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.

This is the first fatal accident in WDW's 38 year Monorail history
(c) Jay Malone via flickr

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.

• Orlando Sentinel: Disney World monorails crash, killing 21-year-old Disney employee
• Video from the Disney Monorail Crash

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.

• Heart Attack Symptoms
• Heart Attack Myths or Truths
• The Difference Between Cardiac Arrest and a Heart Attack
• Don't Take Chest Pain to the Doctor's Office

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.

• How Opiates Kill
• Cardiac Arrest vs Heart Attack

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.

• Head Injuries
• Talk and Die Syndrome
• Do Head Injury Victims Have to Stay Awake?

Rumor has it that Michael Jackson may have overdosed on Demerol, an opioid pain medication similar to heroin. Demerol is synthetic (man-made) and is stronger than heroin, but it works the same way.

I have two questions. One is the timeline. I've read reports that MJ's breathing slowed very soon after he took the medication. This is all unconfirmed rumor at this point, but if any of it is true, there is the possibility that MJ didn't have to die.

Opiate overdoses lead the victim to stop breathing, but it doesn't cause cardiac arrest -- at least not until the victim has been not breathing for so long that his heart stops. If caught in time, simple mouth to mouth can keep a victim of opiate overdose alive long enough for paramedics to arrive and administer the antidote, a medication known as naloxone.

My second question has to do with Jackson's private doctor. The 911 call recording mentioned the doctor was with MJ. If this turns out to be related to Demerol, why didn't the doctor have naloxone available?

One thing to keep in mind: naloxone doesn't help after cardiac arrest. Once the victim loses a pulse, naloxone won't fix anything.

As with any celebrity death, there are bound to be lots of questions about Jackson's sudden death -- and his use of Demerol.

• How Opiate Overdoses Kill
• What is Demerol?
• What is an Opioid Analog?
• Investigation Continues Into the Death of Michael Jackson

News reports are buzzing about Michael Jackson's death (sorry to tell you this way if you haven't already heard, but I don't think you could've navigated the internet this far without finding out).

A common theme I'm hearing is what exactly killed MJ. The term tossed around the most is "cardiac arrest" with more than a few folks wondering aloud about the difference between cardiac arrest and a heart attack.

One thing to understand: unless the brain is directly destroyed (brain injury or decapitation) then life always ends with cardiac arrest. The cause of the cardiac arrest could be a heart attack, but it could be any number of other causes, including drug overdose, stroke, infection, cancer, drowning -- the list goes on.

Some reports claim an autopsy is scheduled for Friday, which should tell us more about Jackson's death. Until then here's to a great performer, despite whatever demons he battled -- maybe to the very end.

• Cardiac Arrest vs Heart Attack
• What is CPR?
• Video on How to Do Hands-Only CPR
• Cardiac Arrest Defined
• Heart Attack Defined

Every few years, it behooves a fellow to remind himself how he came to prefer working in sunshine over spending his nights under the full moon with drunks and prostitutes.

This vessel of enlightenment is known as working the night shift.

I partook of such a welcome reminder on Sunday. Three partners -- including my own beautiful bride -- and one paramedic intern shared this 36 hour search for understanding. When it was over, I'd slept a total of two and a half hours, ran 18 calls and saved no lives as far as I can tell (though a couple of customers were in much better straits once transported to the emergency department).

Being a search for the truth of why I switched from running with the vampires to working the EMS equivalent of banker's hours, here are a few observations I made on my first night shift outside of FEMA hurricane duty (which is so unique as not to really count in night shift circles):

1. It's hard to find an open restroom at two in the morning near a rural street corner five miles from the closest town (before the guys point out the obvious, let me remind all that I was working with ladies).


