A Monorail train at Walt Disney World in Florida crashed into the rear of a stationary train at a passenger station near the Ticket and Transportation Center. At safety-conscious Disney, how did that happen?
A couple of years ago, I rode up front with the driver in a Disneyland Monorail car with my kids. The joystick used to drive the train has a trigger on it. I jokingly asked if the trigger was to shoot at other Monorail trains. The driver told me that despite the desire to nuke another train once in a while, the trigger was actually a failsafe mechanism. If the driver lost consciousness for any reason and let go of the joystick, the train would stop.
If the mechanism works the way it's supposed to, I suppose the unfortunate driver in this accident didn't fall asleep at the, umm, joystick. A picture of the controls of the Mark VI Monorail cockpit shows a different kind of controller than the one I saw in California. Maybe the sleep switch doesn't exist on the trains in Florida (somehow I doubt that).
It's been reported by the Associated Press and others that the Monorail trains had a computerized safety feature that was supposed to stop a train if it got too close to another on the same track. Why did that fail? A Disney fan site blog mentions some of the ways the safety feature (called the MAPO) could have been disabled.
Some reports are that the train in front was backing up to switch rails as the rear train was either stopped or coming into the station. According to the fans and cast members (Disney-speak for employees) that have commented online, the computer failsafe wouldn't work on a train backing up to switch rails.
My wife is a Disneyholic and I have to admit it's rubbed off on me. My kids love the place. I have to say I'm partial to Disneyland -- we took our first family trip to Walt Disney World this year and I wasn't too impressed. It's much less magical and much more businesslike. It's also huge, which means guests must rely on Monorail trains and buses to get anywhere.
This happened on a holiday and there are reports that the deceased driver's Facebook page had several mentions of him having to work extra hours. If fatigue played a part in this tragedy, Disney should take some responsibility for the incident.
As much as I enjoy Disney parks, I'm a little concerned about the company's willingness to be forthcoming in whatever it discovers to be the cause of this terrible mistake. I hope Disney has the courage to tell all -- and to take steps to fix the problems.
It's good to hear that Billy Mays didn't have a head injury from his rough airplane landing. On the other hand, it sounds like he may have had a little discomfort on his way to bed.
The Associated Press reported that Mays told his wife he wasn't feeling well when he went to bed the night before he was found dead. Did he have chest pain? Maybe he had shortness of breath.
If Mays suffered sudden cardiac arrest in his sleep, it's very possible he was having a heart attack before he went to bed. He was a boisterous, type A kind of guy. He didn't strike me as the type to complain about a little pain in his chest.
Heart attacks are very private conditions. Often, there's only chest discomfort -- sometimes pain, sometimes not -- and maybe a little shortness of breath. The victim might break out in a cold sweat, but it's not required.
Surviving a heart attack is all about not ignoring the symptoms of a heart attack and seeking the right kind of medical care. Never take chest pain to your doctor's office, always go to the emergency department if you think you may be having a heart attack. Indeed, the best bet is to call 911.
Is having a doctor at the bedside a guarantee of proper emergency care?
Nope.
It seems to reason that a physician would be the best person to react to just about any medical emergency. It may just be that in Michael Jackson's case, we could learn why that belief is a myth.
CPR? With a Pulse
Dr. Conrad Murray, MJ's personal physician, has said through his attorney, Edward Chernoff, that he found Jackson not breathing. Chernoff was quoted by Rolling Stones saying, "There was a weak pulse in [Jackson's] femoral artery. [Dr. Murray] started administering CPR."
For the layperson, doing CPR on a victim with a pulse is appropriate, but a healthcare provider (with proper equipment -- we'll go there in a minute) would administer positive pressure ventilation. Jumping to chest compressions
when the heart is still beating calls into question this doctor's competence -- or at least his attorney's ability to accurately portray what really happened.
Describing Jackson as "not breathing" but "with a pulse" is consistent with an overdose of opiates. It's also a blow to the idea that MJ died as a result of sudden cardiac arrest, which is most often caused by a lethal, sudden heart rhythm change like ventricular fibrillation (hence the reason we use defibrillators to treat sudden cardiac arrest).
What Dr. Murray's lawyer is describing is known as respiratory arrest instead of cardiac arrest.
What About Naloxone?
