Black, White and Gray

Things I Prefer Not Be in My Code Style Guides

2018-08-26T00:00:00-05:00

Spaces for indentation and cuddled elses.

JavaScript is getting a wider audience at the office lately so I found myself searching around for JavaScript style guides. With more people very new to writing code maybe some guidelines would help establish good habits? Ultimately I realized the answer was no. Leading horses to water and all that. These things have to come organically from the bottom up and I eventually remembered that suggesting them tends to do the opposite.

But reading through a few prominent guides made me think. You can tell a lot about a community through its rules, reasonings and how they present them. Not surprisingly, I didn’t find one that fit my personal style. Since that’s what personal internet sites are all about…

Of all the nit picky things that show up in style guides the two that stood out for me where how often spaces are preferred for indentation and all the else cuddling.

Lea Verou covers TABs versus spaces nicely. Spot on.

The cuddling thing? It’s interesting that most places you see talking about bracing show simple if/else examples and nobody is talking about "cuddled else ifs". I prefer the line start with the else if or else. Just like the line starts with the if.

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9 if(inYourHouse) {
	// do what you like
}
else if (inSomeoneElsesHouse) {
	// follow their rules
}
else {
	// follow the community's social norms (and the law)
}

Much easier for my brain to see the blocks that way.

Of course, "match what’s there" wins over all of this. If you’re in somebody elses' home play by their rules. But when I build my own they use TABs and else is on its own line.

Uhm... Microsoft?

2015-09-29T00:00:00-05:00

I have just had my first experience with Windows 2012 Server.

I was putting it off as long as possible but couldn’t avoid it today. There was a test database I needed to see. So I started up remote desktop and…

…it was like an H.P. Lovecraft story where you can’t find your way out, landmarks have been erased and there are things hiding in the shadows that make no sense and should not be.

No. Just, no.

And yet the Great Old Ones cannot be stopped within the office walls and we will all be consumed eventually. At least there’s Debian at home.

On Bloomington and Garbage

2015-06-11T00:00:00-05:00

Our new home city of Bloomington, MN currently uses a mostly open market approach to garbage collection. This works great. The haulers understand economics because they actually have to run a business and pay people. This makes them efficient and incentivizes new ideas. I get to price haulers against each other and use somebody else if I’m unhappy. Markets at work.

The city council has decided this will not do and has been “investigating” a change to city managed garbage collection. It’s a forgone conclusion the council will decide that their idea for a government monopoly will bring peace to our time and good will toward men. Probably in the very near future because I have already seen city labeled trash bins in our parks and to avoid a recent petition initiative. This utopia is, of course, impossible, but I need to write out why it’s a stupid idea so I can get it out of my head and move on.

As an aside let me get off my chest that I’m pissed off I need to spend time on this at all. It’s garbage. It’s a solved problem. Who wants to deal with that all over again? But NO. Something must be done!

And before the venting starts in earnest let me send sincere thanks to the council members whom I have communicated with personally and in email. I very much appreciate their willingness to spend time on their constituents even if I think the majority are telling themselves some seriously imaginative stories. Thanks especially to Councilwoman Bemis Abrams, the sole dissenting member in all of this.

I also still believe individual Bloomington city workers are doing the best possible in a tough situation. If it’s unclear below replace “the city” with “the city council” because those are the people clearly deciding we are all getting in this hand basket and where we are going.

Now onto politics.

I’m going to wade through this by responding to the nine issues called out in the information packet offered at the open house on April 23rd.

Reduce truck noise and litter
Improve safety
Improve recycling, composting and waste reduction
Lower environmental impacts
Enhance public education and awareness
Improve value of services
Minimize City staff resources devoted to solid waste administration
Promote local economic development
Reduce road wear impacts

There’s been a lot of city propaganda but most of it falls into these blurry categories in some tenuous way or another. I will note the list above buries the lede quite a bit and the informational packet that boldly lists these in the first page provided no actual information with respect to these bullet points.

The issue of the day will change depending on the audience and the day. Classic politics. I’ll just go in the order above.

Reduce Truck Noise and Litter

Litter is a red herring. Of course we all want to reduce litter! Who hauls our garbage won’t change how much falls out of the trucks one bit but it sure sounds nice.

Reducing truck noise makes some sense but there’s background here the city doesn’t want you to think about.

See, the last time the city council thought this was the greatest idea since sliced bread they got hammered by public opinion and backed off. (What has changed since then nobody seems to know.) But politics being politics they still got a ratchet locked down and required all garbage trucks to run in zones on specific days. So all the trucks are in the same part of the city on the same day. They’re concentrated by city ordinance.

