“Daddy had to go up to see Grandfather Follet,” their mother explained. “He says to kiss both of you for him and he’ll probably see you before you’re asleep tonight.”
“When?” Rufus asked.
“Way, early this morning, before it was light.”
“Why?”
“Grampa Follet is very sick. Uncle Ralph phoned up very late last night. . . . He wanted very much to see Daddy, just as quick as Daddy could come.”

James Agee
A Death in the Family

A tan bullet comes hurtling down the road. Strapped inside is a man I know, a physician, specialist in diseases of the heart. Twenty times a day he listens and probes, observing the signs of age as they appear in his patients’ flesh. He too grows older, and, as if to erase in himself what he sees in others, he pushes himself hard. When he was younger he would play tennis, sweating in the sun each noon. Now he rides bicycles and horses, eats lean, does not smoke. He is a disciple of Paul Dudley White; he will not permit his body to fail him. He is as hard as a man far younger. I sometimes expect that I will slip into decrepitude long before this older friend of mine.

There is hardly an evening when he is not called from his house to the hospital or another scene of disaster, real or imagined. He strides, smiling, toward the car, skipping down the front steps and waving to his family if they are still awake. Then he climbs into his vehicle and careens like a maniac into the night.

A few minutes before 10, the phone rang. Mary hurried to quiet it.
“Hello?”
The voice was a man’s, wiry and faint, a country voice. It was asking a question, but she could not hear it clearly.
“Hello?” she asked again. “Will you please talk a little louder?”. . . Now, straining and impatient, she could hear, though the voice seemed still to come from a great distance.
“Is this Miz Jay Follet?”
“Yes; what is it?” (for there was a silence); ‘yes, this is she.”
After further silence, the voice said, “There’s been a slight. . . your husband has been in an accident.”
His head! she told herself “Yes,” she said, in a caved-in voice.
At the same moment the voice said, “A serious accident.”

The wife of my friend the doctor lost her father in a car crash in 1930, when she was three years old. What can we know of the terror she feels when the phone rings, and, this time, it is her husband who is away too long? To know we would have to live with that half-second of certainty, the naked moment before rationality can smother alarm, the accumulated panic of 43 years reaching up to shake her roughly and turn her face towards disaster and tell her, yes, this is what you’ve feared all along, you thought that by ignoring it you could make it go away, but you see now how close it must dwell to the surface if it can escape through the smallest fissure of suspicion.

This woman is hardly unique in her apprehension. Yet the political—and especially intellectual—efforts to prevent what she fears are minimal. She can read in her magazines about world affairs and political trends, but not about violent death. We must understand this blind spot if we hope to reduce our losses on the roads.

Each year 55,000 people are killed in traffic accidents in this country, 10,000 injured every day, two million seriously disabled in a year. The comparisons are familiar but still striking: more of our citizens are killed on the roads in one year than died in Vietnam during a dozen years of fighting. Accidents are the third leading cause of death in the United States, and the 1971 totals indicate the disproportionate role of traffic fatalities: of the 115,000 people killed by all forms of accidental injury (many experts prefer the term “trauma,” since “accident” implies that the deaths were merely the result of bad luck), 55,000 died on the roads.

This figure alone tells us that a lot of people are being killed. However, it has a greater significance: unlike cancer and heart disease, traffic deaths are largely preventable. We are doing very little about a kind of epidemic we have the power to control, while we pour our energies and resources into the research of diseases we don’t yet know how to cure or prevent.

“On the basis of our present knowledge, it is probably true that a dollar spent in this area [treatment of traumatic injury] would bring a greater return in the prevention of death and disability than a dollar spent in any other way,” according to Dr. Henry Huntley, former head of the division of Emergency Medical Services in the Department of Health Education, and Welfare. This is so because we need neither new inventions nor enormous investments of capital in order to save many of the people now killed by trauma. One good illustration is the country’s ambulance services and hospital emergency rooms. The experts already know what needs to be done to improve the emergency system and agree that the cost would be relatively modest. Dr. Huntley estimates that even with no reduction in the number or severity of accidental injuries, improving emergency care could reduce traffic fatalities by 15 to 20 per cent, and save a total (including other accident victims) of 60,000 lives each year. Dr. William Fitts of the University of Pennsylvania, editor of The Journal of Trauma, adds, “In the treatment of accidental injury, the gap between what can be done and what is being done is wider than for any other [area] ,” and Dr. J. Finton Speller, Secretary of Health for the Commonwealth of Pennsylvania, has said:

President Nixon’s war on cancer is a gamble in two respects—ultimate success rests on the hope that we will discover scientific principles now unknown, and there is no way of guessing how many lives will eventually be saved. . . . To declare war on unnecessary death in the ditch, in the ambulance, and in the emergency department is no gamble at all.

