When Rene Ismael Martinez collapsed while playing soccer last November 7th, his friend and teammate, Luis San Ramon, could think of just one thing: Rene’s young children and what they would do without their dad. The thought was grimly real; 44-year-old Rene had just suffered a sudden cardiac arrest. This notion would be enough to paralyze most people – freezing them like a driver at a red light. But not Luis, he managed to block out the background noise so he and another teammate could attempt to resuscitate Rene. The other man was Alejandro Higareda, the assistant director of operations at Marin Academy High School; trained in CPR and basic life support as a pre-requisite for his job. Alejandro knew to perform chest compressions fast and deep, sternum to backbone while keeping count in his head and giving direction to Luis (who was providing rescue breathing) and others. This powerful CPR, the force of which at first worried some onlookers, proved to be life-saving. Later described by one of the responding paramedics from Novato Fire as “simply awesome,” Alejandro’s forceful chest compressions kept blood circulating through Rene’s body for the five or so minutes it took help to arrive. Alejandro was just doing what he’d been trained to do – with the help and support of bystanders who urged him on – and he had no idea how profoundly important his actions were for Rene.
This past May 19th at the First Annual Marin EMS Survivors’ celebration, Rene Martinez walked onto the stage with Luis, Alejandro, and a crowd of paramedics, firefighters, doctors, nurses, and medical communications specialists (dispatchers and interpreters). It had been a little over six months since that day on the soccer field, and if we hadn’t just heard the story, no one in the audience would have guessed that Rene had so recently suffered a cardiac arrest. Through an interpreter, Rene tearfully thanked everyone on stage for saving his life.
Rene is one of the lucky ones. Nationwide, over 200,000 people a year suffer a cardiac arrest and of these only 2-8% survive long enough to be discharged from the hospital. Some of these never fully recover brain function. But Rene regained mental faculties by the time he reached the hospital. I know, because I was there that day and asked his doctor, Bob Stein, how it could be that his patient, who had just suffered a prolonged cardiac arrest, was now awake and talking to the staff? I don’t recall exactly what Dr. Stein replied, but I now know the explanation. Without a doubt, Rene’s remarkable recovery was due to the simply awesome CPR he received from Alejandro. This CPR kept his brain oxygenated while his heart was stalled (weakly fibrillating like a SonicCare toothbrush low on batteries.) Thus, after the Novato Fire paramedics used an electronic defibrillator to re-start his heart (re-charging the battery, if you will), Rene’s brain was able to quickly recover.
Rene Martinez was one of seventeen Marin residents who survived an out-of-hospital cardiac arrest last year. This number represents a 15% survival rate – much better (albeit with a small sample size) than national averages. But could it be better? What would it take to do better? A new hospital? Defibrillators in every home? No, nothing that drastic. All it would take is every citizen knowing how to do CPR (a simple, physical act that can be performed by a third-grader.) And now, it’s easier to learn CPR than ever – as new evidence and guidelines suggest that hands-only CPR (that is without rescue breaths) is at least, if not more, effective in adult patients with cardiac arrest than traditional CPR with mouth-to-mouth breaths.
I asked our new County Public Health Officer, Dr. Jason Eberhart-Phillips, about the importance of bystander training for CPR. “Heart attacks,” he wrote, “remain one of the leading causes of out-of-hospital death in Marin County. When heart attacks happen, bystanders who phone 911 and begin CPR can greatly increase the chances of survival. Effective chest compressions can move oxygen-rich blood to the heart and brain, keeping a victim alive until emergency responders arrive on the scene.”
So, wondering how you can be prepared to be a hero among us like Luis and Alejandro? Or how you can feel confident that your fellow citizens would save you like they did Rene Martinez? It’s simple, really. Rehearse. This is, as Malcolm Gladwell and many others have counseled, good advice for anyone, in any profession. Learn something, practice it, and when the time comes, memory will kick in. So, for those interested in learning proper CPR (this is yet one more thing that the movies do not get right), here are some options…
First, you can sign up for a basic life support course or encourage your employer to offer one (Alejandro is extremely appreciative that Marin Academy provided his training). Second, you can pay attention to where Automated External Defibrillators (AEDs) are kept – you will notice them in gyms, at malls, and in airports. And yes, there is an app for this too. Finally, this Saturday you can come out to one of multiple sites in Marin and receive free (non-certified) training in hands-only CPR and AED use from local EMTs, paramedics, nurses, and doctors. The training will take less than ten minutes of your time and just might help you save someone’s life. As Alejandro Higareda will attest, this is both an opportunity and an honor, and one best informed by rehearsal.
********************************
Hands-Only CPR and AED Training. Presented by Marin County Emergency Medical Services. This Saturday, June 4th 10am-2pm. Locations include: Vista Point, Strawberry Village, Toby’s Feed Barn, The Village, Red Hill Shopping Center, Town Center, Northgate Mall, Mill Valley Depot Plaza and Vintage Oaks at Novato.
Interested in volunteering to help the trainers? Call Karrie Groves at 415-473-3214.
Monday, May 30, 2011
Monday, May 23, 2011
Red Light Camera. California Vehicle Code.
For those interested in such details as the state vehicle code...
V C Section 21455.5 Traffic Signal Automated Enforcement Photographic Records
Traffic Signal Automated Enforcement: Photographic Records
21455.5. (a) The limit line, the intersection, or a place designated in Section 21455, where a driver is required to stop, may be equipped with an automated enforcement system if the governmental agency utilizing the system meets all of the following requirements:
(1) Identifies the system by signs that clearly indicate the system's presence and are visible to traffic approaching from all directions, or posts signs at all major entrances to the city, including, at a minimum, freeways, bridges, and state highway routes
(2) If it locates the system at an intersection, and ensures that the system meets the criteria specified in Section 21455.7.
(b) Prior to issuing citations under this section, a local jurisdiction utilizing an automated traffic enforcement system shall commence a program to issue only warning notices for 30 days. The local jurisdiction shall also make a public announcement of the automated traffic enforcement system at least 30 days prior to the commencement of the enforcement program.
(c) Only a governmental agency, in cooperation with a law enforcement agency, may operate an automated enforcement system. As used in this subdivision, "operate" includes all of the following activities:
(1) Developing uniform guidelines for screening and issuing violations and for the processing and storage of confidential information, and establishing procedures to ensure compliance with those guidelines.
(2) Performing administrative functions and day-to-day functions, including, but not limited to, all of the following:
(A) Establishing guidelines for selection of location.
(B) Ensuring that the equipment is regularly inspected.
(C) Certifying that the equipment is properly installed and calibrated, and is operating properly.
(D) Regularly inspecting and maintaining warning signs placed under paragraph (1) of subdivision (a).
(E) Overseeing the establishment or change of signal phases and the timing thereof.
(F) Maintaining controls necessary to assure that only those citations that have been reviewed and approved by law enforcement are delivered to violators.
