I was struck by lightning yesterday—and boy am I sore
arstechnica.com
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If anything, he should make sure he's on somebody's radar.
Edit, source: I'm a physician.
What I have learned is this:
1. You will almost never get warning before lightning strikes. Only once did I get the hair-on-end. Every other time, no warning whatsoever before discharge. However, as is obvious, highly active cloud-to-cloud lightning indicates an extremely active cell, with extreme danger.
2. Lightning can reach a /long/ way to get you. The closest call I ever had, the storm was 15 miles away. I was standing outside watching it and it struck 2 feet away from me. It wasn't a stringer either - it was a full discharge and sent me flying (more through my own surprise than physical force).
3. If you can hear thunder, you can get struck quite easily.
4. A few drops of rain increase the chances of being struck by several orders of magnitude. The atmosphere is far more conductive and therefor danger skyrockets.
5. Lightning will strike the most out-of-way/odd places. I've watched it blitz trees in a deep valley over and over again without hitting the peaks once. There is no predicting what is likely to get struck.
6. In an instable environment, any cloud that is rising rapidly is extremely suspect. I once was watching a storm that was cranking away about 10 miles off. A small cumulus tower went up next to me, but didn't look like much. 30 seconds later it discharged only about 1/4 mile away.
7. Some wikipedia entries and other sources state lightning is uncommon over water and the open ocean. This is completely untrue - there is a lot of it. If you are boating and see a squall, be prepared to book it out of there as a boat is a highly dangerous place to be during a storm.
8. A fantastic shot of the close-range effects of lightning is 00:01:15 into this video: http://www.youtube.com/watch?v=P7K3m2zHEhs
What you'll notice about that shot is the effect it has and how very clear it is, along with how quiet it is at close range. The sparks off the metal roof, the movement of the actual channel, even the rate at which it discharges is apparent. Probably one of the best shots so far (though I welcome others!)
Stay safe.
One other thing to be aware of, one the injuries that lightning causes is blindness (temporary but possibly lasting a couple of days). Several of those closest to the strike were blinded - it was described to me as a sunburn of the retina, where vision is not restored until the burns heals. That may not be medically accurate, but describes the experience they went through.
Excellent point about CPR and blindness as well.
(except, I just checked on eBay; a surprising number of decent machines for <$500, allegedly pulls from gyms or hospitals. I wonder how hard it is to test and recertify, and also how hard it is to figure out how many of them have just been stolen.)
Assuming it does pass, it's probably better than none at all, although in the worst case the person trying to use it is wasting time with it when they could be giving you CPR. Definitely a tough call.
CPR won't restart the heart. An AED _might_. If the person has been down for several minutes, then a few rounds of CPR is a good thing, but if it's less that 2-3 minutes, go right to the AED, don't bother with compressions.
Do you have a source on this? We're talking about a healthy but traumatized heart, right? And are we talking about totally stopped, arrhythmia, or either?
(I think you can use them in full manual mode with open chest and electrodes to treat a few more weird rhythms, along with cardiac massage (open-chest or regular CPR), but probably not happening on a paramedic call-out, more likely in a hospital setting. Normally you use CPR + drugs and then try the AED again. I'm not really sure of the details of the limits of dealing with asystole in a hospital setting, but I suspect in an OR they have some extra options vs. other places.)
I guess another option might be a rapid way to put someone on heart/lung bypass, either in the field or at least in the ER, rather than only in the OR. Or rapid chilling, or both. I suppose if we either had long-term useful artificial hearts, or a more efficient/effective organ transplant regime, this might be more of an issue.
Rapid cooling is becoming very widespread in post-ROSC situations (we're spec'ing a chiller box for saline in our next rigs for that very reason), but if they're still dead, cooling them isn't likely to do much for them.
By 'stopped' I mean 'stopped being effective'. If the heart has truly stopped (asystole), then by all means, pump on the chest.
If a heart has stopped completely (asystole or 'flatline'), then an AED is useless. You can try CPR and epinephrine, and in the best case scenario, you might get the heart into a condition where you can use the defibrillator.
A defibrillator is useful when the heart is beating in a chaotic fashion (or _way_ too fast). The electrical shock it delivers completely stops the heart, in the hopes that the heart's internal pacemaker can take over again.
CPR can't 'reset' the heart, all it can do it help slow down the dying process until you can get a defibrillator in use. Without the defibrillator, the heart will progress into a state where even the defibrillator won't be useful.
Here's the basic protocol: 1) If it's a child, do two minutes of CPR before using the AED (the most common cause of cardiac arrest in kids is respiratory arrest, so ventilating them is sometime all they need)
2) If it's an adult, and they've been down for more than a few minutes, do 2 minutes of CPR to 'prime' the heart to make it more 'shockable'
3) If it's an adult, and you just witnessed the arrest, use the AED straight away. Their heart is likely still oxygenated enough to restart easily. If they're not breathing, be sure to fix that...
http://en.wikipedia.org/wiki/Automated_external_defibrillato...
