75: Accident: No such thing?

Dr Adrian Davis

Top line: Most collisions with the potential for harm in road transport are not accidents but crashes which may have a number of causes – most often involving human error – and are therefore preventable.

For many years safety officials and public health authorities have discouraged use of the word “accident” when it refers to injuries or the events that produce them. An accident is often understood to be unpredictable—a chance occurrence or an “act of God”—and therefore unavoidable. However, most injuries and their precipitating events are predictable and preventable. In 1993 Evans explained why “motor vehicle crash” is an appropriate expression but “motor vehicle accident” is not: “The word crash indicates in a simple factual way what is observed, while accident seems to suggest in addition a general explanation of why it occurred without any evidence to support such an explanation.”1
“Accident” conveys a sense that the losses incurred are due to fate and are therefore devoid of rational explanation or predictability. Yet the motivation to study subjects like traffic safety is to discover factors that influence the likelihood of occurrence of, and resulting harm from, “crashes,” the preferred term. There are very few traffic related deaths for which the word crash is inappropriate.

By way of example, in medical and air transport incidents the main decision makers are highly trained professionals, and rarely is there any violation of elementary safety procedures, as commonly occurs when car drivers are drunk, violate speed limits, or jump red lights. Evans noted that “unfortunately it is too easy a step from identifying factors associated with losses in transport or medicine to adopting a narrow focus on assigning blame. Perhaps this is what gives “accident” its most potent appeal – the sense that it exonerates participants from responsibility.”

In 2001 the British Medical Journal ‘banned’ the use of the term accident along with a number of emergency medicine journals. As the proponents of the ban noted: “Purging a common term from our lexicon will not be easy. “Accident” remains entrenched in lay and medical discourse and will no doubt continue to appear in manuscripts submitted to the BMJ. We are asking our editors to be vigilant in detecting and rejecting inappropriate use of the “A” word, and we trust that our readers will keep us on our toes by alerting us to instances when “accidents” slip through.2 While some may see this as nothing more than a “pedantic quibble,” they noted that the correct and consistent terminology will help improve understanding that injuries of all kinds—in homes, schools and workplaces, vehicles, and medical settings—are usually preventable. Such awareness, coupled with efforts to implement prevention strategies, will help reduce the incidence and severity of injuries.

1 Evans L. Medical accidents: no such thing? British Medical Journal 1993: 307: 1438-9.
2 Davis, R. Pless, B. Editorial. BMJ bans “accidents”. Accidents are not predictable. British Medical Journal 2001: 322: 1320-1.

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