Tech, education could help prevent fatal crash repeat
Automated technology, clearer instructions for healthcare professionals and compact messages similar to cigarette plain packaging were cited as measures that could prevent a recurrence of a fatal accident.
An inquest is investigating a fatal crash in the Victorian town of Daylesford in 2023, when 69-year-old William Swale suffered a severe hypoglycaemic attack and crashed into people sitting outside the Royal Daylesford Hotel.
Pratibha Sharma, 44, her nine-year-old daughter Anvi and her partner Jatin Kumar, 30, along with their friend Vivek Bhatia, 38, and her 11-year-old son Vihaan were killed on November 5, 2023.
Mr Swale had left a shooting event in Clunes at around 4pm when he checked his glucose monitoring device, which recorded 7.2mmol/L.
This level dropped significantly by 5.17pm and he became severely hypoglycaemic, so he stopped in Daylesford to buy food but was turned away from a cafe because they were busy.
He then made “some very stupid decisions” by trying to avoid food and described how his brain had shut down due to hypoglycemia just before the crash.
The decision to administer insulin without eating was described by endocrinologist John Carter as the “most egregious act” that led to the fatal collision.
On Thursday, Coroner Dimitra Dubrow heard from a panel of experts about measures that could help prevent similar incidents from happening.
Endocrinologist Sybil McAuley suggested investigating automated insulin delivery systems that can change insulin levels based on user activity.
“If a person using the system will have greater insulin sensitivity with exercise and be at greater risk of hypoglycemia, the target glucose level can be changed by pressing the button,” he said.
He noted a potential “driving mode” or even a “wish list” measure of using a vehicle’s ignition integrated with a user’s glucose monitoring device.
All experts agreed that healthcare professionals’ obligations to provide important information to patients with diabetes need to be more clearly stated.
Endocrinologist Richard O’Brien said that although many doctors complete fitness-to-drive forms to meet their obligations to assess the risks of hypoglycaemia and diabetes, the same cannot be said for advising the patient on safe driving practices.
Associate Professor McAuley said some doctors struggled to balance therapeutic relationships with patients who had long-term diabetes and wanted to drive.
“If the rules aren’t clear enough, they see it as a negotiation,” he said.
Diabetes Australia’s chief medical officer, David Simmons, said there was also “misalignment” between the National Transport Commission and the National Diabetes Services Program on safe driving assessment recommendations.
“We need to make sure there is a single source of information,” he said.
Professor Carter suggested looking at short, simple messages, such as the plain packaging of a cigarette, to get the message across about the dangers of hypoglycaemia while driving.
“This is deliberately confrontational and 100 percent accurate, and we hope that it will reduce the chance of events like the ones we discussed this week occurring,” he said.
The investigation continues.
