Well, we all will, unless there’s some sort of miracle breakthrough in medicine or technology. But that’s not what I’m talking about. Rather, I’m talking about something anyone who has thought about it much has probably already assumed is true: that in the event of a large-scale pandemic, procedures will be put into effect by medical authorities to determine who will be treated and who will be allowed to die.

This is called triage. And to the best of my knowledge, for the first time such procedures are being publicly put forth as being applicable for all hospitals in the US, in recognition that it is better to have consistent and uniform criteria already in place before a disaster hits. The May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), today carried a supplement titled Definitive Care for the Critically Ill During a Disaster. From the press release on the ACCP website:

(NORTHBROOK, IL, May 5, 2008)—In an unprecedented initiative, US and Canadian experts have developed a comprehensive framework to optimize and manage critical care resources during times of pandemic outbreaks or other mass critical care disasters. The new proposal suggests legally protecting clinicians who follow accepted protocols for the allocation of scarce resources when providing care during mass critical care events. The framework represents a major step forward to uniformly deliver sufficient critical care during catastrophes and maximize the number of victims who have access to potential life-saving interventions.

“Most countries, including the United States, have insufficient critical care resources to provide timely, usual care for a surge of critically ill and injured victims,” said Asha Devereaux, MD, FCCP, Task Force for Mass Critical Care. “If a mass casualty critical care event occurred tomorrow, many people with clinical conditions that are survivable under usual health-care system circumstances may have to forgo life-sustaining interventions due to deficiencies in supply, staffing, or space.” As a result, the Task Force for Mass Critical Care developed an emergency mass critical care (EMCC) framework for hospitals and public health authorities aimed to maximize effective critical care surge capacity.

So, is this just good public health planning? Well, yes. But it is also very sobering to read the following:

The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

“When”. Emphasis mine. Not “if”. The news report goes further:

Bentley said it’s not the first time this type of approach has been recommended for a catastrophic pandemic, but that “this is the most detailed one I have seen from a professional group.”

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list “was emotionally difficult for everyone.”

That’s partly because members believe it’s just a matter of time before such a health care disaster hits, she said.

“You never know,” Devereaux said. “SARS took a lot of folks by surprise. We didn’t even know it existed.”

Again, emphasis mine.

I’ve written many times about the possibility of widespread flu or some other kind of pandemic. Partly this is just because such a catastrophe sets the stage for Communion of Dreams. But more importantly - and this is even part of the reason *why* I wrote Communion of Dreams - is that I don’t think that people give this matter nearly enough thought.

It is good to see that the public health authorities are taking this step. And I was heartened to hear about it on NPR as I started to compose this post. Maybe it will prompt people to stop and think for a moment about what they themselves should be doing to prepare for some kind of pandemic or other disruption. Because I bet that almost no one you know is actually ready to ride out such an event - and by the time you hear of a pandemic starting, it will be too late to get everything you will need to increase the chances of you and your loved ones surviving. This is not fear-mongering; this is taking some reasonable precautions - the same sorts of precautions that have lead to the development of this new triage plan. If you want to know more, check out the Flu Wiki (where they also link to this resource).

Yeah, we’re all gonna die. And I can easily imagine disaster scenarios where I would not want to live. But I sure as hell don’t want to die needlessly from something I can avoid, or ride out with a little advance prep.

Jim Downey

If you know me at all, from personal experience or just from my writings, you might be a bit surprised to know that when I was a kid I was considered bookish, uninterested in athletics, a bit nerdy. I distinctly remember being pushed to close whatever book I was quietly reading, and to go outside and play ‘like a real boy’.

Why do I mention this? Well, because I have been following with some interest the whole ‘controversy’ around Lenore Skenazy’s recent column and subsequent news coverage/website devoted to the concept of “Free Range Kids“. In itself, it is fascinating that Skenazy’s ideas have generated this kind of reaction - challenging the prevailing cultural norms about child-rearing and parental control (under the guise of keeping kids safe). Lots of people are saying that it is about time for us to get away from “helicopter parents” who so over-protect their kids that the kids never get any real life experience. Just look at the comments at BoingBoing, on her website, or just about anywhere else - she gets some criticism, but for the most part people are saying either that “it’s about time” or “what’s the big deal - this is how most of the working class folks get along”.

But beyond that, there is something else that comes through: a basic desire for people to have some freedom back, that the whole “security” mindset may have gone too far, that we have gotten well away from our self-professed ideal of being the “Home of the Brave”. I don’t think that this is the least bit surprising, nor that it would show up in these kinds of discussions, because I think that the issues are very closely interrelated.

