If someone knows this guy, please tell him to consult a physician. Sounds like he may be experiencing rhabdomyolysis. When massive muscle contractions occur involuntarily, the fibers tend to break down and those proteins spill into the blood. This spillage may not peak for 12-36 hours. This can clog the kidneys and lead to acute kidney failure, which can then lead to acute heart failure, all told potentially 48 hours out. HN user arn is a nephrologist, he could comment more intelligently.
If anything, he should make sure he's on somebody's radar.
isn't there also a condition where electicical voltage-lysed cells spill out their contents and trigger cascading apoptosis, leading to death, but only after a few days? I don't know if there's a prophylaxis for this, but if there is, it might seem prudent.
Rhabdo is probably what you're thinking of. As a minor point, traumatic cell death is generally considered necrotic, not apoptotic. Apoptosis is programmed cell death.
Yeah I was under the impression that the initial trauma released specific factors into the blood that trigger apoptosis away from the trauma site... But I guess rhabdo is what I was thinking of.
I've been nearly struck several times. I love lightning, and apparently it loves me right back. And wants to touch me.
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.
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!)
As someone who also has first hand experience with a severe lightning strike (that left one dead and 11 hospitalized) and on a separate occasion saw a lot of people with hair sticking straight up (we ran to our cars before lightning struck that time), I second this. Don't assume you're safe because you're not near a high point. Lightning strikes wherever. And never, ever, ever stand under a tree. They make great conductors, but your body (a sack of salt water) is an even better conductor, so the lightning jumps to you. Last, lightning strikes are one of the cases where CPR can be effective. The body is still well-oxygenatd, but the heart may stop from the shock, so keeping blood circulating can save a life.
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.
>Don't assume you're safe because you're not near a high point
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.
It has nothing to do with intuition, just with over-simplification. It is true that high points tend to attract lightning and that this can make you safe. The effect just isn't as strong as most people think.
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.
I grew up in an area that frequently had thunderstorms. I witnessed many strikes in my yard, including my house while I was in it, and investigated many in my neighborhood. Much of what the OP said was bullshit. If it were true, the lightning rods that attracted and diverted many strikes wouldn't need to be place high.
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.
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.
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.
Another note is that the stepped leader that comes down meets another coming up from the ground. The one which reaches the one from the cloud creates the main channel, no matter where it is coming up from.
Seems like an excellent argument for having an AED available. (I'm really torn; it's just at the price point where buying one without any particular risk factors seems crazy, but EMS in the east bay tends to suck.)
(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 hasn't been opened and screwed with (which should hopefully be apparent from tamper-evident case construction), it should have a fairly comprehensive self-test built in. There's a pretty in-depth tear-down of one on youtube[1] that describes some of the test aspects.
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.
If you have an AED, then you're not 'wasting time' getting it set up.
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.
Except you cannot know if the patient is flat-lined or has arrhythmia. The AED performs an ECG and delivers a shock only if appropriate; if you have one available, you should always use it (which does not exclude CPR in the meantime).
Hence the 'might'. An AED may be able to restart a heart in ventricular fibrillation or ventricular tachycardia (I suppose we can quibble over what 'restart' means).
CPR alone never restarts a heart (ok... not 'never', but it's uncommon enough (in adults) that it's not worth fighting over).
In most cases you are correct, an exception is a lightning strike. Random Google coughed up this result "CPR usually has a success rate of 10% or less. In cases of lightning injury, CPR can have success rates of up to 90%. As such, normal rules of triage do not apply. If you find someone without a pulse or respirations after a lightning strike, begin CPR immediately." [1]
[1]http://www.wildernessutah.com/learn/lightning.html
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?
We're talking about a heart that has been sent into either a pulse less ventricular tachycardia, or ventricular fibrillation, due to the timing of the electric shock (generally during the S-T interval).
By 'stopped' I mean 'stopped being effective'. If the heart has truly stopped (asystole), then by all means, pump on the chest.
Clarification is great, but what I really want is a source saying that an AED can help a healthy heart but CPR can't. I've heard somewhat similar things but I've seen little hard data and none of it was related to healthy hearts.
It's simply a matter of what each thing is designed to do.
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...
I think by "restart", he meant the useful shorthand of "restore a useful rhythm, restart the heart as a pump instead of a tasty snack", and only in the case where the heart was in ventricular fibrillation or tachycardia. AEDs won't turn a "dead" heart into anything but slightly-cooked meat.
