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Thursday, September 23, 2010

1.12 Accident Avoidance/ Nuclear Meltdown Japan/Air,Rail,Road Accident

Physician's Notebooks 1 - http://physiciansnotebook.blogspot.com - See Homepage

Eliminate Accidents  (Note, the old Eliminate Accidents chapter is now the following 3 chapters: 1-12 Non-Transportation Accidents, 1-12-2 Transportation Accidents, and 1-12-3 Natural Accidents that includes Nuclear meltdown.
Update 10 Aug. 2018
Following is a list of the headings in order as they appear. Scroll down to read the topic

 Banging Head
Bed Accident
Burns
Crowd Crush
Crushing Fingertip
Cuts
Dental Accident 
Design Accident
Drug
Falls
Fire
Footwear
Gas
Lifting and Carrying
Needle Puncture
Oxygen Lack
Poisoning
Sex Accidents
Shaving Accident
Spills
Step Accident 
Stains
Street Accident
Transparent Glass and Other Too-Quick Movement Accidents
 Water Accident
 Surfing Spinal Cord Damage with Paralysis 
WC, or Bathroom Accident


Banging Head is a rarely thought-about problem that ups risk of Alzheimer Disease by repeated jarring to brain. In every room and especially kitchen and WC, be alert to a jutting-out point or a too-low doorway and ceiling. Especially before buying or renting a house or a flat, check for a head-bump hazard, and, if so, say No. When you have no choice but a house with the hazard, paste a warning tickler – a flexible tube that contacts your head seconds before banging – on bumpy spot, low entrance-way and ceiling. Also wear a long-front-visor cap with top button.


Bed Accident   My older brother fell out of a high bed, fractured his hip and died of it. In another case, a 20-year-old fell out of a double deck bunk-bed from the top and got a bad fracture that ruined his life. (Double deck bed accidents are too much, too many!) The safest sleeping place is the Japanese type futon - a mat on the floor. If you use a bed, keep it low off the floor and, if you control the floor, make it Japanese tatami or else a soft rug around the bed to cushion a fall.

Burns   Mostly in kitchen from pouring hot fluid (soup, bacon fat, cooking oil), knocking over kettle and bare hand to hot surface. Best prevention is to cover skin (Heavy-duty glove, clothing of body surface, shoe or top-covered slipper to protect top of foot). Never cook a naked lunch!
   Forbid toddler to tour kitchen while cooking.
   Use thermometer for preventing burn. Not only does hot food and drink cause burn but repeated hot drinking causes cancer of mouth and esophagus. Using thermometer and taste and heat judgment, here is my scale: Steaming hot, 600 C (acceptable to serve); 700 or more is too hot to serve. This can also be applied to semi-solid food like just-cooked rice, cereal, pudding, hot pie. Also from my kitchen experiment: Food and beverage cool down at 10 C per minute between 700 and 600 C.
   In bath, thermometer is useful to stop bad habit of dipping toe or finger in bathwater to test comfortable temperature, which is how diabetic may lose toe or foot. Safe bath temp: 420C (107.60 F).

Crowd Crush  Give yourself enough breathing room. Don’t fight against the flow of the crowd if you are trying to get out of it; rather, go with it, and, during lulls, try to work your way diagonally through the crowd to the perimeter. If you feel faint, grab on to someone, and, if you do fall, try to protect your head.

Crushing fingertip or Stubbing Toe on a door  (In Japan, my toe got caught in sliding door): Keep it in mind whenever a door, window or other potential rock-and-hard-place closure is possible. Stubbing toe due to abrupt obstruction in floor surface and walking barefoot or open-toed; especially in unfamiliar place such as hotel into step-up bathroom, can lead to fracture or dislocated hammertoe. Use slipper with cushion tip; do not go barefoot!

Cuts   Do not try to force an ice cube into a too-small drinking glass or pick up broken glass with bare-hand. A knife cut is more serious. It may slice off fingertip or may stab as one pares or cores fruit. Heavy-duty gloves protect or dull knife that relies more on brawn than sharp. And quickly clean and put band-aid on a cut.

Dental accident that cost me time and trouble happened because a nurse I worked with offered me sweet semi-hard Jujube candy. Its strong sticky chewing dislodged dental work and it cost me months of expensive dentist visits. Same with chewing hard nuts. Stop it!  Another expensive accident occurred because I stupidly used my front teeth to try to pull open a tight cover stuck on a container. Use teeth only for eating!  
   Every time you brush teeth, many gum bacteria enter blood stream. The healthy person survives without problem but someone with heart disease or with low immunity may get infection on heart valve. Before tooth brushing, do antibacterial mouthwash. With same aim, no toothpick. Pressing a toothbrush's bristles into crevices between teeth works as well with less risk.

Design Accident, eg, the “gap” accident on Tokyo transit. Depending on station, a wide gap used to occur between edge of platform and coach entrance. I once observed a commuter fall through it onto the track. It is a design accident (ie, inherent in poor design). Examples in airplane and car construction. Be alert to it and other design accidents.

Dulled alertness or euphoria from drugs, sleepiness or even stimulants that make one easily distracted: Scarily, I recall where under the euphoria of caffeine from coffee I almost got killed crossing road and was only spared by hearing the screech of a car brake. Alcohol is worse; as are also Rx- and non-prescription drugs. (Almost got killed by car in Japanese side street recently going out for snack after taking recreational drug) If you take drug, be hyper-vigilant for accident. Especially in dark street crossing roadway at night. And in the 12 hours before you operate potentially death-dealing machinery or drive car do not drug.


Falls take toll and kill us if we live long enough. At home, a cause is getting something off high shelf for which we must climb up on chair. Reduce need to climb by using high shelf for storage of never-needed thing you ought to throw-out but can’t bring yourself to, and also for soft things not needing fine handling and retrieved by broomstick.   
   Another climb on chair is to replace bulb in ceiling light fixture. Whenever you get the urge to climb on a chair, stop and think about the chair collapsing and you hurting or dying or injured. Never try to reach something too high for you by getting up on a folding chair or a frail chair or a chair piled high with papers or books. If you must stand on a chair, test the chair’s stability with your hand and other hand to steady self.

   On floor, a throw-down rug or slippery vinyl floor increases risk.      
 Be alert for discontinuity where you walk: be alert at end of an escalator or a moving-way at airport, or a sidewalk on old pavement, or dark, unfamiliar floor especially after drinking alcohol, and also step-ups or step downs into room like a WC at a hotel.

And consider every time you walk down a stair a risk: Go slow, hold onto banister, watch step, and stay on toes. Especially as you get old, be alert to the few stairs one has to go down when coming out of places.
 The safest walking against slip and trip is to step instead of shuffle as you walk. “Step” means lifting your foot high enough to clear obstruction. "Shuffle" is when your feet barely clear the floor and drag or slide along, easily impacting on discontinuity and pitching the walker forward on face. In lifting foot, it should be “up on your toes, down on your toes”.

Other walking habit to prevent fall is walking on wide base, not being top-heavy with load, or not running for bus, taxi, train. And look where your feet go! Fall accident due to unnoticed cable, chain, rope, low fence can be 3F's– frequent, fracture and fatal.

Walking Surface: strive to eliminate fall-risk floor and ground (risks being smooth linoleum, marble floor, highly shellacked wood, throw-down rug) and replace with high-friction, obstruction-free, even-level, soft-to-impact walking surface. Outside, be alert to increased risk of dangerous flooring or ground. At home, Japanese tatami floor is safest and stops breakage from fall.
Walking the dog has been a site of some bad falls, eg, the following from a reader - "I was walking the dog at night and I tripped over a rock with my right foot ... ." She got a bad fracture and needed serious surgery and requires months of post-op physiotherapy.
Then her partner suffered fall from electric motorbike he was testing by simply getting on it to sit; it collapsed on him and fractured his thigh bone.
Oh yes! I just remembered because it just happened to me, very serious fall injuries happen on moving vehicles that suddenly jerk one way or another and the inertia carries your body hard against the floor. On March 23rd 2018, I was standing in a subway car that was about to come to a stop at my final station. Stupidly, I wasn't holding on to anything and the subway car gave a sudden jerk and I plummeted on my back and fractured my pelvis and ended up 10 weeks on my back at a hospital almost dying. Hold on when you're on a moving vehicle! Remember the law of inertia. 

Fire  Are your basement, attic and closet free from rubbish, oily rag, paper? No gasoline or other flammable for cleaning? Is the wall and ceiling next to heating unit or to electric switch or to hot pipe protected by well-insulated, fire-resistant material? Are heating, gas and electric units used as directed and inspected, cleaned and adjusted regularly? Is fireplace screened off and used with care against touch burns? Are matches kept in closed container away from heat and out of reach of child? Is smoking prohibited at home? Is electric extension cord in open and not under rug and is your home electric system latest standard? Is Christmas tree fire resistant? Do you know how to turn in fire alarm from telephone and location of alarm? How to use your fire extinguisher and is it up to date and filled? Do you have plan of escape in case of fire, especially at night? Do you use electric appliance if wet and without rubber gloves?

Footwear and “feet where?” are important in falls of walking. First rule about footwear is not to go barefoot. ("Do as I say, not as I do!" is my aphorism because I often, in office, stupidly go bare feet) Many foot accidents and diseases occur because people insist on walking barefoot. A person knows he always needs footwear outside but thinks going bare at home OK. It ain’t! Sharps litter a floor, foot fungus abounds, and kitchen accident from heavy pointed knife or scissor plunging into bare feet or from hot cooking fluid scalding is risk. Not only should it be rule to wear footwear at home, but be sure your slipper has adequate protective cover for top part of foot and front toes because most accidents involve a thing falling on it from above or toes striking hard place. No open toes slippers! Ideal footwear (shoe) should fit comfortably but not so overly large that it shifts about on foot when walking and not so snug it causes pressure sore. Safest shoe is lightweight and string-less. Sole should be ridged, cupped or hard-gummed to stop slipping on moist or otherwise low-friction floor. Sole and heel should be soft and springy. Front end should not present hard, thick, inflexible impacting surface; rather slight upward curve at front, resilient with the sole flexible, in order to minimize fall due to forward impact on discontinuous obstructing point in floor or sidewalk. The best shoes – which I use – are the inexpensive, lightweight cloth top, rubber-sole shoes sold in cut-rate stores and usually made in China.
Shoe lace tripping accidents are frequent and can be deadly. Use no-lace shoes and live healthier and longer!

 Gas is problem for kitchen  For safety we ought to cook in microwave. With gas, forgetting a turned-on due to your getting distracted and leaving the kitchen or even your house is a source of fire. The moment a distraction you must make rule to turn off gas. Prolonged cooking in big pot is worst offender. Cut gas burner time by using residual heat of boiling water to cook. If you must use an old gas stove that lights by match, keep your head far away and use eye protection. Some old stoves explode with wide ranging flame at instant of lighting.

Lifting and Carrying Accident: Sadly I remember a paralyzed right arm that afflicted me after a trip to Hong Kong carrying a heavy shoulder bag. Where its strap pressed down on shoulder, it crushed a motor nerve and I could not use telephone, shake hands, or lift my arm to write for weeks. Do not overly load a shoulder bag; rather, be sure the point where its strap crosses shoulder is padded and shift the bag between shoulders every several minutes.
   Travel is risk for back pain because of picking up and lugging valise. Wheeled luggage is best to prevent back pain. If you must lift, do it with assist. And lift with elbows close to body and bend knees when picking up something so that strain of lifting will be on legs rather than back.

Needle Puncture happens to those who hold sewing needle or who use tack or give injection with needle syringe. Puncture may lead to blood poisoning and HIV/AIDS. Sewing-needle worker should use thimble. Person who pushes a tack should protect finger.

   Hypo syringe needle puncture happens to medical person on sheathing needle after giving injection. In hospital the sheathing has been replaced by dropping the used needle into protective container. After using needle, hold needle hub with forceps or needle clamp instead of fingers.
   Here should also be mentioned fingertip puncture from attempting to remove a staple bare-hand. Usually this is minor but in a person with low immunity or rheumatic heart disease it could result in blood poisoning and heart valve infection. And a diabetic could lose finger due to the infection. So think before you remove staple. Use staple remover rather than your bare finger.



Oxygen Lack comes from space-heating while asleep. Especially in Japan in Tokyo or points north, where winter room warming depends much on gas or kerosene or electric heater. Do not heat room while doors and windows all closed. And keep in mind: low level of Carbon Monoxide gas poisoning is undetectable but will reduce the usable oxygen to heart muscle and brain cell and could promote, after repeated exposure later, Alzheimer's or coronary artery disease. Turn off space heating before sleep and be sure of good ventilation. And if you live 5,000 feet altitude (Denver Colorado) or higher, go to a medical supply store and get oxygen with breathing mask and valve control. It could be life saving with altitude sickness or person with chronic lung disease suddenly going to high altitude. And get a pulse oximeter; a SaO2 readout below 90% is an indication to breathe pure oxygen.

Poisoning: Just after World War 2, when food was scarce in Japan, people went hungry and quickly ate anything offered. One day a man walked into a Tokyo bank and, after discussion with employees about a loan, passed around some Marzipan cherry chocolates. Within minutes the employees were dead from cyanide. The alleged murderer died after life imprisonment, claiming innocence. Whether guilty or not, the lesson here is: Don’t pop anything into mouth just because it is free and seems to taste good, and never start to eat, or swallow, fast. (Cf. 18 July 2013 Patna India free school lunch fatal mass poisonings) Before starting food or drink, inspect appearance and odor and taste before swallowing. And even while chewing, be alert to a sharp object. Never feel shy about spitting food out at last moment if its taste seems strange. And inspect, cook or heat all eats out of a can. (Cf. recent cases of needles in airline gourmet sandwiches)
   Poison Info: 24-hr/7-days a week and holiday the number is in NYC or Direct-digit from international access code +1-212-3404494 (Checked recently and they say, have your facts at hand as you call) and +1-800-2221222. (toll-free US; English & Spanish)

Sex accidents I have treated are a bleeding, bitten penis from wife's newly learning oral sex, a vaginal heavy bleeding from a too vigorous first penis into vagina, and a 20-watt white light bulb that must have been carefully inserted into rectum and that I just as carefully removed.

Shaving Accident: Men who shave non-electrically may do a shave in which multiple tiny cuts convert face into sea of dripping red. Every once in a while you may buy disposable razor with razor edge defect. Prevention is alertness. On first use, test-shave small area of skin and if within seconds it bleeds, discard razor and try another. And with first-use razor shave “gingerly” (with care, not roughly or strongly). If continually getting bleeding with any blade, suspect bleeding from blood disease or medicine. Most commonly it’s from taking an anticoagulant like Coumadin (Warfarin) but could be too frequent aspirin. Prefer acetaminophen (Tylenol, Paracetamol) to aspirin to avoid the bleeding.
But, best of all, switch to electric shaver. Last year I witched and I absolutely love my BRAUN CT6cc CoolTec model which self cleans, cools your face as you shave, and sterilizes; and thus can be used among a group of persons who need to shave. (It is more energy-saving than bare shaving because  you save disposables and shaving lotion)

Spills burn by hot fluid on skin but also spills lose drink or medicine and break glass, cup or saucer. Major type involves breakage loss from tipping-over and dislodging. Spill is something one has to have “on the brain” if one is to reduce it. Whenever a container with fluid in it comes into view, the image of it spilling and you losing and hurting should come to mind. (Not only "You" but your eating or drinking partner) And follow the following “Nots”: Not on ledge – asking to be knocked off. Not out of view, – increasing probability you will knock it over. Not adjacent to or near an object like a book that is frequently reached for – asking to be knocked over. Not next to someone (human) or something (animal) that will move unpredictably – increasing the chance it will be lapped up or knocked over. Not in risky receptacle for tipping over, a long-stem cocktail glass – an almost certain spill. Not standing directly touching tabletop; place on saucer-like container-stand so that if spilled it will be contained and not mess up desk or furniture, and if it’s valuable (drug) or tasty (drink) it will not be lost to enjoyment or will not need to be replaced. Not containing intrinsically hazardous fluid – strong acid, base, poison, scalding fluid. (Note the lawsuits against fast food takeout stores for scalding coffee spills) And not filled to top.
  Spill not only can harm body, it can mess up expensive carpet and furniture.

Step Accident can happen at home or outside: Good lighting, large-letter warning, familiarization with new living space, and careful stepping in unlit place are preventive.

   Another step accident occurs at bottom of stair. In it, a person, say a lady in the dark, unobservant and immersed in thought thinks she has reached bottom of stair but actually has one or more steps to go so she steps ahead as if on level ground only to pitch forward and twist or break ankle. Solution: watch and see where your feet are at all times. And if you can’t see, be careful in stepping forward until you have tested the ground for support. Be running scared of stairs. Go down slow! Hold banister! Stay on your toes.



Stains: Rules to keep in mind here in order of importance: if you have a choice use the least staining form of a product (white wine, not red; tea, not coffee), do not eat where you can make a damaging, irremovable stain (over expensive carpets, in rooms with expensive furnishings) or, if you must, then cover the furnishings or rug with plastic, and, finally, if you do spill a staining material on expensive rug, put warm but not hot water over it immediately; do not let it dry. Again the advantage of tatami floor: it can be washed and scrubbed without damaging its appearance.

Street Accident: Each morning after waking while still in bed, review your going-out plan. Start with: Why must I leave home today? Is it mere restlessness? Is it need that can’t be done by just making telephone call, sending fax or email, or other alternative?
   Review outside chore and ask: “Have I made proper preparation? Do I have what I need? Am I protected against probable and serious accident?” I know it is difficult to order one’s thinking process so; still, it is good goal.
   Thing other than raindrop can fall on my head. (A good allegory concerning a deadly falling object is the Flitcraft anecdote in Dashiell Hammett’s The Maltese Falcon) You may fall on your head from slippery street due to slippery sidewalk from rain and slippery sole of shoe. The other evening, on a rainy street, I set my footsteps on top of metal grill-top drain canal that runs down many sidewalks in Tokyo, and suddenly slid, landing on my butt and almost fracturing a wrist in extending palm of hand to cushion fall. Especially when pavement is wet, guide your steps to its most frictional part. And wet or dry, be especially alert in the vicinity of someone wheeling large boxes or other detachable heavy materials. These can suddenly collapse on you. Keep a distance.
   Recently, at 11 PM, I left my office and coming out the sliding open door from the building's lobby to sidewalk I did not pause, as I should have, to glance right and left; instead I just quickly stepped out onto the street and seconds later I felt a strong bang on back of my legs and was knocked forward and to the ground. It was a bicycle ridden too fast and against the rules on a sidewalk and the bicyclist was too surprised by my sudden appearance to brake. Luckily I only got a bruise on back of my leg but I could have got killed or got bone fractures. I call this the encountering accident due to split-second bad luck. Also it's a too-quick movement accident. (And see below with transparent glass doors) Always, whenever you make a sudden appearance on a walkway from a point you cannot be seen by a rider, stop, look to left and right, and go slow.
   Slow! Slow! Slow! and you will live healthily Long! Long! Long!
   Alertness on street should not be limited to danger from falling object. Every other human or animal you come near ought to receive attention to be sure she, he, they or it is not about to subject you to sudden, mad murder.
   Street brings pedestrian car accident to mind. Unconsidered is being hit while on sidewalk at night when drunk-driver car goes out of control and maims or kills unsuspecting sidewalk pedestrian. Scenario is you – seemingly safe position of standing on a corner. And a suddenly curb-hopping car kills you. The End!
 On a street corner be alert waiting for red light to change. Stand on sidewalk with pedestrian between you and curb. If metal barrier, stand behind it. Also, knowing of the 3 August 2013 Venice California boardwalk malicious car driver who killed and injured unsuspecting persons on a boardwalk, (And very recently a similar ISIS killer in west-side NYC) always be alert to the potential of moving cars near and behind you either going out of control or maliciously aiming to hit you.

Transparent glass accident: I saw one that disfigured its victim. It happened at a Tokyo hotel and the victim was drunk and mistook transparent glass door panel for air and impatiently lurched into it. Another, more recent case happened when someone late at night when she ought to have been asleep decided to go out and buy a snack from a 711, but in her inattentive, sleepy mode, she walked into a glass door that she mistakenly expected would automatically open, but did not and she banged her nose, her lips and her knee. It reminds me that an accident may be worsened because of a natural tendency to be forcefully quick. In the second case, luckily, she was not forceful or quick so she avoided serious injury but, even so, slower motion would have saved her from the bang. Cultivating moving slowly and cautiously is solution. (Not throwing things down but putting them down slowly and carefully) Slow motion is a good notion.
Additionally, wearing a long visor cap ought to prevent banging into glass accident. 

Water Accident happens in swim pool or even bath in or outside home and also in open body of water, on ice and involving baby or toddler: Do not use a swim pool. It poses danger of drowning and is money and water wasting. Never walk on ice. Preventive is learning to swim, to never dive, and to stay out of depth. Also note recent increase in spinal cord injury with paralyses from diving into shallow water. And watch out for vacation shore like Hawaii (Maui island the worst) or Phuket Thailand because of the many surf drownings, major trauma or Tsunami. A particular ocean wave accident most common on Pacific shores is the sleeper wave that just as well should be called sneaker or sneaky wave because sneaks up and catches a beach-goer or a surf casting fisherman on a jetty outside of his awareness.  It is an unusually high, strong wave that suddenly appears in a moderate surf - not quite a tsunami but many times higher and stronger than its close fellow waves and it sweeps over the previous dry beach or jetty powerfully and drags persons in its path out to sea and death.  The best prevention is constant awareness of the danger while at the shore. Most frequently reported from the shores of northern California, Oregon, Washington and the Canadian northwest; also also south eastern Australia. (Pacific Ocean)

Surfing Spinal Cord Damage with Paralysis is getting frequent, especially reported from Hawaii, and involves mostly first-time, or new surfers who spend too much time on the surfboard at one outing and, right after, engaged in vigorous activities. Within an hour of the surfing there is upper back pain followed weakness-paralysis of the legs and trouble peeing. In some cases it has been permanent. My advice is stop, or never start surfing. It is not worth the risk. And Christopher Reeve, the movie Superman!  Remember him being flung forward by the horse and getting total paralysis from upper spinal cord injury!  "Horse riding is worse riding"; stop it!

 WC, or bathroom AccidentDying on and around toilet seat happens much. Mostly straining at pushing out stool, which shoots up blood pressure, or the abrupt change in blood pressure due to sudden getting into and exit out of hot bath.
   On toilet seat, the act of straining to evacuate constipated stool and, in older men or urinating against enlarged prostate is cause of tearing an artery and of stroking out in brain. Also of causing surgical hernia. Never strain mightily at stool. If you find yourself straining more than a little, give it up! It is not important that stool be passed quickly; it can wait in rectum many, many hours;another day. If you must pass constipated, stool, use lubricated index finger inserted from anus. Men with prostate hypertrophy should sit to urinate, and use firm downward abdominal pressure above pubic bone pressing with fist. Or pee in the bath.
For hot bath, use thermometer and not above 42C (107.6F). A safe in-bath body position should be with legs stretched, not in a squat that favors blood clot in vein. Hot water should not come above chest level for more than a minute because of overheating the heart that may cause fatal arrhythmia. And if you have high BP and take a daily pill to lower your BP, take it after, not before your day's bath.
   Getting out of bath is danger point because dilated skin arteries cause the blood to pool in legs and drop the blood pressure, risking fainting and a stroke, myocardial infarct, or sudden death; or you might also hit head on side of tub fainting. In getting out of tub, stand slowly, and reach & grasp overhead pipe and pull self erect. Meanwhile be pumping calf muscles to ‘one, two, button shoe’. These maneuvers are to pump (contracting calf muscle) and drain (elevating arm above head) blood back to heart in order to increase cardiac output and prevent stroke, heart attack or sudden death.

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