Dr. Quigley Presents Crash Course on Low Impact Crashes
Crash Course on Low Impact Car Crashes
- Get practical and reliable information on creating a strong case
- Learn how to properly document low-impact collisions in order win your case
- Discover valuable information about different factors which may affect your client’s condition.
- Gain the knowledge needed to combat misconceptions about speed and collisions, so you can better protect your clients
Dr. Chris Quigley:
All right. Today’s topic is vehicle damage and patient injury. It’s obviously a critical area in the personal injury world. We’re going to review a couple of concepts that we talked about last week, and then we will move into the meat and potatoes. All right.
Dr. Chris Quigley:
The number one thing you need to keep in mind is this concept called momentum. All right? Momentum from a physics perspective is momentum equals mass times velocity. Basically for the rest of the world, the larger something is and the faster it goes, the more energy it has. Pretty common sense.
Dr. Chris Quigley:
There we go. Now, conservation of momentum is a law so it can’t be debated. It’s not up for a justification or validation, is just the way it is, right? The calculated energy going into the collision can and will be accounted for at the outcome.
Dr. Chris Quigley:
Energy into a collision equals the energy coming out. We’ve got a great little diagram here and this sums it up very nicely. We have two units of momentum going into the car that had stopped. It had zero, and now they come out, each having one. Energy going in equals energy coming out.
Dr. Chris Quigley:
Now a crumple zone is a zone of a car that deflects energy upon impact. The purpose of a crumple zone is to increase the amount of time it takes the car to come to a complete stop in comparison to the object it hits. By increasing the time it takes for your car to come to a stop after you hit the object, the force is spread over a longer period.
Dr. Chris Quigley:
And as we talked about before, acceleration is the injury arbiter, the change in velocity. Acceleration is the speeding up, and negative acceleration is slowing down.
Dr. Chris Quigley:
All right, now, let’s get into the references. The issue with this topic is a lot of this research has been done, so there’s not a lot of new research out there. The most recent article we’re going to have is 2006, 2007, because it’s already been handled. We have this quote from a low speed rear impacts and elastic properties of automobiles, 1989 for the Department of Civil Engineering, University of British Columbia. It says, “Experimental results indicate that some vehicles can withstand a reasonable high-speed impact without significant structural damage. The resulting occupant motions are marked by a lag interval followed by a potentially dangerous acceleration up to speeds greater than that, of the vehicle.” All right, that’s a key point, right? When you get, especially in a rear-ender, your head is going to be a multiplier effect when the acceleration happens to the head and the neck. Our view of accident reports indicate that a significant percentage occur with little or no accompanied vehicle damage.
Dr. Chris Quigley:
Here’s a slide. Let’s take a quick look at this. Let’s start in our upper right-hand side. What is that? A Lincoln. All right? Bigger cars and pickup trucks tend to be stiffer than smaller cars. They tend to break at a much higher level. We see that in this research project. This is by the San Diego Spine Research Society. We can see that we have 9.9 miles per hour of Delta V, and no damage to the car, right? The person in that car is going to take a real good whack.
Dr. Chris Quigley:
We see the other vehicles. We have a maximum of 8.6 miles an hour before the car broke in the Chrysler LeBaron. We have the Ford Focus or something like that, 7.2 mile an hour. Then in the Honda, we’re talking 7.2 miles an hour. Again, it creates that multiplier effect onto the spine.
Dr. Chris Quigley:
Continuing from Nevin and Romily, “As the vehicle becomes stiffer, the vehicle damage costs are reduced as less permanent deformation takes place. However, the occupants experience more violent ride, which increases their risk for injury. The average acceleration experienced by the occupant in the elastic, no damaged vehicle, would be approximately twice that of the plastic structurally damaged vehicle,” right? That’s another key concept.
Dr. Chris Quigley:
I’ll read it again, “Acceleration experienced by the occupant in the elastic, no damage vehicle, would be approximately twice that of the plastic structurally damaged vehicle. This theory implies that vehicles which do not sustain damage in low speed impacts, can produce correspondingly higher dynamic loadings on their occupants than those which plastically deform under the same or more severe impact conditions.”
Dr. Chris Quigley:
Now, this is one of the top two or three research articles you want to have in your pocket, dealing in a low impact crash. This is from Robbins Society of Automotive Engineers, they have this article, and it’s great article. Robbins states, “The amount of crush or damage you see by a motor vehicle in a collision is indicative of velocities involved from the stiffness of the motor vehicle and object or objects is no. However, the crush damage does not relate to the expected occupant injury, i.e., the more vehicle damage, the more chance the occupant injured is not a conclusion that can be made. In fact, it is more likely the reverse. If the occupant decelerated over a greater time or distance due to a large crush or resting distance, then the likelihood of injury is reduced.”
