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Mitch: From University of Utah Health and The Scope Presents, this is Clinical.

Here at Clinical, we strive to bring you the stories of the people that make a hospital a hospital. Not just the talented doctors and nurses, which we definitely have, but also the compelling lives and efforts of the often unsung workers that make up the complex ecosystem of healthcare.

Over the next few episodes, we'll be taking a look at a group of professionals that have been on the frontline against dangerous unseen pathogens well before the COVID-19 pandemic. Armed with an arsenal of cleaners and a regiment of protocols and a wealth of knowledge about microscopic enemies, it's the technicians and custodians of Environmental Services that ensure the safety of the facilities for every single person that enters those doors.

At a time when the world seems to rush ever faster by, we wanted to get to know the people who we see in the hospital keeping it spotless and germ-free without ever knowing their names or the often arduous journeys that brought them here.

Presented by Clinical and written and reported by Stephen Dark, this is "Keeper of the Keys."

Stephen: It's 5:00 p.m. in the north stairwell in University Hospital, and Jacobo Lucero is hard at work. As doctors and nurses go up and down the stairs past signs inquiring, "Did you get your steps in today?" Lucero digs into corners of the steps with his broom.

In his gray tunic and black pants uniform of Environmental Services, the 60-year-old keeps mostly to himself as he cleans the 6 stairwells and 10 visitor lifts assigned to him.

The Guatemalan native is a shy, quiet man with a soft, melodious voice that draws you in as he describes work he's done for more than a decade. He's taking English classes, but prefers to speak in Spanish.

Interpreter: I've been cleaning the staircase for 13 years.

Stephen: How many?

Interpreter: Thirteen years cleaning only the staircase. It's funny, isn't it? Time just passed by. I like cleaning because I didn't have to force myself to study English.

Stephen: Doors slam and American voices echo down the stairwell. Lucero wields his broom and mop exchanging only the odd word in English with those who take the time to say hello.

Interpreter: They all go passing by. Do I say hello to anyone in particular? No. After so many years, that doesn't happen. There are a few that I say hello to with two or three little words, but nothing else.

Stephen: Outside of his friends in EVS, no one knows his name, where he came from, how he got here. But like so many of the 235 people who work as Environmental Services Technicians at University of Utah Health, the journey that brought him to the beehive state was far from easy.

Lucero was born to farm laborers in Asuncion Mita, a sleepy little rural town in Guatemala, on the border with El Salvador. His parents moved him and his six siblings to the capital when he was 4.

Man: Good evening. A UN debate was dramatically interrupted Friday afternoon with the emergency announcement that 5,000 Indians in a Guatemalan village were about to be murdered by government troops.

Man: [foreign language 00:04:23 to 00:04:36].

Stephen: In the early 1980s, Guatemala was in the end stages of a 36-year civil war that saw over 200,000 killed and 45,000 disappeared, the vast majority indigenous Mayan civilians. The United Nations attributed 90% of the atrocities committed during the war to the military dictatorship, which was determined to stamp out dissent among the rural poor. Lucero was 23 when two of his older siblings vanished.

Interpreter: I don't know what to say because they were kidnapping everybody. There were so many disappeared. My brother was at the university, and my sister had graduated from beauty school and was already cutting hair.

Stephen: And what happened to them?

Interpreter: We never saw them again.

Stephen: Lucero had a little store. And together with his sister, they adopted the siblings' orphaned children. He and his sister, he says, did the best they could for their niece and nephew. His sister immigrated to the United States and settled in California and told Lucero to come and join her. He traveled from Guatemala through Mexico to cross the border into the United States. It's a trip that over 30 years on he still can't bring himself to talk about.

Interpreter: Extremely difficult. For me, it was very difficult.

Stephen: In what way? If you want to talk about it. You don't have to talk about it.

Interpreter: I don't want to talk about it.

Stephen: Roughly one-third of EVS staff are refugees who came to United States seeking asylum, shelter, food, and the opportunity for a new life. Some came here from childhoods of trauma. Others fled violence, genocide, civil war. Some came from Eastern Europe, others from Asia and African nations. Many also have come from South America, most crossing the border with Mexico without papers at some point in their past. They can only work at the hospital or neighborhood clinics if they have since secured work permits, green cards, or citizenship.

In total, Environmental Services boasts employees from 30 different nations, making it the most diverse department in the healthcare system. What they all have in common is finding a stepping-stone, an opportunity at EVS to build a better life for themselves and their loved ones.

Alisha Barker is the charge nurse in the medical ICU. The MICU takes the sickest of the sick, and during the pandemic became the COVID-19 unit. EVS plays a fundamental role at the MICU, Barker explains.

Alisha: They are on the frontline. They're handling a lot of . . . they're emptying the trash, whereas I can't tell you . . . I throw all kinds of gross stuff in those garbages or the linens. It's incredible. I mean, I have just a great sense of respect for the EVS personnel. I mean, they make our jobs possible.

I'm so grateful when if we have a very sick patient, and we're doing all kinds of things in the room, and we're filling up the trash cans, and opening packages, and frantically working and your garbage can gets full and then you start to have to throw things on the floor, most of the time they're very aware of which rooms are busy and they will come and get the trash for you. Just that simple task is huge to making our job easier.

Stephen: While to some staff and visitors EVS technicians are invisible, for others, there are opportunities to forge relationships, discover commonalities, even if language isn't one of them. Barker found common ground with one EVS employee from Ethiopia, Simret Hagos.

Alisha: She's from Africa, and we talk about kids. We show each other . . . she shows me pictures. I show her pictures of ours. So we have that connection.

Stephen: Hagos' nickname is Mimi, one that her dad gave her. The 35-year-old was born in Addis Ababa, Ethiopia. When she was 19, family and friends brought her over to the United States. She came to the U.S. to help her family back home and to get to grips with the English language.

Mimi: Just to learn the language, and to get a job, and to work, and to help my family.

Stephen: Her father passed away. She supports her mother, she says, and her siblings in Ethiopia. That role has necessitated getting a second job as a cashier at a big-box store.

Mimi: My mom, she no work no more. I'm the one helping her. But my sister . . . I have a younger sister and younger brother. They live in my country. They go to the university, and I'm the one who helps them.

Stephen: She started working for EVS in 2008 in the hospital emergency department. She did nighttime shifts, which proved challenging.

Mimi: So when I came in the night, I have to clean every OR detail, like the ceiling, the walls, the trash, the table, everything, sweep them up.

Stephen: A lot of blood.

Mimi: A lot of blood I have to clean. I just don't touch the instrument, but I have to clean everything. I think I have three ORs every night I come in.

There is a lot of blood, especially I remember room 16 or 14. It's a big room because that room is for heart surgery. It takes a long time. So when they finish, they have a lot of blood we have to clean. So it takes you a long time than in other ORs.

Stephen: She reserves a deep passion for the staff at the Medical ICU from which she was reassigned over a year ago.

Mimi: Oh, I really miss . . . I can't even . . . I don't know. Working in MICU is really good. That's like my second home. I really love MICU. I don't know how to say thanks to them, the doctors, the nurses, the manager, the nurse manager, and the physical therapy, the pharmacy, the CNA, the hack. Everybody loved me crazy and I love them crazy.

Stephen: The Roman god Janus was the keeper of the keys, a two-faced deity who marks beginnings, endings, and doorways. The word janitor finds its roots in Janus, someone who guards entrances and, metaphorically, keeps the keys to the kingdom. A custodian performs a similar duty guarding, cleaning, and protecting access points, record, stores, and individuals.

