No financial disclosures I will always own a Malinois. Nothing is more important than family

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1 Three Things My Family Will NEVER Own EVER! No financial disclosures I will always own a Malinois Nothing is more important than family Mark L Shapiro, MD FACS Duke University Medical Center Few things are more peaceful than target practice, this is not a gun talk 2 3 We are arguably in the most violent times in peacetime history. The murder rate is being held down by medical technology, but the aggravated assault rate, the rate at which we are trying to kill or seriously injure each other, might be at the highest levels in peacetime history. This is true in almost every major industrialized nation in the world, and yet violence is still incredibly rare. The per capita aggravated assault rate in the U.S. is only four per thousand per year. This means that 996 out of 1,000 Americans will go a year without someone attempting to inflict serious bodily harm on them. Every day, nearly 300 million Americans bounce off each other, but the average American will go a lifetime and never have someone commit a felonious assault upon them. OSHA Act of 1970 Assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance. SAFETY Excerpt From: Lt. Col. Dave Grossman with Loren W. Christensen. On Combat. ibooks Those jurisdictions include the District of Columbia, Puerto Rico, the Virgin Islands, American Samoa, Guam, Northern Mariana Islands, Wake Island, Johnston Island, and the Outer Continental Shelf Lands as defined in the Outer Continental Shelf Lands Act 6 Powered Industrial Trucks (Forklift) etool Forklifts or lift trucks: Move large objects Lower large objects Remove large objects Remove a number of smaller objects on pallet/boxes/crates/ containers Influencing Factors: Vehicle type /where truck is used - Falling load accident more common in sit-down high lift rider truck versus motorized hand truck (is capable of lifting load much higher than motorized hand truck) Different Workplace Challenges Retail establishments often face greater challenges than other worksites in maintaining pedestrian safety. This etool* specifically provides information on OSHA's Powered Industrial Truck requirements [29 CFR ] and 7 Publix employee dies in forklift accident at Boynton Beach distribution center Tuesday, June 18, 2013 Brewery worker dies in forklift accident By Pauline Repard11:01 P.M.AUG. 24, 2013 Man killed in freak fork lift accident By Natasha Velez October 3, :14pm 8 85 fatalities/year 34,900 injuries/year 42% of the forklift fatalities due to the operator being crushed by a tipping vehicle Safest place is for driver to be belted into vehicle Compliance officers will enforce the use of such devices under Section 5(a)(1) of the OSH Act, the General Duty Clause. C Paulausky, OH&S Sep 01,

2 Key Factor s Center of Gravity Position of load needs to be as close as possible to center of the PIT Load of Center Load close as possible to the CoG towards the verticle face of the forks Stability Triangle Formed by front axle, rear center point inline with rear axel Consumer Product Safety Commission Definition: Off-road, motorized vehicle having three or four lowpressure tires, a straddle seat for the operator, and handlebars for steering control. From 1982 through 2011, CPSC staff received reports of 2,865 ATV-related fatalities of children younger than 16 years of age. This represents 25 percent of the total number of reported ATVrelated fatalities (11,688) 43% of these (2,865) were younger than 12 years of age (1,226) 16 The majority of the 2011 estimated ATV-related, emergency-department treated injuries had injuries of the arm (the shoulder down) and the head or neck (29 and 28 percent, respectively)

3 2 Reporting is ongoing for Estimates have been rounded. Source: U.S. Consumer Product Safety Commission: Directorate for Economic Analysis and Directorate for Epidemiology/Division of Hazard Analysis. Note: Italics denote the period for which reporting is ongoing. Table 2 Reported ATV-Related Fatalities (by State) ATVs with 3, 4, or Unknown Number of Wheels Reported for the Period January 1, 1982 through December 31, 2011 Cumulative Reported Deaths Total Percent of U.S. (Ongoing Reported Deaths* Reported Deaths Reported Deaths Reporting) (Ongoing State * Reporting) CALIFORNIA 504 5% TEXAS % PENNSYLVANIA % WEST VIRGINIA % KENTUCKY % FLORIDA % TENNESSEE % NEW YORK % NORTH CAROLINA % MICHIGAN % GEORGIA % MISSISSIPPI % OHIO % MISSOURI % ARKANSAS % WISCONSIN % MINNESOTA % Figure 3 Annual ATV-Related Hospital Emergency Department-Treated Injury Estimates for All Ages and Less Than 16 Years: ATVs with 3, 4, or Unknown Number of Wheels ( ) 2013 NEWLY REPORTED CHILD ATV DEATHS Click on dots for published account of each death. ATV-Related Injury Estimate 0 50, , ,000 Total Under Source: U.S. Consumer Product Safety Commission: National Electronic Injury Surveillance System. Year More Brain and Spinal Cord Injuries in All-Terrain Vehicle Riders Gandey October 08, Table 4 Annual Estimates of ATV-Related Fatalities and Risk of Death per 10,000 4-Wheel ATVs in Use Based on Fatality Data Available as of December 31, 2011 Year 2 Reported Deaths Estimated Deaths Associated with ATVs with 3, 4, or Unknown Wheels Estimated Deaths Involving 4- Wheel ATVs Estimated 4- Wheel ATVs in Use (millions) 3 Estimated Risk of Death per 10,000 4-Wheel ATVs in Use Table Annual Estimates of ATV-Related Fatalities and Risk of Death per 10,000 4-Wheel ATVs in Use Based 198 on Fatality Data 243 Available as 167 of December 31, Estimated Deaths Estimated Estimated Risk Associated 242 with Deaths 159 Estimated of Death 0.8 per 1991 Reported 230 ATVs with 3, 254 4, or Involving Wheel ATVs 1.8 in 10, Wheel Year 2 Deaths Unknown Wheels Wheel ATVs Use (millions) 3 ATVs in Use Reporting ongoing 240 for Source: U.S. Consumer Product Safety Commission: Directorate for Economic Analysis and Directorate for Epidemiology/Division of Hazard Analysis. Note: Italics denote the period for which reporting is ongoing. 13 3

