He’s dying Jim!

Less than a minute after the mountain biker blew by me on the trail I heard the wail. It was scary. I raced forward with my hiking partner and very quickly came upon the accident scene. Thomas was laying in a crumpled mess, his $1500 mountain bike further down the trail with one more bend in the frame than the manufacturer had created it with.  This didn’t look good.

The hillside was steep and Thomas was on his side. I dropped my pack and went to backside of Thomas. Quickly my training kicked in. I introduced myself and asked him his name. His response re-assured me. He was breathing and had a pulse. And in medical terms, he appeared to be alert and oriented times three.

I put on my gloves (yes, I do carry nitrile or latex or material gloves pretty much anyplace I go, you should too!)  I then moved to his backside and palpated his head. So far, so good. No blood or cerebral-spinal fluid.  Since he was on his side, it was an ideal (if one could call his situation that) position for me to check his spine. Working down, so far so good until I got to the top of his lumbar portion. There I felt something very wrong.  Ok, shit just got real.  Upper torso, so far so good. Lower torso, right side, a reaction to pain. Barely noticeable, but definitely some mass internally. Again, not good. I continued down his legs. I got to his feet and normally I’d have saved this for the secondary survey, but since I already had a bad feeling and this wouldn’t take very long, I asked him to press his toes against my hands like he was pressing the gas. Nothing. I asked him to pull up his toes, again nothing.  This was not good. Same lack of reaction on the other side.  I could hear the panic in his voice, “why I can’t I move my legs?”

In all my past training they always taught us, “never lie to the patient. But also remember you’re not a doctor.” So I was honest. “Look, it could be a lot of things. I’m not a doctor so I don’t want to speculate. We’ll leave that to the professionals.” But deep down I knew. Bad tumble off a bike, bad position of a lumbar vertebra, and lack of sensation distal to that all added up to some sort of spinal injury. Would it be permanent, I had no idea.

I also checked his right arm since it was immediately available and this time came up with blood and point pain over the radius/ulna.  This matched what the accident most likely was.  He had hit a rock or something and wrapped his right side around a tree, breaking his arm, damaging his spine and most likely causing internal bleeding.

But I still had the left side to check.

With my partner’s help, we got a ground pad behind him and then rolled him very gently onto it. It’s always a risk moving a patient with apparent trauma like this but we needed to get him isolated from the could ground which was stealing his body heat and I needed to check for injuries on the left side.

Fortunately, this was the only bright news. A thorough check of his left side showed no apparent trauma. But, his shivering was getting worse and his mental state was decomposing. Whereas he was had previously been alert and oriented to who he was, where he was and approximately the time, now he kept asking the time.  Taking a set of vitals, things were not what one would like to get.

My partner was writing down all this information and giving me gear as needed. We had gotten the groundpad under him and clothing on top, but we needed to do more.  At this point, since we confirmed he wasn’t about to bleed out, we worked on splinting his arm. Providing traction in-line proved to be a bit painful at first, but ultimately gave him some pain relief and temporarily solved that particular issue. We did as much as we could in the back-country.

I took another set of vitals, and the numbers were a wee bit worse. In addition, Thomas was now wondering where he was. I repalpated his lower right abdomen and got an increased pain response and the firm area was larger. This was a very worrying sign.

While doing this, my partner ran down the trail with a copy of his notes until he got cell service and called 911. He gave them the details and then came back.  At this point, with his help we decided to get Thomas into a bivy sack to help keep him warm.  This took some effort since Thomas was bigger than either of us, fairly muscular and we were doing out best to protect his spine. But eventually we got it around him. Between this and some liquid “squirt” we were able to give him, his pending hypothermia appeared to stabilize and eventually improve.

But his vitals continued to degrade and the pain and mass in lower right his abdomen continued to get worse. He was dying and there was nothing I could do about it.

Well there was one thing I could do. I looked at Thomas and said, “well I think that’s it. Did I miss anything or do you think we got this exercise covered?”

He looked up and smiled, “Nope, I think you got it.  By the way, the biv sack really did help a lot. I was actually starting to get cold for real.” We removed the biv sack and he remarked, “Wow, you really did have a lot of warm stuff on me.”