At University Hospital, with the advent of the COVID-19 pandemic, Mimi and her fellow keepers of the keys found themselves thrust onto the frontline with critical care nursing staff and providers, medical specialists who have vast tracks of knowledge to draw upon when it comes to understanding the virus they face. But for EVS stuff, some rely on more abstract notions to keep them safe.

Mimi: It's not new training. But when COVID came in, I have to be careful. The training is the same.

Stephen: Were you concerned or worried about it?

Mimi: I worried too much because I say, "I'm the one cleaning COVID room in ED." I'm really scared when I clean the room. But I leave it to God.

Stephen: Over time, she's got used to it a little.

Mimi: Yeah. When I clean those rooms, I'm stressed. Stressful, because I'm thinking, "Oh, while I'm cleaning, I know I'll be careful, but you don't know sometimes what's going to happen." So maybe I'm going to have these COVID, but right now no. But when they start, I was so scared, but right now it's okay.

Stephen: They are essential workers without whom the very fundamentals of hospital care simply could not continue. They weren't always seen this way, however.

Man: Despite the temporary imposition of martial law, the Shah's new government appears determined to press ahead with liberal reform.

Man: University students demonstrating in Tehran shouting, "Death to the Shah," pledged allegiance to the Islamic movement of the ayatollahs.

Man: The number of killed in Tehran since the beginning of the month is probably well over 100. But people in this crowd were saying and believing 7,000 have been killed. Emotions over the . . .

Stephen: 1979, the Shah of Iran had fled abroad, leaving his supporters to their fate as a brutal coup swept away the former regime. For University of Utah foreign student [Abbas 00:15:22] Bakhsheshy, overnight he had been severed from his past and his country. Over 11,000 kilometers away in Salt Lake City, Utah, he felt alone in the world. Shy, timid, and extremely introverted, he nevertheless had to find work if he was to eat. That first job was washing pots and pans at a kitchen in University Hospital.

Abbas: If you think that dishwashing is as noble as it is, it's not something that anyone wishes to pursue as a career. Dishwashing is actually a promotion to pot washing.

So I remember that the very first day that I was washing pots and pans and my skin was red and my fingernails were so soft, I really decided that this is not the life for me. I had a difficult time. I was shy, bashful, timid. So I was really incredibly devastated. I didn't know how to go about living in this country and I missed my parents.

Stephen: His colleagues in the kitchen saw how hard he was struggling, one in particular.

Abbas: More than anything else, I remember the very gentleman who taught me how to wash pots and pans. His name was Kurt, that had so much patience, and so much love and care. He was telling me how important it is to fill out this massive metal sink, put certain amount of chemicals in there, make sure that the temperature is the right temperature, and make sure to let all these pots and pans be soaked before you actually get in there and try to clean them. I still remember to this day that he told me, "If you do the job right the first time, you do not have to redo it."

Stephen: They taught him a lesson that stayed with him all his life.

Abbas: It's the pride and satisfaction that you take in achieving those series of goals that happened to be your responsibility.

Stephen: Not only did he learn valuable life lessons in the kitchen, Bakhsheshy also found a support system among his colleagues.

Abbas: Those were truly genuinely my heroes because they're the ones that supported me. They stood by me. They tried to coach and mentor me so that I did not end up doing something drastic, such as ending my life.

Stephen: For the next four years, he worked his way up the ladder with the help of his new friends.

Abbas: So because of the kindness, empathy, compassion, and love of these individuals, I was promoted from pot washer to the dishwasher, to working on tray line when you put food together and send to patient. Then I became team leader. I became assistant supervisor, supervisor, manager, assistant director, associate director.

Stephen: Until finally, in 1983, he took over the newly named Environmental Services. The department had struggled with high staff turnover for years.

Abbas: The perception came from the fact that these are the lowest paid individuals, the perception that these are not important people. They're a dime a dozen. They're expendable. They come and go.

Stephen: Bakhsheshy knew he needed to change the culture at EVS and how employees felt about their work. To do that, he used the lessons he'd learned in the kitchen.

Abbas: At that time, it was like a revolving door. People would come and people would go. It's not a glorious job. People don't want to stick with it unless you develop some sort of pride in what they do. You give them meaning associated with that contribution. You give them the feeling that you are as important as a physician, as a hospital administrator. Once they find meaning associated with their contribution, they become inspired. They become motivated.

Stephen: Since the majority of his employees did not graduate high school, he sought to educate them in air quality, hygiene, safety, cleaning supplies. In essence: why when it came to removing germs and bacteria, that job mattered so much. And then to further support his own staff, he set up a coaching and mentoring team to provide additional training on the job. He hammered home, "If you get the job right the first time, then you don't get called back."

Abbas: So, if you do the job right in the first place, you do not have to receive a call from a nurse manager or from a supervisor to say, "This room was not vacuumed properly," or, "These equipment are not cleaned properly, so come and redo it."

Stephen: Which brings us to 10 coins. Every morning, Bakhsheshy would put 10 quarters in his left trouser pocket. Those coins were there to remind him, as he walked around the hospital, to look for 10 employees living up to the hopes he had had for all his staff.

Abbas: And the moment I will see one of the employees doing something nice for another employee, or a patient looking confused trying to find a particular location and this custodian put the vacuum aside and says, "Sir/Ma'am, can I help you? Which department are you looking for?" and then he or she would take that visitor or that patient to the right floor, to the right room, after that I would go and tell him, "Thank you very much for going out of your way to help patients and visitors."

Stephen: And he would move a coin to his other pocket, one coin for each act of generosity, kindness, thoughtfulness, and caring. And each night, he put the coins on the table and he'd sit down in his office and write 10 thank you letters to the loved ones of the employees that he had seen do a good deed that day.

Abbas: But then I also wanted their wife, husband, children, and others to know that his wife or her husband is such a wonderful contributor to the overall wellbeing of . . . and I will say, "Thank you for supporting him. Thank you," because I felt that the moment they go home, they could be hero in the eyes of their wife, husband, children, others. As a matter of fact, employees would tell me that this is much more significant than anything else that we have done for them.

Stephen: By 1990, employee turnover had shrunk.

Abbas: Our turnover dropped dramatically. I believe, in less than four years, our turnover from somewhere between 60% to 70% dropped to about 10% to 15%. And that 10% to 15% were mostly associated with being promoted to different position within the same institution, outside of the department. So it was really significant.

Stephen: And they were no longer invisible. The evidence for that is on a wall adorned with citations and awards in Bakhsheshy's office in the David Eccles School of Business. The dapper professor, folded handkerchief peeking out of his jacket lapel pocket, singles out one photograph as one of his most meaningful achievements: 200 people from 30 different races smile up at the camera that April 1990 afternoon, the white borders of the image covered in signatures of his former employees. That was the day Environmental Services was named best department in University of Utah Health Sciences Center for "its loyal and dedicated service."

Among those upturned faces on Bakhsheshy's wall is Connie Becerril. Then a supervisor, 30 years on, Becerril is about to retire after almost half a century in Environmental Services. It's a department that different disciplines of which still fascinates her, as it did when she began.

Connie: You weren't just in radiology, you weren't just in maternity, and you weren't just in an intensive care unit. You became an integral part and a requirement to know everyone's purpose within the hospital. So that's what intrigued me and I stayed with it.

Stephen: Ask her why she stayed so long in one profession, one department, and she says that it's because of the people she's worked with. They matter to her as they matter to the hospital, which is why she gets upset when she hears people using the word housekeeping to describe her employees.