Low and behold citizens noticed the higher truck density. Especially as Bloomington residents aged and more were home during the day. Thus the bitching and moaning about all those trucks. Nice setup city council of old. Well played.

So, sure, less truck noise. OK. Next up FedEx, UPS, DHL and the post office trucks. Those bastards have been terrorizing our neighborhoods for decades.

Improve (Public) Safety

This is such a clichéd appeal to fear I’m surprised (not really) they’re still flogging it. When will “for the children” get taken out for a spin?

There has been zero, no, evidence offered to support the idea garbage trucks are a public safety issue. When asked, the city could not provide one example of a garbage truck accident much less serious injury or fatality. With that kind of record these guys should be given Metro Area Transit jobs or start driving city vehicles. The buses, trains and city trucks do get in accidents fairly regularly so let’s give the garbage drivers a chance.

Improve Recycling, Composting and Waste Reduction

There’s no data to back up this claim either but, again, it sure sounds nice.

We’re already recycling because it makes sense. It means getting by with a smaller, cheaper, garbage bin. The city can’t change the economics of recycling so there’s nowhere to save on that one.

That the city claims anything about composting shows they haven’t really thought about this. The people that do this already do it for free in their back yards. Adding curbside composing costs extra in the city’s proposal so who is going to sign up for that?

And how is government going to reduce waste exactly? (Insert joke about $500 hammers here.) The dirty secret is the only way for this to happen is for the city to control collection so they can set the rules we all have to follow. Once they have the control they can start shrinking bin sizes until they meet whatever waste stream size limit they make up out of thin air. It’s classic environmental cover pushing us along the path to this weird better place where we’re freezing in the dark instead of killing the Earth with our furnaces or wasting electricity on a light bulb. Why are we still believing this stuff?

Lower Environmental Impacts

This is another hand wavy, no data, feel good bullet point. I’m evil because I don’t want to save the environment. Whatever.

When was the last time you saw government reduce anything? Me either.

Enhance Public Education and Awareness

The city doesn’t need to take over garbage collection to make progress on this one. So let’s charitably call it tinsel on the political Christmas tree this whole issue has become and move on.

Improve Value of Services

Again, when has a government service ever done this? DMV? Public housing? Health care? Transportation? Do you realize what that light rail is costing you? Improved value on anything? Ever? Government ran a whore house in Nevada and lost money for crying out loud.

But let’s use this one as an example of not just the claims with no supporting data mentioned above (with more below) but outright lies about “data” used to promote all this.

The city spent (we don’t know how much) money on (we don’t know how many) collection consultants. One of the consultant ideas was a survey. This survey is the only piece of data I’ve ever heard of in this entire fiasco. That survey asked about rates people were paying and, I believe, whether the city should look at taking over collection. I just moved here so I never got a chance to fill it out.

It had 276 respondents.

Bloomington has approximately 26 thousand households. Never mind the biased sample of who responds to a survey asking if the city should take over collection. Never mind the question begging that is part of every survey, as opposed to statistically valid sample methodology, ever. This sample size represents 1%. One. Percent. Across three different garbage bin sizes, seven haulers, with options for yard waste and compost, across nobody knows how many different household sizes.

This is not data, this is narrative crafting. And it’s being used to claim millions, MILLIONS!, will be saved. The mayor doubled down on this stupidity in the recent (state required) public hearing (where I’ll guarantee nothing was actually heard) by admitting the survey wasn’t statistically valid but that he’s sure the numbers will match up when the take over is complete.

Uh huh.

In the real world it took me 20 minutes when we moved here to find a rate 25% lower than the city used months to negotiate. And I hate talking on the phone.

So another example where government comes to the rescue of those too lazy to pick up the damned phone and save themselves a few bucks by taking it out of my pocket instead. Great way to promote a strong civic culture there guys. Can’t wait to see what that line of thinking does for the city over the next generation.

Oh, and yard waste and compost will still be additional fees but they don’t know how much or how that will work yet. Top. Men. How much have we spent just getting to this point again?

Minimize City Staff Resources Devoted to Solid Waste Administration

What the? Seriously? What the hell?

Reduce staff resources from where to what? The city hours being burned to investigate and manage consultants and “negotiate” with haulers and watch the city council naval gaze over this issue?

We’re talking about adding new government responsibilities. City staff will be expected to actually do the organizing part of organized city collection right? Something they are not responsible for today?

What the hell world do these people live in where new responsibilities accountable to 26,0000 households results in less work?

Promote Local Economic Development

Here’s another one what I just have to shrug my shoulders on. The hypocrisy here is obvious right?