Now, fortunately, all this had been an exercise, part of a SOLO Wilderness First Aid class I was taking over the weekend in order to renew my certificate.  The scenario was completely made up. But, I have to say, the feeling of helplessness was real.

Strangely though I’d say that was a good thing. For any skill we want to maintain competency in, we need to practice. Fortunately, I haven’t come across a crumpled mountain biker and most if not all back-country medical emergencies I’ve encountered have basically been fairly simple (an abrasion here, a blister there, or most commonly, mild hypothermia). But, continual practice does help. When arriving at the staged scene, I knew what I wanted to do and I knew how I wanted to do it and how to do it. The years of training and practice came back very easily. I knew how to do a primary survey and what I wanted to look for. I knew what vitals I needed and what trends I wanted.  There wasn’t much searching for knowledge, it bubbled up as needed. Practice really does in a sense “make perfect.”

And, even knowing that my mock patient most likely had internal bleeding that was leading to hypovolemic shock was good to know. Knowing that there was very little I could do if this was a for-real in the back-country was scary, but also strangely reassuring. I was confident that I had done all that I could reasonably do. And sometimes that may have to be enough.

I’ve talked previously about training as one fights. This should be true in any situation you may find yourself in: caving, the back-country, or even something as mundane as being a DBA. When’s the last time you practiced restoring a backup or doing a failover test?

Practice may or may not make perfect, but it does provide confidence.

P.S. if you’re in the Hampton Roads area tomorrow night (October 16th) come check me out speaking on System Databases at the Hampton Roads SQL Server User Group. Rumor has it, they’re serving wings!

Rolling Back

I’ve had a number of thoughts rolling around my head lately and they’re somewhat related so here goes.

I’m going to start with a depressing headline and URL: Civilization will end in 2050. Ok, perhaps that’s more of an alarmist headline than anything else. I posted this elsewhere, and some folks correctly pointed out that this could have been written by Thomas Malthus over two centuries ago.  And it’s true; prognosticators have predicted the fall of humans since probably before recorded history.  How many of us recall in the last century alone predictions of world-wide famine, a world-wide ice age, comets smashing into us and other horrible events.

Some were prevented, such with the Green Revolution. Some were corrected with better data or a better understanding of the data. Some where just… nuts.  That said, some predictions can be made with 100% certainty, even if the bounds on the actual circumstances are fuzzy. I’ve been giving this particular nugget a lot of thought.  Since I’ve passed that magical (at least to humans) mark of a half-century, I’ve given more thought to what I call my expiration date. It’s a fact. At some point I will cease all biological functions and will be dead.  I can’t escape that. Every day the odds increase a very tiny percentage.  So, I am predicting my own death, most likely sometime in the next 1/2 century. There’s a very slight possibility it could be tomorrow, and a much greater chance it could be 40 years from now, and based on current medicine an absolute certainty 80 years from now.  You’ll note I hedged that last one. It’s quite possible in the next few decades we figure out how to extend the human lifespan by decades if not centuries.  But I’m not counting on it. And even then, there are no guarantees I’m not hit by a driver while biking or some other catastrophic event.

That said, right now I’d say the odds are decent I’ll be alive in 2050. And almost certainly my kids will be (and very likely I’ll have grandkids by then).  So, am I worried that the world will end in 2050? Yes and no. For one thing, there’s time between now and then for a lot to happen. But, as we get closer, it’s going to be harder and harder to forestall the impacts of higher levels of CO2 in the atmosphere and oceans. Yes, to be clear, I believe the evidence supports that humans are greatly impacting the climate via CO2 and other emissions.

But I’m also optimistic that we’ll work harder, especially as things get worse, to stave off the most pessimistic scenarios. But it won’t be easy and the longer we wait, the harder it will be.

While anecdotal, I’ve already seen the impacts in my life, earlier springs, caves that once held ice year round no longer do, less snow in the winters, etc. It worries me. But I also still have some hope.

That said, an analogy that’s been rolling around in my head that isn’t 100% perfect but fits me as a DBA.