Why, then, have we refused to bet on the sure thing? And why, when so much has been written about other kinds of preventable self-destruction (pollution, for example), has reporting on traffic death prevention been left to magazines like Parade and Reader’s Digest?

Thank Hugh

When Unsafe at Any Speed by Ralph Nader was published in 1966, the public finally grasped what safety experts had been groping at for 20 years: the design of car and road might have more influence on crashes and on the severity of the injuries that follow than do the drivers themselves. Evidence leading to this conclusion had surfaced in experiments begun during the 1940s by a Cornell researcher named Hugh De Haven. When he was a pilot in the first World War, De Haven was puzzled by the seeming illogic of airplane injuries. Some human bodies withstood remarkable amounts of shock without permanent injury, while others were severely damaged by apparently moderate amounts of force. Later, in his Cornell experiments, De Haven isolated at least two factors that determined whether or not a victim was seriously injured—whether the body was “cushioned” inside the vehicle, and how the impact was absorbed over time and distance (that is, whether the car decelerated from 50 mph all in one instant) or was stopped more slowly by caroming through a series of impacts). A later pioneer in this field, Dr. J. R. Stapp, belted himself into rocket sleds to quantify the thresholds of human physiological endurance. In 1955 he demonstrated that, properly restrained, the human body could withstand a deceleration from 632 miles per hour to zero within 1.4 seconds, a force far more extreme than that involved in most fatal collisions.

During the 1960s, the American space program contributed additional data on how the body endured stress, but some of the most important extensions of De Haven’s work were being done by Dr. William Haddon, Jr., a physician who directed the federal government’s highway safety agencies from 1966 to 1969 and is now president of the Insurance Institute for Highway Safety.

One of the most provocative IIHS studies indicated that people should be able to survive many of the impacts that now are fatal. The basic scientific data indicated that under ideal conditions humans can endure forces as great as 45 g’s (45 times the force of gravity) for very short periods of time. From this, Haddon has produced graphs showing that crashes in which the victim decelerates from 50 mph to zero in less than three feet need not be fatal, if the victim is protected from the steering wheel, the windshield, and the other hazards involved in the “second collision” of driver with car.

The public seems not to have followed the implications of this work as easily as it understood Nader’s graphic portrayal of the Corvair going out of control and causing a crash. To accept Haddon’s suggestion that most collisions were unnecessarily fatal meant rejecting the experience of three generations in which people had been killed while traveling only 20 or 30 mph. Partly, too, as in the early days of the environmental movement, the public mistook the vulnerability introduced by human engineering for nature’s own frailty.

Copernicus at the Wheel

Meanwhile, a different group of scientists was also making discoveries that upset traditional ideas about accidental fatalities. Articles began to appear in medical journals suggesting that those who died after collisions might have suffered their most severe trauma not in the car but in an ambulance or in a poorly equipped emergency room. Conditions were set for a classic scientific revolution, a change as fundamental and, in its own way as important, as the Copernican theory of the universe or Columbus’ challenge to the flat-world theory. Scientific revolutions often follow a period of ferment, a time when the old theories cannot explain observed phenomena, and that is what was happening in traffic safety.

The old-school approach to accident prevention had changed very little since 1936, when the National Safety Council introduced its familiar slogan, “If you drive, don’t drink; if you drink, don’t drive.” But even before that, in the first years of the century, when the first connection between alcohol and collisions was being made, what would become the standard theory of safety was developed—defect, mainly human, causes crashes, therefore defect must be eliminated.