Connie: So we have continued to evolve. Matter of fact, no one in my organization is permitted to use the word housekeeping. They know that very well in front of me. If they do, they owe me a dollar. If anybody uses the word housekeeping, they are to pay a dollar. It goes into a fund for the custodians.

Stephen: There's so much more than that, she says.

Connie: A housekeeper may be someone that you hire to come to your home to help you do the dishes, and clean the dirty bathroom, and vacuum a carpet. They do much more than that in Environmental Services. They go hand in hand with our medical team. The medical team may be eliminating bacteria/organisms that live internally, and our Environmental Services staff eliminate those bacteria and infections that are in the environment. They manage the environment. If we don't do well, then our physicians and our nursing staff aren't able to do their best either.

Stephen: She sees her department much as Bakhsheshy did: as a stepping-stone for those who want to advance, as well as a place to build new lives. Some, she knows, were highly educated, white-collar workers in their home countries, but the United States government doesn't always recognize their educational credentials. Others found the work a stepping-stone into medicine.

Connie: I've actually had people who have come in and are now nurses. I have one gentleman that went on to be a doctor.

Stephen: Becerril has worked hard to modernize her department. Four years ago, she secured funding for eight ultraviolet cleaning robots to help support her staff, a squadron of machines she calls her R2-D2s.

Connie: The robot can actually . . . the UV light, it breaks down any residual. It is probably the final piece when you're cleaning and turning over a discharge room.

Stephen: Imagine a tall cylindrical robot that spins out purple beams hazardous to life. It's locked away inside a patient room, zapping proteins and bugs after an EVS employee has finished cleaning it post-discharge of the patient.

Connie: So the robots were our last piece of defense to ensure that we were not exposing the environment to harsh chemicals, something that could cause other people to be sick. And it has been championed by all of our medical pathologists throughout the country and outside of our country, and so . . .

Stephen: For all the hardware she's managed to secure to bring EVS into the 21st century, it's her people that she's proudest of, like Lynette Nelson. Nelson grew up in Gary, Indiana, and came to Utah when she was 21 to find work. Seventeen years ago, Becerril hired Nelson to join her staff of frontline workers. One patient was so moved by Nelson's attentive, caring manner, a family donated money to the university in her name.

Lynette: The donation was I took care of a patient, a mom patient in the family. I guess they really liked me. And then Connie said, "Lynette, you got a donation from that family." So, yeah, I felt pretty proud, but I'm not a bragger or nothing. I don't know. It wasn't talked . . .

Stephen: Becerril identifies something crucial in that story when it comes to understanding the impact EVS has on the hospital.

Connie: She made such an impression on them, was such a kind soul. She's just a sweet girl. She was very genuine. She would do whatever it took to make them happy. And she took time out of her day to talk to the patient.

I think that's what many people don't understand, is that the patient in, I would say, a very, very high percentage has more of a connection with the person that's cleaning their room than they do with the care provider. They see that person every day. That person speaks to them every day. They sometimes tell them things that they would not tell their nurse.

Stephen: If Nelson epitomizes the idea of how employees in EVS fulfill Bakhsheshy's philosophy of always trying to do more, then Jacobo Lucero is, in many ways, the nightly living embodiment of that gift.

More often than not, when employees of University Hospital use the stairwell in the late afternoon or evening, they'll hear a voice that belongs more in a church or a cathedral than in such a utilitarian space as a stairwell.

Jacobo: [singing]

Stephen: For many nurses and other carers in the hospital, Lucero provides a moment of respite, even solace, during difficult times. He offers them spiritual care in his own anonymous church as he sweeps and mops the floor. Charge nurse Alisha Barker finds Lucero's voice almost bewitching.

Alisha: It's just an escape and it's calming. And he just has a beautiful voice. I've tried to make eye contact with him and to be friendly with him. You walk by and he's very closed off. And he'll stop singing and you walk by and you're like, "No, keep going. Hi. I can't tell you how much I love your singing and how much it helps me."

Stephen: Lucero has never had a singing class. He laughs at the idea. In Guatemala, he sang popular songs by Latin American artists for his own amusement. In Utah, he found a church on North Temple that he liked, and it was there he sang for the congregation with a guitarist from Honduras. He sings, he says, to relax. He finds peace in his singing. That's because he's singing to someone else.

Interpreter: To sing, for me, is to communicate with God. For me, one has to worship God all the time. Even if I'm sad and I'm with someone, I still have to praise God because that is my responsibility as a good Christian. Thus, "What's it worth?" the Lord says. That you have to praise him all the time, in time of illness, in time of poverty, in time of prosperity. And singing is a way to praise him.

Stephen: Praising God through his singing, he says, brings him a sense of freedom.

Interpreter: And when one sings where the spirit of God is, there is freedom. If someone can't sing, it's because he isn't free. The enemy doesn't want him to sing. The devil has him tied up so he can't sing.

Stephen: So you're expressing . . .

Interpreter: The freedom that God gives me.

Stephen: In the months since the pandemic has taken an ever-tighter grip of the University Hospital and its critical care staff, his songs of compassion and love have created their own oasis in this otherwise nondescript stairwell.

If Lucero sings to his God, he's also singing for God's people. In this echoing chamber of steps connecting one lifesaving floor to another, he treats wounded hearts, offering no more than the precious, priceless gift of his melodic balm.

Jacobo: [singing]

Mitch: Next time on Clinical, we revisit the self-described maverick, Jessica Rivera, and share her journey to becoming a director of the many teams at the University of Utah Health clinics and explore not only Environmental Services' response to the COVID-19 pandemic, but also how the managers are balancing not only being caretakers for the hospital, but how they care for the workers that they're responsible for. Join us next time for A Bushel and a Peck.

Clinical is part of The Scope Presents network and brought to you by University of Utah Health. If you liked what you heard, please be sure to subscribe and share with your friends. And if you haven't yet, why not give us a rating on Stitcher or Apple Podcasts?

And to all of our doctors, nurses, admins, interpreters, operators, technicians, and all the other hospital employees out there, we know you're listening. Do you have a story that you would like to share with us? A message to the workers that you've heard about today? Feel free to reach out to our listener line by calling 1-601-55SCOPE. Again, that's 1-601-55SCOPE. Or email us at hello@thescoperadio.com.

Clinical is produced by me, Mitch Sears, and Stephen Dark. A very special thanks to Francisco Soto and Interpreter Services for providing translation and voice acting for this episode.

Music by Bottega Baltazar, Vortex, Giants & Pilgrims, Ian Post, Muted Artist, Nadav Coehn, and Ziv Moran. Audio news clips from PBS NewsHour, C-SPAN, and the American Archive of Public Broadcasting.

And of course, a heartfelt thanks to the men and women who have shared their stories with all of us and work to this very day to keep each and every one of us safe.

Interviewer: Lawnmower safety from an emergency room physician's perspective, that's next on The Scope.

Announcer: This is From the Front Lines with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: It's that time of year when you get the lawnmower out, and maybe this is even going to be the year where you let your kids mow the lawn for the first time. I know it's kind of like a transition into adulthood. But, you should really think about lawnmower safety. We're going to find out more about that right now from Dr. Troy Madsen. He's an emergency room physician at University of Utah Health.

I think most of us hear lawnmower safety and go, oh we're being safe. But, there are actually a couple of things that could surprise you. I'd also like to get your thoughts on what are some of the more common things that you see so people can avoid them.

