Taking on the Number One Killer of Teens

The girl’s face was strangely beautiful, covered with a shimmering powder that glistened like diamond dust beneath the lights of I-59. The pulverized glass might have been makeup for a prom, but this girl would never go shopping for a prom dress. She would never dance again. Her friend in the driver’s seat beside her had died, too, not quite instantly enough after impact with the guard rail that had driven through the center of the car.

Leaning between the two, a Birmingham firefighter worked to free their friend in the back seat. She was unhurt, but trapped and terrified. To calm her, he talked with her as he worked. Her story was all too familiar; three teenage girls having a fun night out, and three teenage boys in another car who were either chasing or racing them. The firefighter recognized the shock in her voice as she struggled with the idea of mortality, and the fact that physics doesn’t care how old you are, or that you have dreams or should have years of life ahead.*

 “Young people don’t realize that traffic accidents are the leading cause of death among teens in the United States. Alabama is number two in the nation in teen traffic fatalities,” Kathy Monroe, MD, Medical Director of Children’s Hospital of Alabama’s Emergency Department, said.

While a child dying of an incurable disease is sad, a child dying in a traffic accident often meets the criteria of a Greek tragedy. Too many of these deaths are preventable if someone takes action soon enough to address the issues that cause them.

Just as the campaign for using car seats is saving the lives of small children, and the campaign for using bike helmets is making progress in reducing head injuries, a concerted effort led by the Alabama Safe Teen Driving Coalition is working to stop preventable deaths and injuries by changing the behaviors that are most often linked to traffic accidents involving teens.

Healthcare providers are in a position of unique credibility in getting that message across.

 “We have study data that shows teens whose doctors have talked with them about safe driving are less likely to engage in risky behaviors linked to accidents,” Monroe said.

Among these behaviors are distracted driving from handheld devices or having too many friends in the car, not wearing a seatbelt, speeding, reckless driving, and driving under the influence of alcohol or drugs. Another problem is lack of skill in driving at night, in rain, in interstate traffic and other conditions before they have had enough supervised practice.

 “On our website, ChildrensofAlabama.org, we have a Teen Driver’s Toolkit that physicians can print out to give young patients and their families the resources they need to help them become better drivers. Click ‘For Health Professionals,’ then ‘Health Professionals Information.’ You’ll see the toolkit in the list on the left. It also provides links to more online resources and explains Alabama’s graduated driver’s license law.”

The graduated driver’s license law in Alabama applies to 16-year-olds, and to 17-year-olds with less than six months of driving experience. Limits include no more than one non-family passenger, no nonessential handheld devices and no driving between midnight and six a.m. except under specific exceptions such as medical emergencies or driving to or from work.

 “The toolkit also includes a log for the recommended 50 hours of supervised driving practice under a variety of road conditions to help young drivers build their skills,” Monroe said.

Why are healthcare providers particularly well equipped to speak persuasively with young drivers? In addition to being able to speak from direct experience—almost everyone who has done an emergency department rotation has seen what two tons of moving metal can do to a body—health professionals can help teens understand the whys behind the rules.

Repeated “no’s” or “because I said so” are easy to ignore when no one is watching. However, teen who understand the reasons behind the rules, are more likely to remember and practice safe driving habits.

 “Although fast reflexes make teens good gamers, the part of their brain that governs impulses and prioritizing doesn’t develop until they are around 24 years old. That’s why there are rules to rely on until the rest of their brain catches up with their reflexes,” Monroe said.

Teens who are good with computers may look at a car as just another machine and underestimate the skill needed to drive well. It takes time for muscles and nerves to learn to act in situations where there is little time to think. Inexperienced drivers are less likely to leave adequate space between cars, or to recognize hazards, and they tend to underestimate the distance required to stop at higher speeds. Like learning to tie shoes, becoming a good football player, dancer or musician, driving skills improve with practice. The graduated drivers license and supervised practice sessions are opportunities to build those skills.

Another topic to talk about with teens is why seatbelts make sense. Compared with other age groups, teens have the lowest rate of seat belt use. Only 55 percent reported always using seat belts when riding with someone else. The reasons they gave for not using seatbelts included a fear of being trapped, and the belief that they could hold on in a crash.

Simple math shows otherwise. If a car travelling at 30 miles an hour hits a stationary object, a 100-pound girl without a seat belt would be thrown forward with 3,000 pounds of force. Her 150-pound boyfriend would hurtle forward with 4,500 pounds of force. Even the greatest weight lifter ever known couldn’t grab and hold on to that kind of weight. When the body makes contact with an object, the sudden deceleration is even worse. If the person’s face hits the dash, the windshield or the steering wheel, all that energy goes into less than an inch of depth. After such a strong impact, the odds of being conscious and able to open a car door would be near zero.

Unfortunately, even if the girl and her boyfriend use their seatbelts every time, an unbelted passenger behind them could be thrown forward into their head and kill them. Everyone in the car needs to use seatbelts—even the family dog, so Fido doesn’t become a lethal unguided missile.

Riding with a friend who has been drinking is another point that needs to be discussed. In a national survey, 22 percent of teens reported that in the past month they had ridden with a driver who had been drinking. Wanting to be cool and appear grown up are big pressures—but in a recent year, almost one in four teen drivers involved in a deadly accident had been drinking.

Putting a friend’s life at risk by driving under the influence of alcohol or drugs isn’t cool. It’s a sign of immaturity. Good drivers take the responsibility for the safety of their passengers seriously. Staying alive and safe is more important than indulging a friend’s bad habits. Teens should always have a plan B for how to get home.

Per mile driven, teen drivers age 16 to 19 are nearly three times more likely to be in a fatal crash than drivers over 20. With safer teen driving habits, many of the deaths and injuries that occur in traffic accidents could be preventable. We would be overjoyed with a cure rate that high for so many deadly diseases.

It doesn’t take millions of research dollars, or new drugs or medical equipment to save those lives. It takes a few minutes to share some words of wisdom that could work wonders.

*The opening paragraphs are based on actual events as told to the writer by firefighters on the scene.         


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Alabama Safe Teen Driving Coalition, Children’s Hospital of Alabama, ChildrensofAlabama.org, Kathy Monroe MD, Teen Driver’s Toolkit


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