Many of us in the SQL server community have started a long running transaction, only to realize we’ve brought the server to a halt. In other words, no other user can access their data until our transaction is complete. We can abort the transaction, but if we wait too long, that can be a far worse solution than trying to stop it early on. For the non geeks, in other words, if our transaction is going to update 1 billion records and we realize 5 minutes in that it will take 10 hours, we can abort it and it should take about 5 minutes to rollback to the original state. This means we’ve only brought the server to a halt for about 10 minutes. However, if we ignore the problem, and keep pretending it’ll go away and we wait say 9 hours and then finally decide, “oh what the heck, let’s try to fix the problem now” it might take another 9 hours to rollback. In other words, by waiting to long to resolve the problem, instead of being 10 minutes, it can be 1080 minutes.

In other words, the longer you wait, the harder it can be to recover. I think that’s where we’ll be at by 2050. Whether or not I’m still alive (though I plan to be!)

Punditry

We’re all experts on everything. Don’t think so? Go to any middle school or high school soccer game and you’ll be amazed at how many parents are suddenly experts on soccer. It’s also amazing at how many parents are parents of future NCAA Division I scholarship soccer players.

Seriously though, we’re all guilty of this from time to time. I’ve done it and if you’re honest, you’ll admit you’ve done it.

Yesterday the world suffered a loss, the near destruction of Notre Dame.  Early during the fire our President tweeted:

“Perhaps flying water tankers could be used to put it out. Must act quickly!”

As many have pointed out, this was actually a terrible idea. The idea of dropping 100s of kilograms of water onto an already collapsing roof is most likely to do more damage than not. But, while I think it’s easy to mock the President for his tweet, I won’t. In some ways it reminds me of the various suggestions that were made last summer during the Thai Cave Rescue. We all want to help and often will blurt out the first idea that comes to mind.  I think it’s human nature to want to help.

But, here’s the thing: there really are experts in the field (or to use a term I see in my industry that I dislike at times: SME (it just sounds bad) Subject Matter Expert.)

And sometimes, being a SME does allow you to have some knowledge into other domains and you can give some useful insight. But, one thing I’ve found is that no matter how much I know on any subject, there’s probably someone who knows more. I’ve written about plane crashes and believe I have a more than passing familiarity in the area. Perhaps a lot more than the average person. But, there’s still a lot I don’t know and if I were asked to comment by a news organization on a recent plane crash, I’d probably demur to people with far more experience than I have.

Having done construction (from concrete work in basements to putting the cap of a roof on), I again, have more than a passing familiarity with construction techniques and how fire can have an impact. That said, I’ll leave the real building and fire fighting techniques to the experts.

And I will add another note: even experts can disagree at times. Whether it’s attending a SQL Saturday or the PASS Conference itself, or sitting in a room with my fellow cave rescue instructors, it can be quite enlightening to see the different takes people will have on a particular question. Often no one is wrong, but they bring different knowledge to the table or different experiences.

And finally, you know what, sometimes the non-expert CAN see the problem, or a solution in a way that an expert can’t. But that said, at the end of the day, I’ll tend to trust the experts.

And that’s the truth because I’m an expert on punditry.

Followers and CPR/First Aid

Yesterday, I performed a little social experiment and was pleased to find it worked. I’ve got to say, sometimes it’s the small things that make me happy.

Despite the below zero (Fahrenheit, so really cold, not that warm-cold of 0°C) temperatures, my son and I decided to head up to a local state park and do a hike.  Surprisingly, OK, maybe not, when we arrived, the parking lot was completely empty.  It had been plowed, but there was still a layer of snow over the entire thing, so it was impossible to see where the parking lines were. Now in the summer, this parking lot can be completely full, but I wasn’t too worried about that occurring when the temp was about -4°F.

So, which way to park? Well, there was some sun, so I figured I’d park so that the windshield would get the most sun and hopefully warm up the car just a bit while we hiked. I was sure at the time and later confirmed, this was at a 90° angle to the way the parking lines run. Ironically it was also about 90° colder than the summer temps!

Even when we started hiking, no one else had shown up. But, I have to admit, in the back of my mind I had to wonder if I would start a trend.

Sure enough, 1.5 hours later, when we arrived back at the car there were 3 other cars.  Not only were they parked in the same orientation, they were all parked right next to my car.  This parking lot probably covers 3 acres. They could have parked pretty much any place they wanted in any direction they wanted. But, because I had randomly picked a spot (and not so randomly a direction) 1 car was parked next to me in the same orientation and the other 2 parked facing us.

