Do Drunk People Really Survive Car Crashes More?

Brexstacular asks: Why don’t drunk drivers get injured very often in wrecks?

There are seemingly never ending news stories involving the mug shot of a drunk driver mostly unharmed after getting in an accident. Meanwhile, their victims are left fighting for their lives, or worse, already dead.  The perception from this is that somehow being drunk will protect you from sustaining injuries in the event of a car crash or some other trauma.  As to why, the commonly held idea is that the more relaxed you are in your drunken stupor, the less likely you will be to get injured.  As to why, the general idea often put forth is that you’ll bend and contort into whatever shape the accident puts you in without fighting it.  Stiffening up prevents your ability to fold like a pretzel and makes all your inner bits tense. Thus, you snap like a twig, injuring yourself more readily and severely.  But is any of this actually true? Are drunk drivers actually less likely to be injured than their vastly more responsible compatriots?

It turns out there are indeed many studies on the topic that show you have a greater chance of survival from trauma should alcohol be in your system.  That said, other studies show overall mortality can be as much as 2-fold higher if you have alcohol on board.  So, which is correct and is the whole floppy drunk thing actually protecting you?

To begin with, let us look at the whole Floppsy the drunk thing.  All the nerve cells in your central nervous system can be either excited or inhibited by neurotransmitters.  The more excited, the quicker and stronger your muscles will react.  Glutamate is an excitatory neurotransmitter.  Thus, it gives your brain and spinal cord the ability to send electrical signals at high rates of speed.  Alcohol inhibits glutamates’ ability to do this by reducing ion flow through glutamate receptors.  It can do this with blood alcohol levels as low as 0.03. The more alcohol you consume, the harder it is for you to control those muscles because glutamate can no longer transmit as readily.  The result makes you walk like Gumby in an earthquake.

So now let’s look at Floppsy in a car wreck. When you get into such an accident, there are three collisions- the car hitting something; you hitting the inside of the car; and your organs hitting the inside of your body.  So as the floppy-drunk hypothesis goes, if you’re sober as a catholic priest on Sunday, you’ll tense up, reducing the absorption capacity of your body to take the punch and making your rubber band like tendons and the like tighter and more likely to snap as a result; compare that to your inebriated counterpart who takes the path of least resistance, turning their arms and legs into a newly acquired air-bag and fully taking advantage of your stretchy inner bits doing their thing.  On the surface, this all seems reasonable enough.

Unfortunately, due to the decrease in your muscles tension, the argument can be made the impact of your body with the car will be a greater force than if your arms or legs were tensed and able to direct that force in a more controlled way.  On that note, in the journal article Does alcohol intoxication protect patients from severe injury and reduce hospital mortality? published in ‘The American Surgeon’ in Dec. of 2013, researchers found those with positive blood alcohol levels actually had an increased risk of sustaining head, facial, chest and abdominal injuries.  Those injuries are obviously much more prone to killing you then the arm or leg fractures, torn tendons, and the like sustained from stiffened limbs.

From this and other such studies, while the research to date is unfortunately far from definitive, the idea that you’re more likely to survive a car accident because you become as floppy as your grandpa before Viagra is generally considered somewhat suspect- or at the least currently falling solidly under the category of “more research needed”.

That said, there really is a growing body of evidence showing a large amount of alcohol in your system will give you a better chance of survival in a traumatic event. (Though, also drastically increases your chances of getting in that traumatic event in the first place, not just in cars, but doing anything- “Hold my beer” being a meme for a reason.)

Further indicating that being flopsy isn’t the root cause is that it turns out the benefit here does require you make it through your alcohol-fueled traumatic event and reach medical aid.

Whether drunk or not, unsurprisingly, should you remain alive long enough to see the hospital, chances are, you’ll survive the initial assault on your system. For everyone, the complications after, from how the body reacts to your injury, will now be your greatest enemy to whether you survive beyond.  And it is this that is thought to be where the real benefit comes from- how alcohol affects these bodily reactions.

On that note, in Jan. of 2010, researches publishing in the Journal of American Medical Association, ‘Motor Vehicle Crashes: The Association of Alcohol Consumption with the Type and Severity of Injuries and Outcomes’, found that those whose injuries were the most severe had a significantly better survival rate compared to those who didn’t if they had high levels of alcohol in their system. On top of that, even though drunk people were more likely to get severe head trauma and septic complications (infections), they nevertheless had better survival rates despite this.

Backing up this idea, in 2012 at The University of Illinois at Chicago, researcher and injury epidemiologist Lee Friedman found alcohol decreased mortality for all types of traumatic injuries-  fractures, open wounds, and internal injuries to name a few.  The only type of trauma not seeing a benefit was burn patients.  This makes sense given the immunosuppressant effects of alcohol and the known, deadly complication of infection in burn patients.

Dr. Friedman also showed the benefits increased the higher the blood alcohol concentration was, reducing mortality up to 50% in some cases.  Unfortunately, as he points out, no one definitively knows why this is the case. There just aren’t currently many studies looking at the physiologic mechanisms involved in alcohol’s protective effects once the body is injured.

Nonetheless, in an attempt to solve the mystery, Dr. Friedman took a stab at explaining why alcohol might help in these cases.  In his 2014 study, ‘Complications Associated with Blood Alcohol Concentration Following Injury’, he hypothesized the protective benefits came from how alcohol affects the many types of complications following injury, specifically reducing the chances of having said complications in the first place.

