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Driving developments in the field of traffic medicine

Traffic medicine is a new area that is “very under-researched”, Prof Des O’Neill, Director of the National Programme Office for Traffic Medicine, tells the Medical Independent (MI).

“There are only a handful of researchers in the world that have taken an interest in it. It’s kind of surprising, because driving is such a key part of people’s everyday lives. Health can impact on it, yet surprisingly there has been very little in the way of original research.”

The National Programme Office for Traffic Medicine will host a research day in the RCPI on 14 March to help build on the growing work in this area in Ireland and abroad.

The term ‘traffic medicine’ has evolved to embrace all the disciplines, techniques and methods aimed at reducing the harm that traffic crashes inflict on human beings.

It includes medical and surgical care provided to crash victims, improving vehicle crashworthiness, developing better safety belts and brakes, designing safer roads and traffic control systems, training and educating drivers, research into the biomechanics and epidemiology of traffic crashes, and developing and enforcing traffic safety policies.

The national office was jointly established by the RCPI and the Road Safety Authority of Ireland (RSA) in 2011, bringing the specialty of traffic medicine to Ireland for the first time.

“Our own programme in Ireland is ahead of the curve internationally,” says Prof O’Neill, Consultant Physician in Geriatric and Stroke Medicine at Tallaght Hospital, Dublin, and Professor of Medical Gerontology, Trinity College Dublin.

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Prof Des O’Neill, Director, National Programme Office for Traffic Medicine

“We have developed the first certificate in traffic medicine in Europe [and] a certificate in road safety, both of which have been oversubscribed. We have designed the guidelines, we have online courses and we have done quite a bit of research. So what we are trying to do is encourage research around the community.

“This is about trying to tease out of the woodwork people who are interested. We also have received quite remarkable essays from students on it [aspects of traffic medicine].

“It’s a burgeoning area and somewhere Ireland can take the lead. There is a lot of interest from a range of disciplines, geriatric medicine in particular, but general practice as well. It is really an interesting and helpful journey in Ireland.”

European Union

But why is there a growing interest in Ireland? One wonders if it is because of demographic changes, with an older population projected across all developed countries.

“No,” says Prof O’Neill. “Older drivers are in fact the safest drivers of all. It’s not really to do particularly with older people. It’s more to do with, I think, changes taking place at European level.

“One of the big impetuses is that the European Union has taken an interest. It issued directives back in 2009, which put into law issues around diabetes, vision and epilepsy. It has added to that most recently with sleep apnoea and also on the way [in directives] is heart disease.

“So many countries like Ireland had no apparatus by which to deal with this… although we have been interested in this [the EU initiatives] really sparked a huge amount of interest.

“There were attempts to do this without medical input, which failed around 2010. But what’s very impressive is that the RSA has really engaged with this in a wholehearted manner.”

In recent months, there was an announcement of significant research funding that has been made available in traffic medicine. Last October, a €40,000 grant was awarded by the RSA in association with the National Programme Office for Traffic Medicine to researchers at University College Cork (UCC).

Dr Carol Sinnott and Dr Colin Bradley, Department of General Practice at UCC, are now leading a team of five researchers representing UCC, the ICGP and the Alzheimer Society of Ireland.

The research project is titled ‘Talking to patients with cognitive impairment about fitness to drive: Current approaches and possible improvement strategies for a general practice setting’.

Its main purpose is to look at how patients with cognitive impairment and GPs manage the discussion around safe driving.

“We are delighted to have been given this wonderful opportunity to investigate an area of traffic medicine that is so necessary and is intended to help to keep people driving safely for longer,” Dr Sinnott, co-lead of the research team, said in October.

Enabling

Traffic medicine is not purely focused on safety, explains Prof O’Neill.

“There are two parts of it. It’s not just about safety. It is also about enabling and rehabilitating people to continue driving. So that has been an important part of it. Its focus is mobility with due safety, and in the past, there was perhaps too much emphasis on safety and that kind of put people off.”

Prof O’Neill thinks the upcoming research day is a great opportunity for researchers to meet with other people in the field, while hearing from top international speakers.

“We are getting an interest from researchers around the country, hopefully from UCC and in Dublin, and hopefully from a wide range of disciplines.

“We have got three very high-level speakers, one from Canada who is the head of Medical Fitness to Drive in the province of Quebec.

“We have a very senior researcher on older people and transport policy from Denmark and we have someone from Switzerland, where they have a programme that is very actively researching the general issues of medical fitness to drive.”

According to the RCPI, medical fitness to drive guidelines “highlight the need for all of us to appreciate and accept responsibility for managing our health and medications for safe driving.

“Our doctor may advise us on the impact of driving on our health and medications but we have a responsibility not to drive if we ever feel unfit to do so. For example, you should not drive if you feel dizzy or light-headed or if you are a diabetic and you feel hypoglycaemic.”

Driver fitness is governed by EU law and regulations made in Ireland under the Road Traffic Acts.

The aim of this research seminar is to provide an open forum for all those researching in areas related to traffic medicine.

According to the RCPI, the research day will be a unique opportunity for researchers from a wide range of disciplines “to engage with, and learn more about, research in traffic medicine”.

The winner of The Mary Ward Essay Prize for Traffic Medicine, which aims to raise awareness of traffic medicine among medical students, will present his/ her winning essay at the seminar.

The essay competition is sponsored by the RSA and commemorates Mary Ward, the victim of the first fatal automobile accident in history, which happened in Birr, Co Offaly, in 1869.

Attendance at the seminar is free and all are welcome. “The focus of this research seminar is developing an evidence base for decisions on medical fitness to drive,” added Prof O’Neill.

For more information about the Research Day on 14 March, log on at www.rcpi.ie/traffic-medicine.

A driverless world ‘hard to future-forecast’

With the rapid development in the technology of car automation, will a future of self-driving cars mark the end of much of the research being commenced in traffic medicine?

Prof O’Neill says it “may well”.

“What we are going to find is that the automation of cars takes a lot of this out of circulation, so to speak.”

However, Prof O’Neill cautions against expectations that a world of ‘driver-free’ cars may be imminent. He also points to recent initiatives from state governments in the US, where the research on traffic medicine is being applied to driverless cars. 

“If the automated cars came in, this could be very helpful, but it’s very hard to future-forecast this. For example, the originator of the car, Gottlieb Wilhelm Daimler, thought there would never be more than a million cars because that was the number of people who were trained as chauffeurs. So we have got to have humility about what the future may bring.

“There will be a big issue around people moving away from the ownership of the car. It is one thing to move from the ownership of CDs to online music; it is quite another to move from ownership of cars and car culture.

“I think there are a lot of imponderables. I think it is something that could happen fast, or it could happen slowly.

“We are actively looking at that area and keeping in touch with the International Transport Research Board on this issue.

“California put out the first guidelines for medical fitness to drive in automated cars and in fact, they have decided for the time being it is the same as non-automated cars.”

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