So what does this little experiment have to do with First Aid or CPR? Have you ever been at an event when someone has a medical event and at first no one reacts? It’s actually fairly common.  Everyone is standing around waiting for someone else to react. But once someone reacts, others tend to follow.  Be that person that others follow.  Learn CPR and learn First Aid so that when something happens, you can be the first to react. Sometimes people just need a leader to follow; and often they don’t necessarily realize it.

There’s no good reason anyone else parked just like I did, and yet they did. But there is a good reason for people to follow you if you can be the first to react in an emergency.  And you don’t have to be an expert. Obviously it didn’t take “expertise” to park yesterday, but people followed anyway. You don’t have to be an EMT or paramedic to react at a medical emergency. You can be the person that simply shouts, “Call 911” and gets people reacting.

That said, I still highly recommend taking a CPR and First Aid course. Not only do you learn very useful medical response skills, it will help you be that person that reacts first.

And stay warm!

Why the submarine wouldn’t work

I was going through my old drafts and found this post I had started to write earlier this year but never finished.  Actually it appears I meant this to be part of White (K)nights but I cut it out to make that post more readable.

During my media interactions I was asked multiple times to comment on Elon Musk and once or twice on his submarine. I tried to keep my comments fairly neutral, but the truth is, I and some of my fellow trained cave rescuers were pretty bothered by Musk’s attempted involvement. I got into at least one online debate about how the people in charge obviously were clueless and that Musk’s solution of a submarine was a brilliant idea.

It wasn’t and I figured I’d address some of my concerns.  Please note as with all situations like this, I was not directly involved, so I’m going on publicly available facts and my training as a cave rescue person and a cave rescue instructor. I am also not in any way speaking on behalf of the National Cave Rescue Commission or the NSS.

Now let’s discuss the device itself:

  • It almost certainly would not have fit. By all accounts, the tightest pinch was 15″ and hard to navigate. Anyone who has moved through a cave knows that even larger passages can be hard to navigate. Locally we have a cave that has a pinch that’s probably close to 15″, but that is at the bottom of a body sized V-shaped passage. Unless you can bend in the middle, you will not fit through it. A cylinder like Musk designed, would not fit. I don’t know the passages in the Thai cave, but odds are there is more than one passage where flexibility is important.
  • It also, in many ways was superbly dangerous. Once sealed into the tube, there would be no easy way to monitor the patient’s vitals. And if the tube had started to leak (cave environments can be extremely destructive, even to metal objects), there appears there would have been no recourse except to keep swimming and hoping to get to an air filled chamber quickly enough and that was large enough to debug the issue.
  • In addition, if the patients were not sedated, I’d have to imagine that being sealed into such a tube, even with lights for 20-40 minutes at a time would have been sheer terror. As it is, the kids were in fact apparently heavily sedated (a fact that some of us still find a bit surprising, even though very understandable), and yet at least one started to come out of sedation while in a water passage. Without being able to directly monitor the vitals of the patient, who knows what would have happened.
  • There’s probably other issues I could come up with. But let me end with this one. Rarely if ever do you want to beta-test or heck even alpha-test, which is what this would have been, a brand new design in a life or death situation when there are alternatives.

Like our White Knights, we want our brilliant tech solutions, but often we’re better off adapting what we’ve done in the past. In cave rescue we try to teach our students a “bag of tricks” that they can adapt to each particular rescue. Foe example, there is no single rigging solution that will work for every rescue.  How I might rig a drop in Fantastic in Ellison’s might be very different from how I’d rig a drop here in New York.  How I  package a patient for movement here may be different than in a Puerto Rican cave.  And honestly I’ve seen a lot of high-tech equipment get suggested for cave rescue that simply doesn’t work well in a cave environment and we often go back to the simple proven stuff.

I will add a tease, to perhaps a future blog post, of a mock rescue rescue where a high-tech approach failed after several hours of trying, and the low-tech solution solved the problem.