(d) The activities listed in subdivision (c) that relate to the operation of the system may be contracted out by the governmental agency, if it maintains overall control and supervision of the system. However, the activities listed in paragraph (1) of, and subparagraphs (A), (D), (E), and (F) of paragraph (2) of, subdivision (c) may not be contracted out to the manufacturer or supplier of the automated enforcement system.
(e) (1) Notwithstanding Section 6253 of the Government Code, or any other provision of law, photographic records made by an automated enforcement system shall be confidential, and shall be made available only to governmental agencies and law enforcement agencies and only for the purposes of this article.
(2) Confidential information obtained from the Department of Motor Vehicles for the administration or enforcement of this ( )1 article shall be held confidential, and may not be used for any other purpose.
(3) Except for court records described in Section 68152 of the Government Code, the confidential records and information described in paragraphs (1) and (2) may be retained for up to six months from the date the information was first obtained, or until final disposition of the citation, whichever date is later, after which time the information shall be destroyed in a manner that will preserve the confidentiality of any person included in the record or information.
(f) Notwithstanding subdivision ( )2 (e), the registered owner or any individual identified by the registered owner as the driver of the vehicle at the time of the alleged violation shall be permitted to review the photographic evidence of the alleged violation.
(g) (1) A contract between a governmental agency and a manufacturer or supplier of automated enforcement equipment may not include provision for the payment or compensation to the manufacturer or supplier based on the number of citations generated, or as a percentage of the revenue generated, as a result of the use of the equipment authorized under this section.
(2) Paragraph (1) does not apply to a contract that was entered into by a governmental agency and a manufacturer or supplier of automated enforcement equipment before January 1, 2004, unless that contract is renewed, extended, or amended on or after January 1, 2004.
Amended Sec. 1, Ch. 496, Stats. 2001. Effective January 1, 2002.
Amended Sec. 1, Ch. 511, Stats. 2003. Effective January 1, 2004.
Amended Sec. 230, Ch.328, Stats. 2010. Effective January 1, 2011.
The 2010 amendment added the italicized material, and at the point(s) indicated, deleted the following:
1. “Article ”
2. “(d)”
V C Section 21455.5 Traffic Signal Automated Enforcement Photographic Records
Traffic Signal Automated Enforcement: Photographic Records
21455.5. (a) The limit line, the intersection, or a place designated in Section 21455, where a driver is required to stop, may be equipped with an automated enforcement system if the governmental agency utilizing the system meets all of the following requirements:
(1) Identifies the system by signs that clearly indicate the system's presence and are visible to traffic approaching from all directions, or posts signs at all major entrances to the city, including, at a minimum, freeways, bridges, and state highway routes
(2) If it locates the system at an intersection, and ensures that the system meets the criteria specified in Section 21455.7.
(b) Prior to issuing citations under this section, a local jurisdiction utilizing an automated traffic enforcement system shall commence a program to issue only warning notices for 30 days. The local jurisdiction shall also make a public announcement of the automated traffic enforcement system at least 30 days prior to the commencement of the enforcement program.
(c) Only a governmental agency, in cooperation with a law enforcement agency, may operate an automated enforcement system. As used in this subdivision, "operate" includes all of the following activities:
(1) Developing uniform guidelines for screening and issuing violations and for the processing and storage of confidential information, and establishing procedures to ensure compliance with those guidelines.
(2) Performing administrative functions and day-to-day functions, including, but not limited to, all of the following:
(A) Establishing guidelines for selection of location.
(B) Ensuring that the equipment is regularly inspected.
(C) Certifying that the equipment is properly installed and calibrated, and is operating properly.
(D) Regularly inspecting and maintaining warning signs placed under paragraph (1) of subdivision (a).
(E) Overseeing the establishment or change of signal phases and the timing thereof.
(F) Maintaining controls necessary to assure that only those citations that have been reviewed and approved by law enforcement are delivered to violators.
(d) The activities listed in subdivision (c) that relate to the operation of the system may be contracted out by the governmental agency, if it maintains overall control and supervision of the system. However, the activities listed in paragraph (1) of, and subparagraphs (A), (D), (E), and (F) of paragraph (2) of, subdivision (c) may not be contracted out to the manufacturer or supplier of the automated enforcement system.
(e) (1) Notwithstanding Section 6253 of the Government Code, or any other provision of law, photographic records made by an automated enforcement system shall be confidential, and shall be made available only to governmental agencies and law enforcement agencies and only for the purposes of this article.
(2) Confidential information obtained from the Department of Motor Vehicles for the administration or enforcement of this ( )1 article shall be held confidential, and may not be used for any other purpose.
(3) Except for court records described in Section 68152 of the Government Code, the confidential records and information described in paragraphs (1) and (2) may be retained for up to six months from the date the information was first obtained, or until final disposition of the citation, whichever date is later, after which time the information shall be destroyed in a manner that will preserve the confidentiality of any person included in the record or information.
(f) Notwithstanding subdivision ( )2 (e), the registered owner or any individual identified by the registered owner as the driver of the vehicle at the time of the alleged violation shall be permitted to review the photographic evidence of the alleged violation.
(g) (1) A contract between a governmental agency and a manufacturer or supplier of automated enforcement equipment may not include provision for the payment or compensation to the manufacturer or supplier based on the number of citations generated, or as a percentage of the revenue generated, as a result of the use of the equipment authorized under this section.
(2) Paragraph (1) does not apply to a contract that was entered into by a governmental agency and a manufacturer or supplier of automated enforcement equipment before January 1, 2004, unless that contract is renewed, extended, or amended on or after January 1, 2004.
Amended Sec. 1, Ch. 496, Stats. 2001. Effective January 1, 2002.
Amended Sec. 1, Ch. 511, Stats. 2003. Effective January 1, 2004.
Amended Sec. 230, Ch.328, Stats. 2010. Effective January 1, 2011.
The 2010 amendment added the italicized material, and at the point(s) indicated, deleted the following:
1. “Article ”
2. “(d)”
Monday, May 16, 2011
Public Health - Just Due It?
“Program Goal: To improve the safety of our community for vehicular, bicycle and pedestrian traffic” – The San Rafael Police Department (SRPD) on the Automated Red Light Photo Enforcement System
“Oh No!!” – This author after receiving a red light camera ticket in the mail.
According to publicly available data, the advent of red light violation enforcement by cameras in the city of San Rafael has been associated with a twelve percent decrease in accidents at camera-enabled intersections. Between November 2008 and April 2009 there were 48 accidents at the intersection of 3rd and Irwin in central San Rafael, compared to 43 between November 2009 and April 2010. The prevention of five accidents (none of the accidents were fatal by the way) is nothing to sniff at, although, from a scientific standpoint, it is far from proof that these cameras improve public safety. Consider the other possibilities. Have accidents decreased because yellow light times have been extended (from 3.0 to 3.5 seconds)? Or, have motorists intentionally avoided 3rd and Irwin and chosen other routes instead? Or is this finding a statistical fluke? One thing that is not at all flukish is the amount of money collected in fines from violators. The current fine is $479, of which the city of San Rafael receives 30%, and with the addition of court and traffic school fees, the sum approaches $600. If you consider that since its inception, the city has averaged roughly 467 violations/month, over a six-month period, the yield (in fines charged per prevented crash) works out to an estimated $268,000. Expensive. Perhaps too expensive?