CPR alone never restarts a heart (ok... not 'never', but it's uncommon enough (in adults) that it's not worth fighting over).
Yet again human intuition proves counter-intuitive. It's easier for us to visualize that being at a high point is more dangerous than a lower place. If there were a method to use FFT and convert land from a height map to the resistance/conductivity domain, I'm sure there will be very very surprising results.
Basically, the "leader" that establishes the path through which the main discharge will happen moves randomly downwards, but will be strongly attracted towards grounded objects that it comes close enough to - and "close enough" is only about 50 meters. So if there is a high point within a sphere of 50m radius centered 50m above your head, you're indeed almost completely safe (or at least you won't be hit directly - what hit Marlin was apparently a part of the charge that was moving through his house.
The strikes always hit taller object like houses and trees and I never ever saw a strike or evidence of one in the middle of a field.
1. http://www.youtube.com/watch?v=oqzjk1kp5Ug - Notice in the shot how the lightning hits a small, low-in-the-water boat.
2. http://www.youtube.com/watch?v=keVm06H26ik - In Boulder, with the mountains right next door, lightning strikes twice in the city proper, around 1,000 feet lower in elevation.
3. http://www.youtube.com/watch?v=YKw9kpD0rNc - Lightning strikes the water, less than a hundred feet away, instead of the palm trees the photographer is at.
My point was that assuming lightning will strike the highest point is patently false; it doesn't meant that a valley isn't any safer than a mountain - just don't assume that being in a valley protects you.
HOW? The lightning entered his window...!
Somehow animals can sense it. I've seen animals flee seconds before lightning struck.
I think it is hit-or-miss (pun intended) in the end, but it would be interesting to see if anyone has done more in-depth research on it.
My Dad and I were on a fishing trip in Michigan and floating down the river with a guide in a long, canoe-like river boat. A storm came down the river from behind us pretty soon after we put the boat in. The guide decided to pull the boat to the side of the river under some overhanging tree branches. It didn't appear to be that big of a storm when we had looked at the radar earlier, and it was moving fast, so we weren't all that worried.
At the time I wasn't sure if it we had made the best decision, but there weren't any immediately better alternatives. As the rain got heavier, and the storm got closer, we just waited. I was in the bow of the boat, and the current kept swinging me out from under the branches into the main current. Every few minutes I'd pull on the branches to give myself better cover from the rain.
Eventually it really started pouring, and then hailing. The storm was right overhead, so we hunkered down. All in an instant I felt something weird come over my body (not hair standing up, just something different), I saw a bright orange flash, I screamed like a little girl, I ducked and covered my head while hearing an extremely loud crack.
After maybe a second I popped up and said to my Dad and the guide "Are you okay?" I was a bit surprised to hear myself after having been so close to such a loud sound. They didn't respond. I repeated myself, and they both said, "Did you see that?" I said, "Did you hear me scream." They both said that they hadn't.
My dad says that he saw a hole in the water where the lightning struck, just two or three feet from where I was sitting in the boat. The bow of the boat had been in that spot minutes before, but I had pulled it back under the trees. I wasn't holding my fishing (lightning?) rod, but I easily could have been.
I felt sick. We could smell the ozone.
I don't think it was a particularly big/strong bolt, but it was big enough.
There was a guy across the river who had also pulled off to take cover. He was freaked out because he was so close to where the bolt struck. Then he realized how close we were.
After the storm passed, we called it a day (didn't even catch a fish), and paddled back to the lodge (which was about 20 minutes downstream).
About a month and a half later, we were with the same guide in the same boat, but on a different stretch of river. We thought we were clear from the storm that we saw on the radar, but this massive cell ended up right on top of us. We were right on its edge, so the lightning would get closer and then farther away and then closer again. We were smart enough to get out of the boat this time, but ended up crouching in the woods for nearly three hours hoping the storm would pass.
It was pretty terrifying. I'm definitely scarred by my experience. I can't enjoy thunderstorms the way I used to. When I see the orange flash or hear the loud crack of a close strike, I'm taken back to last May and I feel kind of sick. I'm really lucky that is the only lasting effect from a few poor decisions.
------
What I've learned:
1. Don't put yourself in a bad situation. Watch the radar, and have a plan for if/when a storm is getting close.
2. Don't be afraid to travel to a safer place. There is a time to hunker down, but it's not until you really have no other options.
3. Most people don't know much about lightning safety.
4. Your friends will make fun of you for taking electrical storms seriously. Getting some crap from your friends is better than getting hit by lightning.
5. You are never totally safe. If a guy in his office chair can get hit, then you can get hit almost anywhere. Still, there is almost always a safer place to be. Get there if you have time.
