If Preventable Why Not Prevented?

It takes multiple deaths in a rail crash, an aircraft disaster, a motorway pileup or grossly abnormal weather conditions for death or injury due to accident to be news, yet every day in Great Britain there are 40 deaths ascribed to accidents. Why does society accept with so little protest 14 500 deaths a year, over 2% of all deaths, and a waste of 215 000 years of working life each year (more than from ischaemic heart disease)? One third ofthe deaths are attributed to accidents in the home, mainly among old people and children. A third of the deaths arise from road traffic accidents, mainly in the 15-24 age group where 38% of all male deaths are due to this cause compared with 1% of deaths at all ages. Why does the suffering and social cost of the many nonfatal accidents and the disabilities arising from them have so little impact? Why does the medical profession not protest at the use or misuse of NHS resources from 545 000 inpatient discharges a year, including deaths in hospital, following injury with an average daily bed occupancy of 13 500? The 850 000 bed nights occupied each year by road casualties alone would certainly help with waiting lists and the resources used for the treatment of temporary and permanent disabilities could be better utilized. Much has been done to reduce the toll of accidental death in the last 20 years. The crude death rate from accidents per million population fell from 400 to 300 from 1965 to 1985. Deaths from motor vehicle accidents fell from 155 to 102 in the same period though the figure was 97 per million in 1950. At the same time there has been an increase ofa quarter in the number of inpatient discharges following accident. This latter increase must be partly due to improvements in treatment so that more seriously injured people are surviving, but it also suggests that more injured people are being admitted because techniques offer an improved end result from treatment. The public apathy about the public health problem ofdeath and injury due to accidents is in remarkable contrast to the concern about AIDS or drug addiction. Public apathy can be dispelled by the medical profession taking the lead in urging adequate health education or legislation, where necessary, as has been shown in the campaign to reduce smoking and in the legislation for the compulsory wearing of seatbelts. The Medical Commission on Accident Prevention was set up nearly 25 years ago by Royal Colleges following the initiative of His Royal Highness The Duke ofEdinburgh with the wholehearted support of the Royal College of Surgeons. Its purpose is to serve as a medical advisory body and to foster research into the medical, physiological and psychological aspects of accident prevention. It has the continued support, t 1 ATPE 1988 C