http://www.subtlebraininjury.com/blog Mon, 06 Sep 2010 17:47:40 +0000 en hourly 1 http://wordpress.org/?v=3.0.1 http://www.subtlebraininjury.com/blog/2010/03/pittsburgh-man-dies-after-desperate-911-calls-fail-to-bring-help.html http://www.subtlebraininjury.com/blog/2010/03/pittsburgh-man-dies-after-desperate-911-calls-fail-to-bring-help.html#comments Mon, 01 Mar 2010 12:46:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/03/pittsburgh-man-dies-after-desperate-911-calls-fail-to-bring-help.html http://www.chicagotribune.com/news/sns-ap-us-snow-911-death,0,7798733.story

In a story very well reported by the Associated Press, 50-year-old Curtis Mitchell, a former steel worker, died despite the desperate efforts of Edge to save him. During a big Feb. 6 snowstorm, Mitchell got bad stomach pains, and Edge called 911 for help.

During her first call, Edge was told that help was coming. After 10 callbacks to 911, and 30 hours later, Mitchell died in his cold apartment, where the storm had knocked out the power.

Mitchell had previously suffered from pancreatitis, or inflammation of the pancreas, and had been hospitalized for treatment in January.

In Pittsburgh, officials are investigating what went wrong in Mitchell’s case. They are also looking to make changes to emergency services so this kind of fatality never happens again.

The storm had left two feet of snow in Pittsburgh. But two times, ambulances were within walking distance of Mitchell’s home, a quarter of a mile away, but they couldn’t drive their vehicle over a bridge to reach him. The notion of getting out of the ambulance to fetching their patient didn’t seem to occur to them.

AP quotes Pittsburgh’s public safety director as saying they failed Mitchell. There’s an understatement for you. The problem on pushing a program like 911 calls like we have, is that when it fails, there really is no backup. This is a life or death program and there is just no room for human or computer error. It must work, each and every time.]]> http://www.subtlebraininjury.com/blog/2010/03/pittsburgh-man-dies-after-desperate-911-calls-fail-to-bring-help.html/feed 1 http://www.subtlebraininjury.com/blog/2010/02/luger-who-sustained-a-concussion-on-olympic-luge-track-warned-officials-of-its-dangers.html http://www.subtlebraininjury.com/blog/2010/02/luger-who-sustained-a-concussion-on-olympic-luge-track-warned-officials-of-its-dangers.html#comments Sat, 20 Feb 2010 09:36:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/02/luger-who-sustained-a-concussion-on-olympic-luge-track-warned-officials-of-its-dangers.html http://www.nytimes.com/2010/02/19/sports/olympics/19luge.html?hp

An article headlined “Luger Warned of Track Before the Games” reports that luger Werner Hoeger lost consciousness and suffered a concussion during a trial run at the Whistler Sliding Centre in November.

That’s the same luger track where Nodar Kumaritashvili was killed last Friday, after slamming his back into a steel pillar.

Hoeger after his Nov. 13 accident repeatedly wrote and e-mailed international luge and Canadian officials, telling them that the track wasn’t safe, according to The Times. Obviously, officials didn’t heed Hoeger’s warning.

The International Luge Federation said Thursday that it will issue a report on the Georgian luger’s death at the end of next month. Changes were made to the luge track after last week’s fatal accident.

For a very detailed account of Hoeger’s back and forth with officials over the dangerous track, read The Times’ piece.

Notice is a major element to any claim for negligence or wrongful death. Looks like the Canadian officials had that.]]> http://www.subtlebraininjury.com/blog/2010/02/luger-who-sustained-a-concussion-on-olympic-luge-track-warned-officials-of-its-dangers.html/feed 0 http://www.subtlebraininjury.com/blog/2010/02/the-bible-of-mental-disorders-dsm-iv-may-undergo-controversial-revisions.html http://www.subtlebraininjury.com/blog/2010/02/the-bible-of-mental-disorders-dsm-iv-may-undergo-controversial-revisions.html#comments Thu, 11 Feb 2010 12:07:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/02/the-bible-of-mental-disorders-dsm-iv-may-undergo-controversial-revisions.html http://www.nytimes.com/2010/02/10/health/10psych.html?em
is undergoing some revisions that could have affect litigation and lawsuits.

