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.

A LITTLE BRIGHT SPOT- Finding one where I can!

Sorry for being away for so long. I'm still not really "feeling it" with regard to writing on the blog. That having been said, I was reading an article in the Washington Post Magazine today about the author's trepidation about having his car inspected, and it got me thinking about a recent experience that I had in the world of auto inspection. The experience was so positive, that it made my whole week. Here's the story:

I needed to renew the registration for my truck, which is my primary vehicle. In order to do this, I had to get an emissions test performed at the inspection station. Getting any sort of inspection done (emissions, safety, etc.) in the WWW is a pain in the ass, because there are so many people around here with so few inspection stations, that there is almost never a good time to go. Add to that situation the fact that I work in an area of Virginia where emissions testing is not required and no one has the equipment, and you have a formula for inconvenient day planning for me.

I have begun to resolve this situation by finding the most out-of-the-way inspection station that I can find, and by going there before they open so that I can get in first and get out as quickly and easily as possible. This has worked for me for about the past year. My designated inspection spot is a little mom and pop garage located right off of U.S. 1 in Woodbridge, and which doesn't have any advertising. In fact, their required "inspection station" signage is not even visible from the roadway. In short, no one goes there for inspections, and it is the perfect place for me to go, as opposed to, let's say, the gas station by the mall. The gas station by the mall has a two or three hour line every day, all day, without regard to whether it is the end of the month or not. The advantage of my chosen place is obvious.

So, like I said, I had to get an emissions inspection on my primary vehicle. I didn't really think it would be a problem, as my truck is relatively new and doesn't produce any visible smoke. My only two gripes with this unit have been that the emergency brake light stays on constantly, and that the "check engine" light would stay on intermittently, though not all the time. (BTW, both problems are well documented quirks of my type of truck, so I never really paid them much mind- hey, I read the forums.) I went at this particular emissions test with a little bit of trepidation, because the last time I got an emissions test, my secondary car failed miserably and was essentially knocked permanently out of service. Allow me to digress....

Right after I got my current job, we needed to get a third vehicle so that our live-in au pair could have something to drive. After literally looking to see if I could get a used Yugo, or some other silly-cheap car, I happened upon a government surplus auction website. Lo and behold, the County next to me was auctioning off a bunch of old Sheriff's Office cruisers. I bid on the oldest one, and won the auction for the seller's-premium-included cost of $326.00. This car is a 1992 Ford Crown Victoria, and it is complete with the Earl Scheib white-over-brown bogus paint job, the spotlight mount, odometer broken at 136943, the red-lens interior dome light, the cage marks on the backs of the seats, scotchlight on all of the interior door panels, and the oh-so-awesome visible sticker residue on the doors. When I got it, it had been sitting for a few months. Once I got it started, it ran pretty well. Once I got a new battery, it ran perfectly. Once I was convinced that it wouldn't blow up and that it was reliable, I started driving it full time. I let my live-in babysitter from Bosnia drive my pimped-out truck with the dubs, heated leather seats and other bling. I was thrilled that my "bluesmobile" was maybe the best cash/efficiency ratio purchase of all time. The only trouble with that car is that any repair (and I mean any repair) fails the cost-benefit analysis. OK, back to the story.

The failure of the emissions test on my hoop-dee meant that I had to spend a few hundred bucks in order to get a new registration, and the valid license plates that go along with it. being unwilling to do this, the failure put the bluesmobile on the sidelines for now. I walked into the shop that morning thinking that it would be nice to get a quick emissions pass and to get on the road. After waiting a minute for someone to show up at the shop, I was directed to the emissions bay by the manager, whom I had dealt with before. He hooked the truck up to the state-issued computer, and started with the tests. Long story short, that pesky check engine light intermittently goes on because when the environmental package fails, you're supposed to check the engine. My environmental package had failed. The computer analysis was able to pinpoint the problem right down to the cylinder and the valve. It was a small, yet gloriously expensive part that needed to be unscrewed and replaced. The rules of emissions testing are that the shop that tests you has to do the work to fix any deficiencies, and the shop guy said he could get the part and have me out in about four hours.

I was still reeling from the second (and this time unexpected) failure from this shop. Perhaps my off-the-beaten-trail inspection shop idea was stupid. I was also under time pressure. I needed to get the test passed quickly so that I could get my registration. I had to go to court. I had a bunch of stuff to do that couldn't wait for me to be four hours in an auto shop. Then something even more unexpected happened......

The manager guy, hearing that I needed to get to work, offered to drive me to work. I explained that my office is like 40 miles from the shop, and we both shared a little laugh about how that plan wouldn't work. Then, without even thinking about it, he pulled out his personal keyring, pulled off his car key, and told me to take his car, and to come back after I got off work. I asked him if he was sure, and he said that it would be "no problem". I thanked him profusely, shifted some gear from my truck to his passenger seat, and was about to take off, when he took my name and address for the shop's real (i.e., not the estimate) paperwork. And then I went to work.

It was strange to drive to work in a stranger's car. It was strange to drive back to the shop after work in a stranger's car. I filled it up with fuel at a nearby convenience store, and rolled back into the shop. My car was done, with a pass on the emissions test, with the check engine light (hopefully forever) out, and with a service bill significantly less than the original estimate. I paid the guy, and thanked him for his above-and-beyond the call of duty customer service. He just moved on to the next car.

I think that in my chosen professions, I have come to expect the worst in people. I see people on the worst days of their lives. In the fire department, I see people who are highly stressed, drunk, injured, or who have lost greatly. In the law, my job as the "good guy" makes me the "bad guy" for as many as fifty or sixty defendants in a day, and I am absolutely sure that I make some (deserving) people very unhappy every day that I set foot in court. But I also get to work every day with people who are highly stressed, drunk, injured, or who have lost greatly. In both places, people that I deal with do irrational things. People do mean and irrational things. If you read this blog, you know the drill. Additionally, the non-court aspects of my job offer a very broad opportunity to see a very negative and depressing side of life that, thankfully, most people don't get to see. In short, it is good to be reminded that there are good people out there. This was a shining example. It made me happy.

The little bright spot for that day was a very helpful, accommodating, generous and honest car mechanic, who went out of his way to do me a solid favor, even though he didn't know me. His name is Wang Chung (and no, I'm not kidding). If you want to know where his shop is, leave me a comment with enough info so that I can find you.

I'll try to get back into the writing groove. This helped.

DTXMATT12