The brain in action Q & A
Q: When
the children are very stressed, does that affect the actual
surgery process? eg. extra tense brain tissue?
Dr.
Ash Singhal:
A: Stress
does not really affect the acutal surgery process.
The brain tissue does not become more tense. If stress
means physiological stressors, like fever or infection or
malnutrition (as opposed to generic "stress",
which is not really a specific medical entity), then there
is a higher risk of surgical complications including infection
and wound healing problems.
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Q: How
much has been done to study the effects of neurosurgery
on the development and prevention of mental health issues?
Dr.
Ash Singhal:
A: There
is an extensive history of neurosurgery and mental health
issues. Neurosurgical procedures can cause or trigger mental
health problems (particularly surgery of the temporal lobe
or frontal lobes) and surgery can also (occasionally) be
used to treat mental health problems (such as obsessive
compulsive disorder).
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Q: What
are some of the neurologic diseases that are still untreatable?
Dr.
Ash Singhal:
A: Examples
of untreatable or very poorly treatable neurologic diseases
include Alzheimer's disease, Huntington's disease,
and Amyotrophic Lateral Sclerosis (Lou Gehrig's disease).
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Q: What
do you think of seatbelts (or lack there of) in school
buses?
Dr.
Shelina Babul - Injury Prevention Unit:
A: This
is a very good question and we frequently get queries with
regard to this issue. Since seatbelts have been proven to be
effective at saving lives, why don't
they put them in school buses? The Canadian Safety Council
address this question in detail.
Over
the past 10 years, there has been, on average, less
than one fatality/year inside a school bus. According
to the statistics, the school bus is the safest way for
children to get to school.
Research
provides no safety benefits
Installing
seat-belts on school buses is not a new idea. There is a
wealth of research from across North
America on whether
such a requirement would improve safety. Surprisingly, no
safety benefit has ever been proven. In fact, crash tests
have shown seat-belts could create more drawbacks than advantages.
In
1984, Transport Canada crash tested three
different sizes of school buses (one small bus, one van
conversion type bus and one large bus), each containing
unbelted and belted test dummies. The tests indicated that
the use of a lap belt on forward-facing seats could increase
the risk of head injuries during a severe frontal collision.
In a head-on collision, the most common type of school bus
crash, the occupant's head could hit the seat in front,
resulting in severe or fatal head and neck injuries.
Further
investigation showed that the combination lap and shoulder
belts would require stiffer seats, which could increase
injury to unbelted students. Moreover, the shoulder belts
increased the chance of abdominal injuries because of submarining.
Tests showed children would slip down, risking injuries
to organs covered by the lap belts.
In
1986, Transport Canada designed, fabricated
and tested five different types of seats, each using a seat-belt,
in an effort to improve protection for riders. The rearward-facing
seat provided the greatest potential for occupant protection
during frontal and near-frontal collisions. In a head-on
collision, the crash forces are spread over the back of
a rearward facing occupant instead of being concentrated
on the head. However, motion sickness was found to be a
drawback of the rearward-facing seats. There is no intention
to make rearward facing seats mandatory.
A
1999 study by the US National Transportation Safety Board
(NTSB) suggests that adding seat belts to school buses will
cause additional head injuries and probably additional deaths
in some crashes. It says school buses built since 1977 rely
for safety not on seat-belts but on the close spacing of
seats with padded seat backs, called compartmentalization.
Seat-belts, by holding a child's pelvis firmly in place,
allowed the torso to crack like a whip, with the head striking
a seat back or a hard object with greater force than if
the whole body has been thrown. The NTSB found the evidence
ambiguous enough to avoid recommending seat belts, but was
also not persuaded to endorse taking them out.
Some US states require seat-belts on school buses. However, none
of them, fortunately, has experienced a crash that would
demonstrate any benefits of adding seat-belts to school
buses. There is still no scientific evidence that lives
would be saved.
Perspectives
on the Issue
Seat-belts
were designed for cars, and have saved thousands of lives.
School buses are designed with safety (but not seat-belts)
in mind; they are not built like cars. Buses are much larger,
higher and heavier than other vehicles on the road, so they
have a body-on-frame design. For seat-belts to enhance rider
safety, the bus body would have to be completely re-engineered
with seat-belts integrated at the design stage.
Beyond
the engineering problems someone would need to ensure the
seat-belts are used, adjusted properly between uses by small
and larger children, and repaired when damaged. In an emergency,
seat-belts could hinder evacuation. Young children should
not be placed in a situation where they must become responsible
for their own safety.
School
bus standards vary between countries. In Canada , almost 40 federal
standards apply to the design and construction of school
buses. These standards combine to make Canadian school buses
an extremely safe mode of transportation. A school bus does
not have safety belts like a passenger vehicle, but it does
have many passive safety systems engineered into it.
The
real safety issue is not seat-belts, but reductions in school
bus service. Without the bus, more children are exposed
to risk by walking to school or using alternate forms of
transportation. Yet pedestrians account for almost 40 per
cent of road fatalities to children aged 5 to 9. This is
an issue worthy of attention by those concerned about children
getting to and from school safely. Children are 16 times
safer riding in a school bus than in a passenger vehicle.
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Q: What
were the exceptions to wearing seatbelts?
Dr.
Shelina Babul - Injury Prevention Unit:
A: The
exceptions to wearing a seatbelt are relatively rare. The
law says that any motor vehicle manufactured after December
1, 1963 shall not
be driven unless it is equipped with two front seat seatbelt
assemblies. This may suggest that vehicles built prior to
that date, if properly licensed, may be operated without
seatbelts. However, anyone operating a classic or antique
vehicle would probably be well advised to have seatbelts
installed.
There
are also exceptions for people who have been given a government-certified
exemption for physical or medical reasons. Driving in reverse
does not require seatbelt use. Also exempted are commercial
drivers who get in and out of their vehicles at frequent
intervals and who, while engaged in their work, do not drive
at a speed exceeding 40 km/h.
Again
these are rare exceptions and the best advice is ALWAYS
WEAR YOUR SEATBELT...IT CAN SAVE YOUR LIFE!
