All posts by TheTraumaPro

An Airbag In Your Seatbelt?

Ford is introducing rear seat belts with built-in airbags in its 2011 Explorer SUV. It’s a $395 option that is designed to diffuse crash impact across a wider area of the chest. This is particularly important when strapping children in the back seat.

The system uses a cold gas system, unlike the heated gases in standard airbags that can cause minor burns. Ford plans to roll it out to additional models in later model years.

The video shows how the system works in slow motion. Very “cool”!

Sleepiness and Car Crashes

There are generally about 30,000 deaths from car crashes each year. An analysis by the AAA shows that drowsiness is a factor in about 1/6 of them! In the early 1990’s, NHTSA looked at this problem and found only about 4% of fatal crashes were due to sleepiness.

What gives? Is everybody suddenly a lot sleepier these days? It’s actually due to the way it is reported. As you can imagine, it’s difficult to figure out if fatigue was the cause after the fact in a fatal crash. The driver certainly can’t tell you. 

AAA looked at crash rates and applied information it obtained from a driver survey it administered. They found that 41% of drivers admitted to falling asleep behind the wheel at some point. And one in ten admitted to it happening in the past year. The AAA believes that their estimates are far more accurate than the lower NHTSA numbers. 

Sometimes our patients tell us that they think they may have fallen asleep at the wheel. You should assume it in anyone who is driving home after a long shift, especially early in the morning. 

Educate your patients about the warning signs of fatigue while driving. Everyone knows the obvious ones: droopy eyes, frequent daydreams, drifting in and out of lanes. But here are some of the not so obvious:

  • Difficulty remembering the last few miles driven
  • Frequent yawning
  • Restlessness, irritability or aggressiveness
  • Frequent scratching and rubbing

Once fatigue becomes a factor, the driver is not only a danger to themselves, but to everyone else on the road as well. The solution: pull off as soon as practical and call for assistance. Caffeinated drinks are overrated and take too long to work!

Sources: American Automotive Association, NHTSA, National Sleep Foundation


Communicating With Our Patients

Although you may not agree with this at first, communicating with our patients is one of the most important things we do as trauma professionals. You can be the “best” doctor, nurse or paramedic in the world, but if you can’t communicate well your patients will have nothing good to say about your care of them.

The most important skill needed for good communication is empathy. You need to be able to put yourself in their position. Imagine what you would want if you were on the receiving end of the information you are about to deliver. What would you say if you were talking to your spouse, your mother, or your child?

Next, think about what kinds of things they would want to know. In trauma, they obviously want to know information about the injuries. Patients and families also need to hear about the short term and long term plans. What’s going to happen in the next few hours? Will surgery be needed? When? How long will I be in the hospital? How long will I be out of work?

Many of these questions are difficult to answer at the time of admission after trauma. If you don’t know or it’s impossible to determine, say so. Experienced clinicians can make some pretty good guesses, but should always qualify their answers. You should make it clear that you are giving an estimate, and that things may very well change. Also explain that as these changes occur and time passes, you will give better estimates.

One of the most important things to remember is the “keep it simple” mandate. Our patients and their families are smart. Although they may not know the lingo that we are familiar with, they can grasp the concepts of what is happening. Be careful to keep your explanations understandable, and don’t make the mistake of using any complicated medical terms. Imagine the surprise of the patient when they find out what “we’re going to insert a Foley catheter now, sir” really means. Also keep in mind that the patients and their families are stressed, and may not be able to concentrate on or remember everything you say. Repetition is good in these situations.

Communication after major trauma is challenging. Remember, if the families don’t get what you’re saying, it’s your fault, not theirs.

Up In The Air: Tree Stand Injuries

Deer hunting season is upon us, so it’s time for emergency departments to start seeing an increase in hunting injuries. Although you would think this would mean accidental gunshot wounds, that is not the case. The most common hunting injury in deer season is a fall from a tree stand.

Tree stands typically allow a hunter to perch 10 to 30 feet above the ground and wait for game to wander by. They are more frequently used in the South and Midwest, usually for deer hunting. A recent descriptive study by the Ohio State University Medical Center looked at hunting related injury patterns at two trauma centers.

Half of the patients with hunting-related injuries fell, and 92% of these were tree stand falls. 29% were gunshots. The authors found only 3% were related to alcohol, although this seem very low compared to our experience in Minnesota.

Most newer commercial tree stands are equipped with a safety harness. The problem is that many hunters do not use it. And don’t look for comparative statistics anytime soon. There are no national reporting standards.

The image on the left is a commercial tree stand. The image on the right is a do-it-yourself tree stand (not recommended). Remember: gravity always wins!

Commercial tree stand Do-it-yourself tree stand