But, is it possible that a city that utilizes red light camera enforcement increases safety not just at the enforced intersections, but across the entire city? This is consistent with James Q. Wilson’s “broken-window” theory (embraced by former New York police commissioner William Bratton) that visible disorder in a neighborhood leads to greater lawlessness citywide. So rather than look at San Rafael in isolation (I was unable to get city-wide data on crashes from the SRPD), it makes sense to take a larger view of the effect of red light camera enforcement. And I should stress that, nationwide, this is not a trivial problem – according to the Insurance Institute for Highway Safety (IIHS) there were over 2 million intersection related crashes in 2009, resulting in 7,538 deaths.
Just this past February, one of the largest studies to date on this topic was published by the IIHS. The report, lead authored by Wen Hu, compared cities with and without red light camera enforcement programs across two time periods (1992-1996 and 2004-2008). The investigators looked not just at the enforced intersections, but citywide, to discern differences between those with and without red light camera enforcement. The authors report a 21% greater decline (35% vs 14%) in fatal red light crashes in cities with camera enforcement versus those without it. The investigation also reports an estimated 17% decrease (versus expected rates) in fatal crashes at signalized intersections in cities with cameras. This study has a lot of strengths – it is big – looking at 62 U.S. cities (14 with camera programs and 48 without) and focusing on an important outcome (fatal crashes). It also does a reasonable job of creating a nationwide sample and of adjusting for population (crash rates per 100,00 in population) and accounting for outside influences (what researchers call confounders) such as population density and land area. In sum, it is reasonably convincing. But, there are important caveats and limitations.
One of these is the question of conflict of interest – the IIHS is funded by the insurance industry, an industry that benefits not only if there are fewer car accidents but also if more drivers accumulate points on their license (increased fees for these drivers). But, let’s give them the benefit of the doubt and assume that they are interested in studying road safety in an unbiased fashion. So, what then are the limitations of the study? First, those cities implementing cameras had a higher baseline rate of crashes (65% higher) – meaning they had larger room for improvement. Second, there were significant differences in rates across cities (crashes increased by 165% in Raleigh, NC while decreasing by 75% in Chandler, AZ). Third, the “control” group – those without cameras – has two major outliers whose crash rates more than tripled across the study period. Removing these two cities from the analysis might have led to much more modest results. Fourth, the analysis could not account for changes in yellow light times or other interventions that might have been the true cause of decreased fatal crashes. Finally, this data excluded crashes from illegal turns on red (the vast majority of red light tickets in most locales are for illegal turns). Thus, this study is unable to inform the question of whether policing failure to come to a complete stop on red benefits the public welfare. So, what does this all mean? Well, in my opinion it means that the jury is still out on the public health impact of red light camera enforcement.
On the other hand, the jury is no longer in deliberation for my red light camera enforcement citation. Well, to be clear, there was no jury – just an honorable Superior Court judge and a twelve second videotape. My judge was not sympathetic to the plea that a failure to come to a complete stop on red was not equivalent (penalty-wise) to that of busting through a straight-ahead intersection. Oh well. For myself and others perps, we can take heart that our fine money is not only supporting the San Rafael Police Department (and Redflex Systems of Phoenix AZ), but also a whole host of public services ($ amounts based on the previous penalty schedule of $445): $8.92 County General Fund, $17.15 Criminal Justice Facilities Fund, $ 13.72 Courthouse Construction Fund, $19.60 EMS, $9.80 DNA Identification Penalty Assessment, $13.72 Maddy EMS, $3.43 Automated Fingerprint ID System Fund…and the list goes on. Sometimes a state budgetary crisis and a public health initiative can become inextricably linked. Public health…just due it?
“Oh No!!” – This author after receiving a red light camera ticket in the mail.
According to publicly available data, the advent of red light violation enforcement by cameras in the city of San Rafael has been associated with a twelve percent decrease in accidents at camera-enabled intersections. Between November 2008 and April 2009 there were 48 accidents at the intersection of 3rd and Irwin in central San Rafael, compared to 43 between November 2009 and April 2010. The prevention of five accidents (none of the accidents were fatal by the way) is nothing to sniff at, although, from a scientific standpoint, it is far from proof that these cameras improve public safety. Consider the other possibilities. Have accidents decreased because yellow light times have been extended (from 3.0 to 3.5 seconds)? Or, have motorists intentionally avoided 3rd and Irwin and chosen other routes instead? Or is this finding a statistical fluke? One thing that is not at all flukish is the amount of money collected in fines from violators. The current fine is $479, of which the city of San Rafael receives 30%, and with the addition of court and traffic school fees, the sum approaches $600. If you consider that since its inception, the city has averaged roughly 467 violations/month, over a six-month period, the yield (in fines charged per prevented crash) works out to an estimated $268,000. Expensive. Perhaps too expensive?
But, is it possible that a city that utilizes red light camera enforcement increases safety not just at the enforced intersections, but across the entire city? This is consistent with James Q. Wilson’s “broken-window” theory (embraced by former New York police commissioner William Bratton) that visible disorder in a neighborhood leads to greater lawlessness citywide. So rather than look at San Rafael in isolation (I was unable to get city-wide data on crashes from the SRPD), it makes sense to take a larger view of the effect of red light camera enforcement. And I should stress that, nationwide, this is not a trivial problem – according to the Insurance Institute for Highway Safety (IIHS) there were over 2 million intersection related crashes in 2009, resulting in 7,538 deaths.
Just this past February, one of the largest studies to date on this topic was published by the IIHS. The report, lead authored by Wen Hu, compared cities with and without red light camera enforcement programs across two time periods (1992-1996 and 2004-2008). The investigators looked not just at the enforced intersections, but citywide, to discern differences between those with and without red light camera enforcement. The authors report a 21% greater decline (35% vs 14%) in fatal red light crashes in cities with camera enforcement versus those without it. The investigation also reports an estimated 17% decrease (versus expected rates) in fatal crashes at signalized intersections in cities with cameras. This study has a lot of strengths – it is big – looking at 62 U.S. cities (14 with camera programs and 48 without) and focusing on an important outcome (fatal crashes). It also does a reasonable job of creating a nationwide sample and of adjusting for population (crash rates per 100,00 in population) and accounting for outside influences (what researchers call confounders) such as population density and land area. In sum, it is reasonably convincing. But, there are important caveats and limitations.
