2017 Annual Meeting

1. Evaluate how alcohol and illicit substances – within legal limits - affect the decision to use a helmet in motorcycle and scooter riders.
2. Evaluate reckless decisions among varying levels of intoxicated riders compared to sober riders.
3. Demonstrate methods of intervention programs to reduce substance use while riding while improving protective gear usage in motorcycle and scooter population.

The Survive the Ride program at the University of Miami is an intervention project that takes aim at trauma injury and fatality prevention. Here, we evaluate substance use and the effects they have on decision making among riders. We hypothesize alcohol and drug use negatively affects helmet use decision-making, and we address how legal limits affect this. Recent studies link alcohol consumption and drug use with decreased likelihood of helmet use, but fail to link quantifiable thresholds of intoxicants to multiple variables of the crash/fatality. We compare three categories of fatal motorcycle/scooter crash populations: sober, within limits, and intoxicated outside legal limits.

Autopsy and health records of motorcycle/scooter fatalities over three years (n=165) in Miami-Dade County were categorized into 3 populations – sober (n=62), within limits (n=7; defined as BAC <0.08%), and intoxicated (n=45; defined as BAC ≥0.08% or positive for illicit drug use) – and subjected to comparative analysis to determine how intoxication affected decisions for helmet use. Reckless behaviors were assessed in conjunction with lack of helmet use, evaluating cumulative effects on decision making. Chi-square is used to determine bivariate significance of substance use and safety decisions among included fatalities.

Sober, intoxicated within, and outside legal limit populations were observed to be (sex as male%, mean age) 94.23%, 33 years; 100%, 40.4 years; and 93%, 34.8 years respectively. Roughly 90% of each population rode motorcycles, yet helmet compliance decisions waned with increasing degrees of intoxication; 58.73% (sober), 57.14% (within limits), to 35.56% (intoxicated). Mean BAC of intoxication fatalities (0.16%; StDev=0.07) was 8 times higher than within-limits (0.02%; StDev=0.01), and mean illicit substances (0.27 mg/L) detected in 38.6% of cases. Intoxicated were observed at average speeds 2.53MPH (StDev=16.01) higher than sober victims.

Motorcycle and scooter crash fatalities are a major public health issue that create a heavy burden on trauma systems.  For this reason, we chose to evaluate the impact of alcohol and illicit substances on decision making of riders involved in fatal crashes. We found that in motorcycle and scooter crash fatalities, intoxication was positively associated with decreased helmet use and increased speed. While some crash factors cannot be prevented, rider intoxication, lack of protective gear, and excessive speed are highly preventable through education. Our findings suggest that decreasing rider intoxication may improve helmet use, and programs like Survive the Ride—which utilize a teachable moment to educate patients about safe riding habits and the dangers of riding while intoxicated—provide multiple avenues of preventative care, particularly in states lacking universal helmet laws.