The driver of this car lost control of her vehicle on a dual carriageway, in the early morning rush-hour. She had intended to overtake a tractor pulling a trailer. Sadly, going 70mph, she misjudged it. The car skidded and the trailer sliced the car in two.
At least, that is what we think happened. The driver was sending a text at the time, so no one is quite sure.
She arrived at my A&E department, about an hour after the accident, strapped to a spinal board and escorted by three paramedics.
What is remarkable about this story is not that a young woman crashed while texting, but that immediately after the accident she opened the remains of her driver's door and stepped out onto the hard shoulder, completely unscathed. She even rescued her handbag.
How is it possible for a human being to survive that tangled wreck?
There are a few explanations we could offer. Pure luck is clearly high on the list. Yet the data is also unequivocal: in 1966 almost 8,000 people lost their lives on the UK's roads. Today, the annual total is less than a quarter of that number. A 75% decrease. That's not luck.
How has this happened? Because, since 1966 almost everything on the road has changed. Not just the design of cars, which have been transformed by new materials and computer-aided design, but also the road itself: markings, studs, surfaces, signage. And roundabouts. So many roundabouts.
But much else has changed. When I was 17 I was given a permit to ride any production motorbike available - including the much coveted (by me) Honda CB750, top speed 128mph. My parents good sense and my own poverty prevented me killing myself before reaching majority. The government - or the system - by contrast seemed to want me dead. I gained the necessary licence by riding round the block on a moped while the examiner stood in one spot, outside the testing station. He must have seen me ride about 100 yards. The most exacting part of the test was ensuring I didn't run him over when he asked me to do an emergency stop.
Today, by contrast, even if you can pass the gruelling theoretical and practical tests on a motorcycle, you'd be hard pushed to find any insurer that would give you cover if you're under 30.
Another thing: on the whole, we don't drink and drive.
In the 1960s, it was de-rigeur to have "one for the road" to steady your nerves before you weaved your way through the car park. Nowadays, you'll be cast-out like a leper if you admit being in the same room as a Campari. And it's become a serious moral issue. (If you don't believe me, go to dinner with some good friends, down a bottle of wine and then reach for the car-keys. You may not enjoy what comes next.)
And then there are seat belts. And helmets. And finally, of course, there are cameras. Villainous yellow beasts that entrap the innocent … or so you will hear from those that have been caught. But they do slow people down - and as a result of this and everything else 6000 people who would otherwise have been killed this year will have Christmas with their families. There is clearly more to do, since 2000 families will have had their hearts ripped out … but without doubt, the roads are safer than they were 50 years ago.
Which brings me, via the country route, to the subject of safety in healthcare.
Martin Bromiley, in the foreword to NAP4, in 2011 said "You will now be familiar, and probably tired of the constant comparisons between pilots and anaesthetists." Comparing anaesthetists to pilots is part of a wider trend of asking healthcare to think, from a safety perspective, like aviation, concentrating on human factors in particular. However, while aviation is an extraordinary and laudable example of safety culture producing remarkable results, the power of the metaphor outside the operating theatre is strained. Most healthcare is pretty low tech: getting some pills out of a bottle and putting them in the hands of the patient, is just so much less challenging than flying a plane, even if, for the patient, it can be equally dangerous.
The catastrophe is that 1 in 10 hospital stays result in avoidable harm to patients. Even trying to do our best, we can badly damage our patients: "Never events", failing to check the patient for bedsores, medication errors, wrong diagnoses … there is no end to the things we can do wrong.
The government has even appointed the wonderful Don Berwick to act as a the NHS's "Safety Tsar" to help us sort out this mess.
(As an aside here: weren't the Tsars absolute rulers whose every word had to be obeyed, that nonetheless came to a particularly sticky end? I mean, Tsar is surely not the right word in these circumstances. There must be better power-based historical metaphors for such roles. "The NHS Safety Shogun" maybe?)
Safety in healthcare is a complex issue - the Health Foundation has an excellent paper which tries to unpick some of this complexity but the fact is, putting pills in people's hands, ordering blood results, checking for bedsores are also just, well ... mundane.
Mundane, in fact, like driving a car.
Instead of pilots and airlines, perhaps it would be better to think of the healthcare landscape as being like the roads and motorways, where patients are the passengers and pedestrians; healthcare workers are doing the driving; the roads are the pathways and processes that we choose to navigate for and with our patients; the vehicles are the technology we employ to help us get there.
As with driving, the experience and skill of a careful driver can make all the difference to the outcome of a journey.
Clearly, in this metaphor, we are still living in 1966. Our roads are poorly signed, and poorly lit, our vehicles are badly designed and many of our drivers should probably not be on the road. As a result many people are being damaged.
So here's the question: what are the transformations we may need to reduce our deaths by 75%?
Drive carefully!
At least, that is what we think happened. The driver was sending a text at the time, so no one is quite sure.
