# A Day in the Life of a Trauma Surgeon: Buckle Up For Safety

By on July 8, 2013

Note: The article has a picture of what happens when a shifter gets impaled in a leg. If you are queasy, don’t click. If you click, don’t  complain.

During my career as a trauma surgeon taking care of patients injured in motor vehicle collisions (MVCs), I have all too frequently heard, “he would have died had he been wearing his seat belt.” Late one Friday night, I heard those words from the family of Mr. Smith. Whenever presented the opportunity to lay to rest misguided beliefs, I take off the white coat, stand on the bully pulpit and start preaching.

In a MVC, there are actually three collisions that occur and are governed by Newton’s laws. Newton’s first law states that objects at rest (or in motion) remain at rest (or in motion) unless acted upon by a force. Newtons third law says that for every action (force) there is an equal and opposite reaction (force). To understand how these laws apply to a MVC and the occupants, the simplified example of a vehicle striking an immovable concrete barrier will be used. When the vehicle strikes the concrete barrier, the vehicle in motion will come to a complete rest because the concrete barrier will deliver an equal and opposite force. The vehicle striking the concrete barrier is the fist collision. In Mr. Smith’s case, he lost control of his pickup truck and had a right frontal offset collision with a bridge abutment.

The second collision is the occupant versus the vehicle. Just as the vehicle comes to a complete stop, so must the occupant. The unrestrained occupant will stay in motion until striking the interior of the vehicle. A restrained occupant almost simultaneously (understanding seatbelt laxity and deformability of the human body) decelerates with the vehicle as the front of the vehicle collapses striking the barrier. The length of time the occupant takes to come to a stop is called the crash pulse. Another to way to describe the crash pulse is the time it takes to decelerate. The longer the crash pulse, the likelihood of survivability increases and injury decreases. Air bags augment the three point belt lengthening the crash pulse and decreasing contact with injury-producing contact surfaces such as the steering wheel and windshield. Mr. Smith was not wearing his seatbelt so he stayed in motion until he struck the interior of the vehicle. Since the collision was a right frontal offset, he went to to the right of the steering wheel. Mr. Smith’s face struck the windshield on the passenger side, his chest and abdomen the dash, and his thigh the shifter knob.

The third collision are the internal organs of the occupant. In summary, the vehicle hits the barrier, coming to a stop, and then the occupant comes to stop. Imagine the chest wall hitting the seatbelt, then the airbag and finally the steering wheel (if severe enough of an impact). The heart continues in forward motion decelerating until it strikes the back of the chest wall. In Mr. Smiths collision, his heart was not injured but his spleen cracked when it decelerated and struck his abdominal wall. A multitude of variables and forces occur in a MVC, but just as crash impulse time plays a role, so does the area of distribution of force. The greater the area the deceleration force can be distributed, the chance for injury decreases. For example, consider the same deceleration force against an unrestrained occupant’s chest striking a pointed 1950s steering wheel versus a three-point seatbelt and airbag. When Mr. Smith’s leg struck the shifter knob, it impaled his leg.

Impalements are unusual, infrequent, quite spectacular, and always draw a crowd in the trauma bay. Mr. Smith was fortunate and only skin and muscle were injured. I was able to extract the shifter in the trauma bay and then I repaired his leg in the operating room.

No two real world accidents are the same and there are an infinite number of variables. Therefore, behavior behind the wheel should not based upon anecdotal evidence and “what if” scenarios. Rather, behavior should be based upon statistical analysis and probabilities of MVCs and crash testing.

Mr. Smith recovered from his facial fractures and lacerations, rib fractures, splenic laceration and impalement. He progressed well with physical therapy and was walking with crutches. Prior to discharge, I took off the white coat and stood up on the pulpit. As always, I put away the doctor talk and explained things in plain English. I told Mr. Smith that there have been tremendous advances in automotive and racing safety.