Dr. Madsen: Sure. Yeah, you're exactly right. I think we all think well as long as I turn the lawnmower off I'm fine. I can adjust it. I can adjust the wheel height. I can get some lawn out from the blade that's stuck there. This is one of these things where it is a little bit deceptive. I have seen cases of this. It's rare, but we've talked about snowblowers before and snow getting stuck in there and someone sticking their hand in there and the blade taking off a finger. Same things happen with lawnmowers.

Sometimes you can get that lawn that'll build up in there, maybe some wet lawn, long grass that's built up around the blade. You reach in there to try and pull that grass out and that blade will flip even though the motor is off, it's not running. I have seen cases where it at least cuts the finger or takes a finger off. That's one of these things that's surprising where we think, "Hey, I know what to do," but it still happens.

Interviewer: Yeah. What are some other things that you would say about lawnmower safety especially . . . I mean I think we need to think about it a little differently if we're having our kids mow the lawn for the first time from the perspective that we kind of take all these safety things for granted. We have to teach them to kids.

Dr. Madsen: Sure, yeah. I think first of all before you get the lawnmower out it's worth getting it checked out. At least look over it yourself. Make sure all the nuts and bolts are tightened down, that a blade's not going to flip off or anything crazy like that.

Then, with kids, you've got to think about leg protection. You can have rocks that flip up from lawnmowers hit you in the leg. It can cause issues. You've got to think about eye protection as well, maybe stuff that we even don't pay too much attention to when we're doing it ourselves. It's your kid. Make sure you're careful there. There's always a potential for eye injuries, leg injuries, things like that.

Interviewer: I think another good thing maybe is just, besides what you said where that blade can flip back, never ever leave a lawnmower running and go in to do any sorts of adjustments like adjusting the height of the lawnmower platform or anything like that.

Dr. Madsen: Yeah, that's exactly right. It can be deceptive. Someone might see some parts of the lawnmower that look like there's no contact with a blade there. They might kind of reach under adjusting a wheel height and have something hit their hand. You've got to make sure you're careful there.

Again, I think the most common thing would be rocks and things like that that get flipped by the blade that may hit a person in the leg, maybe stuff that kicks up and gets in their eye. The uncommon thing, kind of the crazy thing we see, is some of these finger injuries that occasionally come in after trying to reach under there even with the mower off.

Interviewer: Yeah, and also probably supervise even though you're teaching responsibility, because I've seen some YouTube videos of people doing things with lawnmowers that you wouldn't . . . kids explore. They want to try and see what it would look like for themselves. It could be very dangerous.

Dr. Madsen: Oh, it can be. I don't know, as a kid, I remember mowing the lawn. I don't know how many sprinkler heads I hit. You probably want to supervise just for that reason alone. Look for some rocks around the yard. Make sure all that stuff's out of the way before you send your kid out there.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

Interviewer: Don't let that helmet make you think you're invincible. We'll talk about that next on The Scope.

Announcer: This is from The Frontlines with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah Health and helmets are good. They can definitely protect you from a lot of injuries, but don't let them make you think you're invincible because there's a lot of other injuries helmets can't protect against that Dr. Madsen will see in the emergency room. Let's talk about that. Whether you're riding a bike or on a four-wheeler what are some of the not helmet related things that you see?

Dr. Madsen: Well, first of all, to address the myth with helmets because I've heard someone say this and this was a police officer who came in to the ER after an accident on his motorcycle, not while he was in his role as a police officer, he wasn't wearing a helmet and people are saying to him, "Why weren't you wearing your helmet? You've got bleeding in your head?"

Interviewer: Yeah, like of all people, you would think this guy . . .

Dr. Madsen: Of all people, yeah. And he said, "Well, the reason I didn't wear a helmet," he said, "because I figured the difference between wearing a helmet and not wearing a helmet on a motorcycle was the difference between an open casket funeral and a closed casket funeral" So first of all, that's a myth. Helmets are not going to just, you know, you're not going to die regardless. Helmets are going to make a huge difference for this guy. He could have avoided bleeding in his head.

Interviewer: A lot of times it can make the difference between whether you walk out of the ER that day or . . .

Dr. Madsen: Oh, absolutely.

Interviewer: Or not that day.

Dr. Madsen: With the helmet on, he would have walked out of the ER. As it was, he was admitted for several days, things turn out okay. So that's probably the first thing to address but it is absolutely true that helmets, on the other hand, do not make you invincible. People with helmets on can still have severe head injuries. You figure it's just some plastic and some cushion around your head, some padding, you can still have severe head injuries. You can absolutely have severe injuries. It's not covering your face so we'd absolutely see those things.

Interviewer: So the important thing is to not think, "Well, I've got my helmet so I'm okay. So I can try some crazy stuff."

Dr. Madsen: Exactly.

Interviewer: It's really, "I should still be careful and prudent." Plus also other injuries, right? That helmet's not going to protect your neck.

Dr. Madsen: Oh, no. Helmet's not going to do anything at all for your neck and cervical spine injuries, neck injuries are one of the also much more serious things we see along with severe head injuries but a helmet will do absolutely nothing to protect your neck. If you come down on your head, you're still going to have that same impact potentially fracturing vertebrae in there, causing spinal cord injury so you're not protected there at all.

Interviewer: What are some other injuries that you see, you know, from helmet related activities that helmets don't protect against?

Dr. Madsen: Well, they're the orthopedic injuries and that's, again, probably the most common thing we see in the ER from bicycles, motorcycles, four-wheelers, horses, you know, all these things where people have helmets on. People will come down and they'll catch themselves. They're not landing on their head. Maybe that's the secondary impact as their head hits the ground but they'll have a forearm fracture, ankle fractures, and knee injuries, ligament injuries.

And then of course, cuts, scrapes, all those sorts of things that happen as well. Helmets do absolutely nothing for that besides, like you said, maybe they make you feel a little more invincible, maybe you'd take some risks that makes you more prone to those things.

Interviewer: And it sounds like what you're saying is you should wear other safety gear other than just the helmet. The helmet has been the thing that's been promoted a lot but like if you're on a motorcycle, wear other stuff.

Dr. Madsen: Exactly. Yeah, I think most motorcyclists . . . I'm not a motorcyclist, but most of them talk to me about wearing their leathers and it seems like that makes a difference. Some guys have come saying they slid for 60 feet, separated from their bike, they'll come in with some road rash but otherwise, okay. And they said it scraped all the way through the leather but obviously, without that, they would have been in much worse shape. So there's definitely other stuff you can wear but definitely don't make that helmet feel like other stuff is not going to happen.

Interviewer: What's your advice to anybody that's participating in activity where a helmet is required along with maybe some other safety equipment?

Dr. Madsen: I mean, my advice and it's maybe wear the helmet to protect yourself from the bad stuff but also don't take risks you won't take without a helmet. It's there if you need it. But you don't want to have that helmet then raising your threshold for what you're willing to do simply thinking, "Hey, this helmet is going to protect me if I go at a higher speed or if I take this jump on my bike," or whatever it might be. If you won't do it without a helmet, don't do it with the helmet.

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Dr. Gellner: Playground politics, how to help your child build social and emotional skills to help solve their own issues when things get out of control is today's topic on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Face it, kids love playgrounds, and we as parents love them to play on playgrounds because it makes them expend energy and get tired. What happens when kids meet other kids on the playground and it turns into a battlefield? The good news is, you as parents can help your child learn skills to help with just these situations. Say your child comes to you and tells you the other kids won't let them play, or that another child is calling them names. You get mad, but you can't let your child see that you're doing that because you, as the adult, need to be the voice of reason.

