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1:06

Charles was diagnosed with cancer. Research shows

1:08

that exposure to police violence has consequences

1:10

on sleep mental health and more scientists

1:12

may have cracked the code on why

1:14

women or four times as likely to

1:16

suffer autoimmune disorders. This is America to

1:19

second. I'm your host Dr. Abdullah said.

1:31

Back when we bought our house in the height of

1:33

the pandemic sarin, I wanted to be as close to

1:35

her workplace as possible. I work from home with the

1:38

time, so we chose a place about five minutes away

1:40

from her office. We. Wanted to limit her

1:42

commute and our carbon footprint more generally. But.

1:45

A few years later, I took a job based

1:47

about forty five minutes away. Fortunately,

1:49

I only work from the office about three days a week. But.

1:51

Nonetheless, that commute still means at least five

1:53

hours in a car every single week. Most.

1:56

The trip is on a highway and just a week ago.

1:59

The. roads are a lot slicker than I thought, and

2:01

I began to spin out at about 50 miles an

2:03

hour. Once I got

2:05

control of my vehicle, I tried to guide myself to

2:07

the shoulder, but I simply couldn't slow myself up. I

2:10

went straight through the shoulder and into the ditch just

2:12

beyond it. I'm lucky that I was in

2:14

a patch of road that had a ditch. I'm lucky that all

2:16

that happened is that I got stuck in a ditch for an

2:18

hour until I got a tow. I'm lucky

2:20

that I didn't hit any other cars, because while I

2:22

was sitting in that ditch, another driver lost control just

2:24

like I did and hit the car in front of

2:26

them. And all of us are lucky nobody

2:28

got hurt. Let

2:31

me put my cars or my car on the table

2:33

here. I live in Michigan, and

2:35

we put America in cars. The automobile built

2:37

Detroit, it built Michigan, it built the home

2:39

I grew up in. Both my parents are

2:41

automotive engineers after all. And I

2:43

really love cars, the engineering, the speed, the sound,

2:46

all of it. But

2:48

I'm also a doctor and an epidemiologist. And

2:50

from a public health standpoint, I gotta face

2:52

the music here. Cars? They

2:55

got issues. First, there's the

2:57

fact that the average commute is half an hour. For

2:59

me, I think about the five hours I spend in my

3:01

car. I could be spending it doing so much else. When

3:04

I lived in New York, my commute was also

3:07

30 minutes. But that was about 15 minutes walking

3:09

and another 15 minutes on the subway. That 30

3:11

minutes of walking I did every day, they were priceless.

3:14

That's 30 minutes of exercise five days a week

3:16

I just don't do in my current car based

3:18

commute. Then there's the isolation.

3:21

While I'd walk and ride the train in New York, I'd

3:23

be people watching getting a sense of the community around me.

3:26

In a car, it's just me by my lonesome. And

3:28

I know that every other car on the road

3:30

holds another lonely commuter like me. But

3:33

we can't see each other, exchange glances or share the

3:35

joy of the busker at the station while we wait

3:37

for our train. Then

3:39

there's the consequences for our climate. All

3:41

that driving we do contributes to climate change. And look,

3:43

I drive a plug in hybrid, but I know that

3:45

while I'm on the gas side, which is

3:48

most of my commute, I'm burning fossil fuels

3:50

into our atmosphere. And it sucks. Collectively,

3:52

in 2022, our vehicles contributed about 1.4

3:55

billion metric tons of CO2 emissions. That's

3:57

about 16% of our country's in higher

4:00

carbon footprint. But it's not

4:02

just the environment at the global level. Just look

4:04

at the built environment, the communities we build to

4:06

accommodate cars. Sprawling, cul-de-sac neighborhoods are

4:09

built to accommodate transit in one way,

4:11

one way only. My car. Sure,

4:13

you can walk around your neighborhood, but let's face it,

4:15

it's boring as hell, walking by endless rows of houses.

4:18

Compare that to walking around communities built for

4:20

alternative modes of transit. You've got shopping

4:22

on the walkway and people you're sharing space with.

4:25

And those car-based communities, they're self-reinforcing. The only

4:27

way to get around them is by car.

4:29

So a car you must have. Rinse and

4:31

repeat. Which brings me back to

4:34

my story. Cars themselves, much bigger today than

4:36

they ever were in the past, are just

4:38

dangerous on their own terms. Automobile

4:40

accidents are one of the nation's leading causes

4:42

of death. And unlike other causes like cancer

4:44

or heart disease, this one is on the

4:46

rise, particularly so since the pandemic. I

4:49

wanted to understand why exactly. So I reached out

4:51

to Dr. Deborah Kools. She's a trauma surgeon who

4:54

studies automotive injury. And she joined me to talk

4:56

about why injuries involving cars are on the rise,

4:58

what it tells us about the ways we've constructed

5:00

our society, and what we can do about it. Here's

5:02

my conversation with Dr. Deborah Kools. Okay,

5:05

can you introduce yourself with the tape? Sure,

5:08

I'm Deborah Kools, and I

5:10

am a trauma critical

5:13

care surgeon at the Kirk Krakorian

5:15

School of Medicine at UNLV.