(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 wonder if the next step would be being able to deliver drugs (atropine?) in a more targeted way (maybe tiny doses highly localized and recurring? I'm not sure exactly how it works) along with electrical or manual stimulation.
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.
Atropine is mostly deprecated in cardiac arrest scenarios nowadays. It's still in-protocol for brady PEAs, but that's about it.
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.
It would be really interesting to see cooling applied to dive medicine (I dive, and a friend of mine is a Canadian Forces MD who did a hyperbaric/dive med fellowship at Duke, so I read some papers on this stuff more than I would otherwise). Also seems like it could be really useful for flight medicine/extended distance transport post ROSC/etc.
This is also an excellent clip showing stepped leaders in extremely slow-motion (the electrical leaders that lead to lightning strikes): http://www.youtube.com/watch?v=RLWIBrweSU8
HN is truly amazing. It seems I had a dangerously nonchalant view of lightning in the area I live. I now consider myself well versed on its hidden dangers.
This is great advice. I had a very close call last year, and have made it a point to ensure that it never happens again.
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.
Yeah, that is about what my closest call was like.
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.
Yeah, I was pretty certain right after it happened that I had sustained hearing damage, but after hearing myself speak I was happy to realize that I hadn't.
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.
First, as others have said, if you get hit by lightning or have any sort of severe electrical shock, so see a doctor and be checked out. The reasoning here is that any of the current that passes through you will create internal burns, resulting any number of issues.
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.
Yes, please, Jason if you're here, for the love of God please go see a doctor --
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.
Ambulance rides are crazy expensive and insurance companies like to question if you actually needed one. If you don't need the EMT, just take Lyft to the ER.
It's such a surreal concept to me that having to be picked up by emergency services will cost you money. I feel so incredibly lucky to live in a country where healthcare is free.
I'd rather see the direct or marginal costs of the ambulance or paramedics billed to the user (so, if they expend saline, or bandages, or whatever, you pay for it), and the hourly wage and vehicle costs for the trip itself. That would price a routine EMT-B ambulance trip around $100 -- still enough that people who didn't need it would take a taxi or drive themselves to a doctor for a non-incapacitating problem, but cheap enough that it could be paid out of pocket.
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 some areas (those with municipal ambulance services), that's exactly what happens.
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.
My daughter had febrile seizures as an infant. The ride in the ambulance to the hospital was ~$1k, IIRC. I don't think that she was on any sort of IV or anything, but my wife was in the back (I rode up front). (This was in Portland, OR)
If you're prepared to socialise some of it, why not go the whole hog. Is there anyone who thinks that ambulances should e user pays? It simplifies things too, as a fair portion of accidents have a blameless victim, so the cost makes them a victim twice.
The problem is when it's totally socialized (like medicare), you end up with people abusing the service. If an ambulance ride costs you less than a taxi or even bus, and you're an asshole, you use an ambulance (in some places, provided by paramedics, so the direct costs are high -- in some places they also send a fire truck, so you end up with like 20 highly-trained guys and $500k of equipment) to go to a routine checkup. 3-5 times a week.
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.
No you don't, because there's no obligation for the ambulance officers to pick you up and take you. A taxi is in the business of taking anyone they can anywhere they can. An ambulance is not. The only time they'll offer you a ride is if they judge that you may need of it, so already qualified ambulance officers have deemed you a possible candidate requiring their services. Moreover, they've only got one destination - the hospital - and it's not as if many people want to go there willingly. It's not as if you can call up an ambulance to pick you up and take you down to the pub for the night. If the ambulance officers are qualified to recognise medical emergencies (they are - that's their job) then they're qualified to determine who requires ambulance transportation and can filter patients accordingly.
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.
I can confirm this, works just fine in Germany and ambulances are free (i.e. covered by mandatory health insurance). And even if it would be abused - which I really can't imagine - I'd much prefer 100 idiots free riding to the hospital to one person dying because he can't afford the trip.
I was always told that here (Austria) if you call the ambulance but are not in actual danger you have to pay for it, and that it's very expensive.
But you can call an emergency physician if you're not sure if somethings wrong which is free in any case afaik. They will examine you and make a determination if you need to go the hospital.
My mother once called them because she was concentrating so hard on her heartbeat while trying to sleep that she started to panic because she thought it wasn't beating normally. The emergency physician examined her and deemed everything normal, made her calm down, and then just left. I was told if she had called the ambulance it would have cost a lot.