The first thing to do is to teach your child empathy. Empathy helps children understand, or feel, what another person is feeling by putting themselves in the other person's shoes. Empathy can help create self-awareness that allows children to differentiate their feelings from the feelings of others. The most powerful way to encourage empathy is to show them how to do it. If your child is hurt or disappointed, you could say, "You sound very sad about that," or, "Please tell me more about what happened."

Next comes the emotional management, which is basically temper control. Teach your child to talk to themselves in a quiet voice. If they're mad, that voice can say, "I need to take three deep breaths before I do something I shouldn't." If they're sad, that voice can say, "I'm not going to let what that child said or did get to me."

The last part is problem solving. Once something happens and your child comes to you, let them tell their story so that they're heard. Ask them how that made them feel, ask them what they want to happen, and ask them to give you two or three ideas on how to get what they want. Finally, ask them what they're going to actually do about the situation, and have them also think, what would they do next time? So they're prepared, and can address the situation themselves if it happens again, which you know it will.

Managing social dynamics when there are several children other than your own involved can be very stressful for both children and their parents. Teaching your child these social-emotional skills can help children de-escalate a conflict, advocate for themselves, and find more acceptable, safe and socially appropriate ways of getting their needs met when they may be feeling bullied or dismissed.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Are you struggling with the decision whether or not you should let your kids play sports because of the danger of concussion? Dr. Greg Hawryluk is a concussion expert and neurosurgeon. Give us your perspective.

Dr. Hawryluk: The first point is that we don't want people to be overly concerned about concussion. There are so many benefits to sporting activities. We're seeing very high rates of childhood obesity. Sports are good for you. We don't want people being pulled out because of fear of concussion.

The second point is that we really want to encourage players to respect their own bodies and the bodies of their competitors. We don't want them using their heads as a battering ram. They need to be using proper tackling technique.

The third point is we really want the coaching staff to have the proper training and experience where they can recognize concussion, they understand the importance of it, and so they know how to take the right steps if concussion happens to one of their athletes.

updated: June 10, 2021
originally published: April 18, 2019

Dr. Jones: Both sexting and Internet safety are increasing concerns for parents of adolescents. I'm Dr. Kyle Bradford Jones, a Family Physician at the University of Utah. We'll find out why, coming up next on The Scope.

Announcer: Medical News and Research, from the University Utah Physicians and Specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: Every year, the CS Mott Children's Hospital at the University of Michigan in Ann Arbor performs a poll of adults on the biggest concerns they have for children in the United States. The results of the survey this year showed that there are two topics that increased in rankings much more than any other: sexting and Internet safety. So what is sexting? This is basically sending any sexually explicit messages, which may or may not include sexually related photos, over text or over the Internet. So you can see how this adds a new element to the sexual experience for adolescents.

Now, there have been multiple studies that have looked at this. From a public health perspective, it's estimated from 7-31% of adolescents engage in sexting. But many of the studies have found multiple negatives from this. First of all, adolescents are more likely to engage in riskier sexual behaviors if they participate in sexting. This means more partners, more unprotected sex, which leads to more sexually transmitted infections and unwanted teen pregnancies. It also decreases the age at which they become sexually active, which can then worsen the other risky behaviors that we just mentioned.

Another negative about sexting is that it increases the likelihood of an adolescent using both legal and illegal substances, such as alcohol, drugs, etc. There is also the increased likelihood that adolescents will have low self-esteem and this contributes to emotional confusion in relationships, not only in the short term but can set them up for that for the rest of their lives. There's also the risk that any explicit pictures or messages can make it online in a public forum if a relationship goes poorly.

Now, sexting goes right along with Internet safety, which has many of the same concerns. So a lot of this concern over Internet safety has to do with inappropriate relationships, whether sexual or otherwise. Adolescents then spend too much time on other things on the computer, which can lead to poor socialization and even an increase in obesity.

A few things to watch for in your adolescent. Maybe lots of computer use in a private place, such as their bedroom and when you go to talk to them or check in on them, they might be trying to hide something. Another thing is poor social relationships with friends. So that they mainly have connections with Internet acquaintances they may be more willing to share personal info with. Another thing is obsessions with certain celebrities that may provide a poor example of sexuality and what is considered normal and so that is one thing to keep an eye on, on whom their role models are.

So in summary, sexting and Internet safety are increasing worries for parents and have many public health consequences. The best ways to get help and to get around this are to talk with your children about this so they understand your concerns and know that they can come to you when needed.

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Interviewer: You step outside for 30 seconds, you come in and your body is covered with mosquito bites. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking to Dr. Kirtly Parker Jones. She is the expert in all things woman, and she is going to tell me why my mom, when she steps outside, is a mosquito magnet, but I'm totally fine. I'm assuming it has to do with blood type.

Dr. Jones: Well, it's a complicated question, but let's get to the normal part.

Interviewer: Yes, is this normal?

Dr. Jones: Remember, we've decided in medicine that something that happens to less than 5% of the population is not normal so if it's something that happens to more than 5% of the population is normal. Twenty percent of people, one out of five, are mosquito magnets so we're normal.

Interviewer: So we're normal people. So I'm not normal, then.

Dr. Jones: No, you're part of the 80% so it's normal to be a mosquito magnet and to not be a mosquito magnet. Now, I am a mosquito magnet and it ticks me off. Here are some of the things that mosquitos like. First of all, mosquitos can find you from 160 feet away. They can find you by the carbon dioxide that you emit. People who emit more carbon dioxide, people who are exercising and pregnant women, those are the triggers for mosquitos to come and find you. So more carbon dioxide can attract mosquitos.

Now, people who are mosquito magnets can just be sitting there and not breathing too much, drinking beer . . . guys drink beer, they sit outside, they get mosquito bites. It turns out that mosquitos would prefer somebody who drank beer because they must be smelling the beer.

Interviewer: That's so interesting to me.

Dr. Jones: You know how you can smell beer on a guy.

Interviewer: Yeah, okay.

Dr. Jones: Also, we do know that people who are O blood type. So, how mosquitos can tell O blood types from other blood types, but O blood types are more likely to get mosquito bites. There are some other things too that people are looking into. Now, this is big business. You can bet that the Off people, the people who make mosquito repellant, are very interested in trying to figure out why some people get bitten and some people don't and coming up with some answers with what we might put on ourselves.

It's important to know that mosquitos like some colors too. They are more attracted to dark colors or bright colors.

Interviewer: Oh, like skin? Are you talking about skin color?

Dr. Jones: Well, skin color, but colors that you wear. Remember, they're seeing you from 100 feet away. They say, "There's red," or, "There's black," or, "There's blue; let's go over there." If you're covered in white, they're less likely to bite you. So we don't know all the answers that make people into mosquito magnets, and there probably are hormones or steroids or scents that we don't know about yet, but one in five people get more bites than others.

Now, getting a bite is also a function of how you respond to it. Some people get a bite and it's a tiny, little round thing, and some people get a bite and it's a great, big welt. It could be that the people with the little, tiny round thing are getting as many bites, but they don't have the same kind of immune response to the bite.

Interviewer: So it's not so much the mosquito bite, it's how you react to it.

Dr. Jones: Right. Remember, the mosquito is doing this really cool thing. First of all, there are only girl mosquitos. Only girl mosquitos do the biting because they need a blood meal for their eggs. Mosquitos insert a little chemical that makes blood flow more easily, but that chemical causes a little irritation. They want to put in a little anticoagulant so they can suck your blood, but sometimes there's an immune response to that. Some people have a bigger response than others.

