BMJ  2004;328:E300 (12 June), doi:10.1136/bmj.328.7453.E300

BMJ USA: Editor's choice

No accidents

Public health types have for years shunned the word "accident" when describing unintentional injuries such as those from motor vehicle crashes. As first pointed out by Theodore Doege in 1978, we shouldn't call most injuries "accidents." To do so implies that they are random occurrences that could not have been foreseen or prevented.

We know today that most unintentional injuries (the preferred term) can be prevented, or at least made less likely. For this reason, the first editor of BMJ USA, Ron Davis, worked to ban the word "accident" from the pages of the BMJ, a policy that was announced two years ago this month. Motor vehicle injuries can be prevented by better road engineering, safer vehicles, lower speed limits, and abstention from drinking and driving. These improvements and others have led to continuing decreases in US death rates from all types of motor vehicle crashes, with one exception: those involving motorcycles.

Deaths on motorcycles have increased 54% since 1997. As soon as helmet laws are reversed or weakened in a state, injuries and fatalities go up. Per mile traveled, the number of deaths on motorcycles is more than 25 times greater than that in cars. Much of this difference is due to the unique vulnerability of motorcycle riders, especially when they are not wearing helmets, but some of it is because of motorcyclists' lack of visibility to other drivers.

In this issue, Guy Mazairac (p 314) gives a personal view of the carnage that results from motor vehicle crashes. Also, Susan Wells and colleagues (p 287) report a case-control study from New Zealand, in which they compared 463 motorcycle drivers involved in crashes with 1233 who were not. After adjustment for possible confounding factors, drivers wearing any reflective or fluorescent clothing had a 37% lower risk of being involved in a crash than those not wearing such clothing. If the driver's helmet was reported to be white or light colored, the risk was 19% less. And use of daytime headlights was associated with a 27% decreased risk.

What can we do to decrease injuries from motorcycle crashes? First, advocate for helmet laws that apply to all who operate or ride motorcycles. Helmet laws save lives. Second, it is reasonable to urge patients who operate motorcycles to obey regulations and not to use alcohol or other drugs when driving. And third, tell them to wear reflective or fluorescent clothing and white or light colored helmets, as well as to use their headlights all the time.

Apparently, "conspicuity" (a new word to me) matters.

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