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Sleepiness can be defined as an early stage of sleep disorder. It is a parameter that is difficult to comprehend, owing to its subjective nature.

“People drive as they live.” Hence, they have their own patterns of behavior, wants, habits, prejudices, frames of reference and ways of looking at things. The act of driving is just one of these patterns. Yet, in the context of road safety, the individual is too often regarded as merely a road user. The tendency is to forget that the individual is first and foremost a human being, with all that that implies.

The act of driving is a highly complex endeavor, partly due to time constraints for detecting, perceiving, and processing information before making a decision and reacting on a road environment full of unpredictable events. It is the driver who has the sole responsibility for how actions are carried out, and reactions to incidents depend wholly on his/her capacity to manage the situation.

Whereas commuting seems to be related to stress-induced emotional strain and will be the focus of the next chapter (Chapter 5), there is also evidence that commuting, particularly by car, can directly cause physical and physiological strain or damage. Among the known physical consequences of commuting by car are elevated risk for acute herniated lumbar intervertebral disk (Kelsey & Hardy, 1975; Kelsey et al., 1984), cardiovascular stress (Aronow, Harris, Isbell, Rokaw, & Imparato, 1972), and possible associations with various types of cancer (Gubrean, Usel, Bolay, Fioretta, & Puissant, 1992). We review the evidence for each of these consequences separately and then discuss both their implications for employers and possible prevention methods (see Table 4.1 for a summary of these effects).

The question behind this chapter is, very broadly, how do events come to be understood and defined such that particular legal responses are perceived to be appropriate? I shall be looking at this as a process of social categorization. By that, I mean the process whereby events or cases are classified as examples of a class, where the categorization carries social, perhaps legal, consequences or implications.

The greatly increased evidence of drug taking in general, the misery which is caused by this abuse and the death toll which results, requires the continued attention of every serious minded physician. It is essential that each patient be considered as an individual and that his own personal needs be fully explored. The therapist must retain an eclectic view of all forms of treatment available and apply or adapt them as required.

The study of the variation in road accident statistics between different nations has become a well-accepted part of road accident analysis over the last few years. Little work has been completed, however, on the internal variations within one country, between different urban areas. The research outlined in this paper attempted to look at this variation within England, Scotland and Wales, using a multi-stage statistical approach. The variation was studied both spatially and temporally using data from the years 1960–1970. Such studies perform a two-fold function. Besides being valuable for use in deriving basic properties, and much needed system models, they are also useful in investigating the relative effectiveness of countermeasure treatments.

Multi-drug abuse has become common in developed countries and is spreading to developing countries.

The paper reviews known risks on the highway in perspective with the options available for reduction of risk, illustrating principles from experience in Great Britain.

Accidents are by far and away the commonest cause of death in childhood and are an equally important reason for the admission of children to hospital. Although accident rates have fallen slowly throughout this century, the decline has not been as dramatic as has been that for the other common diseases of children. Indeed the whole picture of mortality and morbidity in children has changed during this century (Table 20.1) [1]. The previously devastating illnesses in children, which were largely infective in origin, have been conquered so that accidents have become the leading cause of death in children beyond the first year of life. Accidents accounted for one-third of all deaths in this age-group in 1985 (Table 20.2). However, deaths are only the tip of the iceberg. Almost one-fifth of all admissions for children for any reason from birth to the end of childhood are due to accidents and many of these will result in substantial long-term physical and psychological morbidity additional to the distress and anguish caused by the accident itself.

There is no doubt that alcohol is an important factor in road accidents, but not enough information exists regarding the role of other drugs. Indeed not enough is known about the scale of drug taking by motorists.

This account of the major trends in mortality in the last ten to twenty years is necessarily limited to the broad features of these trends, owing to lack of time and space; a full treatment would be much more extensive. A good recent discussion has been published by Campbell1 and in preparing this note I have drawn heavily on his account.

The risk of a driver under the influence of alcohol being caught by the police is generally considered to be very small. It might happen through a report to the police from some persons seeing him drinking, a police raid or a minor road accident where the smell of alcohol on the driver’s breath betrays his condition or the driver attracts the attention of a police patrol by driving in a way that makes the police suspicious. Instances of drug misuse are generally detected in this way. It means, in effect, that a drug taker is unlikely to be caught unless he is so heavily under the influence that he cannot drive properly or that he shows obvious signs of intoxication when stopped in a police spot-check.