By Henry S. Fraser From Caribbean360

BRIDGETOWN, Barbados, Sunday October 19, 2014 – Barbados is a small country of just over 280,000 population, plus a variable number of visitors and temporary residents, some from North America and Europe, who will be driving on what they consider the wrong side of the road … and narrow, winding roads at that.

Add to this equation the many testosterone-and-social-drug-driven youths. Add to that the limited sign posting, and the almost totally faded arrows on the roads indicating straight or left at roundabouts. And THEN, add the casual intake of alcohol, with no legislation about alcohol and driving, as there is in virtually every other country that considers itself civilised and developed. And the result is a fatality rate of about 30 unnecessary deaths and nearly 10,000 road traffic accidents each year. The fatality rate is 240% that of Britain, and the road traffic accident rate is one each year for every thirty people!

The Faculty of Medicine, UWI has long called for action. It’s almost 30 years since I organised a Continuing Medical Education symposium with a focus on emergencies, and therefore with presentations on road traffic accidents and the issues of alcohol limits and legislation, and seat belt wearing. I well remember the excellent paper by Professor Harley Moseley and some medical students on the limited seat belt wearing, in spite of wide publicity of the lives and injuries saved. I recall that a senior member of our dedicated police force was present and spoke. An eloquent call was made for breathalysers, alcohol blood level testing and appropriate legislation, with consensus that this was a matter of urgency. Three decades later it seems that more serious consideration is being given by authorities to this “urgent” matter. Excuses have been postulated that prosecution and disqualifying from driving for alcohol excess would be as politically unpopular as taking away the licenses of repeatedly law-breaking mini bus drivers, who appear to be above the law. Common sense suggests that government cannot procrastinate any longer on this urgent issue.

The fact is that alcohol excess affects judgement, delays responses and affects psychomotor coordination at blood levels below those which produce obvious inebriation. There is therefore world-wide acknowledgement that “driving under the influence” (DUI) is dangerous and must therefore be dealt with by legislation. Driving under the influence of drugs, both sedative prescribed drugs and social drugs including marijuana, can be equally dangerous, but more complex to assess and judge.

Most countries have now accepted a legally recognised Blood Alcohol Content or Concentration (BAC) above which prosecution and conviction for DUI will follow, with penalties. In most countries this level is 0.08 BAC or 80 mg of alcohol per 100 millilitres (mls) of blood, e.g. in the UK and the USA; while in some countries it is 0.05 or 50 mg per 100 mls. This is because although research in the ‘70s suggested that psychomotor impairment and delayed reflexes did not occur in most people until blood levels exceeded 80 mg per 100 ml, it has since been shown that divided attention, tracking and reaction time can all become impaired at levels of 50 mg per 100 ml or even lower, and varies considerably with individuals. We are often told of some people who only have to sip an alcoholic drink to feel discombobulated, to put it non-pejoratively!

And this leads to the common questions: What is drinking responsibly? And what is a safe amount to drink?

The answers depend very much on the individual’s gender, size or body weight, and the rate at which the alcoholic drink is consumed. The first point is well established, although not entirely understood, that women have a lower tolerance than men, and possibly a lower metabolic rate for alcohol. The second point, that size or body weight matters, seems obvious: someone weighing 240 pounds will have a far larger body to distribute the alcohol than someone weighing 120 pounds. The third point is not recognised by most people, but is important. The body metabolises alcohol at around 10 grams per hour… for habitual drinkers it may be higher. This means that 40 grams of alcohol consumed over four hours will not raise the blood alcohol level to dangerous levels, but if consumed in three quick drinks in half or one hour, it would almost certainly produce a dangerous BAC above the legal limit.

In Britain pubs closing at 11 o’clock would call for a “last round” at a quarter to 11 and that last quick point would “do the damage”. In Barbados there used to be a social tradition that “you can’t travel on one leg” and “One for the road” would be pressed on the pliable guest …. providing that one for an accident on the road.

It’s a “no brainer” that Barbados needs legislation to empower police officers to carry out breathalyser testing on the spot. and for medical personnel to take blood samples on first encounter with those under suspicion in the emergency department. We’re decades behind other developed countries, and we must not hide our heads in the sand any longer in relation to alcohol and driving (or to law breaking PSV operators!)

Postscript: Sadly, we’re often way behind developed countries in many ways AND we don’t learn from the mistakes of our Caribbean cousins. We’ve watched the tribalisation of politics in Jamaica – my second home – and we’re not far behind at times. We watched them borrow excessively with huge debts and a vicious downward spiral, and we too borrowed excessively. We watched their drug culture develop and ditto. We’ve watched their chikungunya epidemic devastate the country two months ago, and waited until last week to launch significant public campaigns to eradicate mosquitoes. (We heard there were forty cases when many of us knew a dozen victims already.) The point is that the mosquitoes spreading chikungunya today were bred from eggs laid in water a month or more ago, so we will have at least another month of a rapidly spreading epidemic before this week’s public health measures and education may take effect. When will we ever learn, as the song goes!

Professor Fraser is past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine. Website: profhenryfraser.com

IMAGES:

A speedometer measuring how drunk the driver is

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For more on this story go to http://www.caribbean360.com/opinion/henry-s-fraser-the-urgency-of-blood-alcohol-legislation-and-driving#ixzz3Ghl4INre