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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.

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A Day in the Life of a Trauma Surgeon: Get Your Foot Off of My Dash http://www.thetruthaboutcars.com/2013/02/a-day-in-the-life-of-a-trauma-surgeon-get-your-foot-off-of-my-dash/ http://www.thetruthaboutcars.com/2013/02/a-day-in-the-life-of-a-trauma-surgeon-get-your-foot-off-of-my-dash/#comments Tue, 12 Feb 2013 07:11:18 +0000 http://www.thetruthaboutcars.com/?p=477268   WARNING: If you think this picture is too gross, do NOT hit the jump. – BS We have all seen it before. You are cruising right down the road, and it immediately catches your attention. There is a female passenger in another vehicle with her feet up on the dash.  Imagine the horror if […]

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WARNING: If you think this picture is too gross, do NOT hit the jump. – BS

We have all seen it before. You are cruising right down the road, and it immediately catches your attention. There is a female passenger in another vehicle with her feet up on the dash.  Imagine the horror if someone did this to your brand new vehicle!

The nightmare came true for both Bob and Carol. They were running errands around town and Carol put her foot up on the glistening dash of Bob’s new SUV. Holding back his true thoughts, Bob politely says, “Honey, please get your foot off of my new dash.” Carol replies, “I am just admiring my new pedicure like you’ve been admiring your new SUV.” As the conversation heats up, Bob becomes distracted while making a left hand turn at a four-way intersection and fails to yield to an oncoming vehicle. Distracted as well, Carol still has her foot on the dash at the time of impact.

Brake pedals are slammed to the floor and evasive maneuvers fail. Bob’s brand new SUV is struck in the right front corner sending it into a spin, before it rolls over onto its roof and slides to a stop. Fortunately, all the occupants of both vehicles were seat belted and most were able to walk away from the crash. Carol was not so lucky. As the passenger frontal bag deployed, it pushed Carol’s foot through the windshield and her toes were amputated as the vehicle slid on its roof, dragging her foot across the hot summer asphalt.

One can only imagine the pain and fear when Carol looked down and saw that her toes were gone. After stabilizing Carol for transport to the hospital, the good-intentioned paramedic recovered her missing toes. After transferring Carol’s care to me, he said, “here are her toes for you to put back on.” I smiled and thanked him, knowing well that was not going to happen. Not only were two toes completely missing but the three amputated toes along with her foot were too badly damaged to perform a reimplantation.

Carol received a complete trauma evaluation, and fortunately the only injury was to her foot. We took her to the operating room and cleaned things up, leaving Carol a functional forefoot amputation. After a couple of days of physical therapy she was back on her feet. Humor truly is good medicine, especially with trauma patients who tend to forget how lucky they are.  Carol could have lost her leg, both legs, her life. One day on rounds I told her I had good news and bad news for her. The bad news, Carol, is you lost your toes. The good news is your pedicures will be half-priced. But hearing the phrase, “you won’t be standing on your tippy-toes” brought a momentary scowl to her face. We both laughed and Carol was grateful for her life and not having been injured worse.