The city council has taken seven successful businesses, employing local workers doing a difficult job, to the woodshed and made them offers they can’t refuse. (Nice business you have there. Shame if anything would happen to it.) The proposed setup says each hauler will keep their market share which is a nice way of saying their business growth potential is zero. On top of that these businesses and local jobs will suffer some level of chaos and losses as the city, hopefully, learns and makes, inevitable, mistakes during this transition.

This is the exact opposite of promoting local economic development. If I was a small business owner I wouldn’t touch Bloomington with a 10 foot pole. Who’s next on the city’s chopping block?

Reduce Road Wear Impacts

The city has admitted it has no data on this one either and, at the same time, doesn’t hesitate to claim the savings will be hundreds of thousands of dollars. So they don’t know and are just throwing more political tinsel on the tree.

I’ll admit that, yes, the bigger the truck the more wear it produces on road ways. I have my own engineering degree and my roommates were a couple of civil engineering majors. This level of physics isn’t rocket science.

The fact we’re not supposed to remember is that those smelly garbage trucks pay (big) registration taxes, fuel taxes and (big) licensing fees just like you and I do. This money is supposed to go toward road maintenance. The haulers are already paying their fair share. Like you and me they have every right to drive their trucks to Home Depot, McDonalds and to drop their kids off at school if they want to. Would it be OK for the city to tell you how often you can drive your car, truck, SUV, mini van or motorcycle? No. It would not be OK.

But it’s somehow OK to tell the garbage haulers because those trucks smell or something?

The city is admitting, but doesn’t want you to notice, that the government program for road maintenance isn’t working while claiming this government garbage collection program is totally different and is absolutely going to be awesome.

In Conclusion

I’m disappointed in my city’s council which has long term repercussions for my interactions with my government.

Instead of incremental, data based, changes to well defined problems they’ve created a staggeringly massive all or nothing political problem out of thin air. They are ham handedly taking over responsibility for seven local businesses, an unknown number of area jobs and the decision making power of 26,000 households all for the fleeting and emotional power of “doing something” and leaving their mark.

I don’t think that mark will last and, if it does, it’ll feel like graffiti in few years.

At best my family will pay more for the same great level of service we receive from our current hauler. I expect we’ll pay more for worse service very soon; the city will be the customer to keep happy, not us. And we’ve seen how well the city responds to citizens concerns on this issue already. Over time the city will have to make real world decisions about costs and services. As a monopoly the inevitable result will be less and less service for more and more money.

“We’re from the government and we’re here to help” shouldn’t make the hair on the back of my neck stand up but it surely does. I didn’t need yet another example…

On Perl and Priorities

2015-01-24T00:00:00-06:00

A confession. My swiss army hacking tool is still Perl.

The other day I was on a refactoring tear and needed something to find unused SASS variables and mixins. A quick search for this has-to-be-a-solved-problem showed a thousand links to the same Bash one liner. Which is great if your Windows system at the office has Bash installed…

So I hacked something up in Perl.

Then I thought I should really start getting out there and put something onto my long ignored GitHub account. Maybe somebody else could use this? Which is when I got this odd feeling I might be doing the equivalent of airing my dirty laundry in public. Which is when I got to wondering why I felt that way.

It is no great secret that Perl is no longer the scripting language of the upscale professional. If it ever really was. Perl always reveled in a duct tape vibe ¹ which is what drew me in the first place. Duct tape is frick’n awesome. But I lost touch with the community after it started wandering through the Perl 6 desert lo those many years ago.

The thing is, Perl 5 just keeps solving the problems I need solved. I’ve got a decade of muscle memory typing $, @ and %, CPAN hasn’t crumbled into the ocean, Strawberry is pretty nice, ActivePerl is still weird and useful for our corporate type customers and stuff still needs to get taped together in the real world. Duct tape is still handy stuff.

Yes, Python and Ruby are on my list of things to try. Trouble is, Python doesn’t appear to do anything Perl can’t do and I mostly want to learn Ruby for the Rails not the Ruby. And, since my current gig is a Microsoft house, Rails isn’t anywhere near the top of of the priority list. What time I do have for new scripting languages is mostly used to find my way through the PowerShell maze these days.

And since I’m airing dirty laundry anyway I’ll admit that programming languages for their own sake aren’t high up my personal list right this moment either.

We’re finally into our new (to us) house and starting to feel like we live here. With a new home comes new projects which get the nod after coming home from the office. I’m finding it hard to get excited about another six hours in front of the keyboard after the previous eight hours in front of the keyboard.

I’d rather get the basement wired so I can find a lathe and learn how to make threads in steel. My motorcycle needs more miles. The dogs need a walk in the park space down the road. I’ve owed my lovely wife a real vacation for years. There are new bourbons to try and food to make. There are those 15 pounds to loose. My AR and M&P should be getting fed much more often and finding a trainer to do that with would be good. Maybe some trap or skeet with friends. We haven’t been to the Boundary Waters Canoe Area in way too long. And on and on and on.

