may be at risk for ongoing difficulties . For beginning to develop an evidence base to guide pediatric care providers in addressing acute traumatic responses , the aim of the current investigation was to describe systematic ally the range and type of symptoms of ASD in children and their parents after pediatric traffic injury . METHODS A prospect i ve cohort study was conducted of traffic-injured children , who were 5 to 17 years of age and admitted to the hospital for treatment of injuries from traffic crashes , and their parents . All children who met eligibility criteria between July 1999 and May 2000 were invited to participate in the study . After consent/assent was obtained , children and their custodial parents ( or guardians ) were interviewed within 1 month after injury via a structured assessment to determine the circumstances of the crash and the presence of ASD symptoms . Relevant demographic and clinical information ( eg , age , race , gender , date of injury ) was abstract ed from the medical records of subjects . A survey instrument to assess the presence of ASD symptoms was completed by both the child and his or her guardian . All children completed the  Child Acute Stress Question naire , and all parents completed the  Stanford Acute Stress Reaction Question naire . Responses were scored for the presence of dissociation , reexperiencing , avoidance , and /or hyperarousal symptoms as well as broad distress ( symptoms present in every category ) . RESULTS Symptoms of ASD were commonly observed in the children and parents . Eighty-eight percent of children and 83 % of parents reported having at least 1 clinical ly significant symptom ; this affected 90 % of the families . Broad distress was observed for a large minority : 28 % of children and 23 % of parents . No statistically significant association was found between child broad distress and either child age ( r = -0.12 ) or child injury severity score ( r = -0.05 ) . chi(2 ) analyses revealed no significant association between broad distress and child gender , child race , or mechanism of injury . No statistically significant association was found between parent broad distress and child age ( r = -0.06 ) or child injury severity score ( r = 0.09 ) . chi(2 ) analyses revealed no significant association between parent broad distress and child gender or parent presence at the crash scene . Associations were found between parent broad distress and race in that fewer white parents reported broad distress . In addition , mechanism of injury was associated with parent broad distress : more parents reported broad distress when their children were involved in pedestrian-motor vehicle crashes , and fewer parents reported broad distress when their children were injured in a bicycle fall . CONCLUSIONS Pediatric care providers can expect to see some ASD symptoms in most children and parents in the immediate aftermath of traffic-related injury . Brief education is appropriate to explain that these symptoms are normal reactions that are likely to resolve . If symptoms persist for > 1 month or are particularly distressing in their intensity , then referral for psychological care may be necessary for treatment of posttraumatic stress disorder . Given the high prevalence of pediatric traffic crashes and the underdiagnosis of posttraumatic stress disorder , probing for recent crash exposure might be appropriate during routine child health maintenance . The following are recommendations for pediatricians : 1 ) routinely call the family several days and 1 to 2 weeks after a traffic injury and ask about behavioral symptoms and family function ; 2 ) make use of the ongoing physician-patient relationship to explore symptom presence and intensity and any functional impairment in the injured child ; a brief office visit with the child and parents could serve this purpose ; 3 ) be sure to explore the effect that the child 's injury has had on the family ; remember that the parent 's experience posttraumatic stress symptoms after pediatric traffic-related injuries and these symptoms may limit the parent 's ability to support the child ; 4 ) provide supportive care and give families the opportunity to discuss the crash and their current feelings ; do not force families to talk about the crash ; 5 ) although any child in a traffic crash or his or her parent is at risk for posttraumatic symptomatology , regardless of injury severity , particular attention should be paid to the parents of child pedestrians who are struck by motor vehicles . These parents experience posttraumatic symptoms more commonly than parents of children in other traffic crashes BACKGROUND Psychological debriefing is widely used for trauma victims but there is uncertainty about its efficacy . We have previously reported a r and omised controlled trial which concluded that at 4 months it was ineffective . AIMS To evaluate the 3-year outcome in a r and omised controlled trial of debriefing for consecutive subjects admitted to hospital following a road traffic accident . METHOD Patients were assessed in hospital by the Impact of Event Scale ( IES ) , Brief Symptom Inventory ( BSI ) and question naire and re-assessed at 3 months and 3 years . The intervention was psychological debriefing as recommended and described in the literature . RESULTS The intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms ( BSI ) , travel anxiety when being a passenger , pain , physical problems , overall level of functioning , and financial problems . Patients who initially had high intrusion and avoidance symptoms ( IES ) remained symptomatic if they had received the intervention , but recovered if they did not receive the intervention . CONCLUSIONS Psychological debriefing is ineffective and has adverse long-term effects . It is not an appropriate treatment for trauma victims & NA ; Two dosage levels of both d‐Amphetamine and Pentobarbital and a placebo were given to 75 normal females in a r and omized , test‐retest , double blind study of body experience and mood . All the substances ingested led to an increase in the definiteness of the body boundary . The increase following both placebo and d‐Amphetamine significantly exceeded that previously obtained under analogous nonspecific stress . It was proposed that the body boundary enhancing effect derived from the increase in body awareness that the ingestion of a “ drug ” produced . The only consistent alteration of body experience was depersonalization . All the substances ingested led to a significant increase in feelings of Depersonalization . With Pentobarbital this increase significantly exceeded the placebo group , the d‐Amphetamine group , and those previously obtained in a variety of stress situations . Evidence exists that depersonalization is used by normal people as a common mode of coping with altered life experience . Pentobarbital ingestion apparently produces such an alteration . The Pentobarbital groups reported a significantly greater increase in fatigue and decrease in concentration than the d‐Amphetamine groups . Considering all drug groups combined , depersonalization correlated significantly with increased fatigue and a decrease in concentration . While the predominant type of body experience distortion‐‐depersonalization‐‐was increased with these agents , the total distortion following these substances was significantly less than observed in a variety of stress situations . It has been proposed that habitual body l and marks might be predictors of body experience . The major finding was that the greater the potency of the drug the more likely the pattern of body experience was to alter from the habitual baseline body l and mark . Questions were raised for future research as to whether body image variables play a role in the overuse of drugs OBJECTIVE To establish a profile of injured adult pedestrians and attempt to define the role which alcohol plays in this regard . DESIGN Prospect i ve survey of injured pedestrians who presented consecutively over 9 weeks to Groote Schuur Hospital . Data on fatally injured pedestrians were retrospectively collected from the State Mortuary . SETTING Hospital-based study conducted at the trauma unit , Groote Schuur Hospital . PARTICIPANTS A total of 321 pedestrians--196 injured and 35 ' dead on arrival ' . MAIN OUTCOME MEASURES Sociodemographics ,  blood alcohol concentration ( BAC ) and injury severity . RESULTS Patients were predominantly male and , on average , 35.6 years old . They were most frequently injured at night and over weekends . The BAC was positive in 62.1 % of pedestrians , and the mean BAC was 0.19 g/dl . Most pedestrians had at least one lower limb injury and nearly half had a head injury ; however , BAC-positive pedestrians were 2.6 times more likely to have a head injury ( P = 0.0009 ) . Furthermore , BAC-positive pedestrians sustained more severe injuries , more frequently required admission to the ICU , had longer hospital admission and were more likely to die of their injuries . The overall case fatality rate was 19.5 % . CONCLUSIONS The influence of alcohol intoxication among injured adult pedestrians in Cape Town is high , suggesting that alcohol plays a major role in these accidents . Consequently , there should be some degree of culpability in those who cross the road while in an intoxicated state . However , equal attention should be given to safe and convenient crossing points , good lighting and education with regard to the wearing of reflective clothing after dark BACKGROUND Dissociative symptoms during trauma predict post-traumatic stress disorder ( PTSD ) , but they are often transient . It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms . AIMS To investigate prospect ively the relationship between dissociative symptoms before , during and after a trauma and other psychological predictors , and chronic PTSD . METHOD Two sample s of 27 and 176 road traffic accident survivors were recruited . Patients were assessed shortly after the accident and followed at intervals over the next 6 months . Assessment s included  measures of dissociation , memory fragmentation , data -driven processing , rumination and PTSD symptoms .  RESULTS All measures of dissociation , particularly persistent dissociation 4 weeks after the accident , predicted chronic PTSD severity at 6 months . Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters . Memory fragmentation and data -driven processing also predicted PTSD . Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms . CONCLUSIONS Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop  chronic PTSD  than initial reactions Abstract Objectives To examine the association between self assessed driving while sleepy and the risk of serious road traffic accidents ( RTAs ) .  Design Prospect i ve cohort study . Setting France . Participants 13 299 of the 19 894 living members of the GAZEL cohort , workers and recent retirees of a French national utility company followed up since 1989 . Main outcome measures  Frequency of driving while sleepy in the previous 12 months , reported in 2001 ; rate ratios for serious RTAs in 2001 - 3 , estimated by using generalised linear Poisson regression models with time dependent covariates . Results The risk of serious RTAs increased proportionally with the frequency of self reported driving while sleepy . After adjustment for sociodemographic characteristics , driving behaviour variables , work conditions , retirement , medical conditions and treatments , depressive symptoms , and sleep disorders , the adjusted rate ratios of serious RTAs for participants who reported driving while sleepy in the previous 12 months “ a few times ” or “ once a month or more often ” were 1.5 ( 95 % confidence interval 1.2 to 2.0 ) and 2.9 ( 1.3 to 6.3 ) respectively compared with those who reported not driving while sleepy over the same period . These associations were not explained by any reported sleep disorders . Conclusions Self assessed driving while sleepy was a powerful predictor of serious RTAs , suggesting that drivers ' awareness of their sleepiness while driving is not sufficient to prevent them from having RTAs . Messages on prevention should therefore focus on convincing sleepy drivers to stop driving and sleep before resuming their journey Psychiatric problems are common after major or minor road accidents . 1 2 3 4 Mayou et al found that one fifth of victims developed an acute stress reaction and one quarter displayed psychiatric problems within the first year.1 Long term psychiatric problems were mainly mood disorder ( 10 % ) , phobic travel anxiety ( 20 % ) , and post-traumatic stress disorder ( 11 % ) . Interest has been stimulated in preventive interventions , especially routine psychological “ debriefing . ” Although widely used after trauma , no r and omised controlled trials of debriefing have been reported , and debriefing may sometimes increase distress.5 This r and omised controlled study aim ed to test whether a single debriefing could reduce post-traumatic psychopathology in road accident victims . The subjects were victims of road accidents admitted consecutively to the John Radcliffe Hospital . We excluded those who could not
Best- evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury , and a moderate level of evidence between amphetamine use and the risk of death due to road trauma .
This is the first review to synthesis e evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident .
More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance .
Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma .
However , the role of this substance in crash causation remains equivocal .
We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents .