1. Bennett, Vicki J. MSN, RN

Article Content

Many of us remember "Lost in Space" and for those too young to remember, Google it on your computer, cell phone, or personal digital assistant, or perhaps, text message a friend. After all, it is 2009, and we can surf the Web to find anything.


You may wonder why I am writing about this topic. My simple answer is that I am truly concerned. This concern particularly struck me as I was driving to work one Saturday, and while I stopped at a red light, I noticed a young man peddling down the bike path without wearing a helmet and his iPod plugged in his ears. What really caught my attention was the fact that he was also texting on his cell phone, totally detached from planet Earth. That's right, he was text messaging while riding his bicycle and totally oblivious to his surroundings. "Look ma, no hands" suddenly had a new meaning.


Our society's obsession with technological gadgetry has caused a rapid proliferation of many devices that have interfered with safe human performance of everyday actions. We are a society of multitaskers. Whether that includes using cell phones, laptops, and personal digital assistants while driving, walking, talking, or riding-distraction exists. Danger lurks.


Driver distraction due to cellular phone use is a major cause of motor vehicle crashes. Whether or not it is the actual cell phone use and resultant distracting behavior or other unsafe driving patterns is difficult to determine. However, most would agree that either or both increase crash risk.1-4 An estimated 30% of all crashes involve some type of driver distraction.5 A recent survey of Maryland motorists concluded that drivers using cell phones were more likely to engage in other unsafe behaviors such as speeding, careless driving, jumping a red light, and driving under the influence of alcohol or drugs that place them at a higher risk for a traffic crash independent of cell phone use.6


While we all know the dangers of such usage, text messaging while in motion is reaching new highs as a dangerous trend involving inattentiveness and poor choices. More than 75 billion text messages were sent in the United States in June 2008 compared with 7.2 billion in June 2005, according to CTIA-the Wireless Association, the leading industry trade group.7,8 New estimates state that more than 42 million text messages are sent daily.9 According to a 2006 study by Nationwide Insurance,1 19% of drivers were engaged in text messaging while at the wheel, and this number jumped to 37% among drivers aged 18 to 27 years.


The probability of injuries to drivers, passengers and pedestrians is too high to ignore. A recent study published in Accident Analysis & Prevention noted that pedestrians using cellular phones were more likely to step into oncoming traffic, thus increasing their injury potential. They also noted some commonalities with drivers and pedestrians in that situational awareness is decreased secondary to cognitive distraction.4


A driver engaged in text messaging is not looking at the road, and both of his or her hands are not on the wheel. Not only may one be driving down the road but also walking down the street, rollerblading, and, yes, some even bicycling while sending a text message. You stare in disbelief as I have[horizontal ellipsis]until we question ourselves of perhaps doing the same thing while stopped at a red light. However, many feel a sense of urgency to communicate and do not wait until they have time to respond in a safer environment, attempting to do multiple things at once.


The headlines of teenagers being killed in crashes because of their text messaging immediately prior to a crash or distracted pedestrians walking in front of oncoming traffic are becoming more common. Perhaps, you may have read of former Senator Obama's aide who sprained her ankle while texting as she unknowingly stepped off a curb,9 of the death of a Florida teen who recently stepped into the path of a vehicle while text messaging with his head down, or of the 5 teenaged girls who were killed in a car crash in New York because the driver was text messaging.1,10,11 In more recent news,12,13 text messaging was confirmed as having played a role in the fiery commuter train crash that killed 25 individuals in southern California and injured another 135. In addition, a trolley conductor's apparent text messaging to his girlfriend resulted in a recent trolley collision in Boston that injured 49 people.14 These are the terrible end results of poor choices that cause needless tragedies.


There are situations that require constant attention that cannot be safely performed while distracted. David Strayer, a University of Utah psychology professor, has studied the effect of cell phone use on motorists and calls this "inattention blindness." People are so involved in focusing on a keyboard and screen while typing in a message that they are not aware of things that go by. It is estimated that it takes a period of 5 to 10 seconds to readjust focus of the human eye.13 This is enough time to cause a tragedy. In an interview with The New York Times, Paul Saffo, a technology-trend forecaster in Silicon Valley, noted that certain hobbies are incompatible and are not meant to be practiced at the same time. He went on to state that the act of texting automatically removes 10 IQ points.7,8


Countries other than the United States totally ban cell phone use while driving.15 Many states have enacted legislation that has banned talking on a cell phone while driving, and others have implemented mandatory hands-free devices. While these are not a solution, they are an attempt to increase safety. A few have addressed the issue of text messaging while driving. In fact, during the time spent writing this article, states that banned text messaging by drivers doubled in number. At the time of this writing, there are 10 states, Alaska, Arkansas, California, Connecticut, Louisiana, Minnesota, New Jersey, Utah, Virginia, and Washington, and the District of Columbia that have banned text messaging while driving.1,16 For an up-to-date listing of laws, refer to


Auto safety groups such as the American Automobile Association and the makers of handheld devices have stated their support of a ban. The ban is chafing among many libertarians and others who deem it an infringement on personal freedoms much like motorcycle helmet laws. Many politicians believe that the behavior is foolish but are concerned that criminalizing it will make monitoring and enforcement difficult, if not impossible.1 Aside from legal initiatives, efforts have focused on prevention. There are many organizations that are taking steps to deliver warnings of the dangers of text messaging while in motion.


In anticipation of the new school year, the American College of Emergency Physicians issued a statement warning of the dangers of text messaging. Emergency department visits are increasing, with a growing number of incidents arising from text messaging and multitasking.


We can all learn something from the following 5 tips that Dr Linda Lawrence, president of the American College of Emergency Physicians Foundation, offers on its Web site17:


1. Do not text or talk on the phone in situations that require constant attention, such as while walking in a busy area, cycling, sailing, and roller-skating or while playing sports.


2. Never text or use your mobile phone while operating a motor vehicle or motorcycle and be aware that though headsets and other hands-free systems can be helpful, they are not a solution.


3. Keep mobile phones in easily accessible areas of backpacks, purses, or loose pockets, so you do not have to rummage around for the device and divert attention from other tasks.


4. Do not hesitate to ignore a call or message alert if it might interfere with whatever you are doing at a given time. There will be plenty of time to respond in a safer situation. Also, consider turning off your mobile phone before taking part in activities that require a high level of attention, such as driving.


5. Be aware of your surroundings while using a mobile device and never text or talk on the phone in environments in which doing so could lead to safety concerns, such as while you are alone in the evening, waiting for public transportation, or anywhere else someone may attempt to capitalize on your inattention by stealing.17



Others taking action include Nationwide Insurance and the National Association of Sports Car Auto Racing, which have enlisted the help of race car driver Jeff Burton as a safety advocate to help deliver safety messages by appealing to the public, especially the younger "generation Y-ers," many of whom honestly believe that they have the talent to do more than one task at a time safely. Nationwide and the National Safety Council have also developed a Web site,, aimed at helping young drivers develop safe driving behaviors.18


Why has our world of technology increased to the point that we have forgotten how to talk to one another and how to communicate through the written word? For example, do you, or do others you know, send text messages across the room to a coworker while in a meeting? Have you ever seen someone text message friends across the classroom or a sibling across the living room?


Yes, indeed, text language has become so commonplace that many students are using it in submitting schoolwork because they believe it is acceptable. Many teachers will tell you that students have forgotten what complete sentences look like and are using text abbreviations in submitted paperwork.


What is so important that cannot wait? Is life so unimportant that we are willing to risk harming ourselves and those around us? Many will say that we cannot legislate everything, and perhaps this is true. However, it is our responsibility as trauma care providers to promote injury prevention initiatives related to activities that have been strongly associated with injury, disability, and death.


No longer should we suffer from TWTMO on life. That would be "Texting while totally missing out." "Lost in space" is not the destination of choice when lives are at stake.




1. Konigsberg E. Councilman seeks to ban text messaging at wheel. New York Times. Accessed August 20, 2008. [Context Link]


2. Peters GA, Peters BJ. The distracted driver. J R Soc Health. 2001;121(1):23-28. [Context Link]


3. Eby DW, Vivoda JM, St Louis RM. Driver hand-held cellular phone use: a four-year analysis. J Saf Res. 2006;37(3):261-265. [Context Link]


4. Nasar J, Hecht P, Wener R. Mobile telephones, distracted attention, and pedestrian safety. Accid Anal Prev. 2008;40(1):69-75. [Context Link]


5. Insurance Information Institute. Dangerous driving distractions. Text messaging. Accessed October 2, 2008. [Context Link]


6. Beck KH, Van F, Wand MQ. Cell phone users, reported crash risk, unsafe driving behaviors and dispositions: a survey of motorists in Maryland. J Saf Res. 2007;38(6):683-688. [Context Link]


7. Frail N. Text messaging dangers lead to nationwide bans. Accessed October 2, 2008. [Context Link]


8. As text messages fly, danger lurks. New York Times. Accessed October 2, 2008 [Context Link]


9. Tanner L. ER docs: don't text and walk, skate-or cook. U S A Today. Accessed August 1, 2008. [Context Link]


10. Text-messaging boy dies after stepping in car's path. Accessed October 2, 2008. [Context Link]


11. Associated Press. Texting to blame for crash that killed 5 teens? Accessed August 1, 2008. [Context Link]


12. Blood Michael R. NTSB to seek cell phone records in LA train crash. Accessed September 15, 2008. [Context Link]


13. Metrolink engineer sent text message moments before fatal crash. Los Angeles Times.,0,2880289.s. Accessed October 2, 2008. [Context Link]


14. Text messaging leads to Boston trolley collision. Accessed May 10, 2009. [Context Link]


15. Countries that ban cell phones while driving. Accessed September 15, 2008. [Context Link]


16. Cellphone laws 2009. Accessed September 15, 2008, and April 20, 2009. [Context Link]


17. American College of Emergency Physicians Foundation. Text messaging: emergency physicians express safety concerns as kids go back to school. Accessed August 1, 2008. [Context Link]


18. Nationwide Insurance. NASCAR driver Jeff Burton encourage local drivers to stop texting while driving. Accessed September 15, 2008. [Context Link]