The updating of the Diagnostic and Statistical Manual of Mental Disorders has been the subject of much lobbying by various advocacy groups. The proposed changes to the book, which physicians rely on to categorize their patients’ illness, were released Tuesday. http://www.dsm5.org/Pages/Default.aspx

Both The Times and AOL News noted that any changes in the this manual of mental ailments have “huge implications” — not just for psychiatrists but for the legal system, government programs and pharmaceutical companies – in terms of who is considered normal or who is considered disabled.
http://www.aolnews.com/nation/article/big-changes-proposed-for-diagnostic-and-statistical-manual-of-mental-disorders/19352107?icid=main|main|dl1|link3|http%3A%2F%2Fwww.aolnews.com%2Fnation%2Farticle%2Fbig-changes-proposed-for-diagnostic-and-statistical-manual-of-mental-disorders%2F19352107

One of the revisions that has some experts worried is a new “at risk” category for those who show early signs of illnesses like dementia. The fear is that this new label will stigmatize patients.

Another recommendation is the creation of a new childhood disorder, temper dysregulation disorder with dysphoria. It’s a new category for aggressive children who previously might have been misdiagnosed as having bipolar disorder, and then were given antipsychotic drugs that have serious side effects.

New proposed categories for the DSM include one for sex addiction, “hypersexuality,” defined as when “a great deal of time is consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.”

And binge eating is a new suggested disorder, defined as at least one binge a week for three months, followed by guilt and mood swings.

Interesting that the news doesn’t focus on the bogus definition of Post Concussion Disorder in the Appendix’s of the DSM-IV. Through two revisions, the drafters of this “bible” have been unable to agree on what defines a concussion. The proposed definition still contains a requirement of a 5 minute loss of consciousness, a requirement that has uniformly been rejected by the American Academy of Neurologists, the CDC, the United States Armed Services and virtually every peer reviewed research article this century.]]> http://www.subtlebraininjury.com/blog/2010/02/the-bible-of-mental-disorders-dsm-iv-may-undergo-controversial-revisions.html/feed 0 http://www.subtlebraininjury.com/blog/2010/02/super-bowl-coverage-and-the-concussion-issue.html http://www.subtlebraininjury.com/blog/2010/02/super-bowl-coverage-and-the-concussion-issue.html#comments Mon, 08 Feb 2010 10:07:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/02/super-bowl-coverage-and-the-concussion-issue.html
With the Super Bowl just hours away from starting, Goodell told “Face the Nation” Sunday that the league was still studying ways to make the game safer and cut down head injuries in particular.

Goodell said that the so-called “three point stance,” where players square off with one hand on the ground, could eventually be barred, according to a New York Times story on his interview with Bob Schieffer. The article was headlined “Commissioner Stresses New Culture of Safety.” http://www.nytimes.com/2010/02/08/sports/football/08nfl.html?ref=sports

On the “Face the Nation,” Goodell said that for years “the culture” at the NFL was that concussions weren’t serious injuries.

“I think we have changed that culture and made sure that people understand they are serious and they can have serious consequences if they’re not treated seriously,” he told Schieffer.

On Super Bowl Sunday both The Philadelphia Inquirer and The Washington Post weighed in on the concussion issue.

In an editorial, http://www.philly.com/inquirer/currents/83742022.html
The Inquirer cited a Time magazine issue with a cover story on “the most dangerous game,” pro-football, which The Inquirer said “has crippled retirees mentally and physically.”

Young players sustain 140,000 concussions a year, and half of them return to the field so soon they may suffer permanent braind damage, The Inquirer warns.