6. Small storms can be more dangerous that big storms. If you hear thunder, take it seriously.
7. Take a few minutes to read up on lightning safety (http://www.lightningsafety.noaa.gov). It will probably be useful at some point in your life, and what you think you know is probably not 100% right.
8. Most lightning safety tips seem overly cautious. They are, but it's something uncommon enough and dangerous enough that being overly cautious is worth the aggravation.
What I've always found interesting is the lack of sound in about half the cases I've learned of. In my own closest call, which was 23" away from my left arm (streetlight), I remember hearing a buzzzzzz-bzzt and then wondering why I was in the air falling toward the mud.
About half a second later a giant crack happened, from a stringer off the main bolt.
In the first video I referenced, it wasn't even that loud! The whole sound/proximity question still fascinates me.
As for your experience, I've been a fisherman for most of my life. Thankfully, I've not had really bad experiences with lightning while fishing, but yours is a great lesson.
And one thing to note is that a fishing rod is one /hell/ of a lightning attractor. If you've got carbon fiber near you, get away from it rapidly.
> Small storms can be more dangerous that big storms. If you hear thunder, take it seriously.
This is extremely important as well, because we'll often disregard a towering cumulous cloud with the classic "aw, that ain't a storm!" That can change in seconds, because powerful updrafts can move upwards of 100mph. Being outside in a highly unstable weather environment is inherently dangerous.
I've had quite a few thunderstorms come up on me while I was fishing. The one that almost got me was one of the less scary ones in terms of my feeling of safety. I think I'm now destined for a life where every plane overhead or truck driving by immediately makes me think thunder.
The second thing is that often these voltages travel on the surface of a conductor (called the skin effect) rather than through the middle so if you don't have a hole in your skin with a burn mark around it (that is what you are looking for in step one above) you might dodge serious damage.
A friend of mine in high school was hit by lightning why riding his motorcycle off road around Las Vegas (back when it was easier to do that :-) and was fine except for two pretty bad burns, one where his belt buckle was (apparently it got red hot) and on his feet where the metal in his riding boots was similarly heated up.
Step-dad is a firefighter; so many times they get to the scenes of accidents, and everything looks fine on the outside, patient feels completely fine so refuses ride to the hospital, but then 2-3 hours (sometimes even up to a day later) they end up far worse off and sometimes even dead from internal injuries that EMTs are not qualified to assess.
Person: No, free.
You: So how will the doctor get paid?
Person: By the government.
You: Where does the government get its money?
Person: Oh...
Even more, in most systems I know the amount paid for health insurance is fairly explicit. Where I live you actually get a bill from a non-state company (some things may be subsidized from other taxes, and if you can't afford it you also get a subsidy, though) so no, people don't think it's "really-really" free. It's "people with more money contribute more".
It works this way whether you're talking about a city-owned ambulance at the fire station or a privately-owned one idling in a parking lot somewhere. In either case, you (or your insurance, or your city, or your state...) are paying for a driver and at least one paramedic to sit around at the ready, not just for the quick trip.
If that were true - if the price was based on the cost - you would have small towns & rural areas where it would be so expensive, no one could use them, and cities where even though there were more ambulances, EMTs, etc, the cost would be spread so thin as to be barely noticeable
I don't believe the price is tied so directly to cost of service
Regarding rural areas and small towns: they often keep costs down by having crappy medical services in general, and slower response times specifically. It's not always that bad, though. If a town isn't sprawled out response times shouldn't suffer so much.
I have heard on more than one occasion that the reason emergency services (ambulances, ER, etc) are so expensive is to recover the cost of all the uninsured users.
People can be refused at a clinic if they have no insurance, so they go to ER for everything, where in many places they cannot be turned away. Hospitals therefore have to bill YOUR insurance to recover these costs
That's why your ambulance ride is so expensive.
> Hospitals therefore have to bill YOUR insurance to recover these costs
You know who takes an even bigger hit? Uninsured but solvent patients. Insurance companies have greater bargaining power.
None of that has anything to do with the ambulance business.
You're not only paying for the time you spend in the ambulance, but for the paramedics to be on standby, and for technicians to clean and prepare the ambulance for its next trip afterwards.
Both in the ~$200k neighborhood.
There was a public investigation in Paraguay when a public entity paid 200k for an ambulance, they should cost 100k at the most.
In Peru the cost of transforming a van into an ambulance is 14.000 dollars.
http://www.laestrella.com.pa/online/impreso/2011/10/05/dispa...
http://www.larepublica.pe/11-03-2007/hubo-sobrevaloracion-en...
We're in the processing of spec'ing two new ambulances. We're looking at 'mid-range' rigs, and most bids are coming in around $185k-$190k.
I've heard that a lot of medical expenses in the U.S. are due to the high amounts of litigation (I still can't believe the stories of healthcare costs in the United States).
The provider is Anjo Tech, according to the article.
