Check out this interesting article care of CBC News that discusses how the traditional design of crash test dummies may be the reason why it is more likely for a female to sustain serious to fatal injuries in an automobile collision and how “building a better dummy” may be the key to resolving this inequality.
October is National Car Safety Month and maximizing car safety should be on the top of everyone’s list year-round. Take a look at our previous post, Wash Your Car – Save a Life, to learn how maintaining a clean car will keep you safer on the road.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
The other day I was driving through a busy parking lot. I noticed an elderly man who parked his car, got out, and proceeded to walk through the parking lot without ever surveying his surroundings. He did not see my vehicle approaching him, and did not appear to notice the other cars that had to stop to let him pass. The other drivers looked both annoyed and perplexed that he could be so clueless.
According to the CDC “Increasing frailty may leave the elderly more vulnerable to being hit by traffic. Age-linked declines in mental function, vision and physical disabilities might place older adult pedestrians at greater risk for being struck by a vehicle.”
With this man, what I noticed was quite telling. He was looking at his feet. Many seniors do this when walking. Why? Because they are afraid to fall. With a decline in physical ability comes problems negotiating uneven terrain. Parking lots and sidewalks are full of holes, stones, and cracks that could be problematic for someone with declining mobility. So, they stare at the ground to avoid falling, the entire time being unable to also look around at other risks in the environment. And when you combine this with reduced peripheral vision, they may not notice vehicles approaching.
Society expects seniors to “know better” in that they have been trained, over a lifetime, about the perils of traffic. With children, we don’t expect them to know better because they are carefree and often move before thinking. As driver’s, we watch for children and take extra care when we see them around roads or in parking lots. We also tend to take the same precautions when we notice someone who is more visibly disabled using a wheelchair, or white cane. But disabilities are not always visible and we have to be careful to not make assumptions – especially with seniors who may have an unnoticeable visual, cognitive, physical or auditory problem.
My message here is that drivers should be cautious with all pedestrians, but need to be especially mindful of seniors – much like they are with children or other people with visible disabilities. Seniors deserve our patience and the extra time it might take to help them safely go about their day and negotiate the sometimes challenging outdoor environment.
Previously posted July 2013
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Welcome to 2019! While the New Year is a wonderful time to reflect, organize, plan, appreciate and look forward with enthusiasm and gratuity, this year in Ontario it is also an important time to familiarize ourselves with the new laws for Distracted Driving.
Working in Ontario’s insurance industry, our role as Occupational Therapists is to help people recover from car accidents. While this work is both rewarding and fulfilling, it is also fraught with heartache and loss as we meet and work with people who have endured so much, and sometimes “lost everything” with their accident. We see loss of income, function, or hope. Sometimes there is the corresponding death of a child, spouse, friend or family member. There is a loss of roles, purpose, and meaning. Occasionally an accident causes poverty and loss of shelter, independence and a means of transportation. Recovery is not easy, it always takes longer than people expect or want, and the insurance system is designed to challenge the client (oddly their “customer”) for what they want and need to get better. Talk to anyone in the system and most (all?) say they just “want their old life back”. It is important that we listen to them and their stories and do all we can to prevent ourselves from causing someone else’s loss, or from becoming a “client” ourselves.
Yet, despite all the ongoing education and media about how unsafe distracted driving is, I still see it daily. I can typically count 3-5 people per day that I see driving and texting or texting at a stop light. The easiest ones to spot are on the highways as you see them drifting lanes and quickly over-correcting. I suppose all of these offenders believe “it won’t happen to me”…until it does. Hopefully, these new laws will scare them straight, or they will be ticketed and stop this unsafe behavior before they hurt themselves or others.
So, what are the new distracted driving laws in Ontario (https://www.ontario.ca/page/distracted-driving):
Distracted driving is no longer limited to just texting and making phone calls. It also now includes anything from simply holding an electronic device in one’s hand to eating while behind the wheel.