That's not true at all. If you call 911 (or someone calls for you), and you don't want to go to the hospital, you have to sign a form saying we offered to take you, but you are choosing not to go.
As rdl pointed out, the liability is just too high to refuse to take someone to the hospital.
When I lived in the UK, I called for an ambulance. The responder listened to my situation and told me I didn't sound high enough risk, so I got a taxi. I didn't get the sense this was unusual.
However, it wouldn't surprise me if the liability issues were very different in the UK.
Even in silly Poland (not to speak of Netherlands) abuse of ambulance service is treated very seriously. If the hospital makes the case that you made a call either as a prank or frivolously, you're in a world of trouble.
The argument isn't that they shouldn't get care, or even that they should have to pay for transport, but that they should be guided (using cost incentives, in the US market model) to use the most appropriate transport. ALS, BLS, mobility-but-not-EMS, or taxi). The problem is there are a lot of places in the US where "take an old person to see a doctor for a checkup" requires using BLS or even ALS ambulances, which is crazy, because ambulance would be covered but taxi would not be. It's better to just give these patients taxi vouchers, if you want the government paying for it, for $10-20, vs. a $100-500 direct-cost ambulance ride.
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.
The liability for refusing to transport a patient to ER who claims certain symptoms would be huge. Even doctors won't make that call in the US; there's no way an EMT or paramedic would.
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.
Some wilderness rescue services have an interesting take on it. If what you were doing was really stupid (like, hiking up and skiing a mountain in the middle of the night, during a storm), they bill you, but if you really just got screwed (fell and broke your leg), it's free.
I also think if you got "saved" by wilderness EMS, and were in a position to do so, you'd probably really want to donate money or other resources (time? promotion? something) to thank them.
A lot of patients need to go for visits with doctors at the hospital or in an associated complex. Many of those patients don't need special medical transport, or at the very least could go with BLS, but there are places where ALS gets used for everything and thus is very expensive. Medicare patients don't see this, but the reimbursement from Medicare to EMS is very small, too. If you have a substantial elderly or sick population, it can be a real problem.
If you talk to EMTs you'd find most calls are for elderly people with heartburn. Yes, some people abuse the system. Maybe offer one free ride a year or something.
In SF it seems to be a small population of seriously mentally ill, drug addicts (both OD and drug-seeking), those with ongoing conditions which they fail to manage properly, etc.
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)?
These has got to be some sort of war-on-drugs or drug policy thing going on here. Why is this so bad where you are, while it isn't a massive problem where I am (New Zealand). Sure there are drug problems (Meth and alcohol are hitting headlines too often), but you rarely seen the sorts of scenes I saw on a brief visit to SF.
SF ends up with drug addicts/mentally ill from an area of maybe 30-50mm people, due to what are perceived (correctly) as more welcoming city services, culture, etc. Add to that the war on drugs and weird issues with medical care for the poor (medi-cal), lots of Vietnam era veterans, etc., and one of the most dysfunctional city/county governments I've ever seen. (Detroit and New Orleans are worse, but those cities are poor; SF is rich).
I do not mind paying some taxes so that anyone can get help when they need it. The thought 'Do I have enough money to call an ambulance?' should never be something someone should consider. If you need emergency services you should be able to call and get help.
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.
In the US right now "spending marginally less money" probably means "borrowing marginally less money", which would actually be good. I don't think taxes would be lowered in response to cost savings, but deficit borrowing might be.
I am not a crazy anti-healthcare nut as this comment will make me appear, but I think you mean "healthcare is paid for by others/collectively", since it isn't free to provide services, unless your doctors are working for no money.
There are 7 billion people on Earth right now. You are going to find some that don't know what the hell "breathing" means if you just try hard enough. Using this to pick apart at the word "everyone" is just as pedantic as picking at the specific definition of "free" in that question.
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".
I'm afraid breathable air does cost you the energy required to operate the lungs. This energy is mostly generated from digesting organic matter such as vegetables and meat which can vary in price. Free cannot exist since we live in a universe with entropy. In other words in any given system some energy (cost) is lost.
I thought you explained it perfectly yourself, but sure. You were not addressing the original point about breathable air being free. Instead, you built a straw man, based on the presumed cost of /breathing/ it, which actually had nothing to do with the original point.
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.
The quick response times our ambulances achieve are due to their being strategically placed around a city, manned and ready to go.
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.
I don't think that doesn't make any "economic logic", for lack of being able to remember the correct term.