There’s lots to learn out there. So I’m going to keep leveraging the learning I’ve already done, keep hacking Perl and stop feeling bad about that.

If you’ve got a Node/Angular project you’d like some help on I might be interested though…

[1]: In retrospect I like the idea of duct tape holding things together more than the reality. Safety wire and a ClampTite will stay put forever and don’t get gray goo all over everything.

Did I mention we're selling our house?

2014-06-19T00:00:00-05:00

We’re knee deep in the process of selling the 100 year old house we’ve been updating for the past 13 years and finding the next place for us.

The black and white part of my brain knew this was going to be tough. But it’s realizing how unprepared it is for the rainiest June in over 100 years and the full onslaught of the fuzzy gray part of my brain raging against its loss of routine and the demands of all these new people that want our time.

Thankfully we’ve got willing friends and family and great people working with, and for, us.

Now back to driving on…

HuMn HW2 Aluminum Wallet Review

2014-01-10T00:00:00-06:00

Also known as “why I had to, unfortunately, send mine back.”

Like many tech types I’m always on the lookout for a better way to deal with stuff. Most recently I’ve been on a wallet hunt.

My last wallet hunt lead to a Dopp Regatta 88. It kept just the stuff I needed, forced me to keep what I needed to a minimum, looked good, and wasn’t too expensive. I’ve gone through two of them now. Eventually credit cards blow out the sidewall of the thiner cloth interiors. They’re still a great option, but it was time to try something else.

I’ve been intrigued by the HuMn designs ever since I first saw them in one of the thousand other wallet posts online. The aluminum plates make the mechanical engineering part of my brain happy and the idea is just so damn elegant. After a couple Regatta’s at $25 a piece the HuMn prices, that put me off a couple years ago, didn’t seem bad anymore. It’ll last forever. And good design is worth it, dammit.

So I ordered a gray/black, two plate, HW2 just after Christmas.

The order process was easy and it arrived faster than I was hoping. It came packed in a small microfiber bag and the plates were perfectly cut and finished with clean, but not sharp, edges. Very nice machine work. It also included their Shock Strap 2, using a rubber banding on the strap instead of the original metal. So my one concern about scratching whatever else is next to the wallet in my pocket wasn’t an issue. Perfect.

Putting my stuff in the HW2 gave me a bundle about as wide and thick as my Nexus 4 phone, and about 1/3 shorter. The phone and wallet fit together in the front left pocket of my Levi’s comfortably. So far so good.

Unfortunately, two issues killed the HW2 for me:

Opening the wallet as shown in HuMn’s videos pinned the US cash I wanted to carry on the inside behind my finger, making it very tricky to get it out of the wallet. I don’t want to show everybody who sees my wallet how much cash is there so I wasn’t willing to strap it to the outside of the wallet like others seem to do.

The cash access issue was pretty specific, but I found it tricky in general to get things in and out of the wallet. With my finger holding it open, pinning the bottom of the plates together, I felt like I was fighting the wallet to pick a card and pull it out. The reverse was also true for me. Putting stuff back in required navigating around the finger keeping the wallet open and pushing the stuff already in there down out of the bottom. Looking at the videos again as I’m writting this I probably would’ve figured it out after some more practice. It seems likely the “cash inside” layout was the problem for me.
I have two cards I need to swipe multiple times per day - a public transit smart card and a one of those common (in the US) white building access cards that are about double the thickness of a common credit card. Neither of the readers I need to use would register their respective cards when they were strapped to the outside of the HW2. Pulling those cards off the wallet each time seems like a minor issue until a few days go by and you realize how many times you swipe cards…

So I regrettably filled in a return form on HuMn’s website outlining these issues. Ken replied almost instantly and thanked me for the feedback. Great customer service!

Both of my issues are personal use things. If you don’t swipe cards daily, or the readers you use are more powerful, or you don’t carry/use cash often, or your fingers are smaller, or RFID skimming protection is more important to you, or, or, or, the HuMn is very much worth a try and the price. It’s an elegant design that will last forever, looks great, and can be customized via material and color selections to make yours unique.

Ken at HuMn did mention a new polycarbonate option they’re working on so I’ll keep stopping back.

NOLS WMI Wilderness First Aid Part 4 (Misc Stuff)

2013-12-17T00:00:00-06:00

To finish up this series I putting all the rest of the notes I haven’t rewritten yet here. These are out of context but maybe writing them down again will help me out.