4 The U.S. Consumer Product Safety Commission (CPSC) wants you and your family to be safe when using trampolines. CPSC estimates that in 2012 there were 94,900 hospital emergency room-treated injuries associated with trampolines. CPSC is also aware of a total of 22 deaths in the 10-year period between 2000 and Injuries and deaths can be caused by: Colliding with another person on the trampoline Landing improperly while jumping or doing stunts on the trampoline Falling or jumping off of the trampoline Falling on the trampoline springs or frame Take these steps to help prevent tragic deaths and serious trampoline injuries, especially paralysis, fractures, sprains and bruises: Allow only one person on the trampoline at a time. Do not attempt or allow somersaults, because landing on the head or neck can cause paralysis. Do not use the trampoline without shock-absorbing pads that completely cover its springs, hooks and frame. Place the trampoline away from structures, trees and other play areas. No child under 6 years of age should use a full-size trampoline. Do not use a ladder with the trampoline, because it provides unsupervised access by small children. Always supervise children who use a trampoline. Trampoline enclosures can help prevent injuries from falls off trampolines. Publication U.S. CONSUMER PRODUCT SAFETY COMMISSION (800) CPSC Reports Sharp Rise in Trampoline Injuries; Olympic Debut of Sport Underscores Rising Popularity SEPTEMBER 20, 2000 Release today released a report showing that hospital emergency room-treated trampoline injuries almost tripled in the last decade - from an estimated 37,500 in 1991 to almost 100,000 in Nearly two-thirds of the victims were children 6 to 14 years of age. About 15 percent of injuries involved young children under 6 years old. Since 1990, CPSC has received reports of 11 deaths related to trampoline use. 1998, AN ESTIMATED 640,000 CPSC NEW STANDARD FOR BACKYARD TRAMPOLINES WERE TRAMPOLINES (1999) SOLD IN THE UNITED STATES. 28 Quest to walk again: Tucson man fights to recover from trampoline park injury - KGUN9.com 29 Reasons for Emergency Department visits: 1. result of jumpers colliding with one another, 2. falling on the trampoline springs or frame, 3. falling or jumping off the trampoline 4. attempting somersaults and stunts. 1. Padding over the metal frame, hooks, and all springs. 2. Label on 20 inch trampoline: not recommended for children under 6 years of age. 3. Ladders cannot be sold with trampolines to prevent access by young children. 4. Warning label not to allow more than one person to jump at a time 5. Warning against somersaults that can cause paralysis and death. 30 Bobby Knight Trampoline Safety A. Einstien

5 AAOS CPSC 246,875 treated injuries in US 186,405 among children 14yo or younger ED treated injuries almost tripled: 37,500 in 1991 to almost 100,000 in deaths during range 3-43yo Falls 1999 stats Resulted in crippling injuries/death, including paralysis ~2/3 injury victims 6-14yrs; 15% children under 6yo 40% leg/foot injuries 29% arm/hand injuries 20% head/neck/face injuries 10% shoulder/trunk injuries Copryright Foundation for Spinal Cord Injury Prevention, Care & Cure 37 Copryright Foundation for Spinal Cord Injury Prevention, Care & Cure OUCH!!! 7,000 square feet of connected, world-class trampolines. 24 trampolines, the famous angled wall trampolines and a series of launching decks of different heights. EXPERIENCE DEFY Consumer Product Safety Commission National Electronic Surveillance System And sign the waiver please.. 13yo female Hx: Hearing Impaired since birth, hypothyroidism Enjoying trampoline excursion Jumped head first into a foam pit + LOC Reported + decreased R sided movement with weakness + Numbness + Neck pain Complete spine immobilization Level 3 Trauma Activation Jumped into foam pit performing flip landing on head Family friend saw no movement pulled from pit unresponsive. C/o bilateral arm pain No stepoffs/crepitus Atraumatic Head Midline C1-3 tenderness on palpation TTP bilateral hands. Decreased sensation bilateral hands (hyperesthesia) and lower extremities 5

6 CT Findings C5 burst fx Concern for ligamentous injury Midline 2 column fx C6 MRI Findings C5 flexion teardrop fx Disruption of posterior longitudinal ligament Cord edema/contusion C6 vertebral body fx Anterior Corpectomy C5 Fusion C4-C6 Discharged home 8/29 Post op Day #7 SAFETY/SUPERVISION 5yo male Birthday party Jumping on trampoline when knocked over by older girl. Proximal left tibia fracture Observation overnight for compartment syndrome. National Vital Statistics Reports Volume 61, Number 6 October 10, 2012 Number of deaths for leading causes of death Heart disease: 597,689 Cancer: 574,743 Chronic lower respiratory diseases: 138,080 Stroke (cerebrovascular diseases): 129,476 Accidents (unintentional injuries): 120,859 Alzheimer's disease: 83,494 Diabetes: 69,071 Nephritis, nephrotic syndrome, and nephrosis: 50,476 Influenza and Pneumonia: 50,097 Intentional self-harm (suicide): 38,