Sledding Safety

It's snowy out there, and we're beginning to see an increase in injuries from sledding at our trauma center. Here are some commonsense things that can keep your children safe:

• Supervise your children! Children age 12 and under should be watched, and children 5 and under should have an adult ride with them.
• Dress your children appropriately. Clothing should be warm, dry and worn in layers. Avoid scarves and drawstrings, as they may pose a strangulation hazard.
• Consider a helmet, especially on more advanced slopes or those with hazards such as trees.
• Choose the right sled. A steerable sled is preferred. Avoid items like pieces of cardboard or plastic, as rocks and other sharp objects can pierce them and cause injury.
• Pick the right slope. It should have a reasonable slope and long length. Avoid slopes with a layer of ice underneath because it increases speeds and decreases controllability. Avoid slopes with jumps, bumps and obstacles, and those that end at a street or parking lot.
• Use the right techniques. Walk up the slope at the edge, not in the middle of sled traffic. Sit face-forward, feet first, and keep hands and feet on the sled. If you lose control, just roll off into the snow. Once you are off the sled, watch for traffic and move to the edge of the slope as soon as possible. Don't ride into a snow bank (you don't know what it's covering up), and don't get pulled by any motorized vehicle (car, snowmobile, etc.).

The most common injuries we see in children are cuts and bruises. Occasionally, collisions with other sledders or objects (trees) cause broken bones and concussions. Adults riding with children can get the same injuries, but riding over bumps and jumps can lead to back injuries as well.

Ride safe and enjoy the winter fun!

Ski Safety For Kids

The time for winter recreation is upon us! With the recent snowstorms throughout the country, the number of people heading out to ski or snowboard is growing quickly. Our trauma center sees about 20 serious ski/snowboard injuries every year. These tend to involve younger people, and the injuries range from simple to fix fractures to catastrophic brain injuries.

Although these snow sports are very safe compared to many other sports, there are a few simple things to protect you and your children even better:

• Wear a helmet! Buy a ski helmet, don't just use a bicycle helmet. Make sure it fits properly and snugly. A recent 6-year old patient of ours was spared a very serious brain injury because she wears a helmet every time she skis! See this link for details. Start having them wear helmets early in life so it becomes the normal thing to do.
• Wear proper clothing. Make sure it is water and wind resistant with wind flaps for zippers. A hat or headband is essential due to the amount of heat loss from your child's head. And dress in layers to keep warm and dry.
• Don't forget sun protection! Sunglasses or goggles are recommended in sunny climates, as well as sunscreen.
• Remember ID! Place your cell phone number and your home or hotel address in your child's pocket in case they are separated from you.

Where Do I Take My Injured Child?

This is a question that every parent faces at some point. The problem is that there are no good guidelines available. Although most parents are aware of the hospitals in their area, they are not familiar with hospital capabilities.

To figure out the best place to take your child, there are two questions that need to be answered:
1. How badly is my child hurt?
2. What services do the medical facilities in my area offer?

How badly is my child hurt? There are several different degrees:

• Minor injuries. These include sprains, mildly painful body parts, bruises, cuts, etc. that you are not comfortable taking care of at home without professional evaluation.
• Moderate injuries. These are injuries that you think may require hospitalization, and include concussions, broken bones, or any condition that causes serious pain. This category also includes kids who do not seem to have significant injury but have been involved in a major event like a higher speed car crash of fall from more than 10 feet.
• Severe injuries. These injuries obviously require hospitalization, and are usually caused by major trauma like a high speed car crash, shooting, stabbing, or being struck by a car. Events that cause prolonged unconsciousness (more than 5 minutes) are also in this category.

What services do various medical facilities offer?

• Walk-in clinics – staffed by doctors, or sometimes a nurse. Basic xrays, and treatments like splints and suturing wounds is usually available.
• Community hospital emergency department – staffed by doctors with expertise in emergency care. Xray diagnosis is available, and some specialists like orthopedic and plastic surgeons may be available. Wounds can be sutured and simple fractures splinted.
• Children’s hospital emergency department – staffed by doctors with expertise in pediatric emergency care. The same services that are available in the community hospital ED are available here, but are more tailored to children. A Children’s hospital is not necessarily a trauma center.
• Adult Trauma Center – staffed by doctors with expertise in the treatment of any degree of injury. A full range of specialists is rapidly available that can treat most (Level II) or all (Level I) injuries. Many pediatric services, such as a Pediatric ICU, are available in these centers.
• Pediatric Trauma Center – staffed by doctors with expertise in the treatment of any degree of injury in children. A full range of pediatric trained specialists is rapidly available. Pediatric social services, education and rehab are also usually available.
  

