Summertime is 'trauma season' for hospital ERs


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When the thermometer hits 80, as it did Thursday and is expected to today, hospitals brace themselves.

You may know it as summer, but in emergency rooms across the country, the three-month period that follows spring is known as "trauma season." That's particularly true in the North, when children -- and adults -- who have been cooped up for months emerge from hibernation and school classrooms.

"The first thing that lets us know [trauma season is near] is when we turn the clock ahead," said Barbara Gaines, a trauma surgeon at Children's Hospital of Pittsburgh of UPMC. Kids get "an extra hour or two in the evening to play."

In April, incidences of bicycle-related injuries start to rise. As the months get hotter, there are more swimming and water-play injuries. And every summer, there are reliably three to five lawn mower injuries that require the attention of trauma surgeons at Children's.

Among children, traumatic injuries can double during summer months, Dr. Gaines said. In winter months, Children's might see 100 kids a month for traumatic injuries. From May to September, that number is usually between 170 and 200 a month.

Adult trauma cases also jump 25 to 30 percent in the summer months, said Louis Alarcon, medical director of trauma at UPMC Presbyterian.

Adults, naturally, tend to have more grown-up injuries -- bad sunburns, burns from gas grills and joint injuries among weekend warriors who aren't in top physical form (golfer's elbow is one of the most-reported summer issues for men). Falls are more common, too, as people who are painting houses and cleaning gutters tumble from ladders, Dr. Alarcon said.

Most ER visits are still nontraumatic -- chest pains, abdominal pains, breathing difficulties, worsening colds, toothaches and severe fevers; as a share of total ER visits, traumatic injuries are pretty far down the list. And even in the summer, most child and adult injuries don't require a trip to the ER. The majority can be treated with a bandage or a trip to an outpatient clinic.

Still, more time outside -- particularly for children, and especially when they are unsupervised -- means more injuries.

Here are a dozen injuries that physicians and hospital ERs will be dealing with over the next few months:

1. Bicycling-related injuries

"Bicycles are the most dangerous toys that we give our kids," Dr. Gaines said. "That said, I have three kids, and they all have bicycles." Injuries to the extremities are most common -- arm and wrist fractures, predominantly -- and head injuries are common, too, which is why children and adults alike should always wear a helmet.

Some cycling accidents are caused by high speed and user negligence, but it's also important to check the bike each spring to make sure brakes and tires are in good working order. If you have a child, make sure the bike still fits him -- and make sure that the helmet still fits, too.

And while most cycling spills are routine, bicycle-vs.-automobile accidents are also more common in the summer months (that's true for both adults and children).

2. Lawn mower accidents

These are, thankfully, rare among children, but when they happen, "they tend to be pretty nasty," Dr. Gaines said. "A riding mower is not a toy. It is not a ride."

A good rule of thumb: "If you have a child, they don't need to be anywhere near that mower," she said.

Adults, too, are at risk -- far more so than children, because they are the ones operating the devices. In 2011, according to the Consumer Product Safety Commission, more than 83,000 people were treated in U.S. ERs for lawn mower injuries.

Never wear sandals when mowing a lawn; always be on the lookout for rocks and branches; and whether you're pushing or riding, watch out for steep grades.

3. Swimming injuries

Drownings, naturally, occur more often in the summer months, for both kids and adults, spiking in June and July. Kids are more likely to drown, or nearly drown, in swimming pools; teens and adults are more likely than children to drown in natural bodies of water, either while swimming or after a tumble from a watercraft.

Diving injuries are more prevalent, too -- they may not result in death, but they can be nearly as catastrophic. Up to 5 percent of all spinal cord injuries are the result of diving accidents, according to the University of Alabama at Birmingham National Spinal Cord Injury Statistical Center.

4. ATV, dirt bike and motorcycle injuries

ATV-related wrecks are a regional phenomenon, Dr. Gaines said. "We have some colleagues in Philadelphia" who have never treated an ATV injury. Meanwhile, at Children's, they see 80 to 100 ATV accidents a year. "We feel pretty strongly that kids under 16 shouldn't be driving ATVs," she said.