In between learning the PAS and going outside to practice it we did a ton of other stuff. Covering:

Spine injury
- immobilization
- rolling techniques
Head injury
Shock
Wound management
- infection
Burns
Muscluloskeletal injury
- splinting
- dealing with dislocations
- taping ankles
Heat illness
- dehydration
Cold injuries
- treatment myths
- real treatments
Lightning
Altitude illness
Anaphylaxis
- carrying Benadryl
- where do they keep an epi pen?
The medical patient
- abdominal pain
- chest pain
- shortness of breath
- altered mental status

This stuff is all online already or in books. It was a lot to take in that fast. A few things I wrote down above and beyond the handouts they provided:

Infection

The acronym here is SHARP:

S - Swelling
H - Heat
A - Aches (lymph swelling)
R - Redness
P - Puss

Infection is bad. If you see fever, swollen lymph nodes, sigh/symptoms of shock, read streaking it’s time to go. No good progress in 24 hours is also an EVAC.

Athletic Injuries

First time I ever taped an ankle. Kind of crazy how much something like that can help. Assessment here is LAF:

L - Look (swelling, discoloration, deformity, compare to other side)
A - Ask (severity of pain 1-10, what’s a 10? What happened? How much force? Pops? Snaps?)
F - Feel (tenderness, range of motion)

Treatment is RICE - Rest, Ice, Compression and Elevation.

When taping two rolls of 1”x10yard athletic tape will do about three ankles. Since you want to take it off each night to monitor, check CSM, and run cold water over it, that could turn into a lot of tape.

Medical Patients

When dealing with things like abdominal pain or general aches and pains it’s OPQRST:

O - Onset (abrupt or gradual? when?)
P - Provoke (what makes it better? what makes it worse?)
Q - Quality (chronic or acute? localized or general? try not to lead them.)
R - Radiate (one spot? moves?)
S - Severity (1-10. What’s a 10?)
T - Time (how long has this been happening?)

Low Level of Responsiveness

When dealing with low levels of responsiveness it’s TO STOP:

To - Toxins (white gas is a possibility)
S - Seizure/Sugar
T - Temperature
O - Oxygen
P - Pressure (altitude sickness)

What to Have With You

We didn’t talk much about first aid gear. Most of this can be done with what’s around you, like splinting with tent poles, branches, and their foam sleeping pad. Couple things stuck out as items I needed to add:

Something to put between the patient and the ground to prevent hypothermia
Tape; I never really thought about an ankle injury on a day hike
Tincture of benzoin helps bandages sick which would be really handy
12cc irrigation syringe
A watch
A notebook and pencil
Gloves
Benadryl

These are all things that are hard to improvise, make a real difference, and are (generally) small. Otherwise, you’ll improvise. And, again, use there stuff when possible so when they EVAC away from the group you don’t loose your coat or pack stays.

Conclusion

The two days were absolutely worth it. My WFA certificate is good for two years and when that’s coming due I’ll probably sign up for another class. I’d really like to take the WMI Wilderness First Responder course (WFR or woofer) but it’s 10 days on site. That’ll be hard to swing but it’d be great.

NOLS WMI Wilderness First Aid Part 3 (End Game)

2013-12-17T00:00:00-06:00

In the last part I covered the patient assessment system (PAS) through the first three levels:

Scene Size Up
Life Threats (ABCDEs)
Head to Toe/Vital Signs/SAMPLE

The first part of a first aid situation will be a mess. I was seriously messed up ever time we did a scenario and it was just class in REI’s back yard. Try to get through the previous steps, write everything down or you’ll forget it, and do the best you can.

During all that chaos, with your other hand, you should also be trying to put the patient at ease and dealing with environmental issues. I learned damn fast that laying on the ground will make you cold right damn now. If your patient is laying on the ground get something underneath them when you roll them over to check their spine. I have a couple NATO, fold up, sleeping pads I picked up 100 years ago and my plan is to bring them along “outdoors.”

If hypothermia is possible get them into some shelter. You may need to put the shelter up around them if you’re holding their head for a possible c-spine.

Use their stuff if you possibly can. If they’re EVACed away with your shell and it starts raining you’ll be the next hypothermia patient. And out your shell because you’re not getting that back.

But now we’re to the introspective part. Deep breath.

Problem List and Plan

This is the fourth level on the PAS pyramid.

The patient is as stable as possible, you’re squared away, and you have all kinds of information scribbled down incoherently all over the place. If you’re on day 4 of a 10 day hike and they’ve broken their leg, you can take some time to figure out how screwed you are.

“Stay and play” or “gotta go?”

Since this is first aid class we’ll assume gotta go. How’s that going to work? We practiced carrying a person and it sucked big damn rocks. Seriously. Sucked. If it is at all possible for them to self evac that is 110% the way to go. If they can’t, build a litter. Or call for help. Or ranger up because this is gonna suck.