How to choose? First, call your pediatrician for guidance. If they are not available, use the following table as a guideline. Choices are listed in order of preference. If the first choice is not available, move down the list to the next one.

Mild injury

1. Walk-in clinic
2. Children’s hospital emergency department
3. Community hospital emergency department

Moderate injury

1. Children’s hospital emergency department
2. Community hospital emergency department
3. Pediatric Trauma Center (Level I or II)
4. Adult Trauma Center (Level I or II)

(If child is taken to a community or children’s hospital, the doctors will determine if transfer to a trauma center is needed)

Severe injury

1. Level I Pediatric Trauma Center
2. Level II Pediatric Trauma Center
3. Adult Trauma Center

(Other hospitals will transfer to the closest appropriate trauma center)

Some States To Allow High-Power Beer: Good Idea or Not?

Several states have already passed laws to allow up to 16% over the past several years. The average alcohol content of most beers is about 4.5%. Ohio began allowing up to 12% in 2002, and since then Georgia, North Carolina and South Carolina have followed suit. Vermont and Montana lifted their caps last year, and Alabama now allows up to 13.9% alcohol as of May of this year.

The Brewer’s Association argues that limiting the amount of alcohol also limits the flavor, because it is not possible to add as much malt or sugar. They also point out that consumers of microbrews “don’t drink to get drunk. They drink to appreciate the flavors.” In my experience, the people that are treated in trauma centers are not drinking beer for the flavor. It’s hard to argue the “drinking for the flavor” point when you are drinking upwards of a case of beer a day.

There are two major problems with raising the alcohol limits in beer. First, people are creatures of habit. They will spend the same amount of time at the tap, which may result in the same number of beers consumed, even thought they are more potent. The second issue is that if the beer is double-strength or more, one glass will raise blood alcohol to twice the normal level.

For an average 150lb person, one standard beer (5% alcohol) will raise blood alcohol by about 0.03. A single beer with 14% alcohol will raise the blood alcohol level to over 0.08, which is the legal limit for driving. So tossing down a single super-powered beer could land one in jail, the trauma center, or in the morgue. Is it all worth the “better taste?”

Kids Hit By Cars on Halloween

Safe Kids USA, a national organization that promotes child safety, is raising awareness of a Halloween safety issue. According to their spokeswoman, this upcoming holiday is the most dangerous day of the year for children walking outside. Several issues put these kids at risk:

• Dark colored costumes
• Masks that make it more difficult for children to see traffic
• Walking after dark, sometimes without parental supervision
• Modern suburbs without sidewalks
• Children are more likely to dart out from between cars

More than 540 children are struck and killed by cars each year. The likelihood of this happening on Halloween eve is more than twice as high as any other evening of the year!

I reviewed our Pediatric Trauma Center statistics, and we have not seen the same increase as reported nationally. Since we are located in a mid-sized city, cars move more slowly and nearly all neighborhoods have sidewalks for pedestrian traffic. This combination makes city trick or treating a little more safe.

How can you protect your children on Halloween?

• Accompany your child. You can be their eyes and ears to help keep them safe.
• Carry a flashlight.
• Have your children wear reflective clothing
• Never jaywalk! Nearly 8 of 10 pedestrian deaths take place in the middle of the block, away from marked crosswalks.

Sources: Safe Kids USA, Regions Hospital Pediatric Trauma Registry

People Hit By Trains Double This Year!

Trains have killed 11 people to date in Minnesota this year, compared to only 5 last year. Two train-related deaths have been in the news in the past week. In one case, a man tripped and fell on the tracks shortly before sunrise, and in the other a 24 year old was walking on tracks listening to music with headphones. There were also two fatalities on the Minneapolis light rail tracks in August.

What is going on? There are several possibilities. First, more railways are being built, including light rail systems. More importantly, people are not paying attention. Smart phones and music players are big offenders. Pedestrians also fail to appreciate that a train, even a light rail train, is not a car. Being much heavier, they cannot stop in the same distance a car can.

How can you stay safe near trains? Remember these tips:

• Walking or operating any kind of vehicle (including ATVs and snowmobiles) on train tracks is trespassing
• Before crossing multiple sets of tracks, check all directions on all rails
• Don’t leave anything on the tracks. This can cause train derailment
• Stay well away from tracks. Train cars extend 3 to 4 feet out from them

Sources: Minnesota Operation Lifesaver, Inc. (http://bit.ly/24tup2)
St. Paul Pioneer Press (http://bit.ly/39WOqd)

Alcohol Predicts Survival After Severe Traumatic Brain Injury?

Everyone knows that drinking and driving is a bad combination. On average, nearly 17,000 people are killed each year in drunk driving crashes, which is more than a third of all traffic-related crashes. Although it is very well understood that drinking and driving increases the likelihood of crashing, little has been done to look at the effect of alcohol on brain injury in survivors.

