Monday, 27 June 2016

Police

You may not want to hear this, but ladies and gentlemen, it's about that time again.  No, not another insufferable, unreadable vaccine post (though as a fair warning a series of that is coming up soon).  Even though I talked about seat belts fairly recently, it's once again time to talk about . . .

Nutrition!

Just kidding, just kidding.  It's seat belts.  Oh be quiet, I can hear you groaning from all the way over here.  Yes, I realise I talk about them a lot, and you realise I talk about them a lot, and I realise that you realise that I talk about them a lot, and because I won't shut my damned mouth about them you therefore probably also realise just how important they are.  If you do, this post is not for you.  Instead this is directed to the people who still think seat belts are either A) not that important, or B) dangerous.

Something else (that ties into this story) that is even more important than seat belts is the police (the men and women who uphold the law, not the British rock band (though they were pretty damned cool too)).  I'm sure many people here, especially those who have ever been stopped for speeding, aren't such big fans of these folks.  Though I've been stopped a couple of times for speeding myself (though not in the last decade or two), and though I was admittedly righteously pissed off at the time, I only had myself and my stupid heavy foot to blame.  I now thoroughly respect the officers who were simply doing their job trying to protect me and the drivers around me.  As a trauma surgeon, this respect has only deepened.  It turns out that the people they deal with on a daily basis correlate quite nicely with my patient population.

But unfortunately police officers aren't perfect.  They are human, and they make mistakes.  Just like Colby (not his real name™).

When a group of police officers gathers outside my trauma bay, it can mean only one of two things: A) they are protecting everyone from the asshole they just brought to me, or B) one of their own was just brought in.  In Colby's case, it was the latter.  He was chasing a suspect at high speed in the rain when he hydroplaned and spun out.  This launched his car into the woods where he struck a tree and got knocked out.  When he came to, the medics were pulling him from the back seat of his cruiser.

At this point the clever readers are probably wondering, "Hey, how in the hell did he end up in the back seat if he was wearing his seat belt?"  Never fear, intrepid reader.  I'll get to that.

He arrived looking in not-too-bad shape, but his oxygen saturation was only 90%.  For a healthy (and very muscular) 25-year old kid, his oxygen level should have been no less than 98% unless something seriously wrong was seriously wrong.  I asked him what hurt, assuming it would be his chest.

"My chest, sir.  It's not so bad though, Doc."

Sir.  Heh.  I have to admit I thoroughly enjoy the "sir" whenever I hear it, which is almost never.  Getting "sir" from a patient is like eating filet mignon - something you experience very rarely but enjoy the hell out of it whenever you get the opportunity.

But why was he in the back seat, Doc?

Quiet, you.  I'm getting there.

A chest X-ray confirmed my suspicion - a couple of broken ribs, a lung contusion, and a pneumothorax big enough to require a chest tube.  Chest tubes are designed to evacuate the air (or fluid) that has accumulated around a punctured lung, allowing it to re-expand fully.  Colby wasn't enthralled with the idea of me shoving a tube the size of my thumb into his chest between his ribs, but he tolerated the procedure with hardly a grunt.  As soon as it was in, his oxygen level normalised and his shortness of breath disappeared.  A follow-up X-ray predictably showed that his lung was now fully inflated (HUZZAH!), so he was admitted and taken up to the trauma ward a short while later.

But Doc . . .

SHUSH.

The following day I went to see Colby, and he was doing very well and in rather high spirits.  He was a model patient - eager to get up and walk despite the large tube hanging out of his chest and the constant pain in it that stabbed him every time he coughed.  I decided this was the right time to get the answer to the question that everyone was asking: how did he end up in the back seat of the car if he was wearing his seat belt?

He gave me a rather abashed glance towards the floor as he gave me his a very simple explanation: he wasn't.  His colleague sitting in the chair next to him looked down and shook his head.

As he explained it, none of the officers in his district wears a seat belt.  He gave me some vague (read: bullshit) excuse about possibly maybe needing to jump out of the car suddenly and not wanting to risk getting ensnared in the seat belt or some crap.  I just gave him the look.  The Look.  You know, that look you give your kid when she tries to claim she didn't steal that last Oreo when you actually watched her do it five seconds ago.  Yeah, that look.

He gave me a sheepish smile and said, "I know, sir.  I know.  I'm sorry."

