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Only one person per skateboard. Never hitch a ride from a car, bus, truck or bicycle ... to wear safety equipment when riding scooters, skateboards or skating ...

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case presentation 19
Alameda County EMS

Case Presentation #19

Jim Pointer, M.D., FACEP

Medical Director

Alameda County EMS

the call
Alameda County EMSThe Call
  • You respond to a 9-1-1 call on a busy suburban street for “traumatic injury.” Your patient, a seven year-old male, is lying prone on the street with his head nodding in confusion. An electric microscooter lies on its side in the middle of the street.
initial assessment
Alameda County EMSInitial Assessment
  • ABCs:
    • Airway – open
    • Breathing – labored
    • Circulation – no bleeding
  • Glasgow - 9:
    • Eyes – 2
    • Verbal – 3
    • Motor – 4
focused h p
Alameda County EMSFocused H & P
  • On lookers state the patient attempted to avoid a car, swerved and fell, striking his head and “legs.”
  • Child was wearing no safety equipment and was traveling about 10 mph on the wrong side of the street.
  • No other history available and the parents are at work.
pertinent findings
Alameda County EMSPertinent Findings
  • Vital Signs:
    • B/P – 80/50
    • RR – 32
    • HR – 145
    • Pulse Ox – 96%
  • Young male obviously seriously injured
pertinent findings cont
Alameda County EMSPertinent Findings (cont.)
  • HEENT:
    • Head – large abrasion left fronto-temporal area
    • Ears – no blood from ears
    • Eyes – pupils 4 mm, slightly sluggish, reactive
    • Nose – WNL
    • Teeth – WNL
  • Neck – no obvious injuries, unable to assess pain or tenderness
pertinent findings cont7
Alameda County EMSPertinent Findings (cont.)
  • Chest and abdomen: no significant trauma
  • Pelvis: stable
  • Extremities: deformity left lower leg, distal pulses intact
  • Neuro: GCS – 9
    • Patient does not answer questions but is seen to move all four extremities
  • Skin: cool and moist
initial treatment
Alameda County EMSInitial Treatment
  • Attempts at intubation unsuccessful
  • Non-rebreather mask - 100% O2
  • Two large bore IVs started
  • Spinal immobilization
  • Left lower leg splinted
  • Transported to Children’s Hospital
hospital findings
Alameda County EMSHospital Findings
  • Young, white male in acute distress
  • Vital signs: B/P – 120/82, RR – 40, HR – 142, Pulse Ox – 98% on O2
  • Physical findings essential the same as yours
lab studies
Alameda County EMSLab Studies
  • CBC: WBC – 17.2 K, H & H – 15.3 / 47.2
  • Chemistries, glucose, urinalysis: WNL
  • X-rays: Spinal, chest, pelvic and Left lower leg
  • Plain CT of the head
  • Hospital staff can not find the parents
hospital outcome
Alameda County EMSHospital Outcome
  • Patient taken to OR for evacuation of subdural hematoma
  • Open reduction, internal fixation (ORIF) of the tibial fracture
  • Discharged eight days later on crutches with case, neurologically intact!
addendum
Alameda County EMSAddendum
  • Parents were cited by local police for allowing a child under 16 to operate a motorized scooter and for failure to provide safety equipment.
discussion
Alameda County EMSDiscussion
  • Skateboard and scooter injuries:
    • Skateboards
      • 56,000 ED visits
      • 1,900 hospitalized
    • Scooters (all)
      • 15,800 ED visits
  • 90% of all injuries occur in kids < 15 years old.

Source: American Academy of Pediatrics

skateboard injuries
Alameda County EMSSkateboard Injuries
  • 87% - male
  • Distribution of Injuries:
    • 74% - extremities
    • 21% - head & neck
    • 5% - trunk
  • Injuries occur more frequently in the younger child

Source: US Consumer Product Safety Committee

skateboard injuries cont
Alameda County EMSSkateboard Injuries (cont.)
  • Most common Injuries:
    • Wrist fractures
    • Ankle sprains
    • Face lacerations
    • Lower arm fractures
    • Wrist sprains

Source: US Consumer Product Safety Committee

motorized scooters
Alameda County EMSMotorized Scooters
  • Rising in popularity
  • Gasoline or battery powered
  • Cost: $200 - $1500
  • Cost of protective gear: $35
  • Gas models against the law in many jurisdictions
  • Many areas have restrictions
    • California’s age is 16
  • US CPSC issued warning in 2001
  • Parents poor judgment a major factor in injuries.
motorized scooter injuries
Alameda County EMSMotorized Scooter Injuries
  • 39% are kids < 15 years old
  • At least three deaths associated with motorized scooters
    • 6 year old boy who fell off
    • 11 year old boy who crashed with a truck
    • 46 year old man who was struck by a car
  • Fractures the most common injury
  • Over 5000 injuries requiring ED treatment in 2002
slide21
Alameda County EMS

SCOOTER

SAFETY

injury prevention skateboards scooters
Alameda County EMSInjury PreventionSkateboards & Scooters
  • Never ride in the street
  • Never ride at night
  • Obey all traffic laws
injury prevention cont
Don’t take chances

Complicated tricks require careful practice and a specially designed area

Only one person per skateboard

Never hitch a ride from a car, bus, truck or bicycle

Alameda County EMS

Injury Prevention (cont.)
injury prevention cont24
Alameda County EMSInjury Prevention (cont.)
  • Learn how to fall – it may help reduce serious injury
    • Losing balance – crouch down so you won’t have as far to fall
    • If you fall –
      • try to land on “fleshy” parts of your body
      • try to roll rather than absorb the force with your arms
      • try to relax your body rather than stiffen
injury prevention cont25
Alameda County EMSInjury Prevention (cont.)
  • Use Safety equipment!
    • helmet
    • Slip resistant shoes
    • Padding (knee, elbow and wrist guards)
  • Children < 5 should not use skateboards or scooters
  • Children < 16 should not ride motorized scooters
california law
Alameda County EMSCalifornia Law
  • January 1, 2000:
    • Children under 16 prohibited from operating motorized vehicles, including scooters, and requiring helmet.
  • January 1, 2003:
    • Bicycle helmet law expanded to require children under 18 to wear safety equipment when riding scooters, skateboards or skating
ems helmet bicycle safety brochure
Alameda County EMSEMS Helmet & Bicycle Safety Brochure

Alameda County

Emergency

Medical

Services

Agency

Helmet &

Bicycle

Safety

Program

(510) 618-2050

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