Professor Denis Cusack:

On behalf of the Medical Bureau of Road Safety and as its director, I thank the Cathaoirleach and members of the committee for the kind invitation to present and assist the committee with regard to current aspects of road safety. I see the Minister of State, Deputy Chambers, on the other monitor speaking to the Seanad on road safety at this very moment. I addressed this committee on 30 June last year and some of what I say will be a repeat of what I said at that time. However, it must be repeated as it is even more relevant today.

As I am the last to deliver an opening statement, some of what I have to say has already been said. I am curtailing some of my written presentation to make this oral presentation.

As well as speaking as the director of the bureau, I am also going to, as I usually do, bring in my experience as a coroner and forensic clinical doctor. I have been involved in each of the Government road safety strategies since the first in 1998 when the number of road fatalities in Ireland was 472. That was a time when we had a much smaller population and that 472 equated to 124 per million of population. In 2023, as we have heard, there has been a significant and tragic increase of almost 25% on the 2022 figure with 136 people killed to date, exceeding the total number of deaths recorded for all of 2021. That is a shocking and jolting reminder of how these figures are subject to stark change in a short period. As has been said, each of those dead persons was a unique individual with a loving family and friends who is now lost to us before his or her time. A large number of those who died were young, under the age of 35, including children. As a doctor, I wish to stress one of the points that has already been made. I have been with my colleagues in the National Rehabilitation Hospital on Rochestown Avenue. The number of not only life-changing but life-shattering injuries, with blighted lives and enormous stresses on families, is approaching 900 this year to date.

Factors causing road crashes stubbornly remain the same and need to be named over and over again. They include, as we have heard, speeding, the non-use of safety belts and protective gear, and dangerous and careless driving due to fatigue. The term "distracted driving" is used but the word "distracted" makes it sound like there is something external causing drivers to be distracted. I prefer the term "driver lack of attention", which puts the responsibility back on the driver rather than on an external factor. That could be due to mobile phone use. Of course, driving under the influence of intoxicants is also a cause of crashes. None of this is new and we must approach it on all fronts. Our response must be evidence-based and including the new speed limits must be proportionate. There must be buy-in from the public. We must have the confidence of each citizen.

What do we have to do now to refocus yet again? I will deal first with driving at excessive speed. I am putting on my coroner's hat. Excessive speed for the road condition and driving under the influence of alcohol and drugs remain the highly significant problems in road crash causation. That has not changed. I emphasise and support the measures to tackle this problem based on speeding, which is often combined with intoxicated driving, not wearing seatbelts and lack of attention. Practical measures to address this include the lowering of the speed limits on certain roads to appropriate levels, education that the limits are not targets, an increased mobile speed detection programme, more fixed speed cameras and average speed detectors. They work elsewhere and they can work here. They are going to cost money but will save money and, more importantly, save lives and injuries. I urge the allocation of resources and funding to bring the current mobile speed detection system to the maximum achievable in the immediate term. That does not mean next year. It means in the next month or so, leading up to the end of the year. That will have an immediate outcome on the horrendous injuries and deaths.

Something else I have noticed only occurred to me in my own driving. There should be greater use by individual drivers of the speed limiters in modern cars. I use one. From time to time, we do not attend to the speed limits. A speed limiter is a very good control. Someone said to me that would mean we adjust the limiter as we move between speed limits. That is exactly the point. It means drivers must pay attention to adjust the limiter up and down. We are not making use of that simple technology. I urge the use of an education programme encouraging drivers to use speed limiters.

Regarding driving and intoxicants, the committee knows about the Medical Bureau of Road Safety, MBRS, so I will not go into it. We operate under the Road Traffic Acts 1968-2016. In 2022, a total of 5,662 blood and urine driver samples were received by the MBRS for alcohol and drug testing with 3,800 being tested for drugs. More than 3,800 breath samples were tested for alcohol in 87 Garda stations across the country. Some 1,400 preliminary alcohol breath testing devices are supplied by the bureau to the Garda. The number of blood and urine samples received this year to 22 September was just under 4,000, a 6.5% reduction on 2022 but higher than the 2019 pre-Covid figure.

Alcohol remains the most frequently used intoxicant in driving. In drivers found positive for alcohol in samples analysed in 2022, the average blood alcohol level was 160 mg per 100 ml of blood. The limit for the ordinary driver is 50 mg per 100 ml. The highest level found was 415 mg in blood. That is enough to kill a lot of people from alcohol poisoning. The vast majority of drivers with alcohol intoxication are very drunk when driving and the predominant cohort responsible is men under the age of 45. It is not just people who miscalculate and take an extra bit of wine when they do not need to. These people are far over the limit.

One of the actions in the road safety strategy, and now part of one of the ministerial priorities, is the alcohol interlock device which will prevent a vehicle from starting if the breath sample from the driver is over the alcohol limit. This is being led by the bureau. We have already had an EU invitation answered by a number of manufacturers. We are getting ready to test and approve such devices in the coming months. They will initially be for fleet drivers but they will later also be used in driver offender programmes. It is very technical but this ensures that any device introduced conforms to the highest standard. It will, in the first instance, be used on a voluntary basis for those fleets. The fleet insurers should be involved. Perhaps they have some incentives to offer. I cannot go into more detail in that respect because I know the Department is working on it. This would only be the first step. The figures show that approximately one third of the drivers in coroner's reports had alcohol on board. That does not mean it was the cause of the accident but that is certainly significant. If we could eliminate that factor by not allowing cars and other vehicles to start, we could make great headway.

On the issue of drug driving, samples were found positive for cannabis, cocaine and benzodiazepines. As with alcohol, those drivers who were detected drug driving were multiple times the limits. They were five, ten and 12 times the limits we have for cannabis and cocaine, in particular. When they are over the limit, they are way over it. It is also most common among those under 45 years of age.

I am now holding up the current system we use. It is not like the big machine and that is important. It tests for cannabis, cocaine, opiates, benzodiazepines, amphetamines and methamphetamines. The introduction of this new cassette system will facilitate the proposed introduction of mandatory roadside drug testing at the scene of a crash where injury has occurred. This will bring the powers of the Garda to the same level available as in respect of alcohol under section 9 of the Road Traffic Act 2010 at the site of a crash where there is an injury.

All of these measures, together with reviewing penalties for polydrug use, which means alcohol and drug use or two types of drug use, will be top priorities in the current legislative review. They give a clear message that intoxicated driving is not permissible.

We must also ensure that drivers on medications, properly prescribed and dispensed for medical conditions, continue to take their medications. That is important to me as a medical practitioner. Sláinte agus tiomáint and the leaflets on medicines and driving are important. We must have a medical and dependency rehabilitation programme to assist the health and well-being of the small number of drivers who have alcohol and drugs misuse addictions. Those should be available in addition to sanctions through the courts.

I will end on a positive note. There has been a lot of despondency, which I understand. I have dealt with families whose loved ones have died or been injured. Notwithstanding the terrible toll of road deaths and injuries, we already have road safety tools in place. We must double down on these measures and hold our collective nerve. We must show courage to act on both existing and new measures. With that, we can again decrease the numbers of road crashes and injuries. I have summarised in seven points some practical measures to address speeding and intoxicated driving.

I commend these measures and initiatives to the committee. I thank all my colleagues in the bureau. I am pleased, as are my colleagues here, to assist the committee and to answer questions from the members about issues arising. I thank members for their courtesy and attention.