5:17

And I'm also the chief of

5:19

trauma at University Medical Center of

5:21

Southern Nevada. We

5:23

really appreciate you joining us today. And I

5:26

kind of want to go way back. What

5:28

got you interested in understanding the

5:30

consequences of automobile injury? When did

5:32

that become a focus

5:34

for you and your work? So

5:37

I developed an interest in

5:39

it during my training. In trauma

5:42

surgery, we see kind

5:44

of repetitive behaviors that

5:47

result in injury. And

5:49

the injuries can be so

5:52

devastating that the idea

5:54

of presenting them was certainly

5:57

mentioned like during my training, but it's

5:59

something That really resonated with me

6:01

and the more I did. Trauma.

6:04

Surgery. The mart resonated

6:06

with me. And then I learned

6:08

also at the very end of

6:10

my training and as I started

6:13

as an authentic surgeon that it

6:15

is required for all thera side.

6:18

Trauma. Centers to actually

6:20

do injury prevention And

6:22

so it. it seems

6:25

like it was. Definitely

6:28

the right center for me because

6:30

I enjoyed caring for insert. A

6:33

sense working with their families.

6:35

Because both the patient usually

6:37

and their family. They.

6:40

Got up think he was gonna be

6:42

a normal good days and this anything.

6:44

Sad sad after in

6:46

Surrey and ensure usually

6:49

happens so quickly that

6:51

I think people just

6:53

don't anticipate. That the laces

6:55

utensil changing right in front

6:57

of their eyes. Yeah,

7:00

I I wanted Ospreys.

7:02

I'm. As listeners know, I'm

7:04

I'm from Michigan and more like, in the

7:07

heart of our country, and we've literally put

7:09

their country on wheels, which may or may

7:11

not be a good thing. and often when

7:13

you're talking about injury, it's not a good

7:16

thing. Can you tell us a little bit

7:18

about some of the clinical hallmarks of injury

7:20

by automobile? Like what are the kinds of

7:22

injuries that you usually see when somebody you're

7:25

struck by an automobile are involved in automobile

7:27

accident? Though.

7:30

A as a variety of things

7:32

so let's just take people who

7:34

are stacked an. Automobile I live

7:37

in Las Vegas and that's

7:39

one of our. Real

7:41

challenge Us: How to decrease

7:43

the number of people who

7:45

are. It. By Automobiles

7:47

and Aqsiq sold by

7:50

Automobiles and that types

7:52

of injuries. That they

7:54

sustain. It. Is a

7:56

completely vulnerable road users. The slut.

7:58

We call them. Then he

8:01

not as people driving

8:03

quickly and sometimes and

8:05

large cars we can

8:07

just imagine safe force

8:09

that become a person.

8:11

So it's. Their. Interests

8:13

are that. Across

8:15

your entire body. So many

8:17

will have. A brain injury aren't

8:19

they can heavens and a spine

8:22

injury sometimes. At least some

8:24

paralyzed and the bones in

8:26

their chest or broke him

8:28

on. Their that which is largely

8:30

ribs. And in

8:32

their abdomens. Ah, With

8:35

typically abdomen and fathers be

8:37

sealed lot of powerful countries

8:39

because the bones take a

8:41

lot of the forests and

8:43

then they break that. Also

8:45

we see internal injuries that

8:47

can be really highly varied

8:49

from. What we

8:51

call a solid organs, liver and

8:53

spleen minister severely injured. Assesses,

8:56

Immediately start bleeding and with pelvic

8:58

fractures to swell there are huge

9:00

number of blood vessels that ran

9:02

through that area and they can.

9:05

They can. Very easily bleed

9:07

and potentially lead to

9:09

death extremities. Again, depending upon

9:12

the size of the car, how high

9:14

it is off the road, and the

9:16

size of the person. Extremities

9:19

can be. In

9:22

a broken into many pieces. Sometimes

9:24

they get actually drive a car

9:27

so then they get equivalent of

9:29

like a burn on that part

9:31

of their body. So I would

9:34

say people who get struck by

9:36

the calls are among the most.

9:38

Insert Business hours Our

9:41

safety devices. That.

9:43

We've now. Some. Are

9:46

incorporated. By laws and some

9:48

by the desire for people to

9:50

be safe in their automobiles. That

9:53

none of the safety measures. Really?

9:57

In. An effect the pedestrian excited to

9:59

death. of people who are walking. Similarly,

10:02

people who are on bikes, they're

10:04

unprotected. And so all of the

10:09

safety initiatives in

10:12

terms of automobile manufacturing so

10:15

far are they don't

10:17

protect the pedestrian at all. And

10:19

so they remain some of

10:21

our most serious injuries,

10:24

but clearly one can

10:26

get very injured and other raised

10:28

by automobiles. Yeah, I

10:30

mean, what you're describing is a very complex set

10:33

of injuries. And you know, what you just said makes

10:35

sense is that we we've

10:37

designed the automobiles to protect the people inside,

10:39

not the people outside. And you

10:42

know, in part, that's part

10:44

of that is like the cars have just gotten bigger. And,

10:46

you know, that is almost a

10:48

protective device from the folks inside, but they

10:50

also reduce visibility. It means that the nature

10:53

of the injury just basic physics, the

10:56

injury is going to be worse for somebody outside.

