WINTER HAZARDS

BEWARE THOSE MECHANIZED SHORTCUTS

BY GEOFFREY G. HALLOCK, MD

MOST OF US SURVIVED THE BLITZ AND BUZZ OF THE PAST SPRING AND SUMMER WITHOUT LOOKING BACK.

Perhaps someone [or two] may have glanced at the Spring issue of this journal, in which I had admonished all to protect their fingertips from the evils of modern machines and technology, overused with overzealous speed and efficiency as we accomplished our daily tasks (1). We knew the gloom and doom of Winter would be inevitable, bringing cold and snow hand-in-hand. Not just fingertips will be at risk this season, justifying this requested encore presentation.

We must first dig out from every blizzard so we can get to where we must go [Figure 1.]. A snow shovel may just be too slow. The magic of the snowblower is the better answer. Or is it?

Today, most snowblowers are dual-staged machines, in which the front rotating, spiral, or corkscrew shaped blades will readily push the snow backwards to encounter an even faster rotating impeller blade that expels the snow out of the exit chute [Figure 2.]. Wet snow is always heavier and more difficult to clear than a dry, powdery snowfall. This I well know, since it always means more calls from the emergency room— invariably someone has tried to unclog the obstruction the wetness has caused with their fingertips. The long(er) fingers, dominant hand, and men are most at risk—and the latter are typically experienced operators (2,3). Most admit an awareness of the safety warnings, so why was the machine usually left on (2)? And beware, even once turned off, enough rotational energy remains to still cause injury once the clog is cleared (2)! So never forget to read the safety instructions in the manual!

Unlike a lawnmower whose blades move at high kinetic energy causing “high velocity missile wounds,” the impeller blades of the snowblower are

Figure 1 Figure 2 Figure 3 Figure 4

Figure 5 Figure 6 Figure 7 Figure 8

Figure 1.: Winter—snow and cold and lest we forget—more snow. Figure 2.: A high powered snowblower—only the old broom belongs to me, for breaking up the exit chute impaction. Figure 3.: Insert not your long fingers into the snowblower to remove clogs—they WILL be crushed—or worse! Figure 4.: Always have a back-up chainsaw when the first ceases to work—inevitable! Figure 5.: Typical jagged, mangled thumb amputation by a chainsaw, not clean nor sharp as would be the surgeon’s knife [left], great toe harvested [center], to restore a working hand [right]. Figure 6.: Diagram of a wood splitter at rest, available for rent. Figure 7.: Poorly supervised wood splitter usually just amputates those fingers still holding the log. Figure 8.: An old-fashioned approach to wood splitting; this way always “heats you twice.”

only a meager 1/10th as energetic so only cause “low velocity missile wounds (2):” just simple cuts, fractures, and finger amputations [Figure 3.]. Remind yourself, it is far better to use an old broom handle to clean out the chute AFTER the machine is turned off. If too difficult, poor a bucket of water into the chute, as long as there’s no fear that your sidewalk or driveway will become a skating rink!

When you are at last able to go to where one must get, what about time to recover and stay warm? Cold weather reminds me of Winter days as a general surgery resident in Vermont. Every day was a snow day and outdoors your breath froze into your face. The oil truck never made it up the hill to fill your tank, and what would happen if the electricity went out? That’s why even we flatlanders all had wood stoves, and like the natives, we were prepared. We appreciated the value of wood heat knowing “it heats you twice.”

To stock a precious woodpile, a chainsaw was essential [Figure 4.]. Indeed, we knew these toys were more dangerous than a snowblower! In the emergency room we saw two kinds of victims—the novice who had never used a chainsaw, and the old professional [Figure 5.]. Maybe he had just become too complacent?

What more to fear? Kickback of the guide bar tip, inappropriately hitting an object or pinched out by the wood, which can strike the face, extremities, or even chest (4). Once a young man we rushed to the operating room appeared to have almost completed his own median sternotomy with his chainsaw. The posterior cortex was found intact, with the visible beating heart seen just behind!

To minimize such potential disasters, again, always read the safety instructions. Also, wear appropriate clothing, boots, gloves, goggles, and earmuffs. Keep the chain and bar comfortably away from your body. Make sure the surrounding ground where you are felling, bucking, or pruning will allow unimpeded escape in case of unexpected trunk or branch spring back, as well as chainsaw kickback itself!