- Simply holding an electronic device in your hands (hand-held communication during driving is against the law)
- Using a cellular phone to talk, text, check maps or switch playlists
- Eating (there may not be a license suspension, but the RCMP warn you could be fined or given six demerits depending on the food)
- Reading books or documents
- Typing a destination into the GPS
What are the consequences:
- First offence: 3 days suspension and $1,000 fine
- Second offence: 7 days suspension and $2,000 fine
- Three or more offences: 30 days suspension, $3,000 fine and six demerit points
For Novice Drivers (G1, G2, M1 or M2 license) the rules are different and include:
- First offence: 30 days suspension and $615-$1000 fine
- Second offence: 90 days suspension and $615-$2000 fine
- Three or more offences: Cancellation of your license, $615-$3,000 fine
So, what is allowed:
- a hands-free device (e.g. Bluetooth) but only to turn it on and off
- a mounted device (e.g. phone, GPS) as long as it is secure – not moving around while driving
What do you have to lose by being a Distracted Driver? Maybe nothing, or maybe everything: your physical, mental or emotional function, your job, spouse, house, car, your independence and freedom, your pain-free “do what I want when I want” physical and mental abilities…or maybe you don’t lose those, you just cause the loss of those for others which might launch you into a lawsuit that takes years to resolve and threatens every asset you have and the livelihood of you or your family. Or, maybe it just riddles you with guilt as you live every day with the knowledge that you killed or hurt someone. And all for a text or a call? Or to multi-purpose driving and eating a hamburger? Sorry, but nothing is more important than the protection of the health and wellbeing of ourselves, our family, and others.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
As a kid in the 80’s I remember seeing a newspaper article about a girl that was struck by a car after exiting a school bus. There was a picture of the girl on the ground being attended to by emergency personnel. It was a disturbing image and I was about her age. After that, it seemed that school buses started to have stop signs and flashing lights, and huge fines were imposed for passing a school bus when it stopped to let children on or off. Whether these two events are directly related or not, it is true that laws tend to change when something horrible happens and people are hurt or killed.
In April of this year, tragedy struck Saskatchewan as the Humboldt Bronco’s Junior hockey team bus was in a collision with a transport truck, killing 16 people on board and seriously injuring 13 others. Those killed and injured were teenagers, coaches, and trainers. Could any good come of this senseless loss of life and talent? Maybe, as those involved are asking people to #buckleupforthebroncos by encouraging the use of seat belts on tour buses if these are present.
Transport Canada is already responding and by 2020, all newly built transport buses will be required to have seatbelts.
So, what are the current laws in Canada for this? Well, seatbelt use falls under the jurisdiction of the provincial and territorial governments and in most provinces the law states that seatbelts must be worn if they are provided, but of course, most motor coaches are not required to be equipped with belts, so they are not always available to be worn. That will change in 2020.
Working in the field of auto insurance where my clients are people injured in car accidents, I can state clearly that seatbelts save lives. Bus accidents are rare but are catastrophic when they happen. These new laws could save many lives and hopefully will reduce the significance or impact of bus-accident-related injuries.
But all of this got me thinking…my daughter is a varsity athlete for a prominent University. I asked her if the coach bus that transports them to games and tournaments has belts. Her answer was “no, they do not”. I suspect this means that most University, College or Sports teams buses don’t as well, so change is necessary and if these buses can’t be retrofitted to include belts, they need to be replaced. I too am in the sports arena as the assistant coach of a sports team and our club also travels by coach bus. I have asked our travel coordinators to make sure our tour operators provide buses with belts, and if they don’t, to find another vendor. Hopefully, that can help promote change — one team at a time.
We all need to buckle-up and if belts exist, use them. Even if you don’t feel the need to wear a belt, in the event of an impact if you are unsecured you would be tossed around the inside of the vehicle, threatening the security of others. Secure yourself, secure your belongings, and secure your passengers. There is no logical reason not to.
Have your children ever asked you if they could just wait in the car while you run into the bank, grocery store or post office? Though it may seem like a short trip where kids would be safe, they may not be.
In keeping with our posts about summer health and safety, I thought I would touch on another very tragic, but preventable, circumstance surrounding cars and children. It was the first very hot and humid day a few summers ago when I heard of the death of a two-year-old after his grandmother left him in the car. She just forgot he was there and went about her day. While it might seem inconceivable that this could happen to any caring and well-intentioned adult, I read an article recently that helped me to understand how possible this is.