10:58

One of the reasons that we wanted to chat

11:01

today is because pedestrian injuries have skyrocketed

11:03

over the past several years. Can

11:06

you just tell us first and foremost,

11:08

like, is there a demographic that's being

11:10

affected most by pedestrian injury? So

11:13

what we found in our community, so

11:16

we've studied this in Southern Nevada, because

11:20

I think if we know the demographic that

11:22

is most injured, then we can reach

11:25

out to them with specific interventions

11:27

to try to keep them safer. So

11:30

in terms of

11:32

like age distribution, and so forth,

11:35

we find that it's bimodal, meaning

11:37

that there are really two groups

11:39

that appear to be most

11:42

disproportionately injured. And

11:44

it's the younger group that may

11:46

be distracted by

11:48

texting while they're walking across the

11:50

road or something, and then

11:53

an older group. And so it

11:56

really is bimodal in that way.

11:58

And what we've We also

12:00

know is that these are

12:02

people who probably

12:05

don't have a lot of

12:07

alternatives for transportation

12:10

and they will

12:13

be taking a bus and then crossing

12:15

a street and

12:17

then perhaps not be

12:19

looking or somebody's trying

12:21

to avoid the bus and

12:24

hits them. So

12:27

that's one demographic and I'd

12:29

like to also just comment on roads

12:31

as well and this may

12:33

be, this likely varies by

12:35

geographic area but in the area

12:38

in Nevada where I live, the

12:41

roads are very wide and

12:44

the blocks are extremely long and

12:47

while you can have a crosswalk between

12:50

blocks or in the middle of a block, that

12:53

isn't very common and

12:55

so for pedestrians to

12:59

get to a crosswalk, they

13:01

often have to walk a fair

13:03

distance to find a crosswalk to

13:05

then walk. So the

13:08

demographic of those who ride

13:10

public transportation and

13:14

the crashes that happen surrounding those

13:16

areas has also been an area

13:18

of focus that we've looked at

13:20

and we've tried to intervene and

13:23

the engineers that design

13:25

roads and bus stops in Silper they

13:27

have done a very good job in

13:30

reconstructing some of those areas to make

13:32

them safer but as you

13:34

can imagine in like metropolitan areas

13:36

and so forth, that's a

13:38

huge undertaking to go back

13:40

and re-engineer roads

13:43

and bus stops and so forth. Yeah,

13:46

no, one of the pieces

13:48

that I really appreciate you highlighting is

13:52

the length of a block. I didn't think

13:54

about that but say you're trying to walk

13:57

to a strip mall on the other side of

14:00

a block, if that block is really long and the strip mall

14:02

is right in front of you, you might be tempted to just

14:04

try and cross the road. And

14:06

that just increases the probability that you're going

14:09

to be a pedestrian in a collision with

14:11

a car. And

14:14

that note about these bimodal distributions,

14:16

you can imagine two very different

14:18

causal chains, right? Young people, I've

14:21

been in situations where folks are literally

14:23

jaywalking across the street looking at their

14:25

phone and just oblivious

14:28

to your approaching them. And

14:31

then obviously, the situation with seniors, less

14:35

able to evade a car or

14:37

potentially even see a car coming in a situation

14:39

where they could be crossing. And

14:42

it just speaks to the nature of the way

14:44

we've designed so much of our space, right? So

14:46

much of it has been designed specifically around cars

14:49

without the engagement of the idea

14:51

of what happens when cars and

14:54

people intermingle. And to your point,

14:56

a lot of the folks in the way that you shared

14:58

it, don't necessarily have

15:01

alternatives to automobiles. So if you're somebody

15:03

who can't afford a car in a

15:05

car driven society,

15:08

that means that you are

15:10

by definition exposed to what happens because

15:12

we've built everything around cars. And

15:15

sometimes I think we take that for granted.

15:17

In Michigan, we are remarkably unwalkable outside of

15:19

a couple of our

15:21

cities. And you start to

15:24

appreciate when you're walking in a cul-de-sac neighborhood, a

15:26

lot of them just

15:28

don't even have sidewalks. I mean, these

15:30

are literally built to just engage in

15:32

cars. And it says a lot about

15:35

the way that industry is wrapped around and the way

15:37

we built around particular industries. But it

15:39

also forces us to think a bit about what

15:41

happens in a situation like the one we

15:44

face where the cost of owning a car

15:46

over the past several years has gone up

15:48

tremendously. The cost of buying a car has

15:50

gone up. Literally the way

15:52

we've built our society has priced people out of the

15:55

basic mode of transit. And to add

15:57

injury to insult, it then... leaves

16:00

you a lot more liable to being injured.