She arrived at my A&E department, about an hour after the accident, strapped to a spinal board and escorted by three paramedics.
What is remarkable about this story is not that a young woman crashed while texting, but that immediately after the accident she opened the remains of her driver's door and stepped out onto the hard shoulder, completely unscathed. She even rescued her handbag.
How is it possible for a human being to survive that tangled wreck?
There are a few explanations we could offer. Pure luck is clearly high on the list. Yet the data is also unequivocal: in 1966 almost 8,000 people lost their lives on the UK's roads. Today, the annual total is less than a quarter of that number. A 75% decrease. That's not luck.
How has this happened? Because, since 1966 almost everything on the road has changed. Not just the design of cars, which have been transformed by new materials and computer-aided design, but also the road itself: markings, studs, surfaces, signage. And roundabouts. So many roundabouts.
But much else has changed. When I was 17 I was given a permit to ride any production motorbike available - including the much coveted (by me) Honda CB750, top speed 128mph. My parents good sense and my own poverty prevented me killing myself before reaching majority. The government - or the system - by contrast seemed to want me dead. I gained the necessary licence by riding round the block on a moped while the examiner stood in one spot, outside the testing station. He must have seen me ride about 100 yards. The most exacting part of the test was ensuring I didn't run him over when he asked me to do an emergency stop.
Today, by contrast, even if you can pass the gruelling theoretical and practical tests on a motorcycle, you'd be hard pushed to find any insurer that would give you cover if you're under 30.
Another thing: on the whole, we don't drink and drive.
In the 1960s, it was de-rigeur to have "one for the road" to steady your nerves before you weaved your way through the car park. Nowadays, you'll be cast-out like a leper if you admit being in the same room as a Campari. And it's become a serious moral issue. (If you don't believe me, go to dinner with some good friends, down a bottle of wine and then reach for the car-keys. You may not enjoy what comes next.)
And then there are seat belts. And helmets. And finally, of course, there are cameras. Villainous yellow beasts that entrap the innocent … or so you will hear from those that have been caught. But they do slow people down - and as a result of this and everything else 6000 people who would otherwise have been killed this year will have Christmas with their families. There is clearly more to do, since 2000 families will have had their hearts ripped out … but without doubt, the roads are safer than they were 50 years ago.
Which brings me, via the country route, to the subject of safety in healthcare.
Martin Bromiley, in the foreword to NAP4, in 2011 said "You will now be familiar, and probably tired of the constant comparisons between pilots and anaesthetists." Comparing anaesthetists to pilots is part of a wider trend of asking healthcare to think, from a safety perspective, like aviation, concentrating on human factors in particular. However, while aviation is an extraordinary and laudable example of safety culture producing remarkable results, the power of the metaphor outside the operating theatre is strained. Most healthcare is pretty low tech: getting some pills out of a bottle and putting them in the hands of the patient, is just so much less challenging than flying a plane, even if, for the patient, it can be equally dangerous.
The catastrophe is that 1 in 10 hospital stays result in avoidable harm to patients. Even trying to do our best, we can badly damage our patients: "Never events", failing to check the patient for bedsores, medication errors, wrong diagnoses … there is no end to the things we can do wrong.
The government has even appointed the wonderful Don Berwick to act as a the NHS's "Safety Tsar" to help us sort out this mess.
(As an aside here: weren't the Tsars absolute rulers whose every word had to be obeyed, that nonetheless came to a particularly sticky end? I mean, Tsar is surely not the right word in these circumstances. There must be better power-based historical metaphors for such roles. "The NHS Safety Shogun" maybe?)
Safety in healthcare is a complex issue - the Health Foundation has an excellent paper which tries to unpick some of this complexity but the fact is, putting pills in people's hands, ordering blood results, checking for bedsores are also just, well ... mundane.
Mundane, in fact, like driving a car.
Instead of pilots and airlines, perhaps it would be better to think of the healthcare landscape as being like the roads and motorways, where patients are the passengers and pedestrians; healthcare workers are doing the driving; the roads are the pathways and processes that we choose to navigate for and with our patients; the vehicles are the technology we employ to help us get there.
As with driving, the experience and skill of a careful driver can make all the difference to the outcome of a journey.
Clearly, in this metaphor, we are still living in 1966. Our roads are poorly signed, and poorly lit, our vehicles are badly designed and many of our drivers should probably not be on the road. As a result many people are being damaged.
So here's the question: what are the transformations we may need to reduce our deaths by 75%?
- A "DVLA" - a single licensing authority for anyone who wants to drive anything?
- A "Transport Research Laboratory" that works out how to make driving safe?
- A "Highway Code" of behaviour for pedestrians and drivers alike?
- A well-lit, clearly mapped network of roads?
- Road-savvy pedestrians?
- Vehicle's built for safety, not looks?
- Traffic management systems?
Drive carefully!
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