Men like Stapp and Haddon might have succeeded by now in changing safety theory from subjective to scientific if they had been able to challenge the old school on its central premise, that drivers “cause” crashes. If only science could have shown that the cars actually did cause most accidents, that the driver was not to blame, that death hung over us like the ball at the lip of the roulette wheel and could drop as indiscriminately. If so, public attention might already have turned to the other strategies for reducing injury.

But the facts wouldn’t fit this pattern. Even the scientists most dismayed by the traditional approach to traffic safety acknowledged that the driver usually “causes” the crash. Alcohol, in the words of the authoritative government report issued in 1968, “has been found to be the largest single factor leading to fatal crashes.” The influence of age and sex is also too clear to deny. Males have more crashes than females; those 18 to 19 have more than anyone else. According to Susan P. Baker of the Johns Hopkins School of Hygiene and Public Health, males aged 15 to 24 “have an exceptionally high death-to-injury rate, suggesting that a larger proportion of their injuries are severe (suggesting, in turn, that their crashes are more severe).”

What, then, is wrong with the “nut-behind-the-wheel” approach if the facts seem so irrefutable? In one of his technical papers, Haddon explained:

There is no logical reason why the rank order (or priority) of loss-reduction countermeasures. . . must parallel the sequence, or rank order, of causes contributing to the result of damaged people or property.

The importance of Haddon’s statement is this: the two most important causes of crashes alcohol and the hot blood of youth—are the two least possible to control. Even during Prohibition alcohol was a major cause of fatal crashes, and since then there has been virtually no indication that any socially acceptable anti-alcohol campaigns make a significant difference. As Susan Baker has said of the problem of violence among young males, “The comparatively high death and injury rates noted for males suggest the role of behavioral factors, some of them probably innate.” But none of this should discourage us if, as Haddon recommends, we are looking for the best ways to reduce loss rather than obsessively working to eradicate the causes (which, of course, we should keep trying to understand).

Haddon’s scientific revolution, represented in the phrase “loss reduction,” may best be explained by analogy. For years, such communicable diseases as cholera, typhoid, and polio were thought to be “caused” by defective human behavior: we were not careful enough in what we ate or what strangers we permitted to contaminate our air or water. The advent of scientific public health marked a change in the question doctors asked, from “How is this disease spread?” to “How can we best minimize its damage?” The answer, once attention was untethered from seeking the simple “cause” of the problem, could include such responses as mass immunization, the construction of sewers, the testing of public food supplies.

In a series of papers which stretch from the mid-sixties through the last few years, Haddon laid the groundwork for a similar approach to violent death. Using the term “energy damage” to define such varied occurrences as a head-on collision and the detonation of a nuclear bomb, he has composed a menu of 10 “countermeasure strategies”:

1) prevent the “marshaling” of the destructive energy—keep the nuclear bomb from being built, the baby from climbing on top of the table, the car from taking the road.

2) reduce the amount of energy so marshaled—build smaller bombs or firecrackers, put fewer aspirin tablets in each bottle, reduce the speed of cars.

3) prevent the release of energy—keep the bomb from dropping, the suicide from jumping, the car from crashing.

4) modify the release-over-space of the energy—deflect the avalanche with trees and trails, let the car hit a movable barrier instead of a fixed object.

5) separate the energy release from the potential victims—take the Bikini Islanders off their atoll and the pedestrians out of the road.

6) insert a material barrier between the energy and the victim—provide helmets for football players, nets for acrobats, padding for cars.

7) modify the contact surface—use cardboard sticks instead of wooden ones for lollipops, take the daggers off car grilles and the protruding screws from their interiors.

8) strengthen the structure that will absorb the energy—build stronger bomb shelters and make buildings fireproof, vaccinate against smallpox, reinforce car bodies.

9) identify and treat the damage as soon as possible—send out a fire truck, get the crash victim to the hospital.

10) restore as much of the damage as possible after the emergency treatment—repair the gutted building, let the broken bones knit.