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
It's hard to make out exactly what your point is but you're correct if you're trying to say that the price here is not simply about supply and demand. The costs of ambulances are subsidized in many ways (but they're never "free") and you're also dealing with people who generally don't have the ability to shop around. It's not a "market" item, really, on either side of the transaction.
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 don't want to push this next claim too far, as I only have "I have heard" to back it & no actual numbers or links, but...
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
You are assuming too much: my ambulance ride isn't expensive. I live in a municipality which provides its own ambulances. In a geographically dense suburb it's efficient, logical and cheap (relatively) for EMS services to piggyback off of fire services. There aren't enough free riders around for the system to fall over from the "uninsured." If you're around here, you've probably helped pay for it.
> 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.
When you consider all the costs involved, it's not so unreasonable. You've got the cost of the ambulance station, ambulance itself, equipment, maintenance, fuel, medical consumables, paramedics, technicians, etc.
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.
Wow. Maybe there are legal or labor expenses way over what we have in South American countries.
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).
There must be a difference in ambulance spec too. How do you compare this? Can I confirm that the earlier comment of yours meant $14,000USD? I can't read Spanish unfortunately. Thanks.
I grew up in a country (Canada) where healthcare was free, but you still paid for emergency services. The two are not the same, and there is a real benefit to discouraging the unnecessary use of ambulances.
> It's such a surreal concept to me that having to be picked up by emergency services will cost you money. I feel so incredibly lucky to live in a country where healthcare is free.
We have a (very good) public healthcare system here in Australia; but an ambulance will still cost you.
Not for people in Queensland. It used to be rolled in to our electricity bill at $24/quarter but that was abolished a while ago (apparently 2003). We're now just covered simply by living in Queensland for ambulance transport anywhere in Australia (that is, if I need an ambulance in Victoria, I am covered by the State) [1].
I'm in Vancouver. I got hit by a cab on New Year's and had to pay $80 for the ambulance. The cab's insurance is picking that up, despite the whole ordeal being my fault, so they're sending me a check for $110 then asking me for $1500 back. Go figure.
In my country, ambulances are free for only life-threatening cases, but most everyone pays for an Emergency service (ambulances and walk-in ER), which costs U$ 15/month.
FYI, where I am, people other than pensioners pay a small annual registration / insurance fee to the ambulance service to avoid large fees upon use of the service
Someone always makes this comment. It's unhelpful as the meaning of free is clear. It's the same kind of free as the bank bailout. It cost you nothing and a hell of a lot at the same time.
>picked up by emergency services will cost you money
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.
> Thanks to Kennedy no one can be turned away from the ER
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.
Whatever next? So every injury type is specified? This is surreal. How is this cost effective? I thought socialised healthcare was bad as it was inefficient, yet someone writing up the injuries you're covered for doesn't seem very cost friendly.
Yes, every injury type is specified. You wouldn't believe what is defined in ICD-10. E.g. Stabbed while crocheting: Y93D1 (not to be confused with Activity, computer keyboarding: Y93C1), Hurt at the opera: Y92253. And then there's the famous V9027XA: Drowning and submersion due to falling or jumping from burning water-skis, initial encounter. I should emphasize that these are all real; I am not making this up.
Yup, and as others have mentioned ICD-10 is worse.
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.
The cynic in me sees the insurance company trying to figure out if the part of the bolt that struck came from the cloud or the ground, and if the former, dismissing the claim as an 'act of god'...
If you get struck by lightning, please call an ambulance...
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.
It's not so much that we're not qualified to assess them, it's just that no one has invented portable X-ray (or CT, or MR...) glasses yet (I'm looking at you, Google!).
Field portable x-ray (DR, even) and US is pretty widely available. Probably not something you'd put on even a normal ALS truck, but on expedition medicine or if you had to set up a facility in advance, were far from a permanent facility, etc. I've seen DR used for tb screening quite frequently (it avoids exposing the expensive radiologists to the field...); US for midwives for ob/gyn also makes a lot of sense, and I've seen those used with GSM or 3G backhaul of images to a radiologist.
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.)
Adequate in 5-10. I doubt this. I have trained students for 10ish years. I have seen what very experienced ED nurses (and consultants, anaesthetists etc) do with their 'diagnosis' from films, despite numerous courses and flash qualifications. This is without taking the film. Do it for years, see lots of things, make lots of mistake and then you'll get good.