The days of not wearing a seat belt for fear of being trapped in your car and burned alive should be a long distant memory. In reality, only 0.5% of MVCs end in fire or submersion. To not wear your seatbelt for a 0.5% probability simply does not make sense. The more likely result of not wearing a seat belt is ejection from the vehicle. “Doc, you should see the car, it was crushed so bad, he would have died had he stayed in it.” I certainly have seen MVCs where the occupants survived because they were ejected. However, if you are ejected from a vehicle in a MVC, you are four times more likely to be killed as those who remain inside the vehicle. I am not rolling the dice at those odds.

The greatest single advancement in automotive safety has been the seat belt. Seat belts reduce serious injury and deaths in MVC by 50%. Airbags do augment the effectiveness of seat belts, but are not a substitute. Mr. Smith was very appreciative of my care and taking the time to talk to him about wearing his seat belt. But as I have learned all too often in life, entrenched beliefs are rarely altered by exposure to fact. Hopefully, you have already made up your mind and religiously click your seat belt every time you get in a vehicle.

Dr. Delaney is a trauma surgeon, lifelong automotive enthusiast, shade tree mechanic, race fan, and motor vehicle safety expert. During his career, he has seen injuries one just cannot make up, and many of them involve motor vehicle crashes. He has been telling these stories for years, and he thinks it’s time to write them down.

## 52 Comments on “A Day in the Life of a Trauma Surgeon: Buckle Up For Safety...”

• I have to wonder what would happen to his insurance rates if it became known he wasn’t wearing his seatbelt.

• My brother, as a teenager struck a concrete barrier. He was the type-A personality that ALWAYS argued with my parents about everything.

After smashing his face against the front windshield (at guestimated 40mph) and CRACKING the windshield with his face, he now wears his seatbelt.

In a similar regard, people wonder why I “dress-in-all-that-stuff” when I ride my motorcycle. “All-that-stuff” is neck-to-toe leather & a dot/snell full face helmet. Doing anything else is (statistically) stupid.

• afflo

I grew up listening to so many stories from my dad (career state trooper) about scooping up body parts and peeling faces off of windshields. (shudder). ALWAYS wear my seatbelt, period.

I do ride a motorcycle, and I’m a bit conflicted on the gear arguments.

“In a similar regard, people wonder why I “dress-in-all-that-stuff” when I ride my motorcycle. “All-that-stuff” is neck-to-toe leather & a dot/snell full face helmet. Doing anything else is (statistically) stupid”

I too wear full gear (though in South Texas, I opt for mesh in the summer as a compromise so that I don’t stroke out). Abrasion resistant gear is much more about keeping my skin attached rather than doing a dance called the Human Crayon on I-35. Most of the studies seem to put the reduction of death risk on a motorcycle by wearing a helmet at around 50-60%. The death risk INCREASE by riding a motorcycle vs driving a car is around 30 times the number in cars (per mile driven).

So… 3000% increase in risk, and gear making a 50-60% difference. It’s hard to see any way that riding a motorcycle is NOT statistically stupid. I do it, I enjoy riding, and I accept that risk, but I don’t find it to be rational in any way.

• Driving a car is statistically stupid compared to going in public transport or taking an airplane. Should we all take airplanes everywhere? Should we all drive the biggest 8 cylinder, highest bumper SUVs/Pickups? How many airplane/helicopter deaths are there per million passenger miles?

You need to find what transport works best for you and then decide how risky you are going to make it, IMHO.

I’m not walking to work as I can’t walk 30-40 miles in any reasonable amount of time. I’m not taking public transport either due to not wanting to add 1-1.5 hours to my commute every day. I’m not driving a large SUV as they aren’t my preference, although compared to the tons of fits/smart cars/motorcycles I’d probably be safer.

When you’ve already chosen a transportation option, it’s best to make it as safe as possible.

Of ~ 140 motorcycle deaths/year in my state (IL) about 40% had BAC > 0. That is why I don’t drink (even 1 beer) and ride.
Something like 90%+ aren’t wearing a full face helmet.

• burgersandbeer

Blaming alcohol at anything > 0 says even one beer results in impairment. While possible, not often true. Also, some of the fatalities without the full-faced helmet might have been fatalities anyway. This circles back to the author’s point about how each accident is different and there are almost infinite variables in determining your odds of survival. You can improve your odds with gear and responsible riding, but only to a point.