16:03

I wanna sort of think a little bit

16:05

about some of the hypotheses around what's driving

16:07

this. I'd like to break it down maybe

16:09

in like pedestrian features and driver features. And

16:11

on the pedestrian side, you named a couple

16:13

of them. Could you go a

16:15

little bit deeper into some of the hypotheses

16:18

that we think may be causing this increase

16:20

in pedestrian injury? We've talked about some of

16:22

them as we take a deeper dive. I

16:26

think there is the, I

16:30

think assumption that drivers are very

16:35

aware of their surroundings, right?

16:37

And that I think there's

16:39

the assumption that drivers need

16:41

the pedestrians. And

16:43

again, in my city and then

16:45

others, they can be

16:48

crossing at night in

16:51

dark clothing and

16:54

I really think they

16:56

expect to be seen. But

17:00

when you look at the driver's side of

17:02

it, you have people who are

17:04

in a hurry,

17:06

right? Our lives have gotten

17:09

more complicated. We're in a hurry

17:11

to get somewhere by a certain

17:14

time. We know that

17:16

there's increased speed. And

17:19

so that even if you

17:21

have an alert driver who can actually

17:23

see a pedestrian, so

17:25

if you're traveling faster, your

17:28

ability to respond and actually

17:30

stop the vehicle is

17:33

going to be longer because

17:35

you're speeding. And

17:37

then if there's decreased visibility, you

17:40

might not, the driver might not even see

17:42

the pedestrian until

17:44

they're very, very, very close.

17:47

That's one hypothesis.

17:50

And we notice that a

17:52

lot of pedestrians

17:55

are in dark clothing. I

17:58

assume just not in my city. in

18:01

other states, so decreases

18:03

the visibility from their perspective.

18:06

And we're all distracted by our cell

18:09

phones, largely, texting,

18:12

getting phone calls. And

18:15

it's not uncommon that you

18:17

have both a

18:19

distracted driver and a distracted

18:21

pedestrian. And so

18:23

what we try

18:26

to instruct pedestrians is be sure

18:28

to make eye

18:30

contact with the person in

18:32

the automobile. But that's

18:35

challenging, right, if you have wide streets.

18:39

And you could be hit on any

18:41

one of, I don't know, six to eight

18:43

lanes, depending upon the area.

18:46

You can have people who turn right

18:48

on red, who,

18:51

again, should be looking at the

18:53

crosswalk that presumably would be right in

18:55

front of them. So

18:57

we think, actually, that distraction

18:59

is a huge component as

19:02

well for both. And

19:06

I think for people

19:08

who are just really struggling

19:10

to get to locations

19:12

and who are pedestrians, I

19:16

think our hypothesis

19:18

anyway is that they get

19:21

desensitized to the potential danger

19:23

of getting hit by an

19:26

automobile. And

19:28

I think, generally speaking, for people who

19:30

are drivers, our automobiles

19:33

have become essentially like our

19:35

living rooms, right? So

19:38

they're very comfortable, which we all

19:40

appreciate, right? There

19:43

are a lot of gadgets. There's

19:46

the ability to entertain

19:49

the passengers with various

19:51

video devices. There are lots

19:54

of options that we have that

19:57

we can do climate

19:59

control. can really fine

20:02

tune the music that we're watching or

20:04

listening to or something like that. So

20:07

there are a lot of distractions within

20:09

an automobile and they're so

20:11

comfortable that I

20:13

think that our

20:16

hypothesis is that people

20:18

are so comfortable in their vehicles that

20:20

they don't realize that if

20:22

they don't drive really responsibly that

20:25

they can be a vehicle

20:27

of death, not only

20:29

for themselves and the passengers, but

20:31

for people around them, whether they

20:33

be pedestrians or people

20:35

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Wednesday, February 21st at noon Pacific through PM

21:34

Eastern. You

21:39

know, that point that you made about the design

21:41

of cars, there are so

21:43

many ways to get distracted. I remember

21:45

when I did my driver's training, this

21:48

would have been in the late 90s.

21:50

And one of the things I made you do was turn

21:52

on the radio. And now I think

21:55

about the gigantic touchscreen on my dash now

21:57

and all of the different things that I

21:59

can do. do and let

22:02

alone the phone that is right there

22:04

for the touching if it pings

22:06

me with so and so message. And

22:09

then I commute quite a long distance to work

22:11

and I'm usually on the phone most of the

22:13

time. And so I

22:15

can be caught up in my

22:17

conversation discussing some

22:20

minute detail of work and

22:23

it means that you may not be as

22:25

focused on the circumstances around

22:27

you. And you can imagine in all

22:29

of that, right, with all of those

22:31

distractions, it gets a lot

22:33

more complicated. And then there's also the fact

22:36

that I drive, I live in

22:38

Michigan and for half the year it's potentially

22:40

snowy. I drive an SUV

22:42

and I drive a hybrid SUV

22:44

in case I get shamed and don't at me,

22:46

anybody on extra Twitter. But

22:49

my SUV is very big and that means that

22:51

my visibility is not as good as it might

22:53

have been if I were more at the pedestrian

22:55

level, right? I'm driving usually with my head a

22:58

good foot or two feet higher

23:01

than the average pedestrian. And

23:03

so sometimes I take a lot, I have a six year

23:05

old and I always tell her when you're going to cross

23:07

in front of anybody's car, you got to

23:09

cross way in front of the car so that they

23:11

can see you. My six year old, if

23:13

she was right in front of the car, I couldn't see her. And

23:16

that always scares me to death.

