Medical Conditions and Driving: A Review of the Literature (1960 – 2000)
TRD Page
Foreword
Acknowledgements
Section1: Introduction
Section 2: Vision
Section 3: Hearing
Section 4: Cardiovascular
Section 5: Cerebrovascular
Section 6: Peripheral Vascular
Section 7: Nervous System
Section 8: Respiratory
Section 9: Metabolic
Section 10: Renal
Section 11: Musculoskeletal
Section 12: Psychiatric
Section 13: Drugs
Section 14: Aging Driver
Section 15: Anesthesia and Surgery
Appendix A
List of Tables
List of Figures
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Section 4: Cardiovascular Diseases

4.1b. Sudden Death at the Wheel

Crashes due to sudden death while driving represent one possible tragic outcome for individuals with coronary heart disease, and is a source of potential danger to other road users. A review of the literature suggests that sudden or natural death while driving due to cardiac and other illnesses is a rare event. Early reports suggest that ‘sudden death while driving’ is a causal agent in less than one percent of all crashes (Baker and Spitz, 1970; Grattan and Jeffcoate, 1968; Herner, Smedby, and Ysander, 1966; Peterson and Petty, 1962) and similar results are reported by Copeland (1987). In the Copeland study, case files from the Medical Examiner’s office in Miami, Florida, were examined from 1980-1984. Results reveal that less than one percent of all motor vehicle related accidental deaths were due to ‘sudden natural death at the wheel’. More recently, Halinen and Jaussi (1994) investigated the incidence of fatal traffic crashes caused by sudden incapacity of the driver due to cardiac and other illnesses in Finland and Switzerland. Results, based on a retrospective analysis from traffic accident data files in Finland (1984-1989) and police records of crashes from Vaud, Switzerland (1986-1989), reveal that sudden driver incapacity caused 1.5 percent of all traffic deaths in Finland, and 3.4 percent in Vaud. According to the authors, the higher rate of traffic deaths in Vaud due to sudden driver incapacity is likely due to higher traffic densities in the county of Vaud, which place heavier demands on the driver, and the more advanced age of drivers in Switzerland compared to Finland.

Epilepsy and myocardial infarction (MI) are two of the most common causes of natural death while driving, with MI accounting for the majority of the deaths. In the Halinen and Jaussi (1994) study cited above, 68 percent of all driver deaths from the Finnish component of the study and 79 percent of all driver deaths from the Switzerland component were due to probable/possible cardiac arrest. These results are consistent with those from previous studies (See Table 5).

Table 5  Sudden Natural Death at the Wheel: Causes of Death
 (Reproduced, in part, from Schmidt, P., Haarhoff, K., & Bonte, W. (1990). Sudden natural death at the wheel-a particular problem of the elderly. Forensic Science International 48, 155-162, with permission from Elsevier Science)

Study

Sample
Size

CVD (percent)

CAD (percent)

Tamaska (1961)

60

83.3

45

Peterson et al. (1962)

81

98.8

70.4

Gerber et al. (1966)

57

93

87

West et al. (1968)

155

94

86

Saternus et al. (1973)

91

88

—

Breitenecker (1976)

12

91.7

83.3

Krauland (1978)

433

91

83

Missliwetz et al. (1978)

76

92.1

85.5

Copeland (1987)

133

82

61.8

Ostrom et al. (1987)

126

96

88.9

Christina (1988)

64

87.5

76.8

Penttila et al. (1988)

60

—

75

Antecol and Roberts (1990)

20

—

80

Schmidt et al, (1990)

39

97

90

—      = Data not reported
CVD = Cardiovascular Disease
CAD = Coronary Artery Disease

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