 

 

 

The Soyuz Abort

Many of you are probably aware of the Soyuz abort last week. It reminded me of discussions I’ve had in the past with other space fans like myself and prompted some thoughts.

Let’s start with the question of whether Soyuz is safe. Yes but…

When Columbia was lost on re-entry a lot of folks came out of the woodwork to proclaim that Soyuz was obviously so much safer since no crew had died the ill-fated Soyuz 11 flight in 1971. The problem with this line of thought was that at the time of Columbia, Soyuz had only flown 77 times successfully vs 89 successful flights since the Challenger Disaster. So which one was safer? If you’re going strictly on the successful number of flights, the Space Shuttle. Of course the question isn’t as simple as that. Note I haven’t even mentioned Soyuz 1, which happened before Soyuz 11 and was also a fatal flight.

Some people tried to argue that the space shuttle was far less safe because during the program it had killed 14 people during its program life vs 4 for Soyuz.  I always thought this was a weird metric since it all came down to the number of people on board. Had Columbia and Challenger only flown with 2 on each mission, would the same folks argue they were equally safe as Soyuz?

But we can’t stop there. If we want to be fair, we have to include Soyuz-18a. This flight was aborted at a high altitude (so technically they passed the Karman Line and are credited with attaining space.)  Then in 1983, Soyuz T-10a also suffered an abort, this time on the pad.

So at this point I’m going to draw a somewhat arbitrary line as to what I consider a successful mission: the crew obtains an orbit sufficient to carry out a majority of their planned mission and returns safely. All the incidents above, Soyuz and Space Shuttle are failed missions.  For example, while Soyuz-11 and Columbia attained orbit and carried out their primary missions, they failed on the key requirement to return their crew safe.

Using that definition, the shuttle was far more successful. There was one shuttle flight that did undershoot the runway at Edwards, but given the size of the lakebed, landed successfully.  We’ll come back to that in a few.

Now let me add a few more issues with the Soyuz.

  • Soyuz-5 – failure of service module to separate, capsule entered upside-down, and the hatch nearly burned through. The parachute lines also tangled resulting in a very hard landing.
  • TMA-1 – technical difficulties resulted in the capsule going into a ballistic re-entry mode.
  • TMA-10 – Failure of the Service Module to separate caused the capsule to re-enter in an improper orientation (which could have lead to a loss of the crew and vehicle) which ended up causing the capsule also re-enter in a ballistic re-entry mode. The Russians initially did not tell the US.
  • TMA-11 – Similar issue as TMA-10, with damage to the hatch and antenna that was abnormal.

And there have been others of varying degree. I’m also ignoring the slew of Progress failures, including the 3 more recent ones that were launched on a rocket very similar to the current Soyuz-FG.

So, what’s safer, the Soyuz or the Space Shuttle?  Honestly, I think it’s a bit of a trick question. As one of my old comrades on the Usenet Sci.space.* hierarchy once said, “any time a single failure can make a significant change in the statistics, means you really don’t have enough data.” (I’m paraphrasing).

My personal bias is, both programs had programmatic issues (and I think the Russians are getting a bit sloppier when it comes to safety) and design issues (even a perfectly run shuttle program had risks that could not have been solved, even if they might have prevented both Challenger and Columbia).  However, I think the Russian Soyuz is ultimately more robust. It appears a bit more prone to failures, but it has survived most of them. But, that still doesn’t make it 100% safe. Nor does it need to be 100% safe.  To open the new frontier we need to take some risks.  It’s a matter of degree.

“A ship in harbor is safe, but that is not what ships are built for.” – John A. Shedd.

A spacecraft is safe on the ground, but that’s not what it’s built for.

In the meantime, there’s a lot of, in my opinion naive, talk about decrewing ISS. I suspect the Russians will fly the Soyuz TM-11 flight as scheduled. There’s a slight chance it might fly uncrewed and simply serve to replace the current Soyuz TM-9 capsule, but it will fly.

 

Crying Wolf

We all know the story of the boy who cried wolf. Last week we had a nationwide example of that.

I’m about to break an unwritten rule I have for this blog in that I try to avoid politics as much as possible. But here I’m going to try to steer away from any particular partisan position and try to discuss the impact of both certain policies and the resulting reactions.

