Demographics and presenting clinical signs of non-motorised road users
Demographics and presenting clinical signs of non-motorised road users (source: Alcohol intoxication in non-motorised road trauma by Mitra et al)

A study published in the latest issue of Emergency Medicine Australasia finds that a significant proportion of pedestrians suffering serious injuries in road crashes are “intoxicated” at the time (see Alcohol intoxication in non-motorised road trauma by Mitra et al). Researchers from the Emergency and Trauma Centre at the Alfred Hospital in Melbourne analysed all patients presenting to the hospital from July 2009 to June 2014 who were involved in a road traffic crash as a non-motorised road user i.e. pedestrians, cyclists, non-motorised scooter users, horse riders.

There were 1,622 cases, of which 299 were excluded because a blood alcohol concentration (BAC) test was not done on them. Nevertheless, a strength of this study is that the number excluded is relatively small given that BAC testing is only mandatory for patients involved in a vehicle crash. The authors note the severity of injuries in the non-tested group was considerably lower than it was for the rest.

Of 1,323 patients where a BAC reading was taken, 651 were pedestrians, of whom 25% were intoxicated. Another 644 were cyclists, of whom 7% were intoxicated. The authors make strong recommendations:

Drunk non-motorised road user laws have been introduced overseas. Pedestrians have been classified as ‘users of the road’ in Spain, and all relevant road user laws, including BAC limits, apply to pedestrians. Although this might appear extreme, if a zero toll is indeed a serious goal, this might be an effective strategy to reduce the burden of road trauma further. Frequent random testing, as is in the case of motorised road users, and mandatory reporting should accompany such laws to improve effectiveness.

Wow! A mandatory BAC limit for pedestrians with random breath testing? This reminds me of the sorts of “out-there” recommendations I expect to see from Coroners. Some have a tendency to make sweeping public policy recommendations without giving sufficient weight to basic concerns of policy-makers like costs vs benefits, practicality, equity implications, and community acceptability (see Do coroners (sometimes) go too far?). The Age reckons the authors go even further and argue that drunk cyclists and pedestrians could be causing scores of car crashes every year but since I couldn’t find much in the paper that directly supports that claim I’ll let it pass.

I think the researchers make the mistake of treating pedestrians like motorists. The definition of intoxication adopted by the researchers (they also refer to it as “drunk”) is a BAC of 0.05. That might make sense for motorists who travel at high speed with the potential to inflict serious injury on others, but it’s nonsense to apply it to pedestrians when they’re crossing a public road.

There’s no question that judgement is impaired at 0.05 but walking is infinitely easier for humans than driving; there are sensible reasons why it doesn’t require a license or specialised training and testing at 18 years of age and above. It’s much less demanding of concentration, in part because it’s an order of magnitude slower than driving but also because the human body is a lot more manoeuvrable. And the consequences for others of crashing while walking under the influence bear no comparison with driving.

Another issue is the researchers say nothing about exposure. I’ve no doubt huge numbers of people walk in public with BACs over 0.05 at night and on weekends all over Australia, including crossing roads, without causing a serious problem for themselves or others. We already have laws that regulate unseemly or dangerous behaviour by very drunk pedestrians, but they’re a small proportion of all persons who walk while “drunk”.

The problem, I think, isn’t with pedestrians. Walking across the road while inebriated will always be risker than walking on the footpath, but Australians aren’t about to accept limits on their drinking. They should be able to have a few drinks – or a bellyful for that matter – without undue risk of ending up dead or in hospital. The problem is with motorists who assume they have a higher priority on roads and don’t drive in ways that allow for the possibility of unexpected – even seemingly irrational – behaviour. Road managers reinforce that assumption.

We could learn from the Netherlands where motorists understand there’s an onus on them to anticipate and look out for vulnerable road users, including those who behave in ways that put their own welfare at risk (see Are Dutch motorists strictly liable if they collide with cyclists?). Our courts seem to take a similar view; Mitra et al note (seemingly with regret):

In the case of Allianz Australia Insurance Limited v Swainson, and a similar case of McAndrew v AAI Limited, the Queensland Court of Appeal and the Supreme Court of Queensland recognised the contribution of the intoxicated person but still held that the driver and rider were negligent for failing to avoid the intoxicated pedestrian.

But neither road managers nor most motorists seem to see it this way. Anti-social behaviour like violence shouldn’t be excused by alcohol, but crossing the road on foot with impaired judgement due to drinking isn’t anti-social. We don’t think of walking on the footpath after drinking as especially dangerous; crossing the road is necessarily more fraught, but we shouldn’t accept that it must be especially dangerous.

I’d encourage pedestrians to take extra care when crossing the road after drinking (even at 0.02) but we shouldn’t accept that walking under the influence is as anti-social as driving while over the limit. Road managers should look at options like more pedestrian-only zones in areas where people tend to congregate on foot; slower traffic; better engineering and design of places where roads and-pedestrian interact; a review of the idea that “jay-walking” is an offence in all situations; and most of all, a clear and conscious understanding that motorists must be alert to pedestrians and accommodate their greater vulnerability irrespective of how they behave.