If indeed Michael Jackson had a pulse but was not breathing when the doc found him, he would most likely have benefitted from naloxone, the antidote for opiate overdose. Even if Dr. Murray didn't know MJ was doing Demerol and oxycontin, as Chernoff the lawyer claimed on Dateline, a quick look at the pupils would confirm opiate use. Oxycontin, fentanyl, morphine, heroin, vicodin, percocet, Demerol and other opioid medications cause the pupils to constrict. Emergency medical providers call this sign pinpoint pupils.
The reason chest compressions won't work for an opiate overdose is because the opiates only stop the heart after it runs out of oxygen. If Jackson (or anyone else) died of an opiate overdose, chest compressions won't help once the heart stops. Instead, he needs a fresh supply of oxygen before the heart stops, and mouth-to-mouth (rescue breathing
) would likely be enough.
Not all doctors understand these subtleties. Based on the things the lawyer, Chernoff, has been quoted saying, I believe Dr. Murray is the kind of doctor who didn't quite understand opiate overdoses. If indeed he didn't give Jackson any opiates, he probably didn't know how to recognize (or didn't think to consider) an overdose.
The Right Tools for the Job
Even had Dr. Murray recognized that Michael Jackson's respiratory depression was a result of opiate overdose, his treatment needed to be different. He needed to at least give mouth-to-mouth. If his role as Jackson's private physician included treating MJ during an emergency (Chernoff said Jackson wanted Dr. Murray to watch over him as he slept, presumably to respond in an emergency). To do this correctly, Dr. Murray would need some basic emergency equipment. At a minimum, that would include a bag-valve-mask (manual ventilator) and an automated external defibrillator (AED).
There've been no reports that the doc had any emergency equipment, and his attorney's statements suggest that if the doc did have equipment, he didn't use it.
Even the choice to do CPR on a mattress with only one hand, as the lawyer claimed on Dateline, shows poor emergency medical judgment.
Skip the Private Doc, Call a Paramedic
Having a doctor sitting at your bedside will only help if the doc is familiar with emergency medicine, capable of using specialized emergency medical equipment and has that equipment available. It sure doesn't sound to me like any of that existed in this case.
Having the right doc at the bedside might help, but based on all the things I've started to hear about Dr. Murray, I'm not sure he's the right doc for anything. Patrick Malone, author of The Life You Save, in a blog post shows how some relatively easy snooping into Dr. Murray's past would lead to serious doubts about his competence.
Was the doc at fault? I don't think so, but I think a paramedic at the scene quicker (I've heard reports that the doc worked on MJ for 30 minutes before calling 911) would have been much more effective. Los Angeles paramedics carry naloxone, and if they'd gotten there earlier, they may have been able to use it.
Maybe -- just maybe -- Michael Jackson didn't have to die.
Billy Mays, the famous pitchman known best for his OxiClean commercials, was on a US Air plane that had a rough landing when a tire blew out on touchdown Saturday. TMZ.com is quoting Mays from a television interview saying he was hit in the head by falling debris. TMZ is also saying the FAA claims Mays wasn't wearing his seat belt.
Mays was found dead in his Tampa, Florida home sometime after the flight landed. Could this be another head injury like Natasha Richardson suffered when she fell during a ski trip near Montreal?
When we're talking about dying from closed head injuries, we are usually talking specifically about the brain. There are basically two types of traumatic brain injuries: concussions and hemorrhages. Concussions are relatively mild injuries that often cause a loss of consciousness (makes the victim pass out) and the victim usually can't remember what happened.
Brain injuries that result in hemorrhage (active bleeding) will often look just like a concussion at first, or they can be so mild to begin with that the victim doesn't even pass out. There are two types of bleeding in the brain: subdural hematoma and epidural hematoma. The bleeding can continue in the brain until death unless surgery is performed to release the pressure.
An autopsy will certainly show if Mays died from a head injury. Until then, it's all speculation. TMZ is reporting that Mays was "acting fine and normal" and was "talking business with his father-in-law." Just because Mays wasn't showing outward signs of injury doesn't mean he felt OK. It's possible he didn't feel well. If head injury does turn out to be the culprit, Mays's death should remind us to listen to our bodies.
If you get knocked out from a blow to the head, call 911 or go to the ER. If you get hit in the head and the pain gets worse over the next few minutes, go to the ER. If your family member or friend is the person that got smacked on the noggin, watch for things like staggering, slurred speech or confusion. If you see any of those, call 911.