Dr. Chris Quigley:
Robbins goes on to say, “It is for this very reason that racing cars, when seen in a collision, almost appear to shed their body structure. The main outside structure of these racing cars is designed to allow for crushing and to dissipate energy in the event of a collision. Here we see heavy vehicle body damage and relatively low occupant injury rates. The body of the racing car is sacrificed to prevent the driver injury or death.”
Dr. Chris Quigley:
Now, my quote is, “In passenger cars, it’s the opposite way around. The body of the occupant is sacrificed to protect the car.” All right?
Dr. Chris Quigley:
We have this thing called the Insurance Institute for Highway Safety, or whatever it is. They rate cars on how well they survive a crash. What they do is they rate the auto insurers and they’ll take that information, and then they take it out and it meets the road when they’re determining your auto insurance rates. If they had a car that doesn’t deform until 10 miles an hour, you get lower injury insurance rates because your car is not going to break as easily.
Dr. Chris Quigley:
“This false reasoning is often applied by insurance adjusters, attorneys, and physicians, and frequently results in costly unjustified litigation. Due to this litigation process, the injured parties often are not compensated resulting in unjustified hardships to the party who has already been injured.”
Dr. Chris Quigley:
Now, Dr. Ruth Jackson here, is a pioneer. She was the first female orthopedic surgeon. She was an orthopedic surgeon but then they came up with the Association for Orthopedic Surgeons and they said they wouldn’t let her in. She had to retake the boards to get into the American Academy of Orthopedic Surgeons. She wrote a book called The Cervical Syndrome, and it still one of the best texts out there as far as spine injuries. We’ll see what Dr. Jackson has to say.
Dr. Chris Quigley:
“The forces which are imposed on the cervical spines of passengers of colliding vehicles are tremendous. If one attempts to calculate mathematically the amount of such forces, the results are unbelievable. The damage to the vehicles and collisions is no indication of the extent of injuries imposed on the passengers. The extent of damage to the vehicles is no way proportional to the extent of damage imposed upon cervical spines of the passengers. ”
Dr. Chris Quigley:
Now, since you work in the [inaudible 00:07:36] world, how many IMEs have you seen or records of review that say, “Oh, the patient had a strain,” right? We’ve all heard that hundreds of times. Dr. Jackson writes in her book that if you have a muscle strain, it’s going to heal in three weeks. If your client has pain after four weeks, by definition, it cannot be a muscle strain. All right? Just good information for her book.
Dr. Chris Quigley:
In Macnab in 1982, “The amount of damage sustained by the car bears little relationship to force applied. To take an extreme example, if the car was stuck in concrete, the damage sustained might be very great, but the occupants would not be injured because the car could not move forward, whereas on ice, the damage to the car would be slight, but the injuries sustained might be severe because of the rapid acceleration permitted”.
Dr. Chris Quigley:
Carrol et. al., 1986, “The amount of damage to the automobile bears little relationship to the force applied to the cervical spine as the occupants. The acceleration of occupant’s head depends upon the force imparted, the moment of inertia of the struck vehicle, and the amount of collapsed force disseminated by the crumpling of the vehicle.”
Dr. Chris Quigley:
Ameis, 1986, “Each accident must be analyzed in its own auto speed and damage are not reliable parameters.”
Dr. Chris Quigley:
Hirsh, et. al., “The amount of damage to the automobile may bear a little relationship to the forces applied to the cervical spine and to the injuries sustained by the cervical spine.”
Dr. Chris Quigley:
Smith, in 1993, “The absence or presence of vehicle damage is not a reliable indicator of injury potential in rear impacts. Based upon the principle of conservation of energy, any energy which does not go into the damage to the vehicle, must be converted into kinetic energy, the source of injuries for the occupant.”
Dr. Chris Quigley:
Nordhoff and Emori, 1996, “Historically insurance claims adjusters have assumed that collision injuries correlate to the vehicle, external structural damage and cost repair. The assumption that injuries relate to the amount of external vehicle damage in all types of crashes has no scientific basis. There is a little correlation between neck injury and vehicle damage in the low speed rear end collision.”
Dr. Chris Quigley:
Parmar and Raymakers, 1993, “There was no relationship between the prognosis and the type of car or the severity of the damage it sustained. Some factors bore no relationship to the prognosis and they included the amount of damage sustained by the vehicle.”
Dr. Chris Quigley:
Sturzenegger. Dr. Sturzenegger has got some great stuff. His quote here today in 1994, “The amount of damage to the automobile and the speed of the cars involved in collision bears little relationship to the injury sustained by the cervical spine. The velocities of the involved vehicles and the extent of car damage are not directly related to the forces acting on the cervical spine.”
Dr. Chris Quigley:
Ryan, et. al., 1994, “No statistically significant associations between crash severity and six months injury status was found. There was no statistically significant relationship between injury status at six months and either measure of crash severity. There was no statistically significant associations between crash severity variables and injury at six months.”
Dr. Chris Quigley:
Dr. Sturzenegger in his next article, 1995, “Attempts to correlate the outcome with the extent of damage to involved cars and their speed has previously shown to be of little prognostic value.”
Dr. Chris Quigley:
All right. Dr. Duffy returns, “The myriad of dynamic variables between occupants and vehicles precludes a definition of change in velocity thresholds.” All right, this was a great article. This is one you should definitely get in your archives. It’s a case report about a whiplash from a low velocity bumper car collision. The patient ended up having surgery, but Dr. Duffy does a great job talking about the whole physics of the situation here, so a great article. You definitely want to have that in your top 10 list. Okay?
Dr. Chris Quigley:
Dr. Gun, “Disability appears unrelated to the severity of the collision. The degree of damage to the vehicle was not a projector of outcome.”
Dr. Chris Quigley:
Poberskin, 2005, “Striking vehicle speeds are not related to the initial VAS scores.” That’s the pain scales. “Striking vehicle speeds are not related to the number of days that the victim will have neck pain. Striking vehicle speeds are not related to neck pain severity initially, or at one year, visual analog scales, at one year. There is little evidence that the severity that of the impact predicts early onset of neck pain or pain at one year.”
Dr. Chris Quigley:
Dr. Poberskin continues, “The myriad of dynamic variables between occupants and vehicle precludes a definition of change in velocity thresholds for neck injury from car collisions. This is something you’ll see in accident reconstruction reports talking about the Delta V wasn’t so bad so it couldn’t cause a problem. Well, Delta V is irrelevant. It’s Delta A, the acceleration, that’s the important one. “In this study, driving a large car and being struck, increases the risk of neck pain. This seems counterintuitive. Large cars are less likely to deform, and therefore more of the energy of the collision was transmitted to the occupants.”
Dr. Chris Quigley:
Rene Cailliet, in his book, Whiplash and Associated Diseases, “Simulated impacts have been studied extensively and essentially confirmed that a low speed impact with minimal and no damage to the impacted vehicle can cause significant musculoskeletal injury to the drivers or occupants head and neck. It has been shown that high speeds are not specifically pertinent in determining the extent of whiplash injuries sustained.”
Dr. Chris Quigley:
Dr. Cailliet continues, “Numerous injuries result from vehicle accidents, even when the impacts are not very big and there’s minimal damage to both vehicles. In many instances, a person experienced whiplash after a vehicle accident has caused little significant damage to either vehicle.”
Dr. Chris Quigley:
Henderson, 2006, “Collisions between motor vehicles and the occupants of those vehicles must conform to Newton’s law of motion. Historically, the argument about injury or likelihood of injury had been the domain of medical experts, albeit without any true scientific evidence on which to base an opinion. A struck vehicle will accelerate forward with or without vehicle damage. This will cause accelerations of the occupant’s head and chest.
Dr. Chris Quigley:
Henderson continues, “Crashes resulting in a change of velocity of 5.97 miles per hour of the struck vehicle cause a 4.7 G acceleration of the occupant’s chest and an 8.3 G acceleration of the occupant’s head,” right? That’s an important one, Matt. Check on that one.
Matt:
Yeah.
Dr. Chris Quigley:
This is your multiplier effect, right? You have 4.7 G acceleration of the chest and an 8.3 acceleration of the occupant’s head. “The difference between the head and chest acceleration is 3.6 Gs. This resulted in the symptoms of strain and headaches. Not all occupants reacted the same manner to the same change velocity. It is my opinion that beyond a speed change of five miles an hour, the risk of injury is high. The risk of injury between three and five miles an hour is a gray area that would need further exploration and injury cannot be ruled out.
Matt:
Right, but six miles an hour is not that bad.
Dr. Chris Quigley:
This is another key article from Dr. Brault. This is one of your, again, top couple. If you look at this Dr. Sigmund here, the third guy on the list here, he is another tremendously productive author. He’s got literally hundreds of articles on the top. All right, Dr. Brault says, “The results, approximately 29% and 38% of the subjects exposed to a four kilometer per hour crash and an eight kilometer speed changes, respectfully experienced whiplash symptoms with cervical symptoms of headaches predominant.” That’s not a lot of speed, right? Four kilometers is 2.49 miles per hour and double that, so five miles an hour for eight kilometers an hour. Objective clinical deficits consistent with whiplash were measured in both men and women, subjects at both four kilometers and eight kilometers per hour. At four kilometers per hour, the duration of symptoms experienced by women was significantly longer when compared with that in men,”
Dr. Chris Quigley:
There were no significant differences in the presence and severity of whiplash between men and women at four and eight kilometers per hour or in the duration of whiplash at eight kilometers per hour. There was no significant difference in the presence, severity and duration of whiplash between four and eight kilometers per hour, and no pre-impact measures were predictive of whiplash associated disorder.”
