Tomorrow’s World is very much the here and now. As the technologies of childhood dreams continue to develop at a rate of knots, careful consideration must be given to the potential implications of exciting new innovations. This is especially true for the world of automated, driverless or self-driving vehicles. Not only are millions of taxi and delivery drivers about to be made redundant but we should expect to see both positive and negative implications for the healthcare sector.
The first thing worth noting is that there are different levels of automation ranging from your standard driver assistance aids such as forward collision warning and emergency braking (Level 0), adaptive cruise control and lane assist (Level 2) up to near full automation (Level 4). Lower level automation is widely incorporated into most modern cars and has significantly reduced the rate of rear-end frontal impacts.
The benefits of removing humans from the driving equation altogether are obvious. Human error is a factor in 90% of vehicle collisions with a significant chunk of that down to people driving while under the influence of alcohol or drugs. Driverless cars allow the users all the benefits of owning a vehicle, with the addition of not having to worry about parking, or watching how much you drink on a night out and also allows for greater productivity during the 200 hours per year the average person spends commuting. Replacing millions of private gas-guzzling vehicles with a smaller pool of shared cleaner or electric vehicles also has positive environmental implications. The state of Arizona is one of several locations throughout the US and Canada that have been used as a testing hub for companies like Waymo, Tesla and Uber. Waymo (the offspring of Google’s automated vehicle program) hit the 10 million mile mark in October 2018, however despite this the long-term data required to make sensible safety comparisons between conventional and automated vehicles is lacking. Cars driven under traditional human control are currently involved in approximately 1.18 fatalities for every 100 million miles. It’s worth noting that there are still over 37000 road traffic deaths on US roads each year, including around 6000 pedestrians. To date there have been 5 recorded self-driving car fatalities. Four of those killed were Tesla test drivers in the US and China and perhaps most tragically one involved a pedestrian struck by an Uber vehicle (with a human backup driver on board) in March 2018. It was later found that the car’s sensors had detected the victim but the emergency braking had been disabled owing to previous passenger complaints about the jerkiness of the ride. Until driverless cars clock up hundreds of millions of miles however, it’s difficult to draw any solid conclusions from a handful of tragic cases.
It is projected that a 10% penetration of the vehicle market by driverless cars would result in a 4% reduction in the annual vehicle collision burden and that a 90% market share would result in almost 80% of vehicle collisions being avoided each year. Globally, 10 million lives per decade could be saved thanks to driverless cars. That’s awesome. But will such a reduction in work load make some trauma centers and their staff equally as redundant as the truck drivers? Will it provide governments with an excuse to cut back on health spending? Will we see a sharp downfall in the supply of organs for donation? Around 20% of organ transplants come from road fatalities. Or will a new source of death and disability arise, that, much like the impact of ride-hailing apps, we cannot even conceptualize at this point?
We’ve yet to see how these vehicles function outside of their carefully selected test locations. Adverse weather conditions, roadworks and the subtle non-verbal social interactions that are integral to communicating your intentions (and frustrations) to other road users may prove tricky nuts to crack and it may be some time before fully automated cars are let loose on the streets of the world. However, the healthcare sector may find itself having to quickly adapt to the unforeseen second-order effects of this new technology.
Obi Nnajiuba is a British surgical resident and current PhD student with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone
