Your Health

Trauma season

When the mercury soars, so do the number of visits to Winnipeg's emergency departments. Here are some tips to help you avoid a trip to the hospital.

When the mercury soars, so do the number of visits to Winnipeg's emergency departments. Here are some tips to help you avoid a trip to the hospital.
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Cycle safety

ATV safety

Car seat tips

Water safety

West Nile virus and using
repellents

Lyme disease, tick bites and how to safely remove ticks

Skin cancer

Using sunscreens

Safe driving information

BY JOEL SCHLESINGER
Winnipeg Health Region
Wave, Summer 2011

Winnipeggers live for summer.

After a long winter, we want to get outside and swim, run and frolic while the sun shines and the breeze is gentle and warm.

But emergency department physicians have another name for the time between the May long weekend and Labour Day weekend: Trauma Season.

"All the trauma units get far busier in July and August, a lot of times around the weekend," says Dr. Lynne Warda, Medical Director of the Winnipeg Health Region's Injury Prevention program, also known as IMPACT. "It's predictable. It's every year."

Call it spring fever, summer fever - whatever you want. But the giddiness that comes with nice weather and clear skies has a habit of clouding our good judgment, says Dr. Alecs Chochinov, Head of Emergency Medicine at the University of Manitoba's Faculty of Medicine and the Medical Director of the Region's Emergency Medicine Program.

"Heart attacks, bowel perforations, strokes and aneurysms don't increase," he says. "Those are the types of emergency conditions that are less dependent on the time of year, and tend to have to do with a person's physiology."

But when we get outside, against the elements, there's always an increased chance for injury - be it sporting activities, sun exposure or simply being out on the road. "Sometimes what gets people into trouble outside is beyond their control - like you can't stop an earthquake or a tsunami, but if you're standing in the middle of an open field in a lightning storm, it's not just the environment's fault," he says. "Good judgment tends to keep people away from harm, and anything that impairs good judgment increases people's risks."

Alcohol is a case in point. "It's just an incredibly common denominator in emergency department visits in the summer," says Chochinov.

Still, a little advice and cautionary information can go a long way in keeping us safe this summer, so here's a prescription for staying out of harm's way while having fun.

Road rules

Black ice, slush and blizzards sound like the perfect storm of conditions to jack up fatal collisions on the roads in Manitoba. But surprisingly, it's the summer months that statistically see the most serious and fatal vehicular collisions.

"The simple fact is that people just tend to be out on the road more in the warm weather - often late at night, going to parties," Chochinov says.

About 350 Manitobans died on our roads during the last 10 years, or roughly six people for every 100,000 Manitobans, according to Winnipeg Health Region statistics. That makes it by far one of the most dangerous activities we do every day. Yet many of us take it for granted that we're safe on the road when we get behind the wheel. Impaired driving, speeding and not wearing seatbelts are the common denominators for serious and fatal collisions.

Warda, who specializes in pediatric emergency medicine, says children are often victims in collisions because their parents and guardians fail to ensure that they are secured safely in seatbelts and child booster seats for their age, weight and height.

"Children involved in a lot of the fatal collisions often weren't restrained, or weren't restrained properly, such as not being in a booster seat when they should have been in one," she says.

Here are a few rules of thumb for children in vehicles. If they're 12 years of age and under, they should ride in the back seat. Infants should be in a child safety seat that's strapped in properly and facing backward until age two.

Once they outgrow the safety seat for toddlers, children need a booster car seat until they reach 4 feet, 9 inches (145 centimetres) in height, or nine years of age.

Off-road rules

People often forget about safety once they get off the road and onto an allterrain vehicle. Yet, they need to be just a vigilant - and even more so when children are involved, says Warda.

"Last year, we had a huge spike in very serious incidents involving ATVs and young children," she says. "In some cases, these incidents involved children as young as two years old."

The emergency department at Winnipeg's Children's Hospital treated 30 ATV-related trauma incidents last summer - and almost every one was preventable.

While it may be common in rural communities for parents to let their children ride around on ATVs, the fact is people must recognize that these machines are potentially dangerous. Here are a few guidelines for safety:

  • Always wear a helmet specifically designed for the activity;
  • Only one person should ride on the vehicle, unless it's designed for more than one rider;
  • Operators should be at least 16 years of age.

Bikes, blades and boards

Motorized vehicle collisions that cause serious and fatal injuries often involve a high degree of speed, but other common summer road activities usually don't require much velocity at all to cause a life-altering or life-ending injury.

Cycling, rollerblading and skateboarding are great ways to keep active and enjoy the outdoors, but the fact is that many riders do not take proper precautions.

The Chief Medical Examiner's Office of Manitoba found that 27 Manitobans died in bicycle accidents between 1999 and 2008. Every year, about 140 cyclists are admitted to emergency departments with injuries, including about 40 with head injuries, Manitoba Health reports. And about 60 of these cyclists are under the age of 15.