NOLS has a protocol for calling for help. The idea is to get the most important info out first. If the connection is spotty search and rescue (SAR) will have something to go on.

An aside. You let somebody know where you were going, right? Somebody knows when it’s been too long and something’s wrong, right? I need to get in the habit of leaving a note…

Anyway, you’re calling somebody for help.

“This is Aric Czarnowski (C as in Cat, Z as in Zebra …) and I’m 5 days into the BWCA from Saw[schreech]”

At least now they can hit the permit list to find yours out of Sawbill and have a radius to start looking.

The pocket card NOLS sells on their site covers the radio report so I won’t rewrite it in detail. Here’s what you’re trying to cover in order:

Subjective/Summary/Story (Who, What and Where): a. Your name and your request for evac help b. Your location c. Name/age of the patient with chief complaint d. Brief method of injury (MOI) e. Current patient status
Objective/Observation/Findings (Head to Toe, Vitals, Patient History): a. Major injury list b. Vital signs (skin, orientation, heat/resp rates, heart/resp quality) c. Relevant SAMPLE notes
Assessment a. “We suspect the following problems….”
Plan a. Treatment plan b. EVAC plan c. List of needed help/assistance

Try to keep this to the point. Reorganize your notes and you probably want to also write down what you’re planning to say on the call. The SAR guys don’t want to listen to you rambling for 15 minutes. And if you get the info out in a concise way you’ll be in a better position to hand off when they get there. They won’t think they’re dealing with an idiot.

With your plan in place make it happen. That might mean making yourselves comfortable for a really long wait.

Monitor

This is the final, base layer, of the PAS pyramid. After all the rush of the previous PAS steps maybe your best option is to sit down and wait for the cavalry. Or you need to take a day to see what happens next. You’re now in a monitoring phase.

Retake vitals, check wounds for changes, make sure they’re doing OK, keep’em warm and fed, etc. Hurry up and wait. Catch them getting worse before it becomes a crisis.

Good notes matter here because you’ll eventually hand them off. Keep good records with time, LOR, HR, RR, SCTM, intake, output, etc. What else you got to do?

There’s not much else to it at this point. Either they’re staying and playing, they’re self EVACing, you’re working our ass off to carry them out, or you’re waiting for the cavalry.

NOLS WMI Wilderness First Aid Part 2 (PAS)

2013-12-10T00:00:00-06:00

The WMI Patient Assessment System (PAS) was the core of the course. It’s laid out as a pyramid starting at the most important and time critical, down through the stages where you clarify and dig deeper, until you get to a stabil(ish) patient and can deal with the long term “what now” at the bottom.

You get a copy of a pocket sized card, showing the pyramid, that turned out to be really handy. I picked up another copy for my “other” first aid kit.

Scene Assessment

The top of the PAS pyramid is scene assessment. This is supposed to take 30 seconds to a minute while you’re walking up to the [whatever is going on]. It has five steps which you can count down on your fingers as you go and rhyme to yourself:

Who’s #1, I AM: Which means your #1 priority is to make sure you’re safe too.
What happened to you?: Which means ball parking what probably just happened (avalanche? bike fall? blacked out? etc.)
Don’t get any on me: Which means making sure all their body fluids won’t get on you (gloves at least and maybe more)
Are there any more?: Is there anybody else hurt we aren’t seeing yet?
Dead or alive?: If this person is gone, move onto that other person.

The Approach

The next level of the pyramid is the approach. Once you’ve got an overview of the scene and have your gloves on, you get involved.

First you introduce yourself and ask if they want your help. This is also the best time, based on the scenarios we ran, to ask how old they are. It’s hard to remember to do this later but it’s really good info to have.

Assuming they do, and you can assume that if they’re unconscious, you go through your ABCs:

A - Airway
B - Breathing
C - Circulation/Bleeding
D - Decision about c-spine injury
E - Expose all known injuries

“Hi, I’m Aric. I’m Bob. Hey Bob. I’ve got some first aid training. Can I help? OK. How old are you Bob? Got anything in your mouth? …”

These are the big hitters. If at any point something isn’t good here you fix it ASAP. Choking on the teeth they just broke? Get those out of there. Can’t take a deep breath? Figure out what’s up. Bleeding out? Compression. Etc.

Some notes I made around this:

If they have anything in their mouth ask them to spit it out. But let them do it. Digging around in there is to be avoided.
Ask if they can take a deep breath to cover breathing.
There’s a technique for blood checking where you go down the trunk, each arm, and each leg, putting both (gloved) hands on each section and pulling your hands away to look for blood at each spot. You don’t want to wipe down the person because if you have blood at the end it could’ve come from anywhere on that wipe.