ATV injuries are often caused by rollovers, while with dirt bike injuries, high speeds and jumps are often the culprit. As with bicyclists, riders of motorbikes and dirt bikes should always wear helmets; lower extremity fractures are common, too.

5. Trampoline trauma

One kid on a trampoline is risky enough -- put two or more on there, and you have a human particle collider. Concussions, sprains and occasional broken bones are the result.

6. Burns

Men (and women and children), take heed: The steps and the bathtub are the two most dangerous things in your house, but the grill might just be the most dangerous item on the outside of it. Outdoor grills, both charcoal and propane, cause hundreds of injuries and thousands of fires every year. Campfire and fire pit injuries are more common, too.

Fireworks, meanwhile, injure an estimated 10,000 Americans every year, either by force of the explosion or the resulting fire, with more than half of the injuries happening in the first week of July.

And don't forget about sunburns -- while the sunburns themselves rarely result in hospitalization, some of the side effects of sun exposure, such as heat stroke or dehydration, can.

7. Joint injuries

More tennis, more golf and more rec-league basketball means more joint pain and knee injuries. The most "dangerous" summer sport? Basketball, resulting in 1 million youth injuries a year, says the American Academy of Orthopedic Surgeons. Stress fractures, throwing injuries and running injuries (like plantar fasciitis and iliotibial band inflammation) also flare in the warm weather, as people train for marathons and other road races.

8. Bites

Dog bites result in thousands of hospital ER visits every year, and researchers say that children are more likely to be bitten by dogs in the summer months. While adults are more likely to be bitten on arms or legs, children are more likely than adults to be bitten on the head, neck and face, according to the American Academy of Otolaryngology.

9. Amusement rides

Annually, more than 4,000 injuries come by way of amusement park rides. The vast majority are minor injuries -- bruises, cuts and the occasional whiplash -- but, two or three times a week, the injuries are serious enough that a child is hospitalized. More than 70 percent of the amusement park ride injuries happen May through September, according to the Center for Injury Research and Policy at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio.

Interestingly, children are far more likely to be injured in a fall from a coin-operated ride (the kinds in arcades and shopping malls) than at an amusement park. Most of those rides don't have restraints, and toddlers like to climb on and off of them.

10. Gunshot wounds

Violence-related injuries (shootings and stabbings) account for about 10 percent of all trauma admissions, Dr. Alarcon said, and these tend to spike in the summer. Much of that is intentional violence ("When it's really, really cold out, people tend to stay inside and mind their own business," he said), but handgun and rifle accidents start to climb in the summer, too, particularly among children, who are more likely to be left home alone in the summer.

It's not just handgun and rifle injuries, though. In the summer, kids can get into trouble with air rifles, BB guns and paintball guns. About half of all nonpowder gunshot wounds occur in the summer or early fall.

Sixty percent of airgun injuries occur in the pediatric population, and -- no surprise -- 71 percent of those injuries were to boys.

11. Foot injuries

Barefoot and bare-legged kids (and adults) mean a higher incidence of puncture wounds, bee stings and warm-weather rashes such as poison ivy.

12. Falls

It's a generic category, but it's also the biggest one -- from jungle gyms, to skateboarding accidents, to bare feet slipping on wet surfaces, to run-of-the-mill face-plants on the concrete, falling onto something hard is the traumatic event most likely to land a kid or an adult in the ER. Seniors are susceptible year-round, while adults climbing ladders are especially at risk in the summer.

"If you fall 30 feet or more, the chance of dying is about 50 percent," Dr. Alarcon said. Over the past five years, falls have exceeded motor vehicle crashes as the top reason for a trauma hospitalization.

By and large, summer accidents are avoidable -- or, at least, the risk of serious injury can be lessened with proper safety precautions and adult supervision, Dr. Gaines said.

"Physical activity is wonderful for children ... [but] they need to be supervised, playing in a safe environment," she said.

And for adults up to age 44, physical trauma is the No. 1 cause of death, Dr. Alarcon said. "Most of these things are preventable," he said. "That's why we don't call them accidents."


Bill Toland: btoland@post-gazette.com or 412-263-2625.

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