GENIUS AT WORK- MedicChris and the 0-50-100 Shoe Knock-Off Rule
If you have been reading this blog for any period of time, you will know that the guy who first showed me a blog was MedicChris, who is the author of the NightRuns blog (See link on this site). Chris and I were assigned to the same fire/rescue duty crew at various times for many years. Chris was the ALS lead, and I was usually some sort of an officer, either lieutenant or captain. We have run hundreds (likely thousands) of calls together. A few weeks ago, we got into a discussion with a couple of other senior fire department members about the phenomenon of people who get hit by something (usually a car) hard enough to get knocked out of their shoes. Rookies overhearing the conversation didn't believe that it happened. I told one quick tale, and then Chris hit us all with a bit of statistical genius.
The tale was this: When I was 19, I had just been cut loose to ride as an acting officer for an engine company. In our department, we call this position "incident officer", or more usually "I/O". We got a call for a vehicle fire on Interstate 95 in neighboring Fairfax County. It was reported to be a non-hazmat tractor-trailer, and that Fairfax units would already be on the scene. With me that night was a driver who I don't remember, and a brand-new rookie fireman who had just learned moments before the call that he passed his initial firefighter training and could actually help staff the unit. His name was David (and he went on to be the finest of firemen and deputy chief of our department). We arrived on the scene after a while and found a tractor trailer on fire. Unremarkable really. It was a produce truck, and the part that was on fire was a few crates of spring onions. Not much flame. Stinky. Lots of steam. There were a bunch of Fairfax units there, but no one was working on the truck. We got our hose and started to go to work, when we noticed something. Something odd. Right in front of the fire was a pair of really fancy sort of top-of-the line cowboy boots. A picture would help here, but the boots were not side-by-side, rather, they were one-step-in-front of the other. David and I looked at the boots for a second, looked up at each other, and then turned to look across the roadway. There, under a bloody sheet four lanes and 150 feet down the road, was the owner of the boots. Turned out that he had been the driver of the truck, had made some effort at extinguishing the fire, and had been hit by a car. The impact knocked him out of his boots. He was dead. All of the Fairfax units were over with him, and not really concerned with the fire. David and I sort of laughed it off as an oddity.
It is not an oddity. People hit by cars get knocked out of their shoes all of the time. Same goes for people falling from heights, and who are hit by trains, bicycles, or playground equipment, and also in sports hits or in significant assaults. In the ensuing too-many-years, we have all seen many people traumatically knocked out of their shoes. This fact has led to the most recent episode of the genius of MedicChris.
All of the participants noted or observed that when impact trauma happens, one of three things can happen to the victim and their shoes. Either they lose no shoes, they lose one shoe, or they lose both shoes. Chris, by his intellectual superiority, made the super-smart leap to correlate the number of shoes missing to the probability of survival. And thus was born the 0-50-100 rule.
Stated most simply it is this: If a patient is traumatically injured by a mechanism of injury resulting from whole-body impact forces, and they lose no shoes, then their chances of fatality arising from the traumatic event are approximately 0%. If, in the same event, the person loses one shoe, but not the other, the mortality rate from the traumatic event will be approximately 50%. And naturally, losing both shoes under these circumstances leads to the catastrophic, but generally accurate, 100% fatality rate.
The genius of this whole plan is that it is so simplistic. We ran through a bunch of calls where we remembered shoes coming off, and the 0-50-100 rule worked to near perfection each time. The one-shoe loss is always going to be a little more difficult to rate, because we were not easily able to quantify the live/die percentages. Everyone had seen some people living and some people dying with one shoe on. Conversely, no one could remember someone living after having been knocked out of two shoes.
Question to the readership: How does the 0-50-100 rule hold up in your experience? Post a comment and let me know. (oh, and won't I feel like a dumbass if Chris read this thing in a medical text or something!)
Visit Chris' blog at the link on the right. He's way better at this than I am. Visit my other links as well. You will be enlightened and entertained. Did I mention you should post a comment? At any rate, I am planning on writing Part I of the "best day ever" post, as the federal trial is now over. Talk to you soon.
The tale was this: When I was 19, I had just been cut loose to ride as an acting officer for an engine company. In our department, we call this position "incident officer", or more usually "I/O". We got a call for a vehicle fire on Interstate 95 in neighboring Fairfax County. It was reported to be a non-hazmat tractor-trailer, and that Fairfax units would already be on the scene. With me that night was a driver who I don't remember, and a brand-new rookie fireman who had just learned moments before the call that he passed his initial firefighter training and could actually help staff the unit. His name was David (and he went on to be the finest of firemen and deputy chief of our department). We arrived on the scene after a while and found a tractor trailer on fire. Unremarkable really. It was a produce truck, and the part that was on fire was a few crates of spring onions. Not much flame. Stinky. Lots of steam. There were a bunch of Fairfax units there, but no one was working on the truck. We got our hose and started to go to work, when we noticed something. Something odd. Right in front of the fire was a pair of really fancy sort of top-of-the line cowboy boots. A picture would help here, but the boots were not side-by-side, rather, they were one-step-in-front of the other. David and I looked at the boots for a second, looked up at each other, and then turned to look across the roadway. There, under a bloody sheet four lanes and 150 feet down the road, was the owner of the boots. Turned out that he had been the driver of the truck, had made some effort at extinguishing the fire, and had been hit by a car. The impact knocked him out of his boots. He was dead. All of the Fairfax units were over with him, and not really concerned with the fire. David and I sort of laughed it off as an oddity.
It is not an oddity. People hit by cars get knocked out of their shoes all of the time. Same goes for people falling from heights, and who are hit by trains, bicycles, or playground equipment, and also in sports hits or in significant assaults. In the ensuing too-many-years, we have all seen many people traumatically knocked out of their shoes. This fact has led to the most recent episode of the genius of MedicChris.
All of the participants noted or observed that when impact trauma happens, one of three things can happen to the victim and their shoes. Either they lose no shoes, they lose one shoe, or they lose both shoes. Chris, by his intellectual superiority, made the super-smart leap to correlate the number of shoes missing to the probability of survival. And thus was born the 0-50-100 rule.
Stated most simply it is this: If a patient is traumatically injured by a mechanism of injury resulting from whole-body impact forces, and they lose no shoes, then their chances of fatality arising from the traumatic event are approximately 0%. If, in the same event, the person loses one shoe, but not the other, the mortality rate from the traumatic event will be approximately 50%. And naturally, losing both shoes under these circumstances leads to the catastrophic, but generally accurate, 100% fatality rate.
The genius of this whole plan is that it is so simplistic. We ran through a bunch of calls where we remembered shoes coming off, and the 0-50-100 rule worked to near perfection each time. The one-shoe loss is always going to be a little more difficult to rate, because we were not easily able to quantify the live/die percentages. Everyone had seen some people living and some people dying with one shoe on. Conversely, no one could remember someone living after having been knocked out of two shoes.
Question to the readership: How does the 0-50-100 rule hold up in your experience? Post a comment and let me know. (oh, and won't I feel like a dumbass if Chris read this thing in a medical text or something!)
Visit Chris' blog at the link on the right. He's way better at this than I am. Visit my other links as well. You will be enlightened and entertained. Did I mention you should post a comment? At any rate, I am planning on writing Part I of the "best day ever" post, as the federal trial is now over. Talk to you soon.
posted by DTXMATT12 at 8:20 PM
3 Comments:
I think most of the dead people that I have run on lacked shoes, I never really paid attention to single shoes though
So far that formula has held true for me. Have you ever heard MedicChris' formula for Domestics? Its not so much a formula as a factoid. MedicJon told it to me once while staging for a domestic. Goes something like this, In every domestic, there are ALWAYS dishes in the sink. Doesn't matter if its male on female, female on male, or male on male. There is just *ALWAYS* dishes in the sink... Ask him, tell him MedicJonJr told you so....
RUNFLAT AND JONJR: Thanks for posting comments. As I wrote, the single-shoe phenomenon needs some more examination. And Jon, it has been my experience as a fireman, as a domestic relations law attorney, and as a prosecutor, that in the absence of dirty dishes, there is no domestic violence. I'm not kidding. Take care and keep checking back. I'm happy to have readers.
DTXMATT12
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