C-spine is a big decision. If you decide they may have a spinal and immobilize their head, you’re immobilizing their head for the duration. You can’t take this one back. Hope you have a competent partner with you because doing everything else you need to do while you’re holding their head is going to be hard.

On the other hand, if you can’t convince yourself they for sure could not have hurt their spine you should immobilize it (hold their head).

There aren’t a lot of hard rules they could give us here. The wilderness is pretty variable. But if they fell less than their body height, low speeds, and didn’t loose consciousness, they’re probably fine. Tipping over on your bike probably isn’t but coming down the mountain into a tree probably is. Vehicles - snowmobiles, ATVs, etc. - are good ?candidates for spinals.

Rounding Things Out

The next step down the PAS pyramid, it’s getting wider, is made up of three parts:

Head to Toe
Vital Signs
SAMPLE

At this stage you’re making sure you didn’t miss anything, getting more info and details, and making sure you didn’t miss anything. At this point you should really be writing stuff down.

Head to Toe

You’re going to touch the patient on every part of their body looking for blood, feeling for stuff moving that shouldn’t, noting if the patient is in pain, etc. This is where you really get into their space. It’s going to be awkward. Push hard on stuff.

Check their brow and nose. Back of their head. Push down on their hips with your full body weight (these are strong bones). You can check their sternum by putting the edge of your hand along it (karate chop style) and asking them to breath deep. They’ll need to deep breath to check ribs too.

Roll them over and check their back. Run your hands down their spine. Everything solid and in line? No wet spots (blood)? This is tricky if you’re holding their head because of a possible c-spine in the ABCDE phase. We got some techniques here but it’s really easiest if there’s two people helping.

While you’re going along keep checking your hands for blood spots.

If you find anything, expose it. You need to see everything you think might be an injury.

This is your last chance to find anything life threatening so be thorough.

Write down what you find.

Vital Signs

As you finish up your head to toe:

Note brain state: are they awake/oriented, awake/disoriented, or unconscious?
Take a look at the skin on their upper chest near their neck. It’s protected so usually a good general indicator of overall state. Is it pink and warm or pale and clammy? The inside of their lower lip is another good spot to check.
Have them grab your hands and ask them to squeeze. Are both sides strong and even?
On each hand pinch a finger. Ask them which one you’re squeezing. Did they get it right?
Move to their feet. Have them push down like a gas pedal on both sides. Strong and even? Have them push up on both sides. Strong and even?
On each foot squeeze either their big or little toe (most people can’t tell individual toes like they can fingers). Did they get it right?

You’re looking for SCTM (skin color, temperature and moisture), LOR (level of responsiveness), and control differences side to side. If one hand isn’t as strong as the other, but you haven’t noted an injury on the weak side, you might have found something new.

Write all this down.

Now you’re going to find their heart and respiratory rate. You have a watch right? I didn’t. I’m looking for one now. Doing this with a phone sucks.

Find their radial pulse (it’s less intrusive than going for their neck but, honestly, I’m not sure that’s worth the trade for finding the damn thing after you’ve touched them all over). Tell them you’re taking their heart rate. Take it for 30 and remember the number, then start counting chest rises to get breath rate. Remember that. Then double both of them to get the per minute values.

They’ll think you’re taking pulse for a minute and hopefully won’t think about their breathing. If you tell somebody you’re checking their breathing they’ll do it wrong. ;)

If you’re having trouble seeing their chest rise ask them to lay their arm across their chest. That makes it easier to see movement.

Is their pulse strong or week? Is their breathing easy or labored?

You’re hoping for 50-100 beats per minute and 12-20 breaths per minute.

Write these values down and the date and time. (I need to add a waterproof notebook to my going out kit along with the watch.) Something like:

Time: 11:40 Brain: awake/oriented Heart: 78 bpm strong Resp: 14 rpm easy Skin: pink/warm/dry (chest)

You’ll probably be checking these on intervals so you can tell if the patient is stable, getting worse, or getting better. You need the running log to tell this. A single set of numbers doesn’t tell you all that much. This might be every 5 minutes, hour, or half hour depending on what’s going on. If you’re waiting for evac what else do you have to do?