With this list a door opens, things fall into place. We see how much we had ignored before and sense that even if we can’t get rid of the drunken drivers and the Corvairs, we may have a chance of surviving when they come careening into our cars. A few loss-reduction devices have already been installed in cars—steering columns, for example, designed not to puncture the aorta upon hitting the driver’s torso. In cars made before 1967, those with rigid steering columns, impacts of 50 mph were fatal 50 per cent of the time and inflicted “serious injuries” on the other 50 per cent of the victims. With collapsible steering columns, a 50-mph impact leaves 20 per cent of the drivers uninjured, 60 per cent with minor injuries, and the rest with only moderate injuries. On some highways, breakaway pilings for roadside lamps and signs, instead of rigid posts designed to preserve the sign at the cost of the driver’s life, are now being installed. “That such poles have been thoroughly tested and introduced in a few areas and shown to be practical, effective, and competitive in cost,” says Haddon, “indicates that virtually any death in a pole impact at virtually any impact speed is completely unnecessary.”

A new highway just opened in the District of Columbia, the “Center Leg Freeway,” carries this and other improvements to the roadside environment a step further by installing “impact attenuators.” “It’s the latest concept in preventing personal injury,” the city’s traffic engineer, George W. Schoene, has said. “Damage will still be done to the vehicle, but any serious injury to the driver will be minimized. When the car hits the attenuator, the black cells with mushroom-like tops pop out one at a time, spraying water everywhere.”

“He’d crawl to the hospital first.”
The Washington ambulance service is run by the fire department. There are no permanent ambulancemen. All the firemen have to serve one year on an ambulance some time during their first five years of service and almost all of them hate it, in spite of the extra $600 that goes with the job. There are 10 ambulances in the city.

We were racing through the city, shooting red lights and hooting at the drivers scrambling to get out of the way. The threatening “wee-ow wee-ow” of the siren throws everyone on the street into confusion, sends shivers and thrills down the spine. The driver, Mallory, is enjoying himself. There is just time to catch fleeting glimpses of bystanders frozen in curious attitudes, hands to their ears, or the fear in their eyes, or two fingers of contempt jerked up at the men in uniform.

All that was known about this run was the word “seizure” and an address scrawled on a card by the man in the firehouse who had taken the telephone message from the central dispatchers. It turned out to be at the top of a big office block.” Once we arrived at the address the ambulancemen forgot the speed of the drive and began to dawdle. After the ride through the city it was agonizing to watch them climb down so slowly, open the back of the van, chat with the doorman, make jokes as they fumbled while pulling the stretcher out on its wheels. “What floor, buddy?” asked Mallory, who seemed to take control of every situation. We squeezed into the narrow elevator and shot up nine floors. Office staff were waiting at the top in great agitation, and we pushed our way through to a back room where a plain young white girl was lying on two chairs looking dazed and embarrassed. She was loaded clumsily onto the stretcher while the ambulancemen took her particulars from a nervous manager. They enjoyed being the center of attention, the big guys who could cope with any situation, and they threw out various medical terms which sounded impressive. They played the part well, but too lengthily.

After leaving the girl at the hospital we drove back slowly to the firehouse, stopping on the way for Newman to mail a letter. It was hard for them to get used to driving without the siren, to stopping for lights and people, but they compensated with a great deal of hooting and yelling . at drivers. “Hey, are you squeamish?” Mallory called back to me with a loud laugh. Newman giggled. “I don’t know yet,” I said nervously.

Back in the firehouse the other firemen laughed. “She doesn’t know if she’s squeamish?” They began swapping horror stories from the time when they had been on ambulance duty: the doctor who got caught between an elevator and the shaft “and there was nothing left but a pile of meat to scrape off the walls”; a woman who committed suicide by opening an elevator door, putting her head out, and pressing the button, “her head was on the top floor and the rest of her was in the basement.” Mallory said that last week on another ambulance in that district, an inexperienced ambulanceman had put a tourniquet around a man’s neck, “you guessed already, he was dead on arrival.” They all roared with laughter and looked at me to see how I was taking it.

Am-bulance, am-bu lance,” drawled the loudspeaker. Mallory poured the rest of his can of Coke down his long body and munched up the last of his Hershey bar. Firemen eat all day long. We drove off with sirens and lights. This time it was an address in one of the better parts of the ghetto, a small detached house with a big front porch with an old rocking chair. We came into the main bedroom. A thin, tiny, old black woman was standing with tremendous dignity and calm by the bed, where an enormously fat, pop-eyed, gray-haired man was lying in a pair of green pajamas. The woman explained quietly and efficiently that he had a history of heart trouble, diabetes, arthritis, and gout, and that he was in great pain. “Is that right, buddy? You been throwing up blood?” Mallory asked. The woman explained that he was deaf as well. She asked that he be taken to the hospital where his records were. “He goes to that clinic,” she said. Mallory misunderstood her, “Ma’am, we ain’t taking no one to no clinic appointment,” he snapped.