Several years ago a mother in Calgary was returning to her job as a University Professor after a one-year maternity leave following the birth of her second child. She was a well-educated and diligent mother that did everything she could to protect the safety of her children during pregnancy, at home, and in the community. With her return to work the family had to adopt a new routine. She dropped her older child at day care and proceeded to take her daughter (11 months) to her new child care provider. The mother and daughter were singing and laughing in the car when the child fell asleep. The mother then spent the next several minutes putting together a very detailed mental plan of how she was going to get her child out of the car seat and into the day care without waking her. Once she visualized that process, and understood how it would all work, her mind rapidly switched to thoughts about her first week back at work and all the things she needed to accomplish. She arrived at work, went about her day, and realized when she came to her car to go home that her daughter was still in the car seat.
Her purpose of engaging in the interview and having the article published was to help people understand how this could happen and how it can be prevented. For her, she believes that the process of “visualizing” the drop off of her daughter made her mind believe that it actually happened. When her mind switched to thinking about work, it was convinced that her other responsibilities had been completed. This is the power of visualization, and of a distracted mind.
But I feel the most important aspect of the article were the strategies for prevention. The mother went on to have other children and talked openly about the steps she now takes to ensure she does not relive this tragedy. She explained that she always makes sure she puts something in the back seat with her children. Her purse, work bag, lunch. This requires her to enter the back seat of her car when getting out. Or, the opposite could also work – put a diaper bag, toy or child backpack in the front seat to cue you to their presence. This mother also said she has asked her child care providers to call her directly if her children are not dropped off on time, as expected. Lastly, when putting her children in their car seat she puts on a bracelet that is kept in the seat. She takes it off when getting them out. This serves as a visual cue, but has also become part of her new car seat routine that will reinforce a new behavior (put the bracelet back in the car seat when leaving the vehicle, making her access the seat).
According to WebMD “there is no safe amount of time to leave a child (or pet) in a car”. The temperature inside a car can rise or fall exponentially faster than the temperature outside, as your car functions as a greenhouse. Just get in your car on a hot day and try to breathe. Preventing child death from being left in a car is possible, and parents need to be wary of new routines, changes in schedules, and the cognitive process of remembering multiple things. And most of all, don’t be naïve enough to believe the self-fulfilling “this could never happen to me” phenomenon. Any oversight, regardless of how significant, can happen to us all.
Summer Programming Note:
Summer vacation is here and we will be taking a break from our regular schedule. We will be posting some of our popular seasonal blogs just once a week throughout the summer but will resume our regular three weekly posts in September, filled with new and exciting content including our popular O-Tip of Week series.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Samantha Hunt, Student Occupational Therapist
My father-in-law was terminally ill and suffered from dementia. Eventually, his decline became significant and his doctor filed a mandatory report with the Ministry of Transportation (MTO) to suspend his license pending a driver’s exam. He refused to attend the exam yet continued to drive even without a valid license. He still paid for car insurance because he knew this was important but was not well enough to connect his own disabilities to his safety and the safety of others. The family planned to remove his vehicle from his possession but before we could he ventured out one night, got lost, and the police found him 8 hours later driving in a farmer’s field. The good news was that no one got hurt and his car was beyond repair. Now, he could no longer drive even if he wanted to.
Driving is an important daily activity for many and provides drivers with an independent means to get around and to manage our own needs outside of the home. It reduces our reliance on others and provides us with freedom and control. But it is a privilege, not a right, and sometimes people reach a point where driving is no longer safe, but yet they don’t voluntarily stop.
Up until recently, the ownness to report unsafe drivers has fallen to the legal responsibility of doctors, nurse practitioners and optometrists. However, on July 1, 2018 the legislation will change to add a new class of “discretionary” reporting, and occupational therapists will be included in the list of professionals that can submit these “discretionary” reports.
Considering this major change to the Highway Traffic Act (HTA), and the significance of this on OT practice in Ontario, we wanted to provide a brief overview of the key facts and guidelines for the OT’s that this may impact.
Background on Medical Reporting Legislation
Mandatory medical reporting for physicians and optometrists in Ontario has been in place since 1968 and was enacted to help protect the public from drivers diagnosed with certain medical conditions or impairments that made it dangerous for them to drive. Mandatory reporting is a legal requirement to report that pertains to physicians, nurse practitioners, and optometrists, outlined in the HTA. The legislation states that every prescribed person shall report to the MTO “any person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a prescribed medical condition, functional impairment or visual impairment that may impair driving ability.”