Radiography students are generally competent for unsupervised chest radiography after about 6 months to a year. This is working 2 days a week, study for 3 days. You could probably produce a crap film but good enough to show ET tube in significantly less time, but a good operator has other ways to verify tube placement.
Portable x-ray in bigger towns provides a great service to rest homes, prisons etc and is fiddly and laborious. It's a niche market. The same (but less common) with mobile MRI. CT must be done somewhere in a mobile fashion, I haven't seen it.
It is easy to get a little twisted with terminology, but mobile x-ray generally means you push it around the hospital, portable meaning you carry it out the van, up the stairs, into the rest home (the 600kg mobile machine is not something you would carry easily).This terminology is widely abused though!
I meant "adequate for verifying chest tube placement", not " images which would actually be generally useful" (I saw plenty of skill differences among fully licensed rad techs, out of maybe ~50 military rad techs I observed, so I can appreciate the level of skill involved). (as for non-rads "reading"; it was pretty weird. Plenty of orthos were excellent, as expected, for the specific things they cared about, but there were a fair number of rad techs and GP doctors who got really good at some specific things. In working on PACS, I learned enough to be able to identify what was in the image, whether it was good, basic errors in shooting vs. later image corruption, etc., but beyond really obvious things like major fractures, it was really hard. The "look for violations of bilateral symmetry" cheat breaks down in a lot of cases where the body isn't symmetric :( But verifying ETT was one thing I could do pretty quickly. But even with trauma I think a lot of what the rad was for was to look for things like cancer or other less obvious issues, possibly pre-existing, even in trauma patients.
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.
I have never really considered imaging without interpretation. Sorry! This must be a legal nightmare - I'm imagining a missed pneumothorax, fluid collection (Not always obvious when supine). That said, something is often better than nothing. Were you in the military? I assume this would be more trauma type work, which tends to be a bit easier for identifying badness. However the working conditions would be somewhat worse I imagine (I have been hospital/clinic based). I would have thought that the most useful type of imaging I the fields would be ultrasound for finding a decent vessel to jab or guiding some sort of drainage (chest fluid, ascites etc). What was most your work?
Sorry rdl, I cant seem to reply to your comment below (comment to deep?), thats some great experience. There must be a few hairy stories from that period. What was your company's product name (No problem if you cant post this). Ive used Agfa, IntelliPacs, Kodak (didnt enjoy).
From 2008-2010 I worked for medweb (company and product, it's a small/private business, doesn't make imaging devices, just software and packaged PACS); it's an ActiveX based viewer, really low end but also a cutting edge idea back in 1997 or so when they invented it. They ended up making a super lightweight system with the PACS server on a laptop, too.
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.)
The sector is ripe for a grand slam by a good, integrated system. Decent CD/DVD printers that don't cost $20k US (for the damn referrers that insist on some kind of physical product), decent Mac and PC compatibility. Software that talks to GE, Siemens, Philips, Toshiba hardware in a reasonable manner. The ability to edit bad data easily and have it update remote workstations properly. Be easily searchable (Let me set up customised searches PLEASE - last 3 days of imaging off the scanner right by me for example). There are so many pieces to the puzzle and all seem to actively break each other. It's a hell of a mess at the moment.
You should talk to the Clariso guys -- I think they're US focused but really smart. Talking DICOM to the various modalities isn't that big a deal (although they all have weird bugs, and DICOM is a disgusting protocol), but good support for those stupid Plasmon archivers would be useful, or just figuring out a good client support option for local-to-workstation DVD burners. As for interop, the big issue is usually HL7/HIS integration at hospitals (for DoD, it was AHLTA, and for the VA, Vista, and for everyone else, usually EPIC but sometimes Practice Fusion). I think even the worst PACS is usually better than most hospital HIS/EHR.
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 worked for a small PACS vendor (mainly IT support and network engineering, and satellite network stuff, but also training rads, techs, and other doctors on how to use the image viewer, report writer, etc.) which was used for dod and others in iraq/afghanistan/kuwait/etc, and spent 2 years in Afghanistan (enh), Kuwait (awesome), and Iraq (been there, done that, was kind of boring by 2010). Also by the federal bureau of prisons, and some cruise lines.
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).
Those are fairly common uses of 'mobile' and 'portable' in general (the 'mobile' radio is attached to the truck, the 'portable' radio is on your hip).
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.