I gave him The Look again and asked him if he was going to give himself a ticket.  He chuckled as I reminded him that he was the one who needed to make sure that we wear out seat belts, and that in addition to protecting us, he needs to protect himself too.  It is his sworn duty to keep us safe, but a large part of that is setting a good example.  His colleague started nodding solemnly.

"Yes, sir.  If I had been wearing it, I probably wouldn't be here.  I mean, I'd be here, I just wouldn't be . . . you know, here . . . in this hospital, here.  I probably would've been fine and walked away.  I will from now on, sir."

Now that is what I was waiting to hear.

47 comments:

  1. I have lost count of the number of times a seat belted occupant has helped us package a non-seat-belted occupant for shipment to the trauma bay.
    for those curious, this is what we mean by "package"
    http://farm4.staticflickr.com/3217/3134010075_cc1fd85e8a_z.jpg

    if you think a seat belt is uncomfortable, wait until you get put in this - and THEN seatbelted onto the gurney with four more belts.

    as for the "better to be thrown clear" argument. my first fatal was a guy who got thrown partway clear.
    he was declared DRT: Dead, Right There.

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    1. I once volunteered to act as a patient for an EMT training course. I started the day perfectly well but after eight hours on and off of backboards, I was in serious pain.

      I'll take the seat belt any day. And the only way I am ever going on another backboard is if I'm unconscious.

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  2. Did you mean "unless something seriously wrong was seriously wrong"? It's unorthadox but I actually quite like it!

    One of these days, when I have more time, I'll rant some more about how it's disrespectful to the engineering in a modern vehicle not to wear your seatbelt. For now, suffice it to say that a lot of very clever peope have dedicated their time, energy and even health to improving your safety in the an automibile and that's all wasted if you don't wear your damned seatbelt.

    Glad he got away with a warning, so to speak.

    Ugi

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    1. I did mean it that way. I think it sounds rather nifty.

      I tried to convince his partner to give him a citation, but he must have thought I was kidding. I wasn't.

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    2. Your writing was a bit strange this time around, I have to say, but still enjoyable as always :)

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    3. Well, here's a cop doing the right thing: ticketing himself for not wearing a floating vest while riding a small boat

      http://www.lapresse.ca/actualites/insolite/201607/25/01-5004241-un-policier-photographie-sans-gilet-de-sauvetage-se-donne-une-contravention.php

      Sorry it's in French.

      Al

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  3. WTF! In my state it is state law that occupants in a motor vehicle must wear a seat belt. Law enforcement should wear one not only for their safety but to set an example to the motoring public. Not only that not wearing a seat belt is probable cause for law enforcement to stop you. Wear the damn belt! I'm sure you can tell, I'm a devoted belt wearer.I starting wearing them when seat belts were an option in cars.

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    1. I drive my district's parade engine which has no provisions for seat belts. I always feel a bit underdressed when I am taking it to a parade.

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  4. on the topic of seat belts; Jay Leno (which we have no reason to believe is not his real name) was in a rollover crash in a stunt car yesterday. thanks to proper seat belts, he had his helmet off and was cracking jokes to the paramedics before stepping out of the car. the 80 year old driver was also unhurt.

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  5. We have a saying here in California, "Click it or ticket." I am not sure if any other states use that catchphrase.

    Slightly off topic but I have been wondering what Doc's opinion of 'Brexit' and now 'Regrexit' are. :)

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    1. In answer to your question, go check out Doc's Twitter feed.

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    2. Pretty sure "click it or ticket" is a nationwide campaign. At any rate, I've heard it in every state I've been to.

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    3. Australia had an even better add campaign when I was a kid. It featured a man sitting in a chair being slapped while the voiceover endlessly repeated "wear a seatbelt, wear a seatbelt". Has stuck with me all these years.

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    4. I was fortunate enough to come across a number of Australian commercials for safety, with fairly graphic consequences indicated. "If Bob was driving 5kph slower..." We need more of these.

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  6. I always where my seat belt and nobody rides in my car if they don't buckle up doc B. I have been at red lights next to a police car and noticed no seat belt being used. I drive an SUV so can look down into their car.
    Back several decades ago when I was a child, my dad had a Dodge Van with no seats except for the driver and one passenger. When we all went some place we 5 kids would bring out kitchen chairs to sit on. It's a wonder I made it through childhood!
    Mary

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  7. Spent several years working in the E.D. of a large trauma center. Majority of cops I met over those years admitted to not wearing seatbelts for just the same stupid reason your guy gave you.

