Drunk Driving, Sleep Deprivation, Unsafe Vehicle, and Poor Road Design: Converging Hazards in a Road Traffic Crash in Sukhothai Province, Thailand, 2025

Road traffic injuries are a leading cause of death globally, with alcohol impairment increasing the risk of an accident. At 7:10 AM on 10 Feb 2025, a pickup truck rear-ended a passenger vehicle carrying students in Sukhothai, Thailand. This study aimed to identify factors associated with the crash and recommend preventive measures. Data were collected through medical record reviews, site surveys, interviews with witnesses and stakeholders, and a joint agency meeting. Haddon’s Matrix guided the analysis. All 20 occupants (2 drivers, 18 students) sustained injuries, with one case requiring admission for eyelid laceration. The weather was clear, the road was dry, and both drivers were experienced. Pre-crash risks included driver intoxication (blood alcohol concentration of 133 mg/dL) and drowsiness, the use of a modified passenger vehicle with unsafe seating and no seatbelts, and an inadequate road design, specifically a sudden lane reduction and a sub-standard U-turn constructed at villagers’ request. Crash-phase risks included speeding, an abrupt lane change, and a steep roadside with a narrow (30 cm) shoulder, which caused the passenger vehicle to overturn. Post-crash issues included a lack of initial scene management, resulting in poor crowd control. This incident illustrates how alcohol impairment, an unsafe passenger vehicle, poor road design, and emergency response gaps contributed to the crash severity. The investigation led to policy actions, including U-turn closures, school transport vehicle reforms, and improved emergency medical services training. The value of field investigations in turning real-world crashes into targeted, system-level prevention strategies is underscored.