If the chain gets pinned, turn the engine off! Don’t lift the branch up to free it as my patient did a few weeks ago, allowing the engine to start again. The chain lacerated his knee and several hand extensor tendons—a weekend adventure for us both. Possession of a second chainsaw so when the first stops working is an excellent safety factor to allow a different trajectory.

As I get older, I hope I am getting a little wiser. Maybe. I now have a lithium battery powered chainsaw, just like the batteries used to power most of our drills and saws in the operating room, whereas before we were encumbered by electrical cords and gas lines that always got tangled around our appendages. When you take your finger off the electronic chainsaw trigger switch, the engine almost immediately ceases; and far better, will start immediately on demand by just once again compressing the trigger. So effortless, when compared to those gasoline powered chainsaws that could be a struggle

to both turn on and stay on. Admittedly, the battery needs recharging often since they have a short duration battery life, so it would be impractical if you’re off in the deep woods. To be safe, always have a second charged battery on hand so you are not caught in a precarious situation with a chain that has stopped.

The job is not done until the truly “Herculean” task of stacking the cords needed with wood pieces small enough to fit into your stove is completed. One of my New Hampshire mentors once wrote an article in the plastic surgery literature—no, not about facelifts, but wood splitters to simplify this aforementioned requirement (5). There are many varieties. Each log is put on a trough that at one end has a stationary sharp wedge, and the other a broad faceplate, or vice versa, where behind the mobile part, a hydraulic piston will thrust forward to split the wood [Figure 6.].

In that classic study, the most important causal factor for inadvertent injury was when a two-man operation was used, rather than a preferable (but slower) one-man show. The man operating the control level for the piston would invariably fail to wait until the man loading the log onto the trough had removed his hands from the log. I do remember that often a little alcohol was on board, but we couldn’t write about such factors.

One interesting case involved an unsupervised 11-year-old boy who tried to split his pencil (5)! Fortunately, usually only the fingers holding the logs are sacrificed [Figure 7.]. I must admit I have no personal experience with a wood splitter, only anecdotal. Instead, I am old-fashioned and still use a maul and sledgehammer, with an assortment of wedges for slow splitting [Figure 8.]—yet good enough for maintaining cardiac aerobics during these long Winter months, and usually safer!

My take-home message is repetitious: with a machine, if anything can go wrong, it will. The truth is that these devices have afflicted all socioeconomic groups, the young and the old, well-educated professionals, even doctors themselves, but rarely women (2-5)!

Beware, because injury can involve any body part, but the hands most often. If you have suffered but a simple fingertip violation, see the suggestions in the past Spring magazine to see if treatment can be straightforward (1). If more catastrophic injury occurs, having the right surgeon from the outset will be the best course of action.

I have never forgotten the chilling words of my New England mentor: “All the world is pre-op.” So, beware and be careful.

WINTER TOOLS SAFETY CHECKLIST

 Always FIRST read the safety manual instructions.

 Wear appropriate Winter apparel.

 Use protective devices, like eye goggles & earmuffs.

 Get the right equipment for the right job.

 Respect the capabilities of your machines.

 Respect the limitations of your machines.

 Be focused and professional.

 Seek assistance when

called for. REFERENCES:

1.Hallock, GG, Watch Your Fingertips—the Dangers of Spring Cleaning, Lehigh Co Health & Med, 2001; Spring:22-24.

2.Master, D, Piorkowski, J, Zani, S, Babigian, A, Snowblower Injuries to the Hand Epidemiology, Patterns of Injury, and Strategies for Prevention, Ann Plast Surg, 2008;61:613–617.

3.Chin, G, Weinzweig, N, Weinzweig, J, Geldner, P, Gonzalez, M, Snowblower injuries to the hand. Ann Plast Surg. 1998;41:390–396.

4.Bryant, MW, Jabaley, ME, Dowden, WL, Chain Saw vs. Face—Another Hazard of Mechanized Progress, J Trauma, 1976;16:149-152.

5.Jaxheimer, E, Morain, WD, Brown, FE, Woodsplitter Injuries of the Hand, Plast Reconstr Surg, 1981;68:83-88.