By the way, if you want to be as anal about the definition of "free" as to include totally peripheral expenses (as if a pencil costs you $100 for signing a check with it), you might as well get to the bottom of it and say that everything is free on the basis that no matter or energy is ever expended.
It does cost you money. Europe plays a different game than the US but both are games. Thanks to Kennedy no one can be turned away from the ER for lack of insurance and bills are paid off later for cents on the dollar if you have no assets. If you have assets and no insurance too bad.
Which is funny, since they're only required to "stabilize" you once you're there. I know a guy who was attacked, suffered head injuries, and couldn't remember who he was. He was patched up and discharged in that condition since he didn't have his insurance card on him (and, I assume, since a shirtless and beaten-looking guy with long hair is just assumed to be homeless).
I am quite certain that behavior isn't typical of the hospitals in our area, but I bet it's totally legal. And a valuable cost-saving measure! An MBA somewhere is surely proud.
Hospitals make a lot of money from unpaid bills http://www.youtube.com/watch?feature=player_detailpage&v...
We have a (very good) public healthcare system here in Australia; but an ambulance will still cost you.
The costs of keeping ambulances ready, training, etc. could be socialized somehow. I benefit by having 5-10 minute EMS response times even if I never use it for 70 years, so paying for that out of taxes or some other universal subscription fee to users makes sense, rather than putting all the costs on those unlucky enough to need it.
In my case, I volunteer with a combination career/volunteer fire/rescue/EMS agency. Our 'operating costs' are payed by taxes, but if you use the service, you get a bill ranging from ~$100 for a routine BLS transport to ~$500 for a 'significant' ALS call (lots of drugs and advanced interventions). We don't itemize, but we do adjust billing based on what was done.
You could probably waive charging direct costs if you had some other way of deterring abuse, but they essentially always have to respond to 911 calls, so the only way I could think of doing so would be to arrest someone who misuses the service. A policy of informally losing the bill for legitimate calls might work, or doing the standard drug dealer "first one's free" strategy. But I don't think $100-500 for an ambulance would break most people, particularly with insurance; a charity could also cover the bills for some people.
The problem with 'a charity covering the bill' is that you then need people to donate out of goodwill. That doesn't often happen.
There's already fines and punishment for abusing emergency support systems (e.g.: calling 000/911/your country's equivalent). Even if you abuse that, and even if you mislead the call centre operator to dispatch an ambulance to your house, they're not going to ferry you to your desired location unless your vitals show reason to consider it a possible requirement.
Ambulance services are free here, insofar as you pay for a small tax on every rates bill (said rates cover ambulance and waste management services) edit: Apparently not since 2003 - it's now simply just covered by the State. There's no out-of-pocket expense. I can guarantee you that we don't have ambulances running people not requiring their services around 24/7.
And, if they're evaluating you on scene, even if they decide not to transport, they've already rolled the truck(s) to see you, which is probably much of the cost.
As rdl pointed out, the liability is just too high to refuse to take someone to the hospital.
However, it wouldn't surprise me if the liability issues were very different in the UK.
There's a separate argument about who should pay for what services, but "care should be delivered in the most cost-effective way to get the best patient outcomes" is independent of that.
Lots of 'fall down go booms' and 'they just aren't acting right' (yeah... it's called 'getting old')
There probably should be a cheaper way to treat them than sending SF Fire over and over to the same addresses. And that way would probably be both more comfortable for the patients and lead to better long-term outcomes. Maybe more extended inpatient care for them (in a low-cost-per-day facility)?
But I do understand what you are saying, I just do not think of it as spending money as my taxes most likely would not change regardless, they would just be used for something else.
The money to pay for that ambulance ride is coming from somewhere.
In any event, a trip to the ER is definitely warranted, even if it's not in an ambulance.
http://www.pbs.org/newshour/rundown/2013/03/struck-by-a-turt... http://www.hipaaspace.com/Medical_Billing/Coding/ICD-10/Diag...
There are also CPT codes that specify the procedures and diagnostic techniques that doctors and other healthcare providers do.
Insurance is then a mapping from ICD codes to allowed CPT codes. Good luck getting that information from your insurance company, however. Once I had a claim denied because someone transposed two digits in an ICD-9 code, and the treatment obviously didn't make sense. The insurance company couldn't tell me what the codes were - just that it was not an approved treatment for the reported condition. That took a lot of painful debugging to resolve.
Oh, and CPT codes are copyrighted by the AMA [1]. If you want to use them you have to pay licensing fees. Too bad it's not usually a case of "want to use" but instead "must use." I'm not sure if ICD codes are copyrighted.
[1] http://en.wikipedia.org/wiki/Current_Procedural_Terminology#...
There are _many_ people who call ambulances for things a taxi could handle just as well (often those people aren't worried about paying for it... medicaid will cover some small portion of the bill, and they'll ignore the rest), but a lightning strike isn't one of those things.