In 2015, amendments were passed that allowed for a new reporting model to be introduced in Ontario and were approved in February 2018. These include:
· A combination of mandatory and discretionary reporting
· Authority to add additional healthcare professionals
· Specific requirements regarding what must be reported
Resulting from these amendments, the MTO regulations state that as of July 1, 2018, occupational therapists are identified as discretionary reporters. Discretionary reporting is not a legal requirement but gives authority for reporting to occupational therapists, physicians, nurse practitioners and optometrists for: “any person who is at least 16 years old who, in the opinion of the prescribed person, has, or appears to have, a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle”. Discretionary reporting therefore allows OTs to report concerns about a client’s fitness to drive if they choose.
With respect to consent and confidentiality, OTs are protected from legal action for breaking confidentiality when making a discretionary report; the HTA states that the authority of a prescribed medical professional making a report to the MTO overrides the duty of that professional to maintain a client’s confidentiality. Nevertheless, an OT making a report would be expected to advise the client of this decision.
Summary of Discretionary Reporting Rules for OTs
· OTs can report concerns about a client’s fitness to drive directly to the MTO. There will be a standard MTO form to be used for this purpose.
· OTS may report a driver but are not legally required to do so.
· OTs can make a report without client consent to prevent or reduce risk of harm.
· OTs can only make a report if they have met the client for assessment or service delivery.
· OTs can report on both prescribed conditions and any other medical conditions, functional impairments or visual impairment that may make it dangerous for a client to drive.
Prescribed medical conditions include the following:
1. Cognitive Impairment: a disorder resulting in cognitive impairment that,
i. Affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and,
ii. Results in substantial limitation of the person’s ability to perform activities of daily living.
2. Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.
3. Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.
4. Visual impairment:
i. A best corrected visual acuity that is below 20/50 with both eyes open and examined together.
ii. A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.
iii. Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching.
5. Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.
6. Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.
· OTs who make a report in good faith are protected from legal action but failing to report when they should have could be a breach of professional obligations.
OTs are NOT expected to report on conditions that, in their opinion, are of:
· A transient or non-recurrent nature
· Modest or incremental changes in ability
Lastly, although OTs are not legally required to make discretionary reports, a professional obligation to identify a potential safety issue with a client (such as a concern about fitness to drive) and, taking action to address this concern, is expected of the OT. Taking action may or may not include making a discretionary report to the MTO.
Reporting, Intake, and Review Process
The three types of approaches for assessing fitness to drive include a General Functional Assessment, Driving Specific Functional Assessment, and/or a Comprehensive Driving Evaluation (more information can be found in the resources below). Once an assessment has been completed or a concern has been identified, an OT may fill out a report. A new standardized form that OTs (along with physicians and nurse practitioners) must use when making a report has been approved and will be available online as of July 1, 2018. Once reports are received by the ministry, they will be reviewed and the MTO is to take appropriate action following within 30 business days. When an OT is reporting to the ministry, this does not mean the OT is taking the person’s license away. The licensing body has the responsibility to make this decision or to decide if more information is required.
For more information and resources, the College of Occupational Therapists of Ontario has created an Interim Guide to Discretionary Reporting of Fitness to Drive, which can be found at: https://www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018
Warning: Long Weekend ahead! This warning is one we re-post every year as, unfortunately, many need a reminder to make smart and safe choices during this first long weekend of the season.
While the Victoria Day long weekend is often a kick-off to summer, it is also known as one of the deadliest weekends in Canada. Impaired driving and boating numbers are highly elevated during long weekends and MADD Canada estimates that impaired driving kills between 1,250 and 1,500 people every year, and injures more than 63,000 in Canada. The following PSA is a great reminder of the effects drinking and driving can have on your life and on the life of someone else.
So please, while you enjoy this first long weekend of the season, think smart and be safe. Don’t drink and drive.