And Washington Post columnist Leonard Shapiro complained that the Super Bowl pregame show and telecast made no mention of the concussion issue. http://www.washingtonpost.com/wp-dyn/content/article/2010/02/07/AR2010020703736.html

It is an interesting question, whether football is really the most dangerous sport. Boxing will always be on the top of my list even though it involves far fewer participants. The goal of boxing is to cause a brain injury to one’s opponent. Much of the impetus behind the growing movement to forbid return to play on the day of a concussion comes out of concern for the “second impact syndrome.” In second impact syndrome, the brain’s ability to regulate cranial blood pressure is impaired by the first concussion. When a second concussion occurs there can be a resulting catastrophic increase in intracranial pressure, ICP. It was such injury that caused Zachery Lystedt’s brain injury. Well how does one reconcile no return to play rules, when the injured person continues to box?]]> http://www.subtlebraininjury.com/blog/2010/02/super-bowl-coverage-and-the-concussion-issue.html/feed 0 http://www.subtlebraininjury.com/blog/2010/02/wall-street-journal-offers-its-take-which-is-our-take-on-why-cellphone-bans-don%e2%80%99t-decrease-accidents.html http://www.subtlebraininjury.com/blog/2010/02/wall-street-journal-offers-its-take-which-is-our-take-on-why-cellphone-bans-don%e2%80%99t-decrease-accidents.html#comments Thu, 04 Feb 2010 16:38:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/02/wall-street-journal-offers-its-take-which-is-our-take-on-why-cellphone-bans-don%e2%80%99t-decrease-accidents.html http://online.wsj.com/article/SB10001424052748704022804575041552234321736.html?mod=WSJ_LifeStyle_Lifestyle_5

The Journal story was a follow-up on a study released last week by the Highway Loss Data Institute (HDLI) and the Insurance Institute for Highway Safety (IIHS). The study didn’t find any significant drop in accident claims in states that have barred the use of cellphones while driving.

That HLDI survey flies in the face of other research and what common sense would dictate: That without the distraction of using a handheld cellphone, there should be less crashes. But that wasn’t necessarily so. The Journal reported that New York banned the use of hand-held cellphones in November 2001, and driver cellphone use decreased 47 percent. And while there was a drop in monthly collision claims in the Empire State, that trend had begun before the ban was passed, according to The Journal.

An HLDI official, Kim Hazelbaker, told the newspaper that the institute was surprised at the results of its own research. The Journal cited a number of possible reasons why the number of crashes didn’t decrease after the cellphone and texting bans.

The bans are not being enforced, some said. And then the story cited the reason we previously pointed out, namely that talking on any type of phone while driving can be a deadly distraction.

A spokesman for the Governors Highway Safety Association claimed that in light of the HLDI study, it recommends that states enact bans on motorists texting but wait before barring cellphone use.

The IIHS said it’s long argued there hasn’t been a huge spike in car accidents, despite the proliferation of cellphones.

The U.S. Department of Transportation, according to The Journal, will be launching two pilot programs in New York and Connecticut to see what happens when authorities enforce cellphone bans as strictly as they do drunk-driving and seat-belt laws.]]> http://www.subtlebraininjury.com/blog/2010/02/wall-street-journal-offers-its-take-which-is-our-take-on-why-cellphone-bans-don%e2%80%99t-decrease-accidents.html/feed 0 http://www.subtlebraininjury.com/blog/2010/02/cellphone-bans-don%e2%80%99t-cut-down-on-accidents-insurer-backed-study-claims.html http://www.subtlebraininjury.com/blog/2010/02/cellphone-bans-don%e2%80%99t-cut-down-on-accidents-insurer-backed-study-claims.html#comments Mon, 01 Feb 2010 17:00:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/02/cellphone-bans-don%e2%80%99t-cut-down-on-accidents-insurer-backed-study-claims.html
But first, some background on the Institute, which is an affiliate of the Insurance Institute for Highway Safety. Both organizations are supported by what seems like an endless list of insurers.

Here is how both describe themselves on their Web site: “The Insurance Institute for Highway Safety is an independent, nonprofit, scientific, and educational organization dedicated to reducing the losses — deaths, injuries, and property damage — from crashes on the nation’s highways…The Highway Loss Data Institute shares and supports this mission through scientific studies of insurance data representing the human and economic losses resulting from the ownership and operation of different types of vehicles and by publishing insurance loss results by vehicle make and model.”

Keep all this in mind when you hear the results of their study, which got press in many newspapers last Friday, including The Los Angeles Times http://www.latimes.com/news/local/la-me-cellphones30-2010jan30,0,1114154.story
, The New York Times http://bayarea.blogs.nytimes.com/2010/01/29/sampler-palo-alto-to-plant-trees-and-san-jose-to-consider-tree-maintenance-tax/ and the The Mercury News. http://www.mercurynews.com/top-stories/ci_14290083

In a press release http://www.iihs.org/news/rss/pr012910.html dated Jan. 29, HDLI said it found no reduction in crashes after hand-held phone bans took effect. It compared insurance claims for crash damage in four jurisdictions before and after such bans, and and claim rates were similar to nearby states without the bans.