Mallory said the man would be taken to the nearest hospital that would have him. The two ambulancemen and a policeman, who had arrived on the scene before us, humped the old man awkwardly onto a special stretcher to which he could be strapped and held upright to get him down the narrow stairs. Newman, another one of the ambulance attendants, grumbled loudly about his bad back. “He’s so heavy. My God he’s heavy,” they groaned and complained, as if the man who was groaning too was dead and not right there beneath them. No one spoke to him. The patients never got spoken to on the way to the hospital—not a comforting word or a try at conversation to take their minds off things. They were just lumps of meat to be transported and talked about as if they were dead.

A friend or relation is allowed to travel in the back of the ambulance with the patient, but mostly the patients travel alone. There is no one to see how they get treated on the way. If they fall off the stretcher as the van spins round a corner and the ambulanceman doesn’t catch them, a very common occurrence, there is no one to see or complain.

When I hear the squeal and screech of sirens now, I don’t think of dying people for whom each second is precious, being given oxygen, gently tended by concerned ambulancemen fighting for a life. I think of poor, ill, tired, drunk old men, unconscious girls, frail old people being hurled off their stretchers because the driver gets a kick out of shooting lights, stopping all the other traffic, being a law unto himself. And what better excuse—he’s driving an ambulance. I didn’t see one case where the use of sirens and flashing lights, the violent driving, resulted in anything but more suffering to the patient. The thrill was in the driving, not the saving lives.

It was Newman who said to me, “No ambulanceman would ever call an ambulance. He’d crawl to the hospital first.”

Polly Toynbee

‘I Love You Anyway’

Other innovations are the springy bumpers on late-model cars—intended more to eliminate the $200 bill for the two-mph collision than to prevent serious injury—and seat belts, installed first as options, then as requirements, now equipped with buzzers, and soon to be connected to an “interlock” system that will prevent the car from moving if the belts are not fastened. Public enthusiasm for safety belts does not mirror their proven worth. Ralph Nader estimates that five per cent of all drivers wear the belts, and while other surveys produce figures in the 10 to 15 percent range, no one contends that more than a handful of drivers use the simple device that cuts fatality rates in half. Even the warning buzzer has not made a difference. The most graphic evidence of its failure came from IIHS researchers who looked through cars at the Department of Transportation’s own parking lot and found that a large number of drivers had de-activated their buzzers. Still, the belts are credited with what reduction there has been in traffic deaths, from 56,000 to 54,700 between 1969 and 1971.

Several of the IIHS studies have tried to uncover the reasons for this seemingly suicidal refusal to use seat belts. In 1971 the investigators produced six television advertisements promoting seat belt use. The films were designed to play on what earlier studies had identified as the strongest incentive for wearing belts, the fear not of death but of disfigurement and crippling injuries. The experimenters’ own description of one of the films conveys their flavor:

A woman whose face cannot be seen is shown in front of a mirror applying makeup. A full-face picture on her dressing table shows her as a beautiful woman. Her husband enters and suggests that they go to a party. She asks him not to look at her without make-up as she turns to reveal a scarred face…. The announcer continues, as the picture on the table is shown, “Terry would still look like this if she had been wearing a safety belt…. It’s much easier to wear safety belts than to hear your husband say, ‘Honey, I love you anyway.’ ”

For nine months the six messages were shown to half the households in a community supplied with cable TV. Meanwhile, the investigators were observing the drivers who wore seat belts and then tracing their license numbers to determine whether they had seen the messages. At the end of the study the investigators had a conclusion of unmistakable clarity: “The campaign had no effect whatsoever on seat-belt use.” A more recent experiment testing the effect of the buzzer system had similar results: “The evidence presented here indicates that the buzzer-light system had no statistically significant effect on the safety-belt use rate.”