Yeah, even shooting good x-ray films is hard (rather, you can probably learn the absolute basics of radiation exposure, etc fairly quickly, but there is enough art to it that a good tech does a much better job than a radiologist (usually) or a bad tech, just at very practical things like patient positioning. At least in my experience -- the other issue being the craziness of an entire trauma team plus potentially a patient's unit representative plus techs plus radiologist all in a small CT room, or in the case of enemy combatants, armed MPs plus sometimes "other" guys plus patient plus techs...
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.
This is what I do now, I used to do CT and X-ray. MRI and CT have very little in common. While the images, very broadly speaking, look similar, the background knowledge required is very different. And they have crap interfaces. Really bad one. I save the error messages that are funniest now. MRI scanners are unreliable, temperamental, hard to get consistent results from and require constant care to avoid screwing things up! MRI isn't very good with serious trauma - too slow. I do miss that work though.
Yes to you and RDL - I see the point. I do dispute the 5-10 minutes though, but the point was that it could be learnt relatively fast. I'd assume some sort of weight versus exposure factors chart would hold 80% of the knowledge and when combined with a set 180cm tube-film distance and a digital system (forgiving!), things would be learnt quite fast.
It is deceptive how hard it is to get a patient properly straight, and thereby prevent ET looking deviated.
You could probably combine a CCD/CMOS imager (i.e. cheap webcam) with an x-ray (and maybe mm-wave imager or something) to help with this. Something like an AED as applied to radiology, with safety interlocks.
It would definitely be possible to have very simple scans done by someone who was given a crash course training (knees, lumbar spines, brains). The problem is that the most complicated work always fails to advertise itself - I found a liver tumour yesterday while scanning a lumbar spine. It appeared on 1 image of the planning scan (a crap, low res image). The student was was present didn't see it and dismissed it as an artifact when I pointed it out, and she is a good student. I'm sure protocols could be made to avoid problems (send all imaging to the PACS, even the duds) like this however.
One advantage is that you have a very fixed environment in the back of an ambulance. The stretcher is going to be in exactly the same place every time (I'd assume you'd have some sort of 'slot' to drop the 'film' in on the underside of the stretcher), and there are all sorts of fixed reference points in the back of the truck.
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...)
The bit where they are fighting you off is the bit I always watched with interest. The erect or supine images are sort of scripted in ones mind after a while. It's the semi erect child with ankylosing spondylitis or some such thing that cause distraction. I remember the situation like it was yesterday. It must have been 10 years ago. I never did manage to get a film where the poor guys knee caps didn't appear over the bases of his lungs on every attempt. We never did see his lung fields well.
I was being a bit flippant in my initial post. I'm aware of (and quite excited about) the increased use of imaging (and various other labs) in the field.
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...)
What would be cool would be using telerad (and telemed in general) to let some combination of family-caregiver, EMT, Paramedic, NPs, and doctors do both initial and definitive care in the field; should be a lot lower cost, both because it's cheaper and because it's better (old/sick/etc. people not being transported and then exposed to a bunch of other sick people would be a big win.)
I think (or at least hope) this is the direction medicine is headed in...
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.
Even with x-ray available to paramedics, they don't get the type of training needed to understand what they are seeing on an x-ray and even then they wouldn't have the training to correct any issues or authority to prescribe treatment. The best they could do is get a radiogram and pass it on, but even then, they usually are not in the best position to dose out radiation, nor would their patients likely sit still, since the idea is to get them to a hospital or care provider ASAP.
Probably one of the most common users of portable (ok, maybe I should say mobile) xrays are large animal veterinarians. I've seen them used with horses. Generally there's power at barns (someplace nearby, at least), but I imagine a generator would work.
Easier said and done. If you get struck by lightning in Canada, UK or Australia then it's obviously a no brainer but the sad way in which the American health system works is that you pay for everything. An ambulance ride costs money, consultation costs money, tests cost money The guy has a family, spending large amounts of money only to be told that you're fine might give you and your family piece-of-mind, but it won't help with the savings (if you have any).
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.
The vast majority of American medical cost is also socialized, despite the propaganda (employer mandates to provide health insurance, medicaid, medicare, VA). It's just socialized in a very inefficient manner.
Could a doctor do anything about internal burns? Such questions are prudent to ask in the US, where "being checked out" for a few hours (mostly waiting) can easily surpass $10K.
Isn't skin effect an AC thing in cabling?
The reason DC power is sometimes preferred for high-voltage high-power transmission is specifically because there is no skin effect and the cables can therefore handle more power per weight.
