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!