Regarding tree stands, we had such a case in northern Iowa wherein a hunter fell from the stand and broke his back by landing supine over a barbed wire fence below. When he came to the ER he was for all intents & purposes paraplegic, with just a touch of sensation in his right toes, no motor ability, bowel or bladder control.

My hat was off to the paramedics who transported his fractured spine by on-site stabilization on a backboard and delivery to the ER without any further relative motion. We sent him on to a neurosurgeon at a larger trauma center, and he completely regained lower cord function – just bruised, not transected. So after his back healed, all he had was a bit of lumbar stiffness as a memento. Guardian angels were busy that day.

I’ve seen stuff recently that says stabilization in the field is a myth, and patients do equally well backboarded or not. It seems counterintuitive, but the trend in EMS seems to be away from so much attention to maintaining rigid relationship of spine-connected structures and towards rapidity of transport.

Here’s one of many peer-reviewed articles on it:

http://www.jems.com/article/patient-care/research-suggests-time-change-prehospita

The change they recommend is quite subtle, though, and still recommends spinal motion restriction for pts showing signs of spinal cord trauma.

It was also entertaining for the authors’ use of the old parachutist gag line: “It isn’t the fall that causes injury; it’s the sudden stop at the end.” Also known in the jumping world as “deceleration sickness.” “What happened to Ted?” “He never pulled. Bad case of deceleration sickness on the runway.”

I thought this line was interesting:

“Standard spinal immobilization techniques can also take away the patient’s ability to effectively protect their own airway thus significantly increasing the risk of aspiration.”

Just goes to show that in medicine, whether OR or pre-hospital, anything you do can kill the pt, including doing nothing.

That’s true, and the proof of the pudding is in the eating.

But as for airway protection, whatever happened to direct observation and logrolling? Haven’t the providers got brains anymore?

Here’s hoping Aesop doesn’t take offense, but the big difference I’ve noticed between MDs in general and RNs in general (there are lots of exceptions!) is that MDs tend to regard rules as guidelines to be broken when the case suggests, whereas RNs tend to regard rules as handed down by God, or government, which seems to be the same things these days in many folks’ minds.

I would be more than ashamed of myself if I didn’t appreciate and anticipate the risk of aspiration when a patient is supine and incapacitated. I think I told the story before of a group of young adult hunters who split into 2 teams deer hunting and blasted away at each other when the deer ran between them, sending a slug through one teen’s internal jugular vein and laryngopharynx. The poor sod was thrown supine into a pickup without attendance while his buddies frantically drove to the ER. And he drowned in his own blood and was brain-dead by the time we got him. At least his other organs survived.

Oh, and yes, regarding the article, I would agree that immobilization is overused. I’ve had EMTs slap a C-collar on anyone that got in an accident, regardless of the fact that they were fully conscious and had NO pain anywhere near the spine.

One of the more amusing incidents was when I personally was driving into Iowa City as a surgical resident and my right front wheel broke off, going around a curve at 45 mph. The Capri dug its right front fender into the ditch and did a 360 degree roll, landing on its wheels, then a 180 crunching the roof flat with the top of the car seats, then another 180 coming to rest on its wheels again in the ditch. I track-starred it out the front window which was blown out by the roof hit, and ran to get away from hissing in the engine compartment, not wanting to be a Post Toasty myself. And then I walked back to see what the hissing was about, 5 minutes later, to discover that it was a torn radiator hose, and not the gas line I had feared. Another 5 minutes and the ambulance came screaming up and the University Hospital EMTs insisted on forcing me to lay down, clamping a C-collar on me even though I had only the merest abrasion on my right ankle from the gas pedal.

There I was, fully alert, no pain, a surgical resident who had already rotated through the ER, saying I’m fine, but no, they wouldn’t leave me be. I had to do things THEIR way…

You can refuse treatment by EMTs. Some won’t let you. I’ve done it once, successfully, and really pissed off the balance crew; and failed once, got transported anyway, and then pissed off the ER crowd by walking out. (Never understood that. What the hell, they all bitch they have too many patients, decrement the stack by one, I’m outa here).

I persisted in the teenage illusion of immortality way too long.