Now here are findings to give us pause. Doubtless they point us toward our complicated attitudes about automobiles and, ultimately, the risk of death. But to the loss-reduction engineers they indicate an absolutely clear-cut course of action: seat belts don’t work, so we need airbags, and better roads, and emergency care, and a lot more.

It is equally important to remove the more grotesque hazards now built into the cars. Earlier this year the IIHS test-crashed cars to see how they hold up during impact. Six 1973 model cars were slammed at speeds of 30 to 40 mph into the tail ends of other new cars, which were parked. In all six cases the gas tank of the parked car ruptured, in one case spontaneously engulfing both vehicles in flames, and offering the potential for fire in all the others. Except for the fires, rear-end crashes at this speed would cause little injury. But when the test vehicles did catch fire, the dummies inside were horribly charred. The best estimates are that between 2,000 and 3,500 people each year are cremated inside their cars after collisions they otherwise might have survived. In that light, the IIHS tests make the government’s recent decision to delay once more standards for rupture-proof tanks, this time until 1976, appear reprehensible at the very best.

One-Stop Service

Even after the crash and its injuries have taken place, there are ways of reducing the casualties. For quick results, nothing could go farther toward reducing violent death—not a new wave of Prohibition, not denying licenses to those under 25, not mandatory seat belts or super-safety vehicles—than improving emergency care.

Two studies, one in Michigan and one in California, suggest why. Dr. Charles Frey took the records of 159 accident fatalities in Michigan and tried to determine the conditions contributing to their deaths. In 29 of the cases he concluded that the victims could have not only survived the injuries, but also returned to full, normal lives—if they had received adequate emergency care. Another nine could have had a good chance of survival. That’s a total of 38, or nearly 25 per cent who died because they couldn’t get care in time.

The California investigation was directed by Dr. Julian Waller. Comparing accidental deaths in rural areas with those in the city, Waller found that the fatality rate was four times higher in the country than in the city, even though the rural crashes took place at generally lower speeds and should have left their victims with a greater chance of survival. The distinguishing factor was the quality and speed of emergency care: in the country it took longer to get to the hospital and the care was not as good.

In the minutes after an injury even small differences in rescue time can greatly alter the patient’s chances. Dr. Robert Baker, director of the trauma unit at Cook County Hospital, has estimated that for each 30 minutes that pass before the victim gets skilled medical care, the mortality rate triples.

The hair-raising inadequacy of the nation’s ambulance service is certainly the greatest single factor in poor emergency care. The Ambulance Association of America itself makes the startling admission that each year about 25,000 people are permanently injured or disabled by untrained ambulance attendants. Of the 220,000 ambulance technicians in the country, only about five per cent had, by 1970, received the 80 hours of training that the government’s Emergency Medical Services division recommends as a minimum. The situation has improved since then, but even now only two states require the 80 hours for certification. “Barbers and beauticians get an average of 1,500 hours’ training,” says Dr. Dawson Mills of the National Highway Traffic Agency. “To be a mortician you need two years of college, two years of apprenticeship, and one year as an embalmer. But in most places, all you need to operate an ambulance is a driver’s license.” We might be wise not to sneer at our well-educated morticians—they still operate almost half of the ambulances in the country, 19,000 out of a total of 44,000. Hospitals operate only 1,300, and the balance is made up by volunteers (11,000), commercial companies (4,700), and police or fire departments (4,500).

The War Pays Off

On the bright side, emergency care has given us that long-awaited example of something good that happened because of the Vietnam war. “Wars are when the progress is made in emergency care,” Mills says. “Most physicians just don’t get that much exposure in their normal practice.” Vietnam also provided a specific new technology—helicopters as rescue vehicles. In each major war of this century the fatality rate among the injured has been cut roughly in half. Statistically, you would be safer as a soldier getting shot in Vietnam than as a driver skidding into a crash in New Jersey, because as a soldier you could count on quick helicopter evacuation and transport to a specialized emergency center.

In 1970, even before the war was over, three federal departments—Defense, HEW, and Transportation—formed a cooperative, experimental program called MAST (Military Assistance to Safety and Traffic), which placed military helicopters stationed at bases in the U. S. at the disposal of hospitals and highway agencies in neighboring regions. While limited in ambition (there are just five sites and only about 2,000 patients have been transported), the program is remarkable for its cost of zero dollars. The machines and their crews are paid for in the normal military budget; they substitute the emergency runs for routine practice flights.