23:18

And I think about what happens when a higher

23:20

degree, a higher proportion of the

23:22

cars that we drive are larger. And

23:25

so you have that reduced visibility above and beyond

23:27

the fact that it's just particularly comfortable and

23:29

you can get lost in whatever activity it is

23:31

that you are pursuing aside

23:33

from driving the killer

23:35

vehicle that you're driving. I

23:39

wanted to ask you, as you think about

23:41

automotive design, you talked about being

23:43

designed specifically to protect the folks inside the car,

23:45

not outside the car. Has there

23:47

been any attention paid to automotive design

23:50

to protect potential pedestrians? Yes,

23:52

there has been. Certainly

23:55

backup cameras. There

23:57

have been. devices

24:00

that are placed on cars that

24:03

will detect another vehicle

24:07

and including a pedestrian. So

24:10

there are some innovations in

24:12

that area as well. And

24:16

those are great innovations. And

24:18

I think we applaud

24:21

the industry for trying to make

24:25

cars safer for people outside

24:27

the car as well

24:29

as people inside the car.

24:31

And I spoke more about

24:34

those safety devices in the

24:36

car previously. But those

24:38

external that would detect someone like

24:41

a pedestrian in dark clothing and

24:43

so forth, those are

24:45

really great. It will take a number of

24:47

years though. When we

24:49

look at how long people drive cars

24:52

before they're not drivable anymore

24:54

and so forth, it's going

24:56

to take a period of time for those

24:58

really to take effect. And

25:01

I would say that I haven't looked

25:03

at all the manufacturers and so forth. They

25:06

may be optional

25:08

on sent vehicles. So I

25:12

think our government has played a

25:14

huge role in terms

25:17

of either encouraging

25:19

or actually mandating certain safety devices.

25:22

So I think it's really important

25:24

that we look at that aspect. There

25:27

are many other factors, right? One

25:30

is also the design of roads and

25:32

roadways. And that's

25:34

really specialized area of engineering.

25:36

I want to get

25:39

to the roadways question. I want to ask you one more

25:41

question about cars though. And this has been a hot debate

25:43

because there has been this

25:45

debate about self-driving cars. And once

25:48

you enable what a self-driving car basically

25:50

is, it is enabled with

25:52

so many of these sensors that ostensibly this

25:55

thing can drive itself. And there was a

25:57

recent case with a pretty prominent company called

25:59

Kriva. where there had

26:01

been an accident and a woman

26:03

was hit by actually a human

26:05

driven car, was flung underneath a

26:07

self-driving car that then ended up

26:09

dragging her a considerable distance. And

26:12

there have been a number of ethical questions

26:14

about how do you program a car in

26:17

these situations where you've got

26:19

to choose between hitting a baby versus

26:21

hitting a group of adults, like how do

26:23

you assess that? But one

26:26

thing that is going to become clear

26:28

is that these cars are going to become more

26:30

and more effective. And there's this nexus between almost,

26:33

I don't think we're going to go entirely

26:35

self-driving as much

26:37

as techno optimists think we are. I think what's going

26:39

to happen is you're going to have more and more

26:42

of these tech-enabled cars

26:44

that will do things like

26:46

automatically stop when they sense

26:48

something that you may not sense. I want

26:50

to ask you, you talked about government and

26:52

the role that government and policy have in

26:55

mandating this. you think about this

26:57

problem, where do you stand on it, on

26:59

this question of self-driving cars? Do

27:02

you think that we could get to a point

27:04

where they're more effective and safer over time? Do

27:07

you think that there's a role for government in

27:09

mandating more and more of these tech specs that

27:12

sort of augment the human driver? How

27:14

are you thinking about it? I

27:17

would just say that that is not one

27:19

of my strengths in terms of the background.

27:22

I do think that with not

27:24

only the type of technology

27:27

that we're talking about, those signals, if you

27:29

will, have to be interpreted. And

27:31

artificial intelligence is a huge topic

27:34

these days. And

27:36

I think that can help to integrate the

27:38

data. I would say in

27:40

my own city, we're starting to see

27:42

self-driving like tabs and

27:45

so forth. But it's not something

27:47

that I really have the background

27:50

to truly evaluate. It

27:52

does seem like for the foreseeable

27:54

future that you would want human

27:57

beings being able to

27:59

intervene. you will. And there

28:02

are so many factors, including you

28:04

mentioned dragging, right? You would,

28:07

when a human is driving a car, I would

28:10

presume if they hit

28:12

someone and that

28:14

person is being dragged, it

28:17

would cause some noise to

28:19

be interpreted as what's going on

28:21

here. First of all, oh, what

28:23

was that impact? And I presumably

28:26

didn't see that person, right? And

28:30

a number of relevant

28:32

thoughts. I would just

28:34

say that is a

28:37

great question and a great

28:40

question for the future. Yeah.