SAMPLE

Now that you’re getting to know each other, and you’re sure they’re not about to bleed out, you can finish up with Q and A. SAMPLE stands for:

S, Symptoms: How are they feeling? Dizzy? Nauseous? Short of breath?
A, Allergies: Foods? Animals? Plants? Medicines? Stings? What happens when you’re hit with your allergy? Have you been stung today? Do you have an epi pen with you?
M, Medicines: Prescription? Over the counter? Herbals/vitamins? Recreational? When was the last time? How much (dose)?
P, Past/Pertinent: Old back injuries? Heart problems? Longs? Diabetes? Pregnant? The “big stuff.”
L, Last in/Last out: When was the last food/drink in? What was it? How much? When was the last time they urinated and defecated (yeah, embarrassing). Clear or dark? Normal or ? How much?
E, Events leading to the incident: Prior to injury> Afraid of a bee so you lost track and fell off the cliff? Got dizzy and tripped?

You’re trying to find any last details that might help figure out what’s going on with this person. If they had a granola bar and a bottle of water on the way out here 6 hours ago and they’re dizzy, dehydration?

Recreational drugs are a relatively new one. Pot is legal in a few states and many people don’t think of alcohol as a drug/medicine. You might need to work around to asking about weed and that flask you found during the head to toe…

What Next?

That’s in the next part…

NOLS WMI Wilderness First Aid Part 1 (Introduction)

2013-12-09T00:00:00-06:00

In late October of 2013 I went to a two day wilderness first aid course put on by NOLS and taught at the REI in Bloomington. This is my first stab at some notes: part after action report, part concepts, and part random stuff before I loose track of what my hasty days of scribbles actually say. I’m not planning on rehashing signs and symptoms or treatments for wounds, head trauma, etc. That stuff is listed pretty accessibly in books and on the net.

Hopefully, writing this down will help it stick in my head a bit better.

First Impressions

The course was taught by Erik and Amy. Erik runs a wilderness program at Winona State and Amy is a nurse. Each had their own teaching styles that were great and complimented each other really nicely. Both were obviously comfortable in front of the group, handled questions great, and included everyone all through the course.

Both days stayed as close as possible to the 0900-1800 schedule as 24 random students could allow.

There was a ton of information passed along. Erik mentioned in his introduction that we were not going to simply soak it all up. His goal was to get us doing 100% in class so three months from now, after time takes its toll, we’ll still be running at 60% if we need to. I was pretty impressed with the honesty.

How the Course Ran

The two days were split pretty evenly between lecture and actually doing things. We did get to know all the other students going through practice scenarios, checking them over for injuries, splinting, rolling people over, carrying them, etc. Remember to put stuff you don’t want others to deal with into your day bag before class starts!

When we did scenarios a group was taken outside and movie make-up dashed on to simulate injuries. I thought it was pretty interesting how much this detail helped get the right mindset setup.

Weather was 40s, overcast, and sprinkling for the weekend and we were outside in it practicing. Just like we would be in a real wilderness scenario. I appreciated this too. I definitely learned some things by really being out there in it.

Wilderness First Aid Goals

The end goal of the class was to get students to the point where we can decide if somebody can “stay and play” or “has gotta go.” For the most part, if there’s any doubt, going is the right choice. If somebody has a wound that makes you wonder if they’re done is anybody going to be having enough fun to stay?

Of course, that’s not always cut and dry when you’re on the fifth day of a 10 day trip…

EVAC

Because “going” is an outcome, we talked about that off and on through the course. Again, because the wilderness is a big variable, there wasn’t a lot of hard rules. How do you evac somebody that can’t walk? With a possible spinal injury? Who is unconscious?

It’s not always going to be cut and dry.

I’ll get to WMI’s “radio report” for calling out for help, but want to mention here that you should be thinking about how to call for help on big trips. Do cell phones work? Radio? What kind? Who do you contact? What’s their level of service and their procedures? You don’t just get out your sat phone and expect a Chinook medvac in 30…

Do some research on the area you’ll be in so you’ll know your rescue and medical support options.

Acronyms

Like every specialty there were a bazillion acronyms. Here’s my list:

PAS - Patient Assessment System
ABCDE - Airway, Breathing, Circulation, Decide c-spine, Exposure (to the elements and expose the injury)
SAMPLE - Symptoms, Allergies, Medicines, Pertinent past history, Last in last out, Events that contributed to injury
RICE - Rest, Ice, Compression and Elevation
LOR - Level Of Responsiveness
SCTM - Skin Color, Temperature and Moisture
CMS - Circulation, Sensation and Motion
MOI - Method Of Injury
BSI - Body Substance Isolation
HR - Heart Rate
RR - Respiratory Rate
SHARP - Swelling, Heat, Aches, Redness and Puss (signs of infection)
OPQRST - Onset, Provoke, Quality, Radiate, Severity, Time (pain qualification)
TO STOP - Toxins, Seizure/Sugar, Temperature, Oxygen, Pressure/Altitude (cause of unresponsiveness)
SAR - Search And Rescue

The next part will start with the Patient Assessment System.