Six years of data were reviewed by researchers at the LA County – University of Southern California Medical Center in Los Angeles. They saw over 1000 people with severe head injuries, and 482 had alcohol levels measured. A total of 179 tested positive.

Intoxicated patients had higher rates of infection, an increased chance of needing a tracheostomy tube in their neck for breathing, but overall their survival was better than in non-intoxicated ones.

How could this be? The study numbers are low and the design was very basic, which increases the chance this could be a statistical fluke. But it may very well be that alcohol does have some kind of protective effective on brain cells. This has been shown in a few other human studies as well.

Does this mean that people should feel free to drink so they have a better chance in a car crash? Absolutely not! The chance of getting into a crash in the first place goes up dramatically after just a few drinks. The likelihood of the crash being immediately fatal increases as well. Finally, although these people survived, they were not necessarily normal. Adults are far less likely to recover completely after a bad head injury. The need for a tracheostomy tube tells me that many of these people ended up in transitional care units or nursing homes after their discharge from the hospital.

The bottom line: it’s still a bad idea to drink and drive!

Salim, Teixeira, Ley et al. J Trauma 2009; 67(4):697-703.

Personal Decisions are the Leading Cause of Death

A relatively obscure research paper published last December by Ralph Keeney at Duke University makes this startling claim: over half of the people who died in this country in the year 2000 did so because of their own personal decisions! If you look at current mortality statistics, the top four causes of death from year to year are heart disease, cancer, stroke and injury. We naturally look at this and think that these people had a heart attack or discovered a cancer or crashed their car. What these statistics fail to show is how the people really ended up with these conditions.

Keeney's paper looked beyond what was written on the death certificate and looked at how frequently personal choices caused these conditions. For example, smoking leads to heart disease, cancer, stroke, and high blood pressure, to name a few. Being overweight leads to heart disease, diabetes, high blood pressure, and many others. Inappropriate use of alcohol can lead to cancer, liver disease and a tendency to get into accidents.

The top causes of death were analyzed, looking at the percentage that could be caused by personal decisions such as smoking, diet, exercise, and use of alcohol or other drugs. A personal decision was defined as a situation where the individual could make a choice between two or more readily available alternatives (for example, smoking and not smoking) and that they had control over this choice. These choices are not necessarily easy to make because habits, social pressure, or genetic predisposition can make some alternatives hard to select.

Keeney found that about 55% of deaths in 2000 were caused by personal decisions. This compares to about 5% in the year 1900. This is due to the fact that the majority of the causes of death in 1900 were due to infectious diseases, and there were no antibiotics at the time to treat them.

The bottom line is that we don't need to resign ourselves to the fact that we will likely die of a heart attack, or stroke, car crash, or complication of diabetes. Decisions we make can dramatically change the balance. These choices may not be easy, and may take lots of willpower, support from others, and possbibly the use of social services available in our communities. Hopefully, recognizing that we have the ability to determine our fate (and our lifespan) by making wise choices will catch on and we can all live longer and happier lives.

Reference: Keeney RL. Operations Research 56:6, 1335-1347, 2008.

More Motorists Die On Rural Roads

More than half of the 37,000+ traffic deaths in this country occurred on rural roads in 2008, according to the National Highway Traffic Safety Administration (NHTSA). Although there are more crashes in urban areas, the percentage of fatalities is less. There are a number of reasons for this, including:

• People tend to drive faster in rural areas. There tends to be less traffic and less traffic enforcement by the police
• The roads are not as well engineered and many times are not in the best shape
• There tends to be less seat belt use and more drunken driving in rural areas
• Emergency Medical Services (EMS) response times are longer due to greater distances
• High level trauma care is usually farther away as well

The upper midwest seems to be hardest hit by this phenomenon, in part because there is a much greater area considered rural in those states. for example, the number of traffic deaths on rural roads is 92% of the total traffic deaths in Montana, 88% in North Dakota, and about 70% in both Minnesota and Wisconsin. Interestingly, large parts of California and Nevada are rural, but their percentage of rural traffic deaths are only 38%.

Many states are taking inexpensive steps to reduce this problem. Seat belt campaigns can be effective. The state of Minnesota recently made lack of seat belt use a primary offense, and the compliance rate now approaches 90%. Other states are installing rumble strips, creating safe large animal crossing areas (deer and elk), and stepping up drunk driving checks.

If you must drive in a rural area, your best protection is to pay attention. Don't get lulled into believing you are safe because you appear to be the only person on the road. Keep an eye out for animals near the roadway, and pay particular attention to all drivers as you approach intersections. You can't count on the other drivers to follow the rules!