The second time the crew was probably right as I had been concussed in an MVA with a pretty good forehead strike on the windshield. (Lap belt tried to hold but inertia reel on the shoulder belt chose that moment to let go). I kept asking what had happened and really pissed Herself off.

Two years old… that suggests the safe and/or gun were stored at knee level.

Safe left open, apparently. Or at least unlocked. One of those cashbox-sized bedside “safes”?

I dunno… while the fail level is obviously high, I’d want to see contact burns and/or powder speckling before I’d accept that story. At least they didn’t claim the gun went off all by itself while they were cleaning it…

A 2-year-old can be a prodigious climber and explorer.

I have noticed that whether people are charged after a gun mishap seems to depend more upon the jurisdiction than the facts of the case. My personal feeling is that parents who have killed a child through error need no further punishment, whether it’s a firearm, a hot-car disaster, or some other tragic example of parental error. Some prosecutors seem to get their jollies pursuing these cases, especially when they have what Tom Wolfe (in The Bonfire of the Vanities) called The Great White Defendant.

I recall many years ago was a Boston prosecutor who wanted to jail a mom when one of her kids knocked out a screen in one of those high-rise “public housing” projects and fell to death. The mom turned her back on the kid for just moments, and the screen was not secured because, of course, the building was one of the Housing Authority’s slums. Public as an adjective meaning “substandard” again, as always.

By demonstrated performance (monkey see, monkey do) a 3 year old boy can load a Colt Single Action Army 45; much to the surprise of the child’s father.

Don’t ask me how I know this.

Gun safety is one of those things, isn’t it? You get one chance to screw it up, and then it;s over. Either you have a deceased someone you’d rather were otherwise, or you’re being prosecuted for something stupid.

Most of the people I know that hunt are not interested in the guns they use. They know little about the rifle or its workings or the finer points of maintenance. They are only interested in bagging whatever it is. It is a real testament to the engineering of guns that when the explosion goes off next to your head, the only thing you feel (usually) is recoil….. except, as you say, for that one time.

I see that as a liability. You should understand what you are doing from every aspect, not just the ones that result in filling your tag. This is dangerous and potentially lethal, and should never, ever, be taken as read. When I see ‘accidental discharge’, the word ‘disingenuous’ comes to mind, since there are no accidents with guns, only misapprehensions.

You guys do good work. Thank you for your efforts.

No gun is safe. Those are two conceptual sets that have no intersection. That said, it is possible to influence human use of a product through design of that product’s human interface.

The Glock interface, for example, resulted from conscious decisions about the intended use and level of training of the intended users. Its employment by users with different levels of training has hit some turbulence, sometimes.

The Russians faced this squarely with the design of their service pistol in the 1920s and 1930s. Apart from a half-cock notch, the adopted pistol, the TT-30 and TT-33, have no mechanical safety. Imagine a Russian accent: “Is not safe. Is gun.”

One of the safest pistols in history is the double-action revolver that was the standard police revolver for about ninety years (~1890s-1980s). It is hard to shoot unintentionally. But people still managed to shoot themselves. Imagine an Irish Officer O’Malley accent: “‘T’isn’t safe, lad. ‘Tis a gun.”

The basic safety rules are simple, effective and redundant. But if we wanted to we could probably write the Gun Accident Blog with posts like this every jeezly day. And we’re reminded of a saying from our air safety buds: “There are no new accidents, just new people having the same old accidents.” And just as most aircraft accidents involve humans doing things they should have known better about, most gun accidents… same thing.

PS — thanks for reading, commenting, and thanks also for the kind words.

When I was 4 or 5 my dad took me out shooting on my grandfather’s farm. We were a mile or so away from anyone else. I will never forget the expression on his face ot the tone of voice when he introduced me to his double barreled Parker Brothers 16 GA. He carefully unloaded it, handed it to me and said, This is a lethal (deadly) firearm. It will kill what or who it is point at. It’s only purpose is to kill who or what it is pointed at.

You saw me take the shells out of this gun but to you it is always-always fully loaded. He had some light-loaded #8 bird shot and he let me fire it. It kicked the bejesus out of me but I was thrilled at the right of passage. By the time I was 11 I was regularly hunting squirrels and quail by myself. (safely I might add).

This is sadly not the norm these days.