This discussion reminds me of the scene in Hurt Locker where the guy gives up on his bomb suit because the explosives would destroy an armored vehicle if they detonated.

• I was always taught even minor amounts of alcohol can affect judgement/reflexes to some degree. In any case, drinking before riding will NEVER put you ahead instead of being sober. I don’t have much tolerance (to alcohol) anyhow. My personal tolerance when riding is 0.

http://www.cdc.gov/Motorvehiclesafety/Impaired_Driving/bac.html

With that being said, correlation definitely doesn’t = causation.

I do try to give myself every (statistical) advantage possible while still enjoying motorcycling (yes, I took the MSF course too even though I couldn’t skip my driving test with it).

The problem with saying that driving is “statistically stupid” compared to other modes of transportation is that we’re talking about average drivers. Or at least the average of all drivers, which is pretty much the same thing. If you’re a good driver, your chances of surviving on the road increase dramatically.

• I think that goes for driving of more than automobiles as well.

• Landcrusher

Actually, the average dead driver wasn’t at fault. IOW, the bad driver is more likely to survive than his victim.

Also, the average driver who thinks he is better than average is only 40% likely to be correct. :)

I made up the percentage, but you get the point. Safety really improves with judgement more than anything else, and to borrow from another thread, it seems to be a “niche” product..

• afflo

“Driving a car is statistically stupid compared to going in public transport or taking an airplane. Should we all take airplanes everywhere? Should we all drive the biggest 8 cylinder, highest bumper SUVs/Pickups? How many airplane/helicopter deaths are there per million passenger miles?”

Wow… hyperbole much?

Public transit is not available in most places (and exposes one to the risk of pedestrian travel).
Airplanes are not practical for local point-to-point travel. For long distance travel, air planes are absolutely a better choice.
May as well toss in the Russian Soyuz rockets, the Goodyear Blimp, and Ocean Liners for the comparison.

A motorcycle provides comparable transportation to an automobile. They use the same routes, have similar ranges and speeds.

For occupants, SUVs are slightly safer than the compact cars, and but primarily if you’re talking about full-sized SUVs, and not by much.
http://www-nrd.nhtsa.dot.gov/Pubs/809979.pdf

http://www-nrd.nhtsa.dot.gov/Pubs/810990.PDF
That’s a few years old, but it lists the following numbers:

Per 100 Million Vehicle Miles Traveled
Motorcycles: 39.00
Passenger cars: 1.11
Light trucks: 1.10

So, given the choice of getting on my motorcycle to make a local trip, or getting into my car, I’m approximately 35 times more likely to be killed.

I can try to hide behind rationalizations (Most motorcyclists who crash were ____) at the time! If I don’t ____, I’m safe!*). I can try to hide behind my estimation of my confidence (“I’ll use my spidey-sense, SEE, practices braking and swerving and countersteering and so on”), but defensive driving and practicing emergency techniques is something I do in my car as well.

In the end, I enjoy motorcycling for the sense of freedom, and yeah, the sense of danger and risk as well. It’s a very visceral thing, and I don’t judge anyone for doing it. The sense of freedom, danger, and risk also leads people to go ahead and up that 3500% risk increase a bit more by riding around with a ball cap and Ed Hardy T-shirt. I won’t judge them either. It’s their choice.

* I don’t buy the “BAC greater than 0.00” arguments. A fair number of motorcyclists do get sloshed and saddle up, but an even larger number go on a ride, and have A beer with lunch, or at a favorite watering hole at the end of the ride. There’s a lot of room for correlation there. I could say that huge percentage of motorcycle fatalities involve people with motorcycle keys in their posession at the time, but honestly, the hyperbole horse is tired and needs a drink.

• No hyperbole here!

The fact is that people who drive “automobiles” (passenger cars/trucks) take an inherent daily risk much higher than walking, public transportation or air travel. They choose to take that risk (just as motorcyclists do), and I think they don’t even realize what they are doing is one of the most risky things they do during the day! (If they did, they wouldn’t tailgate 3′ off my bumper @ highway speeds)

Sure, motorcycling is more dangerous, but it really grinds my gears for people to say “yes, I drive a car, it’s safe!” when in reality it is actually one of the most dangerous methods of transportation (more than walking, bicycling on non-road surfaces, walking, taking the train or bus).