2. Sleeping in the front seat of an ambulance is not difficult -- moving afterwards is.


3. Shade is much easier to find.


4. Day drunks and night drunks are different. Day drunks are professionals, maintaining a therapeutic blood alcohol level that just kind of ebbs and flows throughout the day. Day drunks only get ambulances when people with cell phones see them. Night drunks are amateurs, binging on celebratory tequila in honor of such accomplishments as procreation and, well, more procreation. Night drunks get ambulances when their slightly less intoxicated -- but no less dramatic -- companions become overwhelmed by the depth of the vomit puddle.


5. It's dark (see #3). There is a distinct lack of light in the sky (there were pretty little sparkly things up there, however, kind of nice to look at).


6. I complain more at night.

I confess that at times I miss the nocturnal fauna that populate our empty city streets. For the time being, however, I will continue to eat dinner with the family, sleep in my own bed and relegate my hours on the bus to those that generally fall between sunrise and sunset.

In a few years, when I've forgotten the beauty of emergency lights flooding everything at the scene in alternating strobes of red and yellow, I will again stow my sunglasses, ready my flashlight and settle in for a visit to the dark side of EMS.

The FDA and Nestlé Foods are recalling all packages of refigerated Nestlé Toll House Cookie Dough. The dough may be contaminated with E Coli.

We don't buy that stuff -- I'm too likely to sit and eat the cookie dough raw by the spoonfulls. I just wait for my oldest daughter to get home from the navy and bake me some cookies -- she's the best cookie maker. At least that way I won't get E Coli from my cookie dough snack.

If you have any of the prepackaged cookie dough from Nestlé, the FDA says to throw it out. Don't try to bake it -- you'll just end up contaminating your fingers, the counter and everything else the uncooked dough touches.

• E Coli
• Food Poisoning
• Recall notice: FDA Warns Consumers Not to Eat Nestle Toll House Prepackaged, Refrigerated Cookie Dough

How hard do you have to bump your head to get a head injury?

(c) Claire Greenway/Getty Images

Apparently, not that hard -- if you're a 57 year old rock and roll star.

Brad Whitford, a guitarist for Aerosmith, knocked his noggin getting out of his Ferrari and the resulting head injury required surgery.

I'll bet you didn't realize you could get a head injury from a fast car without actually crashing it. Maybe Whitford should wear a helmet. I'd like to hear more about his injury to know just how serious this got.

• Aerosmith’s Whitford Plots July 7th Return From Head Injury : Rolling Stone : Rock and Roll Daily
• Head Injuries

The Oklahoma Highway Patrol released the dash cam video from Trooper Martin's patrol car. Martin was responding to a call with lights and sirens and became enraged when an ambulance crew didn't pull over fast enough. Martin went back to cite the EMT driving the ambulance for failure to yield.

The incident ended with an altercation between the paramedic, Maurice White, and Trooper Martin. The incident became big news (see my original blog post on the paramedic vs the trooper) when the son of the patient in the ambulance recorded the altercation on his cell phone and posted the video on YouTube.

I've read the reports and watched both videos now. This trooper acted inappropriately, period. There's no excuse for the behavior. Fox News reported that the trooper was on administrative leave; I hope that's true and that the trooper gets some sort of discipline for his actions.

On the other hand, I have to point out that the paramedic climbed out of the ambulance ready for a confrontation. In his official report and in an interview with Fox News, White says he climbed out of the ambulance out of concern for a citizen rider he says was in the trooper's patrol car. If that's true, he switched gears pretty quickly. On the dash cam video, White can be heard confronting Trooper Martin immediately after exiting the ambulance.

I also want to point out that the trooper used his siren, contrary to the paramedic's report.

Trooper Martin had no reason to restrain White. Indeed, he had no reason to pull over the ambulance as far as I'm concerned. I've spent more than half my life sitting behind the windshield of an ambulance. When we roll code 3 (lights and sirens), we're lucky to have folks pull over at all. It's clear from the dash cam video that the trooper's car was directly behind the ambulance, in blind spot hard to see through the side mirrors.

The ambulance pulled over reasonably quickly. The medic never touched the trooper. This incident should never have happened.