28:42

And I think our governing

28:44

bodies, they really need to look

28:47

at all of the data, but they're overall

28:51

the goal of

28:53

our elected representatives, as well as

28:55

those that are appointed by our

28:58

elected representatives. Their

29:00

duty is to protect the

29:03

public, right? And so I think that

29:05

has to be a

29:08

guiding force. I'm a physician. My

29:10

guiding light is to help save

29:13

lives when

29:15

I work as a physician. And

29:17

when I look at traffic

29:20

safety, my physician

29:22

lens is very much part

29:25

of looking at injury

29:27

prevention. Yeah, I appreciate that. You

29:30

were beginning to talk about roads. Tell

29:32

us a little bit about some of the innovations in

29:34

terms of designing roads to be safer for pedestrians. Clearly

29:38

visible crosswalks

29:42

and visibility,

29:44

even in terms of if a

29:46

pedestrian is in a crosswalk. I

29:49

live in an area that I've

29:51

mentioned before, has really long blocks

29:54

and really wide roads and

29:56

fairly high speed limits, actually. And

30:00

If there is a pedestrian crossing,

30:02

particularly where there isn't a traffic

30:04

light, it's very

30:07

helpful as a driver to know

30:10

by flashing lights there is a

30:12

pedestrian in a crosswalk. And

30:15

I think that's been really helpful. And

30:18

I've learned a lot from actually engineers

30:20

in this regard and

30:23

probably have a lot more to learn from

30:26

them, but also in the middle of a

30:28

very wide road to have

30:30

what's called a pedestrian refuge,

30:33

a place that is, and

30:36

often it's concrete or concrete, some

30:38

other material that separates

30:40

the two different

30:43

lanes going in opposite directions,

30:46

that it creates like a refuge for them.

30:48

If they can't make it all the way

30:50

across multiple lanes, which

30:52

sometimes people with disabilities

30:56

or are slow for any

30:58

other reason, that if they

31:00

can only make it halfway, they at least

31:02

have a fairly safe refuge in the middle,

31:04

that they're not standing literally on the

31:06

median strip or something like

31:08

that. So those have helped. There

31:12

has been a little bit of research

31:14

done even on types

31:17

of substances that are used

31:19

in road construction. And

31:23

I trust our engineers in

31:25

that regard, but I think that's an

31:27

area of continued

31:30

investigation. And

31:32

I'm really grateful that we have

31:34

people who totally specialize in those

31:37

areas. And I think

31:39

when we are starting

31:41

to look at behaviors, the

31:44

intersection of engineering and

31:46

behaviors is interesting as

31:48

well. That's

31:51

one of the really important aspects

31:54

of traffic crashes that I think

31:56

we really need to understand. We've

31:59

made a real distinction in language

32:02

between crashes and accidents.

32:06

Accidents, I think if we

32:08

look up actually the definition

32:10

of accidents, like they're unavoidable,

32:12

they're random occurrences

32:14

and so forth. But the

32:16

majority of crashes that happen in the

32:19

US, and I would suspect in other

32:21

countries as well, are

32:23

related to a behavior. Whether

32:28

it's driving under the

32:30

influence of impairing substances,

32:33

and that data has been very

32:36

clear for a long time. Trauma

32:39

centers, hospitals that actually

32:42

routinely screen, find

32:45

that they're positive

32:47

for substances that potentially could

32:50

impair the driver in more than

32:53

50 percent of the cases. I've

32:55

been out of fellowship now for almost 24 years,

32:59

and that was a fact when I

33:01

was a fellow over two decades ago,

33:03

and it continues and probably gets even

33:06

more complex today. That's

33:08

just one behavior. Speeding

33:11

is we're finding

33:13

we've studied our citation data, and

33:16

that's one of the most common reasons

33:19

for citations to be given by law

33:21

enforcement. Speeding,

33:25

we potentially

33:27

lose control of your vehicle. If

33:29

you're speeding, if you see a

33:31

pedestrian or some other vulnerable road

33:33

user, your time

33:36

to respond to avoid a crash

33:38

and injuring or killing a person

33:41

is decreased because you're going very

33:44

fast. If we couple

33:46

that then with speeding,

33:49

even more inappropriately, let's say in bad

33:52

weather, you're from Michigan. In

33:54

Nevada, it's so little rain that when

33:56

we get rain, we

33:58

have a lot of oil on there. the roads

34:00

and the roads are very, very

34:02

slippery than we see increased motor

34:05

vehicle crashes. Yeah. So

34:07

those are just some of the behaviors.

34:10

And since COVID,

34:12

we started to really notice

34:14

this with COVID that what

34:17

are considered aggressive drivers, that

34:20

number has gone way up

34:23

as well. And

34:25

we all understand that COVID and

34:27

sheltering in place and all

34:30

of the other aspects

34:32

of the COVID pandemic

34:35

that occurred caused

34:38

a lot of frustration in

34:40

people and often caused hardship, right?