The other day I was traveling on a major highway as I was heading to a shopping center. I had five teenagers with me – my own four kids and a significant other. We were in the middle lane and the mini-van in front of us was slowly drifting. It would drift a bit right then correct, a bit left then correct. Sometimes it would go slightly over the line, sometimes a lot. Years ago I would have assumed that the person driving might have been drinking. This time I said to my car full of teens “I bet this person is texting and driving – watch them”. The teens acknowledged quickly that the car was definitely all over the place. I decided to speed up and pass this vehicle (much safer for us to have her behind us than in front of us). As we passed her, sure enough, this middle-aged looking woman was texting. I honked and we all stared at her as we passed. I hope she got the point. And yes, sure, maybe she was texting a dying relative, telling a sick child she was “on her way” to get them from school, or solidifying the best business deal of her life…but, in the end, she was being selfish, insensitive and unsafe. Not to mention was breaking the law. If anything was more important in that moment then her need to drive her car safely then she needed to pull off the highway, deal with the issue and then continue on her way.
The benefit I have is that I work with people who may have been injured by their own “it won’t happen to me” mentality, or by others that have caused horrible accidents driving like this. So, I drive with heightened awareness. And people I am sorry, but it is pretty obvious what you are doing when your head is anywhere but forward while you are operating a vehicle. I see several people a day texting or holding a phone to their ear while behind the wheel. It is still COMMON.
I fully support these New Laws for Distracted Driving. I also would support any opportunity to have a passenger in my car take a photo or video of a distracted driver to post online or to fire off to Crime Stoppers to deter this type of behavior. I agree that “no text is worth a life” – even your own.
Guest Blogger Lauren Heinken, Occupational Therapist
It’s winter, and with the season comes decreased daylight and increased risk of weather-related adverse driving conditions. These factors can contribute to a higher incidence of motor vehicle collisions, and this may be particularly true for older adult drivers who are experiencing physical and cognitive health changes. The Ontario Ministry of Transportation (MTO) reports that senior drivers with cognitive impairment/dementia have up to 4.7 times the risk of being involved in a motor vehicle collision. The MTO’s Senior Driver License Renewal Program operates in an effort to ensure that older adult drivers are screened for health changes that may impact their ability to drive. Occupational Therapists (OTs) may be involved in the process by administering the screening tools that can play a role in determining an individual’s fitness-to-drive; however, physicians and the MTO work together to ultimately decide whether an individual is able to maintain their license or not.
Many older adults see driving as imperative for maintaining their independence, especially if they have been lifelong drivers or are relatively unfamiliar with other forms of transportation. More physically demanding forms of transportation, walking to bus stops, or cycling, may no longer be viable alternatives for many. Outside of the main urban centres, Canada’s population is dispersed across great geographic distances; in more rural areas, public transportation services may be sparse if available at all. The distances individuals need to travel on a frequent basis to access services and participate in activities of their choosing are often great. As health professionals who focus on helping individuals find ways to engage in their chosen occupations, it fits that OTs should be involved in supporting older adults who have lost, or are at risk of losing, their ability to drive. OTs can work with their clients to minimize the way in which losing one’s license influences overall quality of life and ability to engage in chosen occupations.
As with any major life change, planning for the loss of one’s drivers license well in advance can help to limit the impact of the change when it happens. After all options for ensuring and promoting someone’s ability to drive safely have been exhausted, the next responsible therapist-client step would be to initiate discussions related to transportation alternatives, regardless of whether or not this lifestyle change will be occurring in the near future. It is understandable that OTs may be reluctant to initiate these discussions as safe continuation of driving is often an emotionally charged subject and can lead to very difficult conversations. Introducing the subject slowly and matching the content of the conversation to the client’s comfort level can help to limit any negative effects on the OT-client therapeutic relationship. Below is a proposed progression of an OTs involvement with a client who has lost, or is at risk of losing their ability to drive.
OTs should let the changing seasons serve as a reminder to consider initiating these discussions during client sessions. Although clients may be unreceptive and unwilling NOW to accept intervention aimed at preparing for this lifestyle change for LATER, a brief discussion may be enough to get them thinking about this important topic to help them adjust to the possibility when / if it arises. Sometimes as therapists the ideas we introduce early are not accepted for months or years later, but our role includes having the patience to work with clients around their comfort level and to support change when they are ready to accept it.