Probably the best use would be to have x-ray capability in the truck to verify placement of endotracheal tubes. Shooting an adequate chest film is something you can learn in 5-10 minutes (although, licensure requirements...).
(I've seen fairly portable CT, but in the sense of "shipping container with 1-2 day setup"; there are of course the CT and MR imaging trucks too.)
As far as '5-10' goes... rdl wasn't talking about interpreting films, he was talking about shooting them (and then transmitting them to a doc somewhere for interpretation).
There are some interpretations that could be taught in minutes . Most importantly, the one rdl mentioned, "Does that radio-opaque wire stay straight in the trachea, or does it deviate?".
Edit: I'm not sure the comparison to ED nurses is apt. Paramedics and nurses do very different jobs.
Patient positioning is something that we're pretty good at to begin with (if you think it's a pain to get them lined up to shoot the ET... try lining them up to drop it in the first place...)
But ETT and a few other things are the low hanging fruit. And with teleradiology you can even skip the "verify you got a decent image" step, particularly intra-hospital or for small images, because the rad can look at it immediately and tell you if you should reshoot.
I'd almost bet you could take a zero-training nurse or paramedic and give him a telerad-enabled x-ray or CT and get acceptable results working interactively with a radiologist and/or real rad tech remotely. Ultrasound might be trickier, but I saw midwives (who couldn't read or write, although they were really smart otherwise) trained in 3 days. I've never actually seen an MR used in person (since metal fragments tend to not go well with them; they just magically appeared on the PACS from elsewhere), but I imagine the basics of operating the machine aren't too much more difficult than a CT.
It has three primary uses: -FAST exams in trauma -IV access -Assessing for cardiac tamponade and guiding pericardiocentesis
Mobile CT are kind of interesting; I've only ever seen a mobile head CT, and that was designed to be wheeled into the OR to use in the middle of surgery, rather than sending the patient down the hall to the full body CT. But this was almost exclusively at hospitals designed around trauma care in a healthy 18-45 year old patient population.
In most of the hospitals I saw, it was never "mobile vs. portable", but "the Philips" or "the GE" vs. "the MinXRay", and even those were essentially left on wheeled carts most of the time.
Before that I was doing satellite/wireless/etc. networking, and some of my customers were various SOF who had fairly badass medics (regular army SF 18D is probably better than a civilian paramedic, at least for trauma, and the "other" guys had people beyond that, including some actual MDs who were also shooters). I did "combat lifesaver" class and then spent a lot of my spare time hanging out with the SF or SOF medics (because they tended to be more interesting than the shooters). I got some of the rad techs to teach me the basics of how to get decent images from CR/DR/CT/US, since I was trying to figure out which problems were caused by technique, which were caused by emitters or tables, which were caused by plates or scanners, and which were caused by our system. I kind of want to do an EMT course when I have time here, although I'm not sure where I'd volunteer to keep the skills current after that.
Before all of this I actually lived out in Baghdad for most of 2004/2005 with ~zero medical care or really any professional support (2 Americans, 100+ Iraqis), so it was mostly "learn anything you might possibly need well enough to do it yourself", and "don't get shot").
There were also civil affairs/outreach efforts, and some charity efforts (rotary club) to bring medical care to civilian population, which was weird, since Kabul had a private hospital with a 64-slice CT (when DOD had 16 and 32), and there was a private 2 Tesla MR in Jalalabad.
Mostly I was in "role 3" facilities, which were essentially as good a level 2 trauma center and a little bit of additional facility in the US. Also went to "role 2" (which were essentially 5-10 doctors, plus nurses and techs, with a couple of trauma bays, and X-Ray and US but not usually CT, and some of the FSTs (who augmented role 2 with much better surgical capabilities). In general the equipment and staff were top-notch, and the only problems were physical facilities. CTs tended to be in shipping containers, and the Army CSHes were big tent farms (which sucked), while USN and USAF tended to build fairly decent hardstand buildings (not as good as Stanford, but better than most of the rural counties).
On the issue of imaging without interpretation -- it's kind of funny. One of the big DoD pushes was to go back and have a radiologist read and issue an official report for every image shot of a US patient from the start of operations (2001/2002), in ... 2009 or 2010. There is the benefit that US people can't sue the government for malpractice, and Iraqis/Afghans aren't really in a position to sue, either (arguably the only ones with standing would be enemy combatants held in US custody).
AGFA was probably my least unfavorite, although IIRC they were really expensive. (In Kanadahar, the Canadian Forces who ran the medical role 3 until 2010 were using a pirated version of the software; they kept re-installing a trial license and hacking the date to work!) Really none of them were amazing, although I did really like the high-megapixel Barco monitors.
I've talked to some people doing an interesting cloud-hosted PACS (although they're in private beta, I see them listed in various places, so I think they're public -- radiology.io, now clariso.com.)