So yes, you are normal if you're a mosquito magnet. I'm glad to say, as a mosquito magnet that I'm normal, but I'm ticked off. Is it my blood type? No, I'm type A. Is it my exercise? No, I don't exercise that much, just enough, and it's usually inside. Is it my beer? I don't drink beer. Is it my perfume? It could be, but I get it when I'm coming out of the lake. So I'm not exactly sure why, but I do know what to do about it. And that is I cover up in light clothing. If I'm in an area where West Nile fever is a big deal, I might use DEET, but normally I usually just cover up. There are many new products on the market to help people, which aren't DEET, decrease the chance of getting bitten. So, for the one in five of you listening who is a mosquito magnet, so sorry for you. Wear white and cover up.

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Interviewer: Dehydration. When should you really worry? We'll talk about that next with Dr. Scott Youngquist on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: In the summer months you hear a lot about dehydration, and I've actually even heard that when you're thirsty it's too late. You're already dehydrated. So we're going to talk about that and other things about dehydration with Dr. Scott Youngquist. He's an emergency room physician at University of Utah Health Care. First of all, is there any truth to that, "When you're thirsty it's too late?" I'm already dehydrated?

Dr. Youngquist: There's some truth to that. That's not way too late, but it's a sign that you are dehydrated. That cotton-mouth, thirsty feeling is your body telling you it's time to get some more water.

Interviewer: I remember when I was younger nobody carried water bottles anywhere. You'd go out on hikes. My dad was a rancher. He'd go out and work all day and never take any water with him. Nowadays, you can't go anywhere without somebody having water. Is that silly or is that actually good?

Dr. Youngquist: That's a good question. One recent study suggested that children, at least, get not enough water during the day. So they're not drinking enough water for their regular needs and probably are going around in a state of constant dehydration.

Interviewer: I think I saw that study. They get a lot of juices and stuff like that but not actual water. Like a lot of kids don't ever drink pure water.

Dr. Youngquist: Yeah, absolutely. And some of those juices that are high in sugar actually cause you to be more dehydrated. So they will cause what's called a diuresis or cause you to urinate more fluids than you actually took in. So they can actually be a negative in terms of overall hydration status. And I think that some of the mild symptoms in kids, that are probably true for adults as well, are feeling tired, lethargic, not able to concentrate. Those may be signs that you are dehydrated.

And most adults like to start their day with a drink of coffee or several coffees during the course of the morning, which is also diuretic. Caffeine is something that causes you to urinate and it's also sort of a negative fluid. In other words, you'll pee out more than you took in with coffee alone.

Interviewer: So on a day-to-day basis, if I'm not necessarily super active or out in the sun working, am I probably not getting enough fluid and dehydrated? And is that a problem?

Dr. Youngquist: Yeah. It's only a problem if it causes impaired function for your day. So if you're feeling, like I said, excessively tired, trouble concentrating, and things like that, you may try drinking water.

Interviewer: So that's interesting. That seems like something I would never consider. I think, "Well, maybe I had too big of a lunch, or I didn't get enough sleep." But it could actually be water.

Dr. Youngquist: Yeah. Water could be a part of it. And a lot of people will get into a cycle of treating that with additional doses of coffee or Diet Coke or something like that. They're actually making their hydration status worse rather than better. So consider taking more water as one possible solution to that feeling you get in the afternoon.

Interviewer: All right, let's go outside for a second. On a 90 degree day, for example, I like to cycle or hike or do something like that. When should I start worrying if I don't have water? Like if I'm doing a ten-mile bike ride and I don't take water with me, is that a problem?

Dr. Youngquist: That's going to vary depending on how much water you had beforehand. So when you start out in the morning, actually, you haven't had anything to drink all night long. If you think about it, even fasted. You haven't had anything to drink. And most of your hydration status is actually come from mobilizing that's in your soft tissues. It's kind of accumulated in your feet and legs during the day through gravity. And that gets reabsorbed back into the vascular space while you're sleeping. But you can quickly become dehydrated in the morning without having enough hydration because of that, and you're actually have just urinated, not taken in any fluids at all.

Interviewer: So on a hike, say a couple miles, if for the most part I'm drinking water and I don't take water on that hike, and it's a hot day and I'm out in the sun for a couple hours, I'm probably going to be fine. It's just getting back to everybody's got water with them at all times.

Dr. Youngquist: Yeah absolutely. So it's going to depend on the duration of exercise, the amount of heat that you're exposed to, and your pre-exercise hydration status.

Interviewer: At what point should I start being concerned as a general rule, if I'm relatively well-hydrated most of the time?

Dr. Youngquist: Well, I'll give you just a general rule of thumb. I would say anything more than a couple of miles, you should probably bring some water.

Interviewer: Okay. And how much water should I be drinking every day? It tends to vary a lot. Like I've heard ten cups. I've heard as much as a gallon. Is there a general rule on that?

Dr. Youngquist: Yeah there is, and I don't know off the top of my head unfortunately, but there is.

Interviewer: Maybe ten cups is a gallon.

Dr. Youngquist: There is a calculation you could do, and you could look this up online, but there are various numbers given for the amount of appropriate fluids. We tend to calculate people's fluids on a maintenance basis when they come into the hospital and have to go without food or water because they're preparing for surgery or something like that. And for an adult we tend to go around 125 to 200 milliliters per hour as a maintenance fluid.

Interviewer: So what does that translate into in ounces then?

Dr. Youngquist: That's somewhere between four to eight ounces. So one half to a whole cup of water per hour is about what your maintenance requirement is.

Interviewer: While I'm awake?

Dr. Youngquist: Yes.

Interviewer: Wow, really? And how much should that increase when I'm exercising?

Dr. Youngquist: So you could probably at least double that when you're exercising. People tend to, instead of maintaining that fluid status, tend to get behind and catch up with a lot of water, and then get behind and catch up. So we don't consume that evenly throughout the course of the day, and it's probably impossible to do so. But that's why we have kidneys. Kidneys are good about conserving water when we need it and getting rid of it when we've got excess.

Interviewer: Can you drink too much?

Dr. Youngquist: You can, certainly. Yeah there's a phenomenon known as "water intoxication." You can get very sick from it. In fact, there have been some high-profile deaths from water consumption contests. There was a famous one, I think in California, where a radio station sponsored a water consumption contest, and I believe it was a female participant died shortly thereafter from water intoxication. So yes, you can drink too much.

Interviewer: But beyond that, I've heard that you could wash out all the good vitamins and minerals if you're drinking too much water. You could flush too much of the good stuff out of your body. Is there any validity to that?

Dr. Youngquist: I don't know about vitamins. It depends on if they're water soluble or not, but yes most of the time if you take supplemental vitamins most of it ends up in your urine anyway, regardless of how much water you take. And that's why you take some B12 vitamins and you'll notice that your urine becomes distinctly kind of dark yellow-orange in color, and it's not because you're suddenly dehydrated. It's because of the concentration of those vitamins.

Interviewer: So as long as you're doing about four to eight ounces, you're good.

Dr. Youngquist: Yeah. On average per hour.

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Interviewer: Did you know that fireworks injuries are actually worse on the 24th of July here in Utah than the 4th of July? We'll explore why and give you some safety tips coming up next on The Scope.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: Brad Wiggins is a nurse manager at University of Utah Healthcare Brun Center. And Brad was telling me that the 24th of July is your worst day of the year for fireworks burns. I find that interesting. Why do you think the 24th?