Let’s talk about Skenazy’s notions again for a moment. Her basic premise is that while we need as parents (and as a society) to take some reasonable precautions, it is also extremely important that kids be allowed to actually experience life outside the purview of parents and other authorities - to have a little room to learn about things like self reliance, independence, and problem solving. Her example is letting her 9 year old son ride the subway in NYC on his own. What happened? I’ll quote from her site:

When I wrote a column for The New York Sun on “Why I Let My 9-Year-Old Take The Subway Alone,” I figured I’d get a few e-mails pro and con.

Two days later I was on the Today Show, MSNBC, FoxNews and all manner of talk radio with a new title under my smiling face: “America’s Worst Mom?”

Yes, that’s what it took for me to learn just what a hot-button this is — this issue of whether good parents ever let their kids out of their sight. But even as the anchors were having a field day with the story, many of the cameramen and make up people were pulling me aside to say that THEY had been allowed to get around by themselves as kids– and boy were they glad. They relished the memories!

And the next paragraph nicely summarizes what the real problem is, as I see it:

Had the world really become so much more dangerous in just one generation?Yes — in most people’s estimation. But no — not according to the evidence. Over at the think tank STATS.org, where they examine the way the media use statistics, researchers have found that the number of kids getting abducted by strangers actually holds very steady over the years. In 2006, that number was 115, and 40% of them were killed.

Now, why do people have the perception that the world is much more dangerous now, when the statistics don’t support that? Hmm. Think about it for half a moment and the answer is obvious: because that is what we are constantly told by the mainstream media, both in news and in fiction. And I’m not just talking about kids being kidnapped, assaulted, or murdered. If it isn’t the government trying to scare us senseless about some new terrorist threat, it is some TV show preying on your fears with murder or deadly ingredients in your food/water. Think of what sells papers and ad-time, and you’ll understand the motivation. It has always been so. But what has changed in the last generation is the absolute saturation that we get from these sources.

I am the first to acknowledge that the world is, indeed, a dangerous place. When I was barely starting adolescence my dad was murdered, and my mom was killed in a car accident, for crying out loud. Sure, neither of those is as bad as the loss of a child, but still. I do take reasonable precautions in going about my life, from trying to watch my diet to getting exercise to carrying a gun (and other safety tools). I use my seat belt and pay attention while driving. But I also live my life - because I know that no matter what, I’m going to die of something someday, and I would much rather enjoy the life I have than live in fear of losing it.

It is simply impossible to live a fully protected life. Just as it is simply impossible to fully protect kids from harm. Furthermore, it is completely counter-productive. In the case of kids, all you are doing is denying them the opportunity to really learn about themselves - the one and only person that they will have to rely on in the future. Kids have to learn to walk on their own. And they have to learn to get up when they fall. Sure, they’ll get hurt. They’ll scrape a knee, maybe get cut, maybe even break a bone. Know what? That’s life. They’ll heal, or learn to deal with it.

That’s harsh, but I am not advocating harshness. I am advocating bravery. Because that is what will come from learning that yes, you will get hurt - but you will recover from it. Yes, life will present problems, but you can learn to overcome them or cope with it. Learning that is liberating, and the sooner someone learns it, the more fully they will enjoy what life they have.

Likewise, in seeking to protect ourselves from threats, we have done nothing but lose our bravery as a nation. And lose our freedoms.

Let the kids range free. And let your own faith in yourself range a little freer, as well.

Jim Downey

(Cross posted to UTI.)

A good friend and I have a running joke about getting our six chickens and a goat, and retiring from the world to farm while things fall slowly into ruin.

But the thing is, it’s not a joke. Not really.

I’m not saying that everyone should fall into a paranoid spiral, become some kind of survivalist nut. I’m not ready to do that. But when you read something like this, it does make you wonder. An excerpt (please note, I added the embedded links in the following):

For decades, his [James Lovelock's] advocacy of nuclear power appalled fellow environmentalists - but recently increasing numbers of them have come around to his way of thinking. His latest book, The Revenge of Gaia, predicts that by 2020 extreme weather will be the norm, causing global devastation; that by 2040 much of Europe will be Saharan; and parts of London will be underwater. The most recent Intergovernmental Panel on Climate Change (IPCC) report deploys less dramatic language - but its calculations aren’t a million miles away from his.