For all of you wondering about the doctor thing, here's his answer from the comments on that page:
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 :)
Men are often discouraged by society from seeking first aid or admitting any sort of ailment or weakness.
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.
> 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".
I think he misread the situation. If you're an EMT it is clearly in your best interest to remain calm and project an air of calmness to others because you're going to be in situations where the shit is hitting the fan and keeping your cool is the difference between someone living and dying.
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'm a pretty 'man the f* up' guy but there are certain things where I don't apply this philosophy. Being struck by a lightning is certainly one of the things where I wouldn't care if the EMT thinks I'm a sissy.
yep, as someone who had to go to the ER earlier this year I can attest to the high bills. I spent more time in the billing office than I did being attended by medical staff.
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)
Yes, but we should be completely ashamed that our medical system is so poor in every way. I mean, who are we comparing to, Zimbabwe?
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.
Yeah, it was really meant as more of a dark joke than a serious point. But it does make you wonder what people consider "serious enough" to warrant a trip to the hospital, given that medical costs are so high.
From his comments defending not visiting ER given a recent unrelated health issue: The hospital billed $11,000 for a cat scan; the insurance paid 6k.'
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]
Cost of full body CT scan may be greater than that - it would likely put you in Hiroshima-survivor radiation dose range.
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.
I know a lot of people who call it casualty but on signs at the hospital it's usually A&E (Accident & Emergency). It might be regional or something that's changed over the years.
If you don't have insurance it can be quite expensive. The technical director for Ars Technica, I'm guessing has insurance. He probably didn't go to the hospital because of the potential absurd wait times.
I don't get it. It's not an emergency now, but he could be in danger of something happening later.
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.
jerrya gave a hint of a possible "reason" somewhere in this thread: "men are often discouraged by society from seeking first aid or admitting any sort of ailment or weakness."
The odds of getting hit by a lightning is actually surprisingly high (1 in 3000 in an average lifetime). He should really go see a doctor though, since there's a 70% chance that he may be affected with serious long-term conditions.
Good luck! I imagine there'll be some interesting challenges. I don't know how useful the alt-text will be since I guess it's sort of a cheeky second-comic, so coming up with clever ways to index relevant ideas/terms will be interesting.
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 :)
Uh, it would be wise to see and doctor immediately! The electrical shock may have damaged your internal organs, even if there are no apparent external burns.
I was going to say that too - those Lichtenburg scar pictures that are linked don't look good. While they might seem 'cool' aren't those just 3rd degree burn scars? You have to wonder about the 3rd degree burns on the inside that you can't see.
I know that he didn't receive any scarring externally. My point was that anything that can do things like that externally could have resulted in very bad things internally.
Yeah, I'm not a big fan of hospitals, but this is one of those potential "oh, yeah, internal bleeding... that wouldn't have been quite such a problem if you had stopped in, you know, a few days ago, genius" moments.
Interesting that he had just moved to North Carolina. Strangely enough, NC is very high up (#4) on the list of "most dangerous states for lighting accidents"[1].
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...
North Carolina is on the eastern ass-end of a common circulation pattern of cold fronts. They get a lot of the big squall-line fronts with heavy/torrential downpours in storm cells, while the mountains act as an extra lifting mechanism.
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.
Not really. I've lived in Spokane for the past ten years and we almost never get thunderstorms here. I can remember one big one a couple of years ago where I thought we were going to get a tornado (something else that never happens here), but no such luck. That was the only storm excitement in forever. In general it's a fairly hot/dry place in the summer, and I don't think we get that magic combo of heat and humidity needed to cook up a good storm.
Really. It hardly rains at all in the summer here. Just sun and heat, sun and heat. Everyone has to water their lawns or they all die. I grew up in New England where we had proper storms in the summer, and I WISH we had them here, if only to get a little wx excitement once in a while.
Stats:
https://en.wikipedia.org/wiki/Spokane,_Washington#Climate
Well, that's quite amazing it chased him inside the house, and that he survived considering the ridiculously high punch these things pack. I've experienced what it can do.
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.
Lightning toasted my house in 2007, just arrived home 30 mins after it happened, glad I wasn't in the house given the magnitude of the destruction...TV exploded scrapnel everywhere, ceilings down upstairs and down....but worst of all, dealing with our insurance company for damages...
Can't believe this guy is not the only family member to have been hit, insane!
One of my co-workers was working with some radio equipment years ago. A storm started moving in and he decided to go turn off the equipment and unplug things. Just as he got over to the equipment, lightning struck.