HDLI looked at New York, the District of Columbia, Connecticut and California.
“The laws aren’t reducing crashes, even though we know that such laws have reduced hand-held phone use, and several studies have established that phoning while driving increases crash risk,” Adrian Lund, president of both the Insurance Institute for Highway Safety and HLDI, said in the HLDI press release.

The HLDI database doesn’t identify drivers using cellphones when their crashes occur. However, reductions in observed phone use following bans are so substantial and estimated effects of phone use on crash risk are so large that reductions in aggregate crashes would be expected, the group said

In New York, the HLDI researchers did see a drop in collision claim frequencies, relative to comparison states, but this decreasing trend began well before the state’s ban on hand-held phoning while driving and actually paused briefly when the ban took effect, according to the HLDI. Trends in the District of Columbia, Connecticut, and California didn’t change.
“So the new findings don’t match what we already know about the risk of phoning and texting while driving,” Lund said. “If crash risk increases with phone use and fewer drivers use phones where it’s illegal to do so, we would expect to see a decrease in crashes. But we aren’t seeing it. Nor do we see collision claim increases before the phone bans took effect. This is surprising, too, given what we know about the growing use of cellphones and the risk of phoning while driving. We’re currently gathering data to figure out this mismatch.”

The HLDI suggest other factors that might be eroding the effects of hand-held phone bans on crashes. One is that drivers in jurisdictions with such bans may be switching to hands-free phones because no state currently bans all drivers from using such phones. In this case crashes wouldn’t go down because the risk is about the same, regardless of whether the phones are hand-held or hands-free, according to the HNLI.

Twenty-one states and the District of Columbia do prohibit beginning drivers from using any type of phone, including hands-free, but such laws are difficult to enforce. This was the finding in North Carolina, where teenage drivers didn’t curtail phone use in response to a ban, in part because they didn’t think the law was being enforced, according to HNL.
“Whatever the reason, the key finding is that crashes aren’t going down where hand-held phone use has been banned,” Lund said out. “This finding doesn’t auger well for any safety payoff from all the new laws that ban phone use and texting while driving.”

Editorial Note:

As bizarre as this study seems, I am not surprised by the findings. Cell phones are distracting, regardless of whether you are using the hands free device. What is worse is touch screen cell phones that require you to look at the phone to answer. Even worse is scrambling for the hands free device, while trying to answer. Distractions equal accidents. Mobile computers that can also answer phone calls in a car (are you listening Apple) should be illegal.]]> http://www.subtlebraininjury.com/blog/2010/02/cellphone-bans-don%e2%80%99t-cut-down-on-accidents-insurer-backed-study-claims.html/feed 0 http://www.subtlebraininjury.com/blog/2010/01/connecticut-considers-%e2%80%98concussion%e2%80%99-bill-to-protect-student-athletes.html http://www.subtlebraininjury.com/blog/2010/01/connecticut-considers-%e2%80%98concussion%e2%80%99-bill-to-protect-student-athletes.html#comments Sun, 31 Jan 2010 09:29:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/01/connecticut-considers-%e2%80%98concussion%e2%80%99-bill-to-protect-student-athletes.html
Democratic lawmakers in the Nutmeg State have proposed the legislation, according to The Hartford Courant. http://www.courant.com/sports/other/hc-concussions0126.artjan26,0,93453.story

The law’s slogan is “When in doubt, sit it out.”

So far two states, Washington and Oregon, have already passed laws protecting student athletes from the effects of concussion. California has similar legislation pending.

The proposed Connecticut law mandates that student athletes who are believed to have suffered a concussion wait a day until they return to play their sport. The law also requires that coaches be educated about concussions.