* * *

On the day we meet, the Daily Mail has launched a campaign to rid Britain of plastic shopping bags. The initiative sits comfortably within the current canon of eco ideas, next to ethical consumption, carbon offsetting, recycling and so on - all of which are premised on the calculation that individual lifestyle adjustments can still save the planet. This is, Lovelock says, a deluded fantasy. Most of the things we have been told to do might make us feel better, but they won’t make any difference. Global warming has passed the tipping point, and catastrophe is unstoppable.

“It’s just too late for it,” he says. “Perhaps if we’d gone along routes like that in 1967, it might have helped. But we don’t have time. All these standard green things, like sustainable development, I think these are just words that mean nothing. I get an awful lot of people coming to me saying you can’t say that, because it gives us nothing to do. I say on the contrary, it gives us an immense amount to do. Just not the kinds of things you want to do.”

Too late? Yeah, maybe so:

I opened the email to find an article about the most recent “comments and projections” by James Hansen. Hansen, you may know, is perhaps the most famous NASA climate change scientist. He’s the man who testified before Congress twenty years ago that the planet was warming and that people were the source of that warming. He’s the man who was pressured by senior officials at NASA, at the behest of the current administration, to tone down his reports about the impacts of climate change. Thankfully he seems to have resisted that pressure.

I read the article and then I read a related article by Bill McKibben. Hansen says, and McKibben underscores, that there is a critical maximum number of parts per million of carbon dioxide in the atmosphere to heed to prevent climatic catastrophe. That number, he says, is between 300 and 350.

* * *

Can you guess how many ppm of CO2 are in the atmosphere now? Slightly below 350? Slightly above?

We’re at 383 parts per million and counting, well past the number Hansen suggests is critical. We are past it by a lot. We were at 325 parts per million in 1970! Um, I don’t think we can just suck all that carbon back out, ask billions of people not to have been born, tear down all of those new suburban developments, return to non-fossil-based agriculture, and innocently pretend it’s thirty years ago.

So, what to do?

Well, that’s the problem. Lovelock says that you might as well enjoy life while you can, as much as you can, before the shit hits the fan. The second passage, from a very long blog entry evidently by Sally Erickson, explores some options but focuses on the need to convince people that the shit has essentially already hit the fan, in order to radically change behavior sufficient to have a hope to save the world.

I am not sanguine about the prospects of making radical change, nor what that would really mean for our civil liberties. I think, unfortunately, that the mass of humanity just cannot deal with a problem until it becomes an actual, in-your-face emergency, but that once in it, we usually do a fairly decent job of slogging our way out.

This is one of the reasons that I decided to choose a pandemic flu as the cataclysm behind the ‘history’ of Communion of Dreams. As I have discussed previously, I made that decision for reasons of plotting, but also because I actually believe that we’ll likely experience some kind of mass die-off of humanity sometime in the next century, whether due to war, asteroid impact, plague, global warming or some other disaster. We’ve just been too lucky, too long.

But in a way, it is an odd sort of optimism, as reflected in the book, and as shared by James Lovelock (from the same Guardian article):

“There have been seven disasters since humans came on the earth, very similar to the one that’s just about to happen. I think these events keep separating the wheat from the chaff. And eventually we’ll have a human on the planet that really does understand it and can live with it properly. That’s the source of my optimism.”

And not to end it there, here’s a little something for counterpoint, I suppose:

Jim Downey

(Via MeFi here and here.) 

[This post contains mild spoilers in the first paragraph. The rest is safe, even if you haven't read the novel.]

One of the major themes of Communion of Dreams is examining the nature of reality. The title of the book alone gives this away, though I am constantly surprised by comments people make which indicate that they didn’t really take that very big hint into consideration when reading the book. Anyway, the whole notion is that we live within a controlled reality, in that there are artificial limits on what we understand of the outside universe. I use dreams as one access point for information which gets around these limits, and then more fully explore the psychic abilities which are latent in humans later in the book.

I’m a big fan of the TV series Foyle’s War, with its excellent acting and attention to historical details. It provides a brilliant insight into what it must have been like in the United Kingdom during World War II, and shows both the bravery and the cowardice of a population under real threat from a superior enemy. In particular, those episodes set early in the war (during the Battle of Britain) show how the possibility of invasion by Nazi Germany pushed people to do both inspiring and dispiriting things, but mostly how the entire population just ‘got on with it’, coping with the threat and their fears pretty damned well.

Which is why when I read things like this, I just cringe:

Hundreds Evacuated from North Sea oil platform after ‘dream’ sparks bomb alert.