I think it’s closer to the norm than you think. My own father did not care for guns. He owned a .22 when he was young and shot a squirrel, and it really bothered him watching the animal die. He gave the gun to one of my cousins. But I got pretty similar training from an uncle. I had two uncles who were deep in the gun culture.

“While the door was open, and a parent was accessing some of the safe’s contents, he said, the child grabbed the barrel of the pistol hanging on a hook inside the safe door.”

As I understand it, it was a .22 pistol, hanging on a hook by the trigger guard, loaded. It’s meant to be an anti-duress gun.

How about:

1. a mounted holster with retention device instead of the trigger/hook dangle.

2. a decent self defence calibre instead of the plinker.

3. other security measures to prevent duress in the first place.

p.s. Dr Bill, if that was the Aussie designed (some even built & shipped, the rest built under license in the US) Ford Capri that occasioned the motherly ministrations by the medics, sorry about that, they were known as lemons (the Capris, not the medics).

There was a German Ford Capri that was quite a nice and attractive car in the 70s. They did not hold up well over the long term, either in Europe or here in the US. It lacked a good powerplant option to break out in the US market; I drove one with an aftermarket smallblock V8 in it and it was too noseheavy, and understeered badly until it suddenly oversteered even more badly. It was probably a lot better balanced with the factory motors. Dunno if they built those in OZistan.

I wasn’t aware the OZanian one was such a lemon, but damn, it was ugly, and made a cheesy sound. I suspect the designer was indulging another fine Australian product, beer, to excess at that time.

Honestly I have no idea who made it. But as Hognose has previously pointed out, it’s a good idea to train the way you fight, right? So if you plan on doing barrel rolls without wings, it turns out that good practice is a ski vacation, from which I returned the week prior. When you’re on an expert slope and know you’ve lost control, you tuck and roll to keep limbs from snapping or cruciates from popping. So when I saw the horizon out my window look like the Battle of Britain, my recently trained reaction was to get my head down and roll my body sideways into the passenger seat. Otherwise, I would have lost a bit off my height, not to mention spinal cord function when that roof decided to kiss the top of my driver’s seat.

The hot Euro Ford Capri was the one in “The Professionals”…a favourite show in my youth:

https://upload.wikimedia.org/wikipedia/commons/0/07/1977-1986_Ford_Capri_S_coupe_%282010-12-28%29.jpg

The lemon we Aussies shipped to the US was this thing:

https://upload.wikimedia.org/wikipedia/commons/7/79/1989-1992_Ford_Capri_%28SA%29_convertible_01.jpg

Plagiarised from the same Wiki page as the pics:

“The 1989–94 Capri was assessed in the Used Car Safety Ratings 2006 as providing “worse than average” protection for its occupants in the event of a crash. It was also highly criticised as commonly having leaking roof problems, even after multiple replacements from Ford dealerships. This was eventually resolved by a new roof sealing system, and 100% testing in the factory.”

Someone was looking out for Dr Bill that day…by “training” him in what to do when his Crapi decided to convert to tricycle mode. And now, for eye-bleach and to restore Ford’s good name, a vid of a car from when things were different. Don’t burn your legs on the sidepipes, btw….

https://www.youtube.com/watch?v=ZBrMRIb0PWk

Yessir, indeed! The only problem with that Shelby would be me driving it. I once had a ’58 Mercedes 190SL, courtesy of my grandpa who bought it Germany, had it shipped over, and drove it until he got too old. Now imagine how 18 y/o me would use such a beauty. It would do 90mph no sweat in 3rd gear. Anyone want to guess what 4th would do?

Stefan, get thee behind me!

When I was a kid, my opthalmologist, Dr Joseph D’Amico, drove a white 190SL for many years. On good weather days.

Those cars had beautiful lines and details. There are specific proportions, whether in buildings, automobiles, aircraft or women, that guarantee aesthetic appeal. This was known to the ancients. (Well, not the automobiles and aircraft). Come to think of it, the same is true of firearms. The success of Sturm, Ruger was partly secured by the quality and price point, but largely the aesthetics, of the Mark I pistol. The Mark I cribbed its lines from the classic Luger.

Lesson learned: if you’re not a genius, imitate one.