If you CHOOSE to not live in a city with public transport, can’t afford your own personal daily air or train transportation, can’t walk or bicycle on non-road surfaces, then that you are choosing to take a risky way to work, just like a motorcyclist chooses a risk.

Believe/don’t believe whatever you want, but saying driving (a car) is “safe” is only correct relative to a few other methods of transportation. My cdc link above about BAC is not a bunch of made up numbers. CDC isn’t some non-trustable source IMHO (again: Believe what you want).

I personally _reduce_my_ risk by maintaining 0 BAC, wearing full gear and paying attention to my surroundings whenever I’m go riding.

The > Bac 0.0 affects your abilities is _not_ an argument. It’s fact. Look at the CDC link.

With that being said, I don’t really appreciate the tone of your comment.

• Landcrusher

The number I keep seeing quoted for motorcycles is 7 times per mile, not 30. At 30 times, motorcycles are more dangerous than biplanes which I estimate at about 10 times.

• econobiker

But then horse back riding is much, much more dangerous than motorcycle riding per mile ridden…

• afflo

http://www-nrd.nhtsa.dot.gov/Pubs/810990.PDF

And someone else already nerded out with General Aviation (not specifically biplanes, mind you)!

http://www.rapp.org/archives/2011/12/highway-vs-aviation-safety/

• Landcrusher

Thanks for the links! I am off to see them now. :)

• Landcrusher

Okay, the GA points in that article seem about correct, but there is a lot lost in the conversion. I will stick to AOPA’s number of 7 times because they did a much better conversion with a lot more factors.

While I am waving the GA flag here, I will point out that pilots are many times more in control than drivers and riders. Plane choice is huge depending on your likely missions. For flying around and short hops, the aircraft made by Diamond aircraft are so much better than average it makes the others, even ones with whole plane parachutes, look like they aren’t trying. The fatality per 100k hours of the DA20 was .28 last I checked. That’s a third of the Cessna 172. Other than Diamond, you have to go with the Bell Jet Ranger to beat a 172 which is about 1 per 100k iirc. I don’t know the Rangers number, only that it beats the 172 while generally doing a lot more dangerous flying, but rarely being flown without a commercial pilot.

Fly a DA20 only in fair daylight while sober, and you get pretty close to car like safety while going about 140 mph as the crow flies. The problem is needing a car when you arrive.

• Landcrusher

Oh, there is one more thing about being a pilot that must be said. You become an enemy of right minded people everywhere. Being a white, libertarian leaning veteran with a pilot certificate and my own plane makes me a quintuple threat to the good folks who aren’t afraid to take all sorts of social, legal, and financial action. They may like the second amendment, but they don’t hesitate to send men with guns to greet a plane for nothing more than being a plane they don’t own.

• Kyree S. Williams

I’m no motorcycle driver, but I have issues with the way automobile drivers treat them where I live. One of the biggest rules that everyone seems to forget is that you *obviously* shouldn’t follow a motorcycle as closely as you would a car. And so I find it ridiculous when I see someone just hop onto a motorcycle in shorts, a T-shirt…and no DOT-approved helmet.

• I agree 100% on both points. Nice post. I really get annoyed by “gear free” motorcyclists as well as people who tailgate. I try to be in whatever lane has the most stopping distance in front of AND behind me….

• burgersandbeer

Theoretically, you should always allow sufficient space to not hit the vehicle in front of you, regardless of whether it has four wheels or two. That said, most sane people leave a little extra margin for error when a mistake is likely to cause a fatality.

For example, I will try to intimidate slow-moving car traffic out of the left lane. I would never do that to a bike. If a bike travelling at 55mph in the left lane blocking traffic, I’m either stuck there or undertaking.

• Landcrusher

People don’t drive badly because they are insane, but because they are ignorant of the degree of risk. Just like most of them are ignorant of left lane discipline. Others are self important.

