Crash Information

L O C A T I O N	Date of Accident 8/18/2010	Time of Accident 02:40 PM	County Polk - 77	Accident occurred within corporate limits of (city) Des Moines - 1945	Law Enforcement Case Number: 2010048704
	Literal Description EB I-80 TO SB I-235 OFFRAMP				Legal Intervention? No	Private Property? No
					X-Coordinate: 451767.7
					Y-Coordinate 4611020.

U N I T 1	Driver's Name - Last BANKS			First JERRY			Middle LEE		Suffix
	City OSCEOLA			State IA - Iowa, US				Zip 502130000
	Driver's Age 62					Citation Charge Code 1		Citation Charge 1
	Gender Male	State IA - Iowa, US	Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more	Endorsements	Restrictions None	Citation Charge Code 2		Citation Charge 2
	Alcohol Test Given? 1 - None			Drug Test Given? 1 - None		Citation Charge Code 3		Citation Charge 3
						Citation Charge Code 4		Citation Charge 4
	Seating Position 01 - Front: Left Side / Motorcycle Driver	Injury Status 4 - Possible	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 5 - Not deployed	Airbag Switch Status 3 - No ON/OFF switch present		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: DSM MERCY					Transported by: DELAWARE TWP AMBULANCE
	Insurance Co. Name
	Year 2004		Make Chrysler - CHRY		Model PCF		Style SW		Approximate Cost to Repair or Replace 7000
	Initial Travel Direction 2 - East	Vehicle Action 88 - Other (explain in narrative)	Speed Limit 45	Point of Initial Impact 01 - Front	Most Damaged Area 01 - Front	Extent of Damage 4 - Disabling damage	Underride/Override 1 - None
	Total Occupants 02	Traffic Controls 01 - No controls present	Vehicle Config. 03 - Van or mini-van	Cargo Body Type 01 - Not applicable	Vehicle Defect 01 - None	Driver Condition 8 - Other (explain in narrative)	Vision Obscured 01 - Not obscured	Contributing Circumstances, Driver (up to 2)
	SEQUENCE OF EVENTS			First Event 01 - Ran off road, right	Second Event 37 - Tree	Third Event	Fourth Event	Most Harmful Event (by vehicle) 37 - Tree
	Emergency Vehicle Type 1 - Not applicable					Emergency Status 3 - Not Applicable
	Carrier Name			City		State			Zip
	Number of Axles			Gross Vehicle Weight Rating		Placard #			Hazardous Materials Released?

ACCIDENT ENVIRONMENT		ROADWAY CHARACTERISTICS Major Contributing Circumstances:	WORKZONE RELATED?	SEQUENCE OF EVENTS
Location of First Harmful Event 5 - Gore	Weather Conditions (up to two) 01 - Clear	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 37 - Tree
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	Roadway 01 - None apparent	Type
Light Conditions 1 - Daylight	Surface Conditions 1	Type of Roadway Junction/Feature 20 - Off-ramp	Workers Present?

P
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Name- Last
BANKS

First
KATHLEEN

Middle

Suffix

City

State

Zip Code

Age
64

Sex
Female

Unit No.
1

Seating Position
03 - Front: Right Side

Injury Status
4 - Possible

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
5 - Not deployed

Airbag Switch Status
3 - No ON/OFF switch present

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
DSM MERCY

Transported by:
DELAWARE TWP AMBULANCE

NON-MOTORIST

Type

Location

Action

Condition

Safety Equipment

Contributing Circumstances

Unit No. of Vehicle Striking

D
I
A
G
R
A
M

0

NARRATIVE

UNIT 1 WAS ON THE EB I-80 OFFRAMP TO SB I-235 WHEN HIS INTERNAL PACEMAKER SHOCKED HIM WHEN IT ACTIVATED. DRIVER THEN LOST CONTROL OF THE VEHICLE AND DROVE OFF THE EMBANKMENT WHERE HE STRUCK A TREE.

Officer EHLER	Badge No. 212	Time Officer Notified of Accident 14:45	Time Officer Arrived At Scene 14:49
Name of Agency P01	Date of Report 8/18/2010	Investigation made at scene?	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 01 Office
260 NW 48th Place
Des Moines,IA 50313-2299
Phone: (515) 725-0010
Fax: (515) 725-0011