The simple rule of thumb when doing any activity that may involve your head hitting the ground, or anything hard, for that matter, is to wear a helmet, says Dr. Peter Nemeth, Medical Director at the Minor Injury Clinic at the Pan Am Clinic.

"Don't go out on the road without a helmet," he says. "And that goes particularly for parents. I see parents with their kids, and the kids have a helmet but the parents don't, which is a little discouraging because as soon as the kids aren't supervised, they want to be like Mom and Dad and take their helmet off."

Yes, helmets may flatten your hair, but consider this: "If you compare it to the possible outcomes, it's much prettier to have flat hair than a scar and a shaved head from neurosurgery," says Warda.

It's important to remember that even minor collisions can result in serious head injuries. Research over the last decade has shown that repeated minor concussions can add up over time, causing long-lasting brain damage.

"You can sometimes see the aftereffects in the behaviour of a child with a head injury," says Warda. "They can become aggressive and/or develop learning problems."

Here are some tips:

  • Children should be supervised when on a bicycle, rollerblades or skateboards until they understand the rules of the road;
  • Parents should ensure that children ride bikes that are appropriate for their size, and that their helmet fits properly;
  • Bike riders should wear reflective, bright clothing at dusk and have lights on the front and back of the bike at night;
  • Children shouldn't ride on the road at all after dark;
  • Rollerbladers and skateboarders should always wear a helmet, kneepads and wrist guards.

These precautions are important, because as Nemeth says: "It's usually not a matter of 'if,' but 'when' you're going to fall with those activities because of road conditions and everything else." These precautions may seem like inconveniences, but wearing a cast during the summer is the ultimate nuisance, says Nemeth.

"They're hot, itchy and smelly."

Water rules

Water is obviously a much softer landing pad than asphalt, but don't let that lull you into a false sense of security when out on the lake this summer.

Drowning is always among the leading causes of accidental death in Manitoba, consistently in the top five Manitoba Health statistics on fatalities. Accidents on the water are an area of special interest for Chochinov, who has studied how and why drowning and serious boating accidents occur.

Obviously, cold water plays a role, but not as we expect, he says.

"People die in cold water throughout the summer, not because they're bad swimmers and not because they become hypothermic. It's because the cold water impairs their ability to have neuromuscular control over their body."

Another factor particular to cold water is a physiological phenomenon called the gasp reflex. "If you drop a mammal into cold water, one of the first things that happen is a gasp reflex," he says. "You go 'ughh!' and you often inhale a lung full of water."

Yet many water-related accidents do not just involve cold water. Many are the result of driver error and carelessness.

There are two big factors in boatingrelated deaths: impairment and failure to wear a personal flotation device (life jacket). You may be able to swim, but it's hard to do if you're knocked unconscious or injured from a collision on the water.

Another good safety tip: Don't drive the boat at night. "That goes back to using good judgment, and oftentimes, what we see is teenagers out drinking and they just have to get back across the lake, and it's not very far and it's dark," he says.

The bottom line: if you only go out on the water in daylight, you aren't impaired, and you wear a life jacket, chances are you're going to enjoy summer at the lake - incident-free, he says.

Sun rules

As a dermatologist, Dr. Marni Wiseman can only shake her head in disbelief every summer. Wiseman is chair of CancerCare Skin Disease Site Group, which aims to raise skin cancer awareness in the province, but its message doesn't seem to be getting through to many Manitobans.

"It's horrible, horrible, horrible," Wiseman says in reference to seeing young people on the beach, lying out in the sun. "Smoking and tanning are both class-A carcinogens, according to the World Health Organization, so by doing that, people are getting a substantial dose of a known carcinogen, and it makes me sick to see it."

The sun emits ultraviolet radiation, and the tan - or burn - that we get isn't a sign of youthful vigour. It's a symptom of radiation damage.

People would never dream of hanging out near the damaged Fukushima Daiichi nuclear reactors in Japan emitting radiation, but for some reason, many think nothing about UV radiation exposure. Yet while the two types of radiation are different, they both damage our bodies.

UV radiation from the sun damages our skin in two ways, both of which take time to evolve. UV rays age our skin prematurely, and they cause skin cancer.

And skin cancer is on the rise, thanks to our bad habit of sun worship, she says. Of the three types of skin cancer - squamous-cell carcinoma, basal-cell carcinoma and melanoma - melanoma is potentially the most serious. "The earlier you can catch skin cancer, the better - especially melanoma," she says.

While squamous and basal-cell are treatable at any stage, advanced melanoma isn't.

And unlike the other two that often show symptoms later in life, melanoma develops in our 20s, 30s and 40s.

"Unfortunately, once melanoma has spread, the treatment options are limited."

If it spreads to other organs, the fiveyear survival rate - the benchmark for all cancer survivors - is less than 20 per cent.

The good thing is that melanoma is rare and it is preventable.