34:43

Many people weren't able to work and so forth

34:46

that we started to

34:48

see more aggressive drivers. And

34:51

that has not really abated.

34:54

And just like maybe when

34:56

we're at home and

34:58

something is really bothering us, we

35:00

would have the privacy, let's say, I'm

35:03

just going to use a dramatic example of screaming

35:06

in your house, right? We've

35:09

all been here for. Yes. And somehow,

35:11

I think when people get into

35:13

their vehicles, they feel again,

35:15

it's a private space that

35:17

they can just, the vehicle becomes

35:20

an outlet for their frustration and

35:23

often that turns into aggression. And

35:26

that's becoming a huge

35:29

problem in traffic crashes. So

35:32

we talked about some of these driver

35:34

level features, distraction being

35:36

a big one, aggression

35:39

being one, speeding being

35:41

another, being high or

35:43

drunk or under the

35:45

influence in any way being another

35:47

one. What are some of

35:49

the things that you recommend to pedestrians around

35:52

being able to be safe when

35:56

they're using roadways? For

36:00

pedestrians, I recommend they

36:02

are always in a crosswalk. And

36:05

if possible, to

36:08

make eye contact with

36:10

the driver and make

36:13

sure that they feel safe that

36:15

the driver actually sees them. Because

36:18

in a lot of instances, that is really

36:20

not the case. And

36:22

that they are not impaired in any

36:24

way or distracted in any way. So

36:27

not to have earbuds in

36:29

listening to music because they

36:31

may miss someone tooting

36:33

their horn at them

36:36

or other sounds that may indicate

36:38

that they should be more cautious. And

36:41

I would say also wearing

36:43

clothing that can be easily seen.

36:46

And if they're going to be walking

36:49

at dawn, dusk or dark,

36:52

that they should wear light colored clothing.

36:54

And actually, given what I do, if

36:58

I needed to be a pedestrian in

37:00

a regular base, I would

37:03

also have reflected some

37:06

reflective gear to make

37:09

myself more visible. And

37:11

I would be very cognizant of what

37:13

the speed limit is in

37:15

that particular area. And

37:19

just assume that people are generally

37:21

going above the speed limit. So

37:24

it's one thing if you're, let's

37:26

say, in a school zone where

37:28

it's 15 or 20 miles an hour, then

37:32

it should

37:34

be known that cars

37:37

would be traveling slower. Although

37:40

that has been an issue as well, that

37:42

many drivers, either they

37:45

don't see the school zone or they

37:47

ignore it and they continue going along

37:49

at whatever the speed is

37:51

before and after. Just

37:53

be aware of those. And

37:55

in terms of weather, just

37:58

understand that really bad weather. At

38:00

drivers may not be able

38:03

to stop and sixty I

38:05

would say be overly cautious.

38:08

And the fact seats of

38:10

one other very related on.

38:14

Vulnerable users. I think that

38:16

we have a a lot

38:18

of motorized parts which are

38:20

really great say allow and

38:22

people who. Not able to

38:25

walk long distance to actually

38:27

get out on they get

38:29

outside taking. You know,

38:31

travel on. Suffering

38:35

that. Most of

38:37

them are. Don't

38:40

really have reflect the fear on

38:42

them for instance so that they

38:45

become more visible and then they

38:47

have to realize that. Through lower.

38:50

Rate. So needy, more difficult to

38:52

see, Them so again I would

38:54

urge them to be really cautious

38:56

of it also acts as a

38:59

kid. Or.

39:04

He. Preferred normally pedestrians and

39:06

false in their communities

39:08

and as they see

39:10

and I'm really unsafe

39:12

Environment: To to

39:14

engage with of romance.

39:17

And that says, legislature. An

39:19

advocate for themselves. Their

39:22

homes it it says i I

39:24

don't think say have a as

39:26

unified as an advocacy group as

39:28

some other road users. Yeah.

39:31

That's a really good point. I

39:33

want to put on two point

39:35

the made one was on these

39:37

these new motorized vehicles talk about.

39:39

We talked about cards with the

39:41

most of these ubiquitous scooters and

39:43

so bitter occupy this is interesting

39:45

space where they do enable certain

39:47

kind of transit which is really

39:49

liberating but at the same time

39:52

to be really quite dangerous because

39:54

they're less than predictable and people

39:56

don't often. Ah, Use.