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.
A few years back, I was standing in a puddle in a shed plugging in a golf cart when lightning hit a few feet away from me. It was like a bomb going off, vaporizing sheets of drywall, turning the wooden beams into splinters, and blowing a chunk out of the concrete.
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.
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.
My understanding of lightning rods is that they help more in that they help dissipate charges from the surrounding air, preventing a strike, rather than actually taking the strike, in most cases. Though, in such case lightning struck the building, it's much more likely it would go through the lightning protection system if properly installed.
My understanding of lightning rods is that they help more in that they help dissipate charges from the surrounding air, preventing a strike, rather than actually taking the strike, in most cases.
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.
Care to share links? If not then I still consider the national weather service to be more definitive. Particularly since what it says agrees perfectly with the physics courses that I took 20+ years ago, which indicated that the taller and pointier a metal object is, the better a target it becomes for static electricity discharges of all kinds - including lightning.
They actually INCREASE it by making your house TALLER.
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?
I do not discount the value of lightning rods. Exactly because having a safe path to the ground is a real benefit.
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?
I saw this link and didn't bother to check it, but I think you hit the jackpot:
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.
I wonder if teflon coated shoes would be effective, if rubber are not?
No. You have to consider the distance through air. Electricity will still take the path of least resistance which, even if you're wearing rubber or teflon shoes, is still just a couple of centimeters out of the shoe and to the ground. As the article points out: the lightning just traveled a kilometer to get to you, so why would it care about a few centimeters or inches or meters of insulating material when it would just hop through the air around it and to the ground.---
--- 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.
It doesn't seem inconceivable that wearing shoes takes you out of the path of least resistance as compared to some other path, say, the metal-framed shelving you are standing next to. I don't think wearing shoes is any kind of practical way to avoid getting hit by lightning but the 'kilometers of air' argument seems sort of wrongheaded. You don't need to become a more resistant path to ground than a kilometer of air - you just have to be more so than other paths. How long the discharge traveled to form that path doesn't really matter.
Unfortunately, simply reaching the ground may not be sufficient. The ground is not necessarily a good enough conductor to dissipate the full charge quickly. The rest of the charge flows near the ground looking for more ground.
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.
I once saw a very detailed article on what to do if under threat of lightning. Here is what I recall:
(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.
In a true emergency, like if your hairs are already standing on end, sounds like all of the above should be discarded, with the exception of 5 and 6 - squat down, heels together, balls of feet apart.
Unless you could jump and roll away from the tree or something.
Lightening is a capacitor undergoing dielectric breakdown. The ground is one plate, the cloud is the other. Lightening is the evidence of dielectric breakdown. Dielectric breakdown on the order of millions of volts. A mile of air didn't help, no amount of teflon is going to help either.
We had a wood burner installed - they put up the chimney and were going to earth it the next day. Bad idea. Lightning fried a Mac SE30, made its enormous colour (!!) 19 inch screen only show orange and ruined the phones.
After reading through this thread, you'd think it was commonplace. My guess is that people have bastardized the concept of "being struck by lightning," in that they weren't struck, just close to a strike.
The image at the top of the article is Derek Rigg's album art for Iron Maiden's 1985 Live After Death live album. It is one of my favorite album arts. It is the desktop wallpaper on most of my computers. It's so intricate, I could stare at it all day and notice new things hidden in the image. You can see the rest of his work for Iron Maiden here: http://derek.server311.com/
Boy, that takes me back to the two times I was struck. 15 the first time, my legs didn't work for about 15 minutes. Second time I only know about because witnesses told me (it's a black space in my memory).
I don't understand why he didn't go to the hospital. You might feel fine but your heart might have got a little disturbed - and that can be enough to cause serious complications.
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).
Guys, I am often caught in the rain(in Bangalore it's raining these days - and I've, seeing B'lore traffic, decided to rely on public transport) as I have to walk a lot, from drop points - and I keep walking, reaching home sometimes partially soaked and sometimes fully. So, should I just stop it? I mean I feel good getting soaked in the rain from time to time.
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?
You're safe in a car because the lightning will travel around the surface of the vehicle and then go to ground.This occurs because the vehicle acts like a Faraday cage.
I've walked in the rain for at least a decade (in Uruguay) and so have most of my classmates and friends, and never even heard of someone getting struck by lightning.
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).
If anything, he should make sure he's on somebody's radar.
Edit, source: I'm a physician.