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    1. True here in my city also...the patrol officers are not only the biggest offenders when it comes to not wearing seat belts, but also in driving around with one hand holding cell phone to ear, as they carry on conversations (which has also been illegal in my state for several years). IMHO, that's even a worse formula for "distracted driving" than it would be for the rest of us, since carrying on a personal phone conversation also impairs the ability to listen to the calls coming in on the dispatch radio.

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    2. I'm sure there are personal calls in the mix, but often when you see a police officer on his phone, he is talking to dispatch.

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  8. Thanks for this post Doc! This really struck a chord with me. I have always been an advocate for seat belts but I don't think I truly appreciated how important they actually were until I was involved in a bad car accident 4 months ago. Apart from some broken ribs I was okay. It would have been a much different story if I wasn't wearing my belt!
    I love your work Doc!
    Kimberley

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  9. Please let people know there is a right way and a wrong way to wear the seat belt. I saw a young woman on tv years ago teaching this. She was in an accident wearing it the wrong way. The belt sliced across her abdomen cutting her open and releasing her intestines.
    Do not wear the belt across your stomach!
    The right way is having the belt across your hip bones.

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    1. When my father was 16 he was driving his dads mustang at night in the rain. He hydroplaned ans went straight into a tree. It was wrapped so badly around the tree the headlights were facing each other. Luckily, he wore his seatbelt. However, it did dig pretty hard into his sides and he hit his face so hard on the wheel he tore his nose off.(no shoulder strap). He had to cut the seatbelt off with a knife as the holder was warped in the crash. His friend got such a bad concusion for 2 days he was continuously asking "hey mom whats for dinner?" When he got his own mustang, he put in full blown racing seatbelts and so many safety precautions in his car that if he crashed again hed probably just be able to get out and walk away unharmed.this is all despite somewhat experiencing what all the naysayers say will happen "ill hit my head. The seat belt will restrain me i wont be able to get out. Itll dig into my side" etc. Except he recognized the truth: the seatbelts saved their lives.
      Connor

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    2. on that subject, also, do not put the shoulder belt under your arm. and don't drive crowded up to the steering wheel.

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    3. ...but I can't stand the way the shoulder belt cuts into my neck while wearing it *unless* I tuck it under my arm (I'm a passenger, not a driver, FWIW). Any suggestions? I know there are seat belt covers you can get, but I'm not sure about carrying one in my purse at all times. (There were also a couple of well-publicized incidents of people being decapitated by their shoulder belts in metro Atlanta while I was living in Georgia about 20 years ago, which makes me even more antsy about feeling the edge of the belt on my neck...)

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    4. if you are short and don't have an adjustable shoulder belt, there should be clips you can get at auto parts stores that will help. my wife has covers in both cars she drives.
      the belt under the arm will most likely dislocate it in a crash. for a decapitation something had to have gone very wrong. if it was actually a basal skull fracture, somebody REALLY misrepresented it.

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  10. Speaking of seatbelts... let's talk about car seats and boosters! The right type for the child, the right usage, the right install. I just got my certification as a car seat tech and work in pediatrics. Car seats are a soapbox topic for me.

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    1. Yeah, there's not really a lot of education out there on child safety seats when there should be. I kept putting the harness clip near my child's neck instead of chest, until I saw a FB post letting me know the right way to do it.

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    2. So many people use them wrong, install them wrong, or simply transition kids to different seats before they are ready.

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    3. This comment has been removed by the author.

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  11. If someone claim that they were wearing seatbelts after a crash, the police would usually document and examine their shoulders for any signs of seatbelt friction burns in their police report. Standard procedure for insurance investigators.

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    1. there are also other indications of seatbelt use, like the lack of face prints in the windshield.

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    2. Or a lack of teeth left in the steering wheel.

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    3. teeth in the steering wheel usually indicate improper shoulder belt use.

      we also look for damage to the seat belt, itself. the force of the collision usually leaves a mark, if it is in use.

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    4. Insurance companies work very hard to find all sorts of reasons to not pay money on a car insurance claim. If you weren’t wearing your seat belt at the time of the car crash or you were in violation of state driving laws they can deny your coverage. It's something insurance companies don't want the public to know.