You wouldn’t crowd a bumper of a car in the left lane when it was traveling two seconds behind another car that wasn’t yielding to him, but many jerks do. It’s one thing to take a chance crowding a car that clearly has stopping room, but lots of people will tailgate you when doing so forces you to slow down to avoid being between two idiots who likely have poorly performing vehicles (my fave is being tailgates by a minivan or empty pick up.

It’s not insanity, it’s lack of civility and sense that leads to bad driving.

• burgersandbeer

I guess this depends on how strictly we define insane. People ignoring an obviously high-degree of risk are often casually called insane. Semantics though; I’m pretty sure we are on the same page. Call them insane, ignorant, assholes, morons, etc – same principle.

I also set myself up a bit with the crowding comment, so I should clarify that behavior. I only do it to cars blocking open highway. If there is another car only two or three seconds down the road, I consider that traffic and carry on at a safe distance. I also only do it when I can actually see that there is open highway ahead. I don’t crowd vans, Range Rovers with limo tint, and other vehicles I can’t see around or through.

Ideally, I wouldn’t crowd anyone at all – but I’m not that patient. It is a minor weakness in my defensive-driving gameplan.

• V-Strom rider

Here in Australia the road safety experts say that motorcyclists have 38 times the risk of death or serious injury as car drivers. However, I estimate that we have 100 times as much fun, so the risk-to-reward ratio is in our favour :)

That said, I always ride with full gear, including a top-of-the-range full face helmet. I concentrate really hard, adjust my speed and positioning constantly according to observed road and traffic conditions, maintain a good buffer zone etc. I ride with zero BAC. None of this interferes with my enjoyment of a ride – in fact the challenge of riding skillfully and as safely as possible is actually very rewarding in itself.

I’ve ridden to the highest road in the world (Khardung-La in the Himalayas, India) but heavy traffic on a rainy evening at home is probably the most dangerous environment I have encountered.

• Kyree S. Williams

” Airbags do augment the effectiveness of seat belts, but are not a substitute.”

Well that’s why airbags are called Supplemental Restraint Systems…meaning that they supplement the safety belts. This is what I explained to my friend, who just bought a new Maxima and who never wears his safety belt for exactly the reason you mentioned…he doesn’t want to be trapped in the car.

• -Nate

THANK YOU Doctor ! .

This cannot be stated too many times .

Seat belts : always , 100 % of the time as they hold me in place so I can concentrate on driving ‘ spiritedly ‘ .

Moto gear : ATG , ATT as I only survived my Moto Collision (I was run over whilst parked) due to my gear .

Graphic photos and descriptions should be _mandatory_ because I’d rather you puke than get killed or crippled for life like I am .

-Nate
(who managed 250 Miles in a Moto yesterday)
.

• swc7916

“Entrenched beliefs are rarely altered by exposure to fact.”

Love it!

• Dr. Michael Delaney

I have searched without success to find the author of that quote. A colleague of mine used it and he told me it came from the cover of a forestry magazine.

• sirwired

I think the persistence of people that refuse to wear seatbelts comes from simple stubbornness a willful blindness. They don’t want to wear a seatbelt, so they will latch on to any convenient excuse for not doing so, such as the classic “what if my car’s on fire” scenario, to the good friend they have who swears they would have died if they had been wearing one.

My brother-in-law was in a nasty head-on without his seatbelt (in a late 80’s Mustang, IIRC; idiot was passing in a no-passing zone), and somehow he escaped with nothing more than a broken foot. He now uses his survival as some sort of “evidence” that wearing a seatbelt would have killed him. (Although seeing the twisted hulk, I have to admit I’m not sure how he even survived the accident, seat belt or no…)

I put seatbelt refusers in the same strange category of people that think motorcycle helmets are the work of the devil…

• hf_auto

I’ve heard the “I don’t want to be trapped in my car in case of a fire” excuse over and over. Ironically, accidents involving fire benefit more than any other accident type because drivers stay conscious- the result is a 78% improvement in survivability.

The only scenario where UMTRI doesn’t see a difference between belted and un-belted data is in train collisions… just too much energy.

• mitchw

Twenty years ago a friend studying surgery told me that the profs had a name for people on mopeds, ‘organ donors.’
—-
“Entrenched beliefs are rarely altered by exposure to fact.”

