Journal of Trauma
Nursing
Volume 8, Number
1,
January-March 2001
Society of
Trauma Nurses
2743 South
Veterans Parkway, PMB 193
Springfield,
Il. 62704
Guest Editorial
Gary Direnfeld,
MSW
Mr. Direnfeld is
the Executive Director of the I Promise
Program located in Dundas, Ontario, Canada (905) 628-4847
Reducing Injury
and Death in Teen Drivers
Given that
automobile crashes are the leading cause of injury and death in teens, you can
pretty much say that teens drive themselves to trauma centers. And, they do
this in record numbers.
Car crashes
account for approximately 6,000 deaths annually of American teens. While 15 to
20 year olds only account for 6.7% of the total driving population, they
account for a whopping 14% of all fatal crashes. Up to 60% of fatally injured
teen drivers were not wearing a seat belt, 65% of teen passenger deaths occur
at the hands of a teen driver, about 50% of the crashes involving 16-year-old
drivers are single vehicle crashes and 41% of fatal crashes occur at nighttime.
While a single
jet plane crash involving a few hundred lives will make and maintain headline
news for months and years, the epidemic of teen deaths due to driver behavior
is difficult to maintain on any political agenda. Rather, it is an issue that
is fought in the trenches mainly by grass roots organizations often founded by
surviving family members of crash victims. The crusade to reduce and prevent
teen driver crashes goes on several fronts and includes many groups whose
intention is to change rules and regulations with respect to obtaining a
drivers license, to increasing penalties for driving infractions. Perhaps three
fronts symbolize the crusade to prevent or reduce teen driver fatalities:
reduction of the legal limit for blood alcohol content, increase penalties for
impaired driving and graduated licensing.
Driver education
has been a mainstay of the process to obtaining a license. However, this has
been largely unregulated with no nationally enforced standard. Notwithstanding,
there has been a long held belief that education will determine performance and
on this basis, the automobile insurance industry has generally offered premium
discounts to those young drivers who attended some form of driver education. It
seems that some insurers now bemoan having ever entered into this quagmire
believing now that the evidence supporting a reduction of claims, based upon
attendance at driver education is slim – at best. In other words, education in
and of itself is not enough.
Graduated
licensing is the natural progression from driver education. Recognizing that
new drivers need far more than information, graduated licensing recognizes that
driving is a complex learned skill that can only occur with practice, over
time. Graduated licensing provides a process whereby new drivers must practice
and master certain abilities before obtaining increased driver privileges.
Generally the process demands that the driver must master minimum driving
skills for daytime driving on city roads before being allowed to enter
specified major highways. The driver then must obtain another level of
proficiency before nighttime driving is permitted. Throughout these stages, the
driver is required to have differing levels of supervision and has greater
restrictions on blood alcohol content. Graduated licensing is shown to reduce
car crashes in novice drivers.
At some point
however, the young leaves the nest and the novice driver flies solo. From a
human developmental point of view, this couldn’t happen at a worse time. Most
novice drivers flying solo are adolescents. Adolescence is a time of spreading
wings, risk taking and the belief of invincibility. Independence from parents
is paramount, yet without resources for true independence teens are caught in
the developmental bind of relying on parental resources to paradoxically flex
their own might.
It is at this
point in the journey where most teen injuries and deaths occur.
To meet this
next challenge a new initiative is taking the stage, set to provide a process
to take over where graduated licensing leaves off and provide a new mechanism
to reduce the risk associated with novice teen drivers. Dubbed the I Promise Program, the particulars
include a parent-teen contract and a rear window decal with a clearly visible
toll free number. The decal identifies the driver as novice and invites the
community to make reports, positive or critical on driver behavior. The calls
are taken by a call center and a call report is delivered to the parent (owner)
of the vehicle. Critical to the success of the program is the contract. Parent
and teen sit down and complete a 9-page document that sets out mutual
expectation with respect to driving behavior, car maintenance, rewards and
consequences (as negotiated).
This exciting
new program was developed by myself after years of working in brain injury
rehabilitation. The program is still in development and in clearly in order for
it to be successful, the program must reach the greatest number of novice teen
drivers at the lowest cost possible. To that end we have identified the
automobile insurance industry as the most significant partner in the success of
the program as this industry reaches literally every novice driver and had a
vested interest in reducing the cost of claims associated with the carnage of
teen driver error. Interestingly, the I
Promise Program is already garnering international attention. A web site,
developed to introduce the initiative to the automobile insurance industry has
letters of support posted from the US, UK, Canada, Australia, Korea, Poland,
Austria and Romania.
These letters
have been actively solicited knowing that in order to move the insurance
industry, you first must show tremendous support and acceptance of the program.
We identified that each letter is crucial to the development of the program
where the cumulative effect will be the influence they can have on the
insurance industry. In addition to the letters of support, the program has
obtained offers to collaborate on research from Harvard University - School of Public
Health, University of Alabama -Computing and Information Division - Engineering
Research Laboratory and from Plan-It Safe, a program of Children’s Hospital of
Eastern Region in affiliation with the University of Ottawa, Ontario, Canada.
All traumas are
serious. Traumas involving young persons are particularly troublesome.
Graduated licensing and then the I
Promise Program are two significant initiatives that can considerably
reduce the number of teen fatalities. As the largest professional organization
of nurses specializing in trauma care this program will be of interest to you
and your colleagues.
For more
information on the I Promise Program
and to view the letters of support and the contract, go to www.ipromiseprogram.com .
Additional letters of support are encouraged and welcomed. Feel free to contact
me at gary123@sympatico.ca or (905) 628-4847.
Gary Direnfeld,
MSW, Executive Director,
I Promise Program
20 Suter
Crescent,
Dundas, Ontario,
Canada
L9H 6R5
(905) 628-4847