So, to be upfront, I am not a fan of President Trump, nor do I subscribe to his brand or style of politics. That said, let’s carry on.

So, at approximately 2:20 PM EDT on Thursday of last week, millions of Americans had their phones buzz, beep, play some sort of tune, etc.  By the build up and reaction, you would have thought it was the end of the world. Ironically, the system MIGHT someday be used to actually alert us to the end of the world.  Hopefully not.

The event I’m referring to of course was a test of a new system that many phones classify as a “Presidential Alert”.  It’s really the latest in a series of systems the US has had over the years to alert citizens to potential dangers or crises.

Some of my readers may be old enough to recall AM radios that had two markings on them, small triangles with a CD in them. This was for the CONELRAD alert system that was in place from 1953-1963. This was designed to be used strictly in the event of a nuclear attack and was never intended nor used in the event of a natural disaster.

It was replaced by the Emergency Broadcast System. This system was actually used to alert local and regional areas to extreme weather events and other natural disasters.  In 1997 it was replaced by the Emergency Alert System. The EAS was designed to take advantage of the expanding ways of reaching people. This ultimately included the ability to send text alerts to phones in the US.

There are, and have been from day one of the design for phones, three types of alerts, the “Presidential Alert”, alerts for extreme weather or other events and Amber alerts.  Phones have had the ability to receive these alerts for close to a decade now; and, importantly, for the second two type of alerts, the ability to shut them off. Phones can NOT turn off the Presidential Alert. This is by design and this has been a feature of the system from day 1. In other words, despite what many in social media seemed to believe, this feature was baked in long before President Trump took office.

So enough history, let’s get to the the wolf cry. Both before and after, I saw people all over Facebook and other media proclaiming how bothered they were and upset that the President had the ability to text them directly. He (or ultimately she) can’t.

Ok, that’s not quite true. My understanding is that the President can issue a statement through the White House Communications Director that gets passed on to the appropriate people that would activate the EAS and the WEA and the statement would go out. But the idea of President Trump or any President sitting at their desk and picking up their phone and texting all of America is not true.  It’s a myth and image built up by folks who are quite frankly paranoid. This does not mean that the system can’t be abused. However, there are numerous checks in the system that I’m extremely doubtful that such non-emergency use would ever actually intentionally occur.

But, the fact that people apparently feel so strongly about the risks troubles me. There’s no doubt that this President uses social media in ways unlike any previous President. This President is far more likely to say what’s on his mind without much filter. Some people love him for that, some vilify him.

BUT, this man is the President, NOT the Office of the President nor the entire Executive Branch. This is an important distinction and one to keep in mind. Regardless of how one feels about the State of the Union, there are still checks on the actual authority he can wield.  And ultimately if the system did get abused, one would hope that someone along the chain would say “no” or if it got beyond that Congress would ultimately enact additional safeguards.

For a system like the EAS and the WEA to work, we need to test them. And we need to have faith they are properly used. Yes, sometimes mistakes happen in an unscheduled test going out, or worse, a test mistakenly sending out a message that a real event is transpiring. These mistakes NEED to be avoided and minimized so that people don’t panic (which can cause harm, including death in some cases). But the testing needs to happen to make sure the system DOES work when needed.  We need to have a general faith, though perhaps tempered with SOME caution of abuse of the system.  (BTW, I do realize there’s some controversy over exactly what transpired in the Hawaii incident and in fact might actually illustrate an actual abuse of the system by an individual.)

But we should not let the partisan social media actions of one particular President make us never believe the boy who cried wolf. Someday the cry may be real.

As long as the national level tests like the one that occurred last Thursday remain infrequent, with a clear purpose, and are clearly tests, I will continue to advocate for them.

P.S. Oh, one more addendum, anything you see about John McAfee concerning the test, or the E911 of your phone should be basically ignored.

P.P.S One of the eeriest experiences of my life was walking into my apartment and catching a rebroadcast of the movie Countdown to Looking Glass. It made me better understand how folks could have fallen for the Orson Welles broadcast of The War of the Worlds. Now I would never advocate searching for a bootleg copy of the movie on Youtube, but if you can find a copy it’s worth watching in my opinion, and honestly, the last minute or so still sort of freaks me out.