At least a dozen other areas have established helicopter rescue programs—Denver, Los Angeles, and Detroit, as well as regional programs in Maryland, Illinois, and Arizona, to name a few. But at $130,000 or more apiece, the helicopters come at too high a price for many communities, especially when there are simpler and cheaper ways to improve their emergency systems. “Often the first priority has to be upgrading the ambulance attendants themselves,” says Dr. Louis Rousel lot of HEW’s Emergency Services division.

Dr. Rousellot’s division is now financing emergency care projects in six states. Occasionally these involve futuristic-sounding technology —for example, radio-telemetry, which allows a hospital-based doctor to monitor the patient as he is carried in the ambulance. In general, however, the techniques and devices involved are nearly all available now, and usually at moderate cost. A national system of emergency-room classification—one of the higher priorities—is more a matter of making intelligent use of existing resources than of greatly increasing the total supply. Even the mechanical innovations, from helicopters to portable defibrillators, are often applications of devices already in use elsewhere.

Something has happened in these few areas that is not happening elsewhere. The scientific revolution has been recognized, accepted, even if its dominance is still only partial. Authorities have started to think about how to save lives and not just how to prevent accidents. The distance these innovators have put between themselves and the old ways of thinking is somewhat too obvious when one looks at the latest official pronouncement on the subject, made by Claude Brinegar, Secretary of Transportation, last October 22:

I don’t think we are letting up on the car, but in terms of quick payoff, we’re back hard on the driver. . . . The collapsible steering gear, improved windshields, the seat belts, the shoulder harness, and perhaps ahead of us the airbags—those technological things have pretty well been explored. [The figures connecting alcohol with collisions] seem to tell you that if you want to put a lot of effort into quick results—which the country wants—it should be on the driver, and I think that’s where you’ll see the emphasis.. .. It’s a matter of singling out the group—the young people and the people who are excessive drinkers are clearly the ones who are causing most of the accidents.

To a man like William Haddon—so impeccably logical that, it is said, he began wearing his now-totemic bow ties in medical school because other ties flopped down onto his patients—a statement like Brinegar’s simply reveals defective logic. You could not blame the vestigial Ptolemaists for scoffing at Copernicus, nor the Spaniards for staring at the horizon, waiting for Columbus to fall off. The leaders of scientific revolutions in those eras had to patiently explain their cases, much as Haddon feels he must attack the superstition and attack it again. If he is the Sisyphus of traffic safety, he is a Sisyphus with faith—someday you will understand, you witchdoctors and deniers of reason. Major premise. Minor premise. Conclusion: you are wrong, you Brinegars and National Safety Council members. You will accept science and abandon mythology. Stop looking at your cut finger and trying to see why it’s swollen; take this microscope and you will see the germs.

It is scientific, sound—and yet unsatisfactory. For the other kinds of accidental death, science and loss reduction have become part of common sense. We insulate electric wires, package poison in small, tight bottles, spend money on fire departments even while emphasizing fire prevention. In the factory we still hear comments about “careless workers” whenever a limb goes through the machinery, but the motives are rarely hard to detect and do not deter us from passing safety legislation. We line the airports with crash vehicles and spend more money investigating several hundred aircraft fatalities than learning more about our traffic deaths. What’s gone wrong here? What capsule of unreason protects the mythology of the highways from Dr. Haddon’s disinfectant?

Haddon has an answer here too—the “original sin” fallacy, which makes us keep blaming the driver despite our best intentions. No one who has looked through the government’s new plans for “driver training” programs can scoff at that statement, and especially if we have known someone killed by a drunken driver, we can no more forgive those drivers or dismiss our hatred than a woman who has been raped can forgive her attacker. Still, “original sin” has a tinny ring; something is not whole. When the scientific revolution was on the march before—trampling the encampments of old-guard thought about the environment or occupational safety or minority rights—it was cheered on by a rather fine-featured claque of academics, politicians, intellectuals united for the defeat of ignorance. I have on my desk a bibliography of popular articles designed to correct the outdated ideas about pollution. By now it is so thick I can use it for a chopping board. Why isn’t there a thick bibliography of enlightenment for the Brinegars?