One of these is the question of conflict of interest – the IIHS is funded by the insurance industry, an industry that benefits not only if there are fewer car accidents but also if more drivers accumulate points on their license (increased fees for these drivers). But, let’s give them the benefit of the doubt and assume that they are interested in studying road safety in an unbiased fashion. So, what then are the limitations of the study? First, those cities implementing cameras had a higher baseline rate of crashes (65% higher) – meaning they had larger room for improvement. Second, there were significant differences in rates across cities (crashes increased by 165% in Raleigh, NC while decreasing by 75% in Chandler, AZ). Third, the “control” group – those without cameras – has two major outliers whose crash rates more than tripled across the study period. Removing these two cities from the analysis might have led to much more modest results. Fourth, the analysis could not account for changes in yellow light times or other interventions that might have been the true cause of decreased fatal crashes. Finally, this data excluded crashes from illegal turns on red (the vast majority of red light tickets in most locales are for illegal turns). Thus, this study is unable to inform the question of whether policing failure to come to a complete stop on red benefits the public welfare. So, what does this all mean? Well, in my opinion it means that the jury is still out on the public health impact of red light camera enforcement.
On the other hand, the jury is no longer in deliberation for my red light camera enforcement citation. Well, to be clear, there was no jury – just an honorable Superior Court judge and a twelve second videotape. My judge was not sympathetic to the plea that a failure to come to a complete stop on red was not equivalent (penalty-wise) to that of busting through a straight-ahead intersection. Oh well. For myself and others perps, we can take heart that our fine money is not only supporting the San Rafael Police Department (and Redflex Systems of Phoenix AZ), but also a whole host of public services ($ amounts based on the previous penalty schedule of $445): $8.92 County General Fund, $17.15 Criminal Justice Facilities Fund, $ 13.72 Courthouse Construction Fund, $19.60 EMS, $9.80 DNA Identification Penalty Assessment, $13.72 Maddy EMS, $3.43 Automated Fingerprint ID System Fund…and the list goes on. Sometimes a state budgetary crisis and a public health initiative can become inextricably linked. Public health…just due it?
Caught by the Camera
Several weeks ago, on a leisurely weekend morning drive, I exited the 101 into central San Rafael. Life was good, I was on my way home and feeling mellow. Little did I know, I driving myself right into a public health debate…I approached the traffic light at 3rd street; as I did so, it turned yellow. With a full line of sight, sparse traffic at a full stop on the other side of the intersection, and no pedestrians, I performed an incident-free rolling left turn onto 3rd street. I thought nothing of it, until a few weeks later when I received something in the mail. What, might you posit, did I acquire?
1) A letter of acclaim for a safely executed “California Coast” one-way turn.
2) A friendly reminder to come to a complete stop at all signaled intersections.
3) A not-so-friendly notice from some guy in Phoenix offering me an opportunity to appear at the Marin County Superior Court.
Well, anyone else who’s been snagged by red light camera enforcement in San Rafael knows the correct answer. This experience and its price tag (over $600 in fines and fees!) inspired me to take a close look at the rapidly growing, but controversial, practice of using cameras to police busy intersections. In this two part series, I’ll let you know what I’ve discovered, but first some history…
For much of the past century, traumatic injuries were considered unpredictable “accidents” rather than a treatable disease processes (like atherosclerosis). Under this paradigm, the root causes of accidents were broken down into three categories: 1) bad luck, 2) the well-deserved result of stupidity, or 3) something arranged by the mafia. Prevention efforts, to the extent they existed, were predicated on warnings such as “Don’t drive too fast and watch out for drunken drivers,” and “Don’t associate with the mafia.” Thus, civilians of the 1960s were duly warned, but not particularly safe. Fortunately, in the mid-1960s, a handful of public health leaders began to transform this concept of “accidents” and in particular motor vehicle “accidents.” Foremost was William Haddon Jr., the seminal director of the National Highway Traffic Safety Administration and the first person to champion the idea that there’s nothing “accidental” about energy transfer resulting in traumatic injury. According to Haddon, it didn’t matter whether the energy transfer came from a high-speed projectile (bullet) or from rapid deceleration in a car crash, the energy transfer’s effects on human anatomy could be studied and modified. Accidents, Haddon argued, and car accidents especially, weren’t unpredictable or random after all and therefore a vehicle hitting a wall shouldn’t be called an accident but rather a crash. Furthermore, the outcome of a crash, in terms of human injury, wasn’t inevitable but instead dependent on key variables such as speed, object malleability and passenger restraint. Haddon attempted to classify and study these variables using a conceptual tool that came to be known as Haddon’s Matrix – a simple 3x3 grid identifying the factors leading to poor outcomes in trauma. One axis of the matrix lists three time periods: “pre-event,” “event,” and “post-event” and the other lists three physical components: “human,” “vector” and “environment.” From his matrix, Haddon extracted ten conceptual strategies for injury prevention – half of which involve the “event” phase of injury and predominantly support “passive” injury protection – protection that is built into existing systems and not dependant on individual compliance. To illustrate, strategy number four recommends “modifying the rate of spatial distribution of the release of the hazard from its source.” This is a long-winded way of saying that an absorbed blow is less destructive, which of course is the concept behind airbags. Strategy number five suggests that we “separate in time or space the hazard being released from the people to be protected,” which simply means that the farther you are from the action the safer you are (e.g. a pedestrian on a sidewalk is less likely to be struck by a car than one on the shoulder).
Today, Haddon’s strategies sound like common sense, but before Haddon, American culture wasn’t hip to prevention. Haddon’s goal was to inspire a paradigm shift, to make prevention groovy – in a long-winded academic way. It worked - nowadays we accept that there are strategies, such as seat belts, air bags and highway speed limits that prevent or limit injury in car crashes. We recognize that crashworthy vehicles save lives and that vehicle occupant fatalities (per mile of travel) decreased by two-thirds between 1964 and 1990. Without a doubt, this is an incredible public health accomplishment, one that has been achieved with very modest impact on personal liberty.
With success like this, it’s not surprising that a whole new generation of pre-event interventions have been proposed to further limit the carnage on our streets before it occurs. One of these is red light camera enforcement, which strives to limit injury and death from intersection collisions. On its face though, red light camera enforcement feels more like Big Brother than airbags or widened shoulders. It also is not passive – it relies on individual citizen’s knowledge, fear and compliance to be effective. This is in contrast to a more automatic strategy, like lengthening yellow light times. So, believe me, when I started looking into this I certainly hoped to discover that the red light strategy does not work. But, it turns out that a recent analysis from the Insurance Institute for Highway Safety (IISH) suggests that it most likely does. There are, however, some serious caveats. Next time, I’ll breakdown the IIHS study and delve into these caveats. In the meantime, does anyone know a good traffic lawyer?
1) A letter of acclaim for a safely executed “California Coast” one-way turn.
2) A friendly reminder to come to a complete stop at all signaled intersections.
3) A not-so-friendly notice from some guy in Phoenix offering me an opportunity to appear at the Marin County Superior Court.