A 23-year-old woman is expected to appear in court today after reports of a bomb on a North Sea oil rig sparked a full-scale emergency operation involving the army, RAF and police.

According to one report, the scare started when a woman employee on the rig was overheard recalling a dream she had had about a bomb on the platform. Jake Molloy, general secretary of the Offshore Industry Liaison Committee, one of the biggest unions representing offshore workers, said: “It was complete madness. This girl had a dream about a bomb being on board and she was a bit shaken. The next thing anyone knew workers were being evacuated.”

He said the rumour that a bomb was on the accommodation block - or “flotel” - had spread to senior managers within an hour. “It was complete madness on behalf of everyone. There was never any reason to evacuate the platform.”

Read the whole thing. It is clear that this was nothing short of bureaucratic panic. What do I mean? I mean that when bureaucrats are given procedures which they have to implement in order to cover-their-asses, they will do so whether or not the situation really calls for it, and no matter how disruptive and pointless the exercise will be. This is the exact same mindset in operation with the TSA’s Security Theater (credit Bruce Schneier), but played out in a more dramatic fashion.

Somebody overheard someone else talking about a disturbing dream they had. And they panicked. It’s that simple.

We’ve allowed the bureaucrats to so control our lives out of fear of being held responsible, that we’ve become afraid of our own dreams. How pathetic. How sad.

Jim Downey

(Via BoingBoing. Slightly edited version cross-posted to UTI.)

Try to wrap your head around this:

NYPD Seeks an Air Monitor Crackdown for New Yorkers

Damn you, Osama bin Laden! Here’s another rotten thing you’ve done to us: After 9/11, untold thousands of New Yorkers bought machines that detect traces of biological, chemical, and radiological weapons. But a lot of these machines didn’t work right, and when they registered false alarms, the police had to spend millions of dollars chasing bad leads and throwing the public into a state of raw panic.

OK, none of that has actually happened. But Richard Falkenrath, the NYPD’s deputy commissioner for counterterrorism, knows that it’s just a matter of time. That’s why he and Mayor Michael Bloomberg have asked the City Council to pass a law requiring anyone who wants to own such detectors to get a permit from the police first. And it’s not just devices to detect weaponized anthrax that they want the power to control, but those that detect everything from industrial pollutants to asbestos in shoddy apartments. Want to test for pollution in low-income neighborhoods with high rates of childhood asthma? Gotta ask the cops for permission. Why? So you “will not lead to excessive false alarms and unwarranted anxiety,” the first draft of the law states.

***

“There are currently no guidelines regulating the private acquisition of biological, chemical, and radiological detectors,” warned Falkenrath, adding that this law was suggested by officials within the Department of Homeland Security. “There are no consistent standards for the type of detectors used, no requirement that they be reported to the police department—or anyone else, for that matter—and no mechanism for coordinating these devices. . . . Our mutual goal is to prevent false alarms . . . by making sure we know where these detectors are located, and that they conform to standards of quality and reliability.”

This is insane. This is the perfect example of just how far a government obsessed with control - of people, of information, of knowledge - wants to go. Notice the source of this recommended legislation: Department of Homeland Security. Under the guise of fighting terrorism, they want to make sure that people do not have access to even basic information about their environment. Such legislation would allow bureaucratic control of just about every type of pollution research, would mean that many scientists could not conduct experiments within the city, and would likely criminalize even possession of much lab equipment used in schools.

And using the argument that ‘false alarms’ would cause undue panic and anxiety would also necessitate outlawing every kind of burglar or theft alarm, fire alarms, smoke alarms, et cetera.

This has nothing really to do with fighting terrorism. It is only about control. As the article points out, if this legislation were in place following 9/11, independent environmental testing would not have been allowed which eventually proved that the EPA’s assurances that the environment around Ground Zero was safe were nothing but lies. This is a bald-faced attempt by the government to say: “we will tell you what you need to know.”

Insane. And essentially un-American.

Jim Downey

(Via Cory Doctorow at BoingBoing. Cross posted to UTI.)

As I have mentioned previously, I enjoy shooting. And I carry a concealed weapon (legally - by permit and where allowed by law) pretty much all the time. This isn’t paranoia, just a simple recognition that we live in an unpredictable and sometimes dangerous world. That same mindset applies to preparations for any kind of small-scale disaster, whether natural or man-made. If you live in the Midwest, you understand that power outages occur due to weather (tornadoes in Spring, Summer, and Fall, ice-storms in Winter), and that you may need to be self-reliant for days or even a couple of weeks. I’ve long abided by the Scout motto of “Be Prepared”, and while you wouldn’t find a years worth of supplies and a generator cached here, we could manage pretty easily for a period of a couple of months. That’s not too far off what is recommended by both the government and independent health agencies. As I’ve discussed, the onset of a pandemic flu may well cause a disruption of normal economic activity for a prolonged period, and I cite such a disaster as the background for Communion of Dreams.