There were two generations of the Euro Capri. Both were raced (in what’s now a major sedan championship, but was then very small) as well as rallied (World Cup which was and is big) in Europe. I see you have a fine photo of an RHD Australian example of the hi-po RS. I think Australia is the only nation in the world that doesn’t let even single examples of rare cars be registered without the driver’s position being on the right (as in “proper” which is also right as in “hand” in OZ) side. In Japan, a guy buys a Ferrari 250 GTO, he can drive it if his insurance man gets piles of money. In Britain, same. In OZ, the authorities expect him to have the interior of the car inverted before he can take his place among the road trains and utes on the public streets.

As far as the 90s Capri goes, I don’t get Australian aesthetics. I mean, you guys have some of the most beautiful scenery in the world, of both the terrain and the female-of-the-species variety. Made some truly classic movies. Never missing when the civilized world needs tough soldiers. But damn, someone signed off on that car, and there just isn’t enough beer if I hit every bar from Perth to Tasmania, to make me want to go home with that misshapen thing.

No wonder the whole continent collapses into anarchy, as foretold by that prophet, Mad Max.

In the US the Capri badge has been attached to a Mustang clone under the now-defunct Mercury brand, too, in the 1980s. In the 1960s, the Mercury clone of the Mustang was called the Cougar, had its own unique styling, and was even taken Trans-Am racing with, IIRC, Dan Gurney driving. But the Cougar bloated up to luxo-barge status and in the 1980s was a badge-engineered Thunderbird.

How can I, when you keep driving two seater convertibles?

Yes, a sad decline of a once great nation….once upon a time we made this:

https://www.youtube.com/watch?v=fkHSm0gBZLc

It even has four doors and a back seat, so Dr Bill could fulfill his desire to become my chauffeur.

I don’t think we’ve ever had a real four-door race car in this country. In the golden age of muscle cars, every maker made every car line, pretty much, in 2-door and 4-door sedan and hardtop (HTs having no post), 2-door convertible and 4-door station wagon. And every line had a car-based pickup truck (what you guys would call a Ute). Nowadays there’s much less variety in individual lines, and even fewer choices for options and colors. You get red, white, black, silver, maybe blue, and Option Package A or Option Package B. The Japanese started that; in 1959 it was theoretically possible for now two Chevy full-size cars to have been identical, the option list was that long. By 1989 you could only get leather seats in the Corvette if you wanted the FX-3 adjustable suspension and standard shift. (Why someone buys a corvette with an automatic never ceases to amaze me, actually).

Long digression, this.

Little known fact, in the 1960s you could, if you were willing to special order a car (and give up the discount you’d get from a standard one on the lot), specify not just any color for that model, but any color the company used on any vehicle. I’ve seen Mustangs with Thunderbird and Lincoln paint codes and Corvettes with Cadillac codes from the 1960s.

The Grabber colors on the 1969/70 Mustangs came about when somebody special ordered a car painted with farm-equipment paint, and the marketing guys thought it was brilliant. (That the paint was cheaper than a lot of the normal line colors was a bonus).

It was politics that put the kybosh on our lovely cars. There was supposed to be a phase IV version of the Falcon, but the media lapdogs ran a fear campaign, and that was it. Same for the antidote to the Phase III V8 monster, a straight 6 giant killer called Torana. That was supposed to get a 5L V8, which would have made it almost as potent as the Skyline (Godzilla), which also became verboten in racing because unfair. Speaking of nice paintjobs, here is the Torana in its glory:

Link follows, and hopefully the pic via the embed method:

https://upload.wikimedia.org/wikipedia/commons/4/4d/Holden_LJ_Torana_GTR_XU-1.JPG

Reminiscent of the Opels of that period, Kadett/Manta, which were attractive cars but not powerful. Your comment sent me on a long exploration of pre-72 OZ musclecars and of the 1972 media panic. Starting about the same time, the seventies were crap years for cars in the USA, driven by government regulation (especially in the weak Ford and benighted Carter administrations) and insurance company cronyism with government.

Well, at least it got us into Japanese cars, such as the Skyline, and the Mazda rotaries…no ambivalence about the rotisseries, they are either hated or loved, passionately. The Cosmo’s triple rotor 20B with forced air had/has potential….big block V8 power, very high revving, light weight. Not so cool is rebuilding it every few months if it’s tuned high. Ah well, a good thing my dreams have migrated to boats.