Well, anyone else who’s been snagged by red light camera enforcement in San Rafael knows the correct answer. This experience and its price tag (over $600 in fines and fees!) inspired me to take a close look at the rapidly growing, but controversial, practice of using cameras to police busy intersections. In this two part series, I’ll let you know what I’ve discovered, but first some history…
For much of the past century, traumatic injuries were considered unpredictable “accidents” rather than a treatable disease processes (like atherosclerosis). Under this paradigm, the root causes of accidents were broken down into three categories: 1) bad luck, 2) the well-deserved result of stupidity, or 3) something arranged by the mafia. Prevention efforts, to the extent they existed, were predicated on warnings such as “Don’t drive too fast and watch out for drunken drivers,” and “Don’t associate with the mafia.” Thus, civilians of the 1960s were duly warned, but not particularly safe. Fortunately, in the mid-1960s, a handful of public health leaders began to transform this concept of “accidents” and in particular motor vehicle “accidents.” Foremost was William Haddon Jr., the seminal director of the National Highway Traffic Safety Administration and the first person to champion the idea that there’s nothing “accidental” about energy transfer resulting in traumatic injury. According to Haddon, it didn’t matter whether the energy transfer came from a high-speed projectile (bullet) or from rapid deceleration in a car crash, the energy transfer’s effects on human anatomy could be studied and modified. Accidents, Haddon argued, and car accidents especially, weren’t unpredictable or random after all and therefore a vehicle hitting a wall shouldn’t be called an accident but rather a crash. Furthermore, the outcome of a crash, in terms of human injury, wasn’t inevitable but instead dependent on key variables such as speed, object malleability and passenger restraint. Haddon attempted to classify and study these variables using a conceptual tool that came to be known as Haddon’s Matrix – a simple 3x3 grid identifying the factors leading to poor outcomes in trauma. One axis of the matrix lists three time periods: “pre-event,” “event,” and “post-event” and the other lists three physical components: “human,” “vector” and “environment.” From his matrix, Haddon extracted ten conceptual strategies for injury prevention – half of which involve the “event” phase of injury and predominantly support “passive” injury protection – protection that is built into existing systems and not dependant on individual compliance. To illustrate, strategy number four recommends “modifying the rate of spatial distribution of the release of the hazard from its source.” This is a long-winded way of saying that an absorbed blow is less destructive, which of course is the concept behind airbags. Strategy number five suggests that we “separate in time or space the hazard being released from the people to be protected,” which simply means that the farther you are from the action the safer you are (e.g. a pedestrian on a sidewalk is less likely to be struck by a car than one on the shoulder).
Today, Haddon’s strategies sound like common sense, but before Haddon, American culture wasn’t hip to prevention. Haddon’s goal was to inspire a paradigm shift, to make prevention groovy – in a long-winded academic way. It worked - nowadays we accept that there are strategies, such as seat belts, air bags and highway speed limits that prevent or limit injury in car crashes. We recognize that crashworthy vehicles save lives and that vehicle occupant fatalities (per mile of travel) decreased by two-thirds between 1964 and 1990. Without a doubt, this is an incredible public health accomplishment, one that has been achieved with very modest impact on personal liberty.
With success like this, it’s not surprising that a whole new generation of pre-event interventions have been proposed to further limit the carnage on our streets before it occurs. One of these is red light camera enforcement, which strives to limit injury and death from intersection collisions. On its face though, red light camera enforcement feels more like Big Brother than airbags or widened shoulders. It also is not passive – it relies on individual citizen’s knowledge, fear and compliance to be effective. This is in contrast to a more automatic strategy, like lengthening yellow light times. So, believe me, when I started looking into this I certainly hoped to discover that the red light strategy does not work. But, it turns out that a recent analysis from the Insurance Institute for Highway Safety (IISH) suggests that it most likely does. There are, however, some serious caveats. Next time, I’ll breakdown the IIHS study and delve into these caveats. In the meantime, does anyone know a good traffic lawyer?
Tuesday, April 5, 2011
A donkey might do the trick (Marin IJ)
In belated celebration of the glib and informal holiday known as April Fools Day, I’d like to take a serious look at the foolishness some will employ in the name of health. “Medicine, like politics, is a powerful magnet for weighty convictions of false metal.” So writes Richard Gordon in The Alarming History of Medicine. Among the many proofs-of-concept Gordon provides for this proclamation are the following folk remedies for whooping cough (pertussis):
1) Drink water from the skull of a bishop.
2) Catch a fish, place in patient’s mouth, return fish (and disease) to river.
3) Pass under and over a donkey. Repeat nine times.
Sound pretty ridiculous? Well, don’t chuckle too hard, because we have by no means outgrown such silliness. Recent concerns about, and “treatments” for radiation traveling to California from Japan are a perfect case-in-point. Be assured, the risk to Californians is currently, and almost certainly will continue to be, negligible, but that hasn’t stopped people from seeking therapy.
A quick spin across the Internet turned up multiple homeopathic sites with advice on deterring the effects of nuclear radiation exposure. Homeopathy, for those who need a little bit of a refresher, is a several centuries old form of alternative medicine. It is, at least in its original form, mostly harmless yet (beyond placebo effects) completely unproven. And while the term homeopathy has taken on a number of nuances, especially here in Marin, its purest methodology focuses on exposing patients to miniscule concentrations of therapeutic or toxic agents with the idea that “like cures like.” Often in commercial settings, however, homeopathic remedies include potent substances in potentially dangerous quantities. In the case of homeopathy for radiation exposure, “treatments” include Potassium iodide, Cadmium iodide, Phosphorus, Strontium carbonicum, and x-ray. That’s right, x-ray radiation as a treatment for nuclear radiation – as far as I’m concerned that’s on par with passing up and over a donkey nine times. But, fear and wishful thinking are powerful motivators, even in the face of potential adverse effects. I remember when my hairline started receding in college and I let a friend convince me that topical Preparation H would help. “Anything is worth a try,” I rationalized. Thankfully, after several days of being ribbed as a Pat Riley wannabe, I realized that established evidence was far superior to a tip from a source with dubious expertise. And with that assertion in mind, here courtesy of the California Department of Public Health (CDPH) are the current facts regarding radiation risk in California.
*Monitoring sites in California have found only trace levels of nuclear radiation, well below a person’s average daily exposure (about 2 millirem a day). Your daily exposure, by the way, comes from sun, soil, air, toxins (such as cigarettes) and man-made technology.
*These monitoring sites, including one in Livermore, are currently conducting surveillance every 48 hours.
*All available data sources suggest that there is unlikely to be any significant migration of radiation from Japan to California (it is 5,000 miles after all).
* If you’re really worried about your personal radiation exposure, rethink any unnecessary medical scans. A chest x-ray, for example is approximately 10 millirem. A CT scan of the abdomen is around 500 millirem; nearly equivalent to the amount of “background” radiation an average person is exposed to in a year.
*California has a response plan for nuclear emergencies and a stockpile of potassium iodide pills in case there were to be a nuclear disaster much closer to home. Learn more at http://www.cdph.ca.gov/HealthInfo/environhealth/Documents/NERP/NERP.pdf.
*There is no reason to take or stockpile potassium iodide on your own. Potassium iodide has numerous potential side effects, including allergic reactions, heart irregularities, vomiting, and electrolyte abnormalities. "Really,” says Dr. Peter N Bretan, President of the Marin Medical Society, “there is no question at all medically - it is black and white, there is no need for people to be taking this."