It was really funny when I was supporting an ActiveX-based system and every single one of the doctors had a Mac personally, and I used a Mac running VMware windows as my primary machine. I think the percentage of radiologists (or really, doctors in general) using Macs is >75%, but the hospital deployments are always Windows.
One good way for a new PACS or RIS to get started would be in training environments. Telerad is the other good way (sending CTs, and usually several studies, over a VSAT network with ~16/4M bandwidth for all of theater, was interesting -- especially since the goal was to always beat the patient to the facility to give surgical teams time to study the studies. Easy for the 8h ride to Landstuhl, hard for the <60 minute medevac helecopter from Jalalabad to Bagram.)
What surprised me is a lot of people wanted to at least be able to read reports (and usually look at images) on an iPad. Some rads even wanted to read on an iPhone screen (!!!) so they didn't have to get out of bed, although that was for things like sprained ankles and they'd read for real the next day. A Retina iPad is a pretty adequate device, though, honestly; it would be amazing to see what a Retina MacBook Pro 15 could do. (for everyone else, a radiology monitor is often $10-20k and approximately Retina resolution; there are some special FDA regulations about the screens for uniformity, but fundamentally they're 2-3x overpriced for what they are. A decent IPS LCD is perfectly adequate in many cases, particularly for CT/MR/US which are low resolution; mammography is the main area where really high quality screens matter (often black and white, 3-5MP). And the high quality screen really only matters for a radiologist; for every other doctor reviewing the images, a good quality normal monitor is perfectly adequate, as the rad writes a text report and marks up the images to identify anything important.)
I expect in 5-10 years ultrasound will be quite common, and x-ray may not be too far behind (mostly for respiratory related stuff... tube confirmation, confirming pleural effusions, etc...)
In the early (Johnny and Roy) days, it was _all_ telemedicine (send the strip and start LR...). We slowly got away from that for a variety of reasons, and are just now heading back to it.
While I'm not a huge fan of 'mother may I' medicine, I think it's crazy not to leverage the major advances in communications technology to bring a much broader range of specialties into the back of an ambulance.
Some area are having a lot of success with Paramedic Practitioners. The idea being that the can a) handle 'routine' medical calls without a trip to the ER, and can b) make proactive welfare checks on known frequent fliers (brittle diabetics, etc), reducing the load on the EMS system in general. Obviously they're also available as advanced level providers when needed, but this gives them something to do (and bill for) in their downtime.
It's stories like this that make me thankful for living in Australia. It doesn't cost money to visit a public hospital or visit a doctor who bulk bills (no up-front costs), medication is heavily subsidised (antibiotics and other common drugs), tests are all mostly bulk-billed and heck some places even offer Government subsidised dental care. I got a scale, polish, check-up (including x-rays) and clean from my local dental hospital for $59, you're being seen by final year dental students who are being overseen by a senior dentist.
Jason will be fine by the looks of it. Understandably, I can see why he wouldn't want to see a doctor given the costs you might incur, but then you can't argue leaving your family fatherless is definitely a whole lot worse than short-term financial loss. We shouldn't judge though.
Health care is free in America too. Total lifetime income: $2M. Cost of emergency room visit for once-in-lifetime lightning strike: $2k.
Ratio: 0.1%. Only in Washington, D.C. is a 0.1% expense a crisis worth ripping up the constitution over.
Jason Marlin Technical Director reply 29 minutes ago Story Author report spam ignore user
>Onerunjunior wrote:
>I don't understand how you can justify not going to the doctor for testing after you've been hit by lightning. If not for yourself, go get checked out for your wife and kid. It's incredibly stupid not to.
No I agree and do plan on going - was going to try and get in today. I probably should have just cruised with the guys yesterday but they were so nonchalant about the whole thing I was like "welp, guess only losers see the doc when struck by zeus".
Edit: from another comment
I should be better about these things, but have had some fairly unimpressive attempts at diagnosis for various issues over the past few years. I feel a bit like if you don't have blood squirting out of your eyes, it's assumed that you're either a) trying to score meds or b) seeking attention (why not both?). HOWEVER, I have scheduled an appointment for tomorrow morning. I'll update the post if I die :)
Plus Emergency Rooms are known for very long wait times, especially if you are otherwise looking in good health. (triage favors the folks bleeding out).
If you are presented a bill, it's not just an ER charge but a charge from the ER, from the doctor, the anesthetist, and seemingly everyone staffing the ER seems to have their own bill and billing agency.
That's above and beyond the high cost of ER care.
> No I agree and do plan on going - was going to try and get in today. I probably should have just cruised with the guys yesterday but they were so nonchalant about the whole thing I was like "welp, guess only losers see the doc when struck by zeus".