39:58

Them in the most responsible. And you'll have

40:00

one of these cutting really quickly into the road, 20

40:03

miles an hour, which is a lot harder

40:05

to adjust to than somebody walking at five

40:07

to six. And

40:10

that becomes really dangerous. And too often, folks

40:12

aren't wearing their helmets, even though they're moving

40:14

pretty quickly. The other point

40:16

that's important to bring up is around

40:18

engineering. It's not just how we

40:20

engineer our roadways or our cars. It's also how

40:23

we engineer our whole societies. The

40:25

notion that we have such a paucity

40:27

and limitation in mass transit, where

40:30

so much is so driven by cars, the

40:33

need to be in a car or the exclusion

40:35

from a car that creates a

40:38

situation where you have this kind

40:40

of interaction where pedestrians get hit. We

40:43

really appreciate you joining us today and

40:45

talking us through some of the causes

40:48

and consequences of pedestrian injury. Our

40:51

guest today was Dr. Deborah Kules. She's

40:53

a professor of surgery and chief of

40:55

the section of critical care at the

40:57

Krakorian School of Medicine at UNLV's Division

40:59

of Acute Care Surgery. And

41:02

she's also program director at the

41:04

Krakorian School of Medicine's Surgical Clinical

41:06

Care Fellowship Program. And

41:09

finally, she's also the medical director

41:11

of the University Medical Center's trauma-intensive care

41:13

unit. Dr. Kules, we really appreciate you

41:15

joining us and sharing your wisdom and

41:17

all the work you do to save

41:19

lives in these circumstances. It's

41:22

been a pleasure and I really hope

41:24

that the people who are listening take

41:26

this information to heart to be safer.

41:30

Well, thank you. We appreciate you sharing it. As

41:32

usual, here's what I'm watching right now. We've

41:35

received breaking news from Buckingham Palace,

41:37

which has announced that the king

41:39

has been diagnosed with cancer. The

41:42

Royal Palace announced that King Charles, 75,

41:44

was diagnosed with an unspecified cancer last

41:46

week. He'd been pursuing treatment for

41:48

an enlarged prostate when the cancer, which is

41:50

not prostate, was identified. He'll pause

41:52

his public events as he pursues treatment. This

41:55

show is called America Dissected. So why am I

41:57

talking about a British monarch? Well,

41:59

because... the show is about health and society, and

42:01

I want to give credit where credit's due. One

42:03

of the biggest challenges we talk about regularly on

42:06

the show, either indirectly or directly, is stigma. And

42:08

too often, stigma keeps folks from getting the care

42:10

that they need. Prostate care? Yeah,

42:12

that's not high on the list for almost

42:14

anyone. If you don't know why, just Google

42:16

Prostate exam. Okay, maybe don't do that. Suffice

42:19

it to say that King Charles being public about

42:21

his health experience creates a permission structure. It normalizes

42:23

getting the care you need when you need it,

42:25

and that matters. A

42:28

new study in the journal JAMA Internal Medicine is

42:30

highlighting the broad impact of police murders of unarmed

42:32

black people. There's no doubt that

42:34

the consequences of these murders hit victims' families

42:37

hardest, but the impact goes deep

42:39

and broad. The study assessed the

42:41

sleep quality of black folks compared to others in

42:43

communities affected by police murders of unarmed black folks,

42:46

and they found a significant reduction in sleep quality

42:48

among black folks, but not others. The

42:51

probability of short sleep was about 50% higher in the 90

42:53

days following an event.

42:55

I share this because it's way too easy

42:57

to assume that the impacts of police violence

43:00

are limited to people indirectly affected. The

43:02

study shows that that's just not true. It

43:04

affects whole communities. If it doesn't rob folks

43:06

of their lives, it robs them

43:08

of so much else, including their sleep. Ask

43:11

yourself what else it might do. After

43:14

all, quality of sleep itself is associated with

43:16

everything from heart disease to automobile accidents. But

43:18

even beyond the downstream impacts of sleep, ask

43:21

yourself about the even broader impacts of the stress

43:23

and anxiety that may be robbing folks of it

43:25

in the first place. It's a

43:28

reminder that health really is collective. Finally,

43:30

scientists may have cracked a code over why women

43:33

are up to four times as likely to suffer

43:35

autoimmune disorders as men. In a

43:37

paper published in the journal Cell last week, scientists

43:39

identified a particular molecule that may be to blame.

43:42

Biological females have

43:44

two X-chromosomes compared to biological males who have

43:46

an X and a Y chromosome. You

43:49

could imagine that with two X-chromosomes, you might

43:51

have two times as much of the protein

43:53

material that's encoded on the X chromosome. Which

43:55

you would, except for a molecule called X-syst, which

43:58

serves to inactivate one of the X-chromosomes. The

44:01

challenge, though, is that it may also be

44:03

generating complex molecules that may trigger an immune

44:05

response. It's not a perfect

44:07

correlation. Biological males still do, after

44:09

all, have autoimmune disorders, like type 1 diabetes,

44:11

which is an autoimmune reaction against the cells

44:14

that make insulin in the pancreas. And it's

44:16

more common in men. But

44:18

this discovery may help unlock more information about

44:20

how autoimmune disorders develop, and how to prevent

44:22

them or treat them. That's it

44:24

for today. On your way out, don't forget to rate and review, it

44:26

really does go a long way. Also, if you

44:29

love the show and want to rep us, do

44:31

drop by the Crooked store for some America-Desected merch,

44:33

and don't forget to follow us at Crooked Media

44:35

and me, at Abdul Al Sayyid, No Dash, on

44:37

IG, TikTok, and Twitter. Thanks

44:58

for listening. This

45:14

is a video of the