“So we drove on toward death through the cooling twilight.”
—F. Scott Fitzgerald (The Great Gatsby)
Sixteen years as a teacher and practitioner of emergency medicine at Yale have taught me that there is no greater tragedy than the loss of a child, and no more difficult duty for a physician than to deliver unthinkable news to disbelieving parents.
Ironically, parents fear dangers unlikely to affect their children, such as kidnapping or murder, while neglecting a far greater menace: motor vehicle trauma. Car crashes are the leading cause of death for people ages 16 to 20, according to the National Highway Traffic Safety Administration (NHTSA), where I recently completed a two-year fellowship. The Centers for Disease Control and Prevention reported that 4,700 American teenagers died in cars in 2001. (By comparison, the number of child kidnappings ending in death is estimated at 100 annually.)
The teenage years usher in a period of dramatically increased risk of vehicular death and serious injury. A newly issued driver’s license may be seen as a ticket in a lottery of death and disability. The NHTSA reports that the fatality rates per million miles driven by 16-, 17- and 18-year-olds are 17, 13 and 7 deaths, respectively, far higher than the rate of 3 deaths per million miles for older drivers.
In view of these numbers, does it make any sense that most parents allow their newly licensed children to drive with few or no restrictions, and that some parents actually give children their own car at this age?
Traffic safety advocates oppose this laissez-faire approach and have persuaded states to enact legislation to protect new drivers. Known as graduated licensure, or GL, the laws impose restrictions on young novice drivers, gradually easing limitations over periods of three to 12 months. These restrictions, which vary by state, include a no-passenger rule, zero tolerance of alcohol and a ban on nighttime driving. For young drivers, these three factors are the major variables associated with high crash and fatality rates.
The effectiveness of GL is well-established. A 1996 study commissioned by the NHTSA found that GL reduced injury, fatality and moving-violation rates among 16- and 17-year-old drivers by about 20 percent.
So what can a parent do if his or her child is about to become a new driver in a state with no GL laws? This was what I experienced in Connecticut, which was not yet a GL state when my oldest son was licensed. First, after getting his learner’s permit, for over a year he had lots of practice with an adult at his side. When he got his license at 17, I imposed house rules including no passengers (except parents), no solo night driving and no “just driving around for fun” before age 18. Perhaps most important to the big picture, I used my position as president of the Connecticut College of Emergency Physicians to work with other groups to win passage of a GL law, making all teen drivers in Connecticut safer.
Concerned parents living in states that do not have GL laws can and should take action. Educating state officials using information obtained from NHTSA and Insurance Institute for Highway Safety websites is a good start. Letters to the editor and the support of civic and school organizations are also essential. Finally, support from police is critical because of their role in enforcement.
The Emergency Department acts as a filter for illness and injury in the surrounding community. This gives emergency physicians the opportunity to identify seemingly random incidents and recognize patterns of pathology that call out for preventive measures. It would be short-sighted and, frankly, irresponsible to simply “treat and street” without going to the source of certain injury or illness patterns in an effort to reduce or eliminate them. There will be more heartbreaking moments of delivering unimaginable news to anguished parents. We owe it to ourselves and our children to do everything we can to make those moments as infrequent as possible.