Anyway, in an accident during one shooting trip this fall I managed to slice open my right thumb pretty well. I had ridden out to the family farm where I usually shoot with one of my buddies, so didn’t have my car, which contains a fairly complete first-aid kit. And, as it turned out, my buddy didn’t have any kind of first aid supplies in his car. We improvised a bandage from stuff in my gun cleaning kit, and things were OK. When I got home, I added a real first aid kit to my ‘range bag’, and didn’t think much more about it.

Then, a couple of weeks later I was back out at the farm with my BIL. We were walking the border of the property adjacent to a state park and marking it as private, since a lot of people don’t bother to keep track of where they are and we’ve had a lot of tresspassing. At one point down in a secluded valley my BIL and I paused for a breather, and just out of curiosity I checked to see if I had a signal for my cell phone. Nope. Hmm.

Now, it was nice weather, just a tad cool and damp when we set out. But it was November, and the leaves were slick in places where a fall could easily result in a twisted knee or a broken bone. I got to thinking - if I were on my own, what did I have with me that I could use in the event of an emergency? Oh, I had plenty of stuff in my car - but that was the better part of a mile away. What did I have on my person?

In truth, I was in better shape than most people would likely be in such a situation. I always have a Leatherman multi-tool on my belt, a small LED flashlight on my keychain, and a pistol and ammo. But still, since I don’t smoke I’m not in the habit of carrying matches or a lighter, I once again didn’t have any first-aid items, et cetera. I had stuck a small bottle of water in my jacket pocket, but that would hardly last long. I could probably cobble together some kind of splint or impromptu crutch, but it would be a challenge to get out of such a situation on my own.

When I got home I got to doing a bit of research about emergency survival kits. Google that, and you’ll come up with about 30,000 hits to sites offering everything from bomb shelters to equipment for first responders. Not particularly helpful. I decided to take a different tack, and started to think about what I wanted to have in a kit small enough that I would *always* have it with me. I set my goal for constructing a kit which would fit into an Altoids tin, since that is small enough to easily slip into any pocket.

This problem has been tackled by others, and there are actually some such small kits for sale that’ll run you upwards of $50. I looked over the commercially available kits, saw what others have done to solve the problems inherent in such a project, and came up with the following:

What you see there is:

• Surgical Mask (can also be used as a bandage)
• Fresnell lens for magnification or starting fires
• 20mm bubble compass
• Single-edged razor blade
• Suture pack (curved needle mounted with suture thread)
• Band-aids & steri-strips
• Antibiotic packet
• Emergency whistle
• Superglue (repairs, fabrication, wound sealant)
• Mini-lighter
• Cotton tinder tabs
• Water purification tablets (can also be used as antiseptic)
• 30′ of Spiderwire (15 lbs test)
• Safety pins
• Small ziplock bag for water
• Cash
• Painkillers
• Benadryl (anti-histamine, sedative)
• Anti-diarrheal tablets

Yes, it all fits in the Altoids tin. Just. It is not entirely satisfactory, as I would have liked to have a large piece (say 18″x24″) of heavy-duty aluminum foil, a couple of garbage bags, some lightweight steel wire, maybe some duct tape or heavier cord. But it is a pretty good start - any small kit like this is by necessity an exercise in trade-offs. (Edited to add 06/01/08: I wrapped about 15′ of 24ga steel wire around the mini-lighter in a single layer, tightly wrapped.  Takes up almost no additional room, and will be easy to unwrap for use.)

In searching out the items I wanted (difficult to find items linked to my sources), it became clear that in some cases I would spend more on shipping for some of the components than I would for the actual items. So I made one such kit for myself, and another half dozen to give to friends. That got the cost down to under $10 each (not including the cash, obviously).

Your best survival tool in any situation is your brain. But it doesn’t hurt to have a few advantages in the form of useful items close at hand. With this small kit, and what I usually have with me anyway, I am reasonably well prepared to deal with most situations that I can envision. And I thought that since I went to the trouble to construct it, I would put the information about it here for anyone else who might have some use for it.

Jim Downey