traumatic brain injury

What Not To Do Wednesday – 3/15/17

Quin Bond, CEAS IIILeave a comment

A recent article in The Daily Meal focused on bad kitchen hygiene habits that can be observed by watching most of the television shows featuring celebrity chefs.  These habits include unsafe handling of meats and vegetables, lack of personal protective equipment (gloves), and unsafe techniques for tasting food while cooking.  The article points out that a reminder during the show about safe techniques could go along way to prevent unsafe and unhealthy techniques being used for cooks at home.  A “Don’t Do What I Do” reminder, if you will.

The celebrity food shows are not the only media in which poor or unsafe techniques are shown.

chip on top step of ladder

I hate to pick on Fixer Upper (it’s a favorite show in our home) as Chip’s goofiness is always the source of a few laughs.  But, this morning as my kids were watching a rerun, I heard him discuss some issues with the roof of a house that they were renovating.  When the word “ladder” came across the speaker of the television, I knew that I needed to take a quick peak.  I grabbed a quick picture with my cell phone as I saw them pull out the sketchy wooden A-frame ladder which was well below the roof line of the house.  Not only did Chip stand on the top step of the ladder with not great holding by his wife, he used this top step as a launching point to climb on to the roof.

In defense of Fixer Upper, almost every home improvement/home repair show on HGTV and DIY features moments just like this one – whether it is with ladders, saws, hammers, etc.  As Joanna Fantozzi of The Daily Meal pointed out in her article, a quick reminder of safety principles could go along way towards better safety practices of homeowners as they are attempting to do home renovations and repairs.

While This Old House may not be as fun and glitzy as its HGTV relatives, they include a lot of safety information as they take on different tasks on the show.

Ladder accidents cause nearly 500,000 injuries per year and the rate of ladder injuries has been increasing every year.  A significant portion of these injuries are not work related and occur at home.

There are several simple solutions to reducing the number of ladder related injuries:

  • Use the right type of ladder.
    • Use wood or fiberglass ladders when dealing with electricity.
    • Make sure that the ladder is of sufficient height for the task being performed.
    • Make sure that the ladder has a sufficient strength rating for the weight of the user and and tools/materials that are being carried or used.
  • Make sure that the ladder is in good shape.
    • If the ladder is worn or damaged, make sure that the ladder is repaired to manufacturer standards or replaced.
  • Make sure that you are using the ladder properly.
    • Maintain 3 points of contact when climbing.
    • Don’t reach out of your base of support.
    • When necessary, climb down, move the ladder, and climb again.
  • Make sure that you use proper ladder placement.
    • Place ladder on firm, even ground.
    • Use an assistant/helper to support the base of the ladder to prevent slipping.
    • Don’t place the ladder in front of doors that have not been secured.

One last suggestion comes from a recent paper in Injury by Ackland et al.  In their review of admissions to intensive care units due to ladder related injuries, they recommend that ladder users wear helmets to reduce the risk of traumatic brain injuries in the event of a fall from a ladder.  They note that this is especially important in home based environments as typical worksite occupational health and safety regulations are not in effect.

 

 

The most important Super Bowl viewers

Quin Bond, CEAS IIILeave a comment

Over the last decade, the issue of concussions in professional football has been addressed in books, movies, lawsuits, and significant coverage in the news media.

While nobody is fully sure of the best way to completely address the issue and minimize the risk of concussions during play and practice, the NFL instituted an important program in 2012 to become more proactive in addressing potential concussion situations during games.  The NFL began placing certified athletic trainers (ATCs) in the stadiums to view games with the purpose of looking at both the in-game contact as well as player behavior after plays and along the sidelines.

The inclusion of these healthcare professionals was a result of a hit to Browns quarterback Colton McCoy during a late season game in  December 2011 after the institution of a video review system for injuries.  The hit that McCoy took was not noticed during the game but after the game.  The NFL realized that a set of eyes were needed to review potential issues in real time.  The ATC spotters observe both the game and video feed from the broadcast coverage in real time to identify plays that may result in concussion or injury whether it is from player to player contact or contact with the ground.  The ATCs then contact either the team medical staff or the unaffiliated neurotruama consultant to advise them of what was observed.  These calls can not be handled by bench staff from the team.  The ATCs also instruct technicians to send the video of the specific incident to the sidelines for medical staff to include in their evaluation of the athlete.  According to the NFL, approximately 10 plays per game initiate this process.  ATC spotters can also initiate a medical timeout.  These timeouts are not charged to either team.

While there are several criteria for ATCs who wish to apply to this program, I think the most interesting are:

  • At least 10 years experience – enough experience to really have an idea of what they are observing
  • Can not have been the Head Trainer for any NFL team previously
  • Can not have been employed by an NFL team in the last 20 years

I think the last two criteria that I mentioned are probably the best at showing a positive intent for this program by the NFL.  These two criteria help to minimize the impact that past relationships with teams and/or players may have on an ATC Spotters observations.

While this is a great program and the NFL appears to have done a great job in keeping the program impartial and they have empowered the ATCs with the authority to stop game play, this only addresses observational, subjective game day issues.  It still does not provide an objective and measured value to the cumulative impacts that occur during the game – or more importantly, the significant hours of practice and seasons of games that comprise a player’s career.

Helmet impact sensors like those from Shockbox may help to provide a more objective dataset to determine the amount of cumulative impacts that a player goes through during the course of games and practices.  The US military has been studying head trauma through the use of helmet sensors since 2007 and began collaborating with the NFL in 2012 to better advance the science and address the issues.

The US Army had been using helmet based sensors in Afghanistan to measure blast pressures during IED events during combat patrols.  The sensors are triggered with forces greater than 150 newtons, which is the equivalent of just under 34 pounds of force.  Not a whole lot of force when compared to the forces of between 447 pounds and 1,066 pounds in boxers when punching.  However, a drawback to the Army/DARPA program was that it was only run in combat zones and did not take into account proximity and cumulative exposure to blast pressures when firing heavy weapons. The program was ended in late 2016.

There is one five year study that was done at University of North Carolina that looked at not just game day impacts but also the hits sustained during practice sessions.  The data that they collected shows some interesting data points.  They found that some impacts that were of significant force did not cause concussions while some lesser impacts that were below “threshold” did cause concussions.  Within these below threshold concussions, they found that the area of the point of impact on the head is just as important as the amount of force.

We still have a lot to learn about the causes and effects of concussions as well as treatment post concussion (as we’ve pointed out in a Friday Five post).  But, we can take notes from the positive aspects of what the NFL has done so far with their ATC Spotter program in being more proactive in dealing with health related “workplace” issues.