Brad: I just think here in Utah, the population of people that we have, they celebrate the 24th a lot more readily than they do the 4th of July. The celebrations around both of those, I think people are celebrating the fact that they live in Utah and that they're a part of the history of Utah being in the United States. So I think they take it a little bit more to the extreme sometimes.

Interviewer: Yeah. And what kind of injuries do you see in the Burn Center? Would that surprise people?

Brad: The types of injuries we see and the type of problems we see, number one, in small children, is related to sparklers. Sparklers are very, very dangerous. And probably the most common thing people don't know is that a sparkler burns close to 2,000 degrees. That's as hot as a blown torch. Would you give your two or three or four or five-year-old a blow torch and have them run around with the blow torch?

Interviewer: Like one of those ones you do a copper pipe repair on, would you light that thing up and let them run around waving it in the air?

Brad: And the answer is no. Nobody does that.

Interviewer: No, of course, you wouldn't. But a sparkler is the same thing essentially.

Brad: Yeah, and I think that's the extreme of people thinking about, "Oh, this is just fireworks fun," and it is fireworks fun. And if you ask me if I held this sparkler when I was a kid, absolutely. But now in my profession, I'm a burn professional and I understand the dangers and the risk and I think they really get associated with some very life-changing types of injuries that people just don't take the time to recognize when it comes to sparkler injuries.

Interviewer: When a child comes in with the sparkler injury, what kinds of injuries do you see and how does that affect the rest of their life?

Brad: Sure. A very simple type of injury we see from a sparkler is the fact that they held this sparkler, not on the handle part, that they actually held it where the chemical is that's burning. And the child doesn't know that. They haven't been educated and taught where to hold the sparklers. And it burns down into their tissue of their hand. When it's burning to 2000 degrees, it gives you a third-degree burn in less than a second.

Interviewer: So it's a guaranteed third-degree burn.

Brad: It's a third-degree burn and the only option for third-degree burn is surgical intervention. And the problem is this when a third-degree burn hits the finger or joint, which is where you're holding it because it's your fingers. So wherever you hit on a joint like that, it can actually lend itself to the possibility of amputation of fingers, partial amputation of fingers, skin grafting procedures on those areas and a lifetime of disability of movement of the joints in that area.

Interviewer: So you see sparklers and what are some of the other usual suspects when people come in like, "Oh yup, now there's another one of those."

Brad: Sure, someone trying to hold a firework like a firecracker, that's obviously going to have big ramifications. You can lose fingers from that, things blown right off.

Interviewer: And you've seen this stuff?

Brad: Absolutely, we see that every Summer. Yeah, absolutely.

Interviewer: It must be heartbreaking.

Brad: It is heartbreaking because it's such an easy thing to prevent. I think that in the burn world, we'd like to say about 75% of all the injuries we see in the burn center are preventable injuries. We're starting to see a lot of aerial types of injuries where someone will point in aerial firework at someone goofing around, having fun, maybe they've had some alcoholic beverage and they're enjoying themselves. Or maybe they have one and they're just being goofy and having fun with their friends. But they point them at each other, they're shooting them at each other and they don't know the ramifications. Most clothing catches on fire incredibly easily. You're pointing fireworks at people, you're sitting too close. Sparks can get you, embers can get you and the same goes back to the sparkler thing. Most catastrophic type of injuries we see from sparklers are that you have a child who's holding one and it catches their clothes in fire and no one is with the child when that happened and extinguish them close enough.

Interviewer: Some of these things that you are saying seemed incredible. People's clothes, catching on fire, that sort of thing, but that happens. You see that.

Brad: We see that every week. It's a common occurrence for us. Yeah, flame injury from clothes catching on fire is a huge deal and those are the types of injuries that are catastrophic on a much larger scale. And that's where people forget that your skin is the largest organ of your body. You damage the largest organ of your body significantly with flame and it's dead, the skin is dead, it impacts every other body system. It's the kind of thing that puts you in intensive care unit. It puts you on a breathing machine. It puts you having most likely to have that have some type of skin grafting and surgical intervention. There's a really huge cascade here from the simple concept of buying a sparkler pack at the booth and letting your child run around and play with it.

Interviewer: You're kind of bombing me out. This festive time now all of a sudden sounds like this is a very dangerous time. So let's talk about safety. It sounds like your number one suggestion is to leave it up to the professionals. But people are going to want to do this sort of thing. So what are your big safety tips other than what we've discussed?

Brad: Actually having a conversation about the safety risk. Promote the idea of letting an adult light the firework or have a supervised teaching moment with your child of, "This is how you do it and these are the risks." Not a scare tactic, but really direct communication about, "This is how you light a firework. This is what you want to do. You never want to hold it in your hand. You never want to try to keep it on some part of your body part. You don't want to throw it at someone because it can cause a life-changing injury for them." Let's just watch it and have some fun. We're going to do it the safe way.

Interviewer: Thank you very much. Hopefully, this conversation will reduce your workload on the 24th.

Brad: Yeah, I certainly hope so. And just as another reminder, if you do need our attention and you do need our care here at the Burn Center, we are available for that. And burns is incredibly unique and there are a lot of specialties to be able to do that. We recommend not using a lot of home remedies out there. There are a lot of myths. There are a lot of things you can find out there on the worldwide web that guide you with different directions. So why not. You have an incredible resource here in the State of Utah. We will take care of you. Let us do it for you.

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Dr. Gellner: How do you know if your child is old enough to stay home by themselves? It's a tricky question that we will discuss today. I'm Dr. Cindy Gellner for The Scope.

Announce: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: So how do you know if your child is old enough to stay home alone? Is there an age that's acceptable? Are there laws? The answer to the age and laws is yes. In the state of Utah, there is no age limit. There is no law about when you can keep your child home alone. There is a lot of debate on this topic and each state has different laws and suggested guidelines.

Not long ago, may preteens started babysitting younger kids when they were as long as 11 themselves. Kids used to play outside all afternoon until it was dark and not have to really check in. Times have changed over the years. It's not that way anymore. That's for a combination of reasons. It seems to be a scarier world, people are more aware, there are some unsafe situations in neighborhoods. The media has definitely gotten everyone more aware of this.

That means leaving kids alone is not as common as it once was. Age is a factor, but age isn't the only thing to consider. Every child is so different. Some things to consider are: How long will you be gone for? Does your child follow directions? Will they follow the house rules while you're away, like not opening the door for strangers? Are there other kids left home too? How many other kids and how old are they? How safe is your neighborhood? And how safe would your child feel staying home by themselves?

Some guidelines include that children under the age of seven may not be left alone for any period of time, children eight to 10 years may be left alone for about one and a half hours and only during the daylight or evening hours. Children 11 to12 may be left alone for up to three hours during the day, but not late at night. Children ages 13 to 15 may be left unsupervised, but not overnight. Children who are 16 or 17 may be left unsupervised and, in some cases, up to two nights.

Safety tips when your child is home alone include needing to know your full name, their address and telephone number. You should post an emergency list with local and long distance numbers to call in case of emergency to reach family and friends. You may need to let your neighbors know that your child may be home alone if you trust your neighbors to keep an eye on them. You can call your child several times while you're away and make sure they're safe. Make sure your child knows how to lock all the doors and windows and make sure your child knows not to go into other people's homes, including the neighbors without your permission or the neighbor's permission. Designate a safe house to run to if the child feels like he or she is in danger by anyone entering the home.

Teach your child kitchen safety and what is and is not okay when you're not home with them. Before you actually leave your child at home alone, you should review a few more things with your child. Remind them of the house rules. Be specific so there is nothing left unsaid. Remind them about the safety of not answering the phone or door unless it's you, not just someone they think they know, but it has to be you.

