A lot has been written about the hazards of distracted driving. Now, there is new information about the impact of distraction on police officers! A public safety administration class at St. Mary’s University here in Minnesota analyzed 378 crashes involving police cars from 2006 to 2010. The results are intriguing!
Key findings included:
Most crashes occurred during non-emergency responses
Crashes occurring during emergency responses were the most expensive
Distracted driving caused 14% of all crashes
Half of distracted driving crashes were due to the use of squad car computers
Average insurance claim was $3,000 per crash. However, if the crash was due to distracted driving it doubled to $6,000. If the crash was due to squad car computer distraction the average cost was $10,000!
This study is interesting, but it’s only a partial snapshot of this type of crash in one state. It did not include some of the larger police departments, such as St. Paul and Minneapolis.
Bottom line: It’s safe to assume that distracted driving is just as dangerous to police (and prehospital providers, too). And with growing dependence on advanced technology for law enforcement, this problem is just going to get worse. It is imperative that everything be done to improve safety for our law enforcement colleagues. Potential solutions include training to increase awareness of distractions within the car, simulator testing of driving while using cockpit technology, and ergonomic studies to maximize field of view from within the car.
Bladder injury after blunt trauma is relatively uncommon, but needs to be identified promptly. Nearly every patient (97%+) with a bladder injury will have hematuria that is visible to the naked eye. This should prompt the trauma professional to obtain a CT of the abdomen/pelvis and a CT cystogram.
The CT of the abdomen and pelvis will identify any renal or ureteral (extremely rare!) source for the hematuria. The CT cystogram will demonstrate a bladder injury, but only if done properly!
During most trauma CT scanning of the abdomen and pelvis, the bladder is allowed to passively fill, either by having no urinary catheter and having the patient hold it, or by clamping the catheter if it is present. Unfortunately, this does not provide enough pressure to demonstrate small intraperitoneal bladder injuries and most extraperitoneal injuries.
The proper technique involves infusing contrast into the bladder through a urinary catheter. At least 350cc of dilute contrast solution must be instilled for proper distension and accurate diagnosis. This can be done prior to the abdominal scan. Once the initial scan has been obtained, the bladder must be emptied and a focused scan of just the bladder should be performed (post-void images). Several papers have shown that this technique is as accurate as conventional retrograde cystography, with 100% sensitivity and specificity for intraperitoneal ruptures. The sensitivity for extraperitoneal injury was slightly less at 93%.
Bottom line: Gross hematuria equals CT of the abdomen/pelvis and a proper CT cystogram, as described above. Don’t try to cheat and passively fill the bladder. You will miss about half of these injuries!
There is a lot of angst out there among trauma professionals when it comes to clearing the cervical spine and possible distracting injuries. I’ve written about this before, and the most important technique I use is to try to see if the patient is aware of pain in areas distant from the suspected distraction.
A recent prospective study looked at injury patterns and c-spine clearance in over 9,000 trauma patients at a single Level I trauma center. Of those, 101 were evaluable (not intoxicated, no head injury) and actually had a cervical fracture. 96% of them were symptomatic, despite the majority having what would normally be considered a distracting injury (87%). Of the 4 who did not have pain or tenderness on examination of the neck, every one of them had a distraction.
There was a pattern as to which “distracting” injuries were really a distraction. All four of the asymptomatic patients had bruising or tenderness to the upper anterior chest, which diverted their attention away from their neck. Other injuries caused pain in some of these patients, but it was outweighed by the chest wall pain.
Bottom line: Distracting injury is currently defined too liberally, which results in lots of patients getting lots of unneeded cervical spine imaging. Although this study is small, it adds one more piece of information to the c-spine clearance puzzle. I personally will add this to my current practice and clear the cervical spine if:
The patient is aware of multiple sources of pain
Subjective pain scale overall is less than 6 (otherwise provide better pain control!)
There is no pain/tenderness/injury to the upper chest
Reference: The presence of nonthoracic distracting injuries does not affect the initial clinical examination of the cervical spine in evaluable blunt trauma patients: a prospective observational study. J Trauma 71(3):528-532, 2011.
This patient was running from an assailant at top speed and fell, tumbling for several feet. Medics found him in this position and pondered how to secure him for transport. eventually they just used straps and belts to hold him on a backboard.
The injury is an interesting one. He has a femur fracture, but there is a twist (literally). If he was a contortionist and had found a way to bend his knee toward his head, his toes would point to his face. If you look at the thigh, twisted muscle bellies can be seen.
The diagnosis is a mid-shaft femur fracture with a 180 degree rotation of the distal portion.