For more information, see this article in USA Today: http://bit.ly/WE6sQ

Make Sure Your Doctor Gets Their H1N1 Flu Vaccine!

A study released today shows that 87% of the public want their healthcare providers to be required to receive the H1N1 vaccine. Unfortunately, only 38% of your providers intend to get vaccinated!

Common reasons cited by healthcare workers for not getting their shot?

• There are drugs out there to treat the flu – true, but you have to get sick first and they don’t always work. Flu viruses frequently develop resistance to antiviral drugs.


• I had my seasonal flu shot, so I’m protected – not true! There is no cross-coverage between the seasonal vaccine and the H1N1 vaccine.

Since your healthcare provider comes into contact with many people who may be infected with H1N1 flu, they have a much higher chance of catching the flu themselves. They will become contagious before they are feeling obviously sick, and may remain contagious for up to a week after they are feeling better.

Protect yourself! When making an appointment to see your provider, ask if they have received their H1N1 flu shot. If not, ask if they intend to. Your interest in their vaccination status may help prompt them to do the right thing and protect everyone they come into contact with.

Finally, if your doctor won’t get the vaccine and you have to see them, ask them to not only wash their hands (which they should do anyway), but wear a mask in your presence. Hopefully, they’ll get the idea!

Bathtub Drowning

Unfortunately, about 300 children drown in bathtubs each year. Most countries have less than 20 such drowning deaths. Only Japan has more than the US, with over 3,000 bathtub drownings each year!

The most common risk factor in bathtub drowning is lack of adult supervision. Parents leave their child alone for “just a moment” or leave them supervised only by a sibling. Frequently, the child is left in a bath seat or ring with the mistaken belief that they are safe in it (see picture).

To avoid this type of tragic event, do the following:

• Remember that a child can drown in as little as 2 inches of water


• Never leave a child alone in the bathtub for even a minute


• Never rely on a sibling for supervision in the tub


• Don't rely on a bath ring to keep your child safe


• If you do use a bath ring, make sure it is secure. Be certain that the suction cups are firmly attached to the tub. Bath rings cannot stick to non-skid and slip-resistant tubs.


• Remove small, loose items from the tub so they do not block the drain


• Place a bath mat or towel next to the tub so your child does not slip when getting out


• Make sure the water temperature is no warmer than 120 degrees to prevent accidental burns.

Sources: World Health Organization, Centers for Disease Control and Prevention

Drunk Driver Avoidance

Drunk drivers are a perennial problem, and there are more repeat offenders out there than you would think. Drunk driving is the most common crime in the US, and kills one person every 30 minutes.

There are over 1.5 million arrests for drunk driving every year, and about one third are convicted of a repeat offense. Each offense makes the driver even more likely to have another. For example, only 50% of first offenders become second offenders, but 80% of those who have a second offense go on to have even more arrests for DWI.

About 40% of all traffic crashes involve alcohol, and over 17,000 people are killed annually in these events. The majority of these crashes involve cars, but motorcyclists in alcohol-related crashes do much worse. About half of motorcycle deaths are due to alcohol in some way, primarily because of the lack of protection for the riders.

Most alcohol-related crashes occur between midnight and 3am, around the time bars close in most states. The majority of deaths involve relatively inexperienced drivers between the ages of 21 and 24.

What can you do to protect yourself from drunk drivers? First, assume that all the drivers around you are intoxicated, especially when driving at night. Watch everyone’s driving very closely. The National Highway Traffic Safety Administration (NHTSA) produced a booklet to help law enforcement officers to detect drunk drivers. They found that drivers engaging in certain behaviors had a specific risk for being intoxicated. Look out for these driving behaviors:

• Turning with a wide turn radius – 65% risk
• Straddling lane markers – 65% risk
• Nearly striking objects or other vehicles (narrow miss) – 60%
• Weaving – 60%
• Driving on areas off the designated roadway – 55%
• Swerving – 55%
• Driving more that 10 mph under the speed limit – 50%
• Stopping in traffic – 50%
• Drifting – 50%
  Following too closely – 45%
• Tires on the center lane marker – 45%
• Lights off – 30%

These signs do not always indicate a drunk driver. They may also be a sign of an inattentive driver (talking on the phone or texting), a drowsy driver, or someone who is just careless. The steps to take are the same for all:

1. Be prepared to take evasive action at a moment’s notice.
2. Keep plenty of distance between your car and theirs.
3. Do not pass the driver.
4. Try to get their vehicle information and notify 911. Don’t get too close.
5. If you see a car heading toward you, immediately move as far off the highway to the right side as possible. Move into the grass if you need to. Slow down and prepare to take evasive action if necessary.