Yesterday, the NTSB released findings from an investigation of a medical flight that crashed in Mosby, Missouri in 2011. I’ve written about distracted driving before, but this is the worst example I’ve seen.
Apparently, the pilot was having a text conversation during the preflight check and missed the fact that the ship was low on fuel. Once enroute, he finally noticed the situation, but proceeded to pick up a patient for transport, planning on a refueling stop enroute to his destination.
But then he got involved in more texting, regarding his dinner plans for that evening. Think about it: texting while flying a helicopter means taking one hand off the collective control. He apparently believed that he did have enough fuel to get to his destination. Unfortunately, the ship, pilot, patient, and two medical personnel crashed a mile from their destination, within sight of the airport.
Teenagers know texting is wrong, but they believe that they know the way to do it safely. New information shows that adults are just as guilty as their children, but they do it anyway. Airline pilots got distracted working on their laptops in the cockpit, and overflew the Minneapolis airport by several hundred miles a few years ago. Everyone is doing it and they know it’s wrong!
Bottom line: There are no easy solutions, and laws are having only limited effect. For situations like this one, the easiest way to deal with it is to expand the team concept in the aircraft. The crew can’t be arbitrarily divided into medical and flight personnel (pilot) anymore. It seems that these days the nurse/medic/docs on board not only need to tend to their patient, but they need to look after the pilot as well. For everyone’s safety!
Reference: Numerous news items on April 9, 2013. See CNN content here.
This is a bad time of year in much of the United States for striking animals on the road. Car vs animal can be challenging, and motorcycle vs animal is frequently deadly. What can our patients do to protect themselves?
- Be especially vigilant when driving for the first few hours after sunset and just before sunrise. More animal activity occurs during these hours.
- If one animal is spotted, look out for others.
- Drive with high beams on as much as possible. In many animals, this will show reflections from their eyes. Some large animals, such as moose, don’t have glowing eyes.
- Always where a seat belt in case an impact does occur.
- If an animal is spotted, slow down quickly and blow the horn.
Most important! NEVER swerve or attempt to quickly change direction. This is one of the most common errors that results in serious injury or death. The driver swerves to avoid and begins to leave the roadway. They then over-correct in the opposite direction and begin a rollover. Always make gentle corrections, staying in the same lane.
For small animals, try to straddle them with the wheels. For larger ones, try to plan the impact so it is in front of the unoccupied front passenger seat. If occupied, plan the strike in the middle of the hood. The idea is to keep the car occupants safe, but to assist with natural selection and remove the animal from the gene pool.
All trauma professionals are keenly aware of how often alcohol is involved in automobile crashes. Something you may not know is that one third of drug tests for other substances are positive in drivers involved in car crashes!
There has been a 5 percent increase in the number of positive drug screens in drivers over the past 4 years. The drugs range from hallucinogens to prescription pain medications.
Seventeen states have enacted legislation making it illegal to drive while on various types of legal and illegal drugs. However, these laws are difficult to enforce because:
- They are more difficult to detect, both by law enforcement at the scene and in the hospital
- We don’t know a lot about the impact of these drugs on driving performance
- A positive drug screen does not tell us when the substance was taken and if it is at a significant level
Drug screens are typically obtained in the ED in seriously injured drivers. It’s a good idea to order one in any patient with a significant head injury. This allows the clinician to guess (and it’s just a guess) that the medications may be impairing the mental status exam. Any patients who have a positive screen should have a documented chemical dependency evaluation and be provided with referral information to get further help.
Reference: National Highway Traffic Safety Administration
ATVs (all-terrain vehicles) are motor vehicles that are designed for use on uneven surfaces. Full-size ATVs can weigh up to 600 pounds and reach speeds of 75mph. There are up to 7 million ATVs currently being used in this country.
Unfortunately, young riders make up a disproportionate number of injuries and fatalities. About a third of all ATV-related deaths and ED visits involve riders under the age of 16. The risk factors for ATV injuries are well known:
- No helmet
- Risk-taking behaviors
- Male (seems to go along with the previous one)
- Large engine
- Small child
- 3-wheeled ATVs
- Driving on public roads
- Riding with a passenger
The University of Connecticut published a recent study in which they surveyed youths at four major agricultural fairs covering the 4 major geographic areas of the state. The average age that the kids began riding was 9 years. The majority rode for fun, but more than a third admitted to racing informally with friends. 70% engaged in double-riding, 59% rode alone without family present, and 46% rode after dark. Most kids were trained on ATVs by family or friends, although 25% were self-taught. The majority wore appropriate clothing and 80% wore a helmet.
Nearly half of these kids admitted to being involved in at least one ATV crash. The most frequent type of crash was a rollover, followed by collision with a stationary object. 10% were pinned under the ATV. Commonly reported causes of the crash were poor driving conditions, lack of experience, and lack of strength to control the ATV. Those who reported crashing were also more likely to engage in risky ATV behavior like racing, riding after dark, riding without supervision, or riding a large ATV.
This study points to the need for additional education and training for both children who want to ride an ATV and their parents. The only way to reduce the number of children injured or killed by these vehicles is to make sure both groups understand the need for safe riding practices.
Reference: Campbell et al, J Pediatric Surg 45:925-929, 2010.