In fact, but let’s not get political, there’s a subset of the population which will adhere even more closely to their original belief if confronted with solid, contrary evidence. Sometimes, I am a member of that subset, against which I endeavor to apply the Golden Mean.

• kvndoom

To get slightly political, I’ve heard more than a few numbnuts chime about the Gubmint not telling them what to do. I don’t care if they get Darwin Awards, but when they don’t make their kids buckle up either, they need to have their licenses revoked and spend 2 years with Bubba.

• burgersandbeer

CA actually prohibits smoking in a car with kids in it, so I would hope there is a severe penalty for not making the kids buckle up.

Besides the immediate safety issues, not stressing seat belt use to kids is a problem that will snowball for generations. Those kids likely grow up not using seat belts, then their kids, and so on.

Thanks to my parents, I’m pretty much incapable of moving a car in the driveway without using a seat belt. Buckling the seat belt quickly became muscle memory, not a conscious thought.

• manbridge

Looks like one of those damnable Ford shifters from the late 80s/early 90s from which the knob came loose after roughly two weeks of ownership. Even though this knob appears to still be attached there must be some deaths due to the ridiculous engineering concerning its construction resulting in impalement.

• deandorsey

my fiance was just in a offset frontal collision in her civic with both cars traveling at least 45mph. front, side and curtain airbags went off – she was able to open the door and walk out. when i arrived at the scene i was amazed she was ok. i wrote about it here:

http://www.vtec.net/forums/one-message?message_id=1155588&page_number=1&amp;

i have no doubt that if she had been in her old mkiv jetta her injures would have been much more severe.

i also here the misguided wives tails of “old cars were safer/ seat belts trap you/ new cars fold like tinfoil” a lot.

• fincar1

Shortly after my daughter became an EMT, she and her partner were doing a transport from Seattle to eastern Washington somewhere. On I-90 near Ellensburg an oncoming Dodge pickup left the pavement into the median and rolled several times. The driver came a little farther out the driver’s door window with each roll of the truck until he was thrown clear.

I used to install seat belts in cars I bought in the early 1960’s that didn’t already have them – and most didn’t. But even if I’d been a “seat belt refuser”, listening to her recount what she saw that day would have changed my mind.

• snakebit

fincar1, I could have written your posting from similar experiences. I, too, got a hand-me-down 1950’s car in the mid sixties, and my dad and I put aftermarket seat belts in it before I began using it. It already had padded dash and recessed steering hub(part of the 1956 Ford safety features that many other car makers hadn’t moved to at that point). All of the driver training cars had belts, and students were asked to buckle up before moving into traffic, so wearing seatbelts was second nature, as much a part of driving as shutting the door. When I got a Mustang in my senior year, I and my dad made sure it came with belts(just lap belts were offered that year).

As far as being thrown from a car if you’re not wearing seat belts, what do you think the trajectory of a body leaving a closed car is? It’s rarely one clean Superman flight through an open window or already popped-out winshield. It’s rarely that neat an exit, as fincar1 wrote. That’s why being thrown from a car is often fatal.

As for the issue of states mandating seatbelt use,get past that, and remember who else is probably mandating it: your family and your friends, who can’t and shouldn’t have to envision a life without you. Not important enough to do it for yourself? Do it for them.

As for motorcycles, I once discussed their safety with an Los Angeles motorcycle patrolman. His opinion of rider was that there are only two classes of riders: those who have already been knocked off their rides, and those who will have been knocked off at some point. He said a rider would take to heart all of the training they got to avoid collisions, and still be at the mercy of an automobile driver who didn’t look before changing directions or lanes. He said a rider has to be extra vigilant, try not to be in someones blind spot, make sure to wear leathers or protective clothing, and assume that sometime in your riding experiences, if you’re lucky, you still encounter near misses, just the same.