The Connecticut bill is being sponsored by State Sen. Majority Leader Martin Looney of New Haven and Sen. Thomas Gaffey of Meriden.]]> http://www.subtlebraininjury.com/blog/2010/01/connecticut-considers-%e2%80%98concussion%e2%80%99-bill-to-protect-student-athletes.html/feed 0 http://www.subtlebraininjury.com/blog/2010/01/the-near-fatal-football-injury-that-lead-to-california%e2%80%99s-proposed-laws-on-concussions.html http://www.subtlebraininjury.com/blog/2010/01/the-near-fatal-football-injury-that-lead-to-california%e2%80%99s-proposed-laws-on-concussions.html#comments Tue, 26 Jan 2010 06:45:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/01/the-near-fatal-football-injury-that-lead-to-california%e2%80%99s-proposed-laws-on-concussions.html
The San Francisco Chronicle today has a detailed story, http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/01/24/MN6V1BM6OR.DTL, on
the young man whose near-fatal football injury lead to the proposed legislation.

Blea was playing for San Jose Academy High when he was hit in the chest during a play at a Thanksgiving Day game last year. He got up from the field, got to the sidelines and then collapsed. He was put in a drug-induced coma for a week, spent almost a month in hospitals and lost 31 pounds, according to the Chronicle.

The story cites a number of statistics regarding high school injuries. For example, about 68,000 concussions were sustained during the 2008 high school football season, according to the National High School Sports-Related Injury Surveillance Study.

And the man who helped organize that study, Ohio State associate professor Dawn Comstock, said that in 2008 16 percent of high school football players who had concussions where they lost consciousness went back to play that same day.

Blea played as a running back and linebacker, positions that one study found are most likely to get concussions.

Two U.S. high school players died as a direct result of football injuries last year, the Chronicle story says.

Physicians say Blea’s outlook is good, but he can’t play football again.

When he was hit, Blea fell and his head hit the turf, with his brain “slamming against his skull,” according to the Chronicle.

The story then describes his surgeries and recovery.]]> http://www.subtlebraininjury.com/blog/2010/01/the-near-fatal-football-injury-that-lead-to-california%e2%80%99s-proposed-laws-on-concussions.html/feed 0 http://www.subtlebraininjury.com/blog/2010/01/evolution-in-the-understanding-of-concussion-sport-concussions-get-witnessed-and-documented.html http://www.subtlebraininjury.com/blog/2010/01/evolution-in-the-understanding-of-concussion-sport-concussions-get-witnessed-and-documented.html#comments Thu, 07 Jan 2010 06:47:00 +0000 gjohnson http://www.subtlebraininjury.com/blog/2010/01/evolution-in-the-understanding-of-concussion-sport-concussions-get-witnessed-and-documented.html Click here for Part IV of my Concussion Clinic Videos.

Certainly accidents have witnesses and often witnesses that are communicating with the concussed person within the first couple of minutes after the wreck or fall. But even 30 seconds after the incident may be too late.

Compare the situation where someone is in a car wreck to a boxing ring. If a fighter is knocked down by a blow to the head, the boxer presumptively has had a concussion. Yet in the vast majority of the cases, that boxer has returned to his feet within 10 seconds. If the fight isn’t stopped at that point, it means that the boxer has regained sufficient function to engage in his highly dangerous and demanding profession in less than 30 seconds. That model shows us that the window for observing the acute concussion evidence may be as short as 10 seconds.

If the same concussion occurred in an NFL or college football game, we would have a video tape of that concussion. While there isn’t a 10 second knockout rule in football, if a player is still down for 20 seconds, play has to be stopped. The concussion then gets analyzed from several different camera angles and archived for prosperity.

In a car wreck, unless there is a passenger in the car, no one is closely observing the injured person within that 30 second time frame. Certainly witnesses will congregate quickly, but not quickly enough. Almost never will there be someone trained in concussion diagnosis at the scene during the time window that the acute evidence is the clearest. If the concussion occurs in a fall, most times there are no witnesses.

Thus, the diagnosis of an accidental concussion requires either the reliance on a history from the injured person, who is likely to be unreliable historian of the event, or must be reconstructed. The only reliable measure to determine whether there was the concussion is to determine the existence and extent of post traumatic amnesia.]]> http://www.subtlebraininjury.com/blog/2010/01/evolution-in-the-understanding-of-concussion-sport-concussions-get-witnessed-and-documented.html/feed 0