Looking at the data, of those who were covered in the study who died, 43.2% had at least one complication.  However, among the inebriated, instances of complications were indeed decreased. For example, the tipsy individuals saw a decrease in cardiac complications by 23.5%, and renal function complications by 30%. Friedman states “The current analysis shows there were reductions in medical complications dominating the cardiovascular system and kidneys, which provides clues to solving this interesting and potentially life-saving puzzle”.

Throwing a wrench in things, however, is a 2011 study ‘Alcohol Exposure and Outcomes in Trauma Patients’.  Published in the European Journal of Trauma and Emergency Surgery, these researchers found mortality was almost two-fold higher in trauma patients who had alcohol in their system.  Further, victims of penetrating trauma were more likely to be admitted with no vital signs if they had alcohol in their system compared to those who didn’t.  They also found those who were alcohol positive were more likely to be admitted with low blood pressure (hypotension) and a lower GCS, (a measure of mentation known as the Glascow Coma Scale). They surmised this may increase mortality.

As to why, they point out “Alcohol alters hemodynamic, metabolic, and inflammatory homeostasis after hemorrhage, blunts the catecholamine surge after injury, and reduces the electrical threshold for ventricular arrhythmias…immunosuppressive effects from alcohol increase the risk of secondary infections….”  In English, basically you’ll bleed more if you get cut when tipsy because the body’s ability to constrict its blood vessels and clot off is reduced.  The chance of your heart going into deadly rhythms is increased.  Should you get an infection, your body’s ability to fight it will be diminished.

The authors do point out, however, there’s a discordance in the studies resulting in inconsistent findings in the literature.  They also state their study greatly contributes to the continued controversy over the issue and will of course mandate further study to reach any level of definitiveness.

Very important to point out here is that when looking at these various studies, part of the controversy and seemingly inconsistent data is that wildly different results often depend on what type of trauma the researchers are studying- burns vs gun shots vs motor vehicle accidents, etc.  This, of course, shouldn’t come as a big surprise as there’s no such thing as a cure-all, and thus it’s not surprising alcohol might be beneficial in some types of injuries, while not in others. It’s just the question of whether you’ll be safer in, say, a car accident, or not if drunk isn’t yet fully clear when all factors are considered including deaths directly after the initial impact.

That said, while not for every traumatic situation, there is convincing evidence mortality in certain types of patients can be reduced with the addition of some good old-fashioned moonshine.

Take traumatic brain injuries (TBI) for example. There are quite a few studies, and reviews, showing alcohol will have a protective affect should you have one. When you get a TBI your body’s fight or flight nervous system (sympathetic) releases a surge of neurotransmitters like norepinephrine and epinephrine. It also ends up with high levels of excitatory neurotransmitters like glutamate and aspirate.  The release of these cause a cascade of chemistry leading to neuron cell death.  Calcium influx causes mitochondrial death. Mitochondria produces adenosine triphosphate, which is needed to give cells their ability to function.  Sodium influx is also increased causing the cell to swell and die.

To prevent this, if you just blocked the receptor sites allowing these chemicals to weave their web of woe, you can help in the complications from them and your neurons live to fight another day.  One pathway is to block a receptor known as N-methyl-D-aspartate (NMDA).  Remember blocking glutamate makes you all floppy when your drunk?  NMDA is a type of glutamate receptor.  Block it and you’re floppy, and you get to save some brain cells from a TBI.

Alcohol is also associated with marked decreases in epinephrine and norepinephrine release.  So, alcohol will decrease the surge of sympathetic neurotransmitters while not allowing the ones that are there, like glutamate, to work, giving you a greater chance of saving those precious brain cells should you have a TBI.

For what it’s worth, animal studies on rats in 2013 also seem to confirm this data, showing that neuron cell death was decreased after a TBI if alcohol was present in the rats’ bloodstream. Thus, while your chances of getting a TBI are greatly increased when you’re drunk, funny enough, you’ll have a better chance of survival when you get one.

In the end, while we can’t say for sure if alcohol will protect you from injury or death in an accident, contrary to popular belief, while more data is definitely needed to be definitive about it, it does not appear that being floppy is the reason for the protection. There is, however, a growing body of evidence it will help in certain types of injuries that may occur in such an accident, potentially paving the way for a new and effective way to help treat certain traumatic injuries once things are a bit more definitive. Of course, the more you drink, the more likely you are to be injured in the first place. So maybe don’t drink and drive.

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  • Very interesting article that made me think. Maybe a shot of whiskey for stroke victims will become
    the next “chew this aspirin” for suspected MI. I’d imagine the processes are similarly inhibited for
    infarcted brain tissue. Hmmm….

  • Maggie Momentus

    Momentum ?

    A drunk driver toddling away unhurt from a fatal accident has traditionally been attributed to relative momentum.

    If you take the extreme example of a head on collision, any sober person will do their best to avoid or minimize damage, hence jumping onto the brake is a typical first step. An inebriated person has slowed responses and so may fail to decelerate as quickly or at all. At worst, they may confuse the brake with the gas.

    The car with the greater deceleration rate absorbs more of the impact as momentum transfer to it, yielding the worse outcome for the responsible driver while the drunk gets off lightly.

    Hence the saying that “God protects drunks and fools”.