There has, in fact, been an abundance of articles on traffic death, but nearly all of them had appeared in journals such as Good Housekeeping, and Motor Trend. Two years ago The Saturday Review printed Arthur Freese’s laudable article, “Trauma: One Neglected Epidemic,” and from time to time publications like The New Republic report that the Transportation Department is controlled by Detroit. With these few exceptions, the intellectual press has given the deaths of 55,000 people a year attention mainly in fiction, where the car is a brutal and plausible mechanism for removing characters. Why?

White Collar Daredevils

Past a certain point there are questions we cannot ask about the automobile. It would be naive not to recognize how deeply the car has become part of our national psyche. It would be equally naive to expect our complicated emotions to yield to simple statements of logic. Many people with an intellectual blind spot about death and the car feel an ambivalence about its threat of violence. Something in them sympathizes with the teenager who roars away from the intersection or drives madly down the highway. They share that sense of freedom and command that comes from guiding one’s own, private, unassailable little capsule.

They may also share the desire to ride along the brink, to court and control danger. Even while questioning this emotion in skydivers or motorcycle racers, they may feel their own lives somehow empty without it. Most Western European countries have controlled the wells of violence that spill out as murder and rape in the U. S., but they have not reduced the violence of the automobile. Movies like Godard’s Weekend and Joseph Losey’s Accident make us aware that the threat of sudden death may fill some need in societies where perhaps too much predictability has been imposed on the other events of life. A psychiatrist, Norman Tabachnick, has estimated that one tenth of our traffic fatalities are suicides. The roots of our irrationality go too deep for us to find.

There are other complications that obstruct the scientists’ strict logic. Players at the roulette wheel, we reckon cancer and heart disease as part of the normal odds, bets we must cover. Violent death is the double-0, the number no one counts on and which turns the game in the croupier’s favor. We are complicated too by a curious respect for skills. Even those who would not honor the Junior Johnsons of the race track may take pride in controlling their own cars, feeling the same cool skill as a pilot in the cockpit or at the tiller. They are the white collar equivalents of the teenage speeder, those who manage their cars as they manage their lives, deftly and with precision. This is the only explanation I can give for my friend the doctor. By mastering the extra risks he himself creates, he demonstrates his sureness, his agility. Finally, automobiles almost forbid us to view them from a communal rather than an individual perspective. Although most people don’t wear seat belts, their presence in the car constitutes a kind of free choice. Those who strap them on know that those who don’t are, in some inarticulated sense, responsible for the consequences.

But this can be carried just so far. There are many people who feel none of this romance of danger, who want mainly to protect themselves against getting killed. Their numbers must be larger than the noise they make in the intellectual press. Why don’t they face the issue?

The explanation may be a subtler form of blaming the victim than Haddon describes. Many of us suspect, in raising questions about traffic safety, that we know what the answers will be. Alcohol and youth are the causes—can the solutions not involve steps, presumably drastic ones, against alcoholics and the young? The Brinegars have been allowed to set the terms of the argument: we believe it when they blame the victim, but since we don’t want the victim to be punished we turn away altogether. To acknowledge the gravity of the situation would be implicitly to support grave efforts for its correction, and this we feel unwilling to do.

Faced directly, traffic safety is actually a hopeful issue. There are ways to reduce the carnage quickly, even before we understand the behavior that lies behind it. That should not prevent us from trying to understand the behavior—especially the acculturation that breeds such anger among young males—it may reduce the dishonesty of pretending the problem doesn’t exist until we understand its roots.

He’s dead. He died last night while I was asleep and now it was, already morning. He has already been dead since way last night and I didn’t even know until I woke up. He has been dead all night while I was asleep and now it is morning and I am awake but he is still dead and he will stay right on being dead all afternoon and all night and all tomorrow while I am asleep again and wake up again and go to sleep again. . . . Dead now.

A Death in the Family

James Fallows

James Fallows began his magazine career at the Washington Monthly in the 1970s, later serving as editor of U.S. News & World Report and as a White House speechwriter. He has written 12 books, the most recent being Our Towns, coauthored with his wife, Deborah Fallows, which was a national best-seller and the basis of a 2021 HBO documentary.