You don't want to give them too much information to scare them, but you do need to have an open conversation to make sure that they are comfortable being left alone and you are comfortable leaving them alone. Again, this goes back to is her or she ready. Only you as parents and your child can make these decisions.

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Interviewer: When it comes to things that could be a threat to your eyes, a lot of people don't think of things around the home as a possibility, like construction sites, sure; and maybe athletic events, yes. But around the home there are a lot of dangers to your eyes, and we're going to find out how you can make sure you and your family are safe. We're with Dr. Bill Barlow. He's an ophthalmologist at the Moran Eye Center.
The home is an unlikely place, at least that people think eye injuries can happen, and nothing could be further from the truth. Tell me about that.

Dr. Barlow: When people were surveyed, just a general survey about where they were likely to have an eye injury, less than half of them mentioned the home as a possible place for an eye injury to occur.

Interviewer: Where are the places people think they are happening then?

Dr. Barlow: Well they think they're happening; I'm a construction worker at my worksite, and specific places like that, or paintball.

Interviewer: Sure, yeah.

Dr. Barlow: Gun ranges, things like that, things when they're thinking about risk of injury, and not just eye injury, but other types of injuries.

Interviewer: But home doesn't really cross people's minds, so they get a little lax I'd imagine?

Dr. Barlow: Yeah, home is a place where you take your shoes off, kick your feet up, and you're there to relax, it's safe, it's a comfortable place. You're not thinking of a place that you're comfortable in as a place with potential dangers lurking, so to speak.

Interviewer: Yeah. So what has been your experience with the types of eye injuries that happen around the home?

Dr. Barlow: Eye injuries that happen around the home include exposure to chemicals, cleaning chemicals, making sure that people have good ventilation or eye protection to avoid being exposed to those. People who like to cook, especially with grease or oil that can sometimes splatter and splash up into the eye causing significant burns.

Interviewer: Really? Wow.

Dr. Barlow: People who use curling irons, or other types of heated devices to do their hair or other things that they get around their eyes and their faces, inadvertently will strike the eye and that can cause a burn or a serious injury to the eye.

Interviewer: I guess I never thought about that; that things hot. How hot are those things, 400 or 500 degrees, probably, huh?

Dr. Barlow: I don't know the exact temperature, but yeah, high enough to create a significant burn in a very short period of time.

Interviewer: Yeah, if you make one misstep.

Dr. Barlow: Exactly.

Interviewer: Wow.

Dr. Barlow: So it's important to be thinking of these different things, for children, different toys can become projectile objects very easily if they throw them or things like Nerf Guns where they shoot these soft bullets. But when they're shot at a very high velocity they can cause significant blunt trauma injury to the eyes. So it's important that you're thinking about these things and making sure that your kids are aware of that.
Outdoor activities, such as mowing the lawn, trimming the lawn, anything that's loose debris can become a high projectile, essentially a missile if you will if it's picked up and flipped up towards either the person who's doing the activity, or an innocent observer. So it's important to wear eye protection when you're doing those higher risk activities at home.

Interviewer: I wear glasses; does that qualify as eye protection, or should I have something else?

Dr. Barlow: It's important to have something that wraps around and doesn't leave a lot of open space. So if you wear glasses, getting something that would go over them that wraps around that is ANSI certified. That's A-N, as in Nancy, S-I; that's an acronym for the American National Standards Institute. They have set specific standards based on testing to provide adequate protection in these situations.

Interviewer: All right, so out in the yard, that was one thing that came to mind. Another is I do some woodworking, and I generally wear eye protection, and then I'd imagine you'd really recommend that?

Dr. Barlow: Absolutely, you're hammering on things, especially on hard objects, something happens and you didn't recognize something underneath that wood. You hammer on that nail and it can flip up and become a high velocity missile and again, can strike the eye and cause significant injury, or obviously soft tissue injury to other parts. So it's important to be wearing protection.

Interviewer: What are some of the less common threats around the home that somebody should be aware of that they might not have considered?

Dr. Barlow: Things to think about in terms of less common threats are loose rugs, or sharp edges to furniture, especially if you have children or elderly individuals in the home. They are more likely to become unbalanced, slip and fall. If they hit their face or their eye on one of those objects it can cause a serious injury to the eye. So either creating some way to soften the blow with soft padding on those sharp edges, or tacking down loose rugs so they are not easily tripped over; that can be very important, and it's not something that many people think about.

Interviewer: We talked about some precautions wearing proper eye protection that's certified. Inside, if I'm using cleaners and I'm cleaning the bathroom mirror, do I need to be wearing goggles?

Dr. Barlow: You may not need to wear goggles, but make sure you read the label and know how you're supposed to use that substance and in some cases they may want good ventilation. And some people like to mix chemicals or mix cleansers, and make sure you're not mixing those.

Interviewer: More than just getting it in your eye, the fumes...

Dr. Barlow: Yeah, the fumes can be toxic to any mucous membranes, and the surface of the eyes is a mucous membrane.

Interviewer: Oh, I never think of that.

Dr. Barlow: Also the mouth, and the lungs.

Interviewer: Right.

Dr. Barlow: So if you're inhaling those substances it can be very damaging to those mucous membranes as well. Really avoiding getting them in the eye by wearing eye protection is important. But reading the label and making sure that you're being safe in the way that you're using it and following the directions that they've provided to make it safe.

Interviewer: What should I do if something does happen; say I do get something in my eye? You mentioned a bunch of different scenarios; chemicals, or something that hits the eye. Is it all kind of the same, or are there different procedures?

Dr. Barlow: If you're getting chemicals in the eye, the first and foremost thing to do is to flush the eye, and then you think you're done, to flush it some more. And that's to neutralize any acidic or non-neutral ph substance as quickly as possible to minimize the extent of injury.

Interviewer: Okay.

Dr. Barlow: With other things, of course, if you're struck by a high velocity object it's getting in to be seen by a trained ophthalmologist as soon as possible to have that evaluated and look for any significant injury and have that treated as appropriate based on the injury. Those things require medical attention and evaluation. Obviously the exposure to chemicals does as well, but rinsing and flushing the eye is the first thing you want to do and have somebody else call to make the appointment or make arrangements to get you seen on an emergency basis. But flush the eye and flush it some more to neutralize any non-neutral ph substance that has gotten into the eye.

Interviewer: What about, like you said, trauma or a scratch to the eye? Is there anything I should do other than just call somebody and get in?

Dr. Barlow: In those cases if it's significant trauma, we recommend you take something like a paper cup, cut out the edge and just tape it over the eye to protect it from getting bumped by anything else. That would be the only other thing that I would recommend, and again, it's getting in to be seen to evaluate the eye for injury and determine if it's a blunt injury or a sharp injury and what treatment is needed to try and recover the injury.

Interviewer: What's the threshold though; say I get whacked by something in the eye and it hurts, but I can open my eye, and I can still see. Do I still need to come in?

Dr. Barlow: I would recommend it. If you've been hit by something that's high velocity, you have an irritation, even just a corneal abrasion, there is the risk of developing an infection or other problem associated with that; making sure, particularly if it's vegetable matter, like something that came out of the lawn, there's a little bit higher risk of infection, making sure there are no signs of that, and making sure treatment is instituted to avoid or prevent injury and infection.

Interviewer: So when it comes to your eyes, better safe than sorry.

Dr. Barlow: Better safe than sorry, exactly.

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