Nowhere on the CDPH site is there any mention of using diluted x-ray radiation as a treatment for nuclear radiation – so I think you can give that recommendation the fish in the mouth treatment (and throw it back). As for the best approach to getting good information about this and other health scares? Trusted websites (such as those of the CDC and CDPH) are great sources. Dr. Bretan has another practical suggestion..."Your most important resource is your own physician - they can help advise you whether you should be concerned or not." And that’s no April Fools.
1) Drink water from the skull of a bishop.
2) Catch a fish, place in patient’s mouth, return fish (and disease) to river.
3) Pass under and over a donkey. Repeat nine times.
Sound pretty ridiculous? Well, don’t chuckle too hard, because we have by no means outgrown such silliness. Recent concerns about, and “treatments” for radiation traveling to California from Japan are a perfect case-in-point. Be assured, the risk to Californians is currently, and almost certainly will continue to be, negligible, but that hasn’t stopped people from seeking therapy.
A quick spin across the Internet turned up multiple homeopathic sites with advice on deterring the effects of nuclear radiation exposure. Homeopathy, for those who need a little bit of a refresher, is a several centuries old form of alternative medicine. It is, at least in its original form, mostly harmless yet (beyond placebo effects) completely unproven. And while the term homeopathy has taken on a number of nuances, especially here in Marin, its purest methodology focuses on exposing patients to miniscule concentrations of therapeutic or toxic agents with the idea that “like cures like.” Often in commercial settings, however, homeopathic remedies include potent substances in potentially dangerous quantities. In the case of homeopathy for radiation exposure, “treatments” include Potassium iodide, Cadmium iodide, Phosphorus, Strontium carbonicum, and x-ray. That’s right, x-ray radiation as a treatment for nuclear radiation – as far as I’m concerned that’s on par with passing up and over a donkey nine times. But, fear and wishful thinking are powerful motivators, even in the face of potential adverse effects. I remember when my hairline started receding in college and I let a friend convince me that topical Preparation H would help. “Anything is worth a try,” I rationalized. Thankfully, after several days of being ribbed as a Pat Riley wannabe, I realized that established evidence was far superior to a tip from a source with dubious expertise. And with that assertion in mind, here courtesy of the California Department of Public Health (CDPH) are the current facts regarding radiation risk in California.
*Monitoring sites in California have found only trace levels of nuclear radiation, well below a person’s average daily exposure (about 2 millirem a day). Your daily exposure, by the way, comes from sun, soil, air, toxins (such as cigarettes) and man-made technology.
*These monitoring sites, including one in Livermore, are currently conducting surveillance every 48 hours.
*All available data sources suggest that there is unlikely to be any significant migration of radiation from Japan to California (it is 5,000 miles after all).
* If you’re really worried about your personal radiation exposure, rethink any unnecessary medical scans. A chest x-ray, for example is approximately 10 millirem. A CT scan of the abdomen is around 500 millirem; nearly equivalent to the amount of “background” radiation an average person is exposed to in a year.
*California has a response plan for nuclear emergencies and a stockpile of potassium iodide pills in case there were to be a nuclear disaster much closer to home. Learn more at http://www.cdph.ca.gov/HealthInfo/environhealth/Documents/NERP/NERP.pdf.
*There is no reason to take or stockpile potassium iodide on your own. Potassium iodide has numerous potential side effects, including allergic reactions, heart irregularities, vomiting, and electrolyte abnormalities. "Really,” says Dr. Peter N Bretan, President of the Marin Medical Society, “there is no question at all medically - it is black and white, there is no need for people to be taking this."
Nowhere on the CDPH site is there any mention of using diluted x-ray radiation as a treatment for nuclear radiation – so I think you can give that recommendation the fish in the mouth treatment (and throw it back). As for the best approach to getting good information about this and other health scares? Trusted websites (such as those of the CDC and CDPH) are great sources. Dr. Bretan has another practical suggestion..."Your most important resource is your own physician - they can help advise you whether you should be concerned or not." And that’s no April Fools.
Friday, March 25, 2011
Know CPR
Imagine a family member or friend collapsed in front of you and wasn't moving or breathing. Would you know what to do? Could you help save his or her life? Novato resident Stacey Beltran knew what to do when her uncle Doug Briggs crumpled to the floor this past Christmas Eve. Fred Potter of Tiburon knew what to do when his good friend Steve Sears went down in January 2008. They called for help and started CPR.
Fifty years ago, the closed-chest resuscitation technique (the cardiac component of what is commonly known as CPR) was described by William Kouwenhoven in the Journal of the American Medical Association. Kouwenhoven and colleagues at Johns Hopkins reported a success rate of 70 percent - unheard of in those days - when using the technique to treat hospital patients suffering from sudden heart attack related arrest. The implications were immediate and widespread. "The closed-chest method replaced the 'ghastly' ritual of open cardiac massage (cutting through skin and bone to access the heart). No longer would resuscitation be limited to surgeons bold enough to wield a scalpel," wrote W. Bruce Fye in American Cardiology.
This year the technique of chest compressions combined with assisted respirations celebrates its 50-year anniversary. Since its adoption, CPR has become a staple of care for patients whose hearts have stopped and has been taught to thousands of health-care providers, first responders and citizens. Multiple studies have shown that CPR, particularly
when paired with early use of an electronic defibrillator, saves lives.
Consider a study of 1,667 patients with outside-the-hospital cardiac arrest in King County, Wash. In this group of patients, if CPR and defibrillation (or other advanced life support intervention) were started immediately, the patient had a 67 percent chance of survival.
For each minute that passed without these, the chance of survival dropped by 5.5 percent. Thus, 10 minutes after cardiac arrest, if nothing had been done, the survival odds were 12 percent. In another two to three minutes they were zero.
However, if CPR alone was performed (keeping blood flowing to the brain and vital organs while awaiting help), the odds improved by 2.3 percent a minute - essentially doubling survival at 10 minutes post-arrest.
But, statistics are just part of the story. Sears, owner of Sam's Anchor Cafe in Tiburon, is alive today because Potter started CPR. It was mid-afternoon on Jan. 17, 2008, and Sears was tending to the business side of his restaurant when he collapsed. "My heart had been racing all day," Sears told me. "I remember standing in my office. After that, I don't remember anything."
Potter, a retired engineer-paramedic with Tiburon Fire, was on the deck of Sam's showing his brother the view of the bay when he heard a commotion from inside. Potter handed his cup of coffee to his brother, rushed into the office and started CPR. "The adrenaline was definitely pumping," Potter told me. "I knew what to do, but it was the first time I'd ever had to do it on a good friend."
Moments later Tiburon Fire Battalion Chief Ed Lynch arrived with an automated external defibrillator (AED) - a life-saving device that Potter describes as "easier to use than a cell phone."
Briggs is alive today because his niece knew what to do. Beltran had just taken a course in CPR from Sandy Wargo of Novato Fire. After her sister dialed 911 and got a dispatcher on the line, Beltran put her CPR skills to use.