Bicycles are another issue perenially. I can’t tell you the number of times that I’ve seem daredevils on bikes. I sometimes cross a bike path that intersects several roads. On the path, in both directions, are stop signs, and on the road are standup signs that tell drivers to yield to people in the marked crosswalk(pedestrians with and without bikes have the right-of-way). I emphasis ‘in the crosswalk’. As the law is enforced locally, a person riding(as opposed to walking along side) a bicycle is considered a moving vehicle, i.e. subject to the same laws and signage restrictions that apply to cars and trucks. I can’t count the number of bicyclists who sail by stop signs on the path in both directions, not stopping, not getting off of their bikes or walking across the road, with apparently no concern for a car coming down the road, with presumably the attitude that a car will stop once they see the bicyclist zooming across the road. A reminder, bicyclist, the cars have a ‘yield’ sign, you have a ‘stop’ sign. What part of ‘stop’ don’t you understand? This is one instance of might really meaning right. Don’t bet your life on who’s got the right-of-way in your mind.

• burgersandbeer

The patrolman’s point about being at the mercy of other drivers is pretty much why I can’t bring myself to ride, as much as I would like to give it a shot. Too many variables out of your control.

Speaking of motorcycle police – with all this talk about always wearing proper riding gear, can someone explain why the CHP wear t-shirts and open-faced helmets?

• 360joules

“Impalements…always draw a crowd in the trauma bay.” Yeah, the Looky-Lous annoy me. I have been tempted to put a collection cup in front of my bays to defray the patient’s share of his/her bill. I have yet to see a trifecta: no seat belt, ejected, then impaled – but those folks usually don’t make it to me.

• mies

Great article. I walked away from getting rear ended by a drunk driver on the interstate back in 2008 because I was buckled up. I was going 50’ish and he was going 90’ish. The trunk of my car was pushed into my back seat, I hit guard rail on one side of the road and bounced accross 2 lanes to the concrete barrier wall. Even with the heavy damage to my vehicle, I was able to get unbuckled and get myself out of the car. I don’t actually remember the accident, or the first 7 hours of that day for that matter, because of the concussion I sustained. The police said I was out of the car and making phone calls. The drunk driver, who was also not buckled in, survived, but he was unconcsious for a couple of days. I don’t know the extent of the rest of his injuries, but I’m sure it wasn’t pretty since his SUV flipped after he hit me. Aside from my concussion, the belt prevented any serious injuries (although the concussion messed me up for a couple of years).

I don’t care about any annectdotal evidence about your uncle Jimmy getting thrown from his Galaxy 500 and miraculously surviving. Seat belts work. I’m sure the percentage of people that die from being buckled in is far lower than the miniscule percentage of people that survived despite being unbuckled.

• Big Al from Oz

How safety is viewed is cultural. An environment must be created to value safety, so it becomes instinctive.

Regardless of how many safeguards that are in place and incident will occur.

I work in the aviation industry and safety is paramount, even on the job. Part as my job was to study what is called Human Factors. For any manager or even a worker google this subject. You will learn from it and probably become a better manager/worker.

I know there are people who view safety as impinging on their perceived freedoms and rights. This type of personality generally are involved in what we call violations, that is to blatantly disregard a process or procedure. Then there are oversights. Both of these actions can be deadly, not only when operating a vehicle but on the job.

But, also these people must realise that when they are ‘unsafe’ they are also affecting the safety of others.

As a manager now I’m totally responsible for the actions of my workers. But this can only go so far, as I stated there as those who think they know better.

Remember, if you do something you might harm or kill others, through your actions.

• Kyree S. Williams

That’s just it. Your irresponsibility doesn’t just exist in its own little bubble of mayhem where you can only hurt yourself; your actions *can* harm others. Sadly, there are a lot of traffic accidents wherein the perfectly-innocent party ends up far worse-off than the leadfoot/street racer/drunk driver that was actually at fault. And it’s absolutely ridiculous not to make your children buckle their safety belts…

• Motorcyclists (and bicyclists!) should always dress to be seen, day and (especially) night. I’ve seen motorcyclists in black leather at night. And in Cambridge, of all places, a lot of cyclists go around in dark clothes with puny, or no lights. When I bicycle, I wear one of those lime green jerseys that’s visible from the International Space Station.