Dr. Chris Quigley:
“Conclusion, empirical findings in the study contribute to establishing a causal relationship between rear end collisions and clinical signs and symptoms.” I think that, is it. Any questions there, counsel? I can talk. You can hear me, right?
Matt:
I can hear you, yes.
Dr. Chris Quigley:
Yeah, okay. Really, your goal is to get everyone to realize that the emperor has no clothes here. The skills as the expert witness and the skills as the attorney has to make that picture clear. As the old adage goes, whoever has the best pictures wins. This is why it’s really important to a really big diagnostic work up because now if you find objective injuries, now you have something to hang your hat on. Right? I definitely understand where you’re coming from in terms of, “Oh,” but if you walk into a courtroom and drop a dozen eggs, you can look back at the carton and the cart is still in good shape, but there’s a dozen eggs that are scrambled, right? That’s a great metaphor.
Dr. Chris Quigley:
Football, you see two guys get hit. The helmet doesn’t break, but they got a concussion, right? You’ve got to use these metaphors to teach the jury what’s going on. It’s a lot easier for the expert witnesses if there’s a great workup.
Dr. Chris Quigley:
If you have great meaty stuff in the exam findings, it makes the expert witness job a lot easier. We had a case that I just got finished up today. The guy got hit pretty good, but he had some pre-existing injury, but we found an objective measurement on his x-rays; his bones had actually shifted three millimeters. Now, most people wouldn’t even look at that, but because that’s who we are, I took his x-rays from the year before, I took his x-rays now, we found a three millimeter slippage and in the vertebrae. That’s a lot.
Dr. Chris Quigley:
That’s a kind of thing and now you take that, you add that to a discussion about eggs in a carton and football helmets and now, you can get somewhere. I’ll show you a video. Someone sent me a video recently. It was a guy, a wide receiver catching a ball and some guy hitting him, steamrolling him from behind. The head just whips back. His helmet was in great shape, but he had a concussion still.
Dr. Chris Quigley:
Yeah, it’s the whole case. It’s always number one, is the witness number one, is your client, you know you have a good client, but it’s the exam findings. It’s the witness. You’ve got to put the whole story together. I think the adjusters, they’re not close minded. They know this is bullshit.
Matt:
Yeah, They act like it, at least.
Dr. Chris Quigley:
This isn’t their first rodeo, come on. They’ve been handed a line of BS over the years and shoveling it, you might want to say.
Matt:
Yeah.
Dr. Chris Quigley:
They have their agenda now. They stick to it, for sure.
Matt:
Yeah.
Dr. Chris Quigley:
This is why we take all this training. This is why we learn. We can come up with some good stuff. We can hit these the research. That’s the nice thing about an expert report or a demand letter even. A demand letter is a great place to put this research. Now I wrote an article for MATA and I said that the days of the one page or two page demand letter are out, done. This information is the kind of stuff you put into demand letter and you can just hit them. Now you’re going to have a dozen references here that you can just put one after the other after another in your demand letter and now you have some good juice there.
Dr. Chris Quigley:
Yeah. I got case an attorney down from the South Shore. He got the low ball offer. I’m like, “Well, send me your demand letter.” He gives me this two page thing. I’m like, “Really, are you shocked?” The guy had five disc injuries and he’s got a one-page demand letter, or maybe it was a page and a half. I’m like, “That doesn’t work,” as he found out. Mary, any questions from you? She’s muted there. Excuse me.
Dr. Chris Quigley:
All right, everyone. It’s been a good workshop, but take these references. These are the stuff that they get. Take them and put them word for word right into your demand letter. Obviously fix the typos before you them in.
Matt:
Yeah.
Dr. Chris Quigley:
Put them in there. If you want me to read it over for you, I’d be happy to do that. I can point you in some directions. That’d be my pleasure to do that for you, especially when you had the ligament laxity cases, those are the ones you really want to really beef it up with the references because the higher ups at the insurance companies know about the ligament laxity, the lower ups don’t. Let the lower downs don’t. When you put that in there, and you’ve got a ligament laxity diagnosis, from what I hear from the insurance people is that they have to reserve $60,000 when they see that ligament laxity diagnosis. You want that diagnosis, if you got it.