"All of a sudden, I remembered the steps in CPR É I looked at his chest, hoping for movement, and nothing É so I put my hands together, looked for the spot on his chest and started compressions. I counted aloud just like Sandy taught me to do."
Moments later, the Novato Fire paramedics were on scene and shocked Briggs' heart rhythm back to normal.
Sears and Briggs suffered heart attacks that caused a sudden alteration in heart rhythm called ventricular fibrillation. Both required stents to open coronary arteries and both were home and mostly recovered within a few weeks. They are exactly the type of people - relatively young (under 70) and relatively healthy - who are the best candidates to survive cardiac arrest. But their survival, and that of others like them, is predicated on immediate assistance.
So, would you know what to do? Would you be able to put aside emotion and do what was needed? Or would you just stand there? If you're not sure, there are steps you can take. First, you can sign up for a basic life support course. Second, you can pay attention to where AEDs are kept - you will notice them at the gym, on campus and at the airport. And finally, on June 4 you can come to one of multiple sites in Marin and celebrate CPR's 51st birthday by receiving free (noncertified) training in hands-only CPR and AED use. The training will take less than 10 minutes, and just might help you to save someone's life.
But, don't take my word for it. "It is extremely important," said Sears. "Because without training, people freak out É they don't have the confidence to know what to do. I was fortunate to be in a circumstance where people knew what to do. I hope that my story will motivate people to get out there and get trained."
Fifty years ago, the closed-chest resuscitation technique (the cardiac component of what is commonly known as CPR) was described by William Kouwenhoven in the Journal of the American Medical Association. Kouwenhoven and colleagues at Johns Hopkins reported a success rate of 70 percent - unheard of in those days - when using the technique to treat hospital patients suffering from sudden heart attack related arrest. The implications were immediate and widespread. "The closed-chest method replaced the 'ghastly' ritual of open cardiac massage (cutting through skin and bone to access the heart). No longer would resuscitation be limited to surgeons bold enough to wield a scalpel," wrote W. Bruce Fye in American Cardiology.
This year the technique of chest compressions combined with assisted respirations celebrates its 50-year anniversary. Since its adoption, CPR has become a staple of care for patients whose hearts have stopped and has been taught to thousands of health-care providers, first responders and citizens. Multiple studies have shown that CPR, particularly
when paired with early use of an electronic defibrillator, saves lives.
Consider a study of 1,667 patients with outside-the-hospital cardiac arrest in King County, Wash. In this group of patients, if CPR and defibrillation (or other advanced life support intervention) were started immediately, the patient had a 67 percent chance of survival.
For each minute that passed without these, the chance of survival dropped by 5.5 percent. Thus, 10 minutes after cardiac arrest, if nothing had been done, the survival odds were 12 percent. In another two to three minutes they were zero.
However, if CPR alone was performed (keeping blood flowing to the brain and vital organs while awaiting help), the odds improved by 2.3 percent a minute - essentially doubling survival at 10 minutes post-arrest.
But, statistics are just part of the story. Sears, owner of Sam's Anchor Cafe in Tiburon, is alive today because Potter started CPR. It was mid-afternoon on Jan. 17, 2008, and Sears was tending to the business side of his restaurant when he collapsed. "My heart had been racing all day," Sears told me. "I remember standing in my office. After that, I don't remember anything."
Potter, a retired engineer-paramedic with Tiburon Fire, was on the deck of Sam's showing his brother the view of the bay when he heard a commotion from inside. Potter handed his cup of coffee to his brother, rushed into the office and started CPR. "The adrenaline was definitely pumping," Potter told me. "I knew what to do, but it was the first time I'd ever had to do it on a good friend."
Moments later Tiburon Fire Battalion Chief Ed Lynch arrived with an automated external defibrillator (AED) - a life-saving device that Potter describes as "easier to use than a cell phone."
Briggs is alive today because his niece knew what to do. Beltran had just taken a course in CPR from Sandy Wargo of Novato Fire. After her sister dialed 911 and got a dispatcher on the line, Beltran put her CPR skills to use.
"All of a sudden, I remembered the steps in CPR É I looked at his chest, hoping for movement, and nothing É so I put my hands together, looked for the spot on his chest and started compressions. I counted aloud just like Sandy taught me to do."
Moments later, the Novato Fire paramedics were on scene and shocked Briggs' heart rhythm back to normal.
Sears and Briggs suffered heart attacks that caused a sudden alteration in heart rhythm called ventricular fibrillation. Both required stents to open coronary arteries and both were home and mostly recovered within a few weeks. They are exactly the type of people - relatively young (under 70) and relatively healthy - who are the best candidates to survive cardiac arrest. But their survival, and that of others like them, is predicated on immediate assistance.
So, would you know what to do? Would you be able to put aside emotion and do what was needed? Or would you just stand there? If you're not sure, there are steps you can take. First, you can sign up for a basic life support course. Second, you can pay attention to where AEDs are kept - you will notice them at the gym, on campus and at the airport. And finally, on June 4 you can come to one of multiple sites in Marin and celebrate CPR's 51st birthday by receiving free (noncertified) training in hands-only CPR and AED use. The training will take less than 10 minutes, and just might help you to save someone's life.
But, don't take my word for it. "It is extremely important," said Sears. "Because without training, people freak out É they don't have the confidence to know what to do. I was fortunate to be in a circumstance where people knew what to do. I hope that my story will motivate people to get out there and get trained."
Wednesday, March 23, 2011
Sleep on it
“In the great green room there was a telephone, and a red balloon, and a picture of - the cow jumping over the moon.” So begins the final chapter of a ritual played out in bedrooms across the land…“Goodnight room, goodnight moon, goodnight cow jumping over the moon.” The soothing repetition of Goodnight Moon and similar verses is employed by millions of parents each night as they send their kids off to dreamland. For many parents, including myself, this is but the penultimate step in an extended bedtime routine. Dinner, bath, pajamas, warm milk (but not so warm to make it too hot), books on the couch, clean teeth, a wave to the stars, a march up stairs, a tuck into bed (making sure to get the pillows propped just so), Goodnight Moon and songs, and, finally, a kiss goodnight. Phew. I know I’m not alone in performing a regimen of this sort – in fact I know many moms and dads who practically obsess about the timing, ritual and quality of their children’s sleep. Why is it so important? Because, as everyone knows, sleep matters. Children whose rest routines are irregular are irritable; transforming from adorable puddle jumpers into barely bearable brats.
This parental commonsense is also backed by strong science. Rats that don’t sleep don’t just become brats, they become dead (within four to five weeks.) And the data isn’t just about rats. Studies demonstrate that sleep deprived people have delayed reactions, difficulty concentrating, and impaired cognition and judgment. This, of course, explains the rationale for sleep deprivation interrogations. Given all this, why is it that a nation so meticulous about its children’s sleep is so careless when it comes to properly resting its adults?