• healthy skeptic

I vote for more stories from the good Doc. I imagine he’s got quite a few of them. Trauma surgeons have great stories. Nice new addition to TTAC.

• Dr. Michael Delaney

Appreciate your support. Every day on call is like Christmas, full of surprises–stories patients tell you as how to they got hurt and no two injuries are alike.
Dr. Delaney

• troyohchatter

In reference to the motorcycle riding being 3000% more dangerous, I disagree and the statistics seem to bear this out. See, in order to be accurate, you must elliminate a few things. First, let’s ditch the riders that:

-Don’t have an endorsement
-Drunk
-Don’t have a MSF or similar advanced training
-Are breaking the law
-Are not geared up with helmet, mesh or leather, etc (indicator of responsible riding).
-Are not dressed to be visable (biggest pet peeve of mine is black top to botton and wondering why “they didn’t even see me!!”

MSF states that if you line out ALL of these, you end up with a very VERY small percentage of people that have accidents. But of course, they always lump the responsible riders like me with the squids on a sportbike with shorts and flipflops along with the midlife crisis dudes with his first bike, an HD chromed out, half lit with three beers from bike night.

Unfortunately, because the typical motorcycle use in this country is more slanted towards morons as very few of us actually ride for transportation/commuting.

• afflo

You will do the same to the car driver numbers, right? You can’t just remove all the bad eggs from the riders and leave them in the cager column.

A comparable list would be:
-Drunk
-Are breaking the law
-Aren’t wearing seatbelts
-Not using healights/DRLs in low-vis situations
-Texting/cellphone use

Get rid of all of those, and driving is far less dangerous as well.

Believe me, I’m all about taking steps to mitigate the risks of riding, but in the end, it’s still a giant, unnecessary risk, and I can either accept it for what it is, or hang up the keys. I choose the former.

• troyohchatter

I’ve been riding for 20 years, about 15K miles a year and avoid the potential accidents that come quite frequently, like every single mile it seems.

Now I drive probably 20K miles a year or more (man I sure do burn gas, don’t I?). I have been hit twice in my car and both times they were accidents I would have avoided on the motorcycle. Does that say that motorcycle riding is actually LESS risky than driving a car? No way, but only because the fact that most people can’t DRIVE is modified 10 fold when those same a\$\$hats attempt motorcycle riding.

• Landcrusher

Afflo’s point was correct, and your answer shows a lack of objectivity. You even throw in a personal anecdote with perception bias.

What I think would be a good thing for you would be to stop trying to change the facts. It’s perfectly acceptable for you to decide that you will mitigate risks by avoiding the behaviors that get many riders killed and accept the extra risks that you can’t control because you like to ride. You can even say that in spite of the numbers you feel more comfortable on a bike than in a car even if you likely should not.

When you seem to fight the methodology of the stats, you invite argument from people who think you are deluding yourself and displaying bad judgement. Just don’t deny the numbers outright. Instead, accept the general conclusion, that riding is dangerous, while decrying the bad behaviors that exaggerate the differences rather than the unfairness of lumping in all the jerks in your pool.

I would be happy to agree that 30 times seems high and if you go digging you might find something that shows that some smart decisions are greatly reducing your risks.

• bachewy

I had an uncle who had the same belief that he didn’t want to be trapped inside a burning vehicle. He also had an opinion that if about to wreck on his motorcycle he’d rather lay the bike down than get thrown off his bike. This crash expert didn’t actually ride a motorcycle until his 60’s and even then, would trailer the bike to any event and just ride it for a couple blocks, every article of clothing bedazzled with “Harley” labels (but actually made in China), claiming to be a hard-core biker (insert laughter here).

This type of person never takes classes to LEARN anything . They just go through life with opinions based off a single incident or urban myth.

Stubborn to the end and against doctor orders, he left the hospital with emphysema and pneumonia. He died that same night.

Darwin award nominee?

• Great article. I did not read all of the comments above, but based on 35 years of driving, this really struck a chord. As a teenager in the late 70s I recall SO clearly the “… are you planning to crash?…” “…do you drive that badly…” “…wouldn’t you want to be thrown clear?…” sniping. Still, for so many, facts will never mean anything.

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