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    5. Not the US. I've been in some serious car accidents and not once has a police officer documented whether I had seat belt burns or not (hint: I didn't). I have a few friends that have completely totaled their cars, wrapping them around trees and they had no seat belt burns. The only injuries my friends who wore their seat belts had was a black eye or some broken teeth because of the airbag. The type of clothing you were wearing can stop a friction burn. If you are in a serious crash and need to be cut out, the firefighters can testify they had to cut the seat belt to get you out.

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    6. Some cops will document them but not everyone. Also, the type of clothing you were wearing will not stop a friction burn. I don't care if you were wearing a thick jacket during the time of the crash but the physics of seat belts from crash tests have shown that the type of clothing you were wearing during a crash WILL NOT stop friction burn. They may not be more prominent but they will still be there.

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    7. Seat belt burns must come from very specific circumstances, they only prove you had a seat belt on, but don't prove that you did not and are therefore invalid for insurance to deny. The only way I can see that holding up is if the person is still thrown from the car despite wearing a seat belt.

      I think Ken's explanation holds up better to check the actual seat belt. Generally people on site will know if you're strapped in unless you've left the vehicle and are walking around relatively uninjured. If you are thrown from the car, you were not wearing a seat belt. No one I know in a severe car wreck (including myself) has had seat belt marks on their shoulders or chest. The damage all came from the airbags, and it was never a question if anyone was wearing a seat belt from the fact that we were all alive and uninjured.

      Either way, you'll still have a headache as both health insurance and the other person's car insurance bicker back and forth. Adulthood sucks sometimes.

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    8. Checking the actual seat belt after a crash is not only stupid but also a waste of time. Sure, you can visually check them for 1 second but they're irrelevant. Physical exam on the actual driver is the protocol.

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    9. Anon - Respectfully, it's not stupid. Seat belts can rarely cause their own unique injuries, including lacerations of the aorta, small intestine, and bladder. Knowing if the patient was wearing it or not helps guide my diagnosis, especially in the case of a unstable patient who is unable to be adequately imaged with CT scans.

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    10. I'm aware of seat belt internal injuries after a crash but that's not the issue. I'm talking about the evidence pointing to the use or non-use of seat belts after an accident.

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    11. Anon: well, what do I know. it's not like I am an emergency responder who assists with accident investigations, or anything.

      Shark: seen it. it was the guy who broke his car into pieces. the impact blew out his seat belt as well as tearing the car in two at the firewall, and tearing the roof off.

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    12. I wish I could upvote! I almost didn't smell the sarcasm.

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    13. Ken, I bet he survived.

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    14. he was alive when we poured him onto a backboard and shipped him off to the trauma bay. he was alive when they drew blood to get a reading of drunk times 3.5.
      don't know beyond that. he didn't feel the need to update us.

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  12. Hello Doc, just wanted to thank you for the great work you do, and for letting us know what you have to put up with day by day. Not everyone would sacrifice 12 years to intensive study to end up doing awful night shifts filled with dumbness and death ...
    You blog is always a pleasure to read. For non-native English speakers, it's a source of highly sophisticated style :).
    BTW please keep the idiot-english translation engine you mentioned in one later post. It might not be 100% accurate but helps the inner equilibrium.

    All the best to Marilyn's family ...

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  13. It’s really such nice information to get advantage from. Cheap Health insurance in Houston

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  14. This reminds me of an incident that happened just recently in Northern Ontario. Some kids were driving late at night (or early in the morning.. Whichever you prefer), and passed another vehicle on the highway.
    The other vehicle was going too fast and they couldn't get back into the lane, so they slowed down, but not fast enough and got ploughed by a vehicle from the oncoming lane.
    To add insult to injury, a transport then hit them all as well, also from the oncoming lane.
    They all survived with minor injuries, by some miracle, except for the one boy who wasn't wearing his seatbelt. He was sitting in the backseat. On impact, he went through the windshield head-first. Died shortly after. He was 17.
    I always wear my seatbelt now. Scary. Seatbelts really do save lives, everybody.

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  15. Seat belts are a bit more of a complex issue. There is a something called "risk compensation". John Adams covers it in great detail in his book "Risk" (and also on his web site).
    The gist is that yes seat belts may save you in an accident, but on a population level there will be more (and more serious) accidents. And more worryingly more pedestrians, cyclist and motor cyclist will be "taken out".

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