You may have heard about the recent Center for Disease Control and Prevention (CDC) report on sleep. Based on a telephone survey of over 70,000 adults, including some 11,000 Californians, over a third of Americans get less than 7 hours of sleep a night. This, as you may know, is less than the minimum amount recommended by the CDC, the National Sleep Foundation and The Sleep Train. An even more concerning finding in this study is that 38% of respondents reported nodding off unintentionally in the last 30 days, and 5% of these people admitted that this had occurred while driving. This suggests that data from the National Highway Traffic Safety Administration indicating that driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths each year may actually be an underestimation. As a shift worker, I have personal experience with this. Driving home after a night shift in the ER can be scary, sometimes it seems like my consciousness is on the verge of automatic shut down. For shift workers and parents of young children some level of sleep deprivation is virtually inevitable, but for many others, sleep deficits are preventable and should – for health, safety and sanity reasons – be prevented.
There’s no shortage of advice about sleeping to be found via Google, but to save you the time of sorting through it all, let me give a less than exhausted… I mean exhaustive, review.
So, what follows (with the help of the good people at Quoteland), is a quip-based guide to getting good with sleep.
“The sleeping fox catches no poultry.” -Benjamin Franklin
I am a big Ben Franklin fan, and while he may be technically right on this one, his advice is not applicable to most human beings. Franklin, famously, required very little sleep. And while there are certainly in-born differences between individuals in sleep requirements, there are not too many Franklinesque 30-minute-cat-nap types out there. Far more common is the burn-it-at-both-ends type who ignores her sleep need – piling onto a deficit that can only be repaid at the bedtime bank. To not settle up is to play chicken with health and longevity. If you don’t already know, figure out how much sleep you need to be at your best, and make sure you get it.
“The two best physicians of them all -- Dr. Laughter and Dr. Sleep.”-- Gregory Dean Jr.
Well, I might have to throw Dr. Feelgood into the mix too. But seriously, we are just beginning to understand the physiological functions of sleep – which include encoding memories via nerve-signal repetition; increased cellular production of proteins that are likely involved in repairing damage from stress, ultraviolet light and dietary toxins; and spikes in growth hormone release in young people. Sleep is good medicine.
“You can't stay married in a situation where you are afraid to go to sleep in case your wife might cut your throat. “ -Mike Tyson
Practical advice indeed from Mr. Tyson. How about some other suggestions for ensuring a restful night? The CDC has a list of sleep hygiene tips that include sticking to a regular sleep schedule (just like your kids!), sleeping in a dark and relaxing environment, removing all computer and other gadgets from the bedroom (but keep the white noise machine), and avoiding alcohol, caffeine and large meals within a few hours of bedtime. Another important suggestion is to just say “no” to pharmaceutical sleep aids unless you’re making a sleep transition (such as when coping with travel time changes or the disorientation of being “Sprung Forward”) and have discussed the sleep aid options with a doctor. Some over-the-counter medications may have more side effects than you expect. Instead, mindfulness exercises and yoga might be useful for the sleepless and a comfy mattress seems like a no-brainer.
“Drop, drop in our sleep, upon the heart sorrow falls, memorys pain, and to us, though against our very will, even in our own despite, comes wisdom by the awful grace of God. “
-Aeschylus
I am not sure exactly what this means, although it sure sounds pretty and I think it may be referencing the germination of inspiration. Guess I’ll try sleeping on it.
This parental commonsense is also backed by strong science. Rats that don’t sleep don’t just become brats, they become dead (within four to five weeks.) And the data isn’t just about rats. Studies demonstrate that sleep deprived people have delayed reactions, difficulty concentrating, and impaired cognition and judgment. This, of course, explains the rationale for sleep deprivation interrogations. Given all this, why is it that a nation so meticulous about its children’s sleep is so careless when it comes to properly resting its adults?
You may have heard about the recent Center for Disease Control and Prevention (CDC) report on sleep. Based on a telephone survey of over 70,000 adults, including some 11,000 Californians, over a third of Americans get less than 7 hours of sleep a night. This, as you may know, is less than the minimum amount recommended by the CDC, the National Sleep Foundation and The Sleep Train. An even more concerning finding in this study is that 38% of respondents reported nodding off unintentionally in the last 30 days, and 5% of these people admitted that this had occurred while driving. This suggests that data from the National Highway Traffic Safety Administration indicating that driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths each year may actually be an underestimation. As a shift worker, I have personal experience with this. Driving home after a night shift in the ER can be scary, sometimes it seems like my consciousness is on the verge of automatic shut down. For shift workers and parents of young children some level of sleep deprivation is virtually inevitable, but for many others, sleep deficits are preventable and should – for health, safety and sanity reasons – be prevented.
There’s no shortage of advice about sleeping to be found via Google, but to save you the time of sorting through it all, let me give a less than exhausted… I mean exhaustive, review.
So, what follows (with the help of the good people at Quoteland), is a quip-based guide to getting good with sleep.
“The sleeping fox catches no poultry.” -Benjamin Franklin
I am a big Ben Franklin fan, and while he may be technically right on this one, his advice is not applicable to most human beings. Franklin, famously, required very little sleep. And while there are certainly in-born differences between individuals in sleep requirements, there are not too many Franklinesque 30-minute-cat-nap types out there. Far more common is the burn-it-at-both-ends type who ignores her sleep need – piling onto a deficit that can only be repaid at the bedtime bank. To not settle up is to play chicken with health and longevity. If you don’t already know, figure out how much sleep you need to be at your best, and make sure you get it.
“The two best physicians of them all -- Dr. Laughter and Dr. Sleep.”-- Gregory Dean Jr.
Well, I might have to throw Dr. Feelgood into the mix too. But seriously, we are just beginning to understand the physiological functions of sleep – which include encoding memories via nerve-signal repetition; increased cellular production of proteins that are likely involved in repairing damage from stress, ultraviolet light and dietary toxins; and spikes in growth hormone release in young people. Sleep is good medicine.
“You can't stay married in a situation where you are afraid to go to sleep in case your wife might cut your throat. “ -Mike Tyson
Practical advice indeed from Mr. Tyson. How about some other suggestions for ensuring a restful night? The CDC has a list of sleep hygiene tips that include sticking to a regular sleep schedule (just like your kids!), sleeping in a dark and relaxing environment, removing all computer and other gadgets from the bedroom (but keep the white noise machine), and avoiding alcohol, caffeine and large meals within a few hours of bedtime. Another important suggestion is to just say “no” to pharmaceutical sleep aids unless you’re making a sleep transition (such as when coping with travel time changes or the disorientation of being “Sprung Forward”) and have discussed the sleep aid options with a doctor. Some over-the-counter medications may have more side effects than you expect. Instead, mindfulness exercises and yoga might be useful for the sleepless and a comfy mattress seems like a no-brainer.
“Drop, drop in our sleep, upon the heart sorrow falls, memorys pain, and to us, though against our very will, even in our own despite, comes wisdom by the awful grace of God. “
-Aeschylus
I am not sure exactly what this means, although it sure sounds pretty and I think it may be referencing the germination of inspiration. Guess I’ll try sleeping on it.
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