The Trauma Professional's Blog
Medical Helicopter Crash - The Ultimate Distracted Driving

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!

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Reference: Numerous news items on April 9, 2013. See CNN content here.


Distracted Driving In Police Officers

A lot has been written about the hazards of distracted driving. Now, there is new information about the impact of distraction on police officers! A public safety administration class at St. Mary’s University here in Minnesota analyzed 378 crashes involving police cars from 2006 to 2010. The results are intriguing!

Key findings included:

  • Most crashes occurred during non-emergency responses
  • Crashes occurring during emergency responses were the most expensive
  • Distracted driving caused 14% of all crashes
  • Half of distracted driving crashes were due to the use of squad car computers
  • Average insurance claim was $3,000 per crash. However, if the crash was due to distracted driving it doubled to $6,000. If the crash was due to squad car computer distraction the average cost was $10,000!

This study is interesting, but it’s only a partial snapshot of this type of crash in one state. It did not include some of the larger police departments, such as St. Paul and Minneapolis.

Bottom line: It’s safe to assume that distracted driving is just as dangerous to police (and prehospital providers, too). And with growing dependence on advanced technology for law enforcement, this problem is just going to get worse. It is imperative that everything be done to improve safety for our law enforcement colleagues. Potential solutions include training to increase awareness of distractions within the car, simulator testing of driving while using cockpit technology, and ergonomic studies to maximize field of view from within the car.

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New Developments On Distracted Driving

The Governors Highway Safety Association released a study that sifted through 350 scientific papers dealing with distracted driving. They summarized their analysis in a nice report that can be downloaded here.

There are 4 types of distraction:

  • Visual - looking at something other than the road
  • Auditory - listening to something not related to driving
  • Manual - manipulating something other than the steering wheel
  • Cognitive - thinking about something other than driving

Smart phones provide all four modalities! About two thirds of drivers report using a cell phone while driving, and 7-10% were observed to be using one at any given time. About 12% of drivers admit to texting while driving, and about 1% of drivers are texting at any given time. At least one driver is reported to be distracted in 15-30% of car crashes. 

The following items were gleaned from the papers reviewed:

  • Cell phone use increases crash risk, but the exact amount is not known
  • Hands-free cell phone use has not been shown to be safer
  • Texting increases crash risk, but the exact amount is not known
  • Hand-held phone bans reduce use somewhat
  • Texting bans have not shown any significant effect, although high visibility enforcement campaigns offer some hope

Syracuse NY and Hartford CT enacted high visibility campaigns (“Phone in one hand, ticket in the other”) in late 2010 and spring 2011. They found that cell phone use dropped by half, and texting dropped 72% in Hartford and 32% in Syracuse. These results do not agree with the GHSA findings, most likely because of the intensity of the efforts in these two cities. 

Bottom line: We all know that texting while driving is bad and cell phone discussions while on the road are not very good either. There may be some utility to enacting bans on these activities. However, given the other responsibilities of our police departments, enforcement will always be a lower priority. Engineering solutions like roadway rumble strips can help divert attention back to driving, and crash investigations should aggressively examine any contributions to driver distraction. Ultimately, we’re going to have to treat this problem like we do for driving while intoxicated, with stiff penalties and driving restrictions. Unfortunately, I don’t think we’ve got the fortitude to do it anytime soon.

Download: GHSA Report on Distracted Driving

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EAST Evidence Based Review: Distracted Driving
EAST is branching out from one of its core areas, creating trauma practice guidelines. They are now beginning to address other problems using the same techniques for developing their practice guidelines. Instead of generating guidelines for clinical care, they are creating action statements based on the best available literature.
This Distracted Driving review was one of a group of new EBRs was presented last week at the EAST Annual Scientific Assembly. The panel reviewed information from government agencies and studies based on crash databases and simulations. The number of cellphone subscribers has surpassed 250 million, and the number of deaths from distracted driving has followed a similar curve. 
Distracted driving is implicated in 20% of injury crashes and 16% of fatal crashes. Drivers under age 20 has the highest proportion of distracted drivers. 
EAST made three Level II recommendations, which means that they are reasonably justifiable by available scientific evidence and strongly supported by expert opinion. They are:
Drivers should minimize all distractions while on the road
Cell phone use and texting should not be performed while driving
Younger inexperienced drivers should not use cell phones during their probation period (if such a period is mandated by their state)
Future areas of interest will include studying the impact of legislation regarding cell phones and texting, development of crash avoidance systems, and evolving cell phone technologies.
Reference: Evidence Based Review on Distracted Driving, presented at the 2011 EAST Annual Scientific Assembly. Note: this information is preliminary and may be changed prior to publication.

EAST Evidence Based Review: Distracted Driving

EAST is branching out from one of its core areas, creating trauma practice guidelines. They are now beginning to address other problems using the same techniques for developing their practice guidelines. Instead of generating guidelines for clinical care, they are creating action statements based on the best available literature.

This Distracted Driving review was one of a group of new EBRs was presented last week at the EAST Annual Scientific Assembly. The panel reviewed information from government agencies and studies based on crash databases and simulations. The number of cellphone subscribers has surpassed 250 million, and the number of deaths from distracted driving has followed a similar curve. 

Distracted driving is implicated in 20% of injury crashes and 16% of fatal crashes. Drivers under age 20 has the highest proportion of distracted drivers. 

EAST made three Level II recommendations, which means that they are reasonably justifiable by available scientific evidence and strongly supported by expert opinion. They are:

  • Drivers should minimize all distractions while on the road
  • Cell phone use and texting should not be performed while driving
  • Younger inexperienced drivers should not use cell phones during their probation period (if such a period is mandated by their state)

Future areas of interest will include studying the impact of legislation regarding cell phones and texting, development of crash avoidance systems, and evolving cell phone technologies.

Reference: Evidence Based Review on Distracted Driving, presented at the 2011 EAST Annual Scientific Assembly. Note: this information is preliminary and may be changed prior to publication.