An EMT calmly telling you that you really should go to the ER with them is likely not being "nonchalant", just level-headed. I'm sure this guy is sick of hearing it by now but he made an unwise decision, even if it turns out he's fine after all.
I intend to live for a few more years :)
Tip: if you so much as bumped your head (such as falling over when hit by lightening) emphasis this. A head injury will bump you to the top of the queue (most of the people queuing should not be in the ER in any case, but are for a number of reasons)
I personally am in favor of copying the (excellent and very effective) veterinary model for our human medical care, not continuing to copy the model that was used for governing the Soviet Union.
Yes. See: banana republics.
Seriously, if you need a an elective scan and it's going to cost you more than a couple of grand after insurance: take a vacation, fly first class, stay in a 5 star hotel, get seen privately in a first class facility, have a relaxing rejuvenating break, and come home with change. Cost of a full-body CT scan in Europe?: < $1000.[1]
[1] http://www.privatehealth.co.uk/private-healthcare-services/d... Other parts of Europe (and no doubt elsewhere outside the US) will be much cheaper still.
Edit: did some reading. The risk is surprisingly low. For a 45 year old a single whole body scan has a mortality risk of 0.08%, and if the same person had one annually thereafter till 75, its a 1.9% lifetime risk. David, Brennee and Ellison in Radiology, 2004.
At the risk of derailing the thread - is this because going to A&E in the US is expensive?
I wonder how his hearing is.
(For those following along at home: A&E is "Accident and emergency [department]", or what Americans call the ER.)
Why go to the emergency room? Head to a walk-in clinic. I had to go a few months back. It was about a 20 min wait, total bill was $150 and I paid a $20 co-pay.
Don't go to the emergency room unless you have no other choice.
[source : http://news.nationalgeographic.com/news/2004/06/0623_040623_... ]
You'd probly get some impressive looking results by just taking the echo-chamber approach of looking for HN links to comics and index what the discussion was about.
Hell, just hard-coding comments for horse battery staple and bobby tables would probably pass 30% of the unit tests :)
I'm not not sure exactly what it is about NC that makes us so prone to lightning related accidents, but we sure do have a lot of them. I'd always speculated that it was something to do with geography / climate... just the right sort of semi-tropical climate to have lots of severe late-afternoon summertime thunderstorms or something. But when you look at the top 10 list, they seem to be fairly spread out. South, Southeast, Midwest, Southwest and Northeast all represented. The only conspicuous absence, to me, is the Pacific Northwest.
Edit: Did some more exploring... this graphic[2] makes it more apparent that there may be a geographic / climatic correlation. Southern states, Eastern states and Southwestern states seem to be particularly prone to lighting strikes and damage, with the Midwest, West and Pacific Northwest seemingly safer.
But, when you weight by population, the pattern seems much more muddled and nonsensical. Hmm...
[1]: http://weather.about.com/od/thunderstormsandlightning/tp/lig...
[2]: http://www.lightningsafety.com/nlsi_lls/fatalities_us.html
With that combo, you get much more lightning overall. This may account for the high death rate.
The Pacific Northwest has much fewer thunderstorms where population is concentrated. Go east of the cascades and there are far more storms, but far fewer people.
I lived there for 3 years and we got a ton of storms. I'm quite surprised - eastern washington used to get them relatively often during the summer.
Well, eastern Oregon on the eastern slope of the cascades gets quite a few as well, and I got there often enough to experience them :)
I lived there 1998-2001 while attending Gonzaga. We had a ton of storms in the spring and summer those years. Must have been a string of odd years.
I live in San Diego now - I haven't seen a good blitz of a storm in sooooo long ~_~
Here in Brazil lighting is common during summer. I had one strike a metal pole in a cement slab atop my house once. It heated the pole so hot it vaporized (nowhere to be found), and the slab exploded in hundreds of pieces. All that debris showering the roof sounded like hail - only after I stepped outside I found out it wasn't. The ground was covered in debris, still hot. I still have one of the pieces somewhere.
Can't believe this guy is not the only family member to have been hit, insane!
He woke up on his floor, could smell something burning, and found electrical components all over the place -- some embedded in the wall.
What happened afterward was kind of amusing. He went to the ER and signed in. The front desk nurse said something about their being a long wait (this was before they wrote down the reason.) Him describing the doctor running into the room moments later saying "You got struck by what!?" was pretty funny.
They ran tests and thankfully everything was fine. He didn't take a direct hit, I guess. No crazy scars or anything... hearing, heart, et. al were fine.
Anyway, my main point is, lightning is some crazy stuff.
The usual word is 'shrapnel', but this actually makes more sense in a portmanteau word sort of way: It's scraps that were hurled around as shrapnel. Scrapnel.
In the room upstairs, it melted a mirror and fried all the electrical devices. A monitor close by got a really neat wavy pattern like it was exposed to a magnet.
All in all, that was a terrible afternoon at work.