Here's how to protect yourself:

  • Stay out of the sun when possible, and if you do have to go outside, cover up and seek shade;
  • Wear sunscreen with an SPF of at least 30. (Wearing SPF does not give people the ability to go sit in the sun at liberty. It's an extra defence for people in addition to keeping covered.);
  • If you have to go out in the sun, do so before 10 a.m. or after 3 p.m., when the sun's intensity is reduced;
  • If you think you have an odd-looking mole - often the sign of most skin cancers - go get it checked out, sooner rather than later.

Stay cool

Sun exposure isn't the only heat-related worry in the summer. Warda says it's important, especially for infants, toddlers and the elderly, to stay cool when the temperature reaches the high 20s and beyond. Stay hydrated and keep cool, and avoid intense activity on really hot days.

The signs of heat exhaustion are dizziness, nausea, vomiting, fatigue and muscle cramps. The symptoms of the more severe heat stroke are high body temperature, absence of sweating, delirium, hallucinations, difficulty breathing, rapid pulse, coma and/or seizures.

Warda says it's important to pay special attention to young children during heat waves. "Kids under three should always be carefully protected from the sun and heat because they won't be able to communicate the symptoms of heat stress," she says. "They can't say, 'I feel dizzy. I feel like I'm going to pass out.'"

Play - and work - safe

When it comes to minor injuries - sprains, pulls and small fractures - summer doesn't necessarily mean an increase in their frequency. But there is a change in the pattern of injuries, Nemeth says.

"You see people who have been active in the winter who transition into a different activity that they might not be prepared for, or you see people who are much less active in the winter, and they are now getting back into activity and they have problems because they've been inactive."

The most common complaints are strains from yard work or sprains and fractures from falls, such as rollerblading or cycling, he says.

A piece of advice: start off slow. Warm up with light activity. Stretching is always helpful, and make sure the equipment is in good condition.

If you do find yourself in pain as a result of activity, refrain from that activity until the sore spots heal. "If you're throwing a baseball and your shoulder is getting sore, then you want to stop doing that," he says.

It's simple advice, but people can be impatient. After all, summer is short. So, here are a couple of tips to care for sprains and pains to speed up the healing process. Ice the sore area immediately after activity. This will reduce swelling and inflammation. Once that goes down, the healing process can begin. After that, apply heat. "Heat actually helps restore blood flow and loosens tissues that have tightened up."

And when should you seek help for an injury? See your physician when the pain and swelling is unusually high and is not going away, he says.

"For example, if you roll your ankle, and it hurts a little bit, but you can walk fine and there's not much swelling, I think that can probably be treated at home with ice, a tensor bandage and then progress to heat," he says. "But if you're having more significant pain, you can't weight-bear, there's a lot of swelling and your function is reduced, then it's worth seeing a healthcare professional because you may have significant ligament damage or a fracture."

Don't let the bugs bite

Mosquitoes and wood ticks are a fact of outdoor life in Manitoba during the summer. While both are known to carry potentially deadly viruses, it doesn't mean we should live in a state of paranoia, Chochinov says. Wood ticks can carry Lyme disease, a virus that takes weeks to show symptoms, such as fever, aching joints and neurological problems. If left untreated, in rare cases, it can cause death. But Lyme disease is very rare and just finding a tick on your skin, doesn't necessarily mean you should head to the doctor in a panic.

"The best way to be cautious is if you're in an area with a lot of ticks, at the end of the day, you need to do a full body search for ticks," he says.

If you do find one, gently remove it. "It's not like if there's a tick on you, that you need to get it off in five minutes," he says. "But you can't leave it on there for a couple of days because it may burrow under the skin and then pass on disease."

The illness usually starts with a rash around the bite. "If there is a rash that appears in the days and weeks after a tick bite, then you should get checked out."

Equally as feared and just as rare is West Nile virus, passed on by certain types of mosquitoes. Only about one per cent of all mosquitoes carry the virus in an area where the disease has been found, the Public Health Agency of Canada website states. That means it's exceedingly rare in humans. Still, Chochinov says a handful of Manitobans do fall ill with the disease in the summer. If you catch a fever this summer, you don't need to rush to the emergency department thinking it's West Nile. Call your family doctor or Health Links at 788-8200 for guidance if the fever is high or persists longer 24 hours.

West Nile can cause a high fever and a condition called encephalitis, swelling around the brain, but it's a very involved process to diagnose the virus. The bottom line is that West Nile, when serious, will make you so sick that there will be no ifs, ands or buts about going to the emergency department.

"By the time a person has got complications from West Nile, they certainly then belong in emergency, but again, it's not that people should worry about getting West Nile," he says. "They have to worry about taking proper precautions when being exposed to an environment with mosquitoes."

It all comes down to limiting exposure to the hazards. Cover up, avoid infested areas and use bug spray when needed.

"I think the message to the public is to use good judgment," he says, adding it's a universal safety rule. "Simply put, stay out of the line of fire if you can avoid it."

Joel Schlesinger is a Winnipeg writer.

Wave: Summer 2011

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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