Your understanding is incorrect. See, for example http://www.srh.noaa.gov/jetstream/lightning/lightning_faq.ht..., for evidence that lightning rods increase the odds of being struck by lightning and decrease the damage if you are.
Lightning rods will not prevent your building from being struck. They actually INCREASE it by making your house TALLER. The purpose of the lightning rod is to direct the current from the lightning to the ground along a preferred path instead of to the house. However, this works only if the rod is connected to the ground with heavy gauge wire.
It's a bit more complex than that. From my quick browse on the Internet, it seems there's a slight increase in odds caused by the increase in height. But if the rod can actively and effectively dissipate the electric field then that should mitigate the increase in odds (and then some) caused by the added height. Finally, if well constructed, a lightning rod will reduce the amount of damage caused.
the taller and pointier a metal object is, the better a target it becomes for static electricity discharges of all kinds...
I'm not disputing any of the above. But how much more likely or "better a target" does the rod make it? I couldn't find any quantitative measure of the increase in odds. Do you have any? If the odds of a strike are increased by just 1%, that statement by the NWS is still correct. Would you discount the use of a lightning rod because it ever so slightly increases the odds of a strike, when you know it also offers the additional benefits of dissipation and a safe path to ground?
But I am discounting the reality of "dissipation" as an advantage. In fact the opposite should be true. To the extent that you create a cloud of negative charge, you should attract lightning, not avoid it.
Buildings with rods didn't get struck; buildings without, did. And the conflict was finally settled, once and for all, when a church somewhere in Spain was struck by lightning, setting off explosives that were stored underneath, leveling the town and killing most of the people in it.
I couldn't find references to this. Does anyone know any?
http://en.wikipedia.org/wiki/List_of_the_largest_artificial_...
Palace of the Grand Master Explosion, in Rhodes
On 4 April 1856, the Ottomans had storaged a large amount of gunpowder in the palace and the adjacent church, which were also full of people. In that time, it was considered that the ringing of bells could prevent the formation of storms. Unfortunately, a lightning hit the gunpowder, triggering a huge blast that killed 4,000 people.
Thanks.
Might have a problem with grip though...
https://en.wikipedia.org/wiki/Electrical_resistivity_and_con...
I wonder if teflon coated shoes would be effective, if rubber are not?
--- I suppose that you could argue that a really large teflon pad would increase the aggregate resistance (through your nice, self-contained ocean and then over the large teflon pad) to such an extent that the lightning would pass by you and ground directly, but those would be giant shoes and the little gap between them would probably defeat the whole purpose of wearing giant teflon snow-shoes.
Most lightning strike survivors are probably surviving "near misses", albeit sometimes ones where substantial electricity flowed through their body. A direct hit is probably going to be lethal nearly 100% of time -- there is a lot of energy in a lightning strike.
(1) Get away from high ground. (Duh.) (2) Get away from trees. (Duh.) (3) Do not go for low, low ground or any ditch. A very small local high piece of ground in a general lowish ground is good. (4) Do not lie down. (5) Squat down. (6) Put your heels together and spread the balls of your feet apart.
The latter non-obvious, points is because a strike will cause enormous local current near the ground in the immediate vicinity. Yes, the discharge wants to neutralize against ground, but the ground itself is not a good enough conductor to necessarily dissipate the full charge quickly. The discharge will therefore fly along the ground"as best it can.
What you want to do is avoid letting the powerful surface currents run right through your heart or head. Lying down is therefore bad. Putting your heels together might short circuit a current flow along the ground, while away from your torso. Being on a very smallish hill increases the chance that you can ride above the worst of near strike. A ditch or other low point puts your head and torso exactly where you do not want to be.
And, yes, your shoes are irrelevant.
Unless you could jump and roll away from the tree or something.
...uhm ...can anyone here compute the probability of 2 people in one family being struck by lighting in this timerange/pattern.
For developers working in teams, there is no better way to communicate as a group. Text chat has a scroll back, you can opt to participate in the conversation or just lurk, check it on your own time but are never interrupted in your focus by it (unless you set it up that way).
And when do I know, if there's a way, that 'okay, no fooling around in rains today - looks like it's bad today'? Or I should just avoid altogether?
Also, as the OP has mentioned he was in a room so I am sure it was well insulated, so that means standing in the shop sheds is just gonna save me from the rain and not the lighting, right? What about standing beneath dense and big trees?
And I wear a leather shoe or sports shoe - both with plastic/fiber/rubber soles(I'm not sure) - so they are gonna help? Umbrella?
Cars, with all those metals around must be most unsafe then?
http://science.howstuffworks.com/nature/natural-disasters/li...
The odds are still pretty low (they vary according to Google, but the lowest estimate is 1 in 3000 in your lifetime, with the highest being 1 in 500.000).
I'd be a lot more worried about cancer (1 in 6 chances).